1
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Galeano-Lovera SF, Pollak P, Phillips S, Gonzalez C, Cabalka AK, Bravo-Jaimes K. Intravascular Lithotripsy in an Adult With Fontan Pathway Obstruction. JACC Case Rep 2024; 29:102296. [PMID: 38708431 PMCID: PMC11068967 DOI: 10.1016/j.jaccas.2024.102296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 05/07/2024]
Abstract
Fontan pathway obstruction is a potentially serious complication characterized by an anatomical or functional narrowing anywhere in the cavo-pulmonary pathways. Here, we report the first case in the literature where an innovative Fontan conduit rehabilitation procedure with intravascular lithotripsy was used achieving a dramatic increase in the pathway size.
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Affiliation(s)
| | - Peter Pollak
- Department of Cardiovascular Medicine. Mayo Clinic Jacksonville, Florida, USA
| | - Sabrina Phillips
- Department of Cardiovascular Medicine. Mayo Clinic Jacksonville, Florida, USA
| | - Carolyn Gonzalez
- Department of Cardiovascular Medicine. Mayo Clinic Jacksonville, Florida, USA
| | - Allison K. Cabalka
- Division of Pediatric Cardiology, Mayo Clinic Rochester, Minnesota, USA
- Division of Structural Heart Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine. Mayo Clinic Jacksonville, Florida, USA
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2
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Quesada O, Crousillat D, Rodriguez F, Bravo-Jaimes K, Briller J, Ogunniyi MO, Mattina DJ, Aggarwal NR, Rodriguez CJ, De Oliveira GMM, Velarde G. Cardiovascular Disease in Hispanic Women: JACC Review Topic of the Week. J Am Coll Cardiol 2024; 83:1702-1712. [PMID: 38658109 DOI: 10.1016/j.jacc.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 04/26/2024]
Abstract
Cardiovascular disease affects 37% of Hispanic women and is the leading cause of death among Hispanic women in the United States. Hispanic women have a higher burden of cardiovascular risk factors, are disproportionally affected by social determinants of health, and face additional barriers related to immigration, such as discrimination, language proficiency, and acculturation. Despite this, Hispanic women show lower rates of cardiovascular disease and mortality compared with non-Hispanic White women. However, this "Hispanic paradox" is challenged by recent studies that account for the diversity in culture, race, genetic background, country of origin, and social determinants of health within Hispanic subpopulations. This review provides a comprehensive overview of the cardiovascular risk factors in Hispanic women, emphasizing the role of social determinants, and proposes a multipronged approach for equitable care.
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Affiliation(s)
- Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA.
| | - Daniela Crousillat
- Division of Cardiovascular Sciences, Department of Medicine, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Joan Briller
- Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA; Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Modele O Ogunniyi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Grady Health System, Atlanta, Georgia, USA
| | - Deirdre J Mattina
- Department of Cardiovascular Medicine, Cleveland Clinic, Beachwood, Ohio, USA
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Gladys Velarde
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
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3
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Chambergo-Michilot D, Becerra-Gonzales VG, Kittipibul V, Colombo R, Bravo-Jaimes K. Racial Differences in Hospice Care Outcomes in Patients With Advanced Heart Failure: Systematic Review and Meta-analysis. Am J Cardiol 2024; 217:5-9. [PMID: 38382703 DOI: 10.1016/j.amjcard.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/08/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
There remains a paucity of investigational data about disparities in hospice services in people with non-cancer diagnoses, specifically in heart failure (HF). Black patients with advanced HF have been disproportionally affected by health care services inequities but their outcomes after hospice enrollment are not well studied. We aimed to describe race-specific outcomes in patients with advanced HF who were enrolled in hospice services. We obtained the data from PubMed, Scopus, and Embase for all investigations published until January 11, 2023. All studies that reported race-specific outcomes after hospice enrollment in patients with advanced HF were included. Of the 1,151 articles identified, 5 studies (n = 24,899) were considered for analysis involving a sample size ranging from 179 to 11,754 patients. Black patients had an increased risk of readmission (odds ratio 1.55, 95% confidence interval [CI] 1.34 to 1.79, I2 0%) and discharge (odds ratio 1.75, 95% CI 1.53 to 1.99, I2 0%) compared with White patients. Moreover, Black patients have a nonsignificant lower risk of mortality compared with White patients (relative risk 0.67, 95% CI 0.43 to 1.05, I2 90%). In conclusion, this study showed that Black patients with advanced HF receiving hospice care have a higher risk of readmission and discharge compared with White patients.
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Affiliation(s)
| | - Victor G Becerra-Gonzales
- Division of Cardiology, Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | | | - Rosario Colombo
- Division of Cardiology, Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida.
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4
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Cabrera Fernandez DL, Lopez KN, Bravo-Jaimes K, Mackie AS. The Impact of Social Determinants of Health on Transition From Pediatric to Adult Cardiology Care. Can J Cardiol 2024:S0828-282X(24)00291-5. [PMID: 38583706 DOI: 10.1016/j.cjca.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024] Open
Abstract
Social determinants of health (SDoH) are the economic, social, environmental, and psychosocial factors that influence health. Adolescents and young adults with congenital heart disease (CHD) require lifelong cardiology follow-up and therefore coordinated transition from pediatric to adult healthcare systems. However, gaps in care are common during transition, and they are driven in part by pervasive disparities in SDoH, including race, ethnicity, socioeconomic status, access to insurance, and remote location of residence. These disparities often coexist and compound the challenges faced by patients and families. For example, Black and Indigenous individuals are more likely to be subject to systemic racism and implicit bias within healthcare and other settings, to be unemployed and poor, to have limited access to insurance, and to have a lower likelihood of transfer of care to adult CHD specialists. SDoH also are associated with acquired cardiovascular disease, a comorbidity that adults with CHD face. This review summarizes existing evidence regarding the impact of SDoH on the transition to adult care and proposes strategies at the individual, institutional, and population and/or system levels. to reduce inequities faced by transition-age youth. These strategies include routinely screening for SDoH in clinical settings with referral to appropriate services, providing formal transition education for all transition-age youth, including training on navigating complex medical systems, creating satellite cardiology clinics to facilitate access to care for those who live remote from tertiary centres, advocating for lifelong insurance coverage where applicable, mandating cultural-sensitivity training for providers, and increasing the diversity of healthcare providers in pediatric and adult CHD care.
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Affiliation(s)
- Diana L Cabrera Fernandez
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Keila N Lopez
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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5
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Bravo-Jaimes K, Vasquez-Loarte T, Rojas-Camayo J, Medina M, Mejia CR, Zapata-Galarza H, Berrocal M, Orozco J, Lozano D, Santivañez M, Sangay C, Rosales W, Mamani L, Macedo N, Coronado J, Huaman G, Marquez R, Li Z, Masood KM, Alejos J, Reardon L, Lin J. A new algorithm DEtectS critical Congenital Heart Disease at different altitudes: ANDES-CHD study. J Perinatol 2024; 44:373-378. [PMID: 38308011 DOI: 10.1038/s41372-024-01888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Neonatal pulse oximetry screening (POS) algorithms for critical congenital heart disease (CCHD) have contributed towards decreasing neonatal mortality but cannot be applied at high altitudes. New POS algorithms at high altitudes are needed. METHODS This observational, prospective study included newborns born at different altitudes from 0 to 4380 meters above the sea level in Peru. Healthy newborns underwent neonatal preductal and postductal oximetry, echocardiography and telephonic follow-up up to 12 months of age. Newborns with CCHD underwent preductal and postductal oximetry at the time of telemedicine evaluation while located at the high-altitude hospital where they were born, and their diagnoses were confirmed with echocardiography locally or after arriving to the referral center. Two new algorithms were designed using clinically accepted neonatal oximetry cutoffs or the 5th and 10th percentiles for preductal and postductal oximetry values. RESULTS A total of 502 healthy newborns and 15 newborns with CCHD were enrolled. Echocardiography and telephonic follow-up were completed in 227 (45%) and 330 healthy newborns (65%), respectively. The algorithm based on clinically accepted cutoffs had a sensitivity of 92%, specificity of 73% and false positive rate of 27% The algorithm based on the 5th and 10th percentiles had a sensitivity of 80%, specificity of 88% and false positive rate of 12%. CONCLUSIONS Two algorithms that detect CCHD at different altitudes had adequate performance but high false positive rates.
