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<1>
Accession Number
2013787547
Authors
Hess C.N. Schulte P.J. Newby L.K. Steg P.G. Dalby A.J. Schweiger M.J.
Lewis B.S. Armstrong P.W. Califf R.M. van de Werf F. Harrington R.A.
Institution
(Hess, Schulte, Newby, Califf) Duke University Medical Center, Durham, NC,
United States
(Steg) INSERM, Paris, France
(Dalby) Milpark Hospital, Johannesburg, South Africa
(Schweiger) Baystate Medical Center, Springfield, MA, United States
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Armstrong) University of Alberta, Edmonton, AB, Canada
(van de Werf) University of Leuven, Leuven, Belgium
(Harrington) Stanford University, Stanford, CA, United States
Title
Duration of eptifibatide infusion after percutaneous coronary intervention
and outcomes among high-risk patients with non-ST-segment elevation acute
coronary syndrome: Insights from EARLY ACS.
Source
European Heart Journal: Acute Cardiovascular Care. 2 (3) (pp 246-255),
2013. Date of Publication: 2013.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Background and Objectives: Eptifibatide is indicated during percutaneous
coronary intervention (PCI) with continuation for 18-24 hours post
procedure but is associated with bleeding. We examined the efficacy and
safety of shorter post-PCI eptifibatide infusions in high-risk
non-ST-segment elevation acute coronary syndrome (NSTE ACS) patients.
Methods: EARLY ACS patients treated with PCI and eptifibatide were grouped
by post-procedure infusion duration: <10, 10-13, 13-17, and 17-25 (per
protocol) hours. Adjusted estimated event rates for 96-hour
death/myocardial infarction (MI)/recurrent ischaemia requiring urgent
revascularization (RIUR), 30-day death/MI, post-PCI packed red blood cell
(PRBC) transfusion, and GUSTO (Global Utilization of Streptokinase and
Tissue Plasminogen Activator for Occluded Coronary Arteries)
moderate/severe bleeding were obtained using inverse-propensity weighting
to account for informative censoring of infusions. Results: Among 3271
eptifibatide-treated PCI patients, there were 66 96-hour death/MI/RIUR
events, 94 30-day death/MI events, 127 PRBC transfusions, and 115 GUSTO
moderate/severe bleeds. Compared with per protocol, patients receiving
post-PCI infusions <10 hours had similar adjusted estimated rates of
96-hour death/MI/RIUR (absolute difference 0.021 higher; 0.040 vs. 0.019,
95% CI -0.023 to 0.064; p=0.35) and 30-day death/MI (0.020 higher; 0.046
vs. 0.026, 95% CI -0.021 to 0.062; p=0.34). There were also no differences
in ischaemic outcomes between infusions of 10-17 hours and per-protocol
infusions. Adjusted estimated rates of PRBC transfusion were higher for
the <10-hour infusion group compared with per protocol (0.048 higher;
0.079 vs. 0.031, 95% CI 0.005 to 0.091, p=0.03) but were similar for other
groups. Adjusted GUSTO moderate/severe bleeding rates were similar to
per-protocol rates for all groups. Conclusions: In high-risk NSTE ACS
patients, post-PCI eptifibatide infusions <18 hours were not associated
with worse ischaemic outcomes. Shorter eptifibatide infusions in this
population may be feasible. The European Society of Cardiology 2013.

<2>
Accession Number
2013783447
Authors
Ju N.Y. Gao H. Huang W. Niu F.F. Lan W.X. Li F. Gao W.
Institution
(Ju, Gao, Huang, Niu, Lan, Li) Department of Intensive Care Medicine,
Third Affiliated Hospital, Harbin Medical University, Harbin, China
(Gao) Department of Anaesthesiology, Second Affiliated Hospital, Harbin
Medical University, Harbin, China
Title
Therapeutic effect of inhaled budesonide (Pulmicort Turbuhaler) on the
inflammatory response to one-lung ventilation.
Source
Anaesthesia. 69 (1) (pp 14-23), 2014. Date of Publication: January 2014.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
This prospective, double-blind trial was designed to evaluate the effect
of inhaled budesonide on lung function and the inflammatory response to
one-lung ventilation. One hundred patients scheduled for lobectomy were
allocated randomly to pre-operative nebulised budesonide or saline.
Bronchoalveolar lavage fluid samples were collected from either the
collapsed or the ventilated lung both before one-lung ventilation and 30
min after re-expansion of the lung. The concentrations of serum and
bronchoalveolar lavage fluid cytokines were determined. Budesonide
treatment, compared with saline, reduced both peak (mean (SD) 3.7 (0.4) vs
2.5 (0.2) kPa) and plateau (mean (SD) 3.1 (0.2) vs 2.2 (0.1) kPa,
respectively, p < 0.001 for both) ventilatory pressures. Thirty minutes
after re-expansion, lung compliance increased in the budesonide group
compared with saline (57.5 (4.1) vs 40.1 (3.5)
ml.cmH₂O^-1, respectively p < 0.001). Budesonide also
reduced the concentrations of tumour necrosis factor-alpha,
interleukin-1beta, interleukin-6 and interleukin-8 in bronchoalveolar
lavage fluid, but increased interleukin-10 30 min after re-expansion (p <
0.05 for all measures). Pre-operative nebulisation of budesonide may be
effective in improving ventilatory mechanics and reducing the inflammatory
response to one-lung ventilation during thoracic surgery. 2013 The
Association of Anaesthetists of Great Britain and Ireland.

<3>
Accession Number
2013793509
Authors
Kirtane A.J. Sandhu P. Mehran R. McEntegart M. Cristea E. Brener S.J. Xu
K. Fahy M. Genereux P. Wessler J.D. Stone G.W.
Institution
(Kirtane, Sandhu, Genereux, Wessler, Stone) Department of Medicine,
Columbia University Medical Center, New York, NY, United States
(Kirtane, Mehran, Brener, Xu, Fahy, Genereux, Stone) Cardiovascular
Research Foundation, New York, NY, United States
(Mehran) Department of Medicine, Icahn School of Medicine at Mount Sinai,
New York, NY, United States
(McEntegart) Department of Medicine, Golden Jubilee National Hospital,
Glasgow, United Kingdom
(Cristea) Department of Medicine, Yale University School of Medicine, New
Haven, CT, United States
(Brener) Department of Medicine, New York Methodist Hospital, Brooklyn,
NY, United States
Title
Association between intraprocedural thrombotic events and adverse outcomes
after primary percutaneous coronary intervention for st-segment elevation
myocardial infarction (a harmonizing outcomes with revascularization and
stents in acute myocardial infarction [HORIZONS-AMI] Substudy).
Source
American Journal of Cardiology. 113 (1) (pp 36-43), 2014. Date of
Publication: 01 Jan 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The present study sought to determine the extent to which adverse
angiographic events encountered during percutaneous coronary intervention
for ST-segment elevation myocardial infarction (STEMI) are associated with
adverse clinical outcomes. Patients with STEMI represent a cohort at
particularly high risk of intraprocedural thrombotic events (IPTEs). The
overall frequency and implications of IPTEs occurring in patients with
STEMI have not been systematically quantified in previous studies. A total
of 3,163 patients undergoing primary percutaneous coronary intervention
with stent implantation for STEMI in the Harmonizing Outcomes with
RevasculariZatiON and Stents in Acute Myocardial Infarction (HORIZONS-AMI)
trial underwent detailed frame-by-frame core laboratory angiographic
analysis to assess IPTEs. The clinical outcomes at 30 days were compared
between the patients with and without IPTEs. IPTEs, defined as the
development of new or increasing thrombus, abrupt vessel closure, no
reflow, slow reflow, and distal embolization at any point during the
procedure, occurred in 386 patients (12.2%). The independent predictors of
IPTE were thrombus at baseline, lesion length, and randomization to
bivalirudin; the patients with IPTEs were also more likely to receive
bailout glycoprotein IIb/IIIa inhibitors and unplanned thrombectomy.
Compared with patients without IPTEs, the patients with IPTEs had higher
30-day rates of composite major adverse cardiovascular events (death,
myocardial infarction, ischemic target vessel revascularization, and
stroke; 7.8% vs 4.2%, p = 0.002), major bleeding not related to coronary
artery bypass grafting (11.8% vs 6.5%, p <0.001), and all-cause death
(4.2% vs 1.8%, p = 0.002). On multivariate analysis, IPTEs were
independently associated with 30-day major adverse cardiovascular events,
major bleeding, and death. In conclusion, the development of IPTEs in
patients undergoing primary percutaneous coronary intervention for STEMI
was associated with subsequent adverse outcomes, including major adverse
cardiovascular events, major bleeding, and death. Additional studies of
strategies to decrease the occurrence of IPTEs are warranted. 2014
Elsevier Inc. All rights reserved.

<4>
Accession Number
2013788373
Authors
Kohira S. Oka N. Inoue N. Itatani K. Hanayama N. Kitamura T. Fujii M.
Takeda A. Oshima H. Tojo K. Yoshitake S. Miyaji K.
Institution
(Kohira, Fujii, Takeda, Oshima, Tojo) Medical Engineer Center, Kitasato
University School of Medicine, Sagamihara, Japan
(Oka, Inoue, Itatani, Hanayama, Kitamura, Miyaji) Department of
Cardiovascular Surgery, Kitasato University School of Medicine,
Sagamihara, Japan
(Yoshitake) Department of Clinical Engineer, Kyushu University of Health
and Welfare, Miyazaki, Japan
Title
Effect of the Neutrophil Elastase Inhibitor Sivelestat on Perioperative
Inflammatory Response After Pediatric Heart Surgery With Cardiopulmonary
Bypass: A Prospective Randomized Study.
Source
Artificial Organs. 37 (12) (pp 1027-1033), 2013. Date of Publication:
December 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response. The
neutrophil elastase inhibitor sivelestat is known to suppress this
systemic inflammatory response, which can eventually result in acute organ
failure. The prophylactic effect of sivelestat on acute lung injury,
especially in pediatric cardiac surgery, remains unclear. This prospective
double-blind, randomized study evaluated the perioperative prophylactic
effect of sivelestat in patients undergoing elective pediatric open heart
surgery with CPB. Thirty consecutive patients, weighing 5-10kg and
undergoing open heart surgery with CPB, were assigned to sivelestat (n=15)
or control (n=15) groups. From CPB initiation to 24h after surgery,
patients in the sivelestat group received a continuous intravenous
infusion of 0.2mg/kg/h sivelestat, whereas patients in the control group
received the same volume of 0.9% saline. Blood samples were collected, and
levels of interleukin (IL)-6, IL-8, tumor necrosis factor alpha,
polymorphonuclear elastase (PMN-E), C-reactive protein (CRP), as well as
the white blood cell (WBC) count, platelet count, and neutrophil count
(NC) were measured. PMN-E levels, IL-8 levels, WBC count, NC, and CRP
levels were significantly lower, and platelet count was significantly
higher in the sivelestat group, according to repeated two-way analysis of
variance. The activated coagulation time was significantly shorter in the
sivelestat group, similarly, blood loss was significantly less in the
sivelestat group. In conclusion, Sivelestat attenuates perioperative
inflammatory response and clinical outcomes in patients undergoing
pediatric heart surgery with CPB. 2013 Wiley Periodicals, Inc. and
International Center for Artificial Organs and Transplantation.

<5>
Accession Number
2013781673
Authors
Rabkin S.W.
Institution
(Rabkin) Division of Cardiology, Department of Medicine, University of
British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
Title
Differences in coronary blood flow in aortic regurgitation and systemic
arterial hypertension have implications for diastolic blood pressure
targets: A systematic review and meta-analysis.
Source
Clinical Cardiology. 36 (12) (pp 728-736), 2013. Date of Publication:
December 2013.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
The objective was to evaluate coronary blood flow (CBF) in patients with
systemic arterial hypertension (HTN) and to compare it with CBF in
patients with aortic regurgitation (AR). A systematic literature search
was conducted using the reference terms "coronary blood flow" and either
"aortic regurgitation" or "hypertension." The selection criteria included
CBF measurement in a concomitant control group, except studies evaluating
CBF with aortic-valve replacement surgery. Twenty-two studies met the
inclusion criteria. There were 318 persons with HTN, with 185 controls;
and 102 persons with AR, with 144 controls. Despite an overall increase in
CBF in HTN, CBF per gram of left ventricular mass was significantly (P <
0.0001) reduced. In contrast, CBF per gram of left ventricular mass was
significantly (P = 0.004) increased in AR. Aortic regurgitation was
associated with a significant (P < 0.0001) increase in CBF during systole
and away from diastole, in contrast to persons with HTN. Aortic-valve
replacement reversed the increase in systolic CBF. These data suggest that
patients with HTN are more vulnerable than patients with AR to lower
diastolic blood pressure (DBP), because resting CBF is compromised in HTN.
Furthermore, patients with HTN may not compensate for DBP reductions by
shifting CBF to systole, such as can occur with the low DBP in AR. Lower
DBP in patients with AR cannot be used to justify treating patients with
HTN to similar DBP because of the dramatic differences in CBF between the
2 conditions. 2013 Wiley Periodicals, Inc.

