Cardiology Commons^™

No Patient Left Behind: Improving Transition Of Care In Coronary Artery Disease And Heart Failure Patients, Rebecca Schuyler, Gunjan Mundhra, Mubbasher Syed

South Atlantic Division GME Research Day 2025

No abstract provided.

Pregnant Adults' Interest In Physical And Mental Health Behavior Change Interventions Using Mobile Technology, Natalie M. Yarish, Cassidy M. Sandoval, Alicia Moulder, Meredith I. Turner, Danielle Symons Downs, Kristin E. Heron

Psychology Faculty Publications

Improving the health and well-being of pregnant adults is an important public health priority in the USA, and mobile health (mHealth) interventions may provide a scalable strategy to disseminate behavior change programs to pregnant adults. This study assessed pregnant people’s use of mobile technology, interest in making health behavior changes during and after pregnancy, and their willingness to use mHealth interventions. Participants were 133 pregnant adults (M_age = 27.86; 81% White) living across the USA recruited from social media to complete an online survey. Measures assessed mobile technology use and beliefs about improving mental/physical health in pregnancy and postpartum …

Design Of A Post-Market Registry For The Extravascular Implantable Cardioverter-Defibrillator: The Enlighten Study., Lucas V A Boersma, Anish Amin, Nicolas Clémenty, David Duncker, Gregory Engel, Laurence Epstein, Vikas Kuriachan, Camille Frazier-Mills, Marianne Gwechenberger, Nobuhiro Nishii, Jeff Lande, Christopher Wiggenhorn, Ian Crozier

Heart and Vascular Articles

BACKGROUND: The extravascular implantable cardioverter-defibrillator (EV-ICD) with substernal lead placement has been shown to terminate ventricular arrhythmias safely and effectively while being outside the vasculature. The performance of the EV-ICD system with a novel inappropriate shock-reducing algorithm in a real-world setting has yet to be investigated.

OBJECTIVE: The objective of the Enlighten Study: the EV-ICD Post-Approval Registry is to provide a comprehensive measure of the safety and performance of the EV-ICD system in real-world clinical practice over the lifetime of the device.

METHODS: The Enlighten Study is a global, prospective, observational, multicenter, post-approval study utilizing the manufacturer's Product Surveillance Registry. …

Body Composition In Patients With Obesity-Related Heart Failure With Preserved Ejection Fraction: A Comparison Study, Hannah Salmons, Syed Imran Ahmed, Hayley E. Billingsley, Alex Reavey-Cantwell, Roshanak Markley, Michele Golino, Marco Giuseppe Del Buono, Juan Ignacio Damonte, Sebastian Pinel, R. Lee Franco, Antonio Abbate, Carrie P. Earthman, Salvatore Carbone

EVMS School of Health Professions Faculty Publications

Background

Appendicular lean mass index is a major determinant of cardiorespiratory fitness in patients with obesity-related heart failure with preserved ejection fraction (HFpEF). Moreover, appendicular lean mass index can be used to diagnose sarcopenia and sarcopenic obesity in this population. We aimed to validate the ability of segmental single-frequency bioelectrical impedance analysis (SF-BIA) to assess body composition compared with dual-energy x-ray absorptiometry (DXA) in patients with HFpEF and obesity, with a focus on appendicular lean mass index for its critical role in diagnosing sarcopenia and sarcopenic obesity.

Methods

We analyzed 62 euvolemic patients from a heart failure outpatient clinic with …

The Short And Sweet On Sodium-Glucose Cotransporter Inhibitors And Glucagon-Like Peptide-1 Receptor Agonists In Heart Failure, Jose L. Batista, Tracy Makuvire, Jonathan D. Davis, Salvatore Carbone

EVMS School of Health Professions Faculty Publications

Heart failure (HF) affects 6 million people in the US, and type 2 diabetes (T2D) is a significant risk factor for HF. Since 2008, regulatory agencies have required cardiovascular safety trials for new T2D therapies, and these have consistently demonstrated the cardiovascular benefits of glucose-lowering drugs. Sodium-glucose cotransporter inhibitors (SGLTi) and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs)/glucose-dependent insulinotropic polypeptide (GIP) reduce major adverse cardiovascular events and deaths, regardless of diabetes status, and improve cardiorespiratory fitness. SGLTis, such as dapagliflozin and empagliflozin, benefit patients with reduced and preserved ejection fraction, significantly reducing HF hospitalizations and cardiovascular deaths. The DAPA-HF and EMPEROR-Reduced …

