Cardiology Commons^™

Cardiac Amyloid, The Great Imitator, Nolan R. Fox, Nicholas J. Fox, Emily Newman, Brian Osler, Eugene Storozynsky

Division of Cardiology Faculty Papers

BACKGROUND: Although endomyocardial biopsy (EMB) is the criterion standard for diagnosis of infiltrative cardiac disease, cardiac sarcoidosis (CS) or cardiac amyloid can be diagnosed noninvasively through both clinical suspicion and advanced imaging techniques of cardiac magnetic resonance imaging (CMR) or cardiac positron emission tomography (PET).

CASE SUMMARY: A 79-year-old man with mediastinal sarcoidosis presented with new chest pain and a right bundle branch block, raising concern for CS. CMR and cardiac PET also supported the diagnosis of CS, but EMB ultimately revealed transthyretin amyloid cardiomyopathy. The patient was started on tafamidis and showed improvement at 1-year follow-up.

DISCUSSION: This case …

Genetic Factors Associated With Myocardial Infarction In Saudi Arabia, Abdullah Saeed, Abdullah Alshafea, Hussain Aldaghaies, Abdullatif Saeed, Abdulrahman Alshehri

Journal of the Saudi Heart Association

Introduction:

Myocardial infarction (MI) is one of the leading causes of mortality in Saudi Arabia, with individuals sharing genetic, lifestyle, and environmental risk factors. The present investigation aimed to review the literature on genetic susceptibility to MI among Saudi individuals, with a specific emphasis on genome-wide association studies (GWAS) for coronary artery disease (CAD) and MI. Studies have revealed the relationship between polymorphisms in genes such as proprotein convertase subtilisin/kexin type 9 (PCSK9), cholesteryl ester transfer protein (CETP), and cyclin-dependent kinase inhibitor 2B antisense RNA 1 (CDKN2B-AS1), which are involved in lipid metabolism, inflammation, and endothelial function.

Methods:

This PROSPERO-registered …

Renal Denervation Improves Cardiac Function And Exercise Duration In A Miniswine Model Of Heart Failure With Preserved Ejection Fraction, David J. Lefer, Thomas E. Sharp, Amy L. Scarborough, Amelia G. Haydel, Sanjiv J. Shah, Zhen Li, Traci T. Goodchild

School of Medicine Faculty Publications

Aims: Overactivity of the sympathetic nervous system is a common underlying mechanism in development and progression of several heart failure with preserved ejection fraction (HFpEF) comorbidities. Decreasing renal sympathetic nerve activity using catheter-based renal denervation (RDN) systems have shown efficacy in treating resistant hypertension and cardiac dysfunction in heart failure with reduced ejection fraction. The purpose of this study was to determine if modulation of renal sympathetic nerve activity by RDN improves cardiac function and exercise tolerance in a clinically-relevant minipig model of cardiometabolic HFpEF. Methods and results: Multiple HFpEF comorbidities were induced in adult female Göttingen minipigs by mineralocorticoid …

Impact Of Transcatheter Aortic Valve Implantation (Tavi) On Left Ventricular Mass, Volumes, And Pressure. A Single-Center Echocardiographic Analysis, Fouad Taiwilaa Alshammari, Afrah Asaad Alonazi, Mohammed Dhaifallah Almutairi, Khaled Ahmed Majrashi, Atheer Mansour Almutairi, Muhammad Azam Shah

Journal of the Saudi Heart Association

Background: Transcatheter aortic valve implantation (TAVI) is an alternative treatment for surgically high-risk patients with severe aortic stenosis (AS). This study aimed to assess the echocardiographic outcomes of TAVI in patients with severe AS, focusing on left ventricular mass, volume, and pressure.

Methods: This retrospective,registry-based, single-center study was conducted at King Salman Heart Center, Riyadh, Saudi Arabia. We included 200 adult patients who underwent the TAVI procedure and completed at least one year of clinical and echocardiographic follow-up. Baseline demographic, clinical, and echocardiographic data were collected and paired pre- and post-procedure echocardiographic measurements were analyzed.

Result: Paired analysis …

Can The Location Of Angina Predict The Site Of Coronary Artery Occlusion In Acute Myocardial Infarction? – The Acolyte Study, Kamal Sharma, Ashwati Konat, Poojan Prajapati, Kavya Darji, Shalin Rawal, Vatsa Bhavsar, Prahar Darji, Yashrajsinh Gohil, Masum Patel, Shubham Patel, Parjanya Bhatt, Yashvi Pethani, Stuti Shah, Hardik Desai

Journal of the Saudi Heart Association

Aim: To evaluate the relationship between the location of chest pain (topography) and the site of coronary artery involvement in patients with acute coronary syndrome (ACS) undergoing percutaneous transluminal coronary angioplasty (PTCA).

