Cardiology Commons^™

Management Of Hyperkalemia To Prevent Cardiac Arrest, Jennifer Harklerode, Amber Paul, Crystal Zheng, Olivia Vanscoy, Olivia Henton, Mark Olah

Pharmacy and Wellness Review

Hyperkalemia is a metabolic problem that may be life threatening if left untreated. Cardiac arrhythmias may develop with the potential to lead to cardiac arrest and death. Hyperkalemia can oftentimes be undiagnosed due to the lack of clear, specific symptoms and inconclusive variations in electrocardiogram (ECG) readings and lab values. Therefore, it is important to recognize risk factors that can potentially in-crease serum potassium levels. Screening for medications that increase serum potassium levels and educating patients are steps that both inpatient and outpatient health care professionals can take to increase early detection and prevention of a hyperkalemic episode. It is …

Isolated Right Superior Vena Cava Drained To Left Atrium In A Child With Waardenburg Syndrome And Neurofibromatosis Type I, Omer A. Algonaid, Yahya H. Almashham, Abdulrahman S. Almoukirish

Journal of the Saudi Heart Association

Isolated right superior vena cava (SVC) draining to the left atrium (RSVC-LA) is an extremely rare cyanotic congenital heart disease (CHD). Such lesion is easily missed with improper scanning or inattentive interpretation of echocardiography. This can result in potential systemic severe complications. We report a child with RSVC-LA who has two significant non-cardiac co-morbidities, including Waardenburg syndrome and n neurofibromatosis type I (NF1). This patient was referred to cardiology assessment due to unexplained low saturation and was diagnosed as RSVC-LA; however, fortunately not yet showing complications of systemic thromboembolic phenomenon (STEP).

American Heart Association's Life's Simple 7: Lifestyle Recommendations, Polygenic Risk, And Lifetime Risk Of Coronary Heart Disease, Natalie R Hasbani, Symen Ligthart, Michael R Brown, Adam S Heath, Allison Bebo, Kellan E Ashley, Eric Boerwinkle, Alanna C Morrison, Aaron R Folsom, David Aguilar, Paul S De Vries

Faculty, Staff and Students Publications

BACKGROUND: Understanding the effect of lifestyle and genetic risk on the lifetime risk of coronary heart disease (CHD) is important to improving public health initiatives. Our objective was to quantify remaining lifetime risk and years free of CHD according to polygenic risk and the American Heart Association's Life's Simple 7 (LS7) guidelines in a population-based cohort study.

METHODS: Our analysis included data from participants of the ARIC (Atherosclerosis Risk in Communities) study: 8372 White and 2314 Black participants; 45 years of age and older; and free of CHD at baseline examination. A polygenic risk score (PRS) comprised more than 6 …

A High Precision Machine Learning-Enabled System For Predicting Idiopathic Ventricular Arrhythmia Origins, Jianwei Zheng, Guohua Fu, Daniele Struppa, Islam Abudayyeh, Tahmeed Contractor, Kyle Anderson, Huimin Chu, Cyril Rakovski

Mathematics, Physics, and Computer Science Faculty Articles and Research

Background: Radiofrequency catheter ablation (CA) is an efficient antiarrhythmic treatment with a class I indication for idiopathic ventricular arrhythmia (IVA), only when drugs are ineffective or have unacceptable side effects. The accurate prediction of the origins of IVA can significantly increase the operation success rate, reduce operation duration and decrease the risk of complications. The present work proposes an artificial intelligence-enabled ECG analysis algorithm to estimate possible origins of idiopathic ventricular arrhythmia at a clinical-grade level accuracy.

Method: A total of 18,612 ECG recordings extracted from 545 patients who underwent successful CA to treat IVA were proportionally sampled into training, …

Triglyceride-Rich Lipoproteins, Apolipoprotein C-Iii, Angiopoietin-Like Protein 3, And Cardiovascular Events In Older Adults: Atherosclerosis Risk In Communities (Aric) Study, Aliza Hussain, Caroline Sun, Elizabeth Selvin, Vijay Nambi, Josef Coresh, Xiaoming Jia, Christie M Ballantyne, Ron C Hoogeveen

Faculty, Staff and Students Publications

AIMS: Despite statin and antihypertensive therapies, older Americans have high atherosclerotic cardiovascular disease (ASCVD) risk. Novel measures of triglyceride-rich lipoproteins, low-density lipoprotein triglycerides (LDL-TG), and remnant-like particle cholesterol (RLP-C), are associated with ASCVD in middle-aged adults. Polymorphisms in genes encoding angiopoietin-related protein 3 (ANGPTL3) and apolipoprotein C-III (apoC-III), two proteins involved in triglyceride catabolism, are associated with increased risk for hypertriglyceridaemia and ASCVD and are potential therapeutic targets. We examined associations of LDL-TG, RLP-C, apoC-III, and ANGPTL3 levels with ASCVD events in older adults in the Atherosclerosis Risk in Communities (ARIC) study.

