Methodist Debakey Cardiovasc J
· 2024 · PMID 39184159
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Myocardial recovery is characterized by a return toward normal structure and function of the heart after an injury. Mechanisms of myocardial recovery include restoration and/or adaptation of myocyte structure and functio...Myocardial recovery is characterized by a return toward normal structure and function of the heart after an injury. Mechanisms of myocardial recovery include restoration and/or adaptation of myocyte structure and function, mitochondrial activity and number, metabolic homeostasis, electrophysiological stability, extracellular matrix remodeling, and myocardial perfusion. Myocardial regeneration is an element of myocardial recovery that involves the generation of new myocardial tissue, a process which is limited in adult humans but may be therapeutically augmented. Understanding the mechanisms of myocardial recovery and myocardial regeneration will lead to novel therapies for heart failure.
John K, Khalif A, Tsukashita M
… +1 more, Kanwar MK
Methodist Debakey Cardiovasc J
· 2024 · PMID 39184158
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The overarching goal of cardiogenic shock (CS) therapy is ensuring long-term survival. In recent years, increasing emphasis has been placed on analyzing mechanisms to improve outcomes in CS. This includes averting in-hos...The overarching goal of cardiogenic shock (CS) therapy is ensuring long-term survival. In recent years, increasing emphasis has been placed on analyzing mechanisms to improve outcomes in CS. This includes averting in-hospital mortality, modifying the disease process by promoting heart recovery while avoiding multiorgan failure, and circumventing complications related to both CS and treatment strategies deployed to treat CS. Heart replacement therapies represent a viable strategy for long-term survival but are restricted to a small, select percentage of patients. In this review we focus on pathophysiology of the shock state, with an emphasis on addressing reversible etiologies contributing to the decompensated state, optimizing physiological factors for recovery, and identifying therapeutic targets to promote recovery. We also review the known predictors of myocardial recovery, regardless of the etiology of CS. Lastly, we highlight the current gaps in knowledge in this field and support additional high-quality studies focusing on myocardial recovery in CS.
Methodist Debakey Cardiovasc J
· 2024 · PMID 39184157
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Heart failure poses a significant challenge to healthcare systems and society at large, mainly due to its increasing prevalence among the aging population and its association with frequent hospitalizations with high mort...Heart failure poses a significant challenge to healthcare systems and society at large, mainly due to its increasing prevalence among the aging population and its association with frequent hospitalizations with high mortality rates. At its core, heart failure management seeks to emphasize myocardial recovery across the spectrum of disease, from acute cardiogenic shock to ambulatory heart failure, with care ranging from consideration of mechanical circulatory support to medication optimization. In this review, we propose a definition of "recovery" that extends beyond the restoration of normal myocardial dynamics to the entire human organism, ultimately improving functional capacity and clinical outcomes. Prioritizing this more holistic definition of "recovery" allows a broader representation of the spectrum of disease and corresponding management that falls under the "heart failure" umbrella. In so doing, a more synchronized delivery of care across settings and disciplines may be feasible for the modern patient living with heart failure.
Lang FM, Lee BC, Lotan D
… +2 more, Sabuncu MR, Topkara VK
Methodist Debakey Cardiovasc J
· 2024 · PMID 39184156
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Heart failure (HF) affects millions of individuals and causes hundreds of thousands of deaths each year in the United States. Despite the public health burden, medical and device therapies for HF significantly improve cl...Heart failure (HF) affects millions of individuals and causes hundreds of thousands of deaths each year in the United States. Despite the public health burden, medical and device therapies for HF significantly improve clinical outcomes and, in a subset of patients, can cause reversal of abnormalities in cardiac structure and function, termed "myocardial recovery." By identifying novel patterns in high-dimensional data, artificial intelligence (AI) and machine learning (ML) algorithms can enhance the identification of key predictors and molecular drivers of myocardial recovery. Emerging research in the area has begun to demonstrate exciting results that could advance the standard of care. Although major obstacles remain to translate this technology to clinical practice, AI and ML hold the potential to usher in a new era of purposeful myocardial recovery programs based on precision medicine. In this review, we discuss applications of ML to the prediction of myocardial recovery, potential roles of ML in elucidating the mechanistic basis underlying recovery, barriers to the implementation of ML in clinical practice, and areas for future research.
