Cardiology Commons^™

Coronary Artery Calcification In Rheumatoid Arthritis Patients, Stephanie Nagy, Jordan J. Ditchek, Marc M. Kesselman

HCA-NSU MD Research Day

Objective: To assess the need of coronary artery calcium scoring (CACS) in the standardized management of patients with rheumatoid arthritis (RA) for early identification, prevention of coronary artery obstruction and complications. Background: Worldwide, RA is a leading inflammatory arthropathy. The musculoskeletal impacts of RA are well known; however, the inflammatory nature of the disease extends beyond the joint synovium. The cardiovascular system is the most impacted and the leading cause of death. Recently, CACS has become a popular method to analyze the calcifications within the coronary vessels. Methods: A review was performed using CINHAL, OVID, EMBASE, and Web of Science. …

Recent Developments In Tirzepatide's Role In Reducing Cardiovascular Disease Risk Factors In Adults With Type 2 Diabetes, Talaya Jones, Zaneh Kahook, Carina Bryan, Mayur Parmar

HCA-NSU MD Research Day

Objective: This literature review aims to investigate recent developments in tirzepatide’s ability to lessen CVD risk factors for adults with increased risk of major adverse cardiovascular events. Background: Tirzepatide is an FDA - approved medication primarily used to treat adults with type 2 diabetes mellitus (T2DM) by reducing A1C and chronic weight management, however its efficacy for reducing CVD risk factors is under examination. Methods: This review synthesizes data from recent early findings published by the pharmaceutical company, which has not yet undergone peer review, alongside existing literature on tirzepatide. Additional sources were identified through a systematic search of PubMed, …

When Aml Strikes Twice: A Case Of Acute Myeloid Leukemia With Concurrent Myopericarditis And Acute Pancreatitis, Veronica Benitez, Gabriella A. Morey, Veronica Benitez, Roberto H. Ruiz

HCA-NSU MD Research Day

Introduction: Acute myeloid leukemia (AML) is a hematological malignancy characterized by the proliferation of undifferentiated hematopoietic stem cells, leading to symptoms like fatigue, fever, and bleeding. While AML can infiltrate various organs, myocardial and pancreatic involvement are extremely rare, with myopericarditis and acute pancreatitis being particularly uncommon. Case Description: A 72-year-old hispanic female with a history of pancreatitis and autoimmune disorders presented with worsening lower abdominal pain, dysuria, nausea, and vomiting. Her pancreatitis resolved, but she subsequently developed chest pain and was diagnosed with acute pericarditis. Her elevated white blood cell count, predominantly monocytic, led to the diagnosis of AML …

Lifestyle Effects On An Unusual Presentation Of Syncope: A Case Report, Rishma Gattu, Nisarg Shah, Ramya Ravulapalli, Vania Rodriguez, Gary Merlino

HCA-NSU MD Research Day

Introduction: This case study explores a unique presentation of syncope with a multifactorial etiology and discusses the impact of lifestyle behaviors on syncope exacerbation. Scant literature exists on behavioral modifications affecting cardiogenic responses. Case Presentation: We present a 53 year old Hispanic male with a past history of palpitations and chronic marijuana use coming to the emergency department (ED) with three episodes of sudden loss of consciousness that occurred after starting his job as a night shift worker, which led to severe chronic sleep deprivation. These episodes lacked prodromal (chest pain, shortness of breath, palpitations, diaphoresis) and postictal (drowsiness, nausea, …

Management Of Aorto-Right Ventricular Fistulas After Tavr, Ricardo Chia, Chamaka Kalutota, Kerry Cao, Steven Douedi, William Chang, Dominic Pinciotti, Mohammad Beizaeipour, Jennifer Joiner, Daniel Ice, Ronald Ross, Richard Kovach, Chunguang Chen, Muhammad Raza

Division of Cardiology Faculty Papers

This clinical case series reviews the diagnosis and management of aorto-right ventricular fistulas post-transcatheter aortic valve replacement, highlighting 3 cases. We emphasize early detection, individualized treatment strategies, and the role of multidisciplinary heart teams in achieving favorable outcomes. Comprehensive imaging and procedural planning are crucial for successful intervention and management of this rare complication.

