EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 14

Results Generated From:
EMBASE <1980 to 2010 Week 34>
EMBASE (updates since 2010-08-20)

<1>
Accession Number
2010386461
Authors
de Silva R.J. Armstrong J. Bottrill F. Goldsmith K. Colah S. Vuylsteke A.
Institution
(Armstrong, Bottrill, Vuylsteke) Department of Anaesthesia and Intensive
Care, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge
CB23 3RE, United Kingdom
(de Silva) Department of Cardiothoracic Surgery, Papworth Hospital,
Cambridge, United Kingdom
(Colah) Cambridge Perfusion Services, Papworth Hospital, Cambridge, United
Kingdom
(Goldsmith) MRC Biostatistics Unit, Cambridge, United Kingdom
Title
A lipopolysaccharide adsorber in adult cardiopulmonary bypass: A single
centre randomised controlled pilot trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 11 (1) (pp 86-92), 2010.
Date of Publication: July 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objectives: The aim of this study was to describe the biochemical effects
and safety of selective removal of endotoxin from whole blood using a
lipopolysaccharide adsorber during complex cardiac surgery. Methods: We
carried out a single centre prospective randomised controlled pilot trial
in patients undergoing elective cardiac surgery using cardiopulmonary
bypass (CPB) at a large UK cardiothoracic institution. Seventeen patients
were randomly allocated to one of two groups: with or without an adsorber
included in the CPB circuit. Fourteen patients were included in a complete
case analysis. Blood samples were taken at the time of consent,
immediately following anaesthesia, at 60, 180 and 360 min after the
institution of CPB, and the morning following surgery. Primary outcomes
were plasma levels of endotoxin, IL-6, IL-8 and TNF-alpha. Secondary
outcomes were measures of patient safety including blood chemistry and
coagulation parameters, length of stay, and adverse events. Results: No
differences were seen in endotoxin or cytokine levels between adsorber and
control groups at any of the measured time-points. No difference between
groups was detected in measures of patient safety following the
intervention. Haemoglobin and haematocrit were significantly lower in the
intervention group pre-bypass, P=0.02 in both instances. Conclusion: There
was no effect of the adsorber on endotoxin levels or inflammatory response
in this study, we have demonstrated the device to be safe in a complex
cardiac surgery setting. 2010 Published by European Association for
Cardio-Thoracic Surgery.

<2>
Accession Number
2010414558
Authors
Ajami G. Derakhshan A. Amoozgar H. Mohamadi M. Borzouee M. Basiratnia M.
Abtahi S. Cheriki S. Soltani M.
Institution
(Ajami, Derakhshan, Amoozgar, Mohamadi, Borzouee, Basiratnia, Abtahi,
Cheriki, Soltani) Department of Pediatrics, Nemazee Hospital, Shiraz
University of Medical Sciences, 71937-11351 Shiraz, Iran, Islamic Republic
of
Title
Risk of nephropathy after consumption of nonionic contrast media by
children undergoing cardiac angiography: A prospective study.
Source
Pediatric Cardiology. 31 (5) (pp 668-673), 2010. Date of Publication:
July 2010.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Despite increasing reports on nonionic contrast media-induced nephropathy
(CIN) in hospitalized adult patients during cardiac procedures, the
studies in pediatrics are limited, with even less focus on possible
predisposing factors and preventive measures for patients undergoing
cardiac angiography. This prospective study determined the incidence of
CIN for two nonionic contrast media (CM), iopromide and iohexol, among 80
patients younger than 18 years and compared the rates for this
complication in relation to the type and dosage of CM and the presence of
cyanosis. The 80 patients in the study consecutively received either
iopromide (group A, n = 40) or iohexol (group B, n = 40). Serum sodium
(Na), potassium (K), and creatinine (Cr) were measured 24 h before
angiography as baseline values, then measured again at 12-, 24-, and 48-h
intervals after CM use. Urine samples for Na and Cr also were checked at
the same intervals. Risk of renal failure, Injury to the kidney, Failure
of kidney function, Loss of kidney function, and End-stage renal damage
(RIFLE criteria) were used to define CIN and its incidence in the study
population. Accordingly, among the 15 CIN patients (18.75%), 7.5% of the
patients in group A had increased risk and 3.75% had renal injury, whereas
5% of group B had increased risk and 2.5% had renal injury. Whereas 33.3%
of the patients with CIN were among those who received the proper dosage
of CM, the percentage increased to 66.6% among those who received larger
doses, with a significant difference in the incidence of CIN related to
the different dosages of CM (p = 0.014). Among the 15 patients with CIN, 6
had cyanotic congenital heart diseases, but the incidence did not differ
significantly from that for the noncyanotic patients (p = 0.243). Although
clinically silent, CIN is not rare in pediatrics. The incidence depends on
dosage but not on the type of consumed nonionic CM, nor on the presence of
cyanosis, and although CIN usually is reversible, more concern is needed
for the prevention of such a complication in children. Springer
Science+Business Media, LLC 2010.

