Cardiovascular Diseases Commons^™

Determinant Of Repeat Revascularization Within 5 Years Of Percutaneous Coronary Lntervention At A Tertiary Care Hospital, Karachi: A Matched Case-Control Study, Komal Valliani, Azmina Artani, Iqbal Azam, Javed Tai, M. Masood Kadir

Community Health Sciences

Objective: To determine factors associated with repeat revascularization among adults aged 25 years and above within 5 years of first Percutaneous Coronary Intervention (PCI) at a tertiary care hospital.
Methods: A matched case-control study was conducted through a hospital records review. A total of 90 cases with repeat revascularization and 180 controls without repeat revascularization were included. Data was analyzed using Multiple Conditional Logistic Regression.
Results: The mean age was similar in cases and controls (60.05 ± 10.01 vs 62.20 ± 10.43 years) and sex (male: 77.8% vs. 76.1%). History of being an ever-smoker (40% vs. 25%), overweight (36.3% vs. …

The Correlation Of D-Dimer To Stroke Diagnosis Within 24 Hours: A Meta-Analysis, Adeel Ahmad, Zara Islam, Saad Manzoor Ahmad, Zouina Sarfraz, Azza Sarfraz, Miguel Felix, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Background: Diagnosing D-Dimer early is essential to optimize clinical treatment and quality of life and reduce mortality. This study aims to identify the difference of D-Dimer levels (ng/ml) in patients with stroke within the 6- and 24-h period compared to patients that mimic stroke.
Methods: An electronic database search across PubMed/MEDLINE, Cochrane, Web of Science, CINAHL, EMBASE, and Scopus was conducted until December 10, 2021. Studies were eligible if they included adult patients with stroke compared to stroke mimics or controls reporting D-Dimer values. Quality assessment was conducted using GRADE. The standardized mean difference and 95% confidence intervals were calculated …

The Acute Influence Of Vasopressin On Hemodynamic Status And Tissue Oxygenation Following The Norwood Procedure, Ronald A Bronicki, Sebastian Acosta, Fabio Savorgnan, Saul Flores, Barbara-Jo Achuff, Rohit Loomba, Mubbasheer Ahmed, Nancy Ghanayem, Jeffrey S Heinle, Vicken Asadourian, Javier J Lasa

Faculty, Staff and Students Publications

OBJECTIVES: Arginine vasopressin (AVP) is used to treat hypotension. Because AVP increases blood pressure by increasing systemic vascular resistance, it may have an adverse effect on tissue oxygenation following the Norwood procedure.

METHODS: Retrospective analysis of continuously captured hemodynamic data of neonates receiving AVP following the Norwood procedure.

RESULTS: We studied 64 neonates exposed to AVP within 7 days after the Norwood procedure. For the entire group, AVP significantly increased mean blood pressure (2.5 ± 6.3) and cerebral and renal oxygen extraction ratios (4.1% ± 9.6% and 2.0% ± 4.7%, respectively;

CONCLUSIONS: The right ventricle to pulmonary artery shunt cohort …

Association Between Shift Rotation And 30-Year Framingham Risk Of Cardiovascular Disease Among Male Workers In A Medium-Sized Manufacturing Factory, An-Yi Hung, Lung-Chang Chien, Ro-Ting Lin

Epidemiology & Biostatistics Faculty Research

Rotating shift work is associated with an increased risk of cardiovascular disease (CVD). This study compared the CVD risk score in 129 male line workers aged 22–49 years on different shifts in a medium-sized metal production factory from 2017 to 2020. We classified workers into four groups: permanent day shift, weekly rotation involving five consecutive nights, weekly rotation involving 3–4 consecutive nights, and monthly rotation involving two consecutive nights. We used the Framingham Risk Score to estimate the 30-yr risks of general and hard CVD (CVD risk estimates). We investigated the differences in CVD risk estimates between different groups using …

The Influence Of Preoperative Dialysis On Survival After Continuous-Flow Left Ventricular Assist Device Implantation, Harveen K Lamba, Fadi I Musfee, Subhasis Chatterjee, Ajith P Nair, Andrew B Civitello, Leo Simpson, O H Frazier, George V Letsou

Faculty, Staff and Students Publications

OBJECTIVES: Dialysis is considered a contraindication to continuous-flow left ventricular assist device (CF-LVAD) implantation. We evaluated clinical outcomes and survival in carefully selected, low-risk patients with renal failure who required dialysis before CF-LVAD implantation.

