Results Generated From:
Embase <1980 to 2011 Week 25>
Embase (updates since 2011-06-16)
<1>
Accession Number
2011232667
Authors
Yank V. Tuohy V. Logan A.C. Bravata D.M. Staudenmayer K. Eisenhut R.
Sundaram V. McMohan D. Olkin I. McDonald K.M. Owens D.K. Stafford R.S.
Institution
(Yank, McDonald, Stafford) Stanford Prevention Research Center, Stanford
University, Stanford, CA 94304-5411, United States
(Tuohy) 433 South 45th Street, Philadelphia, PA 19104, United States
(Logan) Division of Blood and Marrow Transplantation, Stanford University
School of Medicine, 269 West Campus Drive, Stanford, CA 94305, United
States
(Bravata) Castlight Health, 685 Market Street, San Francisco, CA 94105,
United States
(Staudenmayer) 300 Pasteur Drive, H3980, Stanford, CA 94305, United States
(Eisenhut) 1027 Amarillo Avenue, Palo Alto, CA 94303, United States
(Sundaram, Owens) Center for Health Policy, Center for Primary Care and
Outcomes Research, Stanford University, 117 Encina Commons, Stanford,
United States
(McMohan) Irishtown Road, Summerfield, Ireland
(Olkin) 950 Lathrop Place, Stanford, CA 94305, United States
Title
Systematic review: Benefits and harms of in-hospital use of recombinant
factor viia for off-label indications.
Source
Annals of Internal Medicine. 154 (8) (pp 529-540), 2011. Date of
Publication: April 2011.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Recombinant factor VIIa (rFVIIa), a hemostatic agent approved
for hemophilia, is increasingly used for off-label indications.Purpose: To
evaluate the benefits and harms of rFVIIa use for 5 off-label, in-hospital
indications: intracranial hemorrhage, cardiac surgery, trauma, liver
transplantation, and prostatectomy.Data Sources: Ten databases (including
PubMed, EMBASE, and the Cochrane Library) queried from inception through
December 2010. Articles published in English were analyzed.Study
Selection: Two reviewers independently screened titles and abstracts to
identify clinical use of rFVIIa for the selected indications and
identified all randomized, controlled trials (RCTs) and observational
studies for full-text review.Data Extraction: Two reviewers independently
assessed study characteristics and rated study quality and indication-wide
strength of evidence.Data Synthesis: 16 RCTs, 26 comparative observational
studies, and 22 noncomparative observational studies met inclusion
criteria. Identified comparators were limited to placebo (RCTs) or usual
care (observational studies). For intracranial hemorrhage, mortality
wasnot improved with rFVIIa use across a range of doses. Arterial
thromboembolism was increased with medium-dose rFVIIa use (risk difference
[RD], 0.03 [95% CI, 0.01 to 0.06]) and high-dose rFVIIa use (RD, 0.06 [CI,
0.01 to 0.11]). For adult cardiac surgery, there was no mortality
difference, but there was an increased risk for thromboembolism (RD, 0.05
[CI, 0.01 to 0.10]) with rFVIIa. For body trauma, there were no
differences in mortality or thromboembolism, but there was a reduced risk
for the acute respiratory distress syndrome (RD, -0.05 [CI, -0.02 to
-0.08]). Mortality was higher in observational studies than in
RCTs.Limitations: The amount and strength of evidence were low for most
outcomes and indications. Publication bias could not be
excluded.Conclusion: Limited available evidence for 5 off-label
indications suggests no mortality reduction with rFVIIa use. For some
indications, it increases thromboembolism. Primary Funding Source: Agency
for Healthcare Research and Quality. 2011 American College of Physicians.
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[Use Link to view the full text]
Accession Number
2011326770
Authors
Jessup J.A. Zhang L. Chen A.F. Presley T.D. Kim-Shapiro D.B. Chappell M.C.
Wang H. Groban L.
Institution
(Jessup, Groban) Department of Physiology and Pharmacology, Wake Forest
University School of Medicine, Winston-Salem, NC, United States
(Zhang, Chen) Department of Surgery, University of Pittsburgh School of
Medicine, United States
(Chen) Vascular Surgery Research, Veterans Affairs Pittsburgh Healthcare
System, Pittsburgh, PA, United States
(Presley, Kim-Shapiro) Chemistry Department, Winston-Salem State
University, United States
(Kim-Shapiro) Translational Science Center, Wake Forest University, United
States
(Chappell) Hypertension and Vascular Research Center, Wake Forest
University School of Medicine, Winston-Salem, NC, United States
(Wang, Groban) Department of Anesthesiology, Wake Forest University School
of Medicine, Winston-Salem, NC, United States
(Groban) Department of Anesthesiology, Wake Forest University School of
Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, United
States
Title
Neuronal nitric oxide synthase inhibition improves diastolic function and
reduces oxidative stress in ovariectomized mRen2.Lewis rats.
Source
Menopause. 18 (6) (pp 698-708), 2011. Date of Publication: June 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
OBJECTIVE: The loss of estrogen in mRen2.Lewis rats leads to an
exacerbation of diastolic dysfunction. Because specific neuronal nitric
oxide synthase (nNOS) inhibition reverses renal damage in the same model,
we assessed the effects of inhibiting neuronal nitric oxide on diastolic
function, left ventricular remodeling, and the components of the cardiac
nitric oxide system in ovariectomized (OVX) and sham-operated mRen2.Lewis
rats treated with N-(1-imino-3-butenyl)-L-ornithine (L-VNIO; 0.5 mg/kg per
day for 28 d) or vehicle (saline). METHODS: Female mRen2.Lewis rats
underwent either bilateral oophorectomy (OVX; n = 15) or sham operation
(or surgical procedure) (sham; n = 19) at 4 weeks of age. Beginning at 11
weeks of age, the rats were randomized to receive either L-VNIO or
vehicle. RESULTS: The surgical loss of ovarian hormones, particularly
estrogen, led to exacerbated hypertension, impaired myocardial relaxation,
diminished diastolic compliance, increased perivascular fibrosis, and
increased relative wall thickness. The cardiac
tetrahydrobiopterin-to-dihydrobiopterin levels were lower among OVX rats
compared with sham-operated rats, and this altered cardiac biopterin
profile was associated with enhanced myocardial superoxide production and
decreased nitric oxide release. L-VNIO decreased myocardial reactive
oxygen species production, increased nitrite concentrations, attenuated
cardiac remodeling, and improved diastolic function. CONCLUSIONS: Impaired
relaxation, diastolic stiffness, and cardiac remodeling were found among
OVX mRen2.Lewis rats. A possible mechanism for this unfavorable cardiac
phenotype may have resulted from a deficiency in available
tetrahydrobiopterin and subsequent increase in nNOS-derived superoxide and
reduction in nitric oxide synthase metabolites within the heart. Selective
nNOS inhibition with L-VNIO attenuated cardiac superoxide production and
limited remodeling, leading to improved diastolic function in OVX
mRen2.Lewis rats. 2011 by The North American Menopause Society.
<3>
Accession Number
2011321423
Authors
Abdulla J. Asferg C. Kofoed K.F.
Institution
(Abdulla, Asferg) Division of Cardiology, Department of Medicine, Glostrup
University Hospital, Copenhagen, Denmark
(Kofoed) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Abdulla) Lyovej 18, 3.TV, Frederiksberg DK-2000, Denmark
Title
Prognostic value of absence or presence of coronary artery disease
determined by 64-slice computed tomography coronary angiography A
systematic review and meta-analysis.