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Affiliation(s)
- Katia Bravo-Jaimes
- Department of Cardiovascular Medicine. Mayo Clinic, Jacksonville, FL, USA.
| | | | | | - Monica Medina
- Instituto Nacional de Salud del Niño de San Borja, Lima, Peru
| | | | | | | | | | | | | | | | | | | | | | - Joel Coronado
- Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Gian Huaman
- Instituto Nacional Cardiovascular, Lima, Peru
| | | | - Zhuo Li
- Department of Cardiovascular Medicine. Mayo Clinic, Jacksonville, FL, USA
| | - Kiran M Masood
- Department of Pediatrics, University of California, Los Angeles, CA, USA
| | - Juan Alejos
- Department of Pediatrics, Mattel Children´s Hospital, California, CA, USA
| | - Leigh Reardon
- Department of Pediatrics, Mattel Children´s Hospital, California, CA, USA
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, CA, USA
| | - Jeannette Lin
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, CA, USA
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6
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Bravo-Jaimes K, Wu X, Reardon LC, Lluri G, Lin JP, Moore JP, van Arsdell G, Biniwale R, Si MS, Naini BV, Venick R, Saab S, Wray CL, Ponder R, Rosenthal C, Klomhaus A, Böstrom KI, Aboulhosn JA, Kaldas FM. Intrahepatic Transcriptomics Differentiate Advanced Fibrosis and Clinical Outcomes in Adults With Fontan Circulation. J Am Coll Cardiol 2024; 83:726-738. [PMID: 38355242 DOI: 10.1016/j.jacc.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/06/2023] [Accepted: 12/04/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND The molecular mechanisms underlying Fontan-associated liver disease (FALD) remain largely unknown. OBJECTIVES This study aimed to assess intrahepatic transcriptomic differences among patients with FALD according to the degree of liver fibrosis and clinical outcomes. METHODS This retrospective cohort study included adults with the Fontan circulation. Baseline clinical, laboratory, imaging, and hemodynamic data as well as a composite clinical outcome (CCO) were extracted from medical records. Patients were classified into early or advanced fibrosis. RNA was isolated from formalin-fixed paraffin-embedded liver biopsy samples; RNA libraries were constructed with the use of an rRNA depletion method and sequenced on an Illumina Novaseq 6000. Differential gene expression and gene ontology analyses were performed with the use of DESeq2 and Metascape. RESULTS A total of 106 patients (48% male, median age 31 years [IQR: 11.3 years]) were included. Those with advanced fibrosis had higher B-type natriuretic peptide levels and Fontan, mean pulmonary artery, and capillary wedge pressures. The CCO was present in 23 patients (22%) and was not predicted by advanced liver fibrosis, right ventricular morphology, presence of aortopulmonary collaterals, or Fontan pressures on multivariable analysis. Samples with advanced fibrosis had 228 upregulated genes compared with early fibrosis. Samples with the CCO had 894 upregulated genes compared with those without the CCO. A total of 136 upregulated genes were identified in both comparisons and were enriched in cellular response to cytokine stimulus or oxidative stress, VEGFA-VEGFR2 signaling pathway, TGF-β signaling pathway, and vasculature development. CONCLUSIONS Patients with FALD and advanced fibrosis or the CCO exhibited upregulated genes related to inflammation, congestion, and angiogenesis.
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Affiliation(s)
- Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA; Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA
| | - Xiuju Wu
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Leigh C Reardon
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Department of Pediatric Cardiology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Gentian Lluri
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Jeannette P Lin
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Jeremy P Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Department of Pediatric Cardiology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Glen van Arsdell
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Division of Congenital Cardiovascular Surgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California USA; Department of Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Reshma Biniwale
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Division of Congenital Cardiovascular Surgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California USA; Department of Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Ming-Sing Si
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Division of Congenital Cardiovascular Surgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California USA; Department of Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Bita V Naini
- Department of Pathology and Lab Services, University of California, Los Angeles, California, USA
| | - Robert Venick
- Department of Gastroenterology, Hepatology, and Nutrition, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Sammy Saab
- Pfleger Liver Institute, University of California, Los Angeles, California, USA
| | - Christopher L Wray
- Department of Anesthesiology, University of California, Los Angeles, California, USA
| | - Reid Ponder
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA
| | - Carl Rosenthal
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California, Los Angeles, California, USA
| | - Alexandra Klomhaus
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kristina I Böstrom
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Fady M Kaldas
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California, Los Angeles, California, USA.
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Lopez KN, Allen KY, Baker-Smith CM, Bravo-Jaimes K, Burns J, Cherestal B, Deen JF, Hills BK, Huang JH, Lizano Santamaria RW, Lodeiro CA, Melo V, Moreno JS, Nuñez Gallegos F, Onugha H, Pastor TA, Wallace MC, Ansah DA. Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care among Minoritized Populations in the United States. J Cardiovasc Dev Dis 2024; 11:36. [PMID: 38392250 PMCID: PMC10888593 DOI: 10.3390/jcdd11020036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.
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Affiliation(s)
- Keila N Lopez
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kiona Y Allen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Carissa M Baker-Smith
- Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE 19803, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Joseph Burns
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bianca Cherestal
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO 64108, USA
| | - Jason F Deen
- Department of Pediatrics and Medicine, University of Washington, Seattle, WA 98105, USA
| | - Brittany K Hills
- Division of Pediatric Cardiology, UT Southwestern, Children's Health, Dallas, TX 75390, USA
| | - Jennifer H Huang
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR 97239, USA
| | | | - Carlos A Lodeiro
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Valentina Melo
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jasmine S Moreno
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Flora Nuñez Gallegos
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94158, USA
| | - Harris Onugha
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Tony A Pastor
- Division of Pediatric Cardiology, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Michelle C Wallace
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Deidra A Ansah
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
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8
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Abstract
In this essay, the author discusses the importance of a Match system that supports and keeps families together while in training.
