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<1>
Accession Number
2009652691
Authors
Nevis I.F. Mathew A. Novick R.J. Parikh C.R. Devereaux P.J. Natarajan M.K.
Iansavichus A.V. Cuerden M.S. Garg A.X.
Institution
(Nevis, Mathew, Iansavichus, Cuerden, Garg) Division of Nephrology,
University of Western Ontario, London, ON, Canada.
(Novick) Division of Cardiac Surgery, University of Western Ontario,
London, ON, Canada.
(Parikh) Section of Nephrology, Yale University, New Haven, CT, United
States.
(Devereaux, Natarajan) Division of Cardiology, McMaster University,
Hamilton, ON, Canada.
(Devereaux, Garg) Department of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, ON, Canada.
(Nevis, Cuerden, Garg) Department of Epidemiology and Biostatistics,
University of Western Ontario, London, ON, Canada.
Title
Optimal method of coronary revascularization in patients receiving
dialysis: Systematic review.
Source
Clinical Journal of the American Society of Nephrology. 4(2)(pp 369-378),
2009. Date of Publication: 01 Feb 2009.
Publisher
American Society of Nephrology
Abstract
Background and objectives: Patients receiving dialysis have a high burden
of cardiovascular disease. Some receive coronary artery revascularization
but the optimal method is controversial. Design, setting, participants, &
measurements: The authors reviewed any randomized controlled trial or
cohort study of 10 or more patients receiving maintenance dialysis which
compared coronary artery bypass graft (CABG) to percutaneous intervention
(PCI) for revascularization of the coronary arteries. The primary outcomes
were short-term (30 d or in-hospital) and long-term (at least 1 year)
mortality. Results: Seventeen studies were found. There were no randomized
trials: all were retrospective cohort studies from years 1977 to 2002.
There were some baseline differences between the groups receiving CABG
compared with those receiving PCI, and most studies did not consider
results adjusted for such characteristics. Given the variability among
studies and their methodological limitations, few definitive conclusions
about the optimal method of revascularization could be drawn. In an
exploratory meta-analysis, short-term mortality was higher after CABG
compared to PCI. A substantial number of patients died over a subsequent 1
to 5 yr, with no difference in mortality after CABG compared to PCI.
Conclusions: Although decisions about the optimal method of coronary
artery revascularization in dialysis patients are undertaken routinely, it
was surprising to see how few data has been published in this regard.
Additional research will help inform physician and patient decisions about
coronary artery revascularization. Copyright copyright 2009 by the
American Society of Nephrology.
<2>
Accession Number
2009603699
Authors
Ferreiro J.L. Ueno M. Angiolillo D.J.
Institution
(Ferreiro, Ueno, Angiolillo) University of Florida College of Medicine -
Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, United States.
Title
Cangrelor: A review on its mechanism of action and clinical development.
Source
Expert Review of Cardiovascular Therapy. 7(10)(pp 1195-1201), 2009. Date
of Publication: October 2009.
Publisher
Expert Reviews Ltd.
Abstract
In patients with acute coronary syndromes and undergoing percutaneous
coronary intervention, numerous large-scale clinical trials have shown
that adjunctive treatment with the P2Y12 receptor antagonist clopidogrel
in addition to aspirin reduces ischemic events. These studies underscore
the importance of blockade of the P2Y12 signaling pathway in these
settings. However, recent findings have shown that clopidogrel therapy may
have some shortcomings. These include its broad range of
interindividual-response profiles, where patients with low P2Y12
inhibitory effects have an increased risk of recurrent ischemic events,
including stent thrombosis, and its irreversible mechanism of action.
These observations underscore the need for novel antiplatelet agents
overcoming these limitations. Cangrelor (AR-C69931MX) is an intravenous,
direct-acting and reversible P2Y12 receptor antagonist. Cangrelor has a
rapid onset and offset of action and achieves significantly greater
degrees of platelet inhibition compared with clopidogrel. This article
provides an overview of the current status of knowledge on cangrelor,
focusing on its pharmacologic properties, clinical development and
potential future applications. copyright 2009 Expert Reviews Ltd.
<3>
Accession Number
2009594277
Authors
Lemos P.A. Moulin B. Perin M.A. Oliveira L.A.R.R. Arruda J.A. Lima V.C.
Lima A.A.G. Caramori P.R.A. Medeiros C.R. Barbosa M.R. Brito Jr. F.S.
Ribeiro E.E. Martinez E.E.
Institution
(Lemos, Ribeiro, Martinez) Catheterization Laboratory, Heart Institute
(InCor), University of Sao Paulo Medical School (USP), Sao Paulo, Brazil.
(Moulin) Catheterization Laboratory, Hospital Universitario Cassiano
Antonio de Moraes, Vitoria, Brazil.
(Perin) Catheterization Laboratory, Hospital Santa Marcelina, Sao Paulo,
Brazil.
(Oliveira) Catheterization Laboratory, Natal Hospital Center, Natal,
Brazil.
(Arruda) Catheterization Laboratory, Hospital Meridional, Vitoria, Brazil.
(Lima) Catheterization Laboratory, Federal University of Sao Paulo
(UNIFESP-EPM), Sao Paulo, Brazil.
(Lima) Catheterization Laboratory, Hospital Universitario Walter Cantidio,
Fortaleza, Brazil.
(Caramori) Catheterization Laboratory, Hospital Sao Lucas - PUC-RS, Porto
Alegre, Brazil.
(Medeiros) Catheterization Laboratory, Rede D'Or de Hospitais, Rio de
Janeiro, Brazil.
(Barbosa) Catheterization Laboratory, Hospital Biocor, Belo Horizonte,
Brazil.
(Brito Jr.) Catheterization Laboratory, Sao Camilo Hospital, Sao Paulo,
Brazil.
Title
Randomized evaluation of two drug-eluting stents with identical metallic
platform and biodegradable polymer but different agents (paclitaxel or
sirolimus) compared against bare stents: 1-Year results of the PAINT
trial.
Source
Catheterization and Cardiovascular Interventions. 74(5)(pp 665-673),
2009. Date of Publication: 01 Nov 2009.
Publisher
Wiley-Liss Inc.
Abstract
Objectives: We tested two novel drug-eluting stents (DES), covered with a
biodegradable-polymer carrier and releasing paclitaxel or sirolimus, which
were compared against a bare metal stent (primary objective). The DES
differed by the drug, but were identical otherwise, allowing to compare
the anti-restenosis effects of sirolimus versus paclitaxel (secondary
objective). Background: The efficacy of novel DES with biodegradable
polymers should be tested in the context of randomized trials, even when
using drugs known to be effective, such as sirolimus and paclitaxel.
