Experts From NYU Langone’s Cardiac & Vascular Institute Present New Research at American Heart Association Scientific Sessions 2013

Experts from the Cardiac and Vascular Institute at NYU Langone Medical Center presented new research and participated in expert panel discussions at the American Heart Association Annual Meeting 2013 in Dallas, TX, November 16-20, 2013.

“NYU Langone is proud of the contribution of our leading scientists and heart experts to the development of effective treatments and best practices for diseases of the cardiovascular system and to the growing body of knowledge regarding cardiovascular health,” said Glenn I. Fishman, MD, the William Goldring Professor of Medicine, Department of Medicine, Leon H. Charney Division of Cardiology at NYU Langone. “At this international meeting, our cardiovascular experts collaborate and share the latest information among clinicians and scientists, leading to enhanced patient care and outcomes for all of our patients, including those with the most complex clinical presentations.”

Notable research from NYU Langone cardiovascular experts includes:

Significant Presentations 

The ISCHEMIA Trial: Are We Doing Too Much or Too Little PCI Now?
Date/Time: Monday, November 18, 2013 9:00 – 9:30am
In this session on Trends, Outcomes and Quality Improvement Dr. Hochman provided an update on the multi-year, 8,000-patient ISCHEMIA clinical trial funded by an $84 million NIH grant studying the comparative effectiveness of two initial management strategies for patients with stable ischemic heart disease. To date over 600 patients have been enrolled and over 300 randomized. Dr. Hochman provided perspective on recent literature on stable ischemic heart disease management and the role of stents in treatment of ischemia. 
George L. Duff Memorial Lecture: The Regression of Atherosclerosis - The Journey from the Liver to the Plaque and Back
Date/Time: Monday, November 18, 2013 2:00 – 2:30pm
Dr. Fisher, one of the world’s foremost experts in plaque regression, was honored at AHA with the AHA/ATVB Council “George Lyman Duff Lecture Award,” the most longstanding and prestigious of the AHA awards. Dr. Fisher spoke about his current research focused on both the precursors of LDL, the “bad cholesterol” that accumulates in the coronary arteries to form heart-attack causing cholesterol-filled plaques, and on reversing the formation of the cholesterol-filled plaques.


