Cardiology Commons^™

Dual Antiplatelet Therapy With Ticagrelor Vs Clopidogrel In Patients With Acute Coronary Syndrome, Binh Vu

Theses and Graduate Projects

Background: Dual antiplatelet therapy (DAPT) is an effective secondary prevention and an essential component of treatment after patients suffering from acute coronary syndrome (ACS). Recently, clinicians rapidly switched to DAPT with ticagrelor as the preferred treatment option after it was introduced in 2011. Compared to clopidogrel, ticagrelor is not a prodrug and does not require metabolic activation to inhibit the platelet P2Y12 receptor. It is the first reversible oral P2Y12 receptor antagonist; and its effect on platelet inhibition is more pronounced compared to clopidogrel.

Purpose: The purpose of this comprehensive review was to evaluate the efficacy and safety …

3d And Bio-Printing As An Efficient And Safe Alternative To Traditional Methods And Materials In Cardiovascular Diseases, Angela Asare-Ose

Theses and Graduate Projects

Background: Cardiovascular diseases are the leading cause of death globally. Therefore, there is the need for more resources to be poured into the research of more treatment options, diagnostic methods and preventative steps for patients. Though several technological advancements are being made in the world of medicine, it is not a bad idea to look at other avenues that have great potential to improve patient outcomes in cardiovascular diseases. 3D and bioprinting, though a relatively new technology in the world of medicine, is showing a promising future. It is already being applied in the field of orthopedic surgery and …

Improving Appropriate Utilization Of Telemetry: Quality Improvement Project, Carlos Vargas, Haris Ahmed, Kashmala Khan, Francis Dimtri, Ahmed Mahmood, Jeffery S. Durbin, Christel Cuevas, Thomas Alexander

Gulf Coast Division GME Research Day 2022

No abstract provided.

Effects Of Tamoxifen Inducible Mercremer On Gene Expression In Cardiac Myocytes In Mice, Leila Rouhi, Siyang Fan, Sirisha M Cheedipudi, Melis Olcum, Hyun-Hwan Jeong, Zhongming Zhao, Priyatansh Gurha, Ali J Marian

Faculty, Staff and Student Publications

The Cre-LoxP technology, including the tamoxifen (TAM) inducible MerCreMer (MCM), is increasingly used to delineate gene function, understand the disease mechanisms, and test therapeutic interventions. We set to determine the effects of TAM-MCM on cardiac myocyte transcriptome. Expression of the MCM was induced specifically in cardiac myocytes upon injection of TAM to myosin heavy chain 6-MCM (Myh6-Mcm) mice for 5 consecutive days. Cardiac function, myocardial histology, and gene expression (RNA-sequencing) were analyzed 2 weeks after TAM injection. A total of 346 protein coding genes (168 up- and 178 down-regulated) were differentially expressed. Transcript levels of 85 genes, analyzed …

Quantification Of Infarct Core Signal Using Ct Imaging In Acute Ischemic Stroke, Uma Maria Lal-Trehan Estrada, Grant Meeks, Sergio Salazar-Marioni, Fabien Scalzo, Mudassir Farooqui, Juan Vivanco-Suarez, Santiago Ortega Gutierrez, Sunil A Sheth, Luca Giancardo

Faculty, Staff and Student Publications

In stroke care, the extent of irreversible brain injury, termed infarct core, plays a key role in determining eligibility for acute treatments, such as intravenous thrombolysis and endovascular reperfusion therapies. Many of the pivotal randomized clinical trials testing those therapies used MRI Diffusion-Weighted Imaging (DWI) or CT Perfusion (CTP) to define infarct core. Unfortunately, these modalities are not available 24/7 outside of large stroke centers. As such, there is a need for accurate infarct core determination using faster and more widely available imaging modalities including Non-Contrast CT (NCCT) and CT Angiography (CTA). Prior studies have suggested that CTA provides improved …

A Right Atrial Mass With Fever And Cutaneous Nodules, Feng Gao, Stephanie Koh, Sara Taveras-Alam, Umair Khalid

Faculty, Staff and Student Publications

Primary cardiac tumors, although exceedingly rare, should be considered in the differential diagnosis during workup of any cardiac mass. Extranodal cardiac lymphomas have a natural aggressive course due to delayed diagnosis. We present a 71-year-old male with a dual-chamber pacemaker who presented with fevers and new cutaneous nodules. He was found to have a right atrial primary anaplastic large-cell lymphoma and had a complete metabolic response after chemotherapy. Our case highlights the importance of a multimodality approach in the diagnosis of cardiac tumors and during follow-up after treatment.

