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Accession Number
2011364207
Authors
Maan A. Shaikh A.Y. Mansour M. Ruskin J.N. Heist E.K.
Institution
(Maan, Shaikh) Department of Internal Medicine, University of
Massachusetts, Medical School, Worcester, MA, United States
(Mansour, Ruskin, Heist) Cardiac Arrhythmia Service, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
(Heist) Cardiac Arrhythmia Service, Massachusetts General Hospital, 55
Fruit St. GRB 109, Boston, MA 02114, United States
Title
Complications from catheter ablation of atrial fibrillation: A systematic
review.
Source
Critical Pathways in Cardiology. 10 (2) (pp 76-83), 2011. Date of
Publication: June 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Atrial fibrillation (AF) is the most common arrhythmia requiring treatment
that is encountered in clinical practice. Recent advances in the
understanding of underlying mechanisms of AF have led to the increased use
of catheter ablation (CA) as a treatment modality for paroxysmal,
persistent, or long-standing persistent AF in patients with symptomatic AF
despite treatment with antiarrhythmic medications. Because of the
complexity in technique and anatomic location of the ablation sites, it is
not surprising that CA of AF is associated with a greater risk of
procedural complications compared with simpler cardiac ablation
procedures. Major and minor complications, including life-threatening
complications, have been described and quantified. This systematic review
describes the potential risks of CA that have been reported over a period
and provides insights into the evolving strategies to minimize these
complications, thus making CA techniques safer and potentially more
efficacious for AF. Copyright 2011 by Lippincott Williams & Wilkins.

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Accession Number
2011362571
Authors
Shahbazi S. Zeighami D. Allahyary E. Alipour A. Esmaeeli M.J. Ghaneie M.
Institution
(Shahbazi, Zeighami, Allahyary, Esmaeeli, Ghaneie) Shiraz Anesthesiology
and Critical Care Research Center, Iran, Islamic Republic of
(Alipour) Epidemiologic Department, Nutrition and Health School, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Title
Effect of colloid versus crystalloid administration of cardiopulmonary
bypass prime solution on tissue and organ perfusion.
Source
Iranian Cardiovascular Research Journal. 5 (1) (pp 24-31), 2011. Date of
Publication: March 15,2011.
Publisher
Iranian Cardiovascular Research Journal (Zand Ave., Shiraz, Iran, Islamic
Republic of)
Abstract
Background: We evaluated the effects of tissue and organ perfusion during
and after coronary artery bypass graft surgery with either colloid
(Voluven) or crystalloid (Lactated ringer's) as prime solution. Methods:
In this prospective randomized-controlled trial study, 70 patients
undergoing on-pump coronary artery bypass graft surgery were randomly
assigned to receive either colloid (Voluven) or crystalloid (Lactated
ringer's) as prime solution, for initiation of cardiopulmonary bypass
machine procedure. Tissue and organ perfusion markers including lactate,
troponin I, liver and renal function tests and electrolytes were measured
sequentially, before induction (T₁) to second days after
surgery (T₅). Results: With exception of chloride and potassium
levels no significant differences detected in other measurements, and the
laboratory results were entirely identical in both procedures. Conclusion:
There was no significant difference between Voluven (hydroxyethyl starch,
HES 130/0.4) and crystalloid (Lactated ringer's) as priming solution on
the basis of organ and tissue perfusion tests assessment.

<3>
Accession Number
2011348967
Authors
James S.K. Roe M.T. Cannon C.P. Cornel J.H. Horrow J. Husted S. Katus H.
Morais J. Steg G. Storey R.F. Stevens S. Wallentin L. Harrington R.A.
Institution
(James, Wallentin) Uppsala Clinical Research Center, Uppsala University,
Uppsala, Sweden
(Roe, Stevens, Harrington) Duke Clinical Research Institute, Durham, NC,
United States
(Cannon) TIMI Study Group, Brigham and Women's Hospital, Boston, MA,
United States
(Cornel) Medisch Centrum Alkmaar, Alkmaar, Netherlands
(Horrow) AstraZeneca R and D, Wilmington, DE, United States
(Husted) Department of Cardiology, Arhus University Hospital, Arhus,
Denmark
(Katus) Medizinische Klinik, Universitatsklinikum Heidelberg, Germany
(Morais) Santo Andre's Hospital, Leiria, Portugal
(Steg) INSERM U-698, Paris, France
(Steg) Universite Paris 7, Paris, France
(Steg) Hopital Bichat, AP-HP, Paris, France
(Storey) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
Title
Ticagrelor versus clopidogrel in patients with acute coronary syndromes
intended for non-invasive management: Substudy from prospective randomised
PLATelet inhibition and patient Outcomes (PLATO) trial.
Source
BMJ. 342 (7812) , 2011. Date of Publication: 25 Jun 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To evaluate efficacy and safety outcomes in patients in the
PLATelet inhibition and patient Outcomes (PLATO) trial who at
randomisation were planned for a non-invasive treatment strategy. Design:
Pre-specified analysis of pre-randomisation defined subgroup of
prospective randomised clinical trial. Setting: 862 centres in 43
countries. Participants: 5216 (28%) of 18 624 patients admitted to
hospital for acute coronary syndrome who were specified as planned for
non-invasive management. Interventions: Randomised treatment with
ticagrelor (n=2601) versus clopidogrel (2615). Main outcome measurements:
Primary composite end point of cardiovascular death, myocardial
infarction, and stroke; their individual components; and PLATO defined
major bleeding during one year. Results: 2183 (41.9%) patients had
coronary angiography during their initial hospital admission, 1065 (20.4%)
had percutaneous coronary intervention, and 208 (4.0%) had coronary artery
bypass surgery. Cumulatively, 3143 (60.3%) patients had been managed
non-invasively by the end of follow-up. The incidence of the primary end
point was lower with ticagrelor than with clopidogrel (12.0% (n=295) v
14.3% (346); hazard ratio 0.85, 95% confidence interval 0.73 to 1.00;
P=0.04). Overall mortality was also lower (6.1% (147) v 8.2% (195); 0.75,
0.61 to 0.93; P=0.01). The incidence of total major bleeding (11.9% (272)
v 10.3% (238); 1.17, 0.98 to 1.39; P=0.08) and non-coronary artery bypass
grafting related major bleeding (4.0% (90) v 3.1% (71); 1.30, 0.95 to
1.77; P=0.10) was numerically higher with ticagrelor than with
clopidogrel. Conclusions: In patients with acute coronary syndrome
initially intended for non-invasive management, the benefits of ticagrelor
over clopidogrel were consistent with those from the overall PLATO
results, indicating the broad benefits of P2Y12 inhibition with ticagrelor
regardless of intended management strategy. Trial registration: Clinical
trials NCT00391872.

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Accession Number
2011356058
Authors
Hachinohe D. Jeong M.H. Saito S. Ahmed K. Hwang S.H. Lee M.G. Sim D.S.
Park K.-H. Hong Y.J. Ahn Y. Kang J.C. Kim J.H. Chae S.C. Kim Y.J. Hur S.H.
Seong I.W. Hong T.J. Choi D. Cho M.C. Kim C.J. Seung K.B. Chung W.S. Jang
Y.S. Rha S.W. Bae J.H. Park S.J.
Institution
(Hachinohe, Jeong, Ahmed, Hwang, Lee, Sim, Park, Kim, Hong, Ahn, Kang)
Chonnam National University Hospital, Gwangju, South Korea
(Hachinohe, Saito) Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
(Kim) Pusan Hanseo Hospital, Pusan, South Korea
(Chae) Kyungpook National University Hospital, Daegu, South Korea
(Kim) Yeungnam University Hospital, Daegu, South Korea
(Hur) Keimyung University, Dongsan Medical Center, Daegu, South Korea
(Seong) Chungnam National University Hospital, Daejeon, South Korea
(Hong) Pusan National University Hospital, Pusan, South Korea
(Choi, Jang) Yonsei University Severans Hospital, Seoul, South Korea
(Cho) Chungbuk National University Hospital, Cheongju, South Korea
(Kim) Kyunghee University Hospital, Seoul, South Korea
(Seung, Chung) Catholic University Hospital, Seoul, South Korea
(Rha) Korea University, Guro Hospital, Seoul, South Korea
(Bae) Konyang University Hospital, Daejon, South Korea
(Park) Seoul Asan Medical Center, Seoul, South Korea
Title
Management of NonST-segment elevation acute myocardial infarction in
patients with chronic kidney disease (from the Korea Acute Myocardial
Infarction Registry).
Source
American Journal of Cardiology. 108 (2) (pp 206-213), 2011. Date of
Publication: 15 Jul 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The aim of this study was to compare clinical outcomes among early
invasive (EI), deferred invasive (DI), and conservative strategies in
patients with acute nonST-segment elevation myocardial infarction (NSTEMI)
and chronic kidney disease (CKD). High-risk patients with NSTEMI are
believed to fare better with an EI strategy, but the optimal treatment for
patients with NSTEMI and CKD is not known. In total 5,185 patients with
acute NSTEMI were enrolled from the Korea Acute Myocardial Infarction
Registry and followed for 1 year. Patients were divided into EI, DI, and
conservative treatment groups and classified into 4 stages using
references from the National Kidney Foundation. The invasive EI and DI
groups were compared to the conservative groups, and the EI and DI groups
were compared according to each renal function stage. At 1-year follow-up,
mortality rates in the conservative group were significantly higher than
in the invasive groups except for the severe CKD group. The benefit of the
EI over the DI strategy, although there were no significant differences
between the 2 groups, tended to decrease as renal function decreased. In
conclusion, in the management of NSTEMI, an invasive strategy decreased
mortality compared to a conservative strategy except for severe CKD. In
the timing of an invasive strategy, the EI strategy was observed to be
superior to the DI strategy in patients with mild CKD; however, this
tendency reversed as renal function decreased. When patients with NSTEMI
have severe CKD, a conservative or DI strategy with prescription of
cardioprotective medications and prevention of further deterioration in
renal function should be considered. 2011 Elsevier Inc. All rights
reserved.