Materials and Methods: This prospective, observational study included 411 consecutive ACS patients admitted to a tertiary care center between January 2017 and December 2019. A total of 589 angina topographic sites were analyzed. The site and characteristics of chest pain, along with electrocardiogram and coronary angiography findings, were documented and assessed for correlation with the involved coronary artery.

Results: Among the 411 patients, 337 (82.0%) were male and …

Effect Of Cardiac Rehabilitation Program On Left Ventricular Systolic Function In Patients With Breast Cancer Receiving Anthracycline-Based Chemotherapy Using Two-Dimensional Speckle Tracking Echocardiography, Sarah Mohamed Abdelhady, Ahmed Kadry Araquib, Adel Mohamed Shabana, Adel Gamal Hassanein, Ramy Raymond Elias

Journal of the Saudi Heart Association

Objectives: Anthracyclines used in the treatment of breast cancer are known for their cumulative cardiotoxic effect. Two-dimensional speckle tracking echocardiography is a promising technique in detection of subclinical cardiotoxicity. Cardio-oncology rehabilitation is a new field aiming to decrease the risk of cardiovascular diseases and improve cardiopulmonary fitness among cancer patients

Methods: The study included 100 female patients with de novo breast cancer and treated with anthracycline-based chemotherapy. Patients were randomly assigned into two groups in a 1:1 ratio. Group (1) included patients who were allocated to cardiac rehabilitation program in addition to their regular chemotherapeutic drugs and group 2 …

Artificial Intelligence-Enhanced Ecg For Hypertrophic Cardiomyopathy Diagnosis: A Systematic Review And Meta-Analysis, Fernando (Alonzo) Theja, Louis (Fabio Jonathan) Jusni, Robby Soetedjo, Dimetrio (Alonzo) Theja

Journal of the Saudi Heart Association

Objectives: Diagnosing hypertrophic cardiomyopathy (HCM) can be challenging due to its nonspecific clinical manifestations, variability in electrocardiographic (ECG) patterns, and limited access to echocardiography, the gold standard for diagnosis, often leading to delayed detection. Recent artificial intelligence (AI) advancements have enabled ECG-based algorithms to improve HCM detection. This systematic review and meta-analysis aim to assess the overall diagnostic performance of AI-enhanced ECG in identifying HCM.

Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Articles were retrieved from PubMed, EBSCO, and Proquest. Inclusion criteria encompassed all studies evaluating AI algorithms for the detection of …

Turning Analysis Into Action: Opportunities And Challenges In Implementing Wastewater Science For Public Health Decision-Making, Anna Gitter, Valeria Ruvalcaba, Katelyn Clark, Theresa Tran Carapucci, Fuqing Wu, Blake M Hanson, Jennifer Deegan, John Balliew, Eric Boerwinkle, Anthony W Maresso, Kristina D Mena

Faculty, Staff and Students Publications

In the 5 years since the emergence of the COVID-19 pandemic, the field of wastewater-based epidemiology (WBE) has dramatically expanded with programs implemented across the globe to monitor for SARS-CoV-2 and other viruses of public health concern. However, the best way to use wastewater surveillance data and inform local communities of the utility of wastewater science remains limited and sporadically discussed. Specifically, there is vague guidance regarding interpreting varying levels of viral loads in wastewater for public health significance. While collaborative efforts are key to implementing these community-specific wastewater surveillance programs, effectively using the data for public health decision-making still …

A Multicenter, Propensity Score-Matched Analysis Of Functional Outcomes And Recanalization Success With Or Without Trevo For Medium And Distal Vessel Occlusion, James E Siegler, Manisha Koneru, Hamza Shaikh, Hamza Adel Salim, Basel Musmar, Nimer Adeeb, Vivek Yedavalli, Motaz Daraghma, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Sherief Ghozy, Luca Scarcia, Benjamin Yq Tan, Jeremy J Heit, Robert W Regenhardt, Rami Z Morsi, Tareq Kass-Hout, Nicholas Vigilante, Nicole M Cancelliere, Joshua D Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil A Sheth, Muhammed Amir Essibayi, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Thomas R Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, Piers Klein, Mohamad Abdalkader, Thanh N Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor R Gonzalez, Markus A Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Christoph J Griessenauer, David S Liebeskind, Alessandro Pedicelli, Andrea M Alexandre, Illario Tancredi, Tobias D Faizy, Erwah Kalsoum, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Jane Khalife, Ankit Rana, Adrien Guenego, Adam A Dmytriw, Mad Mt Investigators

