Cardiovascular System Commons^™

Acute Effects Of Trunk Stretching On Aortic Arterial Stiffness And Central And Peripheral Blood Pressure In Middle-Aged Older Adults, Kylee West

College of Graduate Studies: Theses & Dissertations

BACKGROUND: Physical activity may alter the trajectory of age-related arterial stiffening, which is associated with cardiovascular morbidity and mortality. Trunk stretching has reduced arterial stiffness (AS) in young males, but its effect in middle-aged to older adults is unclear. This study examined the effects of passively assisted trunk stretching (PATS) on aortic arterial stiffness and central and peripheral blood pressure in middle-aged to older adults. METHODS: Carotid-femoral pulse wave velocity (cf-PWV) and Augmentation Index normalized to a heart rate of 75 beats per minute (AIx75) were measured in 28 middle-aged to older adults (14M/14F; 72 ± 7 years; 28.5 …

Topographical Distribution And Morphology Of Sympathetic Postganglionic Innervation And Chronic Intermittent Hypoxia (Cih) Induced Remodeling Of The Whole Heart At Single Cell/Axon/Varicosity Scale, Ariege Bizanti

Electronic Theses and Dissertations, 2020-2023

The sympathetic nervous system is crucial for controlling multiple cardiac functions and its overactivity is associated with many cardiovascular diseases (CVD). Chronic intermittent hypoxia (CIH) is a current model for sleep apnea, which constitutes a major risk factor for CVD through sympathetic overactivity. However, a comprehensive neuroanatomical map of the sympathetic innervation of the heart is unavailable which impedes our understanding of the remodeling of this map in pathological conditions. First, we used a combination of state-of-the-art techniques, including flat-mount tissue processing, immunohistochemistry for tyrosine hydroxylase (TH, a sympathetic marker), confocal microscopy and Neurolucida 360 software to trace, digitize, and …

Multi-Ancestry Genome-Wide Association Analyses Improve Resolution Of Genes And Pathways Influencing Lung Function And Chronic Obstructive Pulmonary Disease Risk, Nick Shrine, Abril G. Izquierdo, Jing Chen, Richard Packer, Robert J. Hall, Anna L. Guyatt, Chiara Batini, Rebecca J. Thompson, Chandan Puvuluri, Vidhi Malik, Brian D. Hobbs, Matthew Moll, Wonji Kim, Ruth Tal-Singer, Per Bakke, Katherine A. Fawcett, Catherine John, Kayesha Coley, Noemi Nicole Piga, Sinjini Sikdar, Martin D. Tobin, Et Al.

Mathematics & Statistics Faculty Publications

Lung-function impairment underlies chronic obstructive pulmonary disease (COPD) and predicts mortality. In the largest multi-ancestry genome-wide association meta-analysis of lung function to date, comprising 580,869 participants, we identified 1,020 independent association signals implicating 559 genes supported by ≥2 criteria from a systematic variant-to-gene mapping framework. These genes were enriched in 29 pathways. Individual variants showed heterogeneity across ancestries, age and smoking groups, and collectively as a genetic risk score showed strong association with COPD across ancestry groups. We undertook phenome-wide association studies for selected associated variants as well as trait and pathway-specific genetic risk scores to infer possible consequences of …

Pengaruh Diaphragmatic Breathing Dan Endurance Exercise Terhdap Peningkatan Kapasitas Kardiorespirasi Pada Pasien Hospital-Acquired Pneumonia, Alifia Azzahra, Annisya Puspitarani, Zahra Sativani, Riza Pahlawi

Jurnal Fisioterapi Terapan Indonesia

The purpose of this case study is to determine the effect of diaphragmatic breathing and endurance exercise in hospital-acquired pneumonia (HAP) cases. HAP is a nosocomial pneumonia that occurs 48 hours or more after the patient is admitted to the hospital, without any signs of pulmonary infection at the time of initial treatment. The existence of clinical manifestations that appear, patients with HAP tend to avoid physical activity which can decrease the functional capacity of the respiratory system and have an impact on decreasing endurance. Diaphragmatic breathing exercise is thought to be able to help reduce shortness of breath, reduce …

Intercellular Communication Via Gap Junctions Influences Cell Survival During Hypoxia, Lauren E. Harmon, David L. Geenen

