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<1>
Accession Number
2010334313
Authors
Vidlund M. Holm J. Hakanson E. Friberg T. Sunnermalm L. Vanky F.
Svedjeholm R.
Institution
(Holm, Vanky, Svedjeholm) Department of Cardiothoracic Surgery, Linkoping
Heart Center, University Hospital, SE-581 85 Linkoping, Sweden
(Hakanson) Department of Cardiothoracic Anesthesia, Linkoping Heart
Center, University Hospital, Linkoping, Sweden
(Vidlund, Friberg, Sunnermalm) Department of Cardiothoracic Surgery and
Anesthesia, University Hospital Orebro, Sweden
Title
The S-100B substudy of the GLUTAMICS trial: Glutamate infusion not
associated with sustained elevation of plasma S-100B after coronary
surgery.
Source
Clinical Nutrition. 29 (3) (pp 358-364), 2010. Date of Publication: June
2010.
Publisher
Churchill Livingstone (1-3 Baxter's Place, Leith Walk, Edinburgh EH1 3AF,
United Kingdom)
Abstract
Background & aims: Concerns have been raised about potential neurological
injury related to exogenous glutamate. In cardiac surgery glutamate has
been administered as a putative cardioprotective agent by cardioplegia or
intravenous infusion. In the GLUTAMICS trial, in addition to surveillance
of clinical neurological injuries, a prespecified subgroup was analyzed
with regard to postoperative S-100B levels to detect potential subclinical
neurological injury related to glutamate infusion. Methods: Sixty-nine
patients operated on for unstable coronary syndrome were randomized to
intravenous infusion of glutamate (n=35) or saline (n=34) perioperatively.
Plasma levels of S-100B were obtained on the third postoperative day.
Results: S-100B in the glutamate group and the control group were 0.079
+/- 0.034. mug/L and 0.090 +/- 0.042. mug/L respectively (p=0.245). There
were no patients with stroke or mortality. Three patients in the control
group and two in the glutamate group had postoperative confusion. These
patients had significantly elevated S-100B compared with those without
confusion (0.132 +/- 0.047vs 0.081 +/- 0.036. mug/L; p=0.003). Overall, 21
patients had S-100B above reference level (>=0.10. mug/L) and these
patients had significantly more calcifications in the ascending aorta on
epiaortic scanning. Conclusions: Intravenous glutamate infusion during
surgery for unstable coronary artery disease did not initiate a sustained
elevation of plasma S-100B. Thus, no evidence for subclinical neurological
injury related to glutamate infusion was found. In contrast, postoperative
elevation of plasma S-100B was linked to calcification of the ascending
aorta and postoperative confusion. 2009 Elsevier Ltd and European Society
for Clinical Nutrition and Metabolism.

<2>
Accession Number
2010389599
Authors
Arazi H.C. Doiny D.G. Torcivia R.S. Grancelli H. Waldman S.V. Nojek C.
Fornari M.C. Badimon J.J.
Institution
(Arazi, Doiny, Torcivia, Grancelli, Waldman, Nojek) Department of
Cardiology, FLENI, Montaneses 2325 (1430), Buenos Aires, Argentina
(Fornari) Laboratorio de Analisis Clinicos Fornari Bioalpha SA, Riobamba
921, Buenos Aires, Argentina
(Nojek) Trinidad Palermo, Cardiology Section, Cervino 4720, Buenos Aires,
Argentina
(Badimon) Atherothrombosis Research Center, Cardiovascular Institute,
Mount Sinai School of Medicine, New York, United States
Title
Impaired anti-platelet effect of aspirin, inflammation and platelet
turnover in cardiac surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 10 (6) (pp 863-867),
2010. Date of Publication: June 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
A reduced platelet inhibitory response to acetyl salicylic acid (ASA) has
been associated with an increased risk of graft thrombotic occlusion after
coronary artery bypass grafting (CABG). We performed a prospective,
observational study of 18 patients on 100 mg/day ASA before and after
CABG. We assessed antiplatelet response to ASA and its relationship with
platelet turnover, inflammatory markers, and soluble thrombomodulin (sTM)
levels. All patients showed optimal response to ASA preoperatively but had
higher values during follow-up. Platelet aggregation and platelet count in
the perioperative period were significantly associated (P=0.05). Platelet
turnover was defined as the average daily turnover (ADTO). The lowest
inhibitory value (28% of patients >=6 ) was recorded at the same time of
the highest platelet turnover (>10% daily in 77.77% of patients), one week
after CABG. ADTO >10% was associated with an increased risk of platelet
aggregation >=6 . Levels of sTM were significantly higher one week after
CABG (median 13 vs. 3 ng/ml preoperatively, P=0.0011). There is a
transient impairment in ASA antiplatelet effect after CABG related to an
increased platelet turnover caused by the inflammatory process. This could
be responsible for the high risk of occlusive thrombosis. 2010 Published
by European Association for Cardio-Thoracic Surgery. All rights reserved.

<3>
Accession Number
2010389761
Authors
Dibra A. Tiroch K. Schulz S. Kelbaek H. Spaulding C. Laarman G.J.
Valgimigli M. Di Lorenzo E. Kaiser C. Tierala I. Mehilli J. Campo G.
Thuesen L. Vink M.A. Schalij M.J. Violini R. Schomig A. Kastrati A.
Institution
(Dibra, Tiroch, Schulz, Mehilli, Schomig, Kastrati) Deutsches Herzzentrum,
Technische Universitat, Lazarettstr. 36, 80636 Munich, Germany
(Kelbaek) Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Spaulding) Assistance Publique-Hopitaux de Paris (AP-HP), Cochin
Hospital, Paris 5 Medical School Rene Descartes University and INSERM
U780-Avenir, Paris, France
(Laarman) King's College Hospital, London, United Kingdom
(Valgimigli, Campo) University of Ferrara, Ferrara, Italy
(Di Lorenzo) A.O.R.N. S. G Moscati, Avellino, Italy
(Kaiser) University of Basel, Basel, Switzerland
(Tierala) Helsinki University Central Hospital, Helsinki, Finland
(Thuesen) Skejby Sygehus, Skejby, Denmark
(Vink) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Schalij) Leiden University Medical Center, Leiden, Netherlands
(Violini) San Camillo Hospital, Rome, Italy
Title
Drug-eluting stents in acute myocardial infarction: Updated meta-analysis
of randomized trials.
Source
Clinical Research in Cardiology. 99 (6) (pp 345-357), 2010. Date of
Publication: June 2010.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Background Use of drug-eluting stents in patients with acute myocardial
infarction (AMI) remains an "off label" indication due to concerns
regarding their performance in this patient subset. Methods We searched
Medline, the Cochrane Central Register of Controlled Trials, and
Internet-based sources of information on clinical trials in cardiology for
randomized trials comparing drug-eluting stents with bare-metal stents in
patients with AMI. Hazard ratios for the composite of death or recurrent
myocardial infarction, (primary safety endpoint), reintervention (primary
efficacy endpoint), death, recurrent myocardial infarction, and stent
thrombosis were calculated performing a meta-analysis of 14 randomized
trials with 7,781 patients. Results There was no difference in the hazard
of death or recurrent myocardial infarction (hazard ratio, 0.91; [95% CI
0.75-1.09]) between patients treated with drug-eluting stents versus
patients treated with bare-metal stents. Treatment with drug-eluting
stents resulted in a significant reduction in the hazard of reintervention
(0.41 [95% CI 0.32-0.52]). The hazards of death (0.90 [95% CI 0.71-
1.15]), myocardial infarction (0.81 [95% CI 0.63-1.04]), and stent
thrombosis (0.84 [95% CI 0.61-1.17]) were not significantly different
between patients treated with drugeluting stents versus patients treated
with bare-metal stents. Conclusions Use of drug-eluting stents in patients
with AMI is safe and markedly reduces the need for reintervention as
compared to bare-metal stents. Springer-Verlag 2010.

<4>
Accession Number
2010389766
Authors
Bauer T. Mollmann H. Weidinger F. Zeymer U. Seabra-Gomes R. Eberli F.
Serruys P. Vahanian A. Silber S. Wijns W. Hochadel M. Nef H.M. Hamm C.W.
Marco J. Gitt A.K.
Institution
(Bauer, Mollmann, Nef, Hamm) Kerckhoff-Klinik, Kardiologie, Benekestr.
2-8, 61231 Bad Nauheim, Germany
(Weidinger) Krankenhaus Rudolfstiftung, Vienna, Australia
(Zeymer, Hochadel, Gitt) Herzzentrum Ludwigshafen, Institut fur
Herzinfarktforschung Ludwigshafen, Universitat Heidelberg, Ludwigshafen,
Germany
(Seabra-Gomes) Instituto do Coracao, Lisbon, Portugal
(Eberli) Stadtspital Triemli, Zurich, Switzerland
(Serruys) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Vahanian) Bichat Hospital, Paris, France
(Silber) Kardiologische Gemeinschaftspraxis und Praxisklinik, Munich,
Germany
(Wijns) Cardiovascular Center, Aalst, Belgium
(Marco) Centre Cardiothoracique de Monaco, Monaco Cedex, Monaco
Title
Use of platelet glycoprotein IIb/IIIa inhibitors in diabetics undergoing
PCI for non-ST-segment elevation acute coronary syndromes: Impact of
clinical status and procedural characteristics.
Source
Clinical Research in Cardiology. 99 (6) (pp 375-383), 2010. Date of
Publication: June 2010.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Abstract Background The most recent ESC guidelines for percutaneous
coronary intervention (PCI) recommend the use of glycoprotein IIb/IIIa
inhibitors (GPI) in high risk patients with non-ST-segment elevation acute
coronary syndromes (NSTE-ACS), particularly in diabetics. Little is known
about the adherence to these guidelines within Europe. Methods and results
Between May 2005 and April 2008 a total of 47,407 consecutive patients
undergoing PCI were prospectively enrolled into the PCI-Registry of the
Euro Heart Survey Programme. In the present analysis we examined the use
of GPI in 2,922 diabetics who underwent PCI for NSTE-ACS. In this high
risk population only 22.2% received a GPI; 8.9% upstream and 13.4% during
PCI. The strategy of the individual institution had a major impact on the
usage of GPI. In the multiple regression analysis clinical instability and
complex lesion characteristics were strong independent determinants for
the use of GPI, whereas renal insufficiency was negatively associated with
its use. After adjustment for confounding variables no significant
differences in hospital mortality could be observed between the cohorts,
but a significantly higher rate of non-fatal postprocedural myocardial
infarction was observed among patients receiving GPI upstream. Conclusions
Despite the recommendation for its use in the current ESC guidelines, only
a minority of the diabetics in Europe undergoing PCI for NSTE-ACS received
a GPI. The use of GPI was mainly triggered by high-risk interventional
scenarios. The Author(s) 2010.

<5>
[Use Link to view the full text]
Accession Number
2010390650
Authors
Schroeder A.R. Axelrod D.M. Silverman N.H. Rubesova E. Merkel E. Roth S.J.
Institution
(Schroeder, Axelrod, Silverman, Merkel, Roth) Department of Pediatrics,
Stanford University, School of Medicine, Palo Alto, CA, United States
(Rubesova) Department of Radiology, Stanford University, School of
Medicine, Palo Alto, CA, United States
(Schroeder) Department of Pediatrics, Santa Clara Valley Medical Center,
San Jose, CA, United States
Title
A continuous heparin infusion does not prevent catheter-related thrombosis
in infants after cardiac surgery.
Source
Pediatric Critical Care Medicine. 11 (4) (pp 489-495), 2010. Date of
Publication: July 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Objective: To determine whether a continuous infusion of heparin reduces
the rate of catheter-related thrombosis in neonates and infants post
cardiac surgery. Central venous and intracardiac catheters are used
routinely in postoperative pediatric cardiac patients. Catheter-related
thrombosis occurs in 8% to 45% of pediatric patients with central venous
catheters. Design: Single-center, randomized, placebo-controlled,
double-blinded trial. Setting: Cardiovascular intensive care unit,
university-affiliated children's hospital. Patients: Children <1 yr of age
recovering from cardiac surgery. Interventions: Patients were randomized
to receive either continuous heparin at 10 units/kg/hr or placebo. The
primary end point was catheter-related thrombosis as assessed by serial
ultrasonography. Results: Study enrollment was discontinued early based on
results from an interim futility analysis. Ninety subjects were enrolled
and received the study drug (heparin, 53; placebo, 37). The
catheter-related thrombosis rate in the heparin group, compared with the
placebo group, was 15% vs. 16% (p = .89). Subjects in the heparin group
had a higher mean partial thromboplastin time (52 secs vs. 42 secs, p =
.001), and this difference was greater for those aged <30 days (64 secs
vs. 43 secs, p = .008). Catheters in place <=7 days had both a greater
risk of thrombus formation (odds ratio, 4.3; p = .02) and catheter
malfunction (odds ratio, 11.2; p = .008). We observed no significant
differences in other outcome measures or in the frequency of adverse
events. Conclusions: A continuous infusion of heparin at 10 units/kg/hr
was safe but did not reduce catheter-related thrombus formation. Heparin
at this dose caused an increase in partial thromboplastin time values,
which, unexpectedly, was more pronounced in neonates. Copyright 2010 by
the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies.

