Total documents retrieved: 20
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EMBASE <1980 to 2009 Week 45>
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<1>
Accession Number
2009492945
Authors
Ejaz A.A. Martin T.D. Johnson R.J. Winterstein A.G. Klodell C.T. Hess Jr.
P.J. Ali A.K. Whidden E.M. Staples N.L. Alexander J.A. House-Fancher M.A.
Beaver T.M.
Institution
(Ejaz, Johnson, Whidden) Division of Nephrology, Hypertension and
Transplantation, University of Florida, Gainesville, FL, United States.
(Martin, Klodell, Hess Jr., Staples, House-Fancher, Beaver) Division of
Thoracic and Cardiothoracic Surgery, University of Florida, Gainesville,
FL, United States.
(Winterstein, Ali) Department of Pharmaceutical Outcomes and Policy,
University of Florida, Gainesville, FL, United States.
(Johnson, Alexander) Renal Diseases and Hypertension, University of
Colorado Health Sciences Center, Denver, Colo, United States.
Title
Prophylactic nesiritide does not prevent dialysis or all-cause mortality
in patients undergoing high-risk cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 138(4)(pp 959-964), 2009.
Date of Publication: October 2009.
Publisher
Mosby Inc.
Abstract
Objectives: Natriuretic peptides have been shown to improve renal blood
flow and stimulate natriuresis. In a recent retrospective trial, we
documented that prophylactic use of nesiritide was associated with a 66%
reduction in the odds for dialysis or in-hospital mortality at 21 days in
patients undergoing high-risk cardiac surgery; therefore, we designed a
prospective trial. Methods: This prospective, randomized, clinical trial
included 94 patients undergoing high-risk cardiac surgery comparing a
5-day course of continuous nesiritide (at a dose of 0.01 mug . kg-1 .
min-1 started before surgery) versus placebo. The primary end point was
dialysis and/or all-cause mortality within 21 days; secondary end points
were incidence of acute kidney injury, renal function, and length of stay.
Results: Nesiritide did not reduce the primary end point of incidence of
dialysis and/or all-cause mortality through day 21 (6.6% vs 6.1%; P =
.914). Fewer patients receiving nesiritide had acute kidney injury
(defined as an absolute increase in serum creatinine [greater-than or
equal to] 0.3 mg/dL from baseline or a percentage increase in serum
creatinine [greater-than or equal to] 50% from baseline within 48 hours)
compared with controls (2.2% vs 22.4%; P = .004), and mean serum
creatinine was lower in the immediate postoperative period in the
nesiritide group (1.18 +/- 0.41 mg/dL vs 1.45 +/- 0.74 mg/dL; P = .028).
However, no difference in length of stay was noted (nesiritide 20.73 +/-
3.05 days vs control 21.26 +/- 4.03 days; P = .917). Conclusions: These
results do not demonstrate a benefit for prophylactic use of nesiritide on
the incidence of dialysis and/or death in patients undergoing high-risk
cardiac surgery. Although nesiritide may provide some renal protection in
the immediate postoperative period, no effect on length of stay was
observed. copyright 2009 The American Association for Thoracic Surgery.
<2>
Accession Number
2009470788
Authors
Prabhu A. Sujatha D.I. Kanagarajan N. Vijayalakshmi M.A. Ninan B.
Institution
(Prabhu) Department of Biochemistry, MMM Academy of Medical Sciences,
Chennai, India.
(Sujatha, Kanagarajan, Ninan) Department of Cardiac Anesthesia, Madras
Medical Mission, Chennai, India.
(Vijayalakshmi) Centre for Bio-Separation Technology, VIT University,
Vellore, India.
Title
Effect of N-Acetylcysteine in Attenuating Ischemic Reperfusion Injury in
Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary
Bypass.
Source
Annals of Vascular Surgery. 23(5)(pp 645-651), 2009. Date of Publication:
September 2009/October 2009.
Publisher
Elsevier Inc.
Abstract
Ischemic reperfusion injury due to oxidative stress remains one of the
challenging problems during cardiac surgeries. The imbalance in the
production of free radicals and antioxidants in vivo determines the extent
of oxidative stress. The use of antioxidants in cardioplegia has become an
important strategy to salvage the myocardium from the attack of these
radicals. The objective of this study was to analyze the cardioprotective
effect of N-acetylcysteine (NAC) on early reperfusion injury in patients
undergoing coronary artery bypass grafting using biochemical markers.
Fifty-three patients with left ventricular ejection fraction >0.4
scheduled for coronary artery bypass grafting with cardiopulmonary bypass
were selected and divided into two groups. The first group of patients (n
= 25) received isothermic cardioplegia alone, whereas the second group of
patients (n = 28) received cardioplegia enriched with NAC (50 mg/kg body
weight). The free radicals, antioxidants, cardiac troponin I, and
hemodynamic and clinical properties of the patients were preoperatively
and postoperatively evaluated at five different time intervals.
Malondialdehyde level as a measure of free radicals was significantly
lower in the NAC-enriched group during reperfusion (p < 0.05) and after 12
hr (p < 0.05) and 24 hr (p < 0.001) of surgery. All the antioxidants were
elevated in the test group during the reperfusion period (p < 0.01). A
significant improvement (p = 0.001) in the postoperative ejection fraction
was noted in the test group. No significant differences were observed
between the groups in the level of cardiac troponin I (p = not
significant). The use of NAC in patients undergoing coronary artery bypass
grafting using cardiopulmonary bypass decreased oxidative stress
substantially. However, it did not lead to improvement in the level of
cardiac troponin I, a marker of myocardial injury, in our study. Hence,
the cardioprotective effect of NAC and the adaptation of the myocardium to
oxidative stress should be extensively studied. copyright 2009 Annals of
Vascular Surgery Inc.
<3>
Accession Number
2009492927
Authors
Xiong J. Jiang B. Guo W. Wang S.-M. Tong X.-Y.
Institution
(Xiong, Guo) Department of Vascular Surgery, Clinical Division of Surgery,
Chinese PLA General Hospital, Beijing, China.
(Jiang) Division of Cardiology, University of Washington, Seattle, Wash,
United States.
(Wang) Department of Vascular Surgery, Institute of Vascular Surgery, The
First Affiliated Hospital, Guangzhou, China.
(Tong) Department of Statistics, Chinese PLA General Hospital, Beijing,
China.
Title
Endovascular stent graft placement in patients with type B aortic
dissection: A meta-analysis in China.
Source
Journal of Thoracic and Cardiovascular Surgery. 138(4)(pp 865-872.e1),
2009. Date of Publication: October 2009.
Publisher
Mosby Inc.
