Charlotte, NC, United States
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PubMed | Clinical Trials Center, Ohio State University, Reid Heart Center, Helios Amper Klinikum and 5 more.
Type: Journal Article | Journal: The American journal of cardiology | Year: 2016

We sought to examine the relation between various degrees of renal function and coronary plaque morphology by grayscale and virtual histology intravascular ultrasound (IVUS). ADAPT-DES was a prospective, multicenter registry of 8,582 consecutive patients treated using coronary drug-eluting stents with a prespecified grayscale and virtual histology-IVUS substudy. A lesion-level analysis of study participants was performed by comparing IVUS parameters of culprit and nonculprit lesions across tertiles of estimated creatinine clearance (CrCl). Preintervention IVUS imaging of 762 patients identified 898 culprit and 752 nonculprit native coronary artery lesions. Patients in the lowest CrCl tertile were older, more often women, and more often presented with stable angina. Compared with the middle and upper tertiles, the lowest tertile was significantly associated with culprit lesion smaller mean external elastic membrane cross-sectional area (12.9 vs 14.2mm

Fargnoli A.S.,Sanger Heart & Vascular Institute | Fargnoli A.S.,University of Pennsylvania | Katz M.G.,Sanger Heart & Vascular Institute | Williams R.D.,Sanger Heart & Vascular Institute | And 2 more authors.
Journal of Cardiovascular Translational Research | Year: 2014

This study evaluates needleless liquid jet method and compares it with three common experimental methods: (1) intramuscular injection (IM), (2) left ventricular intracavitary infusion (LVIC), and (3) LV intracavitary infusion with aortic and pulmonary occlusion (LVIC-OCCL). Two protocols were executed. First (n = 24 rats), retention of dye was evaluated 10 min after delivery in an acute model. The acute study revealed the following: significantly higher dye retention (expressed as % myocardial cross-section area) in the left ventricle in both the liquid jet [52 ± 4] % and LVIC-OCCL [58 ± 3] % groups p < 0.05 compared with IM [31 ± 8] % and LVIC [35 ± 4] %. In the second (n = 16 rats), each animal received adeno-associated virus encoding green fluorescent protein (AAV.EGFP) at a single dose with terminal 6-week endpoint. In the second phase with AAV.EGFP at 6 weeks post-delivery, a similar trend was found with liquid jet [54 ± 5] % and LVIC-OCCL [60 ± 8] % featuring more LV expression as compared with IM [30 ± 9] % and LVIC [23 ± 9] %. The IM and LVIC-OCCL cross sections revealed myocardial fibrosis. With more detailed development in future model studies, needleless liquid jet delivery offers a promising strategy to improve direct myocardial delivery. © 2014, Springer Science+Business Media New York.

PubMed | University of California at San Diego, Sanger Heart & Vascular Institute and Northeast Georgia Heart Center
Type: Journal Article | Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions | Year: 2015

The objectives of this study were to evaluate the ability of interventional cardiologists to accurately measure lesion length and select appropriate stents.Inaccurate measurement of lesion length during percutaneous coronary intervention (PCI) increases the risk of restenosis.Interventional cardiologists (n=40) evaluated 25 matched orthogonal angiographic images that were prescored using quantitative coronary angiography (QCA) by a core laboratory. Visual estimates of lesion length and stent length selection were compared to the maximum QCA value. A 2-4 mm stent overlap of both the proximal and distal lesion edges was considered to be optimal. Based on optimal stent overlap, accurate lesion lengths were those measured from -1 to +4 mm from the QCA. Likewise, appropriate stent lengths were those that measured between +4 mm to +8 mm from the QCA value. Five images were repeated to assess intrarater variability.Lesion length measurements were short and long for 51.1% (95% CI 47.6-54.6%) and 19.0% (95% CI 16.3-21.9%) of the images, respectively. Stent length selections that were short and long were recorded for 55.0% (95% CI 51.5-58.5%) and 22.8% (95% CI 19.9-25.8%) of the images, respectively. Intrarater variability evaluation indicated that 38.5% (95% CI 31.7-45.6%) of lesion length measurements and 37.5% (95% CI 30.8-44.6%) of stent length selections were >3 mm different between the first and second evaluation of repeated images.Visual estimation of coronary lesion length has a high degree of variability, which may lead to inappropriate stent selection. Improving the accuracy of lesion length measurement may improve patient outcomes.

PubMed | Boston Scientific Inc., Cleveland Clinic, Duke University, Intermountain Medical Center and 2 more.
Type: Journal Article | Journal: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing | Year: 2015