Student Summer Scholars Manuscripts

Stem cell therapy can be beneficial following myocardial infarction. However, when murine bone marrow-derived mesenchymal stem cells (mBM-MSCs) are injected into the ischemic area, a large percentage of these cells undergo apoptosis resulting in decreased therapeutic benefits. We hypothesize that the loss of these mBM-MSCs is regulated by intercellular channels or gap junctions (GJs) that provide apoptotic signals passed between ischemic cardiomyocytes and mBM-MSCs. Our research aims to attenuate these GJs by suppressing Connexin-43 (Cx43) expression, the predominant channel-forming protein. We will accomplish this by transiently transfecting a Cx43 siRNA into mBM-MSCs. Our data demonstrate that intracellular fluorescent dyes and …

Glucocentric Drugs In Cardiovascular Disease Protection And Heart Failure, Khawaja M. Talha, Gregg C. Fonarow, Salim S. Virani, Javed Butler

Office of the Provost

Evidence for cardiovascular outcomes with older-generation antihyperglycemic drugs in the management of type 2 diabetes is based on aggregated data from prior randomized controlled trials and observational studies that were not focused on prespecified cardiovascular end points. Newer antihyperglycemic medications have undergone a rigorous evaluation of cardiovascular outcomes through randomized controlled trials since the US Food and Drug Administration imposed a mandatory requirement for all glucose-lowering drugs in 2008. The three classes of drugs that have been most extensively studied are dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter-2 (SGLT2) inhibitors, the latter two reporting significant …

Predicting Left Ventricular Assist Device Outcomes Utilizing The Stanford Integrated Psychosocial Assessment For Transplant Measure, Nicholas Chesher, Kristina L. Greenwood, Candace Fanale, Cody Gustaveson, Brian Jaski, Hirsch S. Mehta, Peter Hoagland, Kristine Ortiz, Marc Verlasky, Robert Adamson, Walter Dembitsky

The VAD Journal

Objective: Durable mechanical circulatory support is a proven therapy to extend survival for patients with end-stage heart failure (HF). The International Society for Heart and Lung Transplantation guidelines recommend a detailed psychosocial assessment when selecting candidates for durable mechanical circulatory support. Currently, there are no formally validated psychosocial evaluation tools for left ventricular assist device (LVAD) candidacy. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) uses a multidisciplinary algorithm to evaluate the impact of pre-transplant risk factors on post-transplant outcomes. Emerging literature suggests that the SIPAT might be useful for assessing psychosocial risk factors for LVAD outcomes.

Methods: A total …

Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation (Lava-Ecmo): Percutaneous Bi-Atrial Drainage To Avoid Pulmonary Edema In A Patient With Left Ventricular Systolic Dysfunction, Kenneth R. Dulnuan, Joseph B. Zwischenberger, John G. Gurley, Maya Guglin

The VAD Journal

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is used in patients with severe cardiogenic shock refractory to medical therapy. During V-A ECMO, retrograde flow in the aorta towards the left ventricle (LV) causes increased left-sided filling pressures, which may lead to pulmonary edema. Different strategies have been proposed to decompress the left heart, including placement of an intraaortic balloon pump (IABP), Impella® (Abiomed), or TandemHeart® (Cardiac Assist). Percutaneous decompression of the left atrium via placement of a transseptal cannula incorporated into the existing venous limb had also been previously done. We describe the novel use of the VFEM venous femoral cannula …

Highlights Of The 2021 Brano Heart Failure Forum, Rajko Radovancevic, Bojan Vrtovec, Igor D. Gregoric

The VAD Journal

Since 2007, the Branislav “Brano” Radovancevic Heart Failure Forum has been held annually to provide a venue for experts to present and discuss “Innovations and New Treatment Strategies in Heart Failure.” Clinicians and researchers gather yearly in a different Eastern European city to discuss the latest in heart failure diagnostics and therapeutics. The forum was postponed in 2020 due to the COVID-19 pandemic and then resumed in September of 2021 in Graz, Austria. It was attended by over 75 faculty from 13 countries. Due to the ongoing pandemic, 13 presentations were given virtually. Throughout the forum, 17 separate sessions focused …

Successful Percutaneous Management Of Lvad Outflow Graft Stenosis: Role Of Invasive Hemodynamics In Decision Making, Tarun Dalia, Amandeep Goyal, Harsh Mehta, Henedine C. Foster, Eric Hockstad, Aaron Rohr, Philip Johnson, Travis Abicht, Bhanu Gupta

