Cardiac Research

RESEARCH SUMMARY

The Cardiologists in the Pediatric Cardiology Department at DMC Children’s Hospital of Michigan have a very active research program focusing on a wide variety of cardiac diagnoses seen and treated by our doctors.

Below is a summary of recent research and articles being conducted by the Cardiology Department and the representative publications.

New Study Suggests that Children with Cardiomyopathy Gain Significant Benefits from Treating Entire Family More information

Pediatric Researchers Find Evidence that Help Prevent Abnormalities in Heart Muscle after Children Receive Chemotherapy More information

Children’s Hospital of Michigan DMC Research Team Leads Cardiology Component of Clinical Trial to Protect the Hearts of Children Who Receive Chemotherapy More information

Research Shows Anti-HIV Medicines Can Cause Damage To Fetal Hearts

Young Children, Energy Drinks a Dangerous Combination

Children’s Hospital of Michigan Researcher Publishes Major Study Showing Effectiveness of Heart-Protecting Drug for Kids Who Undergo Chemotherapy

Groundbreaking Book Offers ‘New Hope’ for Teens with Heart Health Issues

Health Care Savings While Protecting Child Cancer Survivors

Pioneering Study Shows Many Kids With Cardiomyopathy Can Regain Heart Health 

Pediatric Cardiologist at the Children’s Hospital of Michigan to Publish Revised Version of the Ross Classification for Heart Failure in Children

Catheter-based treatment for congenital heart conditions:
  • comparing 3 known ways to repair coarctation (narrowing) of the aorta:
    • surgical repair
    • balloon angioplasty
    • stent placement
  • follow-up evaluation of device used to occlude septal defects

Transcatheter Closure of ASD’s and PFO’s:  A Comprehensive Assessment.  ISBN: 978-0-9790164-9-3

Tang, L., Forbes, T, Du, W., Zilberman, M.  Echocardiographic Evaluation of Pressure Gradient across the Stent in Patients Treated for Coarctation of the Aorta.  Congenital Heart Disease. 2009; 4:269-272.
 
Congenital Cardiovascular Interventional Study

Congenital heart defects account for the most congenital defects in any system in the body, affecting approximately 1 in 120 newborns. One center does not typically have enough volume to be able to spot trends in treatment outcomes. The pediatric cardiologists at the Children's Hospital of Michigan saw this as an opportunity.

Working with the Wayne State University School of Medicine, a worldwide consortium was created to collect information on this topic. Thus far, the Congenital Cardiovascular Interventional Study Consortium (CCISC) includes more than 40 hospitals from around the world including London, Brazil, Toronto and Seattle. Data has been gathered on more than 500 children to date, enabling retrospective analysis of the treatment data associated with these patients.

Currently, there is one project in progress and three more planned for the next two years. The first study, Surgical vs. Balloon Angioplasty vs Stent Placement for treatment of Native and Recurrent Coarctation of the Aorta, which began in 2005 and followed approximately 200 patients for a five-year period.

It is hoped that this worldwide consortium will result in advances in the treatment of children with congenital heart defects.

Use of biomarkers in pediatric heart conditions:

  • studies involved use of biomarkers to detect and/or predict the severity of poor heart function in children treated for cancer and high blood pressure in lung blood vessels.

Aggarwal, S., Pettersen, M., Bhambhani, B., Gurczynski, J., Thomas, R., L’Ecuyer, T.

B-Type Natriuretic Peptide as a Marker for Cardiac Dysfunction in Anthracycline-Treated Children.  Pediatric Blood Cancer 2007; 49:812-816.http://www.ncbi.nlm.nih.gov/pubmed/17171687

Sanjeev, S., Pettersen, M., Lua, J., Thomas, R., Shankaran, S., L’Ecuyer, T.

Role of plasma B-type natriuretic peptide in screening for hemodynamically significant patent ductus arteriosus in preterm neonates.  Journal of Perinatology.2005 Nov; 25(11):709-13.    

Heart structure & function:

  • Heart structure and function as it relates to different races and stage of development

Pettersen, M., Du, W., Skeen ME., Humes, RA. 
Regression Equations for Calculations of Z-Scores of Cardiac Structures in a Large Cohort of Normal Infants, Children, & Adolescents:  An Echocardiographic Study.  Journal of the American Society of Echocardiography. August 2008 (vol 21, Issue 8, p 922-934);
 

Heart Transplant outcomes and risk factors:

  • Kidney function in the heart transplant patient during the first year following transplant
  • Participation in an international pediatric heart transplant study; detailed information supplied on these transplant recipients is analyzed to promote new treatments for patients
  • Outcome of transplant as a function of organ donor size
  • Impact of renal failure on heart transplant

Tang, L., L’Ecuyer, T.J. Perioperative renal failure in pediatric cardiac transplant recipients:  outcomes and risk factors. Pediatric Transplantation (In Press)

Tang, L., Du, W., Delius, R., L’Ecuyer, T., Zilberman, M.  Low donor-to-recipient weight ratio does not negatively impact survival of pediatric heart transplant patients.  Pediatric Transplantation 2010 (In Press)

Buddhe, S., L’Ecuyer, T. “Impact of Pulmonary Hypertension on Transplant Outcomes in Pediatric Cardiomyopathy Patients”.  (Abstract has been accepted for oral presentation at International Society of Heart Lung Transplant meeting in April 2011)

International Health

Ross RD, Delius R, Weinstein S, Rosenkrantz ER, Palaez de Pichardo N, Madera F.

