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<1>
Accession Number
2012312751
Authors
Ozaki Y. Imanishi T. Tanimoto T. Kashiwagi M. Tsujioka H. Sougawa H. Orii
M. Shiono Y. Shimamura K. Ishibashi K. Komukai K. Ino Y. Kitabata H.
Akasaka T.
Institution
(Ozaki, Imanishi, Tanimoto, Kashiwagi, Tsujioka, Sougawa, Orii, Shiono,
Shimamura, Ishibashi, Komukai, Ino, Kitabata, Akasaka) Department of
Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
Title
Effect of direct renin inhibitor, aliskiren, on peripheral blood monocyte
subsets and myocardial salvage in patients with primary acute myocardial
infarction.
Source
Circulation Journal. 76 (6) (pp 1461-1468), 2012. Date of Publication:
June 2012.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: It remains unclear whether angiotensin-converting enzyme
inhibitors (ACEIs) or angiotensin II type 1 receptor blockers (ARBs) have
fully delivered the expected reduction in cardiovascular diseases. We
investigated the effects of adding the direct renin inhibitor (DRI),
aliskiren, to an ACEI or an ARB on monocyte subsets and myocardial salvage
in patients with primary acute myocardial infarction (AMI). Methods and
Results: Twenty-one consecutive patients were treated with an ACEI or an
ARB (non-DRI group), and another 21 consecutive patients received
aliskiren combined with an ACEI or an ARB (DRI group). Two monocyte
subsets (CD14⁺CD16^-and
CD14⁺CD16⁺) were measured by flow cytometry. The
extent of myocardial salvage 7 days after AMI was evaluated by cardiac
magnetic resonance imaging. Both plasma renin activity and aldosterone
levels were significantly lower in the DRI group than in the non-DRI
group. Peak levels of CD14⁺CD16^- monocyte number and
ratio were also significantly lower in the DRI group. The extent of
myocardial salvage was significantly higher in the DRI group than in the
non-DRI group (44.8 [41.2-53.1] vs. 36.0 [28.5-42.6], P=0.001).
Conclusions: A DRI combined with an ACEI or an ARB can better improve the
extent of myocardial salvage after AMI than an ACEI or an ARB alone in
association with the decrease in circulating
CD14⁺CD16^- monocytes.

<2>
Accession Number
2012285794
Authors
Mega J.L.
Institution
(Mega) Brigham and Women's Hospital, Boston, MA, United States
Title
Low-Dose rivaroxaban reduced mortality in patients with a recent acute
coronary syndrome.
Source
Annals of Internal Medicine. 156 (10) (pp JC5-3), 2012. Date of
Publication: 2012.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<3>
Accession Number
2012310964
Authors
Mangukia C.V.
Institution
(Mangukia) Department of General Surgery, B. J. Medical College,
Ahmedabad, India
Title
Coronary artery fistula.
Source
Annals of Thoracic Surgery. 93 (6) (pp 2084-2092), 2012. Date of
Publication: June 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Although coronary arterial fistula is rare, it is one of the most common
among the coronary artery anomalies. Coronary arterial fistula most
commonly affects the right side of the heart. It may occur isolated or
along with congenital heart diseases. Angiography remains the best
investigation for diagnosing the disease. Unless very large and
hemodynamically significant, it is usually asymptomatic in younger
patients. With increasing age, symptoms begin to appear, and the incidence
of complication rises. Treatment by transcatheter or surgical closure
gives the best results, provided this is performed early in the course of
the disease. This review was prepared by searching the terms "coronary
artery fistula," "coronary cameral fistula," "surgical management of
coronary arterial fistula," "MDCT in coronary artery fistula," and
"multiple coronary artery fistulae" in Google Scholar, PubMed, and PubMed
Central and exploring the related articles shown on the side of page.
2012 The Society of Thoracic Surgeons.

<4>
Accession Number
2012307506
Authors
Ahlers S.J.G.M. Van Gulik L. Van Dongen E.P.A. Bruins P. Van De Garde
E.M.W. Van Boven W.J. Tibboel D. Knibbe C.A.J.
Institution
(Van Gulik, Van Dongen, Bruins) Department of Anaesthesiology, Intensive
Care and Pain Management, Netherlands
(Ahlers, Van De Garde, Knibbe) Department of Clinical Pharmacy, St.
Antonius Hospital, Koekoekslaan 1, 3440 EM Nieuwegein, Netherlands
(Van Boven) Department of Cardiothoracic Surgery, Netherlands
(Tibboel) Intensive Care and Department of Pediatric Surgery, Erasmus
Medical Centre, Sophia Children's Hospital, Rotterdam, Netherlands
Title
Efficacy of an intravenous bolus of morphine 2.5 versus morphine 7.5 mg
for procedural pain relief in postoperative cardiothoracic patients in the
intensive care unit: A randomised double-blind controlled trial.
Source
Anaesthesia and Intensive Care. 40 (3) (pp 417-426), 2012. Date of
Publication: May 2012.
