Cardiology Commons^™

Free Cholesterol Bioavailability And Atherosclerosis, Rei J Abe, Jun-Ichi Abe, Minh T H Nguyen, Elizabeth A Olmsted-Davis, Abrar Mamun, Priyanka Banerjee, John P Cooke, Longhou Fang, Henry Pownall, Nhat-Tu Le

Faculty, Staff and Student Publications

Purpose of review: As both a cholesterol acceptor and carrier in the reverse cholesterol transport (RCT) pathway, high-density lipoprotein (HDL) is putatively atheroprotective. However, current pharmacological therapies to increase plasma HDL cholesterol (HDL-c) concentration have paradoxically failed to prevent or reduce atherosclerosis and cardiovascular disease (CVD). Given that free cholesterol (FC) transfer between surfaces of lipoproteins and cells is reversible, excess plasma FC can be transferred to the cells of peripheral tissue sites resulting in atherosclerosis. Here, we summarize potential mechanisms contributing to this paradox and highlight the role of excess free cholesterol (FC) bioavailability in atherosclerosis vs. atheroprotection.

Recent …

Src Stimulates Abl-Dependent Phosphorylation Of The Guanine Exchange Factor Net1a To Promote Its Cytosolic Localization And Cell Motility, Andrea M Murad, Hannah L Hill, Yu Wang, Michael Ghannam, Min-Lee Yang, Norma L Pugh, Federico M Asch, Whitney Hornsby, Anisa Driscoll, Jennifer Mcnamara, Cristen J Willer, Ellen S Regalado, Dianna M Milewicz, Kim A Eagle, Santhi K Ganesh

Faculty, Staff and Student Publications

Spontaneous coronary artery dissection (SCAD) is a potential precipitant of myocardial infarction and sudden death for which the etiology is poorly understood. Mendelian vascular and connective tissue disorders underlying thoracic aortic disease (TAD), have been reported in ~5% of individuals with SCAD. We therefore hypothesized that patients with TAD are at elevated risk for SCAD. We queried registries enrolling patients with TAD to define the incidence of SCAD. Of 7568 individuals enrolled, 11 (0.15%) were found to have SCAD. Of the sequenced cases (9/11), pathogenic variants were identified (N = 9), including COL3A1 (N = 3), FBN1 (N = 2), …

Integrating Pharmacists In Hfref Outpatient Care To Improve Use Of Guideline-Directed Medical Therapy, Roy Robertson Md, Mindy Flanagan Phd, Kris Howard Pharmd, Elizabeth Meisberger Pharmd, Emily Keltner Bs, Ma, Lovekirat Singh Ms, Carly Daley Phd, Shauna Wagner Bsn, Rn, Tammy Toscos Phd, Michael Mirro Md, Facc, Fhrs, Faha

Health Services and Informatics Research

Background: Guideline directed medical therapy (GDMT) is the cornerstone of reducing mortality and morbidity in patients with heart failure with reduced ejection fraction (HFrEF); however, uniform prescribing remains low. There is potential for multidisciplinary care teams, including pharmacists, to improve GDMT use in outpatient care for patients with HFrEF. Investigation is needed to understand the impact of pharmacists in outpatient HFrEF care on GDMT prescribing.

Objectives: To examine the impact of integrating a pharmacist into an outpatient cardiology setting on GDMT prescription rates during HFrEF-related clinic visits.

Methods: This retrospective chart review study examined cardiology clinic visits (HF clinic, “general …

Surgical Ventricular Reconstruction For Ischemic Cardiomyopathy-A Systematic Review And Meta-Analysis Of 7,685 Patients, Brandon Ferrell, Diana C. Jiminez, Danial Ahmad, Kabir Malkani, Jake L Rosen, Gabriel Gaw, Konstadinos A Plestis, T. Sloane Guy, H. Todd Massey, Vakhtang Tchantchaleishvili

Division of Cardiology Faculty Papers

Background: Surgical ventricular reconstruction (SVR) has been used to control adverse ventricular remodeling and improve cardiac function in ischemic cardiomyopathy. The purpose of this systematic review and meta-analysis was to collect and analyze all available evidence on the utilization and efficacy of SVR.

