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<1>
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Accession Number
2010275359
Authors
Issa V.S. Amaral A.F. Cruz F.D. Ferreira S.M.A. Guimaraes G.V. Chizzola
P.R. Souza G.E.C. Bacal F. Bocchi E.A.
Institution
(Issa, Amaral, Cruz, Ferreira, Guimaraes, Chizzola, Souza, Bacal, Bocchi)
Heart Failure Institute (InCor), Faculdade de Medicina, Universidade de
Sao Paulo, Sao Paulo, Brazil
(Issa) Eneas de Carvalho Aguiar, 44, CEP05403-000, Sao Paulo, SP, Brazil
Title
beta-Blocker therapy and mortality of patients with Chagas cardiomyopathy
a subanalysis of the REMADHE prospective trial.
Source
Circulation: Heart Failure. 3 (1) (pp 82-88), 2010. Date of Publication:
January 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-Peculiar aspects of Chagas cardiomyopathy raise concerns about
efficacy and safety of sympathetic blockade. We studied the influence of
beta-blockers in patients with Chagas cardiomyopathy. Methods and
Results-We examined REMADHE trial and grouped patients according to
etiology (Chagas versus non-Chagas) and beta-blocker therapy. Primary end
point was all-cause mortality or heart transplantation. Altogether 456
patients were studied; 27 (5.9%) were submitted to heart transplantation
and 202 (44.3%) died. Chagas etiology was present in 68 (14.9%) patients;
they had lower body mass index (24.1+/-4.1 versus 26.3+/-5.1, P=0.001),
smaller end-diastolic left ventricle diameter (6.7+/-1.0 mm versus
7.0+/-0.9 mm, P=0.001), smaller proportion of beta-blocker therapy (35.8%
versus 68%, P<0.001), and higher proportion of spironolactone therapy
(74.6% versus 57.8%, P=0.003). Twenty-four (35.8%) patients with Chagas
disease were under beta-blocker therapy and had lower serum sodium
(136.6+/-3.1 versus 138.4+/-3.1 mEqs, P=0.05) and lower body mass index
(22.5+/-3.3 versus 24.9+/-4.3, P=0.03) compared with those who received
beta-blockers. Survival was lower in patients with Chagas heart disease as
compared with other etiologies. When only patients under beta-blockers
were considered, the survival of patients with Chagas disease was similar
to that of other etiologies. The survival of patients with beta-blockers
was higher than that of patients without beta-blockers. In Cox regression
model, left ventricle end-diastolic diameter (hazard ratio, 1.78; CI, 1.15
to 2.76; P=0.009) and beta-blockers (hazard ratio, 0.37; CI, 0.14 to 0.97;
P=0.044) were associated with better survival. Conclusions-Our study
suggests that beta-blockers may have beneficial effects on survival of
patients with heart failure and Chagas heart disease and warrants further
investigation in a prospective, randomized trial. Clinical Trial
Registration-clinicaltrials.gov. Identifier: NCT00505050. 2010 American
Heart Association, Inc.
<2>
[Use Link to view the full text]
Accession Number
2010590447
Authors
Halkos M.E. Puskas J.D.
Institution
(Halkos, Puskas) Clinical Research Unit, Division of Cardiothoracic
Surgery, Emory University School of Medicine, Atlanta, GA, United States
Title
Off-pump coronary surgery: Where do we stand in 2010?.
Source
Current Opinion in Cardiology. 25 (6) (pp 583-588), 2010. Date of
Publication: November 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
PURPOSE OF REVIEW: In this review, we will highlight recent studies
comparing off-pump coronary artery bypass surgery with traditional on-pump
coronary artery bypass surgery. RECENT FINDINGS: Current literature
comparing off-pump vs. on-pump coronary artery bypass has failed to
demonstrate the superiority of one technique over the other. Small
prospective randomized controlled trials continue to show equivalent
in-hospital outcomes and continue to raise concerns about vein graft
patency and completeness of revascularization. Larger observational
analyses are better powered to statistically compare in-hospital outcomes
in both low and high-risk patients and in general have shown more
favorable in-hospital outcomes and equivalent long-term outcomes with
off-pump compared with on-pump coronary artery bypass. SUMMARY: Off-pump
coronary artery bypass continues to be a useful technique for coronary
revascularization. The benefits of off-pump techniques may be more
apparent for patients at high risk for complications associated with
cardiopulmonary bypass and aortic manipulation. 2010 Wolters Kluwer
Health | Lippincott Williams & Wilkins.
<3>
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Accession Number
2010590449
Authors
Chaitman B.R. Hadid M. Laddu A.A.
Institution
(Chaitman, Hadid, Laddu) Department of Medicine, Saint Louis University
School of Medicine, St Louis, MO, United States
Title
Choice of initial medical therapy vs. prompt coronary revascularization in
patients with type 2 diabetes and stable ischemic coronary disease with
special emphasis on the BARI 2D trial results.
Source
Current Opinion in Cardiology. 25 (6) (pp 597-602), 2010. Date of
Publication: November 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
PURPOSE OF REVIEW: To determine whether a strategy of prompt coronary
revascularization as compared with an initial strategy of intensive
optimal medical therapy (OMT) in patients with type 2 diabetes and stable
coronary artery disease (CAD) prevents major adverse cardiac outcomes.
RECENT FINDINGS: Randomized controlled clinical trials comparing a
strategy of prompt coronary artery bypass grafting (CABG), percutaneous
coronary intervention (PCI) or medical therapy in patients with type 2
diabetes are reviewed with special emphasis on the Bypass Angioplasty
Revascularization Investigation 2D trial. An initial strategy of PCI or
CABG alleviates symptoms and improves quality of life more than an initial
strategy of OMT. However, an initial strategy of PCI in patients with less
extensive CAD does not significantly reduce death or myocardial
infarction. Patients with more extensive CAD in whom a more complete
coronary revascularization can be achieved with CABG have less subsequent
myocardial infarction, a complication associated with increased mortality,
than those treated with initial OMT. SUMMARY: In many patients with type 2
diabetes and stable CAD in whom angina symptoms are controlled, OMT alone
should be the first-line strategy. In patients with more extensive
coronary disease, prompt CABG, in the absence of contraindications, OMT,
and an insulin sensitization strategy are a preferred therapeutic strategy
to reduce the incidence of myocardial infarction. 2010 Wolters Kluwer
Health | Lippincott Williams & Wilkins.
<4>
Accession Number
2010595313
Authors
Leon M.B. Smith C.R. Mack M. Miller D.C. Moses J.W. Svensson L.G. Tuzcu
E.M. Webb J.G. Fontana G.P. Makkar R.R. Brown D.L. Block P.C. Guyton R.A.
Pichard A.D. Bavaria J.E. Herrmann H.C. Douglas P.S. Petersen J.L. Akin
J.J. Anderson W.N. Wang D. Pocock S.
Institution
(Leon, Smith, Moses) Columbia University Medical Center, New
York-Presbyterian Hospital, Heart Center, 173 Fort Washington Ave., New
York, NY 10032, United States
(Mack, Brown) Medical City Dallas, Dallas, CA, United States
(Miller) Stanford University Medical School, Stanford, CA, United States
(Akin, Anderson) Edwards Lifesciences, Irvine, CA, United States
(Svensson, Tuzcu) Cleveland Clinic Foundation, Cleveland, OH, United
States
(Webb) University of British Columbia, St. Paul's Hospital, Vancouver, BC,
Canada
(Fontana, Makkar) Cedars - Sinai Medical Center, Los Angeles, CA, United
States
(Block, Guyton) Emory University School of Medicine, Atlanta, GA, United
States
(Pichard) Washington Hospital Center, Washington, DC, United States
(Bavaria, Herrmann) Hospital of the University of Pennsylvania,
Philadelphia, PA, United States
(Douglas, Petersen) Duke University Medical Center, Durham, NC, United
States
(Wang, Pocock) London School of Hygiene and Tropical Medicine, London,
United Kingdom
Title
Transcatheter aortic-valve implantation for aortic stenosis in patients
who cannot undergo surgery.