Abstract
Objective: We summarized all published studies for endovascular stent
graft placement among patients with type B aortic dissection in China with
respect to clinical success, complications, and outcomes. Methods: A
meta-analysis was performed on all published studies of retrograde
endovascular stent graft placement encompassing 3 or more patients with
type B aortic dissection. Thirty-nine studies, involving a total of 1304
patients from January 2001 to December 2007, were included. Results: The
average patient age was 52 years. Procedural success was reported in 99.2%
+/- 0.1% of patients. Major complications were reported in 3.4% +/- 0.1%
patients, with the most severe neurologic complications in 0.6%.
Periprocedural stroke was encountered more frequently than paraplegia
(0.2% vs 0%). The overall 30-day mortality was 2.6% +/- 0.1%. In addition,
1.5% +/- 0.1% of patients died over a mean follow-up period of 27.1 +/-
17.5 months. Life-table analysis yielded overall survival rates of 96.9%
at 30 days, 96.7% at 6 months, 96.4% at 1 year, 95.6% at 2 years, and
95.2% at 5 years. Conclusion: Although therapy with traditional medicines
still remains the first line of treatment for type B aortic dissection,
endovascular stent graft placement has shown its advantages, with a
success rate of 99% or greater in a select cohort. The technical survival
rate, major complications, and acute and midterm survival rates in the
Chinese-language literature appeared to favorably compare with that seen
in published literature. This analysis is the first to provide an overview
of the currently available literature on endovascular stent graft
placement in type B aortic dissection in China. copyright 2009 The
American Association for Thoracic Surgery.
<4>
Accession Number
2009530114
Authors
Karthikeyan G. Moncur R.A. Levine O. Heels-Ansdell D. Chan M.T.V.
Alonso-Coello P. Yusuf S. Sessler D. Villar J.C. Berwanger O. McQueen M.
Mathew A. Hill S. Gibson S. Berry C. Yeh H.-M. Devereaux P.J.
Institution
(Karthikeyan, Yusuf) Department of Cardiology, All India Institute of
Medical Sciences, New Delhi, India.
(Karthikeyan, Yusuf, McQueen, Devereaux) Department of Medicine, Hamilton
Health Sciences, McMaster University, Hamilton, Ont., Canada.
(Karthikeyan, Heels-Ansdell, Yusuf, Devereaux) Department of Clinical
Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster
University, Hamilton, Ont., Canada.
(McQueen, Hill) Department of Pathology and Molecular Medicine, Hamilton
Health Sciences, McMaster University, Hamilton, Ont., Canada.
(Karthikeyan, Yusuf, McQueen, Devereaux) Population Health Research
Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ont.,
Canada.
(Moncur) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, Ont., Canada.
(Levine) School of Medicine, Queen's University, Kingston, Ont., Canada.
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong, Hong Kong.
(Alonso-Coello) Iberoamerican Cochrane Center, Hospital Sant Pau,
Barcelona, Spain.
(Alonso-Coello) CIBER de Epidemiologia y Salud Publica (CIBERESP),
Barcelona, Spain.
(Sessler) Department of Outcomes Research, The Cleveland Clinic,
Cleveland, OH, United States.
(Villar) Facultad de Medicina, Universidad de la Sabana, Bogota, Colombia.
(Berwanger) Research Institute (IEP-HCor), Hospital do Coracao-/HCor, Sao
Paulo, Brazil.
(Mathew) Department of Medicine, University of Western Ontario in London,
London, Ont., Canada.
(Gibson) Department of General and Vascular Surgery, Gartnavel General
Hospital, Glasgow, United Kingdom.
(Berry) BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine,
University of Glasgow, Glasgow, United Kingdom.
(Yeh) Department of Anesthesiology, National Taiwan University Hospital,
Taipei, Taiwan (Republic of China).
Title
Is a Pre-Operative Brain Natriuretic Peptide or N-Terminal Pro-B-Type
Natriuretic Peptide Measurement an Independent Predictor of Adverse
Cardiovascular Outcomes Within 30 Days of Noncardiac Surgery?. A
Systematic Review and Meta-Analysis of Observational Studies.
Source
Journal of the American College of Cardiology. 54(17)(pp 1599-1606),
2009. Date of Publication: 20 Oct 2009.
Publisher
Elsevier USA
Abstract
Objectives: We conducted a systematic review and meta-analysis to
determine if pre-operative brain natriuretic peptide (BNP) (i.e., BNP or
N-terminal pro-B-type natriuretic peptide [NT-proBNP]) is an independent
predictor of 30-day adverse cardiovascular outcomes after noncardiac
surgery. Background: Pre-operative clinical cardiac risk indices have only
modest predictive power. BNP predicts adverse cardiovascular outcomes in a
variety of nonsurgical settings and may similarly predict these outcomes
in the perioperative setting. Methods: We employed 5 search strategies
(e.g., searching bibliographic databases), and we included all studies
that assessed the independent prognostic value of pre-operative BNP
measurement as a predictor of cardiovascular complications after
noncardiac surgery. We determined study eligibility and conducted data
abstraction independently and in duplicate. We calculated a pooled odds
ratio using a random effects model. Results: Nine studies met eligibility
criteria, and included a total of 3,281 patients, among whom 314
experienced 1 or more perioperative cardiovascular complications. The
average proportion of patients with elevated BNP was 24.8% (95% confidence
interval [CI]: 20.1 to 30.4%; I2 = 89%). All studies showed a
statistically significant association between an elevated pre-operative
BNP level and various cardiovascular outcomes (e.g., a composite of
cardiac death and nonfatal myocardial infarction; atrial fibrillation).
Data pooled from 7 studies demonstrated an odds ratio (OR) of 19.3 (95%
CI: 8.5 to 43.7; I2 = 58%). The pre-operative BNP measurement was an
independent predictor of perioperative cardiovascular events among studies
that only considered the outcomes of death, cardiovascular death, or
myocardial infarction (OR: 44.2, 95% CI: 7.6 to 257.0, I2 = 51.6%), and
those that included other outcomes (OR: 14.7, 95% CI: 5.7 to 38.2, I2 =
62.2%); the p value for interaction was 0.28. Conclusions: These results
suggest that an elevated pre-operative BNP or NT-proBNP measurement is a
powerful, independent predictor of cardiovascular events in the first 30
days after noncardiac surgery. copyright 2009 American College of
Cardiology Foundation.
<5>
Accession Number
2009525463
Authors
Lai V.K. Ang K.-L. Rathbone W. Harvey N.J. Galinanes M.
Institution
(Lai, Ang, Rathbone, Galinanes) Department of Cardiovascular Sciences,
University of Leicester, Glenfield Hospital, Leicester LE3 9QP, United
Kingdom.
