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Physicians and Researchers Present at the American College of Cardiology (ACC) 66th Annual Scientific Session

The UPMC Heart and Vascular Institute will be well-represented at the American College of Cardiology (ACC) 66th Annual Scientific Session in Washington, DC. Faculty research will be featured in both oral and poster presentations throughout the conference, including:

 

Friday, March 17

Session 1120: Novel Echocardiographic Methods for Assessing Cardiac Function

Racial Differences in Left Ventricular Recovery in Patients With Peripartum Cardiomyopathy Assessed by Global Longitudinal Strain

Presented by: Masataka Sugahara, Dennis McNamara, Joan Briller, Leslie Cooper, Julie Damp, Mark H. Drazner, James Fett, Eileen Hsich, Navin Rajagopalan, John Gorcsan

 

Session 1130: Innovations in Practice Management and Social Media

Formal CPR Status Policy and Process Increased Documentation Rates

Presented by: Joshua E. Levenson, Aken Desai, Karen Kelly, Emilie Prout, Joon Lee, Mark Schmidhofer, Winifred Teuteberg

 

Session 1149: Arrhythmias and Clinical EP: Devices 2

Persistent Gender Disparities in Implantable Cardioverter-Defibrillator Therapy

Presented by: Amber E. Johnson, Shubash Adhikari, Andrew Althouse, Floyd Thoma, Oscar Marroquin, Stephen Koscomb, Leslie Hausmann, Larissa Myaskovsky, Samir Saba

 

Session 1150: Arrhythmias and Clinical EP: AF Ablation

Characterization of Pulmonary Vein Reconnection Post Cryoballoon Ablation

Presented by: Shivang Shah, Wenjie Xu, Evan Adelstein, Andrew Voigt, Samir Saba, Sandeep Jain

 

Session 1157: Complex Coronary Intervention: Left Main/Bifurcations and Multivessel Disease

Multivessel Versus Culprit-Only PCI in Patients With Non-ST Segment Elevation Myocardial Infarction and Multivessel Disease: Results From the PROMETHEUS Study

Presented by: Birgit Vogel, Usman Baber, Samantha Sartori, Jaya Chandrasekhar, Serdar Farhan, Michela Faggioni, Sabato Sorrentino, Annapoorna Kini, William Weintraub, Sunil Rao, Samir Kapadia, Sandra Weiss, Craig Strauss, Catalin Toma, J. Muhlestein, Anthony C. DeFranco, Mark Effron, Stuart Keller, Brian Baker, Stuart Pocock, Timothy Henry, Roxana Mehran

 

Session 4101: Advanced heart Failure and VAD Therapy
Presented by: Jeffrey Teuteberg

 

Saturday, March 18

Session 904: Highlighted Original Research: Pulmonary Hypertension and Venous Thrombo-embolic Disease and the Year in Review

Simplified Measures of Right Ventricular and Atrial Remodeling Are Predictive of Outcomes in Patients With Pulmonary Hypertension

Presented by: Masataka Sugahara, Keiko Ryo-Koriyama, Akiko Goda, Omar Batal, Marc Simon, John Gorcsan

 

Session 1196: Nuclear Cardiology: Beyond Perfusion

Regional Right Ventricular (RV) Function as Determined by Gated Blood Pool SPECT (GBPS) Provides Additive Value to Evaluation of Patients Undergoing Left Ventricular Assist Device (LVAD) Implantation

Presented by: Christopher B. Link, Aditi Nayak, Robert Kormos, Marc Simon, Jeffrey Teuteberg, Luigi Lagazzi, Andrew Althouse, Prem Soman

 

Session 1201: Advances in HCM, PPCM and Other Cardiomyopathies

Extended Course of Recovery in Patients With Peripartum Cardiomyopathy Assessed by Left Ventricular Wall Distensibility

Presented by: Masataka Sugahara, Dennis McNamara, Lori Blauwet, Rami Alharethi, Paul Mather, Kalgi Modi, Richard Sheppard, Vinay Thohan, Gretchen Wells, John Gorcsan