Source
New England Journal of Medicine. 363 (17) (pp 1597-1607), 2010. Date of
Publication: 21 Oct 2010.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Many patients with severe aortic stenosis and coexisting
conditions are not candidates for surgical replacement of the aortic
valve. Recently, transcatheter aortic-valve implantation (TAVI) has been
suggested as a less invasive treatment for high-risk patients with aortic
stenosis. METHODS: We randomly assigned patients with severe aortic
stenosis, whom surgeons considered not to be suitable candidates for
surgery, to standard therapy (including balloon aortic valvuloplasty) or
transfemoral transcatheter implantation of a balloon-expandable bovine
pericardial valve. The primary end point was the rate of death from any
cause. RESULTS: A total of 358 patients with aortic stenosis who were not
considered to be suitable candidates for surgery underwent randomization
at 21 centers (17 in the United States). At 1 year, the rate of death from
any cause (Kaplan-Meier analysis) was 30.7% with TAVI, as compared with
50.7% with standard therapy (hazard ratio with TAVI, 0.55; 95% confidence
interval [CI], 0.40 to 0.74; P<0.001). The rate of the composite end point
of death from any cause or repeat hospitalization was 42.5% with TAVI as
compared with 71.6% with standard therapy (hazard ratio, 0.46; 95% CI,
0.35 to 0.59; P<0.001). Among survivors at 1 year, the rate of cardiac
symptoms (New York Heart Association class III or IV) was lower among
patients who had undergone TAVI than among those who had received standard
therapy (25.2% vs. 58.0%, P<0.001). At 30 days, TAVI, as compared with
standard therapy, was associated with a higher incidence of major strokes
(5.0% vs. 1.1%, P = 0.06) and major vascular complications (16.2% vs.
1.1%, P<0.001). In the year after TAVI, there was no deterioration in the
functioning of the bioprosthetic valve, as assessed by evidence of
stenosis or regurgitation on an echocardiogram. CONCLUSIONS: In patients
with severe aortic stenosis who were not suitable candidates for surgery,
TAVI, as compared with standard therapy, significantly reduced the rates
of death from any cause, the composite end point of death from any cause
or repeat hospitalization, and cardiac symptoms, despite the higher
incidence of major strokes and major vascular events. (Funded by Edwards
Lifesciences; ClinicalTrials.gov number, NCT00530894.) Copyright 2010
Massachusetts Medical Society.
<5>
Accession Number
2010598831
Authors
Gavrielatos G. Anthopoulos P.L. Pappas L.K. Gavaliatsis I. Salachas A.
Ifantis G. Antonelis I.
Institution
(Gavrielatos, Pappas) 2nd Department of Cardiology, Evangelismos General
Hospital, Athens, Greece
(Anthopoulos, Gavaliatsis, Salachas, Ifantis, Antonelis) Cardiac
Catheterisation and Interventional Cardiology Department, Evaggelismos
General Hospital, Athens, Greece
Title
Clinical outcome and angiographic results with novel polysulfone polymer
coating paclitaxel eluting stent in real-world clinical practice: A
clinical centre registry.
Source
Case Reports and Clinical Practice Review. 16 (10) (pp MT77-MT82), 2010.
Date of Publication: 2010.
Publisher
Medical Science International (ul. Ustrzycka 11, Warsaw 02-141, Poland)
Abstract
Background: The Intek-Apollo stent (Switzerland) employs a polysulfone
polymer coating which has demonstrated low interaction with blood and high
thrombo-resistance. The aim of this study was to assess the clinical and
angiographic outcomes after Intek-Apollo stent utilisation in a real-world
setting. Material/Methods: A total of 130 patients (77.7% males) were
enrolled with 174 lesions in native coronary arteries (92.4%), saphenous
vein grafts (7.5%) and in-stent restenosis (6.3%). Indications for
stenting were stable coronary artery disease (CAD) 52.3%, acute coronary
syndrome (ACS) 37.7% and STEMI 10%. Clinical follow-up and coronary
angiography (after symptoms occurrence or positive stress test) was
performed at 6 and 12 months.The primary end points were target lesion
revascularization (TLR) and target vessel revascularization (TVR), while
secondary end points were major adverse cardiac events (MACE) during the
follow-up period. Results: The mean age of patients included was
61.62+/-11.13 years. Complex lesions treatment (ostial, bifurcation)
reached 13.7%. Mean stenosis diameter was 83.52+/-10.5%. Reference vessel
diameter was 2.85+/-0.39 mm with a mean lesion length of 14.66+/-4.5mm.
Average stent size was 2.93+/-0.39mm x 16.6+/-4.73 mm. At 15+/-3 months,
primary events includedTLR (4.6%), TVR (4.6%) and MACE (2.3%). There was
1one myocardial infarction and no cardiac death). No incidence of early or
late stent thrombosis was demonstrated. Conclusions: Intek-Apollo stent
implantation is safe and efficient in a real world population. The unique
properties of polysulfone polymer coating can effectively protect from
late stent thrombosis and lead to reduced rates of TLR, TVR and MACE. Med
Sci Monit, 2010.
<6>
Accession Number
20653331
Authors
Angeli F. Verdecchia P. Karthikeyan G. Mazzotta G. Gentile G. Reboldi G.
Institution
(Angeli) Department of Cardiology, Clinical Research Unit - Preventive
Cardiology, Hospital Santa Maria della Misericordia, Perugia, Italy.
Title
Blockers reduce mortality in patients undergoing high-risk non-cardiac
surgery.
Source
American journal of cardiovascular drugs : drugs, devices, and other
interventions. 10 (4) (pp 247-259), 2010. Date of Publication: 2010.
Abstract
BACKGROUND: Adrenergic receptor antagonists (beta-blockers) are frequently
used with the aim of reducing perioperative myocardial ischemia and
infarction. However, randomized clinical trials specifically designed to
evaluate the effects of beta-blockers on mortality in patients undergoing
non-cardiac surgery have yielded conflicting results. OBJECTIVE: This
study aimed to examine the effect of perioperative blockers on total and
cardiovascular mortality in patients undergoing non-cardiac surgery.
METHODS: We conducted a meta-analysis of randomized clinical trials that
examined the effects of blockers versus placebo on cardiovascular and
all-cause mortality in patients undergoing non-cardiac surgery. We
extracted data from articles published before 30 November 2009 in
peer-reviewed journals indexed in MEDLINE, Cochrane Central Register of
Controlled Trials (CENTRAL), EMBASE and CINAHL. Data extraction was
carried out independently by two reviewers on the basis of an
intent-to-treat approach, and inconsistencies were discussed and resolved
in conference. The present meta-analysis was undertaken according to the
Quality of Reporting of Meta-analyses (QUORUM) statement. RESULTS: A total
of 2148 records were screened, from which we identified 74 randomized
controlled trials for non-cardiac surgery. After excluding 49 studies that
did not report the clinical outcome of interest or were subanalyses or
presented duplicate data, the final search left 25 clinical trials.
Treatment with blockers had no significant effect on all-cause mortality
(odds ratio [OR] 1.15; 95% confidence interval [CI] 0.92, 1.43; p =
0.2717) or cardiovascular mortality (OR 1.13; 95% CI 0.85, 1.51; p =
0.5855). However, surgical risk category markedly differed across the
studies. According to Joint American College of Cardiology and American
Heart Association guidelines for perioperative assessment of patients
having non-cardiac surgery, five trials evaluated the effect of blockers
in patients treated with emergency and vascular surgery (high-risk
category) whereas 15 and five trials evaluated the effect of blockers in
intermediate low and intermediate high surgical risk categories,
respectively. Subgroup analyses showed that the surgical risk category and
dose titration of blockers to target heart rate affected the estimate of
the effect of blockers for all-cause and cardiovascular mortality.