Publisher
Australian Society of Anaesthetists (P.O. Box 600, Edgecliff NSW 2027,
Australia)
Abstract
As pain in the intensive care unit (ICU) is still common despite important
progress in pain management, we studied the efficacy of an intravenous
bolus of morphine 2.5 vs 7.5 mg for procedural pain relief in patients
after cardiothoracic surgery in the ICU. In a prospective double-blind
randomised study, 117 ICU patients after cardiothoracic surgery were
included. All patients were treated according a pain titration protocol
for pain at rest, consisting of continuous morphine infusions and
paracetamol, applied during the entire ICU stay. On the first
postoperative day, patients were randomised to intravenous morphine 2.5
(n=59) or 7.5 mg (n=58) 30 minutes before a painful intervention (turning
of patient and/or chest drain removal). Pain scores using the numeric
rating scale (Numeric Rating Scale, range 0 to 10) were rated at rest
(baseline) and around the painful procedure. At rest (baseline), overall
incidence of unacceptable pain (Numeric Rating Scale >=4) was low (Numeric
Rating Scale >4; 14 vs 17%, P=0.81) for patients allocated to morphine 2.5
and 7.5 mg respectively. For procedure-related pain, there was no
difference in incidence of unacceptable pain (28 vs 22%, P=0.53) mean pain
scores (2.6 [95% confidence interval 2.0 to 3.2] vs 2.7 [95% confidence
interval 2.0 to 3.4]) between patients receiving morphine 2.5 and 7.5 mg
respectively. In intensive care patients after cardiothoracic surgery with
low pain levels for pain at rest, there was no difference in efficacy
between intravenous morphine 2.5 mg or morphine 7.5 mg for pain relief
during a painful intervention.

<5>
Accession Number
22419321
Authors
Moller C.H. Penninga L. Wetterslev J. Steinbruchel D.A. Gluud C.
Institution
(Moller) Department of Cardiothoracic Surgery, RT 2152, Copenhagen
University Hospital, Rigshospitalet, Copenhagen,
Title
Off-pump versus on-pump coronary artery bypass grafting for ischaemic
heart disease.
Source
Cochrane database of systematic reviews (Online). 3 (pp CD007224), 2012.
Date of Publication: 2012.
Abstract
Coronary artery bypass grafting (CABG) is performed both without and with
cardiopulmonary bypass, referred to as off-pump and on-pump CABG
respectively. However, the preferable technique is unclear. To assess the
benefits and harms of off-pump versus on-pump CABG in patients with
ischaemic heart disease. We searched the Cochrane Central Register of
Controlled Trials (CENTRAL) on The Cochrane Library (Issue 1, 2011),
MEDLINE (OVID, 1950 to February 2011), EMBASE (OVID, 1980 to February
2011), Science Citation Index Expanded on ISI Web of Science (1970 to
February 2011) and CINAHL (EBSCOhost, 1981 to February 2011) on 2 February
2011. No language restrictions were applied. Randomised clinical trials of
off-pump versus on-pump CABG irrespective of language, publication status
and blinding were selected for inclusion. For statistical analysis of
dichotomous data risk ratio (RR) and for continuous data mean difference
(MD) with 95% confidence intervals (CI) were used. Trial sequential
analysis (TSA) was used for analysis to assess the risk of random error
due to sparse data and to multiple updating of accumulating data.
Eighty-six trials (10,716 participants) were included. Ten trials (4,950
participants) were considered to be low risk of bias. Pooled analysis of
all trials showed that off-pump CABG increased all-cause mortality
compared with on-pump CABG (189/5,180 (3.7%) versus 160/5144 (3.1%); RR
1.24, 95% CI 1.01 to 1.53; P =.04). In the trials at low risk of bias the
effect was more pronounced (154/2,485 (6.2%) versus 113/2,465 (4.6%), RR
1.35,95% CI 1.07 to 1.70; P =.01). TSA showed that the risk of random
error on the result was unlikely. Off-pump CABG resulted in fewer distal
anastomoses (MD -0.28; 95% CI -0.40 to -0.16, P <.00001). No significant
differences in myocardial infarction, stroke, renal insufficiency, or
coronary re-intervention were observed. Off-pump CABG reduced
post-operative atrial fibrillation compared with on-pump CABG, however, in
trials at low risk of bias, the estimated effect was not significantly
different. Our systematic review did not demonstrate any significant
benefit of off-pump compared with on-pump CABG regarding mortality,
stroke, or myocardial infarction. In contrast, we observed better
long-term survival in the group of patients undergoing on-pump CABG with
the use of cardiopulmonary bypass and cardioplegic arrest. Based on the
current evidence, on-pump CABG should continue to be the standard surgical
treatment. However, off-pump CABG may be acceptable when there are
contraindications for cannulation of the aorta and cardiopulmonary bypass.
Further randomised clinical trials should address the optimal treatment in
such patients.

<6>
Accession Number
22254265
Authors
Edrich T. Frendl G. Rawn J.D. Paschalidis Y.
