EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2013063844
Authors
Pahwa A.K. Arbab-Zadeh A. Brotman D.J. Feldman L.S.
Institution
(Pahwa, Brotman, Feldman) Department of Medicine, The Johns Hopkins
University, Baltimore, United States
(Arbab-Zadeh) Division of Cardiology, Department of Medicine, The Johns
Hopkins University, Baltimore, United States
Title
Potential role of coronary computed tomography-angiography for guiding
perioperative cardiac management for non-cardiac surgery.
Source
Heart International. 8 (1) (pp 1-3), 2013. Date of Publication: 2013.
Publisher
Page Press Publication (via Giuseppe Belli, Pavia 7, 27100, Italy)
Abstract
Perioperative cardiac events can be a major consequence of surgery. The
American College of Cardiology Foundation/American Heart Association has
set out guidelines to aid physicians in identifying patients at the
highest risk for these events. The guidelines do recommend for some
patients to undergo noninvasive cardiac stress testing for further risk
stratification, but their sensitivity and specificity for predicting
cardiac events is not optimal. With more data emerging of the superior
performance of computed coronary tomography angiography (CCTA) compared to
noninvasive stress testing, CCTA could be more useful in risk
stratification for these patients. A.K. Pahwa et al., 2013 Licensee
PAGEPress, Italy.

<2>
Accession Number
2013062014
Authors
Gandham R. Syamasundar A. Ravulapalli H. Karthekeyan R. Vakamudi M.
Kodalli R.B. Nandipati S.
Institution
(Gandham, Syamasundar, Ravulapalli, Karthekeyan, Vakamudi, Kodalli,
Nandipati) Department of Cardiac Anesthesiology, Sri Ramachandra Medical
College, Chennai, Tamil Nadu, India
Title
A comparison of hemodynamic effects of levosimendan and dobutamine in
patients undergoing mitral valve repair/replacement for severe mitral
stenosis.
Source
Annals of Cardiac Anaesthesia. 16 (1) (pp 11-15), 2013. Date of
Publication: January-March 2013.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Aims and Objectives: We aimed to compare the hemodynamic effects of
levosimendan and dobutamine in patients undergoing mitral valve surgery on
cardiopulmonary bypass (CPB). Materials and Methods: Sixty patients were
divided into 2 groups of 30 each. Group-L patients received levosimendan
0.1 mug/kg/min and Group-D patients received dobutamine 5 mug/kg/min while
weaning off CPB. Additional inotrope and/or vasoconstrictor were started
based on hemodynamic parameters. Hemodynamic data were collected at the
end and at 30 minutes after CPB, thereafter at 6, 12, 24, and 36 hours
post-CPB. Mean arterial pressure (MAP), central venous pressure (CVP),
heart rate (HR), cardiac index (CI), systemic vascular resistance index
(SVRI), and lactate levels were measured. Results: Group-L showed
increased requirement of inotropes and vasoconstrictors. The SVRI, CVP,
and MAP were reduced more in Group-L. The CI was low in Group-L in the
initial period when compared to Group-D. Later Group-L patients showed a
statistically significant increase in CI even after 12 hrs of
discontinuation of levosimendan infusion. The HR was increased more in
Group-D. Lactate levels, intensive care unit stay, and duration of
ventilation were similar in both groups. Conclusions: Levosimendan 0.1
mug/kg/min compared to dobutamine 5 mug/kg/min showed more vasodilation
and lesser inotropic activity in patients undergoing mitral valve surgery
for mitral stenosis. Levosimendan compared to dobutamine showed a
statistically significant increase in CI even after 12 hrs of
discontinuation. The requirement of another inotrope or vasopressor was
frequent in levosimendan group.

<3>
Accession Number
2013062012
Authors
Suryaprakash S. Chakravarthy M. Muniraju G. Pandey S. Mitra S.
Shivalingappa B. Chittiappa S. Krishnamoorthy J.
Institution
(Suryaprakash, Chakravarthy, Muniraju, Pandey, Krishnamoorthy) Department
of Anesthesiology, Fortis Hospital, Bannerghatta Road, Bangalore,
Karnataka - 560 052, India
(Mitra, Shivalingappa, Chittiappa) Cardiac Surgical Intensive Care Unit,
Fortis Hospital, Bannerghatta Road, Bangalore, Karnataka, India
Title
Myocardial protection during off pump coronary artery bypass surgery: A
comparison of inhalational anesthesia with sevoflurane or desflurane and
total intravenous anesthesia.