Source
International Journal of Cardiovascular Imaging. 27 (3) (pp 413-420),
2011. Date of Publication: March 2011.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
To determine via a meta-analysis the prognostic value of 64-slice computed
tomography angiography (CTA) by quantifying risk of major adverse cardiac
events (MACE) in different patient groups classified according to CT
angiographic findings. A systematic literature search and meta-analyses
was conducted on 10 studies examining stable, symptomatic and intermediate
risk patients by 64-slice CTA. Patients were followed up for a mean of 21
month. Patient groups with CT-angiographic non-obstructive (stenosis <50%
of luminal narrowing) or obstructive (stenosis >=50% of luminal narrowing)
CAD were compared to those having normal angiography without CAD. MACE
(cardiac death, non-fatal myocardial infarction and revascularization)
numbers were used to calculate odds ratios (OR) with 95% confidence
interval (CI) in each group. Ten studies including 5,675 patients were
eligible for meta-analysis. The cumulative MACE rate over 21 months were
0.5% in patients with normal CTA, 3.5% in non-obstructive CAD and 16% in
obstructive CAD. Compared to normal CTA, non-obstructive CAD was
associated with significant increased risk of MACE with OR = 6.68
(3.01-14.82 CI 95%), P = 0.0001. Obstructive CAD was associated with
further significant increased risk of MACE with OR = 41.19 (22.56-75.18,
CI 95%), P = 0.0001. The studies were homogenous, P-value >0.05 for
heterogeneity. 64-slice CTA is able to differentiate low-risk from
high-risk patients with suspected or known CAD. Absence of CAD predicts
excellent prognosis, while obstructive CAD is associated with markedly
increased risk of MACE. 2010 Springer Science+Business Media, B.V.
<4>
Accession Number
2011319426
Authors
Dasari T.W. Hennebry T.A. Hanna E.B. Saucedo J.F.
Institution
(Dasari, Hennebry, Hanna, Saucedo) Department of Internal Medicine,
Cardiovascular Section, University of Oklahoma Health Sciences Center,
Oklahoma City, OK, United States
(Dasari) Department of Internal Medicine, Section of Cardiology,
University of Oklahoma Health Sciences Center, 920 SL Young Blvd., WP
3010, Oklahoma City, OK 73190, United States
Title
Drug eluting versus bare metal stents in cardiac allograft vasculopathy.
Source
Catheterization and Cardiovascular Interventions. 77 (7) (pp 962-969),
2011. Date of Publication: 01 Jun 2011.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background: Cardiac allograft vasculopathy (CAV) is a distinct
pathological condition characterized by diffuse and progressive
arteriopathy and it is an important determinant of long-term graft
survival. Definitive CAV treatment is retransplantation but palliation
with stenting might temporarily alleviate it. The benefit of drug eluting
stents (DES) over bare metal stents (BMS) in the treatment of such lesions
is debatable. We therefore sought to do a literature search to review the
available evidence comparing DES to BMS. Methods: We conducted Pub Med,
EMBASE, Cochrane database review, Web of Science search of studies
comparing DES with BMS in CAV. Available studies were retrospective in
nature with either direct comparison groups (n = 5) or historical controls
(n = 1). The main outcomes analyzed were in stent restenosis (ISR) during
follow-up and clinical outcomes. Results: A total of 312 patients from six
studies were included in the review (1995-2007). Most commonly used DES
were sirolimus eluting stent. DES appeared to reduce the long-term risk of
ISR compared with BMS. Three of the five studies showed a statistically
significant reduction in ISR at 12 months while the one study assessing
ISR at 6 months showed no significant difference. Clinical endpoints such
as death and major adverse cardiac events were not statistically
different. Conclusion: DES appear to reduce the incidence of ISR in CAV as
compared with BMS. Prospective randomized clinical trials are needed to
determine the clinical benefit of DES beyond a reduction in ISR. Copyright
2011 Wiley-Liss, Inc.
<5>
Accession Number
2011319365
Authors
Palmerini T. Genereux P. Caixeta A. Cristea E. Lansky A. Mehran R. Dangas
G. Lazar D. Sanchez R. Fahy M. Xu K. Stone G.W.
Institution
(Palmerini) Istituto di Cardiologia, Policlinico S. Orsola, Bologna, Italy
(Palmerini, Genereux, Caixeta, Cristea, Lazar, Sanchez, Fahy, Xu, Stone)
Columbia University Medical Center, New York-Presbyterian Hospital,
Cardiovascular Research Foundation, 111 East 59th Street, New York, NY
10022, United States
(Lansky) Yale University, School of Medicine, New Haven, CT, United States
(Mehran, Dangas) Mount Sinai Medical Center, New York, NY, United States
Title
Prognostic value of the SYNTAX score in patients with acute coronary
syndromes undergoing percutaneous coronary intervention: Analysis from the
ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY)
trial.
Source
Journal of the American College of Cardiology. 57 (24) (pp 2389-2397),
2011. Date of Publication: 14 Jun 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: We sought to investigate the predictive value of the SYNTAX
(Synergy Between PCI With Taxus and Cardiac Surgery) score (SS) for risk
assessment of 1-year clinical outcomes in patients with nonST-segment
elevation acute coronary syndromes undergoing percutaneous coronary
intervention (PCI). Background: In the SYNTAX trial, the SS was effective
in risk-stratifying patients with left main and triple-vessel coronary
disease, the majority of whom had stable ischemic heart disease. Methods:
The SS was determined in 2,627 patients with nonST-segment elevation acute
coronary syndromes undergoing PCI in the angiographic substudy of the
ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY)
trial. Patients were stratified according to tertiles of the SS: <7 (n =
854), <7 and <13 (n = 825), and <13 (n = 948). Results: Among patients in
the first, second, and third SS tertiles, the 1-year rates of mortality
were 1.5%, 1.6%, and 4.0%, respectively (p = 0.0005); the cardiac
mortality rates were 0.2%, 0.9%, and 2.7%, respectively (p < 0.0001); the
myocardial infarction (MI) rates were 6.3%, 8.3%, and 12.9%, respectively
(p < 0.0001); and the target vessel revascularization (TVR) rates were
7.4%, 7.0%, and 9.8%, respectively (p = 0.02). By multivariable analysis,
the SS was an independent predictor of 1-year death (hazard ratio [HR]:
1.04, 95% confidence interval [CI]: 1.01 to 1.07; p = 0.005), cardiac
death (HR: 1.06, 95% CI: 1.03 to 1.09; p = 0.0002), MI (HR: 1.03, 95% CI:
1.02 to 1.05; p < 0.0001), and TVR (HR: 1.03, 95% CI: 1.02 to 1.05; p <
0.0001). The SS affected death, cardiac death, and MI both within the
first 30 days after PCI and between 30 days and 1 year, whereas it
affected TVR primarily within the first 30 days. The predictive value of
an increased SS was consistent among multiple pre-specified subgroups.
Conclusions: In patients with nonST-segment elevation acute coronary
syndromes undergoing PCI, the SS is an independent predictor of the 1-year
rates of death, cardiac death, MI, and TVR. (Comparison of Angiomax Versus
Heparin in Acute Coronary Syndromes [ACS]; NCT00093158) 2011 American
College of Cardiology Foundation.
<6>
Accession Number
2011319364
Authors
Hu S. Liu S. Zheng Z. Yuan X. Li L. Lu M. Shen R. Duan F. Zhang X. Li J.
Liu X. Song Y. Wang W. Zhao S. He Z. Zhang H. Yang K. Feng W. Wang X.
Institution
(Hu, Liu, Zheng, Yuan, Zhang, Li, Liu, Song, Wang, Zhang, Yang, Feng,
Wang) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese
Academy of Medical Sciences, Beijing, China
(Hu, Liu, Zheng, Yuan) Center for Cardiovascular Regenerative Medicine,
Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
(Hu, Liu, Zheng, Yuan) National Key Laboratory of Cardiovascular
Translational Medicine, Fuwai Hospital, Chinese Academy of Medical
Sciences, Beijing, China
(Li) Department of Anesthesia, Fuwai Hospital, Chinese Academy of Medical
Sciences, Beijing, China
(Lu, Shen, Zhao, He) Department of Cardiac Nuclear Imaging, Fuwai
Hospital, Chinese Academy of Medical Sciences, Beijing, China
(Duan) Department of Echocardiography, Fuwai Hospital, Chinese Academy of
Medical Sciences, Beijing, China
(Hu) Department of Surgery, Fuwai Hospital, Chinese Academy of Medical
Science, Beilishi Road, Xi Chen District, Beijing 100037, China
Title
Isolated coronary artery bypass graft combined with bone marrow
mononuclear cells delivered through a graft vessel for patients with
previous myocardial infarction and chronic heart failure: A single-center,
randomized, double-blind, placebo-controlled clinical trial.