The VAD Journal

Left ventricular assist device (LVAD) outflow graft stenosis (OGS) is a rare but lethal complication. We present a case of a 79-year-old male with pertinent past medical history of an LVAD implanted as destination therapy, stage III chronic kidney disease, and hypertension. He was admitted for low-flow alarms, and the echocardiogram showed stable right ventricle function and no pericardial effusion. Invasive hemodynamic assessments demonstrated a peak-to-peak gradient of 90 mm Hg in the outflow graft between the mid and distal ends of the graft on pullback. Contrast angiography confirmed OGS. The OGS was successfully treated with a VBX-covered stent (Gore). …

A Unique Case Of Inflow Cannula Obstruction By A Tissue Membrane, Roopa A. Rao, Kashif Saleem, Bistees George, Maya Guglin

The VAD Journal

The use of a left ventricular assist device has increased and is a primary surgical treatment for heart failure. However, one major complication of left ventricular assist device support is an obstruction in the blood flow pathway. Pump thrombosis and outflow graft occlusion are some of the common causes of such obstructions. Here, we describe a unique case of HeartMate II (Abbott Laboratories) inflow cannula obstruction from a membranous structure without evidence of thrombus. The histology showed evidence of fibrous tissue and heart muscle tissue in the membrane. The patient underwent a successful device exchange with a HeartMate 3 (Abbott …

Intra-Aortic Balloon Pump May Attenuate Adverse Hemodynamic Effects Of Negative Intrathoracic Pressure In Cardiogenic Shock, Faris Araj

The VAD Journal

High negative intrathoracic pressure (NIP), as occurs during obstructive sleep apnea or hiccups, results in adverse hemodynamic consequences, specifically a decrease in left ventricle (LV) performance. These untoward effects can potentially be catastrophic in the case of an already compromised LV in cardiogenic shock. The interplay of intra-aortic balloon pump counter pulsation during abrupt high NIP in cardiogenic shock is described.

The Role And Outcomes Of Thoracodistal Bypass, Andrea Mcsweeny, Anthony Feghali, Tuong Nguyen, Michael Nooromid, Dawn Salvatore, Paul Dimuzio, Babak Abai

Department of Surgery Faculty Papers

Objectives

Endovascular procedures for lower extremity revascularization are becoming more commonplace due to low morbidity, mortality, and shorter length of stay. The role of open bypass must be reconsidered. Aortobifemoral bypass is the gold standard for extensive aortoiliac occlusive disease (AIOD); however, thoracodistal bypass holds a niche position. We investigate indications and outcomes of thoracodistal bypass.

Methods

Medical records of five patients who underwent thoracodistal bypass at Thomas Jefferson University Hospital (TJUH) between 2012 and 2019 were reviewed. Contemporary and historical literature was reviewed.

Results

Indications included calcified paravisceral pathology, previous failed or infected bypass grafts, and prior abdominal operations. …

Clinical Characteristics And Implications Of Bradycardia In Covid‐19 Patients Treated With Remdesivir: A Single‐Center Retrospective Cohort Study, Ariyon Schreiber, Justin S. Bauzon, Kavita Batra, Salman Mohammed, Kevin Lee, Nazanin Houshmand, Uyen Pham, Celica Cosme, Kim Inciong, Omar Al‑Taweel, Keaton Nasser, Jibran Rana, Chris Sossou, Ariel Go, Dalia Hawwass, Jimmy Diep, Chowdhury H. Ahsan

School of Medicine Faculty Research

Background and Objectives: Remdesivir is an antiviral drug used to treat coronavirus disease 2019 (COVID-19) with a relatively obscure cardiac efect profle. Previous studies have reported bradycardia associated with remdesivir, but few have examined its clinical characteristics. The objective of this study was to investigate remdesivir associated bradycardia and its associated clinical characteristics and outcomes. Methods: This is a single-institution retrospective study that investigated bradycardia in 600 patients who received remdesivir for treatment of COVID-19. A total of 375 patients were included in the study after screening for other known causes of bradycardia (atrioventricular [AV] nodal blockers). All patients were …

Impact Of Atrial Fibrillation On Outcomes After Left Ventricular Assist Device Implantation: Systematic Review And Meta-Analysis, Chandan Buttar, Sofia Lakhdar, Mahmood Nassar, Nso Nso, Giovina Collura, Most Sirajum Munira

The VAD Journal

Background: Atrial fibrillation (AF) is a common finding in patients with heart failure and is well-known for its deleterious effects on cardiac function and hemodynamics; however, there are gaps in knowledge regarding the impact of AF on patients with left ventricular assist devices (LVADs).