Source
Annals of Cardiac Anaesthesia. 16 (1) (pp 4-8), 2013. Date of Publication:
January-March 2013.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Aims and Objectives: The objective of the study was to evaluate the
myocardial protective effect of volatile agents-sevoflurane and desflurane
versus total intravenous anesthesia (TIVA) with propofol in offpump
coronary artery bypass surgery (OPCAB) by measuring cardiac troponin-T
(cTnT) as a marker of myocardial cell death. Materials and Methods: The
study was conducted on 139 patients scheduled to undergo elective OPCAB
surgery. The patients were randomly allocated to receive anesthesia with
sevoflurane, desflurane or TIVA with propofol. The cTnT levels were
measured preoperatively, at arrival in postoperative intensive care unit,
at 8, 24, 48 and 96 hours thereafter. Results: The changes in cTnT levels
at all time intervals were comparable in the three groups. Conclusion: The
study did not reveal any difference in myocardial protection after OPCAB
with either sevoflurane or desflurane or TIVA using propofol as assessed
by measuring serial cTnT values.

<4>
Accession Number
2013053853
Authors
Birgand G. Radu C. Alkhoder S. Al Attar N. Raffoul R. Dilly M.-P. Nataf P.
Lucet J.-C.
Institution
(Birgand, Lucet) Infection Control Unit, Bichat-Claude Bernard Hospital,
Assistance Publique-Hopitaux de Paris, Paris, France
(Birgand, Al Attar, Nataf, Lucet) Unite d'Hygiene et de Lutte Contre
l'Infection Nosocomiale, GH Bichat-Claude Bernard, 46 rue Henri Huchard,
75877 Paris Cedex 18, France
(Radu, Alkhoder, Al Attar, Raffoul, Nataf) Department of Cardiac Surgery,
Bichat-Claude Bernard Hospital, Assistance Publique-Hopitaux de Paris,
Paris, France
(Dilly) Department of Anesthesiology, Bichat-Claude Bernard Hospital,
Assistance Publique-Hopitaux de Paris, Paris, France
Title
Does a gentamicin-impregnated collagen sponge reduce sternal wound
infections in high-risk cardiac surgery patients?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (2) (pp 134-141),
2013. Date of Publication: February 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives Sternal wound infections occurring after cardiac surgery have a
critical impact on morbidity, mortality and hospital costs. This study
evaluated the efficacy of a gentamicin-collagen sponge in decreasing deep
sternal-wound infections in high-risk cardiac surgery patients. Methods We
conducted a quasi-experimental single-centre prospective cohort study in
diabetic and/or overweight patients undergoing coronary-artery bypass
surgery with bilateral internal mammary artery grafts. The end-point was
the rate of reoperation for deep sternal wound infection. The period from
January 2006 to October 2008, before the introduction of the gentamicin
sponge, was compared with the period from November 2008 to December 2010.
Results Of 552 patients (median body mass index, 31.5; 37.7% with diabetes
requiring insulin), 68 (12.3%) had deep sternal wound infections.
Reoperation for deep sternal wound infections occurred in 40/289 (13.8%)
preintervention patients and 22/175 (12.6%) patients managed with the
sponge. Independent risk factors were female sex and longer time on
mechanical ventilation, but not use of the sponge (adjusted odds ratio,
0.95; 95% confidence interval, 0.52-1.73; P = 0.88). The group managed
with the sponge had a higher proportion of gentamicin-resistant
micro-organisms (21/27, 77.8%) compared with the other patients (23/56,
41.1%; P < 0.01). The median time to reoperation for wound infection was
higher with the sponge (21 vs 17 days, P < 0.01). Conclusions A
gentamicin-collagen sponge was not effective in preventing deep sternal
wound infections in high-risk patients. Our Results suggest that a
substantial proportion of wound contaminations occur after bypass surgery
with bilateral internal mammary artery grafts. 2012 The Author.

<5>
Accession Number
2013053852
Authors
Sepehripour A.H. Athanasiou T.
