Cardiology Commons^™

Equalization Of Four Cardiovascular Risk Algorithms After Systematic Recalibration: Individual-Participant Meta-Analysis Of 86 Prospective Studies, L. Pennells, S. Kaptoge, A. Wood, M. Sweeting, X. Zhao, I. White, S. Burgess, P. Willeit, K. W. Davidson, E. Di Angelantonio, +90 Additional Authors

Journal Articles

© 2018 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. Aims There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after 'recalibration', a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied. Methods and results Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), …

Association Of Coronary Vessel Characteristics With Outcome In Patients With Percutaneous Coronary Interventions With Incomplete Revascularization, E. L. Hannan, Y. Zhong, P. B. Berger, A. K. Jacobs, G. Walford, F. S. K. Ling, F. J. Venditti, S. B. King

Journal Articles

© 2017 American Medical Association. All rights reserved. IMPORTANCE Many studies have compared outcomes for incomplete revascularization (IR) among patients undergoing percutaneous coronary interventions (PCI), but little is known about whether outcomes are related to the nature of the IR. OBJECTIVE To determine whether some coronary vessel characteristics are associated with worse outcomes in patients with PCI with IR. DESIGN, SETTING, AND PARTICIPANTS New York's PCI registrywas used to examine mortality (median follow-up, 3.4 years) as a function of the number of vessels that were incompletely revascularized, the stenosis in those vessels, and whether the proximal left anterior descending artery …

Confronting System Barriers For St- Elevation Mi In Low And Middle Income Countries With A Focus On India, S. Mehta, C. Granger, C. L. Grines, A. Jacobs, T. D. Henry, I. Rokos, A. Lansky, A. Baumbach, R. Botelho, S. Hiremath, +8 Additional Authors

Journal Articles

© 2017 Our previous research found seven specific factors that cause system delays in ST-elevation Myocardial infarction management in developing countries. These delays, in conjunction with a lack of organized STEMI systems of care, result in inefficient processes to treat AMI in developing countries. In our present opinion paper, we have specifically explored the three most pertinent causes that afflict the seven specific factors responsible for system delays. In doing so, we incorporated a unique strategy of global STEMI expertise. With this methodology, the recommendations were provided by expert Indian cardiologist and final guidelines were drafted after comprehensive discussions by …

Is Transcatheter Aortic Valve Replacement Better Than Surgical Aortic Valve Replacement In Patients With Chronic Obstructive Pulmonary Disease? A Nationwide Inpatient Sample Analysis, T. Ando, O. Adegbala, E. Akintoye, S. Ashraf, M. Pahuja, A. Briasoulis, H. Takagi, C. L. Grines, L. Afonso, T. Schreiber

Journal Articles

No abstract provided.

Determinants And Outcomes Of Vasoplegia Following Left Ventricular Assist Device Implantation, K. M. Tecson, B. Lima, A. Y. Lee, F. S. Raza, G. Ching, C. Lee, J. Felius, R. D. Baxter, S. Still, S. M. Joseph, +2 Additional Authors

Journal Articles

No abstract provided.

High-Frequency Percussive Ventilation Facilitates Weaning From Extracorporeal Membrane Oxygenation In Adults, I. Gulkarov, J. Schiffenhaus, I. Wong, A. Afzal, F. Khusid, B. Worku

Journal Articles

© 2018 American Society of Extra-Corporeal Technology. All Rights Reserved. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an invaluable rescue therapy for patients suffering from cardiopulmonary arrest, but it is not without its drawbacks. There are cases where patients recover their cardiac function, yet they fail to wean to mechanical conventional ventilation (MCV). The use of high-frequency percussive ventilation (HFPV) has been described in patients with acute respiratory failure (RF) who fail MCV. We describe our experience with five patients who underwent VA-ECMO for cardiopulmonary arrest who were successfully weaned from VA-ECMO with HFPV after failure to wean with MCV. Weaning …

Sternotomy Closure Using Rigid Plate Fixation: A Paradigm Shift From Wire Cerclage, K. B. Allen, K. J. Icke, V. H. Thourani, Y. Naka, K. J. Grubb, J. Grehan, N. Patel, T. S. Guy, K. Landolfo, M. Bonnell, +1 Additional Author

Journal Articles

No abstract provided.

