Emory Clinical Cardiovascular Research Institute

Atlanta, GA, United States

Emory Clinical Cardiovascular Research Institute

Atlanta, GA, United States
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Ambrosy A.P.,Duke University | Gheorghiade M.,Northwestern University | Chioncel O.,University of Bucharest | Mentz R.J.,Duke University | And 2 more authors.
Current Heart Failure Reports | Year: 2014

Heart failure (HF) is a public health problem of global proportions afflicting more than 25 million patients worldwide. Despite stable or declining per capita hospitalization rates in the USA and several European countries, there are over one million hospitalizations for HF annually in the USA, with similar numbers in Europe, accounting for 6.5 million hospital days and the majority of the approximately $40 billion spent each year on HF-related care. Moreover, clinical trial data suggest that post-discharge survival and readmissions have largely remained unchanged. Thus, understanding geographic and ethnic variations in HF is essential to formulating public policy at the local, national, regional, and international levels and setting the agenda for basic, translational, and clinical research endeavors. This paper aims to describe regional and ethnic variations in patient characteristics, management, and outcomes in hospitalized HF. © 2014, Springer Science+Business Media New York.

Ozkor M.A.,Emory Clinical Cardiovascular Research Institute | Murrow J.R.,Emory Clinical Cardiovascular Research Institute | Rahman A.M.,Emory Clinical Cardiovascular Research Institute | Kavtaradze N.,Emory Clinical Cardiovascular Research Institute | And 4 more authors.
Circulation | Year: 2011

Background-: We assessed the contribution of endothelium-derived hyperpolarizing factors to resting and agonist-stimulated vasodilator tone in health and disease. Tetraethylammonium chloride (TEA) was used to inhibit KCa channel activation and fluconazole was used to inhibit cytochrome P450 2C9-mediated epoxyeicosatrienoic acid synthesis. We hypothesized that endothelium-derived hyperpolarizing factors contribute to resting vascular tone by KCa channel activation and epoxyeicosatrienoic acid release and that endothelium-derived hyperpolarizing factors compensate for reduced nitric oxide bioavailability at rest and with endothelium-dependent vasodilators. Methods and results-: In 103 healthy subjects and 71 nonhypertensive subjects with multiple risk factors, we measured resting forearm blood flow (FBF) using venous occlusion plethysmography before and after intra-arterial infusions of N-monomethyl-L-arginine (L-NMMA), TEA, fluconazole, and their combination. The effects of these antagonists on resting FBF and on bradykinin- and acetylcholine-mediated vasodilation were studied. Resting FBF decreased with TEA and L-NMMA in all subjects (P<0.001); however, the vasoconstrictor response to L-NMMA was greater (P=0.04) and to TEA was lower (P=0.04) in healthy subjects compared with those with risk factors. Fluconazole decreased resting FBF in all subjects, and the addition of TEA further reduced FBF after fluconazole, suggesting that cytochrome P450 metabolites and other hyperpolarizing factor(s) activate KCa channels. Both L-NMMA and TEA attenuated bradykinin-mediated vasodilation in healthy and hypercholesterolemic subjects (P<0.001). In contrast, acetylcholine-mediated vasodilation remained unchanged with TEA in healthy subjects but was significantly attenuated in hypercholesterolemia (P<0.04). Conclusions-: First, by activating TEA-inhibitable KCa channels, endothelium-derived hyperpolarizing factors, together with nitric oxide, contribute to resting microvascular dilator tone. The contribution of KCa channel activation compared with nitric oxide is greater in those with multiple risk factors compared with healthy subjects. Second, activation of KCa channels is only partly through epoxyeicosatrienoic acid release, indicating the presence of other hyperpolarizing mechanisms. Third, bradykinin, but not acetylcholine, stimulates KCa channel-mediated vasodilation in healthy subjects, whereas in hypercholesterolemia, KCa channel-mediated vasodilation compensates for the reduced nitric oxide activity. Thus, enhanced endothelium-derived hyperpolarizing factor activity in conditions of nitric oxide deficiency contributes to maintenance of resting and agonist-stimulated vasodilation. © 2011 American Heart Association, Inc.