<6>
[Use Link to view the full text]
Accession Number
2010293813
Authors
Melsop K. Brooks M.M. Boothroyd D.B. Hlatky M.A.
Institution
(Melsop, Boothroyd, Hlatky) Stanford University School of Medicine,
Stanford, CA, United States
(Brooks) University of Pittsburgh, Graduate School of Public Health,
Pittsburgh, PA, United States
Title
Effect of race on the clinical outcomes in the bypass angioplasty
revascularization investigation trial.
Source
Circulation: Cardiovascular Quality and Outcomes. 2 (3) (pp 186-190),
2009. Date of Publication: May 2009.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background-In observational studies, clinical outcomes for black patients
with coronary disease have been worse than for white patients. There are
few data from randomized trials comparing the outcomes of coronary
revascularization between black patients and white patients. Methods and
Results-We analyzed data from the Bypass Angioplasty Revascularization
Investigation randomized trial. At study entry, the 113 black patients had
significantly higher rates of diabetes, hypertension, smoking, heart
failure, and abnormal left ventricular function than the 1653 white
patients. Black patients had significantly higher mortality than white
patients (hazard ratio, 2.16; P<0.001), which remained significant after
statistical adjustment for differences in baseline clinical
characteristics (hazard ratio, 1.59; P=0.003). In a substudy of economic
and quality of life outcomes, the 67 black patients had similar frequency
of physician visits and use of evidence-based cardiac medications but
significantly worse physical function scores than the 885 white patients.
The effect of random assignment to either surgery or angioplasty on
clinical outcomes was not significantly modified by race (interaction
probability values >=0.18). Conclusions-Clinical outcomes of black
patients after coronary revascularization were worse than those of white
patients in a clinical trial setting with similar treatment and access to
care. The differences in outcome between black and white patients were not
completely attributable to the greater levels of comorbidity among black
patients at study entry. (Circ Cardiovasc Qual Outcomes. 2009;2:186-190.)
2009 American Heart Association, Inc.

<7>
Accession Number
2010328920
Authors
Heneghan C. Tyndel S. Bankhead C. Wan Y. Keeling D. Perera R. Ward A.
Institution
(Heneghan, Tyndel, Bankhead, Perera, Ward) Department of Primary Health
Care, University of Oxford, Oxford, United Kingdom
(Wan) Department of Health Statistics Fourth Military Medical University,
Xi'an, China
(Keeling) Department of Haematology, Oxford Radcliffe Hospitals, Oxford,
United Kingdom
Title
Optimal loading dose for the initiation of warfarin: A systematic review.
Source
BMC Cardiovascular Disorders. 10 , 2010. Article Number: 18. Date of
Publication: 19 Apr 2010.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Background: Selection of the right warfarin dose at the outset of
treatment is not straightforward, and current evidence is lacking to
determine the optimal strategy for initiation of therapy.Methods: We
included randomized controlled trials in patients commencing
anticoagulation with warfarin, comparing different loading dose or
different regimens.We searched Medline, EMBASE, the Cochrane Library and
the NHS Health Economics Database up to June 2009. Primary outcomes were
time to stable INR and adverse events. We summarised results as proportion
of INRs in range from date of initiation and compared dichotomous outcomes
using relative risks (RR) and calculated 95% confidence intervals
(CIs).Results: We included 11 studies of 1,340 patients newly initiated on
warfarin. In two studies that used single INR measures, a loading dose of
10 mg compared to 5 mg led to more patients in range on day five. However,
in two studies which measured two consecutive INRs, a loading dose of 10
mg compared to 5 mg did not lead to more patients in range on day five (RR
= 0.86, 95% CI, 0.62 to 1.19, p = 0.37). Patients receiving a 2.5 mg
initiation does took longer to achieve the therapeutic range, whilst those
receiving a calculated initiation dose achieved target range 0.8 days
quicker (4.2 days vs. 5 days, p = 0.007). More elderly patients receiving
an age adjusted dose achieved a stable INR compared to the Fennerty
protocol (48% vs. 22% p = 0.02) and significantly fewer patients on the
age adjusted regimens had high out-of-range INRs. Two studies report no
significant differences between genotype guided and 5 mg or 10 mg
initiation doses and in the one significant genotype study the control
group INRs were significantly lower than expected.Conclusion: Our review
findings suggest there is still considerable uncertainty between a 10 mg
and a 5 mg loading dose for initiation of warfarin. In the elderly, lower
initiation doses or age adjusted doses are more appropriate, leading to
less higher INRs. Currently there is insufficient evidence to warrant
genotype guided initiation, and adequately powered trials to detect
effects on adverse events are currently warranted. 2010 Heneghan et al;
licensee BioMed Central Ltd.

<8>
Accession Number
2010328946
Authors
Cuthbertson B.H. Campbell M.K. Stott S.A. Vale L. Norrie J. Kinsella J.
Cook J. Brittenden J. Grant A.
Institution
(Cuthbertson) Department of Critical Care Medicine, Sunnybrook Health
Sciences Centre, Toronto, ON, Canada
(Cuthbertson, Campbell, Vale, Cook) Health Services Research Unit, Health
Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, United
Kingdom
(Stott) Intensive Care Unit, Aberdeen Royal infirmary, Westburn Road,
Aberdeen, United Kingdom
(Norrie) Robertson Centre for Biostatistics, University of Glasgow,
Glasgow, United Kingdom
(Kinsella) Department of Anaesthesia Pain and Critical Care, University of
Glasgow, Glasgow, United Kingdom
(Brittenden) Department of Surgery, University of Aberdeen, Foresterhill,
Aberdeen, United Kingdom
(Grant) Institute of Applied Health Sciences, Health Sciences Building,
University of Aberdeen, Foresterhill, Aberdeen, United Kingdom
(Vale) Health Economics Research Unit, Polwarth Building, University of
Aberdeen, Foresterhill, Aberdeen, United Kingdom
Title
A pragmatic multi-centre randomised controlled trial of fluid loading and
level of dependency in high-risk surgical patients undergoing major
elective surgery: Trial protocol.
Source
Trials. 11 , 2010. Article Number: 41. Date of Publication: 16 Apr
2010.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Background: Patients undergoing major elective or urgent surgery are at
high risk of death or significant morbidity. Measures to reduce this
morbidity and mortality include pre-operative optimisation and use of
higher levels of dependency care after surgery. We propose a pragmatic
multi-centre randomised controlled trial of level of dependency and
pre-operative fluid therapy in high-risk surgical patients undergoing
major elective surgery.Methods/Design: A multi-centre randomised
controlled trial with a 2 $ 2 factorial design. The first randomisation is
to pre-operative fluid therapy or standard regimen and the second
randomisation is to routine intensive care versus high dependency care
during the early post-operative period. We intend to recruit 204 patients
undergoing major elective and urgent abdominal and thoraco-abdominal
surgery who fulfil high-risk surgical criteria. The primary outcome for
the comparison of level of care is cost-effectiveness at six months and
for the comparison of fluid optimisation is the number of hospital days
after surgery.Discussion: We believe that the results of this study will
be invaluable in determining the future care and clinical resource
utilisation for this group of patients and thus will have a major impact
on clinical practice.Trial Registration: Trial registration number -
ISRCTN32188676. 2010 Cuthbertson et al; licensee BioMed Central Ltd.

<9>
Accession Number
2010330536
Authors
McKenna C. Burch J. Suekarran S. Walker S. Bakhai A. Witte K. Harden M.
Wright K. Woolacott N. Lorgelly P. Fenwick L. Palmer S.
Institution
(McKenna, Walker, Harden, Wright, Woolacott, Palmer) Centre for Health
Economics, University of York, York, United Kingdom
(Burch, Suekarran) Centre for Reviews and Dissemination, University of
York, York, United Kingdom
(Bakhai) Barnet General Hospital, Barnet, United Kingdom
(Witte) University of Leeds and Leeds General Infirmary, Leeds, United
Kingdom
(Lorgelly, Fenwick) Section of Health Policy and Public Health, University
of Glasgow, Glasgow, United Kingdom
Title
A systematic review and economic evaluation of the clinical effectiveness
and cost-effectiveness of aldosterone antagonists for postmyocardial
infarction heart failure.
Source
Health Technology Assessment. 14 (24) (pp i-161), 2010. Date of
Publication: 2010.
Publisher
National Co-ordinating Centre for HTA (Bouldrewood, Mail Point 728,
Highfield, Southhampton, United Kingdom)
Abstract
Background: Two aldosterone inhibitors are currently licensed for heart
failure (HF) in the UK: spironolactone and eplerenone. Recent clinical
guidelines recommend eplerenone after an acute myocardial infarction (MI)
for patients with symptoms and/or signs of HF and left ventricular
dysfunction. Objectives: The primary objective was to evaluate relative
clinical effectiveness and cost-effectiveness of spironolactone and
eplerenone in patients with postMI HF and explore the possibility of
conducting an indirect comparison of spironolactone and eplerenone. A
second objective was to undertake value-ofinformation (VOI) analyses to
determine the need for further research to identify research questions
critical to decision-making and to help inform the design of future
studies. Data sources: Relevant databases including MEDLINE, EMBASE and
CENTRAL were searched between September and December 2008. Randomised
controlled trials (RCTs) of spironolactone, eplerenone, canrenone or
potassium canrenoate were included if conducted in a postMI HF population.
Trials of general HF patients with a subgroup of postMI HF patients were
considered if they had at least 100 ischaemic participants per arm and the
authors provided subgroup data when contacted. Adverse events summary data
were sought from recognised reference sources and RCTs or observational
studies in any population that recruited more than 100 articipants. Review
methods: The comparative clinical effectiveness and cost-effectiveness of
spironolactone and eplerenone was derived using Bayesian meta regression
drawing on a wider 'network' of aldosterone trials to those considered in
the main clinical effectiveness review. An alternative scenario was also
considered assuming a 'class effect' for the aldosterone antagonists in
terms of major clinical events, but allowing for potential differences in
side effect profiles. Cost-effectiveness was assessed using incremental
cost-effectiveness ratios (ICERs) where appropriate. Uncertainty in
cost-effectiveness results was also presented and used to inform future
research priorities using VOI analyses based on expected value of perfect
information (EVPI). A probabilistic decision analytic model was developed
to estimate cost-effectiveness of spironolactone, eplerenone and standard
care for management of postMI HF, provide estimates relevant to the NHS
and explore alternative approaches to an indirect comparison between
spironolactone and eplerenone. The model incorporated a lifetime horizon
to estimate outcomes in terms of quality-adjusted life-years (QALYs) and
costs from the NHS persepctive. In the base-case analysis, 2-year
treatment duration was assumed, consistent with the follow-up in the main
RCTs. Other scenarios were explored to examine the robustness of
alternative assumptions including impact of different treatment durations.
Results: Searches yielded five RCTs: two spironolactone trials of poor
methodological quality and three trials of which only one (of eplerenone)
specifically examined postMI HF (Eplerenone Post-Acute Myocardial
Infarction Heart Failure Efficacy and Survival Study, EPHESUS). One trial
of spironolactone (Randomised Aldactone Evaluation Study, RALES) and one
of canrenone (Antiremodelling Effect of Aldosterone receptors blockade
with canrenone In mild Chronic Heart Failure, AREA IN-CHF) comprised
general HF, but data were available for an ischaemic subgroup. Structural
similarity of spironolactone and eplerenone suggests that they may be
interchangeable, but formal indirect comparison between the three trials
was severely limited by trial differences. Relative safety data were
limited from RCTs and observational sources. Hyperkalaemia rates varied,
but were generally higher than for placebo; data were insufficient to
assess discontinuation because of hyperkalaemia. Gynaecomastia rates were
higher with spironolactone.Adverse event data were sparse. Systematic
review of economic evidence identified three main published studies but
none used a UK perspective or attempted to compare cost-effectiveness in
postMI HF. The new decision model indicated that eplerenone was the most
cost-effective strategy for postMI HF (ICER of eplerenone compared with
standard care was 4457 per QALY, increasing to 7893 per QALY if treatment
continued over the patient's lifetime); in neither scenario did
spironolactone appear cost-effective. The ICER of eplerenone was
consistently under the 20,000-30,000 per QALY threshold used to establish
value for money in the NHS. Uncertainty resulted in EVPI estimates between
820M (base-case) and 1265M (lifetime treatment duration scenario). When
class effect for mortality and hospitalisations was assumed spironolactone
emerged as the most costeffective treatment and EVPI estimates were
negligible. If class effect is considered more plausible than the results
of the evidence synthesis model then there would be limited value in
additional research. Limitations: Exchangeability between trials was poor
and there was a lack of robust data in RCTs. Conclusions: Only two
good-quality trials of aldosterone inhibitors in the postMI HF population
were found, but lack of exchangeability with respect to study populations,
meant that a comparison between these drugs could not be done. It
consistently emerged that, compared with usual care, use of an aldosterone
antagonist appears to be a highly costeffective strategy for the
management of postMI HF patients in the NHS. An adequately powered,
wellconducted RCT that directly compares spironolactone and eplerenone is
required to provide more robust evidence on the optimal management of
postMI HF patients. 2010 Queen's Printer and Controller of HMSO.