METHODS: We extracted medical record data of patients who underwent CF-LVAD placement at our centre between 1 January 2006 and 31 August 2017, with 2 clinical scenarios: those who required long-term (>14 days) dialysis and those who required short-term (≤14 days) dialysis immediately before implantation. Demographic, clinical and intraoperative characteristics and survival outcomes were assessed.

RESULTS: Of 621 patients who underwent CF-LVAD implantation during the …

Catastrophic Perforation In Streptococcus Pneumoniae Aortitis: Complications Of Infective Endocarditis In The Current Antimicrobial Era, Sana Shaikh, Jorge Isaac Peña Garcia, Michelle Shieh, Alexandre Lacasse

Journal of Community Hospital Internal Medicine Perspectives

Infectious aortitis is an uncommon but life-threatening cause of aortitis. Given the lack of specific symptoms, establishing the diagnosis is often a challenge. When it is associated with an endovascular infection, such as infective endocarditis, blood cultures may be diagnostic although often limited by low positive predictive value. Imaging studies may reveal characteristic findings, with computerized tomography angiography being the most sensitive. Management includes prompt initiation of antimicrobial therapy followed by surgical intervention, keeping in mind that operative mortality is high due to weakened arterial wall integrity. Here we describe a 25-year-old woman without relevant medical history, who presented to …

Virtual Simulated Implantation Of An Adult-Sized Left Ventricular Assist Device In A Pediatric Patient, Dilachew A Adebo, Santosh C Uppu, Avichal Aggarwal, Jorge D Salazar, Damien J Lapar

Faculty, Staff and Student Publications

There is very limited experience with simulated virtual implantation of left ventricular assist devices (LVADs) to assess device fitness in pediatric patients. In this clinical vignette, we report the case of a 9-year-old male patient with dilated cardiomyopathy who underwent successful placement of an LVAD after virtual simulated implantation was performed. (Level of Difficulty: Advanced.)

Myocardial Rev-Erb-Mediated Diurnal Metabolic Rhythm And Obesity Paradox, Shiyang Song, Chih-Liang Tien, Hao Cui, Paul Basil, Ningxia Zhu, Yingyun Gong, Wenbo Li, Hui Li, Qiying Fan, Jong Min Choi, Weijia Luo, Yanfeng Xue, Rui Cao, Wenjun Zhou, Andrea R Ortiz, Brittany Stork, Vatsala Mundra, Nagireddy Putluri, Brian York, Maoping Chu, Jiang Chang, Sung Yun Jung, Liang Xie, Jiangping Song, Lilei Zhang, Zheng Sun

Faculty, Staff and Students Publications

BACKGROUND: The nuclear receptor Rev-erbα/β, a key component of the circadian clock, emerges as a drug target for heart diseases, but the function of cardiac Rev-erb has not been studied in vivo. Circadian disruption is implicated in heart diseases, but it is unknown whether cardiac molecular clock dysfunction is associated with the progression of any naturally occurring human heart diseases. Obesity paradox refers to the seemingly protective role of obesity for heart failure, but the mechanism is unclear.

METHODS: We generated mouse lines with cardiac-specific Rev-erbα/β knockout (KO), characterized cardiac phenotype, conducted multi-omics (RNA-sequencing, chromatin immunoprecipitation sequencing, proteomics, and metabolomics) …

Early Postoperative Arrhythmias After Pediatric Congenital Heart Disease Surgery: A 5-Year Audit From A Lower- To Middle-Income Country, Sidra Ishaque, Saleem Akhtar, Asma Akbar Ladak, Russell Seth Martins, Muhammad Kamran Younis Memon, Alisha Raza Kazmi, Fatima Mahmood, Anwar Ul Haque

