Enhancing mHealth Technology in the Patient-Centered Medical Home Environment to Activate Patients With Type 2 Diabetes: A Multisite Feasibility Study Protocol.

Background: The potential of mHealth technologies in the care of patients with diabetes and other chronic conditions has captured the attention of clinicians and researchers. Efforts to date have incorporated a variety of tools and techniques, including Web-based portals, short message service (SMS) text messaging, remote collection of biometric data, electronic coaching, electronic-based health education, secure email communication between visits, and electronic collection of lifestyle and quality-of-life surveys. Each of these tools, used alone or in combination, have demonstrated varying degrees of effectiveness.

Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center.

Background: Patient prognosis has been shown to directly correlate with the severity of coronary artery disease diagnosed by coronary computed tomography angiography (CCTA). Although the presence of coronary artery calcium has been associated with increased incidence of ischemic stroke, there are no data on the incidence of ischemic stroke based upon the severity of coronary artery disease by CCTA. Therefore, we sought to investigate the rate of major adverse cardiovascular events, including ischemic stroke, based upon the severity of coronary artery disease by CCTA over a 6-year period in a high-volume single military center.

Thermogenic supplement use does not alter characteristics of sudden death in the young.

Background: To evaluate supplement use, most notably ephedra, which has been temporally associated with sudden death. Animal models suggest increased myocardial irritability may predispose to primary arrhythmic death.

Methods: Clinical, pathological, and investigative records from the Office of the Armed Forces Medical Examiner's Cardiovascular Death Registry were reviewed.

Sudden death in young adults: an autopsy-based series of a population undergoing active surveillance.

Objectives: The purpose of this study was to define the incidence and characterization of cardiovascular cause of sudden death in the young.

Background: The epidemiology of sudden cardiac death (SCD) in young adults is based on small studies and uncontrolled observations. Identifying causes of sudden death in this population is important for guiding approaches to prevention.

The effect of airway pressure release ventilation on pulmonary catheter readings: specifically pulmonary capillary wedge pressure in a Swine model.

Background. Airway pressure release ventilation (APRV) is a mode of mechanical ventilation that theoretically believed to improve cardiac output by lowering right atrial pressure. However, hemodynamic parameters have never been formally assessed.

Computed tomography coronary angiography versus stress myocardial perfusion imaging for risk stratification in patients with high occupational risk.

Purpose: To compare the performance of myocardial perfusion imaging (MPI) versus cardiac computed tomographic angiography (CCTA) in patients with a low pretest likelihood of obstructive coronary artery disease and high-risk occupation.

Materials And Methods: We performed a retrospective chart review of all MPI and CCTA studies performed at our institution from January 2006 to May 2008. The primary outcome measure was the incidence of referral to invasive coronary angiography (ICA).

Coronary thrombus detected by cardiac CT angiography before cardiac catheterization.

A patient presented with a complaint of pleuritic chest discomfort with elevated cardiac biomarkers. After a cardiac magnetic resonance imaging scan for the suspicion of myopericarditis showed a potential myocardial infarct, a coronary CT scan was performed. This revealed a thrombus of the left anterior descending artery.

The Effects of Extended Release Niacin in Combination with Omega 3 Fatty Acid Supplements in the Treatment of Elevated Lipoprotein (a).

Objective. To assess the effectiveness of niacin/fish oil combination therapy in reducing Lipoprotein (a) [Lp(a)] levels after twelve weeks of therapy. Background.

Differential manifestation of cardiovascular complaints as a function of utilization of ergogenic supplements.

Introduction: The rate of use of dietary supplements among young adults is significant. While the military makes significant restrictions on the use of certain pharmacologic drugs and actively tests for illegal drugs in a deployed environment, there is a near-unlimited supply of body-enhancing supplements available at military exchanges to deployed personnel. By emphasizing physical performance and providing these for purchase, the military leadership, perhaps unknowingly, endorses the use of these products.

Transcatheter cardiac fistula repair with the Amplatzer Duct Occluder: a case report and review.

Background: Clinically significant cardiac fistulas occur rarely and traditionally are surgically repaired. We describe the first known case of percutaneous closure of a left ventricular outflow tract (LVOT) to left atrium (LA) fistula formed as the result of aortic valve replacement surgery.

Case Report: The patient was an 86-year-old woman with a history of aortic valve replacement who began complaining of shortness of breath 7 years later.

Smallpox vaccination and ischemic coronary events in healthy adults.

Although smallpox vaccine-associated myopericarditis has been reported, the risk of cardiac ischemic events remains uncertain. We identified personnel receiving the smallpox vaccination and compared them to a historical referent population. The rate of cardiac ischemia diagnoses in the 30 days following smallpox vaccination was 140.

Early coronary revascularization diminishes the risk of ischemic stroke with acute myocardial infarction.

Background And Purpose: Ischemic stroke is an uncommon but devastating complication of myocardial infarction (MI). It is possible that delay in the acute revascularization of these patients influences the risk of peri-MI ischemic stroke independent of size of infarction or residual ventricular function. The influence of the timing and type of revascularization on risk of ischemic stroke in the patient with MI has not previously been assessed.

Mortality following defibrillator implantation in patients with renal insufficiency.