Methods: Overall, 274 patients with de novo coronary lesions in native
vessels scheduled for stent implantation were randomly assigned (2:2:1
ratio) for the paclitaxel (n 5 111), sirolimus (n 5 106), or bare metal
stent (n 5 57) groups. Angiographic follow-up was obtained at 9 months and
major cardiac adverse events up to 12 months. Results: Both paclitaxel and
sirolimus stents reduced the 9-month in-stent late loss (0.54-0.44 mm,
0.32-0.43 mm, vs. 0.90-0.45 mm respectively), and 1-year risk of target
vessel revasculariza-tion and combined major adverse cardiac events (P <
0.05 for both, in all comparisons), compared with controls. Sirolimus
stents had lower late loss than paclitaxel stents (P < 0.01), but similar
1-year clinical outcomes. There were no differences in the risk of death,
infarction, or stent thrombosis among the study groups. Conclusion: Both
novel DES were effective in reducing neointimal hyperplasia and 1-year
re-intervention, compared to bare metal stents. Our findings also suggest
that sirolimus is more effective than paclitaxel in reducing angiographic
neointima, although this effect was not associated with better clinical
outcomes. copyright 2009 Wiley-Liss, Inc.
<4>
Accession Number
2009594276
Authors
Manjunath C.N. Srinivasa K.H. Ravindranath K.S. Manohar J.S. Prabhavathi
B. Dattatreya P.V. Sridhar L. Dhanalakshmi C.
Institution
(Manjunath, Srinivasa, Ravindranath, Manohar, Prabhavathi, Dattatreya,
Sridhar, Dhanalakshmi) Department of Cardiology, Sri Jayadeva Institute of
Cardiology, Bannerghatta Road, 9th Block, Jayanagar, Bangalore 560069,
India.
Title
Balloon mitral valvotomy in patients with mitral stenosis and left atrial
thrombus.
Source
Catheterization and Cardiovascular Interventions. 74(4)(pp 653-661),
2009. Date of Publication: 01 Oct 2009.
Publisher
Wiley-Liss Inc.
Abstract
Objectives: To evaluate the safety and efficacy of balloon mitral
valvotomy (BMV) in symptomatic rheumatic mitral stenosis (MS) patients
with left atrial (LA) thrombus and to address the technical issues.
Background: LA thrombus in patients with MS has long been regarded as a
contraindication for BMV. There are few reports of BMV in presence of LA
appendage (LAA) thrombus and reports of BMV in presence of LA body
thrombus are still rare. Methods: 2,763 patients with suitable valve
morphology were screened for BMV. 194 patients had LA/LAA thrombus and
were put on adequate anticoagulation for 8-12 weeks. A total of 108
patients with persistent LA thrombus who satisfied the inclusion criteria
(LA thrombus type Ia, Ib, and IIa) formed the study group and the
remaining 2,622 patients who did not have any LA thrombus constituted the
control group. All patients in the study group underwent BMV by modified
over the wire technique. Results: There was significant and comparable
improvement in the mitral valve area, mitral valve gradient, LA mean and
pulmonary artery systolic pressure following the procedure in both groups.
In the study group, there were no thromboembolic episodes during the
procedure. However, there was one case of transient ischemic attack in the
study group which occurred 6 hr after a successful BMV. In the study
group, one patient had cardiac tamponade needing aspiration and there was
no inhospital death. Conclusions: In selected patients of mitral stenosis
with LA thrombus (type Ia, Ib, and IIa), BMV can be performed safely with
the modified over the wire technique. Systemic thromboembolism, technical
failures and other complications are very rare when performed by
experienced operators. copyright 2009 Wiley-Liss, Inc.
<5>
Accession Number
2009594217
Authors
Montalescot G. Gallo R. White H.D. Cohen M. Steg Ph.G. Aylward P.E.G. Bode
C. Chiariello M. King III S.B. Harrington R.A. Desmet W.J. Macaya C.
Steinhubl S.R.
Institution
(Montalescot) Institut du Coeur, Centre Hospitalier Universitaire
Pitie-Salpetriere, Paris, France.
(Gallo) The Montreal Heart Institute, University of Montreal, Montreal,
Canada.
(White) Auckland City Hospital, Auckland, New Zealand.
(Cohen) Division of Cardiology, Newark Beth Israel Medical Center, Newark,
NJ, United States.
(Steg) INSERM U-698, Universite Paris 7 and AP-HP, Paris, France.
(Aylward) Cardiology Research, Flinders Medical Centre, SA, Australia.
(Bode) Abteilung Innere Medizin III, Universitatsklinikum Freiburg,
Freiburg, Germany.
(Chiariello) Division of Cardiology, Federico 2nd University, Naples,
Italy.
(King III) St Joseph's Heart and Vascular Institute, Atlanta, GA, United
States.
(Harrington) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States.
(Desmet) University Hospital Gasthuisberg, Leuven, Belgium.
(Macaya) Servicio de Cardiologia, Hospital Universitario, Madrid, Spain.
(Steinhubl) Geisinger Clinic, Geisinger Center for Health Research,
Danville, PA, United States.
(Steinhubl) The Medicines Company, Zurich, Switzerland.
Title
Enoxaparin Versus Unfractionated Heparin in Elective Percutaneous Coronary
Intervention. 1-Year Results From the STEEPLE (SafeTy and Efficacy of
Enoxaparin in Percutaneous coronary intervention patients, an
internationaL randomized Evaluation) Trial.
Source
JACC: Cardiovascular Interventions. 2(11)(pp 1083-1091), 2009. Date of
Publication: November 2009.
Publisher
Elsevier Inc.
Abstract
Objectives: Our purpose was to evaluate long-term mortality and identify
factors associated with 1-year mortality in patients who underwent
elective percutaneous coronary intervention (PCI). Background: While
long-term outcomes in PCI patients have been reported previously, limited
data are currently available regarding the comparative long-term outcomes
in PCI patients who receive enoxaparin versus intravenous unfractionated
heparin (UFH). Methods: We conducted a follow-up analysis of clinical
outcomes at 1 year in patients enrolled in the STEEPLE (SafeTy and
Efficacy of Enoxaparin in Percutaneous coronary intervention patients, an
internationaL randomized Evaluation) trial of 3,528 patients undergoing
elective PCI. Patients were randomized to receive either intravenous
0.50-mg/kg or 0.75-mg/kg enoxaparin or intravenous UFH during elective PCI
procedures. All-cause mortality at 1 year after index PCI was the main
outcome measure. Results: Mortality rates were 1.4%, 2.0%, and 1.5% from 1
month to 1 year, and 2.3%, 2.2%, and 1.9% from randomization to 1 year,
after index PCI in patients receiving 0.50 mg/kg enoxaparin, 0.75 mg/kg
enoxaparin, and UFH, respectively. Multivariate analysis identified
nonfatal myocardial infarction and/or urgent target vessel
revascularization up to 30 days after index PCI (hazard ratio: 3.5, 95%
confidence interval: 1.7 to 7.3; p < 0.001), and major bleeding within 48
h (hazard ratio: 3.0, 95% confidence interval: 1.1 to 8.5; p = 0.04) as
the strongest independent risk factors for 1-year mortality. Conclusions:
The 1-year mortality rates were low and comparable between patients
receiving enoxaparin and UFH during elective PCI. Periprocedural ischemic
or bleeding events were the strongest independent predictors of 1-year
mortality. (The STEEPLE Trial; NCT00077844). copyright 2009 American
College of Cardiology Foundation.
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Accession Number
2010061466
Authors
Willems A. Harrington K. Lacroix J. Biarent D. Joffe A.R. Wensley D.
Ducruet T. Hebert P.C. Tucci M.
