Methodist Debakey Cardiovasc J
· 2024 · PMID 39525378
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Air pollution, mostly from fossil fuel sources, is the leading environmental cause of global morbidity and mortality and is intricately linked to climate change. There is emerging evidence indicating that air pollution i...Air pollution, mostly from fossil fuel sources, is the leading environmental cause of global morbidity and mortality and is intricately linked to climate change. There is emerging evidence indicating that air pollution imposes most of its risk through proximate cardiovascular kidney and metabolic (CKM) etiologies. Indeed, there is compelling evidence linking air pollution to the genesis of insulin resistance, type 2 diabetes, hypertension, and other risk factors. Air pollution frequently coexists with factors such as noise, with levels and risks influenced substantially by additional factors such as social determinants and natural and built environment features. Persistent disparities regarding the impact and new sources of air pollution, such as wildfires attributable to climate change, have renewed the urgency to better understand root sources, characterize their health effects, and disseminate this information for personal protection and policy impacts. In this review, we summarize evidence associating air pollution with cardiovascular health, the impact of air pollution on CKM health, and how interactions with other exposures and personal characteristics may modify these associations. Finally, we discuss new integrated approaches to capture risk from air pollution in the context of an exposomic framework.
Methodist Debakey Cardiovasc J
· 2024 · PMID 39525377
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A 14-year-old child with recurrent cyanotic spells at the age of 9 months underwent echocardiography at that time, which revealed tetralogy of Fallot (TOF). Follow-up computed tomography angiography revealed TOF with val...A 14-year-old child with recurrent cyanotic spells at the age of 9 months underwent echocardiography at that time, which revealed tetralogy of Fallot (TOF). Follow-up computed tomography angiography revealed TOF with valvular pulmonary stenosis and a right-sided aortic arch with mirror image branching. Interestingly, an unusual anomalous course of the left brachiocephalic vein was seen. Instead of coursing anterior to the aortic arch, the left brachiocephalic vein had a U-shaped course like a garland, where it descended vertically down behind the esophagus and the descending aorta, crossed the midline at T4 level of the vertebral body, and then ascended upwards to join the superior vena cava. This case highlights the role of computed angiography in depicting anomalous venous anatomy in TOF, which can have potential clinical implications.
Gaona GA, Kassamali AA, Isakadze N
… +1 more, Martin SS
Methodist Debakey Cardiovasc J
· 2024 · PMID 39525376
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The cardiovascular exposome encompasses the array of external and internal factors affecting cardiovascular health throughout life, inviting comprehensive monitoring and analysis to enhance prevention, diagnosis, and tre...The cardiovascular exposome encompasses the array of external and internal factors affecting cardiovascular health throughout life, inviting comprehensive monitoring and analysis to enhance prevention, diagnosis, and treatment strategies. Wearable and digital technologies have emerged as promising tools in this domain, offering longitudinal, real-time data on physiological parameters such as heart rate, heart rhythm, physical activity, and sleep patterns. This review explores the advancements in wearable sensor technology, the methodologies for data collection and analysis, and the integration of these technologies into clinical practice and research. Primary findings indicate significant improvements in device accuracy and functionality, facilitated by enhanced sensor technology, artificial intelligence, and data connectivity. These advancements enable precise monitoring, early detection of cardiovascular anomalies, and personalized healthcare interventions. Ultimately, wearables and digital health technologies have the potential to facilitate a deeper understanding of cardiovascular disease and behavior and bridge gaps in traditional healthcare models to help usher in more efficient, personalized, patient-centered care.