Institution
(Edrich) Department of Anesthesia, Perioperative and Pain Medicine,
Brigham and Women's Hospital, Boston, MA 02115, USA.
Title
Modeling the effects of bivalirudin in cardiac surgical patients.
Source
Conference proceedings : ... Annual International Conference of the IEEE
Engineering in Medicine and Biology Society. IEEE Engineering in Medicine
and Biology Society. Conference. 2011 (pp 120-123), 2011. Date of
Publication: 2011.
Abstract
Bivalirudin is direct thrombin inhibitor used in patients with
heparin-induced thrombocytopenia. A pharmacokinetic and--dynamic model
that predicts the partial thromboplastin time (PTT) based on the past
infusion rates of bivalirudin following dose adjustment would be useful to
guide optimal therapy. In this retrospective study we randomized 132
patients to a derivation and a validation cohort, and tested two models.
The first model is a single-state linear model; the other incorporates a
non-linear element to account for renal elimination of bivalirudin. Both
models predicted PTT changes equally well with root-mean squared errors of
15 to 16 seconds (Pearson correlation coefficients for both were 0.67).
Intra- and inter-individual variability of response to bivalirudin was
significant. Although a high percentage of patients had moderate to severe
renal dysfunction at one point during the bivalirudin infusion, the
non-linear model that incorporates variable renal clearance of drug did
not perform better than the linear model. This finding persisted even in
the subgroup analysis of patients with moderate and low estimated
glomerular filtration rates.

<7>
Accession Number
70767924
Authors
Van De Watering L.
Institution
(Van De Watering) Sanquin, LUMC Jon J van Rood Center for Clinical
Transfusion Research, Leiden, Netherlands
Title
Blood transfusion and immuno modulation.
Source
Blood Transfusion. Conference: 40 Convegno Nazionale di Studi di Medicina
Trasfusionale Rimini Italy. Conference Start: 20120523 Conference End:
20120526. Conference Publication: (var.pagings). 10 (pp s61-s63), 2012.
Date of Publication: May 2012.
Publisher
SIMTI Servizi Sri
Abstract
The issue of immunomodulation by blood transfusions started with the
publication by Opelz and Terasaki on a multivariate analysis of
observational studies showing a significant enhancement of survival of
kidney grafts in recipients of multiple transfusions compared to
non-transfused patients1. This gave rise to concern for wider consequences
of this immunosuppressive transfusion effect for instance on
immunosurveillance against cancer, as was raised by Gantt2. Since then,
transfusion-related immunomodulation (TRIM) is claimed to cause
postoperative nosocomial infections, recurrence of (and new) malignancies
and leading to increased mortality after surgery. Transplantation
tolerance By showing that a single blood transfusion improved graft
survival, provided the blood was not leukocyte-depleted, Persijn and
colleagues made a causal role for allogeneic leukocytes in transplantation
tolerance very likely3. The beneficial effect of pretransplant blood
transfusions is not restricted to cadaver kidney transplantation. Over the
last 30 years a beneficial effect has been published in heart, liver, and
combined pancreas-kidney transplantation. Also, new and highly effective
immunosuppressive drugs to prevent or treat rejection were developed. It
is difficult to compare the effect of a pretransplant blood transfusion
between studies with a historical control group, since outcome after organ
transplantation depends on several factors which cannot be controlled for
in a retrospective study. Although a beneficial transfusion effect remains
present, notwithstanding the use of modern immunosuppressive drugs,
deliberate pre-transplant transfusions are currently virtually abandoned.
The main reasons are concerns about transfusiontransmitted diseases and
development of alloimmunization, where also the results without
transfusion have improved considerable. Immunological effects of blood
transfusions Transfusions affect both the innate and the adaptive immune
system. Transfusions contain many foreign antigens and always apoptotic
and necrotic cells (more with longer storage; less in filtered units). The
apoptotic cells interact with macrophages which start to produce
anti-inflammatory cytokines such as prostaglandin E-2 and TGF-s. Thereby
not only suppressing the innate immune response of macrophages and NK
cells but also impairing the antigen presenting cell (APC) capacity,
thereby down regulating the adaptive antigen-specific immune response.
Soluble response modifiers accumulate in blood products during storage.
Factors derived from leucocytes are e.g. elastase, soluble HLA class I and
II molecules, sFasL, IL-1, IL-6, and IL-8. Proinflammatory cytokines are
an important cause of nonhemolytic febrile transfusion reactions (NHFTR).
