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<1>
Accession Number
2013013046
Authors
Dorbala S. Di Carli M.F. Beanlands R.S. Merhige M.E. Williams B.A. Veledar
E. Chow B.J.W. Min J.K. Pencina M.J. Berman D.S. Shaw L.J.
Institution
(Dorbala, Di Carli) Brigham and Women's Hospital, Department of Radiology,
Noninvasive Cardiovascular Imaging Section, 70 Francis Street, Boston, MA
02115, United States
(Beanlands, Chow) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Merhige) Niagara Falls Memorial Medical Center, Buffalo, NY, United
States
(Williams) Geisinger Medical Center, Danville, PA, United States
(Veledar, Shaw) Emory University School of Medicine, Atlanta, GA, United
States
(Min, Berman) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Pencina) Boston University Biostatistics, Harvard Clinical Research
Institute, Boston, MA, United States
Title
Prognostic value of stress myocardial perfusion positron emission
tomography: Results from a multicenter observational registry.
Source
Journal of the American College of Cardiology. 61 (2) (pp 176-184), 2013.
Date of Publication: 15 Jan 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The primary objective of this multicenter registry was to
study the prognostic value of positron emission tomography (PET)
myocardial perfusion imaging (MPI) and the improved classification of risk
in a large cohort of patients with suspected or known coronary artery
disease (CAD). Background: Limited prognostic data are available for MPI
with PET. Methods: A total of 7,061 patients from 4 centers underwent a
clinically indicated rest/stress rubidium-82 PET MPI, with a median
follow-up of 2.2 years. The primary outcome of this study was cardiac
death (n = 169), and the secondary outcome was all-cause death (n = 570).
Net reclassification improvement (NRI) and integrated discrimination
analyses were performed. Results: Risk-adjusted hazard of cardiac death
increased with each 10% myocardium abnormal with mildly, moderately, or
severely abnormal stress PET (hazard ratio [HR]: 2.3 [95% CI: 1.4 to 3.8;
p = 0.001], HR: 4.2 [95% CI: 2.3 to 7.5; p < 0.001], and HR: 4.9 [95% CI:
2.5 to 9.6; p < 0.0001], respectively [normal MPI: referent]). Addition of
percent myocardium ischemic and percent myocardium scarred to clinical
information (age, female sex, body mass index, history of hypertension,
diabetes, dyslipidemia, smoking, angina, beta-blocker use, prior
revascularization, and resting heart rate) improved the model performance
(C-statistic 0.805 [95% CI: 0.772 to 0.838] to 0.839 [95% CI: 0.809 to
0.869]) and risk reclassification for cardiac death (NRI 0.116 [95% CI:
0.021 to 0.210]), with smaller improvements in risk assessment for
all-cause death. Conclusions: In patients with known or suspected CAD, the
extent and severity of ischemia and scar on PET MPI provided powerful and
incremental risk estimates of cardiac death and all-cause death compared
with traditional coronary risk factors. 2013 American College of
Cardiology Foundation.

<2>
Accession Number
2013017797
Authors
Kheirandish-Gozal L. Farre R.
Institution
(Kheirandish-Gozal) Department of Pediatrics, University of Chicago,
Chicago, IL, United States
(Farre) Facultat de Medicina, Universidad de Barcelona, Barcelona, Spain
Title
The injury theory, endothelial progenitors, and sleep apnea.
Source
American Journal of Respiratory and Critical Care Medicine. 187 (1) (pp
5-7), 2013. Date of Publication: 01 Jan 2013.
Publisher
American Thoracic Society (61 Broadway 4th Floor, New York NY 10006 -
2755, United States)

<3>
Accession Number
2012751872
Authors
Suraseranivongse S. Wungpayon B. Akavipat P. Prownpun P. Klanarong S.
Institution
(Suraseranivongse) Department of Anesthesiology, Faculty of Medicine
Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
(Wungpayon) Department of Anesthesia, Pichit Hospital, Pichit 66000,
Thailand
(Akavipat) Department of Anesthesia, Prasart Neurological Institute,
Bangkok 10400, Thailand
(Prownpun, Klanarong) Department of Anesthesia, Buddhachinaraj Hospital,
Phitsanulok 65000, Thailand
Title
Printed anesthetic-risk information and perioperative anxiety: A
multi-center study.
Source
Asian Biomedicine. 5 (2) (pp 295-303), 2011. Date of Publication: April
2011.
Publisher
Asian Biomedicine (Ananda Mahidol Building, Faculty of Medicine,Bangkok
10330, Thailand)
Abstract
Background: Currently, there is a considerable variation concerning the
provision of preanesthetic-risk information, especially potential
detrimental adverse outcomes. Objective: Determine the effects of printed
anesthetic-risk information before surgery including patients' anxiety,
refusal of surgery, knowledge perception of adverse events and factors
affecting anxiety. Methods: Patients in a university hospital, a tertiary
care hospital, a secondary care hospital, and a neurological institute in
Thailand, undergoing low-to-moderate risk surgery were randomly allocated
to control group (C) and study group (S), where group C received printed
general information in anesthesia, and group S received printed incidences
of five anesthetic adverse events as sore throat, nausea/vomiting, tooth
loss, not waking up after surgery, cardiac arrest. Spielberger State-Trait
Anxiety Inventory Scale (STAIS, STAIT) for anxiety and Visual Analog Scale
(VAS) for knowledge perception were recorded before and after information,
and after surgery. Numbers of patients who refused surgery and needed
anesthetic-risk information in the next surgery were also recorded. STAIS
>45 were considered "high anxiety". Results: Eight-hundred and twenty-four
patients were analyzed (group C: 414, group S: 410). There was no
difference in age, sex, ASA physical status, salary, education level,
habitat, anesthetic experience and operative risk between groups. STAIS
and STAIT, proportion of patients with high anxiety, proportion of
patients who refused surgery were not different between groups. Patients
in control group needed anesthetic-risk information in the next surgery
more than study group (p <0.001). VAS for knowledge about five adverse
events in study group were significantly higher than control group (p
<0.001). Risk factors by the multivariate analysis included patients with
high baseline trait anxiety and low income of less than 10,000 Baht/month.
Conclusion: Printed anesthetic-risk information did not increase anxiety,
but increased knowledge perception of the patients.

<4>
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Accession Number
2013007702
Authors
Guo-Han C. Jian-Hua G. Xuan H. Jinyi W. Rong L. Zhong-Min L.
Institution
(Guo-Han, Jian-Hua, Xuan, Jinyi, Rong, Zhong-Min) Department of
Cardiothoracic Surgery, East Hospital, Tongji University School of
Medicine, Shanghai 200120, China
Title
Role of creatine phosphate as a myoprotective agent during coronary artery
bypass graft in elderly patients.
Source
Coronary Artery Disease. 24 (1) (pp 48-53), 2013. Date of Publication:
January 2013.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
OBJECTIVE: To evaluate the myocardial protective effect of exogenous
creatine phosphate added to a cardioplegic solution for elderly patients
undergoing a coronary artery bypass graft (CABG) in China. METHODS:
Twenty-four patients (age>65 years) who underwent CABG were randomly
divided into a control group (n=12) and an experimental group (n=12). The
concentrations of malonyldehyde and superoxide dismutase in the blood were
measured before aortic clamping and at 0, 30, 60, and 120 min after the
release of aortic clamping. Creatine phosphokinase (CK), creatine
phosphokinase-MB (CK-MB), lactate dehydrogenase, and cardiac troponin T
were measured before aortic clamping and at 2, 24, and 48 h after the
release of aortic clamping. Myocardial ultrastructures were examined under
an electron microscope. RESULTS: The concentrations of malonyldehyde in
both groups increased after the release of aortic clamping (at 0, 30, 60,
and 120 min), but were higher in the control group compared with the
experimental group (P<0.01). The concentrations of superoxide dismutase in
both groups were decreased after the release of aortic clamping and were
higher in the experimental group compared with the control group (P<0.01)
at 0, 30, 60, and 120 min after the release of aortic clamping. The values
of CK, CK-MB, lactate dehydrogenase, and cardiac troponin T at 2, 24, and
48 h after the release of the aortic clamping were lower in the
experimental group than in the control group (P<0.01). Electron microscopy
showed that the mitochondria in the experimental group were histologically
better than those in the control group. CONCLUSION: Exogenous creatine
phosphate added to the cardioplegia solution can provide energy to
myocardial cells and can relieve ischemia/reperfusion-related injury in
elderly patients during CABG in China. Lippincott Williams & Wilkins.