<5>
Accession Number
2011363354
Authors
Shan J. Guo Y. Luo L. Lu J. Li C. Zhang C. Huang Y. Feng L. Wu W. Long D.
Li S. Li Y.
Institution
(Shan, Guo, Luo, Lu, Li, Zhang, Huang, Feng, Wu, Long, Li, Li) Key
Laboratory of Transplant Engineering and Immunology of Health Ministry of
China, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan
Province, China
(Shan) Regenerative Medicine Research Center, West China Hospital, Sichuan
University, Chengdu, 610041 Sichuan Province, China
(Li) Chinese Cochrane Centre, Chinese Evidence-Based Medicine Centre,
China
Title
Do CD4+Foxp3+ Treg cells correlate with transplant outcomes: A systematic
review on recipients of solid organ transplantation.
Source
Cellular Immunology. 270 (1) (pp 5-12), 2011. Date of Publication: 2011.
Publisher
Academic Press Inc. (6277 Sea Harbor Drive, Orlando FL 32887-4900, United
States)
Abstract
Regulatory T cells (Tregs) are considered to be critical for the induction
of transplant tolerance. Tregs counts were measured in blood, biopsy and
urine sample after transplantation in many studies. Although not
unanimous, some studies have suggested that Tregs is associated with
better outcome and can also serve as an immune marker to predict the
individual risk of rejection and identify tolerant patients. In this
study, we systematically reviewed the correlation between Tregs and
transplant outcomes, identifying if Tregs can predict transplant rejection
and tolerance. A total of 22 articles were included and assessed, the
results showed that Tregs in recipients are helpful to maintain a stable
graft function, reduce acute/chronic rejection rate. And the Tregs in
graft and urine, rather than in PBL, may have a better diagnostic value
for transplant outcomes. However, since the low quality of included
studies, results may be influenced by bias. More high quality studies with
bigger sample size are still needed in future. 2011 Elsevier Inc.

<6>
Accession Number
2011353884
Authors
Karuppasamy P. Chaubey S. Dew T. Musto R. Sherwood R. Desai J. John L.
Shah A.M. Marber M.S. Kunst G.
Institution
(Karuppasamy, Kunst) Department of Anaesthetics, Intensive Care Medicine
and Pain Therapy, King's College, Hospital NHS Foundation Trust, Denmark
Hill, London SE5 9RS, United Kingdom
(Chaubey, Desai, John) Department of Cardiothoracic Surgery, King's
College, Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS,
United Kingdom
(Dew, Musto, Sherwood) Department of Clinical Biochemistry, King's
College, Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS,
United Kingdom
(Shah) Cardiovascular Division, James Black Centre, King's College London,
125 Coldharbour Lane, London SE5 9NU, United Kingdom
(Marber) Cardiovascular Division, King's College, St Thomas' Hospital,
Lambeth Palace Rd, London SE1 7EH, United Kingdom
Title
Remote intermittent ischemia before coronary artery bypass graft surgery:
A strategy to reduce injury and inflammation?.
Source
Basic Research in Cardiology. 106 (4) (pp 511-519), 2011. Date of
Publication: July 2011.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Perioperative myocardial ischemia contributes to postoperative morbidity
and mortality. Remote intermittent ischemia (RI) has been shown to benefit
patients undergoing coronary artery bypass graft (CABG) surgery by
decreasing postoperative cardiac troponin levels. In addition, there is
evidence that volatile anesthetics may provide myocardial protection. In
this prospective randomized controlled trial we tested the hypothesis that
RI is cardioprotective under a strict anesthetic regime with volatile
anesthesia until cardiopulmonary bypass (CPB). We also assessed whether RI
modulates postoperative cytokine and growth factor concentrations.
Fifty-four patients referred for elective CABG surgery without concomitant
valve or aortic surgery were randomized to three 5-min cycles of left
upper limb ischemia by cuff inflation (RI) or placebo without cuff
inflation (Plac). All patients received the volatile anesthetic isoflurane
(1.15-1.5 vol%) before CPB and the intravenous anesthetic propofol (3-4
mg/kg/h) thereafter until the end of surgery. Cardiac arrest during CPB
was induced by intermittent cross-clamp fibrillation, or by blood
cardioplegia. We excluded patients older than 85 years, with unstable
angina, significant renal disease, and those taking sulfonylureas.
Troponin I (cTnI) was measured preoperatively and after 6, 12, 24 and 48
h. In addition, brain natriuretic peptide (BNP), creatine kinase (CKMB)
and a panel of cytokines and growth factors were analyzed perioperatively.
Although cTnI, BNP and CKMB all increased post-CABG, there were no
significant differences between RI and Plac groups; area under the curve
for cTnI 189.4 (183.6) ng/mL/48 h and 183.0 (155.2) ng/mL/48 h mean (SD),
p = 0.90, respectively, despite a tendency to a shorter (p < 0.07)
cross-clamp time in the treatment group. Similarly, there were no
differences between groups in the central venous concentrations of
numerous cytokines and growth factors. In patients undergoing CABG surgery
RI does not provide myocardial protection under a strict anesthetic regime
with volatile anesthesia until CPB, and RI was not associated with changes
in cytokines. 2011 Springer-Verlag.

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Accession Number
2011360421
Authors
O'Neil A. Sanderson K. Oldenburg B. Taylor C.B.
Institution
(O'Neil, Oldenburg) School of Public Health and Preventive Medicine,
Monash University, Alfred Hospital, 89 Commercial Rd, Melbourne, VIC 3004,
Australia
(Sanderson) Menzies Research Institute, University of Tasmania, Hobart,
TAS, Australia
(Taylor) Stanford Medical School, Stanford University, Stanford, CA,
United States
Title
Impact of depression treatment on mental and physical health-related
quality of life of cardiac patients: A meta-analysis.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 31 (3) (pp
146-156), 2011. Date of Publication: May-June 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
PURPOSE: To conduct a meta-analysis evaluating the effectiveness of
depression treatment on mental and physical health-related quality of life
(HRQOL) of cardiac patients. ETHODS: Studies were identified using
medical, health, psychiatry, psychology, and social sciences databases.
Inclusion criteria were (1) 1 or more control conditions, (2) random
assignment to condition after admission for myocardial infarction
(MI)/acute coronary syndrome, after recording positive results on a
depression screener, (3) documentation of depression symptoms at baseline,
(4) depression management as a component of the
rehabilitation/intervention, (5) validated measure of HRQOL as an outcome,
at minimum 6-month followup. For meta-analysis, mental and physical HRQOL
were the end points studied, using standardized mean differences for
continuous outcome measures, with 95% confidence intervals. Heterogeneity
was explored by calculating I₂ statistic. RESULTS: Five
randomized controlled trials included in the analysis represented 2105
participants (1058 intervention vs 1047 comparator). Compared with a
comparator group at 6 months, a test for overall effect demonstrated
statistically significant improvements in mental HRQOL in avor of the
intervention (standardized mean differences =-0.29 [-0.38 to-0.20], [P <
.00001]; I₂= 0%). Depression treatment had a modest yet
significant impact on physical HRQOL (standardized mean differences =-0.14
[-0.24 to-0.04] [P = .009]; I₂-15%). CONCLUSION: While the
impact of post-MI depression interventions on physical HRQOL is modest,
treatment can improve mental HRQOL in a significant way. Future research
is required to develop and evaluate a program that can achieve vital
improvements in overall HRQOL, and potentially cardiovascular outcomes, of
cardiac patients. Copyright 2011 Wolters Kluwer Health | Lippincott
Williams & Wilkins.

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Accession Number
2011353577
Authors
Dhruva S.S. Bero L.A. Redberg R.F.
Institution
(Dhruva) Departments of Medicine, Clinical Pharmacy, United States
(Bero) School of Pharmacy, Institute for Health Policy Studies, United
States
(Redberg) School of Medicine, Division of Cardiology, University of
California, San Francisco, United States
(Redberg) Women's Cardiovascular Services, 505 Parnassus Ave, United
States
(Redberg) School of Medicine, Division of Cardiology, University of
California, San Francisco, San Francisco, CA 94143-0124, United States
Title
Gender bias in studies for food and drug administration premarket approval
of cardiovascular devices.
Source
Circulation: Cardiovascular Quality and Outcomes. 4 (2) (pp 165-171),
2011. Date of Publication: March 2011.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background-Cardiovascular devices can have different safety and
effectiveness profiles in men and women. The type and quality of
sex-specific data reviewed by the Food and Drug Administration (FDA)
before approval of these devices are unknown. Methods and Results-We
performed A systematic review of the demographics, comments on gender
bias, and analysis of results by sex for 78 high-risk cardiovascular
devices that received premarket approval by the FDA between 2000 and 2007.
FDA summaries of evidence did not report sex of enrollees in 34 (28%) of
123 studies. For studies reporting sex distribution, the study populations
were, on average, 67% men. There was no increase in the enrollment of
women over time. Explanations for the relatively low percentage of women
often stated that the trials reflected either underlying disease
distribution or referral rates for similar procedures or that the sex
distribution reflected similar or previous trials. Forty-one percent of
studies included a gender bias comment or analysis, and 12 (26%) of 47 of
these analyses identified some difference in device safety or
effectiveness by sex. Conclusions-There is A lack of sex-specific safety
and effectiveness data for high-risk cardiovascular devices before FDA
approval. The justifications for this lack of evidence may perpetuate the
status quo. More rigorous FDA requirements for sex-specific data before
device approval could present an opportunity to improve cardiovascular
outcomes. (Circ Cardiovasc Qual Outcomes. 2011;4:165-171.). 2011 American
Heart Association, Inc.

