Cardiology Commons^™

Potential And Pitfalls Of Pharmacovigilance Databases In Oncology, Ilana Schlam, Michael S Ewer, Sandra M Swain

Faculty, Staff and Student Publications

No abstract provided.

Association Of Metformin With The Development Of Age-Related Macular Degeneration, Amitha Domalpally, Samuel A Whittier, Qing Pan, Dana M Dabelea, Christine H Darwin, William C Knowler, Christine G Lee, Jose A Luchsinger, Neil H White, Emily Y Chew

Faculty, Staff and Student Publications

IMPORTANCE: Age-related macular degeneration (AMD) is a leading cause of blindness with no treatment available for early stages. Retrospective studies have shown an association between metformin and reduced risk of AMD.

OBJECTIVE: To investigate the association between metformin use and age-related macular degeneration (AMD).

DESIGN, SETTING, AND PARTICIPANTS: The Diabetes Prevention Program Outcomes Study is a cross-sectional follow-up phase of a large multicenter randomized clinical trial, Diabetes Prevention Program (1996-2001), to investigate the association of treatment with metformin or an intensive lifestyle modification vs placebo with preventing the onset of type 2 diabetes in a population at high risk for …

Inter-Observer Variability Of Expert-Derived Morphologic Risk Predictors In Aortic Dissection, Martin J Willemink, Domenico Mastrodicasa, Mohammad H Madani, Marina Codari, Leonid L Chepelev, Gabriel Mistelbauer, Kate Hanneman, Maral Ouzounian, Daniel Ocazionez, Rana O Afifi, Joan M Lacomis, Luigi Lovato, Davide Pacini, Gianluca Folesani, Ricarda Hinzpeter, Hatem Alkadhi, Arthur E Stillman, Anna M Sailer, Valery L Turner, Virginia Hinostroza, Kathrin Bäumler, Anne S Chin, Nicholas S Burris, D Craig Miller, Michael P Fischbein, Dominik Fleischmann

Faculty, Staff and Student Publications

OBJECTIVES: Establishing the reproducibility of expert-derived measurements on CTA exams of aortic dissection is clinically important and paramount for ground-truth determination for machine learning.

METHODS: Four independent observers retrospectively evaluated CTA exams of 72 patients with uncomplicated Stanford type B aortic dissection and assessed the reproducibility of a recently proposed combination of four morphologic risk predictors (maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and intercostal arteries). For the first inter-observer variability assessment, 47 CTA scans from one aortic center were evaluated by expert-observer 1 in an unconstrained clinical assessment without a standardized workflow and compared to a …

Reducing The Risk Of Mortality In Chronic Obstructive Pulmonary Disease With Pharmacotherapy: A Narrative Review, Matthew Mintz, Igor Barjaktarevic, Donald A. Mahler, Barry Make, Neil Skolnik, Barbara Yawn, Bree Zeyzus-Johns, Nicola A. Hanania

Abington Jefferson Health Papers

In 2020, chronic obstructive pulmonary disease (COPD) was the fifth leading cause of death in the United States excluding COVID-19, and its mortality burden has been rising since the 1980s. Smoking cessation, long-term oxygen therapy, noninvasive ventilation, and lung volume reduction surgery have had a beneficial effect on mortality; however, until recently, the effects of pharmacologic therapies on all-cause mortality have been unclear. Inhaled pharmacologic treatments for patients with COPD include combinations of long-acting muscarinic receptor antagonists (LAMAs), long-acting-β2-agonists (LABAs), and inhaled corticosteroids (ICS). The recent IMPACT and ETHOS clinical trials reported mortality benefits with ICS/LAMA/LABA triple therapy compared with …

Structural Valve Deterioration After Self-Expanding Transcatheter Or Surgical Aortic Valve Implantation In Patients At Intermediate Or High Risk., Daniel O'Hair, Steven J Yakubov, Kendra J Grubb, Jae K Oh, Saki Ito, G Michael Deeb, Nicolas M Van Mieghem, David H Adams, Tanvir Bajwa, Neal S Kleiman, Stanley Chetcuti, Lars Søndergaard, Hemal Gada, Mubashir Mumtaz, John Heiser, William M Merhi, George Petrossian, Newell Robinson, Gilbert H L Tang, Joshua D Rovin, Stephen H Little, Renuka Jain, Sarah Verdoliva, Tim Hanson, Shuzhen Li, Jeffrey J Popma, Michael J Reardon

Heart and Vascular Articles

IMPORTANCE: The frequency and clinical importance of structural valve deterioration (SVD) in patients undergoing self-expanding transcatheter aortic valve implantation (TAVI) or surgery is poorly understood.