Institution
(Sepehripour, Athanasiou) Department of Cardiothoracic Surgery, Imperial
College Healthcare, London, United Kingdom
(Sepehripour, Athanasiou) Division of Surgery, Imperial College London St.
Mary's Hospital, QEQM Building, South Wharf Road, London W2 1NY, United
Kingdom
Title
Is there a surgeon or hospital volume-outcome relationship in off-pump
coronary artery bypass surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (2) (pp 202-207),
2013. Date of Publication: February 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether there is a surgeon or hospital
volume-outcome relationship in patients undergoing off-pump coronary
artery bypass surgery. A total of 281 papers were found using the reported
searches, of which six represented the best evidence to answer the
clinical question. The authors, date, journal, study type, population,
main outcome measures and Results are tabulated. The studies found
analysed the outcomes of off-pump coronary artery bypass surgery in
relation to surgeon or hospital volume and evaluated the presence of a
volume-outcome relationship. Reported measures included mortality and
major adverse cardiovascular and cerebrovascular events. The
methodological quality and strength of each study for exploring
volume-outcome relationships were quantitatively assessed using a
predefined scoring system. Three studies analysed surgeon volume and three
studies analysed hospital volume. The two largest and most recent studies
presented a significant volume-outcome relationship in mortality and
postoperative complications. Perhaps owing to the smaller sample size,
this significant relationship in mortality was not observed in the four
smaller studies; however, one of these studies demonstrated a
significantly positive relationship for postoperative complications and
another study demonstrated a similar significant relationship for the
number of grafts and the degree of completeness of revascularization.
While the volume-outcome relationship in coronary artery bypass graft
surgery is very well-documented, the technically challenging nature of
off-pump surgery, the length of the learning curve associated with the
operation and the higher risk profile of patients undergoing off-pump
surgery in comparison with routine on-pump surgery render these Results
difficult to interpret. Although our review does support the idea of a
volume-outcome relationship in off-pump coronary artery bypass surgery,
this relationship may not be so clearly defined and requires further
analysis by higher-quality studies. 2012 The Author.

<6>
Accession Number
2013053849
Authors
Papalexopoulou N. Young C.P. Attia R.Q.
Institution
(Papalexopoulou, Young, Attia) Department of Cardiothoracic Surgery, Guy's
and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road,
London SE1 7EH, United Kingdom
Title
What is the best timing of surgery in patients with post-infarct
ventricular septal rupture?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (2) (pp 193-196),
2013. Date of Publication: February 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'in which patients with a
post-infarct ventricular septal rupture (PIVSR) might immediate surgery
give better Results than delayed surgery in terms of mortality'?
Altogether, 88 papers were found using the reported search criteria, of
which 6 represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and Results of these papers are tabulated.
The recommendations are based on outcomes from 3238 patients undergoing
surgery for PIVSR. Mean age was 67.5 +/- 8.8 (40-88 years). Left
ventricular function was compromised in most patients with mean ejection
fraction of 40%. All papers carried out univariate and/or multivariate
analyses of variables that contributed to different in-hospital
mortalities. Early surgery, i.e. from >3 days to within 4 weeks after MI,
had an overall in-hospital mortality of 52.4%; delayed surgery, typically
from 1 week to after 4 weeks post-myocardial infarction, had an overall
operative in-hospital mortality of 7.56%. Most authors observe that a
shorter time between rupture and surgery is an unfavourable predictor of
outcome independent of haemodynamic status. The consensus was that nearly
all patients with PIVSR, particularly if >15 mm diameter with a
significant shunt and resultant haemodynamic deterioration, should undergo
early surgical repair. The precise timing of surgery depends on patients'
haemodynamic status. Exclusion from surgery should be considered if life
expectancy or quality is severely limited by another limiting underlying
pathology. If the patient is in cardiogenic shock, due to pulmonary to
systemic blood flow ratio shunt rather than infarct size, immediate
surgery should follow resuscitation measures and cardiac support. If the
patient is haemodynamically stable, surgery could be performed after 3-4
weeks of medical optimization with inotropic and mechanical cardiac
support. If there is clinical deterioration, immediate surgery is
indicated. 2012 The Author.

<7>
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Accession Number
2013055419
Authors
Van Der Bom T. Winter M.M. Bouma B.J. Groenink M. Vliegen H.W. Pieper P.G.
