EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2012603753
Authors
Tleyjeh I.M. Alasmari F.A. Bin Abdulhak A.A. Riaz M. Garbati M.A. Erwin
P.J. Kashour T. Al-Mallah M.H. Baddour L.M.
Institution
(Tleyjeh, Alasmari, Bin Abdulhak, Garbati) Department of Internal
Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
(Tleyjeh, Riaz) Research and Scientific Publication Center, King Fahad
Medical City, Aldabab Street, PO Box 59046, Riyadh 11525, Saudi Arabia
(Tleyjeh, Baddour) Division of Infectious Diseases, Mayo Clinic,
Rochester, MN, United States
(Erwin) Mayo Medical Library, Mayo Clinic, Rochester, MN, United States
(Tleyjeh) Division of Epidemiology, Mayo Clinic, Rochester, MN, United
States
(Kashour) Cardiac Center, King Fahad Medical City, Riyadh, Saudi Arabia
(Al-Mallah) King Fahad National Guard Hospital, Riyadh, Saudi Arabia
(Al-Mallah) Wayne State University, Detroit, MI, United States
Title
Association between preoperative statin therapy and postoperative
infectious complications in patients undergoing cardiac surgery: A
systematic review and meta-analysis.
Source
Infection Control and Hospital Epidemiology. 33 (11) (pp 1143-1151), 2012.
Date of Publication: November 2012.
Publisher
University of Chicago Press (1427 E. 60th Street, Chicago IL 60637-2954,
United States)
Abstract
Infectious complications of cardiac surgery are often severe and life
threatening. Statins having both immunomodulatory and anti-inflammatory
effects were intuitively thought to influence the development of
postsurgical infections.We sought to systematically examine whether any
association exists between statin use and risk of infectious complications
in patients undergoing cardiac surgery. We searched Ovid MEDLINE, Ovid
EMBASE, Thomson Scientific Web of Science, and Elsevier Scopus from
inception through February 2011 for comparative studies examining the
association between statin use and risk of postoperative infections in
patients undergoing cardiac surgery.We contacted a study's author for
missing information. We conducted a random-effects meta-analysis of
individual studies' odds ratios (adjusted for potential confounders). We
identified 6 cohort studies for inclusion, 3 of which were conducted in
Canada and 3 of which were conducted in the United States. Four were
single-center studies, and 2 were population based. Exposure ascertainment
was based on a review of admission medication list or prescription
databases. Infectious outcomes were heterogeneous and included surgical
site infections within 30 days, serious infections (sepsis), or any other
postoperative infection. Statin use in the preoperative period was
associated with a trend toward reduction in the incidence of postoperative
infections in patients who underwent cardiac surgery (odds ratio, 0.81
[95% confidence interval, 0.64-1.01]; P=.06; I²=75%).
Heterogeneity was explained by country effect. Studies performed in Canada
showed weaker associations than studies performed in the United States.
This difference could not be attributed to study quality alone. We did not
find good evidence to support an association between statin use and
postoperative infectious complications. However, the trend toward
statistical significance for this association indicates that further
investigation is warranted. 2012 by The Society for Healthcare
Epidemiology of America.

<2>
Accession Number
2012601318
Authors
van Dieren S. Kengne A.P. Chalmers J. Beulens J.W.J. Cooper M.E. Grobbee
D.E. Harrap S. Mancia G. Neal B. Patel A. Poulter N. van der Schouw Y.T.
Woodward M. Zoungas S.
Institution
(van Dieren, Kengne, Chalmers, Neal, Patel, Woodward, Zoungas) George
Institute for Global Health, University of Sydney, Sydney, Australia
(van Dieren, Beulens, Grobbee, van der Schouw) Julius Center for Health
Sciences and Primary Care, University Medical Center Utrecht, Utrecht,
Netherlands
(Cooper) Baker Heart Research Institute, Melbourne, Australia
(Harrap) University of Melbourne, Royal Melbourne Hospital, Melbourne,
Australia
(Mancia) University of Milan-Bicocca, San Gerardo Hospital, Milan, Italy
(Poulter) Imperial College, St Mary's Hospital, London, United Kingdom
(Zoungas) School of Public Health, Monash University, Melbourne, Australia
Title
Effects of blood pressure lowering on cardiovascular outcomes in different
cardiovascular risk groups among participants with type 2 diabetes.
Source
Diabetes Research and Clinical Practice. 98 (1) (pp 83-90), 2012. Date of
Publication: October 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Aims: To asses differences in treatment effects of a fixed combination of
perindopril-indapamide on major clinical outcomes in patients with type 2
diabetes across subgroups of cardiovascular risk. Methods: 11,140
participants with type 2 diabetes, from the ADVANCE trial, were randomized
to perindopril-indapamide or matching placebo. The Framingham equation was
used to calculate 5-year CVD risk and to divide participants into two risk
groups, moderate-high risk (<25% and no history of macrovascular disease),
very high risk (>25% and/or history of macrovascular disease). Endpoints
were macrovascular and microvascular events. Results: The mean age of
participants was 66 years (42.5% female). 1000 macrovascular and 916
microvascular events were recorded over follow-up of 4.3 years. Relative
treatment effects were similar across risk groups, (all P-values for
heterogeneity >=0.38). Hazard ratios for combined macro- and microvascular
events were 0.89 (0.77-1.03) for the moderate-high risk and 0.92
(0.81-1.03) for the very high risk. Absolute treatment effects tended to
be greater in the high risk groups although differences were not
statistically significant (P>0.05). Conclusions: Relative effects of blood
pressure lowering with perindopril-indapamide on cardiovascular outcomes
were similar across risk groups whilst absolute effects trended to be
greater in the high risk group. 2012 Elsevier Ireland Ltd.

<3>
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Accession Number
2012605525
Authors
Kunadian V. Pugh A. Zaman A.G. Qiu W.
Institution
(Kunadian, Zaman) Faculty of Medical Sciences, Newcastle University,
Freeman Hospital, Newcastle upon Tyne NE2 4HH, United Kingdom
(Pugh) Institute of Cellular Medicine, Faculty of Medical Sciences,
Newcastle University Medical School, Newcastle Upon Tyne, United Kingdom
(Qiu) Channing Laboratory, Department of Medicine, Brigham and Women's
Hospital/Harvard Medical School, Boston, MA, United States
Title
Percutaneous coronary intervention among patients with left ventricular
systolic dysfunction: A review and meta-analysis of 19 clinical studies.
Source
Coronary Artery Disease. 23 (7) (pp 469-479), 2012. Date of Publication:
November 2012.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
BACKGROUND: Coronary artery disease (CAD) is the most common cause for
left ventricular dysfunction. Coronary artery bypass surgery (CABG) has
not reduced mortality among patients with CAD and left ventricular
systolic dysfunction receiving guideline-indicated pharmacological
therapy. However, the benefit of percutaneous coronary intervention (PCI)
among patients with left ventricular systolic dysfunction is not clear.
OBJECTIVES: A meta-analysis of studies utilizing PCI among patients with
left ventricular systolic dysfunction (ejection fraction<=40%) was
performed to determine in-hospital and long-term (>=1 year) mortality.
METHODS: A systematic computerized literature search was performed using
the search terms 'poor left ventricle', 'percutaneous coronary
intervention', 'revascularization', 'LV dysfunction' and 'heart failure'.
Studies of patients undergoing PCI for CAD in the presence of left
ventricular systolic dysfunction were included. Studies that did not
report long-term mortality data and same-centre studies were excluded.
RESULTS: In total, 4766 patients from 19 studies were included in this
meta-analysis. The mean (pooled estimate) age was 65 years [95% confidence
interval (CI) 62-68] with 80% (95% CI 75-84%) males. The mean (pooled
estimate) ejection fraction was 30% (95% CI 27-33%). The in-hospital
mortality using random-effects model (13 studies, total PCI n=2202) was
1.8%, n=39 (95% CI 1.0-2.9%). The long-term mortality (mean pooled
estimate 24 months) using the random-effects model (19 studies, total
follow-up n=2937) was 15.6%, n=401 (95% CI 11.0-20.7%). Five studies
compared PCI versus CABG (n=455 vs. n=502) and provide long-term mortality
data (deaths-PCI: n=102 vs. CABG: n=115). The relative risk using the
random-effects model (PCI vs. CABG) was 0.98 (95% CI 0.8-1.2, P=0.83).
CONCLUSION: The present meta-analysis demonstrates that on the basis of
available clinical studies, PCI among patients with left ventricular
systolic dysfunction is feasible with acceptable in-hospital and long-term
mortality and yields similar outcomes to CABG. However, neither
intervention may improve outcome compared with pharmacological therapy
alone. 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

<4>
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Accession Number
2012605526
Authors
Sa M.P.B.O. Ferraz P.E. Escobar R.R. Martins W.N. Nunes E.O. Vasconcelos
F.P. Lima R.C.
Institution
(Sa, Ferraz, Escobar, Martins, Nunes, Vasconcelos, Lima) Division of
Cardiovascular Surgery of Pronto Socorro Cardiologico de Pernambuco,
PROCAPE, Edf. Paqueta, Av. Eng. Domingos Ferreira n 4172, Recife,
51021-040, Pernambuco, Brazil
(Sa, Ferraz, Escobar, Martins, Nunes, Vasconcelos, Lima) University of
Pernambuco, UPE, Pernambuco, Brazil
(Sa, Lima) Nucleus of Postgraduate and Research in Health Sciences,
Faculty of Medical Sciences and Biological Sciences Institute, FCM/ICB,
Recife, Pernambuco, Brazil
Title
Prophylactic intra-aortic balloon pump in high-risk patients undergoing
coronary artery bypass surgery: A meta-analysis of randomized controlled
trials.
Source
Coronary Artery Disease. 23 (7) (pp 480-486), 2012. Date of Publication:
November 2012.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
OBJECTIVES: The aim of this study was to assess the efficacy of a
prophylactic intra-aortic balloon pump (IABP) in high-risk patients
undergoing coronary artery bypass graft surgery. METHODS: MEDLINE, EMBASE,
CENTRAL/CCTR, SciELO, LILACS, Google Scholar, and reference lists of
relevant articles were searched. We included only randomized controlled
trials. Assessments for eligibility, relevance, and study validity and
data extraction were performed in duplicate using prespecified criteria.
Meta-analysis was carried out using fixed-effect and random-effect models.
RESULTS: Seven publications fulfilled our eligibility criteria. There was
no important statistical heterogeneity or publication bias among included
studies. In total, 177 patients received prophylactic IABP and 168 did
not. Overall relative risk (RR) for hospital mortality in patients treated
with prophylactic IABP was 0.255 [95% confidence interval (CI),
0.122-0.533; P<0.001; same results for both effect models]. Pooled RR for
postoperative low cardiac output syndrome was 0.206 (95% CI, 0.109-0.389;
P<0.001) for the fixed-effect model and 0.219 (95% CI, 0.095-0.504;
P<0.001) for the random-effect model. Patients treated with prophylactic
IABP presented an overall difference in means for length of intensive care
unit stay and hospital stay, which was lower than that in the control
group (P<0.001 for both effect models). Only 7.4% (13/177) of patients who
received prophylactic IABP developed complications at an insertion site,
with no IABP-related death. CONCLUSION: This meta-analysis supports the
use of prophylactic IABP in high-risk patients to reduce hospital
mortality. 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

<5>
Accession Number
2012600219
Authors
Kongkaew C. Sakunrag I. Jianmongkol P.
Institution
(Kongkaew, Sakunrag) Faculty of Pharmaceutical Sciences, Naresuan
University, Phitsanulok, Thailand
(Jianmongkol) Buddhachinaraj Hospital, Phitsanulok, Thailand
Title
Non-compliance with digoxin in patients with heart failure and/or atrial
fibrillation: A systematic review and meta-analysis of observational
studies.
Source
Archives of Cardiovascular Diseases. 105 (10) (pp 507-516), 2012. Date of
Publication: October 2012.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: Digoxin is highly potent and efficacious for treatment of
heart failure (HF) and/or atrial fibrillation (AF) yet compliance is often
poor. Aims: To examine prevalence rates of non-compliance with digoxin;
variations between clinical settings, types of non-compliance and methods
of detection; and potential factors influencing non-compliance with
digoxin. Methods: This was a systematic review and meta-analysis of
prospective observational studies of non-compliance with digoxin in
patients with HF and/or AF, published in English. The studies were
identified through these bibliographic databases: MEDLINE, EMBASE, CINAHL,
IPA and Cochrane CENTRAL. Subgroup analysis examined the influence of
clinical settings, types of non-compliance and methods of detection.
Results: Ten studies met the inclusion criteria, comprising 1841 patients
with HF and/or AF. The corresponding prevalence rates of non-compliance
for outpatients, after hospital discharge and inpatients were 43.1%
(interquartile range [IQR] 29-48%), 25% (95% confidence interval [CI]
12-37%) and 4.5%, respectively. In patients with HF and AF co-morbidities,
the prevalence rate of non-compliance with digoxin was 38.7% (IQR 27-46%);
the corresponding prevalence rates of overdosing and underdosing were
33.04% (IQR 22-49%) and 33.8% (95% CI 25-42%), respectively. Rates varied
depending on the methods of detecting non-compliance. Regularity of
prescribed dose, diuretic use, coronary artery bypass, implantable
cardioverter-defibrillator, number of office visits and pill boxes
demonstrated strong associations with non-compliance with digoxin.
Conclusions: Non-compliance with digoxin is prevalent among patients with
HF and/or AF. A better understanding of the factors influencing compliance
and improved intervention strategies are necessary to increase digoxin
compliance. 2012 Elsevier Masson SAS.

<6>
Accession Number
2012597899
Authors
Eriksson E.A. Willekes C.L. McAllen K.J. Romeo O.M. Hooker R.L. Hoogeboom
J.E. Barletta J.F.
Institution
(Eriksson) Medical University of South Carolina, Department of Trauma and
General Surgery, Charleston, SC 29425, United States
(Willekes, Hooker) West Michigan Cardiothoracic Surgery, Grand Rapids, MI
49503, United States
(McAllen) Adult Critical Care, Department of Pharmacy Services, Spectrum
Health, Grand Rapids, MI 49503, United States
(Romeo) Hancock Regional Hospital, General Surgery Department, Greenfield,
IN 46140, United States
(Hoogeboom) Division of Surgical Critical Care, Spectrum Health, Grand
Rapids, MI 49503, United States
(Barletta) Department of Pharmacy Practice, Midwestern University, College
of Pharmacy-Glendale, Glendale, AZ 85308, United States
Title
Adrenal insufficiency in cardiothoracic patients: An evaluation of the
corticotrophin stimulation test and other diagnostic methods.
Source
Journal of Critical Care. 27 (5) (pp 528.e1-528.e6), 2012. Date of
Publication: October 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Purpose: The purposes of the study were to determine the incidence of
adrenal insufficiency (AI) using several published techniques, compare the
response rates using a low-dose (LD) corticotropin (ACTH) stimulation test
vs a standard dose (SD), and identify the technique that is most closely
related to vasopressor use. Materials and Methods: Consecutive adult
patients who were undergoing open heart surgery for CAD or valvular
disease were prospectively enrolled. Exclusion criteria included history
of steroid use, operative steroid, or etomidate administration.
Postoperatively, each patient underwent ACTH stimulation with 1 mug (LD)
and 249 mug (SD), 60 minutes apart. Agreement among the tests was
evaluated, and vasopressor use was compared between groups. Results: There
were 40 patients evaluated. The incidence of AI based on operative change,
postoperative values, and LD-ACTH and SD-ACTH tests was 53%, 38%, 60%, and
38%, respectively. Agreement between the LD- and SD-ACTH tests was 73% ( =
0.476, P = .001). There was a significant difference in the need for (93%
vs 52%, P = .013) and duration (18.9 [0-180.6] vs 0.6 [0-73.2] hours, P =
.003) of vasopressor therapy in patients with and without AI but only
using the SD-ACTH definition. Conclusion: The incidence of AI will vary
greatly based on technique used for diagnosis. The SD-ACTH stimulation
test should be used to determine AI in open heart patients postoperatively
because of the close association with vasopressor usage. 2012 Elsevier
Inc.

