Cardiology Commons^™

Prediction Model For Freedom From Tlr From A Multi-Study Analysis Of Long-Term Results With The Zilver Ptx Drug-Eluting Peripheral Stent., Michael D Dake, Fabrizio Fanelli, Aaron E Lottes, Erin E O'Leary, Heidi Reichert, Xiaohui Jiang, Weiguo Fu, Osamu Iida, Kan Zen, Marc Schermerhorn, Thomas Zeller, Gary M Ansel

Heart and Vascular Articles

PURPOSE: Develop a prediction model to determine the impact of patient and lesion factors on freedom from target lesion revascularization (ffTLR) for patients who are candidates for Zilver PTX drug-eluting stent (DES) treatment for femoropopliteal lesions.

METHODS: Patient factors, lesion characteristics, and TLR results from five global studies were utilized for model development. Factors potentially associated with TLR (sex, age, diabetes, hypertension, hypercholesterolemia, renal disease, smoking status, Rutherford classification, lesion length, reference vessel diameter (RVD), popliteal involvement, total occlusion, calcification severity, prior interventions, and number of runoff vessels) were analyzed in a Cox proportional hazards model. Probability of ffTLR was …

Focal St-Segment Elevation Without Coronary Occlusion: Myocardial Infarction With No Obstructive Coronary Atherosclerosis Associated With Covid-19-A Case Report, Casey Meizinger, Bruce D. Klugherz

Division of Cardiology Faculty Papers

Background: While it is understood that coronavirus disease 2019 (COVID-19) is primarily complicated by respiratory failure, more data are emerging on the cardiovascular complications of this disease. A subset of COVID-19 patients present with ST-elevations on electrocardiogram (ECG) yet normal coronary angiography, a presentation that can fit criteria for myocardial infarction with no obstructive coronary atherosclerosis (MINOCA). There is little known about non-coronary myocardial injury observed in patients with COVID-19, and we present a case that should encourage further conversation and study of this clinical challenge.

Case summary: An 86-year-old man presented to our institution with acute hypoxic respiratory failure …

Male Breast Enlargement After Automated Implantable Cardioverter-Defibrillator Placement, Anisha Valluri, Lynne J. Goebel

Marshall Journal of Medicine

Placement of implantable cardioverter-defibrillators (ICDs) are increasing in frequency due to their indication for the prevention of sudden cardiac death in patients prone to life-threatening arrhythmias. Primary care physicians should be aware of the possible complications so they can treat their patients appropriately. This article describes a rare case of chronic unilateral breast enlargement after the placement of an ICD in a male patient with Tetralogy of Fallot.

Accuracy Of Procalcitonin Levels For Diagnosis Of Culture-Positive Sepsis In Critically Ill Trauma Patients: A Retrospective Analysis, Aisha Bakhtiar, Syed Jawad Haider Kazmi, Muhammad Sohaib Asghar, Muhammad Nadeem Khurshaidi, Salman Mazhar, Noman A. Khan, Nisar Ahmed, Farah Yasmin, Rabail Yaseen, Maira Hassan

Section of Cardiothoracic Surgery

Background: Abdominal trauma and intra-abdominal sepsis are associated with significant morbidity and mortality. Microcirculation in the gut is disrupted in hemorrhagic and septic shock leading to tissue hypoxia, and the damaged gut acts as a reservoir rich in inflammatory mediators and provides a continual source of inflammation to the systemic circulation leading to sepsis. Sepsis is defined as the presence (probable or documented) of infection together with a systemic inflammatory response to infection. Blood culture is commonly considered to be the preferred approach for diagnosing sepsis, although it is time-consuming, that is, reports are normally available only after 12-48 hours. …

Summary Of 2019 Brano Heart Failure Forum Presentations, Rajko Radovancevic, Bojan Vrtovec, Igor D. Gregoric

The VAD Journal

The Branislav “Brano” Radovancevic Heart Failure Forum (BHFF) was established in 2008. Each year, experts in the field of heart failure gather to learn, discuss and debate the recent advances and theories related to diagnostics and therapeutics. The 12th Annual BHFF was held September 18-21, 2019, in Belgrade, Serbia, and was attended by over 350 participants from 15 countries. Over four days, seventeen separate sessions focused on challenges and solutions related to mechanical circulatory support and heart transplantation. For the first time, a summary of selected presentations was organized and presented herein.