<3>
Accession Number
2010418173
Authors
Badhey N. Lichtenwalter C. De Lemos J.A. Roesle M. Obel O. Addo T.A.
Haagen D. Abdel-Karim A.-R. Saeed B. Bissett J.K. Sachdeva R. Voudris V.V.
Karyofillis P. Kar B. Rossen J. Fasseas P. Berger P.B. Banerjee S.
Brilakis E.S.
Institution
(Badhey, Lichtenwalter, De Lemos, Roesle, Obel, Haagen, Abdel-Karim,
Banerjee, Brilakis) Department of Cardiology, VA North Texas Healthcare
System, Dallas, TX, United States
(Badhey, Lichtenwalter, De Lemos, Obel, Addo, Abdel-Karim, Banerjee,
Brilakis) Division of Cardiovascular Medicine, University of Texas,
Southwestern Medical Center, Dallas, TX, United States
(Saeed) Department of Internal Medicine, University of Toledo, Toledo, OH,
United States
(Bissett, Sachdeva) Department of Cardiology, Central Arkansas Veterans
Healthcare System, University of Arkansas for Medical Sciences, Little
Rock, AR, United States
(Voudris, Karyofillis) 2nd Cardiology Department, Onassis Cardiac Surgery
Center, Athens, Greece
(Kar) Division of Cardiology, Michael E. DeBakey Veterans Affairs Medical
Center, Houston, TX, United States
(Rossen) Division of Cardiology, Iowa City Veteran Affairs Medical Center,
Iowa City, IA, United States
(Fasseas) Division of Cardiovascular Medicine, Medical College of
Wisconsin, Milwaukee, WI, United States
(Berger) Division of Cardiovascular Medicine, Geisinger Clinic, Danville,
PA, United States
Title
Contemporary use of embolic protection devices in saphenous vein graft
interventions: Insights from the stenting of saphenous vein grafts trial.
Source
Catheterization and Cardiovascular Interventions. 76 (2) (pp 263-269),
2010. Date of Publication: 01 Aug 2010.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background: We sought to evaluate the contemporary use of embolic
protection devices (EPDs) in saphenous vein graft (SVG) interventions.
Methods: We examined EPD use in the stenting of saphenous vein grafts
(SOS) trial, in which 80 patients with 112 lesions in 88 SVGs were
randomized to a bare metal stent (39 patients, 43 grafts, and 55 lesions)
or paclitaxel-eluting stent (41 patients, 45 grafts, and 57 lesions).
Results: An EPD was used in 60 of 112 lesions (54%). A Filterwire (Boston
Scientific) was used in 70% of EPD-treated lesions, Spider (ev3, Plymouth,
Minnesota) in 12%, Proxis (St. Jude, Minneapolis, Minnesota) in 12%, and
Guardwire (Medtronic, Santa Rosa, California) in 7%. Of the remaining 52
lesions, an EPD was not utilized in 13 lesions (25%) because the lesion
was near the distal anastomosis, in 14 lesions (27%) because of an ostial
location, in one lesion (2%) because of small SVG size, in two instent
restenosis lesions (4%) because of low distal embolization risk, and in 22
lesions (42%) because of operator's preference even though use of an EPD
was feasible. Procedural success was achieved in 77 patients (96%); in one
patient a Filterwire was entrapped requiring emergency coronary bypass
graft surgery and two patients had acute stent thrombosis. Conclusion: In
spite of their proven efficacy, EPDs were utilized in approximately half
of SVG interventions in the SOS trial. Availability of a proximal
protection device could allow protection of ~25% of unprotected lesions,
yet operator discretion appears to be the major determinant of EPD use.
2010 Wiley-Liss, Inc.