<5>
Accession Number
2013009146
Authors
Hussain S.T. Paul M. Plein S. McCann G.P. Shah A.M. Marber M.S. Chiribiri
A. Morton G. Redwood S. MacCarthy P. Schuster A. Ishida M. Westwood M.A.
Perera D. Nagel E.
Institution
(Hussain, Paul, Shah, Marber, Chiribiri, Morton, Redwood, MacCarthy,
Schuster, Ishida, Perera, Nagel) Joint Imaging and Cardiovascular
Division, National Institute for Health Research (NIHR), St. Thomas'
Hospital, Lambeth Wing, London SE1 7EH, United Kingdom
(Plein) Multidisciplinary Cardiovascular Research Centre, Leeds Institute
of Genetics Health and Therapeutics, University of Leeds, Leeds, United
Kingdom
(McCann) NIHR Leicester Cardiovascular Biomedical Research Unit,
Leicester, United Kingdom
(Westwood) London Chest Hospital, London, United Kingdom
(Schuster) Department of Cardiology and Pneumology and Heart Research
Center, Georg-August-University, Gottingen, United Kingdom
Title
Design and rationale of the MR-INFORM study: Stress perfusion
cardiovascular magnetic resonance imaging to guide the management of
patients with stable coronary artery disease.
Source
Journal of Cardiovascular Magnetic Resonance. 14 (1) , 2012. Article
Number: 65. Date of Publication: 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: In patients with stable coronary artery disease (CAD),
decisions regarding revascularisation are primarily driven by the severity
and extent of coronary luminal stenoses as determined by invasive coronary
angiography. More recently, revascularisation decisions based on invasive
fractional flow reserve (FFR) have shown improved event free survival.
Cardiovascular magnetic resonance (CMR) perfusion imaging has been shown
to be non-inferior to nuclear perfusion imaging in a multi-centre setting
and superior in a single centre trial. In addition, it is similar to
invasively determined FFR and therefore has the potential to become the
non-invasive test of choice to determine need for revascularisation. Trial
design. The MR-INFORM study is a prospective, multi-centre, randomised
controlled non-inferiority, outcome trial. The objective is to compare the
efficacy of two investigative strategies for the management of patients
with suspected CAD. Patients presenting with stable angina are randomised
into two groups: 1) The FFR-INFORMED group has subsequent management
decisions guided by coronary angiography and fractional flow reserve
measurements. 2) The MR-INFORMED group has decisions guided by stress
perfusion CMR. The primary end-point will be the occurrence of major
adverse cardiac events (death, myocardial infarction and repeat
revascularisation) at one year. Clinical trials.gov identifier
NCT01236807. Conclusion: MR INFORM will assess whether an initial strategy
of CMR perfusion is non-inferior to invasive angiography supplemented by
FFR measurements to guide the management of patients with stable coronary
artery disease. Non-inferiority of CMR perfusion imaging to the current
invasive reference standard (FFR) would establish CMR perfusion imaging as
an attractive non-invasive alternative to current diagnostic pathways.
2012 Hussain et al.; licensee BioMed Central Ltd.

<6>
Accession Number
2012754100
Authors
Ahmed K. Ashrafian H. Harling L. Patel V.M. Rao C. Darzi A. Hanna G.B.
Punjabi P. Athanasiou T.
Institution
(Ahmed, Ashrafian, Harling, Patel, Rao, Darzi, Hanna, Punjabi, Athanasiou)
Department of Surgery and Cancer, Imperial College London, St Mary's
Hospital Campus, London W2 1NY, United Kingdom
Title
Safety of training and assessment in operating theatres - A systematic
review and meta-analysis.
Source
Perfusion (United Kingdom). 28 (1) (pp 76-87), 2013. Date of Publication:
January 2013.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Objective: Procedural outcomes can be used to assess the performance of
specialists and trainees. This article establishes a systematic evidence
base for the safety of training in the operating theatre. It also explores
the possibility of using early, intermediate and late procedural outcomes
of cardiac surgical operations to evaluate the performance of the
clinicians and the healthcare system. Methods: Medline, EMBASE and
PsycINFO databases were searched. Comparative studies evaluating quality
indicators of cardiac surgical procedures (coronary artery bypass grafting
(CABG) and valve surgery) were included. Guidelines from the Preferred
Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) were
used. Results: Fourteen studies met the inclusion criteria. For CABG,
meta-analysis of outcomes did not show any significant differences between
the technical and non-technical skills of trainees versus specialists
apart from bypass time (less for specialists) and intensive care unit
(ICU) length of stay (less for trainees). Studies reporting outcomes on
valve surgery also did not report any statistically significant
differences amongst the outcomes. Conclusion: This systematic review did
not discern any significant differences between the procedural outcomes of
trainees and specialists, which indicates that trainees are safe to
operate under senior supervision. In addition, this article recommends
that various procedural outcomes can be used to evaluate the performance
of clinicians and healthcare systems. Prospective studies need to be
performed, taking into account the specific contribution of trainees and
specialists during the procedure. This will give a clearer indication of
safety and performance of trainees and specialists in the operating
theatre. The Author(s) 2012.

<7>
Accession Number
2013004049
Authors
Aubrey-Bassler F.K. Sowers N.
Institution
(Aubrey-Bassler) Primary Healthcare Research Unit, Memorial University of
Newfoundland, Health Sciences Centre, NL, St Johns, Canada
(Aubrey-Bassler) Discipline of Emergency Medicine, Memorial University of
Newfoundland, NL, St Johns, Canada
(Aubrey-Bassler) Discipline of Family Medicine, Memorial University of
Newfoundland, NL, St Johns, Canada
(Sowers) Department of Emergency Medicine, Dalhousie University, Halifax,
NS, Canada
Title
613 cases of splenic rupture without risk factors or previously diagnosed
disease: A systematic review.
Source
BMC Emergency Medicine. 12 , 2012. Article Number: 11. Date of
Publication: 14 Aug 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Rupture of the spleen in the absence of trauma or previously
diagnosed disease is largely ignored in the emergency literature and is
often not documented as such in journals from other fields. We have
conducted a systematic review of the literature to highlight the
surprisingly frequent occurrence of this phenomenon and to document the
diversity of diseases that can present in this fashion.Methods: Systematic
review of English and French language publications catalogued in Pubmed,
Embase and CINAHL between 1950 and 2011.Results: We found 613 cases of
splenic rupture meeting the criteria above, 327 of which occurred as the
presenting complaint of an underlying disease and 112 of which occurred
following a medical procedure. Rupture appeared to occur spontaneously in
histologically normal (but not necessarily normal size) spleens in 35
cases and after minor trauma in 23 cases. Medications were implicated in
47 cases, a splenic or adjacent anatomical abnormality in 31 cases and
pregnancy or its complications in 38 cases.The most common associated
diseases were infectious (n = 143), haematologic (n = 84) and
non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma
such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are
less frequently reported. Colonoscopy (n = 87) was the procedure reported
most frequently as a cause of rupture. The anatomic abnormalities
associated with rupture include splenic cysts (n = 6), infarction (n = 6)
and hamartomata (n = 5). Medications associated with rupture include
anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n =
10). Other causes or associations reported very infrequently include other
endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy,
peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic
vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm,
cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia,
rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease,
pheochromocytoma, afibrinogenemia and ruptured ectopic
pregnancy.Conclusions: Emergency physicians should be attuned to the fact
that rupture of the spleen can occur in the absence of major trauma or
previously diagnosed splenic disease. The occurrence of such a rupture is
likely to be the manifesting complaint of an underlying disease.
Furthermore, colonoscopy should be more widely documented as a cause of
splenic rupture. 2012 Aubrey-Bassler and Sowers; licensee BioMed Central
Ltd.

