Brad Sutton

Improved efficacy of stem cell labeling for magnetic resonance imaging studies by the use of cationic liposomes.

Labeling stem cells with FDA-approved superparamagnetic iron oxide particles makes it possible to track cells in vivo with magnetic resonance imaging (MRI), but high intracellular levels of iron can cause free radical formation and cytotoxicity. We hypothesized that the use of cationic liposomes would increase labeling efficiency without toxic effects. Rabbit skeletal myoblasts were labeled with iron oxide by: 1) uptake of iron oxide incorporated into cationic transfection liposomes (group I) or 2) customary endocytosis (group II). In both groups, cell proliferation and differentiation were measured and toxicity was assayed using trypan blue and ratio fluorescence microscopy with BODIPY® 581/591 C11. The effects of the intracellular iron oxide on magnetic resonance image intensities were assessed in vitro and in vivo. Both methods resulted in uptake of iron intracellularly, yielding contrast-inducing properties on MRI images. In group II, however, incubation with iron oxide at high concentrations required for endocytosis caused generation of free radicals, a decrease in proliferation, and cell death. Cytotoxic effects in the remaining cells were still visible 24 h after incubation. Conversely, in group I, sufficient intracellular uptake for detection in vivo by MRI could be achieved at 100-fold lower concentrations of iron oxide, which resulted in a high percentage of labeled cells, high retention of the label, and no cytotoxic effects even after stressing the cells with a hypoxia–reoxygenation insult. The use of cationic liposomes for iron oxide stem cell labeling increases labeling efficiency approximately 100-fold without toxic effects. This technique results in high-contrast-inducing properties on MRI images both in vitro and in vivo and could thus be a valuable tool for tracking stem cells noninvasively.

The Cardiovascular Intensive Care Unit-An Evolving Model for Health Care Delivery.

Prior to the advent of the coronary care unit (CCU), patients having an acute myocardial infarction (AMI) were managed on the general medicine wards with reported mortality rates of greater than 30%. The first CCUs are believed to be responsible for reducing mortality attributed to AMI by as much as 40%. This drastic improvement can be attributed to both advances in medical technology and in the process of health care delivery. Evolving considerably since the 1960s, the CCU is now more appropriately labeled as a cardiac intensive care unit (CICU) and represents a comprehensive system designed for the care of patients with an array of advanced cardiovascular disease, an entity that reaches far beyond its early association with AMI. Grouping of patients by diagnosis to a common physical space, dedicated teams of health care providers, as well as the development and implementation of evidence-based treatment algorithms have resulted in the delivery of safer, more efficient care, and most importantly better patient outcomes. The CICU serves as a platform for an integrated, team-based patient care delivery system that addresses a broad spectrum of patient needs. Lessons learned from this model can be broadly applied to address the urgent need to improve outcomes and efficiency in a variety of health care settings.

Arrhythmia care in a value-based environment: Past, present, and future: Developed and endorsed by the Heart Rhythm Society (HRS)

Fred M. Kusumoto, MD, FHRS (Chair), Steven C. Hao, MD, FHRS (Coach), David J. Slotwiner, MD, FHRS (Coach), Jim W. Cheung, MD, FHRS, Jonathan C. Hsu, MD, FHRS, Marcin Kowalski, MD, FHRS, Ruth A. Madden, MPH, RN, Pamela K. Mason, MD, FHRS, G. Stuart Mendenhall, MD, FHRS, Devi G. Nair, MD, FHRS, Javed M. Nasir, MD, FHRS, Josh R. Silverstein, MD, Brad Sutton, MD, MBA, Khaldoun G. Tarakji, MD, MPH, FHRS, Gaurav A. Upadhyay, MD, FHRS, Emily P. Zeitler, MD, MHS From the Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida, Sutter Pacific Medical Foundation, San Francisco, California, NewYork-Presbyterian/Queens, New York, New York, Weill Cornell Medical College, Cardiology Division, New York, New York, Weill Cornell Medicine, Cardiology, New York, New York, Cardiac Electrophysiology Section, University of California, San Diego, La Jolla, California, Staten Island University, Hospital Northwell Health System New York, New York, Cleveland Clinic, Cleveland, Ohio, University of Virginia Health System, Charlottesville, Virginia, University of Pittsburgh, Pittsburgh, Pennsylvania, St. Bernards Heart & Vascular Center, Jonesboro, Arkansas, Cardiac Electrophysiology and Arrhythmia Service, Stanford University, Stanford, California, Mount Carmel Columbus Cardiology Consultants, New Albany, Ohio, University of Louisville, Louisville, Kentucky, Cleveland Clinic, Cleveland, Ohio, University of Chicago Medical Center, Chicago, Illinois, and Duke University Hospital, Durham, North Carolina.

Femoral arterial closure using ProGlide® is more efficacious and cost-effective when ambulating early following cardiac catheterization

Objective This was a prospective, single-center study evaluating the efficacy and cost-effectiveness of early ambulation (within 30 min) following femoral artery closure with the ProGlide® suture-mediated vascular closure device (PD) in patients undergoing diagnostic cardiac catheterization compared with manual compression. Background It is unclear whether early ambulation with ProGlide is safe or is associated with patient satisfaction and cost savings as compared with manual compression (MC). Methods and results Inclusion criteria were met in 170 patients (85 PD and 85 MC patients). Patients ambulated 20 ft. within 30 min (PD) or after the requisite 4 h recumbent time (MC) if feasible. Primary endpoint was time-to-ambulation (TTA) following device closure. We also directly compared the safety of closure, times-to-hemostasis (TTH), -ambulation (TTA) and -discharge (TTD) with MC and, using a fully allocated cost model, performed cost analysis for both strategies. Multivariate analysis was used to determine predictors of patient satisfaction. The primary endpoint of safe, early ambulation was achieved following closure (mean of 27.1 ± 14.9 min; 95% confidence interval [CI] 25.2–30.2). Predictors of patient satisfaction in the PD group were absence of pain during closure, decreased TTA, and drastic reductions in TTD; the latter contributed indirectly to significant cost savings in the PD group (1250.3 ± 146.4 vs. 2248.1 ± 910.2 dollars, respectively; P < 0.001) and incremental cost savings by strategy also favored closure over MC (

Letter by Sutton et al Regarding Article, “Effect of Rosuvastatin Therapy on Coronary Artery Stenoses Assessed by Quantitative Coronary Angiography: A Study to Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound–Derived Coronary Atheroma Burden”

84,807). Conclusions ProGlide is safe and effective for femoral artery closure in patients who ambulate within 30 min after cardiac catheterization; translating into improved patient satisfaction and substantial cost savings.

Intracardiac transplantation of a mixed population of bone marrow cells improves both regional systolic contractility and diastolic relaxation

To the Editor: Dr Ballantyne and colleagues report modest regression of atherosclerosis after 24 months of rosuvastatin, 40 mg, as measured by quantitative coronary angiography (QCA) in a follow-up analysis of the A Study to Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound–Derived Coronary Atheroma Burden (ASTEROID) trial.1 The authors conclude that a decrease in minimal lumen diameter and percentage diameter stenosis by QCA correlate with …