Institution
(Willems, Harrington, Lacroix, Tucci) Pediatric Intensive Care Unit,
Department of Pediatrics, Universite de Montreal, Montreal, QC, Canada.
(Biarent) Hopital des Enfants Reine Fabiola, Brussels, Belgium.
(Joffe) Department of Pediatrics, Stollery Children's Hospital, Edmonton,
AB, Canada.
(Wensley) Division of Critical Care, BC Children's Hospital, Vancouver,
BC, Canada.
(Ducruet) Research Center, Centre Hospitalier Universitaire
Sainte-Justine, Montreal, QC, Canada.
(Hebert) Critical Care Unit, Hopital General d'Ottawa, Ottawa, ON, Canada.
Title
Comparison of two red-cell transfusion strategies after pediatric cardiac
surgery: A subgroup analysis.
Source
Critical Care Medicine. 38(2)(pp 649-656), 2010. Date of Publication:
February 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To determine the impact of a restrictive vs. a liberal
transfusion strategy on new or progressive multiple organ dysfunction
syndrome in children post cardiac surgery. The optimal transfusion
threshold after cardiac surgery in children is unknown. Design:
Randomized, controlled trial. Setting: Tertiary pediatric intensive care
units. Patients: Participants are a subgroup of pediatric patients post
cardiac surgery from the TRIPICU (Transfusion Requirements in Pediatric
Intensive Care Units) study. Exclusion criteria specific to the cardiac
surgery subgroup included: age <28 days and patients remaining cyanotic.
Intervention: Critically ill children with a hemoglobin [less-than or
equal to]95 g/L within 7 days of pediatric intensive care unit admission
were randomized to receive prestorage leukocyte-reduced red-cell
transfusion if their hemoglobin dropped either <70 g/L (restrictive) or 95
g/L (liberal). Measurements and Main Results: Postoperative cardiac
patients (n = 125) from seven centers were enrolled. The restrictive (n =
63) and liberal (n = 62) groups were similar at baseline in age (mean +/-
standard deviation = 31.4 +/- 38.1 mos vs. 26.4 +/- 39.1 mos), surgical
procedure, severity of illness (Pediatric Risk of Mortality score = 3.4
+/- 3.2 vs. 3.2 +/- 3.2), multiple organ dysfunction syndrome (46% vs.
44%), mechanical ventilation (62% vs. 60%), and hemoglobin (83 vs. 80
g/L). Mean hemoglobin remained 21 g/L lower in the restrictive group after
randomization. No significant difference was found in new or progressive
multiple organ dysfunction syndrome (primary outcome) in the restrictive
group vs. liberal group (12.7% vs. 6.5%; p =.36), pediatric intensive care
unit length of stay (7.0 +/- 5.0 days vs. 7.4 +/- 6.4 days) or 28-day
mortality (3.2% vs. 3.2%). Conclusion: In this subgroup analysis of
cardiac surgery patients, a restrictive red-cell transfusion strategy, as
compared with a liberal one, was not associated with any significant
difference in new or progressive multiple organ dysfunction syndrome, but
this evidence is not definitive. Copyright copyright 2010 by the Society
of Critical Care Medicine and Lippincott Williams & Wilkins.
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[Use Link to view the full text]
Accession Number
2010061454
Authors
Bilgin Y.M. Van De Watering L.M.G. Versteegh M.I.M. Van Oers M.H.J. Brand
A.
Institution
(Bilgin, Van Oers) Department of Hematology, Academical Medical Center,
Amsterdam, Netherlands.
(Brand) Department of Immunohematology and Blood Transfusion, Leiden
University Medical Center, Leiden, Netherlands.
(Versteegh) Department of Cardiothoracic Surgery, Leiden University
Medical Center, Leiden, Netherlands.
(Bilgin, Van De Watering, Brand) Sanquin Blood Bank Southwest Region,
Leiden, Netherlands.
Title
Effects of allogeneic leukocytes in blood transfusions during cardiac
surgery on inflammatory mediators and postoperative complications.
Source
Critical Care Medicine. 38(2)(pp 546-552), 2010. Date of Publication:
February 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To investigate whether the higher prevalence of postoperative
complications in cardiac surgery after transfusion of leukocyte-containing
red blood cells can be related to inflammatory mediators. Design: Analysis
of inflammatory markers interleukin-6, interleukin-10, interleukin-12, and
procalcitonin in patients participating in a randomized trial comparing
leukocyte-depleted with leukocyte-containing, buffy-coat-depleted red
blood cells. Setting: Two university-affiliated hospitals in the
Netherlands. Subjects: A total of 346 patients undergoing cardiac valve
surgery with a complete series of pre-and postoperative blood samples.
Measurements and Main Results: There were no differences in the cytokines
and procalcitonin concentrations between both study arms when the patients
arrived in the intensive care unit. In subgroups, patients who received
zero to three red blood cell transfusions showed similar cytokine
concentrations in both study arms, whereas patients with >4 red blood cell
transfusions had significantly higher interleukin-6 concentrations in the
leukocyte-containing, buffy-coat-depleted red blood cell group. Patients
who developed postoperative infections and multiple organ dysfunction
syndrome showed, respectively, increased concentrations of interleukin-6
and interleukin-12 in the leukocyte-containing, buffy-coat-depleted, red
blood cell group. The interaction tests in these subgroups showed
significantly different reaction patterns in the leukocyte-containing,
buffy-coat-depleted red blood cell group compared with leukocyte-depleted
red blood cell group for interleukin-6 and interleukin-12. Multivariate
analysis showed a high interleukin-6 concentration with multiple organ
dysfunction syndrome and both high interleukin-6 and interleukin-10
concentrations with hospital mortality. Conclusions: Allogeneic
leukocyte-containing blood transfusions compared with leukocyte-depleted
blood transfusions induce dose-dependent significantly higher
concentrations of proinflammatory mediators in the immediate postoperative
period after cardiac surgery. High concentrations of interleukin-6 are
strong predictors for development of multiple organ dysfunction syndrome,
whereas both interleukin-6 and interleukin-10 are associated with hospital
mortality. These findings suggest that leukocyte-containing red blood
cells interfere with the balance between postoperative proinflammatory
response, which may further affect the development of complications after
cardiac surgery. Copyright copyright 2010 by the Society of Critical Care
Medicine and Lippincott Williams & Wilkins.
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[Use Link to view the full text]
Accession Number
2010049159
Authors
Gabrhelik T. Michalek P. Adamus M. Berta E.
Institution
(Gabrhelik, Adamus, Berta) Department of Anaesthesia and Intensive Care,
University Hospital, Olomouc, Czech Republic.
(Michalek) Department of Anaesthesia and Intensive Care, Na Homolce
Hospital, Prague, Czech Republic.
Title
Percutaneous upper thoracic radiofrequency sympathectomy in Raynaud
phenomenon a comparison of T2/T3 procedure versus 12 lesion with phenol
application.