OBJECTIVE: To evaluate the 5-year incidence, clinical outcomes, and predictors of hemodynamic SVD in patients undergoing self-expanding TAVI or surgery.

DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis pooled data from the CoreValve US High Risk Pivotal (n = 615) and SURTAVI (n = 1484) randomized clinical trials (RCTs); it was supplemented by the CoreValve Extreme Risk Pivotal trial (n = 485) and CoreValve Continued Access Study (n = 2178). Patients with severe aortic valve …

Hybrid Epicardial-Endocardial Ablation For Long-Standing Persistent Atrial Fibrillation: A Subanalysis Of The Converge Trial., David B Delurgio, Christopher Blauth, Michael E Halkos, Karl J Crossen, David Talton, Saumil R Oza, Anthony R Magnano, Mark A Mostovych, Sreedhar Billakanty, Steven Duff, Christopher Stees, Jason Sperling, Syed Ahsan, John Yap, Christian Shults, David Pederson, James Garrison, Paul Tabereaux, David M Gilligan, Graham Bundy, Otto Costantini, Eric Espinal, Angelo La Pietra, Felix Yang, Yisachar Greenberg, Israel Jacobowitz, Jaswinder Gill

Heart and Vascular Articles

BACKGROUND: Favorable clinical outcomes are difficult to achieve in long-standing persistent atrial fibrillation (LSPAF) with catheter ablation (CA). The CONVERGE (Convergence of Epicardial and Endocardial Ablation for the Treatment of Symptomatic Persistent Atrial FIbrillation) trial evaluated the effectiveness of hybrid convergent (HC) ablation vs endocardial CA.

OBJECTIVE: The study sought to evaluate the safety and effectiveness of HC vs CA in the LSPAF subgroup from the CONVERGE trial.

METHODS: The CONVERGE trial was a prospective, multicenter, randomized trial that enrolled 153 patients at 27 sites. A post hoc analysis was performed on LSPAF patients. The primary effectiveness was freedom from …

Remote Care Adoption In Underserved Congenital Heart Disease Patients During The Covid-19 Era, Ruth M Vaughan, Judson A Moore, Jasmine S Moreno, Karla J Dyer, Abiodun O Oluyomi, Keila N Lopez

Faculty, Staff and Students Publications

The COVID-19 pandemic restricted in-person appointments and prompted an increase in remote healthcare delivery. Our goal was to assess access to remote care for complex pediatric cardiology patients. We performed a retrospective chart review of Texas Children's Hospital (TCH) pediatric cardiology outpatient appointments from March 2020 to December 2020 for established congenital heart disease (CHD) patients 1 to 17 yo. Primary outcome variables were remote care use of telemedicine and patient portal activation. Primary predictor variables were age, sex, insurance, race/ethnicity, language, and location. Descriptive statistics were used to analyze patient demographics. Multivariate logistic regression determined associations with remote care …

Aortic Stress Activates An Adaptive Program In Thoracic Aortic Smooth Muscle Cells That Maintains Aortic Strength And Protects Against Aneurysm And Dissection In Mice, Chen Zhang, Yanming Li, Abhijit Chakraborty, Yang Li, Kimberly R Rebello, Pingping Ren, Wei Luo, Lin Zhang, Hong S Lu, Lisa A Cassis, Joseph S Coselli, Alan Daugherty, Scott A Lemaire, Ying H Shen

Faculty, Staff and Students Publications

BACKGROUND:

When aortic cells are under stress, such as increased hemodynamic pressure, they adapt to the environment by modifying their functions, allowing the aorta to maintain its strength. To understand the regulation of this adaptive response, we examined transcriptomic and epigenomic programs in aortic smooth muscle cells (SMCs) during the adaptive response to angiotensin II (AngII) infusion and determined its importance in protecting against aortic aneurysm and dissection (AAD).

METHODS:

We performed single-cell RNA sequencing (scRNA-seq) and single-cell sequencing assay for transposase-accessible chromatin (scATAC-seq) analyses in a mouse model of sporadic AAD induced by AngII infusion. We also examined the …

The Potential Of Brain Stimulation Techniques For Substance Use Disorder Treatment, Antonio F Corno, Taylor S Koerner, Jorge D Salazar

Faculty, Staff and Student Publications

No abstract provided.

What Did We Learn About Vads In 2022?, Maya Guglin

The VAD Journal

This is our 9^th annual literature review on mechanical circulatory support devices. Our previous reports were well received by the readers.

In this paper, we summarized the most interesting and important, from our standpoint, publications from 2022. There may be some slight overlap with the end of 2021 because some papers were published online first, and the year of the publication changed when they became available in print.