(Harvey) Glenfield Hospital, Leicester LE3 9QP, United Kingdom.
Title
Randomized controlled trial on the cardioprotective effect of bone marrow
cells in patients undergoing coronary bypass graft surgery.
Source
European Heart Journal. 30(19)(pp 2354-2359), 2009. Date of Publication:
October 2009.
Publisher
Oxford University Press
Abstract
Aims This randomized study investigates whether bone marrow cells (BMCs)
can reduce ischaemic injury during cardiac surgery.Methods and
resultsForty-four elective coronary artery bypass grafting patients were
randomized to control group or BMCs group (whereby autologous BMCs were
administered with each dose of cardioplegia antegradely into the
coronaries). Troponin I and CK-MB were measured during the first 48 h
after surgery and were not significantly different between the control and
BMCs groups. The role of cardiopulmonary bypass (CPB) on the
cardioprotective effects of BMCs was also studied using an in vitro model
of stimulated ischaemia and reoxygenation on right atrial appendages
obtained from controls either before or 10 min after the initiation of
CPB. Bone marrow cells significantly reduced myocardial injury in muscles
obtained prior to CPB. This effect was comparable with ischaemic
preconditioning (IP), although their combination did not afford additional
benefit. However, when muscles were harvested after CPB, myocardial injury
in the ischaemic group alone was less, and BMCs or IP did not exert
further protection.ConclusionBone marrow cells did not afford additional
benefit when used as an additive to cardioplegia during CPB. However, BMCs
offer cardioprotection as potent as IP, when the heart is not subjected to
stress, such as CPB, that per se can precondition the myocardium.
<6>
Accession Number
2009525460
Authors
Fox K. Ford I. Steg P.G. Tendera M. Robertson M. Ferrari R.
Institution
(Fox) Royal Brompton Hospital, Sydney Street, London, United Kingdom.
(Ford, Robertson) Robertson Centre for Biostatistics, University of
Glasgow, Glasgow, United Kingdom.
(Steg) INSERM U-698, Hopital Bichat-Claude Bernard, University Paris 7,
Paris, France.
(Tendera) Medical University of Silesia, Katowice, Poland.
(Ferrari) Chair of Cardiology, University of Ferrara, S. Maugeri
Foundation, Ferrara, Italy.
Title
Relationship between ivabradine treatment and cardiovascular outcomes in
patients with stable coronary artery disease and left ventricular systolic
dysfunction with limiting angina: A subgroup analysis of the randomized,
controlled BEAUTIFUL trial.
Source
European Heart Journal. 30(19)(pp 2337-2345), 2009. Date of Publication:
October 2009.
Publisher
Oxford University Press
Abstract
Aims BEAUTIFUL found no impact of ivabradine on outcomes in patients with
stable coronary artery disease (CAD) and left ventricular systolic
dysfunction (LVSD). We performed a post hoc analysis of the effect of
ivabradine in BEAUTIFUL patients whose limiting symptom at baseline was
angina, particularly in terms of coronary outcomes.Methods and results Of
the BEAUTIFUL population, 13.8% had limiting angina at baseline (734
ivabradine, 773 placebo); of these, 712 patients had heart rate
[greater-than or equal to]70 b.p.m. Median duration of follow-up was 18
months. Ivabradine was associated with a 24 reduction in the primary
endpoint (cardiovascular mortality or hospitalization for fatal and
non-fatal myocardial infarction [MI] or heart failure) (HR, 0.76; 95% CI,
0.58-1.00) and a 42% reduction in hospitalization for MI (HR, 0.58, 95%
CI, 0.37-0.92). In patients with heart rate [greater-than or equal to]70
b.p.m., there was a 73% reduction in hospitalization for MI (HR, 0.27, 95%
CI, 0.11-0.66) and a 59% reduction in coronary revascularization (HR,
0.41, 95% CI, 0.17-0.99). Ivabradine was safe and well
tolerated.ConclusionOur analyses raises the possibility that ivabradine
may be helpful to reduce major cardiovascular events in patients with
stable CAD and LVSD who present with limiting angina. However, a
large-scale clinical trial is ongoing, which will formally test this
hypothesis.
<7>
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Accession Number
2009501522
Authors
Schouten E.S. Van De Pol A.C. Schouten A.N.J. Turner N.M. Jansen N.J.G.
Bollen C.W.
Institution
(Schouten, Van De Pol, Jansen, Bollen) Division of Pediatric Intensive
Care, Wilhelmina Children's Hospital, University Medical Center, Utrecht,
Netherlands.
(Schouten, Turner) Division of Perioperative Care and Emergency Medicine,
Wilhelmina Children's Hospital, University Medical Center, Utrecht,
Netherlands.
Title
The effect of aprotinin, tranexamic acid, and aminocaproic acid on blood
loss and use of blood products in major pediatric surgery: A
meta-analysis.
Source
Pediatric Critical Care Medicine. 10(2)(pp 182-190), 2009. Date of
Publication: 01 Mar 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Aprotinin reduces the blood loss and transfusion of blood
products in children undergoing major surgery. Aprotinin has been
associated with severe side effects in adults, and tranexamic acid and
aminocaproic acid have been found to be safer alternatives in adults. This
systematic review addresses the question of whether tranexamic acid and
aminocaproic acid are equally effective as aprotinin for reducing blood
loss and transfusion in children undergoing major surgery. Data Sources: A
systematic review of the literature was conducted to identify all
randomized controlled trials of aprotinin, tranexamic acid, and
aminocaproic acid involving children undergoing cardiac or scoliosis
surgery. Study Selection and Data Extraction: Twenty-three cardiac
studies, totaling 1893 patients, met the inclusion criteria. None of the
studies directly compared aprotinin to an alternative antifibrinolytic.
Five scoliosis studies, totaling 207 patients, met the inclusion criteria.
Data on blood loss and use of blood products in the first 24 postoperative
hours were extracted. Only homogenously distributed outcomes were pooled.
Data Synthesis: Tranexamic acid showed a homogeneously distributed
reduction of blood loss by 11 mL/kg (95% confidence interval [CI] 9-13
mL/kg). Outcomes of blood loss reduction by aprotinin and aminocaproic
acid were too heterogeneously distributed to be pooled, so the effect on
blood loss could not be evaluated. Both aprotinin and tranexamic acid
significantly reduced packed red cell transfusion (4 mL/kg, 95% CI 2-7
mL/kg and 7 mL/kg, 95% CI 5-10 mL/kg, respectively). Type of
antifibrinolytic was not a determining factor that explained differences
in outcome among trials in a meta-regression analysis. In the scoliosis
studies, aprotinin and tranexamic acid significantly reduced blood loss
compared with placebo (385 mL, 95% CI 727-42 mL and 682 mL, 95% CI
1149-214 mL, respectively). Conclusions: There is no evidence that
suggests that, compared with aprotinin, alternative antifibrinolytics such
as tranexamic acid were less effective in reducing blood loss in major
pediatric surgery. copyright 2009 by the Society of Critical Care Medicine
and the World Federation of Pediatric Intensive and Critical Care
Societies.
