Pitfalls In Quantitative Myocardial Pet Perfusion I: Myocardial Partial Volume Correction, K Lance Gould, Linh Bui, Danai Kitkungvan, Tinsu Pan, Amanda E Roby, Tung T Nguyen, Nils P Johnson

Faculty, Staff and Student Publications

BACKGROUND: PET quantitative myocardial perfusion requires correction for partial volume loss due to one-dimensional LV wall thickness smaller than scanner resolution.

METHODS: We aimed to assess accuracy of risk stratification for death, MI, or revascularization after PET using partial volume corrections derived from two-dimensional ACR and three-dimensional NEMA phantoms for 3987 diagnostic rest-stress perfusion PETs and 187 MACE events. NEMA, ACR, and Tree phantoms were imaged with Rb-82 or F-18 for size-dependent partial volume loss. Perfusion and Coronary Flow Capacity were recalculated using different ACR- and NEMA-derived partial volume corrections compared by Kolmogorov-Smirnov statistics to standard perfusion metrics with established …

Comparison Of Surgical Versus Transcatheter Aortic Valve Replacement For Patients With Aortic Stenosis At Low-Intermediate Risk, Mahin R Khan, Waleed T Kayani, Malalai Manan, Ahmad Munir, Ihab Hamzeh, Salim S Virani, Yochai Birnbaum, Hani Jneid, Mahboob Alam

Faculty, Staff and Students Publications

BACKGROUND: To compare safety and efficacy of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients at low-intermediate risk, given the paucity of robust data.

METHODS: We performed an aggregate data meta-analysis of 7 randomized controlled trials (RCTs) and 6,778 patients comparing TAVR with SAVR for aortic stenosis (AS) in low-intermediate risk patients (Society of Thoracic Surgeons risk-score ≤8%) using the random-effects model. Primary outcome was all-cause mortality at 30-day, 1-year and 2-year of follow-up. Secondary outcomes included cardiac-mortality, stroke, acute kidney injury (AKI), atrial fibrillation (AF), permanent pacemaker (PPM) implantation, major-bleeding, moderate-severe paravalvular regurgitation (PVR) …

Tortuosity-Powered Microfluidic Device For Assessment Of Thrombosis And Antithrombotic Therapy In Whole Blood, David J Luna, Navaneeth K R Pandian, Tanmay Mathur, Justin Bui, Pranav Gadangi, Vadim V Kostousov, Shiu-Ki Rocky Hui, Jun Teruya, Abhishek Jain

Faculty, Staff and Students Publications

Accurate assessment of blood thrombosis and antithrombotic therapy is essential for the management of patients in a variety of clinical conditions, including surgery and on extracorporeal life support. However, current monitoring devices do not measure the effects of hemodynamic forces that contribute significantly to coagulation, platelet function and fibrin formation. This limits the extent to which current assays can predict clotting status in patients. Here, we demonstrate that a biomimetic microfluidic device consisting stenosed and tortuous arteriolar vessels would analyze blood clotting under flow, while requiring a small blood volume. When the device is connected to an inline pressure sensor …

Cofilin-1-Induced Actin Reorganization In Stored Platelets, Swapan K Dasgupta, Perumal Thiagarajan

Faculty, Staff and Students Publications

BACKGROUND: During platelet storage, there are extensive changes in cytoskeleton and phosphatidylserine exposure. The intrinsic mitochondrial pathway of apoptosis, activated in stored platelets, is a major mediator these changes. Cofilin-1 is an effector of actin reorganization. We examined the effect of cofilin-1 deficiency on cytoskeleton and phosphatidylserine exposure during storage and following activation of apoptosis.

METHODS AND RESULTS: We assessed actin filaments by Alexa-647-phalloidin and phosphatidylserine exposure by fluorescein isothiocyanate-lactadherin by fluorescence microscopy. In fresh platelets, actin filaments are distributed in the subcortical region, and they do not express phosphatidylserine in the outer surface. In stored platelets, there is retraction …

Patient And Physician Predictors Of Ffr/Ifr Utilization In Acs And Sihd, Payal Kohli, Peiqi Wang, Andrew Wang, Lucy Liu, Ali Weinstein, Jeptha P. Curtis, John A. Spertus, Jonathan P. Piccini, Marty Makary, Tyler J Gluckman

Articles, Abstracts, and Reports

Background

Despite guidelines supporting FFR/iFR to guide PCI, these modalities remain underutilized. We sought to characterize factors associated with FFR/iFR use in patients undergoing index PCI for an acute coronary syndrome (ACS) or stable ischemic heart disease (SIHD).