Chang R, Amin Z, Cheema NH
… +4 more, Yousefzai S, Gardezi K, Shah A, Javed Z
Methodist Debakey Cardiovasc J
· 2024 · PMID 39525375
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Social determinants of health (SDOH) are known to determine a significant portion of a person's health, influencing downstream outcomes and widespread disparities. Screening for SDOH in clinical practice can improve effi...Social determinants of health (SDOH) are known to determine a significant portion of a person's health, influencing downstream outcomes and widespread disparities. Screening for SDOH in clinical practice can improve efficacy of medical care, highlighting the potential for polysocial risk scores (PsRS) to help evaluate a patient's risk of developing atherosclerotic cardiovascular disease and other conditions. This review highlights existing research about the efficacy of PsRS in practical risk assessment, current gaps in the literature, and opportunities to refine the design and implementation of PsRS in real-world clinical settings. PsRS present unique opportunities to improve traditional risk prediction models for heart disease and other conditions, particularly if they examine both individual and area-level SDOH. Future studies should assess novel methods for extracting SDOH data from patients' medical records as well as PsRS implementation strategies that promote efficiency and patient confidentiality in real-world clinical settings.
Kandula VA, Smith GL, Rajaram R
… +4 more, Palaskas NL, Deswal A, Nasir K, Ali HR
Methodist Debakey Cardiovasc J
· 2024 · PMID 39525372
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Cardiovascular disease (CVD) represents a significant financial burden on patients and families, compounded by both direct and indirect healthcare costs. The increasing prevalence of CVD, coupled with the rising costs of...Cardiovascular disease (CVD) represents a significant financial burden on patients and families, compounded by both direct and indirect healthcare costs. The increasing prevalence of CVD, coupled with the rising costs of treatment, exacerbates financial toxicity-defined as the economic strain and associated physical, emotional, and behavioral consequences on patients. This review explores the scope of financial toxicity in CVD care, detailing its prevalence, associated risk factors, and the complex interplay with social determinants of health such as income, insurance status, and comorbidities. Drawing from models in oncology, we highlight key interventions aimed at mitigating financial toxicity, including patient counseling, financial navigation, and enhanced patient-physician cost discussions. By adopting these approaches, healthcare providers can better support patients with CVD in managing both their health and financial well-being, potentially improving clinical outcomes. Future research is needed to develop standardized assessment tools for financial toxicity in CVD and implement system-wide mitigation strategies.
Sirinvaravong N, Fenberg R, Vankoevering KK
… +4 more, Malara M, Salmeron AW, Rajpal S, Houmsse M
Methodist Debakey Cardiovasc J
· 2024 · PMID 39371373
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We present a case of a 45-year-old male with symptomatic supraventricular tachycardia. Electrophysiology study and 3-dimensional (3D) electroanatomic mapping showed a focal atrial tachycardia originating from a large lef...We present a case of a 45-year-old male with symptomatic supraventricular tachycardia. Electrophysiology study and 3-dimensional (3D) electroanatomic mapping showed a focal atrial tachycardia originating from a large left atrial diverticulum. Due to the unusual anatomy, 3D printing models were used to aid successful catheter ablation of the atrial tachycardia.
Mahmoud A, Saadeh M, Alfawara MS
… +2 more, Maaiah WG, Al-Awaisheh A
Methodist Debakey Cardiovasc J
· 2024 · PMID 39346745
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Coronary arteries normally originate from two separate cusps from the aorta, and various anomalies can occur. One such anomaly is the single coronary artery (SCA), where the coronary arteries originate from a single osti...Coronary arteries normally originate from two separate cusps from the aorta, and various anomalies can occur. One such anomaly is the single coronary artery (SCA), where the coronary arteries originate from a single ostium due to the absence of the contralateral ostia. In a rare case we encountered while evaluating a patient with atypical chest pain, computed tomography angiography revealed that the right ostia was absent, and the right coronary artery originated from the left circumflex artery. This subtype of SCA has been exceedingly rare, with only a few cases reported in the literature.
