Cardiology Commons^™

Hydropneumopericardium Due To Esophageal-Pericardial Fistula: A Rare Complication Of Esophageal Stenting, Svenja Schneider, Margaret Doyle, Suzanna Talento, Waqas Ullah, Gregary D. Marhefka

Division of Cardiology Faculty Papers

We present a case of a 53-year-old woman with a history of ulcerative esophagitis and esophageal stricture status post esophageal stenting that was complicated by stent migration. She presented with fatigue, melena, and dark output from her percutaneous endoscopic gastrostomy tube. An echocardiogram showed hydropneumopericardium with cardiac tamponade physiology requiring emergent pericardiocentesis. The aspirated fluid was brown and cloudy; pathology of the fluid showed meat and vegetable matter consistent with food. She ultimately required esophagectomy with esophagostomy. This case highlights the importance of early recognition of esophageal-pericardial fistulas, as delay in the management carries a high risk for morbidity and …

The Role Of Adolescent Depression Heterogeneity And Resilience Resources In Adulthood Cardiometabolic Health And Depressive Symptoms, Samantha R. Scott

Electronic Theses and Dissertations

Depression in adolescence is a major public health problem and is a risk factor for early-onset cardiometabolic disease. Although adolescent depression is a risk factor for poor cardiometabolic health, depression is heterogeneous and associations may differ by sex. Additionally, if risk factors such as depression can predict adulthood cardiometabolic health, resilience factors (e.g., social, school, neighborhood) that are protective for depression may also be protective for physical health, but this is an ongoing area of research. The goals of the current dissertation were to gain a better understanding of what depressive symptom presentations in adolescents are most concerning for adulthood …

Plug And Coil Procedure For Management Of Large Postinfarct Ventricular Septal Defect, Hussam Al Hennawi, Sergio Flores, Michael Little, Lacy Harville, Ahmad Almomani, Muhammad Hammadah

Abington Jefferson Health Papers

Acute surgical mortality for postinfarction ventricular septal rupture remains alarmingly high at approximately 50%. In comparison, medical mortality is nearly 100% and likely exceeds historical levels because of the declining frequency of these acute surgeries, with many surgeons now performing fewer than 1 or 2 annually. Percutaneous device closure has become a feasible option for managing postinfarction ventricular septal defects in carefully selected patients. However, this technique may be associated with challenges such as significant residual shunting, delayed endothelialization, hemolysis, and extended hospital stays. Here, we present a novel approach using coil packing to enhance closure and reduce shunting.

Comparative Analysis Of Speckle-Tracking Echocardiography And Cardio-Specific Markers For Early Detection Of Cardiotoxicity In Patients With Breast Cancer, Begimaia Akbalaeva, Salman Khan, Priti Singh, Mukhtar Ansari, Muteb Alanazi

Journal of the Saudi Heart Association

Objectives: Breast cancer (BC) treatment often involves cardiotoxic chemotherapy, leading to potential cardiac dysfunction. Early detection of cardiotoxicity is crucial for timely intervention and improved patient outcomes. This study aims to compare the effectiveness of speckle-tracking echocardiography (STE) and cardiospecific markers in detecting early signs of cardiotoxicity in BC patients undergoing chemotherapy.

Methods: The study included 45 women (mean age, 55.8±12 years) diagnosed with HER-2 positive BC. They were treated with doxorubicin and cyclophosphamide for the first four cycles (group-1), docetaxel and Trastuzumab for the second four cycles (group-2), and Trastuzumab for the third four cycles or more subsequent …

Persistent Activation Of Cardiac Fibroblasts Contributes To Myocardial Interstitial Fibrosis And Left Ventricular Dysfunction In Heart Failure, Rachel Biggs

MUSC Theses and Dissertations

Heart Failure (HF) is a complex clinical syndrome that is defined by an inability of the heart to meet the oxygen demands of the body. Myocardial interstitial fibrosis (MIF), the diffuse overaccumulation of extracellular matrix (ECM) proteins within the cardiac interstitium, contributes to ventricular dysfunction in HF. Mechanical devices designed to alleviate left ventricular deficiencies, termed left ventricular assist devices (LVADs), provide a pump that delivers oxygenated blood to the aorta thereby decreasing hemodynamic load on the ventricle. This end-stage HF therapy alleviates symptomatic burden for HF patients, however, LVAD support does not reduce MIF in the LV, and myocardial …

Atrial Fibrillation In An Elite Athlete: Continuous Ecg Monitoring Guiding Therapy And Return To Play., Sean M Muir, Auroa Badin, Anne R Albers, Kanny Grewal

Heart and Vascular Articles

BACKGROUND: The diagnosis of atrial fibrillation (AF) is increasing among elite athletes. This case highlights the novel use of an implantable loop recorder to guide treatment decisions for AF in an elite soccer player.

