Cardiology Commons^™

Rapid Door-To-Balloon Time (≤ 30 Minutes) In The Treatment Of Acute St-Elevation Myocardial Infarction (Stemi) Is Associated With Reduced Length Of Hospital Stay And Improved Clinical Outcomes, Yassir Nawaz Md, Ataul Qureshi Md, Navin K. Subrayappa Md, Orlando E. Rivera Rn, Bruce Feldman Do, Nainesh C. Patel Md

Department of Medicine

No abstract provided.

Pulsating Left Breast After Trans-Apical Aortic Valve Implantation: An Ominous Sign, Yassir Nawaz Md, Navin K. Subrayappa Md, Sumit Duggal Md, Ataul Qureshi Md, Muppidi Raghunandan Md

Department of Medicine

No abstract provided.

An Uncommon Complication During Trans-Aortic Valve Replacement, Sanjeev Nair Md, Yassir Nawaz Md, Nainesh C. Patel Md, David A. Cox Md, William Combs Md, Raymond L. Singer Md, J Patrick Kleaveland Md

Department of Medicine

No abstract provided.

Natural Progression Of Low-Gradient Severe Aortic Stenosis With Preserved Ejection Fraction, Antony Leslie Innasimuthu, Sanjay Kumar, Jason Lazar, William E Katz

The Texas Heart Institute Journal

Because the natural progression of low-gradient aortic stenosis (LGAS) has not been well defined, we performed a retrospective study of 116 consecutive patients with aortic stenosis who had undergone follow-up echocardiography at a median interval of 698 days (range, 371–1,020 d). All patients had preserved left ventricular ejection fraction (>0.50) during and after follow-up.

At baseline, patients were classified by aortic valve area (AVA) as having mild stenosis (≥1.5 cm2), moderate stenosis (≥1 to <1.5 cm2), or severe stenosis (<1 cm2). Severe aortic stenosis was further classified by mean gradient (LGAS, mean <40 mmHg; high-gradient aortic stenosis [HGAS], mean ≥40 mmHg). We compared baseline and follow-up values among 4 groups: patients with mild stenosis, moderate stenosis, LGAS, and HGAS.

At baseline, 30 patients had mild stenosis, 54 had moderate stenosis, 24 had LGAS, and 8 had HGAS. Compared with the moderate group, the LGAS …

Spontaneous Coronary Artery Dissection (Scad): New Insights Into This Not-So-Rare Condition, Sharonne N Hayes

The Texas Heart Institute Journal

No abstract provided.

Sex-Specific Biatrial Volumetric Measurements Obtained With Use Of Multidetector Computed Tomography In Subjects With And Without Coronary Artery Disease, Matthew J Budoff, Sandeep R Pagali, Yasmin S Hamirani, Andy Chen, Gordon Cheu, Yanlin Gao, Dong Li, Songshou Mao

The Texas Heart Institute Journal

Atrial volumetric measurement has proven clinical implications. Advances in cardiac imaging, notably the precision enabled by multidetector computed tomography (MDCT), herald the need for new criteria of what constitutes normal volumetric measurements. With use of 64-slice MDCT, we compared the atrial volumes in healthy individuals with those in individuals with coronary artery disease.

By means of manual segmentation, we measured biatrial volume in 686 participants who underwent retrospective electrocardiographic-gated MDCT angiographic evaluation. The study population included a control group of 203 persons with no cardiac abnormalities, and a study group of 483 patients with obstructive coronary artery disease. All variables …

Exertional Dyspnea As A Symptom Of Infrarenal Aortic Occlusive Disease, Stacey L Schott, Fernanda Porto Carreiro, James R Harkness, Mahmoud B Malas, Stephen M Sozio, Sammy Zakaria

The Texas Heart Institute Journal

Advanced atherosclerosis of the aorta can cause severe ischemia in the kidneys, refractory hypertension, and claudication. However, no previous reports have clearly associated infrarenal aortic stenosis with shortness of breath. A 77-year-old woman with hypertension and hyperlipidemia presented with exertional dyspnea. Despite extensive testing and observation, no apparent cause for this patient's dyspnea was found. Images revealed severe infrarenal aortic stenosis. After the patient underwent stenting of the aortic occlusion, she had immediate symptomatic improvement and complete resolution of her dyspnea within one month. Twelve months after vascular intervention, the patient remained asymptomatic. In view of the distinct and lasting …

Outpatient Management Of Heart Failure In The United States, 2006-2008, Kailash Mosalpuria, Sunil K Agarwal, Sirin Yaemsiri, Bredy Pierre-Louis, Samir Saba, Rene Alvarez, Stuart D Russell

The Texas Heart Institute Journal

Better outpatient management of heart failure might improve outcomes and reduce the number of rehospitalizations. This study describes recent outpatient heart-failure management in the United States.