Methodist Debakey Cardiovasc J
· 2024 · PMID 39184155
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Limericks are an easy, casual, and entertaining way to have fun with the English language. Creating them can be an engaging pastime to assist in memorizing important anatomic relationships necessary for being an interven...Limericks are an easy, casual, and entertaining way to have fun with the English language. Creating them can be an engaging pastime to assist in memorizing important anatomic relationships necessary for being an interventional cardiologist or simply an intellectual exercise that provides respite after a hectic day in the cardiac catheterization laboratory, surgical suite, outpatient clinic, or intensive care unit. Interest in this form of poetry often dates back to when we, as children, were taught the simplistic rhyming pattern of a traditional limerick or learned one during adolescence. As we age, our limericks often became more humorous, personal, and bawdy. That evolution is the beauty of this poetic form. For this edition of Poet's Pen, we invited Dr. Marshall S. Flam, a noted dabbler in the limerick world, to pen "Limericks for Myocardial Recovery and Regeneration" to accompany the theme of this issue.
Methodist Debakey Cardiovasc J
· 2024 · PMID 39157298
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A 76-year-old female with a complicated medical history presented for Watchman (Boston Scientific) placement 2 months after mitral valve transcatheter edge-to-edge repair (TEER). Preoperative workup before Watchman place...A 76-year-old female with a complicated medical history presented for Watchman (Boston Scientific) placement 2 months after mitral valve transcatheter edge-to-edge repair (TEER). Preoperative workup before Watchman placement confirmed the presence of a thrombus in the left superior pulmonary vein. Post-procedure mitral valve TEER transesophageal echocardiogram showed no thrombus in the left atrium appendage or pulmonary veins. We believe the thrombus in the left superior pulmonary vein occurred secondarily due to epithelium damage during the mitral valve TEER.
Lalani K, Rao MS, Dhanse S
… +3 more, Devasia T, Kareem H, Paramasivam G
Methodist Debakey Cardiovasc J
· 2024 · PMID 39131797
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Coronary intervention involving the region of bifurcation remains a challenging issue for the cardiologist as well as a complication. A number of factors including the angulation of side branch with the main branch deter...Coronary intervention involving the region of bifurcation remains a challenging issue for the cardiologist as well as a complication. A number of factors including the angulation of side branch with the main branch determines the success. Though provisional strategy remains the best option in bifurcation intervention, at times a two-stent strategy cannot be avoided. We report a case in which percutaneous coronary intervention was performed on the left anterior descending artery (LAD) at its bifurcation with a major diagonal branch (> 2.5 mm). The ostium of the diagonal was diseased, and the branch took off from the LAD at an unfavorable angle (> 120°). We describe the use of the "shepherd's crook wire curve" approach, a modification of the reverse wire technique, which allowed us to successfully wire, dilate, and protect the diagonal and so named to reflect its resemblance to the shape of a shepherd's crook.
Mahmoud AK, Farina JM, Awad K
… +7 more, Pereyra M, Scalia IG, Abbas MT, Barry T, Alsidawi S, Ayoub C, Arsanjani R
Methodist Debakey Cardiovasc J
· 2024 · PMID 38911827
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Apical hypertrophic cardiomyopathy (HCM) is a rare variant of HCM. A 43-year-old female with a past medical history significant for hypertension and kidney transplantation presented with recurrent syncopal episodes and d...Apical hypertrophic cardiomyopathy (HCM) is a rare variant of HCM. A 43-year-old female with a past medical history significant for hypertension and kidney transplantation presented with recurrent syncopal episodes and dyspnea on exertion. Electrocardiogram showed characteristic diffuse giant T-waves inversion, and cardiac magnetic resonance showed HCM with circumferential apical thickening. This case highlights the rapid development of apical HCM and its challenging diagnostic characteristics.
Puppala R, Benfor B, Timbalia S
… +2 more, Sheu TG, Lumsden AB
Methodist Debakey Cardiovasc J
· 2024 · PMID 38882594
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This paper reports a case of an internal jugular venous malformation (IJVM) and route of treatment in a patient with limited symptoms. After history and imaging studies, a determination of surgical excision was made to r...This paper reports a case of an internal jugular venous malformation (IJVM) and route of treatment in a patient with limited symptoms. After history and imaging studies, a determination of surgical excision was made to rule out possible malignancy and future problems such as thrombosis. The mass was resected, and part of the IJVM was ligated. The mass had no identifiable malignancy, and the patient recovered fully with no complications. The paper highlights the importance of identifying venous malformations and highlights the reasoning behind the course of action.