CASE SUMMARY: A 25-year-old professional soccer player who had received a diagnosis of asymptomatic AF during routine screening underwent cardioversion and continuous monitoring with an implantable loop recorder. A rising AF burden prompted ablation.

DISCUSSION: This case demonstrates the potential utility of advanced monitoring technologies for managing AF in athletes, particularly when symptoms are absent or minimal. Additional studies are needed to confirm whether continuous monitoring …

Racial And Ethnic Representation And Study Engagement In A Siteless Digital Clinical Trial Using A Smartwatch: Findings From The Apple Heart Study., Kaylin T. Nguyen, Jingzhi Yu, Haley Hedlin, Adam T. Phillips, Sumbul Desai, Lauren Cheung, Peter R Kowey, Sneha S. Jain, John S. Rumsfeld, Andrea M. Russo, Christopher B. Granger, Mellanie True Hills, Manisha Desai, Kenneth W. Mahaffey, Mintu P. Turakhia, Marco V. Perez

Department of Medicine Faculty Papers

OBJECTIVE: To evaluate differences in study engagement in diverse racial/ethnic groups that have been significantly underrepresented in atrial fibrillation and digital clinical trials.

PATIENTS AND METHODS: This was a secondary analysis of participants from the Apple Heart Study, a prospective, siteless, single-arm pragmatic clinical trial from November 29, 2017, to January 31, 2019. Black, Hispanic, Asian, and White participants were monitored using an irregular rhythm notification algorithm designed to detect atrial fibrillation on a smartwatch. Logistic regression was performed to evaluate the relationship between race/ethnicity and completion of the first study visit after an irregular rhythm notification, adjusting for demographic …

Xbp1s-Edem2 Prevents The Onset And Development Of Hfpef By Ameliorating Cardiac Lipotoxicity, Oveena Fonseka, Rida Raja, Claire Ross, Sanskruti R Gare, Jiayan Zhang, Susanne S Hille, Katharine King, Andrea Ruiz-Velasco, Namrita Kaur, Xinyi Chen, Jessica M Miller, Riham R E Abouleisa, Qinghui Ou, Zhiyong Zou, Xiangjun Zhao, Cristian Sotomayor-Flores, Derk Frank, Eileithyia Swanton, Martin R Pool, Sara Missaglia, Daniela Tavian, Gabriele G Schiattarella, Tao Wang, Luigi Venetucci, Christian Pinali, Martin K Rutter, Bernard D Keavney, Elizabeth J Cartwright, Tamer M A Mohamed, Oliver J Müller, Wei Liu

Center for Medical Ethics and Health Policy Staff Publications

Background: Morbidity and mortality of heart failure with preserved ejection fraction (HFpEF) is increased in metabolic disorders. However, options for preventing and treating these prevalent outcomes are limited. Intramyocardial lipotoxicity contributes to cardiac dysfunction. Here, we investigate the mechanisms underlying EDEM2 (endoplasmic reticulum degradation-enhancing alpha-mannosidase-like protein 2) regulation of cardiac lipid homeostasis and assess strategies that inhibit the incidence and progression of HFpEF.

Methods: Metabolic stress was induced in C57BL/6 male mice using a high-fat diet and Nω-nitro-L-arginine methyl ester. The recombinant adeno-associated virus 9 delivery system was used for loss- and gain-of-function studies. Palmitic acid and oleic acid …

Reducing Respiratory Compromise In The Cardiac Cath Lab With An Innovative Practice Change, Kathryn Cepero, Melanie Jorgenson, Christopher Brown, Juan N Pulido, Mary Jo Kelly

2025 Swedish FISH (Fostering Interdisciplinary Solutions in Healthcare) Conference

No abstract provided.

Impact Of Gum Chewing On Postoperative Ileus Following Open Heart Surgery, Jacinta Smith, Mary Jo Kelly

2025 Swedish FISH (Fostering Interdisciplinary Solutions in Healthcare) Conference

No abstract provided.

Silent But Deadly: A Case Of Obtuse Marginal Artery Occlusion., Austin M Miller, Vishal Tharani, Erin Fraser, Howard W Levitin

Heart and Vascular Articles

The obtuse marginal artery (OMA) is a key branch of the left circumflex coronary artery, supplying blood to the lateral wall of the left ventricle. OMA occlusions can result in myocardial ischemia and serious cardiac events, often presenting with subtle or atypical electrocardiogram (EKG) changes, unlike the more pronounced alterations observed with left anterior descending artery occlusions. This case report discusses a 57-year-old female presenting with chest pain and shortness of breath, indicative of acute coronary syndrome. The patient's initial EKG showed occasional premature ventricular contractions (PVCs), T-wave flattening in aVL, and 1 mm ST elevation in V6, but otherwise, …

