Cardiovascular Diseases Commons^™

Thrombectomy For Stroke With Large Infarct On Noncontrast Ct: The Tesla Randomized Clinical Trial, Writing Committee For The Tesla Investigators, Albert J Yoo, Osama O Zaidat, Sunil A Sheth, Ansaar T Rai, Santiago Ortega-Gutierrez, Curtis A Given, Syed F Zaidi, Ramesh Grandhi, Hugo Cuellar, Maxim Mokin, Jeffrey M Katz, Amer Alshekhlee, Muhammad A Taqi, Sameer A Ansari, Adnan H Siddiqui, Nobl Barazangi, Joey D English, Alberto Maud, Jawad Kirmani, Rishi Gupta, Dileep R Yavagal, Jason Tarpley, Dhruvil J Pandya, Marshall C Cress, Sushrut Dharmadhikari, Kaiz S Asif, Tareq Kass-Hout, Ajit S Puri, Nazli Janjua, Aniel Q Majjhoo, Aamir Badruddin, Randall C Edgell, Rakesh Khatri, Larry Morgan, Anmar Razak, Alicia Zha, Priyank Khandelwal, Nils Mueller-Kronast, Dennis J Rivet, Thomas Wolfe, Brian Snelling, Ali Sultan-Qurraie, Shao-Pow Lin, Rajkamal Khangura, Alejandro M Spiotta, Parita Bhuva, Sergio Salazar-Marioni, Eugene Lin, Abdul R Tarabishy, Edgar A Samaniego, Murali K Kolikonda, Mouhammad A Jumaa, Vivek K Reddy, Pankaj Sharma, Olvert A Berkhemer, Pieter-Jan Van Doormaal, Adriaan C G M Van Es, Wim H Van Zwam, Bart J Emmer, Ludo F Beenen, Charles B L M Majoie, Nancy Buderer, Michelle A Detry, Anna Bosse, Todd L Graves, Christina Saunders, Lucas Elijovich, Ashutosh Jadhav, Mary Patterson, Hannah Slight, Kristine Below, Sami Al Kasab, Tesla Investigators

Faculty, Staff and Student Publications

Importance: Recent large infarct thrombectomy trials used heterogeneous imaging modalities and time windows for patient selection. Noncontrast computed tomographic (CT) scan is the most common stroke imaging approach. It remains uncertain whether thrombectomy is effective for patients with large infarcts identified using noncontrast CT alone within 24 hours of stroke onset.

Objective: To evaluate the effect of thrombectomy in patients with a large infarct on a noncontrast CT scan within 24 hours of onset.

Design, setting, and participants: Open-label, blinded-end point, bayesian-adaptive randomized trial with interim analyses for early stopping (futility or success) or population enrichment, which was conducted at …

Recent Developments In Cardiac Contractility Modulation For Heart Failure, Joshua R Hirsch, Hamid Afshar

The Texas Heart Institute Journal

No abstract provided.

Association Of Right Ventricular Dysfunction With Risk Of Neurodevelopmental Impairment In Infants With Pulmonary Hypertension, Rossana Romero Orozco, Tazuddin Mohammed, Kerri Carter, Shaaron Brown, Stephen Miller, Roy Sabo, Meredith Campbell Joseph, Uyen Truong, Megha Nair, Victoria Anderson, Jie Xu, Judith Voynow, Karen Hendricks-Muñoz

SKMC Student Presentations and Publications

(1) Background: Pulmonary hypertension (PH) increases pulmonary vascular resistance and right ventricular (RV) afterload. Assessment of RV systolic function in PH using RV fractional area change (RV FAC) as a marker directly correlates with mortality and the need for extracorporeal membrane oxygenation (ECMO). However, few studies have assessed neurodevelopmental outcomes. We hypothesize that cardiac RV systolic dysfunction with lower RV FAC is associated with worse neurodevelopmental impairment (NI).