Source
Journal of the American College of Cardiology. 57 (24) (pp 2409-2415),
2011. Date of Publication: 14 Jun 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study aimed at examining the efficacy of bone marrow
mononuclear cell (BMMNC) delivery through graft vessel for patients with a
previous myocardial infarction (MI) and chronic heart failure during
coronary artery bypass graft (CABG). Background: Little evidence exists
supporting the practice of BMMNC delivery through graft vessel for
patients with a previous MI and chronic heart failure during CABG.
Methods: From November 2006 to June 2009, a randomized, placebo-controlled
trial was conducted to test the efficacy and safety of CABG for
multivessel coronary artery disease combined with autologous BMMNCs in
patients with congestive heart failure due to severe ischemic
cardiomyopathy. Sixty-five patients were recruited, and 60 patients
remained in the final trial and were randomized to a CABG + BMMNC group (n
= 31) and a placebo-control group (i.e., CABG-only group, n = 29). All
patients discharged received a 6-month follow-up. Changes in left
ventricular ejection fraction from baseline to 6-month follow-up, as
examined by magnetic resonance imaging, were of primary interest. Results:
The overall baseline age was 59.5 +/- 9.2 years, and 6.7% were women.
After a 6-month follow-up, compared with the placebo-control group, the
CABG + BMMNC group had significant changes in left ventricular ejection
fraction (p = 0.029), left ventricular end-systolic volume index (p =
0.017), and wall motion index score (p = 0.011). Also, the changes in the
distance on the 6-min walking test as well as B-type natriuretic peptide
were significantly greater in the CABG + BMMNC group than in the control
group. Conclusions: In summary, patients with a previous MI and chronic
heart failure could potentially benefit from isolated CABG (i.e., those
who received CABG only) combined with BMMNCs delivered through a graft
vessel. (Stem Cell Therapy to Improve Myocardial Function in Patients
Undergoing Coronary Artery Bypass Grafting [CABG]; NCT00395811) 2011
American College of Cardiology Foundation.
<7>
Accession Number
2011319363
Authors
Bamberg F. Sommer W.H. Hoffmann V. Achenbach S. Nikolaou K. Conen D.
Reiser M.F. Hoffmann U. Becker C.R.
Institution
(Bamberg, Hoffmann) Department of Clinical Radiology, Ludwig-Maximilians
University, Klinikum Grosshadern, Munich, Germany
(Bamberg, Sommer, Nikolaou, Reiser, Becker) Department of Radiology,
Harvard Medical School, Massachusetts General Hospital, Boston, MA, United
States
(Hoffmann) Institute of Biomedical Informatics, Biometry and Epidemiology,
Ludwig-Maximilians University, Munich, Germany
(Achenbach) Department of Internal Medicine II, University of Erlangen,
Erlangen, Germany
(Conen) Department of Medicine, University Hospital Basel, Basel,
Switzerland
(Bamberg) Department of Clinical Radiology, University of Munich,
Grosshadern Campus, Marchioninistrasse 15, Munich 81377, Germany
Title
Meta-analysis and systematic review of the long-term predictive value of
assessment of coronary atherosclerosis by contrast-enhanced coronary
computed tomography angiography.
Source
Journal of the American College of Cardiology. 57 (24) (pp 2426-2436),
2011. Date of Publication: 14 Jun 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: We conducted a systematic review and meta-analysis to
determine the predictive value of findings of coronary computed tomography
angiography for incident cardiovascular events. Background: Initial
studies indicate a prognostic value of the technique; however, the level
of evidence as well as exact independent risk estimates remain unclear.
Methods: We searched PubMed, EMBASE, and the Cochrane Library through
January 2010 for studies that followed up <100 subjects for <1 year and
reported at <1 hazard ratio (HR) of interest. Risk estimates for the
presence of significant coronary stenosis (primary endpoint; <50% diameter
stenosis), left main coronary artery stenosis, each coronary stenosis,
3-vessel disease, any plaque, per coronary segment containing plaque, and
noncalcified plaque were derived in random effect regression analysis, and
causes of heterogeneity were determined in meta-regression analysis.
Results: We identified 11 eligible articles including 7,335 participants
(age 59.1 +/- 2.6 years, 62.8% male) with suspected coronary artery
disease. The presence of <1 significant coronary stenosis (9 studies,
3,670 participants, and 252 outcome events [6.8%] with 62%
revascularizations) was associated with an annualized event rate of 11.9%
(6.4% in studies excluding revascularization). The corresponding HR was
10.74 (98% confidence interval [CI]: 6.37 to 18.11) and 6.15 (95% CI: 3.22
to 11.74) in studies excluding revascularization. Adjustment for coronary
calcification did not attenuate the prognostic significance (p = 0.79).
The estimated HRs for left main stenosis, presence of plaque, and each
coronary segment containing plaque were 6.64 (95% CI: 2.6 to 17.3), 4.51
(95% CI: 2.2 to 9.3), and 1.23 (95% CI: 1.17 to 1.29), respectively.
Conclusions: Presence and extent of coronary artery disease on coronary
computed tomography angiography are strong, independent predictors of
cardiovascular events despite heterogeneity in endpoints, categorization
of computed tomography findings, and study population. 2011 American
College of Cardiology Foundation.
<8>
Accession Number
2011316581
Authors
Wu Y. Shi Y. Wu H. Bian C. Tang Q. Xu G. Yang J.
Institution
(Wu, Bian, Xu) Department of Cardiology, The Second Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
(Wu, Shi, Tang, Yang) State Key Laboratory for Diagnosis and Treatment of
Infectious Diseases, The First Affiliated Hospital, Zhejiang University
School of Medicine, Hangzhou, Zhejiang, China
(Wu) Department of Ophthalmology, The Second Affiliated Hospital, Zhejiang
University School of Medicine, Hangzhou, Zhejiang, China
(Yang) Department of Toxicology, Hangzhou Normal University School of
Public Health, Hangzhou, Zhejiang, China
Title
Efficacy and safety of abciximab in diabetic patients who underwent
percutaneous coronary intervention with thienopyridines loading: A
meta-analysis.
Source
PLoS ONE. 6 (6) , 2011. Article Number: e20759. Date of Publication:
2011.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background: It has been controversial whether abciximab offered additional
benefits for diabetic patients who underwent percutaneous coronary
intervention (PCI) with thienopyridines loading. Methods: MEDLINE, EMBASE,
the Cochrane library clinical trials registry, ISI Science Citation Index,
ISI Web of Knowledge and China National Knowledge Infrastructure (CNKI)
were searched, supplemented with manual-screening for relevant
publications. Quantitative meta-analyses were performed to assess
differences between abciximab groups and controls with respect to post-PCI
risk of major cardiac events (MACEs), angiographic restenosis and bleeding
complications. Results: 9 trials were identified, involving 2,607 diabetic
patients receiving PCI for coronary artery diseases. Among those patients
who underwent elective PCI or primary PCI, pooling results showed that
abciximab did not significantly reduce risks of MACEs (for elective-PCI
patients: RR<sub>1-month</sub>: 0.93, 95% CI: 0.60-1.44;
RR<sub>1-year</sub>: 0.95, 95% CI: 0.81-1.11; for primary-PCI patients:
RR<sub>1-month</sub>: 1.05, 95% CI: 0.70-1.57; RR<sub>1-year</sub>: 0.98,
95% CI: 0.80-1.21), nor all-cause mortality, re-infarction and
angiographic restenosis in either group. The only beneficial effect by
abciximab appeared to be a decrease 1-year TLR (target lesion
revascularization) risk in elective-PCI patients (RR1-year: 0.83, 95% CI:
0.70-0.99). Moreover, occurrence of minor bleeding complications increased
in elective-PCI patients treated with abciximab (RR: 2.94, 95% CI:
1.68-5.13, P<0.001), whereas major bleedings rate was similar (RR: 0.83,
95% CI: 0.27-2.57). Conclusions: Concomitant dosing of abciximab and
thienopyridines provides no additional benefit among diabetic patients who
underwent PCI; this conclusion, though, needs further confirmation in
larger studies. 2011 Wu et al.
<9>
Accession Number
2011307248
Authors
Anastasiadis K. Argiriadou H. Kosmidis M.H. Megari K. Antonitsis P.
Thomaidou E. Aretouli E. Papakonstantinou C.