Blockers reduced total mortality by 61% more in patients who underwent
high-risk surgery than in those who underwent intermediate high- or
intermediate low-risk surgery. When cardiovascular mortality was assessed,
the benefit of blockers was 74% greater in trials that titrated blockers
to heart rate than in trials that did not, although formal statistical
significance was not achieved. CONCLUSIONS: These data suggest that
blockers may be useful for reducing mortality in patients who undergo
high-risk non-cardiac surgery.
<7>
Accession Number
19788440
Authors
Kawahara Y. Ninomiya I. Fujimura T. Funaki H. Nakagawara H. Takamura H.
Oyama K. Tajima H. Fushida S. Inaba H. Kayahara M.
Institution
(Kawahara) Gastroenterologic Surgery, Department of Oncology, Division of
Cancer Medicine, Graduate School of Medical Science, Kanazawa University,
Ishikawa, Japan.
Title
Prospective randomized controlled study on the effects of perioperative
administration of a neutrophil elastase inhibitor to patients undergoing
video-assisted thoracoscopic surgery for thoracic esophageal cancer.
Source
Diseases of the esophagus : official journal of the International Society
for Diseases of the Esophagus / I.S.D.E. 23 (4) (pp 329-339), 2010. Date
of Publication: May 2010.
Abstract
Sivelestat sodium hydrate (Ono Pharmaceutical Co., Osaka, Japan) is a
selective inhibitor of neutrophil elastase (NE) and is effective in
reducing acute lung injury associated with systemic inflammatory response
syndrome (SIRS). We conducted a prospective randomized controlled study to
investigate the efficacy of perioperative administration of sivelestat
sodium hydrate to prevent postoperative acute lung injury in patients
undergoing thoracoscopic esophagectomy and radical lymphadenectomy.
Twenty-two patients with thoracic esophageal cancer underwent
video-assisted thoracoscopic esophagectomy with extended lymph node
dissection in our institution between April 2007 and November 2008. Using
a double-blinded method, these patients were randomly assigned to one of
two groups preoperatively. The active treatment group received sivelestat
sodium hydrate intravenously for 72 hours starting at the beginning of
surgery (sivelestat-treated group; n= 11), while the other group received
saline (control group; n= 11). All patients were given methylprednisolone
immediately before surgery. Postoperative clinical course was compared
between the two groups. Two patients (one in each group) were discontinued
from the study during the postoperative period because of surgery-related
complications. Of the remaining 20 patients, 2 patients who developed
pneumonia within a week after surgery were excluded from some laboratory
analyses, so data from 18 patients (9 patients in each group) were
analyzed based on the arterial oxygen pressure/fraction of inspired oxygen
ratio, white blood cell count, serum C-reactive protein level, plasma
cytokine levels, plasma NE level, and markers of alveolar type II
epithelial cells. In the current study, the incidence of postoperative
morbidity did not differ between the two groups. The median duration of
SIRS in the sivelestat-treated group was significantly shorter than that
in the control group: 17 (range 9-36) hours versus 49 (15-60) hours,
respectively (P= 0.009). Concerning the parameters used for the diagnosis
of SIRS, the median heart rates on postoperative day (POD) 2 were
significantly lower in the sivelestat-treated group than in the control
group (P= 0.007). The median arterial oxygen pressure/fraction of inspired
oxygen ratio of the sivelestat-treated group were significantly higher
than those of the control group on POD 1 and POD 7 (POD 1: 372.0 [range
284.0-475.0] vs 322.5 [243.5-380.0], respectively, P= 0.040; POD 7: 377.2
[339.5-430.0] vs 357.6 [240.0-392.8], P= 0.031). Postoperative white blood
cell counts, serum C-reactive protein levels, plasma interleukin-1beta,
tumor necrosis factor-alpha levels, and plasma NE levels did not differ
significantly between the two groups at any point during the postoperative
course, nor did serum Krebs von den Lungen 6, surfactant protein-A, or
surfactant protein-D levels, which were used as markers of alveolar type
II epithelial cells to evaluate the severity of lung injury. Plasma
interleukin-8 levels were significantly lower in the sivelestat-treated
group than in the control group on POD 3 (P= 0.040). In conclusion,
perioperative administration of sivelestat sodium hydrate (starting at the
beginning of surgery) mitigated postoperative hypoxia, partially
suppressed postoperative hypercytokinemia, shortened the duration of SIRS,
and stabilized postoperative circulatory status after thoracoscopic
esophagectomy.
<8>
Accession Number
2010585988
Authors
Szerlip M. Grines C.L.
Institution
(Szerlip) University of Arizona, Sarver Heart Center, Tucson, AZ, United
States
(Grines) Division of Cardiology, William Beaumont Hospital, 3601 W.
Thirteen Mile Road, Royal Oak, MI 48073, United States
Title
The current role of angiojet rheolytic thrombectomy in acute myocardial
infarction.
Source
Journal of Invasive Cardiology. 22 (SUPPL. B) (pp 21B-22B), 2010. Date
of Publication: October 2010.
Publisher
HMP Communications (83 General Warren Blvd. Suite 100, Malven PA 19355,
United States)
<9>
Accession Number
2010585989
Authors
Antoniucci D.
Institution
(Antoniucci) Division of Cardiology, Careggi Hospital, Viale Morgagni,
I-50134 Florence, Italy
Title
JETSTENT trial results: Impact on ST-segment elevation myocardial
infarction interventions.
Source
Journal of Invasive Cardiology. 22 (SUPPL. B) (pp 23B-25B), 2010. Date
of Publication: October 2010.
Publisher
HMP Communications (83 General Warren Blvd. Suite 100, Malven PA 19355,
United States)
Abstract
The results of meta-analyses of studies on manual thrombus aspiration and
mechanical thrombectomy support the use of manual aspiration catheters and
contraindicate the use of mechanical thrombectomy devices. However, the
two largest studies dominate the meta-analysis results, the Thrombus
Aspiration during Percutaneous Coronary Intervention in Acute Myocardial
Infarction Study (TAPAS) for the manual aspiration study group, and the
Angiojet rheolytic thrombectomy In patients undergoing primary angioplasty
for acute Myocardial Infarction (AIMI) trial for the mechanical
thrombectomy group. The first demonstrated a clinical benefit of thrombus
removal using the manual aspiration catheter. The AIMI trial, which
included 480 patients, showed a negative and harmful impact on survival of
rheolytic thrombectomy. The results of the recently concluded AngioJET
Rheolytic Thrombectomy Before Direct Infarct Artery STENTing with Direct
Stenting Alone in Patients with Acute Myocardial Infarction (JETSTENT)
trial, which included 501 patients and showed a strong clinical benefit of
rheolytic thrombectomy in the setting of primary PCI for acute myocardial
infarction (AMI), adds new arguments in support of rheolytic thrombectomy
in AMI.
<10>
Accession Number
2010594519
Authors
Akin I. Bufe A. Eckardt L. Reinecke H. Senges J. Richardt G. Kuck K.-H.
Schneider S. Nienaber C.A.
Institution
(Akin, Nienaber) Department of Internal Medicine I, University Hospital
Rostock, Rostock, Germany
(Bufe) Department of Cardiology, Helios Clinic Wuppertal, University of
Witten/Herdecke, Herdecke, Germany
(Eckardt, Reinecke) Department of Cardiology, University Hospital Mnster,
Mnster, Germany
(Senges, Schneider) Institut Fr Klinische Kardiovaskulre Forschung,
Ludwigshafen, Germany
(Richardt) Department of Cardiology, Heart Center Bad Segeberg, Bad
Segeberg, Germany
(Kuck) Department of Cardiology, Asklepios Hospital Hamburg, Hamburg,
Germany
Title
Comparison of outcomes in patients with insulin-dependent versus
non-insulin dependent diabetes mellitus receiving drug-eluting stents
(from the first phase of the prospective multicenter German DES.DE
registry).