<6>
Accession Number
2013790832
Authors
Hardikar A.A. Marwick T.H.
Institution
(Hardikar, Marwick) Menzies Research Institute Tasmania, University of
Tasmania, Private Bag 23, Hobart, 7000, Australia
Title
Surgical thresholds for bicuspid aortic valve associated aortopathy.
Source
JACC: Cardiovascular Imaging. 6 (12) (pp 1311-1320), 2013. Date of
Publication: December 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives This systematic review seeks to present the outcomes of the
natural history of aortopathy associated with bicuspid aortic valve (ABAV)
and after interventions. Background Aortopathy is common in patients with
ABAV, and early intervention has been proposed to reduce the risk of
dissection. In asymptomatic patients, the timing of surgical management is
based upon imaging of aortic size, but the actual threshold is based upon
observational data and expert opinion. As evidence of high risk would
justify early intervention, we sought to define the natural history of
this condition and after interventions. Methods We undertook a systemic
review of the evidence from observational studies of ABAV published up to
June 2013. The primary outcome was annualized all-cause mortality.
Secondary outcomes included acute aortic events, rates of aneurysm
enlargement, and peri-operative complications. A random-effects model was
used to combine outcomes. A meta-regression was undertaken to assess the
impact of potential covariates. Results The 32 eligible papers involved
11,045 patients (9,441 BAV and 1,604 control subjects, age 46 +/- 14
years). There were 3 major groups, nonoperated bicuspid aortic valve (BAV)
patients (ages from 30 to 40 years), patients after aortic surgery
(generally 40 to 60 years of age) and after isolated valve replacement
(>60 years of age). The respective annualized mortality of nonoperated BAV
patients was 0.56% (95% confidence interval [CI]: 0.13 to 0.99), compared
with 0.78% (95% CI: 0.20 to 1.36) in patients after aortic surgery and
2.39% (95% CI: 1.61 to 3.16) after isolated valve replacement. The
annualized acute event rate in nonoperated BAV patients was 0.29% (95% CI:
0.23 to 0.35), this risk being no different from that of a tricuspid
aortic valve (risk ratio: 0.68, 95% CI: 0.34 to 1.36). In the
post-surgical series, 30-day mortality varied from 0% to 2.5%, and the
risk of acute events was 0.16% (95% CI: 0.0 to 0.32) in patients after
aortic surgery and 0.68% (95% CI: 0.42 to 0.94) after isolated valve
replacement. Aortic dilation was at a rate of 0.16 mm/year over 6 decades
in healthy BAV subjects and 1.1 +/- 0.15 mm/year in older aortic valve
replacement patients. Conclusions The risk associated with ABAV varies
according to age and clinical setting. Nonetheless, despite aortic
dilatation, the acute aortic event risk of ABAV appears low in current
practice. Decision-making regarding the timing of intervention needs to be
made on the basis of the balance between this low risk and both the
morbidity and mortality of surgery. 2013 by the American College of
Cardiology Foundation Published by Elsevierinc .

<7>
Accession Number
2013738573
Authors
Ramamurthy G. Trejo E. Faraone S.V.
Institution
(Ramamurthy, Faraone) Department of Psychiatry, SUNY Upstate Medical
University, Syracuse, NY, United States
(Trejo) Department of Psychiatry, Harvard Medical School, Boston, MA,
United States
Title
Depression treatment in patients with coronary artery disease: A
systematic review.
Source
Primary Care Companion to the Journal of Clinical Psychiatry. 15 (5) ,
2013. Date of Publication: 2013.
Publisher
Physicians Postgraduate Press Inc. (P.O. Box 752870, Memphis TN
38119-2870, United States)
Abstract
Objective: Depression has been linked to adverse coronary artery disease
outcomes. Whether depression treatment improves or worsens coronary artery
disease prognosis is unclear. This 25-year systematic review examines
medical outcomes, and, secondarily, mood outcomes of depression treatment
among patients with coronary artery disease. Data Sources: We
systematically reviewed the past 25 years (January 1, 1986-December 31,
2011) of prospective trials reporting on the medical outcomes of
depression treatment among patients with established coronary artery
disease using keywords and MESH terms from OVID MEDLINE. Search 1 combined
depression AND coronary artery disease AND antidepressants. Search 2
combined depression AND coronary artery disease AND psychotherapy. Search
3 combined depression AND revascularization AND antidepressants OR
psychotherapy. Study Selection: English-language longitudinal randomized
controlled trials, with at least 50 depressed coronary artery disease
patients, reporting the impact of psychotherapy and/or antidepressants on
cardiac and mood outcomes were included. Data Extraction: Data extracted
included author name, year published, number of participants, enrollment
criteria, depression definition/measures (standardized interviews, rating
scales), power analyses, description of control arms and interventions
(psychotherapy and/or medications), randomization, blinding, follow-up
duration, follow-up loss, depression scores, and medical outcomes Results:
The review yielded 10 trials. Antidepressant and/or psychotherapy did not
significantly influence coronary artery disease outcomes in the overall
population, but most studies were underpowered. There was a trend toward
worse coronary artery disease outcomes after treatment with bupropion.
Conclusions: After an acute coronary syndrome, depression often
spontaneously remitted without treatment. Post-acute coronary syndrome
persistence of depression predicted adverse coronary artery disease
outcomes. Antidepressant and/or psychotherapy, particularly as part of the
Coronary Psychosocial Evaluation Studies intervention, may improve
prognosis in persistent depression among post-acute coronary syndrome
patients. Noradrenergic antidepressants should be prescribed cautiously in
patients with coronary artery disease. 2013 Physicians Postgraduate
Press, Inc.

<8>
Accession Number
2013738284
Authors
Andrews J. Sathe N.A. Krishnaswami S. Melissa L.
Institution
(Andrews, Sathe, Krishnaswami, Melissa) Vanderbilt Evidence-Based Practice
Center, Institute for Medicine and Public Health, Vanderbilt University
Medical Center, Nashville, TN, United States
(Andrews) Department of Obstetrics and Gynecology, Vanderbilt University
Medical Center, Nashville, TN, United States
Title
Nonpharmacologic airway clearance techniques in hospitalized patients: A
systematic review.
Source
Respiratory Care. 58 (12) (pp 2160-2186), 2013. Date of Publication: 01
Dec 2013.
Publisher
American Association for Respiratory Care (9425 N. MacArthur Blvd. Suite
100, Irving TX 75063, United States)
Abstract
Nonpharmacologic airway clearance techniques are used to reduce the
sequelae of obstructive secretions. We systematically reviewed comparative
studies of nonpharmacologic interventions that health professionals can
employ to achieve mucus clearance in hospitalized or postoperative
patients without cystic fibrosis, over the age of 12 months. We searched
MEDLINE and other databases from 1990 to 2012 to identify relevant
literature. Two reviewers independently assessed each study against
predetermined inclusion/exclusion criteria. Two reviewers also
independently extracted data regarding subject and intervention
characteristics and outcomes, and assigned overall quality ratings. The 32
studies meeting the review criteria included 24 randomized controlled
trials, 7 crossover randomized controlled trials, and one prospective
cohort study. Studies were typically small and together included a total
of 2,453 subjects (mean 76/study). Studies generally examined chest
physical therapy/physiotherapy modalities in postoperative or critically
ill subjects or those with COPD. Interventions, comparators, and
populations varied considerably across studies, hampering our ability to
draw firm conclusions. Interventions, including conventional chest
physical therapy/physiotherapy, intrapulmonary percussive ventilation, and
positive expiratory pressure, typically provided small benefits in
pulmonary function, gas exchange, oxygenation, and need for/duration of
ventilation, among other outcomes, but differences between groups were
generally small and not significant. Harms of the techniques were not
consistently reported, though airway clearance techniques were generally
considered safe in studies that did comment on adverse effects. Further
research with clearly characterized populations and interventions is
needed to understand the potential benefits and harms of these techniques.
2013 Daedalus Enterprises.

<9>
Accession Number
2013759020
Authors
Sutcliffe P. Connock M. Pulikottil-Jacob R. Kandala N.-B. Suri G. Gurung
T. Grove A. Shyangdan D. Briscoe S. Maheswaran H. Clarke A.
Institution
(Sutcliffe, Connock, Pulikottil-Jacob, Kandala, Suri, Gurung, Grove,
Shyangdan, Briscoe, Maheswaran, Clarke) Warwick Evidence, Warwick Medical
School, University of Warwick, Coventry, United Kingdom
Title
Clinical effectiveness and cost-effectiveness of second- and
third-generation left ventricular assist devices as either bridge to
transplant or alternative to transplant for adults eligible for heart
transplantation: Systematic review and cost-effectiveness model.
Source
Health Technology Assessment. 17 (53) (pp a-500), 2013. Date of
Publication: 2013.
Publisher
NIHR Journals Library (Alpha House, Enterprise Road, Southampto SO16 7NS,
United Kingdom)
Abstract
Background: Advanced heart failure (HF) is a debilitating condition for
which heart transplant (HT) offers the best treatment option. However, the
supply of donor hearts is diminishing and demand greatly exceeds supply.
Ventricular assist devices (VADs) are surgically implanted pumps used as
an alternative to transplant (ATT) or as a bridge to transplant (BTT)
while a patient awaits a donor heart. Surgery and VADs are costly. For the
NHS to allocate and deliver such services in a cost-effective way the
relative costs and benefits of these alternative treatments need to be
estimated. Objectives: To investigate for patients aged >= 16 years with
advanced HF eligible for HT: (1) the clinical effectiveness and
cost-effectiveness of second- and third-generation VADs used as BTT
compared with medical management (MM); and (2) the clinical effectiveness
and cost-effectiveness of second- and third-generation VADs used as an ATT
in comparison with their use as BTT therapy. Data sources: Searches for
clinical effectiveness studies covered years from 2003 to March 2012 and
included the following data bases: MEDLINE, MEDLINE In-Process & Other
Non-Indexed Citations, EMBASE, Cochrane Database of Systematic Reviews
(CDSR), Database of Abstracts of Reviews of Effects (DARE), NHS Economic
Evaluation Database (NHS EED), HTA databases [NHS Centre for Reviews and
Dissemination (CRD)], Science Citation Index and Conference Proceedings
(Web of Science), UK Clinical Research Network (UKCRN) Portfolio Database,
Cumulative Index to Nursing and Allied Health Literature (CINAHL),
PsycINFO and National Library of Medicine (NLM) Gateway, Cochrane Central
Register of Controlled Trials (CENTRAL), Current Controlled Trials and
ClinicalTrials.gov. Reference lists of relevant articles were checked, and
VAD manufacturers' websites interrogated. For economic analyses we made
use of individual patient data (IPD) held in the UK Blood and Transplant
Database (BTDB). Review methods: Systematic reviews of evidence on
clinical effectiveness and cost-effectiveness of second- and
third-generation US Food and Drug Administration (FDA) and/or Conformite
Europeenne (CE) approved VADs. Publications from the last 5 years with
control groups, or case series with 50 or more patients were included.
Outcomes included survival, functional capacity (e.g. change in New York
Heart Association functional classification), quality of life (QoL) and
adverse events. Data from the BTDB were obtained. A discrete-time,
semi-Markov, multistate model was built. Deterministic and probabilistic
methods with multiple sensitivity analyses varying survival, utilities and
cost inputs to the model were used. Model outputs were incremental
cost-effectiveness ratios (ICERs), cost/quality-adjusted life-years
(QALYs) gained and cost/life-year gained (LYG). The discount rate was 3.5%
and the time horizon varied over 3 years, 10 years and lifetime. Results:
Forty publications reported clinical effectiveness of VADs and one study
reported costeffectiveness. We found no high-quality comparative empirical
studies of VADs as BTT compared with MM or as ATT compared with BTT.
Approximately 15-25% of the patients receiving a device had died by 12
months. Studies reported the following wide ranges for adverse events:
4-27% bleeding requiring transfusion; 1.5-40% stroke; 3.3-48% infection;
1-14% device failure; 3-30% HF; 11-32% reoperation; and 3-53% renal
failure. QoL and functional status were reported as improved in studies of
two devices [HeartMate II (HMII; Thoratec Inc., Pleasanton, CA, USA) and
HeartWare (HW; HeartWare Inc., Framingham, MA, USA)]. At 3 years, 10 years
and lifetime, the ICERs for VADs as BTT compared with MM were 122,730,
68,088 and 55,173 respectively. These values were stable to changes in
survival of the MM group. Both QoL and costs were reduced by VADs as ATT
compared with VADs as BTT giving ICERs in south-west quadrant of the cost
effectiveness plain (cost saving/QALY sacrificed) of 353,467, 31,685 and
20,637 over the 3 years, 10 years and lifetime horizons respectively.
Probabilistic analyses yielded similar results for both research
questions. Limitations: Conclusions about the clinical effectiveness were
limited by the lack of randomised controlled trials (RCTs) comparing the
effectiveness of different VADs for BTT or comparing BTT with any
alternative treatment and by the overlapping populations in published
studies. Although IPD from the BTDB was used to estimate the
cost-effectiveness of VADs compared with MM for BTT, the lack of
randomisation of populations limited the interpretation of this analysis.
Conclusions: At 3 years, 10 years and lifetime the ICERs for VADs as BTT
compared with MM are higher than generally applied willingness-to-pay
thresholds in the UK, but at a lifetime time horizon they approximate
threshold values used in end of life assessments. VADs as ATT have a
reduced cost but cause reduced QALYs relative to BTT. Future research
should direct attention towards two areas. First, how any future
evaluations of second- or third-generation VADs might be conducted. For
ethical reasons a RCT offering equal probability of HT for each group
would not be feasible; future studies should fully assess costs, long-term
patient survival, QoL, functional ability and adverse events, so that
these may be incorporated into economic evaluation agreement on outcomes
measures across future studies. Second, continuation of accurate data
collection in the UK database to encompass QoL data and comparative
assessment of performance with other international centres. Funding: The
National Institute for Health Research Health Technology Assessment
programme. Queen's Printer and Controller of HMSO 2013.

