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  1. Article ; Online: 53-Year-Old Man With Progressive Dyspnea.

    Lugo-Fagundo, Nahyr S / Sennhauser, Susie / Shapiro, Brian P

    Mayo Clinic proceedings

    2023  Volume 98, Issue 6, Page(s) 933–938

    MeSH term(s) Male ; Humans ; Dyspnea/diagnosis ; Dyspnea/etiology ; Tomography, X-Ray Computed ; Diagnosis, Differential
    Language English
    Publishing date 2023-04-29
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.1016/j.mayocp.2022.10.030
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Appropriately testing patients with intermediate risk for coronary artery disease: how well are we doing?

    Alsaad, Ali A / Shapiro, Brian P

    BMJ evidence-based medicine

    2018  Volume 23, Issue 4, Page(s) 142–149

    Abstract: Background: Cardiovascular risk assessment and stratification of stable coronary artery disease represents a pivotal component of coronary artery disease management. The introduction of risk stratification tools has advanced the detection of patients ... ...

    Abstract Background: Cardiovascular risk assessment and stratification of stable coronary artery disease represents a pivotal component of coronary artery disease management. The introduction of risk stratification tools has advanced the detection of patients with intermediate to high risk for coronary artery events. These patients will ultimately undergo non-invasive and invasive cardiovascular testing.
    Objective: To synthesise evidence illustrating risk stratification tools and non-invasive testing for patients with intermediate risk for coronary artery disease and suggest a simple method for clinicians to follow prior to ordering non-invasive cardiovascular testing.
    Study selection: Literature review of PubMed and MEDLINE Central on studies and evidence highlighting the appropriate use criteria for radionuclide myocardial perfusion imaging.
    Findings and conclusions: Overtestingusing myocardial perfusion imaging is well documented in several studies in the literature. Few studies highlighted the importance of the appropriate use criteria for radionuclide myocardial perfusion imaging, which can reduce unnecessary testing in patients with suspected coronary artery disease. Herein, we propose 'Simple Steps to Follow' to be considered by clinicians prior to ordering radionuclide myocardial perfusion imaging. The target audience of this article is internal and family medicine primary care physicians and other non-cardiologist physicians.
    MeSH term(s) Clinical Decision-Making ; Coronary Artery Disease/diagnosis ; Coronary Artery Disease/diagnostic imaging ; Exercise Test ; Humans ; Medicaid/economics ; Medicare/economics ; Myocardial Perfusion Imaging/methods ; Practice Guidelines as Topic ; Radioisotopes ; Reimbursement Mechanisms ; Risk Assessment/methods ; Risk Factors ; United States ; Unnecessary Procedures
    Chemical Substances Radioisotopes
    Language English
    Publishing date 2018-05-05
    Publishing country England
    Document type Journal Article
    ISSN 2515-4478
    ISSN (online) 2515-4478
    DOI 10.1136/bmjebm-2017-110832
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Exercise intolerance in heart failure: The important role of pulmonary hypertension.

    Taylor, Bryan J / Shapiro, Brian P / Johnson, Bruce D

    Experimental physiology

    2020  Volume 105, Issue 12, Page(s) 1997–2003

    Abstract: New findings: What is the topic of this review? This review concerns the negative impact of pulmonary hypertension (PH) on the pulmonary haemodynamic and gas exchange responses to exercise, considering the mechanisms by which PH plays a role in exercise ...

