Cardiology Commons^™

Antithrombin, Protein C, And Protein S: Genome And Transcriptome-Wide Association Studies Identify 7 Novel Loci Regulating Plasma Levels, Yuekai Ji, Gerard Temprano-Sagrera, Lori A Holle, Allison Bebo, Jennifer A Brody, Ngoc-Quynh Le, Kadri Kangro, Michael R Brown, Angel Martinez-Perez, Colleen M Sitlani, Pierre Suchon, Marcus E Kleber, David B Emmert, Ayse Bilge Ozel, Dre'von A Dobson, Weihong Tang, Dolors Llobet, Russell P Tracy, Jean-François Deleuze, Graciela E Delgado, Martin Gögele, Kerri L Wiggins, Juan Carlos Souto, James S Pankow, Kent D Taylor, David-Alexandre Trégouët, Angela P Moissl, Christian Fuchsberger, Frits R Rosendaal, Alanna C Morrison, Jose Manuel Soria, Mary Cushman, Pierre-Emmanuel Morange, Winfried März, Andrew A Hicks, Karl C Desch, Andrew D Johnson, Paul S De Vries, Charge Consortium Hemostasis Working Group, Invent Consortium, Alisa S Wolberg, Nicholas L Smith, Maria Sabater-Lleal

Faculty, Staff and Student Publications

BACKGROUND: Antithrombin, PC (protein C), and PS (protein S) are circulating natural anticoagulant proteins that regulate hemostasis and of which partial deficiencies are causes of venous thromboembolism. Previous genetic association studies involving antithrombin, PC, and PS were limited by modest sample sizes or by being restricted to candidate genes. In the setting of the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium, we meta-analyzed across ancestries the results from 10 genome-wide association studies of plasma levels of antithrombin, PC, PS free, and PS total.

METHODS: Study participants were of European and African ancestries, and genotype data were imputed …

Heart Failure Knowledge, Symptom Perception, And Symptom Management In Patients With Heart Failure, Jia-Rong Wu, Chin-Yen Lin, Muna Hassan Hammash, Debra K. Moser

UK CARES Faculty Publications

Background: Prevention of heart failure (HF) exacerbations requires that patients carefully self-manage their condition. Symptom perception is a key component in self-care for patients with HF that involves monitoring for HF symptoms and recognizing symptom changes. Heart failure knowledge is a prerequisite for better symptom perception and symptom management. However, the relationships among HF knowledge, symptom perception, and symptom management remain unclear.

Objective: The aim of this study was to explore the inter-relationships among HF knowledge, symptom monitoring, symptom recognition, and symptom response in patients with HF.

Method: We included 185 patients with HF in this study. Heart failure knowledge …

Predictors And Temporal Trends Of Withdrawal Of Life-Sustaining Therapy After Acute Stroke In The Florida Stroke Registry, Ayham Alkhachroum, Lili Zhou, Negar Asdaghi, Hannah Gardener, Hao Ying, Carolina M Gutierrez, Brian M Manolovitz, Daniel Samano, Danielle Bass, Dianne Foster, Nicole B Sur, David Z Rose, Angus Jameson, Nina Massad, Mohan Kottapally, Amedeo Merenda, Robert M Starke, Kristine O'Phelan, Jose G Romano, Jan Claassen, Ralph L Sacco, Tatjana Rundek

Faculty, Staff and Student Publications

Temporal trends and factors associated with the withdrawal of life-sustaining therapy (WLST) after acute stroke are not well determined.

DESIGN: Observational study (2008-2021).

SETTING: Florida Stroke Registry (152 hospitals).