Forming a Consortium to Promote Pediatric Cardiac Care in a Developing Country. J Pediatr 2009;154:311-312

Pulmonary Hypertension

RIGHT VENTRICULAR ADAPTATION TO ELEVATED PULMONARY PRESSURE IN A MOUSE MODEL OF SICKLE DISEASE

Patrick C. Hines, MD/PhD1-3, Margaret Prior, PhD1, Kori Bradley4, Andrew Campbell, MD4, Jian-Ping Jin, MD/PhD1

1Physiology Department, Wayne State University School of Medicine, 2Department of Pediatrics, Division of Pediatric Critical Care Medicine, Wayne State University School of Medicine, 3Children's Hospital of Michigan, 4Department of Pediatrics, Division of Hematology and Oncology, University of Michigan School of Medicine

Sickle cell disease is characterized by disturbances in pulmonary vascular blood flow, predisposing patients to pulmonary hypertension, subsequent elevation of right heart pressures, and complete right heart failure in severe cases.  Although, the ability of the right heart to adapt to pressure overload is an important determinant of survival, little is known about this process.  Dr. J-P Jin, chairman of the Physiology Department at the Wayne State University School of Medicine, recently demonstrated that a heart protein called cardiac troponin T becomes enzymatically altered in response to pressure overload on the left side of the heart.  

This enzymatic change alters cardiac muscle function and ultimately preserves the heart’s output in the response to increased pressure.  As a result, we hypothesized that cardiac troponin T in the right heart undergoes a similar enzymatic reaction in response to elevated pulmonary pressures.  In collaboration with Dr. Andrew Campbell at the University of Michigan, we studied the right heart tissue from mice with sickle cell disease and known elevated pulmonary pressures.  We found this same enzymatically altered version of troponin in higher levels compared to normal mice. 

This is the first demonstration of this adaptive response in a sickle cell disease model, and suggests a novel role for this enzymatic alteration of cardiac troponin T in preserving right heart function in sickle cell disease.

Cardiac rhythm problems in children, their outcomes and treatment:

Arya S, Karpawich PP. Risk Stratification for Symptoms and Arrhythmias after Tetralogy of Fallot Repair. Abstracts, International Academy of Cardiology 15th World Congress 2010 (in press).

Arya S, Kovach J, Singh H, Karpawich PP. Arrhythmia and Sudden Death Risk Among Older Children and Young Adults following Tetralogy of Fallot Repair in the Current Era. Pediatric Cardiology 2010 (in press)

Nishant Shah, Kavitha Chintala, Sanjeev Aggarwal. 

Electrocardiographic Strain Pattern in Children with Left Ventricular Hypertrophy:  A Marker for Ventricular Dysfunction.  
Journal of the American Society of Echocardiography, 2009; 22 (4):607
 

Karpawich, P., Pettersen, M., Gupta, P., Shah, N.  Infants and Children with Tachycardia:  Natural History and Drug Administration.  Current Pharmaceutical Design, 2008, 14, 743-752.

ABSTRACTS 

Reddy SRV, Thomas RL, Ross RD. Prevalence of Pericardial Effusions in Children with Large Atrial or Ventricular Septal Defect. Am J Cardiol 2009;103:271-272.

Prevalence of Pericardial Effusions in Children with Large Atrial or Ventricular Septal Defect. Am J Cardiol 2009;103:271-272

 
Shaddy RE, Boucek MM, Hsu DT, Canter CE, Mahony L, Ross RD et al. 
Carvelilol for Children and Adolescents with Heart Failure, A Randomized Controlled Trial. JAMA 2007;298:1171-1179.

Vitamin D deficiency and arterial wall stiffness in children with chronic kidney disease, CKD. 

Patange, A., Valentini, R., Du, W., Pettersen, M. 

Arterial wall stiffness is a recognized complication in children with CKD.  Children with CKD have stiffer arteries and the magnitude of stiffness correlates with severity of kidney dysfunction.  Vitamin D deficiency is prevalent in children with CKD.

Acute contractility improvement predicts chronic resynchronization pacing (CRT) Efficacy for refractory heart failure in congenital heart.

Karpawich, P., Singh, H., Zelin, K.

Established criteria for CRT pacing in heart failure.  Shown to improve ventricular function improving lifestyle and delaying need for transplant.

Atrial baffle complications following the mustard operation in young adults with D-transposition of the great arteries

Patel, S., Shah, D., Chintala, K., Karpawich, P.  

Found that baffle complications are much more prevalent than previously thought.  Trans thoracic echocardiogram or clinical findings are not effective in recognizing these complications due to azygous vein decompression of obstructed SVC baffle flow to the IVC. MRI or Trans esophageal echocardiogram should be considered to evaluate the atrial baffle before electrophysiology studies.  Intervention device therapy is safe and effective in correcting atrial baffle problems. 
Turner, D., Sabiniewicz, R., Chessa, M., et al.

The atriasept is safe and effective for closure of secundum atrial septal defects up to 22mm in size for children and adults.

Healthy Eating Index and Anthropometric, Inflammatory and Lipid Markers of Cardiovascular Risk In U.S. Adolescents: Insights NHANES III, publication pending, 2011 American Academy of Pediatrics (AAP) National Conference and Exhibition to be held in Boston, MA October 14-18, 2011.