Digital Stethoscope: Technology Update, S. Swarup, A. N. Makaryus

Journal Articles

© 2018 Swarup and Makaryus. Cardiovascular disease (CVD) is recognized as the leading cause of mortality throughout the world. About one-third of global mortality is attributable to CVD. In addition to clinical presentation, specific clinical exam findings can assist in treating and preventing CVD. CVD may initially manifest as pulmonary pathology, and thus, accurate cardiopulmonary auscultation is paramount to establishing accurate diagnosis. One of the most powerful tools available to physicians is the stethoscope. The stethoscope first emerged in the year 1818, invented by a French physician, René Laennec. Since then, the initial modest monaural wooden tube has evolved into …

Spontaneous Coronary Artery Dissection: Current State Of The Science: A Scientific Statement From The American Heart Association, S. N. Hayes, C. E. S. H. Kim, J. Saw, D. Adlam, C. Arslanian-Engoren, K. E. Economy, S. K. Ganesh, R. Gulati, J. H. Mieres, M. J. Wood, +5 Additional Authors

Journal Articles

© 2018 American Heart Association, Inc. Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with …

Real-World Clinical Utility And Impact On Clinical Decision-Making Of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve: Lessons From The Advance Registry., T. A. Fairbairn, K. Nieman, T. Akasaka, B. L. Nørgaard, D. S. Berman, G. Raff, L. M. Hurwitz-Koweek, G. Pontone, M. Poon, M. R. Patel, +13 Additional Authors

Journal Articles

Aims:Non-invasive assessment of stable chest pain patients is a critical determinant of resource utilization and clinical outcomes. Increasingly coronary computed tomography angiography (CCTA) with selective CCTA-derived fractional flow reserve (FFRCT) is being used. The ADVANCE Registry, is a large prospective examination of using a CCTA and FFRCT diagnostic pathway in real-world settings, with the aim of determining the impact of this pathway on decision-making, downstream invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular events (MACE). Methods and results:A total of 5083 patients with symptoms concerning for coronary artery disease (CAD) and atherosclerosis on CCTA were enrolled at 38 international …

Effects Of Endovascular Cooling On Infarct Size In St-Segment Elevation Myocardial Infarction: A Patient-Level Pooled Analysis From Randomized Trials., M. Dae, W. O'Neill, C. L. Grines, S. Dixon, D. Erlinge, M. Noc, M. Holzer, A. Dee

Journal Articles

OBJECTIVES: This study sought to examine the relationship between temperature at reperfusion and infarct size.

BACKGROUND: Hypothermia consistently reduces infarct size when administered prior to reperfusion in animal studies, however, clinical results have been inconsistent.

METHODS: We performed a patient-level pooled analysis from six randomized control trials of endovascular cooling during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in 629 patients in which infarct size was assessed within 1 month after randomization by either single-photon emission computed tomography (SPECT) or cardiac magnetic resonance imaging (cMR).

RESULTS: In anterior infarct patients, after controlling for variability between studies, …

Microvolt T-Wave Alternans In Patients Undergoing Elective Coronary Artery Bypass Grafting: A Pilot Study, G. Khoueiry, M. Abdallah, M. Shariff, M. Kowalski, J. Lafferty

Journal Articles

INTRODUCTION: We designed a prospective observational study targeting a selective population of patients undergoing elective coronary artery bypass grafting with normal systolic function. In this study we looked at the prevalence of pre-operative microvolt T-wave alternans and if it predicts atrial fibrillation after surgery. METHODS: The inclusion criteria included all patients referred to the cardiothoracic outpatient clinic for elective bypass, who can perform aerobic exercise, with a recent exercise stress test exercising at least to 85% of the maximal predicted heart rate (220 - age) and with non-limiting chest pain at maximal exercise. Twenty patients met the inclusion/exclusion criteria between …

Left Ventricular Metastasis From A Primary Pancreatobiliary Tumor, A. N. Makaryus, L. Boxt

Journal Articles

Metastatic disease to the heart is not uncommon. We describe a case of a man in his 60s with an unusual metastasis to the heart and detail its intracardiac location by means of cardiac computerized tomography (CCT) and transthoracic echocardiography. To our knowledge, this is the first report of a pancreatobiliary tumor metastasizing exclusively to the left ventricle (LV) of the heart.