Van Dijk A.P.J. Sieswerda G.T. Roos-Hesselink J.W. Zwinderman A.H. Mulder
B.J.M.
Institution
(Van Der Bom, Winter, Bouma, Groenink, Mulder) Department of Cardiology,
Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
(Groenink) Department of Radiology, Academic Medical Center, Amsterdam,
Netherlands
(Zwinderman) Department of Clinical Epidemiology and Biostatistics,
Academic Medical Center, Amsterdam, Netherlands
(Van Der Bom, Winter, Mulder) Netherlands Heart Institute, Utrecht,
Netherlands
(Vliegen) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Pieper) Department of Cardiology, University Medical Center Groningen,
Groningen, Netherlands
(Van Dijk) Department of Cardiology, Radboud University Nijmegen Medical
Center, Nijmegen, Netherlands
(Sieswerda) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Roos-Hesselink) Department of Cardiology, Erasmus Medical Center,
Rotterdam, Netherlands
Title
Effect of valsartan on systemic right ventricular function: A
double-blind, randomized, placebo-controlled pilot trial.
Source
Circulation. 127 (3) (pp 322-330), 2013. Date of Publication: 22 Jan 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND - The role of angiotensin II receptor blockers in patients with
a systemic right ventricle has not been elucidated. METHODS AND RESULTS -
We conducted a multicenter, double-blind, parallel, randomized controlled
trial of angiotensin II receptor blocker valsartan 160 mg twice daily
compared with placebo in patients with a systemic right ventricle caused
by congenitally or surgically corrected transposition of the great
arteries. The primary end point was change in right ventricular ejection
fraction during 3-year follow-up, determined by cardiovascular magnetic
resonance imaging or, in patients with contraindication for magnetic
resonance imaging, multirow detector computed tomography. Secondary end
points were change in right ventricular volumes and mass, (Equation is
included in full-text article.)peak, and quality of life. Primary analyses
were performed on an intention-to-treat basis. A total of 88 patients
(valsartan, n=44; placebo, n=44) were enrolled in the trial. No serious
adverse effects occurred in either group. There was no significant effect
of 3-year valsartan therapy on systemic right ventricular ejection
fraction (treatment effect, 1.3%; 95% confidence interval, -1.3% to 3.9%;
P=0.34), maximum exercise capacity, or quality of life. There was a larger
increase in right ventricular end-diastolic volume (15 mL; 95% confidence
interval, 3-28 mL; P<0.01) and mass (8 g; 95% confidence interval, 2-14 g;
P=0.01) in the placebo group than in the valsartan group. CONCLUSIONS -
There was no significant treatment effect of valsartan on right
ventricular ejection fraction, exercise capacity, or quality of life.
Valsartan was associated with a similar frequency of significant clinical
events as placebo. Small but significant differences between valsartan and
placebo were present for change in right ventricular volumes and mass.
2012 American Heart Association, Inc.

<8>
Accession Number
2013055353
Authors
Yokoyama J. Ito S. Ohba S. Fujimaki M. Ikeda K. Hanaguri M.
Institution
(Yokoyama, Ito, Ohba, Fujimaki, Ikeda) Department of Otolaryngology, Head
and Neck Surgery, Juntendo University School of Medicine, 113-8421, 2-1-1,
Hongo, Bunkyo-ku, Tokyo, Japan
(Hanaguri) Department of Otolaryngology, Kyushu Rosai Hospital,
Kitakyushu, Japan
Title
A safe and cosmetic method of removing the sternum by bone forceps for
mediastinal dissection of recurrent thyroid cancer.
Source
Head and Neck Oncology. 4 (2) , 2012. Article Number: 58. Date of
Publication: 09 Sep 2012.
Publisher
OA Publishing London (Second Floor, 10-12 Maclise Road, London, England
W140PR, United States)
Abstract
Introduction Thyroid cancer frequently recurs in the superior or anterior
mediastinum. Midline sternotomy is usually performed in order to dissect
recurrent mediastinal cancers, but there is a high risk of haemorrhage
that can result from unintentionally cutting the brachiocephalic veins
adhering to the sternum. A safe and minimally invasive method is thus
required for the treatment of recurrent thyroid cancer in the mediastinum.