Collado E, Bardoczi A, Lumsden AB
… +1 more, Garami Z
Methodist Debakey Cardiovasc J
· 2024 · PMID 39247627
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Agenesis or hypoplasia of the internal carotid artery (ICA) may easily be confused with dissection or occlusion. We report a case of a 24-year-old female with complaint of acute left-hand hypoesthesia and a history of oc...Agenesis or hypoplasia of the internal carotid artery (ICA) may easily be confused with dissection or occlusion. We report a case of a 24-year-old female with complaint of acute left-hand hypoesthesia and a history of occasional intermittent numbness of her right hand with myoclonic jerking. Because previous imaging studies over 2 years were interpreted as occlusion of the left ICA secondary to carotid dissection, the treating physician had prescribed anticoagulant therapy. During transcranial Doppler (TCD) examination, the spectral waveform was unexpectedly normal, prompting a repeat review of all imaging due to the TCD results. Magnetic resonance angiography (MRA) revealed the same "flame-like" appearance of the ICA origin. Late-phase digital subtraction angiography showed a small caliber cervical ICA (occluded at the skull base). Computed tomography demonstrated absence of the carotid canal, confirming an absent intracranial portion of the ICA and establishing a correct diagnosis of left internal carotid hypoplasia. Vascular ultrasound and TCD examinations are noninvasive and inexpensive tools that can improve the interpretation and understanding of the clinical significance of other "static" radiographic tests (MRA, digital subtraction angiography ). An accurate diagnosis is essential to avoid risky, aggressive treatment, such as anticoagulation for an "absent" dissection.
Saleeb AG, Farina JM, Jenkins A
… +6 more, Zeineddine R, Shawwaf K, Yang EH, Alsidawi S, Jaroszewski DE, Downey FX
Methodist Debakey Cardiovasc J
· 2024 · PMID 39247626
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The WATCHMAN™ atrial appendage closure device is designed to reduce the risk of stroke in patients with nonvalvular atrial fibrillation who are not suitable candidates for long-term oral anticoagulation therapy. However,...The WATCHMAN™ atrial appendage closure device is designed to reduce the risk of stroke in patients with nonvalvular atrial fibrillation who are not suitable candidates for long-term oral anticoagulation therapy. However, the device also carries small risks, including procedural complications such as device migration, embolization, or pericardial effusion. We describe a case of WATCHMAN device migration requiring surgical retrieval.
Methodist Debakey Cardiovasc J
· 2024 · PMID 39220352
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This 10-minute video aims at improving skills for the structural assessment of the interatrial septum using 2-dimensional transthoracic echocardiography (TTE) to increase the ability to diagnose-or rule out-the different...This 10-minute video aims at improving skills for the structural assessment of the interatrial septum using 2-dimensional transthoracic echocardiography (TTE) to increase the ability to diagnose-or rule out-the different types of interatrial communications. Of the five types of lesions, this video focuses on ostium secundum atrial septal defect. This is the first video in our MicroLearning Video Series, designed to help a target audience of sonographers, general cardiologists, general practitioners who want to gain knowledge on fundamental cardiology, and technicians. View the video at https://vimeo.com/989145537/4898c3c590.
Saadeh M, Mahmoud A, Ma'aita M
… +4 more, Eiadeh A, Hammoudeh A, Saadeh M, Alfawara MS
Methodist Debakey Cardiovasc J
· 2024 · PMID 39220351
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The pulmonary veins normally drain into the left atrium, with the superior pulmonary veins typically situated anterior and inferior to the right pulmonary arteries. However, anomalies can happen. We encountered an exceed...The pulmonary veins normally drain into the left atrium, with the superior pulmonary veins typically situated anterior and inferior to the right pulmonary arteries. However, anomalies can happen. We encountered an exceedingly rare pulmonary vascular anomaly for a patient presenting with atypical chest pain, where the right superior pulmonary vein aberrantly ran posterior to the right pulmonary artery (RPA) and became compressed between the RPA and the right main bronchus. Coronary computed tomography angiography identified this specific pulmonary vein anomaly but revealed unremarkable coronary arteries.
