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<1>
Accession Number
2013287097
Authors
Dogra J.
Institution
(Dogra) Poly Clinic, Central Government Health Scheme, Jaipur, Rajasthan,
India
Title
Oral azithromycin in extended dosage schedule for chronic, subclinical
Chlamydia pneumoniae infection causing coronary artery disease: A probable
cure in sight? Results of a controlled preliminary trial.
Source
International Journal of General Medicine. 5 (pp 505-509), 2012. Date of
Publication: 2012.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Purpose: Two mega trials have raised the question as to whether the
hypothesis that infection plays a role in atherosclerosis is still
relevant. This controlled preliminary trial investigated an extended dose
of azithromycin in the treatment of Chlamydia pneumoniae infection causing
coronary artery disease (CAD). Patients and methods: Forty patients with
documentary evidence of CAD were screened for immunoglobulin G titers
against C. pneumoniae and grouped into either the study group (patients
with positive titer, n = 32) or control group (patients with negative
titer, n = 8). Cases who met inclusion criteria could not have had
coronary artery bypass graft surgery or percutaneous coronary intervention
in the preceding 6 months. Informed consent was obtained from every
patient. Baseline blood samples were analyzed for red blood cell indices,
serum creatinine, and liver function tests, and repeated every 2 months. A
primary event was defined as the first occurrence of death by any cause,
recurrent myocardial infarction, coronary revascularization procedure, or
hospitalization for angina. Patients in the study group received 500 mg of
oral azithromycin once daily for 5 days, which was then repeated after a
gap of 10 days (total of 24 courses in the 1-year trial period). The
control group did not have azithromycin added to their standard CAD
treatment. Results: In the study group, 30 patients completed the trial.
Two patients had to undergo percutaneous coronary intervention in the
initial first quarter of the 1-year trial period. In the control group,
one patient died during the trial, one had to undergo coronary artery
bypass graft surgery, and one had percutaneous coronary intervention.
Conclusion: The patients tolerated the therapy well and there was a
positive correlation between azithromycin and secondary prevention of CAD.
2012 Dogra, publisher and licensee Dove Medical Press Ltd.

<2>
Accession Number
2013122763
Authors
Vrtovec B. Sever M. Domanovic D. Lezaic L. Poglajen G. Cernelc P. Haddad
F. Torre-Amione G.
Institution
(Vrtovec, Poglajen) Advanced Heart Failure and Transplantation Center, UMC
Ljubljana, Slovenia
(Sever, Cernelc) Department of Hematology, UMC Ljubljana, Slovenia
(Domanovic) National Blood Transfusion Institute, Ljubljana, Slovenia
(Lezaic) Department of Nuclear Medicine, UMC Ljubljana, Slovenia
(Haddad) Stanford University School of Medicine, Stanford, CA, United
States
(Torre-Amione) Methodist DeBakey Heart Center, Houston, TX, United States
Title
Long-term effects of stem cell transplantation in heart failure.
Source
Zdravniski Vestnik. 81 (SUPPL.2) (pp 373-383), 2012. Date of Publication:
2012.
Publisher
Slovene Medical Society (Dalmatinova 10, Ljubljana 1001, Slovenia)
Abstract
Background: We investigated long-term effects of intracoronary
transplantation of CD₃₄+ cells in patients with dilated
cardiomyopathy (DCM). Methods: Of 110 DCM patients, 55 were randomized to
CD₃₄+ cell transplantation (SC) group, and 55 patients received
no cell therapy (controls). In the SC group, peripheral
CD₃₄+cells were mobilized by G-CSF and collected via apheresis.
Patients underwent myocardial scintigraphy and CD₃₄+ cells were
injected in the artery supplying the segments with reduced viability.
Patients were followed for 5 years. Results: At baseline, the 2 groups did
not differ in age, gender, left ventricular ejection fraction (LVEF), or
NT-proBNP levels. At 5 years, stem cell therapy was associated with an
increase in LVEF (from 24.3 + 6.5 % to 30.0 + 5.1 %; P = 0.02), an
increase in 6-minute walk distance (from 344 + 90 m to 477 + 130 m; P <
0.001), and a decrease in NT-proBNP (from 2322 + 1234 pg/mL to 1011 + 893
pg/mL; P < 0.01). During followup, 27 (25 %) patients died and 9 (8 %)
underwent heart transplantation. Of the 27 deaths, 13 were attributed to
pump failure, and 14 to sudden cardiac death. Total mortality was lower in
SC group (8/55 [14 %]) than in controls (19/55 [35 %]) (P = 0.01). The
same was true of pump failure (3/55 [5 %] vs. 10/55 [18 %], P = 0.03), but
not of sudden cardiac death (5/55 [9 %] vs. 9/55 [16 %], P = 0.39). SC
therapy was an independent predictor of outcome on multivariable analysis
(P = 0.04). Conclusions: Intracoronary stem cell transplantation may be
associated with improved ventricular remodeling, exercise tolerance, and
longterm survival in patients with DCM.

<3>
Accession Number
2013578520
Authors
Lodi-Junqueira L. de Sousa M.R. da Paixao L.C. Kelles S.M.B. Amaral C.F.S.
Ribeiro A.L.
Institution
(Lodi-Junqueira, de Sousa, da Paixao, Kelles, Amaral, Ribeiro) Instituto
de Avaliacao de Tecnologias em Saude (IATS), Do Hospital das Clinicas da
Universidade Federal de Minas Gerais (UFMG), Avenida Alfredo Balena, 110,
CEP, 30130-100, Belo Horizonte, MG, Brazil
(Lodi-Junqueira) Setor de Hemodinamica do Hospital das Clinicas da UFMG,
Avenida Alfredo Balena, 110, CEP, 30130-100, Belo Horizonte, MG, Brazil
(de Sousa, Amaral, Ribeiro) Departamento de Clinica Medica, Faculdade de
Medicina da UFMG, Avenida Alfredo Balena, 190, CEP, 30130-100, Belo
Horizonte, MG, Brazil
Title
Does intravascular ultrasound provide clinical benefits for percutaneous
coronary intervention with bare-metal stent implantation? A meta-analysis
of randomized controlled trials.
Source
Systematic Reviews. 1 (1) , 2012. Article Number: 42. Date of Publication:
21 Sep 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: The role of intravascular ultrasound (IVUS) in percutaneous
coronary interventions (PCI) is still controversial despite several
previously published meta-analyses. A meta-analysis to evaluate the
controversial role of IVUS-guided PCI with bare-metal stenting was
performed and a previous published meta-analysis was re-evaluated in order
to clarify the discrepancy between results of these studies.Methods: A
systematic review was performed by an electronic search of the PubMed,
Embase and Web of Knowledge databases and by a manual search of reference
lists for randomized controlled trials published until April 2011, with
clinical outcomes and, at least, six months of clinical follow-up. A
meta-analysis based on the intention to treat was performed with the
selected studies.Results: Five studies and 1,754 patients were included.
There were no differences in death (OR = 1.86; 95% CI = 0.88-3.95; p =
0.10), non-fatal myocardial infarction (OR = 0.65; 95% CI = 0.27-1.58; p =
0.35) and major adverse cardiac events (OR = 0.74; 95% CI = 0.49-1.13; p =
0.16). An analysis of the previous published meta-analysis strongly
suggested the presence of publication bias.Conclusions: There is no
evidence to recommend routine IVUS-guided PCI with bare-metal stent
implantation. This may be explained by the paucity and heterogeneity of
the studies published so far. 2012 Lodi-Junqueira et al.; licensee BioMed
Central Ltd.

<4>
Accession Number
2013578497
Authors
Mans C.M. Reeve J.C. Gasparini C.A. Elkins M.R.
Institution
(Mans) Physiotherapy Department, Waikato Hospital, Waikato District Health
Board, Hamilton, New Zealand
(Reeve) Division of Rehabilitation and Occupation Studies, Faculty of
Health and Environmental Studies, AUT University, Auckland, New Zealand
(Gasparini) Disability Service, Student Support Services, University of
Western Sydney, Sydney, Australia
(Elkins) Centre for Evidence-Based Physiotherapy, George Institute for
Global Health, Sydney, Australia
Title
Postoperative outcomes following preoperative inspiratory muscle training
in patients undergoing open cardiothoracic or upper abdominal surgery:
Protocol for a systematic review.
Source
Systematic Reviews. 1 (1) , 2012. Article Number: 63. Date of Publication:
18 Dec 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: In patients undergoing open cardiothoracic and upper abdominal
surgery, postoperative pulmonary complications remain an important cause
of postoperative morbidity and mortality, impacting upon hospital length
of stay and health care resources. Adequate preoperative respiratory
muscle strength may help protect against the development of postoperative
pulmonary complications and therefore preoperative inspiratory muscle
training has been suggested to be of potential value in improving
postoperative outcomes.Methods/Design: A systematic search of electronic
databases will be undertaken to identify randomized trials of preoperative
inspiratory muscle training in patients undergoing elective open
cardiothoracic and upper abdominal surgery. From these trials, we will
extract available data for a list of predefined outcomes, including
postoperative pulmonary complications, hospital length of stay and
respiratory muscle strength. We will meta-analyze comparable results where
possible, and report a summary of the available pool of
evidence.Discussion: This review will provide the most comprehensive
answer available to the question of whether preoperative inspiratory
muscle training is clinically useful in improving postoperative outcomes
in patients undergoing cardiothoracic and upper abdominal surgery. It will
help inform clinicians working in the surgical arena of the likely
effectiveness of instituting preoperative inspiratory muscle training
programs to improve postoperative outcomes. 2012 Mans et al.; licensee
BioMed Central Ltd.

<5>
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Accession Number
2013102178
Authors
Kotwal S. Jun M. Sullivan D. Perkovic V. Neal B.
Institution
(Kotwal, Jun, Perkovic, Neal) George Institute for Global Health,
University of Sydney, PO Box M201, Sydney, NSW 2050, Australia
(Sullivan) University of Sydney, Sydney, Australia
Title
Omega 3 fatty acids and cardiovascular outcomes: Systematic review and
meta-analysis.
Source
Circulation: Cardiovascular Quality and Outcomes. 5 (6) (pp 808-818),
2012. Date of Publication: November 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Early trials evaluating the effect of omega 3 fatty acids (?-3
FA) reported benefits for mortality and cardiovascular events but recent
larger studies trials have variable findings. We assessed the effects of
?-3 FA on cardiovascular and other important clinical outcomes. Methods
and Results-We searched MEDLINE, EMBASE, and the Cochrane Central Register
of Controlled Trials for all randomized studies using dietary supplements,
dietary interventions, or both. The primary outcome was a composite of
cardiovascular events (mostly myocardial infarction, stroke, and
cardiovascular death). Secondary outcomes were arrhythmia, cerebrovascular
events, hemorrhagic stroke, ischemic stroke, coronary revascularization,
heart failure, total mortality, nonvascular mortality, and end-stage
kidney disease. Twenty studies including 63 030 participants were
included. There was no overall effect of ?-3 FA on composite
cardiovascular events (relative risk [RR]=0.96; 95% confidence interval
[CI], 0.90-1.03; P=0.24) or on total mortality (RR=0.95; 95% CI,
0.86-1.04; P=0.28). ?-3 FA did protect against vascular death (RR=0.86;
95% CI, 0.75-0.99; P=0.03) but not coronary events (RR=0.86; 95% CI,
0.67-1.11; P=0.24). There was no effect on arrhythmia (RR=0.99; 95% CI,
0.85-1.16; P=0.92) or cerebrovascular events (RR=1.03; 95% CI, 0.92-1.16;
P=0.59). Adverse events were more common in the treatment group than the
placebo group (RR=1.18, 95% CI, 1.02-1.37; P=0.03), predominantly because
of an excess of gastrointestinal side effects. Conclusions-?-3 FA may
protect against vascular disease, but the evidence is not clear-cut, and
any benefits are almost certainly not as great as previously believed.
2012 American Heart Association, Inc.