The objective of this study was to evaluate a novel method of removing the
sternum by bone forceps for mediastinal dissection to determine its
safety, aesthetic outcome and duration of hospitalisation, as compared
with conventional reversed T-shaped sternotomy. Materials and methods A
collar skin incision was made followed by the removal of the sternum by
bone forceps. As a result, soft tissues, including the sternothyroid
muscle, behind the sternum were exposed and cut, allowing the surgeon a
clear area in which to observe great vessels in the mediastinum.
Mediastinal dissection could then be performed safely because of the clear
view afforded when retracting the brachiocephalic veins. After dissection,
many pieces of the sternal bone were grafted back to the sternum and were
subsequently covered with vascularised muscle tissue. Twenty-one patients
with recurrent thyroid carcinoma underwent this procedure between 2005 and
2010. The control group consisted of 12 patients treated by conventional
methods between 2002 and 2004. The difference between the two groups was
tested using Student's t-test and Mann-Whitney test; p values <0.05 were
considered to indicate significance. Results and Discussion The mean time
for removal of the sternum was 11 min (9-15 min). After the sternum was
removed, brachiocephalic veins could be clearly observed in the soft
tissue. Mediastinal dissection could be performed safely because of the
clear view provided, and it did not result in any complications. The mean
blood loss for the new method group and that for the control group was 185
ml (35-530) and 278 ml (55-687), respectively. The mean surgical time for
the new method group and the control group was 3 h 5 min and 3 h 58 min,
respectively. The mean duration of hospitalisation for the new method
group and the control group was 8.5 days (7-19) and 12.9 days (8-23),
respectively. These three key areas of comparison were significantly
different between the two groups. Patients were highly satisfied with the
post-operative aesthetic results. This method is effective for the
dissection of the central compartment rather than the lateral compartment.
Conclusion This novel method of removing the sternum by bone forceps is
more effective than the conventional method for mediastinal dissection of
recurrent thyroid cancer in terms of safety, aesthetic outcome and
duration of hospitalisation. Copyright 2012 OA Publishing London.

<9>
Accession Number
2013044614
Authors
Chen X. Zhang N. Cai Y. Shi J.
Institution
(Chen, Zhang, Cai, Shi) Department of Clinical Epidemiology, Institute of
Cardiovascular Diseases and Center of Evidence Based Medicine, First
Affiliated Hospital, China Medical University, Shenyang, China
Title
Evaluation of left ventricular diastolic function using tissue Doppler
echocardiography and conventional doppler echocardiography in patients
with subclinical hypothyroidism aged <60 years: A meta-analysis.
Source
Journal of Cardiology. 61 (1) (pp 8-15), 2013. Date of Publication:
January 2013.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai) (Hongo 4-9-22,
Bunkyo-ku, Tokyo 113, Japan)
Abstract
Studies have suggested that subclinical hypothyroidism (SCH) may have
detrimental effects on left ventricular (LV) diastolic function. Whether
SCH is a risk factor for LV diastolic dysfunction is controversial.
Databases (MEDLINE, PubMed, EMBASE) were searched for cross-sectional
studies evaluating LV diastolic function in SCH patients aged <60 years
using tissue Doppler echocardiography (TDE) and conventional
two-dimensional Doppler echocardiography (2D-DECG) published in the past
12 years. The weighted mean difference (WMD) and 95% confidence interval
(CI) were calculated using fixed or random-effects models. We summarized
the results of 14 cross-sectional studies with 675 participants. SCH
patients had a significantly lower LV mitral annular E_a peak
velocity (WMD=-1.71cm/s; 95%CI: -3.02 to -0.40; p<0.05),
E_a/A_a ratio (WMD=-0.22; 95%CI: -0.40 to -0.05;
p<0.05), and significantly higher mitral annular A_a peak
velocity (WMD=0.47cm/s; 95%CI: 0.10-0.85; p<0.05) than euthyroid subjects
using TDE. Subgroup analyses showed that statistical significance existed
only in E_a and E_a/A_a parameters when data
from " women>=90%" were used, and in the A_a parameter when data
from " women<90%" were used. No matter which subgroup of females was used,
there were significant differences in LV peak transmitral A velocity
(WMD=7.64cm/s; 95%CI: 4.55-10.73; p<0.05), and E/A ratio (WMD=-0.22;
95%CI: -0.31 to -0.21; p<0.05) but no significant difference in peak
transmitral E velocity (p>0.05) between SCH patients and euthyroid
controls using 2D-DECG. Therefore, for those aged <60 years, SCH patients
had significantly worse parameters of LV diastolic function than euthyroid
controls. 2012 Japanese College of Cardiology.