Source
Regional Anesthesia and Pain Medicine. 34(5)(pp 425-429), 2009. Date of
Publication: September-October 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Objectives: Percutaneous radiofrequency (RF) thoracic
sympathectomy is an alternative method to surgical procedures for the
treatment of acral ischemia in Raynaud phenomenon. The procedure is
indicated if conservative therapy fails to provide sufficient relief. The
aim of this study was to compare classic T2 and T3 RF thermolesioning with
a less invasive procedure at the level of T2 only. Methods: Fifty adult
patients, American Society of Anesthesiologists (ASA) classification I to
III, were randomly assigned to 1 of 2 groups. T2 and T3 thoracic RF
thermolesion was performed in 1 group, whereas T2 thermolesion with local
application of 0.5 mL of 6% phenol was delivered in the second group.
Changes in cold perception, pain, and quality of life were assessed using
a questionnaire. Blood circulation in the upper extremity was evaluated
using infrared thermography. Patients were observed for a period of 3
months. Results: A significant decrease in pain according to visual analog
scale (P < 0.001), increase in peripheral temperature in the upper
extremities (P < 0.001), and improvement in quality of life were observed
in both groups of patients after the procedure. Susceptibility to
cold-provoked vasospasm was not significantly affected in either group.
There was no significant difference between the 2 groups in any parameter
apart from the duration of the procedure. Conclusions: Thoracic RF upper
sympathectomy is an effective method in the treatment of resistant forms
of Raynaud phenomenon. A single-shot procedure at the level of T2 may be
preferable because of the shorter procedure duration of this technique.
Copyright copyright 2009 by American Society of Regional Anesthesia and
Pain Medicine.
<9>
Accession Number
2010041997
Authors
LaRosa J.C. Deedwania P.C. Shepherd J. Wenger N.K. Greten H. DeMicco D.A.
Breazna A.
Institution
(LaRosa) State University of New York, Health Science Center, Brooklyn,
NY, United States.
(DeMicco, Breazna) Pfizer, Inc., New York, NY, United States.
(Deedwania) VA Central California Healthcare System and UCSF School of
Medicine, Fresno, CA, United States.
(Shepherd) University of Glasgow, Glasgow, United Kingdom.
(Wenger) Emory University, Atlanta, GA, United States.
(Greten) Hanseatic Heart Center, Asklepios Klinik St. Georg, Hamburg,
Germany.
Title
Comparison of 80 versus 10 mg of Atorvastatin on Occurrence of
Cardiovascular Events After the First Event (from the Treating to New
Targets [TNT] Trial).
Source
American Journal of Cardiology. 105(3)(pp 283-287), 2010. Date of
Publication: 01 Feb 2010.
Publisher
Elsevier Inc.
Abstract
Analyses of randomized clinical trials are usually restricted to
examination of time to first event. However, because many patients have
multiple events, this approach precludes much potentially useful clinical
and economic data. To assess the effect on overall disease burden in the
Treating to New Targets (TNT) study, we evaluated the effect of treatment
with atorvastatin 80 versus 10 mg in the period after the occurrence of a
first cardiovascular event. In TNT, 10,001 patients with stable coronary
heart disease received double-blind therapy with atorvastatin 80 or 10 mg
and were followed for 4.9 years. Post hoc time-to-event analysis was used
to estimate separate hazard ratios for time to any first, second, third,
fourth, and fifth recurrent cardiovascular events. During TNT, 3,082
patients had a first recurrent cardiovascular event, with 1,516, 698, 345,
and 197 developing second, third, fourth, and fifth recurrent events,
respectively. In patients receiving atorvastatin 80 mg, the relative risk
of a first recurrent event was significantly decreased compared to those
receiving atorvastatin 10 mg. Significant benefit with the 80-mg dose was
also observed for second, third, fourth, and fifth recurrent events.
Similar findings were recorded in 5,854 patients with type 2 diabetes
mellitus and/or metabolic syndrome and in 3,809 patients [greater-than or
equal to]65 years of age compared to younger patients. In conclusion,
treatment with atorvastatin 80 mg continued to significantly decrease the
risk of any cardiovascular event over time compared to atorvastatin 10 mg
in patients who had survived previous events. In TNT, analyses limited to
the primary end point significantly underestimated the decrease in total
cardiovascular disease burden achieved by intensive low-density
lipoprotein cholesterol lowering. copyright 2010 Elsevier Inc. All rights
reserved.
<10>
Accession Number
0019858237
Authors
Sohn N. Marcoux J. Mycyk T. Krahn J. Meng Q.
Institution
(Sohn, Marcoux, Mycyk, Krahn, Meng) Department of Pathology and Laboratory
Medicine, Royal University Hospital, University of Saskatchewan,
Saskatoon, Saskatchewan, S7N 0W8 Canada.
Title
The impact of different biocompatible coated cardiopulmonary bypass
circuits on inflammatory response and oxidative stress..
Source
Perfusion. 24(4)(pp 231-237), 2009. Date of Publication: Jul 2009.
Abstract
This study was to compare the impact of different biocompatible coated
circuits on inflammatory response and oxidative stress induced during
cardiopulmonary bypass (CPB). Seventy-eight patients undergoing elective
coronary artery bypass grafting (CABG) with CPB were randomly assigned to
five groups with different biocompatible coated circuits: Trillium,
Bioline, Phosphorylcholine, Polymethoxyethyl acrylate (PMEA), and the
uncoated control group. Blood was drawn at three different time points:
before CPB, 6 and 72 hours post CPB. Unlike the Trillium group, serum
levels of TNF-alpha in the Bioline and Phosphorylcholine groups
significantly increased only at 72 hours post CPB (p < 0.05). Serum levels
of IL-6 significantly increased at 6 and 72 hours post CPB in all groups
(p < 0.01). The Trillium group showed a significant increase of IL-10
compared to the control group at 72 hours post CPB (p < 0.05). Serum
levels of NOx in the Phosphorylcholine group significantly decreased at 6
hours post CPB compared to baseline (p < 0.05). Both the Bioline and
Phosphorylcholine groups showed statistical decreases in serum NOx levels
compared with other groups at 6 hours post CPB (p < 0.05). A significant
difference in NOx levels between the Bioline and the control group was
also observed at 72 hours post CPB. Myeloperoxidase levels were
significantly elevated at 6 and 72 hours post CPB in all groups (p <
0.05). Inflammatory response and oxidative stress are elevated during CABG
with CPB. Heparin-coated and the Phosphorylcholine-coated circuits induce
less inflammatory responses and oxidative stress compared to other
circuits.
<11>
Accession Number
0019808745
Authors
Lenkutis T. Benetis R. Sirvinskas E. Raliene L. Judickaite L.
Institution
(Lenkutis, Benetis, Sirvinskas, Raliene, Judickaite) Clinic of
Cardiothoracic and Vascular Surgery, Kaunas University Hospital, Kaunas,
LT-50009, Lithuania.
Title
Effects of epidural anesthesia on intrathoracic blood volume and
extravascular lung water during on-pump cardiac surgery..
Source
Perfusion. 24(4)(pp 243-248), 2009. Date of Publication: Jul 2009.
Abstract
BACKGROUND: The most important side effect of epidural anesthesia is
hypotension with functional hypovolemia. Aggressive infusion therapy can
reduce the hypotension effect. However, in conjunction with
cardiopulmonary bypass, it can increase acute lung injury. We hypothesized
that epidural anesthesia, by reducing cardiac sympathetic tonus, with
subsequent better pulmonary flow, does not increase lung interstitial
fluids. METHODS: Sixty patients undergoing coronary artery bypass graft
(CABG) surgery with cardiopulmonary bypass (CPB) were randomized to
combined general anesthesia with epidural anesthesia / analgesia, (EA)
group, and to general anesthesia with i/v opiate analgesia, (GA) group.
