Cardiology Commons^™

The Value Of 3d Vena Contracta Area In A Patient With Degenerative Mitral Regurgitation And Multiple Jets, Shing Ching, Chiu Sun Yue

Journal of the Hong Kong College of Cardiology

Quantification of degenerative mitral regurgitation with multiple jets in atrial fibrillation is challenging with two dimensional techniques and may underestimate the severity. We report the feasibility and advantages of vena contracta area in three dimensional transesophageal echocardiography in evaluation of such a patient.

From Bad To Worse: The Clinical Spectrum Of Immune Checkpoint Inhibitor Myocarditis And Associated 3m Syndrome With Concomitant Myositis And Myasthenia, Tsun-Ho Lam, Jeffrey Sum-Lung Wong, Chun-Ka Wong, Gerry Gin Wai Kwok, Miaochang Zhou, Benjamin Yu-Fai So, Ian Yu-Hin Leung, Hung-Fat Tse

Journal of the Hong Kong College of Cardiology

Immune checkpoint inhibitors (ICIs), though revolutionizing cancer care, are well known to cause a diverse array of autoimmune side effects termed immune-related adverse events (IRAEs). ICI Myocarditis is a rare manifestation of IRAE associated with high mortality. We report two cases of fulminant ICI myocarditis refractory to potent immunosuppressants. Our first patient received pembrolizumab for lymphoma, small cell lung cancer and renal cell carcinoma. After 13 doses of ICIs, he developed fulminant myocarditis with concomitant lower-motor neuron type facial nerve palsy. Despite receiving triple immunosuppressive therapies with pulse steroid, mycophenolate mofetil and basiliximab, his cardiac condition progressively worsened and eventually …

Epidemiology And Characteristics Of Surgical Intervention For Infective Endocarditis: A Population-Based Study In The Past Two Decades (2000 – 2019) In Hong Kong, Hang-Long Li, Yi-Kei Tse, Cong Chen, Si-Dong Cai, Meng-Qi Su, Mei-Zhen Wu, Qing-Wen Ren, Jia-Yi Huang, Si-Yeung Yu, Yap-Hang Chan, Hung-Fat Tse, Kai-Hang Yiu

Journal of the Hong Kong College of Cardiology

Background

The ‘inflamm-ageing’ phenomenon may worsen the prognosis of heart diseases including infective endocarditis (IE), while surgery may reduce inflammatory burden by direct removal of bacterial vegetation. This study aims to characterize the epidemiological and clinical features of surgical intervention for IE in Hong Kong in the past two decades.

Methods

All patients with incident IE from 2000-2019 in a territory-wide database were identified. We studied the trends in age-specific incidence of IE and identified the most significant contributors to 1-year all-cause death using the population attributable fraction (PAF). A propensity score approach was used to evaluate the benefits of …

Indicators Of Cardiac Autonomic Dysfunction Associated With Chronic Hyperglycemia: Implications On Vascular Surrogates And Heart Failure, Yap-Hang Chan, Bernard Man-Yung Cheung, Hung-Fat Tse

Journal of the Hong Kong College of Cardiology

Background: Limited data exist on the role of chronic hyperglycemia-related cardiac autonomic dysfunction in incident heart failure (HF). We investigated the relations of resting heart rate (HR) and PR interval with chronic hyperglycemia, and effects on new-onset HF.

Methods: We prospectively studied 550 patients with prior coronary disease, ischemic stroke and/ or type 2 diabetes. Incident HF was ascertained. Heart rate-PR interval dissociation was defined as counter-physiological co-occurrence of increased PR interval (>mean; 173.3ms) and increased resting HR (>mean; 64.4 beats/min).

Results: Over 63 ±11 months, 6.7% patients developed new-onset HF. Resting HR³75bpm was independently predictive of new-onset …

Clinical Features And Prognosis Of Chinese Childhood Pulmonary Arterial Hypertension-Related Gene Mutation Carriers, Zhuoyuan Xu, Hongsheng Zhang, Chen Zhang, Qiangqiang Li, Hong Gu

Journal of the Hong Kong College of Cardiology

Background: The impact of PAH-related gene mutations on the clinical phenotype are not yet fully understood, especially in childhood.

Methods: Retrospective study of 114 pediatric Chinese Han population whose onset of PAH was between 3 months and 18 years of age with IPAH were performed. Whole exome sequencing results, clinical characteristics, treatments and outcomes were recorded in all patients.

