Cardiology Commons^™

Systemic Blood Pressure Trends And Antihypertensive Utilization Following Continuous-Flow Left Ventricular Assist Device Implantation: An Analysis Of The Interagency Registry For Mechanically Assisted Circulatory Support, Adham Elmously, Andreas R. De Biasi, Donald A. Risucci, Berhane Worku, Evelyn M. Horn, Arash Salemi

NYMC Faculty Publications

Background: Elevated systemic blood pressure (SBP) has been linked to complications in Continuous-flow left ventricular assist devices (CF-LVADs), including stroke and pump thrombosis. We queried Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) to describe the response of SBP to CF-LVAD implantation and to delineate contemporary trends in antihypertensive (AH) utilization for patients with these pumps. Methods: We identified all CF-LVAD implantations in patients older than 18 years from 2006-2014, excluding those whose durations were less than 30 days. Pre-implant patient demographics and characteristics were obtained for each record. SBPs [i.e., mean arterial pressures (MAPs)], AH-use data, and vital status …

Antihypertensive Drug Therapy, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

Comparative Effectiveness And Safety Of Empagliflozin On Cardiovascular Mortality And Morbidity In Adults With Type 2 Diabetes, Wilbert S. Aronow, Tatyana Shamliyan

NYMC Faculty Publications

Background: Based on a single placebo-controlled randomized clinical trial, empagliflozin is licensed to reduce cardiovascular death in diabetes and comorbid cardiovascular disease. Methods: We examined the comparative effectiveness of empagliflozin on mortality and cardiovascular morbidity in type 2 diabetes. We conducted random-effects direct frequentist meta-analyses of aggregate data and appraised the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Our search in PubMed, EMBASE, the Cochrane Library, clinicaltrials.gov, and PharmaPendium up to May 2017 identified 11 meta-analyses, multiple publications, and unpublished data from 29 randomized controlled trials (RCTs). Results: Empagliflozin reduces all-cause mortality [relative …

Temporal Trends And Outcomes Of Acute Myocardial Infarction In Patients With Cancer, N Pothineni, N Shah, Yogita Rochlani, M Saad, S Kovelamudi, K Marmagkiolis, S Bhatti, M Cilingiroglu, Wilbert Aronow, A Hakeem

NYMC Faculty Publications

Background: Data on outcomes of ST-elevation myocardial infarction (STEMI) in patients with cancer are scarce. We investigated the nationwide trends in admissions for STEMI, utilization of percutaneous coronary intervention (PCI), and in-hospital outcomes in patients with the three most common cancer diagnoses (lung, breast, and colon) compared to patients without cancer. Methods: We conducted an administrative database study using the Nationwide Inpatient Sample (NIS). All in-patient hospitalizations for STEMI from 2001 to 2011 were identified. Patients with concomitant diagnosis of lung, breast or colon cancer were identified using appropriate International classification of diagnosis (ICD 9-CM) codes. Primary outcome was utilization …

Hypertension Associated With Atrial Fibrillation, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

Masked Hypertension, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

D-Shaped Left Ventricle, Anatomic, And Physiologic Implications, E Cativo Calderon, Tuoyo Mene-Afejuku, R Valvani, D Cativo, D Tripathi, H Reyes, Savi Mushiyev

NYMC Faculty Publications

Right ventricular loading/pressure influences left ventricular function because the two ventricles pump in series and because they are anatomically arranged in parallel, sharing the common ventricular septum. Flattening of the interventricular septum detected during echocardiographic examination is called D-shaped left ventricle. We present a case of an elderly male of African descent, who presented with increased shortness of breath. Transthoracic echocardiogram showed flattening and left sided deviation of interventricular septum causing a decreased size in left ventricle, secondary to volume/pressure overload in the right ventricle. While patient received hemodialysis therapy and intravascular volume was removed, patient blood pressure was noted …

Hypertension Highlights During 2016, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

A Cardiopulmonary Bypass Based Blood Management Strategy In Adult Cardiac Surgery, A Budak, Kevin Mccusker, S Gunaydin

NYMC Faculty Publications

BACKGROUND: Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open-heart surgical procedures. Efforts should be made to decrease or completely avoid transfusions to avoid these negative reactions. METHODS: Our coronary artery bypass grafting database was reviewed retrospectively and a total of 243 patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) were studied in a 12-month period (January-December 2016) after the implementation of the new program, and compared with 275 patients of the previous 12-month period.All the staff involved in the care of the patients were …