<7>
Accession Number
2012600822
Authors
Fang W.-T. Li H.-J. Zhang H. Jiang S.
Institution
(Fang, Zhang, Jiang) Department of Pharmacy, The First Affiliated Hospital
with Nanjing Medical University, Nanjing, Jiangsu 210029, China
(Li) Department of Pharmacy, Qianfoshan Hospital of Shandong Province,
Jinan, Shandong 250014, China
Title
The role of statin therapy in the prevention of atrial fibrillation: A
meta-analysis of randomized controlled trials.
Source
British Journal of Clinical Pharmacology. 74 (5) (pp 744-756), 2012. Date
of Publication: November 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
AIMS The use of statins has been suggested to protect against atrial
fibrillation (AF) in some clinical observational and experimental studies
but has remained inadequately explored. This study was designed to examine
whether statins can reduce the risk of AF. METHODS Meta-analysis of
randomized, controlled trials with use of statins on incidence or
recurrence of AF was performed. RESULTS Twenty studies with 23577 patients
were included in the analysis. Seven studies investigated the use of
statins in patients with AF, 11 studies investigated the primary
prevention of statins in patients without AF, and two studies investigated
mixed populations of patients. The incidence or recurrence of AF occurred
in 1543 patients. Overall, statin therapy was significantly associated
with a decreased risk of AF compared with control (odds ratio 0.49, 95%
confidence interval 0.37-0.65; P<0.00001). A beneficial effect was found
in the atorvastatin subgroup and the simvastatin subgroup, but not in the
pravastatin subgroup or the rosuvastatin subgroup. The benefit of statin
therapy appeared to be more pronounced in secondary prevention (odds ratio
0.34, 95% confidence interval 0.18-0.64; P<0.0008) than in primary
prevention (odds ratio 0.54, 95% confidence interval 0.40-0.74; P<0.0001).
CONCLUSIONS Statin therapy was significantly associated with a decreased
risk of incidence or recurrence of AF. Heterogeneity was explained by
differences in statin types, patient populations and surgery types. The
benefit of statin therapy seemed more pronounced in secondary than in
primary prevention. 2012 The Authors. British Journal of Clinical
Pharmacology 2012 The British Pharmacological Society.

<8>
Accession Number
2012592731
Authors
Hueb W. Gersh B.J. Rezende P.C. Garzillo C.L. Lima E.G. Vieira R.D. Garcia
R.M.R. Favarato D. Segre C.A.W. Pereira A.C. Soares P.R. Ribeiro E. Lemos
P. Perin M.A. Strunz C.C. Dallan L.A.O. Jatene F.B. Stolf N.A.G. Hueb A.C.
Dias R. Gaiotto F.A. da Costa L.M.A. Oikawa F.T.C. de Melo R.M.V. Serrano
Junior C.V. de Avila L.F.R. Villa A.V. Filho J.R.P. Nomura C. Ramires
J.A.F. Filho R.K.
Institution
(Hueb, Rezende, Garzillo, Lima, Vieira, Garcia, Favarato, Segre, Pereira,
Soares, Ribeiro, Lemos, Perin, Strunz, Dallan, Jatene, Stolf, Hueb, Dias,
Gaiotto, da Costa, Oikawa, de Melo, Serrano Junior, de Avila, Villa,
Filho, Nomura, Ramires, Filho) Heart Institute of the University of Sao
Paulo, Sao Paulo, Brazil
(Gersh) Mayo Clinic, Rochester, MN, United States
(Hueb) Av. Dr. Eneas de Carvalho Aguiar 44 AB-114 Cerqueira Cesar, Sao
Paulo-SP, 05403-000, Brazil
Title
Hypotheses, rationale, design, and methods for prognostic evaluation of
cardiac biomarker elevation after percutaneous and surgical
revascularization in the absence of manifest myocardial infarction. A
comparative analysis of biomarkers and cardiac magnetic resonance. The
MASS-V Trial.
Source
BMC Cardiovascular Disorders. 12 , 2012. Article Number: 65. Date of
Publication: 16 Aug 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Although the release of cardiac biomarkers after percutaneous
(PCI) or surgical revascularization (CABG) is common, its prognostic
significance is not known. Questions remain about the mechanisms and
degree of correlation between the release, the volume of myocardial tissue
loss, and the long-term significance. Delayed-enhancement of cardiac
magnetic resonance (CMR) consistently quantifies areas of irreversible
myocardial injury. To investigate the quantitative relationship between
irreversible injury and cardiac biomarkers, we will evaluate the extent of
irreversible injury in patients undergoing PCI and CABG and relate it to
postprocedural modifications in cardiac biomarkers and long-term
prognosis.Methods/Design: The study will include 150 patients with
multivessel coronary artery disease (CAD) with left ventricle ejection
fraction (LVEF) and a formal indication for CABG; 50 patients will undergo
CABG with cardiopulmonary bypass (CPB); 50 patients with the same arterial
and ventricular condition indicated for myocardial revascularization will
undergo CABG without CPB; and another 50 patients with CAD and preserved
ventricular function will undergo PCI using stents. All patients will
undergo CMR before and after surgery or PCI. We will also evaluate the
release of cardiac markers of necrosis immediately before and after each
procedure. Primary outcome considered is overall death in a 5-year
follow-up. Secondary outcomes are levels of CK-MB isoenzyme and I-Troponin
in association with presence of myocardial fibrosis and systolic left
ventricle dysfunction assessed by CMR.Discussion: The MASS-V Trial aims to
establish reliable values for parameters of enzyme markers of myocardial
necrosis in the absence of manifest myocardial infarction after mechanical
interventions. The establishments of these indices have diagnostic value
and clinical prognosis and therefore require relevant and different
therapeutic measures. In daily practice, the inappropriate use of these
necrosis markers has led to misdiagnosis and therefore wrong treatment.
The appearance of a more sensitive tool such as CMR provides an
unprecedented diagnostic accuracy of myocardial damage when correlated
with necrosis enzyme markers. We aim to correlate laboratory data with
imaging, thereby establishing more refined data on the presence or absence
of irreversible myocardial injury after the procedure, either percutaneous
or surgical, and this, with or without the use of cardiopulmonary bypass.
2012 Hueb et al.; licensee BioMed Central Ltd.

<9>
Accession Number
2012592170
Authors
Wang P. Zhou S. Zhou R. Liu G. Tang P. He J. Ma C. He Y. Yang J.
Institution
(Wang, Zhou, Zhou, Tang, He, Ma, He, Yang) State Key Laboratory of
Biotherapy, West China Hospital, Sichuan University, Keyuan Road 4, No. 1,
Chengdu, Sichuan, 610041, China
(Zhou) Department of Electrophysiology, Institute of Cardiovasology,
Luzhou Medical College, Luzhou, Sichuan, China
(Liu) Department of Dermatology, First Hospital, Chongqing Medical
University, Chongqing, China
Title
The effectiveness and safety of triple-antiplatelet treatment based on
cilostazol for patients receiving percutaneous coronary intervention: A
meta-analysis.
Source
Clinical Cardiology. 35 (10) (pp 598-604), 2012. Date of Publication:
October 2012.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
The combination of cilostazol, aspirin, and clopidogrel (triple therapy)
after percutaneous coronary intervention has been considered as an
alternative therapy. We performed a meta-analysis based on 8 randomized
controlled trials with a total of 3332 patients to compare the
effectiveness and safety of this triple therapy with traditional dual
therapy (aspirin and clopidogrel). Our findings suggested that the triple
therapy is more effective than dual therapy in preventing restenosis (odds
ratio [OR]: 0.52, 95% confidence interval [CI]: 0.40-0.66, P < 0.00001),
maintaining minimal lumen diameter (OR: 0.15, 95% CI: 0.10-0.20, P <
0.00001), and avoiding target-vessel revascularization (OR: 0.62, 95% CI:
0.47-0.82, P = 0.001). There is also no significant difference in major
adverse cardiac and cerebrovascular events between the 2 therapies, except
the smaller occurrence rate of target-lesion revascularization in the
triple-therapy group (OR: 0.42, 95% CI: 0.26-0.69, P = 0.0005). However,
the triple therapy is associated with a higher level of adverse drug
events, including rash (OR: 2.45, 95% CI: 1.41-4.23, P = 0.001),
gastrointestinal disorders (OR: 2.59, 95% CI: 1.26-5.30, P = 0.009), and
drug discontinuation (OR: 3.80, 95% CI: 1.59-9.10, P = 0.003), but it has
no difference in bleeding compared with the dual therapy (OR: 1.05, 95%
CI: 0.71-1.55, P = 0.80). 2012 Wiley Periodicals, Inc.

<10>
Accession Number
2012599387
Authors
Florian A. Slavich M. Masci P.G. Janssens S. Bogaert J.
Institution
(Florian, Slavich, Bogaert) Department of Radiology, UZ Leuven, Herestraat
49, B-3000 Leuven, Belgium
(Masci) Cardiac MRI and Cardiovascular Medicine Departments, Fondazione
CNR-Regione Toscana G. Monasterio, Pisa, Italy
(Janssens) Department of Cardiovascular Diseases, UZ Leuven, Leuven,
Belgium
Title
Electrocardiographic Q-wave "remodeling" in reperfused ST-segment
elevation myocardial infarction: Validation study with CMR.
Source
JACC: Cardiovascular Imaging. 5 (10) (pp 1003-1013), 2012. Date of
Publication: October 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: The aim of this study was to evaluate the evolution in Q-wave
expression during the first 5 years after a primary, successfully
reperfused ST-segment elevation myocardial infarction (MI), using cardiac
magnetic resonance (CMR) for infarct location, and to depict changes in
infarct size and left ventricular remodeling over time. Background: In the
absence of QRS confounders, abnormal Q waves are usually diagnostic of
myocardial necrosis. It is hypothesized that Q-wave regression after MI
could be related to smaller infarct sizes. Late gadolinium enhancement
accurately depicts MI of any age. Methods: Forty-six MI patients underwent
electrocardiography and CMR at 1 week (baseline), 4 months, 1 year, and 5
years post-infarction. Conventional CMR parameters were analyzed, and
infarct presence, location, and size were assessed using late gadolinium
enhancement CMR. Infarct locations were anterior or nonanterior (inferior
and/or lateral), using late gadolinium enhancement CMR as a reference. For
each time point, patients were classified as having a
diagnostic/nondiagnostic electrocardiogram (ECG) using the European
Society of Cardiology/American College of Cardiology Foundation/American
Heart Association/World Heart Federation consensus criteria for previous
Q-wave infarct. Results: At baseline, 11 patients (23%) did not meet the
criteria for Q-wave MI. Non-Q-wave infarcts were significantly smaller
than Q-wave infarcts (p < 0.0001). All anterior Q-wave infarcts (n = 17)
were correctly localized, whereas in 7 of 19 nonanterior Q-wave infarcts,
the location or extent of the infarct was misjudged by
electrocardiography. At 4-month/1-year follow-up, in 10 patients (3
anterior/7 nonanterior), the ECG became nondiagnostic. The ECG remained
nondiagnostic at 5-year follow-up. A cutoff infarct size of 6.2% at 1 year
yielded a sensitivity of 89% and a specificity of 74% to predict the
presence or absence of Q waves. Conclusions: The incidence of
nondiagnostic ECGs for previous MI using the current European Society of
Cardiology/American College of Cardiology Foundation/American Heart
Association/World Heart Federation criteria is substantial and increases
with time post-infarction from 23% immediately post-infarction to 44% at
5-year follow-up. 2012 American College of Cardiology Foundation.

<11>
Accession Number
2012596707
Authors
Alston R.P.
Institution
(Alston) Royal Infirmary of Edinburgh, University of Edinburgh, United
Kingdom
Title
Anaesthesia for off-pump coronary artery bypass grafting surgery.
Source
Anaesthesia and Intensive Care Medicine. 13 (10) (pp 510-512), 2012. Date
of Publication: October 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Coronary artery bypass grafting (CABG) surgery may be undertaken with or
without cardiopulmonary bypass (CPB), that is, on- or off-pump.
Traditional high-dose opioid techniques of general anaesthesia should be
avoided and either inhalation or total intravenous (IV) anaesthesia may be
used. Meticulous monitoring, including electrocardiograph and invasive
arterial pressure measurement, is required. During grafting, good
communication between anaesthetist and surgeon is essential. Maintenance
of diastolic arterial pressure (DAP) is the key to preventing myocardial
ischaemia and cardiovascular collapse. Surgical positioning for grafting
to minimize hypotension is paramount and during grafting, IV fluid loading
or vasoconstrictors and inotropes are effective treatments. Correction of
bradycardia with atropine 0.3 mg IV or epicardial pacing also helps to
maintain DAP. Persisting hypotension may require intra-aortic balloon
pumping or conversion to on-pump CABG surgery. As there is less blood
loss, there is a minimal requirement for cardiovascular support and early
recovery of consciousness associated with off-pump compared with on-pump
CABG surgery; patients in some institutions may be managed in a recovery
room then transferred to a high-dependency unit, thus bypassing the
intensive care unit. 2012 Published by Elsevier Ltd.

<12>
Accession Number
2012593424
Authors
Hutton B. Joseph L. Fergusson D. Mazer C.D. Shapiro S. Tinmouth A.
Institution
(Hutton, Fergusson, Tinmouth) Clinical Epidemiology Program, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
(Joseph, Shapiro) McGill University, Department of Epidemiology and
Biostatistics, Montreal, QC, Canada
(Mazer) Department of Anesthesia, University of Toronto, Keenan Research
Center, Toronto, ON, Canada
Title
Risks of harms using antifibrinolytics in cardiac surgery: Systematic
review and network meta-analysis of randomised and observational studies.
Source
BMJ (Online). 345 (7877) , 2012. Article Number: e5798. Date of
Publication: 06 Oct 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To estimate the relative risks of death, myocardial infarction,
stroke, and renal failure or dysfunction between antifibrinolytics and no
treatment following the suspension of aprotinin from the market in 2008
for safety reasons and its recent reintroduction in Europe and Canada.
Design: Systematic review and network meta-analysis. Data sources: A
Cochrane review of antifibrinolytic treatments was chosen as the starting
point for this systematic review. Medline, Embase, and the Cochrane
register of trials were searched with no date restrictions for
observational evidence. Study selection: Propensity matched or adjusted
observational studies with two or more of the interventions of interest
(aprotinin, tranexamic acid, epsilon-aminocaproic acid, and no treatment)
that were carried out in patients undergoing cardiac surgery. Data
analysis: Network meta-analysis was used to compare treatments, and odds
ratios with 95% credible intervals were estimated. Meta-analyses were
carried out for randomised controlled trials alone and for randomised
controlled trials with observational studies. Results: 106 randomised
controlled trials and 11 observational studies (43 270 patients) were
included. Based on the results from analysis of randomised controlled
trials, tranexamic acid was associated on average with a reduced risk of
death compared with aprotinin (odds ratio 0.64, 95% credible interval 0.41
to 0.99). When observational data were incorporated, comparisons showed an
increased risk of mortality with aprotinin on average relative to
tranexamic acid (odds ratio 0.71, 95% credible interval 0.50 to 0.98) and
epsilon-aminocaproic acid (0.60, 0.43 to 0.87), and an increased risk of
renal failure or dysfunction on average relative to all comparators: odds
ratio 0.66 (95% credible interval 0.45 to 0.88) compared with no
treatment, 0.66 (0.48 to 0.91) versus tranexamic acid, and 0.65 (0.45 to
0.88) versus epsilon-aminocaproic acid. Conclusion: Although meta-analyses
of randomised controlled trials were largely inconclusive, inclusion of
observational data suggest concerns remain about the safety of aprotinin.
Tranexamic and epsilon-aminocaproic acid are effective alternatives that
may be safer for patients.

