Methodist DeBakey Heart Research Articles

Homer Liston Beazley, M.D. November 1, 1920 — August 8, 2004

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

Endovascular Techniques in Limb Salvage: Infrapopliteal Angioplasty

Critical limb ischemia (CLI) results from inadequate blood flow to supply and sustain the metabolic needs of resting muscle and tissue. Infragenicular atherosclerosis is the most common cause of CLI, and it is more likely to develop when multilevel or diffuse arterial disease coincides with compromised run-off to the foot. Reports of good technical and clinical outcomes have advanced the endovascular treatment options, which have gained a growing acceptance as the primary therapeutic strategy for CLI, especially in patients with significant risk factors for open surgical bypass. In fact, endovascular recanalization of below-the-knee arteries has proven to be feasible and safe, reduce the need for amputation, and improve wound healing. The distribution of various vascular territories or angiosomes in the foot has been recognized, and it appears advantageous to revascularize the artery supplying the territory directly associated with tissue loss. In addition, the targeted application and local delivery of drugs using drug-coated balloons (DCB) during angioplasty has the potential to improve patency rates compared to balloon angioplasty alone.

Endovascular Techniques in Limb Salvage: Stents

In patients with critical limb ischemia, the first-line approach for limb salvage has shifted over the past decade from bypass surgery to endovascular intervention. Stenting for the treatment of lower-extremity arterial occlusive disease is an important tool and continues to evolve, with new stent designs and technologies that have been developed to provide superior patency rates and limb salvage. In this article, we discuss the role of peripheral stenting in the treatment of patients with critical limb ischemia, including a review of the relevant current literature and the future directions of such interventions.

Davies Lends Editorial Expertise to Follow-Up Issue on Critical Limb Ischemia

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

Limb Salvage in Women

The prevalence of peripheral arterial occlusive disease (PAD) in women and men is equal. Studies to date present conflicting data of gender effects on the risk factors, clinical presentation, and treatment outcomes. Clinical trials have often failed to analyze results by gender or to recruit sufficient women to enable such an analysis. This review summarizes the management and outcome of limb salvage therapy with a particular focus in women.

Remote Monitoring of Heart Failure Patients

"The Teledactyl (Tele, far; Dactyl, finger--from the Greek) is a future instrument by which it will be possible for us to 'feel at a distance.' This idea is not at all impossible, for the instrument can be built today with means available right now. It is simply the well known telautograph, translated into radio terms, with additional refinements. The doctor of the future, by means of this instrument, will be able to feel his patient, as it were, at a distance...The doctor manipulates his controls, which are then manipulated at the patient's room in exactly the same manner. The doctor sees what is going on in the patient's room by means of a television screen." -Hugo Gernsback, Science and Invention Magazine, February 1925 Heart failure continues to be a major burden on our health care system. As the number of patients with heart failure increases, the cost of hospitalization alone is contributing significantly to the overall cost of this disease. Readmission rate and hospital length of stay are emerging as quality markers of heart failure care along with reimbursement policies that force hospitals to optimize these outcomes. Apart from maintaining quality assurance, the disease process of heart failure per-se requires demanding and close attention to vitals, diet, and medication compliance to prevent acute decompensation episodes. Remote patient monitoring is morphing into a key disease management strategy to optimize care for heart failure. Innovative implantable technologies to monitor intracardiac hemodynamics also are evolving, which potentially could offer better and substantial parameters to monitor.

The Writing of My Constitution

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

James K. Alexander, M.D. December 25, 1920 – March 29, 2009

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

Multiple Myeloma Presenting as Pulmonary Renal Syndrome

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

One of a Kind: Jimmy Frank Howell, M.D.

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

Ventricular Assist Devices (VAD) Therapy: New Technology, New Hope?

Ventricular assist devices are commonly utilized in the treatment of end-stage heart failure. Advances in continuous flow technology have improved efficiency, size, implantability, extended support, and overall patient outcomes. This has led to an expanded role of left ventricular assist device (LVAD) clinical use and applications. This review describes the advances and current state of LVAD devices and provides a future outlook for this technology.

Mechanisms of Disease: Is Mitochondrial Function Altered in Heart Failure?