Drug-Induced Causes Of Secondary Hypertension, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

Association Of Obesity With Hypertension, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

Correlation Between Electrocardiographic Changes And Coronary Findings In Patients With Acute Myocardial Infarction And Single-Vessel Disease, Abdallah Sanaani, Srikanth Yandrapalli, George P. Jolly, R Paudel, Howard Cooper, Wilbert Aronow

NYMC Faculty Publications

BACKGROUND: Correlation of ST-segment elevation on the 12-lead electrocardiogram (ECG) with the expected affected coronary territory is established in patients with ST-elevation myocardial infarction (STEMI). In patients with non-ST-elevation myocardial infarction (NSTEMI), correlation of ischemic ECG abnormalities with the affected coronary territory has not been well-established. We sought to investigate the correlation of electrocardiographic abnormalities with the location of 1-vessel obstructive coronary artery disease (CAD) in patients with both STEMI and NSTEMI. METHODS: In this retrospective study, the charts of all patients referred for coronary angiography in 2012 were reviewed. Patients with a single obstructive coronary artery plus angina-equivalent symptoms …

Celiprolol: A Unique Selective Adrenoceptor Modulator, James Nawarskas, Angela Cheng-Lai, William H. Frishman

NYMC Faculty Publications

Celiprolol is a β-blocker with a unique pharmacologic profile: it is a β1-andrenoceptor antagonist with partial β2 agonist activity. Given this combination of effects, celiprolol may be better described as a selective adrenoreceptor modulator. It has antihypertensive and antianginal properties and is indicated for those uses in various countries around the world. In the United States, however, the proposed indication for this drug will be for the treatment of vascular type Ehlers-Danlos syndrome, a rare connective tissue disorder characterized by fragile arterial structure and an increased risk of life-threatening vascular complications. By reducing heart rate and pulsatile pressure, celiprolol may …

Hypertension And Left Ventricular Hypertrophy, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

Management Of Pulmonary Hypertension From Left Heart Disease In Candidates For Orthotopic Heart Transplantation, Anna Koulova, Alan Gass, S Patibandla, C Gupta, Wilbert Aronow, Gregg Lanier

NYMC Faculty Publications

Pulmonary hypertension in left heart disease (PH-LHD) commonly complicates prolonged heart failure (HF). When advanced, the PH becomes fixed or out of proportion and is associated with increased morbidity and mortality in patients undergoing orthotopic heart transplant (OHT). To date, the only recommended treatment of out of proportion PH is the treatment of the underlying HF by reducing the pulmonary capillary wedge pressure (PCWP) with medications and often along with use of mechanical circulatory support. Medical therapies typically used in the treatment of World Health Organization (WHO) group 1 pulmonary arterial hypertension (PAH) have been employed off-label in the setting …

Brain Injury With Systemic Inflammation In Newborns With Congenital Heart Disease Undergoing Heart Surgery, R Pironkova, Joseph Giamelli, H Seiden, V Parnell, D Gruber, C Sison, K Ojamaa

NYMC Faculty Publications

The potential role of systemic inflammation on brain injury in newborns with congenital heart disease (CHD) was assessed by measuring levels of central nervous system (CNS)-derived proteins in serum prior to and following cardiac surgery. A total of 23 newborns (gestational age, 39±1 weeks) with a diagnosis of CHD that required cardiac surgery with cardiopulmonary bypass (CPB) were enrolled in the current study. Serum samples were collected immediately prior to surgery and 2, 24 and 48 h following CPB, and serum levels of phosphorylated neurofilament-heavy subunit (pNF-H), neuron-specific enolase (NSE) and S100B were analyzed. Systemic inflammation was assessed by measuring …

Complete Versus Culprit Only Revascularization In St-Elevation Myocardial Infarction-A Perspective On Recent Trials And Recommendations, Gabriela Andries, Sahil Khera, Robert Timmermans, Wilbert Aronow

NYMC Faculty Publications

The presence of multivessel coronary artery disease (CAD) is strongly associated with higher 30-day mortality, reduced myocardial reperfusion success, reinfarction, and occurrence of major adverse cardiac events (MACE) at 1 year compared with single-vessel CAD. Despite higher morbidity and mortality in patients with ST-elevation myocardial infarction (STEMI) and coexistent multivessel CAD, major guidelines recommended against percutaneous coronary intervention (PCI) on non-culprit lesions at the time of primary PCI in patients with STEMI who are hemodynamically stable. The presence of multivessel CAD often poses a therapeutic dilemma for interventional cardiologists. A few larger scale randomized controlled trials (RCTs) and meta-analyses have …