Successful Transcatheter Mitral Valve Mass Extraction With Complete Resolution Of The Severe Mitral Regurgitation, Hussam Al Hennawi, Ahmad Abulshamat, Shaurya Srivastava, Mohammed Qintar

Abington Jefferson Health Papers

Interest has arisen in exploring the off-label application of left-sided percutaneous mechanical aspiration, where conventional management strategies may not suffice. Percutaneous mechanical aspiration has been shown to be effective as a diagnostic and therapeutic intervention in select patients with infective endocarditis. This paper hereby reports the first case of a successful transeptal large bore manual aspiration device (AlphaVac; Angiodynamics) for nonbacterial thrombotic endocarditis with total resolution of associated severe mitral valve regurgitation.

What Makes An Effective Chief Of Pediatric Cardiology: Insights From Chiefs Of North American Pediatric Programs, Michael E. Kim, Wayne Franklin, Anne M. Dubin, Jeffrey J. Kim, Shubhayan Sanatani, R. Krishna Kumar, Shubhika Srivastava, Thomas R. Kimball, Mark Lewin, Joseph Rossano, Colin J. Mcmahon

Department of Medicine Faculty Papers

BACKGROUND: Although the position of a pediatric cardiology chief is often seen as the apex of one's academic career, its roles, responsibilities, and qualifications are not well defined in the literature. This study was done to gain further insight of the role and attributes of a pediatric cardiology chief by surveying those who are currently serving the position across North American centers.

METHODS AND RESULTS: This was a mixed-methods study with a survey given to North American pediatric cardiology chiefs at programs with fellowship training programs. The survey was a semistructured questionnaire that was independently reviewed by 3 cardiologists. Smaller …

Trends In Transcatheter Versus Surgical Aortic Valve Replacement Outcomes In Patients With Low-Surgical Risk: A Systematic Review And Meta-Analysis Of Randomized Trials, Sina Kazemian, Parisa Fallahtafti, Mohammad Sharifi, Negin Sadat Hosseini Mohammadi, Hamidreza Soleimani, Arman Soltani Moghadam, Elaheh Karimi, Yaser Sattar, Yaser Jenab, Mehdi Mehrani, Alimohammad Hajizeinali, Mina Iskander, Mehrshad Fathian Sabet, Negar Salehi, Karim Al-Azizi, Diaa Hakim, Mahboob Alam, Kaveh Hosseini

Faculty, Staff and Students Publications

Background: Limited data exist on long-term outcomes after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). This meta-analysis aims to elucidate outcome trends following TAVR versus SAVR in patients with severe aortic stenosis and low-surgical risk.

Methods and results: A systematic search was conducted in PubMed, Embase, Scopus, and the Cochrane Library databases from inception until May 2024, to identify studies comparing TAVR versus SAVR in patients with low-surgical risk (Society of Thoracic Surgeons predicted risk of mortality score < 4%). The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, stroke, disabling stroke, rehospitalization, myocardial infarction, aortic valve reintervention, permanent pacemaker implantation, and new-onset atrial fibrillation. Binary random-effects models were used to compare the risk of each outcome across various follow-up intervals and the risk of bias was assessed using the Cochrane Collaboration's Risk of Bias-2 tool. The meta-analysis included 6 randomized trials including 4682 patients. TAVR was associated with a lower risk of all-cause mortality than SAVR in the 30-day (hazard ratio [HR: 0.45] [95% CI: 0.26-0.77], I2: 0%) and 30-day to 1-year (HR: 0.55 [95% CI: 0.37-0.81], I2: 16%) follow-ups. However, the …

Acute Mitral Regurgitation Presenting As Unilateral Pulmonary Edema, Jacob Seth Psomiadis, Austin Kim Md, Whitnee Otto Md, Kavitha Vemuri Md