<8>
Accession Number
2009497395
Authors
Wykrzykowska J.J. Serruys P.W. Onuma Y. de Vries T. van Es G.-A. Buszman
P. Linke A. Ischinger T. Klauss V. Corti R. Eberli F. Wijns W. Morice
M.-C. di Mario C. van Geuns R.J. Juni P. Windecker S.
Institution
(Wykrzykowska, Serruys, Onuma, van Geuns) Department of Interventional
Cardiology Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands.
(de Vries, van Es) Cardialysis, Rotterdam, Netherlands.
(Buszman) Medical University of Silesia, Katowice, Poland.
(Linke) Herzzentrum Leipzig, Leipzig, Germany.
(Ischinger) Department of Cardiology, Hospital Bogenhausen, Munich,
Germany.
(Klauss) Department of Cardiology, University Hospital Munich
(Innenstadt), Munich, Germany.
(Corti, Eberli) Department of Cardiology, University Hospital, Zurich,
Switzerland.
(Wijns) Department of Cardiology, Onze Lieve Vrouw Ziekenhuis, Aalst,
Belgium.
(Morice) Institut Cardiovasculaire, Paris-Sud, France.
(di Mario) Department of Cardiology, Royal Brompton Hospital, London,
United Kingdom.
(Juni) Clinical Trials Unit Bern, Bern University Hospital, Bern,
Switzerland.
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland.
(Eberli) Triemlispital, Zurich, Switzerland.
Title
Impact of Vessel Size on Angiographic and Clinical Outcomes of
Revascularization With Biolimus-Eluting Stent With Biodegradable Polymer
and Sirolimus-Eluting Stent With Durable Polymer. The LEADERS Trial
Substudy.
Source
JACC: Cardiovascular Interventions. 2(9)(pp 861-870), 2009. Date of
Publication: September 2009.
Publisher
Elsevier Inc.
Abstract
Objectives: We assessed the impact of vessel size on outcomes of stenting
with biolimus-eluting degradable polymer stent (BES) and sirolimus-eluting
permanent polymer stent (SES) within a randomized multicenter trial
(LEADERS). Background: Stenting of small vessels might be associated with
higher rates of adverse events. Methods: "All-comer" patients (n = 1,707)
were randomized to BES and SES. Post-hoc-stratified analysis of
angiographic and clinical outcomes at 9 months and 1 year, respectively,
was performed for vessels with reference diameter [less-than or equal
to]2.75 mm versus >2.75 mm. Results: Of 1,707 patients, 429 patients in
the BES group with 576 lesions and 434 patients in the SES group with 557
lesions had only small vessels treated (50.6% of the patient cohort). In
patients with small vessels there was no significant difference in overall
major adverse cardiac events (MACE) rate (12.1% vs. 11.8%; p = 0.89) or
target lesion revascularization (TLR) rate (9.6% vs. 7.4%; p = 0.26)
between BES and SES. The MACE and TLR rates in the small-vessel patient
population were higher than in the large-vessel population. The TLR rate
was 9.6% versus 2.6%, and MACE rate was 12.1% versus 7.1% for small versus
large vessels in the BES arm (TLR: hazard ratio [HR] = 3.724, p = 0.0013;
MACE: HR = 1.720, p = 0.0412). In the SES arm, TLR was 7.4% versus 5.1%,
and MACE was 11.8% versus 10.3% in small versus large vessels (TLR: HR =
1.435, p = 0.2594; MACE: HR = 1.149, p = 0.5546). Conclusions: Prevalence
of small vessel disease is high in an "all-comer" population with higher
TLR and MACE rates. The BES and SES seem equivalent in treatment outcomes
of small vessels in this "all-comer" patient population. copyright 2009
American College of Cardiology Foundation.
<9>
Accession Number
2009520906
Authors
Mehran R. Lansky A.J. Witzenbichler B. Guagliumi G. Peruga J.Z. Brodie
B.R. Dudek D. Kornowski R. Hartmann F. Gersh B.J. Pocock S.J. Wong S.C.
Nikolsky E. Gambone L. Vandertie L. Parise H. Dangas G.D. Stone G.W.
Institution
(Mehran, Lansky, Nikolsky, Gambone, Vandertie, Parise, Dangas, Stone) New
York-Presbyterian Hospital, the Cardiovascular Research Foundation, New
York, NY, United States.
(Witzenbichler) Charite Campus Benjamin Franklin, Berlin, Germany.
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy.
(Peruga) Silesian Center for Heart Disease, Lodz, Poland.
(Brodie) LeBauer Cardiovascular Research Foundation, Moses Cone Hospital,
Greensboro, NC, United States.
(Dudek) Jagiellonian University, Krakow, Poland.
(Kornowski) Rabin Medical Center, Petach Tikva, Israel.
(Hartmann) Universitatsklinikum Schleswig-Holstein, Lubeck, Germany.
(Gersh) Mayo Clinic, Rochester, MN, United States.
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom.
(Wong) New York-Presbyterian Hospital, Weill Cornell Medical Center, New
York, NY, United States.
Title
Bivalirudin in patients undergoing primary angioplasty for acute
myocardial infarction (HORIZONS-AMI): 1-year results of a randomised
controlled trial.
Source
The Lancet. 374(9696)(pp 1149-1159), 2009. Date of Publication: 09 Oct
2009.
Publisher
Elsevier Limited
Abstract
Background: In the HORIZONS-AMI trial, patients with acute ST-segment
elevation myocardial infarction (STEMI) undergoing percutaneous coronary
intervention (PCI) who were treated with the thrombin inhibitor
bivalirudin had substantially lower 30-day rates of major haemorrhagic
complications and net adverse clinical events than did patients assigned
to heparin plus a glycoprotein IIb/IIIa inhibitor (GPI). Here, we assess
whether these initial benefits were maintained at 1 year of follow-up.