<8>
Accession Number
22076751
Authors
Baran C. Durdu S. Dalva K. Zaim C. Dogan A. Ocakoglu G. Gurman G. Arslan
O. Akar A.R.
Institution
(Baran, Durdu, Zaim, Dogan, Akar) Department of Cardiovascular Surgery,
Heart Center, Ankara University School of Medicine, Dikimevi, Ankara
06340, Turkey
(Durdu, Gurman, Arslan, Akar) Stem Cell Institute, Ankara University,
Ankara 06520, Turkey
(Dalva, Gurman, Arslan) Department of Hematology, Ankara University School
of Medicine, Ankara 06340, Turkey
(Dogan) Biotechnology Institute, Ankara University, Ankara, Turkey
(Ocakoglu) Department of Biostatistics, Uludag University School of
Medicine, Bursa, Turkey
Title
Effects of Preoperative Short Term Use of Atorvastatin on Endothelial
Progenitor Cells after Coronary Surgery: A Randomized, Controlled Trial.
Source
Stem Cell Reviews and Reports. 8 (3) (pp 963-971), 2012. Date of
Publication: September 2012.
Publisher
Humana Press (999 Riverview Drive, Suite 208, Totowa NJ 07512-1165, United
States)
Abstract
Objectives: We investigated the effects of short-term use of atorvastatin
on CD34+/VEGF-R2+/CD133+/CD45- endothelial progenitor cell (EPC) count
after on-pump coronary artery bypass surgery (CABG). Methods: Between
Feb-2010 and May-2010, we randomly assigned, in a placebo-controlled,
double-blind study, 60 consecutive patients who underwent isolated,
first-time CABG to receive either 14-day atorvastatin (40 mg/day) or
placebo preoperatively. Urgent CABG and recent myocardial infarction were
excluded. EPCs were quantified (cells/mul) by flow cytometric phenotyping
obtained from venous blood samples collected preoperatively
(T₁), 6-hours (T₂), and on the 5th day
postoperatively (T₃). Levels of markers of inflammation and
serum cardiac troponin I were also measured preoperatively and daily until
day-5 after surgery. Results: There were no differences in baseline risk
factors including cholesterol profiles, and EuroSCORES between the groups.
The composite primary end-point, favored statin group with higher amount
of circulating, early EPC count (cells/mul) at all time points compared
with placebo (T₁, 2. 30 +/- 0.02 versus 1. 58 +/- 0. 03,
p<0.001; T₂, 5. 00 +/- 0. 06 versus 2. 19 +/- 0.06, p<0. 001;
T₃, 3. 03 +/- 0. 08 versus 1. 78 +/- 0. 02, p<0.001).
Postoperative hsCRP rise were inversely correlated with EPC count, and
were significantly lower in the statin group (T₁, 0. 8 +/- 0. 1
versus 2. 2 +/- 1. 5, p<0.001; T₂, 72. 9 +/- 3. 2 versus 96. 0
+/- 3. 6, p<0.001; T₃, 4. 3 +/- 1. 2 versus 11. 4 +/- 4. 1,
p<0.001). Furthermore, the incidence of postoperative atrial fibrillation
was significantly lower in the statin group compared to placebo (3. 3%
versus 23%, p = 0. 02). Conclusions: Short-term atorvastatin use increases
circulating early EPCs both pre- and post-operatively and is associated
with better preservation of sinus rhythm and reduced hsCRP levels.
(ClinicalTrials. gov number, NCT01096875) 2011 Springer Science+Business
Media, LLC.

<9>
Accession Number
2013002976
Authors
Zhang B. Wang J. Ye J.-R.
Institution
(Zhang, Wang, Ye) Department of Anesthesia, First Hospital Affiliated to
Xinjiang Medical University, Urumqi 830054, China
Title
BNP for predicting postoperative adverse cardiovascular events of
non-cardiac surgery: A meta-analysis.
Source
Chinese Journal of Evidence-Based Medicine. 12 (12) (pp 1463-1469), 2012.
Date of Publication: 2012.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To systematically evaluate the effectiveness and accuracy of
brain natriuretic peptide (BNP) for predicting postoperative
cardiovascular events of non-cardiac surgery. Methods Databases including
The Cochrane Library, PubMed, Ovid, EMbase, WanFang Data and CNKI were
searched electrically to collect literature published from 2000 to 2011,
and relevant periodicals and references of the included studies were also
manually retrieved. According to the inclusion and exclusion criteria,
related cohort studies were selected, data were extracted, and quality of
the included studies was evaluated by two reviewers independently. Then
meta-analysis was conducted using RevMan 5.0 software. Results A total of
11 studies involving 3 649 patients were included. The results of
meta-analysis showed that, compared with patients with lower BNP levels
than the cut-off point before surgery, patients with higher BNP levels
than the cut-off point before surgery suffered from a higher incidence of
cardiovascular events, with a significant difference (OR=27.54, 95%CI
17.49 to 43.35, P<0.000 01), while the result of N-terminal pro-brain
natriuretic peptide (NT-proBNP) was similar to that of BNP (OR=19.53,
95%CI 13.54 to 28.17, P<0.000 01). Conclusion Postoperative higher levels
of BNP and NTBNP can be used to predict postoperative cardiovascular
events of non-cardiac surgery patients. This conclusion needs to be
further proved by more high quality studies due to the quality limitation
of the included studies. 2012 Editorial Board of Chin J Evid-based Med.

<10>
Accession Number
2013002974
Authors
Wu W.-Q. Shan J. Li Y.-P. Luo L. Sun G.-X. Zhou Y.-N. Yang T. Xia M.-J.
Guo Y.-J. Feng L.
Institution
(Wu, Shan, Li, Luo, Sun, Zhou, Yang, Xia, Guo, Feng) Key Laboratory of
Transplant Engineering and Immunology of Health Ministry of China,
Regenerative Medical Research Center, West China Hospital, Sichuan
University, Chengdu, 610041, Sichuan Province, China
(Li) Chinese Cochrane Centre, Chinese Evidence-Based Medicine Centre,
China
Title
Adoptive transfusion of tolerance dendritic cells prolongs the survival of
cardiac allograft: A systematic review of 44 basic studies in mice.
Source
Chinese Journal of Evidence-Based Medicine. 12 (12) (pp 1432-1445), 2012.
Date of Publication: 2012.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective Tolerogenic DCs (Tol-DCs), a group of cells with imDC phenotype,
can stably induce T cells low-reactivity and immune tolerance. We
systematically reviewed the adoptive transfusion of Tol-DCs induced by
different ways to prolong cardiac allograft survival and its possible
mechanism. Method MEDLINE (1966 to March 2011), EMbase (1980 to March
2011), and ISI (inception to March 2011) were searched for identification
of relevant studies. We used allogeneic heart graft survival time as
endpoint outcome to analyze the effect of adoptive transfusion of Tol-DC
on cardiac allograft. By integrating studies' information, we summarized
the mechanisms of Tol-DC in prolonging cardiac grafts. Results Four
methods were used to induce Tol-DC in all of the 44 included studies
including gene-modified, drug-intervened, cytokine-induced, and
other-derived (liver-derived & spleen-derived) DCs. The results showed
that all types of Tol-DC can effectively prolong graft survival, and the
average extension of graft survival time for each group was as follows:
22.02 +/- 21.9 days (3.2 folds to control group) in the gene modified
group, 25.94 +/- 16.9 days (4.3 folds) in the drug-intervened groups, 9.00
+/- 8.13 days (1.9 folds) in the cytokine-induced group, and 10.69 +/-
9.94 days (2.1 folds) in the other-derived group. The main mechanisms of
Tol-DCs to prolong graft survival were as follows: a) induceT-cell
hyporeactivity (detected by MLR); b) reduce the effect of cytotoxic
lymphocyte (CTL); c) promote Th2 differentiation; d) induce Treg; e)
induce chimerism. Conclusion For fully MHC mismatched allogeneic heart
transplant recipients of inbred mouse, adoptive transfusion of Tol-DC,
which can be gene-modified, drug-intervened, cytokine-induced,
spleenderived or liver-derived, can clearly prolong the survival of
cardiac allograft or induce immune tolerance. Gene-modified and
drug-induced Tol-DC can prolong graft survival most obviously. Having
better reliability and stability than druginduction, gene-modification is
the best way to induce Tol-DCs at present. One-time intravenous infusion
of 2 x 10⁶ Tol-DC is a simple and feasible way to induce
long-term graft survival. Multiple infusions will prolong it but increase
the risk and cost. Adoptive transfusion of Tol-DC in conjunction with
immunosuppressive agents may also prolong the graft survival time. 2012
Editorial Board of Chin J Evid-based Med.

