Cardiovascular Diseases Commons^™

Potential Role Of The Large Protein Titin In The Development Of Heart Failure, Mary M. Prickett

Senior Theses

I will be exploring the impact of the large protein Titin on heart failure with a preserved ejection fraction (HFpEF). It was hypothesized that myocardial Titin plays a significant role in the progression of HFpEF through isoform, N2BA and N2B, changes. It was hypothesized that an increase in the quantity of N2B Titin, less compliant, and a decrease in N2BA Titin, more compliant, will be observed as HF progresses, contributing to an increase in passive stiffness involved in heart contraction. I will cover a detailed report on the role of Titin in HFpEF and propose research methods to explore further.

Pitfalls In Quantitative Myocardial Pet Perfusion I: Myocardial Partial Volume Correction, K Lance Gould, Linh Bui, Danai Kitkungvan, Tinsu Pan, Amanda E Roby, Tung T Nguyen, Nils P Johnson

Faculty, Staff and Student Publications

BACKGROUND: PET quantitative myocardial perfusion requires correction for partial volume loss due to one-dimensional LV wall thickness smaller than scanner resolution.

METHODS: We aimed to assess accuracy of risk stratification for death, MI, or revascularization after PET using partial volume corrections derived from two-dimensional ACR and three-dimensional NEMA phantoms for 3987 diagnostic rest-stress perfusion PETs and 187 MACE events. NEMA, ACR, and Tree phantoms were imaged with Rb-82 or F-18 for size-dependent partial volume loss. Perfusion and Coronary Flow Capacity were recalculated using different ACR- and NEMA-derived partial volume corrections compared by Kolmogorov-Smirnov statistics to standard perfusion metrics with established …

Tortuosity-Powered Microfluidic Device For Assessment Of Thrombosis And Antithrombotic Therapy In Whole Blood, David J Luna, Navaneeth K R Pandian, Tanmay Mathur, Justin Bui, Pranav Gadangi, Vadim V Kostousov, Shiu-Ki Rocky Hui, Jun Teruya, Abhishek Jain

Faculty, Staff and Students Publications

Accurate assessment of blood thrombosis and antithrombotic therapy is essential for the management of patients in a variety of clinical conditions, including surgery and on extracorporeal life support. However, current monitoring devices do not measure the effects of hemodynamic forces that contribute significantly to coagulation, platelet function and fibrin formation. This limits the extent to which current assays can predict clotting status in patients. Here, we demonstrate that a biomimetic microfluidic device consisting stenosed and tortuous arteriolar vessels would analyze blood clotting under flow, while requiring a small blood volume. When the device is connected to an inline pressure sensor …

Cofilin-1-Induced Actin Reorganization In Stored Platelets, Swapan K Dasgupta, Perumal Thiagarajan

Faculty, Staff and Students Publications

BACKGROUND: During platelet storage, there are extensive changes in cytoskeleton and phosphatidylserine exposure. The intrinsic mitochondrial pathway of apoptosis, activated in stored platelets, is a major mediator these changes. Cofilin-1 is an effector of actin reorganization. We examined the effect of cofilin-1 deficiency on cytoskeleton and phosphatidylserine exposure during storage and following activation of apoptosis.

METHODS AND RESULTS: We assessed actin filaments by Alexa-647-phalloidin and phosphatidylserine exposure by fluorescein isothiocyanate-lactadherin by fluorescence microscopy. In fresh platelets, actin filaments are distributed in the subcortical region, and they do not express phosphatidylserine in the outer surface. In stored platelets, there is retraction …

Comparison Of Surgical Versus Transcatheter Aortic Valve Replacement For Patients With Aortic Stenosis At Low-Intermediate Risk, Mahin R Khan, Waleed T Kayani, Malalai Manan, Ahmad Munir, Ihab Hamzeh, Salim S Virani, Yochai Birnbaum, Hani Jneid, Mahboob Alam

Faculty, Staff and Students Publications

BACKGROUND: To compare safety and efficacy of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients at low-intermediate risk, given the paucity of robust data.

