Cardiology Commons^™

Safety, Timing And Outcomes Of Early Postoperative Cardiac Catheterization Following Congenital Heart Surgery, Karoline Krzywda

Research Days

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Background: Early postoperative ( < 6weeks) cardiac catheterization (EPOCC) has been considered high risk and often delayed. Recently, the safety of EPOCC has been demonstrated. The optimal timing of catheterization and its outcomes in struggling postoperative patients remains uncertain.

Objective: To describe EPOCC in our center and its impact on length of stay (LOS), number of mechanical ventilation days, number of ECMO days, and catheter-based interventions.

Methods: This is a retrospective cohort study of patients who underwent cardiac surgery between 01/01/2010 and 12/31/2019 and EPOCC within 30 days after surgery. Cohorts were early EPOCC (≤72 hr) vs late EPOCC ( >72 hr). Data on timing, indication, and complications of EPOCC; days of mechanical ventilation and ECMO; and CICU/total hospital LOS were collected. Data was analyzed using chi-square and Student’s t-test, …

Ekg Technology: It Is Time For A Change!, Megan Carroll

Research Days

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Background: Technology for obtaining pediatric EKGs has not changed in over 70 years. Current guidelines recommend a 12-lead EKG, which takes approximately 7 minutes to complete. Newer adult technology utilizes between 1-6 leads for EKG analysis. There has not been a study in pediatrics to assess the minimum number of leads required to attain diagnostic accuracy.

Objectives/Goal: To determine the appropriate number of leads needed to read pediatric EKGs safely and accurately.

Methods/Design: This is a single center systematic review that included randomly selected EKGs from our hospital database (2017-2020) read by two independent pediatric …

Neonatal Hypoxia Due To Pulmonary Artery Thrombus, Bianca Cherestal

Research Days

Background: Pulmonary artery thrombus is rare and should be considered in neonates with refractory hypoxia.

Case: Preterm female neonate had persistent hypoxia after birth despite intubation, high-frequency oscillatory ventilation (FiO2 100%), and inhaled nitric oxide. Delivery was via c-section at 33 weeks 4 days for new onset hydrops and poor biophysical profile. Echocardiogram revealed echo brightness in the lumen of the left pulmonary artery (LPA) with no color flow (figure 1a), concerning for occlusive thrombus. Chest CT angiogram confirmed the diagnosis (figure 1b, c). Hematology was consulted and recommended systemic thrombolysis (tissue plasminogen activator, tPA) with concomitant anticoagulation (Bivalirudin). Imaging …

Iv Sotalol Use In Pediatric And Congenital Heart Patients: A Multicenter Registry Study., Lindsey Malloy-Walton, Nicholas H. Von Bergen, Seshadri Balaji, Peter S. Fischbach, Jason M. Garnreiter, S Yukiko Asaki, Jeffrey P. Moak, Luis A. Ochoa, Philip M. Chang, Hoang H. Nguyen, Akash R. Patel, Christa Kirk, Ashley K. Sherman, Jennifer N. Avari Silva, J Philip Saul

Manuscripts, Articles, Book Chapters and Other Papers

Background There is limited information regarding the clinical use and effectiveness of IV sotalol in pediatric patients and patients with congenital heart disease, including those with severe myocardial dysfunction. A multicenter registry study was designed to evaluate the safety, efficacy, and dosing of IV sotalol. Methods and Results A total of 85 patients (age 1 day-36 years) received IV sotalol, of whom 45 (53%) had additional congenital cardiac diagnoses and 4 (5%) were greater than 18 years of age. In 79 patients (93%), IV sotalol was used to treat supraventricular tachycardia and 4 (5%) received it to treat ventricular arrhythmias. …

Iv Sotalol Use In Pediatric And Congenital Heart Patients: A Multicenter Registry Study, Lindsey E Malloy-Walton, Nicholas H Von Bergen, Seshadri Balaji, Peter S Fischbach, Jason M Garnreiter, S Yukiko Asaki, Jeffrey P Moak, Luis A Ochoa, Philip M Chang, Hoang H Nguyen, Akash R Patel, Christa Kirk, Ashley K Sherman, Jennifer N Avari Silva, J Philip Saul