<10>
Accession Number
2010333711
Authors
Moss A.J.
Institution
(Moss) Cardiology Division of the Department of Medicine, University of
Rochester Medical Center, Rochester, NY, United States
Title
What we have learned from the family of multicenter automatic
defibrillator implantation trials.
Source
Circulation Journal. 74 (6) (pp 1038-1041), 2010. Date of Publication:
2010.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Electrical device therapy began 50 years ago with the external
defibrillator, and was followed subsequently with the introduction of
implantable cardiac pacemakers, defibrillators, and resynchronization
devices to prevent bradycardia, sudden arrhythmic death, and heart
failure. During the past 20 years the Multicenter Automatic Defibrillator
Implantation Trial (MADIT) research group has carried out a series of
trials, including the MADIT-I, MADIT-II, and MADIT-III (MADIT-CRT), that
have focused on improving the outcomes for patients with ischemic and
nonischemic cardiac disease. The most recent MADIT-CRT trial showed that a
cardiac resynchronization therapy device with defibrillator (CRT-D) was
effective in reducing the risk of heart failure or death, whichever came
first, in cardiac patients who were asymptomatic or minimally symptomatic
(New York Heart Association class I or II) with reduced ejection fraction
<=0.30 and wide QRS complex >=130 ms when compared with an implantable
cardiac defibrillator (ICD) device. The family of MADIT ICD and CRT-D
trials have provided a firm foundation for improving the clinical
management of at-risk cardiac patients as the second decade of the
21^st century begins.

<11>
Accession Number
2010333732
Authors
Miyazaki S. Kasai T. Miyauchi K. Miyazaki T. Akimoto Y. Takagi A. Aihara
K. Kawamura M. Suwa S. Kojima S. Sumiyoshi M. Daida H.
Institution
(Miyazaki, Miyazaki, Kawamura, Suwa, Kojima, Sumiyoshi) Department of
Cardiology, Juntendo Shizuoka Hospital, Shizuoka, Japan
(Kasai, Miyauchi, Akimoto, Takagi, Aihara, Daida) Department of
Cardiology, Juntendo University, School of Medicine, Tokyo, Japan
Title
Changes of matrix metalloproteinase-9 level is associated with left
ventricular remodeling following acute myocardial infarction among
patients treated with trandolapril, valsartan or both.
Source
Circulation Journal. 74 (6) (pp 1158-1164), 2010. Date of Publication:
2010.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Inhibition of the renin-angiotensin system (RAS) with
angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor
blockers (ARBs) can suppress left ventricular (LV) remodeling after acute
myocardial infarction (AMI), possibly through the modifications of matrix
metalloproteinase (MMP)-9. Whether LV remodeling is suppressed in
association with MMP-9 suppression in post-AMI/-percutaneous coronary
intervention (PCI) patients treated with ACE inhibitor and/or ARB was
examined. The presence of any differences in LV remodeling and MMP-9
levels across the groups was also investigated. Methods and Results:
Sixty-five patients were initiated into each of 3 treatments;
trandolapril, valsartan or a combination of both (half-dose-trandolapril
plus half-dose-valsartan). Changes in MMP-9, LV end-diastolic and
end-systolic volume index (LVEDVI and LVESVI) after 12 months were
assessed. Overall, MMP-9 significantly decreased, although neither LVEDVI
nor LVESVI increased significantly. AMMP-9 was significantly correlated
with LVEDVI (r=0.36) or LVESVI (r=0.39). In comparison, across groups, it
was found that MMP-9, LVEDVI and LVESVI at 12 months were significantly
lower in the combination therapy group than in the trandolapril group.
There were no significant differences between the valsartan group and
combination therapy group, or between the valsartan group and the
trandolapril group. Conclusions: LV remodeling might be suppressed in
association with MMP-9 suppression in AMI patients treated with PCI and
regular dose or half-dose-combination of RAS inhibitors. Furthermore, a
half-dose-combination might suppress LV remodeling more effectively than
trandolapril alone.

<12>
Accession Number
2010388947
Authors
Dabrowski W. Rzecki Z. Wosko J. Biernacka J. Kotlinska E. Czajkowski M.
Institution
(Dabrowski, Rzecki, Wosko, Biernacka, Kotlinska) Department of
Anaesthesiology and Intensive Therapy, Medical University of Lublin,
Jaczewskiego 8, Lublin 20-954, Poland
(Czajkowski) Department of Cardiac Surgery, Medical University of Lublin,
Poland
Title
Volatile anaesthetics reduce serum S100beta concentrations in patients
undergoing elective cardiac surgery.
Source
Applied Cardiopulmonary Pathophysiology. 14 (2) (pp 139-148), 2010. Date
of Publication: 2010.
Publisher
Pabst Science Publishers (Eichengrund 28, Lengerich D-49525, Germany)
Abstract
Background: The effect of volatile anaesthetics on plasma S100beta protein
has not been welldocumented in cardiac surgery patients. The aim of the
study was to analyse the effect of sevoflurane or isoflurane anaesthesia
on plasma S100beta concentration in patients undergoing elective,
uncomplicated coronary artery bypass graft surgery. Methods: One hundred
thirty seven patients were prospectively randomized and allocated into
three groups: A patients, who didn't receive volatile anaesthetics, B who
received sevoflurane and C who received isoflurane. S100beta was measured
during anaesthesia and postoperative days 1 and 2. Results: In all
patients, S100beta increased during anaesthesia and at the postoperative
day 1 and 2. In group A, S100beta increased during anaesthesia and
postoperative days 1 and 2 but in groups B and C only during anaesthesia.
Plasma S100beta concentrations were significantly higher in group A than
in group B and C. Conclusions: 1) cardiac surgery resulted in S100beta
elevation, 2) isoflurane and sevoflurane significantly reduced plasma
S100beta concentrations.

<13>
[Use Link to view the full text]
Accession Number
20197560
Authors
Temporelli P.L. Scapellato F. Eleuteri E. Imparato A. Giannuzzi P.
Institution
(Temporelli) Division of Cardiology, Salvatore Maugeri Foundation, IRCCS,
Via Revislate 13, Veruno, Italy.
Title
Doppler echocardiography in advanced systolic heart failure: a noninvasive
alternative to Swan-Ganz catheter.
Source
Circulation. Heart failure. 3 (3) (pp 387-394), 2010. Date of
Publication: May 2010.
Abstract
BACKGROUND: Although several studies have demonstrated a good correlation
between Doppler echocardiographic and invasive measurements of single
hemodynamic variables, the accuracy of echocardiography in providing a
comprehensive assessment in individual patients has not been validated.
The aim of this study was to assess the accuracy and clinical
applicability of Doppler echocardiography in determining the entire
hemodynamic profile in stable patients with advanced systolic heart
failure. METHODS AND RESULTS: Doppler echocardiography and Swan-Ganz
catheterization were simultaneously performed in 43 consecutive patients
with advanced heart failure. Echocardiographic data required for
estimation of right atrial, pulmonary artery systolic, and pulmonary
capillary wedge pressures; cardiac output; and pulmonary vascular
resistance were obtained and compared with hemodynamic data. For all
variables, invasive and noninvasive hemodynamic values were highly
correlated (P<0.0001), with very low bias and narrow 95% confidence
limits. In 16 patients with elevated pulmonary vascular resistance (>3
Wood U) and pulmonary capillary wedge pressures (>20 mm Hg) at baseline,
hemodynamic and Doppler measurements were simultaneously repeated after
unloading manipulations. Absolute values and changes of pulmonary vascular
resistance and pulmonary capillary wedge pressures after unloading were
still accurately predicted (r =0.96 and r =0.92, respectively).
CONCLUSIONS: Doppler echocardiography may offer a valid alternative to
invasive cardiac catheterization for the comprehensive hemodynamic
assessment of patients with advanced heart failure, and it may assist in
monitoring and optimization of therapy in potential heart transplant
recipients.

<14>
[Use Link to view the full text]
Accession Number
20299607
Authors
Udelson J.E. Feldman A.M. Greenberg B. Pitt B. Mukherjee R. Solomon H.A.
Konstam M.A.
Institution
(Udelson) Tufts Medical Center, 750 Washington Street, Boston, MA 02111,
USA.
Title
Randomized, double-blind, multicenter, placebo-controlled study evaluating
the effect of aldosterone antagonism with eplerenone on ventricular
remodeling in patients with mild-to-moderate heart failure and left
ventricular systolic dysfunction.
Source
Circulation. Heart failure. 3 (3) (pp 347-353), 2010. Date of
Publication: May 2010.
Abstract
BACKGROUND: Aldosterone antagonism has been studied in patients with
advanced heart failure (HF) and also in patients with post-myocardial
infarction and left ventricular (LV) dysfunction with HF symptoms. Few
data are available on effects of aldosterone antagonism in patients with
mild-to-moderate HF. METHODS AND RESULTS: In a multicenter, randomized,
double-blind, placebo-controlled study in patients with mild-to-moderate
HF and LV systolic dysfunction, patients with New York Heart Association
class II/III HF and LV ejection fraction (EF) < or =35% were randomly
assigned to receive eplerenone 50 mg/d versus placebo in addition to
contemporary background therapy. Quantitative radionuclide ventriculograms
to assess LV volumes and ejection fraction were performed at baseline and
again after 9 months of double-blind treatment and were analyzed in a
central core laboratory, blinded to treatment. The primary efficacy
analysis was the between-group comparison of the change in LV
end-diastolic volume index. Secondary analyses examined changes in LV
end-systolic volume index and ejection fraction as well as markers of
collagen turnover. Of the total 226 patients enrolled, 117 were randomly
assigned to receive eplerenone and 109 to receive placebo. There was high
use of contemporary background therapy at baseline, with > 90% use of
angiotensin-converting enzyme inhibitors and/or angiotensin receptor
blockers and > 90% use of beta-blockers. Over 36 weeks of treatment, there
was no apparent between-group difference in the changes in end-diastolic
volume index or end-systolic volume index. There was a reduction in the
collagen turnover marker procollagen type I N-terminal propeptide and
plasma B-type natriuretic peptide in the eplerenone group compared with
placebo (P=0.01 and P=0.04, respectively). There was no change in symptom
status or quality-of-life measures. CONCLUSIONS: In a clinically stable,
well-treated population of patients with mild-to-moderate HF symptoms and
LV dysfunction, 36 weeks of treatment of aldosterone antagonism with
eplerenone at a dose of 50 mg daily had no detectable effect on parameters
of LV remodeling.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 12

Results Generated From:
EMBASE <1980 to 2010 Week 29>
EMBASE (updates since 2010-07-15)

<1>
Accession Number
2010321335
Authors
Bainbridge D. Martin J. Ahmad Sabry M.H.I. Craig A. Iglesias I.
Institution
(Bainbridge, Iglesias) Departments of Anesthesia and Perioperative
Medicine, University of Western Ontario, London, ON, Canada
(Martin) Pharmacology and Physiology, University of Western Ontario,
London, ON, Canada
(Ahmad Sabry) Alexandria Faculty of Medicine, Alexandria University,
Alexandria, Egypt
(Craig) Greenlane Surgical Short Stay Unit, Auckland, New Zealand
(Bainbridge) Department of Anesthesia and Perioperative Medicine, London
Health Sciences Centre-University Hospital, 339 Windermere Road, London,
ON N6A 5A5, Canada
Title
Orogastric tubes do not improve transesophageal echocardiographic imaging
during cardiac surgery: A randomized trial.
Source
Canadian Journal of Anesthesia. 57 (3) (pp 216-221), 2010. Date of
Publication: March 2010.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Introduction: Image quality is often an overlooked consideration that
affects the quality and findings of a perioperative transesophageal
echocardiography (TEE) study. We undertook a study to evaluate the
potential benefit of orogastric (OG) tube insertion following tracheal
intubation as a method to improve TEE image quality. Methods: In this
prospective randomized double-blind controlled trial, 32 adult cardiac
surgery patients were randomized to receive either an orogastric (OG) tube
with suctioning or no OG tube following tracheal intubation and before TEE
probe insertion. Two independent observers graded the quality of related
TEE images on a scale from 1 to 4, and the total image scores (total
scores out of a possible 20) were compared between groups across five
different views. All analyses were by intention to treat. Results: For the
total scores, there was no difference between the OG and control groups
(mean 12.3 [2.1] vs 12.8 [1.8], respectively; P = 0.7). There was a
numerically small but statistically significant difference in total scores
between reviewers (score 2.4 [0.7] vs 2.2 [0.9]; mean difference -0.2; 95%
confidence interval -0.4 to -0.02; P < 0.001). For the most part, the
raters agreed on the scores for each view. Overall, 96% of the total
scores were identical or differed by only one point. Conclusion: While
this study was underpowered to detect small changes in image quality, the
use of an OG tube for routine cases did not improve the overall quality of
the related images acquired during TEE examination. Canadian
Anesthesiologists' Society 2010.

