Elizabeth B Juneman
- Associate Professor, Medicine - (Clinical Scholar Track)
Elizabeth Juneman, MD, is an associate professor of medicine in the Division of Cardiology at the University of Arizona College of Medicine - Tucson, and she is the interim director of advanced heart failure & cardiac transplantation at Banner UMC Tucson.
Dr. Juneman received her BS in electrical engineering at Southern Methodist University in Dallas, Texas. She attended medical school at the University of Texas - Houston Health Sciences Center. Dr. Juneman completed her internal medicine residency and cardiology fellowship at the University of Arizona College of Medicine. She joined the UA faculty in 2007 and worked at Southern Arizona VA Health Care System (Tucson VA) where she served as director of echocardiography and director of heart failure for seven years. In 2015, Dr. Juneman returned to the University of Arizona employment where she served as Director of Ambulatory Cardiology. In 2018, she assume the role of interim Medical Director of the Advanced Heart Failure and Transplantation Program in Tucson.
Dr. Juneman is board certified in internal medicine, cardiovascular disease, echocardiography, nuclear cardiology and advanced heart failure/transplantation. She is a fellow of the American College of Cardiology (FACC). She is a member of American Heart Association and Heart Failure Society of America. Dr. Juneman won the Charles W. Hall Jr. Memorial Cardiology Fellowship Teaching Award in 2011, Southern Arizona VA Health Care System (Tucson VA) Clinician of the Year in 2013, dean list for excellence in teaching first year medical students in 2018 and is recognized by her peers as one of the Best Doctors in America since 2009.
Dr. Juneman’s research interest is focused on mechanical and cellular remodeling in heart failure. She is interested in alterations in systolic and diastolic dysfunction in various cardiomyopathies. In her clinical research, Dr. Juneman’s focus is in heart failure. She has served as a principal investigator in nationally funded, multi-center clinical trials, as well as her own investigator-initiated clinical trials. She has authored multiple original research publications, a book chapter, and multiple clinical reviews. As to the Tucson community, Dr. Juneman has served on the board of directors of a non-profit organization focused on the children of Tucson.
- M.D. Doctor of Medicine
- University of Texas, Houston, Texas, United States
- B.S. Electrical Engineering
- Southern Methodist University, Dallas, Texas
- Banner University Medical Center (2020 - Ongoing)
- Division of Cardiology, Department of Medicine (2018 - Ongoing)
- Banner University Medical Center (2015 - 2018)
- University of Arizona, Tucson, Arizona (2012 - Ongoing)
- Southern Arizona VA Health Care System (2007 - 2014)
- Southern Arizona VA Health Care System (2007 - 2014)
- University of Arizona, Tucson, Arizona (2007 - 2012)
- Eta Kappa Nu Electrical Engineering Honor Society
- Southern Methodist University, Spring 1995
- Tau Beta Pi National Engineering Honor Society
- Texas Iota Chapter Southern Methodist University, Spring 1995
- AMA's Women in Medicine Month Honoree
- Women in Academic Medicine (WAM) at UA College of Medicine, Fall 2019
- Elected Member
- Charter 100 Arizona, Fall 2019
- Dean’s List for Outstanding Teaching in Pre-Clinical Block
- Spring 2019
- Dean's List for Excellence in Teaching
- University of Arizona College of Medicine, Fall 2018
- Advanced Leadership for Physicians
- Banner University Medicine, Summer 2018
- Best Doctor 2017
- Fall 2017
- Learning to Lead Dean's Program for College of Medicine
- University of Arizona, Spring 2017
- Arizona Reynolds Program, Scholar in Aging
- University of Arizona, Spring 2016
- Physician of the Year
- Southern Arizona VA Health Care System, Spring 2013
- American College of Cardiology, Spring 2011
- Finalist, Basic Science Junior Faculty
- Northwestern Cardiovascular Young Investigators’ Forum, Spring 2011
- Northwestern Cardiovascular Young Investigators’ Forum, Spring 2009
- The Charles W. Hall Jr. Memorial Cardiology Fellowship Teaching Award
- Sarver Heart Center / University of Arizona, Spring 2011
- Second Place Finalist and Scholarship Winner, Basic Science Junior Faculty
- Northwestern Cardiovascular Young Investigators’ Forum, Spring 2010
- Special Recognition Award
- Southern Arizona VA Health Care System, Spring 2009
- Tucson’s Best Doctors
- Tucson’s Best Doctors, Cardiology, Tucson Lifestyle 2009-2014, Spring 2009
- Cardiovascular Scholar Awards Winner
- American Federation for Medical Research -- Western Section, Spring 2006
- Novartis Cardiovascular/Renal Scholars Award Winner,
- American Federation for Medical Research -- Western Section, Spring 2004
- Astra Zeneca Scholars Award Winner
- American Federation for Medical Research – Western Section, Spring 2003
- ACP-ASIM Annual Vignette Competition Winner
- University of Arizona / Department of Medicine, Spring 2002
- Charles W. Hall, Jr. Memorial Award for Outstanding Cardiac Care Unit Resident
- University of Arizona / Department of Cardiology, Spring 2002
- Susan M. Allen Award for Outstanding Intern of the Year
- University of Arizona / Department of Medicine, Spring 2001
Licensure & Certification
- Diplomate, American Board of Echocardiography (2012)
- Diplomate, American Board of Internal Medicine, Advanced Heart Failure & Transplantation (2014)
- Diplomate, American Board of Internal Medicine (2004)
- Level II Certificate, Cardiac Computed Tomography (2007)
- Diplomate, Cardiology Nuclear Board Certification (2008)
- Diplomate, American Board of Internal Medicine, Cardiovascular Disease (2009)
- Arizona Medical License, Arizona Medical License (2000)
- Diplomate, National Board of Medical Examiners (2003)
No activities entered.