<13>
Accession Number
70898887
Authors
Morici N. Moja L. Rosato V. Oreglia J.A. Sacco A. De Marco F. Bruschi G.
Klugmann S. La Vecchia C. Savonitto S.
Institution
(Morici, Oreglia, Sacco, De Marco, Bruschi, Klugmann, Savonitto) Divisione
di Cardiologia 1-Emodinamica, Dipartimento Cardio-toracovascolare A. De
Gasperis, A.O. Ospedale Niguarda Ca' Granda, Milan, Italy
(Moja) Italian Cochrane Centre, Mario Negri Institute for Pharmacological
Research, Milan, Italy
(Rosato, La Vecchia) Dipartimento di Epidemiologia, Istituto di Ricerche
Farmacologiche Mario Negri, Milan, Italy
(La Vecchia) Dipartimento di Medicina del Lavoro, Universita di Milano,
Milan, Italy
Title
Time from adenosine di-phosphate receptor antagonists (ADPRAs)
discontinuation to coronary bypass surgery. A metaanalysis.
Source
Giornale Italiano di Cardiologia. Conference: 43 Congresso Nazionale di
Cardiologia dell'ANMCO Firenze Italy. Conference Start: 20120530
Conference End: 20120602. Conference Publication: (var.pagings). 13 (5
SUPPL. 2) (pp 176S), 2012. Date of Publication: May 2012.
Publisher
CEPI s.r.l.
Abstract
Background. Adenosine di-phosphate receptor antagonists (ADPRAs) blunt
hemostasis for several days after administration. This effect, aimed at
preventing cardiac ischemic complications, may increase peri-operative
hemorrhagic events in patients undergoing cardiac surgery. The aim of this
study was to determine whether preoperative ADPRAs discontinuation may be
beneficial prior to coronary artery bypass grafting (CABG). Methods. The
MEDLINE, EMBASE, and Cochrane Library databases were searched for
prospective and retrospective studies published between 2001 and 2012.
Results. There were 39 studies, with 23486 participants, 536 deaths and
562 re-operations due to bleeding. ADPRAs continuation up to CABG was
associated with an increased risk of postoperative mortality (OR 1.6, 95%
confidence interval (CI) 1.25 to 2.05) and reoperations due to bleeding
(OR 1.97; 95% CI 1.51-2.56). Between-study heterogeneity was low (Isquared
4.5%). Meta-analysis limited to high quality or prospective studies gave
consistent results. Discontinuation gave similar benefit at all days
although the majority of studies considered five days as cut-off.
Conclusions. ADPRAs administered within 7 days prior to CABG are
associated with an increased risk of death and reoperations due to
bleeding.

<14>
Accession Number
70900903
Authors
Khawaja M. Haran H. Nadra I. Wilson K. Clack L. MacGillivray K. Hancock J.
Young C.P. Bapat V. Thomas M. Redwood S.
Institution
(Khawaja, Nadra, Wilson, Clack, MacGillivray, Hancock, Young, Bapat,
Thomas, Redwood) Guy's and St Thomas NHS Trust, London, United Kingdom
(Haran) King's College School of Medicine, London, United Kingdom
Title
The effects of pre-existing significant coronary artery disease upon
outcome after TAVI using the Edwards bioprosthesis.
Source
EuroIntervention. Conference: EuroPCR 2011 Paris France. Conference Start:
20110517 Conference End: 20110520. Conference Publication: (var.pagings).
7 (pp M222), 2011. Date of Publication: May 2011.
Publisher
EuroPCR
Abstract
Aims: Patients undergoing surgical aortic valve replacement (sAVR)
routinely undergo simultaneous coronary artety bypass grafting (CABG) for
significant coronary arteiy disease (CAD) due to adverse prognostic
impact. Whilst manufacturers advise percutaneous intervention (PCI) of
significant CAD prior to transcatheter aortic valve implantation (TAVI)
there is considerable variation amongst operators. The aim of this study
was to investigate die impact of significant coronary artety disease upon
outcome after TAVI. Methods and results: We performed a retrospective
analysis of 168 patients who underwent TAVI using the Edwards
bioprosthesis from March 2008 to October 2010 at St. Thomas' Hospital,
London. They were divided into two groups according to the results of the
pre-TAVI coronary angiogram. (Group 1) patients with >=l coronary stenosis
of >=70% severity and those without (Group 2). The end-point was all-cause
mortality.There were no significant differences in the baseline
characteristics between the two groups. The mean age was 83.7+/-7.5 years
(mean+/-SD) in Group 1 vs.81.7+/-8.5 years in Group 2 (p=0.112). Rates of
diabetes (22.9% vs. 27.6%, p=0.492), cerebrovascular disease (15.7% vs.
17.3%, p=0.780), peripheral vascular disease (21.4% vs. 12.2%, p-0.110),
previous percutaneous coronary intervention (PCI) (22.9% vs. 12.2%,
p=0.070) and previous coronary arteiy bypass grafting (CABG) (25.7% vs.
27.6%, p=0.791) showed no statistically significant difference. Nor was
there any difference in either glomerular filtration rate (48.4+/-27.9 vs.
46.8+/-23.1 mls/min/1.73 m², p=0.685), logistic EuroScore
(23.5+/-12.9% vs. 21.5+/-16 2%, p=0.399), left ventricular ejection
fraction (48.8+/-11.3% vs. 47.9+/-12.4%, p=0.658 or aortic valve area (0
63+/-0 20 vs. 0.67+/-0 22 cm², p=0.219). There any difference
in approach (transfemoral, transapical and transaortic) between the
groups: 44.9%, 48.0% and 7.1%vs41.4%, 52.9% and 5.7%
respectively(p=0.778). In total, 70 patients (41.7%) had significant CAD
prior to TAVI, with 10 (6.0%) undergoing PCI prior to their procedure. At
a mean follow up of335+/-277 days (mean+/-SD), the overall mortality was
22.6%; Group 1 mortality was 30% and in group 2 was 17.3% (p=0.124). There
was no difference seen in the length of stay in the intensive care unit
(2.7+/-6.2 vs. 4.1+/-14.9 days, p=0.462) nor in the number of days to
discharge (126+/-10.1 vs. 12 8+/-13, p=0.928). Amongst those patients who
underwent PCI in Group 1,8 had single vessel intervention and 2 had PCI to
2 vessels. The target vessels were left main stem[LMS] (n=2), proximal
left anterior descending artery [LAD] (n=5), circumflex (n=l), right
coronary artery [RCA] (n=2), saphenous vein graftfSVG] to LAD (n=l) and
SVG to circumflex (n=l). Mortality in this sub-group was not significantly
different from the CAD patients who did not receive PCI (50% vs. 26 7%,
p=0.272). Conclusions: The presence of significant CAD had no
statistically significant impact upon the all-cause mortality of patients
after TAVI in our study. As yet, the impact of PCI to significant CAD upon
outcome after TAVI is not known and will be assessed in a prospective,
randomised controlled trial currently underway.

<15>
Accession Number
70898663
Authors
De Lucia V. Cantinotti M. Assanta N. Murzi B. Spadoni I.
Institution
(De Lucia, Cantinotti, Assanta, Murzi, Spadoni) Fondazione Toscana G.
Monasterio, Massa, Italy
Title
Limitations in the prophylaxis and treatment of post-surgical pericardial
syndromes: A critical review with a special emphasis on paediatric age.
Source
Giornale Italiano di Cardiologia. Conference: 42nd Congresso Nazionale
della Societa Italiana di Cardiologia Pediatrica Jesi Italy. Conference
Start: 20121011 Conference End: 20121013. Conference Publication:
(var.pagings). 13 (10 SUPPL. 1) (pp 18S-19S), 2012. Date of Publication:
2012.
Publisher
CEPI s.r.l.
Abstract
Background. Post-surgical pericardial syndromes are common complications
after cardiac surgery, however their treatment remains not well
established. The accuracy/limits of clinical trials on prophylaxis and
treatment of these diseases have been reviewed to identify an
evidencebased therapeutic approach. Methods. A literature search in the
National Library of Medicine has been performed using the keywords
pericardial effusion +/- cardiac surgery +/- paediatric/congenital. The
research was then redefined adding separately the keywords
post-pericardiotomy syndrome (PPS), non-steroidal antiinflammatory drugs
(NSAID), steroids and colchicine. Results. Twelve clinical trials, 8
regarding the prophylaxis, and 4 the treatment of PPS, have been found.
Three majors agent classes, NSAID, corticosteroids, and colchicine, were
tested. Therapy of post-surgical pericardial syndromes is generally based
on NSAID +/- steroids with the adjunct of colchicine for recurrences. Just
a few targeted studies however support actual pharmacological approaches.
NSAID therapy is supported only a few randomized controlled adult trials
(RCT); while efficacy of steroids have been proved only in one small
paediatric work, and no studies are available for colchicine. Studies
furthermore presented some limitations: not univocal end-points (not
allowing for a meta-analysis), a limited sample-size, scarce attention to
confounders (such as the underlying cardiac disease and diuretic/analgesic
regimen). When to start therapy furthermore remain unclear and therapy
based on drug associations have not been assessed. As far as prophylaxis
is concerned (Table 1), more evidence (two wide RCT plus a meta-analysis)
supports the role of colchicine in adults. Prophylaxis with
NSAID/corticosteroids instead failed to prove significant advantage in
children, while a few data are available for adults. (Table presente)
Conclusions. Evidences for the treatment of PSPS are fragmentary and
incomplete. As a result, on the basis of actual knowledge, it results
difficult to establish the treatment of choice and the optimal timing for
starting therapy, especially in children. Treatment in pediatric age is
usually based on personal experience and institutional practice with NAIDS
generally employed first and steroids reserved for more severe forms of
PSPS or recurrences. Further wider and multi-agents studies are advised in
order to establish a therapeutical flow-chart for the treatment of PSPS.

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Total documents retrieved: 15

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<1>
Accession Number
2012591908
Authors
Iancu A. Ober C. Bondor C.I. Cadis H.
Institution
(Ober, Cadis) Niculae Stancioiu Heart Institute, Cluj-Napoca, Romania
(Iancu, Bondor) University of Medicine and Pharmacy Iuliu Ha +ieganu,
Cluj-Napoca, Romania
(Ober) Bondor University of Medicine and Pharmacy Iuliu Hatieganu V.
Babes, Strasse 8 RO, 400012 Cluj-Napoca, Romania
Title
Microvascular effect of intracoronary eptifibatide in acute myocardial
infarction.
Source
Cardiology (Switzerland). 123 (1) (pp 46-53), 2012. Date of Publication:
September 2012.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Objectives: In this prospective, randomized trial in patients with acute
myocardial infarction (AMI) admitted for primary percutaneous coronary
intervention (PPCI), loaded with 600 mg clopidogrel, we hypothesized that
eptifibatide administered downstream of the coronary occlusion leads to a
lower degree of microvascular obstruction compared with no additional
eptifibatide. Methods: Fifty patients with AMI, loaded with 600 mg of
clopidogrel at the first hospital contact, with occlusion of the left
anterior descending artery (LAD), were randomized to an eptifibatide group
(EG) or a control group (CG). In both groups, stenting was performed after
thrombus aspiration. Microvascular reperfusion was assessed by
angiography, electrocardiography, and transthoracic Doppler
ultrasonography of the LAD. Results: TIMI myocardial perfusion grade 2-3
was not different between the EG (72%) and the CG (84%) (p = 0.31). ST
segment resolution >70% was similarly detected in both groups (32 vs. 40%;
p = 0.56). The mean diastolic deceleration time did not differ
significantly between the CG (856.36 +/- 397.88 ms) and the EG (935.72 +/-
252.22 ms) (p = 0.41). Multivariate logistic regression revealed no
significant influence of the treatment with eptifibatide on ST segment
resolution (OR 0.47; 95% CI 0.11-2.10, p = 0.32), TIMI myocardial
perfusion (OR 0.52; 95% CI 0.10-2.59, p = 0.42), and diastolic
deceleration time (OR 0.21; 95% CI 0.03-1.51, p = 0.12). Conclusions: In
AMI patients loaded with 600 mg of clopidogrel undergoing PPCI,
intracoronary administration of eptifibatide does not clearly improve
microvascular obstruction. 2012 S Karger AG Basel.

<2>
Accession Number
2012589401
Authors
Chong S.W. Peyton P.J.
Institution
(Chong, Peyton) Department of Anaesthesia, Austin Hospital, Melbourne,
Australia
(Peyton) Department of Surgery, University of Melbourne, Austin Hospital,
Melbourne, Australia
Title
A meta-analysis of the accuracy and precision of the ultrasonic cardiac
output monitor (USCOM).
Source
Anaesthesia. 67 (11) (pp 1266-1271), 2012. Date of Publication: November
2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Summary The ultrasonic cardiac output monitor is a non-invasive,
continuous-wave Doppler monitor that can be used to measure cardiac
output. Its accuracy and precision in peri-operative and critical care has
been assessed with varied results. We conducted a meta-analysis to
calculate a pooled mean bias, precision and percentage error for this
device. Six studies were suitable for inclusion into a pooled parametric
analysis consisting of 320 measurements. The mean weighted bias was -0.39
l.min^-1 (95% CI -0.25 to -0.53 l.min^-1), precision
1.27 l.min^-1 and percentage error 42.7% (95% CI 38.5-46.9%).
The ultrasonic cardiac output monitor achieved similar agreement with
bolus thermodilution to that of other minimally invasive methods of
peri-operative cardiac output monitoring, and may have a useful role in
cardiac output monitoring. Anaesthesia 2012 The Association of
Anaesthetists of Great Britain and Ireland.

<3>
Accession Number
2012591777
Authors
Alavi S.M. Baharvand Ahmadi B. Baharestani B. Babaei T.
Institution
(Alavi, Babaei) Department of Anaesthesiology and Intensive Care Medicine,
Rajaei Heart Centre, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Baharvand Ahmadi, Baharestani) Department of Cardiovascular Surgery,
Rajaei Heart Centre, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Title
Comparison of the effects of gelatin, Ringer's solution and a modern
hydroxyl ethyl starch solution after coronary artery bypass graft surgery.
Source
Cardiovascular Journal of Africa. 23 (8) (pp 428-431), 2012. Date of
Publication: September 2012.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Objective: The aim of this study was to compare the effect of 6% hydroxyl
ethyl starch solution with 4% gelatin and Ringer's solutions on the
haemodynamic stability of patients after coronary artery bypass graft
(CABG) surgery and immediately after discontinuation of cardiopulmonary
bypass (CPB). Methods: This was a randomised, double-blind clinical trial
of 92 patients who were candidates for on-pump CABG. After discontinuation
of CPB, all patients were transferred to the intensive care unit (ICU) and
divided randomly into three groups. The first group received Ringer's
solution, the second group 4% gelatin, and the third 6% hydroxyl ethyl
starch (HES) solution (Voluven). Haemodynamic parameters such as heart
rate, mean arterial pressure, systolic blood pressure, diastolic blood
pressure, central venous pressure, cardiac output and the presence of
arrhythmias were documented. Results: The volume needed for maintaining
normal blood pressure and central venous pressure in the range of 10-14
mmHg was less in the HES group than in the other groups. The volume was
similar however in the gelatin and Ringer's groups in the first 24 hours
after surgery. Urinary output in the first four and 24 hours after surgery
were significantly higher in the HES group than in the other two groups.
Mean creatinine levels were significantly lower in the HES group.
Conclusion: HES (6%) had a better volume-expanding effect than gelatin
(4%) and Ringer's solutions, and its short-term effects on renal function
were also better than gelatin and Ringer's solutions.

<4>
Accession Number
2012589055
Authors
Devlin J.W. Al-Qadhee N.S. Skrobik Y.
Institution
(Devlin, Al-Qadhee) Northeastern University School of Pharmacy, 360
Huntington Ave. R218 TF, Boston, MA 02118, United States
(Skrobik) Lise and Jean Saine Department in Critical Care Medicine,
University of Montreal, Montreal, QC, Canada
Title
Pharmacologic prevention and treatment of delirium in critically ill and
non-critically ill hospitalised patients: A review of data from
prospective, randomised studies.
Source
Best Practice and Research: Clinical Anaesthesiology. 26 (3) (pp 289-309),
2012. Date of Publication: September 2012.
Publisher
Bailliere Tindall Ltd (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Delirium occurs commonly in acutely ill hospitalised patients,
particularly in the elderly or in cardiac or orthopaedic surgery patients,
or those in intensive care units (ICUs). Delirium worsens outcome.
Pharmaceutical agents such as antipsychotics and, in the critically ill,
dexmedetomidine, are considered therapeutic despite uncertainty regarding
their efficacy and safety. Using MEDLINE, we reviewed randomised
controlled trials (RCTs) published between 1977 and April 2012 evaluating
a pharmacologic intervention to prevent or treat delirium in critically
ill and non-critically ill hospitalised patients. The number of
prospective RCTs remains limited. Any conclusions about pharmacologic
efficacy are limited by the small size of many studies, the inconsistency
by which non-pharmacologic delirium prevention strategies were
incorporated, the lack of a true placebo arm and a failure to incorporate
ICU and non-ICU clinical outcomes. A research framework for future
evaluation of the use of medications in both ICU and non-ICU is proposed.
2012 Elsevier Ltd. All rights reserved.