    Abstract New findings: What is the topic of this review? This review concerns the negative impact of pulmonary hypertension (PH) on the pulmonary haemodynamic and gas exchange responses to exercise, considering the mechanisms by which PH plays a role in exercise intolerance in heart failure (HF) patients. What advances does it highlight? The hallmark limited pulmonary vascular 'reserve' and impaired pulmonary gas exchange responses to exercise in HF are worsened by the development of PH; these are key determinants of exercise intolerance. Even HF patients who present with 'normal' pulmonary vascular function experience exercise-induced PH, which plays a role in exercise intolerance.
    Abstract: Patients with heart failure universally complain of exertional intolerance, but the underlying cause(s) of this intolerance may differ between patients with different disease phenotypes. Exercise introduces an impressive stress to the lungs, where elevations in venous return and cardiac output engender substantial increases in pulmonary blood volume and flow. Relative to healthy individuals, the pulmonary vascular reserve to accept this increase in pulmonary perfusion is compromised in heart failure, with a growing body of evidence suggesting that the development of pulmonary hypertension (PH), and in particular a precapillary component of PH, worsens the pulmonary haemodynamic response to exercise in these patients. Characterized by an exaggerated increase in pulmonary arterial pressure and an elevation in pulmonary vascular resistance, this dysfunctional pulmonary haemodynamic response plays a role in exercise intolerance, probably through an impairment of right ventricular function, underperfusion of the pulmonary circulation and a subsequent reduction in systemic blood flow and oxygen delivery. The hallmark abnormalities in ventilatory and pulmonary gas exchange that accompany heart failure, including a greater ventilatory equivalent for carbon dioxide, are also worsened by the development of PH. This raises the possibility that measures of exercise pulmonary gas exchange might help to 'describe' underlying PH in heart failure; however, several fundamental issues and questions need to be addressed before such gas exchange measures could truly be considered efficacious measures used to differentiate the type of PH and track the severity of PH in heart failure. exercise intolerance, heart failure, pulmonary gas exchange, pulmonary haemodynamics, pulmonary hypertension.
    MeSH term(s) Exercise/physiology ; Exercise Tolerance/physiology ; Heart Failure/physiopathology ; Hemodynamics/physiology ; Humans ; Hypertension, Pulmonary/physiopathology ; Pulmonary Artery/physiopathology ; Pulmonary Circulation/physiology ; Pulmonary Gas Exchange/physiology
    Language English
    Publishing date 2020-03-16
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1016295-1
    ISSN 1469-445X ; 0958-0670
    ISSN (online) 1469-445X
    ISSN 0958-0670
    DOI 10.1113/EP088105
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: 42-Year-Old Woman With Bilateral Arm Tightness.

    Stross, William C / Alsaad, Ali A / Shapiro, Brian P

    Mayo Clinic proceedings

    2018  Volume 93, Issue 5, Page(s) e45–e51

    MeSH term(s) Adult ; Cardiovascular Agents/administration & dosage ; Coronary Vasospasm/diagnosis ; Coronary Vasospasm/drug therapy ; Coronary Vasospasm/prevention & control ; Diltiazem/administration & dosage ; Electrocardiography ; Female ; Humans
    Chemical Substances Cardiovascular Agents ; Diltiazem (EE92BBP03H)
    Language English
    Publishing date 2018-02-01
    Publishing country England
    Document type Classical Article ; Journal Article
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.1016/j.mayocp.2017.05.032
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Clinical and genetic predictors of cardiac dysfunction assessed by echocardiography in patients with hereditary hemochromatosis.

    Cortés, Pedro / Elsayed, Abdelhadi A / Stancampiano, Fernando F / Barusco, Fernanda M / Shapiro, Brian P / Bi, Yan / Heckman, Michael G / Peng, Zhongwei / Kempaiah, Prakash / Palmer, William C

    The international journal of cardiovascular imaging

    2023  Volume 40, Issue 1, Page(s) 45–53

    Abstract: Purpose: Hereditary hemochromatosis (HH) may cause iron deposition in cardiac tissue. We aimed to describe the echocardiographic findings in patients with HH and identify risk factors for cardiac dysfunction.: Methods: In this retrospective study, we ...