Patients in the EA group received a high thoracic epidural,
preoperatively. Intraoperatively, 0.25% bupivacaine 8 mL/h was infused and
general anesthesia with sevoflurane was followed by bupivacaine infusion
for 48 hours postoperatively. General anesthesia in the GA group was with
sevoflurane and fentanyl 10 - 12 microg/kg and analgesia with pethidinum
0.1 - 0.4 mg/kg i.v. postoperatively. Global end-diastolic volume index
(GEDI), intrathoracic blood volume index (ITBI) and extravascular lung
water index (ELWI) were measured before anesthesia, before CPB and 15, 60,
180, 600 min. and 24 hr after CPB. Duration of mechanical lung ventilation
was registered in both groups. RESULTS: ITBI and GEDI were significantly
higher in the EA group at all time points of measurement (ITBI
945.6+/-146.4 ml/m(2) and 870.6+/-146.5 ml/m( 2) vs. 1118+/-153.2 ml/m(2)
and 1020+/-174.9 ml/m( 2); GEDI 720+/-96.19 ml/m(2) and 775.0+/-159.5
ml/m( 2) vs. 805.4+/-97.59 ml/m(2) and 888+/-117.3 ml/m( 2)). GEDI was
significantly lower in the GA group compared with baseline (801.9+/-132.4
ml/m(2) vs. 695+/-169.2 mL/m(2)). ELWI was significantly higher in the GA
group (7.233+/-1.35 ml/kg and 7.333+/-1.32 ml/kg vs. 8.533+/-1.45 ml/kg
and 8.633+/-1.71 ml/kg), but without significant changes in the EA group.
Duration of mechanical lung ventilation was shorter in the EA group
(663.7+/-98.39 min. vs. 362.2+/-33.72 min.). CONCLUSIONS: Epidural
anesthesia / analgesia does not increase interstitial lung fluids by
increasing intrathoracic blood volume or the amount of infusion fluids in
patients undergoing cardiac surgery under cardiopulmonary bypass. There
is, also, a decreased duration of mechanical lung ventilation.
<12>
Accession Number
2010053506
Authors
Ng C.S.H. Wan S. Wan I.Y.P. Hui C.W.C. Wong R.H.L. Ho A.M.H. Underwood
M.J.
Institution
(Ng, Wan, Wan, Hui, Wong, Underwood) Division of Cardiothoracic Surgery,
Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT,
Hong Kong.
(Ho) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
Title
Ventilation during cardiopulmonary bypass: Impact on neutrophil activation
and pulmonary sequestration.
Source
Journal of Investigative Surgery. 22(5)(pp 333-339), 2009. Date of
Publication: 2009.
Publisher
Informa Healthcare
Abstract
Background: Cardiopulmonary bypass (CPB) is associated with neutrophil
activation, pulmonary sequestration, and release of inflammatory mediators
leading to pulmonary dysfunction. We investigate the effect of continuous
ventilation during cardiopulmonary bypass on neutrophil activation and
pulmonary sequestration. Methods: Forty-six patients undergoing coronary
artery bypass grafting with cardiopulmonary bypass were prospectively
randomized to continuous ventilation and nonventilation groups. Blood
samples were collected, and bronchoalveolar lavage (BAL) was performed
following induction of anesthesia and at 4 hr after aortic declamping.
Differential white cell count was measured, and flow cytometry to
determine cell count numbers and quantify CD45 and CD11b leukocyte cell
surface adhesion molecule expression was performed on the blood and BAL
samples. Results: Twenty-three patients were randomized to standard
nonventilated CPB and 23 patients to ventilation throughout CPB.
Significant increases in blood and BAL neutrophil numbers were detected at
4 hr following aortic declamping in both groups (Blood: NV p <. 0001, V p
<.0001; BAL: NV p . 017, V p = .0007). No significant inter-group
differences in BAL and blood neutrophil numbers were found. Significantly
higher blood neutrophil CD11b mean fluorescent intensity levels were
present 4 hr following declamping compared with baseline in both groups
(NV Blood, p . 021; V Blood p <. 0001). No significant inter- or
intragroup differences in BAL neutrophil CD11b mean fluorescent intensity
levels were found. There was no death or major complication. Conclusions:
Cardiopulmonary bypass during coronary artery bypass grafting is
associated with increased neutrophil pulmonary sequestration, and blood
neutrophil CD11b activation. Continuous ventilation during cardiopulmonary
bypass does not significantly reduce neutrophil pulmonary sequestration or
activation. copyright 2009 Informa UK Ltd All rights reserved.
<13>
Accession Number
2010040743
Authors
Costa Jr. J.R. Sousa A. Moreira A.C. Costa R.A. Cano M. Maldonado G.
Campos C. Carballo M. Pavanello R. Sousa J.E.
Institution
(Costa Jr., Sousa, Moreira, Costa, Cano, Maldonado, Campos, Carballo,
Pavanello, Sousa) Instituto de Ensino e Pesquisa, Hospital do Coracao, Sao
Paulo, Brazil.
Title
Incidence and Predictors of Very Late ([greater-than or equal to]4 Years)
Major Cardiac Adverse Events in the DESIRE (Drug-Eluting Stents in the
Real World)-Late Registry.
Source
JACC: Cardiovascular Interventions. 3(1)(pp 12-18), 2010. Date of
Publication: January 2010.
Publisher
Elsevier Inc.
Abstract
Objectives: Our aim was to access the incidence of late major adverse
cardiac events (MACE) and stent thrombosis (ST) in nonselected, complex
patients followed for a period [greater-than or equal to]4 years.
Background: Despite the efficacy of drug-eluting stents (DES) in reducing
repeated target lesion revascularization, concerns regarding the
occurrence of late and very late ST have partially obscured the benefits
of this novel technology. Methods: All consecutive patients treated solely
with DES between May 2002 and January 2005 were enrolled into this
prospective, nonrandomized, single-center registry. The primary end point
was long-term occurrence of MACE up to 7 years. Independent predictors of
MACE, cardiac death, target lesion revascularization, and ST were obtained
by a multivariate Cox proportional hazards regression model. Results: A
total of 1,010 patients were enrolled. Most of them were men (77%) with a
mean age of 63.7 years. Stent/patient rate was 1.4. Patients were kept in
dual antiplatelet therapy for 3 and 6 months after Cypher (Cordis, Johnson
& Johnson, Miami Lakes, Florida) and Taxus (Boston Scientific Corp.,
Natick, Massachusetts) stent implantation, respectively. Follow-up was
obtained in 98.2% of the cohort (median 5.01 years). Survival free of MACE
and cumulative incidence of definite/probable ST were 84.6% and 1.7%,
respectively. Independent predictors of ST were percutaneous coronary
intervention in the setting of acute myocardial infarction, DES
overlapping, treatment of multivessel disease, presence of
moderate-to-severe calcification at lesion site, and in-stent residual
stenosis. Conclusions: The deployment of DES in complex, real-world
patients resulted in a low rate of very long-term MACE and ST. However, ST
still occurs very long after the index procedure. copyright 2010 American
College of Cardiology Foundation.