<5>
Accession Number
2012588467
Authors
Roe M.T. Armstrong P.W. Fox K.A.A. White H.D. Prabhakaran D. Goodman S.G.
Cornel J.H. Bhatt D.L. Clemmensen P. Martinez F. Ardissino D. Nicolau J.C.
Boden W.E. Gurbel P.A. Ruzyllo W. Dalby A.J. McGuire D.K. Leiva-Pons J.L.
Parkhomenko A. Gottlieb S. Topacio G.O. Hamm C. Pavlides G. Goudev A.R.
Oto A. Tseng C.-D. Merkely B. Gasparovic V. Corbalan R. Cinteza M.
McLendon R.C. Winters K.J. Brown E.B. Lokhnygina Y. Aylward P.E. Huber K.
Hochman J.S. Ohman E.M.
Institution
(Roe, McLendon, Lokhnygina, Ohman) Duke Clinical Research Institute, Duke
University Medical Center, 2400 Pratt St, Durham, NC 27705, United States
(Roe, Ohman) Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Armstrong) Division of Cardiology, University of Alberta, Edmonton, AB,
Canada
(Goodman) Division of Cardiology, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(White) Auckland City Hospital, Green Lane Cardiovascular Service,
Auckland, New Zealand
(Prabhakaran) Center for Chronic Disease Control, New Delhi, India
(Cornel) Department of Cardiology, Medical Center Alkmaar, Alkmaar,
Netherlands
(Bhatt) VA Boston Healthcare System, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Clemmensen) Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Martinez) Department of Cardiology, Cordoba National University, Cordoba,
Argentina
(Ardissino) Division of Cardiology, Azienda Ospedaliero-Universitaria di
Parma, Parma, Italy
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Boden) Department of Medicine, Stratton VA Medical Center, Albany Medical
College, Albany, NY, United States
(Hochman) Leon H. Charney Division of Cardiology, New York University
School of Medicine, NYU Langone Medical Center, NY, United States
(Gurbel) Sinai Center for Thrombosis Research, Sinai Hospital of
Baltimore, Baltimore, United States
(Ruzyllo) Department of Coronary Artery Disease, Institute of Cardiology,
Warsaw, Poland
(Dalby) Milpark Hospital, Johannesburg, South Africa
(McGuire) University of Texas-Southwestern Medical Center, Dallas, TX,
United States
(Leiva-Pons) Cardiology Department, Hospital Central Dr. Morones Prieto,
San Luis Potosi, Mexico
(Parkhomenko) Emergency Cardiology, Institute of Cardiology, Kiev, Ukraine
(Gottlieb) Department of Cardiology, Bikur Cholim Hospital, Jerusalem,
Israel
(Topacio) Department of Medicine, Medical Center Manila, Manila,
Philippines
(Hamm) Kerckhoff Heart Center, Bad Nauheim, Germany
(Pavlides) Cardiology Division, Onassis Cardiac Surgery Center, Kallithea,
Greece
(Goudev) Cardiology Department, Queen Giovanna University Hospital, Sofia,
Bulgaria
(Oto) Department of Cardiology, Hacettepe University Faculty of Medicine,
Ankara, Turkey
(Tseng) Division of Cardiology, National Taiwan University College of
Medicine, Taipei, Taiwan (Republic of China)
(Merkely) Heart Center, Semmelweis University, Budapest, Hungary
(Gasparovic) Department of Intensive Care Medicine, Clinical Hospital
Center Zagreb, Zagreb, Croatia
(Corbalan) Cardiovascular Division, Faculty of Medicine, Pontificia
Universidad Catolica de Chile, Santiago, Chile
(Cinteza) Division of Cardiology, Emergency University Hospital of
Bucharest, Bucharest, Romania
(Winters, Brown) Eli Lilly, Indianapolis, IN, United States
(Aylward) South Australian Health and Medical Research Institute, Flinders
University Medical Centre, Adelaide, SA, Australia
(Huber) Third Department of Medicine, Cardiology and Emergency Medicine,
Wilhelminenhospital, Vienna, Austria
Title
Prasugrel versus clopidogrel for acute coronary syndromes without
revascularization.
Source
New England Journal of Medicine. 367 (14) (pp 1297-1309), 2012. Date of
Publication: 04 Oct 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: The effect of intensified platelet inhibition for patients
with unstable angina or myocardial infarction without ST-segment elevation
who do not undergo revascularization has not been delineated. METHODS: In
this double-blind, randomized trial, in a primary analysis involving 7243
patients under the age of 75 years receiving aspirin, we evaluated up to
30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75
mg daily). In a secondary analysis involving 2083 patients 75 years of age
or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel.
RESULTS: At a median follow-up of 17 months, the primary end point of
death from cardiovascular causes, myocardial infarction, or stroke among
patients under the age of 75 years occurred in 13.9% of the prasugrel
group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel
group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P = 0.21).
Similar results were observed in the overall population. The prespecified
analysis of multiple recurrent ischemic events (all components of the
primary end point) suggested a lower risk for prasugrel among patients
under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P =
0.04). Rates of severe and intracranial bleeding were similar in the two
groups in all age groups. There was no significant between-group
difference in the frequency of nonhemorrhagic serious adverse events,
except for a higher frequency of heart failure in the clopidogrel group.
CONCLUSIONS: Among patients with unstable angina or myocardial infarction
without ST-segment elevation, prasugrel did not significantly reduce the
frequency of the primary end point, as compared with clopidogrel, and
similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi
Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.) Copyright
2012 Massachusetts Medical Society.

<6>
Accession Number
2012588466
Authors
Thiele H. Zeymer U. Neumann F.-J. Ferenc M. Olbrich H.-G. Hausleiter J.
Richardt G. Hennersdorf M. Empen K. Fuernau G. Desch S. Eitel I. Hambrecht
R. Fuhrmann J. Bohm M. Ebelt H. Schneider S. Schuler G. Werdan K.
Institution
(Thiele, Fuernau, Desch, Eitel, Schuler) University of Leipzig-Heart
Center, Department of Internal Medicine/Cardiology, Strumpellstr. 39,
04289 Leipzig, Germany
(Zeymer, Schneider) Klinikum Ludwigshafen, Institut fur
Herzinfarktforschung, Ludwigshafen, Germany
(Neumann, Ferenc) Heart Center Bad Krozingen, Bad Krozingen, Germany
(Olbrich) Asklepios Clinic Langen-Seligenstadt, Langen, Germany
(Hausleiter) German Heart Center Munich, Munich, Germany
(Richardt) Heart Center-Segeberger Kliniken, Bad Segeberg, Germany
(Hennersdorf) SLK Kliniken Heilbronn, Heilbronn, Germany
(Empen) Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
(Hambrecht) Klinikum Links der Weser, Bremen, Germany
(Fuhrmann) Zentralklinik Bad Berka, Bad Berka, Germany
(Bohm) University Clinic of Saarland, Homburg/Saar, Germany
(Ebelt, Werdan) Martin-Luther University Halle-Wittenberg, Halle, Germany
Title
Intraaortic balloon support for myocardial infarction with cardiogenic
shock.
Source
New England Journal of Medicine. 367 (14) (pp 1287-1296), 2012. Date of
Publication: 04 Oct 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: In current international guidelines, intraaortic balloon
counterpulsation is considered to be a class I treatment for cardiogenic
shock complicating acute myocardial infarction. However, evidence is based
mainly on registry data, and there is a paucity of randomized clinical
trials. METHODS: In this randomized, prospective, open-label, multicenter
trial, we randomly assigned 600 patients with cardiogenic shock
complicating acute myocardial infarction to intraaortic balloon
counterpulsation (IABP group, 301 patients) or no intraaortic balloon
counterpulsation (control group, 299 patients). All patients were expected
to undergo early revascularization (by means of percutaneous coronary
intervention or bypass surgery) and to receive the best available medical
therapy. The primary efficacy end point was 30-day all-cause mortality.
Safety assessments included major bleeding, peripheral ischemic
complications, sepsis, and stroke. RESULTS: A total of 300 patients in the
IABP group and 298 in the control group were included in the analysis of
the primary end point. At 30 days, 119 patients in the IABP group (39.7%)
and 123 patients in the control group (41.3%) had died (relative risk with
IABP, 0.96; 95% confidence interval, 0.79 to 1.17; P = 0.69). There were
no significant differences in secondary end points or in process-of-care
measures, including the time to hemodynamic stabilization, the length of
stay in the intensive care unit, serum lactate levels, the dose and
duration of catecholamine therapy, and renal function. The IABP group and
the control group did not differ significantly with respect to the rates
of major bleeding (3.3% and 4.4%, respectively; P = 0.51), peripheral
ischemic complications (4.3% and 3.4%, P = 0.53), sepsis (15.7% and 20.5%,
P = 0.15), and stroke (0.7% and 1.7%, P = 0.28). CONCLUSIONS: The use of
intraaortic balloon counterpulsation did not significantly reduce 30-day
mortality in patients with cardiogenic shock complicating acute myocardial
infarction for whom an early revascularization strategy was planned.
(Funded by the German Research Foundation and others; IABP-SHOCK II
ClinicalTrials.gov number, NCT00491036.) Copyright 2012 Massachusetts
Medical Society.

<7>
Accession Number
2012581743
Authors
Shabana A. El-Menyar A.
Institution
(Shabana, El-Menyar) Department of Clinical Medicine, Weill Cornell
Medical College, P.O. Box 24144, Doha, Qatar
(Shabana, El-Menyar) Department of Cardiology, Hamad Medical Corporation,
P.O. Box 3050, Doha, Qatar
(El-Menyar) Clinical Research, Trauma Surgery Unit, Hamad General
Hospital, P.O. Box 3050, Doha, Qatar
Title
Myocardial viability: What we knew and what is new.
Source
Cardiology Research and Practice. 1 (1) , 2012. Article Number: 607486.
Date of Publication: 2012.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Some patients with chronic ischemic left ventricular dysfunction have
shown significant improvements of contractility with favorable long-term
prognosis after revascularization. Several imaging techniques are
available for the assessment of viable myocardium, based on the detection
of preserved perfusion, preserved glucose metabolism, intact cell membrane
and mitochondria, and presence of contractile reserve. Nuclear cardiology
techniques, dobutamine echocardiography and positron emission tomography
are used to assess myocardial viability. In recent years, new advances
have improved methods of detecting myocardial viability. This paper
summarizes the pathophysiology, methods, and impact of detection of
myocardial viability, concentrating on recent advances in such methods. We
reviewed the literature using search engines MIDLINE, SCOUPS, and EMBASE
from 1988 to February 2012. We used key words: myocardial viability,
hibernation, stunning, and ischemic cardiomyopathy. Recent studies showed
that the presence of viable myocardium was associated with a greater
likelihood of survival in patients with coronary artery disease and LV
dysfunction, but the assessment of myocardial viability did not identify
patients with survival benefit from revascularization, as compared with
medical therapy alone. This topic is still debatable and needs more
evidence. 2012 Adel Shabana and Ayman El-Menyar.

<8>
Accession Number
2012582278
Authors
Kim B.-K. Hong M.-K. Shin D.-H. Nam C.-M. Kim J.-S. Ko Y.-G. Choi D. Kang
T.-S. Park B.-E. Kang W.-C. Lee S.-H. Yoon J.-H. Hong B.-K. Kwon H.-M.
Jang Y.
Institution
(Kim, Hong, Shin, Kim, Ko, Choi, Jang) Severance Cardiovascular Hospital,
Yonsei University, College of Medicine, Seoul, South Korea
(Hong, Jang) Severance Biomedical Science Institute, Yonsei University,
College of Medicine, Seoul, South Korea
(Nam) Department of Preventive Medicine and Biostatistics, Yonsei
University, College of Medicine, Seoul, South Korea
(Kang, Park) Dankook University, College of Medicine, Cheonan, South Korea
(Kang) Gachon University College of Medicine, Incheon, South Korea
(Lee, Yoon) Yonsei University, Wonju College of Medicine, Wonju, South
Korea
(Hong, Kwon) Kangnam Severance Hospital, Seoul, South Korea
Title
A new strategy for discontinuation of dual antiplatelet therapy: The reset
trial (real safety and efficacy of 3-month dual antiplatelet therapy
following endeavor zotarolimus-eluting stent implantation).
Source
Journal of the American College of Cardiology. 60 (15) (pp 1340-1348),
2012. Date of Publication: 09 Oct 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The goal of this study was to evaluate shorter duration (3
months) dual antiplatelet therapy (DAPT) after drug-eluting stent (DES)
implantation. Background: There have been few published reports of
prospective randomized clinical studies comparing the safety and efficacy
of shorter duration DAPT after DES implantation. Methods: We randomly
assigned 2,117 patients with coronary artery stenosis into 2 groups
according to DAPT duration and stent type: 3-month DAPT following Endeavor
zotarolimus-eluting stent (E-ZES) implantation (E-ZES+3-month DAPT, n =
1,059) versus 12-month DAPT following the other DES implantation (standard
therapy, n = 1,058). We hypothesized that the E-ZES+3-month DAPT would be
noninferior to the standard therapy for the primary composite endpoint
(cardiovascular death, myocardial infarction, stent thrombosis,
target\vessel revascularization, or bleeding) at 1 year. Results: The
primary endpoint occurred in 40 (4.7%) patients assigned to E-ZES+3-month
DAPT compared with 41 (4.7%) patients assigned to the standard therapy
(difference: 0.0%; 95% confidence interval [CI]: -2.5 to 2.5; p = 0.84; p
< 0.001 for noninferiority). The composite rates of any death, myocardial
infarction, or stent thrombosis were 0.8% and 1.3%, respectively
(difference: -0.5%; 95% CI: -1.5 to 0.5; p = 0.48). The rates of stent
thrombosis were 0.2% and 0.3%, respectively (difference: -0.1%; 95% CI:
-0.5 to 0.3; p = 0.65) without its further occurrence after cessation of
clopidogrel in the E-ZES+3-month DAPT group. The rates of target vessel
revascularization were 3.9% and 3.7%, respectively (difference: 0.2%; 95%
CI: -2.3 to 2.6; p = 0.70). Conclusions: E-ZES+3-month DAPT was
noninferior to the standard therapy with respect to the occurrence of the
primary endpoint. (REal Safety and Efficacy of a 3-month dual antiplatelet
Therapy following E-ZES implantation [RESET]; NCT01145079) 2012 American
College of Cardiology Foundation.

<9>
Accession Number
2012582264
Authors
Makani H. Bangalore S. Halpern D. Makwana H.G. Chaudhry F.A.
Institution
(Makani, Halpern, Makwana, Chaudhry) Division of Cardiology, St. Luke's
Roosevelt Hospital, Columbia University, 1111 Amsterdam Avenue, New York,
NY 10025, United States
(Bangalore) New York University, School of Medicine, New York, NY, United
States
Title
Cardiac outcomes with submaximal normal stress echocardiography: A
meta-analysis.
Source
Journal of the American College of Cardiology. 60 (15) (pp 1393-1401),
2012. Date of Publication: 09 Oct 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The aim of the study was to evaluate the risk of cardiac
events in patients with normal stress echocardiography (SE) who attained
maximal age-predicted heart rate (APHR) compared with those who did not in
the setting of both normal and abnormal SE. Background: SE is an important
tool in the risk stratification and prognosis of patients with known or
suspected coronary artery disease (CAD). The prognostic value of a normal
but submaximal SE (<85% of maximal APHR) is conflicting. Methods: PubMed,
EMBASE, and CENTRAL were searched from 1980 to September 2011 for SE
studies reporting cardiac outcomes in patients with known or suspected CAD
stratified by achieved APHR. Both hard events (cardiac death and
myocardial infarction) and total cardiac events (revascularization
procedures in addition to hard events) were analyzed separately. Data on
all-cause mortality were obtained when available. Results: Fourteen
studies with 11,542 patients followed up for a mean duration of 32 months
fulfilled the inclusion criteria. In 8 studies with 4,577 patients, the
risk of hard events with normal SE (both exercise and dobutamine) was 70%
higher in patients who achieved submaximal compared with those with
maximal APHR (annualized event rate 2.08% vs. 0.77%; p = 0.0008; 95%
confidence interval [CI]: 1.25 to 2.31). In 7 studies with 5,798 patients,
the risk of total cardiac events with normal SE (both exercise and
dobutamine) was 127% higher in patients who achieved submaximal compared
with those with maximal APHR (annualized event rate 1.87% vs. 1.02%; p <
0.0001; 95% CI: 1.54 to 3.34). The risk of total cardiac events was 278%
higher in patients with abnormal SE with submaximal APHR compared with
those with normal SE with submaximal APHR (p < 0.0001; 95% CI: 2.81 to
5.08). There was a trend toward increased all-cause mortality in patients
with normal SE with submaximal compared with maximal APHR (relative risk:
1.36; p = 0.15; 95% CI: 0.89 to 2.09). Conclusions: Patients with
submaximal APHR in the setting of normal SE have a higher risk of
cardiovascular events than those who attained maximal stress test. Thus,
the results of submaximal APHR in the setting of normal SE should be taken
into consideration for more accurate risk stratification and prognosis.
2012 American College of Cardiology Foundation.