<6>
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Accession Number
2013102175
Authors
Pettit S.J. Jhund P.S. Hawkins N.M. Gardner R.S. Haj-Yahia S. McMurray
J.J.V. Petrie M.C.
Institution
(Pettit, Gardner, Haj-Yahia, Petrie) Scottish National Advanced Heart
Failure Service, Golden Jubilee National Hospital, Agamemnon St,
Clydebank, Glasgow, G81 4DY, United Kingdom
(Jhund, McMurray) Institute of Cardiovascular and Medical Sciences, BHF
Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow,
United Kingdom
(Hawkins) Institute of Cardiovascular Medicine and Science, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
Title
How small is too small? A systematic review of center volume and outcome
after cardiac transplantation.
Source
Circulation: Cardiovascular Quality and Outcomes. 5 (6) (pp 783-790),
2012. Date of Publication: November 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-The aim of this study was to assess the relationship between
the volume of cardiac transplantation procedures performed in a center and
the outcome after cardiac transplantation. Methods and Results-PubMed,
Embase, and the Cochrane library were searched for articles on the
volume-outcome relationship in cardiac transplantation. Ten studies were
identified, and all adopted a different approach to data analysis and
varied in adjustment for baseline characteristics. The number of patients
in each study ranged from 798 to 14 401, and observed 1-year mortality
ranged from 12.6% to 34%. There was no association between the continuous
variables of center volume and observed mortality. There was a weak
association between the continuous variables of center volume and adjusted
mortality up to 1 year and a stronger association at 5 years. When centers
were grouped in volume categories, low-volume centers had the highest
adjusted mortality, intermediate-volume centers had lower adjusted
mortality, and high-volume centers had the lowest adjusted mortality but
were not significantly better than intermediate-volume centers. Category
limits were arbitrary and varied between studies. Conclusions-There is a
relationship between center volume and mortality in heart transplantation.
The existence of a minimum acceptable center volume or threshold is
unproven. However, a level of 10 to 12 heart transplants per year
corresponds to the upper limit of low-volume categories that may have
relatively higher mortality. It is not known whether outcomes for patients
treated in low-volume transplant centers would be improved by reorganizing
centers to ensure volumes in excess of 10 to 12 heart transplants per
year. 2012 American Heart Association, Inc.

<7>
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Accession Number
2013102171
Authors
Schneider R.H. Grim C.E. Rainforth M.V. Kotchen T. Nidich S.I.
Gaylord-King C. Salerno J.W. Kotchen J.M. Alexander C.N.
Institution
(Schneider, Rainforth, Nidich, Gaylord-King, Salerno, Alexander) Institute
for Natural Medicine and Prevention, Maharishi University of Management,
Fairfield, IA 52556, United States
(Schneider, Rainforth, Nidich, Gaylord-King, Salerno) Center for Natural
Medicine and Prevention, Maharishi University of Management Research
Institute, Maharishi Vedic City, IA, United States
(Grim, Kotchen, Kotchen) Department of Medicine, Medical College of
Wisconsin, Milwaukee, WI, United States
Title
Stress reduction in the secondary prevention of cardiovascular disease:
Randomized, controlled trial of transcendental meditation and health
education in blacks.
Source
Circulation: Cardiovascular Quality and Outcomes. 5 (6) (pp 750-758),
2012. Date of Publication: November 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Blacks have disproportionately high rates of cardiovascular
disease. Psychosocial stress may contribute to this disparity. Previous
trials on stress reduction with the Transcendental Meditation (TM) program
have reported improvements in cardiovascular disease risk factors,
surrogate end points, and mortality in blacks and other populations.
Methods and Results-This was a randomized, controlled trial of 201 black
men and women with coronary heart disease who were randomized to the TM
program or health education. The primary end point was the composite of
all-cause mortality, myocardial infarction, or stroke. Secondary end
points included the composite of cardiovascular mortality,
revascularizations, and cardiovascular hospitalizations; blood pressure;
psychosocial stress factors; and lifestyle behaviors. During an average
follow-up of 5.4 years, there was a 48% risk reduction in the primary end
point in the TM group (hazard ratio, 0.52; 95% confidence interval,
0.29-0.92; P=0.025). The TM group also showed a 24% risk reduction in the
secondary end point (hazard ratio, 0.76; 95% confidence interval,
0.51-0.1.13; P=0.17). There were reductions of 4.9 mm Hg in systolic blood
pressure (95% confidence interval -8.3 to -1.5 mm Hg; P=0.01) and anger
expression (P<0.05 for all scales). Adherence was associated with
survival. Conclusions-A selected mind-body intervention, the TM program,
significantly reduced risk for mortality, myocardial infarction, and
stroke in coronary heart disease patients. These changes were associated
with lower blood pressure and psychosocial stress factors. Therefore, this
practice may be clinically useful in the secondary prevention of
cardiovascular disease. 2012 American Heart Association, Inc.

<8>
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Accession Number
2012462000
Authors
Lambert-Kerzner A. Del Giacco E.J. Fahdi I.E. Bryson C.L. Melnyk S.D.
Bosworth H.B. Davis R. Mun H. Weaver J. Barnett C. Radcliff T. Hubbard A.
Bosket K.D. Carey E. Virchow A. Mihalko-Corbitt R. Kaufman A.
Marchant-Miros K. Ho P.M.
Institution
(Lambert-Kerzner, Davis, Radcliff, Carey, Virchow, Ho) Denver VA Medical
Center, Cardiology 111B, 1055 Clermont St., Denver, CO 80220, United
States
(Del Giacco, Fahdi, Weaver, Barnett, Hubbard, Mihalko-Corbitt,
Marchant-Miros) Little Rock VA Medical Center, Little Rock, AR, United
States
(Bryson, Mun, Bosket) Puget Sound VA Medical Center, Seattle, WA, United
States
(Melnyk, Bosworth, Kaufman) Durham VA Medical Center, Durham, NC, United
States
Title
Patient-centered adherence intervention after acute coronary syndrome
hospitalization.
Source
Circulation: Cardiovascular Quality and Outcomes. 5 (4) (pp 571-576),
2012. Date of Publication: July 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Adherence to cardioprotective medications in the year after
acute coronary syndrome hospitalization is generally poor and is
associated with increased risk of rehospitalization and mortality. Few
interventions have specifically targeted this high-risk patient population
to improve medication adherence. We hypothesize that a multifaceted
patientcentered intervention could improve adherence to cardioprotective
medications. Methods and Results-To evaluate this intervention, we propose
enrolling 280 patients with a recent acute coronary syndrome event into a
multicenter randomized, controlled trial. The intervention comprises4 main
components: (1) pharmacist-led medication reconciliation and tailoring;
(2) patient education; (3) collaborative care between pharmacist and
primary care provider/cardiologist; and (4) 2 types of voice messaging
(educational and medication refill reminder calls). Patients in the
intervention arm will visit with the study pharmacist 1 week post-hospital
discharge. The pharmacist will work with the patient and collaborate with
providers to reconcile medication issues. Voice messages will augment the
educational process and remind patients to refill their cardioprotective
medications. The study will compare the intervention versus usual care for
12 months. The primary outcome of interest is adherence using the ReComp
method. Secondary and tertiary outcomes include achievement of targets for
blood pressure and low-density lipoprotein, and reduction in the combined
cardiovascular end points of myocardial infarction hospitalization,
coronary revascularization, and all-cause mortality. Finally, we will also
evaluate the cost-effectiveness of the intervention compared with usual
care. Conclusions-If the intervention is effective in improving medication
adherence and demonstrating a lower cost, the intervention has the
potential to improve cardiovascular outcomes in this high-risk patient
population. 2012 American Heart Association, Inc.

<9>
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Accession Number
2012461956
Authors
Arnold S.V. Magnuson E.A. Wang K. Serruys P.W. Kappetein A.P. Mohr F.W.
Cohen D.J.
Institution
(Arnold, Magnuson, Wang, Cohen) St. Luke's Mid America Heart Institute,
University of Missouri, Kansas City School of Medicine, 4401 Wornall Rd,
Kansas City, MO 64111, United States
(Serruys, Kappetein) Erasmus University Medical Center Rotterdam,
Rotterdam, Netherlands
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
Title
Do differences in repeat revascularization explain the antianginal
benefits of bypass surgery versus percutaneous coronary intervention?
Implications for future treatment comparisons.
Source
Circulation: Cardiovascular Quality and Outcomes. 5 (3) (pp 267-275),
2012. Date of Publication: May 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Patients with multivessel coronary disease treated with
coronary artery bypass graft (CABG) have less angina than those treated
with percutaneous coronary intervention (PCI); however, there is
uncertainty as to the mechanism of greater angina relief with CABG and
whether more frequent repeat revascularization in patients treated with
PCI could account for this treatment difference. Methods and Results-In
the Synergy between percutaneous coronary intervention (PCI) with TAXUS
and Cardiac Surgery trial, 1800 patients with 3-vessel or left main
coronary artery disease were randomized to CABG or PCI with
paclitaxel-eluting stents. Health status was assessed at baseline, 1, 6,
and 12 months, using the Seattle Angina Questionnaire and the Medical
Outcomes Study Short Form General Health Survey, and the association
between repeat revascularization and health status during follow-up was
assessed using longitudinal models. In adjusted analyses, patients who
underwent repeat revascularization had worse angina frequency scores than
patients who did not in both treatment groups, with differences of 8.5
points at 6 months and 3.1 points at 12 months in patients treated with
PCI and 19.8 points at 6 months and 11.2 points at 12 months in patients
with patients treated with CABG. Among patients who did not require repeat
revascularization, the adjusted effect of CABG versus PCI on 12-month
angina frequency scores was nearly identical to the overall benefit in the
intention-to-treat analysis. Conclusions-Among patients with multivessel
coronary artery disease treated with PCI or CABG, the occurrence of repeat
revascularization during follow-up did not fully explain the antianginal
benefit of CABG in the overall population. The differential association
between repeat revascularization and anginal status, according to the type
of initial revascularization procedure, suggests that this end point
should play a limited role in any direct comparison of the 2 treatment
strategies. 2012 American Heart Association, Inc.

<10>
Accession Number
2012453140
Authors
Benyamin R.M. Wang V. Vallejo R. Singh V. Helm S.
Institution
(Benyamin, Vallejo) Millennium Pain Center, Bloomington, IL, United States
(Benyamin, Vallejo) University of Illinois, Urbana-Champaign, IL, United
States
(Wang) University of Illinois School of Medicine, Urbana, IL, United
States
(Vallejo) Illinois State University, United States
(Singh) Illinois State University, Normal, IL, United States
(Helm) The Helm Center for Pain Management, Laguna Hills, CA, United
States
Title
A systematic evaluation of thoracic interlaminar epidural injections.
Source
Pain Physician. 15 (4) (pp E497-E514), 2012. Date of Publication:
July/August 2012.
Publisher
American Society of Interventional Pain Physicians (Pain Physicians, 81
Lakeview Drive, Paducah KY 42001, United States)
Abstract
Background: There is a paucity of literature on the use of epidural
injections for the treatment of chronic mid and upper back pain due to
disc herniation and radiculitis, axial or discogenic pain, spinal
stenosis, post surgery syndrome, and post thoracotomy pain syndrome. Study
Design: A systematic review of therapeutic thoracic epidural injection
therapy for chronic mid and upper back pain. Objective: The objective of
this systematic review is to determine the effects of thoracic
interlaminar epidural injections with or without steroids, with or without
fluoroscopy, and for various conditions including disc herniation and
radiculitis, axial or discogenic pain, spinal stenosis, post thoracic
surgery syndrome, and post thoracotomy pain syndrome. Methods: The
available literature on thoracic interlaminar epidural injections with or
without steroids in managing various types of chronic mid and upper back
pain was reviewed. The quality assessment and clinical relevance criteria
utilized were the Cochrane Musculoskeletal Review Group criteria as
utilized for interventional techniques for randomized trials and the
criteria developed by the Newcastle-Ottawa Scale criteria for
observational studies. The level of evidence was classified as good, fair,
or limited (or poor) based on the quality of evidence developed by the
U.S. Preventive Services Task Force (USPSTF). Data sources included
relevant literature identified through searches of PubMed and EMBASE from
1966 to March 2012, and manual searches of the bibliographies of known
primary and review articles. Outcome Measures: The primary outcome measure
was pain relief (short-term relief = up to 6 months and long-term > 6
months). Secondary outcome measures were improvement in functional status,
psychological status, return to work, and reduction in opioid intake.
Results: For this review, 17 studies were identified, including studies
examining adverse reactions. Only 2 studies were included: one randomized
trial and one non-randomized or observational study. The results of this
systematic review evaluating the effectiveness of thoracic epidural
injections with or without steroids in managing chronic thoracic pain
shows fair evidence with one randomized trial in patients with various
causes; whereas the evidence is limited based on one non-randomized study
evaluating chronic pain in post thoracotomy syndrome. Limitations: The
limitations of this study include paucity of evidence. Conclusion: The
evidence based on this systematic review for thoracic epidural injection
in treating chronic thoracic pain is considered fair and limited for post
thoracotomy pain.

