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DISCOVERY: prevalence of transthyretin (TTR) mutations in a US-centric patient population suspected of having cardiac amyloidosis

Akinboboye, Ola; Shah, Keyur; Warner, Alberta L; Damy, Thibaud; Taylor, Herman A; Gollob, Jared; Powell, Christine; Karsten, Verena; Vest, John; Maurer, Mathew S
BACKGROUND:Hereditary transthyretin-mediated amyloidosis (hATTR amyloidosis) is a multisystem disease that presents with polyneuropathy and/or cardiomyopathy. METHODS:) mutations and assess disease characteristics. RESULTS:mutation. Additional independent predictors of such mutations in the total population and Black/African American group were interventricular septum thickness, low electrocardiogram voltage, and age. CONCLUSIONS:mutations occurred in 8% of US patients with suspected cardiac amyloidosis. Most mutations were Val122Ile, almost exclusively found in Black/African American patients. Disease often remains undetected until advanced and difficult to treat, therefore, clinicians should assess at-risk patients for hATTR amyloidosis as early as possible.
PMID: 32456532
ISSN: 1744-2818
CID: 4675642

Transthyretin Cardiac Amyloidosis in Black Americans

Shah, Keyur B; Mankad, Anit K; Castano, Adam; Akinboboye, Olakunle O; Duncan, Phillip B; Fergus, Icilma V; Maurer, Mathew S
Transthyretin-related cardiac amyloidosis is a progressive infiltrative cardiomyopathy that mimics hypertensive and hypertrophic heart disease and often goes undiagnosed. In the United States, the hereditary form disproportionately afflicts black Americans, who when compared with whites with wild-type transthyretin amyloidosis, a phenotypically similar condition, present with more advanced disease despite having a noninvasive method for early identification (genetic testing). Although reasons for this are unclear, this begs to consider the inadequate access to care, societal factors, or a biological basis. In an effort to improve awareness and explore unique characteristics, we review the pathophysiology, epidemiology, and therapeutic strategies for transthyretin amyloidosis and highlight diagnostic pitfalls and clinical pearls for identifying patients with amyloid heart disease.
PMID: 27188913
ISSN: 1941-3297
CID: 2111732

Disparities in Revascularization After ST Elevation Myocardial Infarction (STEMI) Before and After the 2002 IOM Report

Bolorunduro, Oluwaseyi B; Kiladejo, Adekunle V; Animashaun, Islamiyat Babs; Akinboboye, Olakunle O
OBJECTIVES: To examine nationwide trends for racial disparities in Percutaneous Coronary Intervention after ST elevated Myocardial Infarction (STEMI). BACKGROUND: The Institute of Medicine (IOM) report published in 2002 showed that African Americans were less likely to receive coronary revascularization such as CABG and stents even after controlling for socioeconomics. It recommended increased awareness of these disparities among health professionals to reduce this. We hypothesized that increased awareness of disparities since this report would have translated to reduction in racial disparities in percutaneous coronary intervention. METHODS: A retrospective analysis was conducted using data from the Agency of Healthcare Research and Quality's (AHRQ) National Inpatient Sample (NIS) 1998-2007. All patients with STEMI during this period were identified. The proportion that received Percutaneous Coronary Intervention (PCI) during the incident admission was compared by different ethnicities over the time period. Multivariable regression for each year was conducted using Poisson regression with robust variances. The analysis controlled for gender, insurance status, co-morbidities, hospital bed size, location and teaching status. RESULTS: Based on the database, about 2.04 million patients were managed for acute Myocardial Infarction from 1998 to 2007, of these 938,176 had STEMI. The primary PCI rate after STEMI among Caucasians was 29.1%, African Americans-23.3% and Hispanics-28.3% [P < 0.001] On multivariate regression, compared to Caucasians, African Americans and Hispanics respectively were 26% (IRR = 0.74) and 16% (IRR = 0.84) less likely to receive PCI (both with P < 0.001) during the entire study period. CONCLUSION: Ethnic disparities in primary PCI after STEMI persist despite the 2002 IOM report.
PMID: 27372472
ISSN: 1943-4693
CID: 2255132

Right Atrial Myxoma and Syncope

Babs Animashaun, Islamiyat; Akinseye, Oluwaseun A; Akinseye, Leah I; Akinboboye, Olakunle O
BACKGROUND: Right atrial myxoma accounts for 15-20% of cardiac myxomas and syncope is a very rare manifestation. We present the case of an 89-year-old man with right atrial myxoma and syncope, and discuss the role of cardiac magnetic resonance imaging (MRI) in the diagnosis of myxomas. CASE REPORT: An 89-year-old man with a history of hypertension, hyperlipidemia, chronic kidney disease stage 4, mild dementia, and benign prostatic hyperplasia presented to the emergency department with an episode of syncope. Physical examination demonstrated normal and regular heart sounds, and normal respiratory rate and oxygen saturation. Echocardiogram described a well-circumscribed echo-dense mass in the right atrial cavity, which was attached to the septum but not obstructing the tricuspid annulus, measuring 1.7x2.2 cm at its widest diameter. Cardiac MRI revealed a mass with dark intensity which enhanced heterogeneously following intravenous administration of gadolinium-chelate, consistent with a myxoma. The location of this myxoma, coupled with the presence of a stalk allowing mobility, provides a clue to how this patient experienced transient obstruction of the tricuspid valve leading to syncope. CONCLUSIONS: Right heart tumors should be considered in the differential diagnosis of unexplained syncope. Cardiac MRI with gadolinium-chelate administration can help differentiate this tumor from a right-sided atrial thrombus, which can pose a diagnostic challenge.
PMID: 26390076
ISSN: 1941-5923
CID: 2037312

