Incidence, in-hospital case-fatality rates, and management practices in Puerto Ricans hospitalized with acute myocardial infarction

OBJECTIVE: There are extremely limited data on minority populations, especially Hispanics, describing the clinical epidemiology of acute coronary disease. The aim of this study is to examine the incidence rate of acute myocardial infarction (AMI), in-hospital case-fatality rate (CFR), and management practices among residents of greater San Juan (Puerto Rico) who were hospitalized with an initial AMI. METHODS: Our trained study staff reviewed and independently validated the medical records of patients who had been hospitalized with possible AMI at any of the twelve hospitals located in greater San Juan during calendar year 2007. RESULTS: The incidence rate (# per 100,000 population) of 1,415 patients hospitalized with AMI increased with advancing age and were significantly higher for older patients for men (198) than they were for women (134). The average age of the study population was 64 years, and women comprised 45% of the study sample. Evidence-based cardiac therapies, e.g., aspirin, beta blockers, ACE inhibitors/angiotensin receptor blockers, and statins, were used with 60% of the hospitalized patients, and women were less likely than men to have received these therapies (59% vs. 65%) or to have undergone interventional cardiac procedures (47% vs. 59%) (p \u3c 0.05). The in-hospital CFR increased with advancing age and were higher for women (8.6%) than they were for men (6.0%) (p \u3c 0.05). CONCLUSION: Efforts are needed to reduce the magnitude of AMI, enhance the use of evidence-based cardiac therapies, reduce possible gender disparities, and improve the short-term prognoses of Puerto Rican patients hospitalized with an initial AMI

The Metabolic Syndrome in Hispanics – The Role of Inflammation

We report clinical and molecular mechanisms relating the pro-inflammatory and anti-inflammatory process in the development of the components of the metabolic syndrome, emphasizing the cardiovascular problems developed in these groups of patients, especially the Hispanic population. Namely, the incidence, component characteristics and complications of the metabolic syndrome in island Puerto Ricans are described and evidence is presented supporting the fact that the metabolic syndrome may be milder in Puerto Rico than in the mainland United States because it is characterized by less aggressive coronary artery disease and a relatively normal lipid profile. Moreover, data supports the fact that increased serum cholesterol levels produce less myocardial infarctions in Puerto Rico than in mainland Hispanics and Caucasians. In addition, the incidence of ventricular tachycardia, a complication caused by remodeling and ischemia of the heart, may be lower in Puerto Rico than in the United States, although the prevalence of the metabolic syndrome is higher in the island.</p

HDL as a Biomarker of Rejection in Heart Transplant

Background: One hundred once patients underwent heart transplants due to multiple causes. These patients included 36 females and 65 males whose mean age was 51 years.&nbsp;Objective: To study metabolic and lipid changes after heart transplantation with emphasis on HDL in rejected and non rejected hearts.Methods: The metabolic changes pre and post transplant were analyzed.Results:&nbsp;1. Body mass index (BMI): 25 ± 4 - 28 ± 5 kg/ m2 (P&lt;0.05)2. Systolic blood pressure (sBP): 107 ± 17 - 131 ± 20mmHg (P&lt;0.05)3. Diastolic blood pressure (dBP): 70 ± 13 - 81 ± 10 mmHg(P&lt;0.05)4. Fasting blood sugar (FBS): 107 ± 37- 117 ± 55 mg%(0.164) (non significant)5. Cholesterol: 170 ± 55 - 189 ± 32 mg/dl(P&lt;0.05)6. High density lipoprotein (HDL): 38 ± 16 - 52 ± 17 mg/dl (P&lt;0.05)7. Low density lipoprotein (LDL): 99 ± 20- 83 ± 15 mg/dl (0.34).8. Triglycerides: 163 ± 10 -188 ± 12 mg/dl (0.144).Conclusions: The heart transplant patients developed metabolic syndrome (MetS). The elevated HDL levels observed after transplantation are indicative of role of immunologic reaction to chronic rejection processes. The patients who died of rejection (19) exhibited greater elevations in HDL that those who did not (47 ± 22 – 71 ± 40 mg/dl, P&lt;0.05). Seven autopsies were performed and revealed severe atherosclerotic changes in the aorta and coronary arteries that were likely related to dysfunctional HDL. The transplanted hearts were 21 years old. The high levels and persistent elevation of HDL observed in the rejected group can be used as a biomarker of rejection and this will help to change the anti-rejection protocol to try to avoid the rejection of the implanted heart. LDL was found to be a factor in the progressive atherosclerotic process because the level was reduced post transplant.</p