With the introduction of universal leukocyte reduction most countries
reported a decline in NHFTR. Due to phosphorylation defects, the responder
capacity of T cells decreases during storage, impairing the protein
synthesis of T cells upon signaling of the T cell receptor. This reduces
the proliferative response of donor lymphocytes, relevant to impaired
transfusion-associated Graft-versus-Host disease4. The stimulator capacity
by donor APCs of the direct pathway is irreversibly abrogated after 10-14
days of storage because of loss of co-stimulatory molecules, which are
essential for effective APC-helper T cell interaction5. This leaves only
the, less efficient, indirect pathway to elicit an adaptive immune
response after processing of foreign donor antigens. This indirect pathway
is dependent on APCs, which may be affected by pro- and/or
anti-inflammatory stimuli in the blood product. After transfusion, there
is a two-way interaction between donor and recipient cells. Three to five
days after transfusion, depending on the storage interval of contaminant
leukocytes, proliferating lymphocyte blasts can be found in the
circulation6. Most donor DNA disappears after a week, although
haplo-identical cells sharing an HLA-DR antigen can remain detectable for
several weeks. Persistence of donor cells for many years is observed in
approximately 20% of apparently healthy transfused trauma survivors, even
after transfusions of leukocyte-reduced blood stored for longer than 3
weeks. This transfusion-induced chimerism is not associated with apparent
clinical disease; a role for this chimerism in allogeneic
(transplantation) tolerance has not yet been investigated. Cancer
immunosurveillance A deleterious role of blood transfusions on cancer
surveillance was feared because of immunological analogy between
alloimmunity (e.g. organ graft rejection) and tumor immunity. This was
further supported by in vitro studies, animal models and hundreds of
observational studies. One randomized study investigated a role of
presumed suppressive effects of leukocyte-containing transfusions compared
to leukocyte-depleted filtered transfusions on recurrence of colorectal
cancer after surgery with curative intent. This study found no difference
in cancer recurrence after 2 and 5 years follow-up7,8.Most clinically
manifest cancers and metastasis do not elicit an effective immune response
as tumor cells can downregulate allele-specific HLA antigens, escaping T
cell and NK cells. Furthermore, blood transfusions during surgery come in
a late phase of the disease, when immunosurveillance already had its
chance, and failed. A role for transfusions in the development of new
malignancies is especially suggested with subtypes of non-Hodgin
lymphoma9. However, this association may be caused by reverse causality10.
Transfusions and postoperative nosocomial infections The possible effect
of blood transfusions on the incidence of postoperative infections is
widely researched7,11-18. So far this has lead to a large number of
publications, several randomized controlled trials (RCTs) and fierce
discussions19-23. The vast majority of published studies are observational
and compare transfused with non-transfused patients. This design makes
them unsuitable to inform on causal relationships, as infections are
associated with anemia. Multivariate analyses reduced the number of
significant correlations reported, but even the use of multivariate
analyses can never fully correct for the inclusion bias where all patients
have a clinical transfusion indication in one group versus none in the
other group. Several meta-analyses were performed, mainly on the RCTs, in
an attempt to gain more insight in this matter. However, all were hampered
by several factors: 1) Different types of surgical patients were included.
2) Different definitions were used for postoperative infections. 3)
Different blood products were used. 4) Different analyses were reported by
the authors. These differences resulted in the reporting of odds ratios
ranging from <1 to >14, clearly indicating that the studies did not report
on similar situations. Furthermore, there is publication bias, as the
smaller RCTs reported in literature show more pronounced detrimental
effects of leukocyte containing transfusions than the larger RCTs. Authors
of meta-analyses tried various ways to adjust for all these variations,
resulting in different conclusions in metaanalyses based on the same
studies. Of two simultaneously updated meta-analyses, one reports a
significant odds ratio of 1.92 (95% CI, 1.22-3.01) focusing on transfused
patients only, whilst the other one reports a non-significant odds ratio
of 1.24 (95% CI, 0.98-1.56) following analysis according to
intention-to-treat19,24. With such results, an effect of transfusion on
postoperative infections cannot be considered proven, but it definitely
cannot be excluded either. Transfusions and multi-organ failure and
mortality There is an increasing amount of evidence that in specific
patient groups blood transfusions may increase the incidence and/or
mortality rate of multi-organ failure (MOF). The introduction of leukocyte
reduction for all transfusions was used in several countries to perform
before/after studies. Some of these studies reported a beneficial effect
of leukoreduced blood on mortality25,26. Other observational studies
reported transfusions as an independent risk factor for SIRS, MOF and
mortality27-31. Like with postoperative infections, the limitations of the
observational design prevent any definitive conclusion on a causal
relationship. Most of the RCTs reporting on mortality investigated the
effect of leukoreduction by filtration. An association of non-filtered
blood transfusions with mortality was only reported in some of the cardiac
surgery studies. Of the RCTs investigating the use of autologous blood,
none reported a beneficial effect on mortality. Conclusions On one hand
transfusion-related immunomodulation is a concept that is very attractive
to exploit as specific toleranceinducing conditioning prior to organ
transplantation; on the other hand, transfusion-related immunosuppression
enhancing cancer recurrence, infections and mortality is a serious concern
that has led to wide implementation of universal leukocyte reduction of
red blood cell transfusions. A deleterious role of leukocyte-containing
transfusions has only been demonstrated in cardiac surgery. This might be
related to the effects of extracorporeal circulation and reperfusion
injury leading to SIRS, with transfusions disturbing, as a second hit, the
shaky balance of the recovery process.

<8>
Accession Number
2012314335
Authors
Musumeci G. Baroni M. Rossini R.