A Rare Association of Sinus Venosus-Type Atrial Septal Defect and Persistent Left Superior Vena Cava Detected by Transthoracic Echocardiography and Cardiac Magnetic Resonance Imaging

Mousa, Tarek M; Akinseye, Oluwaseun A; Kerwin, Todd C; Akinboboye, Olakunle O
BACKGROUND Association of persistent left superior vena cava (PLSVC) and sinus venosus-type atrial septal defect (SVASD) is rare. We describe a patient with dilated coronary sinus (CS) found to have PLSVC and SVASD. CASE REPORT The patient is a 60-year-old man with history of stroke who underwent a transthoracic echocardiogram (TTE) for evaluation of shortness of breath. TTE demonstrated a markedly dilated CS. Agitated saline was injected into the left antecubital vein to further assess CS. The parasternal long axis view demonstrated immediate filling of the CS and confirmed the presence of a PLSVC. Apical 4-chamber view with injection of agitated saline into the right antecubital vein demonstrated immediate contrast opacification of both atria, consistent with a right to left cardiac shunt. Cardiac magnetic resonance (CMR) was performed, which confirmed the TTE findings of PLSVC and defined the cardiac shunt as SVASD. CONCLUSIONS PLSVC should be suspected in a patient with an abnormally dilated CS. In this case we identified a rare association of PLSVC with a SVASD. TTE with agitated saline contrast injection and CMR are useful diagnostic tools for PLSVC and associated cardiac congenital anomalies, respectively.
PMID: 26262994
ISSN: 1941-5923
CID: 1744812

Correlation of Prehypertension with Left Ventricular Mass Assessed by Cardiac Magnetic Resonance Imaging

Mousa, Tarek M; Akinseye, Oluwaseun A; Berekashvili, Ketevan; Akinboboye, Olakunle O
Introduction. The purpose of this observational cross-sectional study was to assess left ventricular mass (LVM) in prehypertensive individuals in comparison to normotensives and to determine if central blood pressure (BP) correlates better with LVM index (LVMI) than brachial BP. Methods and Result. Brachial and central BP measurements were completed at first visit and at 4 weeks in 65 healthy volunteers who were at least 40 years old and not on medication. Subjects were divided into two groups of normotensives and prehypertensives based on JNC-7 criteria and LVM was obtained using cardiac magnetic resonance imaging. Prehypertensives had significantly higher LVMI compared to normotensives (P < 0.01). Brachial and central BP also both positively correlate with LVMI (r = 0.460, P < 0.01; r = 0.318, P = 0.012, resp.) in both groups and neither method was superior to the other. After multivariate regression analysis and adjusting for cardiovascular risk factors, prehypertension remained an independent determinant of LVM. Conclusion. Prehypertension is associated with cardiovascular target organ damage, and central BP was not superior to brachial BP or vice versa for association with LVMI.
PMID: 26543640
ISSN: 2090-0384
CID: 2039862

Obstructive sleep apnea and cardiovascular disease in blacks: A call to action from the Association of Black Cardiologists

Olafiranye, Oladipupo; Akinboboye, Olakunle; Mitchell, Judith E; Ogedegbe, Gbenga; Jean-Louis, Girardin
Obstructive sleep apnea (OSA) has emerged as a new and important risk factor for cardiovascular disease (CVD). Over the last decade, epidemiologic and clinical research has consistently supported the association of OSA with increased cardiovascular (CV) morbidity and mortality. Such evidence prompted the American Heart Association to issue a scientific statement describing the need to recognize OSA as an important target for therapy in reducing CV risk. Emerging facts suggest that marked racial differences exist in the association of OSA with CVD. Although both conditions are more prevalent in blacks, almost all National Institutes of Health-funded research projects evaluating the relationship between OSA and CV risk have been conducted in predominantly white populations. There is an urgent need for research studies investigating the CV impact of OSA among high-risk minorities, especially blacks. This article first examines the evidence supporting the association between OSA and CVD and reviews the influence of ethnic/racial differences on this association. Public health implications of OSA and future directions, especially regarding minority populations, are discussed.
PMID: 23537962
ISSN: 0002-8703
CID: 288102

Identifying the etiology of a "finger-like" structure inside the left ventricle using cardiac magnetic resonance [Case Report]

Mousa, Tarek M; Leung, Amanda; Akinboboye, Olakunle; Kerwin, Todd C; Buda, Andrew J
PMID: 22835671
ISSN: 1558-3597
CID: 3534432

Detection of multivessel coronary artery disease: looking beyond the extent of perfusion abnormalities [Comment]

Desai, Dipan; Kozeski, Gorgi; Akinboboye, Olakunle
PMID: 19152122
ISSN: 1071-3581
CID: 169996

Myocardial perfusion and function: single photon emission computed tomography

Hansen, Christopher L; Goldstein, Richard A; Akinboboye, Olakunle O; Berman, Daniel S; Botvinick, Elias H; Churchwell, Keith B; Cooke, C David; Corbett, James R; Cullom, S James; Dahlberg, Seth T; Druz, Regina S; Ficaro, Edward P; Galt, James R; Garg, Ravi K; Germano, Guido; Heller, Gary V; Henzlova, Milena J; Hyun, Mark C; Johnson, Lynne L; Mann, April; McCallister, Benjamin D Jr; Quaife, Robert A; Ruddy, Terrence D; Sundaram, Senthil N; Taillefer, Raymond; Ward, R Parker; Mahmarian, John J
PMID: 18022099
ISSN: 1532-6551
CID: 96430