<10>
Accession Number
2013782076
Authors
Piche M.-E. Martin J. Cianflone K. Bastien M. Marceau S. Biron S. Hould
F.-S. Poirier P.
Institution
(Piche, Martin, Cianflone, Bastien, Marceau, Biron, Hould, Poirier)
Faculty of Pharmacy, Laval University, Quebec Heart and Lung Institute,
2725 Chemin Sainte-Foy, Quebec, QC G1V 4G5, Canada
Title
Changes in predicted cardiovascular disease risk after biliopancreatic
diversion surgery in severely obese patients.
Source
Metabolism: Clinical and Experimental. 63 (1) (pp 79-86), 2014. Date of
Publication: January 2014.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective To determine the impact of biliopancreatic diversion with
duodenal switch (BPD-DS) surgery on cardiovascular risk profile and
predicted cardiovascular risk in severely obese patients.
Materials/Methods We compared 1-year follow-up anthropometric and
metabolic profiles in severely obese who underwent BPD-DS (n = 73) with
controls (severely obese without surgery) (n = 33). The 10-year predicted
risk for coronary heart disease (CHD) was estimated using the Framingham
risk-tool. We assigned 10-year and lifetime predicted risks to stratify
subjects into 3 groups: 1) high short-term predicted risk (>= 10% 10-year
risk or diagnosed diabetes), 2) low short-term (< 10% 10-year risk)/low
lifetime predicted risk or 3) low short-term/high lifetime predicted risk.
Results During the follow-up period, body weight and body mass index
decreased markedly in the surgical group (- 52.1 +/- 1.9 kg and - 19.0 +/-
0.6 kg/m² respectively, p < 0.001) vs. (- 0.7 +/- 1.0 kg and -
0.3 +/- 0.4 kg/m², p = 0.51). Weight loss in the surgical group
was associated with a reduction in HbA_1C (6.2% vs. 5.1%),
HOMA-IR (61.5 vs. 9.3), all lipoprotein levels, as well as blood pressure
(p < 0.001). The 10-year CHD predicted risk decreased by 43% in women and
33% in men, whereas the estimated CHD risk in the non surgical group did
not change. Before surgery, none of the women and only 18% of men showed
low short-term/low lifetime predicted risk, whereas a significant
proportion of subjects had high short-term predicted risk (36% in women
and 12% in men). Following surgery, 52% of women and 55% of men have a low
short-term/low lifetime predicted risk. Conclusions These results
highlight the cardiovascular benefits of BPD-DS and suggest a positive
impact on predicted CHD risk in severely obese patients. Long-term studies
are needed to confirm our results and to ascertain the effects on CHD risk
estimates after BPD-DS surgery. 2014 Elsevier Inc.

<11>
Accession Number
2013793493
Authors
Marek J.J. Saba S. Onishi T. Ryo K. Schwartzman D. Adelstein E.C. Gorcsan
III J.
Institution
(Marek, Saba, Onishi, Ryo, Schwartzman, Adelstein, Gorcsan III) Heart and
Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh,
PA, United States
Title
Usefulness of echocardiographically guided left ventricular lead placement
for cardiac resynchronization therapy in patients with intermediate QRS
width and non-left bundle branch block morphology.
Source
American Journal of Cardiology. 113 (1) (pp 107-116), 2014. Date of
Publication: 01 Jan 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The current guidelines most strongly support cardiac resynchronization
therapy (CRT) for patients with heart failure with a QRS width of >=150 ms
and left bundle branch block (LBBB). Our objective was to assess the
potential benefit of echocardiographically guided left ventricular (LV)
lead positioning for patients with a QRS width <150 ms or non-LBBB as a
substudy of the Speckle Tracking Assisted Resynchronization Therapy for
Electrode Region (STARTER) prospective, randomized controlled trial. The
STARTER trial randomized 187 patients with heart failure, a QRS of >=120
ms, and ejection fraction of <=35% to LV lead guided to the site of latest
mechanical activation by speckle tracking radial strain versus routine
implantation. The predefined primary end point was heart failure
hospitalization or death within 2 years. This substudy included 151 CRT
patients with matching echocardiographic and LV lead position data and
complete follow-up data. Patients with a QRS width of 120 to 149 ms or
non-LBBB and LV lead concordant or adjacent to the site of latest
mechanical activation had favorable outcomes after CRT similar to those
with LBBB or a QRS width of >=150 ms. In contrast, patients with a QRS of
120 to 149 ms or non-LBBB and remote LV leads had unfavorable outcomes
(hazard ratio 5.45, 95% confidence interval 2.36 to 12.6, p <0.001, and
hazard ratio 4.92, 95% confidence interval 2.12 to 11.39, p <0.001,
respectively, with significant interaction after adjusting for baseline
variables, p = 0.038 and p = 0.008). In conclusion, LV lead positioning
with respect to the echocardiographic site of latest activation was
significantly associated with more favorable clinical outcomes in patients
with a QRS duration <150 ms and/or non-LBBB. Additional prospective study
is warranted. 2014 Elsevier Inc. All rights reserved.

<12>
Accession Number
2013782559
Authors
Gursu O. Isbir S. Ak K. Gerin F. Arsan S.
Institution
(Gursu, Isbir, Ak, Arsan) Department of Cardiovascular Surgery, Marmara
University Medical Faculty, 34668 Istanbul, Turkey
(Gerin) Department of Medical Biochemistry, Marmara University Medical
Faculty, 34668 Istanbul, Turkey
Title
Comparison of new technology integrated and nonintegrated arterial filters
used in cardiopulmonary bypass surgery: A randomized, prospective, and
single blind study.
Source
BioMed Research International. 2013 , 2013. Article Number: 529087. Date
of Publication: 2013.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. Innovative cardiopulmonary bypass (CPB) settings have been
developed in order to integrate the concepts of "surface-coating,"
"blood-filtration," and "miniaturization." Objectives. To compare
integrated and nonintegrated arterial line filters in terms of peri- and
postoperative clinical variables, inflammatory response, and transfusion
needs. Material and Methods. Thirty-six patients who underwent coronary
bypass surgery were randomized into integrated (Group In) and
nonintegrated arterial line filter (Group NIn) groups. Arterial blood
samples for the assessments of complete hemogram, biochemical screening,
interleukin-6, interleukin-2R, and C-reactive protein were analyzed before
and after surgery. Need for postoperative dialysis, inotropic therapy and
transfusion, in addition to extubation time, total amount of drainage
(mL), length of intensive care unit, and hospital stay, and mortality
rates was also recorded for each patient. Results. Prime volume was
significantly higher and mean intraoperative hematocrit value was lower in
Group NIn, but need for erythrocyte transfusion was significantly higher
in Group NIn. C-reactive protein values did not differ significantly
except for postoperative second day's results, which were found
significantly lower in Group In than in Group NIn. Conclusion.
Intraoperative hematocrit levels were higher and need for postoperative
erythrocyte transfusion was decreased in Group In. 2013 Ozgur Gursu et
al.

<13>
Accession Number
2013787370
Authors
Al-Lawati A.A.M. Muthuswamy V.
Institution
(Al-Lawati, Muthuswamy) Department of Cardiothoracic Surgery, Royal
Hospital, P.O. Box 111, 1331 Seeb, Muscat, Oman
Title
Continuing aspirin causes higher drainage even under full protection with
antifibrinolytics.
Source
Thoracic and Cardiovascular Surgeon. 61 (8) (pp 726-730), 2013. Date of
Publication: 12/2013.
Publisher
Georg Thieme Verlag (Rudigerstrasse 14, Stuttgart D-70469, Germany)
Abstract
Background The purpose of this study was to assess the impact of
continuation of aspirin on bleeding complications following coronary
artery bypass grafting (CABG) surgery operated by a single surgeon.
Methods A total of 109 patients underwent isolated, primary, on-pump
surgery performed over a 17-month period. These patients were divided into
two groups: group 1 (n = 51) received aspirin (81 mg daily) to within 7
days of surgery and group 2 (n = 58) in which aspirin was discontinued > 7
days before surgery. All patients received antifibrinolytic agents. Both
groups had identical preoperative characteristics. Results The aspirin
group had significant more drainage and consumed more blood products than
the nonaspirin group during the first 12 postoperative hours. However,
both groups were similar in terms of: (1) re-exploration rate, (2)
requirements for blood transfusion, (3) drop in hemoglobin levels and
platelet counts, and (4) length of intensive care unit and hospital stay.
Conclusion Continuing aspirin before CABG is associated with increased
blood loss even when used in small doses and under full cover of
antifibrinolytic agents. However, this blood loss is not harmful and does
not negatively affect the patient's clinical progress. 2013 Georg Thieme
Verlag KG Stuttgart, New York.

<14>
Accession Number
2013782001
Authors
Haji Mohd Yasin N.A.B. Herbison P. Saxena P. Praporski S. Konstantinov
I.E.
Institution
(Haji Mohd Yasin, Saxena) College of Medicine and Veterinary Medicine,
University of Edinburgh, Edinburgh, United Kingdom
(Herbison) Department of Preventive and Social Medicine, University of
Otago, Dunedin, New Zealand
(Saxena) School of Surgery, University of Western Australia, Perth,
Australia
(Saxena) Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
United States
(Praporski, Konstantinov) Royal Children's Hospital, Murdoch Children's
Research Institute, University of Melbourne, Melbourne, Australia
Title
The role of remote ischemic preconditioning in organ protection after
cardiac surgery: A meta-analysis.
Source
Journal of Surgical Research. 186 (1) (pp 207-216), 2014. Date of
Publication: January 2014.
Publisher
Academic Press Inc. (1250 Sixth Avenue, San Diego, California CA 92101,
United States)
Abstract
Background Remote ischemic preconditioning (RIPC) appears to protect
distant organs from ischemia-reperfusion injury. We undertook
meta-analysis of clinical studies to evaluate the effects of RIPC on organ
protection and clinical outcomes in patients undergoing cardiac surgery.
Methods A review of evidence for cardiac, renal, and pulmonary protection
after RIPC was performed. We also did meta-regressions on RIPC variables,
such as duration of ischemia, cuff pressure, and timing of application of
preconditioning. Secondary outcomes included length of hospital and
intensive care unit stay, duration of mechanical ventilation, and
mortality at 30 days. Results Randomized control trials (n = 25) were
included in the study for quantitative analysis of cardiac (n = 16), renal
(n = 6), and pulmonary (n = 3) protection. RIPC provided statistically
significant cardiac protection (standardized mean difference [SMD], -0.77;
95% confidence interval [CI], -1.15, -0.39; Z = 3.98; P < 0.0001) and on
subgroup analysis, the protective effect remained consistent for all types
of cardiac surgical procedures. However, there was no evidence of renal
protection (SMD, 0.74; 95% CI, 0.53, 1.02; Z = 1.81; P = 0.07) or
pulmonary protection (SMD, -0.03; 95% CI, -0.56, 0.50; Z = 0.12; P =
0.91). There was no statistical difference in the short-term clinical
outcomes between the RIPC and control groups. Conclusions RIPC provides
cardiac protection, but there is no evidence of renal or pulmonary
protection in patients undergoing cardiac surgery using cardiopulmonary
bypass. Larger multicenter trials are required to define the role of RIPC
in surgical practice. 2014 Elsevier Inc. All rights reserved.