Methodist Debakey Cardiovasc J
· 2024 · PMID 38855041
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Left ventricular assist devices (LVAD) are frequently used in the management of end-stage heart failure, especially given the limited availability of donor hearts. The latest HeartMate 3 LVAD delivers non-physiological c...Left ventricular assist devices (LVAD) are frequently used in the management of end-stage heart failure, especially given the limited availability of donor hearts. The latest HeartMate 3 LVAD delivers non-physiological continuous flow (CF), although the impact on the aorta is not well established. We highlight a case of aortic aneurysm formation complicated by dissection formation that necessitated high-risk re-operative surgery in a patient post CF-LVAD.
Al Hennawi H, Abulshamat A, Sheikh A
… +4 more, Qandeel H, Zakharov K, Bandi A, Qintar M
Methodist Debakey Cardiovasc J
· 2024 · PMID 38855040
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Transcatheter extraction of an intracardiac mass is a newer approach that may lead to nonsurgical treatment of complex cardiac masses. We present a case in which thrombectomy devices were combined to extract a right atri...Transcatheter extraction of an intracardiac mass is a newer approach that may lead to nonsurgical treatment of complex cardiac masses. We present a case in which thrombectomy devices were combined to extract a right atrial mass, which highlights new frontiers in the treatment of complex transcatheter mass extraction. The combined use of two transcatheter thrombectomy devices (Kong and Godzilla) may provide a powerful addition to the existing armamentarium.
Khalid N, Kumar S, Muskula P
… +2 more, Muhammad H, Helmy T
Methodist Debakey Cardiovasc J
· 2024 · PMID 38855039
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We report three cases of coronary artery aneurysm (CAA) in adults who presented with acute coronary syndrome. Two of these patients did not have traditional coronary artery disease risk factors. Management of CAA poses a...We report three cases of coronary artery aneurysm (CAA) in adults who presented with acute coronary syndrome. Two of these patients did not have traditional coronary artery disease risk factors. Management of CAA poses a significant challenge to interventionalists. We discuss the etiologic mechanisms, risk factors, pathophysiology, and diagnosis using angiography, intravascular ultrasound, and coronary computed tomography. We also highlight management options, including medical therapy and catheter-based interventions such as stenting, coil embolization, stent-assisted coil embolization, and surgical exclusion.
Methodist Debakey Cardiovasc J
· 2024 · PMID 38799179
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We present the case of a 60-year-old male, with active smoking and cocaine use disorder, who reported progressive chest pain. Various anatomical and functional cardiac imaging, performed to further evaluate chest pain et...We present the case of a 60-year-old male, with active smoking and cocaine use disorder, who reported progressive chest pain. Various anatomical and functional cardiac imaging, performed to further evaluate chest pain etiology, revealed changing severity and distribution of left main artery (LMA) stenosis, raising suspicion for vasospasm. Intracoronary nitroglycerin relieved the vasospasm, with resolution of the LMA pseudostenosis. A diagnosis of vasospastic angina (VA) led to starting appropriate medical therapy with lifestyle modification counselling. This case highlights VA, a frequently underdiagnosed etiology of angina pectoris. We discuss when to suspect VA, its appropriate work-up, and management.
Methodist Debakey Cardiovasc J
· 2024 · PMID 38765218
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Ovid's tells the story of Icarus - his tragic flight with man-made wings, the melting of the wax that bound them, and the ensuing fall to his death. This moment has been immortalized across the arts and through several...Ovid's tells the story of Icarus - his tragic flight with man-made wings, the melting of the wax that bound them, and the ensuing fall to his death. This moment has been immortalized across the arts and through several mediums, but none are more notable than Bruegel's . Described as a "painter for poets," Bruegel's work served as inspiration for several writers, with this piece in particular providing the basis for ekphrastic poems by W.H. Auden and William Carlos Williams. Though each of these works has a different focus, the unifying theme is that human tragedy is too often placed on the periphery of notice. They are effective reminders to physicians and other healthcare providers about the human aspect of suffering and pain in medicine.
Methodist Debakey Cardiovasc J
· 2024 · PMID 38765217
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Anticoagulation has been the standard therapy for treating pulmonary embolism. However, newly developed pharmacological and interventional treatment options have been shown to provide benefit for certain patient populati...Anticoagulation has been the standard therapy for treating pulmonary embolism. However, newly developed pharmacological and interventional treatment options have been shown to provide benefit for certain patient populations, depending on how they present. This column highlights the use of massive pulmonary embolism risk stratification in determining the presence of cor pulmonale and offers several key points to remember when caring for patients with a pulmonary embolism.