<11>
Accession Number
2012343313
Authors
Jovanovic M.M. Krstic A.Z. Stanojevic G. Stojanovic M. Smiljkovic I.D.
Damnjanovic Z.
Institution
(Jovanovic, Stanojevic, Stojanovic) Medical Faculty of Nis, Serbia
(Jovanovic, Smiljkovic, Damnjanovic) Vascular Surgery Clinic, Clinical
Centre of Nis, Serbia
(Krstic) Clinic for gastroenterology, Clinical Centre Serbia, Belgrade,
Serbia
(Stanojevic, Stojanovic) General Surgery Clinic, Clinical Centre of Nis,
Serbia
Title
Early detection of postoperative deep vein thrombosis after general
surgical procedures.
Source
HealthMED. 6 (3) (pp 1023-1032), 2012. Date of Publication: 2012.
Publisher
Drunpp-Sarajevo (Bolnicka bb, Sarajevo 71000, Bosnia and Herzegovina)
Abstract
Background: Diagnostic algorithm in patients with suspected deep vein
thrombosis (DVT) is well established: repeated ultrasound examinations,
ultrasound examination combined with determination of D-dimer (DD) serum
level, and evaluation of clinical probability of DVT combined with
ultrasound examination and/or D-dimer serum level estimation. Methods: We
have performed a prospective, randomized clinical study, evaluating 4802
operated patients with suspected DVT at University Surgical Clinic Nis,
during the period from 01.01.2003 to 31.12.2004. Patients were randomized
into two groups: DD and control group. Stratification of clinical
probability for DVT ("unlikely" and "likely") was performed using Wells's
clinical model. Results: Normal serum levels of DD excluded the presence
of DVT in 1156 (68.9%) patients with <<unlikely>> DVT and in 53.4% (1679)
of all patients in DD group regardless of the clinical probability.
Negative values of DD also excluded DVT in 47.3% (193/408) of patients
with <<likely>> DVT, who had the negative first US examination. DVT was
definitely ruled out in 1990 patients in DD group and in 1943 patients in
control group. During the three months follow up period venous
thromboembolism (VTE) was registered in 10 patients (0.51%;
95%CI=0.19-0.83%) in the control group and in 3 patients (0.15%; 95%CI=
0.0-0.4%) in the DD group (chi2=3.95; p=0.047; p<0.05, 95% CI=0.01- 0.7%).
The DD diagnostic strategy reduced the need for US examination by 68%.
Conclusion: Proposed strategy significantly raises accuracy and
reliability of early detection of postoperative DVT in patients undergoing
general surgical procedures.

<12>
Accession Number
2012273544
Authors
Garg A.X. Devereaux P.J. Yusuf S. Cuerden M.S. Parikh C.R. Coca S.G. Walsh
M. Cook R.J. Whitlock R.P. Noiseux N. Novick R.J. Ou Y. Lamy A.
Institution
(Garg, Cuerden) Division of Nephrology, Department of Medicine, Western
University, London, ON, Canada
(Garg) Department of Epidemiology and Biostatistics, Western University,
London, ON, Canada
(Garg, Devereaux, Yusuf, Walsh, Whitlock, Lamy) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
(Devereaux, Yusuf, Walsh, Whitlock, Ou, Lamy) Population Health Research
Institute, Hamilton, ON, Canada
(Cuerden, Cook) Department of Statistics and Actuarial Science, University
of Waterloo, Waterloo, ON, Canada
(Parikh, Coca) Section of Nephrology, Yale University School of Medicine,
New Haven, United States
(Whitlock, Lamy) Division of Cardiac Surgery, McMaster University,
Hamilton, ON, Canada
(Noiseux) Department of Cardiac Surgery, Universite de Montreal, Montreal,
QC, Canada
(Novick) Division of Cardiac Surgery, Western University, London, ON,
Canada
Title
Coronary Artery Bypass Grafting Surgery Off- or On-pump Revascularisation
Study (CORONARY): Kidney substudy analytic protocol of an international
randomised controlled trial.
Source
BMJ Open. 2 (2) , 2012. Article Number: e001080. Date of Publication:
2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Introduction: CORONARY is a large international randomised controlled
trial comparing coronary artery bypass graft (CABG) surgery done with and
without a bypass pump. Compared with on-pump, off-pump surgery may prevent
acute kidney injury (AKI) in the short term and may better preserve kidney
function 1 year following surgery. Secondary analyses may also clarify
whether effects are similar in patients with and without pre-operative
chronic kidney disease and whether AKI avoidance mediates preserved 1-year
kidney function. Methods and analysis: With respect to the study schedule,
the last of 4752 patients from 79 sites in 19 countries were randomised in
November 2011 to cardiac surgery performed with an on-pump or off-pump
procedure. The authors will use regression models to compare the groups in
the outcome of peri-operative AKI (per cent change in serum creatinine,
>50% increase in serum creatinine) and 1-year kidney function (per cent
change in estimated glomerular filtration rate (eGFR), >20% eGFR loss 1
year after surgery). The authors will use interaction terms in regression
models to determine if there is a differential impact of the intervention
in those with and without pre-existing chronic kidney disease. The authors
will use regression-based tests to determine the proportion of the total
effect of surgery type (off-pump vs on-pump CABG) on 1-year eGFR that is
mediated by peri-operative AKI. Ethics and dissemination: In the year
2009, the authors were competitively awarded a grant from the Canadian
Institutes of Health Research to answer these kidney questions in
CORONARY. Ethics approval was obtained for additional renal data
collection in centres that agreed to study participation (>90% of
participating centres). This collection began for patients enrolled after
1 January 2010. Remaining 1-year renal outcome data will be collected
throughout 2012. Results will be reported in 2013. Clinical trial
registration number: NCT 00463294.

<13>
Accession Number
2012661383
Authors
Hammoudeh A. Saleh A. Hamam I. Alhaddad I. Bakri M. Nammas A. Alnaquib A.
Izraiq M. Tarawneh H. Harassis A. Tabbalat R. Khader Y. Al-Mousa E.
Institution
(Hammoudeh, Izraiq, Al-Mousa) Cardiology Department, Istishari Hospital,
Amman, Jordan
(Saleh, Hamam) Cardiology Division, Internal Medicine Department, Jordan
University Hospital, Amman, Jordan
(Alhaddad, Bakri) Cardiology Department, Jordan Hospital Medical Center,
Amman, Jordan
(Nammas, Alnaquib) Cardiology Division, Internal Medicine Department,
Islamic Hospital, Amman, Jordan
(Tarawneh, Harassis, Tabbalat) Cardiology Department, Khalidi Hospital
Medical Center, Amman, Jordan
(Khader) Department of Community Medicine, Public Health and Family
Medicine, School of Medicine Jordan University of Science and Technology,
Irbid, Jordan
Title
The prognostic implications of TIMI risk scores in Jordanian patients with
acute coronary syndrome. Results from the glucometabolic abnormalities in
acute coronary syndrome in Jordan (GLORY) study.
Source
Jordan Medical Journal. 46 (3) (pp 237-245), 2012. Date of Publication:
September 2012.
Publisher
University of Jordan (Amman 11942, Jordan)
Abstract
Background and Aims: Western studies have shown that TIMI (Thrombolysis In
Myocardial Infarction) risk scores predict adverse events in patients with
non ST-elevation acute coronary syndrome (NSTEACS) and ST-elevation
myocardial infarction (STEMI). Whether this also applies to Jordanian
patients is largely unknown. Materials and Methods: We prospectively
followed up 656 patients with ACS for total mortality, combined events of
death, nonfatal MI or urgent coronary revascularization up to one year
after admission. Results: Of the whole group, 472 patients (72%) had
NSTEACS, and 184 patients (28%) had STEMI. Among NSTEACS patients, 31.0%
had a low risk score (total points 0-2 of 7), 43.5% had an intermediate
risk score (total points 3-4), and 25.5% had a high risk score (total
points 5-7). In-hospital mortality was not different in the respective
risk score groups (1.4%, 0.5%, and 3.4%, p = 0.123). At 1 year, mortality
was significantly higher in the high risk score group (12.8%) compared
with the intermediate (4%) and low (1.4%) risk groups (p = 0.001). Among
STEMI patients, 58.6% had a low risk score (total points 0-3 of 13-14),
31.0% had a low intermediate risk score (total points 4-6), 8.0% had a
high intermediate score (total points 7-9), and 2.4% had a high risk score
(total points > 10). In-hospital mortality rate was significantly higher
in the two intermediate risk score groups (7.4%, 14.3%, respectively) and
the high risk score group (50%) compared with the low risk score group
(1.0%, p = 0.001). The high risk and the two intermediate risk groups also
had higher one-year mortality (75%, 28.6% and 16.7%, respectively) than
the low risk group (3.9%, p = 0.001). Similarly, composite events occurred
at a significantly higher rate in patients with high risk scores than
intermediate or low risk scores among NSTEACS and STEMI patients.
Conclusions: In Jordanian ACS patients, high TIMI risk scores were
associated with a high risk of cardiovascular events. Such patients are
candidates for early aggressive therapeutic strategies. 2012 DAR
Publishers/University of Jordan. All Rights Reserved.