<10>
Accession Number
2013037706
Authors
Chrysant S.G. Chrysant G.S.
Institution
(Chrysant) Oklahoma Cardiovascular and Hypertension Center, University of
Oklahoma, 5850 W Wilshire Blvd, Oklahoma City, OK 73132, United States
(Chrysant) INTEGRIS Baptist Medical Center, Oklahoma City, OK, United
States
Title
New insights into the true nature of the obesity paradox and the lower
cardiovascular risk.
Source
Journal of the American Society of Hypertension. 7 (1) (pp 85-94), 2013.
Date of Publication: January-February 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Obesity is considered a major risk factor for cardiovascular disease,
hypertension, and diabetes by National and International Committees. For
this reason, they advocate weight loss and prevention of obesity. However,
several studies in patients with established coronary artery disease
(CAD), congestive heart failure, and hypertension have shown an inverse
relationship between obesity and mortality, the so called "obesity
paradox," whereas other studies have not shown such a relationship. In
studies showing the obesity paradox (OP), body mass index (BMI) was used,
almost exclusively as an index of obesity, although is a poor
discriminator of total body fatness. Recent studies using better indices
of obesity such as waist circumference (WC) and waist to hip ratio (WHR)
have shown that high WC and WHR were directly and positively associated
with higher event rate and total mortality in these patients. Because the
OP could convey the wrong message in obese patients, the validity and true
nature of the OP will be examined in this concise review. A Medline search
of the English literature was performed between 2000 and September 2012,
and 46 pertinent articles were selected for this review. The majority of
these studies do not support an OP and those that do have used almost
exclusively BMI as an index of obesity. Therefore, based on recent studies
using other indices of body fat distribution, such as WC and WHR, besides
BMI, the true existence of OP has been questioned and needs to be
confirmed by future studies. 2013 American Society of Hypertension. All
rights reserved.

<11>
Accession Number
2013044134
Authors
Teeuwen K. Adriaenssens T. Van den Branden B.J.L. Henriques J.P.S. Van der
Schaaf R.J. Koolen J.J. Vermeersch P.H.M.J. Bosschaert M.A.R. Tijssen
J.G.P. Suttorp M.J.
Institution
(Teeuwen, Bosschaert, Suttorp) Department of Cardiology, St. Antonius
Hospital, Koekoekslaan1, 3435 CM, Nieuwegein, Netherlands
(Adriaenssens) Department of Cardiology, University Hospitals Leuven,
Herestraat 49, 3000, Leuven, Belgium
(Van den Branden, Tijssen) Department of Cardiology, Amphia Hospital,
Molengracht 21, 4818 CK, Breda, Netherlands
(Henriques) Department of Cardiology, Academic Medical Center, University
of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
(Van der Schaaf) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Oosterpark 9, 1091 AC, Amsterdam, Netherlands
(Koolen) Department of Cardiology, Catharina Hospital, Michalangelolaan 2,
6523 EJ, Eindhoven, Netherlands
(Vermeersch) Department of Cardiology, Middelheim Hospital, Lindendreef 1,
2020, Antwerpen, Belgium
Title
A randomized multicenter comparison of hybrid sirolimus-eluting stents
with bioresorbable polymer versus everolimus-eluting stents with durable
polymer in total coronary occlusion: Rationale and design of the Primary
Stenting of Occluded Native Coronary Arteries IV study.
Source
Trials. 13 , 2012. Article Number: 240. Date of Publication: 15 Dec 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Percutaneous recanalization of total coronary occlusion (TCO)
was historically hampered by high rates of restenosis and reocclusions.
The PRISON II trial demonstrated a significant restenosis reduction in
patients treated with sirolimus-eluting stents compared with bare metal
stents for TCO. Similar reductions in restenosis were observed with the
second-generation zotarolimus-eluting stent and everolimus-eluting stent.