Faculty, Staff and Student Publications

Background There is limited information regarding the clinical use and effectiveness of IV sotalol in pediatric patients and patients with congenital heart disease, including those with severe myocardial dysfunction. A multicenter registry study was designed to evaluate the safety, efficacy, and dosing of IV sotalol. Methods and Results A total of 85 patients (age 1 day-36 years) received IV sotalol, of whom 45 (53%) had additional congenital cardiac diagnoses and 4 (5%) were greater than 18 years of age. In 79 patients (93%), IV sotalol was used to treat supraventricular tachycardia and 4 (5%) received it to treat ventricular arrhythmias. …

Cardiorespiratory, Hemodynamic, And Perceived Exertion Responses To Seated Chair Exercise, Ryan Khemraj, Cristian Solano, Neesirg Patel, Roger Sacks

Posters

INTRODUCTION
The increasing prevalence of cardiovascular disease (CVD) and its sequelae in the United States population has led to escalating health care expenditures. To favorably modify cardiovascular outcomes, exercise physiologists have developed varied exercise programs that are associated with mortality reduction, symptom relief, improved exercise tolerance, favorable risk factor modification and improved psychosocial well-being. For patients with significant disability and deconditioning, chair-based exercise may provide an alternative method of achieving the relative cardioprotective benefits of traditional exercise.

Transcatheter Aortic Valve Replacement: Volume Impact On Length Of Stay And Readmissions, Alexander M. Balinksi, Patrick Karabon, Girish Pathangey, Amr E. Abbas

Posters

INTRODUCTION
TAVR is an alternative to surgery in patients with severe aortic stenosis. Procedural volume impacts mortality but little is known of its effect on length of stay (LOS) and readmissions. We sought to examine the impact of transcatheter aortic valve replacement (TAVR) procedural volume on trends in LOS and hospital readmission rates from 2012 to 2016.

Late Outcomes For Patients With Acute Chest Pain And Positive Fractional Flow Reserve By Computed Tomography, Zach Rollins, Jason Schott, Robert Safian

Posters

INTRODUCTION
Testing with fractional flow reserve derived from computed tomography (FFRCT) can be used to stratify otherwise indeterminate grade stenoses on cardiac computed tomography angiography (CCTA). Long-term clinical outcomes using FFRCT have been reported in stable heart disease but not for acute chest pain (ACP). This study analyzes clinical outcomes in patients with ACP who underwent FFRCT, including the risk of mortality, myocardial infarction (MI), invasive coronary angiography (ICA), and revascularization.

Does Aspirin Reduce Risk For Future Cardiovascular Events In Women With Diabetes?, Olivia Hillier, Amna Zeb, Pamela Marcovitz

Posters

INTRODUCTION
The use of low dose aspirin (LDA) in primary prevention of cardiovascular events (CVE) is no longer recommended due to lack of benefit in prevention of primary outcome and increased bleeding risks. It’s postulated that LDA could still be of benefit in those with very high vascular risk including diabetes mellitus (DM) as it confers a higher risk for future CVE in women as compared to men. We conducted a meta-analysis to determine if use of low dose ASA is beneficial to lower CVE in women with multiple risk factors.

Nurse Practitioner-Led Heart Failure Education Program, Ruairi Fox

The Eleanor Mann School of Nursing DNP Capstone Projects

Heart failure is a chronic, progressive disease that has a global burden on the healthcare system and on patient’s lives. HF patients who experience a hospital admission are at a greater risk of being readmitted to the hospital within 30 days, impacting healthcare spending costs and patient quality of life. Self-care activities by patients, such as monitoring weight and making lifestyle changes, are the hallmark of outpatient care, and is shown throughout the literature to reduce readmissions and impact patient quality of life. Unfortunately, many patients are either unaware of proper self-care management techniques or find them hard to follow. …

The Impact Of Remote Optimization Of Guideline-Directed Medical Therapy In Patients With Nyha Stage Ii And Iii Heart Failure, Maurice N. Tran, Christine Doran, Trevor Laursen, Kellie Graybosch, Jacob Abraham

Providence Pharmacy PGY2 Program at Providence Medical Group 2022

No abstract provided.