<15>
Accession Number
2013781360
Authors
Puri R. Nissen S.E. Shao M. Ballantyne C.M. Barter P.J. Chapman M.J. Erbel
R. Libby P. Raichlen J.S. Uno K. Kataoka Y. Nicholls S.J.
Institution
(Puri, Nissen, Uno, Kataoka, Nicholls) Department of Cardiovascular
Medicine, Cleveland Clinic, Cleveland, OH, United States
(Puri, Shao) C5Research, Cleveland Clinic, Cleveland, OH, United States
(Ballantyne) Section of Cardiovascular Research, Baylor College of
Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX, United
States
(Barter) Centre for Vascular Research, University of New SouthWales,
Sydney, Australia
(Chapman) INSERM Dyslipidaemia and Atherosclerosis Research Unit, Hopital
de la Pitie, Paris, France
(Erbel) West German Heart Center, Essen, Germany
(Libby) Cardiovascular Division, Brigham and Women's Hospital, Boston, MA,
United States
(Raichlen) Astra Zeneca, Wilmington, Delaware, United States
(Nicholls) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide SA5001, Australia
Title
Coronary atheroma volume and cardiovascular events during maximally
intensive statin therapy.
Source
European Heart Journal. 34 (41) (pp 3182-3190), 2013. Date of Publication:
01 Nov 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims The impact of baseline coronary plaque burden on the clinical outcome
in patients receiving aggressive low-density lipoprotein cholesterol
(LDL-C) lowering therapy to levels,70 mg/dL is unknown.We assessed the
prognostic significance of baseline coronary plaque burden following
high-intensity statin therapy. Methods and results SATURNused serial
intravascular ultrasound (IVUS) to measure coronary atheroma volume in
1039 patients before and after 24 months of treatment with rosuvastatin 40
mg or atorvastatin 80 mg. This post hoc analysis compared the relationship
between baseline percent atheroma volume (PAV) and major adverse
cardiovascular events(MACE: Death, myocardial infarction, stroke, coronary
revascularization, hospitalization for unstable angina) in patients with
baseline PAV less than (n = 519) or greater than (n = 520) the median.
Patients with a higher baseline PAV had a similar LDL-C compared with
those with a lower baseline PAV at baseline (119.0+/-29 vs. 121.0+/-27
mg/dL, P = 0.09) and at follow-up (65.3+/-23 vs. 65.8+/-22 mg/dL, P =
0.47). In multivariable analysis, each standard deviation increase in
baseline PAV was associated with a 28% increase in MACE [HR 1.28 (1.05,
1.57), P = 0.01]. Those with the highest quartile of baseline PAV(>41.8%)
had a 2-year cumulativeMACErate of 12%, whichwas significantly higher
(log-rank P = 0.001) thanMACE rates of all lower PAV quartiles (MACE:
Quartile 3, 2, and 1were 5.7, 7.9, and 5.1%, respectively). LDL-C levels
at baseline [HR 0.96 (0.79, 1.18), P = 0.73] and on-treatment [HR 1.19
(0.83, 1.73), P = 0.35] were not associated with MACE. Conclusion
Following 2 years of high-intensity statin therapy, a baseline coronary
atheroma volume predicted MACE, despite the achievement of very low
on-treatment LDL-C levels. The Author 2013.

<16>
Accession Number
2013790569
Authors
Kansagara D. Dyer E. Englander H. Fu R. Freeman M. Kagen D.
Institution
(Kansagara, Dyer, Englander, Fu, Freeman, Kagen) Portland Veterans Affairs
Medical Center, Oregon Health and Science University, Portland, OR, United
States
(Kansagara, Freeman) Portland Veterans Affairs Medical Center, Mailcode
RD71, 3710 Southwest U.S. Veterans Hospital Road, Portland, OR 97239,
United States
(Dyer, Kagen) Portland Veterans Affairs Medical Center, Mailcode P3-MED,
3710 Southwest U.S. Veterans Hospital Road, Portland, OR 97239, United
States
(Englander) Oregon Health and Science University, BTE 119, 3181 Southwest
Sam Jackson Park Road, Portland, OR 97239, United States
(Fu) Department of Public Health and Preventive Medicine, Oregon Health
and Science University, Mailcode CB669, 3181 Southwest Sam Jackson Park
Road, Portland, OR 97239, United States
Title
Treatment of anemia in patients with heart disease: A systematic review.
Source
Annals of Internal Medicine. 159 (11) (pp 746-757), 2013. Date of
Publication: 03 Dec 2013.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: The benefits of anemia treatment in patients with heart
disease are uncertain. Purpose: To evaluate the benefits and harms of
treatments for anemia in adults with heart disease. Data Sources: MEDLINE,
EMBASE, and Cochrane databases; clinical trial registries; reference
lists; and technical advisors. Study Selection: English-language trials of
blood transfusions, iron, or erythropoiesis-stimulating agents in adults
with anemia and congestive heart failure or coronary heart disease and
observational studies of transfusion. Data Extraction: Data on study
design, population characteristics, hemoglobin levels, and health outcomes
were extracted. Trials were assessed for quality. Data Synthesis:
Low-strength evidence from 6 trials and 26 observational studies suggests
that liberal transfusion protocols do not improve short-term mortality
rates compared with less aggressive protocols (combined relative risk
among trials, 0.94 [95% CI, 0.61 to 1.42]; I² = 16.8%),
although decreased mortality rates occurred in a small trial of patients
with the acute coronary syndrome (1.8% vs. 13.0%; P = 0.032).
Moderate-strength evidence from 3 trials of intravenous iron found
improved short-term exercise tolerance and quality of life in patients
with heart failure. Moderate- to highstrength evidence from 17 trials of
erythropoiesis-stimulating agent therapy found they offered no consistent
benefits, but their use may be associated with harms, such as venous
thromboembolism. Limitations: Few trials have examined transfusions in
patients with heart disease, and observational studies are potentially
confounded by indication. Data supporting iron use come mainly from 1
large trial, and long-term effects are unknown. Conclusion: Higher
transfusion thresholds do not consistently improve mortality rates, but
large trials are needed. Intravenous iron may help to alleviate symptoms
in patients with heart failure and iron deficiency and also warrants
further study. Erythropoiesis-stimulating agents do not seem to benefit
patients with mild to moderate anemia and heart disease and may be
associated with serious harms. Primary Funding Source: U.S. Department of
Veterans Affairs.

<17>
Accession Number
2013782291
Authors
Friedberg M.K. Cho M.-Y. Li J. Assad R.S. Sun M. Rohailla S. Honjo O.
Apitz C. Redington A.N.
Institution
(Friedberg, Cho, Li, Sun, Rohailla, Redington) Division of Cardiology,
Labatt Family Heart Center, University of Toronto, 555 University Avenue,
Toronto, ON M5G 1X8, Canada
(Honjo) Division of Cardiac Surgery, Labatt Family Heart Center,
University of Toronto, Toronto, ON, Canada
(Apitz) Pediatric Heart Centre, University Children's Hospital, Giessen,
Germany
(Assad) Heart Institute, University of Sao Paulo, School of Medicine, Sao
Paulo, Brazil
Title
Adverse biventricular remodeling in isolated right ventricular
hypertension is mediated by increased transforming growth factor-beta1
signaling and is abrogated by angiotensin receptor blockade.
Source
American Journal of Respiratory Cell and Molecular Biology. 49 (6) (pp
1019-1028), 2013. Date of Publication: December 2013.
Publisher
American Thoracic Society (61 Broadway 4th Floor, New York NY 10006 -
2755, United States)
Abstract
The pressure-loaded right ventricle (RV) adversely affects left
ventricular (LV) function. We recently found that these
ventricular-ventricular interactions lead to LV myocardial fibrosis
through transforming growthfactor-beta1
(TGF-beta1)signaling.Weinvestigated the mechanisms mediating biventricular
fibrosis in RV afterload and their potential modification by angiotensin
receptor blockade. An adjustable pulmonary artery band (PAB) was
placedinrabbits. In sham-operated control rabbits, the band was left
uninflated (n =6). In the RV afterload group, the PAB was sequentially
inflated to generate systemic RV pressure at 28 days (n = 8). In a third
group, the PAB was inflated to systemic levels, and the angiotensin
receptor blocker losartan was added (n =6). Five weeks after surgery, the
animals were killed for assessments of biventricular hypertrophy,
fibrosis,apoptosis, and the componentsoftheir signaling pathways. PAB
animals developed biventricular hypertrophy, fibrosis, and apoptosis,
versus sham rabbits, in which these conditions were decreased with
losartan. RV and LV TGF-beta1, connective tissue growth factor (CTGF)
(CCN2), endothelin-1 (ET-1), endothelin receptor B, and matrix
metalloproteinase 2/9 mRNA levels were increased in PABanimals versussham
animals, and decreased with losartan. Given the marked biventricular CTGF
up-regulation in PAB and downregulation with losartan, we investigated
CTGF signaling. RV and LV Smad 2/3/4 protein levels and LV RhoA mRNA
levels were increased with PAB and reduced with losartan. In conclusion,
isolated RV afterload induces biventricular fibrosis and apoptosis, which
are reduced by angiotensin receptor blockade. Adverse
ventricular-ventricular interactions induced by isolated RV afterload
appear to be mediated through TGF-beta1-CTGF and ET-1 pathways. Copyright
2013 by the American Thoracic Society.

<18>
Accession Number
2013784187
Authors
Harb S.C. Marwick T.H.
Institution
(Harb) Cardiovascular Imaging Section, Heart and Vascular Institute,
Cleveland Clinic, Cleveland, OH, United States
(Marwick) Menzies Research Institute, 17 Liverpool St, Hobart TAS,
Australia
Title
Prognostic value of stress imaging after revascularization: A systematic
review of stress echocardiography and stress nuclear imaging.
Source
American Heart Journal. 167 (1) (pp 77-85), 2014. Date of Publication:
January 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background Risk assessment may be important in patients being considered
for repeat revascularization after prior coronary intervention or surgery.
We sought the prognostic value of radionuclide stress myocardial perfusion
imaging or echocardiography among patients with previous
revascularization. Methods Studies on the outcomes of stress imaging tests
after revascularization were selected from an electronic search if they
reported the odds or hazard ratio (HR) of an abnormal stress test in the
prediction of mortality (cardiac or total), hard cardiac events (cardiac
death and myocardial infarction [MI]), total hard events (total mortality
and MI]), or overall events (cardiac death, MI, and repeat
revascularization). Results In 29 studies (12,874 patients, 63 +/- 3
years, 80% men), an abnormal test result was associated with hard cardiac
events (HR 1.2, 95% CI 1.1-1.3), cardiac mortality (HR 5.8, 95% CI
0.8-10.8), total mortality (HR 2.2, 95% CI 1.3-3.1), total hard events(HR
2.4, 95% CI 1.4-3.3), and overall events (HR 1.2, 95% CI 1.1-1.3). The
nature of the end point was not associated with differences in the
prediction of events, but the type of revascularization showed a
significant association with outcome, with percutaneous intervention
portending a worse outcome. Age and the timing of the stress imaging
postrevascularization were inversely associated with survival. Gender,
length of follow-up after testing, symptom status, past infarction, and
risk factor status did not explain interstudy heterogeneity. Conclusions
In patients with previous revascularization, abnormal results at stress
echocardiography or radionuclide myocardial perfusion imaging are
predictive of subsequent events, with age, type of revascularization, and
the timing of the stress imaging after revascularization being important
sources of heterogeneity between studies. 2014 Mosby, Inc.