    Abstract Purpose: Hereditary hemochromatosis (HH) may cause iron deposition in cardiac tissue. We aimed to describe the echocardiographic findings in patients with HH and identify risk factors for cardiac dysfunction.
    Methods: In this retrospective study, we included patients with HH who underwent transthoracic echocardiography at our tertiary care center between August 2000 and July 2022. We defined three primary outcomes for cardiac dysfunction: 1) left ventricular ejection fraction (LVEF) < 55%, 2) ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') > 15, and 3) global longitudinal strain (GLS) < 18. Multivariable logistic regression was utilized to identify predictors of cardiac dysfunction.
    Results: 582 patients (median age 57 years, 61.2% male) were included. The frequency of LVEF < 55%, E/e
    Conclusion: We found the traditional risk factors of male sex, and history of myocardial infarction or heart failure, were associated with a reduced LVEF, irrespective of the underlying HFE genetic mutation. Patients with a C282Y/H63D genetic mutation had a higher frequency of myocardial infarction, yet this mutation was associated with reduced odds of diastolic dysfunction compared to other genetic mutations in patients with a normal LVEF.
    MeSH term(s) Humans ; Male ; Middle Aged ; Female ; Hemochromatosis/complications ; Hemochromatosis/diagnostic imaging ; Hemochromatosis/genetics ; Stroke Volume ; Retrospective Studies ; Ventricular Function, Left ; Predictive Value of Tests ; Echocardiography ; Myocardial Infarction ; Mitral Valve
    Language English
    Publishing date 2023-10-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2055311-0
    ISSN 1875-8312 ; 1573-0743 ; 1569-5794 ; 0167-9899
    ISSN (online) 1875-8312 ; 1573-0743
    ISSN 1569-5794 ; 0167-9899
    DOI 10.1007/s10554-023-02973-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Impact of Pulmonary Hypertension Hemodynamic Phenotype on Incident Atrial Fibrillation.

    Morales-Lara, Andrea Carolina / Elkhatib, Wiaam / Oluleye, Oludamilola / Alhusain, Rashid / Saad, Amjad / Salwa, Najiyah / Siddiqui, Habeeba / Wieczorek, Mikolaj A / Ray, Jordan / Parikh, Pragnesh / Burger, Charles / Shapiro, Brian / Kusumoto, Fred / Pillai, Dilip / Adedinsewo, Demilade

    Cardiology

    2023  Volume 148, Issue 4, Page(s) 353–362

    Abstract: ... with incident AF (HR 2.17, 95% CI: 1.26-3.74, p = 0.005). This association was lost following multivariable ... CI: 1.09-1.54, p = 0.003).: Conclusion: We found PH hemodynamic phenotype was not significantly ...

    Abstract Introduction: Atrial fibrillation/flutter (AF) is common among patients with pulmonary hypertension (PH) and is associated with poor clinical outcomes. AF has been shown to occur more commonly among patients with postcapillary PH, although AF also occurs among patients with precapillary PH. The goal of this study was to evaluate the independent impact of PH hemodynamic phenotype on incident AF among patients with PH.
    Methods: We retrospectively identified 262 consecutive patients, without a prior diagnosis of atrial arrhythmias, seen at the PH clinic at Mayo Clinic, Florida, between 1997 and 2017, who had right heart catheterization and echocardiography performed, with follow-up for outcomes through 2021. Kaplan-Meier analysis and Cox-proportional hazards regression modeling were used to evaluate the independent effect of PH hemodynamic phenotype on incident AF.
    Results: Our study population was classified into two broad PH hemodynamic groups: precapillary (64.9%) and postcapillary (35.1%). The median age was 59.5 years (Q1: 48.4, Q3: 68.4), and 72% were female. In crude models, postcapillary PH was significantly associated with incident AF (HR 2.17, 95% CI: 1.26-3.74, p = 0.005). This association was lost following multivariable adjustment, whereas left atrial volume index remained independently associated with incident AF (aHR 1.30, 95% CI: 1.09-1.54, p = 0.003).
    Conclusion: We found PH hemodynamic phenotype was not significantly associated with incident AF in our patient sample; however, echocardiographic evidence of left atrial remodeling appeared to have a greater impact on AF development. Larger studies are needed to validate these findings and identify potential modifiable risk factors for AF in this population.
    MeSH term(s) Humans ; Female ; Male ; Atrial Fibrillation/complications ; Atrial Fibrillation/epidemiology ; Atrial Fibrillation/diagnosis ; Hypertension, Pulmonary/epidemiology ; Hypertension, Pulmonary/complications ; Retrospective Studies ; Heart Atria ; Risk Factors ; Atrial Flutter/complications ; Hemodynamics
    Language English
    Publishing date 2023-06-05
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 80092-2
    ISSN 1421-9751 ; 0008-6312
    ISSN (online) 1421-9751
    ISSN 0008-6312
    DOI 10.1159/000531402
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  7. Article ; Online: Pulmonic Regurgitation in the Adult Cardiac Surgery Patient.