Expert Consensus for Multimodality Imaging Evaluation of Adult Patients during and after Cancer Therapy: A Report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

cardiac dysfunction A. Definition, classification, and mechanisms of toxicity Cardiac dysfunction resulting from exposure to cancer therapeutic

Discovery of non‐HLA antibodies associated with cardiac allograft rejection and development and validation of a non‐HLA antigen multiplex panel: From bench to bedside

We analyzed humoral immune responses to nonhuman leukocyte antigen (HLA) after cardiac transplantation to identify antibodies associated with allograft rejection. Protein microarray identified 366 non-HLA antibodies (&gt;1.5 fold, P&nbsp;&lt;&nbsp;.5) from a discovery cohort of HLA antibody-negative, endothelial cell crossmatch-positive sera obtained from 12 cardiac allograft recipients at the time of biopsy-proven rejection. From these, 19 plasma membrane proteins and 10 autoantigens identified from gene ontology analysis were combined with 48 proteins identified through literature search to generate a multiplex bead array. Longitudinal sera from a multicenter cohort of adult cardiac allograft recipients (samples: n&nbsp;=&nbsp;477 no rejection; n&nbsp;=&nbsp;69 rejection) identified 18 non-HLA antibodies associated with rejection (P&nbsp;&lt;&nbsp;.1) including 4 newly identified non-HLA antigenic targets (DEXI, EMCN, LPHN1, and SSB). CART analysis showed 5/18 non-HLA antibodies distinguished rejection vs nonrejection. Antibodies to 4/18 non-HLA antigens synergize with HLA donor-specific antibodies and significantly increase the odds of rejection (P&nbsp;&lt;&nbsp;.1). The non-HLA panel was validated using an independent adult cardiac transplant cohort (n&nbsp;=&nbsp;21 no rejection; n&nbsp;=&nbsp;42 rejection, &gt;1R) with an area under the curve of 0.87 (P&nbsp;&lt;&nbsp;.05) with 92.86% sensitivity and 66.67% specificity. We conclude that multiplex bead array assessment of non-HLA antibodies identifies cardiac transplant recipients at risk of rejection

Analysis of real-time reservoir monitoring : reservoirs, strategies, & modeling.

The project objective was to detail better ways to assess and exploit intelligent oil and gas field information through improved modeling, sensor technology, and process control to increase ultimate recovery of domestic hydrocarbons. To meet this objective we investigated the use of permanent downhole sensors systems (Smart Wells) whose data is fed real-time into computational reservoir models that are integrated with optimized production control systems. The project utilized a three-pronged approach (1) a value of information analysis to address the economic advantages, (2) reservoir simulation modeling and control optimization to prove the capability, and (3) evaluation of new generation sensor packaging to survive the borehole environment for long periods of time. The Value of Information (VOI) decision tree method was developed and used to assess the economic advantage of using the proposed technology; the VOI demonstrated the increased subsurface resolution through additional sensor data. Our findings show that the VOI studies are a practical means of ascertaining the value associated with a technology, in this case application of sensors to production. The procedure acknowledges the uncertainty in predictions but nevertheless assigns monetary value to the predictions. The best aspect of the procedure is that it builds consensus within interdisciplinary teams The reservoir simulation and modeling aspect of the project was developed to show the capability of exploiting sensor information both for reservoir characterization and to optimize control of the production system. Our findings indicate history matching is improved as more information is added to the objective function, clearly indicating that sensor information can help in reducing the uncertainty associated with reservoir characterization. Additional findings and approaches used are described in detail within the report. The next generation sensors aspect of the project evaluated sensors and packaging survivability issues. Our findings indicate that packaging represents the most significant technical challenge associated with application of sensors in the downhole environment for long periods (5+ years) of time. These issues are described in detail within the report. The impact of successful reservoir monitoring programs and coincident improved reservoir management is measured by the production of additional oil and gas volumes from existing reservoirs, revitalization of nearly depleted reservoirs, possible re-establishment of already abandoned reservoirs, and improved economics for all cases. Smart Well monitoring provides the means to understand how a reservoir process is developing and to provide active reservoir management. At the same time it also provides data for developing high-fidelity simulation models. This work has been a joint effort with Sandia National Laboratories and UT-Austin's Bureau of Economic Geology, Department of Petroleum and Geosystems Engineering, and the Institute of Computational and Engineering Mathematics