PATIENTS: Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) patients.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Importance plots were performed to generate the most predictive factors of WLST. Area under the curve (AUC) for the receiver operating curve were generated for the performance of logistic regression (LR) and random forest (RF) models. Regression analysis was applied to evaluate temporal trends. Among 309,393 AIS patients, 47,485 ICH patients, and …

Genome-Wide Association Study Of Thoracic Aortic Aneurysm And Dissection In The Million Veteran Program, Derek Klarin, Poornima Devineni, Anoop K Sendamarai, Anthony R Angueira, Sarah E Graham, Ying H Shen, Michael G Levin, James P Pirruccello, Ida Surakka, Purushotham R Karnam, Tanmoy Roychowdhury, Yanming Li, Minxian Wang, Krishna G Aragam, Kaavya Paruchuri, Verena Zuber, Gabrielle E Shakt, Noah L Tsao, Renae L Judy, Ha My T Vy, Shefali S Verma, Daniel J Rader, Ron Do, Joseph E Bavaria, Girish N Nadkarni, Marylyn D Ritchie, Stephen Burgess, Dong-Chuan Guo, Patrick T Ellinor, Scott A Lemaire, Dianna M Milewicz, Cristen J Willer, Pradeep Natarajan, Philip S Tsao, Saiju Pyarajan, Scott M Damrauer

Faculty, Staff and Student Publications

The current understanding of the genetic determinants of thoracic aortic aneurysms and dissections (TAAD) has largely been informed through studies of rare, Mendelian forms of disease. Here, we conducted a genome-wide association study (GWAS) of TAAD, testing ~25 million DNA sequence variants in 8,626 participants with and 453,043 participants without TAAD in the Million Veteran Program, with replication in an independent sample of 4,459 individuals with and 512,463 without TAAD from six cohorts. We identified 21 TAAD risk loci, 17 of which have not been previously reported. We leverage multiple downstream analytic methods to identify causal TAAD risk genes and …

Delphi Consensus On Reporting Standards In Clinical Studies For Endovascular Treatment Of Acute Iliofemoral Venous Thrombosis And Chronic Iliofemoral Venous Obstruction., Suresh Vedantham, Peter Gloviczki, Teresa L Carman, Sandra Zelman Lewis, Peter A Schneider, Saher S Sabri, Raghu Kolluri

Heart and Vascular Articles

Acute iliofemoral deep vein thrombosis and chronic iliofemoral venous obstruction cause substantial patient harm and are increasingly managed with endovascular venous interventions, including percutaneous mechanical thrombectomy and stent placement. However, studies of these treatment elements have not been designed and reported with sufficient rigor to support confident conclusions about their clinical utility. In this project, the Trustworthy consensus-based statement approach was utilized to develop, via a structured process, consensus-based statements to guide future investigators of venous interventions. Thirty statements were drafted to encompass major topics relevant to venous study description and design, safety outcome assessment, efficacy outcome assessment, and topics …

Immunometabolism At The Heart Of Cardiovascular Disease, Matthew Deberge, Rajesh Chaudhary, Samantha Schroth, Edward B Thorp

Faculty, Staff and Student Publications

Immune cell function among the myocardium, now more than ever, is appreciated to regulate cardiac function and pathophysiology. This is the case for both innate immunity, which includes neutrophils, monocytes, dendritic cells, and macrophages, as well as adaptive immunity, which includes T cells and B cells. This function is fueled by cell-intrinsic shifts in metabolism, such as glycolysis and oxidative phosphorylation, as well as metabolite availability, which originates from the surrounding extracellular milieu and varies during ischemia and metabolic syndrome. Immune cell crosstalk with cardiac parenchymal cells, such as cardiomyocytes and fibroblasts, is also regulated by complex cellular metabolic circuits. …

Pearls In Anticoagulation Management For Patients With Left Ventricular Assist Devices, Ellen Yin

The Texas Heart Institute Journal

No abstract provided.

Effects Of Covid-19 On The Autonomic Cardiovascular System: Heart Rate Variability And Turbulence In Recovered Patients, Sedat Taş, Ümmü Taş

The Texas Heart Institute Journal

BACKGROUND: COVID-19 may be a risk factor for developing cardiovascular autonomic dysfunction. Data are limited, however, on the association between heart rate variability, heart rate turbulence, and COVID-19. The aims of this study were to evaluate the effect of COVID-19 on the cardiovascular autonomic system in patients with persistent symptoms after recovering from COVID-19 and to determine whether these patients showed changes in ambulatory electrocardiography monitoring.