METHODS AND RESULTS: In 6359 participants (mean age …

Triglyceride-Rich Lipoproteins, Apolipoprotein C-Iii, Angiopoietin-Like Protein 3, And Cardiovascular Events In Older Adults: Atherosclerosis Risk In Communities (Aric) Study, Aliza Hussain, Caroline Sun, Elizabeth Selvin, Vijay Nambi, Josef Coresh, Xiaoming Jia, Christie M Ballantyne, Ron C Hoogeveen

Faculty, Staff and Students Publications

AIMS: Despite statin and antihypertensive therapies, older Americans have high atherosclerotic cardiovascular disease (ASCVD) risk. Novel measures of triglyceride-rich lipoproteins, low-density lipoprotein triglycerides (LDL-TG), and remnant-like particle cholesterol (RLP-C), are associated with ASCVD in middle-aged adults. Polymorphisms in genes encoding angiopoietin-related protein 3 (ANGPTL3) and apolipoprotein C-III (apoC-III), two proteins involved in triglyceride catabolism, are associated with increased risk for hypertriglyceridaemia and ASCVD and are potential therapeutic targets. We examined associations of LDL-TG, RLP-C, apoC-III, and ANGPTL3 levels with ASCVD events in older adults in the Atherosclerosis Risk in Communities (ARIC) study.

METHODS AND RESULTS: In 6359 participants (mean age …

Laryngeal Blastomycosis With Subsequent Heart Failure From Itraconazole Therapy., Daniel Tsang, S Haddad, Mitchell Sternlieb

Department of Medicine Faculty Papers

Blastomycosis is an endemic mycosis in the United States that typically affects the respiratory tract and presents as a pneumonia. Dissemination can occur to any organ system, most commonly involving the skin or bones. Treatment of blastomycosis depends on the severity of disease and consists of itraconazole with liposomal amphotericin B added in during the initial stage in those with more severe disease or those who are pregnant. This case report describes an immunocompetent individual with mild to moderate blastomycosis of the larynx who was started on itraconazole therapy. However, after two months of treatment, he developed new symptomatic heart …

Safety Of Transcatheter Aortic Valve Replacement In Patients With Aortic Aneurysm: A Propensity-Matched Analysis, Justin K. Ugwu, Jideofor K. Ndulue, Khaled A. Sherif, Samson Alliu, Ayman Elbadawi, Tuncay Taskesen, Doha Hussein, Judith N. Ugwu Erugo, Khaled F. Chatila, Ahmed Almustafa

School of Medicine Publications

Introduction

There is a paucity of data regarding the outcomes of transcatheter aortic valve replacement (TAVR) among patients with thoracic or abdominal aortic aneurysms (AA). Using the Nationwide Inpatient Sample (NIS) database, we explored the safety of TAVR among patients with a diagnosis of AA.

Methods

We queried the National Inpatient Sample database (2012–2017) for hospitalized patients undergoing TAVR, using ICD-9 and ICD-10 codes for endovascular TAVR. Reports show that > 95% of endovascular TAVR in the US is via transfemoral access, so our population are mostly patients undergoing transfemoral TAVR. Using propensity score matching, we compared the trends and outcomes …

Breaks In Longitudinal Elastic Fibers Of Human Femoropopliteal Arteries, Elham Zamani

UNO Student Research and Creative Activity Fair

Breaks in Longitudinal Elastic Fibers of Human Femoropopliteal Arteries

Elham Zamani1, Majid Jadidi1

1 Department of Biomechanics, University of Nebraska Omaha, Omaha, NE

Introduction: Elastin is a major protein in the body with half-life >50 years. It is thought that elastic fibers are formed before the postnatal period. In the femoropopliteal artery (FPA), the main artery in the leg, longitudinal elastic fibers are present in External Elastic Lamina (EEL). Our team has studied more than 1000 cadaveric human FPA and has noticed that there are big breaks in their longitudinal elastic fibers in some subjects. Our goal in this work …

Fulminant Giant Cell Myocarditis Requiring Bridge With Mechanical Circulatory Support To Heart Transplantation, Yevgeniy Brailovsky Do, Msc, Amirali Masoumi Md, Rachel Bijou Md, Estefania Oliveros Md, Ms, Gabriel Sayer Md, Koji Takeda Md, Phd, Nir Uriel Md, Msc

Division of Cardiology Faculty Papers

Giant cell myocarditis is a rare cause of cardiogenic shock requiring a high index of suspicion, rapid immunosuppressive therapy, and mechanical circulatory support. We present the case of a patient with giant cell myocarditis who underwent a successful bridge with four different types of mechanical circulatory support devices to heart transplantation. (Level of Difficulty: Advanced.)