<2>
Accession Number
2010372192
Authors
Bilehjani E. Fakhari S.
Institution
(Bilehjani) Department of Cardiovascular Anesthesia, Tabriz University of
Medical Sciences, Madani Heart Hospital, Tabriz, Iran, Islamic Republic of
(Fakhari) Madani Heart Hospital, Daneshqah Street, Tabriz, Iran, Islamic
Republic of
Title
Hemodynamic response to laryngoscopy in ischemic heart disease: Macintosh
blade versus glidescope videolaryngoscope.
Source
Rawal Medical Journal. 34 (2) (pp 151-154), 2009. Date of Publication:
July - Dec. 2009.
Publisher
Pakistan Medical Association (Garden Road, Karachi - 3, Pakistan)
Abstract
Objective To determine the hemodynamic response to laryngoscopy/tracheal
intubation using GlideScope videolaryngoscope in patients with
ischemic heart diseases. Methods In a randomized clinical trial, 80 adult
patient, candidate for coronary artery bypass graft surgery were allocated
in two groups for laryngoscopy (MC=Macintosh blade or GS=GlideScope). The
hemodynamic response, laryngoscopy time, success rate and complication
rate were compared. Results Two patients were excluded because of long
postoperative intubation period. Demographic data and airway
characteristics were comparable. There was no failed intubation.
Laryngoscopy time in MC group was shorter than GS group (14.50+/-8.30
versus 48.80+/-47.82 respectively, p=0.001). Stylet was used commonly and
more attempts to intubation were done in GS group. Hemodynamic response to
orotracheal intubation in 1, 5 and 15 min following intubation was not
different between two groups. Conclusions GlideScope technique
did not have any benefit and increased laryngoscopy time, need to use
stylet and required more attempts. (Rawal Med J 2009;34: 151-154).

<3>
Accession Number
2010362717
Title
Herbal medicine.
Source
Focus on Alternative and Complementary Therapies. 15 (2) (pp 152-157),
2010. Date of Publication: June 2010.
Publisher
Wiley-Blackwell (350 Main Street, Malden MA 02148, United States)

<4>
Accession Number
2010377050
Authors
Deng B. Tan Q.-Y. Zhao Y.-P. Wang R.-W. Jiang Y.-G.
Institution
(Deng, Tan, Zhao, Wang, Jiang) Thoracic Surgery Department, Institute of
Surgery Research, Daping Hospital, Third Military Medical University,
Chongqing 400042, China
Title
Suction or non-suction to the underwater seal drains following pulmonary
operation: Meta-analysis of randomised controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 38 (2) (pp 210-215), 2010.
Date of Publication: August 2010.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objectives: The decision to proceed to simple underwater seal drainage or
to apply active suction to the underwater seal following pulmonary
operation is a controversial one. For the sake of selecting the
alternative to reduce postoperative air leakage, we performed a
meta-analysis of randomised controlled trials (RCTs) to determine the
benefit of suction or non-suction following lung surgery on patient
outcomes. Methods: RCTs published in English from 1999 to 2009 were
included. A fixed-effect model was developed for postoperative
pneumothorax cases. A random-effects model was developed for quantitative
data synthesis, including prolonged air-leak cases, duration of air
leakage, time for the removal of chest tubes and hospital stay. Results:
Odds ratio (95% confidence interval (CI)), expressed as suction versus
non-suction, was 0.11 (0.03-0.49) for postoperative pneumothorax cases;
relative risk was 1.48 (0.82-2.70) for prolonged air-leakage cases;
weighted mean difference was 1.16 (-0.63 to 2.94) for the duration of air
leakage, 0.96 (-0.12 to 2.05) for the time for removal of chest tubes and
2.19 (0.61-4.98) for the hospital stay. Conclusion: There is no necessity
to use suction in most cases, since it cannot decrease the incidence of
prolonged air leak. However, suction can reduce the occurrence of
postoperative pneumothorax resulting from early air leak. As a result, the
early use of postoperative suction might be crucial to specific patients
to whom early elimination of residual space is very important. 2010
European Association for Cardio-Thoracic Surgery.

<5>
Accession Number
2010379773
Authors
Serruys P.W. Silber S. Garg S. Van Geuns R.J. Richardt G. Buszman P.E.
Kelbaek H. Van Boven A.J. Hofma S.H. Linke A. Klauss V. Wijns W. Macaya C.
Garot P. DiMario C. Manoharan G. Kornowski R. Ischinger T. Bartorelli A.
Ronden J. Bressers M. Gobbens P. Negoita M. Van Leeuwen F. Windecker S.
Institution
(Serruys, Garg, Van Geuns) Department of Cardiology, Erasmus Medical
Center, Molewaterplein 40, Ba-583, 3015 GD Rotterdam, Netherlands
(Ronden, Bressers, Gobbens) Cardialysis, Rotterdam, Netherlands
(Van Boven, Hofma) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Silber) Kardiologische Praxis und Praxisklinik, Munich, Germany
(Klauss) University Hospital Munich (Innenstadt), Munich, Germany
(Ischinger) Hospital Bogenhausen, Munich, Germany
(Richardt) Herz-Kreislauf-Zentrum, Segeberger Kliniken, Bad Segeberg,
Germany
(Linke) Herzzentrum Leipzig, Leipzig, Germany
(Buszman) Medical University of Silesia, Katowice, Poland
(Kelbaek) Rigshospitalet, Copenhagen, Denmark
(Wijns) Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
(Macaya) Hospital Universitario, Madrid, Spain
(Garot) Institut Cardiovasculaire Paris-Sud, Quincy, France
(DiMario) Royal Brompton Hospital, London, United Kingdom
(Manoharan) Royal Victoria Hospital, Belfast, United Kingdom
(Kornowski) Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
(Bartorelli) Centro Cardiologico Monzino, Milan, Italy
(Negoita, Van Leeuwen) Medtronic, Santa Rosa, CA, United States
(Windecker) Bern University Hospital, Bern, Switzerland
Title
Comparison of zotarolimus-eluting and everolimus-eluting coronary stents.
Source
New England Journal of Medicine. 363 (2) (pp 136-146), 2010. Date of
Publication: 08 Jul 2010.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: New-generation coronary stents that release zotarolimus or
everolimus have been shown to reduce the risk of restenosis. However, it
is unclear whether there are differences in efficacy and safety between
the two types of stents on the basis of prospectively adjudicated end
points endorsed by the Food and Drug Administration. METHODS: In this
multicenter, noninferiority trial with minimal exclusion criteria, we
randomly assigned 2292 patients to undergo treatment with coronary stents
releasing either zotarolimus or everolimus. Twenty percent of patients
were randomly selected for repeat angiography at 13 months. The primary
end point was target-lesion failure, defined as a composite of death from
cardiac causes, any myocardial infarction (not clearly attributable to a
nontarget vessel), or clinically indicated target-lesion revascularization
within 12 months. The secondary angiographic end point was the extent of
in-stent stenosis at 13 months. RESULTS: At least one off-label criterion
for stent placement was present in 66% of patients. The
zotarolimus-eluting stent was noninferior to the everolimus-eluting stent
with respect to the primary end point, which occurred in 8.2% and 8.3% of
patients, respectively (P<0.001 for noninferiority). There were no
significant between-group differences in the rate of death from cardiac
causes, any myocardial infarction, or revascularization. The rate of stent
thrombosis was 2.3% in the zotarolimus-stent group and 1.5% in the
everolimus-stent group (P = 0.17). The zotarolimus-eluting stent was also
noninferior regarding the degree (+/-SD) of in-stent stenosis
(21.65+/-14.42% for zotarolimus vs. 19.76+/-14.64% for everolimus, P =
0.04 for noninferiority). In-stent late lumen loss was 0.27+/-0.43 mm in
the zotarolimus-stent group versus 0.19+/-0.40 mm in the everolimusstent
group (P = 0.08). There were no significant between-group differences in
the rate of adverse events. CONCLUSIONS: At 13 months, the new-generation
zotarolimus-eluting stent was found to be noninferior to the
everolimus-eluting stent in a population of patients who had minimal
exclusion criteria. Copyright 2010 Massachusetts Medical Society. All
rights reserved.

<6>
Accession Number
2010324480
Authors
Serrano C.V. Souza J.A. Lopes N.H. Fernandes J.L. Nicolau J.C. Blotta
M.H.S.L. Ramires J.A.F. Hueb W.A.
Institution
(Serrano, Souza, Lopes, Fernandes, Nicolau, Ramires, Hueb) Heart Institute
(InCor), Medical School, University of Sao Paulo, Brazil
(Fernandes, Blotta) Department of Clinical Pathology, Faculty of Medical
Sciences, State University of Campinas, Brazil
Title
Reduced expression of systemic proinflammatory and myocardial biomarkers
after off-pump versus on-pump coronary artery bypass surgery: A
prospective randomized study.
Source
Journal of Critical Care. 25 (2) (pp 305-312), 2010. Date of
Publication: June 2010.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Background: The effects of off-pump (OffPCABG) and on-pump (OnPCABG)
coronary artery bypass grafting (CABG) on myocardium and inflammation are
unclear. Objective: Compare the inflammatory response and myocardial
injury from patients (pts) submitted to OffPCABG with those that undergo
OnPCABG. Methods: Patients with normal left ventricular function were
assigned to OffPCABG (n = 40) and OnPCABG (n = 41). Blood samples were
collected before and 24 hours after surgery for determination of creatine
kinase (CK)-MB (CK-MB), troponin I (cTnI), interleukin (IL)-6, IL-8,
P-selectin, intercellular adhesion molecule (ICAM)-1 and C-reactive
protein (CRP). Mortalities were registered at 12 months. Results:
Preoperative CK-MB and cTnI levels were 3.1 +/- 0.6 IU and 1.2 +/- 0.5
ng/mL for OffPCABG and 3.0 +/- 0.5 IU and 1.0 +/- 0.2 ng/mL for OnPCABG
pts. Postoperative CK-MB and cTnI levels were 13.9 +/- 6.5 IU and 19.0 +/-
9.0 ng/mL for OffPCABG vs 29.5 +/- 11.0 IU and 31.5 +/- 10.1 ng/mL for
OnPCABG (P < .01). OffPCABG and OnPCABG pts had similar preoperative IL-6
(10 +/- 7 and 9 +/- 13 pg/mL), IL-8 (19 +/- 7 and 17 +/- 7 pg/mL), soluble
P-selectin (70 +/- 21 and 76 +/- 23 pg/mL), soluble ICAM-1 (117 +/- 50 and
127 +/- 52 ng/mL), and CRP (0.09 +/- 0.05 and 0.11 +/- 0.07 mg/L). At 24
hours, for OffPCABG and OnPCABG: IL-6 was 37 +/- 38 and 42 +/- 41
^,+/- g/mL; IL-8, 33 +/- 31 and 60 +/- 15 ^,+/- pg/mL;
soluble P-selectin, 99 +/- 26 and 172 +/- 30 ^,+/- pg/mL;
soluble ICAM-1, 227 +/- 47 and 236 +/- 87 ^,+/- ng/mL; and CRP,
10 +/- 11 and 14 +/- 13 ^,+/- mg/L ( P < .01 vs preoperation;
^+/-P < .01 vs OffPCABG). Increased 24-hour postoperative CRP
levels was the only marker to have significant positive correlations with
events and occurred just for the OnPCABG pts. In-hospital and 1-year
mortalities for the OnPCABG and OffPCABG pts were 2.0% and 2.2% (P = .1)
and 2.7% and 4.7% (P = .06), respectively. Conclusions: Thus, the absence
of CPB during CABG preserves better the myocardium and attenuates
inflammation-however, without improving survival. 2009.