Honors Independent StudyPSIO 399H (Spring 2018)
Honors Independent StudyPSIO 399H (Fall 2017)
Directed ResearchPSIO 492 (Spring 2017)
Honors ThesisPSIO 498H (Spring 2017)
Directed ResearchPSIO 492 (Fall 2016)
Honors ThesisPSIO 498H (Fall 2016)
- Juneman, E. B. (2014). Non-Cardiac Findings on Echocardiography. In Questions, Tips and Tricks for the Echocardiography Boards..
- Avery, R., Ebong, I., Skaria, R., Day, K., Miller, C., Juneman, E., Oliva, I., Friedman, M., Maltais, S., & Khalpey, Z. (2019). Preoperative Risk Stratification of Right Ventricular Function Utilizing Cardiac Magnetic Resonance Imaging Compared With Echocardiographic and Hemodynamic Parameters. ASAIO journal (American Society for Artificial Internal Organs : 1992).More infoAccurate right ventricle functional analysis prior to mechanical circulatory support continues to be valuable for preoperative stratification of patients at risk for developing right ventricular (RV) failure. While cardiac magnetic resonance imaging (CMR) remains the gold standard, CMR is limited by availability and patient-specific contraindications. Further investigation of other imaging modalities would be beneficial as it may serve as a surrogate to identifying RV systolic dysfunction. A single-center, retrospective study including 29 patients with advanced heart failure was performed. All patients underwent ventricular functional analysis with both CMR and echocardiography, and 19 patients underwent right heart catheterization. Predictability with multimodal assessment of RV function was determined using logistic regression methods. Of the 29 participants, 10 had severe RV dysfunction. Tricuspid annular plane of systolic excursion was a modest predictor of RV dysfunction with odd ratio (OR) of 0.07 (0.01-0.72) and c-statistic of 0.79. Invasive hemodynamic measurement of cardiac index by thermodilution method was also predictive of RV dysfunction but failed to reach statistical significance (OR of 0.03,
- Chinyere, I. R., Hutchinson, M., Moukabary, T., Lancaster, J., Goldman, S., & Juneman, E. (2019). Monophasic action potential amplitude for substrate mapping. American journal of physiology. Heart and circulatory physiology, 317(4), H667-H673.More infoAlthough radiofrequency ablation has revolutionized the management of tachyarrhythmias, the rate of arrhythmia recurrence is a large drawback. Successful substrate identification is paramount to abolishing arrhythmia, and bipolar voltage electrogram's narrow field of view can be further reduced for increased sensitivity. In this report, we perform cardiac mapping with monophasic action potential (MAP) amplitude. We hypothesize that MAP amplitude (MAPA) will provide more accurate infarct sizes than other mapping modalities via increased sensitivity to distinguish healthy myocardium from scar tissue. Using the left coronary artery ligation Sprague-Dawley rat model of ischemic heart failure, we investigate the accuracy of in vivo ventricular epicardial maps derived from MAPA, MAP duration to 90% repolarization (MAPD), unipolar voltage amplitude (UVA), and bipolar voltage amplitude (BVA) compared with gold standard histopathological measurement of infarct size. Numerical analysis reveals discrimination of healthy myocardium versus scar tissue using MAPD ( = 0.0158) and UVA ( < 0.001, = 21). MAPA and BVA decreased between healthy and border tissue ( = 0.0218 and 0.0015, respectively) and border and scar tissue ( = 0.0037 and 0.0094, respectively). Contrary to our hypothesis, BVA mapping performed most accurately regarding quantifying infarct size. MAPA mapping may have high spatial resolution for myocardial tissue characterization but was quantitatively less accurate than other mapping methods at determining infarct size. BVA mapping's superior utility has been reinforced, supporting its use in translational research and clinical electrophysiology laboratories. MAPA may hold potential value for precisely distinguishing healthy myocardium, border zone, and scar tissue in diseases of disseminated fibrosis such as atrial fibrillation. Monophasic action potential mapping in a clinically relevant model of heart failure with potential implications for atrial fibrillation management.
- Lancaster, J. J., Sanchez, P., Repetti, G. G., Juneman, E., Pandey, A. C., Chinyere, I. R., Moukabary, T., LaHood, N., Daugherty, S. L., & Goldman, S. (2019). Human Induced Pluripotent Stem Cell-Derived Cardiomyocyte Patch in Rats With Heart Failure. The Annals of thoracic surgery, 108(4), 1169-1177.More infoTo treat chronic heart failure (CHF), we developed a robust, easy to handle bioabsorbable tissue-engineered patch embedded with human neonatal fibroblasts and human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs). This patch was implanted on the epicardial surface of the heart covering the previously infarcted tissue.