The Cardiovascular Manifestations Of Covid-19: A Review Of The Literature And Institutional Experience, Gina Polsinelli, Steven J. Korzeniewski, Oksana M. Doubrovski, James Paxton

Medical Student Research Symposium

The cardiovascular health of those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) plays a major role in rates of hospitalization, mortality risk, and rates of mechanical ventilation. In patients with COVID-19, acute myocardial injury and history of cardiovascular disease are both independently established risk factors for poor patient prognosis. In addition to myocardial injury, numerous acute cardiovascular manifestations of COVID-19 disease have been identified. Previous work on this topic typically focused either upon a general description of the acute cardiovascular manifestations and sequalae of COVID-19, or upon broad-based clinical outcomes associated with COVID-19 in patients with history of …

Algorithm For Cavo-Tricuspid Isthmus Flutter On Surface Ecgs: The Actions Study., Daniel Frisch, Eitan Frankel, Deanna Gill, Jad Al Danaf

Division of Cardiology Faculty Papers

OBJECTIVE: Cavo-tricuspid isthmus atrial flutter (CTI-AFL) is an important arrhythmia to recognise because there is a highly effective and relatively low-risk ablation strategy. However, clinical experience has demonstrated that providers often have difficulty distinguishing AFL from atrial fibrillation.

METHODS: We developed a novel ECG-based three-step algorithm to identify CTI-AFL based on established CTI flutter characteristics and verified on consecutive ablation cases of typical flutter, atypical flutter and atrial fibrillation. The algorithm assesses V1/inferior lead F-wave concordance, consistency of P-wave morphology and the presence of isoelectric intervals in the inferior leads. In this observation study, the algorithm was validated on a …

Cardiac Cell Therapy: Insights Into The Mechanisms Of Tissue Repair, Hsuan Peng, Kazuhiro Shindo, Renée R. Donahue, Ahmed K. Abdel-Latif

Gill Heart & Vascular Institute Faculty Publications

Stem cell-based cardiac therapies have been extensively studied in recent years. However, the efficacy of cell delivery, engraftment, and differentiation post-transplant remain continuous challenges and represent opportunities to further refine our current strategies. Despite limited long-term cardiac retention, stem cell treatment leads to sustained cardiac benefit following myocardial infarction (MI). This review summarizes the current knowledge on stem cell based cardiac immunomodulation by highlighting the cellular and molecular mechanisms of different immune responses to mesenchymal stem cells (MSCs) and their secretory factors. This review also addresses the clinical evidence in the field.

Ten Things To Know About Ten Cardiovascular Disease Risk Factors, Harold E. Bays, Pam R. Taub, Elizabeth Epstein, Erin D. Michos, Richard A. Ferraro, Alison Bailey, Heval M. Kelli, Keith C. Ferdinand, Melvin R. Echols, Salim S. Virani

Office of the Provost

Given rapid advancements in medical science, it is often challenging for the busy clinician to remain up-to-date on the fundamental and multifaceted aspects of preventive cardiology and maintain awareness of the latest guidelines applicable to cardiovascular disease (CVD) risk factors. The "American Society for Preventive Cardiology (ASPC) Top Ten CVD Risk Factors 2021 Update" is a summary document (updated yearly) regarding CVD risk factors. This "ASPC Top Ten CVD Risk Factors 2021 Update" summary document reflects the perspective of the section authors regarding ten things to know about ten sentinel CVD risk factors. It also includes quick access to sentinel …

Therapeutic Development Of Group B Streptococcus Meningitis By Targeting A Host Cell Signaling Network Involving Egfr, Ningyu Zhu, Chengxian Zhang, Atish Prakash, Zheng Hou, Wei Liu, Weifeng She, Andrew J. Morris, Kwang Sik Kim

Gill Heart & Vascular Institute Faculty Publications

Group B Streptococcus (GBS) remains the most common Gram‐positive bacterium causing neonatal meningitis and GBS meningitis continues to be an important cause of mortality and morbidity. In this study, we showed that GBS penetration into the brain occurred initially in the meningeal and cortex capillaries, and exploits a defined host cell signaling network comprised of S1P₂, EGFR, and CysLT1. GBS exploitation of such network in penetration of the blood–brain barrier was demonstrated by targeting S1P₂, EGFR, and CysLT1 using pharmacological inhibition, gene knockout and knockdown cells, and gene knockout animals, as well as interrogation of the …

