Cardiology Commons^™

Effects Of Atrioventricular Optimization On Left Ventricular Reverse Remodeling With Cardiac Resynchronization Therapy: Results Of The Smart-Crt Trial., Michael R Gold, Kenneth A Ellenbogen, Christophe Leclercq, Jonathan Lowy, Seth J Rials, Morio Shoda, Gery Tomassoni, Ziad Issa, Jean-Francois Sarrazin, John M Jennings, Devi G Nair, Nicholas Wold, Patrick Yong, Michelle M Harbin, Kenneth M Stein, Angelo Auricchio

Heart and Vascular Articles

BACKGROUND: The role of atrioventricular optimization (AVO) to improve cardiac resynchronization therapy outcomes remains controversial. Previous post hoc analyses of a multicenter trial showed that measures of electrical dyssynchrony (right ventricular-left ventricular [LV] or LV electrical delay durations) are associated with patients who benefit from AVO.

METHODS: This was a global, multicenter, prospective, randomized trial of de novo cardiac resynchronization therapy implant patients with an right ventricular-LV duration ≥70 ms to determine whether AVO results in greater reverse remodeling. Patients were randomized 1:1 for either an AVO algorithm (SmartDelay) that determines atrioventricular delay and pacing chamber, biventricular or LV only, …

A Multisite Retrospective Review Of Direct Oral Anticoagulants Compared To Warfarin In Adult Fontan Patients, Amir Kazerouninia, Justin Georgekutty, Payton Kendsersky, Ryan D Byrne, Brendan Seto, Patricia Y Chu, Yunfei Wang, Fred H Rodriguez, Clayton Smith, Anita Saraf, Michael S Lloyd, Benjamin P Frischhertz, Dhaval R Parekh, Peter R Ermis, Wayne J Franklin, Wilson W Lam

Faculty, Staff and Students Publications

PURPOSE: Direct oral anticoagulants (DOACs) are not recommended in adult Fontan patients (Level of Evidence C). We hypothesized that DOACs are comparable to warfarin and do not increase thrombotic and embolic complications (TEs) or clinically significant bleeds.

METHODS: We reviewed the medical records of adult Fontan patients on DOACs or warfarin at three major medical centers. We identified 130 patients: 48 on DOACs and 107 on warfarin. In total, they were treated for 810 months on DOACs and 5637 months on warfarin.

RESULTS: The incidence of TEs in patients on DOACs compared to those on warfarin was not increased in …

The Impact Of Covid-19 On A Large Pragmatic Clinical Trial Embedded In Primary Care, Sarah M Leatherman, Cynthia Hau, Alison Klint, Peter A Glassman, Addison A Taylor, Ryan E Ferguson, William C Cushman, Areef Ishani

Faculty, Staff and Students Publications

INTRODUCTION: The COVID-19 pandemic had significant impact on clinical care and clinical trial operations, but the impact on decentralized pragmatic trials is unclear. The Diuretic Comparison Project (DCP) is a Point-of Care (POC) pragmatic trial testing whether chlorthalidone is superior to hydrochlorothiazide in preventing major cardiovascular (CV) events and non-cancer death. DCP utilized telephone consent, data collection from the electronic health record and Medicare, forwent study visits, and limited provider commitment beyond usual care. We assessed the impact of COVID-19 on recruitment, follow-up, data collection, and outcome ascertainment in DCP.

METHODS: We compared data from two 8-month periods: Pre-Pandemic (July …

Pediatric Swine Model Of Methicillin-Resistant Staphylococcus Aureus Sepsis-Induced Coagulopathy, Disseminated Microvascular Thrombosis, And Organ Injuries, Trung C Nguyen, Juan C Marini, Bobby Guillory, Christian Valladolid-Brown, Marina Martinez-Vargas, Deepika Subramanyam, Daniel Cohen, Sonya C Cirlos, Fong Lam, Barbara Stoll, Inka C Didelija, Caitlin Vonderohe, Renan Orellana, Arun Saini, Subhashree Pradhan, Dalia Bashir, Moreshwar S Desai, Saul Flores, Manpreet Virk, Hossein Tcharmtchi, Amir Navaei, Sheldon Kaplan, Linda Lamberth, Kristina G Hulten, Brooks P Scull, Carl E Allen, Ayse Akcan-Arikan, K Vinod Vijayan, Miguel A Cruz

Faculty, Staff and Students Publications

Sepsis-induced coagulopathy leading to disseminated microvascular thrombosis is associated with high mortality and has no existing therapy. Despite the high prevalence of Gram-positive bacterial sepsis, especially methicillin-resistant

HYPOTHESIS: Our objective is to develop a pediatric sepsis-induced coagulopathy swine model that last 70 hours.