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Accession Number
2011353564
Authors
Truong Q.A. Murphy S.A. McCabe C.H. Armani A. Cannon C.P.
Institution
(Truong) Division of Cardiology, Massachusetts General Hospital, Harvard
Medical School, United States
(Murphy, McCabe, Armani, Cannon) Cardiovascular Division, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Cannon) TIMI Study Group, 350 Longwood Ave, Boston, MA 02115, United
States
Title
Benefit of intensive statin therapy in women results from PROVE IT-TIMI
22.
Source
Circulation: Cardiovascular Quality and Outcomes. 4 (3) (pp 328-336),
2011. Date of Publication: May 2011.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background: Despite the known benefit of intensive statin therapy for
reducing future cardiovascular events, its effectiveness in women has been
questioned by someMethods and Results: In the Pravastatin or Atorvastatin
Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22
(PROVE IT-TIMI 22) trial, 911 (21.9%) women and 3251 (78.1%) men were
randomized to intensive statin (atorvastatin 80 mg) versus standard
therapy (pravastatin 40 mg) therapy for a median duration of 2.1 yearsThe
primary end point was death, myocardial infarction, unstable angina;
revascularization (occurring after 30 days); or strokeSafety end points
included elevations in liver function tests, creatine kinase, and
myalgias/myositisWomen had a reduction in low-density lipoprotein (LDL) of
42.8% from baseline at 30 days (to a median of 60 mg/dL) in the intensive
therapy arm, with 88.8% reaching the LDL goal of <100 mg/dL and 65.0% of
<70 mg/dL, compared with a 16.8% reduction in LDL (to a median of 88
mg/dL) in the standard therapy armWomen receiving intensive statin therapy
had a significant 25% relative reduction over standard dose (hazard ratio,
0.75; 95% CI, 0.57 to 0.99; P=0.04) for the primary composite end point
compared with a 14% reduction for men (hazard ratio, 0.86; 95% CI, 0.75 to
0.99; P=0.04; P-interaction, 0.38)No differences were observed between
sexes for safety (all P-interaction >=0.11)Conclusions: This trial
provides evidence that both women and men derived benefit from intensive
statin therapy after acute coronary syndrome, and thus, sex should not be
a factor in determining who should be treated with intensive statin
therapy. 2011 American Heart Association, Inc.

<10>
Accession Number
2011343144
Authors
Preiss D. Seshasai S.R.K. Welsh P. Murphy S.A. Ho J.E. Waters D.D. DeMicco
D.A. Barter P. Cannon C.P. Sabatine M.S. Braunwald E. Kastelein J.J.P. De
Lemos J.A. Blazing M.A. Pedersen T.R. Tikkanen M.J. Sattar N. Ray K.K.
Institution
(Preiss, Welsh, Sattar) BHF Glasgow Cardiovascular Research Centre,
University of Glasgow, 126 University Pl, Glasgow G12 8TA, United Kingdom
(Seshasai) Department of Public Health and Primary Care, University of
Cambridge, Cambridge, United Kingdom
(Murphy, Cannon, Sabatine, Braunwald) TIMI Study Group, Cardiovascular
Division, Harvard Medical School, Boston, MA, United States
(Ho) Cardiovascular Division, Department of Medicine, Brigham and Women's
Hospital, Boston, United States
(Waters) Department of Medicine, University of California, San Francisco,
CA, United States
(DeMicco) Global Pharmaceuticals, Pfizer, New York, NY, United States
(Barter) Heart Research Institute, Sydney, NSW, Australia
(Kastelein) Department of Vascular Medicine, Academic Medical Centre,
University of Amsterdam, Amsterdam, Netherlands
(De Lemos) Division of Cardiology, University of Texas Southwestern
Medical Center, Dallas, TX, United States
(Blazing) Duke Clinical Research Institute, Durham, NC, United States
(Pedersen) University of Oslo, Centre for Preventative Medicine, Oslo
University Hospital, Ulleval, Oslo, Norway
(Tikkanen) University of Helsinki, Helsinki University Hospital,
Folkhalsan Research Center, Helsinki, Finland
(Ray) Division of Cardiac and Vascular Sciences, St. George's University
of London, Cranmer Terrace, London SW17 0RE, United Kingdom
Title
Risk of incident diabetes with intensive-dose compared with moderate-dose
statin therapy: A meta-analysis.
Source
JAMA - Journal of the American Medical Association. 305 (24) (pp
2556-2564), 2011. Date of Publication: June 22-29, 2011.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: A recent meta-analysis demonstrated that statin therapy is
associated with excess risk of developing diabetes mellitus. Objective: To
investigate whether intensive-dose statin therapy is associated with
increased risk of new-onset diabetes compared with moderate-dose statin
therapy. Data Sources: We identified relevant trials in a literature
search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled
Trials (January 1, 1996, through March 31, 2011). Unpublished data were
obtained from investigators. Study Selection: We included randomized
controlled end-point trials that compared intensive-dose statin therapy
with moderate-dose statin therapy and included more than 1000 participants
who were followed up for more than 1 year. Data Extraction: Tabular data
provided for each trial described baseline characteristics and numbers of
participants developing diabetes and experiencing major cardiovascular
events (cardiovascular death, nonfatal myocardial infarction or stroke,
coronary revascularization). We calculated trial-specific odds ratios
(ORs) for new-onset diabetes and major cardiovascular events and combined
these using random-effects model meta-analysis. Between-study
heterogeneity was assessed using the I² statistic. Results: In
5 statin trials with 32 752 participants without diabetes at baseline,
2749 developed diabetes (1449 assigned intensive-dose therapy, 1300
assigned moderate-dose therapy, representing 2.0 additional cases in the
intensive-dose group per 1000 patient-years) and 6684 experienced
cardiovascular events (3134 and 3550, respectively, representing 6.5 fewer
cases in the intensive-dose group per 1000 patient-years) over a weighted
mean (SD) follow-up of 4.9 (1.9) years. Odds ratios were 1.12 (95%
confidence interval [CI], 1.04-1.22; I² = 0%) for new-onset
diabetes and 0.84 (95% CI, 0.75-0.94; I² = 74%) for
cardiovascular events for participants receiving intensive therapy
compared with moderate-dose therapy. As compared with moderate-dose statin
therapy, the number needed to harm per year for intensive-dose statin
therapy was 498 for new-onset diabetes while the number neededto treat per
year for intensive-dose statin therapy was 155 for cardiovascular events.
Conclusion: In a pooled analysis of data from 5 statin trials,
intensive-dose statin therapy was associated with an increased risk of
new-onset diabetes compared with moderate-dose statin therapy. 2011
American Medical Association. All rights reserved.

<11>
Accession Number
2011312280
Authors
Holzinger C. Podesser B.K. Haumberger W. Buss M. Dietl W. Kassal H.
Institution
(Holzinger, Podesser, Dietl, Kassal) Department of Cardiac Surgery,
Landesklinikum St. Polten, Probst Fuhrerstrase 4, 3100 St. Polten, Austria
(Haumberger, Buss) Department of Anaesthesia and Intensive Care,
Landesklinikum St. Polten, St. Polten, Austria
Title
Transcatheter aortic valve implantation - TAVI: Early results from the
transapical approach in a multimorbid, elderly, high-risk population.
Source
European Surgery - Acta Chirurgica Austriaca. 43 (2) (pp 99-102), 2011.
Date of Publication: April 2011.
Publisher
Springer Wien (Sachsenplatz 4-6, P.O. Box 89, Vienna A-1201, Austria)
Abstract
BACKGROUND: Report of our single centre experiences with transcatheter
aortic valve implantation (TAVI) in a group of high-risk patients without
extracorporeal circulation. METHODS: TAVI was performed via a left-sided
small anterolateral minithoracotomy on the beating heart. A pericardial
xenograft fixed within a stainless steel, balloon expandable stent
(Edwards SAPIEN THV, Edwards Lifesciences) was implanted. RESULTS:
Twenty-two consecutive patients (80.3 a) were operated on from 11/09 until
12/10 using fluoroscopic and echocardiographic visualization. Average
EuroSCORE and STS-score predicted risk for mortality was 24.8 +/- 6.5 and
14.3 +/- 4.5, respectively. Transapical valve positioning was performed
successful in 22 patients, two required immediate conversion to
sternotomy, because of coronary artery obstruction and severe aortic
regurgitation. Echocardiography revealed minor paravalvular or central
leakage in 8 patients. One patient died in-hospital on day 40. Actuarial
survival was 95.5% at a follow-up interval of 223 days (range 19-391
days). Conclusions: TAVI can be performed safely with good results in
selected high-risk patients. Long-term valve performance will need to be
evaluated. 2011 Springer-Verlag.