Results: Thirty-one BMPR2, nine ACVRL1 and 33 other PAH-related gene mutation carriers were detected in this cohort. The median age at diagnosis of PAH was 5.9 (3.4,10.3) years. 54 (47.4%) patients were female. 80 patients including 59 mutation carriers underwent right …

Understanding The Genotypes And Phenotypes Relationship: Progress Toward A Precision Medicine Approach In Pediatric Pulmonary Hypertension, Kin Shing Lun

Journal of the Hong Kong College of Cardiology

No abstract provided.

Kat-Arc Accelerated 4d Flow Cmr: Clinical Validation For Transvalvular Flow And Peak Velocity Assessment, Hosamadin Assadi, Bhalraam Uthayachandran, Rui Li, James Wardley, Tha H Nyi, Ciaran Grafton-Clarke, Andrew J Swift, Ana Beatriz Solana, Jean-Paul Aben, Kurian Thampi, David Hewson, Chris Sawh, Richard Greenwood, Marina Hughes, Bahman Kasmai, Liang Zhong, Marcus Flather, Vassilios S Vassiliou, Pankaj Garg

Faculty, Staff and Student Publications

BACKGROUND: To validate the k-adaptive-t autocalibrating reconstruction for Cartesian sampling (kat-ARC), an exclusive sparse reconstruction technique for four-dimensional (4D) flow cardiac magnetic resonance (CMR) using conservation of mass principle applied to transvalvular flow.

METHODS: This observational retrospective study (2020/21-075) was approved by the local ethics committee at the University of East Anglia. Consent was waived. Thirty-five patients who had a clinical CMR scan were included. CMR protocol included cine and 4D flow using Kat-ARC acceleration factor 6. No respiratory navigation was applied. For validation, the agreement between mitral net flow (MNF) and the aortic net flow (ANF) was investigated. Additionally, …

Recommendations For Optimizing Cardiac Ischemia Detection For Physical Therapy Practice: Research Review, Stacey Pirtle, Germaine Ferreira

Physical Therapy Collection

Purpose: The purpose of this study is to guide physical therapists in recognizing ischemia using electrocardiogram strips during graded exercise stress testing using methods other than relying on ST segment deviation for cardiac ischemia detection.

Methods: A literature review of the English-language literature published between 1975 to 2022 on the detection and prediction accuracy of ECG abnormalities on cardiac ischemia during GXT was conducted using PubMed and CINAHL. Inclusion criteria included studies utilizing 12-lead ECG monitoring while performing GXT for the detection of cardiac ischemia. Exclusion criteria included studies that did not utilize GXT or ECG for detection of cardiac …

Pulmonary Hypertension With “Normal” Pulmonary Vascular Resistance, Marwan F. Jumean, Sriram Nathan, Maria Patarroyo Aponte

Journal of Shock and Hemodynamics

Abstracts not available for Perspectives.

Role Of Veno-Arterial Extracorporeal Membrane Oxygenation In Left Ventricular Conditioning After Lung Transplantation, Emily A. Ingebretson

Journal of Shock and Hemodynamics

End-stage pulmonary hypertension alters intracardiac pressures, leading to distention and failure of the right ventricle, leftward shifting of the intraventricular septum, and, thus, underfilling of the left ventricle (LV). Following the resolution of severely elevated pulmonary vascular resistance with bilateral lung transplantation, the LV is exposed to relatively high filling pressures from a potentially hypertrophic right ventricle pushing blood through normalized pulmonary vascular resistance. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) may be a valuable tool to provide a more gradual exposure of the LV to the newly available preload in the immediate postoperative phase of transplantation, thereby reducing the likelihood …

Scai Shock Stage Classification: What Is Missing From The Latest Update?, Biykem Bozkurt

Journal of Shock and Hemodynamics

The revised Society for Cardiovascular Angiography and Interventions classifications reflect graduation of severity within each stage and pathway by which patients progress or recover. However, they are limited regarding the following: their predictive role to guide therapy; escalation of therapy or referral; variability in diagnostic criteria and interpretation; presence of other disease modifiers and confounders; variability of etiology and reversibility of cause; response to therapy and trajectory to be taken into risk stratification; magnitude and phenotypes of end-organ damage. Thus, we need a modified risk score to predict the necessity to escalate therapy and consider advanced therapies, such as mechanical …

Should All Shock Centers Offer Ecpr? Balancing Futility, Cost Effectiveness, And Hope, Michael Mooney

Journal of Shock and Hemodynamics

There are over 400,000 out-of-hospital cardiac arrests (OHCA) in the United States annually. Of those, 50% are refractory cardiac arrest, defined as the lack of return of spontaneous circulation (ROSC) after 30 minutes of appropriate cardiopulmonary resuscitation (CPR) in the absence of hypothermia. Extracorporeal cardiopulmonary resuscitation (ECPR) has been increasingly used given its potential to improve survival and offer improved neurological outcomes.