<4>
Accession Number
2010431769
Authors
Hemmerling T.M. Charabati S. Zaouter C. Minardi C. Mathieu P.A.
Institution
(Hemmerling) Department of Anaesthesiology, Montreal General Hospital,
1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada
(Hemmerling) Department of Anaesthesiology, McGill University, Montreal,
QC, Canada
(Zaouter, Minardi) Intelligent Technology in Anesthesia Group (ITAG),
McGill University, Montreal, QC, Canada
(Hemmerling, Charabati, Mathieu) Institute of Biomedical Engineering,
University of Montreal, Montreal, QC, Canada
Title
A randomized controlled trial demonstrates that a novel closed-loop
propofol system performs better hypnosis control than manual
administration.
Source
Canadian Journal of Anesthesia. 57 (8) (pp 725-735), 2010. Date of
Publication: August 2010.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Purpose: The purpose of this randomized control trial was to determine the
performance of a novel rule-based adaptive closed-loop system for propofol
administration using the bispectral index (BIS) and to compare the
system's performance with manual administration. The effectiveness of the
closed-loop system to maintain BIS close to a target of 45 was determined
and compared with manual administration. Methods: After Institutional
Review Board approval and written consent, 40 patients undergoing major
surgery in a tertiary university hospital were allocated to two groups
using computer-generated block randomization. In the Closed-loop group (n
= 20), closed-loop control was used to maintain anesthesia at a target BIS
of 45, and in the Control group (n = 20), propofol was administered
manually to maintain the same BIS target. To evaluate each technique's
performance in maintaining a steady level of hypnosis, the BIS values
obtained during the surgical procedure were stratified into four clinical
performance categories relative to the target BIS: <= 10%, 11-20%, 21-30%,
or > 30% defined as excellent, good, poor, or inadequate control of
hypnosis, respectively. The controller performance was compared using
Varvel's controller performance indices. Data were compared using Fisher's
exact test and the Mann-Whitney U test, P < 0.05 showing statistical
significance. Results: In the Closed-loop group, four females and 16 males
(aged 54 +/- 20 yr; weight 79 +/- 7 kg) underwent anesthesia lasting 143
+/- 57 min. During 55%, 29%, 9%, and 7% of the total anesthesia time, the
system showed excellent, good, poor, and inadequate control, respectively.
In the Control group, five females and 15 males (aged 59 +/- 16 yr; weight
75 +/- 13 kg) underwent anesthesia lasting 157 +/- 81 min. Excellent,
good, poor, and inadequate control were noted during 33%, 33%, 15%, and
19% of the total anesthesia time, respectively. In the Closed-loop group,
excellent control of anesthesia occurred significantly more often (P <
0.0001), and poor and inadequate control occurred less often than in the
Control group (P < 0.01). The median performance error and the median
absolute performance error were significantly lower in the Closed-loop
group compared with the Control group (-1.1 +/- 5.3% vs -10.7 +/- 13.1%; P
= 0.004 and 9.1 +/- 1.9% vs 15.7 +/- 7.4%; P < 0.0001, respectively).
Conclusion: The closed-loop system for propofol administration showed
better clinical and control system performance than manual administration
of propofol. (Clinical Trials gov. NCT 01019746). 2010 Canadian
Anesthesiologists' Society.

<5>
Accession Number
2010436811
Authors
Petko C. Minich L.L. Everitt M.D. Holubkov R. Shaddy R.E. Tani L.Y.
Institution
(Petko) Division of Pediatric Cardiology, Universitatsklinikum
Schleswig-Holstein, 24105 Kiel, Germany
(Minich, Everitt, Holubkov, Tani) Division of Pediatric Cardiology,
University of Utah, Salt Lake City, UT 84113, United States
(Shaddy) Division of Pediatric Cardiology, Children's Hospital of
Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, United
States
(Tani) Primary Children's Medical Center, 100 North Mario Capecchi Drive,
Salt Lake City, UT 84113, United States
Title
Echocardiographic evaluation of children with systemic ventricular
dysfunction treated with carvedilol.
Source
Pediatric Cardiology. 31 (6) (pp 780-784), 2010. Date of Publication:
August 2010.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Echocardiography is used to measure the therapeutic effectiveness of heart
failure therapy in adults and children. The purposes of this study were
(1) to assess baseline echocardiographic predictors of clinical outcome,
(2) to investigate changes in echocardiographic parameters, and (3) to
compare these echocardiographic changes with changes in plasma levels of
b-type natriuretic peptide (BNP) in a population of children with systemic
ventricular dysfunction and symptomatic heart failure treated with
carvedilol or placebo. All available baseline and 6-month echocardiograms
from Pediatric Carvedilol Trial (PCT) participants (carvedilol n = 161;
placebo n = 55) were reviewed. Systolic and diastolic sphericity index
(SI; n = 110), TEI index (n = 145), and systemic ventricular dP/dt (n =
70) were measured. The PCT composite definition of clinical outcome (i.e.,
worsened, improved, or unchanged) was used. For all patients, baseline TEI
index was a predictor of worsened outcome. Only children treated with
carvedilol showed a significant decrease in systolic SI (P <= 0.0001),
diastolic SI (P <= 0.0001), and TEI index (P = 0.02). An inverse
correlation between changes in BNP and changes in dP/dt (r = -0.45, P =
0.04) was found only in the carvedilol group. In conclusion, TEI index
predicted outcome in children with systemic ventricular dysfunction and
heart failure. Carvedilol may have a beneficial effect on reversal of left
ventricular remodeling and global ventricular function in pediatric heart
failure. 2010 Springer Science+Business Media, LLC.

