Cardiology Commons^™

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.

Lyme Carditis And Inflammation-Driven Plaque Erosion Presenting As Sudden Cardiac Arrest, Marco Kaldas, Moneal Shah, Diana Pashaieva, Georgios Lygouris, Anita Radhakrishnan

The Texas Heart Institute Journal

Lyme carditis represents a rare cardiac complication of Borrelia burgdorferi infection, often causing conduction disturbances but rarely causing malignant arrhythmias. Inflammatory acute coronary syndrome, driven by immune-mediated plaque erosion rather than rupture, represents a nontraditional ischemic mechanism. This case highlights their overlap. The case of a previously healthy man with Lyme disease who experienced cardiac arrest because of ventricular tachycardia is reported. Imaging showed myocardial inflammation together with coronary plaque erosion instead of plaque rupture. The patient underwent advanced diagnostic testing and received multidisciplinary medical care, which led to complete cardiac recovery and implantable cardioverter-defibrillator placement.

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.

Double Atrial Septum With Interatrial Space In Patients Experiencing Ischemic Attack, Blerim Berisha, Fadhel Hamidani, Mathias Humm

The Texas Heart Institute Journal

No abstract provided.

Sequelae And Surgical Management Of Giant Cardiac Myxoma, Norvin Hernandez, Michael Dileo, Christopher K Wong, Mahboob Alam

The Texas Heart Institute Journal

Cardiac myxomas are a rare phenomenon within the general population, and although there are reports of them, giant myxomas are not common in the medical literature. This report presents a case of a giant left atrial cardiac myxoma in a 57-year-old female patient who was largely asymptomatic until she presented with a diffuse thromboembolic stroke. This case report highlights the importance of surgical management of cardiac myxomas and discusses the difference in open vs minimally invasive surgical resection of giant cardiac myxomas.

Hubungan Abnormalitas Ekokardiografi Terhadap Mortalitas Pasien Terkonfirmasi Covid-19 Derajat Berat Dan Kritis Di Rsupn Dr. Cipto Mangunkusumo, Fidiaji Hiltono Santoso, Idrus Alwi, Sally A. Nasution, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Introduction. The mortality rate of COVID-19 patients in Indonesia is high with manifestations of cardiac complications. Echocardiographic evaluation can help identify cardiac functional and structural disorders associated with patient mortality. Therefore, this study aims to determine the relationship between echocardiographic abnormalities and mortality in severe and critical COVID-19 patients.

Methods. A retrospective cohort study was conducted using medical record data of severe and critical COVID-19 patients at Dr. Cipto Mangunkusumo Hospital Jakarta during March 2020 to April 2021. Subjects were selected using total sampling. Descriptive analysis was performed, presenting descriptive tables, and bivariate analysis was conducted using the …

Iatrogenic Ventricular Septal Defect After Transcatheter Aortic Valve Implantation: A Rare Complication, Muhammad Sabri, Hussam Al Hennawi, Shayan Qadir, Lucy Checchio, Chaitra Janga, Hamza Muhammadzai, Donald C. Haas

Abington Jefferson Health Papers

Iatrogenic ventricular septal defect (VSD) is a rare complication following transcatheter aortic valve implantation (TAVI). An 83-year-old male underwent TAVI for severe aortic stenosis (AS) and was diagnosed with a peri-membranous VSD on echocardiography, which was not evident on pre-procedural imaging. This case highlights the risk factors, symptoms, diagnosis, and management of iatrogenic VSD following TAVI.

Implications Of Myocardial Strain In Primary Mitral Regurgitation-A Cardiovascular Magnetic Resonance Study, Simone Romano, Danai Kitkungvan, Duc T Nguyen, Carlos El-Tallawi, Edward A Graviss, Afshin Farzaneh-Far, Dipan J Shah

Faculty, Staff and Student Publications

Aims: Chronic primary mitral regurgitation (MR) results in progressive left ventricular (LV) remodelling. Abnormal myocardial deformation (strain) can be present despite preserved ejection fraction (EF). Cardiovascular magnetic resonance (CMR) feature-tracking techniques allow assessment of global longitudinal strain (GLS) from routine cine images. The aim of this study is to evaluate the prognostic value of CMR feature tracking-derived GLS in patients with primary MR.