Source
American Journal of Cardiology. 106 (9) (pp 1201-1207), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Drug-eluting stents have been effective in randomized controlled trials,
but their safety and efficacy in patients with insulin-dependent diabetes
has not been well studied. Baseline clinical and angiographic
characteristics and in-hospital and follow-up events were recorded for
enrolled patients. From October 2005 and October 2006, 581 patients with
insulin-dependent diabetes and 1,078 with non-insulin-dependent diabetes
treated with sirolimus- and paclitaxel-eluting stents were enrolled at 98
sites. The composite of death, myocardial infarction, and stroke, defined
as major adverse cardiac and cerebrovascular events, as well as target
vessel revascularization was used as the primary end point. Multiple
logistic regression analysis was used to adjust for confounding
parameters. Baseline clinical characteristics were more severe in patients
with insulin-dependent diabetes, whereas descriptive characteristics were
not unique. At 1-year follow-up, the comparison between the 2 groups
revealed significantly higher rates of overall death (7.4% vs 4.6%, p
<0.05), target vessel revascularization (15.1% vs 10.4%, p <0.05), and
overall stent thrombosis (6.5% vs 4.1%, p <0.05) for insulin-dependent
patients, while rates of major adverse cardiac and cerebrovascular events
were not significantly different (12.8% vs 9.9%, p = 0.09). These results
persisted even after risk adjustment for heterogenous baseline
characteristics of the 2 groups. In conclusion, the data generated from
the German Drug-Eluting Stent (DES.DE) registry revealed that even with
drug-eluting stents, the annual risk for death, target vessel
revascularization, and thrombotic events remains higher in patients with
insulin-dependent diabetes compared to those with non-insulin-dependent
diabetes. 2010 Elsevier Inc. All rights reserved.
<11>
Accession Number
2010594520
Authors
Solheim S. Seljeflot I. Lunde K. Bjornerheim R. Aakhus S. Forfang K.
Arnesen H.
Institution
(Solheim, Seljeflot, Arnesen) Center for Clinical Heart Research, Oslo
University Hospital, Ullevl, Norway
(Solheim, Seljeflot, Bjornerheim, Arnesen) Department of Cardiology, Oslo
University Hospital, Ullevl, Norway
(Seljeflot, Arnesen) University of Oslo, Oslo, Norway
(Lunde, Aakhus, Forfang) Department of Cardiology, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
Title
Frequency of left ventricular thrombus in patients with anterior wall
acute myocardial infarction treated with percutaneous coronary
intervention and dual antiplatelet therapy.
Source
American Journal of Cardiology. 106 (9) (pp 1197-1200), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The aim of the present study was to investigate the prevalence of left
ventricular (LV) thrombus formation and important determinants in patients
with acute ST elevation myocardial infarction localized to the anterior
wall treated with percutaneous coronary intervention (PCI) and
dual-antiplatelet therapy. One hundred selected patients with ST elevation
myocardial infarctions revascularized with PCI in the left anterior
descending coronary artery were included. The patients participated in the
Autologous Stem Cell Transplantation in Acute Myocardial Infarction
(ASTAMI) trial. All were treated with aspirin 75 mg/day and clopidogrel 75
mg/day and underwent serial echocardiography and magnetic resonance
imaging during the first 3 months after PCI. After 4 to 5 days, the
ejection fraction and infarct size in percentage of the left anterior
descending coronary artery area were assessed using single photon-emission
computed tomography in addition to the ejection fraction by
echocardiography. LV thrombi were detected in 15 patients during the first
3 months, 2/3 of them within the first week. No differences in baseline
characteristics between the groups with and without LV thrombi were shown.
However, in the thrombus group, significantly higher peak creatine kinase
levels (6,128 vs 2,197 U/L, p <0.01), larger infarct sizes (82.5% vs
63.8%, p <0.01), and lower ejection fractions on single photon-emission
computed tomography (35.5% vs 40.0%, p = 0.03) and on echocardiography
(43.0% vs 46.0%, p = 0.03) were found compared to patients without LV
thrombi. In conclusion, LV thrombus formation is a frequent finding in
patients with anterior wall ST elevation myocardial infarction treated
acutely with PCI and dual-antiplatelet therapy and should be assessed by
echocardiography within the first week. 2010 Elsevier Inc. All rights
reserved.
<12>
Accession Number
2010594525
Authors
Whrle J. Desaga M. Metzger C. Huber K. Suryapranata H. Guetta V. Guagliumi
G. Witzenbichler B. Parise H. Mehran R. Stone G.W.
Institution
(Whrle) Clinic of Internal Medicine II, University of Ulm, Ulm, Germany
(Desaga) Klinikum Dachau der Amperkliniken AG, Dachau, Germany
(Metzger) Heart Center, Kingsport, TN, United States
(Huber) Wilhelminen Hospital, Vienna, Austria
(Suryapranata) Hospital de Weezenlanden, Zwolle, Netherlands
(Guetta) Sheba Medical Center, Tel Hashomer, Israel
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Witzenbichler) Charit Campus Benjamin Franklin, Berlin, Germany
(Parise, Mehran, Stone) Columbia University Medical Center and
Cardiovascular Research Foundation, New York, NY, United States
Title
Impact of transfer for primary percutaneous coronary intervention on
survival and clinical outcomes (from the HORIZONS-AMI trial).
Source
American Journal of Cardiology. 106 (9) (pp 1218-1224), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Primary percutaneous coronary intervention (PCI) is the preferred
reperfusion strategy in patients with ST-segment elevation myocardial
infarction (STEMI). We evaluated whether presentation of patients with
STEMI to a noninterventional facility requiring transfer for primary PCI
compared to direct admission to a PCI center has an impact on clinical
outcomes. Of 3,602 patients enrolled in the multicenter, prospective
HORIZONS-AMI trial, 988 (24.7%) were transferred for primary PCI and 2,614
were directly admitted to an interventional hospital. Clinical outcomes at
30 days and 1 year were evaluated. Median time to reperfusion in patients
with transfer was 67 minutes longer compared to patients without transfer
(272 vs 205 minutes, p <0.001), and first door-to-balloon time was 47
minutes longer (134 vs 87 minutes, p <0.001). At 30 days and 1 year there
were no significant differences between patients with and without transfer
in the rates of major adverse cardiac events (30 days 5.8% vs 5.4%, p =
0.68; 1 year 11.6% vs 12.0%, p = 0.74), major bleeding (30 days 7.3% vs
6.9%, p = 0.66; 1 year 7.9% vs 7.4%, p = 0.63), or mortality (30 days 2.6%
vs 2.6%, p = 0.92; 1 year 4.0% vs 4.2%, p = 0.81). In transfer and
nontransfer patients use of bivalirudin compared to unfractionated heparin
plus glycoprotein IIb/IIIa inhibitor was associated with lower rates of
bleeding, cardiac death, and net adverse clinical events. In conclusion,
in the HORIZONS-AMI trial, 30-day and 1-year survival rates and clinical
outcomes were comparable in patients with STEMI requiring and not
requiring transfer for primary PCI. 2010 Elsevier Inc. All rights
reserved.
<13>
Accession Number
2010594529
Authors
Wilton S.B. Fundytus A. Ghali W.A. Veenhuyzen G.D. Quinn F.R. Mitchell
L.B. Hill M.D. Faris P. Exner D.V.
Institution
(Wilton, Fundytus, Ghali, Veenhuyzen, Quinn, Mitchell, Exner) Libin
Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB,
Canada
(Wilton, Ghali, Hill, Faris, Exner) Department of Community Health
Sciences, University of Calgary, Calgary, AB, Canada
Title
Meta-analysis of the effectiveness and safety of catheter ablation of
atrial fibrillation in patients with versus without left ventricular
systolic dysfunction.