Faculty, Staff and Student Publications

BackgroundEndovascular therapy (EVT) for stroke due to distal or medium vessel occlusion (DMVO) is safe. Due to the distinct anatomical characteristics of DMVOs, further evaluation of EVT is crucial to determine which devices may yield better outcomes.MethodsA retrospective analysis of adults with DMVO treated in 37 centers (11 countries) was queried. The primary outcome of favorable shift in 90-day modified Rankin Scale (mRS) was compared between patients treated with Trevo versus other devices on first pass using 1:1 propensity score matching (PSM) with multivariable adjustment. Secondary outcomes included the number of pass attempts, final thrombolysis in cerebral infarction (TICI) score …

Dietary Intake Of Protein By Food Source And Incident Hypertension Among Diverse Us Adults: The Mesa Study, Ji Yun Tark, Ruosha Li, Bing Yu, Alexis C Wood, Nikhil S Padhye, Marcia C De Oliveira Otto

Faculty, Staff and Student Publications

Background: Dietary guidelines recommend adequate protein intake from diverse sources for optimal blood pressure; however, its role in hypertension risk remains unclear. We examined prospective associations of protein intake and diversity, overall and by source, with hypertension risk in the MESA (Multi-Ethnic Study of Atherosclerosis) study.

Methods and results: Among 2294 participants aged 45 to 84 years without hypertension at baseline, total, animal, and plant protein intake was assessed using a 120-item food frequency questionnaire. Protein diversity was evaluated using count and the dissimilarity index. Over a 9-year median follow-up, 1356 hypertension cases were identified through blood pressure measurements and …

Effects Of Genetic Polymorphisms On The Oct1 And Oct2-Mediated Uptake Of Atenolol, Mollie Margaret Walton Md, Jonathan Wagner Do, Ceclia E. Villanueva Phd, Bruno Hagenbuch Phd

Research Days

This project characterizes the role of OCT1 and OCT2 on cellular uptake of atenolol and tests the hypothesis that OCT1 and OCT2 proteins with genetic polymorphisms, when expressed in vitro, will result in altered cellular uptake of atenolol relative to the reference genotype. This approach utilizes transiently transfected OCT1 and OCT2 cell assays to perform time-dependent atenolol uptake experiments to generate kinetics information. The goal is to provide a better understanding of polymorphisms associated with OCT1 and OCT2 expression and function as a means to individualize pharmacologic therapy for atenolol.

When The Right Ventricle Fails After Left Ventricular Assist Device Implantation: Prediction Tools, Recognition Strategies, And Support Options, Juan Jose Rodriguez Arias, James Schurr, Phyllis Billia, Joyce W. Wald

Journal of Shock and Hemodynamics

The incidence of right heart failure (RHF) during durable left ventricular assist device (LVAD) surgery ranges from 9% to 42%, depending on the definition. RHF can be divided into three peri-implantation categories: early acute, early, and late. Despite many available risk models, predicting RHF before durable LVAD implantation has been difficult. Preemptive right-sided temporary mechanical circulatory support can improve outcomes; however, if intraoperative RHF is not suspected, early recognition and appropriate intervention after surgery are important.

Duration Of Labor And Umbilical Artery Acidosis In Critical Congenital Heart Disease, Sarah Gwazdacz Md, Teresa Nguyen Bs, Mary Donofrio Md, Faap, Facc, Fase, Timothy Bennett Md, Amanda Mcintosh Md, Faap, Facc.

Research Days

Standard delivery protocols for most prenatally diagnosed CCHD is induction of labor at 39 weeks with aims of a vaginal delivery (VD) near a tertiary care center. There is no benefit to planned Cesarean delivery (CD) over VD for most infants with CCHD. However, longer durations of labor (DOL) in CCHD have been described as a risk factor for umbilical artery (UA) acidosis. We aim to describe the relationship between DOL and UA pH and neonatal outcomes in those with prenatally diagnosed CCHD.

Retrospective chart review of prenatally diagnosed with CCHD born at Children’s Mercy from 2012 – 2023. Inclusion …

Identifying Unnecessary And Excessive Use Of Intravenous Heparin For The Treatment Of Intermediate-Risk Pulmonary Embolism, Youssef Elfatatry, Ryan Gardner, Chukwuemezie Kamanu, Ruben Rhoades

Health Equity and Quality Improvement (HEQI) Summit

Problem Statement

- Intermediate-risk pulmonary embolism (PE) is a diagnosis with heterogenous presentations and mortality rates ranging from 2% to 15%.

- European Society of Cardiology (ESC) guidelines recommend low-molecular weight heparin (LMWH) as first line therapy in most patients. Despite this, the use of IV heparin in intermediate-risk PE remains widespread, due to uncertainty regarding patients receiving further procedures and mitigation of bleeding risk.