We analyzed data from the National Ambulatory Medical Care Survey of 2006–2008, a multistage random sampling of non-Federal physician offices and hospital outpatient departments.

Annually, 1.7% of all outpatient visits were for heart failure (51% females and 77% non-Hispanic whites; mean age, 73 ± 0.5 yr). Typical comorbidities were hypertension (62%), hyperlipidemia (36%), diabetes mellitus (35%), and ischemic heart disease (29%). Body weight and blood pressure were recorded in about 80% of visits, and …

Effects Of An Apn-Led Amiodarone Clinic On Adherence To Recommended Monitoring Guidelines, Melissa Bartoszewicz

Evidence-Based Practice Project Reports

Evidence shows that patients receiving amiodarone therapy have not adhered to monitoring guidelines set forth by the Heart Rhythm Society. Uncertainty with responsibility for monitoring has led to the development of pharmacist-managed or multidisciplinary-managed outpatient amiodarone clinics. Some limitations have been identified in the pharmacist-managed outpatient clinics that may be overcome by advanced practice nurse (APN)-managed clinics. The purpose of this EBP project was to determine what effects an APN-led amiodarone clinic would have on adherence to amiodarone monitoring guidelines. Using the PICOT format, the clinical question was developed: Does enrollment in an amiodarone clinic compared with “usual care” change …

Mitoquinone (Mitoq) Exerts Antioxidant Effects Independent Of Mitochondrial Targeted Effects In Phorbol-12-Myristate-13-Acetate (Pma) Or N-Formyl-L-Methiony-L-Leucyl-L-Phenylalanine (Fmlp) Stimulated Polymorphonuclear Leukocyte (Pmn) Superoxide (So) Release, Matthew Lepera, D. Pesikan, J. Voeun, Kerry-Anne Perkins, Qian Chen, Robert J. Barsotti, Lindon H. Young

Research Day

MitoQ is a mitochondrial-targeted coenzyme Q antioxidant analog that dose-dependently restored cardiac function and reduced infarct size in isolated perfused rat hearts subjected to ischemia reperfusion (I/R). Moreover, mitoQ also dose-dependently attenuated PMA stimulated PMN superoxide (SO) release at the same concentration (10uM) as the cardioprotective dose. NADPH oxidase is the principle source of PMN SO release. We speculate that mitoQ may exert antioxidant effects independent of the mitochondria. Therefore, we hypothesized that inhibition of mitoQ on PMN-SO release will be similar as other coenzyme Q analogs: coenzyme Q1 and decylubiquinone without affecting cell viability. SO release was measured spectrophotometrically …

Gp91ds-Tat, A Selective Nadph Oxidase Peptide Inhibitor, Increases Blood Nitric Oxide (No) Bioavailability In Bind Limb Ischemia And Reperfusion (I/R), Sydney Walker, Tyler Galbreath, Qian Chen, Robert J. Barsotti, H. Patel, William Chau, Lindon H. Young

Research Day

I/R injury induces cell death and organ dysfunction in part due to a burst of reactive oxygen species that occurs upon the reintroduction of oxygen into the ischemic area, leading to endothelial dysfunction: decreased blood NO and increased hydrogen peroxide (H2O2 ) levels. We’ve previously shown in isolated rat hearts subjected to I/R injury, gp91ds-tat attenuated cardiac contractile dysfunction and reduced infarct size compared to controls presumably by the inhibition of NADPH oxidase induced superoxide release. Superoxide can quench NO via the formation of peroxynitrite and also be converted to H2O2 in blood. We attempted to confirm this hypothesis using …

Evaluation Of Echogenic Material On Transvenous Leads By Transesophageal Echocardiography In Patients With And Without Lead-Associated Endocarditis, Toshimasa Okabe, Md, Praveen Mehrotra, Md, Henry Siu, Md, Arnold J. Greenspon, Md

Division of Cardiology Faculty Papers

Echogenic material (EM) on non-infected leads in patients with cardiac implantable device is common on transesophageal echocardiography (TEE). Although several morphologic characteristics of EM are more commonly seen in transvenous lead-associated endocarditis, these characteristics alone are not diagnostic for lead-associated endocardiatis. Lead-associated EM on TEE should be interpreted within the overall clinical context.