<19>
Accession Number
2013784186
Authors
Choudhry N.K. Glynn R.J. Avorn J. Lee J.L. Brennan T.A. Reisman L. Toscano
M. Levin R. Matlin O.S. Antman E.M. Shrank W.H.
Institution
(Choudhry, Glynn, Avorn, Lee, Levin, Shrank) Division of
Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School,
Brigham and Women's Hospital, 1620 Tremont St., Boston, MA 02120, United
States
(Glynn, Antman) Department of Medicine, Harvard Medical School, Brigham
and Women's Hospital, Boston, MA, United States
(Reisman, Toscano) Aetna, Hartford CT, United States
(Brennan, Matlin) CVS Caremark, Woonksocket RI, United States
Title
Untangling the relationship between medication adherence and
post-myocardial infarction outcomes: Medication adherence and clinical
outcomes.
Source
American Heart Journal. 167 (1) (pp 51-58.e5), 2014. Date of Publication:
January 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background Patients who adhere to medications experience better outcomes
than their nonadherent counterparts. However, these observations may be
confounded by patient behaviors. The level of adherence necessary for
patients to derive benefit and whether adherence to all agents is
important for diseases that require multiple drugs remain unclear. This
study quantifies the relationship between medication adherence and
post-myocardial infarction (MI) adverse coronary events. Methods This is a
secondary analysis of the randomized MI FREEE trial. Patients who received
full prescription coverage were classified as adherent (proportion of days
covered >=80%) or not based upon achieved adherence in the 6 months after
randomization. First major vascular event or revascularization rates were
compared using multivariable Cox models adjusting for comorbidity and
health-seeking behavior. Results Compared with patients randomized to
usual care, full coverage patients adherent to statin, beta-blocker, or
angiotensin-converting enzyme inhibitor/angiotensin receptor blocker were
significantly less likely to experience the study's primary outcome
(hazard ratio [HR] range 0.64-0.81). In contrast, nonadherent patients
derived no benefit (HR range 0.98-1.04, P <=.01 for the difference in HRs
between adherent and nonadherent patients). Partially adherent patients
had no reduction in clinical outcomes for any of the drugs evaluated,
although their achieved adherence was higher than that among controls.
Conclusion Achieving high levels of adherence to each and all
guideline-recommended post-MI secondary prevention medication is
associated with improved event-free survival. Lower levels of adherence
appear less protective. 2014 Mosby, Inc.

<20>
Accession Number
2013784182
Authors
Bainey K.R. Mehta S.R. Lai T. Welsh R.C.
Institution
(Bainey, Welsh) Mazankowski Alberta Heart Institute, University of Alberta
Hospital, 2C2 Walter C Mackenzie, Edmonton, AB T6G 2B7, Canada
(Mehta, Lai) Division of Cardiology, McMaster University, Hamilton, ON,
Canada
Title
Complete vs culprit-only revascularization for patients with multivessel
disease undergoing primary percutaneous coronary intervention for
ST-segment elevation myocardial infarction: A systematic review and
meta-analysis.
Source
American Heart Journal. 167 (1) (pp 1-14.e2), 2014. Date of Publication:
January 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background Patients with ST-segment elevation myocardial infarction
(STEMI) and multivessel coronary artery disease who undergo primary
percutaneous coronary intervention (PCI) are most commonly treated with
PCI to the culprit lesion only. Whether a strategy of complete
revascularization in these patients is superior is unknown. We performed a
meta-analysis comparing the benefits and risks of routine culprit-only PCI
vs multivessel PCI in STEMI. Methods MEDLINE, EMBASE, ISI Web of Science,
and The Cochrane Register of Controlled Trials were searched from 1996 to
January 2011. Relevant conference abstracts were searched from January
2002 to January 2011. Studies included STEMI with multivessel disease
receiving primary PCI. The primary end point was long-term mortality. Data
were combined using a fixed-effects model. Results Of 507 citations, 26
studies (3 randomized, 23 nonrandomized; 46,324 patients, 7886 multivessel
PCI and 38,438 culprit-only PCI) were included. There was no significant
difference in hospital mortality with multivessel PCI vs culprit-only PCI
(odds ratio [OR] 1.11, 95% CI 0.98-1.25, P =.10 [randomized OR 0.24, 95%
CI 0.06-0.91, P =.04; nonrandomized OR 1.12, 95% CI 1.00-1.27, P =.06]).
However, if multivessel PCI during index catheterization was performed,
hospital mortality was increased (OR 1.35, 95% CI 1.19-1.54, P <.001).
When multivessel PCI was performed as a staged procedure, hospital
mortality was lower (OR 0.35, 95% CI 0.21-0.59; P <.001; P interaction
<.001). Reduced long-term mortality (OR 0.74, 95% CI 0.65-0.85, P
<.001[randomized OR 0.61, 95% CI 0.28-1.33, P =.22; nonrandomized OR 0.75,
95% CI 0.65-0.86, P <.001]) and repeat PCI (OR 0.65; 95% 0.46-0.90, P
=.01[randomized OR 0.31, 95% CI 0.17-0.57, P <.001; nonrandomized OR 0.88,
95% CI 0.59-1.31, P =.54]) were observed with multivessel PCI. Conclusion
Overall, staged multivessel PCI improved short- and long-term survival and
reduced repeat PCI. Still, large randomized trials are required to confirm
the benefits of staged multivessel PCI in STEMI. 2014 Mosby, Inc.

<21>
Accession Number
2013746148
Authors
Polovina M.M. Potpara T.S.
Institution
(Polovina, Potpara) Cardiology Clinic, Clinical Center of Serbia, 26
Visegradska, 11 000 Belgrade, Serbia
(Potpara) University of Belgrade, 8 Dr Subotica, 11 000 Belgrade, Serbia
Title
Recent advances in antiarrhythmic drug treatment of atrial fibrillation.
Source
Recent Patents on Cardiovascular Drug Discovery. 8 (2) (pp 112-126), 2013.
Date of Publication: 2013.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Atrial fibrillation (AF) is the most prevalent sustained cardiac
arrhythmia in clinical practice associated with significant morbidity and
mortality. With the growing number of the affected individuals, the
development of safe and effective treatment options for AF has become a
worldwide priority. Currently available antiarrhythmic medications for the
restoration and maintenance of sinus rhythm have limitations due to the
modest efficacy and a potential for adverseeffects. Although substantial
progress has been made in AF-ablation techniques, broad application of
these nonpharmacological treatment modalities is limited and
antiarrhythmic drug treatment is still the cornerstone and the first-line
therapy for the majority of AF patients. Improvements in the understanding
of the principal pathophysiological mechanisms of AF obtained in the last
several years have provided promising treatment opportunities. New
therapeutic options are based on the more selective targeting of ion
channels and intercellular connection proteins predominantly expressed in
the atria, the restoration of intracellular Ca²⁺ homeostasis
and the prevention of AF-associated electrical and structural remodeling.
In this review, we provide a highlight of the most important
pathophysiological mechanisms in AF with a relation to the potential
therapeutic interventions, and discuss novel findings regarding the
current and future pharmacological AF management and recent patents. 2013
Bentham Science Publishers.

<22>
Accession Number
2013737827
Authors
Bansal M. Farrugia A. Balboni S. Martin G.
Institution
(Bansal, Farrugia, Balboni) Plasma Protein Therapeutics Association,
Annapolis, MD, United States
(Farrugia) Department of Surgery, University of Western Australia,
Crawley, Australia
(Martin) Emory University School of Medicine, Division of Pulmonary,
Allergy and Critical Care, Atlanta, GA, United States
Title
Relative survival benefit and morbidity with fluids in severe sepsis - A
network meta-analysis of alternative therapies.
Source
Current Drug Safety. 8 (4) (pp 236-245), 2013. Date of Publication: 2013.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Fluid resuscitation is widely practiced in intensive care
units for the treatment of sepsis. A comparison of the evidence base of
different fluids may inform therapeutic choice. Methods: The risks of
mortality and morbidity (the need for renal replacement therapies (RRT))
were assessed in patients with severe sepsis. A network meta-analysis
compared trials for crystalloids, albumin and hydroxyethyl starch (HES). A
literature search of human randomized clinical trials was conducted in
databases, the bibliographies of other recent relevant systematic reviews
and data reported at recent conferences. Mortality outcomes and RRT data
with the longest follow up period were compared. A Bayesian network
meta-analysis assessed the risk of mortality and a pair-wise metaanalysis
assessed RRT using crystalloids as the reference treatment. Results: 13
studies were identified. A fixed-effects meta-analysis of mortality data
in the trials demonstrated an odds-ratio (OR) of 0.90 between crystalloids
and albumin, 1.25 between crystalloids and HES and 1.40 between albumin
and HES. The probability that albumin is associated with the highest
survival was 96.4% followed by crystalloid at 3.6%, with a negligible
probability for HES. Sub-group analyses demonstrated the robustness of
this result to variations in fluid composition, study source and origin of
septic shock. A random-effects pairwise comparison for the risk of RRT
provided an OR of 1.52 favoring crystalloid over HES. Conclusion: Fluid
therapy with albumin was associated with the highest survival benefit. The
higher morbidity with HES may affect mortality and requires consideration
by prescribers. 2013 Bentham Science Publishers.

<23>
Accession Number
2013735302
Authors
Nelson E.A. Dowsey M.M. Knowles S.R. Castle D.J. Salzberg M.R. Monshat K.
Dunin A.J. Choong P.F.M.
Institution
(Nelson, Dowsey, Dunin, Choong) University of Melbourne, Department of
Surgery, St Vincent's Hospital, Melbourne, VIC, Australia
(Knowles) Faculty of Life and Social Sciences, Swinburne University of
Technology, Melbourne, VIC, Australia
(Knowles, Castle, Salzberg, Monshat) St Vincent's Mental Health, The
University of Melbourne Department of Psychiatry, Melbourne, VIC,
Australia
Title
Systematic review of the efficacy of pre-surgical mind-body based
therapies on post-operative outcome measures.
Source
Complementary Therapies in Medicine. 21 (6) (pp 697-711), 2013. Date of
Publication: December 2013.
Publisher
Churchill Livingstone (1-3 Baxter's Place, Leith Walk, Edinburgh EH1 3AF,
United Kingdom)
Abstract
Objectives: A large body of research has demonstrated that patient factors
are strong predictors of recovery from surgery. Mind-body therapies are
increasingly targeted at pre-operative psychological factors. The
objective of this paper was to evaluate the efficacy of pre-operative
mind-body based interventions on post-operative outcome measures amongst
elective surgical patients. Methods: A systematic review of the published
literature was conducted using the electronic databases MEDLINE, CINAHL
and PsychINFO. Randomised controlled trials (RCTs) with a prospective
before-after surgery design were included. Results: Twenty studies
involving 1297 patients were included. Mind-body therapies were
categorised into relaxation, guided imagery and hypnotic interventions.
The majority of studies did not adequately account for the risk of bias
thus undermining the quality of the evidence. Relaxation was assessed in
eight studies, with partial support for improvements in psychological
well-being measures, and a lack of evidence for beneficial effects for
analgesic intake and length of hospital stay. Guided imagery was examined
in eight studies, with strong evidence for improvements in psychological
well-being measures and moderate support for the efficacy of reducing
analgesic intake. Hypnosis was investigated in four studies, with partial
support for improvements in psychological well-being measures. Evidence
for the effect of mind-body therapies on physiological indices was
limited, with minimal effects on vital signs, and inconsistent changes in
endocrine measures reported. Conclusions: This review demonstrated that
the quality of evidence for the efficacy of mind-body therapies for
improving post-surgical outcomes is limited. Recommendations have been
made for future RCTs. 2013.