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Affiliation(s)
- Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville
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9
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Udemgba C, Bravo-Jaimes K, Mejia MO, Oli PR, Shrestha DB, Dawadi S, Kadariya D, Velarde G. Differences in clinical presentation and outcomes in pregnancy-associated Takotsubo Syndrome- A scoping review of the literature: Outcomes in pregnancy-associated Takotsubo. Curr Probl Cardiol 2024; 49:102175. [PMID: 37913927 DOI: 10.1016/j.cpcardiol.2023.102175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Takotsubo syndrome (TS) during pregnancy and postpartum is rare but may lead to significant maternal and fetal morbidity. We compared clinical characteristics and prognosis according to [a] timing of presentation (pregnancy vs post-partum) and [b] modes of delivery (cesarean section vs vaginal delivery). METHODS Systematic review of articles published in PubMed, Scopus, Embase, and Medline databases from inception to July 30, 2023. Patient demographics, obstetric, electrocardiographic, laboratory, echocardiographic characteristics, and prognosis were summarized descriptively. RESULTS An initial database search identified 2162 articles, of which 81 studies were included in this review. TS during pregnancy can have emotional, obstetric, and metabolic triggers and has a higher proportion of adverse fetal outcomes when compared with women who developed TS postpartum. Women with TS after cesarean section had an earlier onset and higher proportion of anesthesia use when compared with those who developed TS after vaginal delivery. There were no differences regarding the degree of systolic dysfunction or the need for advanced therapies, including ventilator support, intra-aortic balloon pump, and extracorporeal membrane oxygenation among groups. CONCLUSIONS TS is associated with various triggers and adverse fetal outcomes when it develops during pregnancy than in the postpartum period. TS occurs more rapidly and with a more aggressive course after cesarean section than after vaginal delivery.
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Affiliation(s)
- Chinelo Udemgba
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL
| | | | - Miluska O Mejia
- Division of Cardiology, Rochester General Hospital, Rochester, NY
| | - Prakash Raj Oli
- Department of Internal Medicine, Province Hospital, Birendranagar, Surkhet, Nepal
| | | | - Sagun Dawadi
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Dinesh Kadariya
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL
| | - Gladys Velarde
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL.
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10
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Mackie AS, Bravo-Jaimes K, Keir M, Sillman C, Kovacs AH. Access to Specialized Care Across the Lifespan in Tetralogy of Fallot. CJC Pediatr Congenit Heart Dis 2023; 2:267-282. [PMID: 38161668 PMCID: PMC10755796 DOI: 10.1016/j.cjcpc.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 01/03/2024]
Abstract
Individuals living with tetralogy of Fallot require lifelong specialized congenital heart disease care to monitor for and manage potential late complications. However, access to cardiology care remains a challenge for many patients, as does access to mental health services, dental care, obstetrical care, and other specialties required by this population. Inequities in health care access were highlighted by the COVID-19 pandemic and continue to exist. Paradoxically, many social factors influence an individual's need for care, yet inadvertently restrict access to it. These include sex and gender, being a member of a racial or ethnic historically excluded group, lower educational attainment, lower socioeconomic status, living remotely from tertiary care centres, transportation difficulties, inadequate health insurance, occupational instability, and prior experiences with discrimination in the health care setting. These factors may coexist and have compounding effects. In addition, many patients believe that they are cured and unaware of the need for specialized follow-up. For these reasons, lapses in care are common, particularly around the time of transfer from paediatric to adult care. The lack of trained health care professionals for adults with congenital heart disease presents an additional barrier, even in higher income countries. This review summarizes challenges regarding access to multiple domains of specialized care for individuals with tetralogy of Fallot, with a focus on the impact of social determinants of health. Specific recommendations to improve access to care within Canadian and American systems are offered.
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Affiliation(s)
- Andrew S. Mackie
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christina Sillman
- Adult Congenital Heart Disease Program, Sutter Heart and Vascular Institute, Sacramento, California, USA
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11
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Bravo-Jaimes K, Bullock-Palmer RP. Adult Congenital Heart Disease Scholarship: An Opportunity to Spark Interest in This Field. JACC Case Rep 2023; 24:102022. [PMID: 37869213 PMCID: PMC10589437 DOI: 10.1016/j.jaccas.2023.102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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12
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Bravo-Jaimes K, Costello BT, Reza N, Sanghavi M, Tamirisa KP, Mehta LS, Mamas MA, Taub CC, Volgman AS, Mieres JH, Ijioma NN, Douglas PS, Hayes SN, Bullock-Palmer RP. A Practical Guide to Address Harassment and Bullying in Cardiology. JACC Case Rep 2023; 22:101988. [PMID: 37790768 PMCID: PMC10544275 DOI: 10.1016/j.jaccas.2023.101988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Affiliation(s)
- Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Briana T. Costello
- Division of Cardiology, The Texas Heart Institute Center for Cardiovascular Care, Baylor St. Luke’s Medical Center, Houston, Texas, USA
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monika Sanghavi
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Laxmi S. Mehta
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, United Kingdom
| | - Cynthia C. Taub
- Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | | | | | - Pamela S. Douglas
- Duke Clinical Research Institute, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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13
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Bravo-Jaimes K, Wu X, Reardon LC, Lluri G, Lin JP, Moore JP, Arsdell GV, Biniwale R, Si MS, Naini BV, Venick R, Saab S, Wray CL, Ponder R, Rosenthal C, Klomhaus A, Böstrom KI, Aboulhosn JA, Kaldas FM. Intrahepatic transcriptomics differentiate advanced fibrosis and clinical outcomes in adults with the Fontan circulation. medRxiv 2023:2023.06.05.23290997. [PMID: 37333414 PMCID: PMC10274997 DOI: 10.1101/2023.06.05.23290997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background The molecular mechanisms underlying Fontan associated liver disease (FALD) remain largely unknown. We aimed to assess intrahepatic transcriptomic differences among patients with FALD according to the degree of liver fibrosis and clinical outcomes. Methods This retrospective cohort study included adults with the Fontan circulation at the Ahmanson/UCLA Adult Congenital Heart Disease Center. Clinical, laboratory, imaging and hemodynamic data prior to the liver biopsy were extracted from medical records. Patients were classified into early (F1-F2) or advanced fibrosis (F3-F4). RNA was isolated from formalin-fixed paraffin embedded liver biopsy samples; RNA libraries were constructed using rRNA depletion method and sequencing was performed on Illumina Novaseq 6000. Differential gene expression and gene ontology analyses were carried out using DESeq2 and Metascape. Medical records were comprehensively reviewed for a composite clinical outcome which included decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, protein-losing enteropathy, chronic kidney disease stage 4 or higher, or death. Results Patients with advanced fibrosis had higher serum BNP levels and Fontan, mean pulmonary artery and capillary wedge pressures. The composite clinical outcome was present in 23 patients (22%) and was predicted by age at Fontan, right ventricular morphology and presence of aortopulmonary collaterals on multivariable analysis. Samples with advanced fibrosis had 228 up-regulated genes compared to early fibrosis. Samples with the composite clinical outcome had 894 up-regulated genes compared to those without it. A total of 136 up-regulated genes were identified in both comparisons and these genes were enriched in cellular response to cytokine stimulus, response to oxidative stress, VEGFA-VEGFR2 signaling pathway, TGF-beta signaling pathway, and vasculature development. Conclusions Patients with FALD and advanced liver fibrosis or the composite clinical outcome exhibit up-regulated genes including pathways related to inflammation, congestion, and angiogenesis. This adds further insight into FALD pathophysiology.