Methodist Debakey Cardiovasc J
· 2024 · PMID 39220350
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Fat emboli may occur in patients after traumatic fractures or orthopedic procedures; however, their clinical detection is a very rare finding. Here, we describe a 77-year-old female who was admitted to the emergency depa...Fat emboli may occur in patients after traumatic fractures or orthopedic procedures; however, their clinical detection is a very rare finding. Here, we describe a 77-year-old female who was admitted to the emergency department with a fracture of the right humerus. We diagnosed fat embolism after an ultrasound of the right subclavian vein. The embolism was detected by high-intensity transient signals present on the spectral Doppler. While these signals are well known for microembolization in transcranial Doppler, to our knowledge this is the first case report in the medical literature to observe and describe high-intensity transient signals seen in the upper extremities by spectral Doppler. Although it is unusual to detect a fat embolism in transit, we believe clinicians should be aware of this finding, particularly when evaluating high-risk patients.
Methodist Debakey Cardiovasc J
· 2024 · PMID 39193116
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Reverse remodeling, the overarching concept behind myocardial recovery, describes the process in which the maladaptive cardiac structural and functional alterations are reversed by removing the underlying etiology or by...Reverse remodeling, the overarching concept behind myocardial recovery, describes the process in which the maladaptive cardiac structural and functional alterations are reversed by removing the underlying etiology or by therapy. This review addresses different imaging modalities and biomarkers as possible predictors for reverse remodeling in patients with chronic heart failure. Although echocardiography remains the imaging modality of choice in daily practice, the presence and amount of fibrosis on cardiac magnetic resonance is a better predictor and inversely correlated with the likelihood for reverse remodeling. A decrease in NT-proBNP levels and serum soluble ST3 during follow-up is associated with better clinical and structural outcomes. The role of troponins and galectine-3 is less clear. There is a promising role for microRNAs in the future, although more research is necessary. Accurate predictors of reverse remodeling could help identify patients with an increased likelihood for reverse remodeling and, in turn, improve patient-tailored medicine.
Methodist Debakey Cardiovasc J
· 2024 · PMID 39184167
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Heart failure with reduced left ventricular (LV) ejection fraction (HFrEF) is a morbid and life-threatening disease, arising secondary to abnormalities of cardiac structure and function that lead to adverse LV remodeling...Heart failure with reduced left ventricular (LV) ejection fraction (HFrEF) is a morbid and life-threatening disease, arising secondary to abnormalities of cardiac structure and function that lead to adverse LV remodeling. Implementation of medical and device therapies results in significant improvements in patient outcomes that are associated with reverse LV remodeling and improved LV ejection fraction. This review provides an overview of the pathobiology of reverse LV remodeling in animal models and in HFrEF patients. We emphasize the differences between myocardial recovery and remission as well as the fragile nature of maintaining a state of myocardial remission.
Verma M, Makhaik S, Rana A
… +2 more, Jhobta A, Thakur P
Methodist Debakey Cardiovasc J
· 2024 · PMID 39184166
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Transthoracic echocardiography and cardiac magnetic resonance imaging revealed a well-defined globular mass attached to the anterolateral papillary muscle. The mass was hyperintense on T1 and T2 weighted images with supp...Transthoracic echocardiography and cardiac magnetic resonance imaging revealed a well-defined globular mass attached to the anterolateral papillary muscle. The mass was hyperintense on T1 and T2 weighted images with suppression of signal on fat saturated and short tau inversion recovery (STIR) images. This imaging established the diagnosis of cardiac lipoma attached to the anterolateral papillary muscle, Papillary muscle is a very rare location of lipoma, which is rarely reported in the literature.
Methodist Debakey Cardiovasc J
· 2024 · PMID 39184165
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The 12th annual Utah Cardiac Recovery Symposium (U-CARS) in 2024 continued its mission to advance cardiac recovery by uniting experts across various fields. The symposium featured key presentations on cutting-edge topics...The 12th annual Utah Cardiac Recovery Symposium (U-CARS) in 2024 continued its mission to advance cardiac recovery by uniting experts across various fields. The symposium featured key presentations on cutting-edge topics such as CRISPR gene editing for heart failure, guideline-directed medical therapy for heart failure (HF) with improved/recovered ejection fraction (HFimpEF), the role of extracorporeal cardiopulmonary resuscitation (ECPR) in treating cardiac arrest, and others. Discussions explored genetic and metabolic contributions to HF, emphasized the importance of maintaining pharmacotherapy in HFimpEF to prevent relapse, and identified future research directions including refining ECPR protocols, optimizing patient selection, and leveraging genetic insights to enhance therapeutic strategies.