<6>
Accession Number
2010429164
Authors
Srilak M. Akar A.R. Eryilmaz S. Cetinkanat E.K. Ozcinar E. Kaya B. Elhan
A.H. Ozyurda U.
Institution
(Srilak, Akar, Eryilmaz, Cetinkanat, Ozcinar, Kaya, Ozyurda) Departments
of Cardiovascular Surgery, Ankara University School of Medicine,
Dikimevi-Ankara 06340, Turkey
(Elhan) Departments of Biostatistics, Ankara University School of
Medicine, Dikimevi-Ankara 06340, Turkey
Title
Micronized purified flavonoid fraction in pretreating CABG patients.
Source
Texas Heart Institute Journal. 37 (2) (pp 172-177), 2010. Date of
Publication: 2010.
Publisher
Texas Heart Institute (1101 Bates Street, P-514, P.O. Box 20345, Houston
TX 77030, United States)
Abstract
The aim of the present study was to determine whether oral pretreatment
with micronized purified flavonoid fraction (Daflon) has beneficial
effects on cardiac function and outcome after cardiac operations. This
prospective, randomized trial enrolled 43 patients who had an impaired
preoperative left ventricular ejection fraction of less than 0.50 (mean,
0.45 +/- 0.04) and a mean New York Heart Association functional class
status of 2.30 +/- 0.74; all were scheduled for elective coronary artery
bypass grafting. Patients who were randomized to the Daflon group (n=21)
received oral Daflon 500 mg (6 tablets daily for 4 days, followed by 2
tablets for 3 days) preoperatively. Outcome variables included
perioperative hemodynamic data, inotropic requirements, morbidity, and
death, as well as cardiac ischemia and various outcome markers.
Hemodynamic and biochemical data were collected before induction of
anesthesia, perioperatively before starting cardiopulmonary bypass,
immediately after bypass, and at the 24th postoperative hour. There was
only 1 death (in the Daflon group). During the post-cardiopulmonary bypass
period, troponin I and lactate dehydrogenase levels were significantly
lower in the Daflon group. Also, the New York Heart Association status of
the patients in the Daflon group was significantly lower postoperatively.
Differences between the 2 groups in lengths of stay in the intensive care
unit and hospital, inotropic requirements, and left ventricular ejection
fraction levels did not reach statistical significance. Orally
administered Daflon might provide better outcomes for patients who have
impaired cardiac function before undergoing cardiac operations that
require cardiopulmonary bypass. 2010 by the Texas Heart Institute,
Houston.

