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Columbia, MO, United States

Chockalingam A.,University of Missouri | Chockalingam A.,Harry uman Medical Center | Xie G.-Y.,University of Missouri | Dellsperger K.C.,University of Missouri
International Journal of Cardiovascular Imaging | Year: 2010

Widespread use of echocardiography has contributed to more frequent recognition of takotsubo stress cardiomyopathy. Initial presentation is similar to acute coronary syndrome and the acute course can be complicated by heart failure, arrhythmias, dynamic left ventricular outflow tract obstruction, hypotension and death. We briefly review the clinical presentation and propose a unified diagnostic algorithm for cardiologists acutely managing this cardiac emergency. We highlight the central role of echocardiography and emphasize the nuances of this peculiar acute cardiomyopathy from an echocardiographers' perspective. © Springer Science+Business Media, B.V. 2010.

Yang Y.,Yunnan Province 2nd Hospital | Yang Y.,University of Missouri | Andresen B.T.,University of Missouri | Andresen B.T.,Harry uman Medical Center | And 3 more authors.
Experimental Biology and Medicine | Year: 2010

Genetic factors are important in the pathogenesis of diabetic retinopathy (DR); there is a clear association of increased expression of vascular endothelial growth factor (VEGF) with DR as well as numerous VEGF polymorphisms that are linked to increased VEGF levels and DR. In this study, the relationships between the VEGF promoter polymorphism -634C/G, plasma VEGF levels and DR were examined in the Han Chinese. Ninety-six healthy subjects and 285 subjects with type 2 diabetes were enrolled in this study. The diabetic subjects were divided into three groups depending on the degree of DR as determined by fundus photography and fluorescent angiography. Along with standard clinical characteristics, the -634C/G polymorphism was examined using TaqMan allelic discrimination, and plasma VEGF levels were analyzed by enzyme-linked immunosorbent assay. The distribution of the polymorphism differed significantly between patients with and without retinopathy; this was most pronounced between the no DR and proliferative DR groups. Significantly greater plasma VEGF levels were present in those with the -634CC genotype, and only the proliferative DR group had elevated plasma VEGF levels. Logistic regression revealed that the -634C/G polymorphism is strongly associated with DR. This study suggests that diabetic Han Chinese carrying the -634CC VEGF promoter polymorphism have a genetic risk of DR, and this polymorphism may be a major factor influencing plasma VEGF levels. Therefore, this polymorphism may be used as a biomarker at the onset of diabetes in the Han Chinese to predict the risk of DR, allowing for clinicians to treat these patients more aggressively. Copyright © 2010 by the Society for Experimental Biology and Medicine.

Chockalingam A.,Harry uman Medical Center | Chockalingam A.,University of Missouri | Linden M.A.,University of Missouri | Del Rosario M.,University of Missouri | And 3 more authors.
Angiology | Year: 2010

Hypertension, diabetes and obesity cause cardiac diastolic dysfunction (DD) which could reduce exercise capacity. Our aim was to determine if 10% weight loss by exercise at 60% VO 2max five days/week (∼-375 kcal/session) and caloric restriction (∼-600 kcal/d) over 6 months improves exercise capacity and DD in Metabolic syndrome (MetS). Eighteen subjects (40 ± 1y, women = 6, BMI = 33.5 ± 1.0 kg/m 2) successfully completed the study. Maximal treadmill stress echocardiography was performed at baseline and post weight loss to determine VO 2max, resting and stress DD as the ratio of peak early diastolic mitral inflow velocity (E) to tissue Doppler early diastolic annular decent (E'). After weight loss (mean = 9.5 ± 0.2%), all metabolic parameters improved. Resting and stress E/E' values remained normal before and after weight loss. Exercise intolerance is likely due to general deconditioning and not cardiac dysfunction in early MetS as VO 2max increases significantly with lifestyle while cardiac function remains unchanged.

Jadhav A.,University of Missouri | Ingole A.,MGMs Medical College and Hospital | Chockalingam A.,University of Missouri | Chockalingam A.,Harry uman Medical Center
American Journal of the Medical Sciences | Year: 2012

Ventricular ectopic beats are commonly seen in daily clinical practice. Majority of them being asymptomatic, some can cause symptoms. In a normal heart, their occurrence is of no clinical significance. However, in the presence of an underlying heart disease, they signify a susceptibility toward more sinister arrhythmias. In some patients, they are triggered by the same mechanism as ventricular tachycardia and these can be cured by catheter ablation. Recent reports on the use of catheter ablation in cases where focal ventricular ectopics are found to trigger ventricular fibrillation. Clinical evaluation and investigations are important in assessing patients with ventricular ectopic beats so that appropriate treatment can be targeted when necessary. This article discusses the current knowledge and practice in this commonly encountered clinical problem. © Southern Society for Clinical Investigation.

Buddineni J.P.,University of Missouri | Chaudhary K.,Harry uman Medical Center | Chaudhary K.,University of Missouri | Whaley-Connell A.,Harry uman Medical Center | Whaley-Connell A.,University of Missouri
Therapy | Year: 2011

Measures to assess kidney function and injury in the diabetic population are currently either inadequate or manifest late in the progressive phase, leading to extensive irreversible damage. Recent efforts to identify novel biomarkers in the diabetic population have been evolving either to detect early kidney injury or repair that ultimately lead to progression of diabetic kidney disease. Emerging roles of urinary biomarkers have proven beneficial due to the ability to standardize the various markers to creatinine or peptides already present in the urine. The role of neutrophil gelatinase-associated lipoprotein, kidney injury molecule-1 and podocin derivatives have gained enormous significance in the process of early identification of kidney injury in the diabetic population. The recent identification of various novel genomic and proteomic applications in investigations of acute kidney injury and chronic kidney diseases has garnered much attention. This article will discuss the evolution of novel biomarkers of diabetes early in the disease process and focus on the new applications being utilized for better understanding of the disease process and early detection. © 2011 Future Medicine Ltd.

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