Methods

ICD-9/10 codes were used to identify patients undergoing PCI and receiving FFR/iFR for an ACS (n=1,042,896) or SIHD (n=255,213) in a Medicare claims database from Jan. 1, 2013-June 30, 2018. Patients with functional/anatomical testing were excluded (5d prior in ACS; 60d prior in SIHD). Individuals with FFR/iFR performed 1-60 days prior to PCI were also excluded to limit analysis to non-staged …

The Frequency Of Left Atrial Thrombus On Transthoracic Echocardiogram In Patients With Mitral Stenosis, Khalil Ahmed, Aziz Rehman Memon, Hussain Liaquat Sr, Mustajab Mujtaba, Chander Parkash, Fateh Ali Tipoo Sultan, Musa Karim

Section of Cardiology

Background: Patients with mitral stenosis (MS) are more prone to develop left atrial (LA) thrombus. This cross-sectional study was conducted to determine the frequency of LA thrombus on transthoracic echocardiography (TTE) in patients with MS.
Methods: In this study, we included patients diagnosed with MS undergoing TTE at the echocardiography department of the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. The severity of MS was classified based on the mitral valve area (MVA) as follows: very severe: MVA of ≤1.0 cm²; severe: MVA of ≤1.5 cm²; and mild to moderate: MVA of >1.5 cm^{2 …}

Clinical Characteristics Of Patients Classified As Very High Risk And Not Very High Risk Based On The 2018 Aha/Acc Multi-Society Cholesterol Guideline, Aparna Sajja, Amir Ali, Hsin-Fang Li, Kateri Spinelli, Salim S. Virani, Seth Shay Martin, Tyler J Gluckman

Articles, Abstracts, and Reports

Background

The 2018 AHA/ACC Cholesterol Guideline recommendation to classify ASCVD patients as very high-risk (VHR) vs not-VHR (NVHR) has important implications for ezetimibe and PCSK9 inhibitor eligibility. We aimed to define the clinical characteristics of these two groups within a large multi-state healthcare system in the Western U.S.

Methods

We performed a retrospective cohort analysis of patients defined as having ASCVD in 2018 using EHR ICD-10 codes. VHR was defined by ≥2 major ASCVD events (ACS ≤12 months, history of MI >12 months, ischemic stroke, or symptomatic PAD) or 1 major ASCVD event and ≥2 high-risk conditions (age ≥65, DM, …

A Case Of Pacemaker Syndrome Mimicking A Heart Failure Exacerbation, Seline Haci, Som Aftabizadeh, Senthil Thambidorai, Karan Gupta, Ahsan Khan, Aman Patel, Kimberly Wilson, Anand Subramanian

Cardiology

No abstract provided.

First-In-Human Visone Heart Failure Study: Asymptomatic Diaphragmatic Stimulation For Chronic Heart Failure With Reduced Ejection Fraction: Case Report, Ana Jorbenadze, Nikoloz Shaburishvili, Michael Mirro Md, Facc, Fhrs, Faha, Michel Zuber, Paul Erne, Tamaz Shaburishvili

Parkview Heart Institute

Background

Asymptomatic Diaphragmatic Stimulation (ADS) is a novel device-based HF therapy under investigation. ADS gaited with the cardiac cycle transiently modulates intrathoracic pressure, thereby enhancing pre- and afterload, and stroke volume. It is hypothesized that ADS improves cardiac function and exercise tolerance in HFrEF patients.

Methods

HFrEF patients (15) underwent laparoscopic implantation of the VisONE ADS system (NCT03484780). Post-implant stimulation levels imperceptible to the patient are determined. At discharge, ADS therapy is turned on. Measures of cardiac function, HF status, QoL and adverse events are assessed every 3 months for 12 months.

Results

Results are presented from an initial patient …

Comparison Of Echocardiographic Outcomes Following Transcatheter Aortic Valve Replacement With Edwards S3 23 Mm Versus Medtronic Evolut 26 Mm Valves, Michael Ring, Ruyun Jin, Rollie Parrish, Brydan Curtis, Matthew Forrester, Branden Reynolds, Sameer Gafoor

Articles, Abstracts, and Reports

Background

Patients with small aortic valve annulus (SAVA) undergoing TAVR are prone to higher post TAVR trans-valve gradients. In many such patients, the choice of TAVR valve commonly involves choosing between the Edwards S3 23 mm (ES23) versus the Medtronic Evolut 26 mm (ME26). The supraannular design of the Evolut has been touted as providing superior hemodynamics in SAVA. We sought to compare performance of these two valves in SAVA, particularly in regard to occurrence of elevated trans-valve gradients.