METHODS: We performed an aggregate data meta-analysis of 7 randomized controlled trials (RCTs) and 6,778 patients comparing TAVR with SAVR for aortic stenosis (AS) in low-intermediate risk patients (Society of Thoracic Surgeons risk-score ≤8%) using the random-effects model. Primary outcome was all-cause mortality at 30-day, 1-year and 2-year of follow-up. Secondary outcomes included cardiac-mortality, stroke, acute kidney injury (AKI), atrial fibrillation (AF), permanent pacemaker (PPM) implantation, major-bleeding, moderate-severe paravalvular regurgitation (PVR) …

The Usefulness Of The Left Atrial Dilation Rate In Determining Severity Of Heart Failure, Laura B. Snyder

Senior Theses

Hypertension and vascular stiffness are two physiological conditions that strain the left ventricle (LV) and cause it to gain muscle mass. Eventually, the LV is unable to fill correctly and the patient develops Heart Failure with a preserved Ejection Fraction (HFpEF). Clinically, a patient’s left atrium (LA) area is measured as a diagnostic parameter of HFpEF severity. However, this doesn’t offer a prognosis or threshold of LA size necessitating hospitalization because of variation in patient demographics, genetics, and lifestyle which affect rates of HFpEF progression.

Since there are no medications or effective treatment options for HFpEF patients, there is a …

A Case Of Pacemaker Syndrome Mimicking A Heart Failure Exacerbation, Seline Haci, Som Aftabizadeh, Senthil Thambidorai, Karan Gupta, Ahsan Khan, Aman Patel, Kimberly Wilson, Anand Subramanian

Cardiology

No abstract provided.

Ten Years Risk Assessment Of Atherosclerotic Cardiovascular Disease Using Astro-Charm And Pooled Cohort Equation In A South Asian Sub-Population, Tariq Ashraf, Muhammad Naeem Mengal, Atif Sher Muhammad, Asal Khan Tareen, Nauman Khan, Khawar Abbas Kazmi, Asif Nadeem, Shakil Sarwar, Zara Bashir, Nadeem Qamar, Musa Karim

Medical College Documents

Background: Atherosclerotic cardiovascular diseases (ASCVD) are on the rise in low and middle-income countries attributed to modern sedentary lifestyle and dietary habits. This has led to the need of assessment of the burden of at-risk population so that prevention measures can be developed. The objective of this study was to assess ten years risk assessment of ASCVD using Astro-CHARM and Pooled Cohort Equation (PCE) in a South Asian sub-population.
Methods: A total of 386 residents of all six districts of Karachi with no ASCVD were enrolled in the study through an exponential non-discriminative referral snowball sampling technique. The inclusion criteria …

Case Series Of Anca Vasculitis As Prognostic Marker For Severity Or Relapse Of Glomerulonephritis., Jake N. Cho, Venkat Chitumalla, Izuchukwu Nwakoby

Nephrology

No abstract provided.

Predictors Of Poor Quality Of Life After Primary Lower Limb Deep Venous Thrombosis: A Perspective From A Developing Nation, Nadeem Ahmed Siddiqui, Muhammad Asad Moosa, Fareed A. Shaikh, Noman Shahzad, Shahid Nazir, Ziad Sophie

Department of Surgery Docs

Objective: We aimed to determine predictors of poor long term quality of life, using the VEINES Quality of Life (QOL) questionnaire, in patients with lower limb deep venous thrombosis (DVT).
Material and Methods: This study included adult patients with primary lower limb DVT between January 2007 and December 2017. Post thrombotic syndrome (PTS) was assessed using the Villalta score and Quality of Life (QoL) by the VEINES quality of life questionnaire.
Results: Our study included 125 patients, 57 (45.6%) of whom were males. The patient population's median age was 41 years (IQR: 34-47 years). The median follow …

