Pauley Research Roundup
A roundup of published research by Pauley faculty from November 2024 through January 2025
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by Tanner Lambson
Articles
Gauging the effectiveness of an automated heart-health assessment tool for cancer survivors
Pauley researchers: W. Gregory Hundley, MD
Journal: Journal of Clinical Oncology
Publication date: Nov 2024
This study evaluated the automated heart-health assessment (AH-HA) clinical decision support tool. This virtual tool was designed by researchers to promote provider-patient cardiovascular health discussions in outpatient oncology. The study found that the AH-HA tool was effective at promoting cardiovascular health discussions during routine follow-up care for survivors, including discussions around recommendations to consult primary care. This tool meets calls to apply simple proven measures to address cardiovascular health needs among cancer survivors.
Sodium-glucose cotransporter 2 inhibitors, malnutrition, cachexia, and survival in patients with heart failure with a history of anthracycline treatment
Pauley researchers: Krishnasree Rao, MD; Salvatore Carbone, PhD
Journal: Journal of Cardiovascular Pharmacology
Publication date: Nov 2024
Patients undergoing anthracycline-based cancer treatments have an increased risk of heart failure or worsening preexisting heart failure as well as adverse metabolic outcomes such as malnutrition and muscle loss, called cachexia. This retrospective study explored the impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on these outcomes in patients with heart failure previously treated with anthracyclines.
Patients were analyzed over a five-year period. SGLT2i use was associated with significantly reduced risks of cachexia, malnutrition, adult failure to thrive, and death. These findings call for additional research to determine whether SGLT2i can improve nutritional status and survival in patients with heart failure receiving anthracycline therapy.
A look at percutaneous coronary intervention during the shortage of iodinated contrast
Pauley researchers: Zachary Gertz, MD; Brian Mitchell, MD; Michael Kontos, MD
Journal: Journal of Invasive Cardiology
Publication date: Dec 2024
A recent COVID-19-related factory shutdown led to a global shortage of iodinated contrast. The authors evaluated how the contrast shortage impacted percutaneous coronary interventions (PCI). The global shortage of iodinated contrast led to a significant decline in contrast use during PCI, with no impact on patient outcomes.
European-ancestry study identifies area of genes that link coronary artery disease and sex hormones
Pauley researchers: Anurag Mehta, MD
Journal: Journal of the American Heart Association
Publication date: Dec 2024
Although sex differences in coronary artery disease (CAD) risk have been observed, little is known about the role of sex hormones in CAD genetics. Accounting for sex hormone levels may help identify the location of CAD‐risk genes and extend our knowledge of the genetic architecture of CAD.
Effect of goflikicept in patients with STEMI
Pauley researchers: Benjamin Van Tassel, PharmD; Roshanak Markley, MD
Journal: Journal of Cardiovascular Pharmacology
Publication date: Dec 2024
In a clinical trial of patients who had had a severe type of heart attack called STEMI, goflikicept, a novel interleukin-1 blocker, significantly reduced inflammation.
Analysis of medication effects on outcomes in patients with systemic right ventricles
Pauley researchers: Sangeeta Shah, MD
Journal: JACC: Advances
Publication date: Dec 2024
Patients with systemic right ventricle (SRV), a structural difference in the heart associated with congenital heart disease, may develop severe right ventricular dysfunction, prompting appropriate medical therapy. However, the efficacy of commonly used medicines, such as ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), and beta-blockers, is unproven. The objective of this study was to determine the effects of these medications on outcomes in SRV patients. Results show that patients with SRV taking beta-blockers, ACEI, or ARB did not have a benefit in survival or reduced hospital stays.
Proteomics in acute heart transplant rejection
Pauley researchers: Inna Tchoukina, MD; Keyur Shah, MD
Journal: Transplantation
Publication date: Dec 2024
A group of 104 post-heart transplant patients underwent endomyocardial biopsy (in which a small sample of cardiac tissue is taken from the heart) and had their blood drawn at the same time. Researchers evaluated 181 proteins in the blood samples, and analysis revealed unique biomarkers and biological pathway expression in the 30 patients who had experienced acute cellular rejection (ACR) and antibody-mediated rejection (AMR). Cardiac injury-associated biomarkers were more pronounced in AMR, whereas inflammatory biomarkers were more pronounced in ACR. This indicates that protein analysis can provide further insights into rejection pathophysiology, detection, and therapy.
QT prolongation and 1-year outcomes in patients with takotsubo syndrome
Pauley researchers: Michele Golino, MD; Francesco Moroni, MD; Jordana Kron, MD; Benjamin Van Tassell, PharmD; Antonio Abbate, MD
Journal: JACC: Clinical Electrophysiology
Publication date: Dec 2024
Takotsubo syndrome (TTS) is characterized by acute regional cardiac contractile dysfunction. Although often reversible, TTS can lead to life-threatening arrhythmias, especially in cases with a prolonged QT interval, a dangerous condition in which the heart’s electrical system takes longer than normal to recover between contractions. This study aimed to determine if a prolonged QT interval was associated with a greater incidence of death or ventricular arrhythmias in patients hospitalized for TTS across multiple centers in the United States.