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Affiliation(s)
- Katia Bravo-Jaimes
- Department of Cardiovascular Diseases. Mayo Clinic Jacksonville Florida
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
| | - Xiuju Wu
- Division of Cardiology. Department of Medicine. University of California, Los Angeles
| | - Leigh C Reardon
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
- Department of Pediatric Cardiology. University of California, Los Angeles Mattel Children’s Hospital
| | - Gentian Lluri
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
- Division of Cardiology. Department of Medicine. University of California, Los Angeles
| | - Jeannette P Lin
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
- Division of Cardiology. Department of Medicine. University of California, Los Angeles
| | - Jeremy P Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
- Department of Pediatric Cardiology. University of California, Los Angeles Mattel Children’s Hospital
| | - Glen Van Arsdell
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
- Division of Cardiology. Department of Medicine. University of California, Los Angeles
| | | | | | - Bita V Naini
- Department of Pathology and Lab Services. University of California, Los Angeles
| | - Robert Venick
- Department of Gastroenterology, Hepatology and Nutrition. University of California, Los Angeles Mattel Children’s Hospital
| | - Sammy Saab
- Department of Gastroenterology, Hepatology and Nutrition. University of California, Los Angeles Mattel Children’s Hospital
| | | | - Reid Ponder
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
| | - Carl Rosenthal
- Dumont-UCLA Liver Transplant Center. Department of Surgery. University of California, Los Angeles
| | - Alexandra Klomhaus
- Department of Medicine Statistics Core. David Geffen School of Medicine. University of California, Los Angeles
| | - Kristina I Böstrom
- Division of Cardiology. Department of Medicine. University of California, Los Angeles
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
- Division of Cardiology. Department of Medicine. University of California, Los Angeles
| | - Fady M Kaldas
- Dumont-UCLA Liver Transplant Center. Department of Surgery. University of California, Los Angeles
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14
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Bravo-Jaimes K, Velarde GP. Diversity in Cardiovascular Medicine. JACC: Case Reports 2023; 10:101749. [PMID: 36974050 PMCID: PMC10039375 DOI: 10.1016/j.jaccas.2023.101749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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15
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Meza K, Vasquez-Loarte T, Rodriguez-Alarcon JF, San Roman O, Rojas-Camayo J, Mejia CR, Medina M, Zapata HA, Saarinen A, Bravo-Jaimes K. Critical congenital heart disease detection in the ANDES: Challenges and opportunities. International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Venkatesh P, Yan KL, Bravo-Jaimes K, Yang EH, Lluri G. Outcomes of malignancy in adults with congenital heart disease: a single center experience. Cardiooncology 2022; 8:20. [PMID: 36419184 PMCID: PMC9685873 DOI: 10.1186/s40959-022-00144-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022]
Abstract
Background Malignancy is known to be a major cause of death in adult congenital heart disease (ACHD). However, data regarding cardiovascular and cancer-related outcomes in ACHD are lacking. Methods We conducted a retrospective single-center cohort study comprising patients with ACHD and malignancy. The primary outcome was all-cause mortality. Key secondary outcomes included major adverse cardiovascular and cerebrovascular events (MACCE), cardiotoxicity events and consequent cancer therapy modifications. Results Sixty-eight patients with ACHD and a history of cancer were included in the study. 82% of patients had moderate or great ACHD anatomic complexity. Over a median follow-up of 5 years after cancer diagnosis, 16 (24%) patients died, with 69% of deaths being due to cancer. Univariate predictors of mortality were baseline arrhythmia (OR 3.82, 95% CI 1.15-12.67, p = 0.028), baseline diuretic therapy (OR 3.54, 95% CI 1.04-12.04, p = 0.044) and advanced cancer stage at diagnosis (OR 2.37, 95% CI 1.32-4.25, p = 0.004). MACCE occurred in 40 (59%) patients and was independently predicted by baseline diuretic requirement (OR 9.91, 95% CI 1.12-87.85, p = 0.039). A 14% incidence of cardiotoxicity was seen; 3 patients needed modification and 1 patient needed temporary interruption of cancer therapy for 2 weeks. Conclusions Considerable mortality occurred in this cohort of patients with ACHD and cancer; most deaths were cancer-related. A high rate of MACCE was observed, yet rates of obligatory modification of cancer therapy due to cardiotoxicity were low. Supplementary Information The online version contains supplementary material available at 10.1186/s40959-022-00144-z.
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Affiliation(s)
- Prashanth Venkatesh
- grid.50956.3f0000 0001 2152 9905Guerin Congenital Heart Program, Department of Cardiology, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA 90048 USA
| | - Kimberly L. Yan
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Katia Bravo-Jaimes
- grid.417467.70000 0004 0443 9942Division of Cardiology, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL USA
| | - Eric H. Yang
- grid.19006.3e0000 0000 9632 6718UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA USA
| | - Gentian Lluri
- grid.19006.3e0000 0000 9632 6718UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA USA
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17
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Bullock-Palmer RP, Bravo-Jaimes K, Mamas MA, Grines CL. Socioeconomic Factors and their Impact on Access and Use of Coronary and Structural Interventions. Eur Cardiol 2022; 17:e19. [PMID: 36643068 PMCID: PMC9820075 DOI: 10.15420/ecr.2022.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 01/18/2023] Open
Abstract
In the past few decades, the accelerated improvement in technology has allowed the development of new and effective coronary and structural heart disease interventions. There has been inequitable patient access to these advanced therapies and significant disparities have affected patients from low socioeconomic positions. In the US, these disparities mostly affect women, black and hispanic communities who are overrepresented in low socioeconomic. Other adverse social determinants of health influenced by structural racism have also contributed to these disparities. In this article, we review the literature on disparities in access and use of coronary and structural interventions; delineate the possible reasons underlying these disparities; and highlight potential solutions at the government, healthcare system, community and individual levels.
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Affiliation(s)
| | - Katia Bravo-Jaimes
- Division of Cardiology, Department of Internal Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, University of CaliforniaLos Angeles, CA, US
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele UniversityKeele, UK
| | - Cindy L Grines
- Division of Cardiology, Department of Internal Medicine, Northside Cardiovascular Institute, Northside HospitalAtlanta, GA, US
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18
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Venkatesh P, Tan W, Bravo-Jaimes K, Aboulhosn J. Right coronary artery originating from the left ventricular outflow tract diagnosed after a Ross procedure: a case report. Eur Heart J Case Rep 2022; 6:ytac237. [PMID: 35911489 PMCID: PMC9336575 DOI: 10.1093/ehjcr/ytac237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/31/2021] [Accepted: 06/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Anomalous coronary origin from the left ventricular outflow tract (LVOT) is an exceedingly rare condition thought to be associated with the bicuspid aortic valve (BAV). While the malignant presentation of this entity has been described, its pathophysiology and diagnostic evaluation are poorly understood. CASE SUMMARY A 33-year-old woman status post Ross procedure in childhood for congenital aortic stenosis due to BAV with presumed common origin of right and left coronary arteries based on single coronary ostium seen on aortic valve inspection, presented with symptomatic pulmonary regurgitation and stenosis. Invasive left coronary angiography revealed retrograde filling of the right coronary artery (RCA) with systolic washout of contrast indicating a patent RCA ostium. No RCA ostium was found on aortic root injection, but an injection into the LVOT revealed an RCA ostium below the aortic valve. Selective RCA angiography revealed pulsatile antegrade flow down the RCA occurring during systole. There was no anatomic RCA stenosis. We proceeded with valve-in-valve TcPVR. The patient had significant improvement of symptoms and RCA reimplantation was hence deferred. DISCUSSION This case is the first of an anomalous coronary artery arising from the LVOT diagnosed in a patient after the Ross procedure. Our angiograms shed light on the unusual physiology of coronary filling during systole and ischaemia arising from inadequate perfusion gradient between the left ventricle and the coronary during systole, leading to collateralization despite the lack of anatomic stenosis. We urge consideration of this potentially malignant entity in any symptomatic patient, especially with concomitant BAV.