Systemic Inflammatory Response Syndrome And Mechanical Circulatory Support Devices, Mircea R. Mihu, Aly El-Banayosy

Journal of Shock and Hemodynamics

Systemic inflammatory response syndrome is an increased inflammatory state affecting the whole body. Mechanical circulatory support (MCS) is a temporary or permanent form of extracorporeal support that may have an associated complication of an exacerbated inflammatory response to the extracorporeal circuit. This brief review will focus on understanding the complex pathophysiology of inflammatory response to MCS, factors that influence the extent of the inflammatory response, the inflammatory response and outcomes as well as potential therapeutic strategies.

Role Of Hypothermia In Cardiogenic Shock, Filio Billia

Journal of Shock and Hemodynamics

While patient management in the intensive care unit has undoubtedly improved over the last 20 years, many questions remain. Neurological prognostication has become very important and aided in improving survival outcomes over time. The limited number of randomized control trials and limitations from currently completed studies leave the field with little certainty regarding targeted temperature management. In addition, implementing hypothermia can use multiple methods and protocols that impact the interpretation and comparison of results.

Management Of Severe Aortic Stenosis In Cardiogenic Shock: Early Percutaneous Mechanical Circulatory Support Or Emergent Transcatheter Aortic Valve Replacement?, Sandeep Nathan

Journal of Shock and Hemodynamics

Aortic stenosis (AS) affects an estimated 1.5 million patients in the United States, with 250,000 patients or more suffering severe, symptomatic aortic stenosis. A subset of these patients also have unrevascularized coronary artery disease and left ventricular dysfunction, representing an extreme risk population of AS patients. Cardiogenic shock (CS) complicates a small minority of AS presentations and/or patients referred for transcatheter aortic valve replacement (TAVR) but is responsible in these cases for a disproportionately high rate of morbidity and mortality. Indeed, CS results in a 4-fold increase in TAVR mortality, proportional to shock severity and largely independent of procedural complications. …

A Case Of Inferior Myocardial Infarction Complicated By Ventricular Septal Rupture Leading To Cardiogenic Shock: Tandem Heart To The Rescue!, Shehab Al-Ansari, Sachin Kumar, Angelo Nascimbene, Manish K. Patel, Igor D. Gregoric

Journal of Shock and Hemodynamics

Ventricular septal rupture (VSR) is a rare but life-threatening complication of acute myocardial infarction. We present a case of VSR-related refractory cardiogenic shock that was successfully managed with TandemHeart® followed by surgical repair.

Early Unloading In Venoarterial Extracorporeal Membrane Oxygenation Shock: When, How, Where, And Why?, Benedikt Schrage

Journal of Shock and Hemodynamics

As extracorporeal membrane oxygenation increases the left ventricular afterload, a successful treatment plan should include strategies to address this issue. One promising approach to do so is the addition of a second device for active left ventricular unloading. However, this relatively new approach is currently only based on retrospective data. This article summarizes the current perspectives on this approach, provides recommendations for its application, and highlights the need for randomized data on this topic.

Microcirculation Versus Macrocirculation In Cardiogenic Shock, Christian Jung

Journal of Shock and Hemodynamics

Macro- and microcirculation are important parameters in cardiogenic shock. Microcirculation is relevant for monitoring organ function and prognosis. Serum lactate might be the best daily life parameter to assess microcirculation, and the crude 8-hour value can be used for outcome prediction. Any treatment should consider the consequences of microcirculation and macrocirculation.

Hemodynamics Of Prolonged Percutaneous Mechanical Circulatory Support – When Vasodilatation Sets, Holger Thiele

Journal of Shock and Hemodynamics

Hemodynamics play an important role in cardiogenic shock assessment for prognosis estimation and for phenotyping cardiogenic shock. This is best done by pulmonary artery catheters. In general, at the beginning of cardiogenic shock, patients have vasoconstriction, which over time may lead to vasodilation. This is often triggered by percutaneous mechanical circulatory support. This review will elucidate the hemodynamics and the factors that possibly lead to vasodilation in patients with mechanical circulatory support.