<10>
Accession Number
2012584887
Authors
Bachinsky W.B. Abdelsalam M. Boga G. Kiljanek L. Mumtaz M. McCarty C.
Institution
(Bachinsky, Abdelsalam, Boga, Kiljanek, Mumtaz, McCarty) Writing Group on
Behalf of the Cardiac Surgery and Interventional Cardiology Groups,
Pinnacle Health Cardiovascular Institute, Harrisburg Hospital, Harrisburg,
PA, United States
Title
Comparative study of same sitting hybrid coronary artery revascularization
versus off-pump coronary artery bypass in multivessel coronary artery
disease.
Source
Journal of Interventional Cardiology. 25 (5) (pp 460-468), 2012. Date of
Publication: October 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Objective: We compared the outcomes of same sitting robotic-assisted
hybrid coronary artery revascularization (HCR) with off-pump coronary
artery bypass grafting (OPCABG) in similar patients with multivessel
coronary artery disease. Background: HCR is a novel procedure in selected
patients with multivessel coronary artery disease (CAD). Although there
are some data on staged HCR, the data on same sitting HCR are limited.
Methods: We conducted a prospective study comparing same sitting
robotic-assisted HCR patients (n = 25) to a group of consecutive low to
moderate risk OPCABG patients (n = 27) during the study period. HCR
patients underwent robotic internal mammary artery takedown followed by
OPCABG via minithoracotomy. After confirming graft patency, immediate
percutaneous coronary intervention on the nonbypass arteries was
performed. Comparative analyses were performed on in-hospital and 30 day
outcomes. Results: The baseline characteristics were similar for both
groups including the severity of CAD (Syntax score 33.5+/-8.2 vs.
34.9+/-8.2, P = 0.556). Overall MACE was similar between both groups;
however, the HCR group showed improved hospital outcomes with lower need
for postoperative transfusions (12% vs. 67%, P < 0.001), and shorter
length of hospital stay (5.1+/-2.8 vs. 8.2+/-5.4 days, P < 0.01). Despite
lower postoperative costs, the HCR group had higher overall hospital costs
due to higher procedural costs ($33,984 +/-$4,806 vs. $27,816+/-$11,172, P
< 0.0001). Propensity model analysis showed similar findings. The HCR
group showed improved quality of life measures with shorter time to return
to work (5.3+/-3.0 vs. 8.2+/- 4.6 weeks, P = 0.01). Conclusions: Same
sitting HCR appears to be feasible and may offer superior outcomes to
standard OPCABG, further studies are warranted. (J Interven Cardiol
2012;25:460-468) 2012, Wiley Periodicals, Inc.

<11>
Accession Number
2012585853
Authors
Freitas Jr. A.F. Bacal F. Oliveira Jr. J.L. Fiorelli A.I. Santos R.H.
Moreira L.F.P. Silva C.P. Mangini S. Tsutsui J.M. Bocchi E.A.
Institution
(Freitas Jr., Bacal, Oliveira Jr., Fiorelli, Santos, Moreira, Silva,
Mangini, Tsutsui, Bocchi) Instituto do Coracao (InCor), Hospital das
Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo,
SP, Brazil
Title
Sildenafil vs. Sodium before nitroprusside for the pulmonary hypertension
reversibility test before cardiac transplantation.
Source
Arquivos Brasileiros de Cardiologia. 99 (3) (pp 848-856), 2012. Date of
Publication: September 2012.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
Background: Pulmonary hypertension is associated with a worse prognosis
after cardiac transplantation. The pulmonary hypertension reversibility
test with sodium nitroprusside (SNP) is associated with a high rate of
systemic arterial hypotension, ventricular dysfunction of the transplanted
graft and high rates of disqualification from transplantation. Objective:
This study was aimed at comparing the effects of sildenafil (SIL) and SNP
on hemodynamic, neurohormonal and echocardiographic variables during the
pulmonary reversibility test. Methods: The patients underwent
simultaneously right cardiac catheterization, echocardiography, BNP
measurement, and venous blood gas analysis before and after receiving
either SNP (1 - 2 mug/kg/min) or SIL (100 mg, single dose). Results: Both
drugs reduced pulmonary hypertension, but SNP caused a significant
systemic hypotension (mean blood pressure - MBP: 85.2 vs. 69.8 mm Hg; p <
0.001). Both drugs reduced cardiac dimensions and improved left cardiac
function (SNP: 23.5 vs. 24.8%, p = 0.02; SIL: 23.8 vs. 26%, p < 0.001) and
right cardiac function (SIL: 6.57 +/- 2.08 vs. 8.11 +/- 1.81 cm/s, p =
0.002; SNP: 6.64 +/- 1.51 vs. 7.72 +/- 1.44 cm/s, p = 0.003), measured
through left ventricular ejection fraction and tissue Doppler,
respectively. Sildenafil, contrary to SNP, improved venous oxygen
saturation, measured on venous blood gas analysis. Conclusion: Sildenafil
and SNP are vasodilators that significantly reduce pulmonary hypertension
and cardiac geometry, in addition to improving biventricular function.
Sodium nitroprusside, contrary to SIL, was associated with systemic
arterial hypotension and worsening of venous oxygen saturation.

<12>
Accession Number
2012575398
Authors
Lawson E.H. Gibbons M.M. Ko C.Y. Shekelle P.G.
Institution
(Lawson, Gibbons, Ko) Department of Surgery, David Geffen School of
Medicine, University of California, 10833 LeConte Ave., CHS 72-215, Los
Angeles, CA 90095, United States
(Lawson, Ko) Division of Research and Optimal Patient Care, American
College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611, United
States
(Gibbons) Department of Surgery, Olive View-UCLA Medical Center, 14445
Olive View Drive, Sylmar, CA 91342, United States
(Ko, Shekelle) Departments of Surgery and Medicine, VA Greater Los Angeles
Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, United
States
(Shekelle) RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United
States
Title
The appropriateness method has acceptable reliability and validity for
assessing overuse and underuse of surgical procedures.
Source
Journal of Clinical Epidemiology. 65 (11) (pp 1133-1143), 2012. Date of
Publication: November 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objective: To summarize the findings of methodological studies on the
RAND/University of California Los Angeles (RAND/UCLA) appropriateness
method, which was developed to assess if variation in the use of surgical
procedures is because of overuse and/or underuse. Study Design and
Setting: A MEDLINE literature search was performed. Studies were included
if they assessed the reliability or validity of the RAND/UCLA
appropriateness method for a surgical procedure or the effect of altering
panelist composition or eliminating in-person discussion between rating
rounds. Information was abstracted on procedure, study design, and
findings. Results: One thousand six hundred one titles were identified,
and 37 met the inclusion criteria. The test-retest reliability is good to
very good (kappa, 0.64-0.81) for total knee and hip joint replacement,
coronary artery bypass grafting (CABG), and carotid endarterectomy (CEA).
The interpanel reliability is moderate to very good (kappa, 0.52-0.83) for
CABG and hysterectomy. Construct validity has been demonstrated by
comparing the appropriateness method with guidelines and/or evidence-based
approaches for endoscopy, colonoscopy, CABG, hysterectomy, and CEA.
Predictive validity has been studied for cardiac revascularization, in
which concordance with appropriateness classification is associated with
better clinical outcomes. Conclusion: Our findings support use of the
appropriateness method to assess variation in the rates of the procedures
studied by identifying overuse and underuse. Further methodological
research should be conducted as appropriateness criteria are developed and
implemented for a broader range of procedures. 2012 Elsevier Inc. All
rights reserved.

<13>
[Use Link to view the full text]
Accession Number
2012581853
Authors
O'Neill W.W. Kleiman N.S. Moses J. Henriques J.P.S. Dixon S. Massaro J.
Palacios I. Maini B. Mulukutla S. Dzavik V. Popma J. Douglas P.S. Ohman M.
Institution
(O'Neill) University of Miami, Miami, FL, United States
(Kleiman) Methodist DeBakey Heart and Vascular Center, Houston, TX, United
States
(Moses) Columbia University Medical Center, New York Presbyterian
Hospital, New York, NY, United States
(Henriques) Academic Medical Center, Amsterdam, Netherlands
(Dixon) Beaumont Hospital, Royal Oak, MI, United States
(Massaro) Harvard Clinical Research Institute, Boston, MA, United States
(Palacios) Massachusetts General Hospital, Boston, MA, United States
(Maini) Pinnacle Health Medical Center, Wormleysburg, PA, United States
(Mulukutla) University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Dzavik) Toronto General Hospital, Toronto, ON, Canada
(Popma) Beth Israel Deaconess Hospital, Boston, MA, United States
(Douglas) Duke Clinical Research Institute, Durham, NC, United States
(Ohman) Duke University Medical Center, Durham, NC, United States
Title
A prospective, randomized clinical trial of hemodynamic support with
impella 2.5 versus intra-aortic balloon pump in patients undergoing
high-risk percutaneous coronary intervention: The PROTECT II study.
Source
Circulation. 126 (14) (pp 1717-1727), 2012. Date of Publication: 02 Oct
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND-: Although coronary artery bypass grafting is generally
preferred in symptomatic patients with severe, complex multivessel, or
left main disease, some patients present with clinical features that make
coronary artery bypass grafting clinically unattractive. Percutaneous
coronary intervention with hemodynamic support may be feasible for these
patients. Currently, there is no systematic comparative evaluation of
hemodynamic support devices for this indication. METHODS AND RESULTS-: We
randomly assigned 452 symptomatic patients with complex 3-vessel disease
or unprotected left main coronary artery disease and severely depressed
left ventricular function to intra-aortic balloon pump (IABP) (n=226) or
Impella 2.5 (n=226) support during nonemergent high-risk percutaneous
coronary intervention. The primary end point was the 30-day incidence of
major adverse events. A 90-day follow-up was required, as well, by
protocol. Impella 2.5 provided superior hemodynamic support in comparison
with IABP, with maximal decrease in cardiac power output from baseline of
-0.04+/-0.24 W in comparison with -0.14+/-0.27 W for IABP (P=0.001). The
primary end point (30-day major adverse events) was not statistically
different between groups: 35.1% for Impella 2.5 versus 40.1% for IABP,
P=0.227 in the intent-to-treat population and 34.3% versus 42.2%, P=0.092
in the per protocol population. At 90 days, a strong trend toward
decreased major adverse events was observed in Impella 2.5-supported
patients in comparison with IABP: 40.6% versus 49.3%, P=0.066 in the
intent-to-treat population and 40.0% versus 51.0%, P=0.023 in the per
protocol population, respectively. CONCLUSIONS-: The 30-day incidence of
major adverse events was not different for patients with IABP or Impella
2.5 hemodynamic support. However, trends for improved outcomes were
observed for Impella 2.5-supported patients at 90 days. 2012 American
Heart Association, Inc.

<14>
[Use Link to view the full text]
Accession Number
2012577890
Authors
Vonk A.B. Muntajit W. Bhagirath P. Van Barneveld L.J. Romijn J.W. De
Vroege R. Boer C.
Institution
(Vonk, Muntajit, Van Barneveld, De Vroege) Department of Cardio-Thoracic
Surgery, Institute for Cardiovascular Research, VU University Medical
Center, Amsterdam, Netherlands
(Bhagirath, Romijn, Boer) Department of Anesthesiology, Institute for
Cardiovascular Research, VU University Medical Center, De Boelelaan 1117,
1081 HV Amsterdam, Netherlands
Title
Residual blood processing by centrifugation, cell salvage or
ultrafiltration in cardiac surgery: Effects on clinical hemostatic and
ex-vivo rheological parameters.
Source
Blood Coagulation and Fibrinolysis. 23 (7) (pp 622-628), 2012. Date of
Publication: October 2012.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
The study compared the effects of three blood concentration techniques
after cardiopulmonary bypass on clinical hemostatic and ex-vivo
rheological parameters. Residual blood of patients undergoing elective
cardiac surgery was processed by centrifugation, cell salvage or
ultrafiltration, and retransfused (n = 17 per group). Study parameters
included blood loss, (free) hemoglobin, hematocrit, fibrinogen and
erythrocyte aggregation, deformability and 2,3-diphosphoglycerate content.
Patient characteristics were similar between groups. Ultrafiltration was
associated with the highest weight of the transfusion bag [649 +/- 261 vs.
320 +/- 134 g (centrifugation) and 391 +/- 158 g (cell salvage); P <
0.01]. Cell salvage resulted in the lowest hemolysis levels in the
transfusion bag. Retransfusion of cell saver blood induced the largest
gain in postoperative patient hemoglobin levels when compared to
centrifugation and ultrafiltration, and was associated with the largest
increase in 2,3-diphosphoglycerate when compared to ultrafiltration
(2,3-diphosphoglycerate 1.34 +/- 1.92 vs. -0.77 +/- 1.56 mmol/l; P =
0.03). Cell salvage is superior with respect to postoperative hemoglobin
gain and washout of free hemoglobin when compared to centrifugation or
ultrafiltration. 2012 Wolters Kluwer Health | Lippincott Williams &
Wilkins.

<15>
Accession Number
70893464
Authors
Irfan A.M. Marshall E. Turner B. Snosek M. Tubbs R.S. Anderson R.H. Loukas
M.
Institution
(Irfan, Marshall, Turner, Snosek, Tubbs, Anderson, Loukas) Department of
Anatomical Sciences, St. George's University, St. George's, Grenada
Title
The anatomy of the aortic root.
Source
Clinical Anatomy. Conference: 29th Annual Meeting of the American
Association of Clinical Anatomists St. George Grenada. Conference Start:
20120708 Conference End: 20120712. Conference Publication: (var.pagings).
25 (7) (pp 930), 2012. Date of Publication: October 2012.
Publisher
Wiley-Liss Inc.
Abstract
The aortic root is the anatomical bridge between the left ventricle and
the ascending aorta. Its clinical importance stems for its everyday use in
aortic valve replacement. In this meta-analysis, we describe the anatomy
of this crucial cardiac component, emphasizing the problems currently
existing due to indiscriminate description of the non-existent annulus.
The aortic valve is made up of the aortic valve cusps supported by the
aortic sinuses (of Valsalva), with the important fibrous interleaflet
triangles interposed between the basal attachments of the leaflets. As
such, it possesses significant length, but because of the semilunar
attachment of the cusps, there is no discrete proximal border to the root.
It is limited distally by the supravalvular ridge (or sinutubular
junction). Its description over the years has been bedeviled by accounts
of a valvar annulus. There are at least 2 discrete anatomic rings within
the root, but neither serves to support the valvar cusps. The essence of
the attachments of the cusps is their semilunar hinges, with each cusp
extending from distal attachments at the supravalvular ridge (sinutubular
junction) to basal ventricular attachments. Of the 3 cusps, 2 are
supported basally by ventricular muscle, but the third has an exclusively
fibrous base. The root acts as a bridging structure not only anatomically,
in that it separates the myocardial and arterial components of the
systemic pathway, but also functionally, since its proximal and distal
components face ventricular and arterial pressures during life. Although
usually describe in terms of possessing an annulus, if translated
literally, an annulus is no more than a little ring, and at least 2 such
anatomic rings can be found within the aortic root, albeit that neither
ring supports the entirety of the hinges of the valvar cusps. When seen in
3 dimensions, the aortic root has a crown-like, rather than a ring-like,
configuration. We submit that future understanding of the structure of the
root, a matter of great clinical significance, would be much facilitated
if anatomists ceased describing a non-existent aortic annulus.