Notable Research

Undiagnosed Peripheral Arterial Disease (PAD) is Common in Patients Referred for Stress Tests Without a History of Atherosclerotic Heart Disease
Amar Narula, MD, Alana Choy Shan, MD,  Ricardo Benenstein, MD, Matthew Konigsberg, MD, Daisy Duan, MD, Larry Phillips, MD, Muhamed Saric, MD, Harmony Reynolds, MD
Presentation: 9146
Date/Time: Sunday, November 17 - 9:30 – 11:00am
Poster Board: 6030
This poster presentation focuses on the addition of a simple, fast, non-invasive test for peripheral arterial disease, the ankle-brachial index, to stress testing. Stress tests are very useful for determining whether a symptom is due to heart disease. However, plaque must block a coronary (heart) artery by at least 70-80 percent before a stress test is positive. In contrast, most heart attacks are caused by plaques which created mild or moderate blockage before the attack or no blockage at all. Many people who exhibit no symptoms but have heart disease risk factors have plaque buildup that goes undetected by stress testing. For this reason, a normal stress test is not a clean bill of cardiovascular health. Ankle-brachial index testing, or ABI, can identify disease in the leg arteries even before that disease causes symptoms. ABI involves measurement of the blood pressure in the arms and legs and can be done in just a minute or two. Screening for peripheral artery disease (PAD) using ABI is recommended by guidelines for people 65 and over and people 50 and over with history of smoking. However, the screening is often not done. In this study, we performed ABI screening both before and after exercise in people referred for stress testing and found that 7.4 percent of those tested had abnormal ABI at rest. Among those who would have qualified for screening under current guidelines, more than 10 percent had abnormal resting ABI. Most patients with abnormal ABI had normal stress test results (93 percent). Therefore addition of ABI to stress testing may improve detection of patients who may benefit from risk factor modification.
Risk Factors Associated With Depression in Patients Undergoing Elective Percutaneous Coronary or Peripheral Intervention
Revathi Balakrishnan, MD, Jeffrey Berger, MD, Omad Ullah, MD, Lisa Tully, MD, Anish Vani, MD, Arthur Schwartzbard, MD, Howard Weintraub, MD, Edward Fisher, MD, Eugenia Gianos, MD
Presentation: 16814
Date/Time: Monday, November 18, 2013 – 3:00-4:00pm 
Location: Hall F, Core 2
Poster Board: 2181
This poster presentation focuses on the prevalence of depression and risk factors associated with depression in patients who have undergone cardiac or peripheral interventions. In this study, researchers found a substantial proportion (about 15 percent) of patients with depression or history of depression, which is nearly two to three times of that found in the general population. The prevalence is consistent with other studies in patients with known coronary disease, however, screening in this elective population is not customary and may be of benefit to patients post-procedure, since depression was also noted to be associated with less optimal control of risk factors for cardiovascular disease and could potentially be targeted. Financial stress was found to be the most closely associated with depression and could also be an area for the hospital social workers to intervene to assist in medical related expenses. This cross-sectional study does not conclude if depression is the cause of the poor risk factor control or if poor risk factor control causes depression - but is clearly a marker for people who may be at higher risk for recurrent events and may benefit from targeted intervention, whether it be more aggressive treatment of cardiovascular risk factors or treatment of the depression itself. 
Association Between Interarm Systolic Blood Pressure Differential and Peripheral Artery Disease: A Population Database of Over 3.6 Million Subjects
Vinay D. Madan, MD, Caron B. Rockman, MD, Yu Guo, MD, Mark A. Adelman, MD, Thomas S. Riles, MD, Jeffrey S. Berger, MD
Presentation: 17204
Date/Time: Wednesday, November 20, 2013 – 9:30-11:00 am
Location: Hall F, Core 2
Poster Board: 2046
This poster presentation focuses on the prevalence of abnormal interarm systolic blood pressure differentials (IBPD) among a large population of individuals undergoing voluntary screening for vascular disease. Prior studies have suggested that the presence of an abnormal IBPD identifies individuals with vascular disease in other territories and portends a higher risk of mortality. Utilizing the Life Line database, researchers found the prevalence of individuals with an abnormal IBPD (defined as > 10 mm Hg) and describe how the presence and severity of this finding varies according to gender, race/ethnicity and age. They also found a strong association of an abnormal IBPD with the presence of peripheral artery disease (PAD) of the lower extremities, diagnosed by an abnormal ankle: brachial index at the time of screening.  These findings suggest that measuring blood pressure in both arms may help identify patients at increased risk for PAD, thereby allowing for targeted screening and interventions. The large size of this cohort, enriched with over 3.6 million participants, substantially outnumbers any prior study investigating the prevalence and clinical implications of an abnormal IBPD.
Electrocardiographic Characteristics of Patients With Sudden Unexplained Death in Epilepsy 
Janice Y. Chyou, MD, Marina Cerrone, MD, Daniel Friedman, MD, William Slater, MD, Daniel Taupin, MD, Sean O'Rourke, MD, Orrin Devinsky, MD, Silvia G. Priori, MD
Presentation: 16882
Date/time: Wednesday, November 20 9:30-11am
Location: Hall F, Core 4
Poster Board: 4018
This poster presentation focuses on electrocardiographic (ECG) features of patients with sudden explained death in epilepsy (SUDEP) and patients with epilepsy. SUDEP is devastating but the mechanisms and risk factors predisposing an individual to epilepsy are not well-understood. JRecently, the NIH-CDC announced the new Sudden Death in the Young Registry that will launch in 2014. Cardiologists and neurologists at NYU Langone have teamed up to look more into possible causes and risk factors for SUDEP. At this poster session, NYU researchers will report new data on ECG features of SUDEP and epilepsy patients.