Institution
(Musumeci, Baroni, Rossini) Cardiovascular Department, Ospedali Riuniti di
Bergamo, Largo Barozzi, 1, 24128 Bergamo, Italy
Title
GP IIb/IIIa inhibitors for STEMI: Still the gold standard or an old
survivor?.
Source
Current Vascular Pharmacology. 10 (4) (pp 443-447), 2012. Date of
Publication: July 2012.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Glycoprotein (GP) IIb\IIIa receptor plays a central role on platelets
activation and its blockage has been a matter of interest since the
beginning of percutaneous revascularization. After first promising trials,
GP IIb\IIIa inhibitors (GPI) have been widely used in cath labs for about
a decade, significantly improving prognosis for patients with STSegment
Elevation Myocardial Infarction (STEMI). However, their utilization isn't
exempt from risks, mainly in form of bleeding disorders, which can
negatively affect patients' outcome. Moreover, routinary administration of
thyenopiridines like clopidogrel and the introduction of new
anticoagulants like bivalirudin significantly reduced indications for GPI.
In this review, a risk/benefit evaluation GP IIb\IIIa inhibitors is
presented and their indications for STEMI patients addressed to
revascularization are discussed according to recent advances reported in
literature. 2012 Bentham Science Publishers.

<9>
Accession Number
70766348
Authors
Kaushik M. Ronco C. Cruz D.
Institution
(Kaushik, Ronco, Cruz) San Bortolo Hospital, Vicenza, Italy
(Kaushik) Ospedale San Bortolo, Vicenza, Italy
Title
Novel biomarkers for prediction of renal replacement therapy in acute
kidney injury: A systematic review.
Source
Nephrology Dialysis Transplantation. Conference: 49th ERA-EDTA Congress
Paris France. Conference Start: 20120524 Conference End: 20120527.
Conference Publication: (var.pagings). 27 (pp ii352-ii353), 2012. Date of
Publication: May 2012.
Publisher
Oxford University Press
Abstract
Introduction and Aims: Novel biomarkers (BM) may aid in early diagnosis of
acute kidney injury (AKI), prediction of AKI severity and adverse
outcomes. As such, one potential clinical application is early
identification of AKI patients who will need renal replacement therapy
(RRT). Our aim was to evaluate the performance of novel BMs for the
prediction of RRT. Methods: We performed a systematic review of
Medline/PubMed to identify novel BM studies which reported RRT as an
outcome, whether separate or part of a composite. Studies which reported
area under the receiver operating characteristic curve (AuROC) and/or
sensitivity/ specificity for any outcome which included RRT were eligible
for full review; we excluded those related to renal transplant. Data were
extracted on study design and quality, population characteristics, and
incidence of RRT and outcomes on standardized case report forms. Primary
outcome was prediction of RRT. Whenever possible, data on RRT alone was
abstracted from composite outcomes. Results: We identified 30 studies (27
prospective cohort, 2 retrospective, 1 RCT), representing a total of 6631
patients (RRT, n= 791 patients). Studies were performed in diverse
clinical settings: cardiac surgery (CS, n=4 studies), critical illness
(ICU, n=9), CS&ICU (n=2), hospital AKI (n=9), other (n=6); sample sizes
ranged from 19-635. Urinary and blood BMs were evaluated in 20 and 17
studies, respectively; 10 evaluated multiple BMs. The most commonly
studied BMs were NGAL (n=18), cystatin C (n=11), KIM-1 (n=5) and IL-18
(n=4). AuROC for RRT or the composite of RRT/death were reported in 12 and
3 studies, respectively. The range of AuROC was <0.66-0.95 for NGAL,
0.62-0.99 for cystatin C (Table 1), 0.62-0.65 for KIM-1 and 0.73 for
IL-18. Specific biomarker cut-offs for RRT decisions were poorly reported.
Conclusions: Evidence regarding novel BM performance for predicting RRT is
(Table Presented) highly heterogeneous. The reported AuROCs exhibit a wide
range, even within a single BM. This is likely related to multiple factors
including clinical setting, comorbidities, timing of specimen collection,
type of specimen and assay, among others. Further studies are needed to
decipher the utility of these BMs in predicting RRT, and to clarify the
optimal biomarker values for informing clinical management decisions.

<10>
Accession Number
22590838
Authors
Baradari A.G. Zeydi A.E. Aarabi M. Ghafari R.
Institution
(Baradari) Department of Critical Care Medicine, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Zeydi) Department of Critical Care Nursing, Faculty of Nursing and
Midwifery, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Aarabi) Department of Epidemiology, Cardiovascular Research Center,
Golestan University of Medical Sciences, Gorgan, Iran, Islamic Republic of
(Ghafari) Department of Cardiac Surgery, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
Title
Metformin as an adjunct to insulin for glycemic control in patients with
type 2 diabetes after CABG surgery: A randomized double blind clinical
trial.
Source
Pakistan Journal of Biological Sciences. 14 (23) (pp 1047-1054), 2011.
Date of Publication: 2011.