Project AIM:

- We aim to (1) identify prescribing patterns and outcomes of anticoagulant therapy on admission, and (2) propose and implement a "PE Care Pathway" in EPIC to address uncertainty in risk-stratifying and treating …

By The Book: A Look At Whether Guidelines Impact Clinical Decision Making In Sglt2i Prescriptions, Marc Mounzer, Vacha Shah, Antony Fuleihan, Brian Osler

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• Specialty-specific guidelines reduce medical errors and support clinical decision- making
• Effective implementation requires timeliness and accuracy, often limited by systemic barriers
• This study investigates factors affecting sodium glucose cotransporter 2 inhibitor (SGLT2i) prescribing in heart failure to enhance guideline adherence and care quality

Pcsk-9 Inhibitors Treatment: The Cardiovascular Disparity, Julia Lees, Seana-Pierre Williams, Tahir Razzaq, Michael B. Roberts

The Journal of Integrated Primary Care

Introduction: According to the Center for Disease Control and Prevention (CDC) and American Heart Association (AHA), cardiovascular disease is the leading cause of death in the United States. This phenomenon disproportionally affects the African American population, who have a 31% higher mortality rate than non-Hispanic Caucasian individuals. A retrospective review of PCSK-9 medication use, specifically in a patient population that had minimal representation in the large, landmark clinical trials, can lead to better understanding about the therapeutic potential in cardiovascular disease reduction and patient outcomes attributed to medication use. Education regarding this novel drug class, medication access and patient support, …

Prevalence Of Cardiovascular-Kidney-Metabolic Stages In Us Adolescents And Relationship To Social Determinants Of Health, Carissa M. Baker-Smith, Abigail M. Gauen, Lucia C. Petito, Sadiya S. Khan, Norrina B. Allen

Department of Pediatrics Faculty Papers

BACKGROUND: Risk factors for atherosclerotic cardiovascular disease begin in youth. Knowledge of the prevalence of cardio-kidney-metabolic (CKM) syndrome in adolescents and its risk factors is critical to understanding the cause of atherosclerotic cardiovascular disease risk burden.

METHODS: We conducted a cross-sectional analysis of the 2017 to 2020 US National Health and Nutrition Examination Survey data and determined the prevalence of each CKM stage in adolescents aged 12 to 18 years. We then assessed the relationship between the family income-to-poverty ratio, health insurance, routine health care access, food security, health behaviors, and CKM stage. We quantified associations between social factors, behaviors, …

Variables Affecting Neurodevelopmental Outcome In Infants With Critical Congenital Heart Disease, Elizabeth Loughman, Julie Weiner Do, Marcie Files Md

Research Days

Background: The mortality of cardiac conditions in infancy is improving with advances in surgical planning and medical management. Neurologic morbidity remains significant. Clinically correlating an infant with their neurologic exam, MRI/EEG, and subsequent developmental testing remains a challenge. Counseling regarding neurologic outcomes after cardiac intervention is difficult due to the wide range of findings that can sometimes be clinically irrelevant.

Purpose: The goal of this study is to identify factors associated with poor neurodevelopmental outcomes in infants with critical congenital heart defects (CCHD) as assessed by the Bayley Scales of Infant and Toddler Development Edition IV (Bayley).

Methods: This is …

Ecmo Without Compressions Versus Ecpr For Lcos Following Cardiac Surgery, Amjad Halloum, Apurva Panchal, Sarah Tabbutt, Martina Steurer, Mousumi Banerjee, John Charpie, Javi Lasa, Amy Mccammond, Katie Moynihan, Nancy Ghanayem, Tia Raymond

Research Days

A retrospective study looking into ECMO vs eCPR outcomes in the CICU. By refining the approach to postoperative ECMO initiation, this study aims to contribute valuable insights that could improve survival and reduce complications in pediatric cardiac surgery patients.

Assessing Ecg Abnormalities In Pediatric Athletes: A Retrospective Study On Incidence And Implications For Screening Protocols, Arkadeep Ghosh, Mark Gelatt, Lindsey Malloy-Walton, Ashley K. Sherman

Research Days

Background: Utilization of Electrocardiogram (ECG) screening in pediatric athletes remains controversial. The American Heart Association (AHA) hasn't supported the use of mandatory ECG screening for pediatric sports evaluations. The financial burden universal ECG screening in pediatric athletes poses on the healthcare system has supported that screening may not be justified given the low incidence of significant cardiac disease.

Objectives/Goal: This study aimed to examine the incidence, type of ECG abnormalities, and associated risk factors in healthy pediatric athletes.

Methods/Design: A single center retrospective cohort study was conducted on a local male youth competitive soccer program, ages 11-18. Exempt status was …