Methods

We queried the Providence St Joseph Health STS/ACC TVT Registry database for patients undergoing TAVR for SAVA with either the …

Differences In Outcomes Of St-Segment Elevation Myocardial Infarction In African American Women Versus Women From Other Races: A United States National Study., Tasleem Katchi, Sanja Virani, Shaun Smithson, Bryan Curry

Cardiology

No abstract provided.

Thrombotic, Inflammatory, And Hif-Regulated Genes And Thrombosis Risk In Polycythemia Vera And Essential Thrombocythemia, Radhika Gangaraju, Jihyun Song, Soo Jin Kim, Tsewang Tashi, Brandi N Reeves, Krishna M Sundar, Perumal Thiagarajan, Josef T Prchal

Faculty, Staff and Students Publications

Thrombosis is a major cause of morbidity and mortality in polycythemia vera (PV) and essential thrombocythemia (ET). The pathophysiology of thrombosis in these disorders remains unclear, and we hypothesized that upregulation of thrombotic, inflammatory, and hypoxia-inducible factor (HIF)-regulated genes may play a role in it. We performed unbiased RNA sequencing in granulocytes and platelets of PV patients and found differential expression of several thrombotic, inflammatory, and HIF-regulated genes. The expression of many of these genes positively correlated with JAK2 expression and JAK2V617F allelic burden. We then validated these findings by quantitative polymerase chain reaction analyses of selected gene transcripts in …

Inflammatory Markers In Bicuspid Transcatheter Aortic Valve Replacement, Molly N. Pantelic, Paul Nona, Dee Dee Wang

Medical Student Research Symposium

Background

Aortic stenosis (AS) has a prevalence of 2%. Valve replacement is the definitive treatment for AS, with transcatheter aortic valve replacement (TAVR) offering a minimally invasive alternative to surgery.

Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality. BAV patients are predisposed to AS, and comprise a distinct, younger TAVR patient population. Given limited prior work on inflammatory markers for TAVR risk assessment, this study sought to investigate if white blood cell count (WBC) correlates with BAV TAVR patient severity and post-TAVR outcomes.

Methods

A single-center retrospective analysis was performed on patients with BAV who underwent TAVR …

Predicting Bleeding And Thrombosis Complications In Patients With Continuous Flow Left Ventricular Assist Devices, Kyle Zacholski, William Kuan, Justin Mccann Mccann, Aric Schadler, Aaron Cook, Sara Parli, Adam Sieg

The VAD Journal

Background: Left ventricular assist device (LVAD) therapy has been proven to relieve heart failure symptoms and improve survival, but is not devoid of bleeding and/or thrombotic complications. Risk stratification tools have been utilized in other cardiovascular disease populations to estimate the risk of bleeding and thrombosis with and without anticoagulation, including the HAS-BLED, HEMORR₂HAGES, CHADS₂ and CHA₂DS₂-VASc models. The study objective was to evaluate the predictive value of available risk models for bleeding and thrombotic complications in patients with an LVAD within one year of implantation.

Methods: This was a retrospective, single-center analysis …

Narrow Escape: A Novel Approach To The Endovascular Treatment Of Superior Vena Cava Syndrome Secondary To Pacemaker Leads With Excellent Long-Term Outcomes, Yury Malyshev, Sergey Ayzenberg, Sonu Sahni, Mazin Khalid, Jeffrey Le

Touro College of Osteopathic Medicine (New York) Publications and Research

Pacemaker or defibrillator placement is a common procedure done in more and more patients due to increased longevity and the prominence of cardiac disease. With more indications for cardiac implantable electrode devices, the devices themselves have evolved into more complex structures with more leads. The mechanical stress, risk of infection, and decreased blood flow through the superior vena cava (SVC) put patients at risk for SVC obstruction. Herein, we present a rare case of complete SVC obstruction secondary to fibrosis due to pacemaker leads which was treated with venoplasty and showed excellent long-term results. We also review the current literature …

Covid-19 Clinical Guidance For The Cardiovascular Care Team, Thomas M. Maddox, Eric C. Stecker, Biykem Bozkurt, Nathalie Demichelis, John U. Doherty, Andrew Freeman, Tyler J Gluckman, Dipti Itchhaporia, Andrew P. Miller, Andrea L. Price, Lonny Reisman, Prem Soman, Mohammad Madjid, Scott D. Solomon, Orly Vardeny

Articles, Abstracts, and Reports

COVID-19 is a quickly evolving public health emergency. The guidance provided in this document is based on the best available published information and expert evaluation. This document is intended to supplement, not supersede, relevant guidance from the Centers for Disease Control and Prevention, state and local health authorities, and your institution’s infectious disease containment, mitigation, and response plan.