Publisher
Asian Network for Scientific Information (308-Lasani Town, Sargodha Road,
Faisalabad, Pakistan)
Abstract
Perioperative hyperglycemia is common in patients with type 2 diabetes
undergoing Coronaiy Arteiy Bypass Graft (CABG) surgery and there is a
direct relation between postoperative hyperglycemia and mortality rate in
these patients. The aim of the present study is to determine the efficacy
of metformin on glycemic control in diabetic patients after CABG surgery.
In a randomized double blind clinical trial, 100 patients with type 2
diabetes admitted in open heart ICU after CABG surgeiy in Mazandaran Heart
Center were enrolled. They were randomly assigned to two intervention and
control groups. Three hours after extubation, therapeutic antiglycemic
regimens were applied in these two groups and continued for three days.
Intervention group received regular insulin infusion along with two
metformin 500 mg tablets per twelve hours while control group received
regular insulin infusion with two placebo tablets per twelve hours. Blood
glucose level and other parameters were measured andrecorded in determined
intervals. To analyze the data, independent T-test, paired T-test,
Mann-Whitney and repeated measure ANOVA tests were employed. Mean blood
glucose level was not significantly different in the two groups at the
beginning of the ICU admission; however, mean glucose level in
insulin-metformin group, twelve hours after the initiation of the study,
was significantly lower than insulin group (p<0.05). In addition, mean
doses of potassium and insulin demand as well as mean number of episodes
of hyperglycemia, hypoglycemia and glucose levels out of the accepted
range were significantly lower in insulin-metformin group (p<0.05).
Alterations in mean levels of lactate, BE, pH and creatinine were not
statistically significant in these two groups. It seems that adding
metformin to insulin leads to a better glycemic control in type two
diabetic patients undergoing CABG surgeiy without causing metabolic
acidosis. Therefore, it might be a potential option in blood glucose
control protocol in this group of patients. 2011 asian network for
scientific information.

<11>
[Use Link to view the full text]
Accession Number
2012311701
Authors
Rosner G.F. Kirtane A.J. Genereux P. Lansky A.J. Cristea E. Gersh B.J.
Weisz G. Parise H. Fahy M. Mehran R. Stone G.W.
Institution
(Rosner, Kirtane, Genereux, Lansky, Cristea, Weisz, Parise, Fahy, Mehran,
Stone) New York-Presbyterian Hospital, Columbia University Medical Center,
Cardiovascular Research Foundation, 111 E 59th St., New York, NY 10022,
United States
(Gersh) Mayo Clinic, Rochester, MN, United States
Title
Impact of the presence and extent of incomplete angiographic
revascularization after percutaneous coronary intervention in acute
coronary syndromes: The acute catheterization and urgent intervention
triage strategy (ACUITY) trial.
Source
Circulation. 125 (21) (pp 2613-2620), 2012. Date of Publication: 29 May
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-The clinical significance of incomplete coronary
revascularization (ICR) after percutaneous coronary intervention in
patients with acute coronary syndromes is unknown. Methods and Results-We
performed quantitative angiography of the entire coronary tree in 2954
patients with acute coronary syndromes in the Acute Catheterization and
Urgent Intervention Triage Strategy (ACUITY) trial. ICR was variably
defined if any lesion with diameter stenosis (DS) cutoffs ranging from
>=30% to >=70% with reference vessel diameter 2.0 mm remained after
percutaneous coronary intervention. The primary outcome was 1-year
composite rate of major adverse cardiac events (death, myocardial
infarction, or ischemia-driven unplanned revascularization). With the use
of DS cutoffs >=30%, >=40%, >=50%, >=60%, and >=70%, the prevalence of ICR
after percutaneous coronary intervention was >=75%, >=55%, >=37%, >=25%,
and >=17%, respectively. The 1-year major adverse cardiac event rate was
increased among patients with ICR using all of the DS cutoffs. ICR (>=50%
DS) was associated with higher 1-year rates of myocardial infarction
(12.0% versus 8.2%; hazard ratio, 1.50; 95% confidence interval,
1.18-1.89; P=0.0007) and ischemia-driven unplanned revascularization
(15.7% versus 10.2%; hazard ratio, 1.58; 95% confidence interval,
1.28-1.96; P<0.0001), with a trend toward increased mortality (3.1% versus
2.2%; hazard ratio, 1.43; 95% confidence interval, 0.90-2.27; P=0.13). By
multivariable analysis, ICR (50% DS) was an independent predictor of
1-year major adverse cardiac events (hazard ratio, 1.36; 95% confidence
interval, 1.12-1.64; P=0.002). The impact of ICR on major adverse cardiac
events was similar regardless of chronic total occlusion presence, but it
was more pronounced with a greater number of nonrevascularized lesions.
Conclusions-Depending on the threshold of percent DS, ICR was present in
17% to 75% of patients with acute coronary syndromes after percutaneous
coronary intervention. Regardless of the threshold, ICR was strongly
associated with 1-year myocardial infarction, ischemia-driven unplanned
revascularization, and major adverse cardiac events. Clinical Trial
Registration-URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00093158. 2012 American Heart Association, Inc.