<12>
Accession Number
2011312276
Authors
Podesser B.K. Holzinger C. Binder K. Schor I. Haumberger W. Valicek G.
Wendler R. Ameri L. Dietl W. Trescher K. Kassal H.
Institution
(Podesser, Holzinger, Binder, Schor, Dietl, Trescher, Kassal) Department
of Cardiac Surgery, Landesklinikum St. Polten, Probst Fuhrerstrase 4, 3100
St. Polten, Austria
(Podesser, Holzinger, Binder, Schor, Dietl, Trescher, Kassal) Karl
Landsteiner Institute for Implementation of Innovative Techniques in
Cardiac Surgery, St. Polten, Austria
(Haumberger, Valicek, Wendler) Department of Anaesthesia and Intensive
Care, Landesklinikum St. Polten, St. Polten, Austria
(Ameri) Department of Medicine III, Landesklinikum St. Polten, St. Polten,
Austria
Title
Off-pump multi-vessel revascularization in patients with poor left
ventricular function.
Source
European Surgery - Acta Chirurgica Austriaca. 43 (2) (pp 103-109), 2011.
Date of Publication: April 2011.
Publisher
Springer Wien (Sachsenplatz 4-6, P.O. Box 89, Vienna A-1201, Austria)
Abstract
BACKGROUND: The subset of patients that benefit most from off-pump CABG
remains controversial. This study randomly compared off- with on-pump CABG
in patients with poor EF. METHODS: Fifty-one patients were included in
this study and randomized to undergo off- (n = 26) or on-pump (n = 25)
CABG. Inclusion criteria were EF < 35% and multi-vessel disease. The
primary end-points were the time to extubation, a composite end-point and
mortality. RESULTS: EF, Euro-score, the number of grafts and inotropic
support were similar between groups. In contrast time to extubation was
11.2 +/- 3.8 hours in the off-pump versus 16.4 +/- 2.7 hours in the
on-pump group (p < 0.05). There were no hospital deaths in both groups.
However, 2 off-pump (8%) compared to 5 on-pump (20%) patients presented a
composite end-point. CONCLUSIONS: In this high-risk cohort off-pump CABG
reduces time to extubation and in-hospital morbidity. 2011
Springer-Verlag.

<13>
Accession Number
2011344927
Authors
Smits P.C. Kedhi E. Royaards K.-J. Joesoef K.S. Wassing J.
Rademaker-Havinga T.A.M. McFadden E.
Institution
(Smits, Kedhi, Royaards, Joesoef, Wassing, McFadden) Interventional
Cardiology, Department of Cardiology, Maasstad Ziekenhuis, Groene
Hilledijk 315, Rotterdam 3075 EA, Netherlands
(Rademaker-Havinga) Cardialysis, Rotterdam, Netherlands
Title
2-year follow-up of a randomized controlled trial of everolimus- and
paclitaxel-eluting stents for coronary revascularization in daily
practice: COMPARE (Comparison of the everolimus eluting XIENCE-V stent
with the paclitaxel eluting TAXUS LIBERT stent in all-comers: A randomized
open label trial).
Source
Journal of the American College of Cardiology. 58 (1) (pp 11-18), 2011.
Date of Publication: 28 Jun 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purpose of this study was to compare the safety and
efficacy of the Xience V (Abbott Vascular, Santa Clara, California)
everolimus-eluting stent (EES) with the Taxus Liberte (Boston Scientific,
Natick, Massachusetts) paclitaxel-eluting stent (PES) at 2-year follow-up.
Background: COMPARE (Comparison of the everolimus eluting XIENCE-V stent
with the paclitaxel eluting TAXUS LIBERT stent in all-comers: a randomized
open label trial) demonstrated a superior clinical outcome of EES over PES
at 1 year in all comers. Whether this superiority is maintained after
discontinuation, at 12 months, of dual antiplatelet therapy is unclear.
Methods: Patients undergoing percutaneous coronary intervention with
limited exclusion criteria were randomly allocated to EES or PES. The
2-year pre-specified endpoints are composites of safety and efficacy and
stent thrombosis. Results: Follow-up was completed in 1,795 of 1,800
patients (99.7%). The groups had similar baseline characteristics. At 2
years, significantly fewer EES patients took dual antiplatelet therapy
(11.4% vs. 15.4%, p = 0.02). The primary composite of all death, nonfatal
myocardial infarction, and target vessel revascularization occurred in
9.0% of EES patients and 13.7% of PES patients (relative risk [RR]: 0.66;
95% confidence interval [CI]: 0.50 to 0.86) driven by a lower rate of
myocardial infarction (3.9% vs. 7.5%; RR: 0.52; 95% CI: 0.35 to 0.77) and
target vessel revascularization (3.2% vs. 8.0%; RR: 0.41; 95% CI: 0.27 to
0.62), in parallel with a lower rate of definite or probable stent
thrombosis (0.9% vs. 3.9%; RR: 0.23; 95% CI: 0.11 to 0.49). Differences
significantly increased between 1- and 2-year follow-up for the primary
composite endpoint (p = 0.04), target vessel revascularization (p = 0.02),
and definite or probable stent thrombosis (p = 0.02). Conclusions: The
substantial clinical benefit of the EES over the PES with regard to
measures of both safety and efficacy is maintained at 2 years in real-life
practice with an increasing benefit in terms of safety and efficacy
between 1 year and 2 years. Comparison of the everolimus eluting XIENCE-V
stent with the paclitaxel eluting TAXUS LIBERT stent in all-comers: a
randomized open label trial: The COMPARE Trial [COMPARE 1]; NCT01016041)
2011 American College of Cardiology Foundation.

<14>
Accession Number
2011341306
Authors
Vink M.A. Patterson M.S. Etten J.V. Ijsselmuiden A.J.J. Dirksen M.T.
Amoroso G. Slagboom T. Laarman G. Kiemeneij F.
Institution
(Vink, Patterson, Etten, Ijsselmuiden, Dirksen, Amoroso, Slagboom,
Kiemeneij) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Oosterpark 9, Amsterdam 1091 AC, Netherlands
(Laarman) Department of Cardiology, TweeSteden Ziekenhuis, Tilburg,
Netherlands
Title
A randomized comparison of manual versus mechanical thrombus removal in
primary percutaneous coronary intervention in the treatment of ST-segment
elevation myocardial infarction (TREAT-MI).
Source
Catheterization and Cardiovascular Interventions. 78 (1) (pp 14-19),
2011. Date of Publication: 01 Jul 2011.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objectives: The objective of this study was to compare the efficacy and
long-term clinical outcome of manual thrombus aspiration with the Export
catheter (Medtronic, Minneapolis, MN) versus mechanical thrombus
cutting/aspiration with the X-sizer system (eV3, White Bear Lake, MN) in
primary percutaneous coronary intervention (PPCI). Background: In PPCI for
acute ST-segment elevation myocardial infarction (STEMI), markers of
myocardial reperfusion are improved with adjunctive thrombectomy. Previous
studies of different devices showed a variability in performance,
suitability, and short-term clinical outcome. In current literature, no
direct comparison is available. Methods: We prospectively randomized 201
patients admitted for PPCI for STEMI to either the Export catheter or the
X-sizer prior to stent deployment. Technical success in advancing to and
across the lesion, improvement of flow, reduction of thrombus, and the
effect on ST-segment resolution were examined. The primary endpoint of the
follow-up study was the combined endpoint of cardiac death, recurrent
myocardial infarction (MI), or target-vessel revascularization (TVR) at 3
years. Results: Although the Export catheter was more successfully
deployed, other procedural parameters were similar with a trend toward
better ST-segment resolution (56.6% vs. 44%; P = 0.06) as compared to the
X-sizer system. The occurrence of the primary clinical endpoint at 3 years
was 22.2% and 18.6%, respectively (HR 1.20; 95% CI 0.65-2.22; P = 0.35).
Conclusion: Despite shorter procedural times, better lesion crossing, and
fewer complications, both surrogate endpoints as well as 3-year clinical
follow-up were similar with the use of the Export catheter as compared to
the X-sizer system. Copyright 2011 Wiley-Liss, Inc.