Methods and results: Consecutive patients undergoing CMR for chronic MR from January 2012 to June 2018 were enrolled. Patients with LVEF < 50% were excluded. The composite primary outcome aiming to detect decompensation related to MR comprised (i) referral for mitral surgery owing to symptoms or LV systolic dysfunction or (ii) cardiovascular death. The secondary outcome was all-cause death. A total of 422 patients were followed for a median of 2.7 years, and the primary endpoint was met in 93 patients (34 patients reported symptoms at baseline). At multivariable analysis, GLS≥ -16.6% was associated with primary outcome [hazard ratio (HR) 1.90, P = 0.01]. In moderate MR cohort, patients with GLS≥ -16.6% had worse event-free survival, whereas there was no significant difference in mild or severe MR groups. GLS≥ -16.0% remained associated with all-cause death after adjusting for other covariates including the MR severity (HR 2.24, P = 0.02).

Conclusion: In patients with primary MR with preserved systolic function, GLS was associated with our composite …

Acute Myocarditis Secondary To Human Metapneumovirus: A Case Series And Mini-Review, Hussam Al Hennawi, Aamna Khan, Alexander Shpilman, Jennifer A. Mazzoni

Abington Jefferson Health Papers

Among viral myocarditis, human metapneumovirus (hMPV) is a rare causative agent with associated cardiac complications. This report provides insight into the disease progression and sheds light on reported cases from the literature. We present the clinical courses of two patients, aged 68 and 58, who developed myocarditis secondary to hMPV infection. Despite the typical severity associated with viral myocarditis in older populations, both patients experienced significant improvement in their condition and ultimately survived. This report highlights the necessity of recognizing hMPV as a potential cause of myocarditis, particularly in older adults presenting with simultaneous respiratory and cardiac symptoms. The recovery …

Pumping Iron, Straining Hearts: Androgen Building Cardiomyopathy In A Middle Aged Bodybuilding Enthusiast, Milan Terzic, Yash B. Patel

Graduate Medical Education Research Journal

A 46-year-old bodybuilder presenting with new onset dyspnea found to have a new onset non-ischemic cardiomyopathy (CM) attributed to exogenous trenbolone and testosterone use. Steroid cessation and guideline-directed heart failure therapy led to notable recovery in left ventricular function supported by global longitudinal strain, ejection fraction and symptomatology.

Anabolic steroid-induced CM involves multiple mechanisms including lipid disturbances, hypertrophy, reduced receptor sensitivity, and cell damage. This case emphasizes the importance of recognizing anabolic steroid misuse as a potential cause of non-ischemic cardiomyopathy in middle aged men. With prompt discontinuation of steroids, remained abstinence and early initiation of guideline-directed medical therapy, myocardial …

Potential Of Right Ventricular Function Assessment With Echocardiography In Transcatheter Aortic Valve Replacement, Yoshihisa Morita, Taro Kariya, Michael Dougherty, Andrew Peters, Nicholas Ruggiero

Division of Cardiology Faculty Papers

BACKGROUND: Right ventricular (RV) function assessment by echocardiography can be challenging due to its complex morphology. Also, increasing use of sedation rather than general anesthesia for transfemoral approach transcatheter aortic valve replacement (TAVR) reduces the need for intraoperative transesophageal echocardiography (TEE). Recent clinical studies have demonstrated the importance of 3-dimensional (3D) echocardiography and a longitudinal strain for RV function assessment. In this study, we compared RV function echocardiographic assessment methodologies in TAVR and investigated its clinical utility.

METHODS: This was a prospective, observational study of TAVR at a large academic hospital. Inclusion criteria were adult patients undergoing TAVR requiring intraoperative …

Redo Minimally Invasive Right Atrial Mass Removal After Surgical Atrial Septal Defect Closure, Chirag Doshi, Pratyaksha Rana, Vidur Bansal, Megha M Sheth, Dinesh Patel

Journal of the Saudi Heart Association

Atrial septal defects are among the most prevalent congenital anomalies necessitating surgical intervention. Thrombus formation is a recognized complication that is typically characterized by an embolic event following patch-based repair. However, thromboembolic complications following primary repair of atrial septal defects are exceedingly uncommon.

Minimally invasive surgery is a suitable alternative to redo sternotomy. We present a 46-year-old man who was diagnosed with a right atrial mass eight years following the patch repair of an atrial septal defect and underwent a successful minimally invasive redo surgery.