<12>
Accession Number
2012311117
Authors
Costanzo M.R. Ivanhoe R.J. Kao A. Anand I.S. Bank A. Boehmer J. Demarco T.
Hergert C.M. Holcomb R.G. Maybaum S. Sun B. Vassiliades Jr. T.A. Rayburn
B.K. Abraham W.T.
Institution
(Costanzo) Midwest Heart Foundation, Edward Heart Hospital, 801 South
Washington Street, Naperville, IL 60566, United States
(Ivanhoe, Hergert, Holcomb) Paracor Medical, Inc., Sunnyvale, CA, United
States
(Kao) Mid American Heart Institute, Kansas City, MO, United States
(Anand) VA Medical Center, Minneapolis, MN, United States
(Bank) St. Paul Heart Clinic, St. Paul, MN, United States
(Boehmer) Penn State Milton S. Hershey Medical Center, Penn State College
of Medicine, Hershey, PA, United States
(Demarco) University of California at San Francisco, San Francisco, CA,
United States
(Maybaum) Montefiore Medical Center, Bronx, NY, United States
(Sun) Minneapolis Heart Institute, Minneapolis, MN, United States
(Vassiliades Jr.) Medtronic Corporation, Mounds View, MN, United States
(Rayburn) Cardiovascular Associates PC, Birmingham, AL, United States
(Abraham) Ohio State University Medical Center, Columbus, OH, United
States
Title
Prospective evaluation of elastic restraint to lessen the effects of heart
failure (PEERLESS-HF) trial.
Source
Journal of Cardiac Failure. 18 (6) (pp 446-458), 2012. Date of
Publication: June 2012.
Publisher
Churchill Livingstone Inc. (650 Avenue of the Americas, New York NY 10011,
United States)
Abstract
Background: Left ventricular (LV) remodeling predicts poor outcomes in
heart failure (HF) patients. The HeartNet cardiac restraint device
(Paracor Medical Inc., Sunnyvale, CA) may reduce LV remodeling and improve
functional capacity, quality of life, and outcomes in HF patients. To
evaluate the safety and efficacy of the HeartNet Ventricular Support
System in HF patients receiving optimal medical therapy. Methods and
Results: Prospective, randomized, controlled, multicenter trial in
patients with symptomatic HF and LV ejection fraction <=35% on optimal
medical and device therapy. The primary efficacy end points were changes
in peak VO₂, 6-minute walk (6MW) distance, and Minnesota Living
with Heart Failure (MLWHF) quality of life score at 6 months. The primary
safety end point was all-cause mortality at 12 months. Because the planned
adaptive interim analysis of the first 122 subjects with a completed
6-month follow-up indicated futility to reach the peak VO₂ end
point, trial enrollment was suspended. Hence, the results on the 96
treatment and 114 control subjects are reported. Groups were similar at
baseline. At 6 months, responder frequency for a prespecified improvement
was similar between groups for peak VO₂ (P =.502) and MLWHF
score (P =.184) but borderline higher for improvement in 6MW distance in
the treatment compared with the control group (33 [38%] vs. 25 [25%]; P
=.044). At 6 months, the treatment group had a significantly greater
improvement in Kansas City Cardiomyopathy Questionnaire (KCCQ) (P < .001)
and decrease in LV mass (P =.032), LV end-diastolic diameter (P =.015), LV
end-systolic diameter (P =.032), and LV end-diastolic volume (P =.031) as
compared with controls. At 12 months, all-cause mortality and responder
rates were similar in the 2 groups. Success rate for the HeartNet
implantation was 99%. Conclusion: Enrollment in the trial was stopped
because an interim analysis showed futility of reaching the peak
VO₂ end point. However, because of the device safety and
favorable signals for LV remodeling and quality of life, further
investigation of this device is warranted. 2012 Elsevier Inc. All rights
reserved.

<13>
Accession Number
2012311114
Authors
Carbone A. Psaltis P.J. Nelson A.J. Metcalf R. Richardson J.D. Weightman
M. Thomas A. Finnie J.W. Young G.D. Worthley S.G.
Institution
(Carbone, Psaltis, Nelson, Metcalf, Richardson, Weightman, Young,
Worthley) Discipline of Medicine, University of Adelaide, Royal Adelaide
Hospital, Adelaide, Australia
(Psaltis) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
(Thomas) School of Medicine, Faculty of Health Sciences, Flinders
University, Adelaide, Australia
(Finnie) SA Pathology, School of Veterinary Science, University of
Adelaide, Adelaide, Australia
Title
Dietary omega-3 supplementation exacerbates left ventricular dysfunction
in an ovine model of anthracycline-induced cardiotoxicity.
Source
Journal of Cardiac Failure. 18 (6) (pp 502-511), 2012. Date of
Publication: June 2012.