Preoperative Phytonadione Supplementation For Mitral Valve Intervention Hemostasis, Katherine M. Nguyen, Joshua Francis, Celine Munoz, Torin P. Fitton

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2022

No abstract provided.

Development Of A Nurse Practitioner Driven Program For Cardiology Providers To Increase Knowledge And Awareness Of Neurodevelopmental Assessment Needs In Children With Congenital Heart Defects, Michele Readman

Doctor of Nursing Practice Final Manuscripts

Children diagnosed with congenital heart defects are at increased risk for neurodevelopmental delays. Timely referral of patients to a neurodevelopmental clinic for initial evaluation and referrals to support services can improve learning outcomes, provide early intervention for neurodevelopmental disorders, and mediate factors affecting low quality of life. Nationally, a substantial proportion of pediatric cardiologists are not referring children for neurodevelopmental evaluation. A review of patient referrals to a Cardiac Neurodevelopmental Clinic within an urban children’s hospital demonstrated an opportunity to improve provider awareness and knowledge of referral recommendations. Using the Iowa Model of Evidence-Based Practice to Promote Quality Care, an …

Small Vessel, Large Problems: An Unusual Cause Of Heart Failure In An Elderly Female., Nicholas Pettit, Jason Bensch

Providence Portland Medical Center Internal Medicine 2022

No abstract provided.

Impact Of Recent Acute Kidney Injury On Creatinine Clearance Estimation In Critically Ill Patients Undergoing Cardiac Surgery, Amaris Fuentes, Jagadeswara R Earla, Tomona Iso, Joshua T Swan

The Texas Heart Institute Journal

Acute kidney injury (AKI), often present in critically ill patients and patients with cardiac dysfunction, may alter estimates of renal function. The impact of recent AKI on the accuracy of the Cockcroft-Gault creatinine clearance equation (CG-CrCl) before cardiac surgery is unknown. This single-center, retrospective study included patients who underwent cardiac surgery from 1 January 2006 through 30 June 2012 and whose 24-hour urine creatinine clearance (24hr-CrCl) was measured in the intensive care unit before surgery. We evaluated CG-CrCl accuracy by calculating absolute differences between 24hr-CrCl and CG-CrCl estimates. Clinical impact was signified by discrepancies in United States Food and Drug …

Supracardiac Total Anomalous Pulmonary Venous Return Repair In A 7-Month-Old Infant, Mislav Planinc, Ivan Malcic, Darko Anic

The Texas Heart Institute Journal

Total anomalous pulmonary venous return is a congenital heart malformation characterized by anomalous pulmonary venous inflow to the right atrium. Surgical repair typically occurs during the first month of life, and survival beyond that age in untreated patients is unlikely. We report an extreme case of supracardiac total anomalous pulmonary venous return in an infant who survived 7 months despite atypical anomalous inflow without atrial-level communication and with right-to-left shunting only through a patent ductus arteriosus. We stabilized the patient's left-sided heart function before surgically repairing the anomalous venous return 2 months later. Three years postoperatively, the patient was well.

An Evaluation Of Oral Anticoagulation Initiation After Ischemic Stroke In Patients With Atrial Fibrillation/Atrial Flutter At Hospital Discharge, Jessica Zhao, Meri Slavica, Vanessa Jenkins, Natalie Swearingen

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2022

No abstract provided.

Retrospective Impact Of Covid-19 Pandemic On Hypertension Management In Primary Care, Carly Barnes, Jayme Johnston, Judy Wong

Providence Pharmacy PGY2 Program at Providence Medical Group 2022

No abstract provided.

Effects Of Pharmacist Intervention On Blood Pressure In Black Versus White Patients, Angela Kim, Benjamin Rosati, Dawn Fuke

Providence Pharmacy PGY2 Program at Providence Medical Group 2022

No abstract provided.

Wearing An Apple A Day Won’T Keep The Doctor Away: Diagnosing Wolff-Parkinson-White Syndrome With An Apple Watch, Grace Judd, Jason Heino

Providence Portland Medical Center Internal Medicine 2022

No abstract provided.