Zilebesiran And Hypertension: A Systematic Review And Meta-Analysis, Mohamed Lemine, Saif Almuzainy, Rayan Aljubeh, Ahmad Alilo

Journal of the Saudi Heart Association

Abstract: Objectives: Zilebesiran is an investigational RNA interference therapeutic designed to lower blood pressure by targeting the hepatic production of angiotensinogen, the most upstream precursor of the renin–angiotensin–aldosterone system. This approach aims to offer long-lasting blood pressure control with potentially fewer doses compared to traditional antihypertensive medications. The objective of this systematic review and meta-analysis was to assess the antihypertensive efficacy of zilebesiran in patients with hypertension. Methods: We conducted a search across PubMed, Cochrane Library, Ovid, EBSCO, up until July 2024. The eligible studies included randomized controlled trials that examined Zilebesiran versus placebo in hypertensive patients. These studies …

Platelet-To-White Blood Cell Ratio (Pwr) : A Novel Prognostic Biomarker For Spontaneous Reperfusion After Primary Percutaneous Coronary Intervention., Gökhan Alıcı, Tayfur Erdoğdu, Arafat Yıldırım, Özge Özcan Abacıoğlu, Ömer Genç, Ceyhun Yücel, Örsan Deniz Urgun, Abdullah Yıldırım, Şerafettin Demir

Journal of the Saudi Heart Association

Background: Spontaneous reperfusion (SR) occurring before primary percutaneous coronary intervention (PPCI) can offer additional clinical benefits to patients with ST-segment elevation myocardial infarction (STEMI). The Platelet-to-White Blood Cell Ratio (PWR) has been recognized as a prognostic indicator in various diseases. We aimed to explore the relationship between PWR and SR in patients with STEMI undergoing PPCI.

Methods: We conducted a retrospective analysis involving 995 patients diagnosed with STEMI who underwent PPCI in a single-center setting. Demographic, clinical, laboratory, and angiographic data were extracted from the hospital database, and PWR was calculated by dividing serum platelet levels by white blood cell …

A Saudi Heart Association Position Statement On Cardiovascular Diseases And Diabetes Mellitus, Waleed Alhabeeb, Abdelfatah Elasfar, Abdulhalim Kinsara, Ahmed Aljizeeri, Ibrahim Jelaidan, Kamal Alghalayini, Mohammed F. Alkheraiji., Mousa Akbar, Sameh Lawand, Sarah M. Alyousif, Saud Alsifri, Taher Hassan

Journal of the Saudi Heart Association

Background: Cardiovascular disease (CVD) and diabetes mellitus are prominent public health concerns in Saudi Arabia owing to their increasingly high prevalence and burden. Based on this, the Saudi Heart Association (SHA) set out to develop an official position statement on CVD and diabetes mellitus, with a focus on the prevention and management of these conditions and relevant special populations in the context of Saudi Arabia.

Methods: A multidisciplinary panel of experts met under the auspices of the SHA in a series of meetings to review and discuss available evidence on the prevention and management of comorbid CVD and diabetes mellitus. …

Assessment Of Coronary Collaterals Among Patients With St-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention And Its Impact On In-Hospital And 30-Day Mortality: A Prospective Observational Study, Zafar Iqbal, Muhammad Naeem Mengal, Tariq Ashraf, Bashir Ahmed Salongi, Rajesh Kumar, Khalid Iqbal Bhatti, Bilal Ahmed, Abdul Samad Achakzai, Tahir Saghir

Journal of the Saudi Heart Association

Objectives: This study aimed to determine the distribution of coronary collaterals (CC) as per the Rentrop Collateral Score (RCS) among patients with ST-segment elevation myocardial infarction (STEMI) and its impact on in-hospital and 30-day mortality after primary percutaneous coronary intervention (PCI).

Methods: In this study, a selected sample of consecutive STEMI patients was assessed for the development of CC as per the RCS classification. An RCS grade of 2 or 3 was taken as the presence of CC with either partial or complete filling of the infarct-related artery (IRA). Patients were followed during the hospital stay and up to 30 …

Letter To "Early Do-Not-Attempt Resuscitation Orders And Neurological Outcomes In Older Out-Of-Hospital Cardiac Arrest Patient: A Multicenter Observational Study", Benjamin Tangkamolsuk, Quang La, David F Lo

Rowan-Virtua School of Osteopathic Medicine Departmental Research

We enjoyed reading the article by Kohri et al., titled “Early do‐not‐attempt resuscitation orders and neurological outcomes in older out‐of‐hospital cardiac arrest patients: A multicenter observational study” and would like to offer additional commentary on the article. We hope these perspectives may provide insight into areas that may require further research and improvement.