Advances in Clinical Medical Research and Healthcare Delivery

Acute mitral regurgitation caused by papillary muscle rupture is a rare and life-threatening complication of myocardial infarction. This devastating complication can present as unilateral cardiogenic pulmonary edema which can be easily mistaken for other cardiopulmonary pathology, resulting in delay of care. Proper evaluation and diagnosis is key for obtaining timely surgical evaluation. Here we present a case of an 87-year-old male with a past medical history of coronary artery disease status post percutaneous intervention with one stent, cerebrovascular accident status post left carotid stenting, and Alzheimer’s dementia that presented to the emergency department with a chief complaint of exertional dyspnea …

Protein Consumption And Risk Of Cvd Among Us Adults: The Multi-Ethnic Study Of Atherosclerosis (Mesa), Ji Yun Tark, Ruosha Li, Bing Yu, Alexis C Wood, Nikhil S Padhye, Marcia C De Oliveira Otto

Faculty, Staff and Students Publications

BACKGROUND: Although some randomized trials have reported beneficial effects of protein intake on cardiometabolic risk factors, evidence from prospective studies have not supported a strong link between protein intake and cardiovascular disease (CVD) risk. It is also unclear whether diversity in protein intake plays a role in CVD risk.

OBJECTIVE: We investigated prospective associations of (1) protein intake, overall and by food source and (2) diversity of protein sources with risk of CVD, coronary heart disease (CHD), and stroke.

METHODS: In a multi-ethnic cohort of 5879 U.S. adults (45-84 years), who were free of CVD at baseline, protein intake was …

Conservative Approach Versus Percutaneous Coronary Intervention In Patients With Spontaneous Coronary Artery Dissection From A National Population-Based Cohort Study, Chayakrit Krittanawong, Beatriz Castillo Rodriguez, Song Peng Ang, Yusuf Kamran Qadeer, Zhen Wang, Mahboob Alam, Samin Sharma, Hani Jneid

Faculty, Staff and Students Publications

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a rare and often underdiagnosed cause of acute coronary syndrome (ACS), predominantly affecting younger women without traditional cardiovascular risk factors. The management of SCAD remains a subject of debate, likely secondary to inconclusive evidence. This study aims to compare the clinical outcomes of SCAD patients treated with optimal medical therapy (OMT) versus those who underwent percutaneous coronary intervention (PCI) using a national population-based cohort.

METHODS: We conducted a retrospective analysis using the National Inpatient Sample (NIS) database from 2016 to 2020. The study included patients identified with SCAD using the ICD-10-CM (the International …

Impact Of Participation In Cardiac Rehabilitation Post Myocardial-Infarction: An Integrative Review, Zoie Maynard, Mallory Stinson

Master's Projects

As one of the most common causes of hospitalization, the prevalence of myocardial infarction is indisputable Since this condition is so ubiquitous, a treatment protocol is initiated with methods to help patients modify their lifestyle, treat their underlying disease process, educate them to prevent reoccurrence, and improve their healthcare outcomes. This protocol relies heavily on the use of cardiac rehabilitation. Despite the implementation of this treatment protocol, the concern for recurrence and rehospitalization remains. The goal of this integrative review is to determine how participation in cardiac rehabilitation post-myocardial infarction impacts healthcare outcomes including rates of rehospitalization and depression. The …

Seasons Of Kawasaki Disease During The Covid-19 Pandemic., Todd T. Nowlen, Ashraf S. Harahsheh, Geetha Raghuveer, Simon Lee, Anji T. Yetman, Nagib Dahdah, Michael A. Portman, Supriya S. Jain, Michael Khoury, Selemet Tierney, Cedric Manlhiot, Pedrom Farid, Brian W. Mccrindle