<14>
Accession Number
2012050720
Authors
Tricoci P. Huang Z. Held C. Moliterno D.J. Armstrong P.W. Van De Werf F.
White H.D. Aylward P.E. Wallentin L. Chen E. Lokhnygina Y. Pei J. Leonardi
S. Rorick T.L. Kilian A.M. Jennings L.H.K. Ambrosio G. Bode C. Cequier A.
Cornel J.H. Diaz R. Erkan A. Huber K. Hudson M.P. Jiang L. Jukema J.W.
Lewis B.S. Lincoff A.M. Montalescot G. Nicolau J.C. Ogawa H. Pfisterer M.
Prieto J.C. Ruzyllo W. Sinnaeve P.R. Storey R.F. Valgimigli M. Whellan
D.J. Widimsky P. Strony J. Harrington R.A. Mahaffey K.W.
Institution
(Tricoci, Huang, Lokhnygina, Leonardi, Rorick, Harrington, Mahaffey) Duke
Clinical Research Institute, Duke University Medical Center, Durham, NC,
United States
(Held, Wallentin) Department of Medical Sciences, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Moliterno) University of Kentucky, Lexington, United States
(Armstrong) Canadian Virtual Coordinating Center for Global Collaborative
Cardiovascular Research, University of Alberta, Edmonton, Canada
(Van De Werf, Sinnaeve) University Hospital Gasthuisberg, Leuven
Coordinating Center, Leuven, Belgium
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Aylward) Flinders Medical Centre, Bedford Park, SA, Australia
(Chen, Pei, Kilian, Strony) Merck, Whitehouse Station, NJ, United States
(Jennings) CirQuest Labs., Department of Medicine, University of
Tennessee, Memphis, TN, United States
(Ambrosio) University of Perugia School of Medicine, Perugia, Italy
(Bode) Department of Internal Medicine III-Cardiology and Angiology,
University Hospital, Freiburg, Germany
(Cequier) Hospital Universitari de Bellvitge, Universitat de Barcelona,
Barcelona, Spain
(Cornel) Medisch Centrum Alkmaar, Alkmaar, Netherlands
(Diaz) Estudios Clinicos Latino America, Rosario, Argentina
(Erkan) Department of Cardiology, Ufuk University, Ankara, Turkey
(Huber) Department of Medicine, Cardiology, and Emergency Medicine,
Wilhelminen Hospital, Vienna, Austria
(Hudson) Henry Ford Hospital, Detroit, United States
(Jiang) Cardiovascular Institute and Fuwai Hospital, Chinese Academy of
Medical Sciences, Peking Union Medical College, Beijing, China
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Lincoff) Cleveland Clinic Coordinating Center for Clinical Research,
Cleveland, United States
(Montalescot) Institut de Cardiologie, Hopital Pitie-Salpetriere, Paris,
France
(Nicolau) Unidade de Coronariopatia Aguda, Faculdade de Medicina,
Universidade de Sao Paulo, Sao Paulo, Brazil
(Ogawa) Department of Cardiovascular Medicine, Kumamoto University
Graduate School of Medical Sciences, Kumamoto City, Japan
(Pfisterer) Division of Cardiology, University Hospital Basel, Basel,
Switzerland
(Prieto) Cardiovascular Department, Clinical Hospital, University of
Chile, Santiago, Chile
(Ruzyllo) Department of Coronary Artery Disease, Cardiac Catheterization
Laboratory, Institute of Cardiology, Warsaw, Poland
(Storey) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
(Valgimigli) Universitaria di Ferrara, Unita Operativa di Cardiologia,
Ferrara, Italy
(Whellan) Division of Cardiology, Thomas Jefferson University,
Philadelphia, United States
(Widimsky) University Hospital Kralovske Vinohrady, Charles University,
Prague, Czech Republic
Title
Thrombin-receptor antagonist vorapaxar in acute coronary syndromes.
Source
New England Journal of Medicine. 366 (1) (pp 20-33), 2012. Date of
Publication: 05 Jan 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1)
antagonist that inhibits thrombin-induced platelet activation. METHODS: In
this multinational, double-blind, randomized trial, we compared vorapaxar
with placebo in 12,944 patients who had acute coronary syndromes without
ST-segment elevation. The primary end point was a composite of death from
cardiovascular causes, myocardial infarction, stroke, recurrent ischemia
with rehospitalization, or urgent coronary revascularization. RESULTS:
Follow-up in the trial was terminated early after a safety review. After a
median follow-up of 502 days (interquartile range, 349 to 667), the
primary end point occurred in 1031 of 6473 patients receiving vorapaxar
versus 1102 of 6471 patients receiving placebo (Kaplan-Meier 2-year rate,
18.5% vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to
1.01; P = 0.07). A composite of death from cardiovascular causes,
myocardial infarction, or stroke occurred in 822 patients in the vorapaxar
group versus 910 in the placebo group (14.7% and 16.4%, respectively;
hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P = 0.02). Rates of moderate and
severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo
group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial
hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95%
CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were
similar in the two groups. CONCLUSIONS: In patients with acute coronary
syndromes, the addition of vorapaxar to standard therapy did not
significantly reduce the primary composite end point but significantly
increased the risk of major bleeding, including intracranial hemorrhage.
(Funded by Merck; TRACER ClinicalTrials.gov number, NCT00527943.)
Copyright 2011 Massachusetts Medical Society.

<15>
Accession Number
2011598427
Authors
Dungan K. Hall C. Schuster D. Osei K.
Institution
(Dungan, Hall, Schuster, Osei) Division of Endocrinology, Diabetes and
Metabolism, The Ohio State University, Columbus, OH, United States
Title
Differential response between diabetes and stress-induced hyperglycaemia
to algorithmic use of detemir and flexible mealtime aspart among stable
postcardiac surgery patients requiring intravenous insulin.
Source
Diabetes, Obesity and Metabolism. 13 (12) (pp 1130-1135), 2011. Date of
Publication: December 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Aim: To determine whether an insulin algorithm could be used in a similar
manner in the setting of diabetes and stress hyperglycaemia following
cessation of intravenous (IV) insulin after cardiac surgery. Methods:
Subjects who were clinically stable, requiring >1 unit/h of IV insulin 48
h after surgery, were randomized to once daily detemir at 50, 65 or 80% of
IV insulin requirements and received aspart according to carbohydrate
intake. Diabetes was defined as any history of diabetes or preoperative
HbA1c 6.5%. Results: The morning glucose in patients with diabetes was 143
mg/dl (n = 61) vs. 124 mg/dl in those with stress hyperglycaemia (n = 21,
p = 0.05) on day 1 and 127 vs. 110 mg/dl over 72 h (p = 0.01). This was
unaffected by adjustment for initial dosing group. At 72 h, 56% of
patients with stress hyperglycaemia reached AM (80-130 mg/dl) and 87%
reached overall (80-180 mg/dl) glucose targets, compared to 90 and 100% of
patients with stress hyperglycaemia, respectively. There was no difference
in hypoglycaemia in patients with stress hyperglycaemia or diabetes. The
percentage of patients with diabetes receiving insulin was 46% on
admission and 77% at discharge, compared to 0 and 42% of patients with
stress hyperglycaemia. Conclusions: Following cardiac surgery, patients
with stress hyperglycaemia may be converted from IV insulin to detemir
with a 50% conversion factor, while patients with diabetes may require a
higher conversion factor. Stress hyperglycaemia may be prolonged; the
intensity and duration of insulin therapy required for optimal outcomes
warrants further examination. 2011 Blackwell Publishing Ltd.

<16>
Accession Number
2011584754
Authors
Dorresteijn J.A.N. Visseren F.L.J. Ridker P.M. Wassink A.M.J. Paynter N.P.
Steyerberg E.W. Van Der Graaf Y. Cook N.R.
Institution
(Dorresteijn, Visseren, Wassink) Department of Vascular Medicine,
University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht,
Netherlands
(Ridker, Paynter, Cook) Division of Preventive Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Steyerberg) Department of Public Health, Erasmus Medical Center,
Rotterdam, Netherlands
(Van Der Graaf) Julius Center for Health Sciences and Primary Care,
Utrecht, Netherlands
Title
Estimating treatment effects for individual patients based on the results
of randomised clinical trials.
Source
BMJ (Online). 343 (7828) , 2011. Article Number: d5888. Date of
Publication: 22 Oct 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objectives: To predict treatment effects for individual patients based on
data from randomised trials, taking rosuvastatin treatment in the primary
prevention of cardiovascular disease as an example, and to evaluate the
net benefit of making treatment decisions for individual patients based on
a predicted absolute treatment effect. Setting: As an example, data were
used from the Justification for the Use of Statins in Prevention (JUPITER)
trial, a randomised controlled trial evaluating the effect of rosuvastatin
20 mg daily versus placebo on the occurrence of cardiovascular events
(myocardial infarction, stroke, arterial revascularisation, admission to
hospital for unstable angina, or death from cardiovascular causes).
Population: 17 802 healthy men and women who had low density lipoprotein
cholesterol levels of less than 3.4 mmol/L and high sensitivity C reactive
protein levels of 2.0 mg/L or more. Methods: Data from the Justification
for the Use of Statins in Prevention trial were used to predict
rosuvastatin treatment effect for individual patients based on existing
risk scores (Framingham and Reynolds) and on a newly developed prediction
model. We compared the net benefit of prediction based rosuvastatin
treatment (selective treatment of patients whose predicted treatment
effect exceeds a decision threshold) with the net benefit of treating
either everyone or no one. Results: The median predicted 10 year absolute
risk reduction for cardiovascular events was 4.4% (interquartile range
2.6-7.0%) based on the Framingham risk score, 4.2% (2.5-7.1%) based on the
Reynolds score, and 3.9% (2.5-6.1%) based on the newly developed model
(optimal fit model). Prediction based treatment was associated with more
net benefit than treating everyone or no one, provided that the decision
threshold was between 2% and 7%, and thus that the number willing to treat
(NWT) to prevent one cardiovascular event over 10 years was between 15 and
50. Conclusions: Data from randomised trials can be used to predict
treatment effect in terms of absolute risk reduction for individual
patients, based on a newly developed model or, if available, existing risk
scores. The value of such prediction of treatment effect for medical
decision making is conditional on the NWT to prevent one outcome event.
Trial registration number: Clinicaltrials.gov NCT00239681.

<17>
[Use Link to view the full text]
Accession Number
2011576943
Authors
Tricoci P. Newby L.K. Hasselblad V. Kong D.F. Giugliano R.P. White H.D.
Theroux P. Stone G.W. Moliterno D.J. Van De Werf F. Armstrong P.W.
Prabhakaran D. Rasoul S. Bolognese L. Durand E. Braunwald E. Califf R.M.
Harrington R.A.
Institution
(Tricoci, Newby, Hasselblad, Kong, Harrington) Duke Clinical Research
Institute, PO Box 17969, Durham, NC 27715, United States
(Giugliano, Braunwald) TIMI Study Group, Brigham and Women's Hospital,
Boston, MA, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Theroux) Institute de Cardiologie de Montreal, University de Montreal,
Quebec, Canada
(Stone) New York-Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Moliterno) Gill Heart Institute, University of Kentucky, Lexington, KY,
United States
(Van De Werf) University Hospital Gasthuisberg, Leuven Coordinating
Center, Leuven, Belgium
(Armstrong) University of Alberta, Edmonton, AB, Canada
(Prabhakaran) Center for Chronic Disease Control, Safdarjung Development
Area, New Delhi, India
(Rasoul) Department of Cardiology, Isala klinieken, Zwolle, Netherlands
(Bolognese) Division of Cardiology, San Donato Hospital, Arezzo, Italy
(Durand) University Paris Descartes, Cardiology Department, European
Georges Pompidou Hospital, Paris, France
(Califf) Duke Translational Medical Institute, Durham, NC, United States
Title
Upstream use of small-molecule glycoprotein IIb/IIIa inhibitors in
patients with non-ST-segment elevation acute coronary syndromes a
systematic overview of randomized clinical trials.
Source
Circulation: Cardiovascular Quality and Outcomes. 4 (4) (pp 448-458),
2011. Date of Publication: July 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-The use of upstream small-molecule glycoprotein (GP) IIb/IIIa
inhibitors in non-ST-segment elevation acute coronary syndromes (NSTE ACS)
has been studied in multiple randomized clinical trials. We systematically
reviewed the effect of upstream GP IIb/IIIa inhibitor use in NSTE ACS as
reported in published clinical trials. Methods and Results-Randomized
clinical trials of upstream small-molecule GP IIb/IIIa inhibitors in NSTE
ACS were identified through a PubMed and EMBASE search and were included
if they contained 30-day outcome data. Odds ratios were generated from the
published data and pooled by means of random effects modeling. The primary
outcome measures were 30-day death and 30-day death or myocardial
infarction. Primary safety measures were major bleeding and transfusion
during the index hospitalization. Twelve clinical trials were included,
evaluating tirofiban, eptifibatide, and lamifiban. Of these, 7 evaluated
upstream GP IIb/IIIa inhibitors versus placebo (n=24 031) and 5 evaluated
a strategy of upstream GP IIb/IIIa inhibitors versus upstream placebo with
later provisional use at the time of percutaneous coronary intervention
(n=19 643). Overall, upstream GP IIb/IIIa inhibitor use was associated
with an 11% reduction in 30-day death/myocardial infarction (odds ratio
[OR], 0.89; 95% confidence interval [CI], 0.83 to 0.95) but no significant
mortality effect (OR, 0.93; 95% CI, 0.83 to 1.05). The risk of major
bleeding was 23% higher in patients treated with upstream GP IIb/IIIa
inhibitors (OR, 1.23; 95% CI, 1.02 to 1.48). Results were similar when
only trials comparing upstream GP IIb/IIIa inhibitors versus placebo were
considered: 30-day death/myocardial infarction (OR, 0.88; 95% CI, 0.81 to
0.95); 30-day death (OR, 0.89; 95% CI, 0.76 to 1.03); and major bleeding
(OR, 1.17; 95% CI, 0.88 to 1.54). Upstream versus selective use at
percutaneous coronary intervention trended toward lower 30-day
death/myocardial infarction (OR, 0.91; 95% CI, 0.82 to 1.01) but had no
effect on mortality (OR, 1.00; 95% CI, 0.81 to 1.23) and increased major
bleeding risk by 34% (OR, 1.34; 95% CI, 1.10 to 1.63). Conclusions-In NSTE
ACS, treatment with upstream small-molecule GP IIb/IIIa inhibitors
provides a significant but modest ischemic benefit when compared with
initial placebo. Compared with delayed, selective use at percutaneous
coronary intervention, early upstream use is associated with a trend
toward fewer ischemic events. However, these modest benefits are
associated with an increased risk of bleeding. 2011 American Heart
Association, Inc.