Effect Of Evacetrapib On Cardiovascular Outcomes In Patients With High-Risk Cardiovascular Disease, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

The Exerrt Trial: "Exercise To Regadenoson In Recovery Trial": A Phase 3b, Open-Label, Parallel Group, Randomized, Multicenter Study To Assess Regadenoson Administration Following An Inadequate Exercise Stress Test As Compared To Regadenoson Without Exercise For Myocardial Perfusion Imaging Using A Spect Protocol, G Thomas, S Cullom, T Kitt, K Feaheny, K Ananthasubramaniam, R Gropler, Diwakar Jain, R Thompson

NYMC Faculty Publications

BACKGROUND: This study assessed the non-inferiority and safety of regadenoson administration during recovery from inadequate exercise compared with administration without exercise. METHODS: Patients unable to achieve adequate exercise stress were randomized to regadenoson 0.4 mg either during recovery (Ex-Reg) or 1 hour after inadequate exercise (Regadenoson) (MPI1). All patients also underwent non-exercise regadenoson MPI 1-14 days later (MPI2). The number of segments with reversible perfusion defects (RPDs) detected using single photon emission computerized tomography imaging was categorized. The primary analysis evaluated the majority agreement rate between Ex-Reg and Regadenoson groups. RESULTS: 1,147 patients were randomized. The lower bound of the …

Management Of Hypertension In Patients Undergoing Surgery, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

Pulmonary Embolism In Transit, Anna Koulova, Ramin Malekan, Wilbert Aronow, Howard Cooper

NYMC Faculty Publications

A 65-year-old woman with recently diagnosed ovarian cancer presented with near syncope, tachypnea, and hypoxia. Transthoracic echocardiography revealed a dilated and hypokinetic right ventricle and a large, mobile mass in the right atrium prolapsing across the tricuspid valve. She was diagnosed with pulmonary embolism in transit and emergent embolectomy was recommended.

Left Ventricular Noncompaction Cardiomyopathy, Amer Hawatmeh, H Habib, Fayez Shamoon

NYMC Faculty Publications

No abstract provided.

A Structured Blood Conservation Program In Pediatric Cardiac Surgery, A Budak, Kevin Mccusker, S Gunaydin

NYMC Faculty Publications

OBJECTIVE: The limitation of alternative transfusion practices in infants increases the benefits of blood conservation. We analyzed the efficacy of a structured program to reduce transfusions and transfusion-associated complications in cardiac surgery

PATIENTS AND METHODS: Our pediatric surgery database was reviewed retrospectively, comparing outcomes from two different time periods, after the implementation of an effective blood conservation program beginning in March 2014. A total of 214 infants (8.1±3.4 months) who underwent biventricular repair utilizing CPB (Group 1 – Blood conservation) were studied in a 12-month period (March 2014-February 2015) after the implementation of the new program, and compared with 250 …

A Case Of Intramural Coronary Amyloidosis Associated With Hemodialysis, F Ronny, George Kleinman, P Kurtin, John Fallon

NYMC Faculty Publications

Dialysis-related amyloidosis predominantly occurs in osteo-articular structures and dialysis-related amyloid (DRA) substances also deposit in extra-articular tissues. Clinical manifestations of DRA include odynophagia, gastrointestinal hemorrhage, intestinal obstruction, kidney stones, myocardial dysfunction, and subcutaneous tumors. The pathological characteristics of DRA in the heart of hemodialysis patients have rarely been reported. We report the case of a 73-year-old female with a history of cerebral palsy and end-stage renal disease status post two failed renal transplants who had been on hemodialysis for 30 years. The patient was admitted with the working diagnosis of pneumonia. An echocardiography showed markedly reduced biventricular function manifested by …

A Review Of Echocardiograms In Hypertensive Patients Greater Than 60 Years In A Community Based Family Medicine Program, Shideh Doroudi, Michael Delisi, Vincent Debari