A Case Of Ventricular Fibrillation Triggered By Ventricular Premature Depolarizations Exiting From Different Sites Of The Purkinje Network, S. E. Mountantonakis, H. Ismail, D. Lin

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No abstract provided.

Use And Outcomes Associated With Bridging During Anticoagulation Interruptions In Patients With Atrial Fibrillation: Findings From The Outcomes Registry For Better Informed Treatment Of Atrial Fibrillation (Orbit-Af), B. A. Steinberg, E. D. Peterson, S. Kim, L. Thomas, B. J. Gersh, G. C. Fonarow, P. R. Kowey, K. W. Mahaffey, M. W. Sherwood, J. Ansell, +2 Additional Authors

Journal Articles

BACKGROUND: Temporary interruption of oral anticoagulation for procedures is often required, and some propose using bridging anticoagulation. However, the use and outcomes of bridging during oral anticoagulation interruptions in clinical practice are unknown. METHODS AND RESULTS: The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry is a prospective, observational registry study of US outpatients with atrial fibrillation. We recorded incident temporary interruptions of oral anticoagulation for a procedure, including the use and type of bridging therapy. Outcomes included multivariable-adjusted rates of myocardial infarction, stroke or systemic embolism, major bleeding, cause-specific hospitalization, and death within 30 days. Of …

Age Influences Inflammatory Responses, Hemodynamics, And Cardiac Proteasome Activation During Acute Lung Injury, H. M. Linge, J. Y. Lee, K. Ochani, K. Koga, N. Kohn, K. Ojamaa, S. R. Powell, E. J. Miller

Journal Articles

Background: Acute lung injury (ALI) is a significant source of morbidity and mortality in critically ill patients. Age is a major determinant of clinical outcome in ALI. The increased ALI-associated mortality in the older population suggests that there are age-dependent alterations in the responses to pulmonary challenge. The objective of this observational study was to evaluate age-dependent differences in the acute (within 6 hours) immunological and physiological responses of the heart and lung, to pulmonary challenge, that could result in increased severity. Methods: Male C57Bl/6 mice (young: 2-3 months, old: 18-20 months) were challenged intratracheally with cell wall components from …

Fractured Inferior Vena Cava Filter Strut Presenting With St-Segment Elevation And Cardiac Tamponade, D. Khurana, J. Raza, S. Abrol, N.L. Coplan

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No abstract provided.

Stress-Induced Cardiomyopathy, F. G. Lisung, A. B. Shah, H. L. Levitt, N. B. Coplan

Journal Articles

A woman in her early 70s presented with chest pain, dyspnoea and diaphoresis 30 min after her husband expired in our hospital. Cardiac markers were elevated and there were acute changes in ECG suggestive for acute coronary syndrome. Echocardiogram showed apical akinesis, basal segment hyperkinesis with an ejection fraction of 30%. Cardiac catheterisation was performed showing non-obstructive coronary arteries, leading to the diagnosis of stress-induced cardiomyopathy. The patient improved with medical management. Repeat echocardiogram 2 months later showed resolution of heart failure with an ejection fraction of 65-70%.

Acute Surgical Pulmonary Embolectomy: A 9-Year Retrospective Analysis, A. R. Hartman, F. Manetta, R. Lessen, R. Pekmezaris, A. Kozikowski, L. Jahn, M. Akerman, M. L. Lesser, L. R. Glassman, M. Graver, J. S. Scheinerman, R. Kalimi, R. Palazzo, S. Vatsia, G. Pogo, M. Hall, P. J. Yu, V. Singh

Journal Articles

Acute pulmonary embolism is a substantial cause of morbidity and death. Although the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines recommend surgical pulmonary embolectomy in patients with acute pulmonary embolism associated with hypotension, there are few reports of 30-day mortality rates. We performed a retrospective review of acute pulmonary embolectomy procedures performed in 96 consecutive patients who had severe, globally hypokinetic right ventricular dysfunction as determined by transthoracic echocardiography. Data on patients who were treated from January 2003 through December 2011 were derived from health system databases of the New York State Cardiac Surgery Reporting System and the …