<24>
Accession Number
2013784453
Authors
Seiler C. Stoller M. Pitt B. Meier P.
Institution
(Seiler, Stoller) Department of Cardiology, University Hospital, Bern
CH-3010, Switzerland
(Pitt) Division of Cardiology, University of Michigan Medical Center, Ann
Arbor, MI, United States
(Meier) University College UCL, London, United Kingdom
(Meier) Yale Medical School, New Haven, CT, United States
Title
The human coronary collateral circulation: Development and clinical
importance.
Source
European Heart Journal. 34 (34) (pp 2674-2682), 2013. Date of Publication:
07 Sep 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Coronary collaterals are an alternative source of blood supply to
myocardium jeopardized by ischaemia. In comparison with other species, the
human coronary collateral circulation is very well developed. Among
individuals without coronary artery disease (CAD), there are preformed
collateral arteries preventing myocardial ischaemia during a brief
vascular occlusion in 20-25%. Determinants of such anastomoses are low
heart rate and the absence of systemic arterial hypertension. In patients
with CAD, collateral arteries preventing myocardial ischaemia during a
brief occlusion are present in every third individual. Collateral flow
sufficient to prevent myocardial ischaemia during coronary occlusion
amounts to one-fifth to one-fourth the normal flow through the open
vessel. Myocardial infarct size, the most important prognostic determinant
after such an event, is the product of coronary artery occlusion time,
area at risk for infarction, and the inverse of collateral supply.
Well-developed coronary collateral arteries in patients with CAD mitigate
myocardial infarcts and improve survival. Approximately one-fifth of
patients with CAD cannot be revascularized by percutaneous coronary
intervention or coronary artery bypass grafting. Therapeutic promotion of
collateral growth is a valuable treatment strategy in those patients. It
should aim at growth of large conductive collateral arteries
(arteriogenesis). Potential arteriogenic approaches include the treatment
with granulocyte colony-stimulating factor, physical exercise training,
and external counterpulsation. The Author 2013.

<25>
Accession Number
2013780462
Authors
Alomar M.E. Michael T.T. Patel V.G. Altomare C.G. Rangan B.V. Cipher D.
Banerjee S. Brilakis E.S.
Institution
(Alomar, Michael, Patel, Altomare, Rangan, Cipher, Banerjee, Brilakis) VA
North Texas Health Care System, University of Texas Southwestern Medical
Center at Dallas, Division of Cardiology (111A), 4500 S. Lancaster Rd.,
Dallas, TX 75216, United States
Title
Stent loss and retrieval during percutaneous coronary interventions: A
systematic review and meta-analysis.
Source
Journal of Invasive Cardiology. 25 (12) (pp 637-641), 2013. Date of
Publication: December 2013.
Publisher
HMP Communications (83 General Warren Blvd. Suite 100, Malven PA 19355,
United States)
Abstract
Objective: We present a systematic review and meta-analysis of the
frequency, consequences, and treatment of stent loss during percutaneous
coronary intervention (PCI). Background: Stent loss during PCI has
received limited study. Methods: We conducted a meta-analysis of 18 case
series and 45 case reports published between 1991 and 2012 on stent loss
during PCI. Data on the frequency of stent loss, treatment strategies, and
clinical outcomes were collected. Results: A total of 1048 stents were
lost in 968 PCIs. Stent loss occurred in 919 of 71,655 PCIs (1.3%; 95%
confidence interval, 0.8%-2.8%). The incidence of stent loss in studies
published before 2000, between 2000 and 2005, and after 2005 was 5%, 1%,
and 0.3%, respectively (P<.001). Of the 1048 lost stents, 698 (66%) were
successfully retrieved from the coronary circulation, 130 (12%) were
deployed, 27 (3%) were crushed, and 28 (3%) were left untreated; treatment
of 165 stents (16%) was not reported. A complication occurred in 171
patients (19%), of whom 98 (57%) had coronary artery bypass graft surgery,
31 (18%) myocardial infarction, 33 (19%) died, 10 (6%) had bleeding
requiring transfusion, 5 (3%) had vascular access complications, and 1
patient (0.6%) had a cerebrovascular accident (some patients had more than
one event). Conclusions: The incidence of stent loss during PCI is low and
has been decreasing. Although the lost stents were successfully retrieved
in most cases, stent loss was associated with high rates of complications,
such as coronary artery bypass graft surgery, myocardial infarction, and
death.

<26>
Accession Number
71261500
Authors
Orlandini A. Castellana N. Pascual A. Botto F. Bahit C. Chacon C. Diaz R.
Institution
(Orlandini, Castellana, Pascual, Botto, Bahit, Chacon, Diaz) ECLA
(Estudios Clinicos Latino America), Rosario, Argentina
Title
Usefulness of myocardial viability tests in the decision making process to
indicate revascularization in patients with left ventricular dysfunction
and coronary artery disease.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 1074), 2013.
Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Purpose: Myocardial viability tests have been proposed as a key factor in
the decision-making process to indicate coronary revascularization
procedures in patients with left ventricular dysfunction and coronary
artery disease (LVD-CAD). In order to evaluate the level of evidence to
support this approach we performed a systematic review of the published
literature to carry out a meta-analysis of studies that compare medical
treatment (medical TX) with coronary bypass surgery (CABG) or percutaneous
coronary intervention (PCI) in patients with viable and non-viable
myocardium. Methods: Eligible studies had to fulfil the following criteria
to be included: (1) patients with LVD-CAD or previous myocardial
infarction (2) myocardial viability test assessment (3) revascularization
procedures (CABG or PCI) and medical treatments groups and (4) cardiac
death or total mortality as the outcome Results: 32 non-randomized (4328
patients) and 4 randomized (1079 patients) studies were included in the
analyses (total 5407 patients). No qualitative interaction between the
groups of patients with or without myocardium viable was observed, either
in non-randomized or in randomized studies (Figure 1). (Figure presented)
Conclusions: The available data do not support the use of myocardial
viability tests in the decision making process to indicate
revascularization in patients with LVD-CAD.

<27>
Accession Number
71261189
Authors
Niwa M. Takagi H.
Institution
(Niwa, Takagi) Shizuoka Medical Center, Shizuoka, Japan
Title
Is 30-day mortality after transcatheter aortic valve implantation lower
than society of thoracic surgeons predicted risk of mortality? A
meta-analysis and meta-regression of contemporary studies.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 991), 2013.
Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Purpose: Under the situation of insufficient direct-comparison data of
transcatheter aortic valve implantation (TAVI) versus surgical aortic
valve replacement (AVR) for aortic stenosis (AS), we performed a
meta-analysis and metaregression comparing observed 30-day all-cause
mortality after TAVI with predicted mortality (for AVR in patients
undergoing TAVI) using the Society of Thoracic Surgeons Predicted Risk of
Mortality (STS-PROM) (not logistic EuroSCORE [European System for Cardiac
Operative Risk Evaluation]) in contemporary studies. Methods: MEDLINE and
EMBASE were searched from January 2011 to December 2012 using PubMed and
OVID. Eligible studies were those enrolling patients with AS undergoing
TAVI and reporting both STS-PROM and outcomes (including 30-day all-cause
mortality) using the VARC [Valve Academic Research Consortium]
definitions. For each study, data regarding observed and predicted
mortality were used to generate mean differences (MDs) and 95% confidence
intervals (CIs). Results: Seventeen reports enrolling >8000 patients
undergoing TAVI were identified and included. Pooled analysis demonstrated
significantly lower 30-day all-cause mortality than STS-PROM
(random-effects MD, -1.63%; 95% CI, -3.22% to -0.05%; P=0.04).
Random-effects meta-regression revealed significantly negative
relationship between STS-PROM and MD (coefficient, -0.83; 95% CI, -1.21 to
-0.45; P<0.001) and 8.7% of the x-axis intercept of the upper 95% CI curve
(Figure 1), suggesting that mortality after TAVI may be significantly
(P<0.05) lower than predicted mortality in patients with >8.7% of
STS-PROM. (Figure presented) Conclusions: Thirty-day all-cause mortality
after TAVI appears to be lower than STS-PROM, especially in patients with
>8.7% of STS-PROM.

<28>
Accession Number
71261179
Authors
D'Ascenzo F. Conrotto F. Giordana F. Moretti C. D'Amico M. Tamburino C.
Vicentini S. Marra S. Gaita F. Rinaldi M.
Institution
(D'Ascenzo, Conrotto, Giordana, Moretti, D'Amico, Vicentini, Marra, Gaita,
Rinaldi) Citta della Saluteedella Scienza, Division of Cardiology, Turin,
Italy
(Tamburino) Ferrarotto Hospital, Institute for Cardiology, Department of
Cardiovascular, Catania, Italy
Title
Mid-term prognostic value of coronary artery disease in patients
undergoing transcatheter aortic valve implantation: A meta-analysis of
adjusted observational results.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 989), 2013.
Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Aims: Coronary Artery Disease (CAD) negatively affects prognosis in
patients undergoing surgical aortic valve replacement, consequently being
appraised in the most common used risk score. Our meta-analysis aims to
clarify the association of CAD on mid-term survival in patients undergoing
TAVI. Methods and results: A systematic literature review was performed
looking for studies reporting multivariate predictors of adverse outcomes
in patients undergoing TAVI and pooled, when appropriate, using a
random-effect method. 960 citations were first screened and finally 7
studies (2472 patients) were included. Diagnosis of CAD was reported in
37% to 51% of patients and 1169 Edwards SAPIEN and 1303 CoreValve
prostheses were implanted. Follow-up time was 452 (357-585) days. After a
median follow up of 452 days (357-585) 24% of patients (19-33) died, and
23 (14-32) for cardiovascular death which was mentioned only in three
works At pooled analysis of multivariate approach, diagnosis of coronary
artery disease did not increase risk of death (OR 1.0, 95% CI, Confidence
Interval, 0.67-1.50). Conclusion: CAD does not affect mid-term TAVI
outcome, and this finding should be weighted to accurately evaluate risk
and strategies for patients with severe aortic stenosis.

<29>
Accession Number
71261010
Authors
Sonne C. Bott-Fluegel L. Hauck S. Hadamitzky M. Lesevic H. Wolf P. Kolb C.
Institution
(Sonne, Hauck, Hadamitzky, Lesevic, Kolb) German Heart Center, Hospital
Rechts der Isar, Technical University of Munich, Munich, Germany
(Bott-Fluegel) Abteilung fur Innere Medizin/Kardiologie, Kreiskrankenhaus
Erding mit Klinik Dorfen, Erding, Germany
(Wolf) Hospital Rechts der Isar, TU Munich, Institute of Medical
Statistics and Epidemiology, Munich, Germany
Title
Novel three dimensional echocardiographic guided optimization improves
outcome in cardiac resynchronization therapy compared to ECG optimization:
Longterm results of a randomized comparison.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 944), 2013.
Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Background: All current cardiac resynchronization therapy (CRT) devices
allow manipulation of both atrioventricular (AV) and
ventricular-to-ventricular (VV) interval with little consensus on the
optimal setting. The aim of this study was to examine the longterm results
of a novel combination of doppler echocardiography (DE) and
three-dimensional echocardiography (3DE) for optimization of
AV-VV-intervals compared to ECG optimization. Methods: In this
double-blind randomized controlled trial 77 patients (male: 57, 41-83
years) with severely reduced ejection fraction (EF), NYHA class III or IV
and wide QRS complex (>120ms) have been included. Patients were randomized
to either AV- and VV-interval-optimization using DE and 3DE (n=39) or ECG
(n=38). 3DE was performed in all patients for the evaluation of left
ventricular (LV) dimensions, EF and dyssynchrony index (SDI) and NYHA
class obtained before CRT and at short- (101+/-31 days) and longterm
(324+/-122 days) follow-up. Primary endpoint of the study was clinical
response to CRT after 3 Months, defined as a reduction of NYHA class by
>=1 score. Secondary endpoints were change of EF, LV volumes and SDI.
Results: At 3 months, there were significantly more responders in group 1
(82%) than in group 2 (58%), p=0.021. Similarly, group 1 showed a higher
increase in EF at short- and longterm follow-up. (Table presented)
Conclusions: Compared with conventional ECG optimization of CRT, the novel
combination of DE-AV- and 3DE-VV-interval optimization resulted in a
higher response rate and improved LV systolic function and can be used to
select the optimal AV-delay and VV-interval in CRT. CARDIAC SURGERY AND
TRANSPLANTATION.

