Cardiology Commons^™

Native Valve Endocarditis Complicated By Abscess Formation Caused By Rothia Mucilaginosa, S Haddad, Y Saade, B Ramlawi, B Kreidieh, B Gilbert, S Rao

Division of Infectious Diseases and Environmental Medicine Faculty Papers

Rothia mucilaginosa is increasingly recognized as an emerging pathogen associated with endocarditis. It has mostly been reported a causative agent for prosthetic valve endocarditis. The previously reported cases of native valve endocarditis caused by this organism only required medical treatment with no surgical intervention. We report a case of R. mucilaginosa native valve endocarditis complicated by abscess formation requiring surgical intervention and review the literature of native valve endocarditis caused by this organism.

St-Segment Elevation In A Patient With Nausea, Vomiting, And Intracerebral Hemorrhage, Ranjan Banerjee, Dustin Hillerson, Steve W. Leung, Vincent L. Sorrell

Gill Heart & Vascular Institute Faculty Publications

A 60-year-old man who presented with nausea, vomiting, and intracerebral hemorrhage developed inferior ST-segment elevation and angina. Coronary angiography showed no coronary obstruction. The patient was found to have a small bowel obstruction causing superior translocation of the heart. Relief of obstruction caused immediate resolution of electrocardiographic changes and symptoms. (Level of Difficulty: Beginner.)

Zwolle Risk Score For Safety Assessment Of Same-Day Discharge After Primary Percutaneous Coronary Intervention, Jehangir Ali Shah, Bashir Ahmed Solangi, Mahesh Kumar Batra, Kamran Ahmed Khan, Ghazanfar Ali Shah, Gulzar Ali, Mehwish Zehra, Muhammad Hassan, Muhammad Zubair, Musa Karim

Journal of the Saudi Heart Association

Objectives: The Zwolle risk score (ZRS) has been considered to be a useful tool for the systematic evaluation of patients for early discharge after primary percutaneous coronary intervention (PCI). Therefore, aim of this study was to evaluate the clinical utility of ZRS for the same-day discharge strategy after primary PCI at a tertiary care cardiac center of Karachi, Pakistan. Methods: This study was conducted at a tertiary care cardiac center between August 2019 and July 2020. Patients discharged within 24 hours (same-day) of the primary PCI procedure were included. Patients were stratified as high- and low-risk based on ZRS score; …

Multiple Migrated Superior Vena Cava Stents With Cardiac Injury - A Stepwise Open Cardiotomy Strategy To Mitigate Potential Fatality, Fayaz Mohammed Khazi, Samer Badr Eddin Alhashimi, Motaz Yousef Majthoob, Ayman Saleh, Ayman Al-Sibaie, Obaid Aljassim

Journal of the Saudi Heart Association

Iatrogenic injuries with migrated interventional stents can sometimes be life-threatening. The interventional retrieval management is generally the treatment of choice, as surgical procedures carry a high mortality risk with only a few cases reported. We report a patient with two stents migrated into the right atrium from superior vena cava resulting in cardiac perforation. She was successfully treated using pericardiocentesis followed by surgical intervention with rapid postoperative resolution of symptoms. The technique presented here substantiates the steps for a safe and effective removal of these multiple displaced stents with minimal postprocedural complications.

Automated Classification Model With Otsu And Cnn Method For Premature Ventricular Contraction Detection, Liang-Hung Wang, Lin-Juan Ding, Chao-Xin Xie, Su-Ya Jiang, I-Chun Kuo, Xin-Kang Wang, Jie Gao, Pao-Cheng Huang, Patricia Angela R. Abu

Department of Information Systems & Computer Science Faculty Publications

Premature ventricular contraction (PVC) is one of the most common arrhythmias which can cause palpitation, cardiac arrest, and other symptoms affecting the work and rest activities of a patient. However, patients hardly decipher their own feelings to determine the severity of the disease thus, requiring a professional medical diagnosis. This study proposes a novel method based on image processing and convolutional neural network (CNN) to extract electrocardiography (ECG) curves from scanned ECG images derived from clinical ECG reports, and segment and classify heartbeats in the absence of a digital ECG data. The ECG curve is extracted using a comprehensive algorithm …

