Access to abstract permanently restricted to Ball State community only / Access to thesis permanently restricted to Ball State community only / School of Physical Education, Sport, and Exercise Science

Access to abstract permanently restricted to Ball State community only / Access to thesis permanently restricted to Ball State community only / School of Physical Education, Sport, and Exercise Science

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Coronary bypass surgery is an increasingly common occurrence. Current literature does not validate the coping mechanisms involved for patients facing this life-threatening event. Lazarus’ theory of stress and coping was utilized as the framework for the study. The purpose of the study was to identify the degree of threat coronary bypass surgery presents and coping mechanisms utilized with this specific insult. The significance of the study was to assist nurses in identification of perceived risks/benefits of having open heart surgery from the patient’s perspective. The population included patients from a private cardiovascular practice in Indianapolis, Indiana. The convenience sample included 38 subjects recovering from coronary bypass graft surgery. Subjects were identified as uncomplicated post-operative surgical patients and were mailed questionnaires one month after discharge from the hospital. The Jalowiec Coping Scale and a questionnaire for demographic data were utilized to collect data. Procedures for protection of human subjects were followed. The research design was non-experimental and descriptive, correlational procedures were utilized to analyze data.The data supported the notions that clients utilized both problem-focused coping and emotion-focused coping, and emotion-focused coping strategies were more effective in reducing the threat. Education was significantly related to emotive coping styles and clients that perceived a higher threat intensity utilized more emotion-focused coping strategies. Recognition of the need to minimize stressors can be an important role the nurse facilitates. Through participatory care, the nurse may assist in finding the meaning for the stressor and encourage open communication patterns and emotional responses. Allowing for reduction of threat perception and intensity may enhance the outcome of the experience. / School of Nursing

Coronary Artery Bypass Graft(CABG) Surgery increases blood flow to the endangered myocardium but does not slow the process of atherosclerosis. The only way to slow the process of coronary artery disease is to acknowledge the risk factors present and minimize or totally eliminate them from an individual's lifestyle. Men and women respond differently to stress and lifestyle modifications. The purpose of this study was to determine if there was a difference between genders in compliance to a heart healthy lifestyle pre and post CABG surgery.Thirty men and thirty women who had CABG surgery at least one year earlier were interviewed to assess coronary artery disease risk. The procedure for the protection of human subjects were followed. The instrument used was the RISKO Heart Hazard Appraisal Tool. This instrument was developed in 1985 by the American Heart Association and scored individuals on systolic blood pressure, weight, serum cholesterol level and cigarette smoking habits. Pre-operative records were also reviewed using the same tool to assess individuals preoperative risk. The research design used was 2 x 2 repeated measures. Data were analyzed using 2 x 2 repeated measures analysis of variance (ANOVA).Two findings were discovered. First there was a statistically significant difference between men and women (F=5.82 p=0.019) with men scoring lower RISKO scores than women, indicating lower risk and better compliance to a heart healthy lifestyle, both pre- and postoperatively. Second there was a significant difference between preand postoperative RISKO scores in the total population (F=8.77 p=0.004). Postoperative RISKO scores were lower indicating an improvement in heart healthy lifestyle. There was no statistically significant difference between genders in the difference of pre- and postoperative RISKO scores (F=2.56 p<.115). The significance of this study was that it looked specifically at gender differences and assessed disparities in cardiovascular risk factors and the impact of surgery on men and women.This study found that overall, men had lower RISKO scores than women. Both genders also had improved RISKO scores postoperatively from preoperatively. No statistically significant difference between genders of the RISKO scores from preoperatively to postoperatively was found. Education needs to continue to play a big part in the cardiac rehabilitation process for both genders and specifically women need to become the target of further research and education to improve compliance to a heart healthy lifestyle. / School of Nursing

Access to abstract permanently restricted to Ball State community only / Access to thesis permanently restricted to Ball State community only / School of Physical Education, Sport, and Exercise Science