<11>
Accession Number
21972329
Authors
Rollman B.L. Belnap B.H.
Institution
(Rollman, Belnap) Division of General Internal Medicine, Center for
Research on Health Care, University of Pittsburgh School of Medicine,
Pittsburgh, PA, United States
Title
The Bypassing the Blues trial: Collaborative care for post-CABG depression
and implications for future research.
Source
Cleveland Clinic Journal of Medicine. 78 (SUPPL. 1) (pp S4-S12), 2011.
Date of Publication: 2011.
Publisher
Cleveland Clinic Educational Foundation (9500 Euclid Avenue, Cleveland OH
44195-5058, United States)
Abstract
Depressive symptoms are reported by up to one-half of patients following
coronary artery bypass graft (CABG) surgery, and are associated with
numerous adverse outcomes, including poorer health-related quality of
life, worse functional status, and delayed recovery. Strategies to detect
and then manage depression in CABG patients and in cardiac populations are
of great interest given the potential for depression treatment to reduce
cardiovascular morbidity. Yet, many tested interventions have had little
or no effect on mood symptoms in cardiac patients. "Collaborative care" is
a safe and proven-effective strategy for treating depression in concert
with patients' primary care physicians; however, it had not been tested
previously in patients with cardiac disease. This article presents the
design and main outcome fi ndings from the National Institutes of
Health-funded Bypassing the Blues study, the fi rst trial to examine the
impact of a collaborative care strategy for treating depression among
patients with cardiac disease, and our efforts to improve upon and expand
the model for testing in other cardiac conditions.

<12>
Accession Number
70958738
Authors
Thielmann M. Kottenberg E. Musiolik J. Wendt D. Gedik N. Schluter M. Pasa
S. S Dohle D. Tsagakis K. Kleinbongard P. Peters J. Jakob H. Heusch G.
Institution
(Thielmann, Wendt, Schluter, Pasa, S Dohle, Tsagakis, Jakob) Dept of
Thoracic and Cardiovascular Surgery, West-German Heart Cntr Essen, Univ
Hosp Essen, Essen, Germany
(Kottenberg, Peters) Dept of Anaesthesiology and Intensive Med Care, Univ
Hosp Essen, Essen, Germany
(Musiolik, Kleinbongard, Heusch) Institute for Pathophysiology, Univ Hosp
Essen, Essen, Germany
(Gedik) Institute for Pathophysiology, West-German Heart Cntr Essen, Univ
Hosp Essen, Essen, Germany
Title
Prognostic benefit from remote ischemic preconditioning in 300 patients
undergoing coronary artery bypass surgery: A randomized controlled trial.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Remote ischemic preconditioning (RIPC) reduced myocardial
injury following coronary artery bypass graft (CABG) surgery in recent
proof-of-concept and small randomized controlled trials (RCT). We have now
investigated not only the short-term effects but also the long-term
prognostic significance of RIPC following CABG surgery in a larger
single-center RCT (NCT01406678 ). Methods and Results: A total of 300
adult patients scheduled for elective isolated first-time CABG surgery
under cardiopulmonary bypass and crystalloid cardioplegia were allocated
in a prospective, randomized controlled and single-blinded trial to
receive either RIPC (n=148; 3 cycles of 5 min transient left upper arm
ischemia with 5 min reperfusion after induction of anesthesia) or serve as
controls (n=152). Baseline characteristics and intraoperative data did not
differ between the two groups. The primary short-term endpoint was
myocardial injury following CABG surgery as reflected by the perioperative
cardiac troponin I (cTnI) serum concentration over 72 h and its area under
the curve (AUC). The mean cTnI concentration in the RIPC group was
significantly lower over 72h after surgery (ANOVA; P<0.001), resulting in
a 31.7% AUC cTnI reduction vs. controls. The primary long-term endpoint
was all-cause mortality, secondary endpoints were major adverse
cardiovascular and cerebrovascular events (MACCE: myocardial infarction
and stroke) and repeat revascularization during follow-up (follow-up time
483+/-438 days). There were 6 deaths in controls and 1 in the RIPC group
over a maximum follow-up for 4 years. Kaplan-Meier overall survival
(P=0.03) and event-free survival (P=0.04) were better in the RIPC group,
but MACCE rate (P=0.13) and rate of repeat revascularization (P=0.42) did
not differ between the two groups. Conclusions: O ur RCT not only confirms
that RIPC provides myocardial protection but also demonstrates for the
first time a prognostic benefit with superior survival for patients
undergoing elective CABG surgery with RIPC.

<13>
Accession Number
70958594
Authors
Eggebrecht H. Schmermund A. Voigtlander T. Mehta R.H.
Institution
(Eggebrecht, Schmermund, Voigtlander) Internal Medicine/Cardiology,
Cardioangiological Cntr Bethanien (CCB), Frankfurt, Germany
(Mehta) Internal Medicine/Cardiology, Duke Clinical Rsch Inst, Durham, NC,
United States
Title
Acute surgical conversion during transcatheter aortic valve implantation
(TAVI)-a weighted meta-analysis of 9,251 patients from 46 studies.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background. Transcatheter aortic valve implantation (TAVI) is a novel
treatment option for high surgical risk patients (pts) with severe
symptomatic aortic valve (AV) stenosis. During TAVI, some pts may require
acute conversion to surgery. However, the incidence, reasons and outcomes
of those needing such acute conversion remain unknown. Methods and
results. We performed search of the English medical literature using
MEDLINE to identify all studies on TAVI to study the incidence of acute
surgical conversion (i.e within 24 hrs of TAVI) and outcomes in these pts.
Forty-six studies comprising of 9,251 pts undergoing transfemoral,
transapical (TA) or transsubclavian TAVI for native AV stenosis published
between 01/2004 and 04/2012 were identified and included in a weighted
meta-analysis. Overall, TAVI pts were 81.3+/-5.4 yrs old and had a high
mean logistic EuroSCORE (24.4+/-5.9%). Few pts required acute surgical
conversion (n=102; 1.1+/-1.1%) and this was marginally higher among those
undergoing TA-TAVI as compared to those undergoing transarterial TAVI
(1.9+/-1.7% vs. 0.6+/-0.9%). Few studies reported cause of such
conversions and >50% of these were performed for embolisation/dislocation
of AV prosthesis, with aortic dissection, coronary obstruction, AV
regurgitation, annular rupture, and tamponade constituting the rest
(Figure). 30-day death was about 8-fold higher in pts who did compared to
those who did not need conversion (48.0+/-44.3% vs. 6.5+/-4.5%).
Conclusions. Reported rates of acute surgical conversion during TAVI were
low with most common cause for it stated as embolization/dislocation of
prosthesis. Conversion was associated with grave prognosis with half of
these pts dying at 30 days. Thus, refinement in TAVI technology should not
only focus on miniaturization of delivery system, which has the potential
for decreasing aortic dissection, annular rupture, and tamponade, but also
incorporate modifications to prevent embolization/dislocation of the
valve.