Shuaib W.,Emory University | Vijayasarathi A.,Emory University | Tiwana M.H.,Emory Clinical Cardiovascular Research Institute | Johnson J.-O.,Emory University | And 2 more authors.
Emergency Radiology | Year: 2014

Rib series rarely add information to the posteroanterior (PA) film for the diagnosis of rib fractures. In this investigation, we evaluated the utility of rib X-rays using turnaround time (TAT), radiation exposure, and cost-efficiency as the key parameters. This investigation was conducted from January 2008 to December 2012. We included patients who had rib series performed for suspected rib fractures. TAT for patients was calculated from the time exam was ordered by the emergency department (ED) physician/staff to time the report was finalized by the attending radiologist. Effective radiation dose for rib series was calculated as a summation of radiation dose from the standard rib series images for each patient. Cost-efficiency was determined based on the number of interventions that took place as a result of a complicated study. Our investigation consisted of 422 patients, 208 females aged (57±20.8) and 214 males aged (48±17.3). A total of 74(17.5 %) abnormal findings were noted, out of which only 1(0.23 %) underwent management change. The mean turnaround time for patients undergoing rib series had a value of 133.5 (±129.8)min as opposed to a single chest PA of 61.8(± 64)min. Average effective radiation dose for a rib series was 0.105 (±0.04)mSv, whereas average effective radiation dose of a single chest PA was 0.02 mSv. Dedicated rib series has a low-yield diagnostic value as it pertains to management change. The overall impact on patient care based on our findings is small when compared to the risks associated with prolonged TAT, repeated exposure to radiation, and extensive medical costs. © 2013 Am Soc Emergency Radiol.

Hayek S.,Emory Clinical Cardiovascular Research Institute | Sims D.B.,Emory Clinical Cardiovascular Research Institute | Markham D.W.,Emory Clinical Cardiovascular Research Institute | Butler J.,Emory Clinical Cardiovascular Research Institute | Kalogeropoulos A.P.,Emory Clinical Cardiovascular Research Institute
Circulation: Cardiovascular Imaging | Year: 2014

As a result of the improved survival of patients with heart failure (HF) and the overall rise in the prevalence of HF,1 the number of patients in advanced (stage D) HF continues to increase, thus exceeding the limited availability of donor organs by a wide margin.2 Initially used primarily as a bridge to heart transplantation, mechanical circulatory support is now increasingly offered as a destination therapy to patients with advanced HF in clinical deterioration who are not candidates for transplantation. Improvement in survival to 80% at 1-year postimplantation3 has steadily followed the development of new technologies such as the continuous-flow pump, which now encompasses 99% of left ventricular assist devices (LVADs),3 and improvements in patient and device management. Far from being a panacea, mechanical circulatory support is still fraught with challenges. Among them, post-LVAD right ventricular failure (RVF) is a major cause of morbidity and mortality. © 2014 American Heart Association, Inc.

Poole J.C.,Emory University | Quyyumi A.A.,Emory University | Quyyumi A.A.,Emory Clinical Cardiovascular Research Institute
Stem Cells International | Year: 2013

ST elevation myocardial infarction (STEMI) is associated with an increased risk for congestive heart failure and long-term mortality despite the widespread use of thrombolysis and catheter-based revascularization. The need for improved post-STEMI therapies has led to a surge of novel therapeutics, especially regenerative approaches using autologous mononuclear cells. Indeed, the past decade has been marked by a number of human trials studying the safety and efficacy of progenitor cell delivery in the post-STEMI setting. While a variety of cell types and delivery techniques have been utilized, directed therapy to the infarct-related artery has been the most widely used approach. From over 1300 subjects randomized in these studies, there is sufficient evidence to conclude that cell therapy after STEMI is uniformly safe, while the efficacy of this intervention for improving outcomes is less clear. Recent meta-analyses have highlighted the importance of both timing of cell delivery, as well as the type, quantity, and mobility of delivered cells as determinants of response. Here, we show the case in which higher doses of CD34+ cells, which are more potent in terms of their migratory capacity, offer the best hope for preserving cardiac function following STEMI. © 2013 Joseph C. Poole and Arshed A. Quyyumi.