Society For Improving Medical Professional Learning Collaborative: What’S It All About?, Joseph B. Zwischenberger, Katherine Breetz, Daniel Cooper

Journal of Shock and Hemodynamics

The Society for Improving Medical Professional Learning (SIMPL) Collaborative is a non-profit, educational, quality improvement consortium focused on developing tools, curricula, and policies to improve physician training. The goal is to provide educators and learners with convenient, reliable, and valid evaluation tools for frequent, real-time workplace assessment and feedback. The SIMPL Operating Room application provides this platform. It was developed to provide high-quality, time-sensitive, procedural feedback. Its objective is to facilitate intra-rotation corrections.

SIMPL is available to all residency programs and has matured to include over 175 residency programs, involving 19 different specialties, 4000 trainees, 5000 attendings, and 354,800 evaluations …

Houston Shock: A Practical Scoring System Incorporating Cardiogenic Shock Dynamic Changes, Marwan F. Jumean, Sriram Nathan, Igor D. Gregoric, Biswajit Kar

Journal of Shock and Hemodynamics

Cardiogenic shock has an unacceptably high mortality rate and additional tools are needed to improve outcomes. The Society of Cardiovascular Angiography and Interventions (SCAI) shock severity classification has provided a unified definition of shock severity that has proven to be reproducible and predictive of survival. However, cardiogenic shock assessment goes beyond standardizing its severity, and a uniform and practical approach to comprehensive assessment that may guide therapy in a dynamic state is currently lacking.

Since cardiogenic shock is a rapidly evolving pathophysiological catastrophe, we propose a new assessment tool – the Houston SHOCK Score – which incorporates dynamic changes. The …

Overcoming The Cardiac Toxicities Of Cancer Therapy Immune Checkpoint Inhibitors, Omoruyi Credit Irabor, Nicolas Nelson, Yash Shah, Muneeb Khan Niazi, Spencer Poiset, Eugene Storozynsky, Dinender K Singla, D. Craig Hooper, Bo Lu

Division of Cardiology Faculty Papers

Immune checkpoint inhibitors (ICIs) have led recent advances in the field of cancer immunotherapy improving overall survival in multiple malignancies with abysmal prognoses prior to their introduction. The remarkable efficacy of ICIs is however limited by their potential for systemic and organ specific immune-related adverse events (irAEs), most of which present with mild to moderate symptoms that can resolve spontaneously, with discontinuation of therapy or glucocorticoid therapy. Cardiac irAEs however are potentially fatal. The understanding of autoimmune cardiotoxicity remains limited due to its rareness. In this paper, we provide an updated review of the literature on the pathologic mechanisms, diagnosis, …

Journal Of Shock And Hemodynamics, Vol 1., Iss. 1 (Print Version)

Journal of Shock and Hemodynamics

The print version of Volume I, Issue I of the Journal of Shock and Hemodynamics was published in September 2022. The PDF of the print version is downloadable here.

Transcatheter Atrial Septal Defect Closure Before Versus After Adulthood, Mohamed Saber Hafez, Mohamed Ibrahim Abdelrahman El-Sayed, Maiy Hamdy El Sayed

Journal of the Saudi Heart Association

Objectives: To evaluate the long term outcome of patients who underwent percutaneous transcatheter closure of secundum atrial septal defects during teenage life versus adulthood. Methods: The study included 100 patients with secundum type ASD who were treated by transcatheter closure of their defects 2-5 years before enrollment. The study population was subdivided into 2 equal groups: group 1 who underwent transcatheter closure during teenage life (13-19 years) and group 2 who underwent transcatheter closure after the age of 30 years. The two groups were compared according to resting 12 lead ECG, 24 hour Holter ECG and transthoracic echocardiographic findings (Right …

Persistent Left Superior Vena Cava, Connected To The Left Atrium Via The Left Superior Pulmonary Vein. An Unusual Cause Of Air Lock, Abdelkader Boukhmis, Mohamed El Amin Nouar

Journal of the Saudi Heart Association

The intraoperative diagnosis of a persistent left superior vena cava (LSVC) that drains into the left atrium (LA) via the left superior pulmonary vein may be difficult because of its extrapericardial pathway. We report here the case of a 48-year-old man, operated for a mitro-aortic endocarditis complicating a Laubry-Pezzi syndrome. The opening of the LA was followed immediately by a sudden air lock. It was only after opening of the left pleura that we were able to find and then ligate the LSVC. The patient underwent mitral valve repair, closure of the infundibular septal defect and aortic valve replacement.