METHODS: Fifty-one adults who had confirmed SARS-CoV-2 infection and presented with persistent symptoms to the cardiology outpatient clinic after clinical recovery between April and June 2021 were included. Patients were prospectively followed for 6 …

Sex-Based Differences In The Presentation And Outcomes Of Acute Pulmonary Embolism: A Systematic Review And Meta-Analysis, Yu Zhang, Yu Qiu, Jinming Luo, Jian Zhang, Qingqing Yan

The Texas Heart Institute Journal

BACKGROUND: The study aimed to review differences in the presentation and outcomes of acute pulmonary embolism (PE) between men and women.

METHODS: PubMed, CENTRAL, Web of Science, and Embase were searched for studies comparing clinical features or outcomes of PE between men and women. Baseline comorbidities, risk factors, clinical features, and mortality rates were also compared between men and women.

RESULTS: Fourteen studies were included. It was noted that men presented with PE at a statistically significantly younger age than women (P < .001). Smoking history (P < .001), lung disease (P = .004), malignancy (P = .02), and unprovoked PE (P = .004) were significantly more frequent among men than among women. There was no difference between the sexes for hypertension, diabetes, and a history of recent immobilization. A significantly higher proportion of men presented with chest pain (P = .02) and hemoptysis (P < .001), whereas syncope (P = .005) was more frequent in women. Compared with men, women had a higher proportion of high-risk PE (P = .003). There was no difference in the use of thrombolytic therapy or inferior vena cava filter. Neither crude nor adjusted mortality rates were significantly different between men and women.

CONCLUSION: This review found that the age at presentation, comorbidities, and symptoms of PE differed between men and …

Emerging Signaling Regulation Of Sinoatrial Node Dysfunction, Mingjie Zheng, Shannon Erhardt, Yuhan Cao, Jun Wang

Faculty, Staff and Student Publications

PURPOSE OF REVIEW: The sinoatrial node (SAN), the natural pacemaker of the heart, is responsible for generating electrical impulses and initiating each heartbeat. Sinoatrial node dysfunction (SND) causes various arrhythmias such as sinus arrest, SAN block, and tachycardia/bradycardia syndrome. Unraveling the underlying mechanisms of SND is of paramount importance in the pursuit of developing effective therapeutic strategies for patients with SND. This review provides a concise summary of the most recent progress in the signaling regulation of SND.

RECENT FINDINGS: Recent studies indicate that SND can be caused by abnormal intercellular and intracellular signaling, various forms of heart failure (HF), …

Cardioembolic Stroke Secondary To Massive Stress-Induced Apical Thrombosis: A Clinical Conundrum Relating To Anticoagulation Initiation, Siva Naga S. Yarrarapu, Parth Shah, Vikramaditya Samala Venkata, Jayasree Ravilla, Gaurav Mohan, Poorva Bhide, David Anwar

Journal of Community Hospital Internal Medicine Perspectives

Takotsubo cardiomyopathy or stress cardiomyopathy is a condition characterized by acute and transient left ventricular systolic dysfunction in the absence of coronary heart disease, occurring after an acute emotional or physical stressful event. Cardiac dysfunction in these patients is suspected to be secondary to catecholamine induced cardiac myocyte injury via cyclic AMP-mediated calcium overload or due to endothelial dysfunction. Even though left ventricular dysfunction in takotsubo cardiomyopathy is transient, it can lead to acute complications. Left ventricular thrombus formation is a widely reported complication and has an incidence of around 5-14% in Takotsubo cardiomyopathy patients and can lead to thromboembolic …

“Guess My Labs”, Ravi Choxi

Transformative Medicine

No abstract provided.