Methods: An electronic database search was performed to identify all retrospective and prospective studies on SVR for ischemic cardiomyopathy in the English literature from 2000 through 2020. A total of 92 articles with a collective 7,685 patients undergoing SVR were included in the final analysis.

Results: The mean patient age was 61 years (95% CI: 59-63) and …

Iatrogenic Diversion Of Superior Vena Cava Into Left Atrium, Tarun Jain, Jamil F Borgi, James C Lee, Karthikeyan Ananthasubramaniam

The Texas Heart Institute Journal

No abstract provided.

Recurrent Parotid Adenocarcinoma Presenting As Diffuse Myocardial Metastatic Disease, Edward A El-Am, Upasana Jarori, Sara J Grethlein, Ronald Mastouri, Abhishek Khemka

The Texas Heart Institute Journal

A 64-year-old man who had undergone treatment for left parotid adenocarcinoma presented with progressive exertional shortness of breath. Evaluation revealed metastatic invasion of the myocardium as a rare presentation of recurrent parotid adenocarcinoma. This case highlights the importance of using multimodal imaging methods in diagnostic evaluation and a collaborative multidisciplinary approach in managing patient care.

Abnormal Electrocardiogram In A Man Presenting With Dyspnea And Chest Pain, Daniel W Nelson, Ryley Mcpeters, Atul Singla

The Texas Heart Institute Journal

No abstract provided.

Patient Knowledge Of Family History Of Cardiac Events And Risk Factors: Potential For Increase In Preventative Care Of Cardiovascular Diseases, Joseph Marentette

Honors Theses

The following literature review regards the preventative care of cardiovascular disease (CVD) patients with the knowledge of familial cardiac events and personal cardiac risk factors, particularly in younger populations ranging from ages 18 to 39, and develop potential preventative care measures. CVD is preventable with early reduction of risk factors. People can lower the impact of cardiac risk factors through the modification of their current lifestyle and behavioral habits. However, this is limited to the education and motivation of the person. Primary emphasis must be placed on community education and physician-patient interactions regarding CVD and cardiac risk factors. Physicians need …

Surgical Correction Of A Complex Aorto-Mitral Pathology, Kubilay Karabacak, Emre Kubat, Elgin Hacızade, Suat Doğancı, Cengiz Bolcal

Journal of the Saudi Heart Association

Pseudoaneurysm of mitral-aortic intervalvular fibrosa is a rare entity related to mostly infective endocarditis and surgical trauma of aortic valve. Its diagnosis may be missed following trans-thoracic echocardiographic assessment. Therefore, further imaging investigation such as trans-esophageal echocardiography and computed tomographic angiography may play a key diagnostic role. Here we present the successful surgical treatment of a 30- year-old male patient referred for surgical treatment of mixed severe calcific aortic valve disease and apparently without additional anatomical abnormalities.

Maine Medical Center Experience With Left Ventricular Device Explantation, Laura Onderko, Lauren Vickerson, Andrew Schwartzman

Costas T. Lambrew Research Retreat 2022

Introduction •Left ventricular assist device (LVAD) is an implantable heart pump that helps support the heart in patients with end stage heart failure with reduced ejection fraction •LVAD therapy is now approved for use as a bridge to transplantation (BTT) and as a destination therapy (DT) in patients who are not candidates for heart transplantation. •The existing literature suggests that close to 10% of patients implanted with LVAD could be explanted for recovery, but the actual rate of explant is significantly lower •Need to examine the clinical course of explanted patients to provide better guidance for the decision to explant …

Takotsubo’Scardiomyopathy: Clinical Characteristics And Outcomes In The Rural State Of Maine, Laura Onderko, Bhavini Prajapati, Wendy Craig, Roisin Morgan

Costas T. Lambrew Research Retreat 2022

Pre-existing psychiatric diagnosis linked to developing Takotsubo’sCardiomyopathy. Patients from rural areas less likely to be on psychiatric medications and had higher Takotsubo’srecurrence rate.