Department of Paediatrics and Child Health

Background: Postoperative arrhythmias are a known complication after surgical repair for congenital heart disease (CHD). This study aimed to identify and discuss the prevalence, diagnosis, and management of common rhythm disturbances seen in the immediate postoperative period after surgery for CHD in the pediatric population at a tertiary care hospital in Pakistan.
Methods: A retrospective study was conducted at a tertiary care hospital in Pakistan between January 2014 and December 2018. All pediatric (old) patients admitted to the intensive care unit and undergoing continuous electrocardiographic monitoring after surgery for CHD were included in this study. Data pertaining to the incidence, …

Conceptual Framework For A Cardiac Surgery Simulation Laboratory And Competency-Based Curriculum In Pakistan - A Short Innovation Report, Ali Aahil Noorali, Asma A H. Merchant, Sardar Shahmir Babar Chauhan, Mustafa Ali Khan, Anam Noor Ehsan, Mohammad Bin Pervez, Muhammad Tariq, Saulat Fatimi

Medical College Documents

Simulation is a commonly utilized technique in healthcare education as it provides trainees a realistic, but safe, environment to learn a variety of skills. Trainees belonging to fields known for high stakes with low margins for error, such as cardiac surgery, can greatly benefit from simulation-based education. We propose the establishment of the first multi-tier high fidelity cardiac surgery simulation lab with a structured curriculum that will eventually provide multidisciplinary training to promising cardiac surgeons across Pakistan. The simulation lab may also be used for research, grant acquisition and patent development. Our setup will include the following levels of simulation: …

Temporary Epicardial Pacing Wires In Isolated Coronary Artery Bypass Graft: Necessity Or Force Of Habit?, Mian Mustafa Kamal, Abdul Ahad Sohail, Majid Osman, Shiraz Hashmi, Muhammad Mehdi, Asma Altaf Hussain Merchant, Hasanat Sharif

Section of Cardiothoracic Surgery

Objective: To determine the frequency of Temporary epicardial pacing wires usage and its predictors in the immediate postoperative period in isolated coronary artery bypass graft surgery.
Methods: The longitudinal study was conducted at the Aga Khan University Hospital, Karachi, from September 2019 to August 2020, and comprised adult patients of either gender who underwent isolated coronary artery bypass graft in the Department of Cardiothoracic Surgery. Demographic, peri-operative and post-operative Temporary Epicardial Pacing Wires use data was extracted from patient's files and the institutional electronic database. Logistic regression models were built to explore predictors of Temporary epicardial pacing wires usage. Data …

Medical Management Of Infants With Supraventricular Tachycardia: Results From A Registry And Review Of The Literature, Nathan Wei, Avani Lamba, Sonia Franciosi, Ian H Law, Luis A Ochoa, Christopher L Johnsrude, Sit Yee Kwok, Teng Hong Tan, Santokh S Dhillon, Anne Fournier, Stephen P Seslar, Elizabeth A Stephenson, Andrew D Blaufox, Michel Cabrera Ortega, Jeffrey N Bone, Ash Sandhu, Carolina A Escudero, Shubhayan Sanatani

Faculty, Staff and Student Publications

BACKGROUND: Several medication choices are available for acute and prophylactic treatment of refractory supraventricular tachycardia (SVT) in infants. There are almost no controlled trials, and medication choices are not necessarily evidence based. Our objective was to report the effectiveness of management strategies for infant SVT.

METHODS: A registry of infants admitted to hospital with re-entrant SVT and no haemodynamically significant heart disease were prospectively followed at 11 international tertiary care centres. In addition, a systematic review of studies on infant re-entrant SVT in MEDLINE and EMBASE was conducted. Data on demographics, symptoms, acute and maintenance treatments, and outcomes were collected. …

Utilization Rates Of Sglt2 Inhibitors And Glp-1 Receptor Agonists And Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease And Type 2 Diabetes: Insights From The Department Of Veterans Affairs, Dhruv Mahtta, David J Ramsey, Michelle T Lee, Liang Chen, Mahmoud Al Rifai, Julia M Akeroyd, Elizabeth M Vaughan, Michael E Matheny, Karla Rodrigues Do Espirito Santo, Sankar D Navaneethan, Carl J Lavie, Yochai Birnbaum, Christie M Ballantyne, Laura A Petersen, Salim S Virani

Faculty, Staff and Students Publications

OBJECTIVE: There is mounting evidence regarding the cardiovascular benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their use.