<7>
Accession Number
2010430748
Authors
Yeates A. Mundy J. Griffin R. Marshall L. Wood A. Peters P. Shah P.
Institution
(Yeates, Mundy, Griffin, Marshall, Wood, Peters, Shah) Department of
Cardiothoracic Surgery, Princess Alexandra Hospital, Woolloongabba,
Brisbane QLD 4120, Australia
Title
Early and mid-term outcomes following surgical management of infective
endocarditis with associated cerebral complications: A single centre
experience.
Source
Heart Lung and Circulation. 19 (9) (pp 523-527), 2010. Date of
Publication: September 2010.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: Surgical management of patients with infective endocarditis
(IE) who have suffered preoperative cerebrovascular complications remains
controversial. This study evaluates the impact of timing from stroke to
valvular surgery on the early and mid-term neurological sequelae,
functional status and quality of life in this high-risk group of patients
with IE. Method: Data on 13/108 (12%) patients with IE who suffered
cerebrovascular complications during the period 1998-2009 was
prospectively collected. Mean follow-up was 37.2 months (100% complete).
Results: Three of 13 (23%) suffered haemorrhagic stroke, 10/13 (77%) had
embolic events (nine, stroke; one, TIA). The clinical diagnosis was made
by a neurologist in 6/13 (46%) and confirmed in all by CT scan. Twelve of
13 had motor deficit involving MCA territory. Thirty-day mortality was
2/13 (one, cardiac; one, neurological) with no late deaths. The mean time
from embolic stroke to surgery was 2.3 weeks (range 3-60 days). The reason
for operating on eight patients in less than two weeks was heart failure
in five, uncontrolled sepsis, AMI and TIA (one each). 2/8 (25%) suffered
additional postoperative neurological events (one, brain death, one, new
MCA stroke). On follow-up of the remaining eight patients with embolic
events, five had improved neurology and three had stable neurology. The
mean time to surgery from haemorrhagic stroke was 5.8 weeks (range 3-60
days). Deficit improved in two patients (<1 week, 1; >8 weeks, 1). On
follow-up the NYHA class was I-II in 6/11 (56%). The EQ-5D questionnaire
was used to assess quality of life. Mean index for the group was 0.67
using the US preference-weighted index score (SD 0.27). Conclusions:
Results regarding timing for haemorrhagic stroke cannot be defined from
the small numbers. Timely surgical intervention (embolic greater than two
weeks and preferably four weeks in absence of heart failure) is associated
with acceptable neurological outcome, functional class and quality of
life. 2010.

<8>
Accession Number
2010431042
Authors
Adembri C. Ristori R. Chelazzi C. Arrigucci S. Cassetta M.I. De Gaudio
A.R. Novelli A.
Institution
(Adembri, Chelazzi, De Gaudio) Section of Anesthesiology and Intensive
Care, Department of Critical Care, University of Florence, Firenze, Italy
(Ristori) Casa di Cura Villa Maria Beatrice Hospital, Firenze, Italy
(Arrigucci, Cassetta, Novelli) Department of Preclinical and Clinical
Pharmacology, Firenze, Italy
Title
Cefazolin bolus and continuous administration for elective cardiac
surgery: Improved pharmacokinetic and pharmacodynamic parameters.
Source
Journal of Thoracic and Cardiovascular Surgery. 140 (2) (pp 471-475),
2010. Date of Publication: 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Cefazolin (1-2 g bolus at induction possibly repeated after
cardiopulmonary bypass) remains the standard for antibiotic prophylaxis in
cardiac surgery. Data indicate, however, that it is underdosed with this
dosing schedule. A prospective, randomized study comparing intermittent
versus loading dose plus continuous infusion for the same total dose of
cefazolin was performed to assess which modality is pharmacokinetically
and pharmacodynamically advantageous. Methods: Patients received 2 g
cefazolin as a starting dose and then were divided into an intermittent
group (receiving another 1 g at 3, 9, and 15 hours after the first dose)
and a continuous group (continuous infusion started after the first dose,
providing 1 g every 6 hours for 18 hours). Cefazolin levels were measured
in blood and atria. Results: Mean total and calculated free trough
concentrations in blood varied greatly among patients in the intermittent
group and were lower than those in the continuous group (P < .05 at 15, 18
and 24 hours). For 9 of 10 (90%) patients in the continuous infusion
group, the targeted pharmacokinetic and pharmacodynamic goal (time above
minimal inhibitory concentration >90%) was achieved, whereas the goal was
met for only 3 of 10 (30%) in the intermittent group (P < .05). The mean
atrial tissue concentration was also higher with continuous infusion (P <
.05). Conclusions: Administration of cefazolin as bolus plus continuous
infusion has pharmacokinetic and pharmacodynamic advantages relative to
intermittent administration. It provides more stable serum levels, lower
interpatient variability, and higher myocardial tissue penetration.
Copyright 2010 by The American Association for Thoracic Surgery.

