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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.