Which Outcomes Are Most Important To Measure In Patients With Covid-19 And How And When Should These Be Measured? Development Of An International Standard Set Of Outcomes Measures For Clinical Use In Patients With Covid-19: A Report Of The International Consortium For Health Outcomes Measurement (Ichom) Covid-19 Working Group, William H. Seligman, Luz Fialho, Nick Sillett, Christina Nielsen, Farhala Mari Baloch, Philip Collis, Ingel K M. Demedts, Marcelo P. Fleck, Maiara A. Floriani, Nasreen Muhammad

Section of Cardiology

Objectives: The COVID-19 pandemic has resulted in widespread morbidity and mortality with the consequences expected to be felt for many years. Significant variation exists in the care even of similar patients with COVID-19, including treatment practices within and between institutions. Outcome measures vary among clinical trials on the same therapies. Understanding which therapies are of most value is not possible unless consensus can be reached on which outcomes are most important to measure. Furthermore, consensus on the most important outcomes may enable patients to monitor and track their care, and may help providers to improve the care they offer through …

Editorial: Perturbations In Metabolic Cues: Implications For Adverse Cardiac Function Leading To Sudden Cardiac Death, Brian P. Delisle, Ademuyiwa S. Aromolaran

Physiology Faculty Publications

No abstract provided.

Same Evidence, Varying Viewpoints: Three Questions Illustrating Important Differences Between United States And European Cholesterol Guideline Recommendations, David I. Feldman, Erin D. Michos, Neil J. Stone, Ty J. Gluckman, Miguel Cainzos-Achirica, Salim S. Virani, Roger S. Blumenthal

Office of the Provost

In 2018, the AHA/ACC Multisociety Guideline on the Management of Blood Cholesterol was released. Less than one year later, the 2019 ESC/EAS Dyslipidemia Guideline was published. While both provide important recommendations for managing atherosclerotic cardiovascular disease (ASCVD) risk through lipid management, differences exist. Prior to the publication of both guidelines, important randomized clinical trial data emerged on non-statin lipid lowering therapy and ASCVD risk reduction. To illustrate important differences in guideline recommendations, we use this data to help answer three key questions: 1) Are ASCVD event rates similar in high-risk primary and stable secondary prevention? 2) Does imaging evidence of …

The Role Of Coronary Artery Disease In Demand Mediated Myocardial Infarction: A Retrospective Study From A Community Hospital, Amr Salama, Nikhil Mehta, Abdullah Abdullah, Ruth Kouides, Jeremiah Depta, Ryan Hoefen, Richard Alweis

Advances in Clinical Medical Research and Healthcare Delivery

Type 2 Myocardial Infarction (T2MI) is an increasingly recognized clinical entity due to the availability of highly sensitive troponin assays for patients admitted due to common medical diagnoses. However, there is little epidemiological data on the significance and long-term prognosis of T2MI, which occurs secondary to an increase in myocardial oxygen demand and/or a decrease in myocardial blood flow. Arrhythmia, hypoxia, and sepsis are the major etiologies for T2MI. Therefore, sepsis was the identified area of interest for the study giving how common it is in a community hospital. We studied the cardiac workup of patients with elevated troponin in …

Shared Decision Making And Patient Reported Outcomes Among Adults With Atherosclerotic Cardiovascular Disease, Medical Expenditure Panel Survey 2006-2015, Victor Okunrintemi, Javier Valero-Elizondo, Neil J. Stone, Ron Blankstein, Michael J. Blaha, Martha Gulati, Salim S. Virani, William A. Zoghbi, Erin D. Michos, Khurram Nasir

Office of the Provost

Importance: Shared decision-making (SDM), one of the pillars of patient centered care is strongly encouraged and has been incorporated into the management of atherosclerotic cardiovascular disease (ASCVD) but the expansion of its use has been limited.
Objective: To determine the association of SDM on patient-reported health status, measures of quality of care, healthcare resource utilization, and healthcare spending among US adults with ASCVD.
Method: This is a retrospective cohort study in an ambulatory setting, utilizing the Medical Expenditure Panel Survey (MEPS) 2006-2015. Analysis completed in December 2020. Participants included were adults 18 years and over with a diagnosis of ASCVD. …

The First Pediatric Heart Transplantation In Saudi Arabia Bridged By Berlin Heart (Excor) Ventricular Assist Device, Abdullah A. Alghamdi Md, Msc, Frcsc, Hatem Elmontaser Md, Ahmed A. Arifi Md, Joao Dantas Msn, Muayed A. Al-Zaibag Md

Journal of the Saudi Heart Association

Pediatric patients on the waiting list for heart transplantation incur the highest risk of death for any organ transplantation. Berlin Heart EXCOR provides a reliable support as a bridge to heart transplantation or recovery for all pediatric age groups. We report the first successful experience of Berlin Heart EXCOR mechanical circulatory support and heart transplantation in pediatric patients in Saudi Arabia. The purpose of this report is to highlight the clinical events and share lessons learned from this endeavor.