Institution
(Anastasiadis, Argiriadou, Antonitsis, Thomaidou, Papakonstantinou)
Department of Cardiothoracic Surgery, Aristotle University of
Thessaloniki, AHEPA University Hospital, Sakellaridi 25, Thessaloniki 542
48, Greece
(Kosmidis, Megari, Aretouli) Laboratory of Cognitive Neuroscience, School
of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
Title
Neurocognitive outcome after coronary artery bypass surgery using minimal
versus conventional extracorporeal circulation: A randomised controlled
pilot study.
Source
Heart. 97 (13) (pp 1082-1088), 2011. Date of Publication: July 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: Neurocognitive impairment can be a debilitating complication
after cardiac surgery. The aim of this study was to assess the effect of
minimal extracorporeal circulation (MECC) versus conventional
extracorporeal circulation (CECC) on neurocognitive function after
elective coronary artery bypass grafting (CABG) and whether this can be
attributed to improved cerebral perfusion intraoperatively. Methods and
results: 64 patients scheduled for elective CABG surgery were
prospectively randomly assigned to surgical revascularisation with MECC
versus CECC. All patients were continuously monitored for changes in
cerebral oxygenation with near-infrared spectroscopy during the procedure.
Neurocognitive assessment was performed before surgery, on the day of
discharge and at 3 months postoperatively using a battery of standardised
neurocognitive tests. Both groups were comparable in terms of demographic
and clinical data. MECC was associated with improved cerebral perfusion
during cardiopulmonary bypass (CPB). Eleven patients operated on with MECC
and 17 with CECC experienced at least one episode of cerebral desaturation
(38% vs 55%, p=0.04) with similar duration (10 vs 12.3 min, p=0.1). At
discharge patients operated on with MECC showed a significantly improved
performance on complex scanning, visual tracking, focused attention and
long-term memory. At 3 months significantly improved performance was also
evident on visuospatial perception, executive function, verbal working
memory and short-term memory. Patients operated on with MECC experienced a
significantly lower risk of early cognitive decline both at discharge (41%
vs 65%, p=0.03) and at 3-month evaluation (21% vs 61%, p<0.01).
Conclusions: Use of MECC attenuates early postoperative neurocognitive
impairment after coronary surgery compared with conventional CPB. This
finding may have important implications on the surgical management
strategy for coronary artery disease. Clinical trial registration number:
The study is registered at ClinicalTrials.gov, number NCT01213511.
<10>
Accession Number
2011270460
Authors
Luo W. Zhu M. Huang R. Zhang Y.
Institution
(Luo, Zhu, Huang, Zhang) Department of Cardiothoracic Surgery, Xiang Ya
Hospital, Central South University, Changsha, Hunan 410008, China
(Luo) Department of Cardiothoracic Surgery, Xiang Ya Hospital, 87 Xiangya
Road, Changsha, Hunan 410008, China
Title
A comparison of cardiac post-conditioning and remote pre-conditioning in
paediatric cardiac surgery.
Source
Cardiology in the Young. 21 (3) (pp 266-270), 2011. Date of Publication:
June 2011.
Publisher
Cambridge University Press (Shaftesbury Road, Cambridge CB2 2RU, United
Kingdom)
Abstract
Background Remote ischaemic pre-conditioning and cardiac ischaemic
post-conditioning provide myocardial protection in cardiac surgery.
However, these two endogenous strategies have not been directly compared
in a clinical setting. The purpose of this study was to compare the
efficacy of remote ischaemic pre-conditioning and post-conditioning in
providing myocardial protection to children undergoing cardiopulmonary
bypass for surgical repair of ventricular septal defect.Methods We
randomly assigned 60 paediatric patients scheduled for surgical correction
of congenital ventricular septal defect to the post-conditioning group (n
= 20), remote pre-conditioning group (n = 20), or control group (n = 20).
Post-conditioning consisted of 30 seconds of ischaemia and 30 seconds of
reperfusion achieved by clamping and unclamping the aorta, repeated three
times over 3 minutes immediately after cardioplegic arrest. Remote
ischaemic pre-conditioning consisted of 5 minutes of lower limb ischaemia
followed by 5 minutes of reperfusion using a blood-pressure cuff inflated
to a pressure of 200 millimetres of mercury, also repeated three times
over 30 minutes. We assayed creatine kinase-MB, troponin I.Results Mean
age, cardiopulmonary bypass times, and aortic cross-clamp times were
matched across groups. Both post-conditioning and remote ischaemic
pre-conditioning reduced the peak release of creatine kinase-MB (86.1 plus
or minus 24.1 units per litre and 92.8 plus or minus 20.6 units per litre,
respectively, versus 111.0 plus or minus 44.6 units per litre in the
control, p less than 0.05) and troponin I (0.28 plus or minus 0.10
nanogram per millilitre and 0.26 plus or minus 0.09 nanogram per
millilitre, respectively, versus 0.49 plus or minus 0.19 nanogram per
millilitre in the control group, p less than 0.05).Conclusions Our study
demonstrates that ischaemic post-conditioning and remote ischaemic
pre-conditioning provide comparable myocardial benefit in children
undergoing cold blood cardioplegic arrest. Copyright Cambridge University
Press 2011.
<11>
Accession Number
2011307843
Authors
Siepe M. Pfeiffer T. Gieringer A. Zemann S. Benk C. Schlensak C.
Beyersdorf F.
Institution
(Siepe, Pfeiffer, Gieringer, Zemann, Benk, Schlensak, Beyersdorf)
Department of Cardiovascular Surgery, University Medical Center Freiburg,
Freiburg, Germany
Title
Increased systemic perfusion pressure during cardiopulmonary bypass is
associated with less early postoperative cognitive dysfunction and
delirium.
Source
European Journal of Cardio-thoracic Surgery. 40 (1) (pp 200-207), 2011.
Date of Publication: July 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: Patients undergoing cardiac surgery procedures are thought to
be at risk of early neuropsychological deficits and delirium. Regional
cerebral hypoperfusion may play a role in the etiology of this
complication. We hypothesized that low systemic perfusion pressure during
cardiopulmonary bypass (CPB) would correlate with early postoperative
cognitive dysfunction in on-pump patients. Methods: In this prospective,
randomized, single-center trial, we assigned 92 patients scheduled for
elective or urgent coronary artery bypass grafting (CABG) to high-pressure
(HP: 80-90mmHg, n=44) or low-pressure (LP: 60-70mmHg, n=48) perfusion
groups during CPB. Patients with prior cerebrovascular or psychiatric
disorders were excluded. Primary end point was the cognitive outcome as
measured by Mini-Mental-Status examination before and 48h after surgery.
Results: Patients' pre- and intra-operative characteristics did not differ
between groups. Significantly more patients in the LP group developed
postoperative delirium than in the HP group (LP 13%. vs HP 0%, p=0.017).
The postoperative drop in Mini-Mental-Status scores was significantly
greater in the LP group (LP 3.9+/-6.5 vs HP 1.1+/-1.9; p=0.012). No group
differences were detected in cerebral oxygenation measured by
near-infrared spectroscopy during CPB. The LP group's postoperative
arterial lactate concentration in the intensive care unit was
significantly higher as compared with the HP group (LP
2.0+/-1.1mmoll<sup>-1</sup> vs HP 1.4+/-0.6mmoll<sup>-1</sup>; p<0.001).
We observed no differences between the groups in any other postoperative
clinical, functional, or laboratory parameters. Conclusion: Maintaining
perfusion pressure at physiologic levels during normothermic CPB
(80-90mmHg) is associated with less early postoperative cognitive
dysfunction and delirium. This perfusion strategy neither increases
morbidity, nor does it impair organ function. 2010 European Association
for Cardio-Thoracic Surgery.
<12>
Accession Number
2011307844
Authors
Athanasiou T. Saso S. Rao C. Vecht J. Grapsa J. Dunning J. Lemma M. Casula
R.
Institution
(Athanasiou, Saso, Rao, Vecht, Grapsa) Department of Biosurgery and
Surgical Technology, Imperial College London, Mary's Hospital, 10th Floor
QEQM Building, Praed Street, London W2 1NY, United Kingdom
(Athanasiou, Casula) Department of Cardiothoracic Surgery, National Heart
and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane
Road, London W12 0HS, United Kingdom
(Dunning) Department of Cardiothoracic Surgery, James Cook University
Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom
(Lemma) Minimally Invasive Cardiac Surgery Unit, Luigi Sacco University
Hospital, Via G.B. Grassi 74, 20157 Milan, Italy
Title
Radial artery versus saphenous vein conduits for coronary artery bypass
surgery: Forty years of competition - which conduit offers better patency?