<7>
Accession Number
2010324863
Authors
Sabzmakan L. Hazavehei S. Morowatisharifabad M. Hasanzadeh A. Rabiee K.
Sadeqi M.
Institution
(Sabzmakan) Qazvin University of Medical Sciences, Iran, Islamic Republic
of
(Hazavehei, Hasanzadeh, Sadeqi) Hamadan University of Medical Sciences,
Iran, Islamic Republic of
(Morowatisharifabad) Yazd University of Medical Sciences, Iran, Islamic
Republic of
(Rabiee) Isfahan Cardiovascular Research Center, Iran, Islamic Republic of
Title
The effects of a PRECEDE-based educational program on depression, general
health, and quality of life of coronary artery bypass grafting patients.
Source
Asian Journal of Psychiatry. 3 (2) (pp 79-83), 2010. Date of
Publication: June 2010.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: Depression is commonly reported as a consequence of coronary
artery bypass grafting surgery. It is the most important barrier to proper
treatment of cardiac patients, causing failure in accepting the condition,
decreasing the motivation in following the therapeutic recommendations,
and negatively affecting the patients' function and quality of life.
Objective(s): The objective of this study was to investigate the effects
of a PRECEDE-based educational program on depression, general health, and
quality of life in coronary artery bypass grafting surgery patients.
Methods: The experimental study included 54 post-bypass surgery patients
in Isfahan Cardiovascular Research Center. The patients were randomly
assigned to intervention and comparison groups (27 patients in each). The
data were collected using four questionnaires (Cardiac Depression Scale,
General Health Questionnaire-12, SF-36, and a PRCEDE-based questionnaire
to measure predisposing, reinforcing, enabling factors, and self-help
behaviors). All subjects were pre-tested. The intervention, consisting of
nine educational sessions per week (60-90 min each) was implemented. The
patients were followed for 2 months post-intervention and post-tested at
the end of the second month. Results: Following the educational
intervention, the mean scores of predisposing factors, enabling factors,
reinforcing factors and self-helping behaviors were significantly
increased in the intervention group, compared to the comparison group (p <
0.001). The mean score for depression in the comparison group (104.5 +/-
30.4) and intervention group (112.8 +/- 21.9) decreased significantly
following educational intervention, but the change was more pronounced in
the intervention group compared with the control group (66.2 +/- 22 vs.
89.2 +/- 27.8). The difference between the two groups on the basis of
general health was statistically significant (p < 0.0001). Improvements in
quality of life on the basis of physical function (p < 0.04), role
limitations resulting from emotional status (p < 0.01), and mental health
(p < 0.04) were statistically significant. Conclusion: The findings of the
study confirmed the effectiveness of an educational program based on the
PRECEDE Model on decreasing depression level, improving general health,
and increasing quality of life in coronary artery bypass grafting surgery
patients. 2010 Elsevier B.V. All rights reserved.

<8>
Accession Number
2010372817
Authors
Koizumi T. Fitzgerald P.J. Honda Y. Ellis S.G. Kent K. Martin S.L. Brown
C.L. Masud A.R.Z. Patterson J.B. Greenberg J. Friedman M. Uchida T. Stone
G.W.
Institution
(Koizumi, Fitzgerald, Honda) Stanford University, Stanford, CA, United
States
(Ellis) Cleveland Clinic Foundation, Cleveland, OH, United States
(Kent) Washington Cardiology Center, Washington, DC, United States
(Martin) Nebraska Heart Institute, Lincoln, NE, United States
(Brown) Piedmont Hospital, Atlanta, GA, United States
(Masud) Buffalo General Hospital, Buffalo, NY, United States
(Patterson) Forsyth Medical Center, Winston-Salem, NC, United States
(Greenberg) Florida Heart Institute, Orlando, FL, United States
(Friedman, Uchida) Boston Scientific Corporation, Natick, MA, United
States
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, New York, NY, United States
Title
Vascular responses to the multiple overlapped paclitaxel-eluting stents
for the treatment of bare-metal in-stent restenotic lesions: Angiographic
and intravascular ultrasound analysis from the TAXUS-V ISR Trial.
Source
Cardiovascular Revascularization Medicine. 11 (3) (pp 140-148), 2010.
Date of Publication: July 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background: Although effective coverage of coronary diffuse in-stent
restenosis (ISR) lesions has warranted the use of multiple drug-eluting
stents, the vessel response to paclitaxel-eluting stent (PES) overlap is
not fully understood. Methods and materials: In the TAXUS-V ISR, i.e.,
comparing PES versus brachytherapy for the treatment of bare-metal ISR,
angiographic analyses at 9-month follow-up were available in 184 ISR
lesions treated with PES. Results: In-stent late loss in entire stented
segment of multiple PES (n=50) was 0.45+/-0.48 mm, whereas that of single
PES (n=134) was 0.3+/-0.47 mm, P=06. No aneurysm was observed at
overlapping PES segments at 9 months. Stent thrombosis up to 9 months was
observed in one in each group (single PES, 0.7% vs. multiple PES, 1.8%;
P=47). In a subset of 30 patients, volumetric intravascular ultrasound
analysis demonstrated that in-stent net volume obstruction was 12.3+/-12.4
in single PES (n=20) and 14.9+/-9.8 in multiple PES (n=10), P=60. The
changes of vessel and lumen at the overlapping PES segment were similar to
those of the adjacent 5-mm segments ({increment}minimum lumen area,
mm²: -1.2+/-1.0, -1.1+/-1.1, -0.8+/-0.9, P=48;
{increment}vessel volume, mm³/mm: -0.2+/-1.4, 0.1+/-1.7,
0.3+/-1.3, P=37; proximal, overlap, distal segment, respectively). There
was no late incomplete stent apposition at overlapping PES segments.
Conclusions: No in vivo evidence of adverse local vessel response at the
site of overlapping PES for the treatment of bare-metal ISR has been
demonstrated. 2010 Elsevier Inc.

<9>
[Use Link to view the full text]
Accession Number
2010378581
Authors
Aslan A. Osmanagaoglu S. Cavolli R. Emiroglu O. Kaya K. Kahraman D. Uymaz
O.K. Tasoz R. Ozyurda U.
Institution
(Aslan, Kahraman, Uymaz) Division of Cardiovascular Surgery, Canada
(Osmanagaoglu) Division of Anesthesiology and Reanimation, Kavaklidere
Umut Hospital, Turkey
(Cavolli, Kaya) Division of Cardiovascular Surgery, Ozel Ankara Ulus
Hospital, Turkey
(Emiroglu, Tasoz, Ozyurda) Department of Cardiovascular Surgery, Ankara
University, School of Medicine, Ankara, Turkey
Title
Sodium nitroprusside infusion prevents hypothyroidism in patients
undergoing coronary artery bypass grafting: A prospective randomized
clinical trial.
Source
Journal of Cardiovascular Medicine. 11 (8) (pp 575-582), 2010. Date of
Publication: August 2010.
Publisher
Lippincott Williams and Wilkins (345 Hudson St., 16th Fl., New York NY
10014-4502, United States)
Abstract
OBJECTIVE: The level of thyroid hormones is an important factor in
determining the outcome of coronary artery bypass patients. Sodium
nitroprusside (SNP) is a natural donor of nitric oxide which has been
shown to interfere with thyroid hormone synthesis. Whether clinical use of
sodium nitroprusside has any effect on thyroid function has not yet been
investigated. The aim of this study was to investigate the effects of SNP
administration on circulating levels of thyroid hormones. METHODS: One
hundred and six consecutive patients who underwent coronary artery bypass
grafting operation were prospectively randomized to receive continuous
infusions of either SNP or saline limited to the rewarming time of
cardiopulmonary bypass (CPB). Free triiodothyronine (T3), total T3, free
thyroxine (T4), total T4 and thyroid-stimulating hormone (TSH) levels were
analyzed. RESULTS: Free T3, TSH and albumin changes of SNP and control
groups were statistically different from each other. In the SNP group,
free T3 values stayed in the euthyroid range between CPB and post-CPB
periods, the period when SNP was infused, whereas it continued to decline
to hypothyroidic levels in the control group. In addition, in the SNP
group, an elevation in TSH levels was observed during the CPB period.
Postoperatively, an earlier restoration of free T3 and TSH levels was
observed in the SNP group when compared to the control group. CONCLUSION:
In this study, administration of SNP during cardiopulmonary bypass is
shown to regulate free T3 and TSH levels positively. 2010 Italian
Federation of Cardiology.

<10>
Accession Number
70195127
Authors
Van De Vyver K. Labeau S. Brusselaers N. Vogelaers D. Blot S.
Institution
(Van De Vyver, Labeau, Brusselaers, Vogelaers, Blot) GhentBelgium
Source
Clinical Microbiology and Infection. Conference: 20th ECCMID Vienna
Austria. Conference Start: 20100410 Conference End: 20100413. Conference
Publication: (var.pagings). 16 (pp S112), 2010. Date of Publication:
April 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Objective: Ventilator-associated pneumonia (VAP) is the most frequent
nosocomial infection in the intensive care unit. Reducing inoculums of
oral pathogenic microorganisms by adequate oral care could prevent VAP.
Methods: A systematic review of the literature concerning oral
decontamination with chlorhexidine or povidone-iodine on intubated
patients, and subsequent meta-analysis evaluating the effects of oral
decontamination on the incidence of VAP was performed. Relevant articles
were searched for in electronic databases as PubMed, CINAHL, Web of
Science and CENTRAL and supplemented by manual searches of reference
lists. Only randomized controlled trials evaluating the effect of oral
care with use of chlorhexidine or povidone-iodine vs. oral care without
use of an antiseptic on the incidence of VAP in adult intubated patients
were included. Data were extracted as dichotomous variables. Data analysis
was performed using RevMan 5.0. Statistical analysis was conducted
according the Mantel-Haenszel model to obtain the relative risk (RR) and
95% confidence interval (CI). Heterogeneity was assessed using the Chi-2
test. Results: Eleven studies were included in the analysis (n
patients=1971) of which 9 that investigated the effect of oral care with
use of chlorhexidine (n patients=1862) and 2 that assessed the effect of
oral care with use of povidone-iodine (n patients=109). The use of an
antisepticum resulted in a significant reduction of the incidence of VAP
with a RR of 0.63 (95%CI 0.50-0.81; p=0.0002). These results are valid for
chlorhexidine (RR 0.68; 95% CI 0.53-0.88; p=0.004) and povidone-iodine (RR
0.38; 95% CI 0.19-0.75; p=0.005). Among studies important differences
exists concerning concentrations of the antiseptic used, frequency of oral
care, and study methodology and diagnostic criteria for VAP. Clinical
heterogeneity was confirmed statistically and was moderate
(X²=43%; p=0.08) for the trials using chlorhexidine and high
(X²=66%; p=0.09) for those assessing povidone-iodine. Subgroup
analyses revealed most beneficial effects with concentrations of 0.12% and
2% chlorhexidine and 10% povidone-iodine, and in a population of cardiac
surgery patients. Conclusions: This analysis shows that oral
decontamination with an antiseptic reduces the incidence of VAP
significantly. Both chlorhexidine and povidone-iodine show this effect.
However, further research is needed to make recommendations about the
concentration and frequency of application.

<11>
Accession Number
70195130
Authors
Dohmen P. Guleri A. Petrosillo N. Utili R. Gonzalez San V. Seaton R.A.
Gonzalez-Ramallo V.J. Hetzer R. Heep M. Thurston H.J. Chaves R.L.
Source
Clinical Microbiology and Infection. Conference: 20th ECCMID Vienna
Austria. Conference Start: 20100410 Conference End: 20100413. Conference
Publication: (var.pagings). 16 (pp S113), 2010. Date of Publication:
April 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Objective: Randomized controlled trials are scarce in endocarditis and
might not be representative for the general patient population. The aim of
this registry was to describe the clinical experience with Daptomycin
(DAP) for the treatment of infective endocarditis (IE) in Europe. DAP is
approved in Europe for the treatment of right-sided endocarditis due to S.
aureus at a dose of 6 mg/kg once daily. Methods: In this multi-centre,
retrospective, non-interventional registry, the outcome data were
collected in patients (pts) who were diagnosed with native or prosthetic
valve IE and treated with at least one dose of DAP. Clinical outcomes were
assessed at the end of DAP treatment by the investigators using standard
definitions (cured, improved, failure, non-evaluable). Success was defined
as the sum of cured or improved outcome rates. Results: Of the total 2581
pts in the EU-CORE registry from Jan 2006 to Aug 2009, 276 pts (68% male
and 53%>=65 years of age) had IE. A total of 117 (42%) pts received DAP in
an ICU, congestive heart failure was present in 31 (11%) pts and cardiac
arrhythmias in 59 (21%) pts. Right sided endocarditis was observed in 66
(24%) pts, left sided endocarditis in 191 (69%) pts, and right plus left
sided endocarditis in 19 (7%) pts, respectively. The most common primary
pathogen was S. aureus (n=73, 26%), of which 25 were reported as MRSA. 180
(66%) pts received concomitant antibiotic therapy, most commonly
aminoglycosides (71, 26%) or carbapenems (46, 17%). The majority of pts
received DAP doses of 6 mg/kg (62%) or higher (21%). The clinical outcome
per IE type were: Right sided endocarditis, success 92%, failure 5%,
non-evaluable (NE) 3%; Left sided endocarditis, success 76%, failure 9%,
NE 14%; Right plus left sided endocarditis, success 89%, NE 11%.The
proportion of pts with low Creatinine clearance (< 30 L/min) improved from
17% (46/276) initially to 13% (35/276) at the end of DAP treatment.
Serious AEs were reported in 34 (12%) pts and 20 (7%) pts discontinued the
study drug due to AEs. Conclusions: Daptomycin appears effective and well
tolerated against a variety of clinical presentations of infective
endocarditis. Success rates and adverse event profile, including renal
safety were comparable to those observed in the pivotal trials. Further
clinical studies on infective endocarditis e.g. on the impact of DAP at
higher doses might be warranted.