Endothelial Cell-Derived Extracellular Vesicles Impair The Angiogenic Response Of Coronary Artery Endothelial Cells, Nigeste Carter, Allison H. Mathiesen, Noel Miller, Michael Brown, Ruben M.L. Colunga Biancatelli, John D. Catravas, Anca D. Dobrian

Bioelectrics Publications

Cardiovascular disease (CVD) is the most prominent cause of death of adults in the United States with coronary artery disease being the most common type of CVD. Following a myocardial event, the coronary endothelium plays an important role in the recovery of the ischemic myocardium. Specifically, endothelial cells (EC) must be able to elicit a robust angiogenic response necessary for tissue revascularization and repair. However, local or distant cues may prevent effective revascularization. Extracellular vesicles (EV) are produced by all cells and endothelium is a rich source of EVs that have access to the main circulation thereby potentially impacting local …

How To Alleviate Cardiac Injury From Electric Shocks At The Cellular Level, Pamela W. Sowa, Aleksander S. Kiełbik, Andrei G. Pakhomov, Emily Gudvangen, Uma Mangalanathan, Volker Adams, Olga N. Pakhomova

Bioelectrics Publications

Electric shocks, the only effective therapy for ventricular fibrillation, also electroporate cardiac cells and contribute to the high-mortality post-cardiac arrest syndrome. Copolymers such as Poloxamer 188 (P188) are known to preserve the membrane integrity and viability of electroporated cells, but their utility against cardiac injury from cardiopulmonary resuscitation (CPR) remains to be established. We studied the time course of cell killing, mechanisms of cell death, and protection with P188 in AC16 human cardiomyocytes exposed to micro- or nanosecond pulsed electric field (μsPEF and nsPEF) shocks. A 3D printer was customized with an electrode holder to precisely position electrodes orthogonal to …

Surgical Intervention For Phlegmasia Cerulea Dolens In A 61-Year-Old Cancer Patient, Christopher Ruben-Castillo, Cesar Cuen-Ojeda, Gabriel Lopez-Peña, Javier E Anaya-Ayala, Carlos A Hinojosa

The Texas Heart Institute Journal

Phlegmasia cerulea dolens, a rare and potentially fatal complication of acute deep vein thrombosis, is characterized by substantial edema, intense pain, and cyanosis. Phlegmasia cerulea dolens may compromise limb perfusion and lead to acute ischemia, gangrene, amputation, and death. We present the case of a 61-year-old woman with a history of breast cancer who had signs and symptoms of phlegmasia cerulea dolens in her left leg. She was treated promptly with open surgical thrombectomy and sequential distal compression with use of an Esmarch bandage to ensure complete thrombus extraction. These techniques restored venous flow and saved her leg. Open surgical …

Thyroid Steal Syndrome Secondary To Active Hyperthyroid State, Harrison Humphries, Johnathon Chung, Reza Pirzadeh, Wesley Jones, Mohamad Ezzeldin

Gulf Coast Division GME Research Day 2022

No abstract provided.

A Case Of Protein Losing Enteropathy After Fontan Operation, Gina Kim

Capstone Showcase

Protein Losing Enteropathy (PLE) is a condition in which an excessive amount of proteins are lost through the gastrointestinal tract leading to hypoproteinemia and manifesting as edema, ascites, and diarrhea. While in most cases PLE is a treatable disorder with good outcomes, the morbidity and mortality of the disorder is significantly elevated in patients with a history of Fontan surgery–an operation used to palliate patients born with a single ventricle by rerouting venous blood return directly to pulmonary circulation. After failure of first-line therapeutics of diuretics and steroids, this case study explores the successful treatment of a 5-year-old patient with …

Percutaneous Coronary Intervention Using Second Generation Drug-Eluting Stents Vs Coronary Artery Bypass Graft In Left Main Coronary Artery And Multivessel Coronary Artery Disease, Eric Kim