Coronary Inflammation And Atherosclerosis By Ccta In Young Adults (Aged 18–45), Annalisa Filtz, Daniel Lorenzatti, Henry A Dwaah, Carlos Espiche, Santiago F Galgani, Jake T Gilman, Alexandrina Danilov, Andrea Scotti, Piotr J Slomka, Daniel S Berman, Salim S Virani, Mario J Garcia, Khurram Nasir, Leslee J Shaw, Ron Blankstein, Michael D Shapiro, Damini Dey, Leandro Slipczuk

Faculty, Staff and Students Publications

Background: Peri-coronary adipose tissue attenuation (PCAT), a marker of coronary inflammation, is linked to coronary artery disease (CAD), but data on the role of PCAT in young individuals are limited.

Aims: This study explores the interplay of PCAT and CAD by CCTA, in a symptomatic young cohort.

Methods and results: Patients aged 18-45 years without prior CAD, from Montefiore CCTA registry (2016-2022), were studied retrospectively. Atherosclerosis and PCAT of the left circumflex (LCX), left anterior descending (LAD), and right coronary artery (RCA) were measured. Youden index determined optimal PCAT thresholds for the risk of CAD, defined as presence of any …

Worldwide Prevalence Of Chagas Cardiomyopathy-An Analysis From The Global Burden Of Disease Dataset, Abdul Mannan Khan Minhas, Rachel Marcus, Salim S Virani, Michael D Shapiro, Robert J Mentz, Luis E Echeverria, Jonathan T Arcobello, Dmitry Abramov

Faculty, Staff and Students Publications

Purpose: The worldwide prevalence of Chagas Cardiomyopathy (CCM) as well as the trends in the prevalence of CCM over time have not been well characterized.

Methods: An analysis of the Global Burden of Disease (GBD) data from 1990 to 2019 was conducted to assess the burden of CCM. This study focused on determining the prevalence of CCM, along with its age-standardized prevalence rate (ASR) per 1,00,000 people, considering various patient demographics and geographical regions as defined in the GBD. Additionally, the study examined the temporal trends over this 30-year period by calculating the estimated annual percentage change (EAPC) in CCM …

Longitudinal Trends In Pediatric Survival By Congenital Heart Defect In Texas, 1999 To 2017, Sara B Stephens, Shaine A Morris, Renata H Benjamin, Mark A Canfield, Charles J Shumate, Ruosha Li, Cecilia Cazaban-Ganduglia, A J Agopian

Faculty, Staff and Student Publications

Background: Despite previously improved survival among children with congenital heart defects (CHDs), U.S. population-level evaluations of survival within recent years are scarce.

Objectives: The purpose of this study was to describe the survival landscape among children with CHDs in a large population-based birth defects registry overall and by CHD lesion.

Methods: This population-based cohort study evaluated 1999 to 2017 live births with ≥1 major CHD in the statewide Texas Birth Defects Registry. Variables included CHD lesion, demographics, gestational age at birth (term/preterm), low birthweight (< 2,500 g at birth), among others. Kaplan-Meier analyses were used to describe survival to 7 days, 28 days, 1 year, 5 years, and 10 years of life. Kaplan-Meier survival estimates were generated for 1-year survival for CHDs overall by lesion, using log-rank tests assessing differences by exposure.

Results: Of 61,656 children with CHDs, survival was 98.1% and 90.7% at 7 days and …

Validity And Reliability Of The Tampa Scale For Kinesiophobia For Adolescents With Heart Disease., David A. White, William R. Black, Emily Cramer, Lindsey Malloy-Walton, Mollie Walton, Laura Martis, Brandy Enneking, Kelli M. Teson, Jessica S. Watson, Jami Gross-Toalson

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: To assess the validity and reliability of a newly adapted Tampa Scale for KP for adolescents with HD (TSK-Heart-A).

METHODS: The TSK-Heart-A survey consists of 17 Likert scale items, producing a summary score (SS) ranging from 17 (low KP) to 68 (high KP). Following content and face validity, adolescents (age 12-18 yr) with arrhythmia disorders or Fontan palliation were recruited. The PROMIS pediatric anxiety and depression short forms, Pediatric Quality of Life Inventory (PedsQL) generic core and cardiac module, and a PA questionnaire for adolescents (PAQ-A) were used for criterion validity. The TSK-Heart-A was completed twice (20.4 ± 6.3 …

Bridging Genomics To Cardiology Clinical Practice: Artificial Intelligence In Optimizing Polygenic Risk Scores: A Systematic Review, Kaveh Hosseini, Nazanin Anaraki, Parham Dastjerdi, Sina Kazemian, Mandana Hasanzad, Mohamad Alkhouli, Mahboob Alam, Khurram Nasir, Jamal S Rana, Ami B Bhatt