Loneliness Associates With Endothelial Dysfunction In A Community-Based Cohort: A Pilot Study And Translational Approach, Yvonne Baumer, Brian A. Tirado, Lola R. Ortiz-Whittingham, Andrew S. Baez, Cristhian A. Gutierrez-Huerta, Laurel G. Mendelsohn, Abhinav Saurabh, Joshua A. Jacobs, Marcus R. Andrews, Valerie M. Mitchell, Billy S. Collins, Antwan Jones, Danielle M. Schwartz, Anca D. Dobrian, Michael V. Stanton, Tiffany M. Powell-Wiley

Department of Biomedical and Translational Sciences Faculty Publications

Loneliness is known to be an important contributor to cardiovascular disease (CVD). However, little is known about the impact of loneliness on endothelial barrier integrity, a crucial hallmark of CVD development and progression. In this study, we aimed to investigate how loneliness might impact the endothelium. We found greater perceived loneliness associated with the product of circulating epinephrine and TNFα (E/T), which, in turn, associated with lower VE-cadherin on endothelial cells in an ex vivo experiment. Additionally, circulating plasma levels of soluble VE-cadherin were associated significantly with subclinical CVD. To explore the mechanistic aspects of these associations, we measured the …

Delayed Hypertension Diagnosis And Its Association With Cardiovascular Treatment And Outcomes, Yuan Lu, John E. Brush Jr, Chungsoo Kim, Yuntian Liu, Xin Xin, Chenxi Huang, Mitsuaki Sawano, Patrick Young, Jacob Mcpadden, Mark Anderson, John S. Burrows, Jordan R. Asher, Harlan M. Krumholz

Department of Medicine Faculty Publications

Importance Hypertension is a major risk factor for cardiovascular disease, yet delays in diagnosis may limit timely treatment initiation and increase cardiovascular risk.

Objectives To examine the timing of clinical hypertension diagnosis, its association with antihypertensive medication prescribing, and its association with long-term cardiovascular outcomes.

Design, Setting, and Participants This retrospective cohort study analyzed electronic health record (EHR) data from an integrated health care system. Adults aged 18 to 85 years with at least 2 outpatient blood pressure (BP) readings of 140/90 mm Hg or more recorded at least 30 days apart from January 1, 2010, to December 31, 2021, …

Role Of Device Therapy In Complementing Contemporary Medical Management, Yoel Benarroch, Natalie Tapaskar, Amin Yehya

Department of Medicine Faculty Publications

Heart failure (HF) is a clinical syndrome characterized by signs and symptoms resulting from any structural or functional deficiency of ventricular filling or blood ejection. The mainstay of initial treatment remains lifestyle modifications, guideline-directed medical therapy, and addressing contributing factors. However, the past two decades have come with significant advances in device therapies to improve morbidity and mortality in HF despite evidence-based management as above. Given the rapidly evolving area of HF research and therapeutic development, it is important for clinicians to be familiar with novel therapies and how they can complement medical management. In this review we discuss the …

Cardiomyopathies Of Endocrine Origin: A State-Of-The-Art Review, Jenyfer M. Fuentes-Mendoza, Marcio J. Concepción-Zavaleta, Juan C. Morón-Siguas, Juan M. Muñoz-Moreno, Aranza I. Pérez-Reyes, Rodrigo Martinez-Galaviz, Raúl D. Aguilar-Castañeda, Oziel González-Godoy, Luis A. Concepción-Urteaga, José Paz-Ibarra