Limited Association Between Perceived Control And Health-Related Quality Of Life In Patients With Heart Failure, Teesta Banerjee, Kyoung Suk Lee, Steven R. Browning, Claudia Hopenhayn, Susan C. Westneat, Martha J. Biddle, Cynthia Arslanian-Angoren, Jo-Ann Eastwood, Gia Mudd, Debra K. Moser

Epidemiology and Environmental Health Faculty Publications

Background: Perceived control has been suggested as a modifiable factor associated with health-related quality of life (HRQOL). However, the relationship between perceived control and HRQOL has not been evaluated in patients with heart failure (HF). The purpose of this study was to determine whether perceived control independently predicts HRQOL in HF patients. Methods: A total of 423 HF patients were included. Hierarchical linear regression was performed to determine the independent association of perceived control to HRQOL after controlling for covariates. Results: Higher levels of perceived control were associated with better HRQOL in univariate analysis. However, this relationship was strongly attenuated …

Lean Body Mass May Explain Apparent Racial Differences In Carotid Intima-Media Thickness In Obese Children., Shahryar M. Chowdhury, Melissa H. Henshaw, Brad Friedman, J Philip Saul, Girish S. Shirali, Janet Carter, Bryana M. Levitan, Tom Hulsey

Manuscripts, Articles, Book Chapters and Other Papers

Background: Racial differences in carotid intima-media thickness (cIMT) have been suggested to be associated with the disproportionally high prevalence of cardiovascular disease in black adults. The objective of this study was to evaluate the effects of cardiovascular risk factors on the racial differences seen in cIMT in obese children.

Methods: Obese subjects aged 4 to 21 years were recruited prospectively. Height, weight, blood pressure, fasting insulin, glucose, lipid panel, high-sensitivity C-reactive protein, and body composition by dual-energy x-ray absorptiometry were obtained. B-mode carotid imaging was analyzed by a single blinded physician.

Results: A total of 120 subjects (46 white, 74 …

Cyclic Nucleotide-Dependent Phosphorylation Regulates Bk-Ca Channel Activity In Human Coronary Artery Smooth Muscle Cells, Raeonda Williams

PCOM Biomedical Studies Student Scholarship

Cardiovascular diseases (CVD) can induce dysfunction in organ systems by attenuating normal blood flow. Gonadal steroids are vasoactive hormones, but their role in contributing to cardiovascular function remains controversial. We have demonstrated that gonadal steroids can relax coronary arteries by opening the large-conductance, calcium- and voltage-activated potassium (BKca) channel in smooth muscle cells by increasing cyclic nucleotide levels; however, the signaling pathways involved remain to be elucidated. The purpose of this study was to identify how phosphorylation (via cAMP- and cGMP-dependent protein kinases) I dephosphorylation (via phosphoprotein phosphatase 2A, PP2A) regulates BKca channel activity in human coronary artery smooth muscle …

Medication Adherence And Intervention To Create Success In Hypertensive African Americans In A Rural Setting, Laneita Davis

DNP Projects

Hypertension is a chronic disease that has been a major problem in the African American community for decades. Although numerous research studies have examined interventions to combat this disease, there has been very little research published that focused on African Americans with hypertension in a rural setting. Rural residents experience many difficulties in accessing healthcare services. This difficult access is a disadvantage that results in higher morbidity and mortality rates compared to those of their urban counterparts. Being from a small town in Mississippi, I have witnessed first hand the many barriers that are encountered. Individuals who live in a …

Ventricular Septal Rupture In The Cardiac Catheterization Laboratory, Loheetha Ragupathi, Md, Xin Zhang, Md, Gregary D. Marhefka, Md, Facp, Facc

Division of Cardiology Faculty Papers

Introduction

• Ventricular septal rupture is a rare but deadly complication of acute myocardial infarction (AMI)

• We describe a case that was recognized at time of occurrence in the cardiac catheterization lab

Serum Levels Of Soluble Icam-1 In Children With Pulmonary Artery Hypertension, Melahat Melek Oguz, Ayse Deniz Oguz, Cihat Sanli, Ayhan Cevik

The Texas Heart Institute Journal

This prospective cross-sectional study attempted to determine both the usefulness of the serum intercellular adhesion molecule-1 (ICAM-1) as a biomarker for pulmonary artery hypertension secondary to congenital heart disease and the nature of this marker's association with catheter angiographic findings.