Despite favorable anti-restenotic efficacy, safety concerns evolved after
identifying an increased rate of very late stent thrombosis (VLST) with
drug-eluting stents (DES) for the treatment of TCO. Late malapposition
caused by hypersensitivity reactions and chronic inflammation was
suggested as a probable cause of these VLST. New DES with bioresorbable
polymer coatings were developed to address these safety concerns. No
randomized trials have evaluated the efficacy and safety of the
new-generation DES with bioresorbable polymers in patients treated for
TCO.Methods/Design: The prospective, randomized, single-blinded,
multicenter, non-inferiority PRISON IV trial was designed to evaluate the
safety, efficacy, and angiographic outcome of hybrid sirolimus-eluting
stents with bioresorbable polymers (Orsiro; Biotronik, Berlin, Germany)
compared with everolimus-eluting stents with durable polymers (Xience
Prime/Xpedition; Abbott Vascular, Santa Clara, CA, USA) in patients with
successfully recanalized TCOs. In total, 330 patients have been randomly
allocated to each treatment arm. Patients are eligible with estimated
duration of TCO >=4 weeks with evidence of ischemia in the supply area of
the TCO. The primary endpoint is in-segment late luminal loss at 9-month
follow-up angiography. Secondary angiographic endpoints include in-stent
late luminal loss, minimal luminal diameter, percentage of diameter
stenosis, in-stent and in-segment binary restenosis and reocclusions at
9-month follow-up. Additionally, optical coherence tomography is performed
in the first 60 randomized patients at 9 months to assess neointima
thickness, percentage of neointima coverage, and stent strut malapposition
and coverage. Personnel blinded to the allocated treatment will review all
angiographic and optical coherence assessments. Secondary clinical
endpoints include major adverse cardiac events, clinically driven target
vessel revascularization, target vessel failure and stent thrombosis to
5-year clinical follow-up. An independent clinical event committee blinded
to the allocated treatment will review all clinical events.Trial
registration: Clinical Trials.gov: NCT01516723. Patient recruitment
started in February 2012. 2012 Teeuwen et al.; licensee BioMed Central
Ltd.

<12>
Accession Number
2012685171
Authors
Qaseem A. Fihn S.D. Williams S. Dallas P. Owens D.K. Shekelle P.
Institution
(Qaseem) American College of Physicians, 190 N. Independence Mall West,
Philadelphia, PA 19106, United States
(Fihn) 1100 Olive Way, Seattle, WA 98101, United States
(Williams) 423 Guardian Drive, Philadelphia, PA 19104, United States
(Dallas) 1906 Bellview Avenue, Roanoke, VA 24014, United States
(Owens) 117 Encina Commons, Stanford, CA 94305, United States
(Shekelle) 11301 Wiltshire Boulevard, Los Angeles, CA 90073, United States
Title
Management of stable ischemic heart disease: Summary of a clinical
practice guideline from the American College of Physicians/American
College of Cardiology Foundation/ American Heart Association/American
Association for Thoracic Surgery/Preventive Cardiovascular Nurses
Association/Society of Thoracic Surgeons.
Source
Annals of Internal Medicine. 157 (10) (pp 735-743), 2012. Date of
Publication: 20 Nov 2012.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Description: The American College of Physicians (ACP) developed this
guideline with the American College of Cardiology Foundation (ACCF),
American Heart Association (AHA), American Association for Thoracic
Surgery, Preventive Cardiovascular Nurses Association, and Society of
Thoracic Surgeons to present the available evidence on the management of
stable known or suspected ischemic heart disease. Methods: Literature on
this topic published before November 2011 was identified by using MEDLINE,
Embase, Cochrane CENTRAL, PsychINFO, AMED, and SCOPUS. Searches were
limited to human studies published in English. This guideline grades the
evidence and recommendations according to a translation of the ACCF/AHA
grading system into ACP's clinical practice guidelines grading system.
Recommendations: The guideline includes 48 specific recommendations that
address the following issues: patient education, management of proven risk
factors (dyslipidemia, hypertension, diabetes, physical activity body
weight, and smoking), risk factor reduction strategies of unproven
benefit, medical therapy to prevent myocardial infarction and death and to
relieve symptoms, alternative therapy, revascularization to improve
survival and symptoms, and patient follow-up. 2012 American College of
Physicians.