Capstone Showcase

Many of the studies that are used in reference to the clinical decision making between PCI vs CABG use BMS or first-generation DES as a comparison. With the advancement of stent technology, second-generation DES have emerged with improved efficacy and overall outcome rates compared to BMS and first-generation DES. Some of the newer studies such as EXCEL1-2 , demonstrated noninferiority of second-generation DES to CABG but there are limited studies that support this conclusion. Currently, the studies remain divided in the impact of newer-generation PCIs, and 10-year follow up studies may be required to further validate noninferiority before it can …

Improving Utilization Of Palliative Care For Heart Failure Patients, Devin Tilley

Doctor of Nursing Practice Projects

The purpose of this program was to educate providers regarding palliative care for heart failure patients. Palliative care is underutilized in conjunction with usual heart failure management despite proven benefits of decreased symptom burden, reduced hospitalizations, and improved overall quality of life. Provider education has the ability to improve provider knowledge of palliative care for heart failure patients. A brief education session was given to hospital providers in an acute care setting to evaluate the benefits of provider education on palliative care utilization for heart failure patients. Findings included improved provider confidence in referring heart failure patients to palliative care. …

Screening For Mixed-Etiology Pleural Effusion Using Point Of Care Ultrasound, Samuel Eglin, Abby Velarde

View All Washington/Montana GME

Presented at the 2022 Virtual Northwest Medical Research Symposium

Eisenmenger Syndrome As A Long Term Complication Of Tricuspid Atresia, Brady Howard, Md

Poster Presentations

No abstract provided.

Kidney Disease After Heart And Lung Transplantation, Carlos M Zapata, Hassan N Ibrahim

Faculty, Staff and Student Publications

Chronic kidney disease (CKD) is not only common after lung and heart transplantation but also is associated with increased morbidity and mortality due to multiple pre-, peri- and post-transplant factors. While the exact incidence of CKD in this population is not well-defined, it seems to have gradually increased over the years as older recipients are more frequently considered. The increasing success of the procedure and expanding transplant candidate pool has allowed many with comorbid conditions to receive a transplant, which was considered prohibitive in the past. This review presents risk factors that have been linked to CKD as well as …

Changes In Physical Activity And Relationships To Submaximal Exercise Capacity And Cardiac Function During Breast Cancer Therapy, Moriah P. Bellissimo

Theses and Dissertations

Background: Breast cancer (BC) survivors are at high risk for heart failure due to curative cancer therapies. In non-cancer populations, physical activity is a first line treatment for preventing cardiovascular disease. This study examined whether more physical activity was associated with better submaximal exercise capacity and cardiac function during the first three months of cancer therapy.

Methods: Participants included 223 women with stage I-III BC before therapy and after three months of undergoing treatment and 126 controls. Leisure time physical activity was reported using the Godin Sheppard leisure time exercise questionnaire. Cardiac function was assessed by cardiac magnetic resonance, and …

Modeling Of Patient-Specific Periaortic Mechanics And Pulmonary Artery Hemodynamics Based On Phase-Contrast Magnetic Resonance Imaging Sequences., Johane H. Bracamonte

Theses and Dissertations

Inverse modeling in cardiovascular medicine is a collection of methodologies that can provide non-invasive patient-specific estimations of clinical risk factors using medical imaging as inputs. Its incorporation into clinical practice has the potential to improve diagnosis and treatment planning with low associated risks and costs.

Herein, three different phase contrast magnetic resonance imaging (MRI) modalities were implemented as input data, displacement encoding with stimulated echoes (DENSE MRI) applied, and time-resolved velocity encoding phase-contrast MRI, in 1D and 3D, applied to pulmonary artery (PA) hemodynamics.

A model to account for the effect of periaortic interactions due to static and dynamic structures …

Associations Between Vascular Diseases And Alzheimer's Disease Or Related Dementias In A Large Cohort Of Men And Women With Colorectal Cancer, Xianglin L Du, Lulu Song, Paul E Schulz, Hua Xu, Wenyaw Chan

Faculty, Staff and Student Publications

BACKGROUND: Long term risk of Alzheimer's disease (AD) and related dementias (ADRD) associated with vascular diseases in people with colorectal cancer is unknown.