Cardiac resynchronization therapy (CRT) improves outcomes in patients with heart failure, yet response rates are variable. We sought to determine whether physician-specified CRT programming was associated with improved outcomes.Using data from the ALTITUDE remote follow-up cohort, we examined sensed atrioventricular (AV) and ventricular-to-ventricular (VV) programming and their associated outcomes in patients with de novo CRT from 2009-2010. Outcomes included arrhythmia burden, left ventricular (LV) pacing, and all-cause mortality at 4 years.We identified 5709 patients with de novo CRT devices; at the time of implant, 34% (n=1959) had entirely nominal settings programmed, 40% (n=2294) had only AV timing adjusted, 11% (n=604) had only VV timing adjusted, and 15% (n=852) had both AV and VV adjusted from nominal programming. Suboptimal LV pacing (<95%) during follow-up was similar across groups; however, the proportion with atrial fibrillation (AF) burden >5% was lowest in the AV-only adjusted group (17.9%) and highest in the nominal (27.7%) and VV-only adjusted (28.3%) groups. Adjusted all-cause mortality was significantly higher among patients with non-nominal AV delay >120 vs. <120 ms (adjusted heart rate (HR) 1.28, p=0.008) but similar when using the 180-ms cutoff (adjusted HR 1.13 for >180 vs. 180 ms, p=0.4).Nominal settings for de novo CRT implants are frequently altered, most commonly the AV delay. There is wide variability in reprogramming. Patients with nominal or AV-only adjustments appear to have favorable pacing and arrhythmia outcomes. Sensed AV delays less than 120 ms are associated with improved survival.

Aung H.,Mayo Medical School | Espinosa R.E.,Mayo Medical School | Powell B.D.,Sanger Heart & Vascular Institute | Mcleod C.J.,Mayo Medical School
PACE - Pacing and Clinical Electrophysiology | Year: 2016

Although rare, Chiari networks are elaborate embryological remnants that can pose distinct challenges for catheter and pacing lead manipulation within the right atrium. Device entrapment may require open thoracotomy for removal, with significant morbidity. We report an unusual case of pacing lead entanglement within this structure, followed by prompt intracardiac echocardiographic identification and laser sheath removal. ©2016 Wiley Periodicals, Inc.

PubMed | Sanger Heart & Vascular Institute
Type: Journal Article | Journal: Critical care nursing clinics of North America | Year: 2015

Todays health care systems are faced with challenges to transform health care delivery and provide quality and valued services for the heart failure population. These challenges require collaboration and the development of strategic processes that will redefine best practices. Implementing a multidimensional nurse navigator transition program is one approach to facilitating cross-continuum of care. Such a program has been proven to significantly reduce 30-day all-cause hospital readmissions, enhanced self-management skills, and improved follow-up compliance. This transitional care model can be used to address the needs of all patients with chronic conditions.

PubMed | Cannon Research Center and Sanger Heart & Vascular Institute
Type: Journal Article | Journal: Anatomia, histologia, embryologia | Year: 2016

Congenital diaphragmatic hernia (CDH) is a rare condition. The aetiology of CDH is often unclear. In our case, a hollow mass was noted on MRI. Cardiac ejection fraction was diminished (47.0%) compared to 60.5% (average of 10 other normal animals, P<0.05). The final diagnosis of congenital diaphragmatic hernia (Bochdalek type) was made when the sheep underwent surgery. The hernia was right-sided and contained the abomasum. Lung biopsy demonstrated incomplete development with a low number of bronchopulmonary segments and vessels. The likely cause of this hernia was genetic malformation.

PubMed | a Vascular and Interventional Specialists of Charlotte Radiology, Sanger Heart & Vascular Institute and Carolinas Medical Center
Type: Journal Article | Journal: Expert review of cardiovascular therapy | Year: 2016

Inferior vena cava (IVC) filters are the mainstay for pulmonary embolic prophylaxis in patients with high venous thromboembolic (VTE) risk-in particular, patients with acute VTE (deep venous thrombosis and/or pulmonary embolism) who have contraindication to therapeutic anticoagulation. Technology continues to evolve regarding IVC filters, with the most exciting changes over the past several decades including techniques of percutaneous insertion from laparotomy and retrieval of these devices. This paper will review current IVC filter designs and concepts and will discuss developments on the horizon.

PubMed | Mount Sinai School of Medicine and Sanger Heart & Vascular Institute
Type: Journal Article | Journal: American journal of physiology. Heart and circulatory physiology | Year: 2016

The mammalian heart has long been considered to be a postmitotic organ. It was thought that, in the postnatal period, the heart underwent a transition from hyperplasic growth (more cells) to hypertrophic growth (larger cells) due to the conversion of cardiomyocytes from a proliferative state to one of terminal differentiation. This hypothesis was gradually disproven, as data were published showing that the myocardium is a more dynamic tissue in which cardiomyocyte karyokinesis and cytokinesis produce new cells, leading to the hyperplasic regeneration of some of the muscle mass lost in various pathological processes. microRNAs have been shown to be critical regulators of cardiomyocyte differentiation and proliferation and may offer the novel opportunity of regenerative hyperplasic therapy. Here we summarize the relevant processes and recent progress regarding the functions of specific microRNAs in cardiac development and regeneration.

PubMed | Mayo Medical School and Sanger Heart & Vascular Institute
Type: Journal Article | Journal: Pacing and clinical electrophysiology : PACE | Year: 2016

Although rare, Chiari networks are elaborate embryological remnants that can pose distinct challenges for catheter and pacing lead manipulation within the right atrium. Device entrapment may require open thoracotomy for removal, with significant morbidity. We report an unusual case of pacing lead entanglement within this structure, followed by prompt intracardiac echocardiographic identification and laser sheath removal.

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