<9>
[Use Link to view the full text]
Accession Number
2010414865
Authors
Marcus H.E. Bonkat E. Dagtekin O. Schier R. Petzke F. Wippermann J.
Bottiger B.W. Teschendorf P.
Institution
(Marcus, Bonkat, Dagtekin, Schier, Petzke, Bottiger, Teschendorf)
Department of Anesthesiology and Intensive Care Medicine, University of
Cologne, Kerpener Str. 62, 50937 Cologne, Germany
(Wippermann) Department of Cardiothoracic Surgery, University of Cologne,
Cologne, Germany
Title
The impact of Trendelenburg position and positive end-expiratory pressure
on the internal jugular cross-sectional area.
Source
Anesthesia and Analgesia. 111 (2) (pp 432-436), 2010. Date of
Publication: August 2010.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background: Increasing the cross-sectional area (CSA) of the right
internal jugular vein facilitates cannulation and decreases complications.
Maneuvers such as the Trendelenburg tilt position and ventilation with a
positive end-expiratory pressure (PEEP) may increase the CSA of the right
internal jugular vein. We determined the changes in the CSA in response to
different maneuvers. Methods: The CSA (cm²) of the right
internal jugular vein was assessed in 50 anesthetized adult cardiothoracic
surgery patients using 2-dimensional ultrasound. First, the CSA was
measured in response to supine position with no PEEP (control condition,
S0) and compared with 5 different randomly ordered maneuvers: (1) PEEP
ventilation with 5 cm H₂O (S5), (2) PEEP with 10 cm
H₂O (S10), (3) a 20degree Trendelenburg tilt position with a
PEEP of 0 cm H₂O (T0), (4) a 20degree Trendelenburg tilt
position combined with a PEEP of 5 cm H₂O (T5), and (5) a
20degree Trendelenburg tilt position combined with a PEEP of 10 cm
H₂O (T10). Results: All maneuvers increased the CSA of the
right internal jugular vein with respect to the control condition S0 (all
P < 0.05). S5 increased the CSA on average by 15.9%, S10 by 22.3%, T0 by
39.4%, T5 by 38.7%, and T10 by 49.7%. Conclusion: In a comparison of the
effectiveness of applying different PEEP levels and/or the Trendelenburg
tilt position on the CSA of the right internal jugular vein, the
Trendelenburg tilt position was most effective. 2010 International
Anesthesia Research Society.

<10>
Accession Number
2010420086
Authors
Rafique A.M. Thomas Peter C. Naqvi T.Z.
Institution
(Rafique, Thomas Peter, Naqvi) Cardiac Non-Invasive Laboratory, Cedars
Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA, United
States
(Naqvi) Echocardiography Laboratories, Keck School of Medicine, University
of Southern California, Suite 322, 1510 San Pablo, Los Angeles, CA 90033,
United States
Title
A revised approach to patient selection for cardiac resynchronization
treatment using multiple asynchrony parameters in Narrow-and Wide-QRS
cardiomyopathy causes cardiac reverse remodelling: A single centre
non-randomized prospective study.
Source
Europace. 12 (8) (pp 1127-1135), 2010. Date of Publication: August 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Conflicting data exists on the benefit of cardiac resynchronization
treatment (CRT) in patients with narrow QRS (Narrow-QRS) cardiomyopathy
(CMP). We determined the effect of CRT in patients with CMP and mechanical
asynchrony based on a comprehensive assessment by multiple
echocardiographic criteria. Methods and results Ninety patients, 65 +/- 16
years, 32 with Narrow-QRS <120 ms and 58 with wide QRS >=120 ms (Wide-QRS)
CMP who met criteria for significant mechanical asynchrony by 15 criteria
before CRT were studied. Responders were patients in whom end-systolic
volume (ESV) reduced by >=15 post-CRT. There was no difference in the
response to CRT in the Narrow-QRS (ESV 132 +/- 60 to 120 +/- 60 mL, P =
0.02) or Wide-QRS (123 +/- 54 to 102 +/- 50 mL, P < 0.01) groups at 1 +/-
2 month follow-up. A difference of >=40 in time to peak contraction in a
cardiac cycle on tissue velocity imaging between the earliest and the most
delayed segment had the best area under curve for response to CRT, 0.71
(0.55-0.85), P = 0.02. Using logistic regression model, delay in
mid-posterolateral segment of >=20 in a cardiac cycle compared with
remaining 10 segments was the only predictor of response to CRT in the
overall study population. Conclusion In patients with CMP and mechanical
asynchrony by multiple criteria, response to CRT in Narrow-QRS group is
similar to those with Wide-QRS. Greater than or equal to 40 delay in
systolic contraction between 12 left ventricular (LV) segments or >=20
delay of posterolateral segment to other LV segments predicted CRT
response. Published on behalf of the European Society of Cardiology. The
Author 2010.