For the sixth time, we wrote a section on extracorporeal membrane oxygenation (ECMO) which primarily addresses new developments in veno-arterial ECMO.

Readers who wish to supplement this review, argue with the …

Monoclonal Antibodies, Gene Silencing And Gene Editing (Crispr) Therapies For The Treatment Of Hyperlipidemia-The Future Is Here, Melody Hermel, Madison Lieberman, Leandro Slipczuk, Jamal S. Rana, Salim S. Virani

Office of the Provost

Hyperlipidemia is a significant risk factor for atherosclerotic cardiovascular disease. Undertreatment of elevated lipids persists despite existing therapies. Here, we provide an update on monoclonal antibodies, gene silencing therapies, and gene editing techniques for the management of hyperlipidemia. The current era of cutting-edge pharmaceuticals targeting low density lipoprotein cholesterol, PCSK9, lipoprotein (a), angiopoietin-like 3, and apolipoprotein C3 are reviewed. We outline what is known, studies in progress, and futuristic goals. This review of available and upcoming biotechnological lipid therapies is presented for clinicians managing patients with familial hyperlipidemia, statin intolerance, hypertriglyceridemia, or elevated lipoprotein (a) levels.

Old But Not Vain : Two Cases Of Refractory Polymorphic Ventricular Tachycardia Associated With Coronary Artery Disease Successfully Treated With Quinidine, Tit-Kei Ng, Tommy King-Him Ma, Chi-Chun Au, Janice Woon-Yan Wong, Jenny Nga-Lai Chow, Andrew Vincent Li, Adrian Yin-Cheung Luk, Sze-Wah Lai, Candy Ming-Yan Cheuk, Jaclyn Chi-Lin Chan, Li-Wah Tam

Journal of the Hong Kong College of Cardiology

Post myocardial infarct polymorphic Ventricular Tachycardia (VT) triggered by injured Purkinje fibres can cause VT storms that are refractory to various treatment even after successful reperfusion or revascularization. We reported such recurrent polymorphic VT in two post myocardial infarct patients after Percutaneous Coronary Intervention. Both of them responded readily to Quinidine. We also discussed the pathophysiology of this arrhythmia and the treatment option of it, namely catheter ablation and antiarrhythmics

Recurrent Cyanotic Spells In An Octogenarian, Chin Tong Kwok, Chun Kit Wong

Journal of the Hong Kong College of Cardiology

We report rare case of an octogenarian who, after years of diagnostic delay, was found to have a patent foramen ovale, and due to an ascending aortic aneurysm that anatomically facilitated right-to-left shunt, presenting with life-threatening cyanotic attacks. The characteristic orthodeoxia-platypnea syndrome and high alveolar arterial gradient hint to the diagnosis. She was eventually treated successfully with urgent percutaneous PFO closure. Routine ordering of a transthoracic echocardiogram, without agitated saline injection under provocation maneuvers, may not be sufficient to rule out shunts.

Roles Of Exercise Treadmill Test In The Diagnosis & Risk Stratification Of Cardiac Channelopathies, Kit Chan

Journal of the Hong Kong College of Cardiology

Channelopathies are the leading causes of SCD in patients without structural heart disease. Missing the diagnosis of high-risk but concealed channelopathies could have lethal clinical consequences. However, the diagnosis of channelopathies is often challenging due to the dynamic clinical presentations and elusive ECG manifestations of these diseases. An integrated approach including clinical assessment, repeated electrocardiography, drug provocation tests, exercise stress test and genetic studies is often required for establishing the diagnosis. Pharmacological provocation tests may have limited sensitivity and may be associated with false positive results. Wide-spread use of genetic studies are limited by low yield, cost-effectiveness and availability issue. …

The Impact Of Renal Insufficiency Upon Admission On The Clinical Outcome Of Patients With Acute St-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention, Wai Lun Kwong, Kwok Ho Yau, Eugene Sin, Kwok Keung Chan

Journal of the Hong Kong College of Cardiology

Background: Coronary artery disease is common in patients with renal insufficiency. In acute coronary syndrome, impaired renal function is present in approximately 30-40% of patients and is associated with worse prognosis. Local data regarding the risks and benefits for those patients suffering from acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) is scarce. We evaluated the clinical outcomes of patients suffering from STEMI with and without renal insufficiency upon admission who underwent PPCI.