METHODS AND MODELS: Ten 3 weeks old piglets, implanted with telemetry devices for continuous hemodynamic monitoring, were IV injected with MRSA (

RESULTS: Compared with the saline treated piglets (control), the septic piglets within 24 hours had significantly lower neurologic and respiratory scores. Over time, PT, d-dimer, and fibrinogen increased, while platelet counts and activities of factors …

Vigorous Exercise In Patients With Hypertrophic Cardiomyopathy, Rachel Lampert, Michael J Ackerman, Bradley S Marino, Matthew Burg, Barbara Ainsworth, Lisa Salberg, Maria Teresa Tome Esteban, Carolyn Y Ho, Roselle Abraham, Seshadri Balaji, Cheryl Barth, Charles I Berul, Martijn Bos, David Cannom, Lubna Choudhury, Maryann Concannon, Robert Cooper, Richard J Czosek, Anne M Dubin, James Dziura, Benjamin Eidem, Michael S Emery, N A Mark Estes, Susan P Etheridge, Jeffrey B Geske, Belinda Gray, Kevin Hall, Kimberly G Harmon, Cynthia A James, Ashwin K Lal, Ian H Law, Fangyong Li, Mark S Link, William J Mckenna, Silvana Molossi, Brian Olshansky, Steven R Ommen, Elizabeth V Saarel, Sara Saberi, Laura Simone, Gordon Tomaselli, James S Ware, Douglas P Zipes, Sharlene M Day, Live Consortium

Faculty, Staff and Students Publications

IMPORTANCE: Whether vigorous intensity exercise is associated with an increase in risk of ventricular arrhythmias in individuals with hypertrophic cardiomyopathy (HCM) is unknown.

OBJECTIVE: To determine whether engagement in vigorous exercise is associated with increased risk for ventricular arrhythmias and/or mortality in individuals with HCM. The a priori hypothesis was that participants engaging in vigorous activity were not more likely to have an arrhythmic event or die than those who reported nonvigorous activity.

DESIGN, SETTING, AND PARTICIPANTS: This was an investigator-initiated, prospective cohort study. Participants were enrolled from May 18, 2015, to April 25, 2019, with completion in February 28, …

Frequent Questions And Responses On The 2022 Lipoprotein(A) Consensus Statement Of The European Atherosclerosis Society, Florian Kronenberg, Samia Mora, Erik S G Stroes, Brian A Ference, Benoit J Arsenault, Lars Berglund, Marc R Dweck, Marlys L Koschinsky, Gilles Lambert, François Mach, Catherine J Mcneal, Patrick M Moriarty, Pradeep Natarajan, Børge G Nordestgaard, Klaus G Parhofer, Salim S Virani, Arnold Von Eckardstein, Gerald F Watts, Jane K Stock, Kausik K Ray, Lale S Tokgözoğlu, Alberico L Catapano

Faculty, Staff and Students Publications

In 2022, the European Atherosclerosis Society (EAS) published a new consensus statement on lipoprotein(a) [Lp(a)], summarizing current knowledge about its causal association with atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis. One of the novelties of this statement is a new risk calculator showing how Lp(a) influences lifetime risk for ASCVD and that global risk may be underestimated substantially in individuals with high or very high Lp(a) concentration. The statement also provides practical advice on how knowledge about Lp(a) concentration can be used to modulate risk factor management, given that specific and highly effective mRNA-targeted Lp(a)-lowering therapies are still in clinical …

Highlights Of The 2022 Brano Heart Failure Forum: Part One, Ugo Livi, Rajko Radovancevic, Bojan Vrtovec, Igor D. Gregoric