Dipyridamole-Induced Stemi: Case Report And Review Of The Literature, Hussam Al Hennawi, Sunita Lakhani, Shayan Iqbal Khan, Sarin Atam, Usama Sadiq, Joseph Rigotti, Abhinav Nair

Abington Jefferson Health Papers

Dipyridamole nuclear myocardial perfusion imaging is a safe and useful modality to assess for myocardial ischemia. It is the modality of choice for cardiac risk stratification in patients unable to exercise. Intravenous dipyridamole causes coronary vasodilation and may yield heterogeneity of coronary blood flow in significant coronary artery disease. Ischemic electrocardiographic changes following pharmacologic stress testing are less likely compared to exercise stress tests. Ischemia more likely presents in the form of ST depression, with ST-elevation being exceedingly rare. We present a case of a 73-year-old patient who developed ST-elevation myocardial infarction following pharmacologic stress testing.

Effect Of Fibrinolytic Therapy On St-Elevation Myocardial Infarction Clinical Outcomes During The Covid-19 Pandemic: A Systematic Review And Meta-Analysis, Anwar Khedr, Hussam Al Hennawi, Muhammed Khuzzaim Khan, Mostafa Elbanna, Abbas B. Jama, Ekaterina Proskuriakova, Hisham Mushtaq, Mikael Mir, Sydney Boike, Ibtisam Rauf, Aalaa Eissa, Meritxell Urtecho, Thoyaja Koritala, Nitesh Jain, Lokesh Goyal, Salim Surani, Syed A Khan

Abington Jefferson Health Papers

BACKGROUND: ST-elevation myocardial infarction (STEMI) is the result of transmural ischemia of the myocardium and is associated with a high mortality rate. Primary percutaneous coronary intervention (PPCI) is the recommended first-line treatment strategy for patients with STEMI. The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019 (COVID-19) pandemic, leading to a projected steep rise in mortality. These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion. It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.

AIM: To determine the incidence of fibrinolytic …

Partial Support In Chronic Heart Failure, Bart Meyns, Walter Droogne, Steven Jacobs

The VAD Journal

Partial left ventricular assist device (LVAD) support offers several advantages in treating chronic heart failure. It also raises concerns about insufficient support, worsening symptoms, and impediment of myocardial recovery. The clinical trial results for the CircuLite device (Medtronic) have shown that close monitoring can ensure improved outcomes for partial support. Another study on the ovine model demonstrated that partial and full support have similar effects regarding reverse remodeling. Thus, patients receiving partial LVAD support need regular follow-up care. Clinical assessment of symptoms and organ function must be used alongside objective judgment of patients’ needs to ensure support levels are appropriately …

Comparative Outcomes Of Interventions For Femoropopliteal Chronic Total Occlusion Versus Non-Chronic Total Occlusion Lesions From The Multicenter Xlpad Registry, Shirling Tsai, Yulun Liu, Lawrence Hoang, Michael Vu, Hua Lu, Bala Ramanan, David Fernandez Vazquez, Zachary Rosol, Sameh Sayfo, Mohamad Amer Alaiti, Panagiotis Koutakis, Emmanouil S Brilakis, Mehdi H Shishehbor, Subhash Banerjee

Faculty, Staff and Student Publications

Background Endovascular intervention of femoropopliteal chronic total occlusions (CTOs) is technically more complex. However, there is lack of comparative analysis between CTO and non-CTO femoropopliteal interventions. Methods and Results We report procedural details and outcomes of patients treated for femoropopliteal CTO and non-CTO lesions in the XLPAD (Excellence in Peripheral Artery Disease) registry (NCT01904851) between 2006 and 2019. Primary outcomes were procedural success and 1-year major adverse limb events, a composite of all-cause death, target limb revascularization, or major amputation. Analysis included 2895 patients (CTO: n=1516 patients; non-CTO: n=1379 patients) with 3658 lesions (CTO: n=1998 lesions; non-CTO: n=1660 lesions). Conventional …

Prolylcarboxypeptidase Alleviates Hypertensive Cardiac Remodeling By Regulating Myocardial Tissue Angiotensin Ii, Binh Y Nguyen, Fangchao Zhou, Pablo Binder, Wei Liu, Susanne S Hille, Xiaojing Luo, Min Zi, Hongyuan Zhang, Antony Adamson, Fozia Z Ahmed, Sam Butterworth, Elizabeth J Cartwright, Oliver J Müller, Kaomei Guan, Elizabeth M Fitzgerald, Xin Wang