<18>
[Use Link to view the full text]
Accession Number
2011353577
Authors
Dhruva S.S. Bero L.A. Redberg R.F.
Institution
(Dhruva) Departments of Medicine, Clinical Pharmacy, United States
(Bero) School of Pharmacy, Institute for Health Policy Studies, United
States
(Redberg) School of Medicine, Division of Cardiology, University of
California, San Francisco, United States
(Redberg) Women's Cardiovascular Services, 505 Parnassus Ave, United
States
(Redberg) School of Medicine, Division of Cardiology, University of
California, San Francisco, San Francisco, CA 94143-0124, United States
Title
Gender bias in studies for food and drug administration premarket approval
of cardiovascular devices.
Source
Circulation: Cardiovascular Quality and Outcomes. 4 (2) (pp 165-171),
2011. Date of Publication: March 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Cardiovascular devices can have different safety and
effectiveness profiles in men and women. The type and quality of
sex-specific data reviewed by the Food and Drug Administration (FDA)
before approval of these devices are unknown. Methods and Results-We
performed A systematic review of the demographics, comments on gender
bias, and analysis of results by sex for 78 high-risk cardiovascular
devices that received premarket approval by the FDA between 2000 and 2007.
FDA summaries of evidence did not report sex of enrollees in 34 (28%) of
123 studies. For studies reporting sex distribution, the study populations
were, on average, 67% men. There was no increase in the enrollment of
women over time. Explanations for the relatively low percentage of women
often stated that the trials reflected either underlying disease
distribution or referral rates for similar procedures or that the sex
distribution reflected similar or previous trials. Forty-one percent of
studies included a gender bias comment or analysis, and 12 (26%) of 47 of
these analyses identified some difference in device safety or
effectiveness by sex. Conclusions-There is A lack of sex-specific safety
and effectiveness data for high-risk cardiovascular devices before FDA
approval. The justifications for this lack of evidence may perpetuate the
status quo. More rigorous FDA requirements for sex-specific data before
device approval could present an opportunity to improve cardiovascular
outcomes. (Circ Cardiovasc Qual Outcomes. 2011;4:165-171.). 2011 American
Heart Association, Inc.

<19>
[Use Link to view the full text]
Accession Number
2011353564
Authors
Truong Q.A. Murphy S.A. McCabe C.H. Armani A. Cannon C.P.
Institution
(Truong) Division of Cardiology, Massachusetts General Hospital, Harvard
Medical School, United States
(Murphy, McCabe, Armani, Cannon) Cardiovascular Division, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Cannon) TIMI Study Group, 350 Longwood Ave, Boston, MA 02115, United
States
Title
Benefit of intensive statin therapy in women results from PROVE IT-TIMI
22.
Source
Circulation: Cardiovascular Quality and Outcomes. 4 (3) (pp 328-336),
2011. Date of Publication: May 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: Despite the known benefit of intensive statin therapy for
reducing future cardiovascular events, its effectiveness in women has been
questioned by someMethods and Results: In the Pravastatin or Atorvastatin
Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22
(PROVE IT-TIMI 22) trial, 911 (21.9%) women and 3251 (78.1%) men were
randomized to intensive statin (atorvastatin 80 mg) versus standard
therapy (pravastatin 40 mg) therapy for a median duration of 2.1 yearsThe
primary end point was death, myocardial infarction, unstable angina;
revascularization (occurring after 30 days); or strokeSafety end points
included elevations in liver function tests, creatine kinase, and
myalgias/myositisWomen had a reduction in low-density lipoprotein (LDL) of
42.8% from baseline at 30 days (to a median of 60 mg/dL) in the intensive
therapy arm, with 88.8% reaching the LDL goal of <100 mg/dL and 65.0% of
<70 mg/dL, compared with a 16.8% reduction in LDL (to a median of 88
mg/dL) in the standard therapy armWomen receiving intensive statin therapy
had a significant 25% relative reduction over standard dose (hazard ratio,
0.75; 95% CI, 0.57 to 0.99; P=0.04) for the primary composite end point
compared with a 14% reduction for men (hazard ratio, 0.86; 95% CI, 0.75 to
0.99; P=0.04; P-interaction, 0.38)No differences were observed between
sexes for safety (all P-interaction >0.11)Conclusions: This trial provides
evidence that both women and men derived benefit from intensive statin
therapy after acute coronary syndrome, and thus, sex should not be a
factor in determining who should be treated with intensive statin therapy.
2011 American Heart Association, Inc.

<20>
Accession Number
2011348967
Authors
James S.K. Roe M.T. Cannon C.P. Cornel J.H. Horrow J. Husted S. Katus H.
Morais J. Steg G. Storey R.F. Stevens S. Wallentin L. Harrington R.A.
Institution
(James, Wallentin) Uppsala Clinical Research Center, Uppsala University,
Uppsala, Sweden
(Roe, Stevens, Harrington) Duke Clinical Research Institute, Durham, NC,
United States
(Cannon) TIMI Study Group, Brigham and Women's Hospital, Boston, MA,
United States
(Cornel) Medisch Centrum Alkmaar, Alkmaar, Netherlands
(Horrow) AstraZeneca R and D, Wilmington, DE, United States
(Husted) Department of Cardiology, Arhus University Hospital, Arhus,
Denmark
(Katus) Medizinische Klinik, Universitatsklinikum Heidelberg, Germany
(Morais) Santo Andre's Hospital, Leiria, Portugal
(Steg) INSERM U-698, Paris, France
(Steg) Universite Paris 7, Paris, France
(Steg) Hopital Bichat, AP-HP, Paris, France
(Storey) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
Title
Ticagrelor versus clopidogrel in patients with acute coronary syndromes
intended for non-invasive management: Substudy from prospective randomised
PLATelet inhibition and patient Outcomes (PLATO) trial.
Source
BMJ. 342 (7812) , 2011. Article Number: d3527. Date of Publication: 25 Jun
2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To evaluate efficacy and safety outcomes in patients in the
PLATelet inhibition and patient Outcomes (PLATO) trial who at
randomisation were planned for a non-invasive treatment strategy. Design:
Pre-specified analysis of pre-randomisation defined subgroup of
prospective randomised clinical trial. Setting: 862 centres in 43
countries. Participants: 5216 (28%) of 18 624 patients admitted to
hospital for acute coronary syndrome who were specified as planned for
non-invasive management. Interventions: Randomised treatment with
ticagrelor (n=2601) versus clopidogrel (2615). Main outcome measurements:
Primary composite end point of cardiovascular death, myocardial
infarction, and stroke; their individual components; and PLATO defined
major bleeding during one year. Results: 2183 (41.9%) patients had
coronary angiography during their initial hospital admission, 1065 (20.4%)
had percutaneous coronary intervention, and 208 (4.0%) had coronary artery
bypass surgery. Cumulatively, 3143 (60.3%) patients had been managed
non-invasively by the end of follow-up. The incidence of the primary end
point was lower with ticagrelor than with clopidogrel (12.0% (n=295) v
14.3% (346); hazard ratio 0.85, 95% confidence interval 0.73 to 1.00;
P=0.04). Overall mortality was also lower (6.1% (147) v 8.2% (195); 0.75,
0.61 to 0.93; P=0.01). The incidence of total major bleeding (11.9% (272)
v 10.3% (238); 1.17, 0.98 to 1.39; P=0.08) and non-coronary artery bypass
grafting related major bleeding (4.0% (90) v 3.1% (71); 1.30, 0.95 to
1.77; P=0.10) was numerically higher with ticagrelor than with
clopidogrel. Conclusions: In patients with acute coronary syndrome
initially intended for non-invasive management, the benefits of ticagrelor
over clopidogrel were consistent with those from the overall PLATO
results, indicating the broad benefits of P2Y12 inhibition with ticagrelor
regardless of intended management strategy. Trial registration: Clinical
trials NCT00391872.

<21>
Accession Number
2011264136
Authors
Tamorgo J. Lopez-Farre A. Caballero R. Delpon E.
Institution
(Tamorgo, Lopez-Farre, Caballero, Delpon) Department of Pharmacology,
School of Medicine, Universidad Complutense, 28040 Madrid, Spain
Title
Dronedarone.
Source
Drugs of Today. 47 (2) (pp 109-133), 2011. Date of Publication: February
2011.
Publisher
Prous Science (P.O. Box 540, Barcelona 08080, Spain)
Abstract
Atrial fibrillation (AF), the most common cardiac arrhythmia, is
associated with substantial morbidity and mortality. Dronedarone is an
amiodarone-like benzofuran which lacks the iodine moiety and presents a
methane sulfonyl group that decreases its lipophilicity, thus shortening
the half-life and decreasing tissue accumulation. Like amiodarone,
dronedarone blocks multiple cardiac ion channels and beta-adrenoceptors,
presenting electrophysiological characteristics of all four Vaughan
Williams classes of antiarrhythmic drugs. In clinical trials, dronedarone
has been found effective for both rhythm and rate control. Dronedarone was
more effective than placebo in maintaining sinus rhythm in patients with
paroxysmal and/or persistent AF and was also effective for ventricular
rate control during AF recurrences, providing incremental rate control on
top of standard drugs in permanent AF. Furthermore, in the ATHENA trial,
dronedarone reduced the incidence of hospitalization due to cardiovascular
events or death in patients with nonpermanent AF. Even when dronedarone
was less effective than amiodarone in decreasing AF recurrence, it had a
better safety profile, being devoid of thyroid, pulmonary and neurological
toxicity. This review analyzes the electrophysiological and
pharmacological properties, as well as the efficacy and safety of
dronedarone in patients with atrial fibrillation. Copyright 2011 Prous
Science, S.A.U. or its licensors. All rights reserved.

<22>
Accession Number
2009341509
Authors
Goud R. De Keizer N.F. Ter Riet G. Wyatt J.C. Hasman A. Hellemans I.M.
Peek N.
Institution
(Goud, De Keizer, Ter Riet, Hasman, Hellemans, Peek) Department of Medical
Informatics, Academic Medical Centre, University of Amsterdam,
Meibergdreef 15, 1100 DD, Amsterdam, Netherlands
(Ter Riet) Horten Centre, University of Zurich, Zurich, Switzerland
(Wyatt) Health Informatics Centre, University of Dundee, Dundee DD2 4BF,
United Kingdom
Title
Effect of guideline based computerised decision support on decision making
of multidisciplinary teams: Cluster randomised trial in cardiac
rehabilitation.
Source
BMJ (Online). 338 (7703) (pp 1132), 2009. Date of Publication: 09 May
2009.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To determine the extent to which computerised decision support
can improve concordance of multidisciplinary teams with therapeutic
decisions recommended by guidelines. Design: Multicentre cluster
randomised trial. Participants: Multidisciplinary cardiac rehabilitation
teams in Dutch centres and their cardiac rehabilitation patients.
Interventions: Teams received an electronic patient record system with or
without additional guideline based decision support. Main outcome
measures: Concordance with guideline recommendations assessed for two
standard rehabilitation treatments - exercise and education therapy - and
for two new but evidence based rehabilitation treatments - relaxation and
lifestyle change therapy; generalised estimating equations were used to
account for intra-cluster correlation and were adjusted for patient's age,
sex, and indication for cardiac rehabilitation and for type and volume of
centre. Results: Data from 21 centres, including 2787 patients, were
analysed. Computerised decision support increased concordance with
guideline recommended therapeutic decisions for exercise therapy by 7.9%
(control 84.7%; adjusted difference 3.5%, 95% confidence 0.1% to 5.2%),
for education therapy by 25.7% (control 63.9%; adjusted difference 23.7%,
15.5% to 29.4%), and for relaxation therapy by 25.5% (control 34.1%;
adjusted difference 41.6%, 25.2% to 51.3%). The concordance for lifestyle
change therapy increased by 3.2% (control 54.1%; adjusted difference 7.1%,
-2.9% to 18.3%). Computerised decision support reduced cases of both
overtreatment and undertreatment. Conclusions: In a multidisciplinary team
motivated to adopt a computerised decision support aid that assists in
formulating guideline based care plans, computerised decision support can
be effective in improving the team's concordance with guidelines.
Therefore, computerised decision support may also be considered to improve
implementation of guidelines in such settings. Trial registration: Current
Controlled Trials ISRCTN36656997.