Coronary magnetic resonance angiography (CMRA) is a potential diagnostic tool for coronary artery disease (CAD). Compared to the current gold standard, x-ray angiography, CMRA provides three-dimensional visualization of coronary vessel lumens without the use of catheters and ionizing radiation. CMRA, however, requires long acquisition times that span multiple heartbeats. Typically, to reduce cardiac motion artifacts, electrocardiogram (ECG) gating is used to synchronize data acquisition windows to diastasis periods. Gating errors may cause vessel blurring by unintentionally triggering the scanner to acquire image data during periods of significant cardiac motion. This is particularly problematic for CMRA because of the associated fine spatial resolution requirement for diagnosing CAD. This thesis presents and tests the novel idea of determining the timing of global epicardial diastasis periods from the motion of the basal ventricular septum. An experiment involving a small patient cohort undergoing elective diagnostic angiography revealed a significant correlation between the beat-to-beat diastasis periods of the ventricular septum and the coronary vasculature. This motivated the ii development and testing of the hypothesis that suggests sharper coronary artery images may be obtained by using cardiac gating windows determined by septal motion. A preliminary study involving a small volunteer cohort provided encouraging results, but also revealed limitations of using ultrasound to measure septal motion during a pre- scan prior to an MRA exam. This led to the major technical development of this thesis, which is a magnetic resonance imaging (MRI) method called the Septal Scout for monitoring septal motion at a very high temporal resolution. The technique was applied to a volunteer cohort which showed that cardiac gating windows as determined by the Septal Scout provided sharper coronary images compared with conventional ECG gating. The scientific knowledge and technical developments presented in this thesis are intended to improve CMRA as a non-invasive diagnostic tool of CAD. In the future, I intend to integrate the concepts presented here into a functioning MRI-based cardiac gating system. As well, I intend to validate the Septal Scout in a patient cohort study.

Increasingly, cell-based therapy with autologous progenitor populations, such as endothelial progenitor cells (EPC), are being utilized for treatment of vascular diseases. However, both the number and functional capacity are diminished when cells are derived from patients with established risk factors for coronary artery disease (CAD). Herein, we report that inhibition of glycogen synthase kinase 3 (GSK) can improve both the number and function of endothelial progenitor cells in patients with CAD or diabetes mellitus (DM) leading to greater therapeutic benefit. Specifically, use of various small molecule inhibitors of GSK (GSKi) results in a 4-fold increased number of EPCs. Moreover, GSKi treatment improves the functional profile of EPCs through reductions in apoptosis, improvements in cell adhesion through up-regulation of very-late antigen-4 (VLA-4), and by increasing paracrine efficacy by increasing vascular endothelial growth factor (VEGF)secretion. Therapeutic improvement was confirmed in vivo by increased reendothelialization(RE) and reductions of neointima (NI) formation achieved when GSKi-treated cells were administered following vascular injury to CD-1 nude mice. Because cell-based therapy is technically challenging, we also tested a strategy of local delivery of GSKi at the site of arterial injury through GSKi-eluting stents. In vitro, GSKi elution increased EPC attachment to stent struts. In vivo, GSKi-eluting stents deployed in rabbit carotid arteries resulted in systemic mobilization of EPCs, improved local RE, and important reductions in in-stent NI formation. Finally, we tested the ability of GSKi to improve EPC-mediated arterial repair in patients with DM. As in patients with CAD, GSKi treatment improved EPC yield and diminished in vitro apoptosis. Utilizing a proteomics approach, we identified Cathepsin B (catB) as a differentially regulated protein necessary for reductions in apoptosis. Indeed, antagonism of catB prevented GSKi improvements in GSKi treated EPC mediated arterial repair in a xenotransplant wire injury model. Thus, our data demonstrates that GSKi treatment results in improvements in EPC number and function in vitro and in vivo resulting in enhanced arterial repair following mechanical injury. Accordingly, GSK antagonism is an effective cell enhancement strategy for autologous cell-based therapy with EPCs from high risk patients such as CAD or DM.