- Brilakis, E. S., Edson, R., Bhatt, D. L., Goldman, S., Holmes, D. R., Rao, S. V., Shunk, K., Rangan, B. V., Mavromatis, K., Ramanathan, K., Bavry, A. A., Garcia, S., Latif, F., Armstrong, E., Jneid, H., Conner, T. A., Wagner, T., Karacsonyi, J., Uyeda, L., , Ventura, B., et al. (2018). Drug-eluting stents versus bare-metal stents in saphenous vein grafts: a double-blind, randomised trial. Lancet (London, England), 391(10134), 1997-2007.More infoFew studies have examined the efficacy of drug-eluting stents (DES) for reducing aortocoronary saphenous vein bypass graft (SVG) failure compared with bare-metal stents (BMS) in patients undergoing stenting of de-novo SVG lesions. We assessed the risks and benefits of the use of DES versus BMS in de-novo SVG lesions.
- Chinyere, I. R., Moukabary, T., Goldman, S., & Juneman, E. (2018). Electrical and mechanical alternans during ventricular tachycardia with moderate chronic heart failure. Journal of Electrocardiology, 51(1), 33-37.More infoA chronic heart failure (CHF) rat underwent epicardial programmed electrical stimulation (PES). Ventricular tachycardia (VT) developed during PES. Mechanical alternans was noted despite fixed tachycardia cycle length. Anti-tachycardia pacing attempts initiated a second VT that generated pulse intermittently and then degenerated into pulseless VT with electrical alternans.To our knowledge electrical and mechanical alternans have not been recorded in animal models of CHF during VT. The distinct events of mechanical alternans and electrical alternans may be indicative of progressively worsened calcium handling in the compromised cardiomyocytes.Although ion channel differences between rodents and humans exist, this work attempts to demonstrate this rat model's usefulness in understanding cardiac electrophysiology in CHF.
- Weisbord, S. D., Gallagher, M., Jneid, H., Garcia, S., Cass, A., Thwin, S. S., Conner, T. A., Chertow, G. M., Bhatt, D. L., Shunk, K., Parikh, C. R., McFalls, E. O., Brophy, M., Ferguson, R., Wu, H., Androsenko, M., Myles, J., Kaufman, J., Palevsky, P. M., & , P. T. (2018). Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. The New England journal of medicine, 378(7), 603-614.More infoIntravenous sodium bicarbonate and oral acetylcysteine are widely used to prevent acute kidney injury and associated adverse outcomes after angiography without definitive evidence of their efficacy.
- Chinyere, I., Moukabary, T., Goldman, S., & Juneman, E. B. (2017). . Electrical and Mechanical Alternans during Ventricular Tachycardia with Moderate Chronic Heart Failure. Journal of Electrocardiography. doi:doi.org/10.1016/j.jelectrocard.2017.09.002
- Chu, M., Novak, S. M., Cover, C., Wang, A. A., Chinyere, I. R., Juneman, E., Zarnescu, D. C., Wong, P. K., & Gregorio, C. (2018). Increased Cardiac Arrhythmogenesis Associated with Gap Junction Remodeling with Upregulation of RNA Binding Protein FXR1. Circulation.More infoBackground -Gap junction remodeling is well established as a consistent feature of human heart disease involving spontaneous ventricular arrhythmia. The mechanisms responsible for gap junction remodeling that include alterations in the distribution of, and protein expression within, gap junctions are still debated. Studies reveal that multiple transcriptional and post-transcriptional regulatory pathways are triggered in response to cardiac disease, such as those involving RNA-binding proteins. The expression levels of Fragile X mental retardation autosomal homolog 1 (FXR1), an RNA-binding protein, are critical to maintain proper cardiac muscle function; however, the connection between FXR1 and disease is not clear. Methods -To identify the mechanisms regulating gap junction remodeling in cardiac disease, we sought to identify: the functional properties of FXR1 expression, direct targets of FXR1 in human left ventricle dilated cardiomyopathy (DCM) biopsy samples and mouse models of DCM through BioID proximity assay and RNA immunoprecipitation, how FXR1 regulates it targets through RNA stability and luciferase assays, and functional consequences of altering the levels of this important RNA binding protein through the analysis of cardiac-specific FXR1 knockout mice and mice injected with 3xMyc-FXR1 adeno-associated virus. Results -FXR1 expression is significantly increased in tissue samples from human and mouse models of DCM via western blot analysis. FXR1 associates with intercalated discs and integral gap junction proteins Cx43, Cx45 and ZO-1 were identified as novel mRNA targets of FXR1 using a BioID proximity assay and RNA immunoprecipitation. Our findings show FXR1 is a multifunctional protein involved in translational regulation and stabilization of its mRNA targets in heart muscle. Additionally, introduction of 3xMyc-FXR1 via adeno-associated virus into mice leads to redistribution of gap junctions and promotes ventricular tachycardia showing functional significance of FXR1 upregulation observed in DCM. Conclusions -In DCM, increased FXR1 expression appears to play an important role in disease progression by regulating gap junction remodeling. Together this study provides a novel function of FXR1 namely that it directly regulates major gap junction components, contributing to proper cell-cell communication in the heart.