The VAD Journal

Since 2007, the Branislav “Brano” Radovancevic Heart Failure Forum (BHFF) 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 2022 BHHF forum was held on the 6^th thru 8^th of September 2022 in Trieste, Italy. It was attended by over 94 faculty from 14 countries. In addition, participation through online streaming was available. Throughout the forum, 17 sessions focused on challenges and solutions …

Reversible Cardiomyopathy, What Should The Clinicians Keep In Mind? A Case Report, Abdulmajeed A. Alzahrani, Saud A. Bahaidarah, Zuhair N. Al-Hassnan, Gaser A. Abdelmohsen

Journal of the Saudi Heart Association

Primary carnitine deficiency (PCD) is an autosomal recessive disorder characterized by decreased carnitine levels essential for Beta oxidation in various organs, including the heart. Early diagnosis and treatment of PCD can revert cardiomyopathy. A 13-year-old girl presented with heart failure due to dilated cardiomyopathy and severe cardiac dysfunction; following L carnitine treatment, the patient's clinical conditions improved, and cardiac functions returned to normal within weeks. Investigations revealed PCD; regular L carnitine has been provided, all cardiac medications are discontinued, and the patient is doing well. We believe PCD should be ruled out in every patient with cardiomyopathy.

A Clot In Transit: A Cause Of Death Or A Bystander?, Al-Zahraa Almahlawi, Mohammad Alghamdi, Mutaz Althobaiti, Duha Alahmadi, Yazeed Almalki, Rahaf Alsahli, Hamdan A Jahdali, Jinan Shamou, Salim Baharoon

Journal of the Saudi Heart Association

Introduction: The clot in transit is a rare manifestation of thromboembolic disease occurring usually in the setting of PE and frequently associated with poor outcomes. The best therapeutic option is not well established. We describe a series of 35 patients diagnosed with clots in transit including their therapeutic interventions and outcome between the period January 2016 to December 2020. Methods: a retrospective chart review of all patients with an Echocardiogram showing thrombi in the right heart chambers including patients with thrombus in the presence of central lines or other devices. We exclude patients where masses were described as tumors or …

Nhc/ Sha 2023 Focused Update Of The 2019 Guidelines For The Management Of Heart Failure, Waleed Al Habeeb, Adel Tash, Abdelfatah Elasfar, Ali Almasood, Abeer Bakhshi, Fayez Elshaer, Fakhr Al Ayoubi, Kamal Alghalaini, Maryam Alqaseer, Mosaad Alhussein, Osama Almogbel, Shukri Alsaif, Yahia Alhebeshi

Journal of the Saudi Heart Association

Background: The burden of cardiovascular diseases is undeniable in local populations, who have high mortality rates and a young age of disease onset. A systematic review of emerging evidence and update of the Saudi Heart Association (SHA) 2019 heart failure (HF) guidelines was therefore undertaken. Methodology: A panel of expert cardiologists reviewed recommendations of the 2019 guidelines following the Saudi Heart Association methodology for guideline recommendations. When needed, the panel provided updated and new recommendations endorsed by the national heart council that are appropriate for clinical practice and local resources in Saudi Arabia. Recommendations and conclusion: The focused update describes …

Implementation Of The Generalized Anxiety Disorder 2-Item Screening Tool For Adult Patients In An Underserved Outpatient Cardiology Clinic, Leila Joint

Doctor of Nursing Practice Final Manuscripts

Background: 11.7% of adults aged 18 and over have regular feelings of worry, nervousness, or anxiety. Anxiety can often present with somatic symptoms. The rates of misdiagnoses are high with symptoms often attributed to physical etiologies. Early recognition and treatment of anxiety can improve quality of life, prevent complications and reduce health care costs.