Methodist Debakey Cardiovasc J
· 2024 · PMID 38765216
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Introductory overview for Issue 20.3 on Pulmonary Embolism, written by the issues' guest editors.Introductory overview for Issue 20.3 on Pulmonary Embolism, written by the issues' guest editors.
Methodist Debakey Cardiovasc J
· 2024 · PMID 38765215
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Pulmonary embolism is a debilitating and potentially life-threatening disease characterized by high mortality and long-term adverse outcomes. Traditional treatment options are fraught with serious bleeding risks and inco...Pulmonary embolism is a debilitating and potentially life-threatening disease characterized by high mortality and long-term adverse outcomes. Traditional treatment options are fraught with serious bleeding risks and incomplete thrombus removal, necessitating the development of innovative treatment strategies. While new interventional approaches offer promising potential for improved outcomes with fewer serious complications, their rapid development and need for more comparative clinical evidence makes it challenging for physicians to select the optimal treatment for each patient among the many options. This review summarizes the current published clinical data for both traditional treatments and more recent interventional approaches indicated for pulmonary embolism. While published studies thus far suggest that these newer interventional devices offer safe and effective options, more data is needed to understand their impact relative to the standard of care. The studies in progress that are anticipated to provide needed evidence are reviewed here since they will be critical for helping physicians make informed treatment choices and potentially driving necessary guideline changes.
Methodist Debakey Cardiovasc J
· 2024 · PMID 38765214
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With a multitude of options for pulmonary embolism management, we review the most common diagnostic tools available for assessing risk as well as how each broad risk category is typically treated. Right heart dysfunction...With a multitude of options for pulmonary embolism management, we review the most common diagnostic tools available for assessing risk as well as how each broad risk category is typically treated. Right heart dysfunction is the cornerstone for triage of these patients and should be the focus for decision-making, especially in challenging patients. We aim to provide a modern, clinical perspective for PE management in light of the multitude of intervention options.
Methodist Debakey Cardiovasc J
· 2024 · PMID 38765213
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Massive pulmonary embolism (MPE) is a serious condition affecting the pulmonary arteries and is difficult to diagnose, triage, and treat. The American College of Chest Physicians (AHA) and the European Society of Cardiol...Massive pulmonary embolism (MPE) is a serious condition affecting the pulmonary arteries and is difficult to diagnose, triage, and treat. The American College of Chest Physicians (AHA) and the European Society of Cardiology (ESC) have different classification approaches for PE, with the AHA defining three subtypes and the ESC four. Misdiagnosis is common, leading to delayed or inadequate treatment. The incidence of PE-related death rates has been increasing over the years, and mortality rates vary depending on the subtype of PE, with MPE having the highest mortality rate. The current definition of MPE originated from early surgical embolectomy cases and discussions among experts. However, this definition fails to capture patients at the point of maximal benefit because it is based on late findings of MPE. Pulmonary Embolism Response Teams (PERTs) have emerged as a fundamental shift in the management of MPE, with a focus on high-risk and MPE cases and a goal of rapidly connecting patients with appropriate therapies based on up-to-date evidence. This review highlights the challenges in diagnosing and managing MPE and emphasizes the importance of PERTs and risk stratification scores in improving outcomes for patients with PE.
Methodist Debakey Cardiovasc J
· 2024 · PMID 38765212
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The presentation of pulmonary embolism (PE) varies from asymptomatic to life-threatening, and management involves multiple specialists. Timely diagnosis of PE is based on clinical presentation, D-dimer testing, and compu...The presentation of pulmonary embolism (PE) varies from asymptomatic to life-threatening, and management involves multiple specialists. Timely diagnosis of PE is based on clinical presentation, D-dimer testing, and computed tomography pulmonary angiogram (CTPA), and assessment by a Pulmonary Embolism Response Team (PERT) is critical to management. Artificial intelligence (AI) technology plays a key role in the PE workflow with automated detection and flagging of suspected PE in CTPA imaging. HIPAA-compliant communication features of mobile and web-based applications may facilitate PERT workflow with immediate access to imaging, team activation, and real-time information sharing and collaboration. In this review, we describe contemporary diagnostic tools, specifically AI, that are important in the triage and diagnosis of PE.