Manuscripts, Articles, Book Chapters and Other Papers

The incidence of Kawasaki Disease has a peak in the winter months with a trough in late summer/early fall. Environmental/exposure factors have been associated with a time-varying incidence. These factors were altered during the COVID-19 pandemic. The study was performed through the International Kawasaki Disease Registry. Data from patients diagnosed with acute Kawasaki Disease and Multiple Inflammatory Syndrome-Children were obtained. Guideline case definitions were used to confirm site diagnosis. Enrollment was from 1/2020 to 7/2023. The number of patients was plotted over time. The patients/month were tabulated for the anticipated peak Kawasaki Disease season (December-April) and non-peak season (May-November). Data …

Vital Exhaustion And Biomarkers Associated With Cardiovascular Risk: The Aric Study, Matthew R Deshotels, Mahmoud Al Rifai, Caroline Sun, Ali Agha, Elizabeth Selvin, B Gwen Windham, Viola Vaccarino, Erin D Michos, Hani Jneid, Glenn N Levine, Christopher Fagundes, Salim S Virani, Christie M Ballantyne, Vijay Nambi

Faculty, Staff and Students Publications

BACKGROUND: Vital exhaustion, defined as excessive fatigue, demoralization, and irritability due to chronic stress, is independently associated with cardiovascular disease (CVD).

OBJECTIVES: The purpose of this study was to examine the association of vital exhaustion with biomarkers associated with CVD risk in the ARIC (Atherosclerosis Risk In Communities) study.

METHODS: We examined the cross-sectional association of vital exhaustion (assessed using the Maastricht Vital Exhaustion Questionnaire [MVEQ]) with cardiac biomarker (high-sensitivity troponin T [hs-TnT], N-terminal pro-B-type natriuretic peptide [NT-proBNP]) and high-sensitivity C-reactive protein (hs-CRP) levels in 11,542 ARIC study participants without CVD at ARIC visit 2 using multivariable logistic and linear …

Health Literacy And Perceived Control: Intermediary Factors In The Relationship Between Race And Cardiovascular Disease Risk In Incarcerated Men In The United States, Jennifer L. Miller, Misook L. Chung, Lovoria B. Williams, Alison R. Connell, Zyad T. Saleh, Abdullah S. Alhurani, Alison L. Bailey, Mary Kay Rayens, Debra K. Moser

UK CARES Faculty Publications

Background: Black race, inadequate health literacy, and poor perceived control are predictors of increased cardiovascular disease (CVD) risk. The purpose of this study was to explore the relationships among race, health literacy, perceived control, and CVD risk while controlling for known risk factors in incarcerated men. Methods: We included data from 349 incarcerated men to examine race and CVD risk (Framingham Risk Score) using a serial mediation model with health literacy and perceived control using 95% confidence intervals (CIs) from 5000 bootstrap samples. Results: Of the participants (age, 36 ± 10; education, 12 ± 2; body mass index, 28.3 ± …

Three-Year Outcomes Following Tavr In Younger (<75 Years) Low-Surgical-Risk Severe Aortic Stenosis Patients., Thomas Modine, Didier Tchétché, Nicolas M Van Mieghem, G Michael Deeb, Stanley J Chetcuti, Steven J Yakubov, Paul Sorajja, Hemal Gada, Mubashir Mumtaz, Basel Ramlawi, Tanvir Bajwa, John Crouch, Paul S Teirstein, Neal S Kleiman, Ayman Iskander, Rodrigo Bagur, Michael W A Chu, Pierre Berthoumieu, Arnaud Sudre, Rik Adrichem, Saki Ito, Jian Huang, Jeffrey J Popma, John K Forrest, Michael J Reardon

Heart and Vascular Articles

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis, but data are limited on younger, low-risk patients. This analysis compares outcomes in low-surgical-risk patients agedsurgery.

METHODS: The Evolut Low Risk Trial randomized 1414 low-risk patients to treatment with a supra-annular, self-expanding TAVR or surgery. We compared rates of all-cause mortality or disabling stroke, associated clinical outcomes, and bioprosthetic valve performance at 3 years between TAVR and surgery patients aged < 75 >years.