Purpose of Project: Implementation of the Generalized Anxiety Disorder 2-item (GAD-2) screening tool in a fast-paced underserved outpatient cardiology clinic for adult patients presenting with chest pain and/or palpitations without documented history of anxiety. The purpose of this project is to improve the utilization …

Infective Endocarditis-Related Pseudoaneurysms After Bentall Surgery: The Role Of 3d Printing In Pre-Surgical Planning And Management: Case Report, Abdalla Eltayeb, Shaid Khan, Irene Landi, Mohammed Aladmawi, Olga Vriz

Journal of the Saudi Heart Association

We present a case report of a male patient who underwent modified Bentall surgery with a mechanical valved conduit due to severe aortic regurgitation and ascending aortic aneurysm. Four years later, the patient developed a cascade of events as acute stoke, infective endocarditis due to Brucella abortus complicated by pseudoaneurysms of aortic graft with left ventricular outflow tract communication. A multi-modality approach, included a three-dimensional printing, facilitated the diagnosis and surgical planning. During surgery, the team opted for a salvage approach, and the patient showed continued improvement during follow-up. This case highlights the importance of careful monitoring and detection of …

Balloon Dilatation In The Management Of Congenital Obstructive Lesions Of The Heart: Review Of Author's Experiences And Observations-Part I, P Syamasundar Rao

Faculty, Staff and Student Publications

Balloon dilatation techniques became available to treat congenital obstructive lesions of the heart in the early/mid-1980s. The purpose of this review is to present the author's experiences and observations on the techniques and outcomes of balloon dilatation of pulmonary stenosis (PS), aortic stenosis (AS) and aortic coarctation (AC), both native and postsurgical re-coarctations. Balloon dilatation resulted in a reduction of peak pressure gradient across the obstructive lesion at the time of the procedure as well as at short-term and long-term follow-ups. Complications such as recurrence of stenosis, valvar insufficiency (for PS and AS cases) and aneurysm formation (for AC cases) …

Sarcopenia And Cardiovascular Diseases, Abdulla A Damluji, Maha Alfaraidhy, Noora Alhajri, Namit N Rohant, Manish Kumar, Christina Al Malouf, Samira Bahrainy, Min Ji Kwak, Wayne B Batchelor, Daniel E Forman, Michael W Rich, James Kirkpatrick, Ashok Krishnaswami, Karen P Alexander, Gary Gerstenblith, Peggy Cawthon, Christopher R Defilippi, Parag Goyal

Faculty, Staff and Student Publications

Sarcopenia is the loss of muscle strength, mass, and function, which is often exacerbated by chronic comorbidities including cardiovascular diseases, chronic kidney disease, and cancer. Sarcopenia is associated with faster progression of cardiovascular diseases and higher risk of mortality, falls, and reduced quality of life, particularly among older adults. Although the pathophysiologic mechanisms are complex, the broad underlying cause of sarcopenia includes an imbalance between anabolic and catabolic muscle homeostasis with or without neuronal degeneration. The intrinsic molecular mechanisms of aging, chronic illness, malnutrition, and immobility are associated with the development of sarcopenia. Screening and testing for sarcopenia may be …

Apolipoprotein E Dyslipidemia And Nephrotic Syndrome: A Rare Connection, Sahana Tito, Avica Atri, Shivaraj Patil, Saima Dean, Sweta Carpenter

Einstein Health Papers

Severe hyperlipidemia warrants an extensive evaluation. We report a case of a 25-year-old man of Chinese descent seen in the cardiology-lipid clinic. He was found to have a serum low-density lipoprotein cholesterol of 12.12 mmol/L (468 mg/dL) and serum triglycerides of 2.29 mmol/L (203 mg/dL) during routine screening. Work-up revealed nephrotic-range proteinuria, and renal biopsy showed dilated glomerular capillary loops with lipid deposits, pathognomonic of lipoprotein glomerulopathy. Genetic studies showed apolipoprotein E3/E4 phenotype. He was treated with a high-intensity statin and fibrate therapy, which resulted in a marked improvement in dyslipidemia and proteinuria.

Low Educational Attainment Is Associated With Higher All-Cause And Cardiovascular Mortality In The United States Adult Population, Najah Khan, Zulqarnain Javed, Isaac Acquah, Kobina Hagan, Madiha Khan, Javier Valero-Elizondo, Ryan Chang, Umair Javed, Mohamad B. Taha, Salim S. Virani

Office of the Provost

Introduction: Educational attainment is an important social determinant of health (SDOH) for cardiovascular disease (CVD). However, the association between educational attainment and all-cause and CVD mortality has not been longitudinally evaluated on a population-level in the US, especially in individuals with atherosclerotic cardiovascular disease (ASCVD). In this nationally representative study, we assessed the association between educational attainment and the risk of all-cause and cardiovascular (CVD) mortality in the general adult population and in adults with ASCVD in the US.
Methods: We used data from the 2006-2014 National Death Index-linked National Health Interview Survey for adults ≥ 18 years. We generated …