Our study included a total of 70 male and female children, comprising 30 patients with both pulmonary artery hypertension and congenital heart disease, 20 patients with congenital heart disease alone, and 20 healthy control subjects. Levels of ICAM-1 in plasma samples from all groups were measured by the enzyme-linked immunosorbent assay method. Cardiac catheterization was also performed in all patients. …

Emergent Surgical Pulmonary Embolectomy In A Pregnant Woman: Case Report And Literature Review, Giovanni Saeed, Michael Möller, Jörg Neuzner, Rainer Gradaus, Werner Stein, Uwe Langebrake, Thomas Dimpfl, Meradjoddin Matin, Ali Peivandi

The Texas Heart Institute Journal

Acute pulmonary embolism is a leading cause of death during pregnancy and delivery in the United States. We describe the case of a 25-year-old woman who presented in cardiogenic shock in week 38 of her first pregnancy. After the emergent cesarean delivery of a healthy male neonate, the mother underwent immediate surgical pulmonary embolectomy. We confirmed the diagnosis of pulmonary embolism intraoperatively by means of transesophageal echocardiography and removed large clots from the patient's pulmonary arteries. Mother and child were doing well, 27 months later. In addition to presenting our patient's case, we discuss the other relevant reports and the …

Bisphenol A Increases Atherosclerosis In Pregnane X Receptor-Humanized Apoe Deficient Mice, Yipeng Sui, Se-Hyung Park, Robert N. Helsley, Manjula Sunkara, Frank J. Gonzalez, Andrew J. Morris, Changcheng Zhou

Saha Cardiovascular Research Center Faculty Publications

BACKGROUND: Bisphenol A (BPA) is a base chemical used extensively in many consumer products. BPA has recently been associated with increased risk of cardiovascular disease (CVD) in multiple large-scale human population studies, but the underlying mechanisms remain elusive. We previously reported that BPA activates the pregnane X receptor (PXR), which acts as a xenobiotic sensor to regulate xenobiotic metabolism and has pro-atherogenic effects in animal models upon activation. Interestingly, BPA is a potent agonist of human PXR but does not activate mouse or rat PXR signaling, which confounds the use of rodent models to evaluate mechanisms of BPA-mediated CVD risk. …

Variability Of M-Mode Versus Two-Dimensional Echocardiography Measurements In Children With Dilated Cardiomyopathy., Caroline K. Lee, Renee Margossian, Lynn A. Sleeper, Charles E. Canter, Shan Chen, Lloyd Y. Tani, Girish S. Shirali, Anita Szwast, Elif Seda Selamet Tierney, M Jay Campbell, Fraser Golding, Yanli Wang, Karen Altmann, Steven D. Colan, Pediatric Heart Network Investigators

Manuscripts, Articles, Book Chapters and Other Papers

M-mode and 2-dimensional (2D) echocardiographic imaging are routinely used to quantify left-ventricular (LV) size and function in pediatric patients with dilated cardiomyopathy (DCM). The reproducibility of and correlation between these techniques are unknown. This analysis sought to compare interreader, intrareader, and interacquisition reproducibility of M-mode versus 2D measurements in pediatric DCM patients. The Ventricular Volume Variability study of the Pediatric Heart Network is a multicenter, prospective, observational study assessing the course of chronic DCM in children. Two sonographers performed baseline image acquisitions locally, and two readers performed measurements at the echocardiographic core laboratory. One reader repeated measurements 1 month later. …

Underutilization Of Statins And Aspirin Following Coronary Artery Bypass Graft Surgery, Kevin M. Curl, Md, Bryan Lebude, Md, Nicholas Ruggiero, Md, D L Fischman, Md, Andrew Rose, Md, Sulay Patel, Md, J. David Ogilby, Md, Paul Walinsky, Md, Babu Jasti, Md, Michael P. Savage, Md