Social Determinants Of Care In The Mmc Cardiology Fellow’S Clinic, Bhavini Prajapati, Laura Onderko, Darcy Chandler, Sanjeev Francis

Costas T. Lambrew Research Retreat 2022

Introduction • Social determinants of health are upstream risk factors for cardiovascular disease. • Patients seen in the Cardiology Fellow’s Clinic at MMC are a diverse group that are burdened by many socioeconomic issues. • Addressing these disparities has the potential to prevent the development of other comorbidities known to increase the risk of a cardiovascular event. • The aim of this project was to identify the prevalence of these factors in the cardiology fellow’s clinic

Mycotic Aortic Aneurysm: A Rare Etiology Of Septic Shock., Kaitlin M Bowers, Vishnu Mudrakola, Christopher M Lloyd

Heart and Vascular Articles

Mycotic aneurysm of the aorta is a rare disease with a high mortality rate due to its likelihood of aneurysmal rupture. This syndrome is predominantly seen in patients over age 65 with the most common presenting symptoms being fever and back pain. Our case illustrates a mycotic aneurysm of the aorta presenting in an elderly female with vague abdominal pain, flank pain, and generalized weakness. We review the investigative approach, diagnostic modalities, and treatment options in patient management. This case emphasizes the need for a high index of suspicion of mycotic aneurysms of the aorta in critically ill elderly patients …

Strategic Recommendations To Bridge The Gaps In Awareness, Diagnosis And Prevention Of Heart Failure In The Middle East Region And Africa, Ahmed Bennis, Elijah N Ogola, Eric Klug, Hadi N. Skouri, Hilal Bahjet Al Saffar, Hany Ragy, Kamal Waheeb Alghalayini, Khaldoon A Alhumood, Magdy Abdelhamid, Mehmet Birhan Yilmaz, Ramzi Tabbalat, Yüksel Çavuşoğlu

Journal of the Saudi Heart Association

Abstract Objective: With the increasing burden of heart failure (HF) in the Middle East Region and Africa (MEA), it is imperative to shift the focus to prevention and early detection of cardiovascular diseases. We present a broad consensus of the real-world challenges and strategic recommendations for optimising HF care in the MEA region. Method: To bridge the gaps in awareness, prevention, and diagnosis of HF, an assembly of experts from MEA shared their collective opinions on the urgent unmet needs. Results: Lack of awareness in the community, high prevalence of risk factors, poor accessibility and affordability of care and diagnostics …

Septic Pulmonary Embolism Related To Right-Sided Infective Endocarditis, Amit Panjwani, Nooraldaem Yousif

Journal of the Saudi Heart Association

No abstract provided.

Reducing 30 Day Chf Readmission Rates: Evaluating Medication Efficacy, Jesse Bebout Msn, Rn, Ccrn, Brandon May Bsn, Rn, Tiara Richmond Bsn, Rn, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background Heart failure (HF) is a leading cause of hospital readmissions and lost revenue under the Hospital Readmission Reduction Program (HRRP). Medication management plays a crucial role in controlling HF symptoms leading to hospitalization. This scoping review examines the benefits of angiotensin receptor-neprilysin inhibitors versus beta-blockers in reducing hospital readmissions within 30 days of discharge related to heart failure with reduced ejection fraction (HFrEF) in the United States.