OBJECTIVE: to determine the risk of ADRD in association with cardiovascular diseases (CVD), stroke, hypertension, and diabetes in a cohort of patients with colorectal cancer.

METHODS: This retrospective cohort study consisted of 210,809 patients diagnosed with colorectal cancer at age≥65 years in 1991-2015 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database with follow-up from 1991-2016, who were free of any ADRD at the baseline (< 30 days after the date of cancer diagnosis).

RESULTS: The crude 26-year cumulative incidence of total ADRD in …

Cancer Treatment-Induced Nad+ Depletion In Premature Senescence And Late Cardiovascular Complications, Priyanka Banerjee, Elizabeth A Olmsted-Davis, Anita Deswal, Minh Th Nguyen, Efstratios Koutroumpakis, Nicholas L Palaskas, Steven H Lin, Sivareddy Kotla, Cielito Reyes-Gibby, Sai-Ching J Yeung, Syed Wamique Yusuf, Momoko Yoshimoto, Michihiro Kobayashi, Bing Yu, Keri Schadler, Joerg Herrmann, John P Cooke, Abhishek Jain, Eduardo Chini, Nhat-Tu Le, Jun-Ichi Abe

Faculty, Staff and Student Publications

Numerous studies have revealed the critical role of premature senescence induced by various cancer treatment modalities in the pathogenesis of aging-related diseases. Senescence-associated secretory phenotype (SASP) can be induced by telomere dysfunction. Telomeric DNA damage response induced by some cancer treatments can persist for months, possibly accounting for long-term sequelae of cancer treatments. Telomeric DNA damage-induced mitochondrial dysfunction and increased reactive oxygen species production are hallmarks of premature senescence. Recently, we reported that the nucleus-mitochondria positive feedback loop formed by p90 ribosomal S6 kinase (p90RSK) and phosphorylation of S496 on ERK5 (a unique member of the mitogen-activated protein kinase family …

Serum Gamma Glutamyltransferase (Ggt) In Coronary Artery Disease: Exploring The Asian Indian Connection, Kunal K Singh, Aditya Kapoor, Roopali Khanna, Ankit Sahu, Vishwas Kapoor, Sudeep Kumar, Naveen Garg, Satyendra Tewari, Pravin Goel

Faculty, Staff and Student Publications

BACKGROUND: There is a need to identify novel markers for CAD, independent of traditional CV risk factors. One of these is gamma-glutamyl transferase (GGT), a marker of increased oxidative stress. Given the high prevalence of CAD in Asian Indians, the link of GGT and CAD in them needs to be studied.

AIM: To assess GGT in patients with angiographically documented CAD.

METHODS AND RESULTS: Two hundred patients aged 58.1 ± 9.95 years, 73% males, hypertension 56%, diabetes 40% were included. Mean GGT was 63.6 ± 44.33 (10–269 U/L). The levels of GGT progressively increased in those with single/double or triple-vessel …

Clinicopathological Correlations In Heart Transplantation Recipients Complicated By Death Or Re-Transplantation, Michelle M Mcdonald, Maks Mihalj, Bihong Zhao, Sriram Nathan, Stanislava Matejin, Giulia Ottaviani, Mateja K Jezovnik, Rajko Radovancevic, Biswajit Kar, Igor D Gregoric, L Maximilian Buja

Faculty, Staff and Student Publications

PURPOSE: This study aimed to identify and correlate pathological findings with clinical outcomes in patients after orthotopic heart transplantation (OHT) who either died or underwent a re-transplantation.

METHODOLOGY AND STUDY DESIGN: Single-center retrospective analysis of primary OHT patients who died or were re-transplanted between October 2012 and July 2021. Clinical data were matched with corresponding pathological findings from endomyocardial biopsies on antibody-mediated rejection, cellular rejection, and cardiac allograft vasculopathy. Re-assessment of available tissue samples was performed to investigate acute myocardial injury (AMI) as a distinct phenomenon. These were correlated with clinical outcomes, which included severe primary graft dysfunction. Patients were …

Evaluation Of Contemporary Echocardiographic And Histomorphology Parameters In Predicting Mortality In Patients With Endomyocardial Biopsy-Proven Cardiac Al Amyloidosis, Efstratios Koutroumpakis, Adam Niku, Christopher K Black, Abdelrahman Ali, Humaira Sadaf, Juhee Song, Nicolas Palaskas, Cezar Iliescu, Jean-Bernard Durand, Syed Wamique Yusuf, Hans C Lee, L Maximilian Buja, Anita Deswal, Jose Banchs

Faculty, Staff and Student Publications

INTRODUCTION: This study examined the role of echocardiographic and cardiac histomorphology parameters in predicting mortality in patients with cardiac AL amyloidosis.