Department of Medicine Faculty Publications

Endocrine disorders are increasingly recognized as potentially reversible causes of secondary cardiomyopathies, yet they often remain underdiagnosed in clinical practice. These conditions-including thyroid dysfunction, acromegaly, pheochromocytoma, diabetes mellitus, adrenal disorders, among others-can significantly alter cardiac structure and function through hormonal excess, metabolic remodeling, and neurohumoral activation. Hyperthyroidism may lead to high-output heart failure (HF) and atrial fibrillation, while hypothyroidism is associated with diastolic dysfunction, pericardial effusion, and accelerated atherosclerosis. Acromegaly promotes biventricular hypertrophy and myocardial fibrosis via insulin-like growth factor 1 overproduction. Pheochromocytoma triggers catecholamine-induced cardiomyopathy, resembling Takotsubo syndrome and carrying a high risk of mortality if left untreated. Diabetes …

Early Palliative Care In Heart Failure, Meadow Stempek, Beverly Balfe, Jennifer Tantarelli

Articles, Abstracts, and Reports

No abstract provided.

Emcreg-International Multidisciplinary Consensus Panel On Management Of Hyperkalemia In Chronic Kidney Disease And Heart Failure, Natalie Kreitzer, Nancy M. Albert, Alpesh N. Amin, Craig J. Beavers, Richard C. Becker, Gregg Fonarow, W. Brian Gibler, Katherine W. Kwon, Robert J. Mentz, Biff F. Palmer, Charles V. Pollack, Iliana L. Piña

Division of Cardiology Faculty Papers

BACKGROUND: Hyperkalemia, generally defined as serum potassium levels greater than 5.0 mEq/L, poses significant clinical risks, including cardiac toxicity and muscle weakness. Its prevalence and severity increase in patients with chronic kidney disease (CKD), diabetes mellitus, and heart failure (HF), particularly when compounded by medications like angiotensin converting inhibitors, angiotensin receptor blockers, and potassium sparing diuretics. Hyperkalemia arises from disruptions in potassium regulation involving intake, excretion, and intracellular-extracellular distribution. In CKD and acute kidney injury, these regulatory mechanisms are impaired, leading to heightened risk. The management of chronic hyperkalemia presents a challenge due to the necessity of balancing effective cardiovascular …

Long-Term Health-Related Quality Of Life In Kawasaki Disease-Related Coronary Artery Aneurysm: A Large Single-Center Assessment In Nanjing, China, Yun Zhou, Mei Chen, Wenting Gao, Yu Chen, Ying Meng

The Texas Heart Institute Journal

BACKGROUND: The impact of coronary artery aneurysms (CAAs) caused by Kawasaki disease (KD) on long-term health-related quality of life (HRQOL) in children has not been well documented.

METHODS: This study investigated long-term HRQOL in a large sample of children diagnosed with KD-related CAAs. A case-control, retrospective study included 66 patients with KD-related CAAs. A total of 98 hospitalized patients were matched as controls based on age and sex: 49 patients were allocated to a group with pneumonia and 49 patients were allocated to a group with arterio-arterial fistula. Both child-reported and parent-proxy-reported Pediatric Quality of Life Inventory surveys were collected. …

The Mental Health Of Cardiology Fellows In Training, Juan Simon Rico-Mesa, Suman M Atluri, Maria Antonia Rico-Mesa

The Texas Heart Institute Journal

No abstract provided.

Effective Thrombectomy For Biventricular Thrombosis With An Endoscope Via The Aortic And Tricuspid Heart Valves, Yuki Endo, Yoshiei Shimamura, Chizuo Kikuchi, Hiroshi Niinami

The Texas Heart Institute Journal

The simultaneous formation of thrombi in the left and right ventricles is extremely rare, and this condition's clinical characteristics and prognosis remain unknown. Therefore, treatment methods are still controversial. This case highlights the potential for endoscopic thrombectomy as a viable option for the treatment of giant floating biventricular thrombi in a patient with restricted cardiac function. This approach via the aortic and tricuspid heart valves allowed for effective and complete removal of the thrombi, thereby preventing further embolic complications.

Navigating The Complexities Of Mitral Valve Clipping: Early Severe Mitral Valve Stenosis After Mitral Valve Clipping, Wassim Abouzeid, Ahmad Haddad, Chrystina Kiwan, Ahsan Khan, Addi Suleiman

The Texas Heart Institute Journal

This case study explores the journey of an 80-year-old male patient with a history of hypertension, diabetes, coronary artery disease after coronary artery bypass grafting, atrial fibrillation, and heart failure. Nine months before he presented to the emergency department, he had undergone mitral valve clipping for severe mitral valve regurgitation. Despite initial improvement, the patient experienced return of symptoms, including dyspnea at rest and lower limb edema. The results of this case-discovery of the need for mitral valve replacement-provides insights into the management of complications from mitral valve clipping and emphasizes that management requires a nuanced, meticulous approach.