The human heart sustains an exceptional energy transfer rate, consuming more energy per gram weight than any other organ system. The healthy heart can rapidly adapt to changes in demand, while the failing heart cannot. Cardiac energy flux systems falter in the failing heart. The purpose of this review is to characterize the fundamental role of mitochondria in this energy transfer system and describe our local research on mitochondrial respiratory capacity in failing human hearts.

MDHVC Researcher Co-authors Paper on Lifestyle Changes and Diabetes

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

When Lilacs Last in the Door-yard Bloom’d

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

Stem Cell Therapy in Patients with Heart Failure

Heart failure results from injury to the myocardium from a variety of causes, including ischemic and nonischemic etiologies. Severe heart failure carries a 50% 5-year mortality rate and is responsible for more than one-third of cardiovascular deaths in the United States.1 Heart failure progression is accompanied by activation of neurohormonal and cytokine systems as well as a series of adaptive changes within the myocardium, collectively referred to as left ventricular remodelling. The unfavorable alterations may be categorized broadly into changes that occur in the cardiac myocytes and changes that occur in the volume and composition of the extracellular matrix.2 Since remodelling in heart failure is progressive and eventually becomes detrimental, the majority of treatment strategies are aimed at stopping or reversing this process. Although medical management, cardiac resychronization therapy, and long-term or destination mechanical circulatory support have been successful in this regard, a considerable number of patients still progress to end-stage heart failure with limited therapeutic options. For these patients, stem cell therapies are being investigated as a safe treatment strategy for decreasing cardiac remodelling on top of conventional medical and device treatment.

Heart Failure: An Illness at the Juncture of Molecular Medicine and New Technology

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

The Computer Art of Dr. Phil

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

Peripartum Cardiomyopathy: A Contemporary Review

Peripartum cardiomyopathy is a rare and potentially fatal disease. Though approximately half of the patients recover, the clinical course is highly variable and some patients develop refractory heart failure and persistent left ventricular systolic dysfunction. It is diagnosed when women present with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found. Etiology remains unclear, and treatment is similar to other cardiomyopathies and includes evidence-based standard heart failure management strategies. Experimental strategies such as intravenous immunoglobulin and bromocriptine await further clinical validation.

Efficacy of 3% Saline vs. Conivaptan in Achieving Hyponatremia Treatment Goals

Hyponatremia is the most common electrolyte abnormality encountered in clinical practice, but its optimal management is still evolving. While guidelines for infusion rates of hypertonic saline (HS) have been introduced, there is a risk of underestimating the response in serum sodium concentration after therapy. Guidelines also have evaluated the use of vasopressin receptor antagonists as alternatives or supplements to standard therapies. This single-center retrospective study from The Methodist Hospital (TMH) compared the effect of HS and conivaptan intervention in the management of 49 patients with hyponatremia from January 2009 through November 2010. Demographics, volume status, medical history, medication data, and serum sodium concentration correction over 48 hours were analyzed. No significant difference was noted with regard to age, ethnicity, gender, volume status, use of medications known to cause hyponatremia, or comorbidities. Baseline serum sodium concentration was not significantly different between HS (120.5 ± 3.8 mEq/L) and conivaptan (118.3 ± 6.7 mEq/L) groups. Regardless of whether the patient was euvolemic or hypervolemic, no significant difference was noted in serum sodium concentration at 4, 12, 24, or 48 hours after initiation of treatment or in frequency of over-correction between groups. This study compares the effect of HS to conivaptan intervention in the management of hyponatremia. No significant differences were identified in adherence to treatment guidelines. Further, based on this small retrospective study, neither agent poses a significant risk of over-correction at 4, 24, or 48 hours of therapy.

Ethical Dilemmas Surrounding the Use of Ventricular Assist Devices in Supporting Patients with End-Stage Organ Dysfunction

Successful practice of cardiovascular medicine requires familiarity with the complex ethical issues that accompany therapeutic innovation and diffusion. Even as technologies transition from experimental to standard care, challenges remain. Mechanical circulatory support devices, for instance, are increasingly conceptualized as conventional therapies. Despite this, or perhaps because of it, the ethical issues surrounding the use of these devices in patients with end-stage organ dysfunction are becoming increasingly apparent. In this paper, we provide an introduction to ethical considerations related to the use of ventricular assist devices (VADs) in end-stage organ failure, focusing on three stages or decision points: initiation, continued use, and deactivation. Our goal is not to exhaustively resolve these dilemmas but to illustrate how ethical considerations relate to decision making.