This study aligns with and expands previous findings, confirming a high incidence of adverse outcomes and QT prolongation. Whether prolonged QT is a marker or contributor to adverse outcomes in TTS remains unclear.
Redefining cardiac antibody-mediated rejection
Pauley researchers: Inna Tchoukina, MD; Keyur Shah, MD
Journal: Circulation: Heart Failure
Publication date: Dec 2024
Heart transplant recipients with donor-specific antibodies (DSAs) and graft dysfunction have an increased risk of a type of transplant rejection called antibody-mediated rejection (AMR). However, many patients with DSA and graft dysfunction do not show evidence of AMR when examined via endomyocardial biopsy (EMB). EMBs, performed shortly after a transplant, are the current standard to monitor for the rejection of a donor heart.
This article aims to expand the characterization of antibody-mediated rejection to include patients with DSA and graft dysfunction by using newer methods of AMR detection.
Targeting nerves in the heart with nanoformulated calcium chloride lowers risk of atrial fibrillation
Pauley researchers: Pouria Shoureshi, MD; Li Wang, PhD; Anindita Das, PhD; Mohammed Quader, PhD; Vigneshwar Kasirajan, MD; Karoly Kaszala, MD, PhD; Kenneth Ellenbohgen, MD; Jose Huizar, MD; Alex Tan, MD
Journal: JACC: Clinical Electrophysiology
Publication date: Dec 2024
Postoperative atrial fibrillation is one of the most common complications following cardiac surgery and is associated with increased morbidity, mortality, and long-term risk for atrial fibrillation. However, its mechanisms remain unclear, and therapeutic options are limited.
This study finds that modulating nerves in the heart with nanoformulated calcium chloride is a therapy that can be applied during surgery to reduce risk for postoperative atrial fibrillation and potentially reduce long-term risk for atrial fibrillation.
Impact of antidiabetic drugs on atrial fibrillation recurrence after catheter ablation in patients with type 2 diabetes
Pauley researchers: Naser Abdelhadi, MD; Jayanthi Koneru, MD; Kenneth Ellenbogen, MD; Ajay Pillai, MD
Journal: Journal of Cardiovascular Electrophysiology
Publication date: Jan 2025
Atrial fibrillation is the most common cause of arrhythmia-induced cardiomyopathy. Effective management strategies include medical therapy for rate and rhythm control and catheter ablation. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), a novel class of antidiabetic drugs, have shown a promising impact in reducing cardiovascular events in both diabetic and nondiabetic heart failure patients. It is unclear what impact SGLT2i use may have on atrial fibrillation recurrence following catheter ablation.
To evaluate these effects, researchers performed a comprehensive literature search through multiple search engines, finding that SGLT2i significantly reduced atrial fibrillation recurrence after catheter ablation in diabetic patients. Further, SGLT2i use was associated with lowered hospitalization and stroke risk. Though no significant difference in mortality was noted, the decrease in hospitalization suggests a favorable effect on cardiovascular events.
Reviews
A systematic review and meta-analysis associating lipoprotein(a) with major adverse cardiovascular events
Pauley researchers: Pamela Alebna, MD, MPH; Anurag Mehta, MD; Mathew Ambrosio, MS; Kayla Harley, BA; Le Kang, PhD; Fadi Salloum, PhD; Dave Dixon, PharmD
Journal: JACC: Advances
Publication date: Nov 2024
This systematic review and meta-analysis aimed to clarify the association between Lipoprotein(a) (Lp(a)) and risk of major adverse cardiovascular events (MACE) across different high-sensitivity C-reactive protein (hs-CRP) levels. The authors found that elevated Lp(a) is associated with an increased risk of MACE independent of hs-CRP levels.
A new dimension in cardiac imaging: three-dimensional exploration of the atrioventricular conduction axis
Pauley researchers: Jayanthi Koneru, MD; Kenneth Ellenbogen, MD
Journal: Heart Rhythm
Publication date: Nov 2024
Much of our understanding of the atrioventricular conduction axis (AVCA), a critical part of the “wiring” of the heart, comes from early 20th-century microscope investigations. These studies, although foundational, are constrained by their two-dimensional representation of complex three-dimensional anatomy. The variability of the AVCA and its relationship to surrounding cardiac structures calls for a more advanced imaging approach. This review provides a contemporary understanding of the AVCA using a cell-level imaging technique called hierarchical phase-contrast tomography. By matching these findings with three-dimensional computed reconstructions in living patients, the authors offer clinicians the insights needed accurately to predict the location of the AVCA. This novel approach overcomes the inherent limitations of two-dimensional imaging, enhancing our ability to understand and visualize the intricate relationships that exist within the heart.