(2) Methods: Retrospective study of 42 subjects with PH to evaluate neurodevelopmental outcomes in the first two years of life based on (i) subjective assessment of RV systolic function and (ii) RV …

The Impact Of Hypertension On Clinical Outcomes In Moyamoya Disease: A Multicenter, Propensity Score-Matched Analysis, Basel Musmar, Joanna Roy, Hammam Abdalrazeq, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan Grossberg, Adam Dmytriw, Aman Patel, Mirhojjat Khorasanizadeh, Christopher Ogilvy, Ajith Thomas, Andre Monteiro, Adnan Siddiqui, Gustavo Cortez, Ricardo Hanel, Guilherme Porto, Alejandro Spiotta, Anthony Piscopo, David Hasan, Mohammad Ghorbani, Joshua Weinberg, Shahid Nimjee, Kimon Bekelis, Mohamed Salem, Jan-Karl Burkhardt, Akli Zetchi, Charles Matouk, Brian Howard, Rosalind Lai, Rose Du, Rawad Abbas, Georgios Sioutas, Abdelaziz Amllay, Alfredo Munoz, Nabeel Herial, Stavropoula Tjoumakaris, Michael Gooch, Robert Rosenwasswer, Pascal Jabbour

Department of Neurosurgery Faculty Papers

BACKGROUND: Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive steno-occlusive changes in the internal carotid arteries, leading to an abnormal vascular network. Hypertension is prevalent among MMD patients, raising concerns about its impact on disease outcomes. This study aims to compare the clinical characteristics and outcomes of MMD patients with and without hypertension.

METHODS: We conducted a multicenter, retrospective study involving 598 MMD patients who underwent surgical revascularization across 13 academic institutions in North America. Patients were categorized into hypertensive (n=292) and non-hypertensive (n=306) cohorts. Propensity score matching (PSM) was performed to adjust for baseline differences.

RESULTS: …

Breaking Boundaries: Unveiling A Cardiac Fistula From The Right Coronary Artery To The Sinus Venosus And From The Sinus Venosus To The Left Subclavian; A Singular Encounter, Maria Eugenia Torres Perez, Carlos Luis Alejos, Jose Romeo Villareal Calderon, Jennifer Rojas Huen, Kamesh Sivagnamam

Research Colloquium

Introduction: Coronary artery fistulas are rare congenital or acquired malformations in the coronary circulation, creating abnormal connections between coronary arteries and heart chambers (coronary-cameral fistulas) or systemic/pulmonary vessels (coronary arteriovenous malformations). Although often asymptomatic and discovered incidentally during coronary catheterization, they can lead to life-threatening complications such as congestive heart failure, myocardial infarction, and pulmonary hypertension.

Case presentation: A 47-year-old patient with hypertension, multiparity and previous history of a large pericardial effusion with cardiac tamponade managed with pericardiocentesis and medical management presented to the emergency department one year after her pericardiocentesis complaining of shortness of breath (SOB) and upper back …

Unraveling Dilated Cardiomyopathy Linked To An Enigmatic Mybpc3 Variant, Khiem D. Ngo, Carlos Alejos, Jennifer Rojas, Sobia Memon, James Stone

Research Colloquium

Background: Non-ischemic cardiomyopathy (NICM), can arise from various causes, including hemodynamic pathology, infections, immunologic abnormalities, toxic injuries, and genetic factors. Determining the prevalence of NICM is challenging due to varying definitions and diagnostic criteria, selection bias, and geographic variation. MYBPC3 is the primary gene known to cause restrictive cardiomyopathy, dilated cardiomyopathy, and left ventricular non-compaction. This gene encodes cMyBP-C, a structural protein of the heart muscle that interacts with actin, myosin, and titin to maintain sarcomeric integrity. While loss-of-function mutations are common, MYBPC3 missense variants of uncertain significance (VUS) are also prevalent. Individuals with MYBPC3 missense VUS predicted to disrupt …

Efficacy Of Thoracic Endovascular Aortic Repair Versus Medical Therapy For Treatment Of Type B Aortic Dissection, Karam Motawea, Samah Rouzan, Rowan Elhalag, Abdelrhaman Abdelwahab, Hussam Al Hennawi, Salem Elshenawy, Mai Saad Mohamed, Pensée Chébl, Mohamed Salem Madian, Mostafa Elsayed Elsayed Hewalla, Sarya Swed, Wael Hafez, Bisher Sawaf, Samer Kaspo, Naim Battikh, Mohammed Najdat Seijari, Amr Farwati, Amine Rakab

Abington Jefferson Health Papers

BACKGROUND: Techniques in endovascular therapy have evolved to offer a promising alternative to medical therapy alone for Type B aortic dissections (TBADs).

AIM: The aim of this meta-analysis was to compare mortality and overall complications between thoracic endovascular aortic repair (TEVAR) and best medical therapy (BMT) in patients with TBADs.