Thrombotic, Inflammatory, And Hif-Regulated Genes And Thrombosis Risk In Polycythemia Vera And Essential Thrombocythemia, Radhika Gangaraju, Jihyun Song, Soo Jin Kim, Tsewang Tashi, Brandi N Reeves, Krishna M Sundar, Perumal Thiagarajan, Josef T Prchal

Faculty, Staff and Students Publications

Thrombosis is a major cause of morbidity and mortality in polycythemia vera (PV) and essential thrombocythemia (ET). The pathophysiology of thrombosis in these disorders remains unclear, and we hypothesized that upregulation of thrombotic, inflammatory, and hypoxia-inducible factor (HIF)-regulated genes may play a role in it. We performed unbiased RNA sequencing in granulocytes and platelets of PV patients and found differential expression of several thrombotic, inflammatory, and HIF-regulated genes. The expression of many of these genes positively correlated with JAK2 expression and JAK2V617F allelic burden. We then validated these findings by quantitative polymerase chain reaction analyses of selected gene transcripts in …

A 12-Lead Ecg Database To Identify Origins Of Idiopathic Ventricular Arrhythmia Containing 334 Patients, Jianwei Zhang, Guohua Fu, Kyle Anderson, Huimin Chu, Cyril Rakovski

Mathematics, Physics, and Computer Science Faculty Articles and Research

Cardiac catheter ablation has shown the effectiveness of treating the idiopathic premature ventricular complex and ventricular tachycardia. As the most important prerequisite for successful therapy, criteria based on analysis of 12-lead ECGs are employed to reliably speculate the locations of idiopathic ventricular arrhythmia before a subsequent catheter ablation procedure. Among these possible locations, right ventricular outflow tract and left outflow tract are the major ones. We created a new 12-lead ECG database under the auspices of Chapman University and Ningbo First Hospital of Zhejiang University that aims to provide high quality data enabling detection of the distinctions between idiopathic ventricular …

Diabetes Debunked: What You Need To Know, Maggie Hutson

Honors Program: Senior Projects (Public)

The goal of this Honors creative project is to encourage health literacy in populations who are curious about Type 2 Diabetes or have Type 2 Diabetes. From personal experience, I have seen noncompliance in diabetics and wondered why since it is a serious, progressive disease. After researching, I found that some diabetics do not understand the scope of their disease, especially since many of the dangerous complications that arise from Type 2 Diabetes do not present until later in the disease when it is too late. For my senior project, I decided to write an educational paper as a supplement …

Inflammatory Markers In Bicuspid Transcatheter Aortic Valve Replacement, Molly N. Pantelic, Paul Nona, Dee Dee Wang

Medical Student Research Symposium

Background

Aortic stenosis (AS) has a prevalence of 2%. Valve replacement is the definitive treatment for AS, with transcatheter aortic valve replacement (TAVR) offering a minimally invasive alternative to surgery.

Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality. BAV patients are predisposed to AS, and comprise a distinct, younger TAVR patient population. Given limited prior work on inflammatory markers for TAVR risk assessment, this study sought to investigate if white blood cell count (WBC) correlates with BAV TAVR patient severity and post-TAVR outcomes.

Methods

A single-center retrospective analysis was performed on patients with BAV who underwent TAVR …

Ct Rapid Implementation In A 600+ Bed Hospital Serving 35 Counties In The Southeast, Christopher Burns Do, Adam Kassar Md, Jacob Beltz Md, Klie Hoffa, Peter Britt

Radiology

No abstract provided.