Low Educational Attainment Is Associated With Higher All-Cause And Cardiovascular Mortality In The United States Adult Population, Najah Khan, Zulqarnain Javed, Isaac Acquah, Kobina Hagan, Madiha Khan, Javier Valero-Elizondo, Ryan Chang, Umair Javed, Mohamad B Taha, Michael J Blaha, Salim S Virani, Garima Sharma, Ron Blankstein, Martha Gulati, Elias Mossialos, Adnan A Hyder, Miguel Cainzos Achirica, Khurram Nasir

Faculty, Staff and Students Publications

Introduction: Educational attainment is an important social determinant of health (SDOH) for cardiovascular disease (CVD). However, the association between educational attainment and all-cause and CVD mortality has not been longitudinally evaluated on a population-level in the US, especially in individuals with atherosclerotic cardiovascular disease (ASCVD). In this nationally representative study, we assessed the association between educational attainment and the risk of all-cause and cardiovascular (CVD) mortality in the general adult population and in adults with ASCVD in the US.

Methods: We used data from the 2006-2014 National Death Index-linked National Health Interview Survey for adults ≥ 18 years. We generated …

Cardiac Pericytes Mediate The Remodeling Response To Myocardial Infarction, Pearl Quijada, Shuin Park, Peng Zhao, Kamal Ss Kolluri, David Wong, Kevin D Shih, Kai Fang, Arash Pezhouman, Lingjun Wang, Ali Daraei, Matthew D Tran, Elle M Rathbun, Kimberly N Burgos Villar, Maria L Garcia-Hernandez, Thanh Td Pham, Charles J Lowenstein, M Luisa Iruela-Arispe, S Thomas Carmichael, Eric M Small, Reza Ardehali

Faculty, Staff and Students Publications

Despite the prevalence of pericytes in the microvasculature of the heart, their role during ischemia-induced remodeling remains unclear. We used multiple lineage-tracing mouse models and found that pericytes migrated to the injury site and expressed profibrotic genes, coinciding with increased vessel leakage after myocardial infarction (MI). Single-cell RNA-Seq of cardiac pericytes at various time points after MI revealed the temporally regulated induction of genes related to vascular permeability, extracellular matrix production, basement membrane degradation, and TGF-β signaling. Deleting TGF-β receptor 1 in chondroitin sulfate proteoglycan 4-expressing (Cspg4-expressing) cells reduced fibrosis following MI, leading to a transient improvement in the cardiac …

Cardiac Biomarkers Differentiate Kawasaki Disease From Multisystem Inflammatory Syndrome In Children Associated With Covid-19, Mollie Walton

Research Days

Background: Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show considerable clinical overlap. The goal of this study was to determine if cardiac biomarkers can differentiate KD from MIS-C.

Objectives/Goal: The goal of this study was to determine if cardiac biomarkers differentiate KD from MIS-C.

Methods/Design: The International Kawasaki Disease Registry enrolled (n=2903) contemporaneous KD and MIS-C patients1st, 2020, through June 30th, 2022. The study population was confined to KD patients meeting American Heart Association KD criteria with no prior COVID-19 infection and MIS-C patients meeting Centers for Disease Control and Prevention criteria with confirmed …

Association Between Remote Monitoring And Interstage Morbidity And Mortality In Single Ventricle Patients Across Socioeconomic Groups, Bianca Cherestal

Research Days

Background: Despite improvements in outcomes over time, morbidity and mortality for infants with single ventricle (SV) heart disease remains high. Among other risk factors for mortality, infants of low socioeconomic status (SES) are known to be particularly vulnerable following stage 1 palliation.

Objectives/Goal: We sought to determine whether use of a novel remote monitoring program, CHAMP (Cardiac High Acuity Monitoring Program), mitigates differences in outcomes by SES for infants with SV during the interstage period.

Methods/Design: Using the CHAMP database, we identified 610 infants across 11 institutions enrolled in the program between 2014–2021. All enrolled patients’ families were provided with …