METHODS: We included randomized control trials and prospective or retrospective cohort studies that compared TEVAR and BMT for the treatment of type B aortic dissection. Multiple electronic databases were searched.

RESULTS: Thirty-two cohort studies including 150,836 patients were included. TEVAR was associated with a significantly lower 30-day mortality rate than …

The Discover In-Hospital Cardiac Arrest (Discover Ihca) Study: An Investigation Of Hospital Practices After In-Hospital Cardiac Arrest, Luke Andrea, Nathaniel S. Herman, Jacob Vine, Katherine M. Berg, Saiara Choudhury, Mariana Vaena, Jordan E. Nogle, Saleem M. Halablab, Aarthi Kaviyarasu, Jonathan Elmer, Gabriel Wardi, Alex K. Pearce, Conor Crowley, Micah T. Long, J. Taylor Herbert, Kipp Shipley, Brittany D. Bissell Turpin, Michael J. Lanspa, Adam Green, Shekhar A. Ghamande, Akram Khan, Siddharth Dugar, Aaron M. Joffe, Michael Baram, Cooper March, Nicholas J. Johnson, Alexander Reyes, Krassimir Denchev, Michael Loewe, Et Al

School of Medicine Faculty Publications

IMPORTANCE: In-hospital cardiac arrest (IHCA) is a significant public health burden. Rates of return of spontaneous circulation (ROSC) have been improving, but the best way to care for patients after the initial resuscitation remains poorly understood, and improvements in survival to discharge are stagnant. Existing North American cardiac arrest databases lack comprehensive data on the post-resuscitation period, and we do not know current post-IHCA practice patterns. To address this gap, we developed the Discover In-Hospital Cardiac Arrest (Discover IHCA) study, which will thoroughly evaluate current post-IHCA care practices across a diverse cohort. OBJECTIVES: Our study collects granular data on post-IHCA …

A Vascular Puzzle: Identifying High-Output Heart Failure In A Patient With End-Stage Renal Disease And A Fresh Arteriovenous Fistula, Carlos Luis Alejos Aguero, Khiem Ng, Jennifer Rojas Huen, Liza Salloum, James Stone

Research Colloquium

Introduction: We present a case highlighting high-output heart failure secondary to an acquired arteriovenous fistula for dialysis. High-output cardiac failure is a less common form of heart failure characterized by the heart pumping an increased volume of blood but failing to meet the body's metabolic demands.

Case presentation: A 74-year-old female with a history of hypertension, dyslipidemia, type 2 Diabetes, and end-stage renal disease (ESRD) on hemodialysis via a left arteriovenous fistula. She presented with worsening dyspnea over 2-3 months, initially relieved post-dialysis but progressing to dyspnea at rest, orthopnea, and paroxysmal nocturnal dyspnea despite dialysis compliance. Physical exam revealed …

Novel Computed Tomography Angiography Parameter Is Associated With Low Cardiac Index In Patients With Chronic Thromboembolic Pulmonary Hypertension: A Retrospective Analysis, Estefania Oliveros, Michel Ibrahim, Carlos Manuel Romero, Paul Navo, Patricia Otero Valdes, Yevgeniy Brailovsky, Amir Darki, Riyaz Bashir, Anjali Vaidya, Paul Forfia, Chandra Dass

Division of Cardiology Faculty Papers

UNLABELLED: Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of incomplete resolution of acute pulmonary embolism. We hypothesize changes in CT Hounsfield Unit gradient (HU-Δ) created by the dispersion of IV contrast through the downstream blood pool correlate with cardiac index (CI). We sought to compare HU-Δ with invasively obtained CI.

METHODS: We completed a retrospective analysis of CTEPH patients in which individuals with low CI (<2.2-L/min/m²) were identified. Both absolute and fractional HU-Δ were derived from pulmonary CTA by subtracting the HU value of the left atrium (LA) and left ventricle (LV) from the main pulmonary artery …