<14>
Accession Number
2010040739
Authors
Girasis C. Serruys P.W. Onuma Y. Colombo A. Holmes Jr. D.R. Feldman T.E.
Bass E.J. Leadley K. Dawkins K.D. Morice M.-C.
Institution
(Girasis, Serruys, Onuma) Thoraxcenter, Erasmus University Medical Center,
Rotterdam, Netherlands.
(Colombo) San Raffaele Hospital, Centro Cuore Columbus, Milan, Italy.
(Holmes Jr.) Mayo Clinic, Rochester, MN, United States.
(Feldman) Evanston Hospital, Evanston, IL, United States.
(Bass, Leadley, Dawkins) Boston Scientific Corporation, Natick, MA, United
States.
(Morice) Institut Cardiovasculaire Paris Sud, Massy, France.
Title
3-Dimensional Bifurcation Angle Analysis in Patients With Left Main
Disease. A Substudy of the SYNTAX Trial (SYNergy Between Percutaneous
Coronary Intervention With TAXus and Cardiac Surgery).
Source
JACC: Cardiovascular Interventions. 3(1)(pp 41-48), 2010. Date of
Publication: January 2010.
Publisher
Elsevier Inc.
Abstract
Objectives: We explore the bifurcation angle (BA) parameters of the left
main coronary artery (LM), the effect of percutaneous coronary
intervention (PCI) on this angulation, and the impact of BA on clinical
outcome. Background: The BA is emerging as a predictor of outcome after
PCI of bifurcation lesions. Three-dimensional (3D) quantitative coronary
angiography (QCA) overcomes the shortcomings of 2-dimensional analysis and
provides reliable data. Methods: This is a substudy of the SYNTAX (SYNergy
Between Percutaneous Coronary Intervention With TAXus and Cardiac Surgery)
trial. The cineangiograms of the 354 patients who underwent PCI of their
LM stem were analyzed with 3D QCA software (CardiOp-B, Paieon Medical,
Ltd., Rosh Ha'ayin, Israel). The proximal BA (between LM and left
circumflex [LCX]) and the distal BA (between left anterior descending and
LCX) were computed in end-diastole and end-systole, both before and after
PCI. The cumulative major adverse cardiac and cardiovascular event (MACCE)
rates throughout the 12-month period after randomization were stratified
across pre-PCI distal BA values and compared accordingly. Results:
Complete analysis was feasible in 266 (75.1%) patients. Proximal and
distal BA had mean pre-PCI end-diastolic values of 105.9 +/- 21.7degrees
and 95.6 +/- 23.6degrees, respectively, and were inversely correlated (r =
-0.75, p < 0.001). During systolic motion of the heart there was an
enlargement of the proximal angle and a reduction of the distal angle
(DeltaBA -8.2degrees and 8.5degrees, respectively, p < 0.001 for both).
The PCI resulted in a mean decrease in the distal BA (DeltaBA 4.5degrees,
p < 0.001). The MACCE rates did not differ across distal BA values;
freedom from MACCE at 12 months was 82.8%, 85.4%, and 81.1% (p = 0.74) for
diastolic values (first through third tertile). Conclusions: Left main BA
analysis with 3D QCA is feasible. Both proximal and distal angles are
affected by cardiac motion; PCI modifies the distal angle. There is no
clear difference in event rates across pre-PCI distal BA values. copyright
2010 American College of Cardiology Foundation.
<15>
Accession Number
2010013826
Authors
Ji Q. Mei Y. Wang X. Sun Y. Feng J. Cai J. Xie S. Chi L.
Institution
(Ji, Mei, Wang, Sun, Feng, Cai, Xie, Chi) Department of Thoraco
Cardiovascular Surgery, Tongji Hospital, Tongji University, 389 Xincun
Rd., Shanghai, 200065, China.
Title
Effect of preoperative atorvastatin therapy on atrial fibrillation
following off-pump coronary artery bypass grafting.
Source
Circulation Journal. 73(12)(pp 2244-2249), 2009. Date of Publication:
2009.
Publisher
Japanese Circulation Society
Abstract
Background: Atrial fibrillation (AF) after coronary artery bypass grafting
(CABG) is still the most common postoperative arrhythmic complication.
Previous studies report that patients undergoing preoperative statin
therapy had a lower incidence of postoperative AF. This study aimed to
assess the effect of preoperative atorvastatin therapy on preventing AF
following off-pump CABG in a randomized, controlled trial. Methods and
Results: The 140 consecutive patients undergoing elective off-pump CABG,
without a history of AF or previous statin treatment, were enrolled and
randomly assigned to a statin (atorvastatin 20 mg/day, n=71) or a control
group (placebo, n=69) starting 7 days preoperatively. The primary endpoint
was the occurrence of post-operative AF; secondary endpoints were major
adverse in-hospital cardiac and cerebrovascular events and identification
of variables predicting postoperative AF. Atorvastatin significantly
reduced the incidence of postoperative AF and the postoperative peak
C-reactive protein (CRP) level vs placebo (14% vs 34%, P=0.009;
126.5+/-22.3 vs 145.2+/-31.6 mg/L, P<0.0001). Logistic regression analysis
showed preoperative atorvastatin treatment was an independent factor
associated with a significant reduction in postoperative AF (odds ratio
(OR) 0.219, P=0.005), whereas a high postoperative CRP level was
associated with increased risk (OR 2.011, P=0.013). Conclusions:
Administration of atorvastatin 20 mg/day, initiated 1 week before elective
off-pump CABG and continued in the postoperative period, significantly
decreases postoperative AF.
<16>
Accession Number
0019861394
Authors
Linde C.
Institution
(Linde) Department of Cardiology, Karolinska University Hospital, S-17176
Stockholm, Sweden.
Title
Cardiac resynchronization therapy in mild heart failure..
Source
Europace : European pacing, arrhythmias, and cardiac electrophysiology :
journal of the working groups on cardiac pacing, arrhythmias, and cardiac
cellular electrophysiology of the European Society of Cardiology. 11
Suppl 5(pp v72-76), 2009. Date of Publication: Nov 2009.
Abstract
It has been firmly established that cardiac resynchronization therapy
(CRT) reduces symptoms and improves mortality in patients with
moderate-to-severe chronic heart failure [New York Heart Association
(NYHA) class III-IV], despite optimal heart failure medication and with
wide QRS complex on the surface electrocardiogram as evidence of
ventricular dyssynchrony, but not whether such treatment is efficacious in
mildly symptomatic heart failure patients. In such patients, the treatment
goal is to prevent disease progression rather than to improve symptoms.
The REVERSE trial was the first randomized, controlled study of CRT in
NYHA I-II patients. Cardiac resynchronization therapy in this study
induced substantial reverse remodelling over 12-18-24 months of follow-up
and was linked to a significant delay in the time to first heart failure
hospitalization and eventually in the time to the combined endpoint of
time to first heart failure hospitalization or death. The MADIT CRT
designed as a morbidity-mortality study corroborated these findings with a
significant reduction in heart failure events and significant reverse
remodelling. These findings most likely will translate into a wider use of
CRT in mildly symptomatic patients to prevent disease progression.