<23>
Accession Number
2009339546
Authors
Kurth T. De Jong P.E. Cook N.R. Buring J.E. Ridker P.M.
Institution
(Kurth, Cook, Buring, Ridker) Department of Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Kurth, Cook, Buring, Ridker) Department of Epidemiology, Harvard School
of Public Health, Boston, MA, United States
(Kurth) INSERM Unit 708 - Neuroepidemiology, Paris, France
(Kurth) Faculty of Medicine, University Pierre et Marie Curie, Paris,
France
(De Jong, Ridker) Department of Internal Medicine, University Medical
Center Groningen, Groningen, Netherlands
(Buring, Ridker) Center for Cardiovascular Disease Prevention, Department
of Medicine, Brigham and Women's Hospital, United States
(Buring) Donald W Reynolds Center for Cardiovascular Research, Department
of Medicine, Brigham and Women's Hospital, United States
(Buring) Department of Ambulatory Care and Prevention, Harvard Medical
School, United States
(Kurth) INSERM Unit 708 - Neuroepidemiology, Hopital de la
Pitie-Salpetriere, 47 boulevard de l'Hopital, 75651 Paris Cedex 13, France
Title
Kidney function and risk of cardiovascular disease and mortality in women:
A prospective cohort study.
Source
BMJ (Online). 339 (7711) (pp 35), 2009. Date of Publication: 04 Jul 2009.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To evaluate the association of kidney function with
cardiovascular disease and mortality among apparently healthy women.
Design: Prospective cohort study. Setting: Women's Health Study, United
States. Participants: 27 939 female health professionals aged >45 who were
free of cardiovascular disease and other major disease and who provided a
blood sample at study entry. Main outcome measures: Time to cardiovascular
disease (non-fatal stroke, non-fatal myocardial infarction, coronary
revascularisation procedures, or death from cardiovascular cause),
specific cardiovascular disease events, and all-cause mortality. End
points were confirmed after review of medical records and death
certificates. Results: Glomerular filtration rate (GFR) was estimated with
the abbreviated Modification of Diet in Renal Disease Study equation. At
baseline, 1315 (4.7%) women had GFR <60 ml/min/1.73 m ². During
12 years of follow-up, 1199 incident cardiovascular disease events and 856
deaths (179 from cardiovascular disease) occurred. Compared with women
with GFR >90 ml/min/1.73 m², the multivariable adjusted hazard
ratios for any first cardiovascular disease were 0.95 (95% CI 0.83 to
1.08), 0.84 (0.70 to 1.00), and 1.00 (0.79 to 1.27) among women with GFR
of 75-89.9, 60-74.9, and <60 ml/min/1.73 m², respectively; the
equivalent hazard ratios for all cause mortality were 0.93 (0.79 to 1.09),
1.03 (0.85 to 1.26), and 1.09 (0.83 to 1.45). Similar null findings were
observed for myocardial infarction, stroke, coronary revascularisation,
and non-cardiovascular death. However, an increased risk of death from
cardiovascular disease was found among women with GFR <60 ml/min/1.73 m
² (hazard ratio 1.68 (1.02 to 2.79)). Conclusions: In this
large cohort of women, a glomerular filtration rate <60 ml/min/1.73
m² was associated with increased risk of cardiovascular disease
death but not other cardiovascular disease events or non-cardiovascular
disease mortality. We observed no increase in risk of any of the outcomes
among women with less severe impairment of kidney function.

<24>
Accession Number
2009511920
Authors
Albus C. Theissen P. Hellmich M. Griebenow R. Wilhelm B. Aslim D. Schicha
H. Kohle K.
Institution
(Albus, Wilhelm, Kohle) Department of Psychosomatics and Psychotherapy,
University of Cologne, Cologne 50924, Germany
(Theissen, Schicha) Department of Nuclear Medicine, University of Cologne,
Cologne 50924, Germany
(Hellmich) Institute of Medical Statistics, Informatics and Epidemiology,
University of Cologne, Cologne 50924, Germany
(Griebenow, Aslim) Department of Internal Medicine II, University of
Cologne, Cologne 50924, Germany
Title
Long-term effects of a multimodal behavioral intervention on myocardial
perfusion-a randomized controlled trial.
Source
International Journal of Behavioral Medicine. 16 (3) (pp 219-226), 2009.
Date of Publication: September 2009.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
Background: Recent advances in drug therapy question as to the additional
impact behavioral interventions may have on the prognosis of patients with
clinically stable coronary heart disease (CHD). Purpose: The aim of the
study was to evaluate the effects of a multimodal, behavioral intervention
on myocardial perfusion (MP) and cardiac events, compared to standardized
cardiologic care, in patients with stable CHD. Methods: Seventy-seven CHD
patients (age 54.2+6.9 years, male 87%) were randomly assigned to a
behavioral intervention plus standardized cardiologic care (INT, n=39) or
standardized cardiologic care alone (CO, n=38). MP was assessed by
²⁰¹Thallium MP-scintigrams (SPECT) at baseline, after 2, 3, and
7 years, respectively. Subsequent cardiac events (MI, PCI, CABG) were
assessed using the cardiologists' charts. Results: Sixty-five patients
(84%) completed the study. In all patients, the course of MP was
significantly better in INT analysis of variance (ANOVA groupxtime
p=0.001); this was also true for patients without subsequent PCI/CABG
(ANOVA groupxtime p=0.002). Incidence of cardiac events was significantly
associated with INT (6 vs. 14; log rank test p=.047). Conclusion: The
study suggests additional long-term benefits of a behavioral intervention
on myocardial perfusion and cardiac events in patients with stable CHD
compared to standardized cardiologic care only. 2009 International
Society of Behavioral Medicine.

<25>
Accession Number
2014048263
Authors
Zhu Y.Y. Hayward P.A.R. Hare D.L. Reid C. Stewart A.G. Buxton B.F.
Institution
(Zhu) School of Medicine, The University of Melbourne, Melbourne, VIC,
Australia
(Hayward, Buxton) Department of Cardiac Surgery, Austin Health, Melbourne,
VIC, Australia
(Hare, Stewart) Department of Cardiology, Austin Health, Melbourne, VIC,
Australia
(Reid) Department of Epidemiology and Preventative Medicine, Monash
University, Melbourne, VIC, Australia
Title
Effect of lipid exposure on graft patency and clinical outcomes: Arteries
and veins are different.
Source
European Journal of Cardio-thoracic Surgery. 45 (2) (pp 323-328), 2014.
Article Number: ezt261. Date of Publication: February 2014.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
OBJECTIVES: We evaluated the influence of lipid exposure upon conduit
patency in long-term follow-up after primary CABG. METHODS: From a
prospectively compiled database, we identified 1207 grafts (436 SV and 771
mixed arterial grafts) among 413 CABG patients with 9.4 + 2.4 years of
follow-up (range 3-13). Surveillance angiography was performed as part of
a randomized trial. All available lipid assays were collected from
pathology laboratories, and from these, mean annualized lipid exposure was
calculated for total cholesterol, HDL, LDL and triglycerides.
Angiographical and clinical data were analysed against lipid exposure.
Graft failure was defined as occlusion, string sign or >80% stenosis.
RESULTS: Six thousand and seventy-seven lipid measurements were obtained,
and there were 154 failed grafts. Three hundred and eleven patients
received at least one vein graft, and all 413 patients received at least
one arterial graft. Overall, only HDL levels were inversely correlated
with graft failure, with total cholesterol and LDL showing no associations
in a mixed pool of arterial and venous grafts. To assess whether total/LDL
cholesterol had no effect or were exerting competing effects in arteries
and veins, separate multivariate analyses were performed. Venous graft
failure was associated with increased total cholesterol/HDL (P = 0.006)
and LDL/HDL (P = 0.032). By contrast, elevated total cholesterol was
correlated with a reduced risk of arterial graft failure (OR for graft
failure 0.705, P = 0.023) with increasing LDL cholesterol following a
similar trend (OR for graft failure 0.729, P = 0.051). CONCLUSION:
Sub-fractions of dyslipidaemia known to be risk factors for native vessel
disease appear to similarly influence vein grafts. Arterial conduits are
at least more resistant to the effects of high lipid exposure, and appear
to be protective. These results favour the use of arterial grafts in
patients with poorly controlled dyslipidaemia. The Author 2013. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<26>
Accession Number
2014048248
Authors
Chen J. Lin Y. Kang B. Wang Z.
Institution
(Chen, Lin, Kang, Wang) Department of Cardiothoracic Surgery, Changzheng
Hospital, Second Military Medical University, Shanghai, China
Title
Indexed effective orifice area is a significant predictor of higher mid-
and long-term mortality rates following aortic valve replacement in
patients with prosthesis-patient mismatch.
Source
European Journal of Cardio-thoracic Surgery. 45 (2) (pp 234-240), 2014.
Article Number: ezt245. Date of Publication: February 2014.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Prosthesis-patient mismatch (PPM) is defined as a too-small effective
orifice area (EOA) of an inserted prosthetic relative to body size,
resulting in an abnormally high postoperative gradient. It is unclear,
however, whether residual stenosis after aortic valve replacement (AVR)
has a negative impact on mid- and long-term survivals. We searched
electronic databases, including PubMed, Embase, Medline and the Cochrane
controlled trials register, through October 2012, to identify published
full-text English studies on the association between PPM and mortality
rates. A significant PPM was defined as an indexed EOA (iEOA) <0.85
cm²/m², and severe PPM as an iEOA <0.65
cm²/m². Two reviewers independently assessed the
studies for inclusion and extracted data. Fourteen observational studies,
involving 14 874 patients, met our final inclusion criteria. Meta-analysis
demonstrated that PPM significantly increased mid-term (odds ratio [OR]
1.42, 95% confidence interval [CI] 1.19-1.69) and long-term (OR 1.52, 95%
CI 1.26-1.84) all-cause mortalities. Subgroup analysis showed that PPM was
associated with higher mid- and long-term mortality rates only in younger
and predominantly female populations. Risk-adjusted sensitivity analysis
showed that severe PPM was associated with reduced survival (adjusted
hazard ratio [HR] 1.50, 95% CI 1.24-1.80), whereas moderate PPM was not
(adjusted HR 0.96, 95% CI 0.86-1.07). Regardless of severity, however, PPM
had a negative effect on survival in patients with impaired ejection
fraction (adjusted HR 1.26, 95% CI 1.09-1.47). PPM (iEOA <0.85
cm²/m²) after AVR tended to be associated with
increased long-term all-cause mortality in younger patients, females and
patients with preoperative left ventricular dysfunction. Severe PPM (iEOA
<0.65 cm²/m2) was a significant predictor of reduced long-term
survival in all populations undergoing AVR. The Author 2013. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<27>
Accession Number
2014010663
Authors
Guven O. Sazak H. Alagoz A. Savkilioglu E. Demirbas C.S. Yildiz A.
Karabulut E.
Institution
(Guven, Sazak, Alagoz, Savkilioglu, Demirbas) Department of Anesthesiology
and Reanimation, Ataturk Chest Diseases and Thoracic Surgery Education and
Research Hospital, Ankara, Turkey
(Yildiz) Department of Cardiology, Harran University, Sanliurfa, Turkey
(Karabulut) Department of Biostatistics, Hacettepe University, Ankara,
Turkey
Title
The effects of local anaesthetics on QT parameters during thoracic
epidural anaesthesia combined with general anaesthesia: Ropivacaine versus
bupivacaine.
Source
Balkan Medical Journal. 30 (4) (pp 410-414), 2013. Date of Publication:
2013.
Publisher
AVES Ibrahim Kara (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey)
Abstract
Background: Many studies focusing on the effects of local anaesthetics on
QT intervals have been performed, but the articles evaluating the
relationship between thoracic epidural anaesthesia combined with general
anaesthesia and QT parameters are very limited. Aims: We aimed to compare
the effects of bupivacaine and ropivacaine on QT interval, corrected QT,
dispersion of QT, and corrected dispersion of QT in patients undergoing
lung resection under thoracic epidural anaesthesia combined with general
anaesthesia. Study Design: Prospective clinical study. Methods: Thirty ASA
physical status 1-3 patients requiring thoracic epidural anaesthesia
combined with general anaesthesia for thoracic surgery. Patients were
randomly assigned to two groups, which were allocated to receive either
bupivacaine (Group B) or ropivacaine (Group R) during thoracic epidural
anaesthesia. Following haemodynamic monitoring, a thoracic epidural
catheter was inserted. Local anaesthetic at an average dose of 1.5 mL/
segment was given through an epidural catheter. The same general
anaesthesia protocol was administered in both groups. Records and
measurements were performed on 10 phases that were between the thoracic
epidural catheter insertion to the 5^th min of endobronchial
intubation. In all phases, systolic arterial pressure, diastolic arterial
pressure, mean arterial pressure, heart rate, peripheral O2 saturation,
and electrocardiogram monitoring were performed in patients. All QT
parameters were recorded by 12-lead electrocardiogram and analysed
manually by a cardiologist. Results: QT intervals were similar between two
groups. In Group R, corrected QT values at the 20^th min of
local anaesthetic injection and the 5^th min of endobronchial
intubation were shorter than those in Group B (p<0.05). The basal
dispersion of QT and dispersion of QT values at the 1st min of propofol
injection were shorter than those in Group R (p<0.05). The corrected
dispersion of QT value at the 1st min of propofol injection was shorter in
Group R (p<0.05). In Group R, the decrease in mean arterial pressure at
the 1st min of fentanyl injection was significant compared with Group B
(p<0.05). There was no significant difference between the groups with
respect to heart rate and complications. Conclusion: The corrected QT,
dispersion of QT, and corrected dispersion of QT intervals were slightly
longer in the patients receiving bupivacaine compared with those receiving
ropivacaine in various phases of the present study. Trakya University
Faculty of Medicine.