Cardiac Manifestations And Outcomes Of Covid-19 Vaccine-Associated Myocarditis In The Young In The Usa: Longitudinal Results From The Myocarditis After Covid Vaccination (Maciv) Multicenter Study, Supriya S. Jain, Steven A. Anderson, Jeremy M. Steele, Hunter C. Wilson, Juan Carlos Muniz, Jonathan H. Soslow, Rebecca S. Beroukhim, Victoria Maksymiuk, Xander Jacquemyn, Olivia H. Frosch, Brian Fonseca, Ashraf S. Harahsheh, Sujatha Buddhe, Ravi C. Ashwath, Deepika Thacker, Shiraz A. Maskatia, Nilanjana Misra, Jennifer A. Su, Saira Siddiqui, Danish Vaiyani, Aswathy K. Vaikom-House, M. Jay Campbell, Jared Klein, Sihong Huang, Christopher Mathis, Matthew D. Cornicelli, Madhu Sharma, Lakshmi Nagaraju, Marla Johnston, Et Al

School of Medicine Faculty Publications

Background: We aimed to study the clinical characteristics, myocardial injury, and longitudinal outcomes of COVID-19 vaccine-associated myocarditis (C-VAM). Methods: In this longitudinal retrospective observational cohort multicenter study across 38 hospitals in the United States, 333 patients with C-VAM were compared with 100 patients with multisystem inflammatory syndrome in children (MIS-C). We included patients ≤ 30 years of age with a clinical diagnosis of acute myocarditis after COVID-19 vaccination based on clinical presentation, abnormal biomarkers and/or cardiovascular imaging findings. Demographics, past medical history, hospital course, biochemistry results, cardiovascular imaging, and follow-up information from April 2021 to November 2022 were collected. The …

Chylopericardium And Superior Vena Cava Syndrome Caused By Central Venous Occlusion From Indwelling Hemodialysis Catheters, Daniel Underberg, Nicholas Demario, Sebastian Rodriguez, Khulkar Mirzozoda, Mark Decaro, Gregary Marhefka

Division of Cardiology Faculty Papers

Chylopericardium is a rare condition. Causes include superior vena cava syndrome resulting from indwelling catheters. We present a case of this condition in a 42-year-old man with end-stage renal disease treated with hemodialysis through a right subclavian vein catheter. He underwent successful endovascular stenting with resolution of his symptoms and chylopericardium.

Residual Stroke Risk Among Patients With Atrial Fibrillation Prescribed Oral Anticoagulants: A Patient-Level Meta-Analysis From Combine Af, Linda Johnson, Alexander Benz, Ashkan Shoamanesh, John W Eikelboom, Michael Ezekowitz, Robert Giugliano, Lars Wallentin, Christian Ruff, Renato Lopes, Sanjit Jolly, Richard Whitlock, Christopher Granger, Stuart Connolly, Jeffrey Healey

Division of Cardiology Faculty Papers

Background: Despite oral anticoagulation, patients with atrial fibrillation (AF) remain at risk of ischemic stroke and systemic embolism (SE) events. For patients whose residual risk is sufficiently high, additional therapies might be useful to mitigate stroke risk.

Methods and results: Individual patient data from 5 landmark trials testing oral anticoagulation in AF were pooled in A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in AF (COMBINE AF). We calculated the rate of ischemic stroke/SE among oral anticoagulation-treated patients with a CHA₂DS₂-VASc score≥2, across strata of CHA₂DS₂-VASc …

Factors Associated With Recanalization And Reintervention Following Below Knee Polidocanol Endovenous Microfoam Ablation For Great Saphenous And Small Saphenous Veins, John Fang, Christian Fang, Andy Moyal, Enrico Ascher, Anil Hingorani, Natalie Marks

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Polidocanol endovenous microfoam (PEM) has been used to treat lower extremity venous reflux for almost one decade with specific advantages for below knee (BK) truncal veins where thermal ablation poses a risk of injury to adjacent nerves. The current literature of the BK segment often examines short-term outcomes with modest sample sizes. We aim to identify factors associated with recanalization and reintervention in this subset of patients.

METHODS: We performed a retrospective study of a prospectively maintained database of patients from a single institution who underwent 1% PEM ablation for BK great saphenous vein (GSV) and small saphenous vein …

A Potential Role For Magi-1 In The Bi-Directional Relationship Between Major Depressive Disorder And Cardiovascular Disease, Priyanka Banerjee, Khanh Chau, Sivareddy Kotla, Eleanor L Davis, Estefani Berrios Turcios, Shengyu Li, Zhang Pengzhi, Guangyu Wang, Gopi Krishna Kolluru, Abhishek Jain, John P Cooke, Junichi Abe, Nhat-Tu Le

Faculty, Staff and Student Publications

Purpose of review: Major Depressive Disorder (MDD) is characterized by persistent symptoms such as fatigue, loss of interest in activities, feelings of sadness and worthlessness. MDD often coexist with cardiovascular disease (CVD), yet the precise link between these conditions remains unclear. This review explores factors underlying the development of MDD and CVD, including genetic, epigenetic, platelet activation, inflammation, hypothalamic-pituitary-adrenal (HPA) axis activation, endothelial cell (EC) dysfunction, and blood-brain barrier (BBB) disruption.