<17>
[Use Link to view the full text]
Accession Number
2010048971
Authors
Katritsis G.D. Siontis G.C.M. Ioannidis J.P.A.
Institution
(Katritsis) Department of Cardiology, Athens Euroclinic, Athens, Greece.
(Siontis, Ioannidis) Department of Hygiene and Epidemiology, University of
Ioannina, School of Medicine, Ioannina, Greece.
(Ioannidis) Biomedical Research Institute, Foundation for Research and
Technology-Hellas, Ioannina, Greece.
(Ioannidis) Institute for Clinical Research and Health Policy Studies,
Tufts Medical Center, Boston, Mass, United States.
(Ioannidis) Department of Medicine, Tufts University, School of Medicine,
Boston, Mass, United States.
Title
Double versus single stenting for coronary bifurcation lesions a
meta-analysis.
Source
Circulation: Cardiovascular Interventions. 2(5)(pp 409-415), 2009. Date
of Publication: October 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Several trials have addressed whether bifurcation lesions
require stenting of both the main vessel and side branch, but uncertainty
remains on the benefits of such double versus single stenting of the main
vessel only. Methods and Results: We have conducted a meta-analysis of
randomized trials including patients with coronary bifurcation lesions who
were randomly selected to undergo percutaneous coronary intervention by
either double or single stenting. Six studies (n=1642 patients) were
eligible. There was increased risk of myocardial infarction with double
stenting (risk ratio, 1.78; P=0.001 by fixed effects; risk ratio, 1.49
with Bayesian meta-analysis). The summary point estimate suggested also an
increased risk of stent thrombosis with double stenting, but the
difference was not nominally significant given the sparse data (risk
ratio, 1.85; P=0.19). No obvious difference was seen for death (risk
ratio, 0.81; P=0.66) and target lesion revascularization (risk ratio,
1.09; P=0.67). Conclusions: Stenting of both the main vessel and side
branch in bifurcation lesions may increase myocardial infarction and stent
thrombosis risk compared with stenting of the main vessel only. (Circ
Cardiovasc Intervent. 2009;2:409-415.) copyright 2009 American Heart
Association, Inc.
<18>
[Use Link to view the full text]
Accession Number
2010048967
Authors
Liistro F. Grotti S. Angioli P. Falsini G. Ducci K. Baldassarre S. Sabini
A. Brandini R. Capati E. Bolognese L.
Institution
(Liistro, Grotti, Angioli, Falsini, Ducci, Baldassarre, Sabini, Brandini,
Capati, Bolognese) Cardiovascular Department, San Donato Hospital, Arezzo,
Italy.
(Capati) Department of Cardiology, University of Siena, Italy.
Title
Impact of thrombus aspiration on myocardial tissue reperfusion and left
ventricular functional recovery and remodeling after primary angioplasty.
Source
Circulation: Cardiovascular Interventions. 2(5)(pp 376-383), 2009. Date
of Publication: October 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Failure to achieve myocardial reperfusion often occurs during
percutaneous coronary intervention (PCI) in patients with myocardial
infarction with ST-segment elevation. We hypothesized that manual thrombus
aspiration during primary PCI would favorably influence tissue-level
myocardial perfusion and left ventricular (LV) functional recovery and
remodeling. Methods and Results: We prospectively randomized 111 patients
with ST-segment elevation myocardial infarction to either standard or
thrombus-aspiration PCI. Primary end point of the study was postprocedural
incidence of ST-segment resolution [greater-than or equal to]70%.
Secondary end points included Thrombolysis in Myocardial Infarction (TIMI)
myocardial perfusion grade [greater-than or equal to]2, the combination of
TIMI myocardial perfusion grade [greater-than or equal to]2 and ST-segment
resolution [greater-than or equal to]70%, post-PCI TIMI grade 3 flow,
corrected TIMI frame count, myocardial contrast echocardiography score
index, the absence of persistent ST-segment deviation, and time course of
wall-motion score index, LV ejection fraction, and LV volume in the 2
groups. The incidence of ST-segment resolution [greater-than or equal
to]70% was 71% and 39% in the thrombus-aspiration and standard PCI groups,
respectively (odds ratio, 3.7; 95% CI, 1.7 to 8.3; P=0.001). TIMI
myocardial perfusion grade [greater-than or equal to]2 was attained in 93%
in the thrombus-aspiration group compared with 71% in the standard PCI
group (P=0.006). The percentage of patients with ST-segment resolution
[greater-than or equal to]70% and TIMI myocardial perfusion grade
[greater-than or equal to]2 was significantly greater in the
thrombus-aspiration group compared with the standard PCI group (69% versus
36%, P=0.0006). Myocardial contrast echocardiography score index was
significantly higher in the thrombus-aspiration group compared with the
standard PCI group (0.86+/-0.20 versus 0.65+/-0.31; P<0.0001). A
significantly greater improvement in LV ejection fraction and in
wall-motion score index from baseline to 6-month follow-up was observed in
the thrombus-aspiration group compared with the standard PCI group (LV
ejection fraction from 48+/-6% to 55+/-6% versus 48.7+/-7% to 49+/-8%,
P<0.0001; wall-motion score index from 1.59+/-0.13 to 1.31 +/-0.19 versus
1.64+/-0.20 to 1.51 +/-0.26, P=0.008). Twelve patients (11%) developed LV
remodeling at 6 months, 2 (4%) in the thrombus-aspiration group and 10
(18%) in the standard PCI group (P=0.02). Conclusions: Manual thrombus
aspiration in the setting of primary PCI improves myocardial tissue-level
perfusion as well as LV functional recovery and remodeling. (Circ
Cardiovasc Intervent. 2009;2:376-383.) copyright 2009 American Heart
Association, Inc.
<19>
[Use Link to view the full text]
Accession Number
2010034535
Authors
Toutouzas K. Synetos A. Drakopoulou M. Stefanadi E. Tousoulis D. Lerakis
S. Stefanadis C.
Institution
(Toutouzas, Synetos, Drakopoulou, Stefanadi, Tousoulis, Stefanadis)
Department of Cardiology, Hippokration Hospital, University of Athens,
Athens, Greece.
(Synetos, Lerakis, Stefanadis) Department of Medicine, Emory University,
School of Medicine, Atlanta, GA, United States.
Title
The role of inflammation in atrial fibrillation: A myth or a fact?.
Source
American Journal of the Medical Sciences. 338(6)(pp 494-499), 2009. Date
of Publication: December 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Atrial fibrillation (AF) is the most common sustained rhythm disturbance
resulting in substantial morbidity and mortality as well as increased
medical costs in general population. The possible association between AF
and inflammation is suggested by several studies that are based on the
identification of inflammatory serum biomarkers that are elevated in
patients with AF. In this population, the successfulness of maintenance of
sinus rhythm after cardioversion and the risk of cardioembolic stroke are
related to the inflammatory burden. Furthermore, the positive effect of
the antiinflammatory agents on the prevention and modulation of AF further
supports this hypothesis. copyright 2009 Lippincott Williams & Wilkins.