Decreased Inr On Lvad Support: To Bridge Or Not To Bridge?, Maya Guglin

The VAD Journal

In volume 6, issue 2 of The VAD Journal, we published a paper by Rainess et al. who reported their experience with managing subtherapeutic INRs, mostly in patients with HeartMate II (Thoratec, Pleasanton, CA). Although, the cohort did include some HeartMate 3-supported patients. In their program (Wake Forest University), pharmacists manage anticoagulation according to the institutional protocol, which allows bridging with low molecular weight heparin when INR decreases to less than 1.8. The study is unique because the patients did NOT require interruption of anticoagulation for any purpose. In all instances, the INR decreased because of dietary variations, recent …

Comprehensive Echocardiographic Findings In Critically Ill Covid-19 Patients With Or Without Prior Cardiac Disease, Renuka Jain, Pedro D. Salinas, Stacie Kroboth, Abigail Kaminski, Sarah Roemer, Ana Cristina Perez Moreno, Bijoy K Khandheria

Journal of Patient-Centered Research and Reviews

Purpose: Coronavirus disease 2019 (COVID-19) presents with a spectrum of disease severity, the most serious cases requiring intensive care. Echocardiography is a front-line tool in evaluating cardiovascular complications of COVID-19 in the intensive care unit (ICU); we analyzed transthoracic echocardiograms obtained from this patient population with state-of-the-art ultrasound technology.

Methods: All patients with COVID-19 requiring ICU admission on whom a transthoracic echocardiogram was obtained were included in the study. Focused transthoracic protocols were performed by experienced sonographers. Echocardiographic variables, including speckle-tracking echocardiography, were collected and analyzed. Clinical information was obtained from the electronic medical record. Patients were followed until discharge. …

Heparin-Induced Thrombocytopenia Presenting As Splenic Hemorrhage Following Cardiac Surgery: A Case Report., Joseph Ferry, Samuel J Youssef, Pierce Wu, Livia Hegerova

Articles, Abstracts, and Reports

BACKGROUND: Heparin-induced thrombocytopenia with thrombosis (HITT) is a paradoxical prothrombotic complication of anticoagulant therapy. As many as 3% of patients undergoing cardiac surgery develop clinical HIT presenting as thrombocytopenia with or without thrombosis within 5-10 days of heparin exposure. Thrombotic complications associated with HIT carry a mortality rate of 5-10%.

CASE PRESENTATION: We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as the main indicator of HIT following cardiac surgery in a 62-year-old woman. She presented to the emergency department on day nine following coronary artery bypass graft surgery with acute weakness, dizziness, and malaise. Her …

Disparities In Cardiovascular Research Output And Disease Outcomes Among High-, Middle- And Low-Income Countries - An Analysis Of Global Cardiovascular Publications Over The Last Decade (2008-2017), Nada Qaisar Qureshi, Syed Hamza Mufarrih, Gerald S. Bloomfield, Wajeeha Tariq, Aysha Almas, Ali H. Mokdad, Muhammad Imran Nisar, Sameen Siddiqi, Zulfiqar Ahmed Bhutta, Zainab Samad

Department of Medicine

Background: Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Health research is crucial to managing disease burden. Previous work has highlighted marked discrepancies in research output and disease burden between high-income countries (HICs) and low- and lower-middle-income countries (LI-LMICs) and there is little data to understand whether this gap has bridged in recent years. We conducted a global, country level bibliometric analysis of CVD publications with respect to trends in disease burden and county development indicators.
Methods: A search filter with a precision and recall of 0.92 and 0.91 respectively was developed to extract cardiovascular publications …

Comparative Effectiveness Of Anti-Inflammatory Drug Treatments In Coronary Heart Disease Patients: A Systematic Review And Network Meta-Analysis, Ivan Wudexi, Elica Shokri, Mohamed Abo-Aly, Kazuhiro Shindo, Ahmed Abdel-Latif

Gill Heart & Vascular Institute Faculty Publications

Introduction and Hypothesis. The role of inflammation is widely recognized in the pathogenesis of coronary artery disease. Research on animal models had shown the potential benefits of targeting specific inflammatory pathways. However, studies on human subjects are limited with small number of patients and no head-to-head comparisons. Methods. We conducted a network meta-analysis of randomized controlled trials that studied the effects of anti-inflammatory medications on cardiovascular outcomes of coronary artery disease patients. We searched the electronic database until March 2020 for relevant studies. Results. Nineteen trials examining the efficacy of eight anti-inflammatory medications (pexelizumab, anakinra, colchicine, darapladib, …