 

Session 669: Distinct Phenotypes in HFpEF: Beyond Ejection Fraction

669-03 – Diagnostic Evaluation of Patients with Dyspnea and Normal LVEF
Presented by: John Gorcsan

 

Session 1226: Put Your Codon! Genetic Insights Into Heart Failure

G-Protein Receptor Kinase 5 Polymorphisms and Outcomes in the African American Heart Failure Trial: Results From the Genetic Risk Assessment of Heart Failure in African-Americans Sub-Study

Presented by: Amber E. Johnson, Karen Hanley-Yanez, Clyde Yancy, Anne Taylor, Arthur Feldman, Dennis McNamara

 

Session 1242: Timely Topics in Acute Coronary Syndromes

Use of Potent P2y12 Inhibitors in African-American Patients Treated With Percutaneous Coronary Intervention for Acute Coronary Syndromes

Michela Faggioni, Usman Baber, Jaya Chandrasekhar, Birgit Vogel, Samantha Sartori, Melissa Aquino, Annapoorna Kini, William Weintraub, Samir Kapadia, Sandra Weiss, Craig Strauss, Clayton Snyder, Catalin Toma, J. Muhlestein, Anthony C. DeFranco, Mark B. Effron, Stuart Keller, Brian Baker, Stuart Pocock, Timothy Henry, Sunil Rao, Roxana Mehran

 

Session 1257: FIT Clinical Decision Making: Heart Failure and Pulmonary Hypertension

1257-408 / 408 – When the Liver Gets Sacked by the Heart Sac: A Diagnostic Challenge of Mixed Heart and Liver Pathology
Presented by: Ahmad Masri, John Gorcsan

 

Session 1245: New Technologies in Echocardiography

1245-219 / 219 – Assessment of Right Ventricular Energy Loss and Efficiency Using Novel Vector Flow Mapping

Presented by: Masataka Sugahara, Nina Hasselberg, Marc Simon, John Gorcsan

 

Session 1246: Nuclear Cardiology: Quality

Repeatability of Appropriateness Category Allocation by Trained Physicians

Presented by: Daniel Nguyen, Aditi Nayak, Christopher Pray, Christopher Link, Andrew Althouse, Prem Soman

 

Session 702: The Forgotten Chamber: The Right Ventricle in Heart Failure

RV Failure After LVAD: Predictable and Preventable?
Presented by: Jeffrey Teuteberg

 

Session 1235: Innovations in Cardiovascular Risk Assessment and Reduction

Ideal Cardiovascular Health Metrics in Couples: A Community-Based Population Study

Presented by: Oluremi Ajala, Sebhat Erqou, Claudia Bambs, Michael Sharbaugh, Andrew Althouse, Aryan Aiyer, Kevin Kip, Steven Reis

 

Session 1230: Predicting the Future: Observations and Discoveries From Registries and Databases

Pulmonary Vascular Resistance Predicts Mortality in End-Stage Renal Disease Patients With Pulmonary Hypertension

Presented by: Jonathan Wolfe, Gavin Hickey, Andrew Althouse, Michael Sharbaugh, Deepak Kumar Pasupula, Dustin Kliner, Michael Mathier, Prem Soman

 

Session 727: Aortic Stenosis: Overview of the Hemodynamics and Ventricular Response

Expanding the Diagnostic Toolbox for Aortic Stenosis
Presented by: João Cavalcante

 

Session 716: Pregnancy and Heart Disease

Peripartum Cardiomyopathy – Long term Outcomes and Management Options
Presented by: Dennis McNamara

 

Session 4103: Advanced Heart Failure and VAD Therapy
Presented by: Jeffrey Teuteberg

 

Sunday, March 19

Session 732: Nuclear Cardiology: Current Applications and Best Practices: Joint Symposium of the American Society of Nuclear Cardiology and the American College of Cardiology