<14>
Accession Number
70958396
Authors
Gyongyosi M. Pokushalov E. Bergmann M.W. Kastrup J. Atsma D. Sylven C.
Maurer G.
Institution
(Gyongyosi, Maurer) Cardiology, Med Univ of Vienna, Vienna, Austria
(Pokushalov) Cardiology, State Rsch Institute of Circulation Pathology,
Novosibirsk, Russian Federation
(Bergmann) Cath lab, Asklepios Klinik St. Georg, Hamburg, Germany
(Kastrup) Cardiology, Righospitalet Copenhagen, Copenhagen, Denmark
(Atsma) Cardiology, Leiden Univ Med Cntr, Leiden, Netherlands
(Sylven) Cardiology, Karolinska Institute, Stockholm, Sweden
Title
Safety and efficacy of intramyocardial delivery of stem cells in ischemic
heart failure: An individual patient data-based meta-analysis.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background. Intramyocardial stem cell delivery mode might be the choice
for regeneration of chronic myocardial ischemia and/or left ventricular
(LV) dysfunction. Methods. Individual patient data-based meta-analysis
includes data of 383 patients (part of MESS database, clinicaltrials.gov
NCT01098591 ) with ischemic cardiomyopathy (iCMP) and treated either with
autologous stem cell (SC) (bone marrow mononuclear or mesenchymal stem
cells) using percutaneous 3D NOGA-guided delivery (n=290) or randomized to
controls (n=93), data received from 5 European centers. Results. The
average follow-up (FUP) was 6.4+/-2.2 months. The baseline end-diastolic
volume (189+/-73 ml vs 201+/-71 ml) and ejection fraction (EF)
(41.4+/-14.5% vs 42.5+/-18.7%) were similar in SC treated vs controls.
Procedural complication occurred in 2.1% of patients, and 80.8x106 cells
were delivered in 11.2+/-2.5 myocardial sites. Compared with controls,
intramyocardial delivery of SC improved (p<0.001) LV EF (mean difference
4.6%; 95% confidence interval /CI/ 6.4% to 2.7%); reduced infarct size
(-2.22%; 95% CI -3.54% to -0.90%) and size of stress-induced myocardial
ischemia (-5.6; 95% CI -7.38% to -3.88%). The CCS angina status (-1.0; 95%
CI -0.68 to -1.06) and NYHA (-0.74; 95% CI -0.54 to -0.93) improved
significantly (p<0.001) post SC therapy as compared with controls.
Kaplan-Meier analysis resulted in a significant better survival (98.8% vs
93.5%, p<0.01) and MACCE-free survival (97.9% vs 78.5%, p<0.001) rate in
SC-treated patients vs controls. Multivariate analysis resulted in a lower
baseline EF and higher total number of intramyocardial delivered SC as
significant predictors for improvement in EF, while norminal regression
analysis revealed SC therapy as significant predictor for MACCE-free
survival in patients with iCMP. Conclusion. Meta-analysis of 3D NOGA
endocardial mapping guided transendocardial stem cell treatment proves the
safety and efficacy of this cardiac regeneration strategy in patients with
chronic ischemia and low EF.

<15>
Accession Number
70957994
Authors
Athappan G. Patvardhan E. Khan M.F.
Institution
(Athappan) Hear and Vascular, Metrohealth Med Cntr, CWRU, Cleveland, OH,
United States
(Patvardhan) Internal Medicine, Steward St Elizabeth, Brighton, MA, United
States
(Khan) Cardiology, Steward St Elizabeth Med center/Tufts, Brighton, MA,
United States
Title
Stroke outcomes : Perucutaneous coronary intervention vs. Coronary artery
bypass grafting.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Stroke is a devastating complication of both PCI and CABG and
its likelihood may be a factor in determining the procedure of choice for
an individual patient. Stroke risks have however not been compared apart
from in single trials and have not been characterized temporally. Studies
have suggested that an early excess risk in CABG may be compensated for by
a slow but progressive 'catch-up' phenomenon in patients undergoing PCI.
To test this hypothesis and characterize the temporal stroke risk, we
undertook a systematic review to compare patients undergoing CABG or PCI
for unprotected left main or MVD revascularization. Methods: Studies
published between January of 1994 and 2012 of PCI vs. CABG for UPLM
stenosis and or MVD were identified using an electronic search and
established meta-analytical guidelines. Studies reporting stroke outcomes
were then included in the analysis. The results were reviewed using the
random effects model of DerSimonian and Laird. The endpoint evaluated was
stroke at progressive time points - 1,2,3,4,5 and greater than 5 years .
Univariate meta regression was performed on apriori selected variables.
Heterogeneity was assessed by Q-statistic and sensitivity analysis was
performed. Results: From 22714 initial citations, 65 studies were included
(55,694 total patients, PCI 30,029 and CABG 25,665) of which eight were
randomized comparisons. A risk ratio (RR) of 0.48 (0.35-0.67) was found at
1 year of follow up for PCI with stenting vs. CABG, 0.80 (0.59-1.08) at 2
years, 0.73(0.59-0.91) at 3 years, 0.68(0.56-0.82) at 4 years ,
0.70(0.46-1.06) at 5 years and 0.72(0.49-1.07) at greater than 5 years of
follow up. Meta regression analysis showed that TVR weakly predicted
stroke rates . Conclusion: We conclude that there is a significantly lower
risk of stroke with PCI as compared to CABG upto year 5. There is also a
trend towards a significant reduction beyond 5 years , which suggests that
there is no late catch up phenomenon.

<16>
Accession Number
70957936
Authors
Zaruba M.-M. Kaczmarek I. Reimann R. Reichart B. Meiser B.
Institution
(Zaruba) Med Dept I and Transplantation Cntr Munich,
Ludwig-Maximilians-Univ, Munich, Germany
(Kaczmarek, Reimann) Dept of Cardiac Surgery, Transplantation Cntr Munich,
Ludwig-Maximilians-Univ, Munich, Germany
(Reichart) Dept of Cardiac Surgery, Ludwig-Maximilians-Univ, Munich,
Germany
(Meiser) Transplantation Cntr Munich, Ludwig-Maximilians-Univ, Munich,
Germany
Title
Tacrolimus with mycophenolate mofetil (MMF) or sirolimus compared with
calcineurininhibitor-free immunosuppression (sirolimus/MMF) after heart
transplantation: 5-year results.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Despite significant improvements in immunosuppressive therapy
over the past decades the most advantageous combination for long-term
outcome for cardiac transplant recipients has not yet been established.
Therefore, we performed a randomized controlled trial to evaluate the
efficacy and safety of three immunosuppressive protocols. Methods: Between
April 2003 and October 2005, 78 de novo cardiac transplant recipients were
randomized on a 2:2:1 basis to receive steroids and either tacrolimus
(TAC) + mycophenolate mofetil (MMF) (n=34), TAC + sirolimus (SRL) (n=29),
or SRL + MMF (n=15). Steroids were withdrawn after 6 months. All patients
received statins. Results: Cumulative survival at 5 years was: 85.3% in
the TAC/MMF group, 93.1% in the TAC/SRL group, and 86.7% in the SRL/MMF
group (p=ns). Freedom from acute rejection episodes (AREs) at 5 years was
not statistically different between the groups: TAC/MMF 81.3%, TAC/SRL
85.2%, SRL/MMF 73.3% (p=ns). Mean levels of serum creatinine at 5 years
revealed a superior preservation of renal function in the SRL/MMF vs. the
TAC/MMF group (p = 0.045): TAC/MMF = 1.70 +/- 0.91 mg/dL, TAC/SRL = 1.44
+/- 0.65 mg/dL and SRL/MMF = 1.25 +/- 0.46 mg/dL. Freedom form cardiac
allograft vasculopathy (CAV) was: TAC/MMF 73.5%, TAC/SRL 80.8%, and
SRL/MMF 93.3% revealing a trend towards superior freedom from CAV with
SRL/MMF compared to the TAC/MMF group (p = 0.090). Freedom from CMV
infection was: TAC/MMF 72.2%, TAC/SRL 89.7%, and SRL/MMF 86.7%. There was
a trend towards superior freedom form CMV infection with TAC/SRL when
compared only to the TAC/MMF group (p = 0.076). Total cholesterol,
LDL-cholesterol, HDL-cholesterol and triglyceride serum levels at 5 years
revealed no significant differences. Freedom from study discontinuation
due to side effects was significantly higher in the TAC/MMF groups vs. the
TAC/SRL (p = 0.034) and the SRL/MMF (p = 0.003) groups. Conclusions: Both
tacrolimus groups proved to be efficacious for the prevention of acute
rejection. The side effect profile for the SRL groups is inferior to the
TAC/MMF group resulting in a high discontinuation rate while the
calcineurininhibitor-free protocol results in a lower incidence of
vasculopathy and preserves renal function.