    Shillcutt, Sasha K / Tavazzi, Guido / Shapiro, Brian P / Diaz-Gomez, Jose

    Journal of cardiothoracic and vascular anesthesia

    2017  Volume 31, Issue 1, Page(s) 215–228

    Language English
    Publishing date 2017
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2016.06.033
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  8. Article ; Online: 40-Year-Old Woman With Breathlessness and Fatigue.

    Ray, Jordan C / Snipelisky, David F / Shapiro, Brian P

    Mayo Clinic proceedings

    2016  Volume 91, Issue 4, Page(s) e49–53

    MeSH term(s) Adult ; Dyspnea/diagnosis ; Dyspnea/therapy ; Fatigue/diagnosis ; Fatigue/therapy ; Female ; Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/therapy ; Treatment Outcome
    Language English
    Publishing date 2016-04
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.1016/j.mayocp.2015.09.026
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  9. Article ; Online: Targeting mitochondrial metabolism for metastatic cancer therapy.

    Passaniti, Antonino / Kim, Myoung Sook / Polster, Brian M / Shapiro, Paul

    Molecular carcinogenesis

    2022  Volume 61, Issue 9, Page(s) 827–838

    Abstract: Primary tumors evolve metabolic mechanisms favoring glycolysis for adenosine triphosphate (ATP) generation and antioxidant defenses. In contrast, metastatic cells frequently depend on mitochondrial respiration and oxidative phosphorylation (OxPhos). This ...

    Abstract Primary tumors evolve metabolic mechanisms favoring glycolysis for adenosine triphosphate (ATP) generation and antioxidant defenses. In contrast, metastatic cells frequently depend on mitochondrial respiration and oxidative phosphorylation (OxPhos). This reliance of metastatic cells on OxPhos can be exploited using drugs that target mitochondrial metabolism. Therefore, therapeutic agents that act via diverse mechanisms, including the activation of signaling pathways that promote the production of reactive oxygen species (ROS) and/or a reduction in antioxidant defenses may elevate oxidative stress and inhibit tumor cell survival. In this review, we will provide (1) a mechanistic analysis of function-selective extracellular signal-regulated kinase-1/2 (ERK1/2) inhibitors that inhibit cancer cells through enhanced ROS, (2) a review of the role of mitochondrial ATP synthase in redox regulation and drug resistance, (3) a rationale for inhibiting ERK signaling and mitochondrial OxPhos toward the therapeutic goal of reducing tumor metastasis and treatment resistance. Recent reports from our laboratories using metastatic melanoma and breast cancer models have shown the preclinical efficacy of novel and rationally designed therapeutic agents that target ERK1/2 signaling and mitochondrial ATP synthase, which modulate ROS events that may prevent or treat metastatic cancer. These findings and those of others suggest that targeting a tumor's metabolic requirements and vulnerabilities may inhibit metastatic pathways and tumor growth. Approaches that exploit the ability of therapeutic agents to alter oxidative balance in tumor cells may be selective for cancer cells and may ultimately have an impact on clinical efficacy and safety. Elucidating the translational potential of metabolic targeting could lead to the discovery of new approaches for treatment of metastatic cancer.
    MeSH term(s) Adenosine Triphosphate/metabolism ; Antioxidants ; Humans ; Mitochondria/metabolism ; Mitochondrial Proton-Translocating ATPases/metabolism ; Neoplasms/metabolism ; Oxidative Phosphorylation ; Reactive Oxygen Species/metabolism
    Chemical Substances Antioxidants ; Reactive Oxygen Species ; Adenosine Triphosphate (8L70Q75FXE) ; Mitochondrial Proton-Translocating ATPases (EC 3.6.3.-)
    Language English
    Publishing date 2022-06-20
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 1004029-8
    ISSN 1098-2744 ; 0899-1987
    ISSN (online) 1098-2744
    ISSN 0899-1987
    DOI 10.1002/mc.23436
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  10. Article ; Online: EDUCATE: An international, randomized controlled trial for teaching electrocardiography.