Mechanism Of Rare Variant In Acta2, P.Arg149cys, Driving Diverse Vascular Disease, Kaveeta Kaw

Dissertations and Theses (Open Access)

Heterozygous variants in ACTA2 (smooth muscle (SM) α-actin) predispose to thoracic aortic aneurysms and dissections (TAAD) and early-onset coronary artery disease (CAD). The most common ACTA2 mutation is a genetic alteration of arginine 149 to a cysteine, ACTA2 p.Arg149Cys, which accounts for disease in 24% of all ACTA2 mutation carriers.(1) ACTA2 p.Arg149Cys mutation carriers present with either TAAD or CAD but rarely have both diseases. To identify the molecular mechanisms dictating whether an individual with ACTA2 p.Arg149Cys develops TAAD or CAD, CRISPR/Cas9 technology was used to generate the mutant mouse, Acta2^R149C/+, in a C57BL6 background. Acta2^R149C/+ mice …

Machine Learning Automated Detection Of Large Vessel Occlusion From Mobile Stroke Unit Computed Tomography Angiography, Alexandra L Czap, Mersedeh Bahr-Hosseini, Noopur Singh, Jose-Miguel Yamal, May Nour, Stephanie Parker, Youngran Kim, Lucas Restrepo, Rania Abdelkhaleq, Sergio Salazar-Marioni, Kenny Phan, Ritvij Bowry, Suja S Rajan, James C Grotta, Jeffrey L Saver, Luca Giancardo, Sunil A Sheth

Faculty, Staff and Student Publications

BACKGROUND: Prehospital automated large vessel occlusion (LVO) detection in Mobile Stroke Units (MSUs) could accelerate identification and treatment of patients with LVO acute ischemic stroke. Here, we evaluate the performance of a machine learning (ML) model on CT angiograms (CTAs) obtained from 2 MSUs to detect LVO.

METHODS: Patients evaluated on MSUs in Houston and Los Angeles with out-of-hospital CTAs were identified. Anterior circulation LVO was defined as an occlusion of the intracranial internal carotid artery, middle cerebral artery (M1 or M2), or anterior cerebral artery vessels and determined by an expert human reader. A ML model to detect LVO …

Free Cholesterol Bioavailability And Atherosclerosis, Rei J Abe, Jun-Ichi Abe, Minh T H Nguyen, Elizabeth A Olmsted-Davis, Abrar Mamun, Priyanka Banerjee, John P Cooke, Longhou Fang, Henry Pownall, Nhat-Tu Le

Faculty, Staff and Student Publications

Purpose of review: As both a cholesterol acceptor and carrier in the reverse cholesterol transport (RCT) pathway, high-density lipoprotein (HDL) is putatively atheroprotective. However, current pharmacological therapies to increase plasma HDL cholesterol (HDL-c) concentration have paradoxically failed to prevent or reduce atherosclerosis and cardiovascular disease (CVD). Given that free cholesterol (FC) transfer between surfaces of lipoproteins and cells is reversible, excess plasma FC can be transferred to the cells of peripheral tissue sites resulting in atherosclerosis. Here, we summarize potential mechanisms contributing to this paradox and highlight the role of excess free cholesterol (FC) bioavailability in atherosclerosis vs. atheroprotection.

Recent …

Src Stimulates Abl-Dependent Phosphorylation Of The Guanine Exchange Factor Net1a To Promote Its Cytosolic Localization And Cell Motility, Andrea M Murad, Hannah L Hill, Yu Wang, Michael Ghannam, Min-Lee Yang, Norma L Pugh, Federico M Asch, Whitney Hornsby, Anisa Driscoll, Jennifer Mcnamara, Cristen J Willer, Ellen S Regalado, Dianna M Milewicz, Kim A Eagle, Santhi K Ganesh

Faculty, Staff and Student Publications

Spontaneous coronary artery dissection (SCAD) is a potential precipitant of myocardial infarction and sudden death for which the etiology is poorly understood. Mendelian vascular and connective tissue disorders underlying thoracic aortic disease (TAD), have been reported in ~5% of individuals with SCAD. We therefore hypothesized that patients with TAD are at elevated risk for SCAD. We queried registries enrolling patients with TAD to define the incidence of SCAD. Of 7568 individuals enrolled, 11 (0.15%) were found to have SCAD. Of the sequenced cases (9/11), pathogenic variants were identified (N = 9), including COL3A1 (N = 3), FBN1 (N = 2), …