Kalogeropoulos A.P.,Emory Clinical Cardiovascular Research Institute | Georgiopoulou V.V.,Emory Clinical Cardiovascular Research Institute | Butler J.,Emory Clinical Cardiovascular Research Institute
Heart Failure Clinics | Year: 2012

Elevated levels of circulating proinflammatory cytokines and adipokines have been repeatedly associated with increased risk for clinically manifest (Stage C) heart failure in large cohort studies. However, the role of low-grade, subclinical inflammatory activity in the transition from risk factors (Stage A heart failure) to structural heart disease (Stage B heart failure) is less well understood. Recent evidence suggests that chronic low-grade inflammatory activity is involved in most mechanisms underlying progression of structural heart disease, including ventricular remodeling after ischemic injury, response to pressure and volume overload, and myocardial fibrosis. Inflammation also contributes to progression of peripheral vascular changes. © 2012 Elsevier Inc.

Wilson P.W.F.,Emory Clinical Cardiovascular Research Institute
Cardiology Clinics | Year: 2011

Observational studies with incidence of cardiovascular disease (CVD) events have typically provided the information that is used. Prediction of risk is dependent on accurate and precise baseline measurements in persons without coronary disease at baseline. Follow-up of 5 to 10 years is a typical interval of interest for the prediction of coronary disease events in adults who are asymptomatic at the baseline. Performance criteria for risk estimation include discrimination, calibration, and reclassification, and newer heart disease risk factors and biomarkers can be evaluated in the context of existing risk estimation approaches. © 2011 Elsevier Inc.

Kim J.H.,Emory Clinical Cardiovascular Research Institute | Baggish A.L.,Massachusetts General Hospital
Journal of Electrocardiology | Year: 2015

Differentiating benign electrocardiographic (ECG) patterns in athletes from those representative of underlying cardiac pathology is both clinically relevant and challenging. Complete right (RBBB) and left (LBBB) bundle branch block are relatively rare in asymptomatic athletic populations, and current expert consensus guidelines recommend further clinical investigation upon detection of either ECG pattern. However, present data suggest that typical RBBB is not associated with structural cardiac pathology and may alternatively represent an ECG marker of exercise-induced right ventricular remodeling. In accordance with current guidelines, the presence of asymptomatic LBBB in athletes is not associated with normal exercise physiology and more likely indicative of underlying cardiac pathology. While long-term outcomes for asymptomatic athletes with RBBB or LBBB remain unknown, current evidence regarding these ECG patterns should be considered to improve the specificity of future athlete-specific ECG interpretation guidelines. © 2015 Elsevier Inc. All rights reserved.

Kalogeropoulos A.P.,Emory Clinical Cardiovascular Research Institute | Georgiopoulou V.V.,Emory Clinical Cardiovascular Research Institute | Butler J.,Emory Clinical Cardiovascular Research Institute
Progress in Cardiovascular Diseases | Year: 2012

The recent explosion of scientific knowledge and technological progress has led to the discovery of a large array of circulating molecules commonly referred to as biomarkers. Biomarkers in heart failure (HF) research have been used to provide pathophysiologic insights, aid in establishing the diagnosis, refine prognosis, guide management, and target treatment. However, beyond diagnostic applications of natriuretic peptides, there are currently few widely recognized applications for biomarkers in HF. This represents a remarkable discordance considering the number of molecules that have been shown to correlate with outcomes, refine risk prediction, or track disease severity in HF in the past decade. In this article, we use a broad framework proposed for cardiovascular risk markers to summarize the current state of biomarker development for patients with HF. We use this framework to identify the challenges of biomarker adoption for risk prediction, disease management, and treatment selection for HF and suggest considerations for future research. © 2012 Elsevier Inc.

Wilson P.W.F.,Emory Clinical Cardiovascular Research Institute
Global Heart | Year: 2013

Research related to lipid levels, correlates of lipid levels, and how lipid levels are related to vascular disease outcomes in the Framingham cohorts are summarized for data obtained from 1948 to the present day. Initial lipid data in Framingham participants were largely confined to cholesterol and triglycerides. Technology evolved to later include lipoprotein cholesterol quantification using ultracentrifugation, apolipoproteins, genetics, lipid particle size and number, and use of lipid information in multivariable equations to estimate risk for the development of initial cardiovascular disease outcomes. The information is presented chronologically to highlight the developments related to the lipids and heart disease over the past 50 years. © 2013 World Heart Federation (Geneva). Published by Elsevier Ltd. All rights reserved.

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