<15>
Accession Number
2011322142
Authors
Ahmed W.G. Al-Afify A.A. Abu-Elnasr N.E.-H.N. El-Gaby S.S. Mohamed H.F.
Institution
(Ahmed, Abu-Elnasr, El-Gaby, Mohamed) Department of Aneshthesia, Faculty
of medicine for Girls Al-Azhar Universiy, Egypt
(Al-Afify) Department of Cardiology, Tanta Universiy, Egypt
Title
Effect of high thoracic epidural analgesia on left ventricular function in
patients with coronary artery disease undergoing elective non-cardiac
surgery.
Source
Research Journal of Cardiology. 4 (1) (pp 28-37), 2011. Date of
Publication: 2011.
Publisher
Academic Journals Inc. (244, 5th avenue, No. 2218, New City NY 10001,
United States)
Abstract
Coronary artery disease is a major risk factor for perioperative
myocardial infarction. In patients with Coronary Artery Disease (CAD),
vasoconstriction is induced through activation of the sympathetic nervous
system. Both alpha1-and alpha2-adrenergic epicardial and microvascular
constrictions are potent initiators of myocardial ischemia. But, there is
still controversy whether High Thoracic Epidural Analgesia (HTEA) improves
left ventricular function. The main aim of this study was to assess
anti-ischemic effect of high thoracic epidural analgesia in patients with
coronary artery disease undergoing elective non-cardiac surgery and to
investigate the effects of sympathetic blockade by HTEA on systolic and
diastolic LV function. Forty eight patients were randomized to receive
either general anesthesia (control group n=24) or general anesthesia with
high thoracic epidural analgesia(HTEA group n=24). Patients were subjected
to ambulatory Holter monitoring to assess the effect of HTEA in myocardial
ischemia. Left ventricular systolic/diastolic function were assessed by
echocardiography using the fractional area change. Echocardiographic and
hemodynamic measures were recorded before and after institution of HTEA.
There was no significant difference between the two groups regarding the
heart rate and mean arterial blood pressures (p>0.05) in the baseline
values. However, a significant reduction in heart rate and mean arterial
blood pressure(p<0.05) was observed till 48 h post operatively in HTEA
group as compared to the control group. The post operative cardiac
troponin I increase was significant in control group versus HTEA group (p
= 0.0001). The incidence of myocardial ischemia was significantly low in
HTEA group than in control group. The S-T segment changes were noted in 8%
of patients in HTEA group as compared to 38% of patients in control group
(p = 0.016). There were no significant changes in left ventricular
systolic function EF and fractional area change FAC in both groups (FAC
55.4+/-6.3 to 54.22+/-6.8 (p-value = 1.00)). Also the improvement in LV
diastolic function was significant in HTEA group than the control group.
In conclusion, the high thoracic epidural analgesia reduced the incidence
of myocardial ischemia and improved the diastolic function in patients
with coronary artery disease undergoing elective non-cardiac surgery.
Therefore, its use might decrease the cardiac morbidity particularly in
patients with preoperative ST ischemic changes and in patients with
pseudo-normalization, or restrictive diastolic dysfunction. 2011 Academic
Journals Inc.

<16>
[Use Link to view the full text]
Accession Number
2011359670
Authors
Smego Jr. R.A. Ahmad H.
Institution
(Smego Jr., Ahmad) Department of Medicine, Commonwealth Medical College,
01 Madison Avenue, Scranton, PA 18510, United States
Title
The role of fluconazole in the treatment of candida endocarditis: A
meta-analysis.
Source
Medicine. 90 (4) (pp 237-249), 2011. Date of Publication: July 2011.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
The treatment of Candida infective endocarditis generally involves
infected valve removal accompanied by antifungal therapy with amphotericin
B or a lipid-based derivative, with or without flucytosine. While often
used as chronic suppressive therapy in these patients, the precise role
for fluconazole has not been established. We conducted a meta-analysis of
64 literature cases of Candida endocarditis whose management did not
include valve replacement but who received fluconazole, alone or
concurrently or in sequence with 1 or more other antifungal
drugs.Forty-nine (77%) patients were cured (n = 44) or improved (n = 5), 4
relapsed (6%), and 11 failed (10 of whom died) (17%). Among 19 patients
for whom fluconazole was administered as the sole antifungal therapy, 11
(58%) were cured or improved. In contrast, among 45 patients who received
1 or more other antifungal agents in addition to fluconazole, 38 (84%)
were cured or improved (p = 0.02). Eighteen of 21 (86%) patients with
native valve infection were cured or improved compared with 13 of 19 (68%)
patients with prosthetic valve endocarditis (p = 0.13). The mean duration
of successful fluconazole regimens was 134 days. Twenty of 21 (95%)
patients who received fluconazole as chronic suppressive therapy for >=6
months were cured. Prognosis was independent of Candida species or patient
age. Among 23 historical controls managed with fluconazole-containing
antifungal therapy plus valvular surgery, survival was 91%.In conclusion,
fluconazole-containing, combination antifungal therapy, with or without
concomitant valve replacement, and followed by prolonged, perhaps
indefinite fluconazole suppression, is effective in patients with Candida
endocarditis. 2011 by Lippincott Williams & Wilkins.

<17>
Accession Number
2011354163
Authors
Stone G.W. Witzenbichler B. Guagliumi G. Peruga J.Z. Brodie B.R. Dudek D.
Kornowski R. Hartmann F. Gersh B.J. Pocock S.J. Dangas G. Wong S.C. Fahy
M. Parise H. Mehran R.
Institution
(Stone, Fahy, Parise) New York-Presbyterian Hospital, Columbia University,
Medical Center and the Cardiovascular Research Foundation, New York, NY,
United States
(Witzenbichler) Charite Campus Benjamin Franklin, Berlin, Germany
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Peruga) Silesian Centre for Heart Disease, Lodz, Poland
(Brodie) LeBauer Cardiovascular Research Foundation and Moses Cone
Hospital, Greensboro, NC, United States
(Dudek) Jagiellonian University, Krakow, Poland
(Kornowski) Rabin Medical Centre, Petach Tikva, Israel
(Hartmann) Universitatsklinikum Schleswig-Holstein, Lubeck, Germany
(Gersh) Mayo Clinic, Rochester, MN, United States
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Dangas, Mehran) Mount Sinai Medical Center, Cardiovascular Research
Foundation, New York, NY, United States
(Wong) New York-Presbyterian Hospital, Weill Cornell Medical Center, New
York, NY, United States
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, 111 East 59th Street, New York, NY 10022, United States
Title
Heparin plus a glycoprotein IIb/IIIa inhibitor versus bivalirudin
monotherapy and paclitaxel-eluting stents versus bare-metal stents in
acute myocardial infarction (HORIZONS-AMI): Final 3-year results from a
multicentre, randomised controlled trial.
Source
The Lancet. 377 (9784) (pp 2193-2204), 2011. Date of Publication: June
25-July 1, 2011.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Primary results of the HORIZONS-AMI trial have been previously reported.
In this final report, we aimed to assess 3-year outcomes. HORIZONS-AMI was
a prospective, open-label, randomised trial undertaken at 123 institutions
in 11 countries. Patients aged 18 years or older were eligible for
enrolment if they had ST-segment elevation myocardial infarction (STEMI),
presented within 12 h after onset of symptoms, and were undergoing primary
percutaneous coronary intervention. By use of a computerised interactive
voice response system, we randomly allocated patients 1:1 to receive
bivalirudin or heparin plus a glycoprotein IIb/IIIa inhibitor (GPI;
pharmacological randomisation; stratified by previous and expected drug
use and study site) and, if eligible, randomly allocated 3:1 to receive a
paclitaxel-eluting stent or a bare metal stent (stent randomisation;
stratified by pharmacological group assignment, diabetes mellitus status,
lesion length, and study site). We produced Kaplan-Meier estimates of
major adverse cardiovascular events at 3 years by intention to treat. This
study is registered with ClinicalTrials.gov, number NCT00433966. Compared
with 1802 patients allocated to receive heparin plus a GPI, 1800 patients
allocated to bivalirudin monotherapy had lower rates of all-cause
mortality (59 vs 77, difference -19 [-35 to -02], HR 075 [058-097];
p=003), cardiac mortality (29 vs 51, -22 [-35 to -09], 056 [040-080];
p=0001), reinfarction (62 vs 82, -19 [-37 to -02], 076 [059-099]; p=004),
and major bleeding not related to bypass graft surgery (69 vs 105, -36
[-55 to -17], 064 [051-080]; p=00001) at 3 years, with no significant
differences in ischaemia-driven target vessel revascularisation, stent
thrombosis, or composite adverse events. Compared with 749 patients who
received a bare-metal stent, 2257 patients who received a
paclitaxel-eluting stent had lower rates of ischaemia-driven target lesion
revascularisation (94 vs 151, -57 [-86 to -27], 060 [048-076]; p<00001)
after 3 years, with no significant differences in the rates of death,
reinfarction, stroke or stent thrombosis. Stent thrombosis was high (>=45)
in both groups. The effectiveness and safety of bivalirudin monotherapy
and paclitaxel-eluting stenting are sustained at 3 years for patients with
STEMI undergoing primary percutaneous coronary intervention. Boston
Scientific and The Medicines Company. 2011 Elsevier Ltd.