Hyperplastic Cardiac Sarcoma Recurrence, M. A. Shariff, J. A. Abreu, F. Durrani, E. Daniele, K. C. Bowman, S. Sadel, K. T. Asgarian, J. T. Mcginn Jr., J. P. Nabagiez

Journal Articles

Primary cardiac sarcomas are rare tumors with a median survival of 6-12 months. Data suggest that an aggressive multidisciplinary approach may improve patient outcome. We present the case of a male who underwent resection of cardiac sarcoma three times from the age of 32 to 34. This report discusses the malignant nature of cardiac sarcoma and the importance of postoperative multidisciplinary care.

Right Heart Transvalvular Embolus With High Risk Pulmonary Embolism In A Recently Hospitalized Patient: A Case Report Of A Therapeutic Challenge, G. K. Acharya, A. M. Adedayo, H. Prabhu, D. R. Brinster, P. Mir

Journal Articles

Thrombus-in-transit is not uncommon in pulmonary embolism but Right Heart Transvalvular Embolus (RHTVE) complicating this is rare. A 54-year-old obese male with recent hospitalization presented with severe dyspnea and collapse. Initial investigations revealed elevated d-dimer and troponin. CTA showed saddle pulmonary embolus and bedside echocardiogram revealed right ventricular (RV) pressure overload and dilatation (RV > 41 mm), McConnell's sign, and mobile echodensity attached to tricuspid valve. Patient was immediately resuscitated and promptly transferred for surgical embolectomy under cardiopulmonary bypass. A long segment of embolus traversing through the tricuspid valve and extensive bilateral pulmonary artery embolus were removed. IVC filter was placed …

Calreticulin Mutated Essential Thrombocythemia Presenting As Acute Coronary Syndrome, B. Nazha, G. Garcia, R. Kandov, M. Odaimi

Journal Articles

Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by a clonal expansion of megakaryocytes. ET can result in both arterial and venous thrombosis. Involvement of the coronary arteries has been reported. Patients who harbor a CALR mutation are half as likely to suffer a thrombotic event as compared to patients with a JAK2 mutation. We report a case of CALR-mutated ET whose initial disease manifestation was a non-ST segment elevation myocardial infarction.

Antiplatelet Therapy Duration Following Bare Metal Or Drug-Eluting Coronary Stents: The Dual Antiplatelet Therapy Randomized Clinical Trial, D. J. Kereiakes, R. W. Yeh, J. M. Massaro, P. Driscoll-Shempp, I. T. Meredith, J. Ormiston, J. F. Tanguay, S. Windecker, K. N. Garratt, L. Mauri, +9 Additional Authors

Journal Articles

IMPORTANCE: Despite antirestenotic efficacy of coronary drug-eluting stents (DES) compared with bare metal stents (BMS), the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Although dual antiplatelet therapy (DAPT) beyond 1 year provides ischemic event protection after DES, ischemic event risk is perceived to be less after BMS, and the appropriate duration of DAPT after BMS is unknown. OBJECTIVE: To compare (1) rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE; composite of death, myocardial infarction, or stroke) after 30 vs 12 months of thienopyridine in patients treated with BMS taking aspirin and (2) …

Sleep Deficiency And Deprivation Leading To Cardiovascular Disease, M. Kohansieh, A. N. Makaryus

Journal Articles

Sleep plays a vital role in an individual's mental, emotional, and physiological well-being. Not only does sleep deficiency lead to neurological and psychological disorders, but also the literature has explored the adverse effects of sleep deficiency on the cardiovascular system. Decreased quantity and quality of sleep have been linked to cardiovascular disease (CVD) risk factors, such as hypertension, obesity, diabetes, and dyslipidemia. We explore the literature correlating primary sleep deficiency and deprivation as a cause for cardiovascular disease and cite endothelial dysfunction as a common underlying mechanism.

Sleep Disorders, Obesity, Hypertension, And Cardiovascular Risk, S. I. Mcfarlane, O. Ogedegbe, A. N. Makaryus, C. Agyemang, G. Jean-Louis

Journal Articles

No abstract provided.