<28>
Accession Number
2014032789
Authors
Shalnova S.A. Deev A.D. Boytsov A.S.
Institution
(Shalnova, Deev, Boytsov) State Research Center for Preventive Medicine,
Petroverigsky per. 10, Moscow, 101990, Russian Federation
Title
Dynamics in medical treatment of ischemic heart disease in clinical
practice.
Source
Rational Pharmacotherapy in Cardiology. 9 (6) (pp 611-618), 2013. Date of
Publication: 2013.
Publisher
Stolichnaya Izdatelskaya Kompaniya (19-2 Stromynka Street, Moscow 107076,
Russian Federation)
Abstract
At the present time ischemic heart disease (IHD) continues to be the
leading cause of cardiovascular mortality. Improvement of treatment
methods is an important aspect in reduction of IHD fatal complications.
Aim. To carry out a meta-analysis of several clinical and epidemiological
studies with research on the use of drugs with established prognostic
effect in patients with IHD. Material and methods. Analysis of dynamics in
drug prescription in IHD was conducted based on Russian clinical and
epidemiological trials, performed from 2004 to 2009 years. Results. The
total amount of patients was 17345. Majority of them suffered from
arterial hypertension (81.6%), one third had a history of myocardial
infarction, more than a half revealed heart failure (59.8%). At that
history of diabetes mellitus was only registered in 10.5% of the patients
varying from 8% to 17.6%. Lipid metabolism disorders were present in more
than a half of the patients. On the average one in four patients was
obese. At drug therapy analysis it was found out that 6.4% of the IHD
patients received no medications. Statins intake increased from 5.3% to
85.7% in men and from 9.6% to 69.3% in women in last 5 years. Incidence of
the renin-angiotensin-aldosterone system blockers intake increased by 13%
in the both genders. Men with IHD received antiplatelet agents more often
than women. So, only 45.9% of women received these drugs in 2004 and 57.9%
- in 2009, while men increased antiplatelet agents use from 58.5% in 2004
to 63.5% in 2009. Men received beta-blockers by 14% more often in 2009
(74.6%) than in 2004 and women - by 30% (82.4%). Conclusion. The incidence
of the prescription of the drugs with established prognostic value has
increased recently. At that rate of IHD mortality in cardiovascular
mortality structure continues to be high probably due to inadequate
treatment. First, the number of coronary surgical interventions in our
patients is significantly lower than in the other countries. Second,
despite considerable increase in the drug use, doses and adherence to
treatment remain insufficient. Representative trials with participation of
different-level healthcare institutions are reasonable.

<29>
Accession Number
2014050359
Authors
Hindricks G. Elsner C. Piorkowski C. Taborsky M. Geller J.C. Schumacher B.
Bytesnik J. Kottkamp H.
Institution
(Hindricks, Piorkowski, Kottkamp) Internal Medicine and Cardiology
Division, University of Leipzig Heart Center, Strumpellstrasse 39, Leipzig
D-04289, Germany
(Elsner) Leipzig Graduate School of Management, Center for Healthcare
Management, Leipzig, Germany
(Taborsky) Na Homolce Hospital, Prague, Czech Republic
(Geller) Bad Berka Central Clinic, Bad Berka, Germany
(Schumacher) Bad Neustadt Heart and Vessel Center, Bad Neustadt, Germany
(Bytesnik) IKEM Hospital, Prague, Czech Republic
(Kottkamp) Hirslanden Clinic, Zurich, Switzerland
Title
Quarterly vs. yearly clinical follow-up of remotely monitored recipients
of prophylactic implantable cardioverter-defibrillators: Results of the
REFORM trial.
Source
European Heart Journal. 35 (2) (pp 98-105), 2014. Date of Publication:
2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims The rapidly increasing number of patients with implantable
cardioverter-defibrillators (ICD) places a large burden on follow-up
providers. This study investigated the possibility of longer in-office
follow-up intervals in primary prevention ICD patients under remote
monitoring with automatic daily data transmissions from the implant
memory.Methods and resultsConducted in 155 ICD recipients with MADIT II
indications, the study compared the burden of scheduled and unscheduled
ICD follow-up visits, quality of life (SF-36), and clinical outcomes in
patients randomized to either 3-or 12-month follow-up intervals in the
period between 3 and 27 months after implantation. Remote monitoring
(Biotronik Home Monitoring) was used equally in all patients. In contrast
to previous clinical studies, no calendar-based remote data checks were
performed between scheduled in-office visits. Compared with the 3-month
follow-up interval, the 12-month interval resulted in a minor increase in
the number of unscheduled follow-ups (0.64 vs. 0.27 per patient-year; P =
0.03) and in a major reduction in the total number of in-office ICD
follow-ups (1.60 vs. 3.85 per patient-year; P< 0.001). No significant
difference was found in mortality, hospitalization rate, or
hospitalization length during the 2-year observation period, but more
patients were lost to follow-up in the 12-month group (10 vs. 3; P =
0.04). The SF-36 scores favoured the 12-month intervals in the domains
'social functioning' and 'mental health'.ConclusionIn prophylactic ICD
recipients under automatic daily remote monitoring, the extension of the
3-month in-office follow-up interval to 12 months appeared to safely
reduce the ICD follow-up burden during 27 months after implantation. 2013
The Author.

<30>
[Use Link to view the full text]
Accession Number
2014049574
Authors
Algra S.O. Jansen N.J.G. Van Der Tweel I. Schouten A.N.J. Groenendaal F.
Toet M. Van Oeveren W. Van Haastert I.C. Schoof P.H. De Vries L.S. Haas F.
Institution
(Algra, Jansen, Van Der Tweel, Schouten, Groenendaal, Toet, Van Haastert,
Schoof, De Vries, Haas) Departments of Pediatric Cardiothoracic Surgery,
Pediatric Intensive Care, Intensive Care and Emergency Medicine,
Netherlands
(Van Oeveren) University Medical Center Utrecht, Lundlaan 6, 3584 EA
Utrecht, Netherlands
Title
Neurological injury after neonatal cardiac surgery: A randomized,
controlled trial of 2 perfusion techniques.
Source
Circulation. 129 (2) (pp 224-233), 2014. Date of Publication: 14 Jan 2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND-: Complex neonatal cardiac surgery is associated with cerebral
injury. In particular, aortic arch repair, requiring either deep
hypothermic circulatory arrest (DHCA) or antegrade cerebral perfusion
(ACP), entails a high risk of perioperative injury. It is unknown whether
ACP results in less cerebral injury than DHCA. METHODS AND RESULTS-:
Thirty-seven neonates with an aortic arch obstruction presenting for
univentricular or biventricular repair were randomized to either DHCA or
ACP. Preoperatively and 1 week after surgery, magnetic resonance imaging
was performed in 36 patients (1 patient died during the hospital stay).
The presence of new postoperative cerebral injury was scored, and results
were entered into a sequential analysis, which allows for immediate data
analysis. After the 36th patient, it was clear that there was no
difference between DHCA and ACP in terms of new cerebral injury.
Preoperatively, 50% of patients had evidence of cerebral injury.
Postoperatively, 14 of 18 DHCA patients (78%) had new injury versus 13 of
18 ACP patients (72%) (P=0.66). White matter injury was the most common
type of injury in both groups, but central infarctions occurred
exclusively after ACP (0 vs 6/18 [33%]; P=0.02). Early motor and cognitive
outcomes at 24 months were assessed and were similar between groups
(P=0.28 and P=0.25, respectively). Additional analysis revealed lower
postoperative arterial PCO2 as a risk factor for new white matter injury
(P=0.04). CONCLUSIONS-: In this group of neonates undergoing complex
cardiac surgery, we were unable to demonstrate a difference in the
incidence of perioperative cerebral injury after ACP compared with DHCA.
Both techniques resulted in a high incidence of new white matter injury,
with central infarctions occurring exclusively after ACP. CLINICAL TRIAL
REGISTRATION-: URL: http://www.clinicaltrials.gov. Unique identifier:
NCT01032876. 2013 American Heart Association, Inc.

<31>
Accession Number
2014043147
Authors
Minami C.A. Chung J.W. Holl J.L. Bilimoria K.Y.
Institution
(Minami, Chung, Holl, Bilimoria) Department of Surgery, Northwestern
University, Northwestern Memorial Hospital, 676 St Clair St, Chicago, IL
60611, United States
Title
Impact of medical malpractice environment on surgical quality and
outcomes.
Source
Journal of the American College of Surgeons. 218 (2) (pp 271-278.e9),
2014. Date of Publication: February 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)

<32>
Accession Number
2014021364
Authors
Harilall Y. Adam J.K. Biccard B.M. Reddi A.
Institution
(Harilall, Reddi) Dept of Cardiothoracic Surgery, Inkosi Albert Luthuli
Central Hospital, KZN, South Africa
(Biccard) College of Health Sciences, University of Kwazulu Natal, South
Africa
(Biccard) Department of Anaesthesia, Inkosi Albert Luthuli Central
Hospital, South Africa
(Adam) Department of Biomedical and Clinical Technology, Durban University
of Technology, South Africa
Title
The effect of optimising cerebral tissue oxygen saturation on markers of
neurological injury during coronary artery bypass graft surgery.
Source
Heart Lung and Circulation. 23 (1) (pp 98-74), 2014. Date of Publication:
January 2014.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: Surgical revascularisation of the coronary arteries is a
cornerstone of cardiothoracic surgery. Advanced age and the incidence of
preoperative co-morbidity in patients presenting for coronary artery
bypass graft surgery increases the potential for stroke and other
perioperative outcomes. It is hypothesised that by using interventions
during cardiac surgery to improve cerebral oxygenation, the risk of
patients enduring adverse neurological outcomes would be reduced. Methods:
Forty patients (mean age 55.3, standard deviation 9.74 and range from 39
to 72 years) undergoing on-pump coronary artery bypass graft surgery were
recruited at Inkosi Albert Luthuli Central Hospital, South Africa.
Patients were randomised into a control group (n=20) and interventional
group (n=20). Intraoperative regional cerebral oxygen saturation
(rSO₂) monitoring with active display and Murkin treatment
intervention protocol was administered for the interventional group.
Arterial blood samples for the measurement of serum S100B were taken pre
and postoperatively. An enzyme immunoassay (ELISA) was used for the
quantitative and comparative measurement of human S100B concentrations for
both groups. A prioritised intraoperative management protocol to maintain
rSO₂ values above 75% of the baseline threshold during
cardiopulmonary bypass was followed. Results: There was a highly
significant difference in the change in S100B concentrations post surgery
between the interventional (37.3picograms per millilitre) and control
groups (139.3pg/ml). The control group showed a significantly higher
increase in S100B concentration over time than the intervention group
(p<0.001). There was a significant difference in cerebral desaturation
time (p<0.001) between the groups. The mean desaturation time for the
control group was 63.85min as compared to 24.7min in the interventional
group. Cerebral desaturation occurred predominantly during aortic cross
clamping, distal anastomosis of coronary arteries and aortic cross clamp
release. Predictors of cerebral oxygen desaturation included, partial
pressure of carbon dioxide (pCO₂), temperature, pump flow rate
(LMP), mean arterial pressure (MAP), haematocrit, heart rate (HR) and
patient oxygen saturation (SpO₂). Conclusion: Monitoring brain
oxygen saturation during on-pump CABG together with an effective treatment
protocol to deal with cerebral desaturation must be advocated. 2013.