RESULTS: In patients < 75 >years, 352 were randomized to TAVR and 351 to surgery. Mean age was 69.1±4.0 years (minimum 51 and maximum …

Analysis Of The Correlation Between In-Hospital Adverse Events And Transcatheter Aortic Valve Replacement Outcomes, Stanislava Matejin, Pavel Poredos, Anja Boc, Vinko Boc, Wahaj Aman, Igor D. Gregoric, Biswajit Kar

Journal of Shock and Hemodynamics

Transcatheter aortic valve replacement (TAVR) has been recommended as the standard treatment for elderly patients with severe aortic stenosis (AS) and those at increased risk for conventional surgical procedures. Recently, TAVR has been recognized as the treatment of choice for intermediate-risk patients or even low-risk populations with AS. Our study aimed to identify factors influencing adverse events after TAVR procedures. This single-center, retrospective cohort study involved patients with severe AS treated with TAVR from 2016 to 2019. The patient’s electronic medical record was reviewed, and those with valve-in-valve replacements and missing demographical data were excluded. We analyzed risk factors related …

Comparison Of Sternotomy Access Versus Thoracotomy Access In The Surgical Treatment Of Aortic Coarctation: A Propensity Score-Matched Study, Ilya A. Soynov, Ksenya A. Rzayeva, Yuriy N. Gorbatykh, Yuriy Yu. Kulyabin, Artem V. Gorbatykh, Ilya A. Velyukhanov, Nataliya R. Nichay, Serezhan. Manukian, Saihuna A. Magbulova, Aleksey N. Arkhipov, Aleksander V. Bogachev-Prokophiev

Journal of the Saudi Heart Association

Background: The search for the "Holy Grail" of surgical repair for aortic coarctation involves finding an access and correction method that successfully and consistently avoids aortic recoarctation and arterial hypertension. The controversy persists as there is still no consensus on the best surgical approach and technique to achieve these objectives. Objective: The objective of this study is to compare sternotomy and left thoracotomy as surgical techniques for treating patients with aortic coarctation and hypoplasia of the distal aortic arch. Methods: From January 2008 to December 2020, 103 patients (21 %) were performed using an extended oblique anastomosis. They were divided …

Right Heart Failure After Tricvalve Implantation For Symptomatic Torrential Tricuspid Regurgitation: A Case Report, King Sum Luk, Chun Kit Wong

Journal of the Hong Kong College of Cardiology

Patients with symptomatic torrential tricuspid regurgitation (TR) presenting with right heart failure are associated with significant morbidity and mortality. While medical therapy is often ineffective, the perioperitive risks of surgical correction are high. Transcatheter TricValve implantation is one of the evolving therapeutic options for this condition with many unanswered questions. We reported a case of life-threatening right heart failure after transcatheter TricValve implantation despite initial improvement. Important considerations of TricValve implantation are discussed. In particular, careful patient selection and evaluation with perioperative echocardiogram are of paramount importance.

Digital, Social Micro-Interventions To Promote Physical Activity Among Midlife Adults With Elevated Cardiovascular Risk: An Ambulatory Feasibility Study With Momentary Randomization., Danielle Arigo, Leah M Schumacher, Kiri Baga, Jacqueline A Mogle

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Although regular physical activity (PA) mitigates the risk for cardiovascular disease (CVD) during midlife, existing PA interventions are minimally effective. Harnessing social influences in daily life shows promise: digital micro-interventions could effectively engage these influences on PA and require testing.

PURPOSE: This feasibility study employed ecological momentary assessment with embedded micro-randomization to activate two types of social influences (i.e., comparison, support; NCT04711512).

METHODS: Midlife adults (N = 30, MAge = 51, MBMI = 31.5 kg/m2, 43% racial/ethnic minority) with ≥1 CVD risk conditions completed four mobile surveys per day for 7 days while wearing PA monitors. After 3 days …