NYMC Faculty Publications

Background: Heart disease as a result of Hypertension is known to occur. Anatomical and functional changes of the heart can easily be detected by echocardiography, which is a safe and readily available study. Objectives: The aims of this study were to evaluate the prevalence of common echocardiographic changes in chronic hypertensive patients and to compare these changes in male and female populations. Design/methods: The study was a community-based cross-sectional study, on 227 hypertensive patients, 60 years and older, seen in St. Joseph's Family Medicine at Clifton, with integrated clinical and echocardiographic data. Results: Study population consisted of 227 hypertensive patients, …

What Should The Blood Pressure Be In Patients With Chronic Kidney Disease?, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

Mechanisms Of Vasovagal Syncope In The Young: Reduced Systemic Vascular Resistance Versus Reduced Cardiac Output, Julian Stewart, Marvin Medow, R Sutton, Paul Visintainer, D Jardine, W Wieling

NYMC Faculty Publications

BACKGROUND: Syncope is a sudden transient loss of consciousness and postural tone caused by cerebral hypoperfusion. The most common form is vasovagal syncope (VVS). Presyncopal progressive early hypotension in older VVS patients is caused by reduced cardiac output (CO); younger patients have reduced systemic vascular resistance (SVR). Using a priori criteria for reduced CO ( downward arrowCO) and SVR ( downward arrowSVR), we studied 48 recurrent young fainters comparing subgroups of VVS with VVS- downward arrowCO, VVS- downward arrowSVR, and both VVS- downward arrowCO& downward arrowSVR. METHODS AND RESULTS: Subjects were studied supine and during 70-degrere upright tilt with a …

Isolated Idiopathic Aortitis With An Unusually Thickened Aortic Wall: Case Report, John Yoon, Irina Gruboy, Altheeb Zaid, Mark Connolly, Wilbert S. Aronow, Walid Elozomor, Jamshed Zuberi

NYMC Faculty Publications

Aortitis includes a broad range of disorders involving inflammation of the aorta. While most forms of aortitis can be linked to a specific cause, patients with idiopathic aortitis (IDA), are asymptomatic and usually diagnosed after surgical removal. The specific pathophysiology is not well understood, but can be strongly associated with tobacco smoking, young age at presentation, and family history of aortic aneurysm. Wall thickening is the most common physical characteristic of aortitis, and the inflammation can affect any layer of the aorta. The normal wall thickness of the aorta is less than 4 mm and can be as thick as …

Attenuation Of Na/K-Atpase Mediated Oxidant Amplification With Pnaktide Ameliorates Experimental Uremic Cardiomyopathy, Jiang Liu, Jiang Tian, Muhammad Chaudhry, Nader G. Abraham, Joseph Shapiro

NYMC Faculty Publications

We have previously reported that the sodium potassium adenosine triphosphatase (Na/K-ATPase) can effect the amplification of reactive oxygen species. In this study, we examined whether attenuation of oxidant stress by antagonism of Na/K-ATPase oxidant amplification might ameliorate experimental uremic cardiomyopathy induced by partial nephrectomy (PNx). PNx induced the development of cardiac morphological and biochemical changes consistent with human uremic cardiomyopathy. Both inhibition of Na/K-ATPase oxidant amplification with pNaKtide and induction of heme oxygenase-1 (HO-1) with cobalt protoporphyrin (CoPP) markedly attenuated the development of phenotypical features of uremic cardiomyopathy. In a reversal study, administration of pNaKtide after the induction of uremic …

Selective Serotonin-Norepinephrine Reuptake Inhibitors-Induced Takotsubo Cardiomyopathy, Rahul Vasudev, Upamanyu Rampal, Hiten Patel, Kunal Patel, Mahesh Bikkina, Fayez Shamoon

NYMC Faculty Publications

CONTEXT: Takotsubo translates to "octopus pot" in Japanese. Takotsubo cardiomyopathy (TTC) is characterized by a transient regional systolic dysfunction of the left ventricle. Catecholamine excess is the one most studied and favored theories explaining the pathophysiology of TTC.

CASE REPORT: We present the case of a 52-year-old Hispanic female admitted for venlafaxine-induced TTC with a review literature on all the cases of Serotonin-norepinephrine reuptake inhibitors (SNRI)-associated TTC published so far.

CONCLUSION: SNRI inhibit the reuptake of catecholamines into the presynaptic neuron, resulting in a net gain in the concentration of epinephrine and serotonin in the neuronal synapses and causing iatrogenic …