Source
American Journal of Cardiology. 106 (9) (pp 1284-1291), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Catheter ablation is a promising therapy for atrial fibrillation (AF), but
its utility in patients with left ventricular systolic dysfunction (LVSD)
is uncertain. The objectives of this study were to perform a systematic
review and meta-analysis of randomized and observational studies comparing
the rates of recurrent AF, atrial tachycardia (AT), and complications
after AF catheter ablation in those with versus without LVSD and to
summarize the impact of catheter ablation on the left ventricular ejection
fraction. Seven observational studies and 1 randomized trial were included
(total n = 1,851). Follow-up ranged from 6 to 27 months. In those with
LVSD, 28% to 55% were free of AF or AT on follow-up after 1 AF catheter
ablation, increasing to 64% to 96% after a mean of 1.4 procedures. The
relative risk for recurrent AF or AT in those with versus without LVSD was
1.5 (95% confidence interval 1.2 to 1.8, p <0.001) after 1 procedure and
1.2 (95% confidence interval 0.9 to 1.5, p = 0.2) after multiple
procedures. No difference in complications was observed in patients with
(3.5%) versus without (2.5%) heart failure (p = 0.55). After catheter
ablation, those with LVSD experienced a pooled absolute improvement in the
left ventricular ejection fraction of 0.11 (95% confidence interval 0.07
to 0.14, p <0.001). In conclusion, patients with and without LVSD had
similar risk for recurrent AF or AT after catheter ablation, but repeat
procedures were required more often in those with LVSD. Significant
improvements in left ventricular ejection fractions after ablation were
observed in those with LVSD. Randomized trials are needed given the
limitations of present data. 2010 Elsevier Inc. All rights reserved.
<14>
Accession Number
2010594544
Authors
Takagi H. Manabe H. Umemoto T.
Title
A contemporary meta-analysis of gender differences in mortality after
coronary artery bypass grafting.
Source
American Journal of Cardiology. 106 (9) (pp 1367), 2010. Date of
Publication: 2010.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
<15>
Accession Number
20563466
Authors
Mota F.A. Marcolan J.F. Pereira M.H. Milanez A.M. Dallan L.A. Diccini S.
Institution
(Mota) Heart Institute and Federal University of Sao Paulo, Sao Paulo, SP,
Brazil.
Title
Comparison study of two different patient-controlled anesthesia regiments
after cardiac surgery.
Source
Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade
Brasileira de Cirurgia Cardiovascular. 25 (1) (pp 38-44), 2010. Date of
Publication: Mar 2010.
Abstract
INTRODUCTION: Acute and severe pain is frequent in patients who undergo
cardiothoracic surgery. Patient controlled analgesia (PCA) can be used to
manage postoperative pain. OBJECTIVE: To compare analgesia of morphine PCA
alone without continuous infusion with morphine PCA plus a continuous
infusion on postoperative period after cardiac surgery and to evaluate
pain scores, morphine consumption, number of demand, patient satisfaction
and side effects. METHODS: Randomized trial was conducted to assess
patients who underwent cardiac surgery receiving either morphine PCA alone
or morphine PCA plus continuous infusion. In the post operative period,
PCA was started at extubation in both regiments according to
randomization. Pain intensity, morphine consumption, number of demand,
satisfaction and side effects were assessed at zero, six, twelve,
eighteen, twenty four and thirty hours after patients' extubation.
RESULTS: The study enrolled 100 patients. 50 patients received morphine
PCA alone, (Group A) and 50 patients received morphine PCA plus a
background infusion, (Group B). Group B patients had less demand, consumed
more morphine and were more satisfied regarding analgesia. No statistical
differences were shown between groups related to pain intensity, and side
effects. CONCLUSIONS: Pain control was effective and similar in both
groups. Morphine PCA alone seems to be better for postoperative pain
manage in cardiac surgery, due to its less morphine expense with the same
effectiveness.
<16>
Accession Number
20563469
Authors
Torina A.G. Petrucci O. de Oliveira P.P.M. de Oliveira Severino E.S.B. de
Souza Vilarinho K.A. Lavagnoli C.F.R. Blotta M.H. Vieira R.W.
Institution
(Torina, Petrucci, de Oliveira, de Oliveira Severino, de Souza Vilarinho,
Lavagnoli, Blotta, Vieira) Surgery Department - Heart Surgery Division,
Faculdade de Ciencias Medicas (Biomedical Perfusionist), Universidade
Estadual de Campinas - UNICAMP, Brazil
Title
The effects of modified ultrafiltration on pulmonary function and
transfusion requirements in patients undergoing coronary artery bypass
graft surgery.
Source
Brazilian Journal of Cardiovascular Surgery. 25 (1) (pp 59-65), 2010.
Date of Publication: Jan./Mar. 2010.
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (Av. Juscelino Kubitschek
de Oliviera 1505, Sao Jose do Rio Preto 15091-450, Brazil)
Abstract
Objective: The inflammatory response after cardiac surgery increases
vascular permeability leading to higher mortality and morbidity in the
post operative time. The modified ultrafiltration (MUF) has shown benefits
in respiratory and hemodynamic function in pediatric patients. This
approach in adults is not well established yet. We hypothesize that
modified ultrafiltration may improve respiratory, hemodynamic and
coagulation function in adults after cardiac surgeries. Methods: A
prospective randomized study was carried out with 37 patients who
underwent coronary artery bypass graft surgery (CABG) were randomized
either to MUF (n=20) at the end of bypass or to control (no MUF) (n=17).
The anesthesia and ICU team were blinded for the group selection. The MUF
were carried out for 15 minutes after the end of bypass. The patients'
data were taken at beginning of anesthesia, ending of bypass, ending MUF,
24 hours, and 48 hours after surgery. For clinical outcome the pulmonary,
hemodynamic and coagulation function were evaluated. Results: We observed
lower drain loss in the MUF group compared to control group after 48 hours
(598+/-123 vs. 848+/-455 ml; p=0.04) and required less red blood cell unit
transfusions compared to control group (0.6 +/- 0.6 vs.1.6+/-1.1
units/patient; P=0.03). The MUF group showed lower airway resistance
(9.3+/-0.4 vs. 12.1+/-0.8 cmH2O.L-1s-1; P=0.04). There were no deaths in
both groups. Conclusion: The MUF reduces post operatory bleeding and red
blood cells unit transfusion, but with no differences on clinical outcome
were observed. The routinely MUF employment was not associated with
hemodynamic instability.
<17>
[Use Link to view the full text]
Accession Number
20802322
Authors
Magder S. Potter B.J. Varennes B.D. Doucette S. Fergusson D. Canadian
Critical Care Trials Group
Institution
(Magder) McGill University, Montreal Quebec, Canada.
Title
Fluids after cardiac surgery: a pilot study of the use of colloids versus
crystalloids.
Source
Critical care medicine. 38 (11) (pp 2117-2124), 2010. Date of
Publication: Nov 2010.
Abstract
OBJECTIVES: To determine whether a starch solution for volume
resuscitation in a flow-based protocol improves circulatory status better
than a crystalloid solution, as defined by the need for catecholamines in
patients the morning after cardiac surgery, and whether this can be
performed without increased morbidity. DESIGN: Concealed, randomized,
double-blind, controlled trial. PARTICIPANTS: Two hundred sixty-two
patients who underwent cardiac surgery at a tertiary care hospital.
INTERVENTIONS: Based on predefined criteria indicating a need for fluids,
and a nurse-delivered algorithm that used central venous pressure and
cardiac index obtained from a pulmonary artery catheter, patients were
allocated to receive 250-mL boluses of 0.9% saline or a 250-molecular
weight 10% solution of pentastarch. RESULTS: Two hundred thirty-seven
patients received volume boluses: 119 hydroxyethyl starches and 118
saline. Between 8:00 am and 9:00 am the morning after surgery, 13 (10.9%)
of hydroxyethyl starch patients and 34 (28.8%) saline patients were using
catecholamines (p = .001). Hydroxyethyl starch patients had less pneumonia
and mediastinal infections (p = .03) and less cardiac pacing (p = .03).