- Gupta, A., Gupta, G., Kim, T. Y., Shi, G., Weigand, K., Batai, K., Fleming, I., Kanady, J., Rutledge, C., Nair, N., Groth, J., Juneman, E. B., Goldman, S., Indik, J. H., Hillery, C., Garcia, J. G., Machado, R. F., Kittles, R., Dudley, S. C., , Choi, B., et al. (2018). IL-18 is a novel mediator of prolonged QTc and ventricular arrhythmias associated with Sickle Cell Disease. Proceedings of the National Academy of Sciences.
- Juneman, E. B., Goldman, S., Moukabary, T., & Chinyere, I. (2017). Electrical and Mechanical Alternans during Ventricular Tachycardia with Moderate Chronic Heart Failure. Journal of Electrocardiography. doi:doi.org/10.1016/j.jelectrocard.2017.09.002
- Pandey, A. C., Lancaster, J. J., Harris, D. T., Goldman, S., & Juneman, E. (2017). Cellular Therapeutics for Heart Failure: Focus on Mesenchymal Stem Cells. Stem cells international, 2017, 9640108.More infoResulting from a various etiologies, the most notable remains ischemia; heart failure (HF) manifests as the common end pathway of many cardiovascular processes and remains among the top causes for hospitalization and a major cause of morbidity and mortality worldwide. Current pharmacologic treatment for HF utilizes pharmacologic agents to control symptoms and slow further deterioration; however, on a cellular level, in a patient with progressive disease, fibrosis and cardiac remodeling can continue leading to end-stage heart failure. Cellular therapeutics have risen as the new hope for an improvement in the treatment of HF. Mesenchymal stem cells (MSCs) have gained popularity given their propensity of promoting endogenous cellular repair of a myriad of disease processes via paracrine signaling through expression of various cytokines, chemokines, and adhesion molecules resulting in activation of signal transduction pathways. While the exact mechanism remains to be completely elucidated, this remains the primary mechanism identified to date. Recently, MSCs have been incorporated as the central focus in clinical trials investigating the role how MSCs can play in the treatment of HF. In this review, we focus on the characteristics of MSCs that give them a distinct edge as cellular therapeutics and present results of clinical trials investigating MSCs in the setting of ischemic HF.
- Pandey, A. C., Lancaster, J. J., Harris, D., Goldman, S., & Juneman, E. B. (2017). Cellular Therapeutics for Heart Failure: Focus on Mesenchymal Stem Cells. Stem Cell International, 2017, 12. doi:doi.org/10.1155/2017/9640108
- Sanchez, P., Lancaster, J. J., Weigand, K., Mohran, S. E., Goldman, S., & Juneman, E. (2017). Doppler Assessment of Diastolic Function Reflect the Severity of Injury in Rats With Chronic Heart Failure. Journal of cardiac failure, 23(10), 753-761.More infoFor chronic heart failure (CHF), more emphasis has been placed on evaluation of systolic as opposed to diastolic function. Within the study of diastology, measurements of left ventricular (LV) longitudinal myocardial relaxation have the most validation. Anterior wall radial myocardial tissue relaxation velocities along with mitral valve inflow (MVI) patterns are applicable diastolic parameters in the differentiation between moderate and severe disease in the ischemic rat model of CHF. Myocardial tissue relaxation velocities correlate with traditional measurements of diastolic function (ie, hemodynamics, Tau, and diastolic pressure-volume relationships).
- Sanchez, P., Lancaster, J., Weigand, K., Mohran, S. A., Goldman, S., & Juneman, E. B. (2017). Doppler Assessment of Diastolic Function Reflect the Severity of Injury in Rats With Chronic Heart Failure.. Journal of Cardiac Failure. doi:10.1016/j.cardfail.2017.08.446
- Weigand, K., Witte, R., Moukabary, T., Chinyere, I., Lancaster, J., Pierce, M. K., Goldman, S., & Juneman, E. (2017). In vivo Electrophysiological Study of Induced Ventricular Tachycardia in Intact Rat Model of Chronic Ischemic Heart Failure. IEEE transactions on bio-medical engineering, 64(6), 1393-1399.More infoThe objective of this study was to define the clinical relevance of in vivo electrophysiologic (EP) studies in a rat model of chronic ischemic heart failure (CHF).
- Chinyere, I., Weigand, K., Moukabary, T., Witte, R. S., Lancaster, J., Goldman, S., & Juneman, E. B. (2016). Model of Induced Ventricular Tachycardia and Cardiac Electrophysiological Mapping. Circulation Research, 119(Supl 1), A 71.
- Hernandez, C. A., Reed, K. L., Juneman, E. B., & Cohen, W. R. (2016). Changes in Sonographically Measured Inferior Vena Caval Diameter in Response to Fluid Loading in Term Pregnancy. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 35(2), 389-94.More infoThe purpose of this study was to determine whether the inferior vena caval (IVC) diameter is influenced by intravascular volume changes in pregnancy.
- Lancaster, J., Chinyere, I., Kim, B. N., Daugherty, S., Kim, S., Jokerst, C., Avery, R., Larson, B., Lancaster, L. D., Juneman, E. B., & Goldman, S. (2016). . Feasibility and Testing of a Human Induced Pluripotent Stem Cell Derived Cardiac Patch in a Pre-clinical Swine Model of CHF. Circulation Research, 119(Supl 1), A 205.
