Mount Sinai School of Medicine researchers presented 86 abstracts and plenary sessions at the American College of Cardiology's (ACC) 61st Annual Scientific Session, including ground-breaking research on aggressive statin therapy, the prevalence of unrecognized cardiovascular disease symptoms in women, and morbidity associated with non-adherence to medication after stent implantation. The meeting took place March 23-27, 2012 in Chicago.
Of 87 patients enrolled in a Mount Sinai trial, half were treated with an aggressive regimen (40 mg) of Rosuvastatin, and the other half received standard lipid therapy. After seven weeks, the group that took Rosuvastatin displayed a 22 percent reduction in the amount of fat in the blockage, while the group with standard lipid therapy showed no significant changes.
"This study provides new scientific information documenting the beneficial effects of aggressive lipid lowering therapy in high-risk patients with coronary artery disease," said Annapoorna Kini, MD, Director of the Cardiac Catheterization Laboratory and Professor of Medicine at Mount Sinai. "Furthermore, the YELLOW trial opens new avenues for evaluating the response of novel therapies in men and women in the United States and abroad."
"Our study indicates that heart disease screening in OB/GYN clinics can play a crucial role in heart disease prevention and earlier intervention," says lead researcher, Roxana Mehran, MD, Professor of Cardiology, and Director of Interventional Cardiovascular Research and Clinical Trials at Mount Sinai School of Medicine. "Many of the women we screened did not have primary care physicians and were unaware that they were having symptoms of heart disease."
Partho Sengupta, MD, Director of Cardiac Ultrasound Research and Jagat Narula, MD, PhD, Director of Cardiovascular Imaging and Professor of Cardiology have assembled a worldwide team of researchers developing novel ways of visualizing directional flow of blood through the heart and its behavior in different disease states as portrayed in a publication that will be released in the March issue of the Journal of the American College of Cardiology-Imaging. Using the same methodology, in a study presented at ACC, they characterized the effects of abnormal electrical behavior on the blood swirling through the chambers of the failing heart. This discovery will help improve diagnosis of heart failure and help researchers identify novel ways of using pacemaker therapy for treating it.
"This new imaging approach may help us design better therapeutic options for failing hearts," said Dr. Sengupta. "Seeing how blood flows through the patient's heart will allow us to personalize valve design and interventional procedures so that patients get optimal blood flow in their heart."
Dr. Narula believes that this technology will revolutionize the ultrasound field.
Dr. Narula was also recognized by the ACC with its Gifted Educator Award at the meeting.
To avoid stent thrombosis, a devastating and often deadly complication after coronary stent implantation, patients are required to take dual antiplatelet therapy, a combination of aspirin and a blood thinner. A multinational research team led by Roxana Mehran, MD, found that patients who did not adhere to the dual antiplatelet regimen six months after stent implantation had a four-fold increased risk for stent thrombosis. The team evaluated self-reported adherence among 5,016 patients. Of these, 310 reported that their treatment course had been interrupted, or that they stopped taking the therapy altogether.
"While only 310 patients claimed to be non-adherent, we expect the number may be much higher," said Dr. Mehran. "These findings show a very high likelihood of a major clinical event in these patients, demonstrating that continued education and monitoring of these patients is critical."
Mount Sinai researchers found in two studies that people with chronic kidney disease (CKD) develop blood clots much faster than healthy adults, and as CKD gets worse, so do the blood clots. They also found people with CKD and diabetes had more pathologic features of high-risk atherosclerotic plaque in their arteries than people with diabetes alone.
"We knew that chronic kidney disease increased risk for the development of adverse cardiovascular events such as heart attacks or strokes, but our study is among the first to show that CKD substantially increases clot strength and the rate at which clots develop," said Usman Baber, MD, Assistant Professor of Medicine at Mount Sinai School of Medicine. "These results demonstrate a significant need to closely monitor the tens of millions of Americans with CKD to reduce the risk of a cardiovascular event."
The blood thinner bivalirudin has been associated with significant reduction in adverse events in patients undergoing percutaneous coronary intervention (PCI), also known as angioplasty, compared to heparin, but Mount Sinai is the first center in the country to study its use in balloon aortic valvuloplasty (BAV), a procedure that uses a balloon to open a narrowed aortic valve.
In a retrospective analysis led by George Dangas, MD, PhD, Professor of Medicine and presented in four abstracts at ACC by Jennifer Yu, a research fellow at Mount Sinai, the research team found that heparin caused major bleeding in 13.1 percent of cases where bivalirudin caused bleeding in only 4.9 percent of cases.
"The majority of the patients undergoing balloon aortic valvuloplasty are elderly and frail, and the larger sheath sizes required contribute to significant rates of bleeding complications," said Dr. Dangas. "The BRAVO data show that bivalirudin is a promising agent in significantly reducing bleeding events and improving clinical outcomes in BAV."
Additional Mount Sinai Presentations of Interest
In total, Mount Sinai researchers participated in 35 plenary sessions and 51 abstract presentations at the ACC meeting. Other notable presentations included:
"The hard work and dedication of our outstanding physician-scientists is exemplified by the enormous presence Mount Sinai has at ACC this year," said Dr. Fuster. "I am very proud of the efforts of my colleagues in Mount Sinai Heart in making such significant contributions to our field that will help change the way we practice cardiovascular medicine."
Valentin Fuster, MD, PhD, Named a "Legend of Cardiovascular Medicine" by the ACC
Dr. Fuster was named a "Legend of Cardiovascular Medicine," a lecture award established this year by the ACC that recognizes his international stature as an innovator and leader in the field of cardiovascular medicine. Dr. Fuster serves several roles at Mount Sinai, including Physician-in-Chief, The Mount Sinai Medical Center, Director of the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Director of Mount Sinai Heart, and the Richard Gorlin, MD/Heart Research Foundation Professor, Mount Sinai School of Medicine.
About The Mount Sinai Medical Center
The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of the leading medical schools in the United States. The Medical School is noted for innovation in education, biomedical research, clinical care delivery, and local and global community service. It has more than 3,400 faculty in 32 departments and 14 research institutes, and ranks among the top 20 medical schools both in National Institutes of Health (NIH) funding and by US News and World Report.
The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation's oldest, largest and most-respected voluntary hospitals. In 2011, US News and World Report ranked The Mount Sinai Hospital 16th on its elite Honor Roll of the nation's top hospitals based on reputation, safety, and other patient-care factors. Of the top 20 hospitals in the United States, Mount Sinai is one of 12 integrated academic medical centers whose medical school ranks among the top 20 in NIH funding and US News and World Report and whose hospital is on the US News and World Report Honor Roll. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 560,000 outpatient visits took place.
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