There were two deaths in each group. There was no difference in the daily
creatinine, development of RIFLE risk criteria during hospital stay, or
new dialysis. The numbers and volumes of packed red blood cells were
similar in the two groups, but more hydroxyethyl starch patients received
plasma transfusions (p = .05). CONCLUSIONS: Use of a colloid solution for
volume resuscitation in a nurse-delivered flow-based algorithm, which
included a pulmonary artery catheter, significantly improved hemodynamic
status, an important factor for readiness for discharge from the intensive
care unit.
<18>
Accession Number
20862837
Authors
Sreekumary D.
Institution
(Sreekumary) Government College of Nursing, Alappuzha, Kerala.
Title
Effect of educational intervention on the specific post-operative
complications in patients of heart valve replacement.
Source
The Nursing journal of India. 101 (3) (pp 66-67), 2010. Date of
Publication: Mar 2010.
<19>
Accession Number
70291762
Authors
Saravanan P. Bridgewater B. Davidson N.C. Dobrzynski H. Trafford A.
Institution
(Saravanan, Bridgewater, Davidson) University Hospitals of South
Manchester, Wythenshawe, Manchester, United Kingdom
(Dobrzynski, Trafford) University of Manchester, Manchester, United
Kingdom
Source
Europace. Conference: Heart Rhythm Congress, HRC 2010 Birmingham United
Kingdom. Conference Start: 20101003 Conference End: 20101006. Conference
Publication: (var.pagings). 12 (pp ii3), 2010. Date of Publication:
October 2010.
Publisher
Oxford University Press
Abstract
Introduction: Omega-3 poly-unsaturated fatty acids (n-3PUFA) have been
reported to reduce risk of ventricular arrhythmias in patients with
myocardial infarction and in those with heart failure, but the mechanism
of action is unclear. The major cause of arrhythmia in these settings is
cellular calcium overload with increased risk of spontaneous calcium
release leading to after-depolarizations. There is limited data on the
effect of n-3PUFA on cardiac cellular calcium handling. We evaluated the
effect of n-3PUFA supplementation on expression levels of calcium handling
proteins in the right atrial appendage tissue of patients undergoing
coronary artery bypass surgery. Methods and results: Cellular sub-study of
a randomized, placebo controlled clinical trial. Patients (n = 53)
undergoing CABG received 2 g/day of n-3PUFA (Omacor) (active group, n =
26) or placebo (olive oil) (control group, n = 27) for at least 5 days
prior to surgery (median: 16 days, range: 12-21 days). n-3PUFA measured in
serum at study entry and at surgery and in right atrial appendage (RAA)
tissue at surgery. Quantitative PCR (qPCR), western blotting (WB) and
immuno-histochemistry (IH) was carried out in frozen RAA tissue to
evaluate the mRNA (message) level, protein level, and distribution
pattern, respectively, of various calcium-handling proteins. There were no
differences in baseline characteristics and drug therapy between the
groups. Omacor supplementation significantly raised the serum and atrial
appendage tissue levels of n-3PUFA. n-3PUFA supplementation resulted in an
up-regulation of ryanodine receptors (RYR) and a down-regulation of
phospholamban receptors (PLBs). There were no changes in the expression
levels of sodium-calcium exchanger protein (NCX) or sarco/endoplasmic
reticulum Ca<sup>2+</sup>-ATPase (SERCA). Conclusions: n-3PUFA
supplementation results in a down-regulation of phospholamban receptor
without a significant change in SERCA activity. This could mean a greater
net SERCA activity, as phospholamban inhibits SERCA, resulting in an
increase in the movement of calcium across the sarcoplasmic reticulum. In
addition, an increased expression of RYR receptor could also facilitate
the movement of calcium resulting in a net decrease in the intra-cellular
calcium, thus reducing the risk of spontaneous calcium release (Table 1).
Table Presented.
<20>
Accession Number
70292215
Authors
Haouala H. Salah O. Lahidheb D. Hajlaoui N. Saadi I. Haggui A. Filali T.H.
Ghommidh M. Barakett N. Fehri W.
Institution
(Haouala, Salah, Lahidheb, Hajlaoui, Saadi, Haggui, Filali, Ghommidh,
Barakett, Fehri) Military Hospital, Department of Cardiology, Tunis,
Tunisia
Source
European Journal of Heart Failure, Supplement. Conference: Heart Failure
2010 Congress Berlin Germany. Conference Start: 20100529 Conference End:
20100601. Conference Publication: (var.pagings). 9 (pp S100), 2010.
Date of Publication: May 2010.
Publisher
Oxford University Press
Abstract
Background: Beta-blockers had widely prouve their efficiency in patients
with chronic heart failure (CHF) and left ventricular dysfunction by
improving outcomes, symptoms and left ventricular ejection fraction
(LVEF). Their effect on diastolic dysfunction is not well established.
Design and method: A prospective non randomised controlled trial with a
4-months follow-up was conducted. A total of 50 patients with stable CHF
(LVEF = 35%) and increased left ventricular filling pressure were enrolled
to either beta-blockers and conventional treatement or only conventional
treatement (contre-indication or intolerance to beta-blockers). Mean
patient age was 61.5 years, 67% were male, 70% NYHA class 2 and 56% had
ischemic etiology. Increased left ventricular filling pressure was defined
as the ratio of E/Vp = 2 and / or E/Ea = 10 by echocardiography. Results:
In the group of patients treated with beta-blockers, left ventricular
filling pressure was improved significantly. The ratio E/Vp and E/Ea
decreased from 2.4 +/- 0.8 to 1.7 +/- 0.5 (p = 0.005) and from 9.8 +/- 4
to 6.7 +/- 2.5 (p = 0.005) respectively. When we compared the two groups
we found an improvement in the same parameters (table). However, there was
no improvement in LVEF. Conclusion: Beta-blockers improve left ventricular
filling pressure in patients with chronic heart failure and left
ventricular dysfunction. This effect occurs before the improvement of left
ventricular remodeling and ejection fraction. (Table presented).
<21>
Accession Number
70292367
Authors
Conceicao-Souza G.E. Oliveira E.S. Osawa E. Oliveira A.S. Vieira J.L. Issa
V.S. Ayub-Ferreira S.M. Bacal F. Chizzola P.R. Bocchi E.A.
Institution
(Conceicao-Souza, Osawa, Oliveira, Vieira, Issa, Ayub-Ferreira, Bacal,
Chizzola, Bocchi) Heart Institute -InCor, So Paulo, Brazil
(Oliveira) Clinicas' Hospital, Nephrology Division, Sao Paulo, Brazil
Source
European Journal of Heart Failure, Supplement. Conference: Heart Failure
2010 Congress Berlin Germany. Conference Start: 20100529 Conference End:
20100601. Conference Publication: (var.pagings). 9 (pp S144-S145),
2010. Date of Publication: May 2010.
Publisher
Oxford University Press
Abstract
Purpose: To evaluate the impact of peritoneal dialysis (PD) in end stage
systolic heart failure (SHF) who are not candidates for heart
transplantation (HT). Methods: Retrospective Cohort study. Inclusion
criteria: SHF defined by Framigham's criteria and left ventricular
ejection fraction (LVEF) < 35%; inpatient stage D SHF defined at heart
failure specialist discretion (under evaluation for HT), dependant on
intravenous inothropic therapy; presence of at least one absolute
contraindication for HT. Exclusion criteria: patients with severe
comorbidities which could affect survival in the next 6 months or with end
stage renal disease with clear indication of dialysis. Patients were
followed by clinical inpatient and outpatient visits and/or telephone
contact after one year of the index admission. Data were additionally
extracted from electronic chart review and telephonic interview with
patients and/or their families. Two goups were followed separately: (G1) -
with patients who underwent PD (under clinical discretion) and (G2) - with
patients who underwent standard therapy. P value was considered
statistically significant if < 0,05. Comparative statistical analysis used
Fischer's exact test for categoric variables; non-paired T-student test
for parametric continuous variables. Results: From january 2007 to june
2009, 12 patients were included - 3 patients in G1 and 9 patients in G2.
