Cardiology Commons^™

Future Perspectives In Acute Myocarditis Complicated By Cardiogenic Shock, Giovanni A. Tavecchia, Iside Cartella, Enrico Ammirati

Journal of Shock and Hemodynamics

Acute myocarditis is an inflammatory disease of the myocardium with a highly variable clinical course. Fulminant myocarditis (FM) represents the most threatening scenario with hemodynamic compromise and cardiogenic shock at presentation. Despite medical advances and the availability of promising mechanical circulatory support (MCS), FM is burdened by a dismal prognosis. Early referral to tertiary hospitals with MCS facilities and prompt diagnosis with endomyocardial biopsy are critical steps toward optimal management. Moreover, beyond supportive care, the prevention of irreversible myocardial damage with immunomodulating therapies must be proven in clinical trials. In this editorial, we briefly describe current evidence and future perspectives …

Surviving Sepsis Campaign: Strategies To Implement In Cardiogenic Shock Management, James Burke Md

Journal of Shock and Hemodynamics

The Surviving Sepsis Guidelines can serve as a structure to help educate and create a set of recommendations on how to care for patients through this complicated pathway of shock. Designing a cardiogenic shock bundle could reduce the variability of care and possibly improve survival. Also, a more standard protocol would allow a review of the outcomes and a system to change practice nationally when new data or technology becomes available. This could create a continuous quality improvement cycle. Creating a “Surviving Cardiogenic Shock” system could help provide awareness for recognition of cardiogenic shock and advanced management alternatives needed at …

Role Of Invasive Hemodynamics In Shock Management: Is A Pulmonary Artery Catheter Always Necessary?, Ajay J. Kirtane

Journal of Shock and Hemodynamics

The pulmonary artery (PA) catheter can be a useful tool in the management of patients with cardiogenic shock; however, there are challenges with the use of this catheter, and clinicians must balance the risks and benefits. In addition, clinicians must properly interpret data generated from a PA catheter in the context of other data to optimize a patient's hemodynamics.

Systematic Review And Meta-Analysis Of Mid-Term Survival, Reoperation, And Recurrent Mitral Regurgitation For Robotic-Assisted Mitral Valve Repair, Michael L. Williams, Aditya Eranki, Andrew Mamo, Ashley Wilson-Smith, Bridget Hwang, Ramanen Sugunesegran, Tristan Yan, Emiliano Navarra, T. Sloane Guy, Johannes Bonatti

Department of Surgery Faculty Papers

Background: Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term data for RMVr.

Methods: Electronic searches of five databases were performed to identify all relevant studies reporting minimum five-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and from moderate or worse mitral regurgitation (MR) …

Synchronized Diaphragmatic Stimulation For Heart Failure With A Reduced Left Ventricular Ejection Fraction Using The Visone System: A First-In-Patient Study With Extended Population, Ana Jorbenadze Md, Lee R. Goldberg Md, Tamaz Shaburishvili Md, Michel Zuber Md, Michael Mirro Md, Facc, Fhrs, Faha, Marat Fudim Md,Mh

Parkview Heart Institute

Highlights

• Synchronized diaphragmatic stimulation (SDS) is a new extra-cardiac HFrEF therapy
• SDS impacts intrathoracic pressure and pericardial restraint•
• SDS exhibits a favorable safety profile over 1 year of chronic use
• Exercise tolerance and QOL improved with SDS over 1 year
• Early results will soon be validated in a randomized control trial

Abstract

Background

Cardiac Biomarkers In Differentiating Kawasaki Disease And Multisystem Inflammatory Syndrome In Children Associated With Covid-19, Mollie Walton, Geetha Raghuveer, K Kamakoti, N Dahdah, L Garrido, S Tierney, T Harris, M Khoury, M Hicar, E Braunlin, D Thacker, M Khare, F Dallaire, R Lowndes, I Glassmeyer, J Ballweg, G Goldenberg, S Merves, C Manlhiot, P Farid, Bw Mccrindle