Faculty, Staff and Students Publications

Despite advances in cardiovascular disease risk stratification, traditional risk prediction models often fail to identify high-risk individuals before adverse events occur, underscoring the need for more precise tools. Polygenic risk scores (PRS) quantify genetic susceptibility by aggregating genetic variants but face challenges in practice. This systematic review investigates how artificial intelligence (AI) and machine learning algorithms can optimize PRS (AI-optimized PRS) to improve cardiovascular disease prediction. Analyzing 13 studies, we found that AI-optimized PRS models enhance predictive accuracy by improving feature selection, handling high-dimensional data, and integrating diverse variables-including clinical risk factors, biomarkers, imaging, and combining multiple PRS. These models …

Managing Hypercholesterolemia In Adults Older Than 75 Years Without A History Of Atherosclerotic Cardiovascular Disease: An Expert Clinical Consensus From The National Lipid Association And The American Geriatrics Society, Vera Bittner, Sunny A Linnebur, Dave L Dixon, Daniel E Forman, Ariel R Green, Terry A Jacobson, Ariela R Orkaby, Joseph J Saseen, Salim S Virani

Faculty, Staff and Students Publications

The risk of atherosclerotic cardiovascular disease increases with advancing age. Elevated LDL-cholesterol and non-HDL-cholesterol levels remain predictive of incident atherosclerotic cardiovascular events among individuals older than 75 years. Risk prediction among older individuals is less certain because most current risk calculators lack specificity in those older than 75 years and do not adjust for co-morbidities, functional status, frailty, and cognition which significantly impact prognosis in this age group. Data on the benefits and risks of lowering LDL-cholesterol with statins in older patients without atherosclerotic cardiovascular disease are also limited since most primary prevention trials have included mostly younger patients. Available …

Association Between Timing Of Angiotensin Ii Administration And Outcomes In Vasoplegia After Cardiac Surgery, Travis J Miles, Michael T Guinn, Orlando R Suero, Todd K Rosengart, Marc R Moon, Joseph S Coselli, Ravi K Ghanta, Subhasis Chatterjee

Faculty, Staff and Students Publications

Objective: Vasoplegic shock after cardiopulmonary bypass (CPB) is a highly morbid condition. The novel vasopressor angiotensin II is increasingly being used for catecholamine-resistant vasoplegia. Although early intervention with adjunctive therapies such as methylene blue can improve outcomes of vasoplegia, the optimal timing for escalation with angiotensin II is unknown.

Methods: Pharmacologic data were extracted from electronic health records for patients who underwent surgery with CPB during 2017-2022. Patients were identified who received angiotensin II intraoperatively or postoperatively (ie, early or late). Multivariable logistic regression was used to determine the risk-adjusted effects of earlier angiotensin II administration on postoperative major adverse …

Antiarrhythmic Drug Use In Atrial Fibrillation Among Different European Countries – As Determined By A Physician Survey, Espen Fengsrud, Carina Blomström-Lundqvist, A. John Camm, Andreas Goette, Peter R. Kowey, Jose L. Merino, Jonathan P. Piccini, Sanjeev Saksena, James A. Reiffel, Giuseppe Boriani

Department of Medicine Faculty Papers

BACKGROUND: There is limited knowledge of physicians' antiarrhythmic drug (AAD) treatment practices for patients with atrial fibrillation and adherence to guidelines in European countries.

METHODS: An online survey (n = 321) of cardiologists, cardiac electrophysiologists and interventional electrophysiologists was conducted in Germany (DE; n = 83), Italy (IT; n = 95), Sweden (SE; n = 60) and the United Kingdom (UK; n = 83) including 96 questions on treatment practices.

RESULTS: ESC guidelines were the most important non-patient factor influencing treatment practice (55-72 %). However, while amiodarone was frequently (88-93 %) used in heart failure with reduced left ventricular ejection …

3- And 4-Dimensional Flow Cmr In D-Transposition Of The Great Arteries After Atrial Switch Operation., Sara Santiaguel, Laura Schoeneberg, Ugonna Nwankwo, Jorge Rosado Gonzalez, Wilson King

Manuscripts, Articles, Book Chapters and Other Papers

A 19-year-old man with D-transposition of the great arteries and pulmonary stenosis underwent atrial switch operation and pulmonary valvotomy in infancy. He was lost to follow-up and presented with multiple respiratory infections. An echocardiogram was inconclusive due to poor windows. Cardiac magnetic resonance (CMR) was performed using ferumoxytol 3-dimensional whole heart and 4-dimensional flow pulse sequences, which demonstrated this patient's complex anatomy and physiology. CMR revealed severe pulmonary venous baffle obstruction. A 3-dimensional printed model was created from the CMR and provided key information for planning the complex catheterization approach required to stent the pulmonary venous baffle.