Medical treatment, clinical, laboratorial and echocardiographic variables
were similar in both groups. Among G1 and G2 patients, respectively, the
main contraindication for HT in both groups was fixed pulmonary
hypertension (67% vs 55% - p=ns). After 12 months follow-up, mortality
incidence was 0% among G1 patients and 67% among G2 patients. In average,
G1 and G2 patients survived for 540+/-176 days vs 255+/-264 days,
respectively. All survivors in G1 group improved their functional class
and there were no complications regarding PD catheter use. Among G2
patients most of the survivors maintained a poor functional status.
Conclusions: PD appear to be safe and seems to benefit end stage
refractory SHF patients who were ineligible for HT. A large randomized
controlled trial is necessary to fully investigate its utility.
<22>
Accession Number
70292561
Authors
Conceicao-Souza G.E. Pego-Fernandes P.M. Moreira L.F.P. Vieira M.L.C.
Grupi C.J. Bacal F. Giorgi M.C.P. Guimaraes G.V. Cruz F.D. Bocchi E.A.
Institution
(Conceicao-Souza, Pego-Fernandes, Moreira, Vieira, Grupi, Bacal, Giorgi,
Guimaraes, Cruz, Bocchi) Heart Institute -InCor, So Paulo, Brazil
Source
European Journal of Heart Failure, Supplement. Conference: Heart Failure
2010 Congress Berlin Germany. Conference Start: 20100529 Conference End:
20100601. Conference Publication: (var.pagings). 9 (pp S195), 2010.
Date of Publication: May 2010.
Publisher
Oxford University Press
Abstract
Purpose: To investigate feasibility and safety of endoscopic clipping
video-assisted thoracoscopy sympathetic blockade (ECVTSB) in symptomatic
systolic heart failure (SHF) patients either refractory or intolerant to
beta-blockers(BB). Secondly,we sought to evaluate its cardiovascular
effects per-operatively and after a six months follow-up. Methods:
Randomized controlled trial. Patients with (LVEF,40%),functional class
(FC)II or III, sinus rythm and HR > 64 bpm despite adequate BB use were
included. Chagas cardiomyopathy, pacemakers or pts with limited short term
survival were excluded. Patients were randomized to either treatment group
(G1) or control group(G2) in a 2:1 basis. All of them underwent clinical
and complementary before and six months after procedure or randomization.
The procedure consisted of lower left stellar ganglion plus left T3-T4
interspinal space clipping through videothoracoscopy. Study interruption
and surgery reversal (clip removal) criteria was death or severe worsening
of SHF symptoms in the per-operative period. Non-paired T-student test was
used for parametric continuous variables or proportions' comparison with p
significant if ,0,05. Results: From January 2007 to september 2009,
fifteen consecutive patients had been included. Baseline characteristics
were similar between G1(n=10) and G2(n=5). There was no indication for
interrupting the study. Three of fifteen patients hadn't completed six
month follow-up yet. There were 2 deaths(25%)among G1 patients and 2
deaths( 50%) among G2 patients. We compared data from G1 patients before
and six-months after the surgery(table) Conclusions: ECVTSB is feasible
and appears to be safe in severe SHF patients refractory to BB. A larger
sample is desirable to explore its utility in this setting.(Table
presented).
<23>
Accession Number
70296255
Authors
Labriola L.
Institution
(Labriola) Nephrology, Universite Catholique de Louvain, Brussels, Belgium
Source
Journal of Vascular Access. Conference: Angio Access for Hemodialysis
Tours France. Conference Start: 20100614 Conference End: 20100616.
Conference Publication: (var.pagings). 11 (pp S24), 2010. Date of
Publication: April-June 2010.
Publisher
Wichtig Editore s.r.l.
Abstract
The prevention of catheter-related bacteraemia (CRB) in hemodialysis (HD)
patients remains a challenge because of high morbidity and mortality
associated to CRB. A number of strategies has been tried for the
prevention of CRB. Interdialytic locking of the lumen catheter with one or
more highly concentrated antimicrobial agents has recently showed to
prevent biofilm formation and thus is used for the prophylaxis of CRB.
Several but not all randomized controlled trials (RCT) including tunnelled
cuffed as well as non tunnelled HD catheters have showed a significant
reduction in the incidence of CRB with antimicrobial lock solutions (ALS)
as compared with heparin alone. Two recent meta-analyses showed that the
use of ALS reduces by about two thirds the risk of CRB in HD patients.
However there was a lack of significant effect of ALS in some included RCT
with low CRB incidence in their control groups. Moreover, the incidence of
CRB obtained with ALS is similar to reported in observational trials with
low incidence of CRB, with presumably stricter hygienic measures. No
included study reported CRB due to bacteria resistant to the antibiotic
included in the ALS neither serious adverse event. However the follow up
was 1 year in most trials, which does not allow to exclude the onset of
adverse events or bacterial resistance with longer use of ALS. Therefore
the first logical step of a preventative strategy should be the
intensification of the education of all dialysis unit staff members on
adequate catheter care. The use of additional prevention methods like ALS
should be reserved to patients at high risk of infection (i.e. diabetics,
carriers of femoral catheters or cases of recurrent CRB) or subjects in
whom a CRB would lead to dramatic consequences (i.e. patients with
artificial heart valves, pacemakers, vascular grafts, . . .). Concerning
use of antibiotic locks in the treatment of CRB, RCT are scarce. However,
current guidelines recommend the combination of systemic antibiotic
therapy and an antibiotic lock when catheter salvage is attempted.
Nevertheless the success rate of catheter salvage in case of S. aureus is
low, even with antibiotic locks, and therefore should be reserved to
problematic cases.
<24>
Accession Number
2010589875
Authors
Seabra V.F. Alobaidi S. Balk E.M. Poon A.H. Jaber B.L.
Institution
(Seabra, Alobaidi, Poon, Jaber) Department of Medicine, Kidney and
Dialysis Research Laboratory, St. Elizabeth's Medical Center, Boston, MA,
United States
(Balk) Center for Clinical Evidence Synthesis, Tufts Clinical and
Translational Science Institute, Tufts University, Boston, MA, United
States
(Seabra, Balk, Jaber) Department of Medicine, Tufts University School of
Medicine, Boston, MA, United States
Title
Off-pump coronary artery bypass surgery and acute kidney injury: A
meta-analysis of randomized controlled trials.
Source
Clinical Journal of the American Society of Nephrology. 5 (10) (pp
1734-1744), 2010. Date of Publication: 01 Oct 2010.
Publisher
American Society of Nephrology (1725 I Street NW, Suite 510, Washington DC
20006, United States)
Abstract
Background and objectives: Off-pump coronary artery bypass grafting (CABG)
has been advocated to cause less inflammation, morbidity, and mortality
than the more traditional on-pump technique. This meta-analysis compares
these two surgical techniques with respect to causing acute kidney injury
(AKI). Design, setting, participants, & measurements: This study searched
for randomized controlled trials in MEDLINE and abstracts from the
proceedings of scientific meetings through February 2010. Included were
trials comparing off-pump to on-pump CABG that reported the incidence of
AKI, as defined by a mixture of criteria including biochemical
parameter/urine output/dialysis requirement. Mortality was evaluated among
the studies that reported kidney-related outcomes. For primary and
subgroup analyses, fixed-effect meta-analyses of odds ratios (OR) were
performed. Results: In 22 identified trials (4819 patients), the weighted
incidence of AKI in the on-pump CABG group was 4.0% (95% confidence
interval [CI] 1.8%, 8.5%), dialysis requirement 2.4% (95% CI 1.6%, 3.7%),
and mortality 2.6% (95% CI 1.6%, 4.0%). By meta-analysis, off-pump CABG
was associated with a 40% lower odds of postoperative AKI (OR 0.60; 95% CI
0.43, 0.84; P = 0.003) and a nonsignificant 33% lower odds for dialysis
requirement (OR 0.67; 95% CI 0.40, 1.12; P = 0.12). Within the selected
trials, off-pump CABG was not associated with a significant decrease in
mortality. Conclusions: Off-pump CABG may be associated with a lower
incidence of postoperative AKI but may not affect dialysis requirement, a
serious complication of cardiac surgery. However, the different
definitions of AKI used in individual trials and methodological concerns
preclude definitive conclusions. Copyright 2010 by the American Society
of Nephrology.