METHODS: Patients with endomyocardial biopsy-proven cardiac AL amyloidosis treated at MD Anderson Cancer Center between 6/2011 and 6/2020 were identified. Stored echocardiographic images and endomyocardial biopsy samples were processed for myocardial strain analysis and a detailed histomorphology characterization.

RESULTS: Of 43 patients; 44% were women and 63% white. Median age was 65 years; 51% underwent stem cell transplantation (SCT). Thirty patients (70%) died during follow up (median follow up: 4.1 years). Lower LA strain (

CONCLUSION: Lower LA strain …

Myeloid Hypoxia-Inducible Factor Hif1a Provides Cardio-Protection During Ischemia And Reperfusion, Ka Lin Heck-Swain, Jiwen Li, Wei Ruan, Xiaoyi Yuan, Yanyu Wang, Michael Koeppen, Holger K Eltzschig

Faculty, Staff and Student Publications

The transcription factor hypoxia-inducible factor HIF1A induces cardioprotection from ischemia and reperfusion injury. Here, we investigate tissue-specific pathways that are critical for HIF1A-elicited tissue protection. Initial studies showed that mice with induced global Hif1a deletion (Hif1aloxP/loxP UbiquitinCre+) have exaggerated myocardial injury during in situ ischemia and reperfusion. Surprisingly, this phenotype was mirrored only in mice with myeloid-specific Hif1a deletion (Hif1aloxP/loxP LysM Cre+). In contrast, mice with myocardial specific (Hif1aloxP/loxP Myosin Cre+), or vascular Hif1a deletion (Hif1aloxP/loxP VEcadherin Cre+) experienced similar levels of injury as controls. Subsequent studies using adoptive transfer of Hif1a-deficient polymorphonuclear neutrophils (PMNs) …

Impact On Clinical Outcomes From Transcatheter Closure Of The Fontan Fenestration: A Systematic Review And Meta-Analysis, Christopher E Greenleaf, Zhia Ning Lim, Wen Li, Damien J Lapar, Jorge D Salazar, Antonio F Corno

Faculty, Staff and Student Publications

BACKGROUND: Meta-analysis of the impact on clinical outcome from transcatheter closure of Fontan fenestration.

METHODS: Cochrane, Embase, MEDLINE, and Open-Gray were searched. Parameters such as changes in oxygen saturation, cavo-pulmonary pressure, maximum heart rate during exercise, exercise duration, and oxygen saturation after fenestration closure were pooled and statistical analysis performed.

RESULTS: Among 922 publications, 12 retrospective observational studies were included. The included studies involved 610 patients, of which 552 patients (90.5%) had a fenestration. Of those patients, 505 patients (91.5%) underwent attempt at trans-catheter closure. When it could be estimated, the pooled overall mean age at trans-catheter fenestration closure was …

Characteristics, Outcomes, And Predictors Of De Novo Malignancy After Heart Transplantation, Jong-Chan Youn, Darae Kim, In-Cheol Kim, Hye Sun Lee, Jin-Oh Choi, Eun-Seok Jeon, Keith Nishihara, Evan P Kransdorf, David H Chang, Michelle M Kittleson, Jignesh K Patel, Danny Ramzy, Fardad Esmailian, Jon A Kobashigawa

Faculty, Staff and Student Publications

BACKGROUND: Post-transplant malignancy (PTM) causes long-term morbidity and mortality in heart transplant (HTx) recipients. However, the detailed characteristics or predictors of PTM are not well-known. We evaluated the incidence, characteristics, long-term outcomes, and predictors of

METHODS: We retrospectively analyzed the types and characteristics of

RESULTS: Two hundred and six patients (20.8%) had

CONCLUSION: Older age, white race, and longer administration of immunosuppressive therapies were independent risk factors for PTM, which was associated with increased mortality. Further research is necessary for the prevention and early detection of PTM in HTx recipients.