Methods: Patients aged 18 years or older were eligible for enrolment in
this multicentre, open-label, randomised controlled trial if they had
STEMI, presented within 12 h after the onset of symptoms, and were
undergoing primary PCI. 3602 eligible patients were randomly assigned by
interactive voice response system in a 1:1 ratio to receive bivalirudin
(0.75 mg/kg intravenous bolus followed by 1.75 mg/kg per h infusion;
n=1800) or heparin plus a GPI (control; 60 IU/kg intravenous bolus
followed by boluses with target activated clotting time 200-250 s;
n=1802). The two primary trial endpoints were major bleeding and net
adverse clinical events (NACE; consisting of major bleeding or composite
major adverse cardiovascular events [MACE; death, reinfarction, target
vessel revascularisation for ischaemia, or stroke]). This prespecified
analysis reports data for the 1-year follow-up. Analysis was by intention
to treat. Patients with missing data were censored at the time of
withdrawal from the study or at last follow-up. This trial is registered
with ClinicalTrials.gov, number NCT00433966. Findings: 1-year data were
available for 1696 patients in the bivalirudin group and 1702 patients in
the control group. Reasons for participant dropout were loss to follow-up
and withdrawal of consent. The rate of NACE was lower in the bivalirudin
group than in the control group (15.6% vs 18.3%, hazard ratio [HR] 0.83,
95% CI 0.71-0.97, p=0.022), as a result of a lower rate of major bleeding
in the bivalirudin group (5.8% vs 9.2%, HR 0.61, 0.48-0.78, p<0.0001). The
rate of MACE was similar between groups (11.9% vs 11.9%, HR 1.00,
0.82-1.21, p=0.98). The 1-year rates of cardiac mortality (2.1% vs 3.8%,
HR 0.57, 0.38-0.84, p=0.005) and all-cause mortality (3.5% vs 4.8%, HR
0.71, 0.51-0.98, p=0.037) were lower in the bivalirudin group than in the
control group. Interpretation: In patients with STEMI undergoing primary
PCI, anticoagulation with bivalirudin reduced the rates of net adverse
clinical events and major bleeding at 1 year compared with treatment with
heparin plus a GPI. This finding has important clinical implications for
the selection of optimum treatment strategies for patients with STEMI.
Funding: Cardiovascular Research Foundation, with unrestricted grant
support from Boston Scientific Corporation and The Medicines Company.
copyright 2009 Elsevier Ltd. All rights reserved.
<10>
Accession Number
2009502101
Authors
Song Y.R. Lee T. You S.J. Chin H.J. Chae D.-W. Lim C. Park K.-H. Han S.
Kim J.-H. Na K.Y.
Institution
(Song) Department of Internal Medicine, Hallym University, Bundang
Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South
Korea.
(Lee, You, Chin, Chae, Na) Department of Internal Medicine,
(Lim, Park) Thoracic and Cardiovascular Surgery,
(Han, Kim) Anesthesiology and Pain Medicine, Seoul National University,
Bundang Hospital, Seongnam,
(Chin, Chae, Lim, Park, Han, Kim, Na) Seoul National University, College
of Medicine, Seoul, South Korea.
Title
Prevention of acute kidney injury by erythropoietin in patients undergoing
coronary artery bypass grafting: A pilot study.
Source
American Journal of Nephrology. 30(3)(pp 253-260), 2009. Date of
Publication: September 2009.
Publisher
S. Karger AG
Abstract
Background/Aims: Depending on the specific definition, acute kidney injury
(AKI) occurs in 7-40% of patients undergoing cardiac surgery. Even small
changes in serum creatinine (SCr) levels are associated with increased
mortality after cardiac surgery. However, there are no current methods for
preventing AKI after cardiac surgery. Erythropoietin (EPO) has been shown
to elicit tissue-protective effects in various experimental models. In
this pilot trial, we evaluated the effectiveness of EPO in the prevention
of AKI after coronary artery bypass grafting (CABG). Methods: 71 patients
scheduled for elective CABG randomly received either 300 U/kg of EPO or
saline intravenously before surgery. AKI was defined as a 50% increase in
SCr levels over baseline within the first 5 postoperative days. Estimated
glomerular filtration rate (eGFR) was calculated from the Cockcroft-Gault
equation. Results: Of 71 patients, 13 developed postoperative AKI: 3 of
the 36 patients in the EPO group (8%) and 10 of the 35 patients in the
placebo group (29%; p = 0.035). The increase in postoperative SCr
concentration and the decline in postoperative eGFR were significantly
lower in the EPO group than in the placebo group. Conclusions: In our
small, pilot trial, prophylactic administration of EPO prevents AKI and
improves postoperative renal function. These data are preliminary and
require confirmation in a larger clinical trial. copyright 2009 S. Karger
AG, Basel.
<11>
Accession Number
2009503460
Authors
Fornara P. Greco F.
Institution
(Fornara, Greco) Department of Urology and Kidney Transplantation,
Martin-Luther-University, Ernst-Grube-Strasse 40, 06120 Halle/Saale,
Germany.
Title
Editorial Comment on: Systematic Review and Meta-Analysis of
Robotic-Assisted versus Conventional Laparoscopic Pyeloplasty for Patients
with Ureteropelvic Junction Obstruction: Effect on Operative Time, Length
of Hospital Stay, Postoperative Complications, and Success Rate.
Source
European Urology. 56(5)(pp 858), 2009. Date of Publication: November
2009.
Publisher
Elsevier
<12>
Accession Number
2009512538
Authors
Venugopal V. Hausenloy D.J. Ludman A. Di Salvo C. Kolvekar S. Yap J.
Lawrence D. Bognolo J. Yellon D.M.
Institution
(Venugopal, Hausenloy, Ludman, Yellon) Hatter Cardiovascular Institute,
University College London Hospital, 67 Chenies Mews, London WC1E 6HX,
United Kingdom.
(Di Salvo, Kolvekar, Yap, Lawrence, Bognolo) Heart Hospital, University
College London Hospitals NHS Trust, London, United Kingdom.
Title
Remote ischaemic preconditioning reduces myocardial injury in patients
undergoing cardiac surgery with cold-blood cardioplegia: A randomised
controlled trial.
Source
Heart. 95(19)(pp 1567-1571), 2009. Date of Publication: October 2009.