Advantages Of Bridging To Durable Left Ventricular Assist Device With The Impella 5.0, Manish K. Patel

The VAD Journal

The mainstay therapy for patients in critical cardiogenic shock (CS) is temporary mechanical circulatory support. Although there is a trend toward use of durable left ventricular assist devices (LVAD) in patients that are less ill, we present our experience with using the Impella 5.0 (Abiomed) to illustrate the potential benefits of supporting patients with critical CS before durable LVAD implantation. Since 2012, our use of the Impella has increased from 5 to 38 per year. Mortality is highest early after LVAD implantation, but our long-term survival is better than data reported to the INTERMACS registry. Use of an Impella 5.0 …

A "Blinking" Left Ventricular Assist Device, Maya Guglin, Roopa Rao

The VAD Journal

A 61-year-old male with history of coronary artery disease and end stage ischemic cardiomyopathy underwent a successful implantation of a HeartMate 3 device with an uneventful recovery. However, after 6 months, he complained of increased fatigue, intermittent dizziness, and weakness after minor exertion. The pulsatility index was increased to 8, but the left ventricular assist device (LVAD) was otherwise functioning properly. No major changes in either medications or laboratory results were noted. The patient started getting low flow alarms seven months after the procedure and the dizziness increased. On the controller, a continuously changing (“blinking”) speed was noted (Supplemental Video …

Shear Stress Associated With Cardiopulmonary Bypass Induces Expression Of Inflammatory Cytokines And Necroptosis In Monocytes., Lan N. Tu, Lance Hsieh, Masaki Kajimoto, Kevin Charette, Nataliya Kibiryeva, Adriana Forero, Sarah Hampson, Jennifer A. Marshall, James O'Brien, Marta Scatena, Michael A. Portman, Ram Savan, Chris Benner, Alberto Aliseda, Muhammad Nuri, Douglas Bittel, Peter Pastuzsko, Vishal Nigam

Manuscripts, Articles, Book Chapters and Other Papers

Cardiopulmonary bypass (CPB) is required during most cardiac surgeries. CBP drives systemic inflammation and multiorgan dysfunction that is especially severe in neonatal patients. Limited understanding of molecular mechanisms underlying CPB-associated inflammation presents a significant barrier to improve clinical outcomes. To better understand these clinical issues, we performed mRNA sequencing on total circulating leukocytes from neonatal patients undergoing CPB. Our data identify myeloid cells, particularly monocytes, as the major cell type driving transcriptional responses to CPB. Furthermore, IL-8 and TNF-α were inflammatory cytokines robustly upregulated in leukocytes from both patients and piglets exposed to CPB. To delineate the molecular mechanism, we …

Predictive Value Of Blood N-Terminal Pro-Brain Natriuretic Peptide Concentrations For Early Patent Ductus Closure In Very Preterm Infants, Solomiia Potsiurko, Dmytro Dobryanskyy, Lesya Sekretar

Journal of the Saudi Heart Association

Objectives. It has been shown that blood concentrations of NT-proBNP may be useful in identifying preterm infants at risk of hemodynamically significant patent ductus arteriosus and its complications. The aim of the study was to assess predictive value of serum NT-proBNP levels for early ductus arteriosus (DA) closure in very preterm newborns.
Methods. Fifty-two infants weeks’ gestation aged (PDA) diameter >1.5 mm were involved in a randomized study. Twenty-seven (52%) of them were treated with ibuprofen or paracetamol starting within the first 3 days of life. Expectant management was applied to 25 (48%) infants. All patients underwent planned echocardiographic (daily) …

Right Atrial Volume Index As A Predictor Of Persistent Right Ventricular Dysfunction In Patients With Acute Inferior Myocardial Infarction And Proximal Right Coronary Artery Occlusion Treated With Primary Percutaneous Coronary Intervention, Mohamed Naseem, Sameh Samir

Journal of the Saudi Heart Association

Objectives: Patients with right ventricular (RV) infarctions associated with inferior infarctions have higher rates of adverse events than isolated inferior infarctions. Right atrial volume index (RAVI) has recently been described as a predictor of clinical outcome in patients with chronic systolic heart failure and pulmonary hypertension. The aim of this study is to assess the ability of RAVI to predict the persistent RV dysfunction after acute inferior STEMI due to occlusion of proximal RCA. To the best of our knowledge, this is the first study to investigate the relation between RAVI and persistent RV dysfunction in such group of patients. …