Cardiac device implantation: techniques and best practices
Pauley researchers: Ajay Pillai, MD; Jose Huizar, MD; Jayanthi Koneru, MD
Journal: Cardiac Electrophysiology Clinics
Publication date: Dec 2024
Using transvenous leads, or wires that carry implantable devices under the skin to the heart, are the standard way to implant devices to treat a too-fast or too-slow heart rate. Risk factors for infections from these implantable devices or complications of transvenous lead extraction represent a complex interplay between non-modifiable patient-related factors and actionable implant-related characteristics or adverse events. The authors of this review discuss how careful attention to patient screening, infection mitigation, lead selection, and implant technique can enhance safety of the procedure and its clinical management.
Applications of intracardiac echocardiography in the electrophysiology and cardiac catheterization labs
Pauley researchers: Rahul Myadam, MBBS; Jeffrey Kolominsky, MD; Pranav Mankad, MD; Jayanthi Koneru, MD
Journal: Seminars in Cardiothoracic and Vascular Anesthesia
Publication date: Dec 2024
Intracardiac echocardiography (ICE) is frequently used in the cardiac electrophysiology and catheterization laboratories and enables operators to have continuous visualization of cardiac anatomy and intravascular catheters, enhancing the success and safety of complex catheter ablation and structural heart procedures.
In this review, the authors describe the utility of ICE in the electrophysiology lab, including accurate visualization of cardiac anatomy, intracardiac catheters and devices, monitoring for procedural complications, and blood flow assessment.
New recommendations in screening, diagnosis, and management of those with liver disease who have a higher risk of cardiovascular disease
Pauley researchers: Anurag Mehta, MD; Arun Sanyal, MD
Journal: Circulation
Publication date: Jan 2025
There is a new awareness of the widespread nature of metabolic dysfunction–associated steatotic liver disease (MASLD, formerly known as nonalcoholic fatty liver disease), and its connection to cardiovascular disease (CVD). In fact, CVD is the most frequent cause of death in patients with MASLD. This has catalyzed collaboration between cardiologists, hepatologists, endocrinologists, and a wider multidisciplinary team to address the need for earlier identification of those with MASLD who are at increased risk for CVD. To achieve this, a group consensus-making process called the modified Delphi method was applied, and a series of evidence-based quality standard recommendations were identified.
The future of hypertension pharmacotherapy: ongoing and future clinical trials for hypertension
Pauley researchers: Anurag Mehtah, MD;
Journal: Current Problems in Cardiology
Publication date: Jan 2025
Hypertension is among the most prevalent diagnoses across the world and increases the risk of many serious health problems, such as stroke, heart disease, and kidney disease. Pharmacological approaches to treat hypertension are often required and these approaches reduce blood pressure through a plethora of mechanisms.
In this review, researchers used clinicaltrials.gov to gather information about ongoing clinical trials of pharmacological hypertension therapy as of March 2024 and found 103 clinical trials that met criteria. The interventions of these 103 clinical trials include novel and previously approved pharmacological and dietary supplement therapies for hypertension. These results provide insight into future therapies and practices for hypertension treatment.
Editorials
Lessons from the CAPLA trial
Pauley researchers: Jayanthi Koneru, MD; Kenneth Ellenbogen, MD
Journal: European Heart Journal
Publication date: Nov 2024
Pauley researchers discuss the lessons learned from the CAPLA trial, a multicenter, international, randomized study evaluating patients with persistent atrial fibrillation undergoing first-time catheter ablation.
Insights into left bundle branch area pacing: important lessons learned
Pauley researchers: Kenneth Ellenbogen, MD; Pranav Mankad, MD
Journal: JACC: Clinical Electrophysiology
Publication date: Nov 2024
Pauley researchers discuss two papers published in the November 2024 issue of JACC: Clinical Electrophysiology that highlight major developments in the field of conduction system pacing.
The dark side of the moon: ventricular dysfunction after left bundle branch area pacing
Pauley researchers: Ajay Pillai, MD; Kenneth Ellenbogen, MD
Journal: JACC: Clinical Electrophysiology
Publication date: Nov 2024
Pauley researchers discuss the results from a study that examines the causes and incidence of a ventricular dysfunction, called NOLVD, that can occur after a patient receives left bundle branch area pacing (LBBAP), an electrical treatment used to help the heart “sync up” its pacing.
Images
Researchers take images in a case of balanced ischemia
Pauley researchers: Phillip Duncan, MD
Journal: Coronary Artery Disease
Publication date: Dec 2024
A 44-year-old man with hypertension and high levels of lipids (fats) in the blood, classified at intermediate risk of cardiovascular disease due to buildup of plaque in the arteries, presented to the emergency department with chest pain. Two weeks prior, the patient underwent a stress test involving myocardial perfusion imaging (MPI), a diagnostic test that shows how well blood is flowing through the heart muscle; that test had returned relatively normal results results.
In this patient’s case, coronary computed tomography angiography (CCTA) was used, finding results that led to an important procedure only a few days later. This resulting image study emphasizes that CCTA should be used in addition to MPI imaging for chest pain in intermediate-risk patients.