Publisher
BMJ Publishing Group
Abstract
Background: Remote ischaemic preconditioning (RIPC) induced by brief
ischaemia and reperfusion of the arm reduces myocardial injury in coronary
artery bypass (CABG) surgery patients receiving predominantly crossclamp
fibrillation for myocardial protection. However, cold-blood cardioplegia
is the more commonly used method world wide. Objective: To assess whether
RIPC is cardioprotective in CABG patients receiving cold-blood
cardioplegia. Design: Single-centre, single-blinded, randomised controlled
trial. Setting: Tertiary referral hospital in London. Patients: Adults
patients (18-80 years) undergoing elective CABG surgery with or without
concomitant aortic valve surgery with cold-blood cardioplegia. Patients
with diabetes, renal failure (serum creatinine >130 mmol/l), hepatic or
pulmonary disease, unstable angina or myocardial infarction within the
past 4 weeks were excluded. Interventions: Patients were randomised to
receive either RIPC (n=23) or control (n=22) after anaesthesia. RIPC
comprised three 5 min cycles of right forearm ischaemia, induced by
inflating a blood pressure cuff on the upper arm to 200 mm Hg, with an
intervening 5 min reperfusion. The control group had a deflated cuff
placed on the upper arm for 30 min. Main outcome measures: Serum troponin
T was measured preoperatively and at 6, 12, 24, 48 and 72 h after surgery
and the area under the curve (AUC at 72 h) calculated. Results: RIPC
reduced absolute serum troponin T release by 42.4% (mean (SD) AUC at 72 h:
31.53 (24.04) mug/l.72 h in controls vs 18.16 (6.67) mug/l.72 h in RIPC;
95% CI 2.4 to 24.3; p=0.019). Conclusions: Remote ischaemic
preconditioning induced by brief ischaemia and reperfusion of the arm
reduces myocardial injury in CABG surgery patients undergoing cold-blood
cardioplegia, making this non-invasive cardioprotective technique widely
applicable clinically. Trial registration number: NCT00397163.
<13>
[Use Link to view the full text]
Accession Number
2009491048
Authors
Venkateswaran R.V. Dronavalli V. Lambert P.A. Steeds R.P. Wilson I.C.
Thompson R.D. Mascaro J.G. Bonser R.S.
Institution
(Venkateswaran, Dronavalli, Wilson, Thompson, Mascaro, Bonser) Department
of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation
Trust, Edgbaston, Birmingham- B15 2TH, United Kingdom.
(Lambert) Department of Immunology, Aston University, Aston Triangle,
Birmingham, United Kingdom.
(Steeds) Department of Cardiovascular Medicine, University Hospital
Birmingham NHS Trust, Edgbaston, Birmingham, United Kingdom.
Title
The proinflammatory environment in potential heart and lung donors:
Prevalence and impact of donor management and hormonal therapy.
Source
Transplantation. 88(4)(pp 582-588), 2009. Date of Publication:
August/2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background.: Brain stem death can elicit a potentially manipulable
cardiotoxic proinflammatory cytokine response. We investigated the
prevalence of this response, the impact of donor management with
tri-iodothyronine (T3) and methylprednisolone (MP) administration, and the
relationship of biomarkers to organ function and transplant suitability.
Methods.: In a prospective randomized double-blinded factorially designed
study of T3 and MP therapy, we measured serum levels of interleukin-1 and
-6 (IL-1 and IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive
protein, and procalcitonin (PCT) levels in 79 potential heart or lung
donors. Measurements were performed before and after 4 hr of
algorithm-based donor management to optimize cardiorespiratory function
and +/-hormone treatment. Donors were assigned to receive T3, MP, both
drugs, or placebo. Results.: Initial IL-1 was elevated in 16% donors, IL-6
in 100%, TNF-alpha in 28%, CRP in 98%, and PCT in 87%. Overall biomarker
concentrations did not change between initial and later measurements and
neither T3 nor MP effected any change. Both PCT (P =0.02) and TNF-alpha (P
=0.044) levels were higher in donor hearts with marginal hemodynamics at
initial assessment. Higher PCT levels were related to worse cardiac index
and right and left ventricular ejection fractions and a PCT level more
than 2 ng*mL may attenuate any improvement in cardiac index gained by
donor management. No differences were observed between initially marginal
and nonmarginal donor lungs. A PCT level less than or equal to 2 ng*mL but
not other biomarkers predicted transplant suitability following
management. Conclusions.: There is high prevalence of a proinflammatory
environment in the organ donor that is not affected by tri-iodothyronine
or MP therapy. High PCT and TNF-alpha levels are associated with donor
heart dysfunction. copyright 2009 by Lippincott Williams & Wilkins.
<14>
Accession Number
2009464118
Authors
Athappan G. Ponniah T.
Institution
(Athappan) Caritas St. Elizabeth Medical Center, Tufts School of Medicine,
Brighton, MA 02135, United States.
(Ponniah) Madurai Medical College, Madurai, India.
Title
Clinical outcomes of dialysis patients after implantation of DES: Meta
analysis and systematic review of literature.
Source
Minerva Cardioangiologica. 57(3)(pp 291-297), 2009. Date of Publication:
June 2009.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Aim. Studies on percutaneous transluminal cardiac angioplasty (PTCA) in
patients with end stage renal disease (ESRD) on hemodialysis have
suggested high rates of procedural complications and restenosis. Bare
metal stent percutaneous coronary intervention (PCI) has significantly
reduced restenosis and subsequent target lesion revascularization in these
patients, although not to the level of non dialysis controls. The
introduction of drug-eluting stents (DES) has dramatically reduced
restenosis rates compared with bare metal stents (BMS) in patients with
various clinical and angiographic characteristics, however their impact on
patients with ESRD on dialysis is unclear due to consistent exclusion of
this population from major trials. The purpose of this study was therefore
to compare the outcomes of PCI with DES and BMS when used for ESRD
patients on dialysis, by meta analytical techniques. Methods. Comparative
studies published between January 2002 and January 2009 of DES vs. BMS in
ESRD patients on dialysis were identified using an electronic search and
reviewed using a random effects model. The primary endpoints of our study
were the hard endpoints of mortality, myocardial infarction (MI) and
target lesion revascularization (TLR). A secondary endpoint of our
analysis was late luminal loss. In hospital mortality and MI were also
assessed. Heterogeneity was assessed using Cochrane Q and I2 statistics.
Results. Five reports comprising 641 patients (279 DES, and 362 BMS) were
included in the analysis. All the studies were non-randomized comparisons
between DES and BMS. The length of follow-up was in the range between 9
and 12 months. In hospital clinical outcomes were similar between the two
groups. At follow-up there was a trend towards lower TLR (OR 0.50, CI
0.27-0.93, P=0.011 I2=48%) and decreased late luminal loss (WMD -0.34, CI
-0.58 - -0.10 P=0.09, I2=58%) in patients undergoing PCI with implantation
of DES. There was no difference in the rates of all cause mortality (OR
0.66, CI 0.40-1.08, P=0.070 I2= 0%), and MI (OR 1.35, CI 0.52-3.52,
P=0.53, I2%) between the two groups. Conclusion. In ESRD patients on
dialysis undergoing PCI, DES are safe and reduce repeat
revascularizations. The limited number of patients and limited quality of
primary studies included, however need careful interpretation of our
results. Further well designed, large randomized controlled trials are
required to establish the strategy of management in ESRD patients
undergoing PCI.