- Lancaster, J., Pandey, A., Weigand, K., Bahl, J., Juneman, E. B., & Goldman, S. (2016). Implantation of an induced pluripotent stem cell derived cardiomyocyte tissue engineered patch improves left ventricular function and electromechanical coupling in rats with heart failure. Journal of Cardiac Failure, 22(8), S 123. doi:http://dx.doi.org/10.1016/j.cardfail.2016.06.383
- Mohran, S., Lancaster, J., Sanchez, P., Goldman, S., & Juneman, E. B. (2016). Differentiation of Moderate and Severe Ischemic Heart Failure by Invasive and Non-invasive Assessments of Diastolic Function in a Rat Model of Chronic Heart Failure. Circulation Research, 119(Supl 1), A48.
- Khan, M. F., Gottesman, S., Boyella, R., & Juneman, E. (2014). Gemcitabine-induced cardiomyopathy: a case report and review of the literature. Journal of medical case reports, 8, 220.More infoNewly developed antineoplastic drugs have resulted in improvements in morbidity and mortality from many forms of cancers. However, some of these new chemotherapeutic agents have potentially lethal side effects, which are now being exposed with their widespread use. Gemcitabine is a nucleoside analog, which is a commonly used agent for various solid organ malignancies. Phase 1 and 2 trials with gemcitabine did not show significant risk for cardiotoxicity; however, with its widespread clinical use over the last decade, a few cases of cardiotoxicity related to gemcitabine use have been reported. Cardiomyopathy after the use of gemcitabine monotherapy is extremely rare; and only one such case has been reported in detail previously.
- Lancaster, J. J., Juneman, E., Arnce, S. A., Johnson, N. M., Qin, Y., Witte, R., Thai, H., Kellar, R. S., Ek Vitorin, J., Burt, J., Gaballa, M. A., Bahl, J. J., & Goldman, S. (2014). An electrically coupled tissue-engineered cardiomyocyte scaffold improves cardiac function in rats with chronic heart failure. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 33(4), 438-45.More infoVarying strategies are currently being evaluated to develop tissue-engineered constructs for the treatment of ischemic heart disease. This study examines an angiogenic and biodegradable cardiac construct seeded with neonatal cardiomyocytes for the treatment of chronic heart failure (CHF).
- Gheorghiade, M., Böhm, M., Greene, S. J., Fonarow, G. C., Lewis, E. F., Zannad, F., Solomon, S. D., Baschiera, F., Botha, J., Hua, T. A., Gimpelewicz, C. R., Jaumont, X., Lesogor, A., Maggioni, A. P., & , A. I. (2013). Effect of aliskiren on postdischarge mortality and heart failure readmissions among patients hospitalized for heart failure: the ASTRONAUT randomized trial. JAMA, 309(11), 1125-35.More infoHospitalizations for heart failure (HHF) represent a major health burden, with high rates of early postdischarge rehospitalization and mortality.
- Juneman, E. B., Arsanjani, R., Thai, H., Lancaster, J., Madwed, J., & Goldman, S. (2013). Development of a Novel Sodium-Hydrogen Exchanger Inhibitor for Heart Failure. Journal of Cardiology and Vascular Medicine..
- Juneman, E. B., Maggioni, A. P., Greene, S. J., Fonarow, G. C., Bohm, M., Zannad, F., Solomon, S. D., Lewis, E. F., Baschiera, F., Hua, T. A., Gimpelewicz, C. R., Lesogor, A., & Gheorghiade, M. (2013). ASTRONAUT Investigators and Coordinators. Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial. European Heart Journal, 34(40), 3117 -3127.More infohttp://eurheartj.oxfordjournals.org/content/34/40/3117
- Maggioni, A. P., Greene, S. J., Fonarow, G. C., Böhm, M., Zannad, F., Solomon, S. D., Lewis, E. F., Baschiera, F., Hua, T. A., Gimpelewicz, C. R., Lesogor, A., Gheorghiade, M., & , A. I. (2013). Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial. European heart journal, 34(40), 3117-27.More infoThe objective of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) was to determine whether aliskiren, a direct renin inhibitor, would improve post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction. Pre-specified subgroup analyses suggested potential heterogeneity in post-discharge outcomes with aliskiren in patients with and without baseline diabetes mellitus (DM).
- Nguyen, J., Juneman, E., & Movahed, M. R. (2013). The value of β-blockers administration during recovery phase of dobutamine stress echocardiography: a review. Echocardiography (Mount Kisco, N.Y.), 30(6), 723-9.More infoDobutamine stress echocardiography (DSE) is a successful technique for detection of ischemia in patients with suspected coronary artery disease (CAD). There are some data that administration of β-blocker after peak infusion of dobutamine can improve sensitivity. The goal of this manuscript is to review the current literature in regard to the mechanism and accuracy of post-dobutamine β-blocker administration for ischemia detection. In this review, we present 2 case reports followed by detailed review of the literature.