<17>
Accession Number
70957622
Authors
Une D. Kulik A. Voisine P. Le May M. Ruel M.
Institution
(Une, Le May, Ruel) Div of Cardiac Surgery and Cardiology, Univ of Ottawa
Heart Institute, Ottawa, Canada
(Kulik) Lynn Heart and Vascular Institute, Boca Raton Regional Hosp, Boca
Raton, FL, United States
(Voisine) Dept of Cardiac Surgery, Hopital Laval, Quebec city, Canada
Title
Smaller graft diameter and beta-blocker use are protective against intimal
hyperplasia of saphenous vein grafts at 1 year after coronary artery
bypass grafting: analysis from the cascade randomized trial.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Intimal hyperplasia of saphenous vein (SV) grafts can lead to
subsequent graft atherosclerosis and occlusion after coronary artery
bypass grafting. The CASCADE randomized controlled trial was designed to
assesse whether clopidgrel was protective against SV graft hyperplasia and
occlusion, assessed by 1-year angiography supplemented with intravascular
ultrasound (IVUS). The CASCADE trial reported that consistent statin use
was significantly associated with a reduction in intimal hyperplasia of SV
grafts, and diabetes constituted a risk factor. The present analyses
examined whether hemodynamic parameters, medications, and anatomical
factors also have an impact on hyperplasia of SV grafts. Methods: We
conducted a post-hoc analysis of the CASCADE trial, where 323 grafts were
assessed by angiography at 1 year postoperatively. To assess risk factors
for SV graft intimal hyperplasia, we examined the following factors :
preoperative demographics, systolic blood pressure (BP), diastolic BP,
mean BP, and resting heart rate at 1 year follow-up, medication profile, %
stenosis of native target coronary, target vessel location, target vessel
quality, target vessel size, and SV diameter. Results: The mean area of SV
graft intimal hyperplasia at 1 year was 4.31+/-2.06 mm2. Univariate
analysis indicated that SV diameter and grafting of the right coronary
artery (1.03+/-0.43 mm2; p=0.019) significantly correlated with the area
of SV graft intimal hyperplasia. There was no significant relationship
with BP. In multivariate stepwise linear regression analysis, independent
predictors of hyperplasia were SV diameter (2.09+/-0.18 mm2/mm; p<0.001)
and beta-blocker use at discharge (-0.96+/-0.48 mm2; p=0.047).
Conclusions: Anatomical and pharmacological factors had a significant
impact on SV graft hyperplasia at 1 year postoperatively. Smaller SV
grafts and use of beta-blocker were protective against SV graft intimal
hyperplasia, while blood pressure control was not. These findings may help
prevent late saphenous vein graft failure and optimize the long-term
outcomes of CABG.

<18>
Accession Number
70957484
Authors
Bittl J.A. He Y. Jacobs A.K. Normand S.-L.T.
Institution
(Bittl) Munoe Heart and Vascular Institute, Munroe Regional Med. Cntr.,
Ocala, FL, United States
(He) Dept. of Health Care Policy, Harvard Med. Sch, Boston, MA, United
States
(Jacobs) Cardiology, Boston Univ. Med. Cntr., Boston, MA, United States
(Normand) Biostatistics, Harvard Med. Sch, Boston, MA, United States
Title
Bayesian methods affirm the use of percutaneous coronary intervention to
improve survival in patients with unprotected left main coronary artery
disease.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Several randomized clinical trials (RCTs) have supported the
Class I recommendation for coronary artery bypass grafting (CABG) for
unprotected left main coronary artery disease (ULMCAD). In the absence of
RCTs directly comparing percutaneous coronary intervention (PCI) with
medical therapy (MT) for this indication, the new Class IIa recommendation
for PCI to improve survival in selected patients with ULMCAD has been
statistically inferred from several studies comparing CABG with PCI.
Hypothesis: We tested whether Bayesian approaches supported the
recommendation for PCI to improve survival in patients with ULMCAD.
Methods: We performed a Bayesian cross-design and network meta-analysis of
12 studies (4 RCTs, 4 observational matched studies and 4 other cohort
studies) comparing CABG with PCI (N=4,574 patients) and of 7 studies (2
RCTs and 5 observational studies) comparing CABG with MT (N=3,224
patients). Results: The odds ratios (ORs) for 1-year mortality after PCI
versus CABG using Bayesian cross-design meta-analysis were not different
among RCTs (OR 0.99, 95% Bayesian credible interval [BCI] 0.67-1.43),
matched cohort studies (OR 1.10, 95% BCI 0.76-1.73), and other types of
cohort studies (OR 0.93, 95% BCI 0.58-1.35). A network meta-analysis
suggested that MT alone is associated with higher 1-year mortality than
the use of PCI for patients with ULMCAD (Figure). Conclusions: Bayesian
methods support the current revascularization guidelines and suggest that
PCI may improve survival over MT alone for patients with ULMCAD. An
integrated approach analyzing data from both observational and randomized
studies using Bayesian methods may yield new insights to enhance the
translation of trial data into clinical practice.

<19>
Accession Number
70957451
Authors
Goto S.-N. Takagi H. Iwata K. Yamamoto H. Umemoto T.
Institution
(Goto, Takagi, Iwata, Yamamoto, Umemoto) Cardiovascular Surgery, Shizuoka
Med. Cntr., Sunto-gun, Japan
Title
Off-pump rather than on-pump coronary artery bypass grafting increases
late mortality: A meta-analysis of randomized controlled trials.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: A recent meta-analysis incorporating 59 randomized controlled
trials (RCTs) of off-pump versus on-pump (conventional) coronary artery
bypass grafting (CABG) suggests that there appears to be a beneficial
effect of off-pump CABG on post-operative (30-day or in-hospital) stroke
but neither all-cause mortality nor myocardial infarction. To determine
whether off-pump CABG reduces late all-cause mortality, we performed a
meta-analysis of RCTs of off-pump versus on-pump CABG. Methods: MEDLINE,
EMBASE, and the Cochrane Central Register of Controlled Trials were
searched through January 2012. Eligible studies were RCTs of off-pump
versus on-pump CABG and reporting late (>=1-year) all-cause mortality as
an outcome. For each RCT, data regarding mortality in both the off-pump
and on-pump CABG groups were used to generate odds ratios (ORs) and 95%
confidence intervals (CIs). Results: Eighteen RCTs enrolling 5358 patients
were identified. Pooled analysis suggested a significant increase in late
total mortality among patients randomized to off-pump versus on-pump CABG
in the fixed-effects model (OR, 1.35; 95% CI, 1.07-1.70; P=0.01; Figure).
There was minimal trial heterogeneity (P=0.87) and accordingly little
difference in the pooled result from the random-effects modeling.
Mortality increase remained significant even after elimination of the
largest and highest-weight RCT (Randomized On/Off Bypass [ROOBY] study)
(OR, 1.32; 95% CI, 1.01-1.72; P=0.04). In general, exclusion of any single
RCT from the analysis did not substantively alter the overall result of
our analysis. There was no evidence of significant publication bias.
Conclusions: Off-pump rather than on-pump CABG appears to significantly
increase late (>=1-year) mortality.