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Affiliation(s)
| | - Weiyi Tan
- Division of Cardiology, Department of Medicine, Ahmanson-UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine, University of California, Los Angeles, 200 Medical Plaza, Suite 202, Los Angeles, CA 90095, USA
| | - Katia Bravo-Jaimes
- Division of Cardiology, Department of Medicine, Ahmanson-UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine, University of California, Los Angeles, 200 Medical Plaza, Suite 202, Los Angeles, CA 90095, USA
| | - Jamil Aboulhosn
- Division of Cardiology, Department of Medicine, Ahmanson-UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine, University of California, Los Angeles, 200 Medical Plaza, Suite 202, Los Angeles, CA 90095, USA
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19
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Bravo-Jaimes K, Mejia MO, Abelhad NI, Zhou Y, Jumean MF, Nathan S, Dhoble A. Gender Differences in the Outcomes of Cardiogenic Shock Requiring Percutaneous Mechanical Circulatory Support. Am J Cardiol 2022; 174:20-26. [PMID: 35469654 DOI: 10.1016/j.amjcard.2022.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
There is evidence for the lower use of percutaneous mechanical circulatory support (pMCS) in women. We aimed to determine (1) whether gender differences exist regarding in-hospital mortality, hospital course, and procedures; (2) whether socio-demographic and treatment-related factors were associated with these differences. Using the National Inpatient Sample, we collected the International Classification of Diseases, Ninth Revision, Clinical Modification codes for cardiogenic shock (CS) because of acute myocardial infarction AMI or acutely decompensated advanced heart failure and included intra-aortic balloon pump, Impella or Tandem Heart percutaneous ventricular assist devices (pVADs), extracorporeal membrane oxygenation. Demographics, co-morbidities, in-hospital course and procedures were recorded, and the Charlson Co-morbidity Index was calculated. Multivariable hierarchical logistic regression analysis and additional sensitivity analyses were performed. We identified 376,116 cases of CS because of acute myocardial infarction or acutely decompensated advanced heart failure, of which 113,305 required pMCS. Women were more likely to be older, non-White, insured by Medicare, and have a higher burden of co-morbidities and higher Charlson Co-morbidity Index. pMCS devices were inserted in 35,516 women (24.9%) and 77,789 men (33.3%). Women were less likely to receive pVAD or pulmonary artery (PA) catheters. Blood transfusions and acute respiratory failure were more common in women than men. Women had 15% higher in-hospital mortality and in a multivariate analysis, women, older age, having no insurance, diabetes mellitus, chronic kidney disease, cerebrovascular disease, peripheral arterial disease, longer time to pMCS insertion, receiving PA catheter, pVAD or extracorporeal membrane oxygenation and having cardiac arrest were associated with higher in-hospital mortality. In conclusion, women requiring pMCS support had a higher co-morbidity load, in-hospital mortality, acute respiratory failure, blood transfusions, and lower PA catheter use. Studies addressing early gender-specific interventions in CS are needed to reduce these differences.
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Affiliation(s)
- Katia Bravo-Jaimes
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California Los Angeles, Los Angeles, California
| | - Miluska Olenka Mejia
- Advanced Heart Failure and Transplantation Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Nadia Isabel Abelhad
- University of Texas Health Science Center at Houston, Department of Medicine, Division of Cardiology, Houston, TX
| | - Yelin Zhou
- University of Texas Health Science Center at Houston, Department of Medicine, Division of Cardiology, Houston, TX
| | - Marwan Faris Jumean
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, Texas
| | - Sriram Nathan
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, Texas
| | - Abhijeet Dhoble
- University of Texas Health Science Center at Houston, Department of Medicine, Division of Cardiology, Houston, TX..
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20
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Bravo-Jaimes K, Venkatesh P, Lluri G, Reardon L, Cruz D, Vucicevic D, Yang EH, Nsair A, Saggar R, Channick R, Kwon M, Van Arsdell G, Aboulhosn J. Temporary axial-flow mechanical circulatory support and intravenous treprostinil in a patient with D-transposition of the great arteries and atrial switch: A case report. International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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21
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Bravo-Jaimes K, Axsom K, Menachem J, Danford D, Kutty S, Cedars A. Impact of the new UNOS donor heart allocation system on waitlist outcomes and early posttransplant mortality among adults with congenital heart disease. Am J Transplant 2022; 22:1123-1132. [PMID: 34859574 DOI: 10.1111/ajt.16900] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 01/25/2023]
Abstract
Adults with congenital heart disease (ACHD) experience worse waitlist outcomes and higher early posttransplant mortality compared to non-ACHD patients. On October 18, 2018; the UNOS donor heart allocation system was redesigned giving unique listing status to ACHD patients. The impact of this change on outcomes in transplant-listed patients is unstudied. Using the Scientific Registry of Transplant Recipients (SRTR) we compared ACHD patients listed for the first-time for heart transplantation from two eras of equal duration. We analyzed waitlist outcomes, posttransplant mortality and length of stay among ACHD patients in both eras and between ACHD and non-ACHD patients in the new era. Of 12 723 listed patients, 535 had ACHD (293 in the new era) and 12 188 did not (6258 in the new era). A total of 163 (56%) ACHD patients in the new era versus 150 (62%) in the prior era were transplanted; 11 (3.8%) versus 15 (6.2%) died on the waitlist; 32 (11%) versus 35 (14%) were delisted and 15 (9.2%) versus 19 (12.7%) died within 30 days of transplant, respectively. The new UNOS donor heart allocation system improved waitlist time and decreased the proportion not transplanted during the first 300 days after listing among ACHD patients without altering early posttransplant outcomes or significantly changing the gap in outcomes compared to non-ACHD patients.
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Affiliation(s)
- Katia Bravo-Jaimes
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, University of California Los Angeles, Los Angeles, California, USA
| | - Kelly Axsom
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Shelby Kutty
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Ari Cedars
- Johns Hopkins University, Baltimore, Maryland, USA
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22
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Bradley EA, Khan A, McNeal DM, Bravo-Jaimes K, Khanna A, Cook S, Opotowsky AR, John A, Lee M, Pasquali S, Daniels CJ, Pernick M, Kirkpatrick JN, Gurvitz M. Operational and Ethical Considerations for a National Adult Congenital Heart Disease Database. J Am Heart Assoc 2022; 11:e022338. [PMID: 35301853 PMCID: PMC9075495 DOI: 10.1161/jaha.121.022338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
As more adults survive with congenital heart disease, the need to better understand the long‐term complications, and comorbid disease will become increasingly important. Improved care and survival into the early and late adult years for all patients equitably requires accurate, timely, and comprehensive data to support research and quality‐based initiatives. National data collection in adult congenital heart disease will require a sound foundation emphasizing core ethical principles that acknowledge patient and clinician perspectives and promote national collaboration. In this document we examine these foundational principles and offer suggestions for developing an ethically responsible and inclusive framework for national ACHD data collection.