Posters

Introduction – Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show considerable clinical overlap making differentiation challenging, particularly in the absence of evidence of evidence of prior COVID-19. Hypothesis – Cardiac biomarkers can differentiate KD from MIS-C. Methods – The International KD Registry enrolled n=2903 contemporaneous KD, MIS-C and acute COVID-19 pediatric patients from 42 sites in 8 countries from January 2020 through July 2022. The study population was confined to 1489 MIS-C patients meeting CDC criteria with confirmed evidence of prior COVID-19 infection and 387 KD patients meeting AHA guideline criteria with confirmed evidence …

Prevalence Of High Blood Pressure Among Youth In India And Association With Future Cardiovascular Disease, Abbas H. Zaidi, Sarah D. De Ferranti

Department of Pediatrics Faculty Papers

No abstract provided.

Successful Long-Term Anticoagulation With Low Molecular Weight Heparin In A Patient With Mechanical Mitral Valve And Atrial Flutter, Narjis Aljaziri, Meshail Saleh Alkhaleel, Norah Alrajhi, Mohammed Alghamdi, Ahmed Aljizeeri

Journal of the Saudi Heart Association

Mechanical heart valves are associated with high risk of thrombosis and thromboembolic complications. Vitamin K antagonist is the only approved oral medication for the anticoagulation in cases of mechanical heart valves. This poses a challenge in cases where vitamin K antagonists are contraindicated. Although temporary anticoagulation with low molecular weight heparin is common among pregnant patients with mechanical heart valves, data about long term anticoagulation with low molecular weight heparin is limited. We report a successful long-term anticoagulation with low molecular weight heparin in a patient with mechanical mitral valve and atrial flutter.

Prevent Vascular Access Complications By Adopting A Vascular Access Assessment Improvement Process In The Adultdialysis Unit, Ana Lopez Franco

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Patient Outcomes: Stemi Diagnosis In The Emergency Care Center (Ecc) Resulting In Subsequent Pci Procedures, Laura Derr

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Diaphragmatic Function In Cardiovascular Disease: Jacc Review Topic Of The Week., Husam M Salah, Lee R Goldberg, Jeroen Molinger, G Michael Felker, Willard Applefeld, Tienush Rassaf, Ryan J Tedford, Michael Mirro Md, Facc, Fhrs, Faha, John G F Cleland, Marat Fudim

Parkview Heart Institute

In addition to the diaphragm's role as the primary respiratory muscle, it also plays an under-recognized role in cardiac function. It serves as a pump facilitating venous and lymph return, modulating left ventricular afterload hemodynamics and pericardial pressures, as well as regulating autonomic tone. Heart failure (HF) is associated with diaphragmatic changes (ie, muscle fiber atrophy and weakness, increased ratio of type I to type II muscle fibers, and altered muscle metaboreflex) that lead to diaphragmatic dysfunction with subsequent symptomatic manifestations of HF. Herein, it is proposed that targeting the diaphragm in patients with HF via inspiratory muscle training or …

The Development And Implementation Of Evidence-Based Preanesthesia Assessment Tools For Lvad Patients Undergoing Non-Cardiac Procedures, Tracey Rooney, Casey Weimer, Eileen Giardino, Kerry Shanklin, Pete Pelletier, Audrey Rosenblatt

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Abstract

A university-affiliated tertiary medical center with a newly developed Advanced Heart Failure and Mechanical Circulatory Support program identified the need to implement a more systematic approach to the preanesthesia assessment process for patients with a Left Ventricular Assist Device (LVAD) undergoing noncardiac procedures and standardized guidelines to determine the best blood pressure monitoring system for patients with an LVAD during these noncardiac procedures. A multidisciplinary panel of clinical experts developed an LVAD Preanesthesia Toolkit using standard recommendations identified via evidence-based literature and expert opinion. The Toolkit included an LVAD Preanesthesia Assessment (VaPA) tool and an LVAD Blood Pressure Monitoring …

Highlights Of The 2021 Brano Heart Failure Forum, Rajko Radovancevic, Bojan Vrtovec, Igor D. Gregoric