<25>
Accession Number
2010591682
Authors
Sun H.-Y. Alexander B.D. Lortholary O. Dromer F. Forrest G.N. Lyon G.M.
Somani J. Gupta K.L. Del Busto R. Pruett T.L. Sifri C.D. Limaye A.P. John
G.T. Klintmalm G.B. Pursell K. Stosor V. Morris M.I. Dowdy L.A. Munoz P.
Kalil A.C. Garcia-Diaz J. Orloff S.L. House A.A. Houston S.H. Wray D.
Huprikar S. Johnson L.B. Humar A. Razonable R.R. Fisher R.A. Husain S.
Wagener M.M. Singh N.
Institution
(Sun, Singh) Infectious Diseases Section, VA Pittsburgh Healthcare System,
University Drive C, Pittsburgh, PA 15240, United States
(Husain, Wagener, Singh) University of Pittsburgh, Pittsburgh, PA, United
States
(Alexander) Duke University Medical Center, Durham, NC, United States
(Forrest) University of Maryland School of Medicine, Baltimore, MD, United
States
(Lyon, Somani) Emory University, Atlanta, GA, United States
(Del Busto) Henry Ford Hospital, Detroit, MI, United States
(Johnson) St. John Medical Center, Detroit, MI, United States
(Pruett, Sifri) University of Virginia, Charlottesville, VA, United States
(Fisher) Virginia Commonwealth University, Richmond, VA, United States
(Limaye) University of Washington, Seattle, WA, United States
(Klintmalm) Baylor University Medical Center, Dallas, TX, United States
(Pursell) University of Chicago, Chicago, IL, United States
(Stosor) Northwestern University, Chicago, IL, United States
(Morris, Dowdy) University of Miami Miller School of Medicine, Miami, FL,
United States
(Houston) Tampa General Hospital, Tampa, FL, United States
(Kalil) University of Nebraska, Omaha, NE, United States
(Garcia-Diaz) Ochsner Clinic, New Orleans, LA, United States
(Forrest, Orloff) Oregon Health Sciences University, Portland, OR, United
States
(Wray) Medical University of South Carolina, Charleston, SC, United States
(Huprikar) Mount Sinai Medical Center, New York, NY, United States
(Razonable) Mayo Clinic, Rochester, MN, United States
(Sun) Department of Internal Medicine, National Taiwan University
Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
(Republic of China)
(Lortholary) Institut Pasteur, Faculte de Medecine Paris Descartes,
Hopital Necker-Enfants Malades, Paris, France
(Dromer) Institut Pasteur, Paris, France
(Gupta) Postgraduate Institute of Medical Education and Research,
Chandigarh, India
(John) Christian Medical College Hospital, Vellore, India
(Munoz) Hospital General Universitario Gregorio Maranon, CIBER de
Enfermedades Respiratorias (CIBERES), Madrid, Spain
(House) University of Western Ontario, London, ON, United States
(Humar, Husain) University Health Network, Toronto General Hospital,
Toronto, ON, Canada
(Humar) University of Alberta, Edmonton, AB, Canada
Title
Unrecognized pretransplant and donor-derived cryptococcal disease in organ
transplant recipients.
Source
Clinical Infectious Diseases. 51 (9) (pp 1062-1069), 2010. Date of
Publication: 01 Nov 2010.
Publisher
University of Chicago Press (1427 E. 60th Street, Chicago IL 60637-2954,
United States)
Abstract
Background. Cryptococcosis occurring <=30 days after transplantation is an
unusual event, and its characteristics are not known. Methods. Patients
included 175 solid-organ transplant (SOT) recipients with cryptococcosis
in a multicenter cohort. Very early-onset and late-onset cryptococcosis
were defined as disease occurring <=30 days or >30 days after
transplantation, respectively. Results. Very early-onset disease developed
in 9 (5%) of the 175 patients at a mean of 5.7 days after transplantation.
Overall, 55.6% (5 of 9) of the patients with very early-onset disease
versus 25.9% (43 of 166) of the patients with late-onset disease were
liver transplant recipients (P = .05). Very early cases were more likely
to present with disease at unusual locations, including transplanted
allograft and surgical fossa/site infections (55.6% vs 7.2%; P < .001).
Two very early cases with onset on day 1 after transplantation (in a liver
transplant recipient with Cryptococcus isolated from the lung and a heart
transplant recipient with fungemia) likely were the result of undetected
pretransplant disease. An additional 5 cases involving the allograft or
surgical sites were likely the result of donor-acquired infection.
Conclusions. A subset of SOT recipients with cryptococcosis present very
early after transplantation with disease that appears to occur
preferentially in liver transplant recipients and involves unusual sites,
such as the transplanted organ or the surgical site. These patients may
have unrecognized pretransplant or donor-derived cryptococcosis. 2010 by
the Infectious Diseases Society of America. All rights reserved.
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Accession Number
2010275249
Authors
Saravanan P. Bridgewater B. West A.L. O'Neill S.C. Calder P.C. Davidson
N.C.
Institution
(Saravanan, O'Neill) University of Manchester, Manchester, United Kingdom
(Saravanan, Bridgewater, Davidson) University Hospital of South
Manchester, NHS Foundation Trust, Manchester, United Kingdom
(West, Calder) University of Southampton, Southampton, United Kingdom
Title
Omega-3 fatty acid supplementation does not reduce risk of atrial
fibrillation after coronary artery bypass surgery: A randomized,
double-blind, placebo-controlled clinical trial.
Source
Circulation: Arrhythmia and Electrophysiology. 3 (1) (pp 46-53), 2010.
Date of Publication: February, 2010.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-Omega-3 polyunsaturated fatty acids (n-3 PUFA) have been
reported to reduce the risk of sudden cardiac death presumed to be due to
fatal ventricular arrhythmias, but their effect on atrial arrhythmias is
unclear. Methods and Results-Patients (n = 108) undergoing coronary artery
bypass graft surgery were randomly assigned to receive 2 g/d n-3 PUFA or
placebo (olive oil) for at least 5 days before surgery (median, 16 days;
range, 12 to 21 days). Phospholipid n-3 PUFA were measured in serum at
study entry and at surgery and in right atrial appendage tissue at
surgery. Echocardiography was used to assess left ventricular function and
left atrial dimensions. Postoperative continuous ECG monitoring (Lifecard
CF) for 5 days or until discharge, if earlier, was performed with a daily
12-lead ECG and clinical review if patients remained in the hospital
beyond 5 days. Lifecard recordings were analyzed for episodes of atrial
fibrillation (AF) >=30 seconds (primary outcome). Clinical AF, AF burden
(% time in AF), hospital stay, and intensive care/high dependency care
stay were measured as secondary outcomes. One hundred three patients
completed the study (51 in the placebo group and 52 in the n-3 PUFA
group). There were no clinically relevant differences in baseline
characteristics between groups. n-3 PUFA levels were higher in serum and
right atrial tissue in the active treatment group. There was no
significant difference between groups in the primary outcome of AF (95%
confidence interval [CI],-6% to 30%, P=0.28) in any of the secondary
outcomes or in AF-free survival. Conclusions-Omega-3 PUFA do not reduce
the risk of AF after coronary artery bypass graft surgery. Clinical Trial
Registration-www.ukcrn.org.uk. Identifier: 4437. 2010 American Heart
Association, Inc.
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