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Accession Number
70977183
Authors
Verberne H.J. Verschure D.O. Veltman C.E. Manrique A. Somsen G. Koutelou
M. Katsikis A. Agostini D. Gerson M.C. Van Eck-Smit B.L.F. Scholte
A.J.H.A. Jacobson A.F.
Institution
(Verberne, Verschure, Van Eck-Smit) Academic Medical Center, Amsterdam,
Netherlands
(Veltman, Scholte) Leiden University Medical Center, Leiden, Netherlands
(Manrique) Service Commun Investigations chez l'Homme, GIP Cyceron, Caen,
France
(Somsen) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Koutelou, Katsikis) Onassis Cardiac Surgery Center, Athens, Greece
(Agostini) CHU Cote de Nacre, Caen, France
(Gerson) University of Cincinnati, College of Medicine, Cincinnati, OH,
United States
(Jacobson) GE Healthcare, Princeton, NJ, United States
Title
For what endpoint does myocardial 123I-MIBG scintigraphy have the greatest
prognostic value in patients with heart failure? Results of a pooled
individual patient data metaanalysis.
Source
European Journal of Nuclear Medicine and Molecular Imaging. Conference:
25th Annual Congress of the European Association of Nuclear Medicine, EANM
2012 Milan Italy. Conference Start: 20121027 Conference End: 20121031.
Conference Publication: (var.pagings). 39 (pp S192), 2012. Date of
Publication: October 2012.
Publisher
Springer Verlag
Abstract
Aim: Despite the numerous single studies demonstrating the prognostic
value of myocardial ¹²³I-metaiodobenzylguanidine (MIBG) in
heart failure (HF) patients, clinical use of this procedure remains
limited. The purpose of this study was to determine the most appropriate
prognostic endpoint for use of MIBG imaging based upon aggregate results
from multiple studies published in the past decade. Materials and Methods:
Published studies from Europe and the United States were identified for
which original individual patient data for heart/mediastinum ratio (H/M)
from late (3-5 hour) planar MIBG imaging were available. Data submitted by
the participating investigators were pooled and Cox proportional hazards
analyses were performed. Endpoints of all-cause mortality, cardiac
mortality, arrhythmic events, and heart transplantation were investigated
to determine which provided the strongest prognostic significance for the
MIBG imaging data. Results: Data from 6 studies with a total of 636 HF
patients were retrieved. The majority of patients was male (78%), had a
decreased left ventricular ejection fraction (LVEF) (31.1% +/- 12.5%) and
a mean late H/M of 1.67 +/- 0.47 (1st quintile <=1.32 2nd to 4th quintile
1.33-1.97, 5th quintile >=1.98). During follow-up (mean 42.1 +/- 26.5
months) there were 95 deaths, 79 cardiac deaths, 38 arrhythmic events, and
57 heart transplants. In univariate Cox analyses, late H/M was a
significant predictor of all event categories, but the highest chi-squares
and lowest hazard ratios (HR) were for allcause (chi²=17.68,
HR=0.37, 95%CI: 0.22-0.61) and cardiac mortality (chi²=14.57,
HR=0.37, 95%CI: 0.21-0.65). In multivariate analysis for the composite of
any event, H/M was a significant predictor (HR=0.53, 95%CI: 0.36-0.78),
with LVEF, gender, and NYHA class also included in the model. In similar
analyses for the individual event categories in subjects with reduced LVEF
(<50%, n=580), H/M was a significant predictor of all-cause (HR=0.49,
95%CI: 0.27-0.89) and cardiac mortality (HR=0.45, 95%CI: 0.23-0.87), with
LVEF, age, and HF aetiology also included in the model. The same 4
variables were significant in models using a dichotomous H/M split at 1.20
(1 SD below the mean) (patients with late H/M <1.2 having the highest
mortality (median survival 71 months)), with an H/M HR for cardiac death
and allcause mortality of 0.39 (95%CI: 0.22-0.71) and 0.49 (95%CI:
0.28-0.86) respectively. Conclusions: Late H/M is strongest as a
univariate predictor of all-cause and cardiac mortality in HF patients. In
multivariate analyses, MIBG imaging tends to be strongest as a predictor
of cardiac death.