Audicor Remote Patient Monitoring: Fda Breakthrough Device And Technology For Heart Failure Management, Marat Fudim Md, Mhs, Michael Mirro Md, Facc, Fhrs, Faha, Hao-Ming Cheng Md

Parkview Heart Institute

Research Letter: The impact of heart failure (HF) on patients, physicians, and hospital systems remains despite recent successes in pharmacologic and device-based treatments. Chronic HF represents one of the nation’s top health issues, leading to reduced patient quality of life, increased risks of hospitalization, increased health care utilization, and high incidence of patient morbidity and mortality. Titration of guideline directed medical therapy and prevention of HF hospitalizations have been identified as key targets in the management of HF. Remote monitoring provides the opportunity to address both issues and has gained significant momentum during the COVID-19 pandemic. Device-based solutions to manage …

Leveraging Structured And Unstructured Electronic Health Record Data To Detect Reasons For Suboptimal Statin Therapy Use In Patients With Atherosclerotic Cardiovascular Disease, Glenn T. Gobbel, Michael E. Matheny, Ruth R. Reeves, Julia M. Akeroyd, Alexander Turchin, Christie M. Ballantyne, Laura A. Petersen, Salim S. Virani

Office of the Provost

Objective: To determine whether natural language processing (NLP) of unstructured medical text can improve identification of ASCVD patients not using high-intensity statin therapy (HIST) due to statin-associated side effects (SASEs) and other reasons.
Methods: Reviewers annotated reasons for not prescribing HIST in notes of 1152 randomly selected patients from across the VA healthcare system treated for ASCVD but not receiving HIST. Developers used reviewer annotations to train the Canary NLP tool to detect and extract notes containing one or more of these reasons. Negative predictive value (NPV), sensitivity, specificity and Area Under the Curve (AUC) were used to assess accuracy …

Inflammatory Bowel Disease And Atherosclerotic Cardiovascular Disease In U.S. Adults-A Population-Level Analysis In The National Health Interview Survey, Khurram Nasir, Isaac Acquah, Amit K. Dey, Tanushree Agrawal, Syed Zawahir Hassan, Kerri Glassner, Bincy Abraham, Eamonn M M. Quigley, Ron Blankstein, Salim S. Virani

Office of the Provost

Objectives: To evaluate the association between inflammatory bowel disease (IBD) and atherosclerotic cardiovascular disease (ASCVD) and whether this association is modified by age or sex.
Methods: We conducted a cross-sectional analysis using data from the 2015-2016 National Health Interview Survey (NHIS). The exposure of interest was self-reported IBD. The outcome of interest was prevalent ASCVD, which included a history of angina, myocardial infarction or stroke. We used survey-specific descriptive statistics to obtain weighted national estimates for IBD and ASCVD prevalence. Logistic regression models were used to assess the association between IBD and ASCVD, progressively adjusting for demographics and traditional risk …

Tirofiban And Rivaroxaban Use In The Management Of Right Coronary Artery Thrombus As A Primary Manifestation Of Essential Thrombocythemia, Muhummad Nasir Rahman, Maleeha Javed

Section of Cardiology

A 45 year old male with hypertension was presented to our centre with a recent inferior wall myocardial infarction (IWMI) and post infarction angina. Invasive coronary angiography revealed an occluded proximal right coronary artery (RCA) with high thrombus burden, in the absence of obstructive disease in the remaining coronary vasculature. Based on raised platelet counts of 923,000/microliter and positive Janus kinase (JAK 2- V617) mutations tested by polymerase chain reaction (PCR), a diagnosis of essential thrombocythemia (ET) was made. A therapeutic strategy of aspiration thrombectomy along with I/V Tirofiban was used for three days, followed by reassessed angiogram and percutaneous …

Radiation Doses In Patients Undergoing Computed Tomographic Coronary Artery Calcium Evaluation With A 64-Slice Scanner Versus A 256-Slice Scanner, Paul Madaj, Dong Li, Rine Nakanishi, Daniele Andreini, Gianluca Pontone, Edoardo Conte, Rachael O'Rourke, Christian Hamilton-Craig, Manojna Nimmagadda, Nicholas Kim, Badiha Fatima, Christopher Dailing, Kashif Shaikh, Chandana Shekar, Ju Hwan Lee, Matthew J Budoff

The Texas Heart Institute Journal

Computed tomographic coronary artery calcium scanning enables cardiovascular risk stratification; however, exposing patients to high radiation levels is an ongoing concern. New-generation computed tomographic systems use lower radiation doses than older systems do. To quantify comparative doses of radiation exposure, we prospectively acquired images from 220 patients with use of a 64-slice GE LightSpeed VCT scanner (control group, n=110) and a 256-slice GE Revolution scanner (study group, n=110). The groups were matched for age, sex, and body mass index; statistical analysis included t tests and linear regression.