<11>
Accession Number
2010421802
Authors
Bertrand O.F. Poirier P. Rodes-Cabau J. Rinfret S. Title L.M. Dzavik V.
Natarajan M. Angel J. Batalla N. Almeras N. Costerousse O. De
Larochelliere R. Roy L. Despres J.-P.
Institution
(Bertrand, Poirier, Rodes-Cabau, Almeras, Costerousse, De Larochelliere,
Roy, Despres) Quebec Heart-Lung Institute, Quebec, Canada
(Rinfret) Hopital Notre-Dame, Centre Hospitalier de l'Universite de
Montreal, Montreal, Canada
(Title) Queen Elizabeth II Health Centre, Halifax, Canada
(Dzavik) Toronto General Hospital, Toronto, Canada
(Natarajan) Hamilton Civic Hospital, McMaster University, Hamilton, Canada
(Angel, Batalla) Hospital Vall d'Hebron, Barcelona, Spain
Title
Cardiometabolic effects of rosiglitazone in patients with type 2 diabetes
and coronary artery bypass grafts: A randomized placebo-controlled
clinical trial.
Source
Atherosclerosis. 211 (2) (pp 565-573), 2010. Date of Publication: August
2010.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Objectives: To assess the efficacy and safety of rosiglitazone on
saphenous vein graft (SVG) atherosclerosis prevention and on modification
of the global cardiometabolic risk profile. Methods and results: This was
a double-blind, randomized, placebo-controlled, multicenter trial which
enrolled 193 post-CABG patients with type 2 diabetes. Atherosclerosis
changes in one SVG were assessed with intravascular ultrasound at baseline
and at 12 months. Serial cardiometabolic assessments were performed. At
baseline, both groups had mean HbA_1C<7%, LDL-cholesterol
(LDL-C)<2.3mmol/l, HDL-cholesterol (HDL-C)>1.0mmol/l and blood
pressure<130/75 mmHg. After 12 months, plaque volume in SVG had increased
(median [interquartile range]) by 7.7mm³ (-17.2 to 37.9) in the
placebo group and decreased by 0.3mm³ (-19.1 to 22.3) in the
rosiglitazone group (P=0.22). Compared to placebo, rosiglitazone treated
patients had a higher (mean+/-SD) body weight (89+/-15kg vs. 84+/-15kg,
P=0.02) at the end of the study, mostly related to an increment in
subcutaneous adipose tissue. Rosiglitazone treated patients also displayed
further improvements in glycemic control compared to placebo
(HbA_1C: 6.4+/-0.7% vs. 7.0+/-0.9%, P<0.001) as well as in
several cardiometabolic parameters such as lipids (HDL-C:
1.16+/-0.28mmol/l vs. 1.06+/-0.23mmol/l, P=0.003), inflammatory profile
(C-reactive protein: 0.92mg/l [0.51-1.56] vs. 1.37mg/l [0.79-3.08],
P=0.02), and adiponectin levels (11.1mug/ml [8.19-17.9] vs. 4.65mug/ml
[3.27-7.15], P<0.001). There was no significant difference in the
incidence of serious adverse cardiovascular events. However, more patients
in the rosiglitazone group had peripheral oedema (33% vs. 18%, P=0.0019).
Conclusion: After a 12-month follow-up, we found no evidence for a
statistically significant effect of rosiglitazone on SVG atherosclerosis
whereas significant effects on glycemic control and on the cardiometabolic
risk profile appeared to be modulated in part by changes in subcutaneous
adiposity. 2010 Elsevier Ireland Ltd.

<12>
Accession Number
2010432767
Authors
Platts D. Brown M. Javorsky G. West C. Kelly N. Burstow D.
Institution
(Platts, West, Kelly, Burstow) Echocardiography Department, Prince Charles
Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
(Platts, Brown, Javorsky) Queensland Advanced Heart Failure and Cardiac
Transplant Unit, Prince Charles Hospital, Rode Rd., Chermside, Brisbane,
QLD 4032, Australia
Title
Comparison of fluoroscopic versus real-time three-dimensional
transthoracic echocardiographic guidance of endomyocardial biopsies.
Source
European Journal of Echocardiography. 11 (7) (pp 637-643), 2010. Date of
Publication: August 2010.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Fluoroscopic-guided right ventricular (RV) endomyocardial biopsy
(EMBx) is the conventional method for obtaining myocardial samples to
assess for rejection following heart transplantation. This study was
designed to assess the feasibility and accuracy of guiding RV sheath and
bioptome tip position using real-time three-dimensional echocardiography
(RT3DE). Methods and results Forty EMBx procedures were performed in 21
patients. Five procedures were in a native heart and 35 were performed
following cardiac transplantation. A RV long sheath was positioned toward
the mid to distal interventricular septum using fluoroscopy. RT3DE was
used to correlate sheath tip position with fluoroscopic position. Bioptome
tip visualization and position against the endocardium was assessed using
RT3DE. Sheath tip location was repositioned in 18 cases (46) following
assessment using RT3DE, due to alignment toward the apex (9) and mid (5)
or distal RV (4) free wall. The bioptome tip could be clearly visualized
using RT3DE in 83 of passes. In 35 of passes, the bioptome tip was
repositioned using RT3DE guidance to improve the sampling site. Conclusion
RT3DE-guided EMBx was feasible in the majority of patients and resulted in
sheath repositioning in 46 of patients and bioptome tip reorientation in
35 of cases. The Author 2010.