A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 40 (1) (pp 208-220), 2011.
Date of Publication: July 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
The internal thoracic artery is the most effective conduit for coronary
artery bypass surgery; however, most patients have multivessel disease and
require additional saphenous vein or radial artery grafts. In this
systematic review of the literature and meta-analysis, we aim to compare
reported patency rates for these conduits and explore if differences are
homogeneous across follow-up intervals. A literature search was performed
using Embase, Medline, Cochrane Library, Google Scholar and randomised
controlled trial databases to identify studies published between 1965 and
October 2009. All studies reporting angiographic comparison of saphenous
vein and radial artery conduit patency were included, irrespective of
language. The end point was angiographic graft patency stratified over
different follow-up intervals. Meta-analysis was performed according to
recommendations from the Cochrane Collaboration and Meta-analysis Of
Observational Studies in Epidemiology guidelines. We used a random-effect
model and the odds ratio as the summary statistic. A total of 35 studies
were identified. They reported early patency (<=1 year, 6795 grafts),
medium-term patency (1-5 years, 3232 grafts) and long-term patency (>5
years, 1157 grafts). Significant variation of comparative patency existed
across different follow-up intervals. Early saphenous vein patency was
similar to radial artery patency with odds ratio of 1.04 (95% confidence
interval 0.68-1.61). Medium-term saphenous vein patency, however,
deteriorated significantly (odds ratio 2.06, 95% confidence interval
1.29-3.29). Similarly, long-term patency was better for radial artery
conduits (odds ratio 2.28, 95% confidence interval 1.32-3.94).
Heterogeneity was due to angiographic patency characteristics and related
to risk of bias. In conclusion, the findings of this systematic review of
the published literature and meta-analysis support the use of radial
artery in preference to saphenous vein conduits for coronary artery bypass
surgery. 2010 European Association for Cardio-Thoracic Surgery.
<13>
Accession Number
2011307837
Authors
Urell C. Emtner M. Hedenstrom H. Tenling A. Breidenskog M. Westerdahl E.
Institution
(Urell, Emtner) Department of Neuroscience, Physiotherapy, Uppsala
University, Uppsala, Sweden
(Urell, Breidenskog) Physiotherapy Section, University Hospital, Uppsala,
Sweden
(Emtner) Department of Medical Sciences, Respiratory Medicine and
Allergology, Uppsala University, Uppsala, Sweden
(Hedenstrom, Westerdahl) Department of Medical Sciences, Clinical
Physiology, Uppsala University, Uppsala, Sweden
(Urell, Tenling, Breidenskog) Department of Cardiothoracic
Anaesthesiology, University Hospital, Uppsala, Sweden
(Westerdahl) Centre for Health Care Sciences, Orebro County Council,
School of Health and Medical Sciences, Orebro University, Orebro, Sweden
Title
Deep breathing exercises with positive expiratory pressure at a higher
rate improve oxygenation in the early period after cardiac surgery - a
randomised controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 40 (1) (pp 162-167), 2011.
Date of Publication: July 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: In addition to early mobilisation, a variety of breathing
exercises are used to prevent postoperative pulmonary complications after
cardiac surgery. The optimal duration of the treatment is not well
evaluated. The aim of this study was to determine the effect of 30 versus
10 deep breaths hourly, while awake, with positive expiratory pressure on
oxygenation and pulmonary function the first days after cardiac surgery.
Methods: A total of 181 patients, undergoing cardiac surgery, were
randomised into a treatment group, performing 30 deep breaths hourly the
first postoperative days, or into a control group performing 10 deep
breaths hourly. The main outcome measurement arterial blood gases and the
secondary outcome pulmonary function, evaluated with spirometry, were
determined on the second postoperative day. Results: Preoperatively, both
study groups were similar in terms of age, SpO<sub>2</sub>, forced
expiratory volume in 1s and New York Heart Association classification. On
the second postoperative day, arterial oxygen tension (PaO<sub>2</sub>)
was 8.9+/-1.7kPa in the treatment group and 8.1+/-1.4kPa in the control
group (p=0.004). Arterial oxygen saturation (SaO<sub>2</sub>) was
92.7+/-3.7% in the treatment group and 91.1+/-3.8% in the control group
(p=0.016). There were no differences in measured lung function between the
groups or in compliance to the breathing exercises. Compliance was 65% of
possible breathing sessions. Conclusions: A significantly increased
oxygenation was found in patients performing 30 deep breaths the first two
postoperative days compared with control patients performing 10 deep
breaths hourly. These results support the implementation of a higher rate
of deep breathing exercises in the initial phase after cardiac surgery.
2010 European Association for Cardio-Thoracic Surgery.
<14>
Accession Number
2011307823
Authors
Wang W. Buehler D. Martland A.M. Feng X.D. Wang Y.J.
Institution
(Wang, Buehler, Martland) Scripps Memorial Hospital, San Diego, United
States
(Feng) Shanghai 1st People's Hospital, Shanghai Yodak Heart Hospital,
China
(Wang) ShanXi Cardiovascular Hospital, China
Title
Left atrial wall tension directly affects the restoration of sinus rhythm
after Maze procedure.
Source
European Journal of Cardio-thoracic Surgery. 40 (1) (pp 77-82), 2011.
Date of Publication: July 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: The surgical treatment of permanent atrial fibrillation (AF)
continues to be a clinical challenge. Increased left atrial (LA) wall
tension affected by LA wall thickness and volume has been associated with
poor restoration of sinus rhythm after the Maze procedure. This study was
designed to investigate the impact of conversion rates to sinus rhythm
using LA wall tension reduction techniques in conjunction with aggressive
postoperative pharmacological therapy in comparison to a modified Maze
procedure alone. Methods: From 1999 to 2008, 322 patients with permanent
AF and biatrial enlargement, who required mitral valve+/-tricuspid valve
surgery were exactly randomized into two groups: The study group used
biatrial reduction with reef-imbricate suture technique concomitant with
the Maze procedure and aggressive postoperative pharmacological therapy;
the control group was treated with the Maze procedure alone. LA dimension
was measured by transesophageal echocardiogram (TEE) or transthoracic
echocardiography (TTE); LA wall thickness was measured by TEE and manually
during surgery. Pulmonary artery (PA) pressures were measured by PA
catheter or TTE, BNP test and clinical follow-up at discharge, 3 months, 6
months and 1 year. There were 187 woman (58%) and 135 men (42%). Their
mean age was 45+/-9.5 years. Results: Overall restoration of sinus rhythm
was significantly improved in the group with aggressive reduction of LA
wall tension during 1-year clinical follow-up (89.3% vs 67.2%, p<0.001).
Calculated LA wall tension was significantly reduced at discharge in the
study group versus control group (4.012+/-1.650dyncm<sup>-1</sup> vs 20
384+/-3313dyncm<sup>-1</sup> (p<0.001)) and at 1-year follow-up
(1059+/-1161dyncm<sup>-1</sup> vs 17 139+/-3170dyncm<sup>-1</sup>
(p<0.001)), respectively. Significant differences in changes in LA
dimension were detected at discharge and 1-year follow-up in the study
group versus control group (43+/-7 vs 61+/-11, p<0.001). LA wall
(3.9+/-1.3 vs 2.3+/-0.9) thickness also significantly differed at the
1-year follow-up. Conclusion: An aggressive approach to reduce LA wall
tension significantly improves restoration of sinus rhythm after the Maze
procedure. LA wall tension directly affects sinus conversion. Further
studies using pharmacologic intervention to reduce LA wall tension for
maintenance of sinus rhythm need to be evaluated. 2010 European
Association for Cardio-Thoracic Surgery.
<15>
Accession Number
2011307842
Authors
Fan Y. Zhang A.-M. Xiao Y.-B. Weng Y.-G. Hetzer R.