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<1>
Accession Number
2012576590
Authors
Cormack F. Shipolini A. Awad W.I. Richardson C. McCormack D.J. Colleoni L.
Underwood M. Baldeweg T. Hogan A.M.
Institution
(Cormack) MRC Cognition and Brain Sciences Unit, 15 Chaucer Road,
Cambridge, United Kingdom
(Shipolini, Awad, McCormack, Colleoni, Hogan) Barts and The London NHS
Trust, Queen Mary University of London, United Kingdom
(Richardson) Brighton and Sussex Medical School, University of Sussex,
Brighton, United Kingdom
(Underwood) Prince of Wales Hospital, Shatin, NT, Hong Kong
(Baldeweg, Hogan) UCL Institute of Child Health, Guildford Street, London,
United Kingdom
(Hogan) University College London Hospital NHS Trust, Euston Road, London,
United Kingdom
Title
A meta-analysis of cognitive outcome following coronary artery bypass
graft surgery.
Source
Neuroscience and Biobehavioral Reviews. 36 (9) (pp 2118-2129), 2012. Date
of Publication: October 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Coronary artery bypass graft (CABG) surgery is an established treatment
for complex coronary artery disease. There is a widely held belief that
cognitive decline presents post-operatively. A consensus statement of core
neuropsychological tests was published in 1995 with the intention of
guiding investigation into this issue. We conducted a meta-analysis
evaluating the evidence for cognitive decline post-CABG surgery.
Twenty-eight published studies, accumulating data from up to 2043 patients
undergoing CABG surgery, were included. Results were examined at 'very
early' (<2 weeks), 'early' (3 months) and 'late' (6-12 months) time
periods post-operatively. Two of the four tests suggested an initial very
early decrease in psychomotor speed that was not present at subsequent
testing. Rather, the omnibus data indicated subtle improvement in function
relative to pre-operative baseline testing. Our findings suggest
improvement in cognitive function in the first year following CABG
surgery. This is contrary to the more negative interpretation of results
of some individual publications included in our review, which may reflect
poor outcomes in a few patients and/or methodological issues. 2012
Elsevier Ltd.

<2>
[Use Link to view the full text]
Accession Number
2012574547
Authors
Dale O. Somogyi A.A. Li Y. Sullivan T. Shavit Y.
Institution
(Dale, Somogyi, Li, Shavit) Discipline of Pharmacology, Faculty of Health
Sciences, University of Adelaide, Adelaide, Australia
(Dale) Department of Circulation and Medical Imaging, Pain and Palliation
Research Group, Norwegian University of Science and Technology, N-7491
Trondheim, Norway
(Dale) Department of Anaesthesia and Emergency Medicine, St. Olav's
University Hospital, Trondheim, Norway
(Sullivan) Discipline of Public Health, Faculty of Health Sciences,
University of Adelaide, Adelaide, Australia
(Shavit) Department of Psychology, Hebrew University, Jerusalem, Israel
Title
Does intraoperative ketamine attenuate inflammatory reactivity following
surgery? A systematic review and meta-analysis.
Source
Anesthesia and Analgesia. 115 (4) (pp 934-943), 2012. Date of Publication:
October 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: Reports regarding the ability of the anesthetic drug ketamine
to attenuate the inflammatory response to surgery are conflicting. In this
systematic review we examined the effect of perioperative ketamine
administration on postoperative inflammation as assessed by concentrations
of the biomarker interleukin-6 (IL-6). Methods: This study was based on a
systematic search in PubMed, Scopus, Web of Knowledge, and the Cochrane
Library. English written randomized controlled trials conducted in humans
were eligible. To be included in the analysis, outcome had to relate to
inflammation or immune modulation. Each study was reviewed independently
by 2 assessors. Data were analyzed according to the GRADE's approach and
reported in compliance with the PRISMA recommendations. Results: Fourteen
studies were eligible for evaluation (684 patients). Surgery was performed
under general anesthesia, and ketamine was given before or during the
surgery in varied doses Eight studies involved cardiopulmonary bypass
operations, 4 were for abdominal surgery, 1 thoracic surgery, and 1
cataract surgery. Three studies were deemed of low quality. Nine studies
measured IL-6 concentrations within the first 6 hours postoperatively; but
in 3 studies, other potent anti-inflammatory drugs were used as
premedication or during the operation; thus 6 studies (n = 331) were
included in the meta-analysis. Using postoperative IL-6 concentrations as
an outcome, ketamine had an anti-inflammatory effect; the meta-analysis
showed a mean preoperative-postoperative IL-6 concentration difference
(95% confidence interval) of -71 (-101 to -41) pg/mL. Conclusions: It can
be concluded that intraoperative administration of ketamine significantly
inhibits the early postoperative IL-6 inflammatory response. Future
studies should further examine the anti-inflammatory effect of ketamine
during major surgery, determine whether ketamine treatment alters
functional outcomes, elucidate the mechanisms of its anti-inflammatory
effect, and suggest an appropriate dosing regimen. Copyright 2012
International Anesthesia Research Society.

<3>
Accession Number
2012569451
Authors
Hirsch J.C. Jacobs M.L. Andropoulos D. Austin E.H. Jacobs J.P. Licht D.J.
Pigula F. Tweddell J.S. Gaynor J.W.
Institution
(Hirsch) Department of Cardiac Surgery, University of Michigan Medical
Center, Ann Arbor, MI, United States
(Jacobs) Department of Pediatric and Congenital Heart Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Andropoulos) Departments of Anesthesiology and Pediatrics, Texas
Children's Hospital, Baylor College of Medicine, Houston, TX, United
States
(Austin) Department of Surgery, University of Louisville, Kosair
Children's Hospital, Louisville, KY, United States
(Jacobs) Department of Cardiac Surgery, All Children's Hospital,
University of South, Tampa, FL, United States
(Licht) Department of Pediatrics, Division of Neurology, Children's
Hospital of Philadelphia, Philadelphia, PA, United States
(Gaynor) Department of Surgery, Division of Pediatric Cardiothoracic
Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United
States
(Pigula) Department of Cardiac Surgery, Children's Hospital of Boston,
Boston, MA, United States
(Tweddell) Department of Surgery, Division of Cardiothoracic Surgery,
Medical College of Wisconsin, Milwaukee, WI, United States
Title
Protecting the infant brain during cardiac surgery: A systematic review.
Source
Annals of Thoracic Surgery. 94 (4) (pp 1365-1373), 2012. Date of
Publication: October 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Prevention of brain injury during congenital heart surgery has focused on
intraoperative and perioperative neuroprotection and neuromonitoring. Many
strategies have been adopted as "standard of care." However, the strength
of evidence for these practices and the relationship to long-term outcomes
are unknown. We performed a systematic review (January 1, 1990 to July 30,
2010) of neuromonitoring and neuroprotection strategies during
cardiopulmonary bypass (CPB) in infants of age 1 year or less. Papers were
graded individually and as thematic groups, assigning evidence-based
medicine and American College of Cardiology/American Heart Association
(ACC/AHA) level of evidence grades. Consensus scores were determined by
adjudication. Literature search identified 527 manuscripts; 162 met
inclusion criteria. Study designs were prospective observational cohort
(53.7%), case-control (21.6%), randomized clinical trial (13%), and
retrospective observational cohort (9.9%). Median sample size was 43
(range 3 to 2,481). Primary outcome was evidence of structural brain
injury or functional disability (neuroimaging, electroencephalogram,
formal neurologic examination, or neurodevelopmental testing) in 43%.
Follow-up information was reported in only 29%. The most frequent level of
evidence was evidence-based medicine level 4 (33.3%) or ACC/AHA class IIB:
level B (42%). The only intervention with sufficient evidence to recommend
"the procedure or treatment should be performed" was avoidance of extreme
hemodilution during CPB. Data supporting use of current neuromonitoring
and neuroprotective techniques are limited. The level of evidence is
insufficient to support effectiveness of most of these strategies.
Well-designed studies with correlation to clinical outcomes and long-term
follow-up are needed to develop guidelines for neuromonitoring and
neuroprotection during CPB in infants. 2012 The Society of Thoracic
Surgeons.

<4>
Accession Number
2012567118
Authors
Sato H. Carvalho G. Sato T. Hatzakorzian R. Lattermann R. Codere-Maruyama
T. Matsukawa T. Schricker T.
Institution
(Sato, Carvalho, Sato, Hatzakorzian, Lattermann, Codere-Maruyama,
Schricker) Department of Anaesthesia, Royal Victoria Hospital, McGill
University Health Center, Montreal, QC, Canada
(Matsukawa) Department of Anesthesiology, Yamanashi University, Yamanashi,
Japan
Title
Statin intake is associated with decreased insulin sensitivity during
cardiac surgery.
Source
Diabetes Care. 35 (10) (pp 2095-2099), 2012. Date of Publication: October
2012.
Publisher
American Diabetes Association Inc. (1701 North Beauregard St., Alexandria
VA 22311, United States)
Abstract
OBJECTIVE - Surgical trauma impairs intraoperative insulin sensitivity and
is associated with postoperative adverse events. Recently, preprocedural
statin therapy is recommended for patients with coronary artery disease.
However, statin therapy is reported to increase insulin resistance and the
risk of new-onset diabetes. Thus, we investigated the association between
preoperative statin therapy and intraoperative insulin sensitivity in
nondiabetic, dyslipidemic patients undergoing coronary artery bypass
grafting. RESEARCH DESIGN AND METHODS - In this prospective, nonrandomized
trial, patients taking lipophilic statins were assigned to the statin
group and hypercholesterolemic patients not receiving any statins were
allocated to the control group. Insulin sensitivity was assessed by the
hyperinsulinemic-normoglycemic clamp technique during surgery. The mean,
SD of blood glucose, and the coefficient of variation (CV) after surgery
were calculated for each patient. The association between statin use and
intraoperative insulin sensitivity was tested by multiple regression
analysis. RESULTS - We studied 120 patients. In both groups, insulin
sensitivity gradually decreased during surgery with values being on
average ~20% lower in the statin than in the control group. In the statin
group, the mean blood glucose in the intensive care unit was higher than
in the control group (153 +/- 20 vs. 140 +/- 20 mg/dL; P < 0.001). The
oscillation of blood glucose was larger in the statin group (SD, P <
0.001; CV, P = 0.001). Multiple regression analysis showed that statin use
was independently associated with intraoperative insulin sensitivity (beta
= -0.16; P = 0.03). CONCLUSIONS - Preoperative use of lipophilic statins
is associated with increased insulin resistance during cardiac surgery in
nondiabetic, dyslipidemic patients. 2012 by the American Diabetes
Association.

<5>
Accession Number
2012571642
Authors
Agus M.S.D. Steil G.M. Wypij D. Costello J.M. Laussen P.C. Langer M.
Alexander J.L. Scoppettuolo L.A. Pigula F.A. Charpie J.R. Ohye R.G. Gaies
M.G.
Institution
(Agus, Steil, Wypij, Costello, Laussen, Alexander, Scoppettuolo, Pigula)
Boston Children's Hospital, Harvard Medical School, Boston, MA, United
States
(Langer) Tufts University School of Medicine, Boston, MA, United States
(Charpie, Ohye) Maine Medical Center, Portland, ME, United States
(Gaies) C.S. Mott Children's Hospital, University of Michigan Medical
School, Ann Arbor, MI, United States
Title
Tight glycemic control versus standard care after pediatric cardiac
surgery.
Source
New England Journal of Medicine. 367 (13) (pp 1208-1219), 2012. Date of
Publication: 27 Sep 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: In some studies, tight glycemic control with insulin improved
outcomes in adults undergoing cardiac surgery, but these benefits are
unproven in critically ill children at risk for hyperinsulinemic
hypoglycemia. We tested the hypothesis that tight glycemic control reduces
morbidity after pediatric cardiac surgery. METHODS: In this two-center,
prospective, randomized trial, we enrolled 980 children, 0 to 36 months of
age, undergoing surgery with cardiopulmonary bypass. Patients were
randomly assigned to either tight glycemic control (with the use of an
insulindosing algorithm targeting a blood glucose level of 80 to 110 mg
per deciliter [4.4 to 6.1 mmol per liter]) or standard care in the cardiac
intensive care unit (ICU). Continuous glucose monitoring was used to guide
the frequency of blood glucose measurement and to detect impending
hypoglycemia. The primary outcome was the rate of health care-associated
infections in the cardiac ICU. Secondary outcomes included mortality,
length of stay, organ failure, and hypoglycemia. RESULTS: A total of 444
of the 490 children assigned to tight glycemic control (91%) received
insulin versus 9 of 490 children assigned to standard care (2%). Although
normoglycemia was achieved earlier with tight glycemic control than with
standard care (6 hours vs. 16 hours, P<0.001) and was maintained for a
greater proportion of the critical illness period (50% vs. 33%, P<0.001),
tight glycemic control was not associated with a significantly decreased
rate of health care-associated infections (8.6 vs. 9.9 per 1000
patient-days, P = 0.67). Secondary outcomes did not differ significantly
between groups, and tight glycemic control did not benefit high-risk
subgroups. Only 3% of the patients assigned to tight glycemic control had
severe hypoglycemia (blood glucose <40 mg per deciliter [2.2 mmol per
liter]). CONCLUSIONS: Tight glycemic control can be achieved with a low
hypoglycemia rate after cardiac surgery in children, but it does not
significantly change the infection rate, mortality, length of stay, or
measures of organ failure, as compared with standard care. (Funded by the
National Heart, Lung, and Blood Institute and others; SPECS
ClinicalTrials.gov number, NCT00443599.) Copyright 2012 Massachusetts
Medical Society.

<6>
Accession Number
2012571045
Authors
Masoumi G. Pour E.H. Sadeghpour A. Ziayeefard M. Alavi M. Anbardan S.J.
Shirani S.
Institution
(Masoumi) Department of Cardiology, Shahid Rajaee Hospital, Isfahan
University of Medical Science, Isfahan, Iran, Islamic Republic of
(Pour, Sadeghpour, Ziayeefard, Alavi) Department of Cardiology, Shahid
Rajaee Hospital, Iran University of Medical Science, Tehran, Iran, Islamic
Republic of
(Anbardan) Tehran University of medical science, Tehran, Iran, Islamic
Republic of
(Shirani) Department of Cardiology, Shahid Chamran Hospital, Isfahan
University of Medical Science, Isfahan, Iran, Islamic Republic of
Title
Effect of different dosages of nitroglycerin infusion on arterial blood
gas tensions in patients undergoing on- pump coronary artery bypass graft
surgery.
Source
Journal of Research in Medical Sciences. 17 (2) (pp 123-127), 2012. Date
of Publication: 2012.
Publisher
Isfahan University of Medical Sciences (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
Background: On-pump coronary artery bypass graft (CABG) surgery impairs
gas exchange in the early postoperative period. The main object on this
study was evaluation of changes in arterial blood gas values in patients
underwent on pump CABG surgery receiving different dose of intravenous
nitroglycerin (NTG). Materials and Methods: sixty-seven consecutive
patients undergoing elective on-pump CABG randomly enrolled into three
groups receiving NTG 50 mug/min (Group N1, n =67), 100 mug/min (Group N2,
n = 67), and 150 mug/min (Group N3, n = 67). Arterial blood gas (ABG)
tensions were evaluated just before induction of anesthesia, during
anesthesia, at the end of warming up period, and 6 h after admission to
the intensive care unit. Results: Pao2 and PH had the highest value during
surgery in Group N1, Group N2, and Group N3. No significant difference was
noted in mean values of Pao2 and PH during surgery between three groups (P
> 0.05). There was no significant difference in HCO₃ values in
different time intervals among three groups (P > 0.05). Conclusion: our
results showed that infusing three different dosage of NTG (50, 100, and
150 mug/min) had no significant effect on ABG tensions in patients
underwent on-pump CABG surgery.