<30>
Accession Number
71260604
Authors
Yao Y. He Z. Yang L.
Institution
(Yao, He, Yang) First Hospital of Lanzhou University, Lanzhou, China
Title
Impact of preoperative renin-angiotensin system inhibitors therapy on
adverse postoperative outcomes in patients undergoing cardiac surgery: A
meta-analysis of over 42, 000 patients.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 835), 2013.
Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Aims: Controversy exists about whether preoperative RASI therapy is
associated with adverse postoperative outcomes after cardiac surgery. We
performed a meta-analysis to evaluate if preoperative renin-angiotensin
system inhibitors (RASI) therapy reduces adverse postoperative outcomes in
patients undergoing cardiac surgery. Methods and results: PubMed, EMBASE,
Web of Science and Cochrane Library were searched for randomized
controlled trials (RCTs) and observational studies (published up to
February 2012) assessing the effects of preoperative RASI use on adverse
postoperative outcomes compared with no-preoperative RASI use. All
statistical analyses were performed with Stata 12.0. Twenty studies with
42, 798 patients were identified. Preoperative RASI therapy was associated
with a 22% increased risk of early all-cause mortality (OR 1.22; 95% CI:
1.08-1.38; P=0.002) and a 24% reduced risk of stroke (OR 0.76; 95% CI:
0.60-0.97; P = 0.03) in patients undergoing cardiac surgery compared with
control. However, sensitivity analysis by limiting to patients undergoing
single coronary artery bypass grafts (CABG) showed that the pooled OR was
0.79 (95% CI: 0.57-1.08, P = 0.14) for incidence of stroke. There is no
significant difference in myocardial infarction (OR 1.07; 95% CI:
0.92-1.24; P = 0.37), atrial fibrillation (OR 0.87; 95% CI: 0.71-1.07; P =
0.18) and acute kidney injury (OR 1.06; 95% CI: 0.88-1.28; P = 0.55).
Conclusion: Preoperative RASI use significantly increases the risk of
early all-cause mortality. It also significantly reduces the incidence of
stroke after cardiac surgery, but doesn't in patients undergoing single
CABG. No significant difference is observed for myocardial infarction,
atrial fibrillation and acute kidney injury.

<31>
Accession Number
71260602
Authors
Harskamp R.E. Brennan J.M. Gaca J.G. Halkos M.E. Peterson E.D. Rao S.V.
Williams J.B. De Winter R.J. Alexander J.H. Lopes R.D.
Institution
(Harskamp, De Winter) Academic Medical Center, University of Amsterdam,
Department of Cardiology, Amsterdam, Netherlands
(Brennan, Peterson, Rao, Williams, Alexander, Lopes) Duke University
Medical Center, Duke Clinical Research Institute, Durham, United States
(Gaca) Duke University Medical Center, Division of Cardiovascular and
Thoracic Surgery, Durham, United States
(Halkos) Emory University, Division of Cardiothoracic Surgery, Atlanta,
United States
Title
A systematic review of outcomes related to hybrid coronary
revascularization in patients with multi-vessel coronary artery disease in
the drug-eluting stent era.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 834), 2013.
Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Purpose: To systematically review the available data on the use, efficacy,
and safety of hybrid coronary revascularization (HCR), defined as surgical
grafting of the left anterior descending artery (LAD) and percutaneous
coronary intervention of non-LAD vessels in patients with multi-vessel
coronary artery disease. Methods: We performed a systematic review of the
literature on available studies on HCR. Using the MEDLINE database we used
search terms that included hybrid coronary revascularization, coronary
artery bypass surgery, and outcomes. Additionally, we reviewed references
from these articles for studies not found through the initial search. A
total of 70 relevant articles were found. Results: All reported studies
were non-randomized, single or two-center experiences. Case series in
which HCR was performed with drug-eluting stents (DES), showed good
event-free survival rates of (89-100%) and low TLR rates (0-7.6%) at
follow-up ranging from (6 to 18 months). One series reported long-term
survival of 92.9% at 5 years, and event-free survival of 75.2% among 224
patients who underwent HCR. To date, 11 non-randomized studies, either
matched or consecutive cohorts, have compared outcomes of HCR with DES and
complete surgical revascularization. Overall, in-hospital mortality,
stroke and reoperation for bleeding rates were comparable among reported
studies. Long-term survival ranged from 86.8 to 100% following HCR and
83.4% to 100% following conventional CABG. Event-free survival ranged from
84.6% to 100% in HCR and 77% to 100% following CABG. Studies comparing
quality of life and patient satisfaction favor HCR over CABG. Also,
intensive-care and in-hospital stay and time to return to work were
reported are shorter, but procedural costs are higher compared with
off-pump CABG. Conclusions: Although the results of HCR are promising,
adequately powered randomized trials are warranted to ascertain that HCR
is a feasible alternative to CABG and/or multi-vessel PCI. Additional
study is required on the timing and order of the percutaneous and surgical
components of HCR, as well as bleeding and acute stent thrombosis related
to antiplatelet strategies, and cost-effectiveness.

<32>
Accession Number
71260234
Authors
Teixeira R. Vieira M.J. Ribeiro M.J. Goncalves L. Gersh B.
Institution
(Teixeira, Ribeiro) Hospital Beatriz Angelo, Loures, Portugal
(Vieira, Goncalves) Faculdade Medicina Universidade Coimbra, Coimbra,
Portugal
(Gersh) Mayo Clinic, Department of Cardiovascular Disease, Rochester,
United States
Title
Coronary artery bypass grafting history and acute coronary syndromes,
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 731), 2013.
Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Background: A recent global rise in the number of acute coronary syndromes
(ACS) has been observed in patients with prior coronary artery bypass
(CABG). Moreover there has been a recent debate regarding its short and
long-term prognostic influence. Purpose: Elaborate a meta-analysis to
study the prognostic influence of a previous CABG in patients admitted for
an ACS. Methods: A system review was performed through January 2013
(MEDLINE, Cochrane Library, Web of Knowledge). All published observational
studies in which ACS outcomes with a previous history of CABG were
compared with ACS outcomes with no history of previous CABG, were
considered for inclusion. Reviews meeting the inclusion criteria underwent
data extraction by one reviewer and were checked by a second. The
endpoints of interest were mortality and non-fatal acute myocardial
infarction. Data were aggregated at 3 follow-up times (in-hospital, 30
days, 1 year) using random-effects models. Results: Twenty-five studies
were included; 19 provided sufficient data for inclusion with 366639
patients available for analysis. During hospital stay, mortality was 16.2%
for the previous CABG group vs 12.3% for the rest of the ACS population
(risk ratio [RR] = 1.26, 95% confidence interval [CI] 1.09-1.46). Pooled
thirty day mortality was also significantly higher for the previous CABG
patients as was the one-year mortality (RR=1.77, 95% CI 1.45-2.17). The
in-hospital re-infarction rate was 4.7% for the previous CABG patients,
versus 3.3% for the rest of the ACS population (RR = 1.28, 95% CI
0.90-1.83). On the contrary, one-year re-infarction was higher for the
previous CABG group (RR 1.73, 95% CI 1.29-2.31). (figure presented)
Conclusions: ACS patients with previous CABG history have a higher risk
for short and long-term events.

<33>
Accession Number
71260005
Authors
Nytroen K. Rustad L.A. Erikstad I. Aukrust P. Ueland T. Gude E. Hervold A.
Aakhus S. Gullestad L. Arora S.
Institution
(Nytroen, Rustad, Erikstad, Gude, Hervold, Aakhus, Gullestad, Arora) Oslo
University Hospital, Rikshospitalet, Department of Cardiology, Oslo,
Norway
(Aukrust, Ueland) University of Oslo, Rikshospitalet University Hospital,
Research Institute for Internal Medicine, Oslo, Norway
Title
High intensity interval training decreases progression of cardiac
allograft vasculopathy in heart transplant recipients - A randomized
controlled trial.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 670), 2013.
Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Purpose: Cardiac allograft vasculopathy (CAV) is a progressive form of
atherosclerosis occurring in heart transplant (HTx) recipients, leading to
increased morbidity and mortality. Given the atheroprotective effect of
exercise on traditional atherosclerosis, we hypothesized that high
intensity interval training (HIIT) would reduce the progression of CAV
among HTx recipients Methods: Forty-three (mean+/-SD age 51+/-16 years,
67% males, time post HTx 4.0+/-2.2 years) clinically stable HTx recipients
> 18 years old, were randomized to either HIIT or control group (standard
care) for one year. The effect of traing on CAV progression was assessed
by intravascular ultrasound (IVUS). Results: IVUS analysis revealed a
significantly less mean increase [95% CI] in percent atheroma volume (PAV)
of 0.9 [-0.3, 1.9] % in the HIIT group as compared to the control group:
2.5 [1.6, 3.5] % (p=0.021). Similarly, mean increase [95% CI] in maximal
intimal thickness (MIT) was 0.02 [-0.01, 0.04] mm in the HIIT group versus
0.05 [0.03, 0.08] mm in the control group (p=0.054). Qualitative plaque
progression (virtual histology parameters) and inflammatory activity
(biomarkers) were similar between the two groups during the study period.
(Figure Presented) Conclusions: HIIT among maintenance HTx recipients
resulted in a significantly impaired rate of CAV progression. Further and
larger studies should examine if exercise rehabilitation strategies should
be included as part of CAV management protocols.

<34>
Accession Number
71258966
Authors
Bartfay S.E. Gude E. Sigurdardottir V. Andreassen A.K. Gullestad L.
Andersson B.
Institution
(Bartfay) Sahlgrenska University Hospital, Dept. of Cardiology,
Gothenburg, Sweden
(Gude, Andreassen, Gullestad) Oslo University Hospital, Dept. of
Cardiology, Oslo, Norway
(Sigurdardottir) Sahlgrenska University Hospital, Transplantation Center,
Gothenburg, Sweden
(Andersson) Sahlgrenska Academy, Univ. of Gothenburg, Dept. of Molecular
and Clinical Medicine/Cardiology, Gothenburg, Sweden
Title
Maintained cardiac reserve in heart transplant patients during early
calcineurin inhibitor avoidance: A substudy of a randomised controlled
trial (SCHEDULE trial).
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 392), 2013.
Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Calcineurin inhibitors have constituted the cornerstone of
immunosuppressive regime following heart transplantation. The transplanted
heart is subjected to increased hypertrophy and the risk of developing
graft vasculopathy. To what extent these negative effects are influenced
by different immunosuppressive drugs, is largely unknown. We conducted a
randomised, open-label, parallel group clinical trial to assess early
introduction of everolimus followed by withdrawal of cy-closporine (EVE)
in de novo heart transplant recipients, compared to a standard protocol of
cyclosporine-based immunosuppression (CYA). In a substudy we investigated
cardiac reserve by invasive hemodynamics during rest and exercise, early
(7 weeks) and later (52 weeks) after heart transplantation, in 28 (EVE)
and 34 (CYA) patients. The aim was to compare cardiac reserve in the two
treatment arms. Methods: Patients had a right heart catheterisation at
rest and during submaximal supine bicycle exercise. Pressures and cardiac
output (CO) were measured Results: At baseline (7 w) PCWP and CO increased
from rest to exercise. After 52 w the hemodynamic pattern was similar,
with a non-significant trend towards higher CO during exercise. There were
no significant differences between treatment groups. Hemodynamics (figure
Presented) Conclusions: Early elimination of cyclosporine and replacement
with an everolimus-based immunosuppressive therapy had no negative effect
on cardiac reserve as measured by invasive hemodynamics.