Nuclear Cardiology: Risk Stratification
Presented by: Prem Soman

 

Session 738: Controversies in Mitral Valve Surgery: Joint Symposium of the Society of Thoracic Surgeons and the American College of Cardiology

What to do if the left ventricle fails after mitral valve surgery
Presented by: Robert Kormos

 

Session 770: Great Debates in Cardiac MRI

Debate Con: Stress MRI is the Test of Choice for Ischemia Assessment
Presented by: Prem Soman

 

Session 4105: Advanced Heart Failure and VAD Therapy
Presented by: Jeffrey Teuteberg

 

Session 1274: The Challenges of Outcome Prediction in Valvular Heart Disease

Poor Agreement Between Transthoracic Echocardiography and Right Heart Catheterization for Assessment of Pulmonary Hypertension Severity: Clinical Applications in the TAVR Era

Presented by: Islam Abdelkarim, Jeffrey Xu, Michael Sharbaugh, Andrew Althouse, William Katz, Frederick Crock, Matthew Harinstein, Dustin Kliner, Forozan Navid, Joon Lee, John Schindler, Thomas Gleason, João Cavalcante

 

Session 1282: Advances in Chronic Total Occlusion Intervention

The Impact of Epicardial Collateral Use on the Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry

Presented by: Judit Karacsonyi, Khaldoon Alaswad, Farouc Jaffer, Robert Yeh, Dimitrios Karmpaliotis, Jeffrey Moses, Ajay Kirtane, Manish Parikh, Ziad Ali, David Kandzari, Nicholas Lembo, William Lombardi, R. Michael Wyman, Anthony Doing, Catalin Toma, James Choi, Mitul Patel, Ehtisham Mahmud, Barry Uretsky, Aris Karatasakis, Bavana Rangan, Imre Ungi, Craig Thompson, Subhash Banerjee, Emmanouil Brilakis

 

Session 1307M: Emerging Applications for Imaging Cardiac Amyloidosis: Nuclear Cardiology

Predictors of a Positive Technetium Pyrophosphate Scan in Patients With Suspected Cardiac Amyloidosis

Presented by: Ahmad Masri, Ricardo Nieves, Michael S. Sharbaugh, Andrew Althouse, William Follansbee, João Cavalcante, Prem Soman

 

Session 1221M: TAVR outcomes Prognostication

Prognostic Value of Right Ventricle-Pulmonary Artery Coupling in TAVR Patients: Time to Integrate the Right Side Unit

Presented by: João Cavalcante, Islam Abdelkarim, Michael Sharbaugh, Andrew Althouse, Jeffrey Xu, Wei Han, William Katz, Frederick Crock, Matthew Harinstein, Dustin Kliner, Forozan Navid, Joon Lee, John Schindler, Thomas Gleason

 

Session 769: Life After LVAD: The Good, The Bad and The Ugly

Right Ventricular Failure After LVAD
Presented by: Robert Kormos

 

Session 785: Radiation from Diagnostic Imaging: Risk-benefit Analysis
Panelist: Prem Soman

Genetic Test Helps Improve Outcomes in Heart Stent Patients

A genetic test recently implemented at UPMC Presbyterian can significantly reduce the risk of cardiovascular events by helping to identify more effective medication for some heart patients, according to the results of a large study conducted in part at the University of Pittsburgh and UPMC. The findings are being presented today at the American Heart Association’s Scientific Sessions in New Orleans.

The test identifies a genetic deficiency that affects the body’s ability to activate clopidogrel, a common anti-clotting drug given after a coronary artery stent is inserted. About 30 percent of all patients have the genetic deficiency, which can lead to decreased clopidogrel effectiveness and increased risk for adverse cardiovascular events, such as strokes, heart attacks and death.

In the current study from the National Institutes of Health’s Implementing Genomics in Practice (IGNITE) Network, researchers at the University of Pittsburgh School of Pharmacy and other sites throughout the country analyzed medical outcomes in 1,815 patients who had genetic testing at the time of their cardiac procedure. The testing allows physicians to pinpoint the best anti-clotting medication for each patient.