<12>
Accession Number
70199170
Authors
Haase-Fielitz A. Bellomo R. Devarajan P. Dragun D. Haase M.
Institution
(Haase-Fielitz, Bellomo, Haase) Department of Nephrology and Intensive
Care Medicine, Charite University Medicine Berlin, Campus
Virchow-Klinikum, Berlin, Germany
(Haase-Fielitz, Haase) Department of Intensive Care, Austin Health,
Melbourne, Australia
(Devarajan) Cincinnati Children's Hospital Medical Center, Cincinnati, OH,
United States
(Dragun) Center for Cardiovascular Research, Charite University Medicine,
Berlin, Germany
Source
Hemodialysis International. Conference: Annual Dialysis Conference - 29th
Annual Conference on Peritoneal Dialysis, 15th International Symposium on
Hemodialysis, and 20th Annual Symposium on Pediatric Dialysis Houston, TX
United States. Conference Start: 20090308 Conference End: 20090310.
Conference Publication: (var.pagings). 13 (1) (pp 122-123), 2009. Date
of Publication: January 2009.
Publisher
Blackwell Publishing Inc.
Abstract
Purpose: To test whether perioperative sodium bicarbonate infusion can
attenuate postoperative acute kidney injury (AKI) in cardiac surgical
patients. Methods: In a double-blind, randomized-controlled trial, we
enrolled 100 cardiac surgical patients at increased risk of postoperative
AKI. Patients were randomized to either 24 hours of intravenous infusion
of sodium bicarbonate (4 mmol/kg) or sodium chloride (4 mmol/kg). The
primary outcome measure was the proportion of patients developing acute
renal dysfunction defined as a postoperative increase in plasma creatinine
concentration >25% of baseline within the first 5 postoperative days.
Secondary outcomes included changes in plasma creatinine, plasma urea,
urinary neutrophil gelatinase-associated lipocalin, and urinary neutrophil
gelatinase-associated lipocalin/urinary creatinine ratio. ResuIts:Patients
were well balanced for baseline characteristics. Sodium bicarbonate
infusion increased plasma bicarbonate concentration (P<0.001), base excess
(P<0.001), plasma pH (P<0.001), and urine pH (P< 0.001). Fewer patients in
the sodium bicarbonate group (16/50) developed a postoperative increase in
serum creatinine compared with control (26/50) (OR 0.43 [95% CI
0.19-0.98]) (P = 0.043). The increase in plasma creatinine, plasma urea,
urinary neutrophil gelatinase-associated lipocalin, and urinary neutrophil
gelatinase-associated lipocalin/urinary creatinine ratio was less in
patients receiving sodium bicarbonate (P= 0.014, 0.047, 0.009, and 0.004).
There were no significant side effects. Conclusions: Sodium bicarbonate
loading and continuous infusion were associated with a lower incidence of
acute renal dysfunction in cardiac surgical patients undergoing
cardiopulmonary bypass. The findings of this pilot study justify further
investigation (ClinicalTrials.gov, NCT00334191).

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 4

Results Generated From:
EMBASE <1980 to 2010 Week 28>
EMBASE (updates since 2010-07-08)

<1>
Accession Number
2010324203
Authors
Vaziri M.T.M. Jouibar R. Akhlagh S.H.A. Janati M.
Institution
(Vaziri, Jouibar, Akhlagh) Department of Anesthesiology, Faghihi Hospital,
Nemazee Hospital Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of.
(Janati) Department of Surgery, Division ofCardiovascular Surgery, Nemazee
Hospital Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of.
Title
The effect of lidocaine and magnesium sulfate on prevention of ventricular
fibrillation in coronary artery bypass grafting surgery.
Source
Iranian Red Crescent Medical Journal. 12(3)(pp 298-301), 2010. Date of
Publication: 2010.
Publisher
Iranian Red Crescent Society
Abstract
Background: One of the most common events, after the release of aortic
cross-clamp in patients undergoing coronary artery bypass grafting surgery
is reperfusion induced ventricular fibrillation, which occurs in 74% of
96% of patients. Regarding the controversies over the use of lidocaine or
magnesium sulfate for the prevention of ventricular fibrillation following
the release of aortic cross-clamp, this study was designed to compare the
effectiveness of magnesium sulfate and lidocaine to suppress ventricular
fibrillation. Methods: In a double blind, prospective, randomized,
controlled trial study, 76 patients who were candidates for elective
coronary artery bypass grafting surgery were divided into three groups
including Group A (lidocaine, n=26), group B (magnesium sulfate, n=25),
and group C (normal saline, n=26). Lidocaine (1.5 mg/Kg), magnesium
sulfate (30 mg/Kg) and normal saline were administered 5 minutes before
the release of aortic cross clamp. Results: The incidence of ventricular
fibrillation significantly decreased in patients receiving magnesium
sulfate (12% vs. 26.9% and 44% in patients who received lidocaine and
normal saline, respectively) There was no statistically significant
difference between the groups with respect to age, ejection fraction (L/
min), anesthetic time (min), cross-clamping time (min), PH, HCT (%), and
serum K+ level (meq). Conclusion: The administration of lidocaine and
magnesium sulfate before the release of aortic cross-clamp reduces the
incidence of postoperative ventricular fibrillation in adult patients
undergoing coronary artery bypass grafting surgery with cardiopulmonary
bypass. In our study, magnesium sulfate was more efficient in prevention
of ventricular fibrillation than lidocaine. Administration of magnesium
sulfate (30 mg/kg) caused no toxic effect and wais safe for patients
undergoing coronary artery bypass grafting surgery with cardiopulmonary
bypass. copyright Iranian Red Crescent Medical Journal.

<2>
Accession Number
2010320725
Authors
Auer J. Leitner A. Berent R. Lamm G. Lassnig E. Krennmair G.
Institution
(Auer) General Hospital Braunau, Austria.
(Auer, Leitner, Lassnig) General Hospital Wels, Austria.
(Auer) General Hospital Simbach, Germany.
(Berent) Center for Cardiovascular Rehabilitation, Bad Schallerbach,
Austria.
(Lamm) General Hospital St. Polten, Austria.
(Krennmair) Medical University Vienna, Austria.
Title
Long-term outcomes following coronary drug-eluting- and bare-metal-stent
implantation.
Source
Atherosclerosis. 210(2)(pp 503-509), 2010. Date of Publication: June
2010.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Although drug-eluting stents (DES) reduce restenosis rates
relative to bare-metal stents (BMS), recent reports have indicated that
the use of DES may be associated with an increased risk of stent
thrombosis. Our study focused on the effect of stent type on clinical
outcomes in a " real world" setting. Methods: 889 patients undergoing
percutaneous coronary intervention (PCI) with either DES (Cypher or Taxus;
n= 490) or BMS (n= 399) were enrolled in a prospective single center
registry. The outcome analysis covered a period of up to 3.2 years (mean
2.7 years +/- 0.5 years) and was based on 65 deaths, 27 myocardial
infarctions, 76 clinically driven target lesion revascularizations (TLR),
and 15 angiographically confirmed cases of definite stent thrombosis and
was adjusted for differences in baseline characteristics. Results: In
total 1277 stents (613 BMS and 664 DES) were implanted in 1215 lesions.
Despite a significantly different unadjusted death rate (10.1% and 5.1% in
BMS and DES patients, respectively; p<. 0.05), the patient groups did not
differ significantly in the risk of myocardial infarction during 2.7 years
of follow-up. After adjustment for differences in baseline characteristics
between groups, the difference in the cumulative incidence of death did
not remain statistically significant (p= 0.22). Target lesion
revascularizations occurred significantly less frequently in patients with
DES compared to individuals after BMS implantation (5.9% and 11.8% in
patients with DES and BMS, respectively; p<. 0.05). The rate of
angiographically confirmed stent thrombosis was 2.1% in patients with DES
and 1.1% in BMS patients (p= 0.31). There was a significantly lower
unadjusted event rate (including deaths, myocardial infarction, target
lesion revascularization, and stent thrombosis) in patients with
drug-eluting stents than in those with bare-metal stents (16.4% and 25.8%,
respectively), with 9.4 fewer such events per 100 patients (unadjusted
hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.46 to 0.87).
After adjustment, the relative risk for all outcome events in patients
with drug-eluting stents was 0.79 (95% CI, 0.67 to 0.95). However, the
adjusted relative risk for death and myocardial infarction did not differ
significantly between groups (adjusted relative risk in patients with
drug-eluting stents 0.94 (95% CI, 0.77 to 1.37)). Conclusions: In this
real-world population, the beneficial effect of first generation DES in
reducing the need for new revascularization compared with BMS extends to
more than 2.5 years without evidence of a worse safety profile. The minor
risk of stent thrombosis and myocardial infarction within this period
after implantation of DES seems unlikely to outweigh the benefit of these
stents. copyright 2009 Elsevier Ireland Ltd.

<3>
Accession Number
2010355528
Authors
Jain S. Vaidyanathan B.
Institution
(Jain, Vaidyanathan) Department of Pediatric Cardiology, Amrita Institute
of Medical Sciences, Kochi, India.
Title
Oral anticoagulants in pediatric cardiac practice: A systematic review of
the literature.
Source
Annals of Pediatric Cardiology. 3(1)(pp 31-34), 2010. Date of
Publication: 01 Jan 2010.
Publisher
Medknow Publications and Media Pvt. Ltd
Abstract
Recent advances in the pediatric heart surgery, especially the Fontan
procedure, has necessitated an increased use of oral anticoagulants in
pediatric cardiac patients. Warfarin is the standard agent used for most
pediatric indications, though there are very few randomized control
studies in children regarding its use. This review summarizes the current
indications and evidence base regarding the use of oral anticoagulants in
the pediatric age group.

<4>
Accession Number
2010308610
Authors
Shah A.J. Liu X. Jadidi A.S. Haissaguerre M.
Institution
(Shah, Liu, Jadidi, Haissaguerre) Hopital Cardiologique du Haut-Levque,
University Hospital of Bordeaux, Avenue de Magellan, 33604 Pessac, France.