Epicardial Cryoablation During Cardiopulmonary Bypass In A Pig Survival Model, Federica Serra, Jonathan M. Philpott, Anna Bulysheva, Christian W. Zemlin

Electrical & Computer Engineering Faculty Publications

Objective

Atrial cryolesions are usually created from the endocardium with the heart arrested. Some cardiac surgeons have used cryoablation epicardially during cardiopulmonary bypass, which is convenient because it does not require an incision into the atrial wall. Here, we analyzed the transmurality of epicardial cryoablations created during cardiopulmonary bypass in an arrested heart 30 days after ablation.

Methods

In Yucatan minipigs (n=5), hearts were exposed via sternotomy. Both caval veins were cannulated to collect blood for the cardiopulmonary bypass. Cryolesions were created applying a cryoprobe for 4 minutes per lesion. Hearts were harvested 30 days after the surgery. The transmurality …

Identification Of Fiducial Points In Seismocardiographic Cycles Using Manual And Automated Annotation Methods, Jasmine-Vy T. Truong

Honors Undergraduate Theses

There is currently a need for complementary methods for non-invasive cardiac monitoring. Seismocardiography (SCG), the measurement of cardiac-induced vibrations at the chest surface, has shown potential clinical utility. Improving the reliability of detecting fiducial points of electrocardiography (ECG) and SCG, which collectively capture the electro-mechanical cardiac activities, could expand ECG/SCG utility as a low-cost, accessible tool for clinical assessment. This study identifies commonly accepted criteria for fiducial point detection in SCG and ECG through an extensive literature review and signal processing techniques. The previous criteria were evaluated to identify their strengths and weaknesses. Based on the findings, an improved set …

Case Report: Prominent Coronary Artery Flow In Fetuses With Congenital Heart Disease, Is It A Marker Of In Utero Distress?, Mohamed Aashiq Abdul Ghayum, Maria Kiaffas, Ashley Warta, Melanie Kathol, David Christopher Mundy, Kelsey Brattrud, Nitin Madan

Manuscripts, Articles, Book Chapters and Other Papers

Prominent coronary artery (CA) flow observed on a fetal echocardiogram has been associated with fetal growth restriction and myocardial dysfunction. We present two cases with this finding, in the presence of congenital heart disease (CHD) and absence of growth restriction or myocardial dysfunction. Both the cases rapidly progressed to extremis, necessitating emergent delivery. Our cases highlight the importance of recognizing prominent CA flow in fetuses with CHD as a potential marker for in utero distress.

Micra Leadless Pacemaker Implantation Via Transjugular Approach, Yuen-Fung Yiu, Ngai-Yin Chan

Journal of the Hong Kong College of Cardiology

Leadless pacemaker implantation offers a safe and effective option for patients with limited venous access or high bleeding risk. The procedure usually necessitates insertion of a large-bore sheath over the femoral vein. We report a case of successful Micra^TM implantation via transjugular approach in a patient with inferior vena cava obstruction.

Atrial Fibrillation Burden And Clinical Outcomes In Dual-Chamber Pacemaker Recipients, Ka Ho Oscar Chiu, Shou Yan Kam, Ka Chun Kevin Lee, To Shing Wong, Jacky Kit Chan, Yuk-Kong Lau, Kwok-Lun Lee, Wai-Ling Jessica Poon

Journal of the Hong Kong College of Cardiology

Background

Pacemaker-detected atrial fibrillation (PDAF) and its burden are associated with adverse clinical outcomes, but consensus is lacking on its definition and local clinical outcomes are unclear. We evaluated PDAF, its burden and relationship with major adverse cardiovascular and cerebrovascular events (MACCE).

Methods

This retrospective study recruited adult patients receiving dual-chamber pacemakers from 2014 to 2022. The presence of PDAF of 5 minutes, PDAF burden (defined by the longest episode) and time to new-onset PDAF were measured and analysed. High PDAF burden was defined as PDAF lasting 24 hours.