<7>
Accession Number
2012569423
Authors
Liu Y. Zhang S.-L. Duan W.-X. Lei L.-P. Yu S.-Q. Qian X.-H. Jin Z.-X.
Institution
(Liu, Zhang, Duan, Lei, Yu, Jin) Department of Cardiovascular Surgery,
Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
(Qian) Department of Pediatric Medicine, Xijing Hospital, Fourth Military
Medical University, Xi'an, Shaanxi Province, China
(Zhang) Department of Cardiovascular Surgery, Shaanxi Provincial Armed
Police Corps Hospital, Xi'an, Shaanxi Province, China
Title
The myocardial protective effects of a moderate-potassium blood
cardioplegia in pediatric cardiac surgery: A randomized controlled trial.
Source
Annals of Thoracic Surgery. 94 (4) (pp 1295-1301), 2012. Date of
Publication: October 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: We investigated the myocardial protective effect of a
moderate-potassium cold blood cardioplegic solution (K⁺, 10
mmol/L) in pediatric cardiac surgery. Methods: Sixty-eight pediatric
patients with congenital heart disease and undergoing open heart surgery
with cardiopulmonary bypass were randomly allocated to the high potassium
(HP [K⁺, 20 mmol/L, n = 31]) cold blood cardioplegia group or
the moderate potassium (MP [K⁺, 10 mmol/L, n = 37]) cold blood
cardioplegia group. Heart arresting time, rhythm recovery time, mechanical
ventilation time, inotropic drug use in the intensive care unit,
perioperative serum cardiac troponin I concentrations, morbidities, and
mortalities were compared between the two groups. Results: There were no
differences in cardiopulmonary bypass time, aorta cross-clamping time,
cardioplegia volume, lowest body temperature during cardiopulmonary
bypass, total volume of cardioplegia delivered, hematocrit value, and
fluid output during the operation between the two groups. However, there
was a longer arresting time and a shorter rhythm recovery time in the MP
group (35.6 +/- 2.4 s, and 30.8 +/- 3.1 s) when compared with that in the
HP group (24.7 +/- 2.7 s, and 42.0 +/- 4.0 s, both p < 0.05). The total
mediastinal drainage volume, the length of stay in the intensive care
unit, the postoperative inotropic drug use, and the postoperative hospital
time were similar between the two groups, but the number of patients with
a long postoperative mechanical ventilation time (>24 hours) in the MP
group (6 of 36) was less than that in HP group (13 of 30; p < 0.05). At 1
hour, 3 hours, and 6 hours after myocardium reperfusion, the serum
concentration of cardiac troponin I significantly decreased in the MP
group (in ng/mL: 15.18 +/- 3.57, 24.83 +/- 4.91, and 19.62 +/- 3.93,
respectively) when compared with that in the HP group (in ng/mL: 32.67 +/-
5.31, 39.26 +/- 7.43, and 30.52 +/- 5.17, respectively, p < 0.05).
Conclusions: The present study demonstrated that the M (10 mmol/L) cold
blood cardioplegia formula is associated with better myocardial protective
effects when compared with conventional HP cardioplegia in pediatric
patients. 2012 The Society of Thoracic Surgeons.

<8>
Accession Number
22234002
Authors
Canguven O. Albayrak S. Selimoglu A. Balaban M. Sasmazel A. Baysal A.
Institution
(Canguven, Albayrak, Selimoglu, Balaban) Clinic of Urology II, Kartal
Teaching and Research Hospital, Istanbul, Turkey
(Sasmazel) Department of Cardiac Surgery, Kartal Kosuyolu Heart and
Research Center, Istanbul, Turkey
(Baysal) Department of Anesthesiology, Kartal Kosuyolu Heart and Research
Center, Istanbul, Turkey
Title
The effect of cardiopulmonary bypass in coronary artery bypass surgeries
(on-pump versus off-pump) on erectile function and endothelium-derived
nitric oxide levels.
Source
International Braz J Urol. 37 (6) (pp 733-738), 2011. Date of Publication:
November/December 2011.
Publisher
Brazilian Society of Urology (Rua Bambina 153, Rio de Janeiro, RJ
22251-050, Brazil)
Abstract
Purpose: To investigate the effects of on-pump and off-pump coronary
artery bypass grafting (cabg) on the erectile Function and
endothelium-derived nitric oxide (eno) levels. Materials and methods:
twenty-eight consecutive patients were randomized into two groups
depending on use of cardiopulmonary Bypass in cabg surgery. The erectile
function was evaluated by using the iief-5 questionnaire. The Plasma eno
levels were determined at baseline and after reactive hyperemia before and
after surgery. Blood was collected In one minute after cuff deflation from
the radial artery on the same side. Results: after cabg surgery the mean
iief-5 score increased insignificantly over baseline from 14.8 to 15.8 (p
= 0.29) And 12.4 to 14.3 (p = 0.11) after on-pump and off-pump cabg
surgeries, respectively. The baseline plasma no levels Before surgery were
18.16 +/- 7.63 nmol/l in on-pump and 21.76 +/- 11.08 nmol/l in off-pump
cabg. After reactive Hyperemia the plasma no levels were 22.14 +/- 10.52
nmol/l in on-pump and 21.49 +/- 9.13 nmol/l in off-pump cabg Before the
surgery. The difference in the plasma no levels before surgery was not
significant (p = 0.51). Two hours after Surgery, the difference of the
plasma no levels at baseline (24.44 +/- 12.31on-pump and 20.58 +/- 6.74
nmol/l off-pump Cabg) and after reactive hyperemia (35.55 +/- 23.54 nmol/l
on-pump and 23.00 +/- 15.40 nmol/l off-pump cabg) were Not significantly
different from each other (p = 0.11).Conclusions: patients who had on-pump
or off-pump cabg surgeries had higher iief-5 scores. Nevertheless, the
improvement Was insignificant in both groups. Meanwhile, on-pump or
off-pump cabg surgeries did not have significant effect on plasma eNO
levels.

<9>
Accession Number
70887293
Authors
Eggebrecht H.
Institution
(Eggebrecht) Cardioangiological Center Bethanien, Frankfurt, Germany
Title
Risk of stroke after TAVI: A metaanalysis of 10,037 published patients.
Source
EuroIntervention. Conference: EuroPCR 2012 Paris France. Conference Start:
20120515 Conference End: 20110518. Conference Publication: (var.pagings).
8 (pp N198), 2012. Date of Publication: May 2012.
Publisher
EuroPCR
Abstract
Aims: Transcatheter aortic valve implantation (TAVI) represents a novel
treatment option for inoperable or high surgical risk patients with severe
symptomatic aortic valve disease. Recent randomised studies have raised
major safety concerns because of increased stroke/transient ischaemic
attack (TIA) rates with TAVI compared to medical treatment and
conventional aortic valve replacement, respectively. We aimed to review
all currently published literature and estimate the incidence of
peri-procedural stroke and outcomes in patients undergoing TAVI. Methods
and results: Fifty-three studies including a total of 10,037 patients
undergoing transfemoral, transapical or trans-subclavian TAVI for native
aortic valve stenosis published between 01/2004 and 11/2011 were
identified and included in a meta-analysis. Patients were 81.5+/-1.8 years
old and had a mean logistic EuroSCORE of 24.77+/-5.60%. Procedural stroke
(<24 h) occurred in 1.5+/-1.4%. The overall 30 day stroke/TIA was
3.3+/-1.8%, with the majority being major strokes (2.9+/-1.8%). During the
first year after TAVI, stroke/TIA increased up to 5.2+/-3.4%. Differences
in stroke rates were associated with different approaches and valve
prostheses used with lowest stroke rates after transapical TAVI
(2.7+/-1.4%). Thirty- day mortality was significantly higher in patients
with compared to those without stroke (25.5+/-21.9% vs. 6.9+/-4.2%).
Conclusions: TAVI was associated with average 30-day stroke/TIA rate of
3.3+/-1.8% (range 0-6%). Most of these strokes were major strokes and were
associated with significantly increased mortality within in the first 30
days.

<10>
Accession Number
70886493
Authors
Cerrato E. D'Ascenzo F. Biondi-Zoccai G. Moretti C. Omede' P. Presutti D.
Cavallero E. Sheiban I. Gaita F.
Institution
(Cerrato, D'Ascenzo, Moretti, Omede', Presutti, Cavallero, Sheiban, Gaita)
University of Turin, San Giovanni Battista Molinette Hospital, Cardiology
Department 1, Turin, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and Biotechnologies
Sapienza, University of Rome, Rome, Italy
Title
Acute coronary syndromes in human immunodeficiency virus patients: A
meta-analysis investigating adverse event rates and the role of
antiretroviral therapy.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 1087), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Aims: Highly active antiretroviral therapy (HAART) dramatically reduces
human immunodeficiency virus (HIV)-associated morbidity and mortality, but
adverse effects of HAART are becoming an increasing challenge, especially
in the setting of acute coronary syndromes (ACS). We thus performed a
comprehensive review of studies focusing on ACS in HIV patients. Methods
and results: MEDLINE/PubMed was systematically screened for studies
reporting on ACS in HIV patients. Baseline, treatment, and outcome data
were appraised and pooled with random-effect methods computing summary
estimates [95% confidence intervals (CIs)]. A total of 11 studies
including 2442 patients were identified, with a notably low prevalence of
diabetes [10.86 (4.11, 17.60); 95% CI]. Rates of in-hospital death were
8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90%
(2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing
cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95%
CI), no deaths were recorded, with an incidence of 9.42% of acute
myocardial infarction (2.68, 16.17; 95% CI) and of 20.18% (9.84, 30.51;
95% CI) of percutaneous coronary revascularization. Moreover, pooled
analysis of the studies reporting incidence of acute myocardial infarction
in patients exposed to protease inhibitors showed an overall significant
risk of 2.68 (odds ratio 1.89, 3.89; 95% CI). Conclusions: Human
immunodeficiency virus patients admitted for ACS face a substantial
short-term risk of death and a significant long-term risk of coronary
revascularization and myocardial infarction, especially if receiving
protease inhibitors.

<11>
Accession Number
70886106
Authors
Arnoult M. Latcu D.G. Saoudi N. Anselme F. Deharo J.C. Maury P. Boule S.
Traule S. Extramiana F. Zimmerman M.
Institution
(Arnoult, Latcu, Saoudi) Princess Grace Hospital Centre, Monaco, Monaco
(Anselme) University Hospital of Rouen, Rouen, France
(Deharo) AP-HM - Hospital La Timone, Marseille, France
(Maury) University Hospital of Toulouse, Rangueil Hospital, Department of
Cardiology, Toulouse, France
(Boule) Hospital Regional University of Lille, Cardiological Hospital,
Department of Cardiology, Lille, France
(Traule) Amiens University Hospital, Department of Cardiology, Amiens,
France
(Extramiana) AP-HP-Hospital Lariboisiere, Department of Cardiology, Paris,
France
(Zimmerman) University Hospital of Geneva, Geneva, Switzerland
Title
Incidence and mechanisms of cardiac perforation during radiofrequency
atrial fibrillation ablation in medium size centers.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 986), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Introduction: Radiofrequency catheter ablation of atrial fibrillation
(CAAF) is being increasingly performed in medium size centers. In a recent
meta-analysis it was shown that Cardiac perforation (CP) occurs in 1.3% of
patients (pts) undergoing CAAF in many high volume centers. In moderate
volume centers little is known about the rate and mechanism of CP.
Methods: A 14 item questionnaire was sent to 8 medium-size EP centers (30
to 150 CAAF/y) in 3 European countries. The per-procedural (<24 h)
incidence rate and the mechanisms of CP were analyzed. Results: Between
1998 and 2011, 3027 CAAF were performed and 42 pts (31 male; mean age
60.5+/-10.2 y) presented CP (incidence rate of 1.46%). In the past year,
the CAAF median range performed per center was 78 (42 to 110). CAAF was
done under general anesthesia for 349 pts (11.7%). Indications of CAAF
were paroxysmal atrial fibrillation (AF) in 28 pts (65.1%), persistent AF
in 12 pts (27.9%) and atrial tachycardia post AF in 3 pts (6.9%). Mean
left atrial size was 35.3+/-10.9 mm. A transesophageal echocardiography
was used to guide transseptal puncture in 6 pts (13.9%). The occurrence of
CP in 16 pts (37.2%) was related to transseptal puncture, in 9 pts (20.9%)
it was due to steam popping during radiofrequency delivery, and in 6 pts
(13.9%) it was attributed to high pressure catheter manipulation. In the
remaining 12 pts CP mechanism was unknown. One pt had CP during a magnetic
navigation procedure (the likely mechanism being steam popping). Invasive
blood pressure monitoring was not performed in any of the CP cases. The
management of CP was conservative in 18 pts (41.8%). Percutaneous
pericardiocentesis was done in 19 pts (44.1%) and 8 pts (18.6%) required
surgery. A total of 6 pts (13.9%) died (mortality rate of 0.19%).
Conclusion: The incidence of CP in medium-size centers appears to be
similar to the results of previous studies in high volume centers. The
three main CP mechanisms identified are steam popping during
radiofrequency delivery, transseptal puncture and high pressure during
catheter manipulation.

<12>
Accession Number
70884463
Authors
Ricci F. Zimarino M. Corazzini A. Romanello M. Cicchitti V. De Caterina R.
Institution
(Ricci, Zimarino, Corazzini, Romanello, Cicchitti, De Caterina) G.
D'Annunzio University, Institute of Cardiology, Center of Excellence on
Aging, Chieti, Italy
Title
Outcomes of complete versus incomplete myocardial revascularization in
multivessel coronary artery disease: A meta-analysis of randomized and
observational studies.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 546), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Purpose: The optimal extent of myocardial revascularization with either
percutaneous coronary intervention (PCI) or coronary artery bypass
grafting (CABG) in patients with multi-vessel coronary artery disease
(MVCAD) is controversial for the lack of trials specifically designed at
directly comparing complete (CR) versus incomplete revascularization
(IR).We compared the effectiveness of CR and IR in a pooled patient
population presenting with MVCAD with a meta-analysis of randomized
clinical trials (RCT) and non-randomized observational studies (nROS) in
all coronary heart disease patients excluding STEMI, where selective
treatment of the culprit lesion is currently recommended. Methods: We
performed a systematic PubMed literature search for RCT and nROS published
between 1990 through January 2012 reporting on clinical outcomes of
patients treated with CR and IR. Search terms included "multi-vessel",
"coronary", "*complete*" and "revasculariz*". Mantel-Haenszel pooled
estimates of Relative Risk (RR) and 95% confidence intervals (CI) for
all-cause mortality and myocardial infarction (MI) were assessed at the
longest follow-up. Subgroup analyses stratified by revascularization type
(PCI versus CABG) were also performed. Results: A total of 15 studies were
identified, including a total of 17,624 patients with MVCAD (median
follow-up 2 years). Compared with IR, CR was associated with a significant
relative risk reduction of all-cause mortality (RR 0.77; 95% CI
0.69-0.85), MI (RR 0.80;95% CI 0.68-0.93). When analyzed according to the
type of revascularization, pooled estimates of relative risk (and
associated 95% confidence interval) for all-cause mortality and MI were
0.71 (0.63-0.80) for CABG vs 0.91 (0.76-1.10) for PCI and 0.84 (0.69-1.02)
for CABG vs 0.74 (0.57-0.95) for PCI, respectively. Conclusions: CR with
either CABG or PCI confers a benefit on survival and MI as compared with
IR in patients with MVCAD, and should be therefore considered the optimal
strategy to be pursued when planning a revascularization procedure in
patients with MVCAD. A significant reduction in mortality was only related
to CR with CABG.