Methods: From 1^st January 2009 to 30^th September 2017, all patients with STEMI treated with PPCI were identified. The primary …

Demonstrating New-Onset Or Worsened Sudomotor Function Post-Covid-19 On Comparative Analysis Of Autonomic Function Pre-And Post-Sars-Cov-2 Infection, Aditi Varma-Doyle, Nicole R. Villemarette-Pittman, Paul Lelorier, John England

School of Medicine Faculty Publications

Background: Autonomic dysfunction including sudomotor abnormalities have been reported in association with SARS-CoV-2 infection. Objective: There are no previous studies that have compared autonomic function objectively in patients pre- and post- SARS-CoV-2 infection. We aimed to identify if SARS-CoV-2 virus is triggering and/or worsening dysautonomia by comparing autonomic function tests in a group of patients pre-and post-SARS-CoV-2 infection. Design/methods: Six participants were enrolled and divided into two groups. The first group of 4 participants reported worsened autonomic symptoms post-SARS-CoV-2 infection. These individuals had their first autonomic test prior to COVID-19 pandemic outbreak (July 2019–December 2019). Autonomic function testing was repeated …

Predictors Of Neurological Complications Of Pediatric Post-Cardiotomy Extracorporeal Life Support, Hala Mounir Agha, Amr Fathalla, Giuseppe Isgro, Mauro Cotza

Journal of the Saudi Heart Association

Background: Post-cardiotomy extracorporeal membrane oxygenation (ECMO) was associated with significant neurological complications affecting the overall outcome. The aim of the work is to determine the incidence and the predictors of neurological events during pediatric extracorporeal life support after cardiac surgery. Patients & Methods: This is a retrospective study that encompassed all neonates, infants, and children (<18 years of age) who need extracorporeal life support following cardiac surgery between January 2015 and December 2018 at San Donato Hospital, Italy. Data as regards surgical procedure of congenital heart disease, in-hospital mortality, length of ECMO, hospital stay durations, short-term neurological ECMO complications and outcome were analyzed. Results: The sixty-three patients who received post-cardiotomy ECMO, Neurological complications were evident in 31.7% in the form of ischemic stroke in 17.5% and hemorrhagic stroke in 11.1%. By multivariable analysis, the older age of cyanotic cases, the need for a venting cannula, and the rapid CO2 drop in the first 24 h were the most independent risk factors for neurological complications. Prolonged ECMO support and hospital stay duration were associated with neurological sequelae. Conclusion: Neurological complications either ischemic or hemorrhagic strokes were common during pediatric postcardiotomy ECMO and were significantly related to prolonged ECMO support and hospital stay. Predictors of these neurological sequelae are the older cyanotic cases, the need for a venting cannula, the oxygenator thrombosis, and the rapid CO2 drop in the first 24 h of ECMO.

Cardiogenic Shock Among Patients With Acute Myocardial Infarction In A Middle Eastern Country: A Single-Centre Experience, Ghada Shalaby, Azmat Khadija Niazi, Sheeren Khaled

Journal of the Saudi Heart Association

BACKGROUND: Cardiogenic Shock (CS) remains the most common cause of death in hospitalized acute ST-segment elevation myocardial infarction (STEMI) patients. Predictors of outcomes in those patients include clinical, laboratory, radiologic variables, and management strategies. The present study aimed to evaluate the incidence, characteristics, predictors of cardiogenic shock and mortality among acute ST-segment elevation myocardial infarction patients in our center METHODS: This was a retrospective, single-center study conducted at KAMC, Makkah during 2015-2020. All acute ST-segment elevation myocardial infarction patients during this era were divided into two groups CS group and non-CS group. RESULTS: In this study total 3074 acute ST-segment …

Trend Of Left Ventricular Assist Device Related Complications: Insight From The National Inpatient Sample Database, Waqas Ullah, Muhammad Khawar Sana, Alexander G. Hajduczok, Yevgeniy Brailovsky, Donald C. Haas, Indranee N. Rajapreyar

Division of Cardiology Faculty Papers

No abstract provided.

Brain Nuclear Receptors And Cardiovascular Function, Mengjie Wang, Yongjie Yang, Yong Xu

Faculty, Staff and Students Publications

Brain-heart interaction has raised up increasing attentions. Nuclear receptors (NRs) are abundantly expressed in the brain, and emerging evidence indicates that a number of these brain NRs regulate multiple aspects of cardiovascular diseases (CVDs), including hypertension, heart failure, atherosclerosis, etc. In this review, we will elaborate recent findings that have established the physiological relevance of brain NRs in the context of cardiovascular function. In addition, we will discuss the currently available evidence regarding the distinct neuronal populations that respond to brain NRs in the cardiovascular control. These findings suggest connections between cardiac control and brain dynamics through NR signaling, which …