<35>
Accession Number
71258920
Authors
Kiyose A.T.K. Suzumura E.A.S. Laranjeira L.N.L. Buehler A.M.B. Santo
J.A.E.S. Cavalcanti A.B.C. Berwanger O.B. Carvalho A.C.C.C. Paola A.A.V.P.
Moises V.A.M.
Institution
(Kiyose, Carvalho, Paola, Moises) Federal University of Sao Paulo
(UNIFESP), Department of Medicine, Cardiology, Sao Paulo, Brazil
(Suzumura, Laranjeira, Buehler, Santo, Cavalcanti, Berwanger) Hospital for
the Heart (Hcor), Sao Paulo, Brazil
Title
The long-term outcome of biological or mechanical prostheses for heart
valve surgery: A meta-analysis of randomised clinical studies.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 380-381),
2013. Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Background: The choice of a mechanical (MP) or biological prostheses (BP)
is still not a consensus for patients with heart valve disease. Both
prostheses have advantages and limitations depending on the age and
clinical situation. The aim of this study was to determine the long-term
results of MP or BP Methods: The methods included a systematic review of
the following electronic databases Medline/Pubmed, Central-Cochrane
Library, Embase/Elsevier, Scopus, Web of Science, and Lilacs which were
conducted by independent researchers. Other journals and manuscript
sources were also consulted. The following outcomes were analysed:
bleeding, infective endocarditis, valve failure, thromboembolism, valve
thrombosis, nonstructural dysfunction, re-operation and mortality rate. We
assessed and quantified statistical heterogeneity using Cochran's Q test
and the I2 statistic. An analysis for the binary outcomes was performed
using the Mantel-Haenszel fixed effect models, or Der Simonian and Laird
for random effect models when heterogeneity was observed. We calculated
the risk ratios (RR) with 95% confidence intervals (95% CIs). An
assessment for publication bias was performed using Egger's linear
regression test. Two-sided p-values < 0.05 were considered statistically
significant. Results: A total of 6, 286 references were identified; 19
were analysed and four were included in qualitative analysis and
meta-analysis. In total 1, 528 patients formed the basis for
meta-analysis. No significant difference was found in the total mortality
rate between BP and MP in a follow-up period of 20 years (RR=1.05;
CI95%:0.97-1.14; p=0.046). The risk of endocarditis (RR=1.44; CI95%:
1.09-1.90), nonstructural dysfunction (RR=11.78; CI95%: 5.11-27.17) and
re-operations (RR=3.60; CI95%: 2.51-5.17) were higher for patients with
BP; however, paravalvular leak (RR=0.45; CI95%:0.24-0.85) was higher in
patients with MP. There were no statistically significant difference
between either BP or MP patients for valve thrombosis (RR=0.66;
CI95%:0.11-3.91), thromboembolism (RR=1.16; CI95%: 0.82-1.64) or bleeding
(RR=0.76; CI95%: 0.54-1.07) Conclusions: This meta-analysis did not show
any differences in long-term mortality rates, thromboembolic events, or
hemorrhage between BP and MP patients after 20 years of follow-up.
However, MP was associated with lower risks of all other outcomes, except
paravalvular leak.

<36>
Accession Number
71258705
Authors
Mckavanagh P. Lusk L. Ball P.A. Trinick T. Duly E. Walls G. Verghis R.
Agus A. Harbinson M. Donnelly P.M.
Institution
(Mckavanagh, Lusk, Ball, Trinick, Duly, Walls, Donnelly) Ulster Hospital,
Belfast, United Kingdom
(Verghis) Clinical Research Support Centre, Belfast, United Kingdom
(Agus, Harbinson) Queen's University, Centre for Vision and Vascular
Science, Belfast, United Kingdom
Title
The 1 year clinical results of the CAPP study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 320-321),
2013. Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Purpose: This work highlights the 1 year follow-up of The Cardiac
Computerised Tomography (CT) for the Assessment of Pain and Plaque (CAPP)
study. [IS-RCTN52480460]. The study is designed to compare the economic
and clinical outcomes of using cardiac CT compared to Exercise Stress Test
(EST) in the assessment of patients with suspected stable troponin
negative chest pain. Method: CAPP is a cost-utilisation analysis
randomised controlled trial. In this study, 500 patients without known
coronary artery disease were recruited from United Kingdom outpatient
rapid access chest pain clinics. Patients were randomised to either EST
which is the standard of care or cardiac CT, with both calcium scoring and
CT coronary angiography. All patients were followed up for
re-hospitalisations rates and adverse events via hospital records and for
angina symptoms with the Seattle Angina Questionnaires (SAQ) via postal
return and telephone calls. Clinical events and changes in SAQ from
baseline to 1 year between cohorts were measured. Results: Of the 500
patients randomised 12 withdrew over the year, resulting in 245 in the EST
arm and 243 in CT arm receiving follow up. The mean age was 58.3 years and
a mean Diamond Forrester score of 46.4%. There were with no significant
differences in the pre-test probabilities, age, sex or risk factors
between the cohorts. Over the 1 year follow up period there were 29
Emergency Department (ED) chest pain attendances in the EST arm, with 13
unplanned admissions, compared to 8 ED attendances with 2 unplanned
admissions in the CT arm. There were also more cardiology outpatient
attendances in the EST arm in the course of the year, with 56 compared to
28 in the CT cohort. In the EST arm there were 7 patients who underwent
Coronary Artery Bypass Grafting (CABG) and 12 who had Percutaneous
Coronary Intervention (PCI), compared to 9 CABG and 29 PCI in the CT arm.
There was also more earlier identification of non-obstructive disease in
the CT arm compared to EST (59 to 4). At 1 year 412 (82.4%) patients had
returned the SAQ, 210 in the CT arm and 202 in the EST. There was a
significant improvement in the SAQ angina stability and quality of life
scores at 1 year in the CT arm compared to EST (p =<0.05). Conclusions:
Cardiac CT as an index investigation for stable chest pain improved
perception of angina stability and quality of life; resulted in fewer
planned and unplanned hospital attendances; and facilitated more
appropriate revascular-isations compared to EST.

<37>
Accession Number
71258141
Authors
Andreassen A.K. Andersson B. Gustafsson F. Eiskjaer H. Raadegran G. Gude
E. Solbu D. Sigurdardottir V. Dellgren G. Gullestad L.
Institution
(Andreassen, Gude, Gullestad) Oslo University Hospital, Rikshospitalet,
Oslo, Norway
(Andersson, Sigurdardottir, Dellgren) Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gustafsson) Rigshospitalet-Copenhagen University Hospital, Heart Centre,
Department of Cardiology, Copenhagen, Denmark
(Eiskjaer) Aarhus University Hospital, Department of Cardiology, Aarhus,
Denmark
(Raadegran) Lund University, Skane University Hospital, Clinic for Heart
Failure and Valvular Disease, Lund, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
Title
Early calcineurin inhibitors avoidance improves renal function in de novo
heart transplant recipients: The results of a randomized controlled trial
(SCHEDULE trial).
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 168), 2013.
Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Purpose: Calcineurin inhibitors remain the mainstay of immunosuppression
following heart transplantation, but are associated with significant long
term complications. We conducted a randomized, open-label, parallel group
clinical trial to assess whether early introduction of everolimus followed
by withdrawal of cyclosporine would lead to superior renal function in de
novo heart transplant (HTx) recipients, compared to a standard protocol of
cyclosporine-based immunosup-pression. Methods: A total of 115 patients
were randomly assigned within 5 days post-operatively to low dose
everolimus and reduced dose cyclosporine (n=56) or standard cyclosporine
dosage (n=59). All received mycophenolate mofetil and corticosteroids. In
the former group, cyclosporine was withdrawn and full-dose everolimus
initiated after 7-11 weeks. The primary efficacy end point was renal
function assessed by measured glomerular filtration rate (mGFR) after 12
months. Secondary objectives included progression of cardiac-allograft
vasculopathy (as assessed by intravascular ultrasound (IVUS)), left
ventricular function (assessed by echocardiography and NT-proBNP), number
of rejections and serious adverse effects. Results: At 12 months, mGFR was
significantly higher in the everolimus group compared to those receiving
standard cyclosporine-based immunosuppression (80 mL/kg/1.73 m²
vs. 62 mL/kg/1.73 m²; p<0.0001; Intention To Treat
population)). A significantly higher incidence of acute cellular rejection
was observed in the everolimus group, while left ventricular dimension and
function as assessed by echocardiography and NT-proBNP, were similar
between the two groups. With similar rates of bacterial infection,
cytomegalovirus infection was significantly less common among everolimus
treated patients (n=3 (5.4%) vs.n=18 (30.5%); p<0.001). IVUS data, not yet
ready, will be presented. Conclusions: Early elimination of cyclosporine
and replacement with an everolimus-based immunosuppressive strategy was
associated with significant and clinically important improvement in renal
function in HTx patients.

<38>
Accession Number
71258125
Authors
Savarese G. Paolillo S. D'Amore C. Losco T. Musella F. Scala O. Rengo G.
Leosco D. Trimarco B. Perrone Filardi P.
Institution
(Savarese, Paolillo, D'Amore, Losco, Musella, Scala, Trimarco, Perrone
Filardi) Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy
(Rengo, Leosco) Department of Medical Translational Sciences, Federico II
University, Naples, Italy
Title
Benefits of statins in elderly subjects without established cardiovascular
disease. a meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2013 Amsterdam Netherlands. Conference Start: 20130831 Conference
End: 20130904. Conference Publication: (var.pagings). 34 (pp 163-164),
2013. Date of Publication: August 2013.
Publisher
Oxford University Press
Abstract
Background: Since ageing of the population is steadily raising, prevention
of Cardiovascular (CV) disease in the elderly is relevant. In elderly
patients with previous CV events, use of statins is recommended by
guidelines, whereas the employ of these drugs in elderly subjects without
previous CV events is still debated. The aim of the present study was to
verify whether statins reduce all-cause mortality and CV events in elderly
people without previous established CV disease. Methods: MEDLINE,
Cochrane, ISI Web of Science and SCOPUS databases were searched for
articles about statin treatment in patients without CV disease until
December 2012. Study inclusion criteria were: randomized allocation to
statin or placebo; age at randomization >65 years or report of outcomes in
the subgroup of patients with age >65 years; report of at least 1 clinical
event among all-cause death, CV death, Myocardial Infarction (MI),
coronary revascularization, stroke and new cancer onset; report of
outcomes separately for patients without established CV disease.
Meta-analysis was performed to assess the influence of treatments on
outcomes. Meta-regression analysis was performed to test the influence of
potential effect modifiers on our results. Publication bias was assessed
by a modified Macaskill's test. Results: Seven randomized trials comparing
statins versus placebo in 23,258 subjects without CV disease were included
in a meta-analysis. Statins compared to placebo reduced the risk of MI by
39.5% (relative risk [RR]: 0.605 [95% confidence interval (CI): 0.459 to
0.797]; p=0.000), coronary revascularization by 50.3% (RR: 0.497 [95% CI:
0.326 to 0.758]; p=0.001) and stroke by 24.6% (RR: 0.754 [95% CI: 0.588 to
0.966]; p=0.026), whereas the risk of all-cause death (RR: 0.938 [95% CI:
0.851 to 1.034]; p=0.196, CV death (RR: 0.911 [95% CI: 0.681 to 1.219];
p=0.530) and new cancer onset (RR: 0.934 [95% CI: 0.776 to 1.126];
p=0.476) was not influenced by treatment. Conclusions: In elderly subjects
at high CV risk without established CV disease statins substantially
reduce the incidence CV morbidities, but do not significantly prolong
survival.

<39>
Accession Number
71257006
Authors
Jung Y. Choi M.
Institution
(Jung, Choi) National Evidence-based Healthcare Collaborating Agency,
Seoul, South Korea
Title
A systematic review of transcatheter aortic valve implantation.
Source
BMJ Quality and Safety. Conference: 10th G-I-N Conference San Francisco,
CA United States. Conference Start: 20130818 Conference End: 20130821.
Conference Publication: (var.pagings). 22 (pp A64), 2013. Date of
Publication: August 2013.
Publisher
BMJ Publishing Group
Abstract
Background Transcather Aortic Valve Implantation (TAVI) was developed as
an alternative to surgical aortic valve replacement (AVR) for patients
with severe symptomatic aortic stenosis (AS) and high or unacceptable
surgical risk. Objectives To evaluate the safety and effectiveness of TAVI
compared with AVR or standard therapy. Methods The searches were conducted
via electronic databases including MEDLINE, EMBASE and the Cochrane
Library and retrieved 1537 non-duplicate citations. Total 17 studies (2
RCT, 5 non-RCT, 10 cohort studies) were included for this review. Results
Compared with standard therapy, TAVI significantly increased major stroke
(risk ratio, 3.91; 95% CI, 1.16-13.22) in two studies, although rate of
major stroke was not significantly different in the TAVI compared with
surgical AVR. Compared with standard therapy in inoperable patients, TAVI
significantly reduced the all-cause mortality (risk ratio, 0.045, 95% CI,
0.26-0.77) at 1 year and improved functional status (NYHA functional
classification). Among high-risk patients, the mortality was not
significantly different in the TAVI compared with surgical AVR. However, a
RCT of 699 high-risk patients who were randomised to treatment either by
TAVI or by surgical AVR reported that the all-cause mortality at 1 year
was 24.2% and 26.8%, respectively and TAVI was non-inferior to surgical
AVR (p = 0.44). Conclusion On the basis of current data, we recommend that
TAVI is possible treatments as an alternative to surgical AVR for patients
with AS who are considered to be inoperable or high risk for surgical AVR.