<15>
[Use Link to view the full text]
Accession Number
2009498518
Authors
Corone S. Iliou M.-C. Pierre B. Feige J.-M. Odjinkem D. Farrokhi T.
Bechraoui F. Hardy S. Meurin P.
Institution
(Corone, Odjinkem, Farrokhi, Bechraoui, Hardy) Centre Medical de Bligny,
Briis Sous Forges, France.
(Iliou) APHP Hopital Broussais-HEGP, Marcy letoile,
(Pierre) Centre I.R.I.S, Marcy letoile,
(Feige) Clinique Rhone Durance, Avignon,
(Meurin) Centre de Readaptation Cardiaque de la Brie,
Villeneuve-Saint-Denis, France.
Title
French registry of cases of type i acute aortic dissection admitted to a
cardiac rehabilitation center after surgery.
Source
European Journal of Cardiovascular Prevention and Rehabilitation.
16(1)(pp 91-95), 2009. Date of Publication: February 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: After surgery for type I acute aortic dissection, the aorta
remains partly dissected. This new population of patients is now referred
to cardiac rehabilitation centers (CRCs). The feasibility of subsequent
physical exercise is unknown. METHODS: Thirty-three consecutive patients
(aged 55.1+/-9.3 years) were included in a prospective registry with
clinical and radiological follow-up for 1 year after admission to a CRC.
Twenty-six patients had undergone standard training sessions with exercise
on a bicycle ergometer. Physical training programs included calisthenics,
respiratory physiotherapy, walking, and cycling. Seven patients did not
perform standard exercise training sessions but only walking and
respiratory physiotherapy. RESULTS: For trained patients, the sessions
(18+/-10) were carried out at 11.3+/-1.5 on the Borg scale ('light'), with
blood pressure monitoring on exercise (<160mmHg in 75% of patients).
Maximum workload during exercise test (bicycle ergometer, 10watts/min)
increased from 62.7+/-11.8 to 91.6+/-16.5watts (P=0.002). We identified
three complications in two patients requiring further thoracic aorta
surgery during follow-up. There was also one case of aortic valve
replacement after 5 months and three cases of peripheral ischemia. No
deaths, cerebral vascular accidents, or myocardial infarctions were
recorded. Ten of the 19 patients of working age were able to return to
work. CONCLUSION: Physical training of moderate intensity seems feasible
and beneficial in postsurgical type I aortic dissection patients.
copyright 2009 The European Society of Cardiology.
<16>
Accession Number
2009495363
Authors
Lichtenwalter C. de Lemos J.A. Roesle M. Obel O. Holper E.M. Haagen D.
Saeed B. Iturbe J.M. Shunk K. Bissett J.K. Sachdeva R. Voudris V.V.
Karyofillis P. Kar B. Rossen J. Fasseas P. Berger P. Banerjee S. Brilakis
E.S.
Institution
(Lichtenwalter, de Lemos, Roesle, Obel, Haagen, Iturbe, Banerjee,
Brilakis) Veteran Affairs North Texas Healthcare System, Dallas, TX,
United States.
(Lichtenwalter, de Lemos, Obel, Holper, Iturbe, Banerjee, Brilakis)
University of Texas Southwestern Medical Center, Dallas, TX, United
States.
(Saeed) Department of Internal Medicine, University of Toledo, Toledo, OH,
United States.
(Shunk) San Francisco VA Medical Center, University of California, San
Francisco School of Medicine, San Francisco, CA, United States.
(Bissett, Sachdeva) Central Arkansas Veterans Healthcare System and
University of Arkansas for Medical Sciences, Little Rock, AR, United
States.
(Voudris, Karyofillis) Onassis Cardiac Surgery Center, Athens, Greece.
(Kar) Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX,
United States.
(Rossen) Iowa City Veteran Affairs Medical Center, Iowa City, IA, United
States.
(Fasseas) Medical College of Wisconsin, Milwaukee, WI, United States.
(Berger) Geisinger Clinic, Danville, PA, United States.
Title
Clinical Presentation and Angiographic Characteristics of Saphenous Vein
Graft Failure After Stenting. Insights From the SOS (Stenting Of Saphenous
Vein Grafts) Trial.
Source
JACC: Cardiovascular Interventions. 2(9)(pp 855-860), 2009. Date of
Publication: September 2009.
Publisher
Elsevier Inc.
Abstract
Objectives: We sought to compare the clinical presentation and
angiographic patterns of saphenous vein graft (SVG) failure after stenting
with a paclitaxel-eluting stent (PES) versus a similar bare-metal stent
(BMS). Background: The mode of SVG failure after stenting has been poorly
characterized. Methods: The SOS (Stenting Of Saphenous Vein Grafts) trial
enrolled 80 patients with 112 lesions in 88 SVGs who were randomized to a
BMS or PES. Angiographic follow-up at 12 months was available in 83% of
the patients. Results: Binary angiographic restenosis occurred in 51% (24
of 47) of BMS-treated lesions versus 9% (4 of 43) of PES-treated lesions
(p < 0.0001). Graft occlusion occurred in 9 of the 21 SVGs (43%) that
failed in the BMS group and in 2 of 4 SVGs (50%) that failed in the PES
group. SVG failure after stenting presented as an acute coronary syndrome
in 10 of the 24 patients (42%) (7 of those 10 patients presented with
non-ST-segment elevation acute myocardial infarction), stable angina in 9
(37%) patients, and without symptoms in 5 (21%) patients. Of the 19
patients (with 20 grafts) who developed symptomatic graft failure, repeat
SVG revascularization was successfully performed in all 13 (100%)
subtotally obstructed SVGs but was attempted (and successful) in only 1 of
7 (14%) occluded SVGs. Revascularization of a native coronary artery was
performed in an additional 4 of 7 (57%) symptomatic patients with an
occluded SVG. Conclusions: SVG failure after stenting often presents as
acute myocardial infarction and with SVG occlusion. Compared with BMS, PES
reduce SVG failure. copyright 2009 American College of Cardiology
Foundation.
<17>
[Use Link to view the full text]
Accession Number
2009490619
Authors
Pela G. Pattoneri P. Passera M. Tirabassi G. Reverberi C. Montanari A.
Gherli T.
Institution
(Pela, Pattoneri, Passera, Tirabassi) Department of Internal Medicine,
Nephrology and Prevention Sciences, University of Parma, Via Gramsci 14,
43100 Parma, Italy.
(Reverberi, Montanari, Gherli) Department of the Heart, University of
Parma, Parma, Italy.
Title
Long-term effects of perindopril on left ventricular structure and
function in patients with stable coronary artery disease: A conventional
and Doppler tissue echocardiographic pilot study.