<18>
Accession Number
2011354161
Authors
Baigent C. Landray M.J. Reith C. Emberson J. Wheeler D.C. Tomson C. Wanner
C. Krane V. Cass A. Craig J. Neal B. Jiang L. Hooi L.S. Levin A. Agodoa L.
Gaziano M. Kasiske B. Walker R. Massy Z.A. Feldt-Rasmussen B.
Krairittichai U. Ophascharoensuk V. Fellstrom B. Holdaas H. Tesar V.
Wiecek A. Grobbee D. De Zeeuw D. Gronhagen-Riska C. Dasgupta T. Lewis D.
Herrington W. Mafham M. Majoni W. Wallendszus K. Grimm R. Pedersen T.
Tobert J. Armitage J. Baxter A. Bray C. Chen Y. Chen Z. Hill M. Knott C.
Parish S. Simpson D. Sleight P. Young A. Collins R.
Institution
(Baigent, Landray, Reith, Emberson, Lewis, Herrington, Mafham,
Wallendszus, Armitage, Baxter, Bray, Chen, Chen, Hill, Knott, Parish,
Simpson, Young, Collins) Clinical Trial Service Unit, Epidemiological
Studies Unit, University of Oxford, Oxford, United Kingdom
(Wheeler) University College London, London, United Kingdom
(Tomson) North Bristol NHS Trust, Bristol, United Kingdom
(Wanner, Krane) Department of Medicine 1, Division of Nephrology,
University of Wuerzburg, Wuerzburg, Germany
(Cass, Neal) George Institute for Global Health, University of Sydney,
Sydney, NSW, Australia
(Craig) Sydney School of Public Health, Children's Hospital at Westmead,
University of Sydney, Sydney, NSW, Australia
(Jiang) China Oxford Centre for International Health Research, Fuwai
Hospital, Beijing, Chinese Academy of Medical Sciences, China
(Hooi) Department of Medicine, Haemodialysis Unit, Sultanah Aminah
Hospital, Johor Bahru, Malaysia
(Levin) University of British Columbia, Vancouver, BC, Canada
(Agodoa) National Institute of Diabetes and Digestive and Kidney Diseases,
National Institutes of Health, Bethesda, MD, United States
(Gaziano) Harvard Medical School, VA Boston, Brigham and Women's Hospital,
Boston, MA, United States
(Kasiske) University of Minnesota, Minneapolis, MN, United States
(Walker) Dunedin School of Medicine, University of Otago, Otago, New
Zealand
(Massy) Division of Clinical Pharmacology, Amiens University Hospital,
University of Picardie Jules Verne, Amiens, France
(Feldt-Rasmussen) Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
(Krairittichai) Division of Nephrology, Department of Medicine, Rajavithi
Hospital, Bangkok, Thailand
(Ophascharoensuk) Department of Internal Medicine, Faculty of Medicine,
Chiang Mai University, Chiang Mai, Thailand
(Fellstrom) University Hospital, Uppsala, Sweden
(Holdaas) Department of Organ Transplantation, Oslo University Hospital,
Rikshospitalet, Oslo, Norway
(Tesar) Department of Nephrology, General University Hospital, Charles
University, Prague, Czech Republic
(Wiecek) Department of Nephrology, Endocrinology and Metabolic Diseases,
Medical University of Silesia, Katowice, Poland
(Grobbee) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
(De Zeeuw) Department of Clinical Pharmacology, University Medical Center
Groningen, Groningen, Netherlands
(Gronhagen-Riska) Helsinki University Hospital, Helsinki, Finland
(Dasgupta) Oxford Radcliffe Hospitals NHS Trust, Oxford, United Kingdom
(Majoni) Royal Darwin Hospital, Darwin, NT, Australia
(Grimm) Berman Center for Outcomes and Clinical Research, Hennepin County
Medical Center, University of Minnesota, Minneapolis, MN, United States
(Pedersen) University of Oslo, Centre of Preventive Medicine, Oslo
University Hospital Ullevl, Oslo, Norway
(Tobert) Tobert Medical Consulting LLC, Warren, NJ, United States
(Sleight) Nuffield Department of Clinical Medicine, John Radcliffe
Hospital, Oxford, United Kingdom
(Baigent) Clinical Trial Service Unit, Epidemiological Studies Unit
(CTSU), Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford
OX3 7LF, United Kingdom
Title
The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in
patients with chronic kidney disease (Study of Heart and Renal
Protection): A randomised placebo-controlled trial.
Source
The Lancet. 377 (9784) (pp 2181-2192), 2011. Date of Publication: June
25-July 1, 2011.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Lowering LDL cholesterol with statin regimens reduces the risk of
myocardial infarction, ischaemic stroke, and the need for coronary
revascularisation in people without kidney disease, but its effects in
people with moderate-to-severe kidney disease are uncertain. The SHARP
trial aimed to assess the efficacy and safety of the combination of
simvastatin plus ezetimibe in such patients. This randomised double-blind
trial included 9270 patients with chronic kidney disease (3023 on dialysis
and 6247 not) with no known history of myocardial infarction or coronary
revascularisation. Patients were randomly assigned to simvastatin 20 mg
plus ezetimibe 10 mg daily versus matching placebo. The key prespecified
outcome was first major atherosclerotic event (non-fatal myocardial
infarction or coronary death, non-haemorrhagic stroke, or any arterial
revascularisation procedure). All analyses were by intention to treat.
This trial is registered at ClinicalTrials.gov, NCT00125593, and
ISRCTN54137607. 4650 patients were assigned to receive simvastatin plus
ezetimibe and 4620 to placebo. Allocation to simvastatin plus ezetimibe
yielded an average LDL cholesterol difference of 085 mmol/L (SE 002; with
about two-thirds compliance) during a median follow-up of 49 years and
produced a 17 proportional reduction in major atherosclerotic events (526
[113] simvastatin plus ezetimibe vs 619 [134] placebo; rate ratio [RR]
083, 95 CI 074-094; log-rank p=00021). Non-significantly fewer patients
allocated to simvastatin plus ezetimibe had a non-fatal myocardial
infarction or died from coronary heart disease (213 [46] vs 230 [50]; RR
092, 95 CI 076-111; p=037) and there were significant reductions in
non-haemorrhagic stroke (131 [28] vs 174 [38]; RR 075, 95 CI 060-094;
p=001) and arterial revascularisation procedures (284 [61] vs 352 [76]; RR
079, 95 CI 068-093; p=00036). After weighting for subgroup-specific
reductions in LDL cholesterol, there was no good evidence that the
proportional effects on major atherosclerotic events differed from the
summary rate ratio in any subgroup examined, and, in particular, they were
similar in patients on dialysis and those who were not. The excess risk of
myopathy was only two per 10 000 patients per year of treatment with this
combination (9 [02] vs 5 [01]). There was no evidence of excess risks of
hepatitis (21 [05] vs 18 [04]), gallstones (106 [23] vs 106 [23]), or
cancer (438 [94] vs 439 [95], p=089) and there was no significant excess
of death from any non-vascular cause (668 [144] vs 612 [132], p=013).
Reduction of LDL cholesterol with simvastatin 20 mg plus ezetimibe 10 mg
daily safely reduced the incidence of major atherosclerotic events in a
wide range of patients with advanced chronic kidney disease.
Merck/Schering-Plough Pharmaceuticals; Australian National Health and
Medical Research Council; British Heart Foundation; UK Medical Research
Council. 2011 Elsevier Ltd.

<19>
Accession Number
2011355942
Authors
Chiumello D. Chevallard G. Gregoretti C.
Institution
(Chiumello, Chevallard) U.O. Anestesia e Rianimazione, Dipartimento di
Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia Del Dolore,
Ospedale Maggiore Policlinico, via Francesco Sforza 35, Milan 20122, Italy
(Gregoretti) Servizio di Anestesia e Rianimazione, Azienda Ospedaliera
CTO-CRF-Maria Adelaide, Turin, Italy
Title
Non-invasive ventilation in postoperative patients: A systematic review.
Source
Intensive Care Medicine. 37 (6) (pp 918-929), 2011. Date of Publication:
June 2011.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Background: Postoperative pulmonary complications, generally defined as
any pulmonary abnormality occurring in the postoperative period, are still
a significant issue in clinical practice increasing hospital length of
stay, morbidity and mortality. Non-invasive ventilation (NIV), primarily
applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic
pulmonary failure, is nowadays also used in perioperative settings.
Objective: Investigate the application and results of preventive and
therapeutic NIV in postsurgical patients. Design: A systematic review.
Data sources: Medical literature databases were searched for articles
about "clinical trials," "randomized controlled trials" and
"meta-analyses." The keywords "cardiac surgery," "thoracic surgery," "lung
surgery," "abdominal surgery," "solid organ transplantation,"
"thoraco-abdominal surgery" and "bariatric surgery" were combined with any
of these: "non-invasive positive pressure ventilation," "continuous
positive airway pressure," "bilevel ventilation," "postoperative
complications," "postoperative care," "respiratory care," "acute
respiratory failure," "acute lung injury" and "acute respiratory distress
syndrome." Results: Twenty-nine articles (N = 2,279 patients) met the
inclusion criteria. Nine studies evaluated NIV in post-abdominal surgery,
three in thoracic surgery, eight in cardiac surgery, three in
thoraco-abdominal surgery, four in bariatric surgery and two in post solid
organ transplantation used both for prophylactic and therapeutic purposes.
NIV improved arterial blood gases in 15 of the 22 prophylactic and in 4 of
the 7 therapeutic studies, respectively. NIV reduced the intubation rate
in 11 of the 29 studies and improved outcome in only 1. Conclusions:
Despite these limited data and the necessity of new randomized trials, NIV
could be considered as a prophylactic and therapeutic tool to improve gas
exchange in postoperative patients. 2011 jointly held by Springer and
ESICM.