The VAD Journal

Since 2007, the Branislav “Brano” Radovancevic Heart Failure Forum has been held annually to provide a venue for experts to present and discuss “Innovations and New Treatment Strategies in Heart Failure.” Clinicians and researchers gather yearly in a different Eastern European city to discuss the latest in heart failure diagnostics and therapeutics. The forum was postponed in 2020 due to the COVID-19 pandemic and then resumed in September of 2021 in Graz, Austria. It was attended by over 75 faculty from 13 countries. Due to the ongoing pandemic, 13 presentations were given virtually. Throughout the forum, 17 separate sessions focused …

Serum High Mobility Group Box-1 Levels Associated With Cardiovascular Events After Lower Extremity Revascularization: A Prospective Study Of A Diabetic Population, Maria Margherita Rando, Federico Biscetti, Andrea Leonardo Cecchini, Elisabetta Nardella, Maria Anna Nicolazzi, Flavia Angelini, Roberto Iezzi, Luis H. Eraso, Paul J Dimuzio, Dario Pitocco, Antonio Gasbarrini, Massimo Massetti, Andrea Flex

Department of Surgery Faculty Papers

Background: Peripheral arterial disease (PAD) is one of the most disabling cardiovascular complications of type 2 diabetes mellitus and is indeed associated with a high risk of cardiovascular and limb adverse events. High mobility group box-1 (HMGB-1) is a nuclear protein involved in the inflammatory response that acts as a pro-inflammatory cytokine when released into the extracellular space. HMBG-1 is associated with PAD in diabetic patients. The aim of this study was to evaluate the association between serum HMGB-1 levels and major adverse cardiovascular events (MACE) and major adverse limb events (MALE) after lower-extremity endovascular revascularization (LER) in a group …

Chronic High Salt Diets Contribute To Neurogenic Hypertension By Increasing B1r Expressionand B1r-Mediated Ace2 Internalization And Degradation, Jagnoor Benipal, Navya Lakkapa, Anna Nuzzo, Mona Elgazzaz, Eric Lazartigues

Medical Research Day

The Centers for Disease Control and Prevention estimates that hypertension affects nearly 50% of Americans1 . Previous studies have shown that chronically elevated dietary salt intake contributes to developing neurogenic hypertension2 . Additionally, increased expression of the bradykinin B1 receptor (B1R) in neurons in the hypothalamic paraventricular nucleus (PVN) is seen in neurogenic hypertension which leads to neuroinflammation and oxidative stress3 . Angiotensin-converting enzyme 2 (ACE2) is a key enzyme in the renin-angiotensin system (RAS) pathway that mitigates the vasoconstrictive effects of Angiotensin (Ang) II by cleaving it to Ang-(1-7)4 . We previously observed that the binding of Ang-II to …

Barriers That Contribute To Disparities Seen In The Prenatal Diagnosis Of Congenital Heart Disease In Patients With Government-Funded Health Insurance, Olivia Crapanzano, Lauren Haddad, Kathleen Crapanzano

Medical Research Day

BACKGROUND: Multiple national studies have established an inverse relationship between surgical center volume and surgical outcomes in pediatric cardiac surgery. The aim of the initial study was to determine whether surgical outcomes for a private, outpatient pediatric cardiology practice that was not associated with a surgical center, differed based on the surgical center volume to which the patient was referred. While we did not find significant differences in clinical outcomes related to surgical center volume, race or insurance status during the initial study, important disparities to care were identified. Children with private insurance were more likely to be diagnosed prenatally …

Validating Contrast-Enhanced Infarct Characterization Of A Novel Manganese-Based Positive Contrast Agent In A Porcine Model Of Myocardial Ischemia Reperfusion, Benjamin Bonner, Salva Yurista, Jaume Coll-Front, Shi Chen, Robert Eder, Anna Foster, Khoi Nguyen, Peter Caravan, Eric Gale, Christopher Nguyen

Medical Research Day

Background: Late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) is an effective and reproducible method for characterizing myocardial infarction (MI). However, gadolinium-based contrast agents are contraindicated in patients with acute and chronic renal insufficiency. This is particularly problematic in the setting of CMR where the coincidence of heart and renal disease is approximately 3 0%. There is therefore a clinical need for alternative forms of MRI contrast agents that are acceptable in the setting of renal insufficiency. Methods: We consider two positive MR contrast agents: gadoteric acid (DOTA), a clinically employed gadolinium-based agent; and RVP-001, a structurally similar manganese-based compound. …