Embolic Stroke In A Patient With Left Atrial Myxoma, Muhammad Sabri, Sheraz Qamar, Naila Ijaz, Mark Decaro

Division of Cardiology Faculty Papers

We present a case of a patient with a left atrial myxoma who presented with an ischemic stroke. Her cardiac myxoma had an irregular contour and was highly mobile, both features that have been associated with a greater risk of thrombo- embolism. She was treated with prompt surgical resection

Pathways From Socioeconomic Factors To Major Cardiovascular Events Among Postmenopausal Veteran And Nonveteran Women: Findings From The Women's Health Initiative, Hind A Beydoun, May A Beydoun, Rebecca L Kinney, Simin Liu, Rona Yu, Matthew Allison, Robert B Wallace, Qian Xiao, Longjian Liu, Philippe Gradidge, Su Yon Jung, Hilary A Tindle, Shawna Follis, Robert Brunner, Jack Tsai

Faculty, Staff and Student Publications

BACKGROUND: Cardiovascular disease (CVD) remains a leading cause of death for women in the United States, with veterans being at potentially higher risk than their nonveteran counterparts due to accelerated aging and distinct biopsychosocial mechanisms. We examined pathways between selected indicators of socioeconomic status (SES) such as education, occupation, household income, and neighborhood SES and major CVD events through lifestyle and health characteristics among veteran and nonveteran postmenopausal women.

METHODS AND RESULTS: A total of 121 286 study-eligible WHI (Women's Health Initiative) participants (3091 veterans and 118 195 nonveterans) were prospectively followed for an average of 17 years, during which …

Perspectives Of Policymakers On Barriers To And Enablers Of The Uptake Of Cardiac Rehabilitation In Saudi Arabia: A Qualitative Study, Ahmed Mohammed Almoghairi, Jane O’Brien, Jed Duff

Journal of the Saudi Heart Association

• Objectives: This study aimed to identify the barriers to and enablers of secondary prevention care and cardiac rehabilitation (CR) utilization by patients with coronary heart disease (CHD) following percutaneous coronary intervention (PCI) from the perspective of policymakers.
• Methods: A qualitative study involving an interpretive descriptive design was conducted through recorded semi-structured interviews with key decision-makers in cardiology care in Saudi Arabia. The analysis was guided by the updated Consolidated Framework for Implementation Research (CFIR), which informed the resulting themes.
• Results: Interviews were conducted with nine key decision-makers: four directors of major cardiac centers, four heads of cardiac rehabilitation units, and …

Venous Thromboembolism Prophylaxis In Orthopedic Surgery: A Narrative Review, Jacob Lahti, Sarah Gallitto, Thomas C. Varkey

Annual Research Symposium

This poster highlights current and updated guidelines for chemical and mechanical prophylaxis for venous thromboembolism in patients undergoing major and minor orthopedic surgery. Existing and new potential therapies were reviewed, as well as an analysis into the lack of high-quality risk-prediction score calculators to improve personalization of prophylaxis regimens. Alongside a summary of existing and potential new prophylaxis protocols, a call to action to improve validity of said risk score calculators so as to improve patient outcomes and personalized medicine is made.

Reply To Author Regarding The Letter “Postoperative Atrial Fibrillation After Cardiac Surgery”, Yasuhiko Imashuku, Susumu Hiraoka, Motoi Inoue, Takayoshi Mizuno, Misuzu Oyagi, Hirotoshi Kitagawa

Journal of the Saudi Heart Association

No abstract for this article type.

Postoperative Atrial Fibrillation After Cardiac Surgery, Mesut Engin, Abdulkerim Özkan, Abdurrahman Demirel

Journal of the Saudi Heart Association

No abstract for this article type.

Guideline-Directed Medical Therapy After Hospitalization For Acute Heart Failure: Insights From The Connect-Hf, Satoshi Shoji, Lisa Kaltenbach, Bradi B. Granger, Gregg C. Fonarow, Hussein R. Al-Khalidi, Nancy M. Albert, Javed Butler, Larry A. Allen, David E. Lanfear, Jennifer T. Thibodeau, Brittany M. Chapman, Sandra M. Oliver-Mcneil, G. Michael Felker, Ileana L. Piña, Christopher B. Granger, Adrian F. Hernandez, Adam D. Devore

Division of Cardiology Faculty Papers

BACKGROUND: Significant gap remains in the implementation of guideline-directed medical therapy (GDMT) in patients with heart failure after a hospitalization. We aimed to evaluate the use and titration of GDMT at discharge and over a 12-month period after hospital discharge and to identify factors associated with GDMT use and titration.

METHODS AND RESULTS: The CONNECT-HF (Care Optimization Through Patient and Hospital Engagement Clinical Trial for Heart Failure) trial evaluated the effect of a hospital and postdischarge quality improvement intervention in participants with heart failure with reduced ejection fraction. In this secondary analysis, we examined use and titration to at least …

Impact Of Aetiology On Short- And Long-Term Outcomes In Open Descending And Thoracoabdominal Aneurysm Repair, Joshua R. Chen, Christopher D. Pritting, Vishal N. Shah, Colin King, Jacqueline Mcgee, Konstadinos A Plestis

Department of Surgery Faculty Papers

OBJECTIVES: We analysed the impact of chronic type B aortic dissection (cTBAD) and degenerative aneurysm (DA) on the short- and long-term outcomes of patients undergoing open descending thoracic aortic aneurysm and thoracoabdominal aortic aneurysm repair.