RESEARCH DESIGN AND METHODS: We used the nationwide Veterans Affairs (VA) health care system data set from 1 January 2020 to 31 December 2020 and included patients with established ASCVD and T2DM. Among these patients, …

Comprehensive Evaluation Of Left Ventricular Deformation Using Speckle Tracking Echocardiography In Normal Children: Comparison Of Three-Dimensional And Two-Dimensional Approaches, Doaa Aly, Nitin Madan, Laura Kuzava, Alison Samrany, Anitha Parthiban

Faculty, Staff and Students Publications

BACKGROUND: Three-dimensional (3D) speckle tracking echocardiography (STE) can overcome some of the inherent limitations of two-dimensional (2D) STE; however, clinical experience is lacking. We aimed to assess and compare the feasibility, agreement, and reproducibility of left ventricular (LV) global longitudinal (GLS), and regional strain by 3D vs 2D STE in normal children.

METHODS: Healthy pediatric subjects (n = 105, age mean = 11.2 ± 5.5 years) were prospectively enrolled. Three-dimensional and 2D LV GLS, as well as regional strain in 16 myocardial segments were quantified. Bland Altman analysis, intra- class correlation coefficients (ICC), percent error and linear regression were used …

Common Genetic Variants Contribute To Risk Of Transposition Of The Great Arteries, Doris Škorić-Milosavljević, Rafik Tadros, Fernanda M Bosada, Federico Tessadori, Jan Hendrik Van Weerd, Odilia I Woudstra, Fleur V Y Tjong, Najim Lahrouchi, Fanny Bajolle, Heather J Cordell, A J Agopian, Gillian M Blue, Daniela Q C M Barge-Schaapveld, Marc Gewillig, Christoph Preuss, Elisabeth M Lodder, Phil Barnett, Aho Ilgun, Leander Beekman, Karel Van Duijvenboden, Regina Bokenkamp, Martina Müller-Nurasyid, Hubert W Vliegen, Thelma C Konings, Joost P Van Melle, Arie P J Van Dijk, Roland R J Van Kimmenade, Jolien W Roos-Hesselink, Gertjan T Sieswerda, Folkert Meijboom, Hashim Abdul-Khaliq, Felix Berger, Sven Dittrich, Marc-Phillip Hitz, Julia Moosmann, Frank-Thomas Riede, Stephan Schubert, Pilar Galan, Mark Lathrop, Hans M Munter, Ammar Al-Chalabi, Christopher E Shaw, Pamela J Shaw, Karen E Morrison, Jan H Veldink, Leonard H Van Den Berg, Sylvia Evans, Marcelo A Nobrega, Ivy Aneas, Milena Radivojkov-Blagojević, Thomas Meitinger, Erwin Oechslin, Tapas Mondal, Lynn Bergin, John F Smythe, Luis Altamirano-Diaz, Jane Lougheed, Berto J Bouma, Marie-A Chaix, Jennie Kline, Anne S Bassett, Gregor Andelfinger, Roel L F Van Der Palen, Patrice Bouvagnet, Sally-Ann B Clur, Jeroen Breckpot, Wilhelmina S Kerstjens-Frederikse, David S Winlaw, Ulrike M M Bauer, Seema Mital, Elizabeth Goldmuntz, Bernard Keavney, Damien Bonnet, Barbara J Mulder, Michael W T Tanck, Jeroen Bakkers, Vincent M Christoffels, Cornelis J Boogerd, Alex V Postma, Connie R Bezzina

Faculty, Staff and Student Publications

RATIONALE: Dextro-transposition of the great arteries (D-TGA) is a severe congenital heart defect which affects approximately 1 in 4,000 live births. While there are several reports of D-TGA patients with rare variants in individual genes, the majority of D-TGA cases remain genetically elusive. Familial recurrence patterns and the observation that most cases with D-TGA are sporadic suggest a polygenic inheritance for the disorder, yet this remains unexplored.