Results

A total of 275 patients were analysed and followed for …

Will Conduction System Pacing Replace Biventricular Pacing For Treating Heart Failure In Patients With Wide Qrs Duration?, Chan Yat Sun Joseph

Journal of the Hong Kong College of Cardiology

Conduction system pacing CSP) is an emerging therapy for resynchronization of patients with heart failure and wide QRS duration. It has been proposed to replace cardiac resynchronization therapy with biventricular pacing (CRT with BVP) mainly because of shortcoming of CRT with BVP including failure to implant coronary sinus leads and unsatisfactory response in certain subset of heart failure patients. The current evidence for CSP in heart failure patients with wide QRS duration is reviewed and the gap in evidence in supporting CSP to replace CRT with BVP is discussed.

Comparison Of Clinical Outcomes Between Provisional Stenting And Two-Stent Approach For True Left Main Bifurcation Lesions In The Era Of Imaging Guided Percutaneous Coronary Intervention, Ming Leo Lau, Ho Fai Daniel Fong, Nim Pong Kwong

Journal of the Hong Kong College of Cardiology

Background

Currently there are two strategies in Percutaneous Coronary Intervention (PCI) of the true left main (LM) bifurcation lesions: provisional stenting and two-stent technique. The optimal treatment strategy for true LM bifurcation lesions is undetermined. In addition, the percentage of use of imaging-guiding in these studies was low. We would like to undertake a retrospective cohort study to compare the clinical outcomes of provisional stenting versus two-stent technique in treating the true LM bifurcation lesions with the help of intravascular imaging.

Methods

Data of consecutive patients undergoing PCI of true LM bifurcation lesions in Yan Chai Hospital from January, 2018 …

Challenges Faced In Managing The Hemodynamic Status Due To Recurrent Gastrointestinal Bleeding In Typhoid Fever With Uncorrected Double Outlet Right Ventricle Patient: A Case Report, Kellyn Trycia Zenjaya, Lindawati Wijoyo, Jovan Amadeo Muliyanto, Rizqi Rokhmadhoni Pikir, Dwi Putri Lestari, Esthy Poespitaningtyas

Journal of the Hong Kong College of Cardiology

Double Outlet Right Ventricle (DORV) is a rare cyanotic congenital heart defect often associated with polycythemia and bleeding risk. A 7-year-old boy with uncorrected DORV presented with fever, melena, and shock. He was cyanotic, tachypneic, and tachycardic, with SpO₂ of 68% and a harsh ejection systolic murmur. Labs showed anemia, thrombocytopenia, leukocytosis, and prolonged APTT. Tubex TF IgM was strongly positive. A diagnosis of typhoid fever with gastrointestinal bleeding and uncorrected DORV was made. Management included oxygen, inotropes, and fluid resuscitation. Propranolol was withheld. Severe infection with underlying cyanotic heart disease and coagulopathy presents a critical management dilemma.

Characteristics And Clinical Outcomes Of Young Patients With St-Segment Elevation Myocardial Infarction A Retrospective Study, Cheung Pak Nung Rocco, Chi Yan Raymond Fung

Journal of the Hong Kong College of Cardiology

Background ST-segment elevation myocardial infarction (STEMI) carries high mortality and poor outcomes without timely treatment. Its occurrence in young patients is especially concerning due to social impact. Objectives This study examined the characteristics and outcomes of young STEMI patients in Hong Kong to identify areas for public health improvement. Methods We retrospectively reviewed STEMI patients admitted to Princess Margaret Hospital from January 2019 to January 2023 who underwent coronary angiography and reperfusion therapy. Patients were grouped as young (years) or older (≥50 years). Results Out of 818 patients treated with PCI, 102 (12.5%) were under 50 years old. Compared to …

An Unusual Cause Of Acute Constrictive Pericarditis, Yue Hin Tang, Raymond Chi Yan Fung

Journal of the Hong Kong College of Cardiology

Constrictive pericarditis, a condition where the pericardium thickens and constricts, has long been considered as a chronic sequela of prior insults to the pericardium such as heart surgery, repeated pericarditis, tuberculosis infection, radiation exposure, etc. Susceptible populations are thus expected to be middle-aged.