Cardiac Biomarkers And Subsequent Risk Of Hospitalization With Bleeding In The Community: Atherosclerosis Risk In Communities Study, Lena Mathews, Junichi Ishigami, Ning Ding, Ron C. Hoogeveen, Anna Kucharska-Newton, Christie M. Ballantyne, Rebecca Gottesman, Elizabeth Selvin, Kunihiro Matsushita

Epidemiology and Environmental Health Faculty Publications

Background

hs-cTnT (high-sensitivity cardiac troponin T), but not NT-proBNP (N-terminal pro-B natriuretic peptide), has been shown to predict bleeding in patients with atrial fibrillation. Whether these biomarkers are independently associated with bleeding in the general population is unknown.

Methods and Results

We used Cox proportional hazards models to examine the association of hs‐cTnT and NT‐proBNP with incident bleeding (defined by International Classification of Diseases, Ninth Revision [ICD‐9] codes) among 9550 middle‐aged men and women without a history of cardiovascular disease or bleeding. There were 847 hospitalizations with bleeding (92% from gastrointestinal bleeding) during a median follow‐up of …

Cardiac Interventions In Patients With Achondroplasia: A Systematic Review., Amrita Sukhavasi, Thomas J O'Malley, Elizabeth J Maynes, Jae Hwan Choi, Jonathan S Gordon, Kevin Phan, Vakhtang Tchantchaleishvili

Jefferson Hospital Staff Papers and Presentations

Patients with achondroplasia and other causes of dwarfism suffer from increased rates of cardiovascular disease relative to the remainder of the population. Few studies have examined these patients when undergoing cardiac surgery or percutaneous intervention. This systematic review examines the literature to determine outcomes following cardiac intervention in this unique population. An electronic search was performed in the English literature to identify all reports of achondroplasia, dwarfism, and cardiac intervention. Of the 5,274 articles identified, 14 articles with 14 cases met inclusion criteria. Patient-level data was extracted and analyzed. Median patient age was 55.5 [interquartile ranges (IQR), 43.8, 59.8] years, …

Anomalous Origin Of The Left Coronary Artery From The Pulmonary Artery: A Surgical Certainty, Ayesha Butt, Muhammad Muneer Amanullah, Mehnaz Atiq Ahmed, Asif Hasan, Waris Ahmad

Medical College Documents

This study aims to assess the clinical presentation and the outcomes of a surgical correction of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). A retrospective review was carried out on the charts of six patients admitted for ALCAPA surgery at Aga Khan University Hospital, Karachi from March 2017 to May 2018.Dyspnoea, palpitation, poor feeding, fatiguability, pallor and a murmur of mitral regurgitation were the main presenting features. The pre-operative median left ventricular ejection fraction (LVEF) was 64%. Coronary reimplantation was performed in all the patients with a mitral valve repair being done in only …

Continuity Of Care And Outpatient Management For Patients With And At High Risk For Cardiovascular Disease During The Covid-19 Pandemic: A Scientific Statement From The American Society For Preventive Cardiology, Amit Khera, Seth J. Baum, Ty J. Gluckman, Martha Gulati, Seth S. Martin, Erin D. Michos, Ann Marie Navar, Pam R. Taub, Peter P. Toth, Salim S. Virani

Office of the Provost

The coronavirus disease 2019 (COVID-19) pandemic has consumed our healthcare system, with immediate resource focus on the management of high numbers of critically ill patients. Those that fare poorly with COVID-19 infection more commonly have cardiovascular disease (CVD), hypertension and diabetes. There are also several other conditions that raise concern for the welfare of patients with and at high risk for CVD during this pandemic. Traditional ambulatory care is disrupted and many patients are delaying or deferring necessary care, including preventive care. New impediments to medication access and adherence have arisen. Social distancing measures can increase social isolation and alter …