Publisher
Churchill Livingstone Inc. (650 Avenue of the Americas, New York NY 10011,
United States)
Abstract
Background: Cumulative dose-dependent nonischemic cardiomyopathy (NICM)
remains a significant risk with the use of some chemotherapeutic agents.
In this context, omega-3 polyunsaturated fatty acids (PUFA) have been
investigated for their cardioprotective potential in rodent and in vitro
models of anthracycline toxicity, with conflicting results. This study
evaluated prophylactic omega-3 PUFA supplementation in a large-animal
model of anthracycline-induced NICM. Methods and Results: Merino sheep
were randomized to oral drenching with omega-3 PUFA (fish oil; n = 8) or
olive oil placebo (n = 9) 3 weeks before commencing repeated intracoronary
infusions of doxorubicin (DOX) to induce cardiac dysfunction. Cumulative
DOX dose was 3.6 mg/kg. Drenching was continued for 12 weeks after final
DOX exposure. Despite significant increases in tissue omega-3 PUFA levels
(P <.05 vs placebo), omega-3-treated sheep displayed greater signs of
anthracycline cardiotoxicity than placebo animals, consisting of left
ventricular dilatation and a greater decline in ejection fraction (P <
.05), although myocardial fibrosis burden was similar in both groups.
Conclusions: Dietary intake of omega-3 PUFA fails to prevent and may
indeed exacerbate DOX-induced cardiotoxicity. Clinical use of omega-3
supplementation during chemotherapy should be deferred until more
information is available regarding the mechanisms of interaction between
fatty acids and the myocardium during anthracycline exposure. 2012
Elsevier Inc. All rights reserved.

<14>
[Use Link to view the full text]
Accession Number
2012311704
Authors
Deja M.A. Grayburn P.A. Sun B. Rao V. She L. Krejca M. Jain A.R. Leng Y.C.
Daly R. Senni M. Mokrzycki K. Menicanti L. Oh J.K. Michler R. Wrobel K.
Lamy A. Velazquez E.J. Lee K.L. Jones R.H.
Institution
(Deja, Mokrzycki) Second Department Cardiac Surgery, Medical University of
Silesia, Katowice, Poland
(Grayburn) Baylor University Medical Center, Dallas, TX, United States
(Sun) Minneapolis Heart Institute, Allina Health Systems, Minneapolis, MN,
United States
(Rao) Toronto General Hospital, Toronto, ON, Canada
(She, Velazquez, Lee, Jones) Duke Clinical Research Institute, Durham, NC,
United States
(Jain) SAL Hospital and Medical Institute, Ahmedabad, India
(Leng) National Heart Centre, Singapore, Singapore
(Daly, Oh) Mayo Clinic, Rochester, MN, United States
(Senni) Ospedali Riuniti, Bergamo, Italy
(Krejca) Pomeranian Medical University, Szczecin, Poland
(Menicanti) IRCCS Policlinico San Donato, San Donato Milanese, Milano,
Italy
(Michler) Montefiore Medical Center, Albert Einstein College of Medicine,
New York, NY, United States
(Wrobel) John Paul II Hospital, Krakow, Poland
(Lamy) Hamilton General Hospital, Hamilton, Canada
Title
Influence of mitral regurgitation repair on survival in the surgical
treatment for ischemic heart failure trial.
Source
Circulation. 125 (21) (pp 2639-2648), 2012. Date of Publication: 29 May
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Whether mitral valve repair during coronary artery bypass
grafting (CABG) improves survival in patients with ischemic mitral
regurgitation (MR) remains unknown. Methods and Results-Patients with
ejection fraction <=35% and coronary artery disease amenable to CABG were
randomized at 99 sites worldwide to medical therapy with or without CABG.
The decision to treat the mitral valve during CABG was left to the
surgeon. The primary end point was mortality. Of 1212 randomized patients,
435 (36%) had none/trace MR, 554 (46%) had mild MR, 181 (15%) had moderate
MR, and 39 (3%) had severe MR. In the medical arm, 70 deaths (32%)
occurred in patients with none/trace MR, 114 (44%) in those with mild MR,
and 58 (50%) in those with moderate to severe MR. In patients with
moderate to severe MR, there were 29 deaths (53%) among 55 patients
randomized to CABG who did not receive mitral surgery (hazard ratio versus
medical therapy, 1.20; 95% confidence interval, 0.77-1.87) and 21 deaths
(43%) among 49 patients who received mitral surgery (hazard ratio versus
medical therapy, 0.62; 95% confidence interval, 0.35-1.08). After
adjustment for baseline prognostic variables, the hazard ratio for CABG
with mitral surgery versus CABG alone was 0.41 (95% confidence interval,
0.22-0.77; P=0.006). Conclusion-Although these observational data suggest
that adding mitral valve repair to CABG in patients with left ventricular
dysfunction and moderate to severe MR may improve survival compared with
CABG alone or medical therapy alone, a prospective randomized trial is
necessary to confirm the validity of these observations. Clinical Trial
Registration-URL: http://www.clinicaltrials. gov. Unique identifier:
NCT00023595. 2012 American Heart Association, Inc.