Recent findings: Single nucleotide polymorphisms (SNPs) in the membrane-associated guanylate kinase WW and PDZ domain-containing protein 1 (MAGI-1) are associated with neuroticism and psychiatric disorders including MDD. SNPs in …

Perceptions Of Hiv-Related Comorbidities And Usability Of A Virtual Environment For Cardiovascular Disease Prevention Education In Sexual Minority Men With Hiv: Formative Phases Of A Pilot Randomized Controlled Trial, S Raquel Ramos, Harmony Reynolds, Constance Johnson, Gail Melkus, Trace Kershaw, Julian F Thayer, Allison Vorderstrasse

Faculty, Staff and Student Publications

Background: Sexual minority men with HIV are at an increased risk of cardiovascular disease (CVD) and have been underrepresented in behavioral research and clinical trials.

Objective: This study aims to explore perceptions of HIV-related comorbidities and assess the interest in and usability of a virtual environment for CVD prevention education in Black and Latinx sexual minority men with HIV.

Methods: This is a 3-phase pilot behavioral randomized controlled trial. We report on formative phases 1 and 2 that informed virtual environment content and features using qualitative interviews, usability testing, and beta testing with a total of 25 individuals. In phase …

Reducing The Incidence Of Frequent Hospital Readmissions In Veterans Population, Dasari Reddy

Student Scholarly Projects

Practice Problem: Veterans hospital readmission problems are challenging, specifically in the heart failure department, which severely impacts the patient's health, mortality, family, and quality of life. Frequent readmissions increase the usage cost, hospital budget, and loss of time from providers to other veterans, and failure to meet the key guidelines of the Center for Medicare and Medicaid for improvement.

PICOT: The PICOT question that guided this project was, in veterans with heart failure and one or more frequent hospital readmissions discharged in the last 30 days(P), does the appointment of a dedicated discharge nurse practitioner as a coordinator(I), compared to …

Improving Firefighter Health Through Education In Sleep Science, Elisabeth J. Filiss

Master's Projects and Capstones

Sleep impacts all aspects of life, from mental health to physical well-being to job performance. Nowhere is this more important than in the fire service, where extreme working conditions are the norm. One of 44 stations in a large fire department (XFD), Firehouse X, has 21 full-time members, six on duty per shift. A microsystem assessment of Firehouse X revealed poor sleep habits and environmental factors that are not conducive to quality sleep. The role of sleep in the fire service has recently been examined, and interventions aimed at improving firefighters’ sleep have been recommended.

This quality improvement project implemented …

Cardiac Mass In A 78-Year-Old Patient With A History Of Cancer: Diagnostic And Treatment Challenges, Bihong Zhao, Ayah Zaqqa, Michelle M Mcdonald, Ismael A Salas De Armas, Igor D Gregoric, L Maximilian Buja

The Texas Heart Institute Journal

Primary cardiac angiosarcoma is a rare, aggressive malignancy that commonly metastasizes to various organs. The presenting symptoms are typically nonspecific, so a comprehensive examination is required to confirm the diagnosis promptly. This case report describes the presentation of an older patient with a history of neoplasms. Echocardiography and biopsy were performed, but despite surgical intervention to resect a large right atrial mass, the patient died. A final diagnosis of primary angiosarcoma was made based on the resected specimen.

Effect Of Cvd Education On The Perception And Modifiable Health Behaviors Of College Students, Sanitha Douglas

Doctor of Nursing Practice Projects

Background

Research reports that cardiovascular disease (CVD) has been a national and global health problem for many years, and that knowledge has increased regarding its prevention (Hennekens, 2020). However, according to Hennekens (2020), CVD remains the number one cause of death in America and most developed countries worldwide. The lack of perception and knowledge of actual CVD risk in the young adult population may be contributing to this deadly disease. This project evaluated the effectiveness of education on CVD risk perception and modifiable health behaviors of college students.

Purpose

This project’s purpose was to assess college students' perception of their …