Angioplasty Of Anomalous Coronaries Arising From The Opposite Sinus With An Inter-Arterial Course, Is It Safe?, Rania Hammami, Imtinene Ben Mrad, Amine Bahloul, Salma Charfeddine, Rym Gribaa, Houssem Thabet, Emna Allouche, Aymen Ben Abdessalem, Majed Hassine, Leila Abid, Samir Kammoun, Hassen Ibn Hadj Amor

Journal of the Saudi Heart Association

Background: The coronary artery with an interarterial course CAIAC is the most threatening coronary anomaly, especially if it concerns the left coronary. Percutaneous coronary intervention PCI is scarcely described given its low prevalence and lack of long-term outcome data. Therefore, we assessed through this case series the feasibility and safety of PCI in this population. Methods This is an observational multicentric study including patients with CAIAC arising from the opposite sinus of Valsalva. The primary endpoints were immediate angiographic success and target lesion revascularization. Results During the period of the study, we performed 27235 PCI in six Cath labs, 26 …

Study Of Safety And Efficacy Of Novel Sirolimus-Eluting Stent Incorporating Properties Of Drug Coating Balloon Among Real World Patients Focusing Among Younger Population ( Under 35 Years), Santosh Kumar Sinha, Umeshwar Pandey, Mahmodullah Razi, Awadesh K. Sharma, Puneet Aggarwal, Mohit Sachan, Praveen Shukla, Ramesh Thakur

Journal of the Saudi Heart Association

Objective- Aim of study was to evaluate safety and efficacy of abluminal Mitigator DES+ Sirolimus Eluting Stent (Envision Scientific, Surat, India) incorporating novel technology of fusion coating of bioresorbable polymer on both abluminal surface of stent and exposed parts of balloon among real world patients specially focusing younger patients ( < 35 years). Method- 1293 patients received Mitigator DES+ at LPS Institute of Cardiology, Kanpur, India. Primary outcome was target lesion failure (TLF)- composite of cardiovascular death, target vessel myocardial infarction (TVMI), and target lesion revascularization (TLR) and secondary end points including peri-procedural device failure (failure of stent delivery, change of stent, stent fracture), target vessel failure (TVF), and patient oriented composite end point (POCE)- composite of all deaths, MI, and revascularization and stent thrombosis (ST) at 1-year follow-up. Result- Younger population comprised of 374(29%) patients. Various indications of interventions were STEMI (n=614, 47.4%), NSTEMI (n=416, 32.2%), UA (n=161, 12.5%), and CCS (n=102, 7.9%). TLF at 1 year in overall population was 3.5% which was driven by TVMI and TLR in 1.3% and 1.1% patients respectively. POCE was observed in 9.5% mainly contributed by any revascularization (3.9%). Failure of stent delivery (1.1%) and edge dissection (0.5%) caused stent failure (2.2%). Definite and probable ST was observed in 1% and 0.8% patients respectively. Young patients showed insignificantly lower TLF, TVF, ST and POCE and significantly lower device failure (1.3% vs. 2.6%, p=0.04) when compared to patients >35 years. Conclusion- Mitigator DES+™ is safe among real world patients especially young population.

Ultrafiltration Rate And Incident Atrial Fibrillation Among Older Individuals Initiating Hemodialysis, Jennifer E Flythe, Sai Liu, Maria E Montez-Rath, Wolfgang C Winkelmayer, Tara I Chang

Faculty, Staff and Students Publications

BACKGROUND: Higher ultrafiltration (UF) rates are associated with numerous adverse cardiovascular outcomes among individuals receiving maintenance hemodialysis. We undertook this study to investigate the association of UF rate and incident atrial fibrillation in a large, nationally representative US cohort of incident, older hemodialysis patients.