<20>
Accession Number
70957450
Authors
Goto S.-N. Takagi H. Iwata K. Yamamoto H. Umemoto T.
Institution
(Goto, Takagi, Iwata, Yamamoto, Umemoto) Cardiovascular Surgery, Shizuoka
Med. Cntr., Sunto-gun, Japan
Title
Transcatheter aortic valve implantation reduces neither 30-day nor midterm
mortality over aortic valve replacement in high-risk patients: A
meta-analysis of randomized and adjusted observational studies.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Our preliminary meta-analysis suggests that transcatheter
aortic valve implantation (TAVI) may not reduce 30-day mortality rate over
surgical aortic valve replacement (AVR) in high-risk patients with severe
aortic stenosis (AS). We performed an updated formal meta-analysis of TAVI
versus AVR for reduction of not only early but also late all-cause
mortality in AS. Methods: MEDLINE, EMBASE, and the Cochrane Central
Register of Controlled Trials weresearched through February 2012. Eligible
studies were randomized controlled trials or adjusted observational
comparative studies of TAVI versus AVR enrolling individuals with AS and
reporting 30-day and/or >=6-month all-cause mortality as an outcome. Odds
ratios (ORs) and/or hazard ratios (HRs) with 95% confidence intervals
(CIs) (adjusted ORs and/or adjusted HRs in case of observational studies)
were abstracted from each individual study. Results: Only one randomized
controlled trial and 11 adjusted observational comparative studies
enrolling 4134 patients with severe AS were identified. Pooled analysis
suggested no significant difference in both 30-day (OR, 0.85; 95% CI, 0.64
to 1.13; P=0.26) and midterm total mortality (HR, 0.99; 95% CI, 0.83 to
1.20; P=0.96; Figure) among patients assigned to TAVI versus AVR.
Exclusion of any single study from the analysis did not substantively
alter the overall result of our analysis. There was no evidence of
significant publication bias. Conclusions: We found that, based on a
meta-analysis of data on >4000 patients from 12 studies, TAVI is likely
ineffective in reduction of both 30-day and midterm all-cause mortality in
high-risk patients with AS.

<21>
Accession Number
70957025
Authors
Wang A. Sangli C. Glower D. Feldman T.
Institution
(Wang) Medicine, Duke Univ Med Cntr, Durham, NC, United States
(Sangli) Structural Heart, Abbott Vascular, Menlo Park, CA, United States
(Glower) Surgery, Duke Univ Med Cntr, Durham, NC, United States
(Feldman) Medicine, NorthShore Univ Health System, Evanston, IL, United
States
Title
Mitral regurgitation severity is associated with renal function: Post-hoc
analysis of the everest II trials of transcatheter mitral valve repair.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The relationship between mitral regurgitation (MR) severity
and renal function has not been described. It is hypothesized that a
reduction of MR following the MitraClip procedure is associated with
improved renal function. Methods: Patients enrolled in the EVEREST II
Randomized Controlled Trial (n=178) and high surgical risk patients from
the EVEREST II High Risk Study (N=78) and REALISM Continued Access Study
(n=133) with baseline moderate-to-severe or severe (3+/4+) MR and treated
with the MitraClip device were evaluated. Creatinine clearance (CrCl) was
calculated by Cockcroft-Gault normalized to body surface area and
quantitative MR severity by American Society of Echocardiography criteria
were evaluated. Linear mixed modeling was performed to evaluate the
relationship between MR severity (grade 3+ or 4+ vs 1+ or 2+) and CrCl.
Both measures were collected at baseline, 30 days, 6 months and 12 months
(n=1,335 data points). Separate models were fit for patients with and
without severe renal dysfunction (CrCl <30 ml/min). Results: Of the 382
patients with available CrCl at baseline, 142 (37%) had CrCl >60 ml/min;
168 (44%) had CrCl 30-60 ml/min; and 72 (19%) had CrCl <30 ml/min. In 45
patients with CrCl <30 ml/min at baseline, 15 (33%) patients had increase
in CrCl to >=30 ml/min at 1 year. Severity of MR was significantly
associated with relative change in CrCl for patients with baseline CrCl
<30 ml/min (p=0.0011) as well as baseline CrCl >=30 ml/min (p<0.0001). In
patients with severe renal dysfunction, reduction in MR to <=2+ at 1 year
was associated with a 30% increase in CrCl (p=0.004). MR etiology
(degenerative or functional) was not associated with relative change in
renal function. Conclusions: Reduction in MR severity with the MitraClip
system is strongly associated with improvement in renal function in
patients with severe renal dysfunction.

<22>
Accession Number
70956530
Authors
Saurav A. Malla V. Koneru S. Kaushik M. Hunter C. Mooss A.V.
Institution
(Saurav) Internal Medicine, Creighton Univ. Med. Cntr., Omaha, NE, United
States
(Malla, Koneru, Kaushik, Hunter, Mooss) Creighton Univ. Med. Cntr., Omaha,
NE, United States
Title
Outcomes of concomitant mitral valve repair compared to replacement in
patients undergoing aortic valve surgery: A meta-analysis of observational
studies.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction Long term superiority of mitral valve (MV) repair compared to
MV replacement is well established in degenerative MV disease. In
rheumatic heart disease (RHD), its benefits are unclear & is often
performed in conjunction with aortic valve replacement (AVR). Hence we
performed a systematic review & meta analysis comparing outcomes of MV
repair Vs replacement in patients undergoing AVR. Methods PUBMED, COCHRANE
& Web of Science databases were searched through May 15th 2012 for English
language studies comparing outcomes of MV repair Vs replacement in
patients undergoing AVR. Analysis was performed using random effects model
(MOOSE recommendation). Data of selected studies was extracted. Study
quality, publication bias & heterogeneity were assessed. Results Total of
1129 abstracts / titles were screened. Of these, 19 were selected for full
text review & 7 studies (3671 patients) were included in analysis; 1160
underwent MV repair & 2511 underwent replacement. Late outcome data was
available in 6 studies (cumulative follow up: 15654 patient years). Early
(in hospital & 30 days after surgery) & late mortality and thromboembolism
(including valve thrombosis) were significantly lower in MV repair group
with odds ratio of 0.64 (95% CI 0.48-0.85 p=0.002), 0.63 (95% CI 0.47-0.83
p=0.001) & 0.56 (95% CI 0.34-0.92 p=0.023) respectively. MV reoperation
rate was more frequent in repair group (OR 2.85, 95% CI 1.01-8.06
p=0.047). In a sensitivity analysis of exclusively RHD patients, mortality
benefit of MV repair was abolished (early OR 0.91, 95% CI 0.42, 1.97
p=0.82; late OR 0.66, 95% CI 0.35, 1.25 p=0.20) & the risk for MV
reoperation was higher (OR 6.17, 95% CI 2.4, 15.8 p>0.0001). Conclusion In
patients undergoing concomitant AV & MV surgery, MV repair is associated
with improved perioperative & long term survival, though this benefit is
not seen in RHD patients. However, MV reoperation remains high in repair
group irrespective of the etiology of valve disease.