Institution
(Fan, Xiao) Department of Cardiovascular Surgery, Chongqing Xinqiao
Hospital, Third Military Medical University, Chongqing, China
(Zhang) Department of Oncology, Chongqing Xinqiao Hospital, Third Military
Medical University, Chongqing, China
(Weng, Hetzer) Department of Cardiothoracic and Vascular Surgery,
Deutsches Herzzentrum Berlin, Berlin, Germany
Title
Glucose-insulin-potassium therapy in adult patients undergoing cardiac
surgery: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 40 (1) (pp 192-199), 2011.
Date of Publication: July 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Glucose-insulin-potassium (GIK) has long been used as adjuvant treatment
for patients with serious cardiovascular disease. Although many studies
have reported their results based on GIK therapy in the setting of heart
surgery, the outcomes remain controversial and inconclusive. The aim of
this meta-analysis of randomized controlled trials (RCTs) was to determine
the clinical effects of GIK in adult cardiac surgery patients. Electronic
databases and manual bibliographical searches were conducted. A
meta-analysis of all RCTs comparing GIK with control in heart surgery was
performed. Data for all-causes mortality (within 2 months after surgery),
perioperative myocardial infarction, postoperative inotropic support,
atrial fibrillation, cardiac index, durations of intensive unit care stay
and total hospital stay were extracted, and we summarized the combined
results of the data of the RCTs as relative risk (RR), with 95% confidence
intervals (CIs). A total of 33 RCTs including 2113 patients were assessed
in this study. GIK infusion was associated with significantly fewer
perioperative myocardial infarctions (RR. =0.63, 95% CI 0.42-0.95), less
inotropic support requirement (RR. =0.66, 95% CI 0.45-0.96), better
postoperative cardiac index (weighted mean difference (WMD). =0.43, 95% CI
0.31-0.55), and reduced length of stay in the intensive care unit (WMD.
=-7.96, 95% CI -13.36 to -2.55). Further analysis showed that diabetic
patients were benefited from GIK with glycemic control, but not GIK
infusion without glucose control. GIK significantly reduced myocardial
injury and improved hemodynamic performance in patients undergoing cardiac
surgery. Glycemic control with GIK might be required for cardiac surgery
patients with diabetes. 2010 European Association for Cardio-Thoracic
Surgery.
<16>
Accession Number
2011317911
Authors
Badheka A.O. Rathod A. Bharadwaj A.S. Manickam P. Kizilbash M.A. Veeranna
V. Jacob S. Afonso L.
Institution
(Badheka, Rathod, Bharadwaj, Manickam, Kizilbash, Veeranna, Jacob, Afonso)
Department of Internal Medicine, Wayne State University, Detroit, MI,
United States
(Kizilbash, Veeranna, Jacob, Afonso) Division of Cardiology, Harper
University Hospital, Wayne State University, 8 Brush, 3990 John R,
Detroit, MI 48201, United States
Title
Preserved or slightly depressed ejection fraction and outcomes after
myocardial infarction.
Source
Postgraduate Medical Journal. 87 (1028) (pp 400-404), 2011. Date of
Publication: June 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background: Left ventricular ejection fraction (EF) in post-myocardial
infarction (MI) patients is a strong predictor of adverse cardiovascular
events. Although resting EF as measured by transthoracic echocardiography
(TTE), contrast ventriculography (CNV), and radionuclide angiography (RNA)
exhibit high correlation, there is only modest agreement between these
modalities. This study sought to explore whether modality of EF assessment
influences prognostication of post-MI patients with normal or slightly
reduced EF. Methods and results: The National Heart, Lung, and Blood
Institute (NHLBI) limited access dataset of the Prevention of Events with
Angiotensin Converting Enzyme Inhibition (PEACE) Trial (1996e2003, n=8290)
comparing trandolapril versus placebo was used. The cohort was partitioned
into TTE (n=2582), RNA (n=816), and CNV (n=1155) groups based on modality
of EF assessment. EF was a significant predictor of cardiovascular
mortality (HR 0.97, 95% CI 0.95 to 0.98; p<0.005) and all cause mortality
(HR 0.98, 95% CI 0.97 to 0.99; p=0.0002) on multivariate analysis in this
population with preserved or mildly depressed EF. Although CNV, TTE, and
RNA groups differed significantly in terms of baseline variables, no
appreciable differences were noted between RNA (HR 1.13, 95% CI 0.85 to
1.50; ns) and CNV (HR 1.13, 95% CI 0.99 to 1.27; ns) groups, compared with
TTE for all cause mortality. Similarly, no significant differences were
observed for cardiovascular mortality between RNA (HR 1.23, 95% CI 0.82 to
1.84; p=0.31) and CNV (HR 1.14, 95% CI 0.78 to 1.67, p=0.49) versus TTE.
Conclusion: EF is a significant predictor of all-cause mortality and
cardiovascular mortality in patients with preserved or mildly depressed
EF. Modalities of EF measurement are interchangeable and do not play a
significant role in prognostication in a post-MI population.
<17>
[Use Link to view the full text]
Accession Number
2011313037
Authors
Mital S. Chung W.K. Colan S.D. Sleeper L.A. Manlhiot C. Arrington C.B.
Cnota J.F. Graham E.M. Mitchell M.E. Goldmuntz E. Li J.S. Levine J.C. Lee
T.M. Margossian R. Hsu D.T.
Institution
(Mital, Manlhiot) Division of Pediatric Cardiology, Hospital for Sick
Children, Toronto, ON, Canada
(Hsu) Division of Pediatric Cardiology, United States
(Chung, Lee) Division of Molecular Genetics, Columbia University, New
York, NY, United States
(Sleeper) New England Research Institutes, Watertown, MA, United States
(Colan, Levine, Margossian) Department of Pediatric Cardiology, Children's
Hospital Boston, Boston, MA, United States
(Arrington) Division of Pediatric Cardiology, Primary Children's Medical
Center, Salt Lake City, UT, United States
(Cnota) Division of Pediatric Cardiology, Cincinnati Children's Hospital,
Cincinnati, OH, United States
(Graham) Division of Pediatric Cardiology, Medical University of South
Carolina, Charleston, United States
(Li) Division of Pediatric Cardiology, Duke University Medical Center,
Durham, NC, United States
(Mitchell) Division of Pediatric Cardiology, Children's Hospital of
Wisconsin, Milwaukee, United States
(Goldmuntz) Division of Pediatric Cardiology, Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Mital) Hospital for Sick Children, 555 University Ave, Toronto, ON
M5G1X8, Canada
Title
Renin-angiotensin-aldosterone genotype influences ventricular remodeling
in infants with single ventricle.
Source
Circulation. 123 (21) (pp 2353-2362), 2011. Date of Publication: 31 May
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: We investigated the effect of polymorphisms in the
renin-angiotensin-aldosterone system (RAAS) genes on ventricular
remodeling, growth, renal function, and response to enalapril in infants
with single ventricle. Methods and results-: Single ventricle infants
enrolled in a randomized trial of enalapril were genotyped for
polymorphisms in 5 genes: angiotensinogen, angiotensin-converting enzyme,
angiotensin II type 1 receptor, aldosterone synthase, and chymase. Alleles
associated with renin-angiotensin- aldosterone system upregulation were
classified as risk alleles. Ventricular mass, volume, somatic growth,
renal function using estimated glomerular filtration rate, and response to
enalapril were compared between patients with 2 homozygous risk genotypes
(high risk), and those with <2 homozygous risk genotypes (low risk) at 2
time points: before the superior cavopulmonary connection (pre-SCPC) and
at age 14 months. Of 230 trial subjects, 154 were genotyped: Thirty-eight
were high risk, and 116 were low risk. Ventricular mass and volume were
elevated in both groups pre-SCPC. Ventricular mass and volume decreased
and estimated glomerular filtration rate increased after SCPC in the
low-risk (P<0.05), but not the high-risk group. These responses were
independent of enalapril treatment. Weight and height z-scores were lower
at baseline, and height remained lower in the high-risk group at 14
months, especially in those receiving enalapril (P<0.05). Conclusions-:
Renin-angiotensin-aldosterone system-upregulation genotypes were
associated with failure of reverse remodeling after SCPC surgery, less
improvement in renal function, and impaired somatic growth, the latter
especially in patients receiving enalapril. Renin-angiotensin-aldosterone
system genotype may identify a high-risk subgroup of single ventricle
patients who fail to fully benefit from volume-unloading surgery.
Follow-up is warranted to assess long-term impact. 2011 American Heart
Association, Inc.