METHODS: We performed a retrospective analysis of a prospectively maintained aortic database. From 1999 to 2023, 245 patients underwent open descending thoracic aortic aneurysm or thoracoabdominal aortic aneurysm repair. We compared preoperative comorbidities, postoperative complications and operative and long-term mortality for patients with cTBAD (120 patients, 49%) and DA (125 patients, 51%).

RESULTS: Patients with cTBAD were significantly younger, more likely to be male and …

Prepared To Protect: Improving Cardiac Emergency Response In Youth Club Sports, Melissa Garcia

Nursing | Student Research Posters

Sudden cardiac arrest (SCA) is a medical emergency where the heart unexpectedly stops beating due to an electrical malfunction. A person experiencing a cardiac arrest collapses, loses consciousness, and ceases breathing (American Heart Association, 2022).

Exercise offers numerous benefits to the cardiovascular system and a person’s overall health. However, there are incidents of sports-related cardiac arrest in apparently healthy athletes, including children and young adults. Athletes may be exposed to dehydration, adrenic surges, electrolyte imbalances, acid/base disturbances, and trauma which increases their risk of experiencing a cardiac event (Wasfy et al., 2016).

Sudden cardiac arrest is the leading cause of …

A Retrospective Validation Of The Hear Score., Jordan Luli, Andrew Scheidemantel, Katelyn Bennett, Jessalyn Schafer, Andrew Costa, Marie Lockhart, Kevin Stiver

Heart and Vascular Articles

Studies have proposed the history, electrocardiogram, age, risk factors (HEAR) score to risk-stratify patients with chest pain in the emergency department. This paper assessed the utility of the HEAR score for ambulatory patients with chest pain. The findings demonstrate patients with low and high HEAR scores can be safely managed in the outpatient setting.

Caffeine And Arrhythmias: A Critical Analysis Of Cardiovascular Responses And Arrhythmia Susceptibility, Adel Khalifa Sultan Hamad

Journal of the Saudi Heart Association

Caffeine is a frequently consumed stimulant in different foods and beverages: coffee, tea, chocolate, sodas, and energy drinks. While its effects on the cardiovascular system have been extensively studied, there remains controversy surrounding its potential risks, particularly in patients with heart disease. This review provides a complete overview of caffeine's pharmacological properties, sources, and cardiovascular effects, particularly emphasizing its arrhythmogenic potential. The proarrhythmic potential of caffeine, particularly on atrial fibrillation and ventricular arrhythmias, is conducted. It explains the mechanism of action, including adenosine receptor antagonism, phosphodiesterase inhibition, calcium mobilization, and catecholamine release of caffeine. Epidemiological evidence and mechanistic insights are …

The Power Of Prevention: Integrating Dental And Cardiovascular Care With The Baledoneen Method™, Amy Doneen Dnp

Metro Denver Dental Society Articulator Magazine

This article details the BaleDoneen Method™ which offers a collaborative, science-based approach to preventing and managing cardiovascular disease (CVD) by targeting the root causes of arterial plaque formation. This method integrates dental care by addressing high-risk periodontal pathogens, recognizing the critical connection between oral health and vascular health, and emphasizes the importance of personalized care to reduce systemic inflammation and cardiovascular risk.

Improved Robustness For Deep Learning-Based Segmentation Of Multi-Center Myocardial Perfusion Cardiovascular Mri Datasets Using Data-Adaptive Uncertainty-Guided Space-Time Analysis., Dilek M Yalcinkaya, Khalid Youssef, Bobak Heydari, Janet Wei, C Noel Bairey Merz, Robert Judd, Rohan Dharmakumar, Orlando P Simonetti, Jonathan W Weinsaft, Subha V Raman, Behzad Sharif

Heart and Vascular Articles

BACKGROUND: Fully automatic analysis of myocardial perfusion cardiovascular magnetic resonance imaging datasets enables rapid and objective reporting of stress/rest studies in patients with suspected ischemic heart disease. Developing deep learning techniques that can analyze multi-center datasets despite limited training data and variations in software (pulse sequence) and hardware (scanner vendor) is an ongoing challenge.

METHODS: Datasets from three medical centers acquired at 3T (n = 150 subjects; 21,150 first-pass images) were included: an internal dataset (inD; n = 95) and two external datasets (exDs; n = 55) used for evaluating the robustness of the trained deep neural network (DNN) models …