    Kashou, Anthony H / Noseworthy, Peter A / Beckman, Thomas J / Anavekar, Nandan S / Cullen, Michael W / Angstman, Kurt B / Sandefur, Benjamin J / Shapiro, Brian P / Wiley, Brandon W / Kates, Andrew M / Sadhu, Justin / Thakker, Prashanth / Huneycutt, David / Braisted, Andrew / Smith, Stephen W / Baranchuk, Adrian / Grauer, Ken / O'Brien, Kevin / Kaul, Viren /
    Gambhir, Harvir Singh / Knohl, Stephen J / Restrepo, Daniel / May, Adam M

    Current problems in cardiology

    2024  Volume 49, Issue 3, Page(s) 102409

    Abstract: ... 95 % CI, 9.1 to 13.7; P<0.01), 9.8 % (95 % CI, 7.8 to 11.9; P<0.01), and 11.0 % (95 % CI, 9.2 to 12.9 ... P<0.01), respectively. In contrast, the control group demonstrated a non-significant improvement ... of 0.8 % (95 % CI, -1.2 to 2.8; P=0.54). While no differences were observed among intervention groups ...

    Abstract Introduction: Despite the critical role of electrocardiograms (ECGs) in patient care, evident gaps exist in ECG interpretation competency among healthcare professionals across various medical disciplines and training levels. Currently, no practical, evidence-based, and easily accessible ECG learning solution is available for healthcare professionals. The aim of this study was to assess the effectiveness of web-based, learner-directed interventions in improving ECG interpretation skills in a diverse group of healthcare professionals.
    Methods: In an international, prospective, randomized controlled trial, 1206 healthcare professionals from various disciplines and training levels were enrolled. They underwent a pre-intervention test featuring 30 12-lead ECGs with common urgent and non-urgent findings. Participants were randomly assigned to four groups: (i) practice ECG interpretation question bank (question bank), (ii) lecture-based learning resource (lectures), (iii) hybrid question- and lecture-based learning resource (hybrid), or (iv) no ECG learning resources (control). After four months, a post-intervention test was administered. The primary outcome was the overall change in ECG interpretation performance, with secondary outcomes including changes in interpretation time, self-reported confidence, and accuracy for specific ECG findings. Both unadjusted and adjusted scores were used for performance assessment.
    Results: Among 1206 participants, 863 (72 %) completed the trial. Following the intervention, the question bank, lectures, and hybrid intervention groups each exhibited significant improvements, with average unadjusted score increases of 11.4 % (95 % CI, 9.1 to 13.7; P<0.01), 9.8 % (95 % CI, 7.8 to 11.9; P<0.01), and 11.0 % (95 % CI, 9.2 to 12.9; P<0.01), respectively. In contrast, the control group demonstrated a non-significant improvement of 0.8 % (95 % CI, -1.2 to 2.8; P=0.54). While no differences were observed among intervention groups, all outperformed the control group significantly (P<0.01). Intervention groups also excelled in adjusted scores, confidence, and proficiency for specific ECG findings.
    Conclusion: Web-based, self-directed interventions markedly enhanced ECG interpretation skills across a diverse range of healthcare professionals, providing an accessible and evidence-based solution.
    MeSH term(s) Humans ; Prospective Studies ; Electrocardiography ; Clinical Competence ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2024-01-15
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 441230-8
    ISSN 1535-6280 ; 0146-2806
    ISSN (online) 1535-6280
    ISSN 0146-2806
    DOI 10.1016/j.cpcardiol.2024.102409
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