The study reported significant results: About 60 percent of patients with the genetic deficiency were given a different, more effective medication. Using the genetic data to guide changes in therapy reduced the percentage of deaths, heart attacks or strokes by nearly half compared with those who continued taking clopidogrel, the researchers found. Among those who had the genetic deficiency and continued taking clopidogrel, 8 percent experienced one of those complications.

“We saw significantly fewer adverse events among patients who were switched to an alternative drug,” said Larisa Cavallari, PharmD, director of the Center for Pharmacogenomics at the University of Florida College of Pharmacy who led the multi-institutional study.

Earlier this year, UPMC Presbyterian became one of the first medical centers in the country to make this test available for patients as part of the PreCISE-Rx (Pharmacogenomics-guided Care to Improve the Safety and Effectiveness of Medications) initiative. Approximately 10 percent of the study population was analyzed by the team at Pitt and UPMC, one of the affiliates in the IGNITE Network.

“This study is a major step forward as it shows applying pharmacogenomics to achieve a precision medicine approach in cardiac stent patients can provide significant benefits,” said Philip Empey, PharmD, PhD, assistant professor of pharmacy and therapeutics at the Pitt School of Pharmacy and leader of the Pitt team.

PreCISE-Rx is a leading initiative of the Institute for Precision Medicine (IPM), a joint effort by UPMC and Pitt to move biomedical research into personalized well-being and clinical care.

“The success of PreCISE-Rx demonstrates that the IPM is well-positioned to dramatically improve the standard of care through precision medicine by taking advantage of the world-class clinical and research expertise in Pittsburgh,” said Adrian Lee, PhD, professor of pharmacology and chemical biology at Pitt, and director of the Women’s Cancer Research Center, University of Pittsburgh Cancer Institute.

Other institutions that participated in the clopidogrel research were the University of North Carolina, the University of Maryland-Baltimore, the University of Alabama-Birmingham, Vanderbilt University Medical Center, the University of Illinois-Chicago, Indiana University-Indianapolis, Sanford Health, Duke University and the University of Pennsylvania.

Heart Failure Care Improving, but Hospitalizations on the Rise

Although hospitalizations have increased in recent years for patients with congestive heart failure, survival rates and length of stay have improved, according to new research from experts at the University of Pittsburgh School of Medicine and UPMC Heart and Vascular Institute. The results, published in the journal Clinical Cardiology and presented Sunday at the American Heart Association Scientific Sessions, were based on more than 15 million US hospital admissions between 1996 and 2009 due to congestive heart failure.

The prevalence of heart failure is increasing in the US due to its aging population and significant advancements in management of associated co-morbidities, such as ischemic heart disease, diabetes, stroke, peripheral vascular disease and hypertension. More than 5 million Americans are living with heart failure, and close to 500,000 patients are newly diagnosed each year.

Heart failure also is a common cause of hospital admissions, leading to significant costs for the nation’s health care system. A recent report from the American Heart Association estimated the annual direct and indirect costs associated with heart failure in the US at more than $30.7 billion. However, until this study, little was known about recent trends involving those admissions, including length of stay and in-hospital mortality.

“There has been significant progress in heart failure management over the past two decades, but more has to be done,” said Muhammad Bilal Munir, MD, clinical instructor of medicine in Pitt’s Division of General Internal Medicine and corresponding author of the study. “The number of hospitalizations has increased, identifying a need to implement heart failure quality measures stringently to reduce these admissions, therefore reducing heart failure-associated health care costs.”

The number of heart failure hospitalizations increased from 1,000,766 in 1996 to about 1,173,832 in 2009, according to study results. The mean length of stay fell from 6.07 days in 1996 to about 5.26 days in 2009, and inpatient mortality rates declined from 4.92 percent in 1996 to 3.41 percent in 2009.