Coronary artery disease (CAD) is the leading cause of death worldwide. Treatment with coronary interventions, long-term treatment and life style changes can reduce symptoms and improve prognosis. The aim of this thesis was to investigate aspects of invasive treatment for multivessel coronary artery disease, and to investigate adherence to prevention guidelines one year after myocardial infarction.  We used the national quality registry SWEDEHEART to collect data on long term treatment one year after myocardial infarction for 51 620 patients &lt; 75 years of age. For 17 236 of the patients, we collected LDL-cholesterol measurements from SWEDEHEART and defined use of lipid lowering drugs from the Prescribed Drug Register. We developed a questionnaire for post-PCI-patients to investigate patients’ understanding of cause and treatment of coronary artery disease. For 23 342 PCI-patients with multivessel coronary artery disease, SWEDEHEART-data was linked to Swedish health data registries to determine one year outcome for patients undergoing incomplete vs. complete revascularization.   Lipid control (LDL-cholesterol &lt; 1.8 mmol/L) was attained by one in four patients one year after myocardial infarction, whereas blood pressure control (&lt; 140 mmHg) was attained by two thirds of patients. Lipid and blood pressure control was lower for women but there was no gender difference in smoking cessation rate: 56 %. Over 90 % of patients were treated with a statin after myocardial infarction but treatment was intensified for only one in five patients with LDL-cholesterol above target. The questionnaire study revealed that non-modifiable factors such as age and heredity were more often seen as cause of coronary artery disease than modifiable life style factors. Only one in five patients perceived CAD as a chronic illness, requiring life style changes. Two thirds of PCI-patients with multivessel disease underwent incomplete revascularisation, and this was associated with a twofold risk for the combination of death, myocardial infarction and repeat revascularization up to one year, compared to patients who underwent complete revascularization. We conclude that  long term treatment after myocardial infarction is suboptimal in relation to guideline recommendations. Assessment of patients’ views on CAD and better health education post PCI may facilitate life style changes. Further studies need to investigate whether complete revascularization will improve outcome for PCI-patients with multivessel disease.

Research shows that the interaction between the weather conditions and human health exists and this interaction has a very wide range, from subjective well-being to death. With respect to reactions to weather variations, people can be divided into weather-resistant and weather-sensitive. However, there is the lack of standardised tools to evaluate weather sensitivity. People with heart disease and people with sensitive nervous system are considered to be more sensitive to weather change than others. There are evidences that psychological distress and Type D personality are both associated with development and progression of coronary artery disease. Also, it is hypothesized that individual differences such as personality traits may have an effect on sensitivity to weather. The aim of this study was to examine and to evaluate associations between weather parameters and subjective well-being of patients with coronary artery disease. The objectives of the study: 1) to examine the validity of Type D personality assessment instrument used in this study; 2) to develop and test the psychometric properties of self-assessment diary for weather sensitivity in patients with coronary artery disease; 3) to evaluate associations between the subjective well-being of patients with coronary artery disease and the weather parameters; 4) to evaluate associations between anxiety, depression and personality and the subjective weather-related well-being in patients with coronary artery disease. / Moksliniai tyrimai rodo, kad egzistuoja sąveika tarp orų pokyčių ir žmonių sveikatos ir ši sąveika sudaro labai platų spektrą – nuo subjektyvios savijautos pablogėjimo iki mirties. Dėl reakcijų į orų pokyčius, žmonės gali būti suskirstyti į dvi grupes – jautrius orų pokyčiams ir atsparius. Tačiau standartizuotų instrumentų, kurie leistų įvertinti jautrumą orams ir atskirti jautrius orų pokyčiams asmenis, ypač skirtingų susirgimų grupėse, trūksta. Sergantieji širdies ligomis ir asmenys išgyvenantys psichologinį distresą priskiriami prie vienų iš jautriausių orų pokyčiams. Įrodyta, kad tiek psichologinis distresas, tiek asmenybės D tipas yra susiję su išeminės širdies ligos išsivystymu ir progresavimu. Be to, pastaraisiais metais keliamos hipotezės, kad individualūs skirtumai, tokie kaip asmenybės bruožai, taip pat gali įtakoti jautrumą orams. Darbo tikslas buvo išnagrinėti ir įvertinti sergančiųjų išemine širdies liga subjektyvios savijautos sąsajas su orais ir jos ryšį su asmenybės bruožais, nerimo ir depresijos simptomais. Darbo uždaviniai: 1) validizuoti tyrime naudojamą instrumentą asmenybės D tipui vertinti; 2) sukurti savikontrolės dienyną jautrumui orams įvertinti ir atlikti jo psichometrinę analizę; 3) nustatyti sąsajas tarp sergančiųjų išemine širdies liga subjektyvios savijautos ir orų, 4) įvertinti sergančiųjų išemine širdies liga subjektyvios orų sąlygotos savijautos sąsajas su nerimu, depresija ir asmenybės bruožais.