- Tanaka, T. D., Lancaster, J. J., Juneman, E., Bahl, J. J., & Goldman, S. (2013). Clenbuterol plus granulocyte colony-stimulating factor regulates stem/progenitor cell mobilization and exerts beneficial effect by increasing neovascularization in rats with heart failure. Journal of cardiac failure, 19(7), 503-8.More infoTreatment of beta2-adrenergic receptor agonists with myeloid cytokines, such as granulocyte colony-stimulating factor (G-CSF) has been reported to enhance stem/progenitor cell mobilization and proliferation in ischemic myocardium. However, whether the combination therapy of G-CSF and clenbuterol (Clen) contributes to improved left ventricular (LV) function remains uncertain. We investigated whether this combination therapy induced bone marrow-derived stem/progenitor cell mobilization, neovascularization, and altered LV function after acute myocardial infarction (MI).
- Bakaeen, F. G., Sethi, G., Wagner, T. H., Kelly, R., Lee, K., Upadhyay, A., Thai, H., Juneman, E., Goldman, S., & Holman, W. L. (2012). Coronary artery bypass graft patency: residents versus attending surgeons. The Annals of thoracic surgery, 94(2), 482-8; discussion 488.More infoData are limited regarding the patency of coronary artery bypass grafts performed by residents versus attending surgeons.
- Farkouh, M. E., Domanski, M., Sleeper, L. A., Siami, F. S., Dangas, G., Mack, M., Yang, M., Cohen, D. J., Rosenberg, Y., Solomon, S. D., Desai, A. S., Gersh, B. J., Magnuson, E. A., Lansky, A., Boineau, R., Weinberger, J., Ramanathan, K., Sousa, J. E., Rankin, J., , Bhargava, B., et al. (2012). Strategies for multivessel revascularization in patients with diabetes. The New England journal of medicine, 367(25), 2375-84.More infoIn some randomized trials comparing revascularization strategies for patients with diabetes, coronary-artery bypass grafting (CABG) has had a better outcome than percutaneous coronary intervention (PCI). We sought to discover whether aggressive medical therapy and the use of drug-eluting stents could alter the revascularization approach for patients with diabetes and multivessel coronary artery disease.
- Juneman, E. B., Saleh, L., Lancaster, J. J., Thai, H. M., Markham, B., & Goldman, S. (2012). The effects of poloxamer-188 on left ventricular function in chronic heart failure after myocardial infarction. Journal of cardiovascular pharmacology, 60(3), 293-8.More infoPoloxamer-188 (P-188) is a biological membrane sealant that prevents the unregulated entry of Ca into cardiomyocytes and has been shown to have the ability to act as a membrane-repair agent in isolated cardiac myocytes. The purpose of this study was to determine if treatment with P-188 would improve left ventricular (LV) function in a rat chronic heart failure (CHF) model.
- Juneman, E., Saleh, L., Thai, H., Goldman, S., & Movahed, M. R. (2012). Successful coronary angiography with adequate image acquisition using a combination of gadolinium and a power injector in a patient with severe iodine contrast allergy. Experimental and clinical cardiology, 17(1), 17-9.More infoA history of severe allergic reaction to iodine contrast leading to anaphylactic shock presents a dilemma in patients requiring cardiac catheterization. As an alternative, gadolinium has been an interesting and potentially useful agent. However, gadolinium produces poor image quality and has been associated with significant arrhythmias in small case series. Furthermore, there is no consensus about the maximal allowable dose that can be administered to a patient. In the present report, a successful combination of gadolinium contrast with a power injector that produced adequate image quality in a patient with severe allergy to iodine contrast is described. The case was complicated by the occurrence of ventricular fibrillation when damping occurred during injection of contrast into the right coronary artery. This complication has been reported previously with intracoronary gadolinium injection. The report is followed by a brief literature review.
- Thal, S., Boyella, R., Arsanjani, R., Thai, H., Juneman, E., Movahed, M. R., & Goldman, S. (2012). Unusual combination of holt-oram syndrome and persistent left superior vena cava. Congenital heart disease, 7(4), E46-9.More infoHolt-Oram (HO) is a syndrome characterized by congenital cardiovascular malformations, specifically atrial and ventricular septal defects, and skeletal abnormalities of the upper limbs bones. Associations of HO cardiac disorders with other congenital cardiac malformations, specifically persistent left superior vena cava (PLSVC) are rarely reported and its real incidence is unknown. We present a case of this unusual combination in a patient undergoing cardiac resynchronization therapy (CRT) device implant.
- Goldman, S., Sethi, G. K., Holman, W., Thai, H., McFalls, E., Ward, H. B., Kelly, R. F., Rhenman, B., Tobler, G. H., Bakaeen, F. G., Huh, J., Soltero, E., Moursi, M., Haime, M., Crittenden, M., Kasirajan, V., Ratliff, M., Pett, S., Irimpen, A., , Gunnar, W., et al. (2011). Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: a randomized trial. JAMA, 305(2), 167-74.More infoArterial grafts are thought to be better conduits than saphenous vein grafts for coronary artery bypass grafting (CABG) based on experience with using the left internal mammary artery to bypass the left anterior descending coronary artery. The efficacy of the radial artery graft is less clear.