Retrospective Comparison Of Patients ≥ 80 Years With Atrial Fibrillation Prescribed Either An Fda-Approved Reduced Or Full Dose Direct-Acting Oral Anticoagulant, Roy Taoutel, Michael D. Ezekowitz, Usman A. Chaudhry, Carly Weber, Dana Hassan, Ed J. Gracely, Mohammed H. Kamareddine, Benjamin I. Horn, Glenn R. Harper

Department of Medicine Faculty Papers

Direct-acting oral anticoagulants (DOACs) represent the standard for preventing stroke and systemic embolization (SSE) in patients with atrial fibrillation (AF). There is limited information for patients ≥ 80 years. We report a retrospective analysis of AF patients ≥ 80 years prescribed either a US Food and Drug Administration (FDA)-approved reduced (n = 514) or full dose (n = 199) DOAC (Dabigatran, Rivaroxaban, or Apixaban) between January 1st, 2011 (first DOAC commercially available) and May 31st, 2017. The following multivariable differences in baseline characteristics were identified: patients prescribed a reduced dose DOAC were older (p < 0.001), had worse renal function (p = 0.001), were more often prescribed aspirin (p = 0.004) or aspirin and clopidogrel (p < 0.001), and more often had new-onset AF (p = 0.001). SSE and central nervous system (CNS) bleed rates were low and not different (1.02 vs 0 %/yr and 1.45 vs 0.44 %/yr) for the reduced and full dose groups, respectively. For non-CNS bleeds, rates were 10.89 vs 4.15 %/yr (p < 0.001, univariable) for the reduced and full doses, respectively. The mortality rate was 6.24 vs 1.75 %/yr (p = 0.001, univariable) for the reduced and full doses. Unlike the non-CNS bleed rate, mortality rate differences remained significant when adjusted for baseline characteristics. Thus, DOACs in patients ≥ 80 with AF effectively reduce SSE with a low risk of CNS bleeding, independent of DOAC dose. The higher non-CNS bleed rate and not the mortality rate is explained by the higher risk baseline characteristics in the reduced DOAC dose group. Further investigation of the etiology of non-CNS bleeds and mortality is warranted.

A Critical Review Of Medication Adherence In Hypertension: Barriers And Facilitators Clinicians Should Consider, Seyed Mehrdad Hamrahian, Omar H. Maarouf, Tibor Fülöp

Department of Medicine Faculty Papers

Hypertension is a global public health problem, and its prevalence is increasing worldwide. Impacting all human societies and socioeconomic strata, it remains the major modifiable risk factor for global burden of cardiovascular disease all-cause mortality and the leading cause of loss of disability-adjusted life years. Despite increased awareness, the rate of blood pressure control remains unsatisfactory, particularly in low-to middle-income countries. Apparent treatment-resistant hypertension is associated with worse adverse health outcomes. It includes both true resistant and pseudo-resistant hypertension, which requires out-of-office blood pressure monitoring to exclude white-coat effect and confirmation of adherence to the agreed recommended antihypertensive therapy. The …

Successful Percutaneous Management Of Lvad Outflow Graft Stenosis: Role Of Invasive Hemodynamics In Decision Making, Tarun Dalia, Amandeep Goyal, Harsh Mehta, Henedine C. Foster, Eric Hockstad, Aaron Rohr, Philip Johnson, Travis Abicht, Bhanu Gupta

The VAD Journal

Left ventricular assist device (LVAD) outflow graft stenosis (OGS) is a rare but lethal complication. We present a case of a 79-year-old male with pertinent past medical history of an LVAD implanted as destination therapy, stage III chronic kidney disease, and hypertension. He was admitted for low-flow alarms, and the echocardiogram showed stable right ventricle function and no pericardial effusion. Invasive hemodynamic assessments demonstrated a peak-to-peak gradient of 90 mm Hg in the outflow graft between the mid and distal ends of the graft on pullback. Contrast angiography confirmed OGS. The OGS was successfully treated with a VBX-covered stent (Gore). …