<13>
Accession Number
70884409
Authors
Boriani G. Diemberger I. Gardini B. Biffi M. Martignani C. Valzania C.
Ziacchi M. Gasparini M. Padeletti L. Branzi A.
Institution
(Boriani, Diemberger, Gardini, Biffi, Martignani, Valzania, Ziacchi,
Branzi) Institute of Cardiology, Univ. of Bologna, Bologna, Italy
(Gasparini) IRCCS Istituto Clinico Humanitas Rozzano, Milano, Italy
(Padeletti) Dept. Cardiology, Firenze, Italy
Title
Meta-analysis of randomized controlled trials comparing left
ventricular-only pacing to biventricular pacing in heart failure: Effect
on all-cause mortality and hospitalizations.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 532), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Aim: Randomized controlled trials (RCT) showed that biventricular (BiV)
pacing reduces heart failure (HF) hospitalizations and mortality in
patients with NYHA class III-IV heart failure (HF), left ventricular (LV)
dysfunction and wide QRS. We performed a systematic review and
meta-analysis of the randomized trials (RCTs) comparing LV-only versus BiV
pacing in candidates for cardiac resynchronization therapy (CRT). Methods
and Results: The systematic review selected 5 RCTs (out of 1888 analyzed
reports) with a cumulative number of 372 patients randomized to BiV pacing
and 258 to LV-only pacing, respectively. The meta-analysis based on RCTs
shows that BiV pacing is not superior to LV-onlypacing and that these two
pacing modalities do not differ with regard to death or heart
transplantation (LV-only vs. BiV pacing OR 1.24, 95% CI 0.57-2.70 with
fixed effect model, OR 1.25, 95% CI 0.48-3.24 with random effect model).
Specific data on hospitalizations were available only in 2 RCTs with a
cumulative number of 127 patients randomized to BiV and 123 to LV-only
pacing, respectively. The meta-analysis shows that BiV pacing is not
superior to LV-only pacing and that these two pacing modalities do not
differ with regard to hospitalizations (LV-only vs. BiV pacing OR 0.86,
95% CI 0.49-1.50 with fixed effect model, OR 0.86, 95% CI 0.49-1.50 with
random effect model). Furthermore, addition of data from two observational
studies, thus reaching an overall population of 376 patients treated with
LV-only pacing and 686 patients treated with BiV pacing, results in the
same conclusions of the previous metaanalysis based only on RCTs. In
detail, the two pacing modalities do not differ with regard to death or
heart transplantation (LV-only vs. BiV pacing OR 0.98, 95% CI 0.61-1.57
with fixed effect model, OR 0.98, 95% CI 0.61-1.59 with random effect
model) and no statistically significant heterogeneity is observed (Test
for heterogeneity Chi-square =6.03 [d.f. = 6], p = 0.419; I-square = 0.6%;
Test for overall effect z =0.10, p = 0.920). Conclusions: BiV pacing is
not superior to LV-only pacing and these two pacing modalities appear to
achieve similar efficacy in candidates for CRT for moderate to severe HF,
in terms of all-cause mortality and hospitalizations during follow up.

<14>
Accession Number
70883999
Authors
Savarese G. Paolillo S. Musella F. D'Amore C. Losco T. Perrone-Filardi P.
Institution
(Savarese, Paolillo, Musella, D'Amore, Losco, Perrone-Filardi) University
of Naples Federico II, Department of Clinical Medicine, Cardiovascular and
Immunological Science, Naples, Italy
Title
6-minute walk distance and clinical events in pulmonary arterial
hypertension: a meta-analysis of 22 randomized studies.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 423), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Purpose: 6-minute walk distance (6MWD) has usually been employed as
endpoint (often primary) in clinical trials to assess the benefit of
therapies in pulmonary arterial hypertension (PAH). The aim of the current
study was to verify whether changes in 6MWD reflect incidence of clinical
events in PAH patients. Methods: MEDLINE, Cochrane, ISI Web of Science and
SCOPUS databases were searched for articles about PAH treatment until
August 2011. Study inclusion criteria were: report of 6MWD at baseline and
at end of follow-up, and of clinical end-points (all-cause death,
hospitalization for PAH and/or lung orheart-lung transplantation,
initiation of PAH rescue therapy); randomized protocol design.
Meta-analysis was performed to assess the influence of treatments on
outcomes. Meta-regression analysis was performed to test the relationship
between 6MWD changes and outcomes. The influence of potential effect
modifiers and the presence of publication bias were also explored.
Results: 22 trials enrolling 3,112 participants were included. Active
treatments led to significant reduction in the risk of all-cause death
(odds ratio [OR]:0.429; 95% confidence interval [CI]:0.277 to 0.664;
comparison (c)p<0.01; heterogeneity (h)p=0.796), hospitalization for PAH
and/or lung or heart-lung transplantation (OR:0.442; CI:0.309 to 0.632; c
p<0.01; h p=0.838), initiation of PAH rescue therapy (OR:0.555; CI:0.347
to 0.889; c p=0.01; h p=0.648) and composite outcome (OR:0.400; CI:0.313
to 0.510; c p<0.01; h p=0.345). In meta-regression analysis, no
relationship between 6MWD changes from baseline to end of follow-up and
outcomes was observed. No publication bias was detected. (Figure
presented) Conclusions: In patients with PAH, improvement in 6MWD, induced
by pharmacological treatment, does not reflect reduction in clinical
events.

<15>
Accession Number
70883998
Authors
Savarese G. Musella F. D'Amore C. Cecere M. Losco T. Marciano C. Gargiulo
P. Perrone-Filardi P.
Institution
(Savarese, Musella, D'Amore, Cecere, Losco, Marciano, Gargiulo,
Perrone-Filardi) University of Naples Federico II, Department of Clinical
Medicine, Cardiovascular and Immunological Science, Naples, Italy
Title
Pulmonary hemodynamic changes, functional capacity and clinical events in
pulmonary arterial hypertension. A meta-analysis of 16 randomized trials.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 423), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Purpose: In patients with pulmonary arterial hypertension (PAH) it is
unknown whether changes in pulmonary hemodynamic parameters induced by
therapy correlate with functional capacity and clinical events (CE).
Methods: MEDLINE, Cochrane, ISI Web of Science and SCOPUS database were
searched for randomized trials investigating PAH therapy until November
2011, measuring hemodynamic parameters by right heart catheterization at
baseline and at end of follow-up and reporting CE (all-cause death,
hospitalization for PAH and/or lung or heart-lung transplantation,
initiation of PAH rescue therapy). Meta-analysis and meta-regression
analysis were performed to assess the effects of treatments on outcomes
and the relationship between hemodynamic (pulmonary artery pressure,
pulmonary vascular resistance (PVR), cardiac index and right atrial
pressure) changes and CE. Spearman correlation was used to test the
relationship between changes in hemodynamics and 6 minute walking distance
(6MWD). The influence of baseline patients' characteristics,hemodynamics
at baseline, 6-minute walk distance (6MWD), Detsky quality score,
follow-up and study publication year were also explored. Macaskill's
modified test was used to assess the presence of publication bias.
Results: 16 trials enrolling 2,353 patients were included in
meta-analysis. Treatments significantly reduced composite
outcome(including all CE) (odds ratio [OR]:0.346; 95% confidence interval
[CI]:0.259 to 0.462; p<0.01) as well allcause death (OR:0.467; CI:0.292 to
0.747; p<0.01), hospitalization for PAH and/or lung or heart-lung
transplantation (OR:0.384; CI:0.218 to 0.674; p<0.01), initiation of PAH
rescue therapy (OR:0.341; CI:0.200 to 0.582; p<0.01). No relationship was
found between changes of hemodynamic parameters and CE, whereas changes of
cardiac index and PVR significantly correlated to changes of 6MWD
(r=0.636, p=0.035; r=-0.547; p=0.043 respectively). No heterogeneity among
trials included in meta-analysis, potential confounding variable or
publication bias was detected. Conclusions: In PAH patients, improvement
of pulmonary hemodynamic parameters correlate with functional capacity
changes but do not predict CE.

<16>
Accession Number
70883737
Authors
Mansur A.P. Hueb W.A. Takada J.Y. Avakian S.D. Soares P.R. Garzilo C.L.
Ramires J.A.F. Kalil Filho R.
Institution
(Mansur, Hueb, Takada, Avakian, Soares, Garzilo, Ramires, Kalil Filho)
Heart Institute (InCor), University of Sao, Paulo Medical School, Sao
Paulo, Brazil
Title
Ten-year follow-up survival of the medicine, angioplasty, or surgery study
(MASS II): Randomized controlled clinical trial of 3 therapeutic
strategies for multivessel coronary artery disease in women.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 354), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Purpose: Coronary artery disease (CAD) is the leading cause of death in
women. The proposed treatments, percutaneous coronary intervention (PCI),
medical treatment (MT) or coronary artery bypass graft (CABG), are similar
to those made for men. However, in women with multivessel stable CAD and
normal left ventricular (LV) function, the best treatment is unknown.
Methods: Prospective study with 10 years of follow-up randomized 188 women
with chronic stable CAD to MT (N = 63; 33%), PCI (N = 69; 37%) or CABG (N
= 56; 30%). CAD was defined by the presence of angina pectoris CCS class
II and III, positive stress test, LV ejection fraction >40% and >=2
coronary lesions >70%. The primary end points were the incidence of total
mortality, Q-wave MI, or refractory angina that required
revascularization. All data were analyzed according to the
intention-to-treat principle. Results: Patients treated with PCI and MT
had more primary events than CABG and, respectively, of 34%, 44% and 22%
(p=0.003) (Figure). The 10-year survival rates were 72% with CABG, 72%
with PCI, and 56% with MT (p=0.156). Relative to the composite end point,
Cox regression analysis showed a higher incidence of primary events in MT
than in CABG [HR=2.38 (95%CI: 1.40 to 4.05); p=0.001], lower incidence in
PCI than in MT [HR=0.60 (95%CI: 0.38 to 0.95); p=0.031] but no differences
between CABG and PCI [HR=1.42 (95%CI: 0.83 to 2.45); p=0.203]. To death, a
protective effect of PCI compared to MT [HR=0.44 (95%CI: 0.21 to 0.90);
p=0.025] was observed but not between PCI and CABG or MT and CABG. (Figure
psented) Conclusion: Women with multivessel CAD and normal LV function,
CABG and PCI were associated with fewer primary events and PCI with lower
mortality.

<17>
Accession Number
70883709
Authors
Lopatin Y.M. Ilyukhin O.V. Ilyukhina M.V. Kalganova E.L. Tarasov D.L.
Ivanenko V.V.
Institution
(Lopatin, Ilyukhin, Ilyukhina, Kalganova) Volgograd State Medical
University, Volgograd, Russian Federation
(Tarasov, Ivanenko) Volgograd Regional Cardiology Centre, Volgograd,
Russian Federation
Title
Long-term trimetazidine modified release therapy improves prognosis in
post-myocardial infarction patients with angina pectoris and heart
failure.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 346-347), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Aim: Several preliminary trials and meta-analysis showed that
trimetazidine (TMZ) reduces mortality in patients (pts) with coronary
artery disease (CAD) and heart failure. However, long-term effects of TMZ
on the prognosis of postmyocardial infarction (post-MI) pts remain
unclear. The aim of our study was to determine long-term effects of TMZ 35
mg modified release (MR) on all-cause mortality in post-MI pts with stable
angina and heart failure. Methods: 120 post-MI pts (mean age 58.4+/-2.2)
with stable angina (mean CCS functional class: 2.4+/-0.1) and heart
failure (mean NYHA functional class: 2.5+/-0.1) were included in this
long-term, prospective, randomized clinical trial. Pts were randomized
into two groups - the group of active therapy (TMZ MR on top of standard
post-MI therapy after discharge from hospital, continued for the next 6
years, n=61) and the control group (standard therapy without TMZ MR,
n=59). Results: Baseline characteristics were the same in the two groups
of post-MI pts. Six-year survival in post-MI pts receiving TMZ MR was 84%
vs. 69% in the Control group), p<0.05. Over the 6 year follow-up, long
term TMZ MR therapy was characterized by a significant reduction of
all-cause mortality (RR 0.51; 95% CI 0.25 - 0.92, p<0.05) (Figure 1), as
well as major cardiovascular events (cardiac death, nonfatal myocardial
infarction, acute stroke, need for coronary revascularization,
hospitalization for unstable angina or heart failure) (RR 0.61; 95% CI
0.35 - 0.97, p<0.05). (Figure presented) Conclusions: Long-term
trimetazidine modified release therapy is associated with a significant
reduction in mortality in post-MI pts with angina and heart failure.
Large-scale randomized clinical trials are needed to further confirm this
data.

<18>
Accession Number
70883434
Authors
Eindhoven J.A. Van Den Bosch A.E. Jansen P.R. Boersma E. Roos-Hesselink
J.W.
Institution
(Eindhoven, Van Den Bosch, Jansen, Boersma, Roos-Hesselink) Erasmus
Medical Center, Thoraxcenter, Department of Cardiology, Rotterdam,
Netherlands
Title
Brain natriuretic peptide in patients with tetralogy of fallot-a
systematic review.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 270-271), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Purpose: Brain natriuretic peptide (BNP) and N-terminal-probrain
natriuretic peptide (NT-proBNP) are well-established markers for heart
failure in the general population. However, the value of BNP and NT-proBNP
as a diagnostic and prognostic marker for patients with surgically
corrected Tetralogy of Fallot (TOF) is still unclear. Methods: A
systematic review was conducted including all articles focusing on TOF.
Data on BNP measurement, patient characteristics and cardiac functional
parameters were extracted. Results: A total of 770 patients from 20
articles were included. Both symptomatic and asymptomatic patients after
surgically corrected TOF revealed higher BNP levels compared to age and
gender matched controls. The severity of pulmonary valve regurgitation
(PVR) and right ventricular end-diastolic volume (RVEDD) correlated
positively with BNP values. Negative correlations between BNP and exercise
capacity were observed. Three small studies with longitudinal data,
describing a total of 77 patients, showed a significant decrease of BNP
levels 6 months or longer after pulmonary valve replacement compared to
BNP levels before the intervention. (Figure Presented) Conclusion: This
systematic review shows higher plasma BNP levels in patients with TOF
compared to controls. The observed significant correlations between BNP
and RVEDD, PVR and exercise capacity mirror the possible future use of BNP
as an indicator of disease severity and additional diagnostic tool for
timing of pulmonary valve replacement. However, as BNP values differ
widely, conclusions for individual patients should be drawn with caution.
Further investigation with sequential BNP measurement in large,
prospective studies is warranted.

<19>
Accession Number
70883251
Authors
Patti G. Cannon C.P. Mega S. Bennet R. Ray K.K. Cavallari I. Ricottini E.
Chello M. Mannacio V. Di Sciascio G.
Institution
(Patti, Mega, Cavallari, Ricottini, Chello, Di Sciascio) Campus Bio-Medico
University of Rome, Department of Cardiovascular Sciences, Rome, Italy
(Cannon) Brigham and Women's Hospital, Department of Medicine,
Cardiovascular Division, Boston, United States
(Bennet, Ray) St George's University of London, Cardiac and Vascular
Sciences Research Centre, London, United Kingdom
(Mannacio) University of Naples Federico II, Department of Cardiac
Surgery, Naples, Italy
Title
Prevention of post-operative atrial fibrillation by statin pre-treatment
in patients undergoing cardiac surgery: A collaborative patient level
meta-analysis of 11 randomized studies.
Source
European Heart Journal. Conference: ESC Congress 2012 Munchen Germany.
Conference Start: 20120825 Conference End: 20120829. Conference
Publication: (var.pagings). 33 (pp 223), 2012. Date of Publication:
August 2012.
Publisher
Oxford University Press
Abstract
Background: Previous studies suggested that statin pre-treatment prevents
postoperative atrial fibrillation (AF) in patients undergoing cardiac
surgery. However, those data were observational and single randomized
trials included limited numbers of patients. Methods: We performed a
collaborative meta-analysis using individual patient data from 11
randomized studies in which 1106 patients received before elective cardiac
surgery statin therapy (N=552) vs no statin therapy (N=554). Postoperative
atrial fibrillation was defined as arrhythmic episodes lasting >= 5
minutes. Results: Post-operative AF occurred in 19% of patients in the
statin vs 36% of those in the control group (60% risk reduction in the
active treatment arm; OR by fixed effects model 0.40, 95% CI 0.30-0.53;
P<0.00001). Arrhythmic prevention by statin pre-treatment was maintained
across various subgroups, and appeared greater in the subset of patients
with elevated baseline C-reactive protein (CRP) levels (71% risk reduction
vs 54% in those with normal CRP). Pre-operative CRP levels were reduced in
patients without vs those with post-operative AF (1.7+/-3.3 vs 4.1+/-10.6
mg/L; P=0.0001) and statin pre-treatment was associated with lower
baseline CRP levels (1.8+/-4.0 vs 2.9+/-7.9 mg/L in the control arm;
P=0.01). Incidence of peri-operative myocardial injury (creatine kinase-MB
>5x ULN or Troponin-I >8x ULN) was significantly lower in the statin arm
(44% vs 56%; P=0.007). Conclusions: Statin pre-treatment prevents from
post-operative AF and perioperative myocardial injury in patients
undergoing cardiac surgery; this supports a routine early initiation of
statin treatment in such patients.