OBJECTIVE: We sought to study the role of common single nucleotide polymorphisms (SNPs) in risk for D-TGA.

METHODS AND RESULTS: We conducted a genome-wide association study in an international set of 1,237 patients …

Health Expectations, Risk Tolerance, And Walking In Peripheral Artery Disease-Related Claudication, Sherene Sharath, Panos Kougias, Neal Barshes

Journal of Social, Behavioral, and Health Sciences

We examined the association between health expectations, baseline physical activity, and self-reported symptom severity among patients with claudication: calf pain that occurs during walking and is relieved at rest. Beliefs and attitudes toward exercise influence the behavior. When walking is prescribed as an alternative to surgical intervention with the intention of decreasing symptom severity, as is the case with claudication, it is important to assess patient perceptions, beliefs, and expectations. Through a phone survey, participants described the severity of their symptoms via the Walking Impairment Questionnaire. Data were collected on (1) health expectations and attitudes, assessments of value placed on …

Trend, Predictors, And Outcomes Of Combined Mitral Valve Replacement And Coronary Artery Bypass Graft In Patients With Concomitant Mitral Valve And Coronary Artery Disease: A National Inpatient Sample Database Analysis, Waqas Ullah, Sajjad Gul, Sameer Saleem, Mubbasher Ameer Syed, Muhammad Zia Khan, Salman Zahid, Abdul Mannan Khan Minhas, Salim S. Virani, Mamas A. Mamas, David L. Fischman

Office of the Provost

Aims: Combined mitral valve replacement (MVR) and coronary artery bypass graft (CABG) procedures have been the norm for patients with concomitant mitral valve disease (MVD) and coronary artery disease (CAD) with no large-scale data on their safety and efficacy.
Methods and results: The National Inpatient Sample database (2002-18) was queried to identify patients undergoing MVR and CABG. The major adverse cardiovascular events (MACE) and its components were compared using a propensity score-matched (PSM) analysis to calculate adjusted odds ratios (OR). A total of 6 145 694 patients (CABG only 3 971 045, MVR only 1 933 459, MVR + CABG …

Endothelial Nitric Oxide Synthase (Enos) And The Cardiovascular System: In Physiology And In Disease States, N Tran, T Garcia, M Aniqa, S Ali, A Ally, Surya M. Nauli

Pharmacy Faculty Articles and Research

Endothelial nitric oxide synthase (eNOS) plays a critical role in regulating and maintaining a healthy cardiovascular system. The importance of eNOS can be emphasized from the genetic polymorphisms of the eNOS gene, uncoupling of eNOS dimerization, and its numerous signaling regulations. The activity of eNOS on the cardiac myocytes, vasculature, and the central nervous system are discussed. The effects of eNOS on the sympathetic autonomic nervous system (SANS) and the parasympathetic autonomic nervous system (PANS), both of which profoundly influence the cardiovascular system, will be elaborated. The relationship between the eNOS protein with cardiovascular autonomic reflexes such as the baroreflex …

Heart In Polycystic Kidney Disease Is Characterized By Cardiac Dysfunction And Structural Deformation, Farideh Amirrad

Pharmaceutical Sciences (PhD) Dissertations

Background: Autosomal dominant polycystic kidney disease (PKD) is a hereditary disorder affecting multiple organs, including the heart. PKD patients have been associated with arrhythmogenic remodeling in some clinical evaluations. However, the structural changes in myocardium and pathway analyses on the pathology of human PKD hearts have never been studied.

Methods: Sex- and age-matched human heart tissues from non-PKD and PKD were studied and verified in a heart-specific PKD mouse model. Structural and functional abnormalities of cardiac tissues and fibrosis-associated pathways were analyzed.

Results: Human PKD myocardium were infiltrated by inflammatory cells M1 and M2. Expressions of transforming growth factor (TGF-β …

Does Tight Glycemic Control Slow The Progression Of Chronic Kidney Disease?, Elani Dodd

Graduate Research Projects

No abstract provided.