Pensa AV, Zheng V, Davis L
… +2 more, Harap RW, Wilcox JE
Methodist Debakey Cardiovasc J
· 2024 · PMID 39184164
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Partial or complete imaging resolution of left ventricular (LV) systolic dysfunction in patients with heart failure with reduced ejection fraction (HFrEF) has gone by many names in the past few decades, including LV reco...Partial or complete imaging resolution of left ventricular (LV) systolic dysfunction in patients with heart failure with reduced ejection fraction (HFrEF) has gone by many names in the past few decades, including LV recovery, remission, reverse remodeling, and, most recently, improvement. This phenomenon has been described in a variety of clinical scenarios, including removal of an acute myocardial insult, unloading with durable LV assist devices, and treatment with various devices as well as pharmacotherapies, termed guideline-directed medical therapy (GDMT). Irrespective of definition, systolic improvement is associated with improved clinical outcomes compared to persistent systolic dysfunction. In the past few years, systolic improvement has been distinguished from HFrEF as a new clinical entity referred to as HF with improved EF (HFimpEF). Given the relative novelty of this condition, there is a paucity of data with regard to the clinical trajectory and management of this population. In this review, we describe the history of myocardial improvement terminology and explore notable findings that have led to the delineation of HFimpEF. Additionally, we highlight the importance of understanding LV trajectory and the potential opportunity for new GDMT management for clinicians when treating patients with HFimpEF.
Martinez-Dominguez P, Ana-Bayona MJS, Guerra EC
… +1 more, Espinola-Zavaleta N
Methodist Debakey Cardiovasc J
· 2024 · PMID 39184162
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Chemotherapy has markedly improved cancer outcomes, yet cancer therapy-related cardiac dysfunction (CTRCD) poses a significant challenge, affecting around 10% of patients. CTRCD can be asymptomatic or present with heart...Chemotherapy has markedly improved cancer outcomes, yet cancer therapy-related cardiac dysfunction (CTRCD) poses a significant challenge, affecting around 10% of patients. CTRCD can be asymptomatic or present with heart failure symptoms. Multimodality imaging, particularly echocardiography, remains pivotal for monitoring cardiac function. Potential biomarkers for CTRCD assessment include troponin and B-type natriuretic peptide. Pharmacological interventions, such as dexrazoxane, angiotensin-converting enzyme inhibitors, and statins, play a crucial role in primary prevention and mitigating cardiotoxicity alongside cardiac rehabilitation programs. Thus, a comprehensive approach is essential for optimal cardiac recovery and improved patient outcomes.
Upadhyaya VD, Wong C, Zakir RM
… +3 more, Aghili N, Faraz H, Kapur NK
Methodist Debakey Cardiovasc J
· 2024 · PMID 39184160
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Despite significant advancements in managing acute ST-segment elevation myocardial infarctions, the prevalence of heart failure has not decreased. Emerging paradigms with a focus on reducing infarct size show promising e...Despite significant advancements in managing acute ST-segment elevation myocardial infarctions, the prevalence of heart failure has not decreased. Emerging paradigms with a focus on reducing infarct size show promising evidence in the improvement of the incidence of heart failure after experiencing acute coronary syndromes. Limiting infarct size has been the focus of multiple clinical trials over the past decades and has led to left ventricular (LV) unloading as a potential mechanism. Contemporary use of microaxial flow devices for LV unloading has suggested improvement in mortality in acute myocardial infarction complicated by cardiogenic shock. This review focuses on clinical data demonstrating evidence of infarct size reduction and highlights ongoing clinical trials that provide a new therapeutic approach to the management of acute myocardial infarction.