Division of Cardiology Faculty Papers

Introduction

Coronary artery bypass graft (CABG) surgery continues to be an important procedure for the treatment of coronary artery disease. However, clinically significant stenoses and complete bypass graft occlusion rates remain high, especially among saphenous vein grafts1. This is associated with significant morbidity and mortality. Both statin medications and aspirin have been shown in numerous clinical trials to play an important role in the medical management of coronary artery disease following CABG surgery. As per the ACC/AHA guidelines, both statin medications and aspirin have class I indications to support their use indefinitely following CABG, unless contraindication exists2. Long term studies …

Wandering Acute Myocardial Infarction., Kamal R. Joshi, D Lynn Morris, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Incorrect electrode placement or cable connection during electrocardiographic (ECG) recording can significantly alter the ECG morphology. We report a case of ST-segment elevation myocardial infarction causing a diagnostic dilemma due to cable interchange.

Cardiac Magnetic Resonance Imaging For The Investigation Of Cardiovascular Disorders Part 2: Emerging Applications, Ajit H Goenka, Hui Wang, Scott D Flamm

The Texas Heart Institute Journal

Cardiac magnetic resonance imaging has emerged as a robust noninvasive technique for the investigation of cardiovascular disorders. The coming-of-age of cardiac magnetic resonance—and especially its widening span of applications—has generated both excitement and uncertainty in regard to its potential clinical use and its role vis-à-vis conventional imaging techniques. The purpose of this evidence-based review is to discuss some of these issues by highlighting the current (Part 1, previously published) and emerging (Part 2) applications of cardiac magnetic resonance. Familiarity with the versatile uses of cardiac magnetic resonance will facilitate its wider clinical acceptance for improving the management of patients with …

The 1,000th Vad, The Great Rivalry, And The Grand Experiment Of The Texas Medical Center, Todd K Rosengart

The Texas Heart Institute Journal

No abstract provided.

The Odyssey Of Tavr From Concept To Clinical Reality, Alain G Cribier

The Texas Heart Institute Journal

No abstract provided.

2014 Massachusetts Family Impact Seminar: A Lot On Our Plate; Chronic Health Threats In Massachusetts, Ira S. Ockene M.D., Christina D. Economos Ph.D, Barbara Goldoftas Ph.D, Denise A. Hines Ph.D., Caitlin Alcorn, Jacqueline A. Daigneault, Jordan R. Daley, Maura A. Flanagan, Carsten-Hendrik Rasche, Heather Rios, Julia Tran, Liam Kelly Fleming

Mosakowski Institute for Public Enterprise

A Lot on Our Plate: Chronic Health Threats in Massachusetts is the fifth Massachusetts Family Impact Seminar, and is designed to emphasize a family perspective in policymaking on issues related to childhood obesity, cardiovascular disease, and type 2 diabetes. In general, Family Impact Seminars analyze the consequences an issue, policy, or program may have for families.

Patient Characteristics And Predictors Of Mortality Associated With Pericardial Decompression Syndrome, Rajesh Pradhan, Md, Toshimasa Okabe, Md, Kazuki Yoshida, Md, Dimitrios Angouras, Md, Matthew Decaro, Md, Gregary D. Marhefka, Md

Division of Cardiology Faculty Papers

Pericardial decompression syndrome is a rare complication of pericardiocentesis and surgical drainage of pericardial effusion with a high morality rate. The minimum amount of drained effusion in our serious was 450 ml. Surgical drainage was associated with a higher mortality rate.

Tachycardia Mediated Cardiomyopathy: Pathophysiology, Mechanisms, Clinical Features And Management., Shuchita Gupta, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Tachycardia mediated cardiomyopathy (TMC) is a reversible form of dilated cardiomyopathy that can occur with most supraventricular and ventricular arrhythmias. Despite the plethora of literature describing this entity in animal models, as well as humans, it remains poorly understood. Over the last decade, new etiologies of TMC, such as frequent premature ventricular complexes in normal hearts, have been identified. Recent advances in catheter-based ablation therapies, particularly for atrial fibrillation and ventricular arrhythmias, have added a new dimension to the treatment of this condition. This review describes the pathophysiology, proposed mechanisms, clinical features and management in various arrhythmic conditions.

One Love, One Heart – Uniting Cardiac Surgery Programs Within A Network, Lori Fuehrer Rn, Hope L. Johnson Msn, Rn, Cnor

Patient Care Services / Nursing

No abstract provided.