Inflammatory Bowel Disease As A Risk Factor For Premature Coronary Artery Disease, P. Ruisi, J. N. Makaryus, M. Ruisi, A. N. Makaryus

Journal Articles

BACKGROUND: Crohn's disease and ulcerative colitis are both systemic chronic diseases that alter bowel physiology. The central process in inflammatory bowel disease (IBD) and the associated manifestations are the result of B-cell production of IgG autoantibodies directed against self-antigens in various organ systems including coronary endothelium. Previous studies have demonstrated significant micro-vascular endothelial dysfunction in patients with IBD compared to patients not affected by the disease. We sought to analyze the relation, if any, between IBD and the development of premature coronary artery disease (CAD). METHODS: We queried our hospital database to find IBD patients admitted to the hospital from …

Echocardiographic Manifestation Of Esophagitis Mimicking A Posterior Mediastinal Mass, S. Swarup, S. Kantamneni, S. Kabir, R. Zeltser, A. N. Makaryus

Journal Articles

Incidental extracardiac findings (ECFs) are commonly noted on cardiac imaging. The majority of the ECFs are noticed on computed tomography (CT), cardiac magnetic resonance scanning, and myocardial perfusion imaging. Although transthoracic echocardiography (TTE) is a widely used cardiac modality, there is scarcity of data describing ECF on TTE. ECFs have the potential to alter patient management. We present a rare case of a cystic mass seen in the posterior mediastinum on TTE, which led to further evaluation and diagnosis of esophagitis with ulceration.

Temporary Mechanical Circulatory Support: A Review Of The Options, Indications, And Outcomes, N. A. Gilotra, G. R. Stevens

Journal Articles

Cardiogenic shock remains a challenging disease entity and is associated with significant morbidity and mortality. Temporary mechanical circulatory support (MCS) can be implemented in an acute setting to stabilize acutely ill patients with cardiomyopathy in a variety of clinical situations. Currently, several options exist for temporary MCS. We review the indications, contraindications, clinical applications, and evidences for a variety of temporary circulatory support options, including the intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), CentriMag blood pump, and percutaneous ventricular assist devices (pVADs), specifically the TandemHeart and Impella.

Planning And Guidance Of Cardiac Resynchronization Therapy-Lead Implantation By Evaluating Coronary Venous Anatomy Assessed With Multidetector Computed Tomography, J. N. Catanzaro, J. N. Makaryus, R. Jadonath, A. N. Makaryus

Journal Articles

OBJECTIVES: We sought to evaluate the utility of multidetector computed tomography (MDCT) in preoperative planning of cardiac resynchronization therapy (CRT) device implantation. BACKGROUND: Variation in coronary venous anatomy can affect optimal lead placement and may warrant preimplantation visualization prior to CRT lead placement. METHODS: Prospective randomized enrollment of 29 patients (17 males; mean age at implant 66.7 +/- 12.8 years) was undertaken. Patients were randomized to preimplantation MDCT (GE((R)) 64-detector Lightspeed, n = 16) or no MDCT. Implantation was planned based on three-dimensional coronary venous reconstruction as visualized in the CT group. Measurement of coronary sinus (CS) angulation, CS ostial …

Twelve Or 30 Months Of Dual Antiplatelet Therapy After Drug-Eluting Stents, L. Mauri, D. J. Kereiakes, R. W. Yeh, P. Driscoll-Shempp, K. N. Garratt, D. P. Lee, T. K. Pow, P. V. Lee, M. J. Rinaldi, J. M. Massaro, +12 Additional Authors

Journal Articles

BACKGROUND Dual antiplatelet therapy is recommended after coronary stenting to prevent thrombotic complications, yet the benefits and risks of treatment beyond 1 year are uncertain. METHODS Patients were enrolled after they had undergone a coronary stent procedure in which a drug-eluting stent was placed. After 12 months of treatment with a thienopyridine drug (clopidogrel or prasugrel) and aspirin, patients were randomly assigned to continue receiving thienopyridine treatment or to receive placebo for another 18 months; all patients continued receiving aspirin. The coprimary efficacy end points were stent thrombosis and major adverse cardiovascular and cerebrovascular events (a composite of death, myocardial …