<13>
Accession Number
2010386383
Authors
Fujii M. Miyagi Y. Bessho R. Nitta T. Ochi M. Shimizu K.
Institution
(Fujii, Miyagi, Bessho, Nitta, Ochi, Shimizu) Division of Cardiovascular
Surgery, Department of Surgery, Nippon Medical School, Tokyo 113-8603,
Japan
Title
Effect of a neutrophil elastase inhibitor on acute lung injury after
cardiopulmonary bypass.
Source
Interactive Cardiovascular and Thoracic Surgery. 10 (6) (pp 859-862),
2010. Date of Publication: June 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Cardiopulmonary bypass (CPB) has been implicated as a cause of acute lung
injury (ALI) in cardiac surgical patients. We used a bronchoscopic
microsampling (BMS) probe to examine alveolar biochemical constituents and
evaluated the effect of sivelestat sodium hydrate, a novel synthesized
polymorphonuclear (PMN) neutrophil elastase inhibitor, on ALI induced by
CPB. Twelve patients undergoing aortic valve replacement were treated with
either sivelestat 0.2 mg/kg/h (sivelestat group, n=6) or 0.9% saline
(control group, n=6) from the start of surgery. Samples were collected by
the BMS probe at three time points: after tracheal intubation, 1 h after
CPB introduction, and 3 h after CPB termination. Pulmonary function was
assessed perioperatively. There were no differences in baseline
characteristics. The concentration of PMN elastase was significantly
suppressed in the sivelestat group, compared with the control group
(P=0.001). The sivelestat group also had lower levels of interleukin-6 and
interleukin-8. Alveolar-arterial oxygen difference markedly increased, and
a worsening of the PaO₂yFiO₂ ratio indicated severe
impairment after CPB. However, sivelestat attenuated the pattern of
physiological deterioration of gas exchange. Sivelestat may attenuate
neutrophil elastase or proinflammatory cytokines, and improve pulmonary
dysfunction in patients undergoing CPB. 2010 Published by European
Association for Cardio-Thoracic Surgery. All rights reserved.

<14>
Accession Number
2010386452
Authors
Silva A.M.R.P. Saad R. Stirbulov R. Rivetti L.A.
Institution
(Silva, Saad, Stirbulov, Rivetti) Department of Surgery, Discipline of
Cardiac Surgery, Santa Casa de Sao Paulo, Faculty of Medical Sciences, Sao
Paulo, Brazil
Title
Off-pump versus on-pump coronary artery revascularization: Effects on
pulmonary function.
Source
Interactive Cardiovascular and Thoracic Surgery. 11 (1) (pp 42-45), 2010.
Date of Publication: July 2010.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Many studies have shown important changes in lung function tests after
coronary artery surgeries. It is controversial if off-pump surgery can
give a better and shorter recovery than the on-pump. A prospective study
was conducted on 42 patients submitted to coronary artery surgery and
divided into two groups: 21 off-pump using intraluminal shunt (G,) and 21
on-pump (G_M), matched by the anatomical location of the
coronary arteries lesions. All patients had spirometric evaluation, blood
gas measurements and alveolo-arterial oxygen gradient (A-aDO₂),
at the fourth and 10th postoperative days (PO₄ and
PO₁₀). Preoperatively, G, and G_M had similar results
(P>0.372). Spirometry showed decreases at PO₄ and remained
decreased until PO₁₀ for both groups, with significant
differences between the groups. The blood gas measurements showed
reduction in arterial oxygen pressure (PaO₂) and carbon dioxide
pressure (PaC0₂), while there was an increase in
A-aDO₂ at PO₄ and PO₁₀ in both groups.
The results suggest that different changes occur in pulmonary function
when the surgery is performed with or without cardiopulmonary bypass. The
off-pump patients showed significantly greater improvement than the
on-pump group. 2010 Published by European Association for Cardio-Thoracic
Surgery.