<23>
Accession Number
70956439
Authors
Wong C.X. Sun M.T. Pathak R. Mahajan R. Lau D.H. Roberts-Thomson K.C.
Sanders P.
Institution
(Wong, Sun, Pathak, Mahajan, Lau, Roberts-Thomson, Sanders) Cardiology,
Cntr for Heart Rhythm Disorders, Univ of Adelaide and Royal Adelaide Hosp,
Adelaide, SA, Australia
Title
Body mass index predicts postoperative atrial fibrillation: Results of a
contemporary meta-analysis.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: There is increasing evidence that obesity is associated with
an increased risk of developing atrial fibrillation (AF). A prior
meta-analysis concluded that there was no significant association between
obesity and postoperative AF. Since this meta-analysis, however, there
have been a number of more recent studies published. Methods: Electronic
databases were searched for published studies up until December 2011.
Studies were included if they assessed the incidence of postcardiac
surgery AF in relation to body mass index (BMI). Data were pooled using
random effects meta-analysis where appropriate. When study data were
reported as a series of dose-specific relative risks compared to a
reference BMI category, these were transformed into risk estimates per
unit of BMI via the Hartemink method to allow pooling. Results:
Twenty-seven studies were identified. One study was not considered for
pooled analysis due to already-included reports from the same institution.
Nine studies did not report sufficient data to convert categorical to
continuous relative risks. Of the remaining studies, pooled analysis of
twelve studies reporting HR data revealed a significant association
between BMI and incident postoperative AF (OR per unit of BMI 1.035 [95
CI% 1.029 to 1.042]). Conclusions: For every unit increase in BMI, there
is a 3.5% increased risk of postoperative AF. These data suggest that
obesity predicts the development of postoperative AF following cardiac
surgery. Our findings raise the interesting possibility that preoperative
weight loss may minimise the risk of developing postoperative AF and
require further study elsewhere.

<24>
Accession Number
70956138
Authors
Zeb I. Nasir K. Budoff M.
Institution
(Zeb) Internal Medicine, Bronx-Lebanon Hosp Cntr, Bronx, NY, United States
(Nasir) Cardiology, Yale Univ, New Haven, CT, United States
(Budoff) Cardiology, Los Angeles Biomedical Rsch Institute at Harbor-UCLA
Med Cntr, Torrance, CA, United States
Title
Coronary computed tomography reduces downstream resource utilization and
is cost-effective test strategy for coronary artery disease assessment - A
systematic review.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cardiac CT angiography (CCTA) has shown superior diagnostic
accuracy. We performed systematic search of literature on the cost
effectiveness and downstream test utilization associated with the use of
CCTA. Methods: We searched literature for randomized controlled trials or
prospective or retrospective non-randomized comparative studies or case
series, decision analytic models and technology reports in which some or
all of the patients underwent CCTA and looking at cost effectiveness,
comparative effectiveness and downstream test utilization associated with
use of CCTA. Results: We found 42 studies matching our criteria. Decision
analytic models showed that CCTA either alone or in combination with
stress testing is a cost effective strategy for initial evaluation of
patients with coronary artery disease (CAD) prevalence of 10% to 50% in
both near-term and long-term diagnostic periods. For CAD prevalence 10%,
SPECT alone' is the most effective strategy However, use of SPECT is
associated with higher incremental cost effective ratios (82,300 vs.
17,000 for SPECT vs. CCTA). CCTA use is associated with lowered healthcare
cost (26.5% lower cost), less likely to undergo coronary revascularization
(odds ratio 0.76, 95% CI: 0.75, 0.77 p<0.001) and no significant
difference for adverse events compared with stress MPI. Downstream testing
is less frequent with CCTA use compared with stress testing (21% vs. 32%,
p=0.003). Another study reported that use of CCTA is associated with
increase in coronary revascularization rates (11.5%) and higher total
healthcare spending (4200 [3193 to 5267]; P<0.001). Use of CCTA is
associated with higher rates of discharge from emergency department
(48.15% vs. 17.55%,p<0.05), shorter length of stay (median 13.3 vs. 26.8
hours, p<0.05) and 55% reduction in time to diagnosis, without increase in
cost of care and associated with safe exclusion of acute coronary syndrome
in low risk acute chest pain patients. Conclusion: CCTA is an effective
diagnostic tool and associated with less downstream testing for diagnosis
of stable chest pain in low to intermediate risk patients whereas for low
risk acute chest pain patients, use of CCTA is associated with expedited
patient management and safe exclusion of ACS.

<25>
Accession Number
70954729
Authors
Nytroen K. Rustad L.A. Aukrust P. Ueland T. Hallen J. Holm I. Rolid K.
Lekva T. Fiane A. Amlie J.P. Aakhus S. Gullestad L.
Institution
(Nytroen, Amlie, Aakhus, Gullestad) Dept of Cardiology, Oslo Univ Hosp
Rikshospitalet, Oslo, Norway
(Rustad) Dept of Circulation and Med Imaging, Norwegian Univ of Science
and Technology, Trondheim, Norway
(Aukrust, Ueland, Lekva) Rsch Institute of Internal Medicine, Oslo Univ
Hosp Rikshospitalet, Oslo, Norway
(Hallen) NIH, Norwegian Sch of Sport Sciences, Oslo, Norway
(Holm) Div of Surgery and Neuroscience, Oslo Univ Hosp Rikshospitalet,
Oslo, Norway
(Rolid) Dept of Clinical Services, Oslo Univ Hosp Rikshospitalet, Oslo,
Norway
(Fiane) Dept of Cardiothoracic Surgery, Oslo Univ Hosp Rikshospitalet,
Oslo, Norway
Title
Effect of high intensity interval training in heart transplant
recipients-a randomized controlled trial.
Source
Circulation. Conference: American Heart Association 2012 Scientific
Sessions and Resuscitation Science Symposium Los Angeles, CA United
States. Conference Start: 20121103 Conference End: 20121106. Conference
Publication: (var.pagings). 126 (21 SUPPL. 1) , 2012. Date of Publication:
20 Nov 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND High intensity interval training (HIIT) is an efficient form of
exercise training in patients with coronary heart disease and heart
failure, while heart transplant (HTx) recipients, mainly because of
denervation, traditionally have not been exposed to HIIT. Even if many
studies have documented effect of exercise in HTx recipients, VO2peak
remain below normal: 50 to 70% of predicted. Our hypothesis was that HIIT
is an applicable and safe form of exercise in heart transplant (HTx)
recipients, and that it would markedly improve VO2peak. Secondarily, we
wanted to evaluate central and peripheral mechanisms behind a potential
VO2peak increase. METHODS Forty-eight clinically stable HTx recipients >18
years old and 1-8 years after HTx underwent maximal exercise testing on a
treadmill, muscle strength testing, echocardiography and quality of life
questionnaires. They were randomized to either exercise group (a one-year
HIIT-program) or control group (usual care). RESULTS The mean+/-SD age was
51+/-16 years, 71% were male and time since HTx was 4.1+/-2.2 years. The
mean VO2peak difference between groups at follow-up was 3.6 [2.0, 5.2]
mL/kg/min (p<0.001). The exercise group had achieved 89.0+/-17.5% of
predicted VO2peak vs. 82.5+/-20.0% in the control group (p<0.001). In
addition, the exercise group improved their muscular exercise capacity
significantly (p<0.001) and had subjectively significant better general
health (p<0.001). There were no changes in cardiac function measured by
echocardiography. CONCLUSIONS The present study documents that a
long-term, partly supervised and community-based HIIT-program is an
applicable, effective and safe way to improve VO2peak, muscular exercise
capacity and quality of life in HTx recipients. The results indicate that
HIIT should be more frequently used among stable HTx recipients in the
future.