Integrating Pharmacists In Hfref Outpatient Care To Improve Use Of Guideline-Directed Medical Therapy, Roy Robertson Md, Mindy Flanagan Phd, Kris Howard Pharmd, Elizabeth Meisberger Pharmd, Emily Keltner Bs, Ma, Lovekirat Singh Ms, Carly Daley Phd, Shauna Wagner Bsn, Rn, Tammy Toscos Phd, Michael Mirro Md, Facc, Fhrs, Faha

Health Services and Informatics Research

Background: Guideline directed medical therapy (GDMT) is the cornerstone of reducing mortality and morbidity in patients with heart failure with reduced ejection fraction (HFrEF); however, uniform prescribing remains low. There is potential for multidisciplinary care teams, including pharmacists, to improve GDMT use in outpatient care for patients with HFrEF. Investigation is needed to understand the impact of pharmacists in outpatient HFrEF care on GDMT prescribing.

Objectives: To examine the impact of integrating a pharmacist into an outpatient cardiology setting on GDMT prescription rates during HFrEF-related clinic visits.

Methods: This retrospective chart review study examined cardiology clinic visits (HF clinic, “general …

Surgical Ventricular Reconstruction For Ischemic Cardiomyopathy-A Systematic Review And Meta-Analysis Of 7,685 Patients, Brandon Ferrell, Diana C. Jiminez, Danial Ahmad, Kabir Malkani, Jake L Rosen, Gabriel Gaw, Konstadinos A Plestis, T. Sloane Guy, H. Todd Massey, Vakhtang Tchantchaleishvili

Division of Cardiology Faculty Papers

Background: Surgical ventricular reconstruction (SVR) has been used to control adverse ventricular remodeling and improve cardiac function in ischemic cardiomyopathy. The purpose of this systematic review and meta-analysis was to collect and analyze all available evidence on the utilization and efficacy of SVR.

Methods: An electronic database search was performed to identify all retrospective and prospective studies on SVR for ischemic cardiomyopathy in the English literature from 2000 through 2020. A total of 92 articles with a collective 7,685 patients undergoing SVR were included in the final analysis.

Results: The mean patient age was 61 years (95% CI: 59-63) and …

Iatrogenic Diversion Of Superior Vena Cava Into Left Atrium, Tarun Jain, Jamil F Borgi, James C Lee, Karthikeyan Ananthasubramaniam

The Texas Heart Institute Journal

No abstract provided.

Recurrent Parotid Adenocarcinoma Presenting As Diffuse Myocardial Metastatic Disease, Edward A El-Am, Upasana Jarori, Sara J Grethlein, Ronald Mastouri, Abhishek Khemka

The Texas Heart Institute Journal

A 64-year-old man who had undergone treatment for left parotid adenocarcinoma presented with progressive exertional shortness of breath. Evaluation revealed metastatic invasion of the myocardium as a rare presentation of recurrent parotid adenocarcinoma. This case highlights the importance of using multimodal imaging methods in diagnostic evaluation and a collaborative multidisciplinary approach in managing patient care.

Abnormal Electrocardiogram In A Man Presenting With Dyspnea And Chest Pain, Daniel W Nelson, Ryley Mcpeters, Atul Singla

The Texas Heart Institute Journal

No abstract provided.

Patient Knowledge Of Family History Of Cardiac Events And Risk Factors: Potential For Increase In Preventative Care Of Cardiovascular Diseases, Joseph Marentette

Honors Theses

The following literature review regards the preventative care of cardiovascular disease (CVD) patients with the knowledge of familial cardiac events and personal cardiac risk factors, particularly in younger populations ranging from ages 18 to 39, and develop potential preventative care measures. CVD is preventable with early reduction of risk factors. People can lower the impact of cardiac risk factors through the modification of their current lifestyle and behavioral habits. However, this is limited to the education and motivation of the person. Primary emphasis must be placed on community education and physician-patient interactions regarding CVD and cardiac risk factors. Physicians need …