Title
Early management of atrial fibrillation: From imaging to drugs to
ablation.
Source
Nature Reviews Cardiology. 7(6)(pp 345-354), 2010. Date of Publication:
June 2010.
Publisher
Nature Publishing Group
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and is
responsible for the highest number of rhythm-related disorders and
cardioembolic strokes worldwide. Early management of this condition will
lower the risk of AF-associated morbidity and mortality. Targeted drug
therapy has an important role in preventing the progression of AF through
modification of the substrate. Discovery of the role of pulmonary veins as
a trigger has been an important breakthrough, leading to the development
of pulmonary vein ablationan established curative therapy for
drug-resistant AF. Identifying the underlying reasons for the abnormal
firing of venous cardiomyocytes and the widespread progressive alterations
of atrial tissue found in persistent AF are challenges for the future.
Novel imaging techniques may help to determine the right time for
intervention, provide specific targets for ablation, and judge the
efficacy of treatment. If new developments can successfully address these
issues, the knowledge acquired as a result will have a vital role in
preclinical and early management of AF. copyright 2010 Macmillan
Publishers Limited. All rights reserved.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 11

Results Generated From:
EMBASE <1980 to 2010 Week 27>
EMBASE (updates since 2010-07-02)

<1>
[Use Link to view the full text]
Accession Number
2010345555
Authors
Veldman A.
Institution
(Veldman) Monash Newborn, Monash Medical Centre, Monash University, 246
Clayton Rd, Clayton 3168, VA, Australia.
(Veldman) Ritchie Centre for Baby Health Research, Monash Institute of
Medical Research, Monash University, Clayton, VA, Australia.
Title
Complications of hydroxyethyl starch in paediatric patients.
Source
European Journal of Anaesthesiology. 27(1)(pp 86-87), 2010. Date of
Publication: January 2010.
Publisher
Lippincott Williams and Wilkins

<2>
[Use Link to view the full text]
Accession Number
2010345546
Authors
Cui W. Li Y. Li S. Wang R. Li J.
Institution
(Cui, Li, Li) Department of Anesthesia, China.
(Wang) National Center for Clinical Pharmacology, Capital Medical
University affiliated Beijing Friendship Hospital, China.
(Li) Department of Neurobiology Beijing Institute for Neuroscience,
Capital Medical University, Beijing, China.
(Li) Department of Neurobiology and Beijing Institute for Neuroscience,
Capital Medical University, #10 You An Men Wai Xi Tou Tiao, Beijing
100069, China.
Title
Systemic administration of lidocaine reduces morphine requirements and
postoperative pain of patients undergoing thoracic surgery after
propofol-remifentanilbased anaesthesia.
Source
European Journal of Anaesthesiology. 27(1)(pp 41-46), 2010. Date of
Publication: January 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and objective Remifentanil is being increasingly used as an
analgesic in fast-track surgery, but severe postoperative pain may happen
occasionally. In this study, we evaluated the effects of systemic
administration of lidocaine on postoperative pain and morphine
requirements after propofol-remifentanil-based anaesthesia. Methods Forty
patients undergoing thoracic surgery were randomly assigned to lidocaine
(33.0mugkg-1 min-1) and physiological saline control groups in propofol-
remifentanil-based anaesthesia. The setting of the plasma concentration (C
p) of the target-controlled infusion of propofol was adjusted according to
the bispectral index of the electroencephalogram and blood pressure. The
Cp and effect-site concentration (Ce) of propofol were calculated by
target-controlled infusion pump during the intraoperative period. Pain
scoring includes a four-point verbal rating scale, Riker's
sedation-agitation scale and a visual analogue scale; the morphine
requirement in the postanaesthesia care unit and the morphine consumption
via a patient-controlled analgesia device on the ward were recorded during
the postoperative period.Results Morphine requirements within 30, 30-60
and 0-120 min in the postanaesthesia care unit of the lidocaine group
decreased significantly (P<0.05, nU20 per group)compared with that of the
control group. The four-point verbal rating scale at 30 min in the
postanaesthesia care unit, visual analogue scale at 6 h on coughing and
patient-controlled analgesia morphine consumption during 2-6 h
postoperative time were also significantly (P<0.05, nU20 per group)
reduced in the lidocaine group. In addition, the intraoperative propofol
Ce in the lidocaine group during the periods of intubation, organ
resection, closing of chest cavity and extubation was significantlylower
(P<0.05, nU20 per group) than that in the control group under the same
hypnotic depth. Conclusion Systemic administration of lidocaine could
reduce morphine requirements, postoperative pain and intraoperative
propofol Ce of patients undergoing thoracic surgery after
propofol-remifentanil- based anaesthesia. copyright 2010 European Society
of Anaesthesiology.

<3>
Accession Number
2010350858
Authors
Kowalczyk M. Banach M. Lip G.Y.H. Kozlowski D. Mikhailidis D.P. Rysz J.
Institution
(Kowalczyk, Rysz) Department of Nephrology, Hypertension and Family
Medicine, Medical University of Lodz, Lodz, Poland.
(Banach) Department of Hypertension, Medical University of Lodz, Lodz,
Poland.
(Lip) University of Birmingham, Centre for Cardiovascular Sciences, City
Hospital, Birmingham, United Kingdom.
(Kozlowski) Department of Cardiology and Electrotherapy, Medical
University of Gdansk, Gdansk, Poland.
(Mikhailidis) Department of Clinical Biochemistry, Medical School,
University College London, London, United Kingdom.
Title
Levosimendan - A calcium sensitising agent with potential anti-arrhythmic
properties.
Source
International Journal of Clinical Practice. 64(8)(pp 1148-1154), 2010.
Date of Publication: July 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Levosimendan is a 'Ca2+sensitiser', which exerts its inotropic effect by
increasing the affinity of troponin C for Ca2+, directly stabilising the
Ca2+-induced conformation of troponin C. It leads to a positive inotropic
effect without impairing diastolic relaxation and causing cytosolic Ca2+
ion overload, which might result in cardiac myocyte dysfunction,
arrhythmias and cell death. Levosimendan may also have significant
anti-inflammatory properties. Data from various studies suggest that
levosimendan might have anti-arrhythmic effects, although the outcome of
clinical trials on the effect of this agent in (for example) atrial
fibrillation (AF) remains controversial. Currently, on the basis of
available data, it is especially worth emphasising the potential role of
this drug in the termination of AF after cardiac surgery, which
significantly influences early- and long-term morbidity and mortality.
This review considers the putative anti-arrhythmic properties of
levosimendan and discusses the potential clinical application of such a
drug. copyright 2010 Blackwell Publishing Ltd.

<4>
Accession Number
2010350843
Authors
Farooqi F.M. Talsania S. Hamid S. Rinaldi C.A.
Institution
(Farooqi, Talsania, Hamid, Rinaldi) St Thomas' Hospital, Guy's and St
Thomas' Hospitals, NHS Foundation Trust, London, United Kingdom.
Title
Extraction of cardiac rhythm devices: Indications, techniques and outcomes
for the removal of pacemaker and defibrillator leads.
Source
International Journal of Clinical Practice. 64(8)(pp 1140-1147), 2010.
Date of Publication: July 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac rhythm management devices (pacemakers) are being increasingly
implanted worldwide not only for symptomatic bradycardia, but also for the
management of arrhythmia and heart failure. Their use in more elderly
patients with significant comorbidities is rising steeply and consequently
long-term complications are increasingly arising. Such an increase in
device therapy is being paralleled by an increase in the requirement for
system extraction. Safe lead extraction is central to the management of
much of the complications related to pacemakers. The most common
indication for lead extraction is system infection Adhesions in
chronically implanted leads can become major obstacles to safe lead
extraction and life-threatening bleeding and cardiac perforations may
occur. Over the last 20 years, specific tools and techniques for
transvenous lead extraction have been developed to assist in freeing the
lead body from the adhesions. This article provides a comprehensive review
of the indications, tools, techniques and outcomes for transvenous lead
extraction. The success rate largely depends on the time from implant. Up
to 12 months from implant, it is rare that traction alone will not
suffice. For longer lead implant duration, no single technique is
sufficient to address all extractions, but laser provides the best chance
of extracting the entire lead. Operator experience is vital in determining
success as familiarity of a wide array of techniques will increase the
likelihood of uncomplicated extraction. Long implantation time, lack of
operator experience, ICD lead type and female gender are risk factors for
life-threatening complications. Lead extraction should therefore, ideally
be performed in high volume centres with experienced staff and on-site
support from a cardiothoracic surgical team able to deal with bleeding
complications from cardiovascular perforation. copyright 2010 Blackwell
Publishing Ltd.

<5>
Accession Number
2010336579
Authors
Carrier M. Perrault L.P. Fortier A. Bouchard D. Pellerin M.
Institution
(Carrier, Perrault, Bouchard, Pellerin) Department of Cardiac Surgery,
Montreal Heart Institute, Universite de Montreal, Montreal, QC, Canada.
(Fortier) Montreal Heart Institute Coordinating Center, Montreal, QC,
Canada.
Title
L-arginine supplemented nondiluted blood cardioplegia: A clinical trial.
Source
Journal of Cardiovascular Surgery. 51(2)(pp 283-287), 2010. Date of
Publication: April 2010.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Aim. L-arginine was shown to improve protection of the myocardium during
coronary artery bypass graft (CABG) surgery. The objective of the present
study was to determine the concentration of L-arginine to obtain the most
effective protection of the myocardium during CABG surgery. Methods.
Seventy-five patients undergoing CABG surgery were randomized in 3 groups.
The first group (N.=25) was administered a placebo injection in the blood
cardioplegic solution, the second group (N.=25) received an injection of 4
mmol/L of L-arginine and a third group (N.=25) an injection of 6 mmol/L of
L-arginine in the blood cardioplegic solution. Blood samples from the
ascending aorta and the coronary sinus catheter were collected before,
immediately after and at 20 minutes after aortic cross-clamping. Total
plasmatic nitrite and nitrate ratio and lactate release from the
myocardium in the collected blood samples were measured. Results.
Seventy-five patients averaging 62+/-7 years of age and undergoing 3.1+/-1
coronary bypass grafts during 41+/-17 minutes of aortic cross clamping
time were recruited. Values of total plasmatic nitrite and nitrate ratio
remains non-significant before and after aortic clamping and also between
groups (P=0.9812 and 0.3573 respectively). Myocardial lactate release was
statistically different before and after cross clamping (P=0.0002) and
also between the 3 groups (P=0.0311). Conclusion. Nondiluted blood
cardioplegic solution supplemented with 4 mmol/L of L-arginine was
associated with a significant decrease of myocardial lactate release after
aortic cross-clamping and reperfusion during CABG surgery.

<6>
Accession Number
2010336575
Authors
Wang J. Wu J.J. Ren X.Y. Chen C.L. Qiao J. Abudureheman M. Zheng H.
Institution
(Wang, Wu, Ren, Chen, Zheng) Department of Anesthesiology, Xinjiang
Medical University, No. 1, Li yu Shan Street, Urumqi, Xinjiang, China.
(Qiao, Abudureheman) Department of Cardiac Surgery, Xinjiang Medical
University, Urumqi, China.
Title
Application of low-volume zero-balanced ultrafiltration and its effect on
blood propofol concentration: A randomized controlled trial.
Source
Journal of Cardiovascular Surgery. 51(2)(pp 257-263), 2010. Date of
Publication: April 2010.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Aim. The aim of this study was to evaluate the effectiveness of low-volume
zero-balanced ultrafiltration during cardiopulmonary bypass in heart valve
replacement surgery. Methods. This was a randomized, double-blind,
controlled study carried out in the operating room. Forty patients of ASA
grade II-III, elected to undergo heart valve replacement surgery, were
enrolled. All patients were randomly assigned to either a low-volume (35
mL/kg) zero-balanced ultrafiltration group (N.=20) or to a control group
(N.=20). Blood propofol concentrations and entropy index were measured
using cardiopulmonary bypass. Concentrations of plasma tumor necrosis
factor-alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-10 (IL-10),
and cardiac troponin I were measured before and after the end of
cardiopulmonary bypass and corrected according to hematocrit. Results.
Blood levels of cardiac troponin I, TNF-alpha, IL-6, and IL-10 after
surgery were all significantly lower in the ultrafiltration group than in
the control group (P<0.05) after the end of bypass. Blood propofol
concentrations decreased significantly in both groups during
cardiopulmonary bypass and remained significantly lower in the
ultrafiltration group than the control group. However, there was no
significant difference between the two groups in the entropy index
(P=0.5583). Conclusion. Low-volume zero-balanced ultrafiltration performed
during cardiopulmonary bypass surgery significantly decreased post-bypass
levels of the cytokines, TNF-alpha, IL-6, IL-10, and postoperative cardiac
troponin I. Blood propofol concentration was also decreased; however, the
depth of anesthesia was not affected significantly.