<18>
Accession Number
2011312654
Authors
Wilson S.R. Sabatine M.S. Wiviott S.D. Ray K.K. De Lemos J.A. Zhou S.
Rifai N. Cannon C.P. Morrow D.A.
Institution
(Wilson, Sabatine, Wiviott, Cannon, Morrow) TIMI Study Group, Brigham and
Women's Hospital, Boston, MA, United States
(Sabatine, Wiviott, Cannon, Morrow) Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital, Boston, MA, United States
(Ray) Department of Public Health and Primary Care, University of
Cambridge, Cambridge, United Kingdom
(De Lemos) Donald W. Reynolds Cardiovascular Clinical Research Center,
University of Texas, Southwestern Medical Center, Dallas, TX, United
States
(Zhou) Harvard Clinical Research Institute, Boston, MA, United States
(Rifai) Department of Laboratory Medicine, Children's Hospital, Boston,
MA, United States
(Morrow) Cardiovascular Division, Brigham and Women's Hospital, 75 Francis
Street, Boston, MA 02115, United States
Title
Assessment of adiponectin and the risk of recurrent cardiovascular events
in patients presenting with an acute coronary syndrome: Observations from
the Pravastatin or atorVastatin Evaluation and Infection
Trial-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22).
Source
American Heart Journal. 161 (6) (pp 1147-1155.e1), 2011. Date of
Publication: June 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Adiponectin, an adipocytokine, is secreted by fatty cells and
exerts a regulatory role in atherogenesis, modulating foam cell formation
and cellular adhesion. In stable atherosclerosis, plasma adiponectin has
been reported to be associated with both increased and decreased
cardiovascular risk. Recent data have suggested a possible discordant
adverse risk relationship in acute coronary syndrome (ACS). Therefore, we
investigated the association between adiponectin and cardiovascular events
in patients with ACS. Methods: We measured plasma adiponectin in 3,931
patients stabilized following ACS and assessed the relationship with
2-year outcome. Patients were followed for all-cause death and major
cardiovascular events. Using multivariable Cox regression, we adjusted for
age, sex, race, ACS type, diabetes, smoking status, triglycerides, blood
pressure, body mass index, estimated glomerular filtration rate, treatment
group (atorvastatin), B-type natriuretic peptide, and C-reactive protein.
Results: Adiponectin correlated negatively with age, diabetes, body mass
index, and triglycerides (each, P < .001) but showed a positive
relationship with the risk of death (P = .01), myocardial infarction (P =
.01), and heart failure (P < .001). After adjusting for clinical risk
factors, B-type natriuretic peptide, and C-reactive protein, adiponectin
greater than the median (4,477 ng/mL) was independently associated with an
increased risk of death or myocardial infarction (hazard ratio 1.58, 95%
CI 1.10-2.28, P = .013) and congestive heart failure (hazard ratio 2.17,
95% CI 1.21-3.89, P = .010). Conclusions: Higher adiponectin
concentrations early after ACS are independently associated with a higher
risk of recurrent cardiovascular events. This finding is directionally
opposite to that observed in patients at risk for atherosclerosis and
reveals the need for investigation to elucidate differences in the
pathobiology of adiponectin in stable versus unstable coronary artery
disease. 2011 Mosby, Inc. All rights reserved.
<19>
[Use Link to view the full text]
Accession Number
2011311957
Authors
Park E.R. Japuntich S. Temel J. Lanuti M. Pandiscio J. Hilgenberg J.
Davies D. Dresler C. Rigotti N.A.
Institution
(Park, Japuntich, Pandiscio, Hilgenberg, Rigotti) Mongan Institute for
Health Policy, Harvard Medical School, Boston, MA, United States
(Park, Japuntich) Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, United States
(Park, Japuntich, Rigotti) Tobacco Research and Treatment Center,
Department of Medicine, Massachusetts General Hospital, Boston, MA, United
States
(Lanuti, Davies) Division of Thoracic Surgery, Massachusetts General
Hospital, Boston, MA 02114, United States
(Dresler) Tobacco Prevention and Cessation Program, Arkansas Department of
Health, Little Rock, AR, United States
(Temel) Thoracic Oncology, Massachusetts General Hospital, Boston, MA,
United States
(Park) Massachusetts General Hospital, Harvard Medical School, 50
Staniford St., Boston, MA 02114, United States
Title
A smoking cessation intervention for thoracic surgery and oncology
clinics: A pilot trial.
Source
Journal of Thoracic Oncology. 6 (6) (pp 1059-1065), 2011. Date of
Publication: June 2011.
Publisher
International Association for the Study of Lung Cancer (PO Box 6511, Mail
Stop 8111, Aurora, Colorado 80045-0511, United States)
Abstract
Introduction: Although most smokers diagnosed with lung cancer report that
they want to quit smoking, many do not succeed. Smokers who quit when lung
cancer is diagnosed have improved treatment efficacy, quality of life, and
survival. Effective smoking cessation interventions targeted to thoracic
oncology patients are needed. Methods: This pilot study examined the
feasibility and potential efficacy of a 12-week program that combined
smoking cessation counseling with varenicline. Seven-day point prevalence
tobacco abstinence rates at the end of treatment were compared with a
usual care control group. From January 2008 to August 2009, patients with
a diagnosed or suspected thoracic malignancy were recruited at their
initial visit to a thoracic surgeon or thoracic oncologist at
Massachusetts General Hospital. Results: Of 1130 patients screened, 187
(17%) were current smokers, and an additional 66 (6%) reported quitting
within the past 6 months. One hundred sixteen (67%) of smokers were
eligible, and 49 (42%) of eligible smokers enrolled (control group n = 17,
intervention group n = 32). Intervention participants completed a median
of nine counseling sessions; 50% of intervention participants completed
the full varenicline course. At 12-week follow-up, biochemically validated
7-day point prevalence tobacco abstinence rates were 34.4% in the
intervention group versus 14.3% in the control group (odds ratio = 3.14,
95% confidence interval = 0.59-16.62, p = 0.18). Conclusion: Our findings
support the feasibility and acceptability of this program. At the end of
treatment, quit rates were higher in the control group. Further testing is
indicated to establish the efficacy of this treatment package in a
randomized clinical trial. Copyright 2011 by the International
Association for the Study of Lung Cancer.
<20>
Accession Number
2011307827
Authors
Martinez-Barenys C. Busquets J. de Castro P.E.L. Garcia-Guasch R. Perez J.
Fernandez E. Mesa M.A. Astudillo J.
Institution
(Martinez-Barenys, de Castro, Perez, Fernandez, Mesa, Astudillo) Thoracic
Surgery Department, University Hospital Germans Trias i Pujol, Badalona,
Barcelona, Spain
(Busquets, Garcia-Guasch) Anesthesiology Department, University Hospital
Germans Trias i Pujol, Badalona, Barcelona, Spain
(Martinez-Barenys) Universitat Autonoma de Barcelona (UAB), Bellaterra,
Barcelona, Spain
Title
Randomized double-blind comparison of phrenic nerve infiltration and
suprascapular nerve block for ipsilateral shoulder pain after thoracic
surgery.
Source
European Journal of Cardio-thoracic Surgery. 40 (1) (pp 106-112), 2011.