The mean dose-length product was 21% lower in the study group than in …

Clonal Hematopoiesis Is Associated With Higher Risk Of Stroke, Romit Bhattacharya, Seyedeh M Zekavat, Jeffrey Haessler, Myriam Fornage, Laura Raffield, Md Mesbah Uddin, Alexander G Bick, Abhishek Niroula, Bing Yu, Christopher Gibson, Gabriel Griffin, Alanna C Morrison, Bruce M Psaty, William T Longstreth, Joshua C Bis, Stephen S Rich, Jerome I Rotter, Russell P Tracy, Adolfo Correa, Sudha Seshadri, Andrew Johnson, Jason M Collins, Kathleen M Hayden, Tracy E Madsen, Christie M Ballantyne, Siddhartha Jaiswal, Benjamin L Ebert, Charles Kooperberg, Joann E Manson, Eric A Whitsel, Nhlbi Trans-Omics For Precision Medicine Program, Pradeep Natarajan, Alexander P Reiner

Faculty, Staff and Student Publications

Background and purpose: Clonal hematopoiesis of indeterminate potential (CHIP) is a novel age-related risk factor for cardiovascular disease-related morbidity and mortality. The association of CHIP with risk of incident ischemic stroke was reported previously in an exploratory analysis including a small number of incident stroke cases without replication and lack of stroke subphenotyping. The purpose of this study was to discover whether CHIP is a risk factor for ischemic or hemorrhagic stroke.

Methods: We utilized plasma genome sequence data of blood DNA to identify CHIP in 78 752 individuals from 8 prospective cohorts and biobanks. We then assessed the association …

Continuous Thoracic Paravertebral Block To Treat Electrical Storm, Daryl I Smith, Sarah A Kralovic, Rafeek A Hegazy, Hai Tran

The Texas Heart Institute Journal

Continuous ganglion block is increasingly being used to help manage ventricular tachyarrhythmias. We present the cases of 2 patients in whom we used continuous left thoracic paravertebral block to achieve sympathetic denervation and improvement in drug-refractory ventricular tachyarrhythmias. Whether as destination therapy or bridging therapy, we conclude that the block is safe, improves patients' comfort, and is superior in several ways to stellate ganglion block and other single-injection techniques.

Artificial Intelligence In Cardiovascular Medicine: Historical Overview, Current Status, And Future Directions, Zvonimir Krajcer

The Texas Heart Institute Journal

Artificial intelligence and machine learning are rapidly gaining popularity in every aspect of our daily lives, and cardiovascular medicine is no exception. Here, we provide physicians with an overview of the past, present, and future of artificial intelligence applications in cardiovascular medicine. We describe essential and powerful examples of machine-learning applications in industry and elsewhere. Finally, we discuss the latest technologic advances, as well as the benefits and limitations of artificial intelligence and machine learning in cardiovascular medicine.

Silent Kawasaki Disease Affecting Multiple Coronary Arteries In A 39-Year-Old Egyptian Woman, Hamdy Singab, Gamal Sami, Mahmoud Tag El Sabah

The Texas Heart Institute Journal

Kawasaki disease, an acute febrile illness, can cause vasculitis in the coronary arteries. It is the chief acquired cause of myocardial infarction and sudden cardiac death in infants, children, and young adults in developed countries. We report a case of chronic, silent Kawasaki disease complicated by multivessel thrombosis in a 39-year-old Egyptian woman. The patient presented with progressive, unstable angina but was otherwise asymptomatic and at negligible risk of ischemic heart disease. Coronary angiograms showed critical arterial stenosis with multiple aneurysms. During revascularization surgery, the patient's harvested left internal mammary artery was found to have occlusive lesions and aneurysmal areas …

Younger Age Of Stroke In Low-Middle Income Countries Is Related To Healthcare Access And Quality, Mohammad H Rahbar, Martin Medrano, Franck Diaz-Garelli, Cosme Gonzalez Villaman, Sepideh Saroukhani, Sori Kim, Amirali Tahanan, Yahaira Franco, Gelanys Castro-Tejada, Sarah A Diaz, Manouchehr Hessabi, Sean I Savitz

Faculty, Staff and Student Publications

Stroke is the second leading cause of mortality globally with higher burden and younger age in low-middle income countries (LMICs) than high-income countries (HICs). However, it is unclear to what extent differences in healthcare access and quality (HAQ) and prevalence of risk factors between LMICs and HICs contribute to younger age of stroke in LMICs. In this systematic review, we conducted meta-analysis of 67 articles and compared the mean age of stroke between LMICs and HICs, before and after adjusting for HAQ index. We also compared the prevalence of main stroke risk factors between HICs and LMICs. The unadjusted mean …