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Affiliation(s)
- Elisa A Bradley
- The Ohio State University Wexner Medical CenterDorothy M. Davis Heart and Lung Research Institute Columbus OH.,Division of Cardiovascular Medicine Heart and Vascular InstitutePenn State University College of Medicine Hershey PA
| | - Abigail Khan
- Adult Congenital Heart ProgramKnight Cardiovascular InstituteOregon Health and Science University Portland OR.,Department of Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Demetria M McNeal
- Department of Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Katia Bravo-Jaimes
- Division of Cardiovascular Medicine University of California Los Angeles CA
| | - Amber Khanna
- Department of Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Stephen Cook
- Indiana University Health and Riley Children's Hospital Indianapolis IN
| | - Alexander R Opotowsky
- Department of Pediatrics The Heart InstituteCincinnati Children's HospitalUniversity of Cincinnati College of Medicine Cincinnati OH
| | - Anitha John
- Division of Cardiology Children's National Health System Washington DC
| | - Marc Lee
- The Heart Center, Nationwide Children's Hospital Columbus OH
| | - Sara Pasquali
- Department of Pediatric Cardiology University of Michigan and Mott Children's Hospital Ann Arbor MI
| | - Curt J Daniels
- Division of Cardiovascular Medicine & Nationwide Children's Hospital The Ohio State University Department of Internal Medicine Columbus OH
| | - Michael Pernick
- Board of Directors Member Adult Congenital Heart Association Media PA
| | - James N Kirkpatrick
- University of Washington Heart Institute and Department of Bioethics and Humanities Seattle WA
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23
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Eshtehardi P, Bullock-Palmer RP, Bravo-Jaimes K, Bozkurt B, Dorbala S, Gillam LD, Grines CL, Mehran R, Mieres JH, Singh T, Wenger NK. Women leaders: transforming the culture in cardiology. Open Heart 2022; 9:openhrt-2022-001967. [PMID: 35228269 PMCID: PMC8886417 DOI: 10.1136/openhrt-2022-001967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/06/2022] Open
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24
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Tauma-Arrué A, Chávez-Saldivar S, Mego JC, Luis-Ybáñez O, Coronado-Quispe J, Lucena S, Alvarez C, Melgar E, Morales A, Marquez R, Wilhalme H, Bravo-Jaimes K. Trends in outpatient visits and deaths due to congenital heart defects in Peru. International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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25
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Lee DT, Venkatesh P, Bravo-Jaimes K, Lluri G, Yang EH, Tan W, Perens G, Prosper A, Levi DS, Aboulhosn JA. Using a 3-Dimensional Printed Model to Plan Percutaneous Closure of an Unroofed Coronary Sinus. Circ Cardiovasc Imaging 2021; 14:e013018. [PMID: 34565176 DOI: 10.1161/circimaging.121.013018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dustin T Lee
- Division of Cardiology, Department of Medicine (D.T.L., P.V., K.B.-J., G.L., E.H.Y., W.T., J.A.A.), University of California, Los Angeles
| | - Prashanth Venkatesh
- Division of Cardiology, Department of Medicine (D.T.L., P.V., K.B.-J., G.L., E.H.Y., W.T., J.A.A.), University of California, Los Angeles.,Ahmanson/UCLA Adult Congenital Heart Disease Center (P.V., K.B.-J., G.L., W.T., D.S.L., J.A.A.), University of California, Los Angeles
| | - Katia Bravo-Jaimes
- Division of Cardiology, Department of Medicine (D.T.L., P.V., K.B.-J., G.L., E.H.Y., W.T., J.A.A.), University of California, Los Angeles.,Ahmanson/UCLA Adult Congenital Heart Disease Center (P.V., K.B.-J., G.L., W.T., D.S.L., J.A.A.), University of California, Los Angeles
| | - Gentian Lluri
- Division of Cardiology, Department of Medicine (D.T.L., P.V., K.B.-J., G.L., E.H.Y., W.T., J.A.A.), University of California, Los Angeles.,Ahmanson/UCLA Adult Congenital Heart Disease Center (P.V., K.B.-J., G.L., W.T., D.S.L., J.A.A.), University of California, Los Angeles
| | - Eric H Yang
- Division of Cardiology, Department of Medicine (D.T.L., P.V., K.B.-J., G.L., E.H.Y., W.T., J.A.A.), University of California, Los Angeles.,UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine (E.H.Y.), University of California, Los Angeles
| | - Weiyi Tan
- Division of Cardiology, Department of Medicine (D.T.L., P.V., K.B.-J., G.L., E.H.Y., W.T., J.A.A.), University of California, Los Angeles.,Ahmanson/UCLA Adult Congenital Heart Disease Center (P.V., K.B.-J., G.L., W.T., D.S.L., J.A.A.), University of California, Los Angeles
| | - Gregory Perens
- Division of Cardiology, Department of Pediatrics (G.P., D.S.L.), University of California, Los Angeles
| | - Ashley Prosper
- Department of Diagnostic Radiology (A.P.), University of California, Los Angeles
| | - Daniel S Levi
- Ahmanson/UCLA Adult Congenital Heart Disease Center (P.V., K.B.-J., G.L., W.T., D.S.L., J.A.A.), University of California, Los Angeles.,Division of Cardiology, Department of Pediatrics (G.P., D.S.L.), University of California, Los Angeles
| | - Jamil A Aboulhosn
- Division of Cardiology, Department of Medicine (D.T.L., P.V., K.B.-J., G.L., E.H.Y., W.T., J.A.A.), University of California, Los Angeles.,Ahmanson/UCLA Adult Congenital Heart Disease Center (P.V., K.B.-J., G.L., W.T., D.S.L., J.A.A.), University of California, Los Angeles
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Ozaki A, Bravo-Jaimes K, Smotherman C, Kraemer DF, Samura A, Velarde GP. Sex and Racial Differences in High-Density Lipoprotein Levels in Acute Coronary Syndromes. Am J Med Sci 2021; 362:435-441. [PMID: 33961844 DOI: 10.1016/j.amjms.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/09/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study aimed to assess sex and racial differences related to high-density lipoprotein cholesterol (HDL-C) levels in those presenting with acute coronary syndromes (ACS). METHODS Records from patients with ACS presenting to the Emergency Department of University of Florida Hospital Jacksonville from 2009 to 2012, were reviewed. Detailed medical history was obtained. HDL-C levels were measured within 72 h of presentation. Pearson chi-square and Wilcoxon rank sum tests were used to compare groups in univariate analysis. Analysis of variance was performed to determine independent predictors of higher HDL-C levels using variable selection. RESULTS Of 2400 patients screened, 614 (382 men and 232 women) met inclusion criteria. Hypertension, chronic kidney disease or prior CAD history was similar between sexes and races. Women were more likely to be older (62.4 vs 58.4 years), diabetic (56.5 vs 36.5%) and have higher body mass index (31.2 vs 30.1 kg/m2). Blacks were more likely to be diabetic (50.3 vs 41.3%). After adjusting for all clinical markers, women and blacks along with absence of CAD or diabetes, were significantly associated with higher HDL-C levels. CONCLUSIONS High HDL-C levels (> 40 mg/dL), considered cardio-protective, were seen in women and blacks with ACS more often than in men and whites. Significant differences in HDL-C levels between sexes were seen in whites but not in blacks. Relevance and quality of HDL-C levels in racial groups need further study as this may have important implications in the interpretation of current guidelines.
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Affiliation(s)
- Asuka Ozaki
- Cardiovascular Therapeutic Lead Diabetes & Cardiovascular Medical Operations, Sanofi KK, Tokyo, Japan
| | - Katia Bravo-Jaimes
- Division of Cardiology, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Carmen Smotherman
- Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Dale F Kraemer
- Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, FL, United States; Department of Neurology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Alfred Samura
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Gladys P Velarde
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, United States.