<20>
Accession Number
2011366553
Authors
Wilton S.B. Leung A.A. Ghali W.A. Faris P. Exner D.V.
Institution
(Wilton, Ghali, Exner) Libin Cardiovascular Institute of Alberta,
University of Calgary, Calgary, AB, Canada
(Leung, Ghali) Department of Medicine, University of Calgary, Calgary, AB,
Canada
(Wilton, Ghali, Faris, Exner) Department of Community Health Sciences,
University of Calgary, Calgary, AB, Canada
Title
Outcomes of cardiac resynchronization therapy in patients with versus
those without atrial fibrillation: A systematic review and meta-analysis.
Source
Heart Rhythm. 8 (7) (pp 1088-1094), 2011. Date of Publication: July
2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: Whether the benefits observed with cardiac resynchronization
therapy (CRT) are similar in patients with versus those without atrial
fibrillation (AF) is unclear. Furthermore, whether patients with AF
receiving CRT should undergo atrioventricular nodal (AVN) ablation remains
uncertain. Objective: The purpose of this study was to compare outcomes in
patients with and those without AF receiving CRT and to evaluate the
influence of AVN ablation on outcomes in patients with AF. Methods: A
systematic review and meta-analysis was performed. Outcomes included
death, CRT nonresponse, and changes in left ventricular (LV) remodeling,
quality of life (QoL), and 6-minute hall walk distance (6MWD). Results:
Twenty-three observational studies were included and followed a total of
7,495 CRT recipients, 25.5% with AF, for a mean of 33 months. AF was
associated with an increased risk of nonresponse to CRT (34.5% vs 26.7%;
pooled relative risk [RR] 1.32; 95% confidence interval [CI] 1.12, 1.55; P
= .001)) and all-cause mortality (10.8% vs 7.1% per year, pooled RR 1.50,
95% CI 1.08, 2.09; P = .015). The presence of AF was also associated with
less improvement in QoL, 6-minute hall walk distance, and LV end-systolic
volume but not LV ejection fraction. Among patients with AF, AVN ablation
appeared favorable with a lower risk of clinical nonresponse (RR 0.40; 95%
CI 0.28, 0.58; P <.001) and a reduced risk of death. Conclusion: The
benefits of CRT appear to be attenuated in patients with AF. The presence
of AF is associated with an increased risk of clinical nonresponse and
death than in patients without AF. AVN ablation may improve CRT outcomes
in patients with AF. 2011 Heart Rhythm Society. All rights reserved.

<21>
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Accession Number
2011360399
Authors
Oscarsson A. Oster S. Fredrikson M. Lindahl T.L. Eintrei C.
Institution
(Oscarsson, Oster, Eintrei) Department of Anaesthesia and Intensive Care,
University Hospital, SE-58185 Linkoping, Sweden
(Fredrikson) Department of Clinical and Experimental Medicine, Division of
Occupational and Environmental Medicine, Linkoping, Sweden
(Lindahl) Division of Clinical Chemistry, University of Linkoping,
Linkoping, Sweden
Title
Platelet function assessed by whole-blood aggregometry in patients
undergoing non-cardiac surgery.
Source
European Journal of Anaesthesiology. 28 (5) (pp 363-369), 2011. Date of
Publication: May 2011.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Background The risk/benefit of continuing low-dose acetylsalicylic acid
(aspirin) for secondary prevention in the perioperative period is still
debated. The primary aim of this study was to determine the effect of
acetylsalicylic acid compared with placebo on platelet function in the
perioperative period. Methods This is a subgroup analysis of a randomised,
doubleblind, placebo-controlled multicentre study. High-risk patients
undergoing major non-cardiac surgery were randomised to 75mg
acetylsalicylic acid or placebo 7 days preoperatively, until the third
postoperative day. In 36 patients, platelet function in response to
arachidonic acid was assessed by whole-blood impedance aggregometry using
a multiplate analyser 1 h before surgery, directly after surgery and 48 h
postoperatively. Results The platelet function was significantly reduced
in patients treated with acetylsalicylic acid compared with placebo in the
preoperative period [200 aggregation units (AU) min (interquartile range
[IQR] 133-261AUmin^-1) vs. 860AUmin (IQR 800-1010AUmin),
P<0.001] as well as postoperatively [198AUmin (IQR 138-270AUmin) vs.
605AUmin (IQR 434-836AUmin), P<0.001]. The platelet response was
significantly reduced postoperatively compared with preoperatively in
patients receiving placebo [860AUmin (IQR 800-1010AUmin) vs. 605AUmin (IQR
434-861AUmin), P=0.0009]. No significant differences were found between
pre-and postoperative platelet function in patients on acetylsalicylic
acid [200AUmin (IQR 133-261AUmin) vs. 198AUmin (133-270AUmin), P=0.21].
Conclusion Multiplate whole-blood impedance aggregometry demonstrates
acetylsalicylic affect in preoperative as well as postoperative samples
derived from patients undergoing noncardiac surgery. 2011 Copyright
European Society of Anaesthesiology.

<22>
Accession Number
2011321508
Authors
Sharma V. Singh A. Kansara B. Karlekar A.
Institution
(Sharma, Singh, Kansara, Karlekar) Departments of Anaesthesiology and
Critical Care, Escorts Heart Institute, Research Centre Ltd., Okhla Road,
New Delhi - 110 025, India
Title
Comparison of transthoracic electrical bioimpedance cardiac output
measurement with thermodilution method in post coronary artery bypass
graft patients.
Source
Annals of Cardiac Anaesthesia. 14 (2) (pp 104-110), 2011. Date of
Publication: May-August 2011.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Transthoracic electrical bioimpedance (TEB) has been proposed as a
non-invasive, continuous, and cost-effective method of cardiac output (CO)
measurement. In this prospective, non-randomized, clinical study, we
measured CO with NICOMON (Larsen and Toubro Ltd., Mysore, India) and
compared it with thermodilution (TD) method in patients after off-pump
coronary artery bypass (OPCAB) graft surgery. We also evaluated the effect
of ventilation (mechanical and spontaneous) on the measurement of CO by
the two methods. Forty-six post-OPCAB patients were studied at five
predefined time points during controlled ventilation and at five time
points when breathing spontaneously. A total of 230 data pairs of CO were
obtained. During controlled ventilation, TD CO values ranged from 2.29 to
6.74 L/min (mean 4.45 +/- 0.85 L/min), while TEB CO values ranged from
1.70 to 6.90 L/min (mean 4.43 +/- 0.94 L/min). The average correlation (r)
was 0.548 (P = 0.0002), accompanied by a bias of 0.015 L/min and precision
of 0.859 L/min. In spontaneously breathing patients, TD CO values ranged
from 2.66 to 6.92 L/min (mean 4.66 0.76 L/min), while TEB CO values ranged
from 3.08 to 6.90 L/min (mean 4.72 0.82 L/min). Their average correlation
was relatively poor (r = 0.469, P= 0.002), accompanied by a bias of 0.059
L/min and precision of 0.818 L/min. The overall percent errors between TD
CO and TEB CO were 19.3% (during controlled ventilation) and 17.4% (during
spontaneous breathing), respectively. To conclude, a fair correlation was
found between TD CO and TEB CO measurements among post-OPCAB patients
during controlled ventilation. However, the correlation was weak in
spontaneously breathing patients.

<23>
Accession Number
2011321506
Authors
Mukherjee C. Tschernich H. Kaisers U.X. Eibel S. Seeburger J. Ender J.
Institution
(Mukherjee, Tschernich, Eibel, Ender) Department of Anaesthesiology and
Intensive Care Medicine II, Heart Center Leipzig, University of Leipzig,
Struempellstrasse 39, 04289 Leipzig, Germany
(Kaisers) Department of Anaesthesia and Intensive Care Medicine, Medical
Faculty, University of Leipzig, Germany
(Seeburger) Department of Cardiac Surgery, University of Leipzig, Germany
Title
Real-time three-dimensional echocardiographic assessment of mitral valve:
Is it really superior to 2D transesophageal echocardiography.
Source
Annals of Cardiac Anaesthesia. 14 (2) (pp 91-96), 2011. Date of
Publication: May-August 2011.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Aim of our study was to investigate the feasibility of use and possible
additional value of real-time 3D transesophageal echocardiography
(RT-3D-TEE) compared to conventional 2D-TEE in patients undergoing
elective mitral valve repair. After ethical committee approval, patients
were included in this prospective study. After induction of anesthesia, a
comprehensive 2D-TEE examination was performed, followed with RT-3D-TEE.
The intraoperative surgical finding was used as the gold standard for
segmental analysis. Only such segments which were surgically corrected
either by resection or insertion of artificial chords were judged
pathologic. A total of 50 patients were included in this study; usable
data were available from 42 of these patients. Based on the Carpentier
classification, the pathology found was type I in 2 (5%) patients, type II
in 39 (93%) patients and type IIIb in 1 (2%) patient. We found that 3D
imaging of complex mitral disease involving multiple segments, when
compared to 2D-TEE did not show any statistically significant
difference.RT-3D-TEE did not show any major advantage when compared to
conventional 2D-TEE for assessing mitral valve pathology, although further
study in a larger population is required to establish the validity of this
study.