We present a case in which a young gentleman was diagnosed with acute constrictive pericarditis due to Adult-onset Still’s disease with macrophage activation syndrome. This case illustrated that constrictive pericarditis could happen in acute settings and thus the importance of cardiologists to maintain open-minded in search of a diagnosis

Bridging Awareness, Risk, And Innovation In Peripheral Arterial Disease, Guang-Ming Tan, Bryan P. Yan

Journal of the Hong Kong College of Cardiology

No abstract for this article type.

Machine Learning-Based Risk Stratification For Limb-Related Outcomes In Peripheral Artery Disease Patients Undergoing Percutaneous Transluminal Angioplasty, Yujia Zhang, Zhoudong Jing, Zhiqiang Liu, Angel Lai, Guangming Tan, Bryan P Yan

Journal of the Hong Kong College of Cardiology

Background: Patients with peripheral artery disease (PAD) remain at high risk of mortality and major adverse limb events (MALE) after endovascular revascularization, yet outcome prediction tools are limited. We apply machine learning (ML) to improve prognostic stratification in this population. Methods: PAD patients undergoing percutaneous transluminal angioplasty (PTA) between 2007 and 2024 were included. The primary endpoint was 1-year major adverse limb events (MALE) or all-cause death. Data were divided into training (70%) and testing (30%) sets. Six ML models were developed, and performance was evaluated using the area under the receiver operating characteristic curve (AUC). Feature importance and risk …

A Cross-Sectional Survey And Latent Class Analysis Of Knowledge On Peripheral Arterial Disease In Hong Kong, Angel Lai, Guang-Ming Tan, Bryan P. Yan

Journal of the Hong Kong College of Cardiology

BACKGROUND: Peripheral arterial disease (PAD) is prevalent and associated with significant cardiovascular (CV) mortality. However, it remains under-recognized, particularly in Asian countries. This study aims to assess awareness of PAD, its risk factors, and perceived consequences in relation to other CV diseases to inform strategies for improving clinical care.

METHODS: A total of 1,008 adults attending outpatient clinics at a university-affiliated tertiary hospital were recruited between January-August 2020 for a phone questionnaire. Differences between awareness groups were analysed by Pearson’s Chi-square test, predictors of PAD awareness were determined using multivariate logistic regression, and latent class analysis (LCA) was performed to …

Iatrogenic Femoral Arteriovenous Fistula After Leadless Pacemaker Implantation Treated With Balloon-Expandable Stent: A Report Of Three Cases, Cheuk Yin Lai, Timothy Ho Him, Mark Tk Tam, Guang-Ming Tan, Bryan P Yan

Journal of the Hong Kong College of Cardiology

Endovascular covered stenting is a minimally invasive option for treating iatrogenic femoral access site complications, including arteriovenous femoral fistula (AVF). Reports on AVF repair mainly concern small bore devices, but large bore devices such as leadless pacemakers post unique challenges. We present 3 cases of iatrogenic femoral AVF after large-bore, 27Fr access sheath insertion for leadless pacemaker implantation. Both underwent endovascular balloon-expandable covered stenting, with resolution of AVF and durable long-term results. As patients referred for leadless pacemaker implantations are often frail with co-morbidities, endovascular stenting is an appealing alternative to open surgical repair for AVF.

Shaping The Future Of "Cardio-Kidney-Metabolic" Health: Insights From The Texas Heart Institute's 2024 Cardiometabolic Syndrome Conference, Arjun Raghuram, Keri Sprung, Stephanie Coulter, Joseph G Rogers

The Texas Heart Institute Journal

At the Texas Heart Institute's 2024 Cardiometabolic Syndrome Conference, held on August 23, 2024, experts from diverse academic fields spoke about novel initiatives for addressing the worsening projections for cardiometabolic syndrome. Four major areas in which innovation is ongoing were highlighted: technology, policy, population health, and lifestyle and behavioral modification. This article presents a brief contextualization, summary, and analysis of the novel initiatives being implemented in each of these 4 areas to address cardiometabolic syndrome. Despite alarming projections, cardiometabolic syndrome presents a unique opportunity for innovators to drive change through collaborative, multidisciplinary efforts.