- Kellar, R. S., Lancaster, J. J., Thai, H. M., Juneman, E., Johnson, N. M., Byrne, H. G., Stansifer, M., Arsanjani, R., Baer, M., Bebbington, C., Flashner, M., Yarranton, G., & Goldman, S. (2011). Antibody to granulocyte macrophage colony-stimulating factor reduces the number of activated tissue macrophages and improves left ventricular function after myocardial infarction in a rat coronary artery ligation model. Journal of cardiovascular pharmacology, 57(5), 568-74.More infoGranulocyte macrophage colony-stimulating factor (GM-CSF) promotes infarct expansion and inappropriate collagen synthesis in a myocardial infarction (MI). This study was designed to determine if treatment with anti-GM-CSF will inhibit macrophage migration, preserve function, and limit left ventricular (LV) remodeling in the rat coronary artery ligation model. Treatment with a monoclonal antibody to GM-CSF (5 mg/kg) was initiated 24 hours before coronary artery ligation and continued every 3 days for 3 weeks. Left coronary arteries of rats were ligated, animals were recovered, and cardiac function was evaluated 3 weeks postligation. Tissue samples were processed for histochemistry. Anti-GM-CSF treatment increased LV ejection fraction (37 ± 3% vs 47 ± 5%) and decreased LV end systolic diameter (0.75 ± 0.12 vs 0.59 ± 0.05 cm) with no changes in LV systolic pressure (109 ± 4 vs 104 ± 5 mm Hg), LV end diastolic pressure (22 ± 4 vs 21 ± 2 mm Hg), LV end diastolic diameter (0.96 ± 0.04 vs 0.92 ± 0.05 cm), or the time constant of LV relaxation tau (25.4 ± +2.4 vs 22.7 ± 1.4 milliseconds) (P < 0.05). Significantly lower numbers of tissue macrophages and significant reductions in infarct size were found in the myocardium of antibody-treated animals (81 ± 21.24 vs 195 ± 31.7 positive cells per 0.105 mm, compared with controls. These findings suggest that inhibition of macrophage migration may be beneficial in the treatment of heart failure after MI.
- Kowey, P. R., Crijns, H. J., Aliot, E. M., Capucci, A., Kulakowski, P., Radzik, D., Roy, D., Connolly, S. J., & Hohnloser, S. H. (2011). Efficacy and safety of celivarone, with amiodarone as calibrator, in patients with an implantable cardioverter-defibrillator for prevention of implantable cardioverter-defibrillator interventions or death: the ALPHEE study. Circulation, 124(24), 2649-60.More infoCelivarone is a new antiarrhythmic agent developed for the treatment of ventricular arrhythmias. This study investigated the efficacy and safety of celivarone in preventing implantable cardioverter-defibrillator (ICD) interventions or death.
- Saleh, L., Juneman, E., & Movahed, M. R. (2011). The use of gadolinium in patients with contrast allergy or renal failure requiring coronary angiography, coronary intervention, or vascular procedure. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 78(5), 747-54.More infoCoronary artery angiography remains an important procedure for the assessment of coronary arteries. It requires injection of iodinated contrast for the opacification of coronary arteries. Severe allergy to iodine contrast and renal insufficiency are two main problems with iodine-based contrast media. Gadolinium (Gd) has different chemical structure with no cross reactivity with iodine-based contrast media in patients with iodine allergy. The use of Gd is commonly used in contrast-enhanced magnetic resonance imaging for image enhancement, making it a potential alternative in patients in whom iodine is contraindicated. The aim of this manuscript is to review the available literature on the use of Gd in patients with contraindication to iodine contrast due to allergy or in patients with severe renal failure requiring coronary or vascular procedures.
- Lancaster, J., Juneman, E., Hagerty, T., Do, R., Hicks, M., Meltzer, K., Standley, P., Gaballa, M., Kellar, R., Goldman, S., & Thai, H. (2010). Viable fibroblast matrix patch induces angiogenesis and increases myocardial blood flow in heart failure after myocardial infarction. Tissue engineering. Part A, 16(10), 3065-73.More infoThis study examines a viable biodegradable three-dimensional fibroblast construct (3DFC) in a model of chronic heart failure. The viable fibroblasts, cultured on a vicryl mesh, secrete growth factors that stimulate angiogenesis.
- Thai, H. M., Juneman, E., Lancaster, J., Hagerty, T., Do, R., Castellano, L., Kellar, R., Williams, S., Sethi, G., Schmelz, M., Gaballa, M., & Goldman, S. (2009). Implantation of a three-dimensional fibroblast matrix improves left ventricular function and blood flow after acute myocardial infarction. Cell transplantation, 18(3), 283-95.More infoThis study was designed to determine if a viable biodegradable three-dimensional fibroblast construct (3DFC) patch implanted on the left ventricle after myocardial infarction (MI) improves left ventricular (LV) function and blood flow. We ligated the left coronary artery of adult male Sprague-Dawley rats and implanted the 3DFC at the time of the infarct. Three weeks after MI, the 3DFC improved LV systolic function by increasing (p < 0.05) ejection fraction (37 +/- 3% to 62 +/- 5%), increasing regional systolic displacement of the infarcted wall (0.04 +/- 0.02 to 0.11 +/- 0.03 cm), and shifting the passive LV diastolic pressure volume relationship toward the pressure axis. The 3FDC improved LV remodeling by decreasing (p < 0.05) LV end-systolic and end-diastolic diameters with no change in LV systolic pressure. The 3DFC did not change LV end-diastolic pressure (LV EDP; 25 +/- 2 vs. 23 +/- 2 mmHg) but the addition of captopril (2mg/L drinking water) lowered (p < 0.05) LV EDP to 12.9 +/- 2.5 mmHg and shifted the pressure-volume relationship toward the pressure axis and decreased (p < 0.05) the LV operating end-diastolic volume from 0.49 +/- 0.02 to 0.34 +/- 0.03 ml. The 3DFC increased myocardial blood flow to the infarcted anterior wall after MI over threefold (p < 0.05). This biodegradable 3DFC patch improves LV function and myocardial blood flow 3 weeks after MI. This is a potentially new approach to cell-based therapy for heart failure after MI.