Researchers say the findings likely reflect the changes in the management of heart failure across the country, which include numerous advances in care such as new drug therapies and sophisticated devices. Further efforts are needed to curb the cost of heart failure management, experts agreed, with a focus on reducing heart failure hospital admissions and readmissions, especially for patients with less severe symptoms who could be treated with aggressive outpatient management.

Additional study authors are Michael S. Sharbaugh, MPH; Floyd W. Thoma; Muhammad Umer Nisar, MD; Amir S. Kamran, MD; Andrew D. Althouse, PhD; and Samir Saba, MD, all from the UPMC Heart and Vascular Institute.

UPMC First in Region to Use New Fully Dissolving Heart Stent

UPMC is the first hospital in western Pennsylvania to use Abbott’s fully dissolving Absorb GT1 Biodegradable Vascular Scaffold System (BVS), a first-of-its-kind device recently approved by the Food and Drug Administration. It functions by opening a blocked artery in the heart, restoring blood flow and providing relief from symptoms of coronary artery disease (CAD). A 58-year-old woman with severe coronary artery disease was the first patient to receive the absorbable device Tuesday.

“We’re only at the beginning of understanding the potential benefits of this technology that could have long-lasting impacts for our patients,” said Catalin Toma, MD, assistant professor, Division of Cardiology, University of Pittsburgh School of Medicine, and director for interventional cardiology research at the UPMC Heart and Vascular Institute and one of the initial medical experts with access to the technology. “By resorbing in time, these implants allow for restoration of the vessel’s natural function without the restriction of the traditional metallic cage of the stent. This may have a positive effect on vessel healing for months and years to come.”

The most common type of heart disease, CAD occurs when arteries that supply blood to the heart become narrowed or blocked due to plaque buildup, leading to chest pain and shortness of breath, as well as an increased risk of heart attack. When patients present with heart attacks or chest discomfort due to plaque buildup, the obstruction is treated with metallic stents. Although this technology has been greatly improved in the past years, potential issues related to the permanent coronary implant may require additional procedures even many years after the initial operation.

Absorb GT1 BVS is made of naturally resorbable material that slowly disappears in about three years, leaving behind a restored vessel, free of a permanent implant. Metallic stents permanently restrict vessel movement, limiting future treatment options. Unrestricted vessels with restored function have the potential to flex, pulse and dilate in response to various demands on the heart, based on people’s lifestyle and activities, and allow for potential treatment options down the road. Similar to current generation drug-eluting stents, the BVS is coated with a drug that prevents the re-narrowing of the vessel over time.

The procedure is similar to regular coronary stenting intervention, which is performed by accessing the artery in the groin or wrist, and threading catheters to the coronary arteries. The blockage is first opened with an angioplasty balloon, followed by balloon-expandable scaffold implantation. While complex and hardened blockages are better served by regular metallic stents at this stage of the technology, the BVS could be beneficial for younger patients with their first CAD presentation, Dr. Toma noted.

UPMC Presbyterian Shadyside is one of the few centers in the US with experience in implanting the scaffolds. The hospital participated in the ABSORB III trial, which led to the recent FDA approval of the device, as well as the ABSORB IV trial, which compares the BVS to the top-performing current metallic stent technology.

The UPMC Heart and Vascular Institute is one of the world’s premier centers for comprehensive care, developing revolutionary devices and new models of treatment that improve the lives of those facing the most complex heart and vascular conditions.

Washington Health System and UPMC Announce Cardiac Surgery Partnership

A new partnership between Washington Health System (WHS) and the UPMC Heart and Vascular Institute will expand cardiac services in the Washington, Pennsylvania, area. Cardiac surgery services at Washington Hospital will now be performed by surgeons from UPMC, who will collaborate alongside WHS-Cardiovascular Care physicians and nurse practitioners, as well as all of the cardiologists and medical staff who practice at WHS.