Source
Journal of Cardiovascular Medicine. 10(10)(pp 781-786), 2009. Date of
Publication: October 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: The aim of this study was to investigate the long-term effects
of perindopril on left ventricular (LV) systolic and diastolic function in
patients with stable coronary artery disease who had previously undergone
coronary artery bypass graft. METHODS: Thirteen patients (12 male and one
female patient) were treated with perindopril 8 mg/day and 13 (nine male
and four female patients) with placebo, and both groups underwent
conventional and Doppler tissue echocardiography (DTE) at baseline and
after 12, 24, 36 and 47 months. DTE was sampled at the four sites of the
mitral annulus and peak velocity (pv) and the time-velocity integral (tvi)
of systolic (S) and diastolic (E and A) waves were calculated. RESULTS:
During the 47 months of follow-up, ejection fraction significantly
increased in the perindopril group from 58 +/- 10 to 69 +/- 6% (P < 0.01)
without any significant change in LV volumes. LV shortening and
relaxation, assessed by DTE, also significantly increased: Stvi from 1.57
+/- 0.18 to 1.95 +/- 0.19 cm (P < 0.01) and Etvi from 0.95 +/- 0.23 to
1.37 +/- 0.59 cm (P < 0.05). There were no changes in ejection fraction
(64 +/- 6 vs. 65 +/- 8%; P = not significant) or S or E waves in the
placebo group, but a significant increase in LV diastolic volume. Blood
pressure remained unchanged in both groups. CONCLUSION: Our data suggest
that perindopril improves both systolic and diastolic LV myocardial
performance, a beneficial effect that may be due to the previously
demonstrated biological, anti-ischemic and endothelium-dependent action of
perindopril. copyright 2009 Italian Federation of Cardiology.
<18>
Accession Number
2009473929
Title
Lessons from the BEAUTIfUL trial: Heart rate targets for coronary
patients.
Source
Cardiovascular Journal of Africa. 20(4)(pp 261-262), 2009. Date of
Publication: July-August 2009.
Publisher
South African Medical Association
<19>
Accession Number
2009484600
Authors
Wiersma J.J. Verberne H.J. Holt W.L. Radder I.M. Dijksman L.M. Eck-Smit
B.L.F. Trip M.D. Tijssen J.G.P. Piek J.J.
Institution
(Wiersma, Radder, Dijksman, Trip, Tijssen, Piek) Department of Cardiology,
Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
(Verberne, Eck-Smit) Department of Nuclear Medicine, Academic Medical
Center, Amsterdam, Netherlands.
(Holt) Department of Cardiology, Amstelland Hospital, Amstelveen,
Netherlands.
Title
Prognostic value of myocardial perfusion scintigraphy in type 2 diabetic
patients with mild, stable angina pectoris.
Source
Journal of Nuclear Cardiology. 16(4)(pp 524-532), 2009. Date of
Publication: 2009.
Publisher
Springer New York
Abstract
Aim: To determine the prognostic value of reversible myocardial perfusion
defects on myocardial perfusion scintigraphy (MPS) in patients with type 2
diabetes mellitus and mild anginal complaints. Methods and results: In the
MERIDIAN trial, patients with diabetes mellitus type 2, stable, mild
anginal symptoms (Canadian Cardiovascular Society classification (CCS)
I-II/IV) and reversible perfusion defects were randomized to either
continued pharmacological treatment or early invasive treatment. In this
sub analysis, the severity of the myocardial perfusion defect was related
to the occurrence of cardiac death and non-fatal myocardial infarction, in
319 patients (63% male, 65+/- 9 years). During follow-up (2.2 +/- 0.6
years), 14 patients had a cardiac event: 3 in 171 patients without
myocardial ischemia and 11 in 148 patients with myocardial ischemia.
Annual event rates rose from 0.8% to 5.8% with increasing severity of
myocardial ischemia. Multivariable analysis identified the presence of
severe myocardial ischemia (hazard ratio (HR) 5.45, 95%CI 1.89-15.71) and
insulin use (HR 4.00, 95%CI 1.25-12.75) as independent predictors of
cardiac events. Conclusions: Type 2 diabetics with mild anginal symptoms
with no or moderate myocardial ischemia have a low annual cardiac event
rate. In patients with severe myocardial ischemia event rate increased 3-6
fold. copyright The Author(s) 2009.
<20>
Accession Number
2009484608
Authors
Ernande L. Cachin F. Chabrot P. Durel N. Morand D. Boyer L. Maublant J.
Lipiecki J.
Institution
(Ernande, Durel, Lipiecki) Department of Cardiology, Gabriel Montpied
University Hospital, Rue Montalembert, 63003 Clermont-Ferrand, France.
(Cachin, Maublant) Department of Nuclear Medicine, Jean Perrin Cancer
Center, Clermont-Ferrand, France.
(Chabrot, Boyer) Department of Radiology, Gabriel Montpied University
Hospital, rue Montalembert, 63003 Clermont-Ferrand, France.
(Morand) Clinical Research, Gabriel Montpied University Hospital, Rue
Montalembert, 63003 Clermont-Ferrand, France.
Title
Rest and low-dose dobutamine Tc-99m-mibi gated-SPECT for early prediction
of left ventricular remodeling after a first reperfused myocardial
infarction.
Source
Journal of Nuclear Cardiology. 16(4)(pp 597-604), 2009. Date of
Publication: 2009.
Publisher
Springer New York
Abstract
Background. Left ventricular (LV) remodeling after myocardial infarction
(MI) occurs frequently despite successful percutaneaous coronary
intervention (PCI) but cannot be predicted by simple clinical parameters.
Methods and Results. This prospective study tested the value of rest and
low-dose dobutamine (LDD) Tc-99m-mibi gated-SPECT for early prediction of
LV remodeling in patients treated by PCI in the acute phase of a first MI.
Infarct size, infarct severity, regional wall motion abnormality (RWMA),
and wall thickening score (WTs) were assessed at rest and on LDD by SPECT
6 +/- 2 days after MI in 40 patients. LV remodeling was defined as 20%
increase at 6 months in LV end-diastolic volume assessed by MRI. Infarct
severity at rest showed the best predictive values for left remodeling
(PPV: 86%, NPV: 88%, accuracy: 88%; AUC: 0.750). Functional parameters at
neither rest nor LDD study further improved predictive values of the SPECT
imaging. Conclusions. Infarct severity assessed by Tc-99m-sestamibi
gated-SPECT performed in the subacute phase of a first STEMI predicts LV
remodeling with high accuracy without incremental value nor of functional
parameters nor of LDD. Therefore, our results suggest that LDD should not
be used in this setting. copyright American Society of Nuclear Cardiology
2009.