Methods We conducted a literature search from August 2020 to November 2021 on the Google Scholar, PubMed, and CINAHL databases using the key phrases heart failure with reduced ejection, beta-blockers, angiotensin receptor-neprilysin …

Advancements In Left Ventricular Assist Devices To Prevent Pump Thrombosis And Blood Coagulopathy, Grainne Malone, Gerges Abdelsayed, Fianait Bligh, Fatma Al Qattan, Saifullah Syed, Prateepan Varatharajullu, Augustin Msellati, Daniela Mwipatayi, Maimoona Azhar, Saulat Hasnain Fatimi

Section of Cardiothoracic Surgery

Mechanical circulatory support (MCS) devices, such as left ventricular assist devices (LVADs) are very useful in improving outcomes in patients with advanced-stage heart failure. Despite recent advances in LVAD development, pump thrombosis is one of the most severe adverse events caused by LVADs. The contact of blood with artificial materials of LVAD pumps and cannulas triggers the coagulation cascade. Heat spots, for example, produced by mechanical bearings are often subjected to thrombus build-up when low-flow situations impair washout and thus the necessary cooling does not happen. The formation of thrombus in an LVAD may compromise its function, causing a drop …

Electrocardiogram-Based Machine Learning Emulator Model For Predicting Novel Echocardiography-Derived Phenogroups For Cardiac Risk-Stratification: A Prospective Multicenter Cohort Study, Heenaben B. Patel, Naveena Yanamala, Brijesh Patel, Sameer Raina, Peter D. Farjo, Srinidhi Sunkara, Márton Tokodi, Nobuyuki Kagiyama, Grace Casaclang-Verzosa, Partho P. Sengupta

Journal of Patient-Centered Research and Reviews

Purpose: Electrocardiography (ECG)-derived machine learning models can predict echocardiography (echo)-derived indices of systolic or diastolic function. However, systolic and diastolic dysfunction frequently coexists, which necessitates an integrated assessment for optimal risk-stratification. We explored an ECG-derived model that emulates an echo-derived model that combines multiple parameters for identifying patient phenogroups at risk for major adverse cardiac events (MACE).

Methods: In this substudy of a prospective, multicenter study, patients from 3 institutions (n = 727) formed an internal cohort, and the fourth institution was reserved as an external test set (n = 518). A previously validated patient similarity analysis model was used …

Clinical Characteristics, Risk Factors, And Outcomes Among A Large Midwestern U.S. Cohort Of Patients Hospitalized With Covid-19 Prior To Vaccine Availability, Viviana Zlochiver, Ana Cristina Perez Moreno, Michael Peterson, Khalil Odeh, Ashley Mainville, Katherine Busniewski, Jon Wrobel, Mohamed Hommeida, Blair Tilkens, Payal Sharma, Hlu Vang, Sara Walczak, Fekadesilassie Moges, Kritika Garg, A. Jamil Tajik, Suhail Q. Allaqaband, Tanvir Bajwa, M. Fuad Jan

Journal of Patient-Centered Research and Reviews

Purpose: The COVID-19 pandemic posed unprecedented demands on health care. This study aimed to characterize COVID-19 inpatients and examine trends and risk factors associated with hospitalization duration, intensive care unit (ICU) admission, and in-hospital mortality.

Methods: This retrospective study analyzed patients with SARS-CoV-2 infection hospitalized at an integrated health system between February 2, 2020, and December 12, 2020. Patient characteristics and clinical outcomes were obtained from medical records. Backward stepwise logistic regression analyses were used to identify independent risk factors of ICU admission and in-hospital mortality. Cox proportional hazards models were used to evaluate relationships between ICU admission and in-hospital …

A Project Proposal: The Effects Of Standard Protocols During Cpr On Hospital-Acquired Infections Of Post-Open-Heart Surgery Patients In The Cvicu, Jessica Monahan

Symposium of Student Scholars

Abstract

A Project Proposal: The Effects of Standard Protocols during CPR on Hospital-Acquired Infections of Post-Open-Heart Surgery Patients in the CVICU

Background: Hospital-acquired infections (HAIs) are one of the most common complications post-cardiac surgeries and are associated with longer hospitalizations, elevated use of healthcare resources, and increased morbidity and mortality. The effects of HAIs after cardio-pulmonary resuscitation (CPR) in recent post-open-heart surgery patients remains largely unexplored. Therefore, the purpose of this project was to determine, in the CVICU does implementing standard protocols during CPR on recent post-open-heart surgery patients reduce HAIs?

Literature Review: HAIs during CPR can be acquired through …