- Thal, S., Thai, H., Juneman, E., & Goldman, S. (2008). Coronary sinus diverticulum complicating CRT device implantation. Pacing and clinical electrophysiology : PACE, 31(9), 1184-5.More infoCoronary sinus diverticula are rare findings usually associated with the presence of accessory pathways. We report the case of a 74-year-old man, who underwent cardiac resynchronization therapy (CRT) device implant. Coronary sinus diverticulum was an incidental finding while attempting to subselectively cannulate the coronary sinus for left ventricle lead implant. The case was able to be completed without complications.
- Rough, S., Juneman, E. B., & Fain, M. (2007). Aldosterone Receptor Antagonists Therapy in Older Heart Failure Patients: Another Look. Arizona Geriatric Society Journal, 12(2), 10-13.More infoAldosterone Receptor Antagonists Therapy in Older Heart Failure Patients: Another Look. Arizona Geriatric Society Journal 2007;12(2):10-13
- Thai, H., Castellano, L., Juneman, E., Phan, H., Do, R., Gaballa, M. A., & Goldman, S. (2006). Pretreatment with angiotensin receptor blockade prevents left ventricular dysfunction and blunts left ventricular remodeling associated with acute myocardial infarction. Circulation, 114(18), 1933-9.More infoThis study was designed to determine the effects of pretreatment with an angiotensin receptor blocker on left ventricular (LV) function and remodeling during acute myocardial infarction (MI).
- Shinde, A. A., Juneman, E. B., Mitchell, B., Pierce, M. K., Gaballa, M. A., Goldman, S., & Thai, H. (2003). Shocks from pacemaker cardioverter defibrillators increase with amiodarone in patients at high risk for sudden cardiac death. Cardiology, 100(3), 143-8.More infoThe efficacy of amiodarone used in combination with a pacemaker cardioverter defibrillator (PCD) to decrease episodes of ventricular tachycardia and subsequent PCD shocks is not clear. We examined a retrospective registry of 82 patients with PCD implantation to define the efficacy of amiodarone treatment. We compared patients treated with amiodarone (for 24 consecutive months without interruption) versus no amiodarone. In patients treated with amiodarone there was a 3-fold increase (p = 0.02) in PCD shocks; in patients not on beta-blockers, amiodarone resulted in a 6-fold increase (p < 0.05) in PCD shocks. Patients with a left ventricular ejection fraction >30% on amiodarone and patients
- Lee, J. Z., Low, S., Yun, S., Dherange, P., Desai, A., Juneman, E. B., Lee, K. S., & Suryanarayana, P. (2016, November). Comparison of Tricuspid Annular Plane Systolic Excursion to Fractional Area Change for Evaluation of Right Ventricular Systolic Function: Systematic Review and Meta-analysis. American Heart Association Scientific Sessions. Orlando, FL: American Heart Association.
- Chinyere, I. R., Weigand, K., Moukabary, T., Witte, R. S., Chu, M., Novak, S., Hutchinson, M., Lancaster, J., Gregorio, C. C., Goldman, S., & Juneman, E. B. (2018, spring). Mapping and Inducing Ventricular Tachycardia in Cardiomyopathic Animal Models. Circ Res. San Antonio, TX: 2018 Circ Res 121:A86.
- Kazui, T., Kazui, T., Lick, S. D., Lick, S. D., Avery, R., Avery, R., Juneman, E. B., Juneman, E. B., Cook, J., Cook, J., Sweitzer, N. K., Sweitzer, N. K., Khalpey, Z. I., & Khalpey, Z. I. (2017, Oct). Minimally invasive off-pump HVAD vs full sternotomy on-pump LVAD placement: comparison of clinical outcomes. The 2017 ISMCS Conference. Tucson: ISMCS.
- Kazui, T., Lick, S. D., Avery, R., Juneman, E. B., Cook, J., Sweitzer, N. K., & Khalpey, Z. I. (2017, Oct). The effectiveness of minimally invasive off pump HVAD placement in redo patients. The 2017 ISMCS Conference. Tucson: ISMCS.
- Lancaster, J., Koevary, J. W., Chinyere, I. R., Juneman, E. B., & Goldman, S. (2017, Summer). Cardiac Grafts Engineered from human iPSC Ventricular Pure or Heterogeneous Cardiomyocytes Display Synchronous Spontaneous Contraction and Reduces Ventricular Tachycardia in Rats with Chronic Heart Failure. J Cardiac Failure. Dallas, TX.