Introduction: Patients with renal insufficiency have an increased risk of atherosclerotic coronary artery disease, cardiovascular events, and sudden cardiac death. Due to under-representation of patients with renal disease in large clinical trials, outcomes of implantable cardioverter defibrillator (ICD) implantation in this group remain unclear.

Methods And Results: Inpatient and ambulatory records were reviewed for 741 consecutive patients undergoing 947 defibrillator implants or replacements at Department of Defense Medical Facilities.

Sudden death associated with anomalous coronary origin and obstructive coronary disease in the young.

Sudden cardiac death in a young patient is a catastrophic occurrence. Anomalous coronary origin (ACO) is a significant cause of sudden cardiac death among individuals under the age of 35 years. We sought to define the premortem clinical and postmortem histopathologic findings in victims of sudden cardiac death resulting from either ACO or obstructive atherosclerotic coronary artery disease (CAD) among U.

Causes of sudden death in young female military recruits.

This study sought to examine the incidence of sudden death in a large, multiethnic cohort of young women. Approximately 852,300 women entered basic military training from 1977 to 2001. During this period, there were 15 sudden deaths in female recruits (median age 19 years, 73% African-American), occurring at a median of 25 days after arrival for training.

Comparison of clinical presentation of acute myocarditis following smallpox vaccination to acute coronary syndromes in patients <40 years of age.

Smallpox vaccine-associated myopericarditis may have a similar presentation to acute coronary syndrome (ACS). The clinical records of 78 young patients (<40 years of age) presenting with ACS (n = 16) or myocarditis after smallpox vaccination (n = 62) were reviewed. Comparisons were made among clinical presentation, cardiac enzymes, echocardiographic findings, and electrocardiographic changes.

Appreciation of precordial cardiac murmur on examination relative to knowledge of valvular heart disease.

Skills associated with physical examination have continued to decline as practitioners have become increasingly reliant on advanced imaging modalities. Our study sought to determine if documentation of valvular heart disease on echocardiography resulted in an increased appreciation and documentation of precordial murmur.

Review of subacute stent thrombosis following percutaneous coronary intervention at a low-volume catheterization laboratory.

Background: The frequency of coronary stent subacute thrombosis (SAT) following percutaneous coronary intervention (PCI) with uncoated stents in recent studies is 0.5%-0.9%.

Sudden death in young adults: a 25-year review of autopsies in military recruits.

Background: Sudden death among military recruits is a rare but devastating occurrence. Because extensive medical data are available on this cross-sectional and diverse population, identification of the underlying causes of sudden death may promote health care policy to reduce the incidence of sudden death.

Objective: To determine the causes of nontraumatic sudden death among a cohort of military recruits.

Ascending aortic hemodynamics and one-year clinical events following percutaneous coronary intervention.

Increased pulse pressure has been shown to predict mortality and major adverse cardiac events (MACE) in large cohorts of ambulatory patients. There have been reports suggesting worsened outcome following percutaneous coronary balloon angioplasty in patients with increased pulse pressure. We reviewed 434 patients undergoing percutaneous coronary stenting to assess for clinical outcomes as a function of pulse pressure (PP) and pulse pressure fraction (PPf).

Cardiopulmonary and mental health diagnoses surrounding the September 11 terrorist acts in a military population.

Background: In addition to psychological disorders, emotional stress can trigger a chain of neurohumoral imbalances that can manifest as cardiopulmonary complaints. No studies were identified that used objective clinical data on complaints after the terrorist attacks of September 11, 2001. The purpose of this descriptive study was to identify all cardiopulmonary and psychological diagnoses among active duty personnel seeking care at a military treatment facility and/or its ancillary facilities before and after September 11, 2001.

Glycoprotein IIb/IIIa inhibitor-associated thrombocytopenia: clinical predictors and effect on outcome.

Glycoprotein IIb/IIIa inhibitors are used as an adjunct to antiplatelet therapy in percutaneous coronary intervention to reduce postprocedural enzyme elevations. Previous studies have shown a risk for thrombocytopenia that is associated with these agents. We sought to evaluate the incidence and outcomes of glycoprotein IIb/IIIa inhibitor-associated thrombocytopenia in an unselected series of patients undergoing percutaneous coronary intervention.

Matrix metalloproteinases in patients with myocardial infarction and percutaneous revascularization.

Background: Extracellular matrix remodeling is a component of coronary artery disease (CAD). Matrix metalloproteinases (MMPs) are enzymes involved in extracellular matrix degradation. The extrapolation of the role MMPs play in the clinical setting of acute coronary syndromes has not yet been defined.

Addition of right-sided and posterior precordial leads during stress testing.

Background: Exercise treadmill testing has limited sensitivity for the detection of coronary artery disease, frequently requiring the addition of imaging modalities to enhance the predictive value of the test. Recently, there has been interest in using nonstandard electrocardiographic (ECG) leads during exercise testing.

Methods: We consecutively enrolled all patients undergoing exercise myocardial imaging with four additional leads recorded (V4R, V7, V8, and V9).

Percutaneous coronary intervention in the elderly: procedural success and 1-year outcomes.

Clinical trials have found increased morbidity in elderly persons presenting for percutaneous coronary intervention for chronic stable angina. Long-term follow-up is limited for the elderly following percutaneous coronary intervention. The authors reviewed all coronary interventions performed from January 1998 to August 2001.