Date of Publication: July 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: Despite the use of thoracic epidural analgesia, a constant
severe ache occurs in the ipsilateral shoulder of almost 75% of patients
after thoracotomy. The aim of this prospective-randomized study was to
investigate the effect of phrenic nerve infiltration (PNI) compared with
suprascapular nerve block (SNB) on ipsilateral shoulder pain after
thoracic surgery. Methods: After Local Research Ethics Committee approval,
written informed consent was obtained from 90 adult patients undergoing
thoracotomy for pulmonary resection. Patients were excluded if they had
preexisting shoulder pain, were unable to understand the visual analog
scale (VAS) scoring system or due to failure of epidural analgesia. The
phrenic group (PNI) received 10. ml of 2% lidocaine infiltrated into the
periphrenic fat pad, 1-2. cm close to the diaphragm, just before chest
closure. The suprascapular group (SNB) received 10. ml of 0.5% plain
bupivacaine injected into the suprascapular fossa once the surgery was
finished. A blinded observer to the study group assessed the patient's
shoulder and thoracotomy pain, using the VAS score and a five-point
observer verbal rating score (OVRS), at 0.5, 1, 2, 3, 4, 5, 6, 12, 48, and
72. h after surgery and at discharge. The time and dose of any
administered analgesic medication were recorded. Results: Finally, 74
patients were included (37 per group). Sixteen patients were excluded
(unable to understand scoring system, failure of the epidural technique,
and lost data). There were no significant differences in age, gender, body
mass index, type/duration of operation, and pain scores at rest, between
the two groups. Shoulder pain intensity was significantly lower in the PNI
group compared with the SNB group (median value of VAS area under the
curve for the PNI group: 8.1 (0-70.9). cm vs 114.3 (43.8-193.8). cm for
the SNB group; P<0.001). There were no significant differences between the
two groups according to postoperative thoracotomy pain. Conclusions:
Phrenic nerve block with 2% lidocaine should be performed in all patients
undergoing a major thoracic surgery procedure. These results strongly
support the hypothesis that irritation of the pericardium and/or
mediastinal-diaphragmatic pleural surfaces results in pain that is
referred to the shoulder via the phrenic nerve. 2010 European Association
for Cardio-Thoracic Surgery.
<21>
Accession Number
70437142
Authors
Donndorf P. Kundt G. Glass A. Kaminski A. Yerebakan C. Liebold A.
Steinhoff G.
Institution
(Donndorf, Kaminski, Yerebakan, Liebold, Steinhoff) Universitat Rostock,
Klinik und Poliklinik fr Herzchirurgie, Rostock, Germany
(Kundt, Glass) Universitat Rostock, Institut fr Biostatistik und
Informatik in Medizin und Alternsforschung, Rostock, Germany
Title
Intramyocardial bone marrow stem cell transplantation during coronary
artery bypass surgery: A Meta-analysis.
Source
Thoracic and Cardiovascular Surgeon. Conference: 40th Annual Meeting of
the German Society for Cardiovascular and Thoracic Surgery Stuttgart
Germany. Conference Start: 20110213 Conference End: 20110216. Conference
Publication: (var.pagings). 59 , 2011. Date of Publication: February
2011.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Experimental and clinical studies have suggested that
intramyocardial transplantation of autologous bone marrow stem cells
(BMSC) combined with CABG might improve left ventricular function in the
setting of chronic ischemic heart disease. In order to summarize present
clinical evidence we conducted a meta-analysis of available publications
regarding efficacy and safety of intramyocardial BMSC transplantation
during CABG. Methods: The electronic databases PUBMED, MEDLINE, Cochrane
controlled trials register and ClinicalTrials.gov (all from there
inception to May 2009) were searched for randomized controlled trials and
cohort studies of intramyocardial BMSC transplantation during CABG to
treat ischemic heart disease. Six studies were included. Results: Compared
with control groups, the BMSC transplantation group showed a significant
improvement of the left ventricular ejection fraction (LVEF) from baseline
to follow up (6.94%, 95%CI: 5.38 to 8.51, p<0.001). Moreover the overall
change of left ventricular end-diastolic volume (LVEDV) from baseline to
follow-up favoured the BMSC therapy group (9.55ml, 95%CI: -2.82 to 21.92,
p=0.13). Major adverse cardiovascular events (MACE), including ventricular
arrhythmia (VA) and the composite of other cardiovascular events (CE) were
not significantly different between the BMSC therapy group and controls
(RRVA=0.951, 95%CI: 0.389 to 2.325, p=0.913; RRCE=1.134, 95%CI: 0.28 to
4.6, p=0.86). Conclusions: Available clinical evidence suggests that
intramyocardial BMSC transplantation in combination with CABG is
associated with modest improvements of functional parameters in patients
with chronic ischemic heart disease. Moreover, surgical intramyocardial
BMSC transplantation appears to be safe. For further evaluation of
efficacy and long-term clinical outcome double-blinded multi-centre trials
are needed.
<22>
Accession Number
70437080
Authors
Knipp S. Scherag A. Jakob H. Diener H.C. Weimar C.
Institution
(Knipp, Jakob) Westdeutsches Herzzentrum Essen, Klinik fr Thorax-und
Kardiovaskulare Chirurgie, Essen, Germany
(Scherag) Institut fr Medizinische Biometrie und Epidemiologie, Essen,
Germany
(Diener, Weimar) Neurologische Klinik, Essen, Germany
Title
The coronary artery bypass graft surgery in patients with asymptomatic
carotid stenosis (CABACS) trial.
Source
Thoracic and Cardiovascular Surgeon. Conference: 40th Annual Meeting of
the German Society for Cardiovascular and Thoracic Surgery Stuttgart
Germany. Conference Start: 20110213 Conference End: 20110216. Conference
Publication: (var.pagings). 59 , 2011. Date of Publication: February
2011.
Publisher
Georg Thieme Verlag
Abstract
Aims: Annually, more than 60,000 CABG procedures are performed in Germany.
Significant carotid stenosis is present in 6-8% of these patients and is
associated with an increased risk of stroke and cardiovascular
complications during and after CABG. In these patients, treatment is
handled controversially. Although synchronous CABG and CEA still
constitutes the current standard of care, no proven gold standard is known
in these patients. Conversely, no randomized trial has assessed whether a
combined synchronous or staged procedure confers any benefit at all
compared to isolated CABG. Objective: To compare the safety and efficacy
of isolated CABG with synchronous CABG and CEA in patients with
asymptomatic high-grade (>=80% ECST) carotid stenosis. Methods: Patients
with asymptomatic, high-grade carotid stenosis scheduled for elective CABG
will be assigned to either isolated CABG or synchronous CABG and CEA by
1:1 block stratified randomization with 3 different stratification factors
(age, sex, modified Rankin scale). Primary efficacy endpoint is the number
of strokes and deaths from any cause (whatever occurs first) at 30 days
after intervention. With 1,160 patients to be randomized, a 4.5% absolute
difference in the 30-day rate of the above endpoints can be detected with
80% power. The study is funded by the Deutsche Forschungsgemeinschaft (WE
2858-3/1). Conclusions: CABACS is the first randomized controlled clinical
trial to compare CABG with and without CEA in patients with concomitant
coronary and high-grade carotid stenosis. The results of this trial will
be of major importance for surgical management in coronary patients with
asymptomatic carotid stenosis.
<23>
Accession Number
70437020
Authors
Brgermann J. Gummert J. Legler T. Kuss O.
Institution
(Brgermann, Gummert, Legler, Kuss) Herz-und Diabeteszentrum NRW, Ruhr
Universitat Bochum, Klinik fr Thorax-und Kardiovaskularchirurgie, Bad
Oeynhausen, Germany
Title
Do treatments effects differ between randomised trials and propensity
score analyses? Evidence from a meta-propensity score analysis in off-pump
versus on-pump coronary artery bypass surgery.
Source
Thoracic and Cardiovascular Surgeon. Conference: 40th Annual Meeting of
the German Society for Cardiovascular and Thoracic Surgery Stuttgart
Germany. Conference Start: 20110213 Conference End: 20110216. Conference
Publication: (var.pagings). 59 , 2011. Date of Publication: February
2011.
Publisher
Georg Thieme Verlag
Abstract
Objective: Analyses comparing randomised to non-randomised clinical trials
suffer from the fact that the study populations are usually different.
Therefore, differences in treatment effects are not necessarily due to the
different treatment modes but may result from differences between
populations. Methods: In a systematic review, wemeta-matched randomised
clinical trials (RCT) and propensity score analyses (PS) that compared the
off-and the on-pump technique in coronary artery bypass grafting.
Meta-confounders were used for meta-matching and were summarised in a
meta-propensity score. We compared treatment effects between RCTs and PS
analyses for ten previously defined binary clinical outcomes in this
meta-matched population as differences in meta-odds ratios. Results: For
all clinical outcomes, the estimated differences in meta-odds ratios were
below an absolute value of 0.15, all confidence intervals included the
null. The overall difference was-0.03 [95% confidence interval:-0.12,
0.07], indicating a small, but precisely estimated difference between RCTs
and PS analyses in the meta-matched sample. Conclusions: In our example,
treatment effects of off-pump versus on-pump surgery from RCTs and PS
analyses were very similar in a meta-matched population of studies,
indicating a small effect of randomisation itself.