<7>
Accession Number
2010289898
Authors
Kim S. Kim H.K. Kang D.-Y. Jeong J.M. Choi Y.H.
Institution
(Kim) Department of Nuclear Medicine, College of Medicine, Korea
University Guro Hospital, South Korea.
(Kim, Kang, Choi) Department of Thoracic and Cardiovascular Surgery,
College of Medicine, Korea University Guro Hospital, South Korea.
(Jeong) Department of Nuclear Medicine, College of Medicine, Seoul
National University, Seoul, South Korea.
Title
Intra-operative sentinel lymph node identification using a novel
receptor-binding agent (technetium-99m neomannosyl human serum albumin,
99mTc-MSA) in stage I non-small cell lung cancer.
Source
European Journal of Cardio-thoracic Surgery. 37(6)(pp 1450-1456), 2010.
Date of Publication: June 2010.
Publisher
Elsevier
Abstract
Objective: In the previous report, to simplify the synthesis and labelling
procedures and to improve the biological properties, we developed a novel
mannose receptor-binding agent, technetium-99m human serum albumin
(99mTc-MSA), for sentinel lymph node detection. This study is the first
clinical trial designed to test the reliability and feasibility of
sentinel node detection using this new radioactive agent in patients with
stage I non-small cell lung cancer. Methods: Forty-two patients (30 men,
12 women; mean age 63.3 +/- 8.9 years) that were candidates for lobectomy
with mediastinal lymph node dissection for stage I non-small cell lung
cancer were enrolled. A total dose of 1 mCi of 99mTc-MSA in 0.2 ml was
administered in one shot at the peritumoural region approximately 3 h
before surgery. The radioactivity in the lymph nodes was counted before
(in vivo) and after (ex vivo) dissection with a hand-held gamma probe. A
sentinel lymph node was defined as any node for which the radioactivity
count was 5 times that of the resected lung tissue with the lowest count
for the ex vivo counts. All harvested lymph nodes were cut into 2-mm
slices and ultimately diagnosed by using formalin-fixed and
paraffin-embedded sections with haematoxylin and eosin staining. Results:
99mTc-MSA was taken up by the lymph nodes and its detection did not change
until 21 h after the injection. The number of dissected lymph nodes per
patient was 22.1 +/- 11.6 (range 4-57). Among 42 patients, the sentinel
lymph nodes could be identified in 40 patients (95.2%). The number of
sentinel lymph nodes identified was 2.3 +/- 1.1 stations (range 1-5) per
patient. Ten out of 40 patients (25.0%) had metastases in 11 sentinel
lymph nodes. Three of these 11 sentinel lymph nodes (27.3%) had skip
metastases. No false-negative sentinel lymph nodes were detected in any of
the 10 patients with N1 or N2 disease (0%). The relationship between in
vivo and ex vivo results for mediastinal sentinel lymph nodes showed
concurrence in 29 out of 40 patients (72.5%). Conclusions: Intra-operative
sentinel lymph node identification using 99mTc-MSA appears to be feasible
and reliable in stage I non-small cell lung cancer. copyright 2010
European Association for Cardio-Thoracic Surgery.

<8>
Accession Number
2010289874
Authors
Ngaage D.L. Bland J.M.
Institution
(Ngaage) Cardiothoracic Centre, Castle Hill Hospital, Kingston-Upon-Hull,
East Yorkshire, United Kingdom.
(Bland) Department of Health Sciences, University of York, United Kingdom.

Title
Lessons from aprotinin: is the routine use and inconsistent dosing of
tranexamic acid prudent? Meta-analysis of randomised and large matched
observational studies.
Source
European Journal of Cardio-thoracic Surgery. 37(6)(pp 1375-1383), 2010.
Date of Publication: June 2010.
Publisher
Elsevier
Abstract
In view of the safety concerns that led to the withdrawal of aprotinin,
should antifibrinolytics be used indiscriminately in cardiac surgery? This
meta-analysis examines the efficacy and safety profile of tranexamic acid,
and in comparison to aprotinin. We identified randomised trials and large
observational studies investigating the use tranexamic acid from January
1995 to January 2009 using Pubmed/Cochrane search engine and included them
in a two-tier meta-analysis. There were 25 randomised trials and four
matched studies with a total of 5411 and 5977 patients, respectively,
reporting tranexamic acid use in varying dosages. Tranexamic acid is
administered intravenously either as single dose, infusion or both,
sometimes added to pump prime or applied topically. Total intravenous dose
of tranexamic acid varies from 1 g to 20 g, administered over a period of
20 min to 12 h. Compared with placebo, tranexamic acid is associated with
a lower mean difference in blood loss (random effect -298 ml, 95%
confidence [CI] -367 to -229, p < 0.001) and decease in rates of
re-operation for bleeding by 48%, transfusion of packed red cell by 47%
and use of haemostatic blood products by 67%. A non-significant tendency
for postoperative neurological events but a decrease in operative
mortality was observed in patients treated with tranexamic acid compared
with non-treatment group. Compared to aprotinin, tranexamic acid has less
effective blood-conserving effect and mortality risk. Given the potential
to increase neurological complications, the current trend towards
indiscriminate use of tranexamic acid for all cardiac patients needs to be
re-evaluated. Further studies are needed to clarify the neurological risk,
appropriate indications and dosing of tranexamic acid. copyright 2010
European Association for Cardio-Thoracic Surgery.

<9>
Accession Number
2010352165
Authors
Armitage J.M. Bowman L. Clarke R.J. Wallendszus K. Bulbulia R. Rahimi K.
Haynes R. Parish S. Sleight P. Peto R. Collins R.
Institution
(Armitage, Bowman, Clarke, Wallendszus, Bulbulia, Rahimi, Haynes, Parish)
SEARCH Study, Clinical Trial Service Unit, University of Oxford, Old Road
Campus, Roosevelt Drive, Oxford OX3 7LF, United Kingdom.
(Sleight) Department of Cardiovascular Medicine, University of Oxford,
United Kingdom.
(Peto, Collins) Clinical Trial Service Unit, University of Oxford, United
Kingdom.
Title
Effects of homocysteine-lowering with folic acid plus vitamin B 12 vs
placebo on mortality and major morbidity in myocardial infarction
survivors: A randomized trial.
Source
JAMA - Journal of the American Medical Association. 303(24)(pp
2486-2494), 2010. Date of Publication: June 23-30 2010.
Publisher
American Medical Association
Abstract
Context: Blood homocysteine levels are positively associated with
cardiovascular disease, but it is uncertain whether the association is
causal. Objective: To assess the effects of reducing homocysteine levels
with folic acid and vitamin B12 on vascular and nonvascular outcomes.
Design, Setting, and Patients: Double-blind randomized controlled trial of
12 064 survivors of myocardial infarction in secondary care hospitals in
the United Kingdom between 1998 and 2008. Interventions: 2 mg folic acid
plus 1 mg vitamin B12 daily vs matching placebo. Main Outcome Measures:
First major vascular event, defined as major coronary event (coronary
death, myocardial infarction, or coronary revascularization), fatal or
nonfatal stroke, or noncoronary revascularization. Results: Allocation to
the study vitamins reduced homocysteine by a mean of 3.8 mumol/L (28%).
During 6.7 years of follow-up, major vascular events occurred in 1537 of
6033 participants (25.5%) allocated folic acid plus vitamin B12 vs 1493 of
6031 participants (24.8%) allocated placebo (risk ratio [RR], 1.04; 95%
confidence interval [CI], 0.97-1.12; P=.28). There were no apparent
effects on major coronary events (vitamins, 1229 [20.4%], vs placebo, 1185
[19.6%]; RR, 1.05; 95% CI, 0.97-1.13), stroke (vitamins, 269 [4.5%], vs
placebo, 265 [4.4%]; RR, 1.02; 95% CI, 0.86-1.21), or noncoronary
revascularizations (vitamins, 178 [3.0%], vs placebo, 152 [2.5%]; RR,
1.18; 95% CI, 0.95-1.46). Nor were there significant differences in the
numbers of deaths attributed to vascular causes (vitamins, 578 [9.6%], vs
placebo, 559 [9.3%]) or nonvascular causes (vitamins, 405 [6.7%], vs
placebo, 392 [6.5%]) or in the incidence of any cancer (vitamins, 678
[11.2%], vs placebo, 639 [10.6%]). Conclusion: Substantial long-term
reductions in blood homocysteine levels with folic acid and vitamin B12
supplementation did not have beneficial effects on vascular outcomes but
were also not associated with adverse effects on cancer incidence. Trial
Registration: isrctn.org Identifier: ISRCTN74348595 copyright2010 American
Medical Association. All rights reserved.

<10>
Accession Number
2010323724
Title
Association of estimated glomerular filtration rate and albuminuria with
all-cause and cardiovascular mortality in general population cohorts: a
collaborative meta-analysis.
Source
The Lancet. 375(9731)(pp 2073-2081), 2010. Date of Publication:
20100612/18.
Publisher
Elsevier Limited
Abstract
Background: Substantial controversy surrounds the use of estimated
glomerular filtration rate (eGFR) and albuminuria to define chronic kidney
disease and assign its stages. We undertook a meta-analysis to assess the
independent and combined associations of eGFR and albuminuria with
mortality. Methods: In this collaborative meta-analysis of general
population cohorts, we pooled standardised data for all-cause and
cardiovascular mortality from studies containing at least 1000
participants and baseline information about eGFR and urine albumin
concentrations. Cox proportional hazards models were used to estimate
hazard ratios (HRs) for all-cause and cardiovascular mortality associated
with eGFR and albuminuria, adjusted for potential confounders. Findings:
The analysis included 105 872 participants (730 577 person-years) from 14
studies with urine albumin-to-creatinine ratio (ACR) measurements and 1
128 310 participants (4 732 110 person-years) from seven studies with
urine protein dipstick measurements. In studies with ACR measurements,
risk of mortality was unrelated to eGFR between 75 mL/min/1.73 m2 and 105
mL/min/1.73 m2 and increased at lower eGFRs. Compared with eGFR 95
mL/min/1.73 m2, adjusted HRs for all-cause mortality were 1.18 (95% CI
1.05-1.32) for eGFR 60 mL/min/1.73 m2, 1.57 (1.39-1.78) for 45 mL/min/1.73
m2, and 3.14 (2.39-4.13) for 15 mL/min/1.73 m2. ACR was associated with
risk of mortality linearly on the log-log scale without threshold effects.
Compared with ACR 0.6 mg/mmol, adjusted HRs for all-cause mortality were
1.20 (1.15-1.26) for ACR 1.1 mg/mmol, 1.63 (1.50-1.77) for 3.4 mg/mmol,
and 2.22 (1.97-2.51) for 33.9 mg/mmol. eGFR and ACR were multiplicatively
associated with risk of mortality without evidence of interaction. Similar
findings were recorded for cardiovascular mortality and in studies with
dipstick measurements. Interpretation: eGFR less than 60 mL/min/1.73 m2
and ACR 1.1 mg/mmol (10 mg/g) or more are independent predictors of
mortality risk in the general population. This study provides quantitative
data for use of both kidney measures for risk assessment and definition
and staging of chronic kidney disease. Funding: Kidney Disease: Improving
Global Outcomes (KDIGO), US National Kidney Foundation, and Dutch Kidney
Foundation. copyright 2010 Elsevier Ltd. All rights reserved.

<11>
Accession Number
2010338776
Authors
Vlasselaers D. Mesotten D. Langouche L. Vanhorebeek I. van den Heuvel I.
Milants I. Wouters P. Meyns B. Bjerre M. Hansen T.K. Van den Berghe G.
Institution
(Vlasselaers, Mesotten, Langouche, Vanhorebeek, van den Heuvel, Milants,
Wouters, Van den Berghe) Department of Intensive Care Medicine, Katholieke
Universiteit Leuven, Belgium.
(Meyns) Department of Cardiac Surgery, Katholieke Universiteit Leuven,
Belgium.
(Wouters) Department of Anesthesiology, Universiteit Gent, Belgium.
(Bjerre, Hansen) Immunoendocrine Research Unit, Aarhus University
Hospital, Denmark.
Title
Tight Glycemic Control Protects the Myocardium and Reduces Inflammation in
Neonatal Heart Surgery.
Source
Annals of Thoracic Surgery. 90(1)(pp 22-29), 2010. Date of Publication:
July 2010.
Publisher
Elsevier USA
Abstract
Background: Neonatal cardiac surgery evokes hyperglycemia and a systemic
inflammatory response. Hyperglycemia is associated with intensified
inflammation and adverse outcome in critically ill children and in
pediatric cardiac surgery. Recently we demonstrated that tight glycemic
control (TGC) reduced morbidity and mortality of critically ill children.
Experimental data suggest that insulin protects the myocardium in the
setting of ischemia-reperfusion injury, but this benefit could be blunted
by coinciding hyperglycemia. We hypothesized that insulin-titrated TGC,
initiated prior to myocardial ischemia and reperfusion, protects the
myocardium and attenuates the inflammatory response after neonatal cardiac
surgery. Methods: This is a prospective randomized study at a university
hospital. Fourteen neonates were randomized to intraoperative and
postoperative conventional insulin therapy or TGC. Study endpoints were
effects on myocardial damage and function; inflammation, endothelial
activation, and clinical outcome parameters. Results: Tight glycemic
control significantly reduced circulating levels of cardiac troponin-I (p
= 0.009), heart fatty acid-binding protein (p = 0.01), B-type natriuretic
peptide (p = 0.002), and the need for vasoactive support (p = 0.008). The
TGC suppressed the rise of the proinflammatory cytokines interleukin-6 (p
= 0.02) and interleukin-8 (p = 0.05), and reduced the postoperative
increase in C-reactive protein (p = 0.04). Myocardial concentrations of
Akt, endothelial nitric-oxide synthase, and their phosphorylated forms
were not different between groups. Conclusions: In neonates undergoing
cardiac surgery, intraoperative and postoperative TGC protects the
myocardium and reduces the inflammatory response. This appears not to be
mediated by an early, direct insulin signaling effect, but may rather be
due to independent effects of preventing hyperglycemia during reperfusion.
copyright 2010 The Society of Thoracic Surgeons.