Faculty, Staff and Student Publications

Background Prolonged activation of angiotensin II is the main mediator that contributes to the development of heart diseases, so converting angiotensin II into angiotensin 1-7 has emerged as a new strategy to attenuate detrimental effects of angiotensin II. Prolylcarboxypeptidase is a lysosomal pro-X carboxypeptidase that is able to cleave angiotensin II at a preferential acidic pH optimum. However, insufficient attention has been given to the cardioprotective functions of prolylcarboxylpeptidase. Methods and Results We established a CRISPR/CRISPR-associated protein 9-mediated global prolylcarboxylpeptidase-knockout and adeno-associated virus serotype 9-mediated cardiac prolylcarboxylpeptidase overexpression mouse models, which were challenged with the angiotensin II infusion (2 mg/kg …

The Prevalence Of Electronic Cigarette Use Among College Students Of Taibah University And Symptoms Of Cardiovascular Disease, Talal Alzahrani, Marwan Fahad Alhazmi, Ahmed Naji Alharbi, Feras Talal Alahmadi, Amer Nasser Alhubayshi, Bader Ahmed Alzahrani

Journal of the Saudi Heart Association

Background: Electronic cigarettes (e-cigarettes) have been increasing in popularity among young adults due to the misconception about the safety of e-cigarettes. Our study aims to identify the prevalence rate of e-cigarette use among college students, the reason behind their use, and the relationship between the use of electronic cigarettes and cardiovascular symptoms among college students. Methods: An online questionnaire was sent to students of Taibah University between 2021 and 2022. Data from this survey were analyzed to obtain the prevalence of e-cigarette use among Taibah University students and to compare the demographic and health characteristics differences between e-cigarette users and …

Transmembrane Stem Factor Nanodiscs Enhanced Revascularization In A Hind Limb Ischemia Model In Diabetic, Hyperlipidemic Rabbits, Eri Takematsu, Miles Massidda, Gretchen Howe, Julia Goldman, Patricia Felli, Lei Mei, Gregory Callahan, Andrew Sligar, Richard Smalling, Aaron Baker

Faculty, Staff and Student Publications

Therapies to revascularize ischemic tissue have long been a goal for the treatment of vascular disease and other disorders. Therapies using stem cell factor (SCF), also known as a c-Kit ligand, had great promise for treating ischemia for myocardial infarct and stroke, however clinical development for SCF was stopped due to toxic side effects including mast cell activation in patients. We recently developed a novel therapy using a transmembrane form of SCF (tmSCF) delivered in lipid nanodiscs. In previous studies, we demonstrated tmSCF nanodiscs were able to induce revascularization of ischemia limbs in mice and did not activate mast cells. …

Troponin In Acute Chest Pain To Risk Stratify And Guide Effective Use Of Computed Tomography Coronary Angiography (Target-Ctca): A Randomised Controlled Trial, Kuan Ken Lee, David Lowe, Rachel O'Brien, Ryan Wereski, Anda Bularga, Caelan Taggart, Matthew T H Lowry, Amy V Ferry, Michelle C Williams, Giles Roditi, John Byrne, Chris Tuck, Denise Cranley, Praveen Thokala, Steve Goodacre, Catriona Keerie, John Norrie, David E Newby, Alasdair J Gray, Nicholas L Mills

Faculty, Staff and Student Publications

BACKGROUND: The majority of patients with suspected acute coronary syndrome presenting to the emergency department will be discharged once myocardial infarction has been ruled out, although a proportion will have unrecognised coronary artery disease. In this setting, high-sensitivity cardiac troponin identifies those at increased risk of future cardiac events. In patients with intermediate cardiac troponin concentrations in whom myocardial infarction has been ruled out, this trial aims to investigate whether outpatient computed tomography coronary angiography (CTCA) reduces subsequent myocardial infarction or cardiac death.

METHODS: TARGET-CTCA is a multicentre prospective randomised open label with blinded endpoint parallel group event driven trial. …