The Lawnmower And The Pediatric Lower Extremity: A Catastrophic Combination, Alvaro Tamayo-Gutierrez, Hassan N Ibrahim

Faculty, Staff and Student Publications

Heart failure can lead to renal impairment, an interaction now termed "cardiorenal syndrome." The prevalent physiological explanation for the renal impairment that accompanies heart failure centers around the forward failure hypothesis, which emphasizes the role of left ventricular dysfunction in causing edema, and the backward failure hypothesis, which singles out venous congestion as the dominant mechanism of edema and reduced glomerular filtration rate. In this review, we provide an appraisal on venous congestion, an extremely important contributor that has received little attention. We also summarize the pharmacology of loop diuretics, explain current understanding of diuretic resistance, and address controversies regarding …

Hypertension Management In Patients With Chronic Kidney Disease, Sean A Hebert, Hassan N Ibrahim

Faculty, Staff and Student Publications

Hypertension and chronic kidney disease are closely linked. Patients with chronic kidney disease have hypertension almost universally and uncontrolled hypertension accelerates the decline in kidney function. The pathophysiology of hypertension in chronic kidney disease is complex, but is largely related to reduced nephron mass, sympathetic nervous system overactivation, involvement of the renin-angiotensin-aldosterone system, and generalized endothelial dysfunction. Consensus guidelines for blood pressure targets have adopted a blood pressure <120/80 mm Hg in native chronic kidney disease and <130/80 mm Hg in kidney transplant recipients. Guidelines also strongly advocate for renin-angiotensin-aldosterone system blockade as the first-line therapy.

Microrna Expression Levels Change In Neonatal Patients During And After Exposure To Cardiopulmonary Bypass., Lance Hsieh, Lan N. Tu, Alison Paquette, Quanhu Sheng, Shilin Zhao, Douglas C. Bittel, James O'Brien, Kasey Vickers, Peter Pastuszko, Vishal Nigam

Manuscripts, Articles, Book Chapters and Other Papers

Background The systemic inflammation that occurs after exposure to cardiopulmonary bypass (CPB), which is especially severe in neonatal patients, is associated with poorer outcomes and is not well understood. In order to gain deeper insight into how exposure to bypass activates inflammatory responses in circulating leukocytes, we studied changes in microRNA (miRNA) expression during and after exposure to bypass. miRNAs are small noncoding RNAs that have important roles in modulating protein levels and function of cells. Methods and Results We performed miRNA-sequencing on leukocytes isolated from neonatal patients with CPB (n=5) at 7 time points during the process of CPB, …

Recurrent Giant Cell Myocarditis After Heart Transplant: A Case Report, Eitan S. Frankel, Alexander G. Hajduczok, Indranee N. Rajapreyar, Yevgeniy Brailovsky

Division of Cardiology Faculty Papers

BACKGROUND: Giant cell myocarditis (GCM) is a rare but well-known cause of fulminant myocarditis. Despite optimal medical therapy, many patients progress to orthotopic heart transplant (OHT). We present a case of recurrent GCM following OHT, including complex considerations in patient management and infectious sequelae.

CASE SUMMARY: A 33-year-old previously healthy male presented with 2 months of worsening shortness of breath. Transthoracic echocardiogram (TTE) demonstrated a left ventricular ejection fraction of 30-35%. After ruling out an ischaemic aetiology, he was discharged on guideline-directed medical therapy and later presented with productive cough, worsening dyspnoea on exertion, and diarrhoea. He was found to …

Carfilzomib-Induced Cardiotoxicity: An Analysis Of The Fda Adverse Event Reporting System (Faers), Benjamin Buck, Eric Kellett, Daniel Addison, Ajay Vallakati

Journal of the Saudi Heart Association

Background: Carfilzomib and other proteasome inhibitors (PIs) have revolutionized treatment of multiple myeloma (MM). PIs have proven to be highly effective, but are associated with significant cardiovascular adverse events (AEs). No prior study has compared the cardiotoxicity of carfilzomib against other PI’s and all other classes of medications. Objectives: The purpose of this study is to characterize the cardiotoxicity of carfilzomib with respect to other PIs and all classes of medications using the US Food and Drug Administration Adverse Events Reporting System (FAERS) database and to define the observed cardiotoxicity profile. Methods: The FAERS database was queried between years 2017 …