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Chávez-Saldívar S, Mego JC, Tauma-Arrué A, Coronado J, Luis-Ybáñez O, Bravo-Jaimes K. [The adult with tetralogy of fallot: what the clinical cardiologist needs to know]. Arch Peru Cardiol Cir Cardiovasc 2021; 2:121-129. [PMID: 38274563 PMCID: PMC10809779 DOI: 10.47487/apcyccv.v2i2.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/26/2021] [Indexed: 01/27/2024]
Abstract
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. After more than seven decades of the first palliative surgery, TOF prognosis has changed dramatically. The prevalence of TOF is approximately 3 per 10 000 births, representing 7 to 10% of congenital heart disease. With a higher survival into adulthood, the clinical cardiologist faces challenges in the management of this population, from severe pulmonary regurgitation to heart failure and ventricular arrhythmias. Its prevalence is approximately 3 per 10 000 live births, representing 7 to 10% of congenital heart disease. This review will describe the most relevant aspects of the care of adult patients with this disease.
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Affiliation(s)
- Samantha Chávez-Saldívar
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Juan Carlos Mego
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Astrid Tauma-Arrué
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Joel Coronado
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Odalis Luis-Ybáñez
- Facultad de Medicina San Fernando. Universidad Nacional Mayor de San Marcos. Lima, Perú.Universidad Nacional Mayor de San MarcosFacultad de Medicina San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
- Sociedad Científica de San Fernando. Lima, Perú.Sociedad Científica de San FernandoLimaPerú
| | - Katia Bravo-Jaimes
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California. Los Angeles, Estados Unidos.University of CaliforniaAhmanson/UCLA Adult Congenital Heart Disease CenterUniversity of CaliforniaLos AngelesUSA
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Bravo-Jaimes K, Palaskas NL, Banchs J, Abelhad NI, Altaf A, Gouni S, Song J, Hassan SA, Iliescu C, Deswal A, Yusuf SW. Rate of Progression of Aortic Stenosis in Patients With Cancer. Front Cardiovasc Med 2021; 8:644264. [PMID: 33816575 PMCID: PMC8012898 DOI: 10.3389/fcvm.2021.644264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with cancer and aortic stenosis (AS) are exposed to several factors that could accelerate the progression of AS. This study aimed to determine the cumulative incidence of AS progression and associated factors in these patients. This retrospective cohort study included patients with cancer, mild or moderate AS and at least two echocardiograms 6 months apart between 1996 and 2016 at MD Anderson Cancer Center. AS progression was defined by an increase in mean gradient of 20 mmHg or peak velocity of 2 m/s by spectral Doppler echocardiography or as requiring aortic valve replacement. Univariate and multivariable Fine-Gray models to account for the competing risk of death were used. One hundred and two patients were included and median follow-up was 7.3 years. Overall, 30 patients (29%) developed AS progression, while 48 (47%) died without it. Yearly rate of mean gradient change was 4.9 ± 3.9 mmHg and yearly rate of peak velocity change was 0.23 ± 0.29 m/s for patients who developed AS progression. In the univariate analysis, coronary artery disease (CAD), dyspnea, prevalent cyclophosphamide and beta-blocker use were associated with AS progression. In multivariable analysis, CAD and prevalent cyclophosphamide use for the time interval of more than 3 years of follow-up remained significantly associated with increased cumulative incidence of AS progression. In conclusion, patients with mild or moderate AS and cancer are more likely to die before having AS progression. AS progression is associated with CAD and prevalent cyclophosphamide use.
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Affiliation(s)
- Katia Bravo-Jaimes
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nicolas L Palaskas
- Division of Internal Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jose Banchs
- Division of Internal Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nadia I Abelhad
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Alveena Altaf
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sushanth Gouni
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Juhee Song
- Division of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saamir A Hassan
- Division of Internal Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cezar Iliescu
- Division of Internal Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anita Deswal
- Division of Internal Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Syed Wamique Yusuf
- Division of Internal Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Velarde GP, Choudhary N, Bravo-Jaimes K, Smotherman C, Sherazi S, Kraemer DF. Effect of atorvastatin on lipogenic, inflammatory and thrombogenic markers in women with the metabolic syndrome. Nutr Metab Cardiovasc Dis 2021; 31:634-640. [PMID: 33485731 DOI: 10.1016/j.numecd.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/05/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Specific drug therapy to target the underlying proinflammatory and prothrombotic state in patients with metabolic syndrome (MS) is lacking. We sought to study the effect of high-intensity atorvastatin on markers of lipogenesis, inflammation and thrombogenesis, in women with MS in the absence of cardiovascular disease or diabetes. METHODS AND RESULTS This randomized double-blinded controlled trial included 88 women with MS (according to National Cholesterol Education Panel Adult Treatment Panel III criteria) and low atherosclerotic cardiovascular risk. Participants were randomized to receive atorvastatin 80 mg or matching placebo. Thrombogenic, lipogenic and inflammatory markers were collected at the time of enrollment, after a 6-week dietary run-in phase (time of randomization), and at 6- and 12-weeks after randomization. At 6 weeks post-randomization, there was significant reduction in total cholesterol, low density lipoprotein cholesterol, triglycerides, apolipoprotein-B (Apo-B) and Apo-B/Apo-A1 ratio in the atorvastatin arm compared to placebo. This difference persisted at 12-weeks post randomization. There was no significant difference in fasting blood glucose, high-density lipoprotein cholesterol, high sensitivity C-reactive protein, serum leptin, Apo-A1, intercellular adhesion molecule 1 and platelet activity. A significant increase in vascular adhesion molecule 1 at 6 and 12 weeks was seen within the atorvastatin arm. No difference was observed in blood pressure and waist circumference. CONCLUSIONS In conclusion, high-intensity atorvastatin has an early and significant impact on lipoproteins and apolipoproteins but did not lower inflammatory, thrombogenic or biomarkers of platelet activity and aggregation in women with MS. The use of statins for primary prevention in these patients should be further explored.
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Affiliation(s)
- Gladys P Velarde
- Division of Cardiology, University of Florida College of Medicine, Jacksonville FL, USA.
| | - Naila Choudhary
- Division of Cardiology, University of Florida College of Medicine, Jacksonville FL, USA
| | - Katia Bravo-Jaimes
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston TX, USA
| | - Carmen Smotherman
- Division of Cardiology, University of Florida College of Medicine, Jacksonville FL, USA; Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Saadia Sherazi
- Department of Internal Medicine, University of Rochester Medical Center, Rochester NY, USA
| | - Dale F Kraemer
- Division of Cardiology, University of Florida College of Medicine, Jacksonville FL, USA; Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, FL, USA
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30
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Bravo-Jaimes K, Ocazionez D. A Pregnant Woman in Her 30s With a Heart Murmur. JAMA Cardiol 2020; 5:1445. [PMID: 32785637 DOI: 10.1001/jamacardio.2020.2817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Katia Bravo-Jaimes
- Division of Cardiology, University of Texas Health Science Center at Houston, Houston
| | - Daniel Ocazionez
- Department of Diagnostic & Interventional Imaging, University of Texas Health Science Center at Houston, Houston
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31
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Affiliation(s)
- Kenneth Hoang
- Department of Medicine, University of Texas Health Science Center at Houston
| | - Katia Bravo-Jaimes
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston
| | - Daniel Ocazionez
- Department of Diagnostic & Interventional Imaging, University of Texas Health Science Center at Houston.