<24>
Accession Number
2011322355
Authors
Kapoor P.M. Mandal B. Chowdhury U.K. Singh S.P. Kiran U.
Institution
(Kapoor, Mandal, Chowdhury, Singh, Kiran) Departments of Cardiac
Anaesthesia and CTVS, CN Centre, All India Institute of Medical Sciences,
New Delhi - 110 029, India
Title
Changes in myocardial lactate, pyruvate and lactate-pyruvate ratio during
cardiopulmonary bypass for elective adult cardiac surgery: Early indicator
of morbidity.
Source
Journal of Anaesthesiology Clinical Pharmacology. 27 (2) (pp 225-232),
2011. Date of Publication: April-June 2011.
Publisher
Journal of Anaesthesiology Clinical Pharmacology (Dayanand Medical College
and Hospital, Ludhiana 141001, India)
Abstract
Background: Myocardial lactate assays have been established as a standard
method to compare various myocardial protection strategies. This study was
designed to test whether coronary sinus (CS) lactates, pyruvate and
lactate-pyruvate (LP) ratio correlates with myocardial dysfunction and
predict postoperative outcomes. Materials and Methods: This prospective
observational study was conducted on 40 adult patients undergoing elective
cardiac surgery with the aid of cardiopulmonary bypass (CPB). CS blood
sampling was done for estimation of myocardial lactate (ML), pyruvate (MP)
and lactate-pyruvate ratio (MLPR) namely: pre-CPB (T1), after removal of
aortic cross clamp (T2) and 30 minutes post-CPB (T3). Results: Baseline
myocardial LPR strongly correlated with Troponin-I at T1 (s: 0.6).
Patients were sub grouped according to the median value of myocardial
lactate (2.9) at baseline T1 into low myocardial lactate (LML) group, mean
(2.39 +/- 0.4 mmol/l), n = 19 and a high myocardial lactate (HML) group,
mean (3.65 +/- 0.9 mmol/l), n = 21. A significant increase in PL, ML, MLPR
and TropI occurred in both groups as compared to baseline. Patients in HML
group had significant longer period of ICU stay. Patients with higher
inotrope score had significantly higher ML (T2, T3). ML with a baseline
value of 2.9 mmol/l had 70.83% sensitivity and 62.5% specificity (ROC
area: 0.7109 Std error: 0.09) while myocardial pyruvate with a baseline
value of 0.07 mmol/l has 79.17% sensitivity and 68.75% specificity (ROC
area: 0.7852, Std error: 0.0765) for predicting inotrope requirement after
CPB. Conclusion: CS lactate, pyruvate and LP ratio correlate with
myocardial function and can predict postoperative outcome.

<25>
[Use Link to view the full text]
Accession Number
2011352033
Authors
Nakada T.-A. Russell J.A. Boyd J.H. McLaughlin L. Nakada E. Thair S.A.
Hirasawa H. Oda S. Walley K.R.
Institution
(Nakada, Russell, Boyd, McLaughlin, Nakada, Thair, Walley) Critical Care
Research Laboratories, University of British Columbia, St. Paul's
Hospital, Vancouver, BC, Canada
(Hirasawa, Oda) Chiba University Graduate School of Medicine, Department
of Emergency and Critical Care Medicine, Inohana, Chuo, Chiba, Japan
Title
Association of angiotensin II type 1 receptor-associated protein gene
polymorphism with increased mortality in septic shock.
Source
Critical Care Medicine. 39 (7) (pp 1641-1648), 2011. Date of
Publication: July 2011.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Objective: Angiotensin II and its postreceptor signaling are crucial in
regulating vasomotor tone. The objective of this study was to test the
hypothesis that single nucleotide polymorphisms in angiotensin II pathway
genes alter outcome of septic shock. Design: Genetic association study and
in vitro experiment. Setting: Intensive care units at academic teaching
centers. Patients: Derivation and validation septic shock cohorts (n = 589
and n = 616, respectively) and a coronary artery bypass surgery cohort (n
= 551). Interventions: Patients with septic shock in the derivation cohort
were genotyped for tag single nucleotide polymorphisms:
angiotensin-converting enzyme (six single nucleotide polymorphisms),
angiotensin II receptor type 1 (five single nucleotide polymorphisms), and
angiotensin II type 1 receptor-associated protein (three single nucleotide
polymorphisms), which is a negative regulator of angiotensin II receptor
type 1. Patients in the septic shock replication cohort and the coronary
artery bypass graft cohort were genotyped for the angiotensin II type 1
receptor-associated protein rs11121816. Measurements and Main Results: The
primary outcome variable was 28-day mortality. Secondary outcome variables
were blood pressure and heart rate. Angiotensin II type 1
receptor-associated protein messenger RNA expression was measured in
genotyped lymphoblastoid cells in vitro. Patients with septic shock
patients the GG genotype of angiotensin II type 1 receptor-associated
protein rs11121816 had increased 28-day mortality in the derivation cohort
(54.8% vs. 41.4%; adjusted hazard ratio, 1.46; 95% confidence interval,
1.09-1.93; p = .010 [all ethnicities]; p = .050 [white]) and in the
replication cohort (43.8% vs. 32.3%; hazard ratio, 1.42; 95% confidence
interval, 1.03-1.98; p = .035 [all ethnicities]; p = .037 [white]).
Patients having the GG genotype had decreased mean arterial pressure
(98.3% of other genotype, p = .058 [derivation cohort]; 97.7%, p = .00060
[replication cohort]) and increased heart rate (104.1%, p = .023
[derivation cohort], 102.9%, p = nonsignificant [replication cohort]). GG
genotype patients undergoing coronary artery bypass grafting had decreased
postoperative mean arterial pressure and increased postoperative heart
rate (p < .05). GG genotype lymphoblastoid cells had 2.0-fold higher
angiotensin II type 1 receptor-associated protein messenger RNA expression
(p < .05). Conclusions: For angiotensin II type 1 receptor-associated
protein, the negative regulator of angiotensin II receptor type 1, the GG
genotype of rs11121816 was associated with increased angiotensin II type 1
receptor-associated protein expression, decreased blood pressure, and
increased heart rate as well as increased 28-day mortality in septic
shock. Copyright 2011 by the Society of Critical Care Medicine and
Lippincott Williams & Wilkins.

<26>
Accession Number
2010224454
Authors
Takagi H. Matsui M. Umemoto T.
Institution
(Takagi, Matsui, Umemoto) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
Title
Increased late mortality with percutaneous stenting for unprotected left
main coronary artery stenosis relative to coronary artery bypass grafting:
A meta-analysis of observational studies.
Source
Journal of Thoracic and Cardiovascular Surgery. 139 (5) (pp 1351-1353),
2010. Date of Publication: May 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)

<27>
Accession Number
2010224434
Authors
Kormos R.L. Teuteberg J.J. Pagani F.D. Russell S.D. John R. Miller L.W.
Massey T. Milano C.A. Moazami N. Sundareswaran K.S. Farrar D.J.
Institution
(Kormos) Heart, Lung and Esophageal Institute, University of Pittsburgh
Medical Center, Pittsburgh, Pa, United States
(Teuteberg) Cardiovascular Institute, University of Pittsburgh Medical
Center, Pittsburgh, Pa, United States
(Pagani) Section of Cardiac Surgery, University of Michigan, Ann Arbor,
Mich, United States
(Russell) Department of Medicine, Johns Hopkins Hospital, Baltimore, Md,
United States
(John) Division of Cardiothoracic Surgery, University of Minnesota,
Minneapolis, Minn, United States
(Miller) Department of Cardiovascular Medicine, Washington Hospital
Center, Washington, DC, United States
(Massey) Division of Cardiac Surgery, University of Rochester, Rochester,
NY, United States
(Milano) Division of Cardiovascular and Thoracic Surgery, Duke University
Medical Center, Durham, NC, United States
(Moazami) Division of Cardiothoracic Surgery, Washington University School
of Medicine, St Louis, Mo, United States
(Sundareswaran, Farrar) Thoratec Corporation, Pleasanton, CA, United
States
Title
Right ventricular failure in patients with the HeartMate II
continuous-flow left ventricular assist device: Incidence, risk factors,
and effect on outcomes.
Source
Journal of Thoracic and Cardiovascular Surgery. 139 (5) (pp 1316-1324),
2010. Date of Publication: May 2010.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The aim of this study was to evaluate the incidence, risk
factors, and effect on outcomes of right ventricular failure in a large
population of patients implanted with continuous-flow left ventricular
assist devices. Methods: Patients (n = 484) enrolled in the HeartMate II
left ventricular assist device (Thoratec, Pleasanton, Calif)
bridge-to-transplantation clinical trial were examined for the occurrence
of right ventricular failure. Right ventricular failure was defined as
requiring a right ventricular assist device, 14 or more days of inotropic
support after implantation, and/or inotropic support starting more than 14
days after implantation. Demographics, along with clinical, laboratory,
and hemodynamic data, were compared between patients with and without
right ventricular failure, and risk factors were identified. Results:
Overall, 30 (6%) patients receiving left ventricular assist devices
required a right ventricular assist device, 35 (7%) required extended
inotropes, and 33 (7%) required late inotropes. A significantly greater
percentage of patients without right ventricular failure survived to
transplantation, recovery, or ongoing device support at 180 days compared
with patients with right ventricular failure (89% vs 71%, P < .001).
Multivariate analysis revealed that a central venous pressure/pulmonary
capillary wedge pressure ratio of greater than 0.63 (odds ratio, 2.3; 95%
confidence interval, 1.2-4.3; P = .009), need for preoperative ventilator
support (odds ratio, 5.5; 95% confidence interval, 2.3-13.2; P < .001),
and blood urea nitrogen level of greater than 39 mg/dL (odds ratio, 2.1;
95% confidence interval, 1.1-4.1; P = .02) were independent predictors of
right ventricular failure after left ventricular assist device
implantation. Conclusions: The incidence of right ventricular failure in
patients with a HeartMate II ventricular assist device is comparable or
less than that of patients with pulsatile-flow devices. Its occurrence is
associated with worse outcomes than seen in patients without right
ventricular failure. Patients at risk for right ventricular failure might
benefit from preoperative optimization of right heart function or planned
biventricular support. 2010 The American Association for Thoracic
Surgery.