Anomalous Origin Of The Left Coronary Artery From The Pulmonary Artery: A Surgical Certainty, Ayesha Butt, Muhammad Muneer Amanullah, Mehnaz Atiq Ahmed, Asif Hasan, Waris Ahmad

Medical College Documents

This study aims to assess the clinical presentation and the outcomes of a surgical correction of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). A retrospective review was carried out on the charts of six patients admitted for ALCAPA surgery at Aga Khan University Hospital, Karachi from March 2017 to May 2018.Dyspnoea, palpitation, poor feeding, fatiguability, pallor and a murmur of mitral regurgitation were the main presenting features. The pre-operative median left ventricular ejection fraction (LVEF) was 64%. Coronary reimplantation was performed in all the patients with a mitral valve repair being done in only …

Continuity Of Care And Outpatient Management For Patients With And At High Risk For Cardiovascular Disease During The Covid-19 Pandemic: A Scientific Statement From The American Society For Preventive Cardiology, Amit Khera, Seth J. Baum, Ty J. Gluckman, Martha Gulati, Seth S. Martin, Erin D. Michos, Ann Marie Navar, Pam R. Taub, Peter P. Toth, Salim S. Virani

Office of the Provost

The coronavirus disease 2019 (COVID-19) pandemic has consumed our healthcare system, with immediate resource focus on the management of high numbers of critically ill patients. Those that fare poorly with COVID-19 infection more commonly have cardiovascular disease (CVD), hypertension and diabetes. There are also several other conditions that raise concern for the welfare of patients with and at high risk for CVD during this pandemic. Traditional ambulatory care is disrupted and many patients are delaying or deferring necessary care, including preventive care. New impediments to medication access and adherence have arisen. Social distancing measures can increase social isolation and alter …

Orthostatic Hypotension, Cardiovascular Outcomes, And Adverse Events: Results From Sprint, Stephen P Juraschek, Addison A Taylor, Jackson T Wright, Gregory W Evans, Edgar R Miller, Timothy B Plante, William C Cushman, Tanya R Gure, William E Haley, Imran Moinuddin, John Nord, Suzanne Oparil, Carolyn Pedley, Christianne L Roumie, Jeff Whittle, Alan Wiggers, Ciarán Finucane, Rose Anne Kenny, Lawrence J Appel, Raymond R Townsend

Faculty, Staff and Students Publications

Orthostatic hypotension (OH) is frequently observed with hypertension treatment, but its contribution to adverse outcomes is unknown. The Systolic Blood Pressure Intervention Trial (SPRINT) was a randomized trial of adults, age ≥50years at high risk for cardiovascular disease (CVD) with a seated systolic BP (SBP) of 130–180 mmHg and a standing SBP ≥110 mmHg. Participants were randomized to a SBP treatment goal of either <120 mmHg or <140 mmHg. OH was defined as a drop in SBP≥20 or diastolic BP ≥10 mmHg one minute after standing from a seated position. We used Cox models to examine the association of OH with CVD or adverse study events by randomized BP goal. During the follow-up period (median 3years), there were 1,170 (5.7%) instances of OH among those assigned a standard BP goal, and 1,057 (5.0%) among those assigned the intensive BP goal. OH was not associated with higher risk of CVD events (primary outcome: HR 1.06; 95%CI: 0.78,1.44). Moreover, OH was not associated with syncope, electrolyte abnormalities, injurious falls, or acute renal failure. OH was associated with hypotension-related hospitalizations or emergency department visits (HR 1.77; 1.11,2.82) and bradycardia (HR 1.94; 1.19,3.15), but these associations did not differ by BP treatment goal. OH was not associated with a higher risk of CVD events and BP treatment goal had no effect on OH’s association with hypotension and bradycardia. Symptomless OH during hypertension treatment should not be viewed as a reason to down-titrate therapy even in the setting of a lower BP goal.

Diagonal 1 And Mid-Lad Myocardial Bridge With Elevated Troponin Enzymes, Ronak Patel Do

Cardiology

No abstract provided.

Syllabus For Clinical Exercise Physiology (Kine 4700), Phillip Drouet

Q2S Enhancing Pedagogy

The syllabus has newly developed learning objectives that will prepare students entering the field of clinical exercise physiology. This course will cover the etiology and pathophysiology of many chronic diseases that plague the population. Assessments of chronic diseases include but are not limited to understanding symptomology will also be covered. Due to the limitations in time the most prevalent chronic disease will be covered and students will have to present on a disease that was not presented in class. The practical application portion of this course will take place during a lab section. Here students will have the opportunity to …