Methods: In this study, we searched PubMed/Medline, Embase, and Cochrane Library databases through September 2021 to find articles that assessed the outcomes of AF in patients with LVADs.

Results: A total of 12 studies that underwent systematic review evaluated the outcomes of 7853 adult patients. The meta-analysis analyzed findings from a total of 1003 patients. Pooled …

Heart To Heart, Mom To Mom, Karis L. Tekwani

Journal of Patient-Centered Research and Reviews

This essay describes the human connection forged between two young moms, one the physician and one the patient, when their paths collided one night in the emergency department of a busy hospital. It describes a challenging and most memorable care experience in the career of a young emergency physician, the clinical outcome, and the patient’s appreciative follow-up message years later.

Pulsatility Is A Predictive Marker Of Improved Cardiac Function In Patients With Liquid Matrix-Treated Left Ventricular Assist Devices, Philemon Mikail, Rinku Skaria, Marvin Slepian, Janny Garcia, Richard Smith, Zain Khalpey

The VAD Journal

Objective: Left ventricular assist devices (LVADs) are utilized as a bridge to transplant or as destination therapy for patients with end-stage heart failure. Although cardiac offloading from these devices rarely leads to complete remodeling and functional recovery, the use of mesenchymal cells to modulate heart failure has been explored in recent years due to its intrinsic regenerative properties. Current methods of evaluating cardiac function have too much variability, difficulty of access, or require too frequent follow up to create universal weaning protocols. We hypothesized that the administration of amniotic allograft liquid matrix (LM) containing amnion-derived mesenchymal stem cells (aMSCs) in …

Pathophysiology Of Aortic Stenosis, Melissa Lee

Nursing Student Class Projects (Formerly MSN)

Pathophysiology of Aortic Stenosis

Melissa J. Lee

Department of Nursing, Otterbein University

NURS 6810: Advanced Pathophysiology for the Advanced Practice Nurse

Dr. Deana Batross & Dr. Shivani Bhatnagar

July 29, 2022

Pathophysiology of Aortic Stenosis

Proper evaluation of co-morbidities is imperative for patient safety and successful outcomes for patients undergoing anesthesia. Aortic stenosis (AS) is one of the most complex diseases encountered in anesthesia, affecting five percent of older adults and ten percent of the 80-89-year-old-cohort (Joseph et al., 2017). The pathophysiological development of AS is the end result of an inflammatory process caused by endothelial damage from mechanical stress, …

Perioperative Risks Of The Patient With Heart Failure, Gabrielle Metoyer

Nursing Student Class Projects (Formerly MSN)

Perioperative Risks of the Patient with Heart Failure

Gabrielle Metoyer

Department of Nursing, Otterbein University

NURS 6810 – Advanced Pathophysiology

Dr. Deanna Batross and Dr. Shivani Bhatnagar

August 5, 2022

Abstract

According to the CDC (2020), heart failure occurs when the heart cannot pump enough blood and oxygen to support other organs in your body. Heart failure is an epidemic disease affecting 1-2% of the population worldwide (Schwinger, 2020). It is one of the leading causes of morbidity and mortality worldwide with an estimated 6.5 million adults with heart failure in the United States (Lo et al., 2021). Medical advances …

Fondaparinux As An Alternative Anticoagulant Treatment In Patients With Left Ventricular Assist Devices And Recurrent Gastrointestinal Bleeding: Case Series, Daniela Piani, Andrea Lechiancole, Massimo Maiani, Igor Vendramin, Sandro Sponga, Elisabetta Auci, Ugolino Livi

The VAD Journal

Gastrointestinal bleeding (GIB) can occur in patients after left ventricular assist device (LVAD) implantation. In cases of recurrent GIB, the management of anticoagulation treatment represents a challenging situation in which the risk of bleeding recurrence and the need for long-term anticoagulation must be balanced. This case series describes the successful management of anticoagulation in three patients with recurrent GIB using fondaparinux.

To our knowledge, these are the first reported cases of recurrent GIB in which a single dose of subcutaneous fondaparinux was used instead of oral anticoagulation. None of the patients presented with signs of pump thrombosis or arterial embolism. …