Endovascular Treatment And Outcomes For Femoropopliteal In-Stent Restenosis: Insights From The Xlpad Registry, Michael H Vu, Glaiza-Mae Sande-Docor, Yulun Liu, Shirling Tsai, Mitul Patel, Chris Metzger, Mehdi H Shishehbor, Emmanouil S Brilakis, Nicolas W Shammas, Peter Monteleone, Subhash Banerjee

Faculty, Staff and Student Publications

BACKGROUND: There is limited "real-world" evidence examining treatment modalities and outcomes in patients with symptomatic peripheral arterial disease undergoing endovascular treatment of femoropopliteal (FP) in-stent restenosis (ISR).

MATERIALS AND METHODS: We compared outcomes in 2,895 patients from the XLPAD registry (NCT01904851) between 2006 and 2019 treated for FP ISR (

RESULTS: ISR patients were more frequently on antiplatelet (94.5% vs 89.4%,

CONCLUSION: Atherectomy and DCB are more frequently used to treat FP ISR lesions. Patients with FP ISR have more intraprocedural distal embolization, higher repeat revascularization procedures, and lower freedom from MALE at 1 year.

Trigger Related Outcomes Of Takotsubo Syndrome In A Cancer Population, Ayesha Safdar, Talha Ahmed, Victor Y Liu, Antoine Addoumieh, Ali M Agha, Dana E Giza, Dinu V Balanescu, Teodora Donisan, Tariq Dayah, Juan C Lopez-Mattei, Peter Y Kim, Saamir Hassan, Kaveh Karimzad, Nicolas Palaskas, January Y Tsai, Gloria D Iliescu, Eric H Yang, Joerg Herrmann, Konstantinos Marmagkiolis, Paolo Angelini, Cezar A Iliescu

Faculty, Staff and Student Publications

BACKGROUND: Takotsubo syndrome (TTS) occurs more frequently in cancer patients than in the general population, but the effect of specific TTS triggers on outcomes in cancer patients is not well studied.

OBJECTIVES: The study sought to determine whether triggering event (chemotherapy, immune-modulators vs. procedural or emotional stress) modifies outcomes in a cancer patient population with TTS.

METHODS: All cancer patients presenting with acute coronary syndrome (ACS) between December 2008 and December 2020 at our institution were enrolled in the catheterization laboratory registry. Demographic and clinical data of the identified patients with TTS were retrospective collected and further classified according to …

Immune Response To Sars-Cov-2 Vaccine Among Heart Transplant Recipients: A Systematic Review, Saeed Shoar, Adriana C Carolina Prada-Ruiz, Gabriel Patarroyo-Aponte, Ashok Chaudhary, Mohammad Sadegh Asadi

Faculty, Staff and Student Publications

BACKGROUND: Heart transplant (HTX) recipients are at a significantly higher risk of adverse clinical outcomes, due to chronic immunosuppression and co-existence of other chronic conditions, when contracting the SARS-CoV-2 infection. Although vaccination against SARS-CoV-2 is currently the most promising measure for the prevention of severe Coronavirus Disease 2019 (COVID-19) among solid organ transplant recipients, the extent of immune response and its protective efficacy among patients receiving HTX has not been sufficiently studied.

METHODS: We performed a systematic review of the literature by inquiring PubMed/Medline to identify original studies among HTX recipients, who had received at least one dose of the …

Safety Of Exercise For Adults With Thoracic Aortic Aneurysms And Dissections, Jesse Li, Alexandra Boyd, Michael Huang, Joshua Berookhim, Siddharth K Prakash

Faculty, Staff and Student Publications

BACKGROUND: Current guidelines for patients with thoracic aortic aneurysms or dissections (TAD) restrict vigorous exertion with the intention to prevent acute aortic dissections. However, a safe threshold for exercise intensity has not been established for TAD patients. In this study, we measured exertional changes in systolic and diastolic blood pressure during isometric and dynamic exercises in a cohort of TAD patients to determine safety of moderate intensity exercise.

METHODS: Thirty-one adults with TAD and 14 controls were recruited from UTHealth outpatient clinics. All participants completed an exercise protocol consisting of two circuits of five moderate intensity exercises: hand grips, leg …