Effective this month, a team of cardiothoracic surgeons from the UPMC Heart and Vascular Institute see patients in an office located at 125 N. Franklin Road, Suite 1-A, Washington, Pa., 15301. The office is in the same building as WHS-Cardiovascular Services.

“Washington Health System is committed to enhancing the quality of health care for patients in our service area,” said Paul Cullen, MD, vice president of medical affairs for WHS. “Having UPMC’s world class cardiac surgeons, right here in our community, will be beneficial to patients as well as WHS-affiliated medical providers. This partnership helps as we continue to strengthen our medical staff of over 200 primary care physicians and specialists and complements our ongoing efforts of collaborative care.”

Through the partnership, WHS is able to expand its cardiac service offerings to include the development of a transcatheter aortic valve replacement (TAVR) program, other minimally invasive procedures, and the expansion of heart failure and valve disease detection and management programs.

“This partnership between WHS and UPMC for cardiovascular care markedly expands the capabilities at WHS to facilitate the delivery of state-of-the-art cardiac surgery and therapeutics to residents of Washington and Greene counties,” said Thomas Gleason, MD, chief of the UPMC Division of Cardiac Surgery and Ronald V. Pellegrini professor at the University of Pittsburgh School of Medicine. “We look forward to jointly serving the patients in this region of western Pennsylvania.”

The cardiac surgery team at WHS includes Dr. Gleason; Chris Cook, MD, cardiac surgeon at the UPMC Heart and Vascular Institute; Claudio Lima, MD, director of cardiovascular surgery at UPMC Mercy and assistant professor of surgery at Pitt; and Forozan Navid, MD, cardiac surgeon and clinical assistant professor of surgery at Pitt.

For more information, call 724-250-4310 or visit www.whs.org.

UPMC Receives Nation’s Top Ratings for Heart Surgery

UPMC has been awarded top quality ratings by the Society of Thoracic Surgeons (STS). The health system recently received the maximum “three star” rating for coronary artery bypass grafting (CABG) procedures.

Based on a review of data that was compiled and publicly reported for the 2015 fiscal year, the score designates that UPMC is statistically better than the national average for this common cardiac procedure.

“We are very proud of the dedication displayed by our physicians and staff that led to consistently high quality across the board for CABG procedures as proven by these tremendous results,” said Thomas Gleason, MD, chief of the UPMC Division of Cardiac Surgery. “The UPMC Heart and Vascular Institute works hard to provide innovative cardiac care of the highest quality to patients throughout our system.”

The STS National Database was established to drive quality and safety improvements among cardiothoracic surgeons. It covers adult cardiac, general thoracic and congenital heart surgery.

The UPMC Heart and Vascular Institute is one of the world’s premier centers for comprehensive care, developing revolutionary devices and new models of treatment that improve the lives of those facing the most complex heart and vascular conditions.

Pitt Finding Suggests New Heart Disease Screening Target for Middle-Aged Black Women

Middle-aged black women have higher levels of a protein in their blood associated with a predictor of heart disease than their white counterparts, even after other factors, such as obesity, are taken into consideration, according to a study conducted by the University of Pittsburgh Graduate School of Public Health and School of Medicine.

The finding, reported today in the journal Menopause, suggests routine blood testing of black menopausal women may be warranted to determine their heart disease risk and potentially when to start therapies, such as aspirin and statins. The research was funded by the National Institutes of Health (NIH).

“Multiple previous studies have shown that black women are at higher risk for heart disease than white women; however, guidelines for assessing cardiovascular disease risk in asymptomatic adults do not recommend selective race- or ethnic-based risk-assessment,” said lead author Norman C. Wang, MD, MS, assistant professor in Pitt’s School of Medicine. “Our study revealed for the first time that in black, but not white, women going through menopause, higher levels of an easily measured risk factor for heart disease are associated with higher amounts of early atherosclerosis, even after accounting for other risk factors for heart disease. A clinical trial to determine whether routine screening in this population can save lives may be warranted.”