METHODS: We used the US Renal Data System linked to the records of a large dialysis provider to identify individuals ≥67 years of age initiating hemodialysis between January 2006 and December 2011. We applied an extended Cox model as a function of a time-varying exposure to compute adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) …

Editorial: Recent Advances In Cardiotoxicity Testing, Tamer M. A. Mohamed, Javid Moslehi, Jonathan Satin

Physiology Faculty Publications

No abstract provided.

The Covid-19 Pandemic Surge And Impact On Rheumatic Valvular Heart Disease Patient Care, Prashanth Kulkarni, Manjappa Mahadevappa

Journal of the Saudi Heart Association

The COVID-19 crisis has surged worldwide putting immense stress on the health care services, leading to institutions deferring elective procedures and struggling to triage the emergency care of the cardiac patient. This has affected the management of the rheumatic valvular heart disease patient especially, in developing countries, potentially placing these patients at enormous risk for complications like congestive cardiac failure, stroke and death. In this article, we explore the COVID-19 pandemic and its impact on rheumatic valvular heart disease patient care. We try to provide a framework that addresses the procedural considerations of interventions like percutaneous transluminal mitral commissurotomy (PTMC), …

3 Cases Of Superior Vena Cava Syndrome Following Percutaneous Right Ventricular Assist Device Placement, John R Vaile, J. Eduardo Rame, René J Alvarez, H. Todd Massey, Vakhtang Tchantchaleishvili, Alec Vishnevsky, Indranee Rajapreyar, Yevgeniy Brailovsky, Mahek Shah

Division of Cardiology Faculty Papers

We present 3 cases of superior vena cava (SVC) syndrome following percutaneous right ventricular assist device (RVAD) placement. Each case underscores the importance of early recognition of SVC syndrome in patients with percutaneous RVAD insertion via the internal jugular vein and calls for heightened awareness of device-associated complications. (Level of Difficulty: Advanced.).

Stent Or Shunt, What Could Be Better For Children With Duct Dependent Pulmonary Circulation?, Ghassan A. Shaath, Abdulraouf Mz Jijeh, Mohammed Fararjeh, Fahad Alhabshan, Mansour B. Almutairi, Ahmed Alomrani, Omar Tamimi

Journal of the Saudi Heart Association

Background: Systemic to pulmonary shunt (Shunt) is offered for children with duct dependent pulmonary circulation to augment pulmonary flow. Recently patent ductus arteriosus (PDA) stent (Stent) is widely used as an alternative method. We aimed to compare post intervention outcomes in children underwent either procedure. Methods: Infants under 3 months who had an initial palliation by Shunt or Stent were retrospectively reviewed between 2008-2016, then followed till the second intervention or 1 year whichever earlier. Results: 187 patients (110 Shunt and 77 Stent) were included. Initial weight and pulmonary artery (PA) branches size were similar between the groups. Shunt patients …

The Kardashian Index Of Cardiologists: Do More Social Media Followers Mean More Citations Or Merely Celebrity Status In Academia?, Talal Almas, Maheera Farooqi, Vikneswaran Raj Nagarajan, Muhammad Ali Niaz, Absam Akbar, Yohan Porus Irani, Jung Hur, Josef Finsterer

Medical College Documents

No abstract provided.

Left Atrial Appendage Occlusion For Stroke Prevention In Nonvalvular Atrial Fibrillation, Fareed Moses S Collado, Claudia M Lama Von Buchwald, Christina K Anderson, Nidhi Madan, Hussam S Suradi, Henry D Huang, Hani Jneid, Clifford J Kavinsky

Faculty, Staff and Students Publications

The majority of embolic strokes in patients with nonvalvular atrial fibrillation are caused by thrombi in the left atrial appendage. It is projected that strokes related to atrial fibrillation will markedly increase in the future unless effective mitigation strategies are implemented. Systemic anticoagulation has been known to be highly effective in reducing stroke risk in patients with atrial fibrillation. However, bleeding complications and nonadherence are barriers to effective anticoagulation therapy. Surgical and percutaneous left atrial appendage occlusion devices are nonpharmacologic strategies to mitigate the challenges of drug therapy. We present a contemporary review of left atrial appendage occlusion for stroke …