<20>
Accession Number
2010030989
Authors
Tang M. Gerds-Li J.-H. Nedios S. Roser M. Fleck E. Kriatselis C.
Institution
(Tang) Department of Arrhythmia, Fuwai Hospital, Chinese Academy of
Medical Science, Beijing 100037, China.
(Gerds-Li, Nedios, Roser, Fleck, Kriatselis) Department of Internal
Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1,
13353 Berlin, Germany.
Title
Optimal fluoroscopic projections for angiographic imaging of the pulmonary
vein ostia: Lessons learned from the intraprocedural reconstruction of the
left atrium and pulmonary veins.
Source
Europace. 12(1)(pp 37-44), 2010. Date of Publication: January 2010.
Publisher
Oxford University Press
Abstract
Aims Electrical isolation of the pulmonary veins (PVs) is the cornerstone
of the ablative treatment of atrial fibrillation. Selective angiography of
the PVs in standard fluoroscopic projections is often used for
intraprocedural identification of PVs and their ostia. Variable spatial
orientation and significant variability of PV anatomy are important
limitations of this imaging approach.Methods and resultsSixty patients
undergoing a PV isolation procedure received intraprocedural rotational
angiography and three-dimensional reconstruction of the left atrium (LA)
and PVs. For each patient, 33 angiographic projections were independently
evaluated [right anterior oblique (RAO) 80degrees to left anterior oblique
(LAO) 80degrees, in steps of 5degrees] by two physicians in order to
identify the optimal projections of the PV ostia according to the
following definition: Sagittal plane: (i) clear identification of both
superior and inferior segments of the LA-PV junction and (ii) no
overlapping between LA (and/or left atrial appendage) and PV ostium.
Frontal plane: (i) clear identification of all four quadrants of the PV
ostium and (ii) fluoroscopic angles at which the maximal horizontal ostial
diameter is visualized. A successful reconstruction of the LA and all PVs
was obtained in 58 (97%) patients. An optimal ostial projection in a
sagittal plane was identified for all four PVs. The optimal ostial
projection was RAO 5degrees for the right superior PVs in 57 out of 58
patients (98%), RAO 55degrees for the right inferior PVs in 54 out of 58
patients (93%), LAO 45degrees for the left superior PVs in 46 out of 58
patients (80%), and LAO 60degrees for the left inferior PVs in 48 out of
58 patients (83%). An optimal ostial projection in a frontal plane was
identified only for the inferior PVs. The optimal ostial projection was
LAO 40degrees for the right inferior PVs in 55 out of 58 patients (95%)
and RAO 45degrees for the left inferior PVs in 51 out of 58 patients
(88%).ConclusionIf selective angiography is to be used to delineate
anatomy and location of the PV ostia to guide PV isolation, different
fluoroscopic projections are required for different PVs. The preselected
RAO and LAO projections proposed in our study result in optimal
angiographic projections of all PV ostia in at least one plane in the
majority of patients.
<21>
Accession Number
2009654556
Authors
Messina M. Boroli F. Landoni G. Bignami E. Dedola E. N'zepa Batonga J.
Magrin S. Zangrillo A.
Institution
(Messina, Boroli, Landoni, Bignami, Dedola, N'zepa Batonga, Magrin,
Zangrillo) Department of Cardiothoracic Anesthesia and Intensive Care
Unit, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan,
Italy.
Title
A comparison of epidural vs. paravertebral blockade in thoracic surgery.
Source
Minerva Anestesiologica. 75(11)(pp 616-621), 2009. Date of Publication:
November 2009.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Aim. Epidural analgesia is considered to be the best method of pain relief
after major surgery despite its side-effects, which include hypotension,
respiratory depression, urinary retention, incomplete or failed block,
and, in rare cases, paraplegia. Paravertebral block is an alternative
technique that may offer a comparable analgesic effect and a better
sideeffect profile. This study measured postoperative pain and respiratory
function in patients randomized to receive either paravertebral block or
epidural analgesia for pain control after thoracic surgery. Methods.
Twenty-four adult patients undergoing thoracic surgery were enrolled in a
prospective and randomized clinical study. Patients were randomly
allocated to receive either postoperative continuous paravertebral
analgesia (N=12) or epidural analgesia (N=12) starting at pleura closure.
Postoperative use of morphine, visual analogue scores, and spirometer data
were collected for 72 hours after surgery as markers of pain relief.
Results. There was a statistically significant (P=0.003) increase in
median (25 th-75th percentiles) patient-controlled use of morphine, with
values of 36 (22-42) mg in the paravertebral group vs. 9 (2-22) mg in the
epidural group. This increase in morphine usage in the paravertebral group
was statistically significant at 6, 24, 48, and 72 hours after surgery.
Postoperative pain measured with the visual analogue score was not
significantly different in the two groups. Spirometer values at 72 h were
better in the epidural group than in the paravertebral group (P=0.03).
Conclusions. Epidural analgesia is more efficient than paravertebral
continuous block at reducing pain after thoracic surgery.
<22>
Accession Number
2009654506
Authors
Chakravarthy M. Narayan S. Govindarajan R. Jawali V.
Institution
(Chakravarthy, Narayan, Govindarajan, Jawali) Wockhardt Hospitals, Mumbai,
India.
Title
Improvement in accuracy of transcutaneous measurement of oxygen with
resumption of spontaneous ventilation in mechanically ventilated patients
after off pump coronary artery bypass procedure: A prospective study.
Source
Journal of Clinical Monitoring and Computing. 23(6)(pp 363-368), 2009.
Date of Publication: December 2009.
Publisher
Springer Netherlands
Abstract
Introduction: Transcutaneous measurement of gases depends on the degree of
skin perfusion. Mechanical ventilation causes alteration in the peripheral
perfusion. The aim of this prospective observational study was to assess
change in the accuracy of interchangeability of arterial blood gases with
those obtained transcutaneously at various phases of mechanical
ventilation such as controlled mandatory, synchronized intermittent
mandatory, continuous positive airway pressure ventilations, spontaneous
breathing trail and spontaneous ventilation after extubation of
endotracheal tube. Methods: Thirty-two adult patients who underwent
uncomplicated off pump coronary artery bypass surgery in a tertiary care
medical center were subjected to transcutaneous measurements of gases from
the sensor placed on the chest during postoperative ventilation. Arterial
blood gas analysis was performed at predetermined time intervals and
transcutaneous measurements were repeated each of those time. Results:
Fifty-four sets of data were obtained during controlled ventilation and
fifty during spontaneous. Correlation coefficient for oxygen increased
from 0.46 (P = 0.0004) during controlled ventilation to 0.75 (P < 0.0001)
during spontaneous. Bland-Altman and mountain plots suggested better
inter- changeability of values between arterial blood gas and
transcutaneous gas monitoring. The bias for oxygen changed from 21 during
controlled ventilation to 25 during spontaneous ventilation and the
precision from 7.1 to 6.4. There was no change in the accuracy of
transcutaneous carbon dioxide values during either phase of ventilation.
Conclusion: The accuracy of transcutaneously measured values of oxygen
improved significantly during spontaneous ventilation. copyright 2009
Springer Science+Business Media, LLC.
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