Dr. Wang and his colleagues examined medical records, blood samples and heart CT scans for 372 black and white women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women averaged just over 51 years old, were not on hormone replacement therapy and had no known heart disease when enrolled.

The researchers looked at blood levels of five biomarkers linked to inflammation. All of the biomarkers were associated with coronary artery calcification, a predictor of heart disease that is measured with a heart CT scan. When the researchers then took into account the participants’ body mass index (BMI), a measure of overall body fat, they found that obesity was a key factor linking most of the elevated inflammation biomarkers and coronary artery calcification.

Regardless of BMI, black women with higher levels of one particular biomarker, C-reactive protein, were more likely to have coronary artery calcification than whites. In fact, black women with coronary artery calcification had an average level of C-reactive protein in their blood that was almost double that of their white counterparts.

“We clearly demonstrated that obesity, inflammation biomarkers and coronary artery calcification are linked for both black and white midlife women, further emphasizing the need to promote lifestyle changes to combat obesity at midlife when women are subjected to many physiological and biological changes that could potentially increase their risk for heart disease,” said senior author Samar El Khoudary, PhD, MPH, assistant professor in Pitt Public Health’s Department of Epidemiology. “Future research should build on our findings regarding black women and C-reactive protein by testing similar associations over time, which could potentially yield interventions that can help these women avoid developing heart disease.”

The researchers noted that their study only looked at black and white women, so the results are not generalizable to other racial or ethnic groups.

Additional researchers on the study are Karen A. Matthews, PhD, Emma J.M. Barinas-Mitchell, PhD, and Chung-Chou H. Chang, PhD, all of Pitt.

This work was supported by the NIH through the National Institute on Aging, National Institute of Nursing Research, Office of Research on Women’s Health and National Heart, Lung, and Blood Institute grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495, HL065581 and HL065591.

Magee-Womens Research Institute Awarded $3.7 Million to Study Pregnancy and Heart Disease

Researchers at Magee-Womens Research Institute (MWRI) have been awarded a four-year $3.7 million grant from the American Heart Association (AHA) Go Red for Women Research Network to examine whether certain pregnancy-related blood vessel changes can uncover mechanisms of later-life cardiovascular disease (CVD) in women, identify women at highest risk, and guide new interventions to help them.

The causes of heart disease, which damages the inner walls of the blood vessels and can lead to spasms and decrease blood flow to the heart muscle, known as microvascular dysfunction, are unclear, said principal investigator, Carl Hubel, PhD, associate professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine and MWRI investigator. During pregnancy, profound metabolic and cardiovascular changes occur, putting extra stress on a woman’s body and requiring the heart and blood vessels to work harder. Researchers believe that studying these cardiovascular changes may reveal early mechanisms of CVD.

“This grant is an important next step for our research team in the ongoing assessment of using pregnancy as a lens to understand CVD in women throughout the life span,” explained Dr. Hubel. “Microvascular dysfunction is a devastating public health challenge because almost two-thirds of women who die suddenly of coronary heart disease have had no previous symptoms. We hope to build on the research of our previous studies by identifying mechanisms of CVD in women that are unmasked or perhaps affected by adverse pregnancy outcomes. By examining these relationships, we aim to discover early heart disease risks in women as well as the causes.”
 

In addition to Magee, four other centers make up the AHA Go Red for Women Research Network: Johns Hopkins University School of Medicine, Columbia University Medical Center, University of California, San Diego and New York University Medical Center.

UPMC Passavant and UPMC Shadyside Receive Nation’s Top Ratings for Heart Surgery

The Society of Thoracic Surgeons (STS) has awarded top quality ratings to UPMC Passavant and UPMC Shadyside. UPMC Passavant received the maximum “three star” rating for coronary artery bypass grafting procedures, placing it in the top 8.8 percent of hospitals nationally. UPMC Shadyside received the same rating for aortic valve replacement procedures, placing it in the top 9.9 percent of hospitals nationally.