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32
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Abelhad NI, Bravo-Jaimes K, Fuentes F. Tension Pneumopericardium in the Intensive Care Unit. Tex Heart Inst J 2020; 47:335-336. [PMID: 33472235 DOI: 10.14503/thij-19-6993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Nadia Isabel Abelhad
- Department of Cardiovascular Medicine, The University of Texas John P. and Katherine G. McGovern Medical School, Houston, Texas 77030
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, The University of Texas John P. and Katherine G. McGovern Medical School, Houston, Texas 77030
| | - Francisco Fuentes
- Department of Cardiovascular Medicine, The University of Texas John P. and Katherine G. McGovern Medical School, Houston, Texas 77030
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33
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Bravo-Jaimes K, Loescher VY, Canelo-Aybar C, Rojas-Camayo J, Mejia CR, Schult S, Nieto R, Singh K, Messing S, Hinostroza J. Effect of altitude on mortality of end-stage renal disease patients on hemodialysis in Peru. Clin Kidney J 2020; 14:998-1003. [PMID: 33777381 PMCID: PMC7986442 DOI: 10.1093/ckj/sfaa056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/23/2020] [Indexed: 11/11/2022] Open
Abstract
Background In Latin America, the prevalence of end-stage kidney disease (ESKD) has risen tremendously during the last decade. Previous studies have suggested that receiving dialysis at high altitude confers mortality benefits; however, this effect has not been demonstrated at >2000 m above sea level (masl) or in developing countries. Methods This historical cohort study analyzed medical records from six Peruvian hemodialysis (HD) centers located at altitudes ranging from 44 to 3827 masl. Adult ESKD patients who started maintenance HD between 2000 and 2010 were included. Patients were classified into two strata based on the elevation above sea level of their city of residence: low altitude (<2000 masl) and high altitude (≥2000 masl). Death from any cause was collected from national registries and Cox proportional hazards models were built. Results A total of 720 patients were enrolled and 163 (22.6%) resided at high altitude. The low-altitude group was significantly younger, more likely to have diabetes or glomerulonephritis as the cause of ESKD and higher hemoglobin. The all-cause mortality rate was 84.3 per 1000 person-years. In the unadjusted Cox model, no mortality difference was found between the high- and low-altitude groups {hazard ratio [HR] 1.20 [95% confidence interval (CI) 0.89-1.62]}. After multivariable adjustment, receiving HD at high altitude was not significantly associated with higher mortality, but those with diabetes as the cause of ESKD had significantly higher mortality [HR 2.50 (95% CI 1.36-4.59)]. Conclusions In Peru, patients receiving HD at high altitudes do not have mortality benefits.
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Affiliation(s)
- Katia Bravo-Jaimes
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Viky Y Loescher
- Department of Radiology, Mount Sinai Hospital, Miami, FL, USA
| | - Carlos Canelo-Aybar
- Institut d'Investigacions Biomèdiques Sant Pau (IIB- Sant Pau), Cochrane Iberoamerican Center, Barcelona, Spain
| | - Jose Rojas-Camayo
- Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Christian R Mejia
- School of Health Sciences, Universidad Continental, Huancayo, Junin, Peru
| | | | - Ruben Nieto
- Division of Nephrology, EsSalud Cusco, Cusco, Peru
| | - Kyra Singh
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Susan Messing
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
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34
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Bravo-Jaimes K, Marah NB, Raghunathan D, Napierkowski S, Ekeruo IA, Kitkungvan D, Milewicz DM, Smalling RW, Prakash SK. TGFBR1 Rare Variant Associated With Thoracic Aortic Aneurysm, Double Chamber Left Ventricle, Coronary Anomaly, and Inducible Ventricular Tachycardia. Circ Cardiovasc Imaging 2020; 13:e010084. [PMID: 32482137 DOI: 10.1161/circimaging.119.010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Katia Bravo-Jaimes
- Division of Cardiology (K.B.-J., N.B.M., D.R., S.N., I.A.E., D.K., R.W.S., S.K.P.), Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Naddi B Marah
- Division of Cardiology (K.B.-J., N.B.M., D.R., S.N., I.A.E., D.K., R.W.S., S.K.P.), Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Deepa Raghunathan
- Division of Cardiology (K.B.-J., N.B.M., D.R., S.N., I.A.E., D.K., R.W.S., S.K.P.), Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Steven Napierkowski
- Division of Cardiology (K.B.-J., N.B.M., D.R., S.N., I.A.E., D.K., R.W.S., S.K.P.), Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Ijeoma A Ekeruo
- Division of Cardiology (K.B.-J., N.B.M., D.R., S.N., I.A.E., D.K., R.W.S., S.K.P.), Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Danai Kitkungvan
- Division of Cardiology (K.B.-J., N.B.M., D.R., S.N., I.A.E., D.K., R.W.S., S.K.P.), Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Dianna M Milewicz
- Division of Medical Genetics (D.M.M., S.K.P.), Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Richard W Smalling
- Division of Cardiology (K.B.-J., N.B.M., D.R., S.N., I.A.E., D.K., R.W.S., S.K.P.), Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Siddharth K Prakash
- Division of Cardiology (K.B.-J., N.B.M., D.R., S.N., I.A.E., D.K., R.W.S., S.K.P.), Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston.,Division of Medical Genetics (D.M.M., S.K.P.), Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
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Abstract
Anomalous origin of the left coronary artery from the non-coronary cusp (LCANCC) is extremely rare and its prognosis and management are still controversial. We present two cases of symptomatic women with LCANCC and a comprehensive review of 19 studies reporting the prevalence, presentation, and management of LCANCC among 174,262 patients. Despite case reports of LCANCC in the pediatric population suggest a much worse prognosis, the optimal risk-stratification scheme for this type of anomaly in adults is yet to be defined, and it should not necessarily be considered a benign condition solely based on its anatomic origin or lack of an interarterial course.
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Affiliation(s)
- Katia Bravo-Jaimes
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, USA
| | - Prakash Balan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, USA
| | - Enrique Garcia-Sayan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, USA
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36
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Seif E, Sherazi S, Bravo-Jaimes K, Cheyne C, Alexis JD. Driving Pulseless: A Driving Survey of Patients With Left Ventricular Assist Devices and Their Providers. J Card Fail 2019; 25:220-221. [PMID: 30753934 DOI: 10.1016/j.cardfail.2019.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Emily Seif
- University of Rochester Medical Center, Rochester, New York..
| | - Saadia Sherazi
- University of Rochester Medical Center, Rochester, New York
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Gruber JS, Stair B, Aktas M, Bravo-Jaimes K. Left Bundle Branch Block and Complete Heart Block Complicating Inferior Myocardial Infarction. Ann Noninvasive Electrocardiol 2017; 22. [DOI: 10.1111/anec.12387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jillian S. Gruber
- School of Medicine and Dentistry; University of Rochester Medical Center; Rochester NY USA
| | - Brad Stair
- Department of Cardiology; School of Medicine and Dentistry; University of Rochester Medical Center; Rochester NY USA
| | - Mehmet Aktas
- Department of Cardiology; School of Medicine and Dentistry; University of Rochester Medical Center; Rochester NY USA
| | - Katia Bravo-Jaimes
- Department of Internal Medicine; School of Medicine and Dentistry; University of Rochester Medical Center; Rochester NY USA
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