 

Based on a review of data that was compiled and publicly reported for the 2014 fiscal year, the three star score designates that UPMC Passavant and UPMC Shadyside are statistically better than the national average in their respective procedures.

 

“The UPMC Heart and Vascular Institute works to provide innovative cardiac care of the highest quality to patients throughout the UPMC system,” said Victor Morell, M.D., vice chairman and director of cardiovascular services, UPMC Department of Cardiothoracic Surgery. “We are proud of the dedication displayed by our physicians and staff that led to these tremendous results.”

 

The STS National Database was established to drive quality and safety improvements among cardiothoracic surgeons. It covers adult cardiac, general thoracic and congenital heart surgery.

Menopause Associated with More Fat Around Heart, Raising Risk for Heart Disease

PITTSBURGH, July 22, 2015 – Late- and post-menopausal women have significantly greater volumes of fat around their hearts – a risk factor for heart disease – than their pre-menopausal counterparts, a University of Pittsburgh Graduate School of Public Health study has shown for the first time.

The finding, published online and scheduled for the Sept. 1 issue of The Journal of Clinical Endocrinology & Metabolism, likely can be attributed to changing hormone levels and could guide potentially life-saving interventions. The work was funded by the National Institutes of Health (NIH) and American Heart Association (AHA).

“Cardiovascular disease is the leading cause of death in women, and it increases after age 50 – the average age when a woman is going through menopause,” said lead author Samar R. El Khoudary, Ph.D., M.P.H., assistant professor in Pitt Public Health’s Department of Epidemiology. “By showing that menopause appears to be associated with a shift in fat deposits that leads to more fat around the heart, we’ve uncovered a new potential contributor to increased risk of cardiovascular disease in women.”

Weight gain in women during and after menopause has long been attributed to aging, rather than menopause itself. However, recent research identified changes in body fat composition and distribution due to menopause-related hormonal fluctuations.

No previous study had evaluated whether those changes in fat distribution during menopause affect cardiovascular fat. Increased and excess fat around the heart and vasculature can be more detrimental than abdominal fat, causing local inflammation and leading to heart disease. Doubling certain types of cardiovascular fat can lead to a more than 50 percent increase in coronary events.

Dr. El Khoudary and her team evaluated clinical data, including blood samples and heart CT scans, on 456 women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women averaged about 51 years of age and were not on hormone replacement therapy.

As concentrations of the sex hormone estradiol – the most potent estrogen – declined during menopause, greater volumes of cardiovascular fat were found. The finding held even after the team took into account the effects of age, race, obesity, physical activity, smoking, alcohol consumption, medication use and chronic diseases.

“Developing prevention strategies to reduce cardiovascular fat in women at midlife may reduce their heart disease risk, especially knowing that the menopausal transition puts women at risk for excess fat around their hearts,” said Dr. El Khoudary. “Previous studies suggest that reducing heart fat is feasible through weight loss or weight management, but these studies only looked at small numbers of people and there have been no clinical trials linking cardiovascular outcomes with heart fat changes due to weight management interventions. Clearly there is a need for larger scale studies to determine the best intervention strategies to help post-menopausal women reduce fat near the heart.”

Dr. El Khoudary and her research team are working on seeking more funds to evaluate whether cardiovascular fat volumes progress over time in midlife women, and, if so, whether this progression will be associated with greater evolution in atherosclerosis and more cardiovascular events in post-menopausal women.

Additional authors on this study are senior author Karen A. Matthews, Ph.D., of Pitt; and co-authors Kelly J. Shields, Ph.D., of Allegheny Health Network; Imke Janssen, Ph.D., and Lynda H. Powell, Ph.D., both of Rush University Medical Center; Carrie Hanely and Emma Barinas-Mitchell, Ph.D., both of Pitt; Matthew Budoff, M.D., of the Los Angeles Biomedical Research Institute; and Susan A. Everson-Rose, Ph.D., of the University of Minnesota Medical School.

This research was supported by NIH grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554 and HL065591; and AHA grant 12CRP11900031.

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