<33>
Accession Number
2014043095
Authors
Nigro Neto C. Landoni G. Cassara L. De Simone F. Zangrillo A. Tardelli
M.A.
Institution
(Nigro Neto, Landoni, Cassara, De Simone, Zangrillo, Tardelli) Department
of Anesthesia and Intensive Care, Dante Pazzanese Institute of Cardiology,
San Raffaele Scientific Institute, Milan, Italy
Title
Use of volatile anesthetics during cardiopulmonary bypass: A systematic
review of adverse events.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (1) (pp 84-89),
2014. Date of Publication: February 2014.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives Recently, evidence of reduction in mortality due to the use of
volatile agents during cardiac surgery led to an increase in their use
during cardiopulmonary bypass (CPB). Because this technique could be
beneficial to patients, but might present several hazards to new users,
the authors decided to perform a systematic review of the main problems
and complications. Design Systematic literature review. Setting Hospital.
Participants Adults undergoing cardiac surgery with use of volatile
anesthetic agents during CPB. Intervention Several databases were searched
for pertinent studies to identify all reports on the adverse events of
using volatile agents during CPB and all randomized controlled trials
using volatile agents during CPB. Measurements and Main Results Six
nonrandomized trials reporting adverse events or complications with the
use of volatile agents during CPB for cardiac surgery were identified: 2
reporting low transfer of isoflurane to the blood with diffusion membrane
oxygenators; 2 reporting iatrogenic causes of damage after spilling liquid
isoflurane onto the surface of the membrane oxygenators while filling the
vaporizer; and 2 suggesting that the use of volatile agents during CPB
increased the pollution of the room and the risk of occupational exposure
of the operating room staff. On the other hand, no adverse event was
reported in 19 studies that randomized 1,195 patients to receive
isoflurane, desflurane, or sevoflurane during CPB. Conclusion It is
mandatory for industry to provide safe and easy-to-use devices to
administer volatile agents during CPB with the standard membrane
oxygenators. 2014 Elsevier Inc.

<34>
Accession Number
2014037193
Authors
Rodriguez-Serrano M. Sanchez-Lazaro I. Almenar-Bonet L. Martinez-Dolz L.
Portoles-Sanz M. Rivera-Otero M. Salvador-Sanz A.
Institution
(Rodriguez-Serrano, Sanchez-Lazaro, Almenar-Bonet, Martinez-Dolz,
Salvador-Sanz) Heart Failure and Transplantation Unit, Department of
Cardiology, Hospital Universitario y Politecnico La Fe, Valencia, Spain
(Portoles-Sanz, Rivera-Otero) Research Center, Hospital Universitario y
Politecnico La Fe, Valencia, Spain
Title
Does the calcineurin inhibitor have influence on cytomegalovirus infection
in heart transplantation?.
Source
Clinical Transplantation. 28 (1) (pp 88-95), 2014. Date of Publication:
January 2014.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Cytomegalovirus (CMV) infection is a major cause of morbidity and
mortality in heart transplant (HTx). Our aim was to analyze the rate of
CMV infection in HTx patients receiving treatment with cyclosporine (CsA)
or tacrolimus (Tac). Ninety-five patients were randomized to receive
either CsA (53.7%) or Tac (46.3%). We performed prophylaxis with
valganciclovir in patients with the highest risk of CMV infection. We
considered CMV infection as an increased viral load or the presence of CMV
in histological samples. We analyzed baseline characteristics, CMV
infection, and other complications. Event-free rates were calculated using
the Kaplan-Meier method. There were no significant differences in baseline
characteristics between both groups. CMV infection was detected in 31.6%
of patients (in 66.7% due to asymptomatic replication). The group treated
with Tac had a lower rate of CMV infection (15.9% vs. 45.1%, p = 0.002)
and longer CMV infection-free survival time (1440 vs. 899 d, p = 0.001).
No differences were observed in the complications analyzed in both groups.
The independent risk factors for infection identified in the multivariate
analysis were treatment with CsA and bacterial infections. This was the
first study to demonstrate a lower rate of CMV infection in patients
treated with Tac vs. those treated with CsA after HTx. 2013 John Wiley &
Sons A/S. Published by John Wiley & Sons Ltd.

<35>
Accession Number
2014042837
Authors
Dinicolantonio J.J. Beavers C.J. Menezes A.R. Lavie C.J. O'Keefe J.H.
Meier P. Vorobcsuk A. Aradi D. Komocsi A. Chatterjee S. D'Ascenzo F.
Gasparini M. Brugts J. Biondi-Zoccai G.
Institution
(Dinicolantonio) Department of Preventive Cardiology, Saint Luke's
Hospital, University of Missouri-Kansas City, Kansas City, MO, United
States
(Beavers) Department of Pharmacy, Centennial Medical Center, Nashville,
TN, United States
(Menezes, Lavie) Department of Cardiovascular Diseases, Ochsner Clinical
School, University of Queensland School of Medicine, New Orleans, LA,
United States
(Lavie) Department of Preventive Medicine, Pennington Biomedical Research
Center, Baton Rouge, LA, United States
(O'Keefe) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, United States
(Meier) Heart Hospital, University College London Hospitals UCLH, London,
United Kingdom
(Vorobcsuk, Aradi, Komocsi) Department of Interventional Cardiology, Heart
Centre, University of Pecs, Hungary
(Chatterjee) Cardiovascular Diseases, St. Luke's - Roosevelt Hospital
Center, Division of Cardiology, New York, NY, United States
(D'Ascenzo) Division of Cardiology, Department of Internal Medicine, Citta
della Salute e della Scienza, San Giovanni battista, Turin, Italy
(Gasparini) Department of Mathematical Sciences, Politecnico di Torino,
Rotterdam, Netherlands
(Brugts) Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam,
Netherlands
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Aradi) Department of Cardiology, Heart Center, Balatonfured, Hungary
Title
Meta-analysis comparing carvedilol versus metoprolol for the prevention of
postoperative atrial fibrillation following coronary artery bypass
grafting.
Source
American Journal of Cardiology. 113 (3) (pp 565-569), 2014. Date of
Publication: 01 Feb 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
A systematic review and meta-analysis was performed to evaluate the
effects of carvedilol versus metoprolol on the incidence of postoperative
atrial fibrillation in patients undergoing coronary artery bypass grafting
in randomized controlled trials. Ovid MEDLINE, PubMed, CENTRAL, and
Excepta Medica (EMBASE) were searched up to March 2013 for suitable
randomized controlled trials. Data were pooled using random-effects model
for pairwise analyses. A total of 4 trials with 601 patients were included
in this analysis. Pairwise analyses showed that compared with metoprolol,
carvedilol significantly reduced the incidence of postoperative atrial
fibrillation (odds ratio 0.50, 95% confidence interval 0.32 to 0.80). In
conclusion, compared with metoprolol, carvedilol significantly reduces the
incidence of postoperative atrial fibrillation in patients undergoing
coronary artery bypass grafting. 2014 Elsevier Inc. All rights reserved.

<36>
Accession Number
2014043099
Authors
Wang A. Cabreriza S.E. Cheng B. Shanewise J.S. Spotnitz H.M.
Institution
(Wang, Cabreriza, Spotnitz) Department of Surgery, Columbia Presbyterian
Medical Center, 622 West 168th Street, New York, NY 10032, United States
(Wang) Duke University School of Medicine, Durham NC, United States
(Cheng) Department of Biostatistics, Mailman School of Public Health,
Columbia University, New York, NY, United States
(Shanewise) Division of Cardiothoracic Anesthesiology, Columbia
Presbyterian Medical Center, New York, NY, United States
Title
Feasibility of speckle-tracking echocardiography for assessment of left
ventricular dysfunction after cardiopulmonary bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (1) (pp 31-35),
2014. Date of Publication: February 2014.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives Effects of temporary biventricular pacing after cardiopulmonary
bypass are unpredictable, and the utility of speckle-tracking
echocardiography in this setting is unclear. Accordingly, speckle-tracking
analysis of transgastric echocardiograms taken during cardiac surgery was
assessed as a potential tool to measure strain, synchrony, and twist as
indices to predict response. Design Prospective observational study, in
part, with a randomized controlled study of temporary permanent
biventricular pacing after cardiopulmonary bypass. Setting Single-center
study at university-affiliated tertiary care hospital. Participants
Twenty-one cardiac surgery candidates with ejection fraction <40% and QRS
duration >100 ms or who were undergoing double-valve surgery.
Interventions Transgastric views of the basal, midpapillary, and apical
levels of the left ventricle were acquired before and after bypass.
Measurements and Main Results Midpapillary sections were analyzable in 38%
of patients. The remainder had epicardial borders extending beyond the
field of view (24%) or inadequate image quality (38%). Only 9% of basal or
apical sections were analyzable. Midpapillary radial strain and synchrony
changed insignificantly after bypass. Variation in fractional area change
correlated with changes in radial strain (p = 0.041) but not with
synchrony. Conclusions Intraoperative transgastric echocardiography is
inadequate for speckle-tracking analysis with current techniques.
Intraoperative predictors of temporary biventricular pacing response are
lacking. 2014 Elsevier Inc.

<37>
Accession Number
2014043103
Authors
Guay J. Andrew Ochroch E.
Institution
(Guay) Departement d'Anesthesiologie, University of Montreal, Succursale
Centre-ville, Montreal, QC H3C 3J7, Canada
(Andrew Ochroch) University of Pennsylvania Health System, Philadelphia,
PA, United States
Title
Continuing antiplatelet therapy before cardiac surgery with
cardiopulmonary bypass: A meta-analysis on the need for reexploration and
major outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (1) (pp 90-97),
2014. Date of Publication: February 2014.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective To determine major adverse outcomes, including the risk of
mediastinal reexploration, death, stroke and myocardial infarction,
associated with continuing antiplatelet therapy in patients undergoing
surgery with cardiopulmonary bypass. Design A meta-analysis of parallel
randomized, controlled trials published in English. Setting A
university-based electronic search. Participants Patients undergoing
surgery with cardiopulmonary bypass (CPB). Intervention Continuing
antiplatelet therapy versus stopping antiplatelet therapy before the
surgery. Measurements and Main Results A search was conducted in PubMed,
EMBASE, MEDLINE(R), and the Cochrane Central Register of Controlled
Trials. Twelve studies were retained for analysis. Continuing antiplatelet
drugs for CPB increases the rate of reexploration by a standardized mean
difference (SMD) 0.22, 95% confidence interval (CI) 0.06, 0.39; I-square
0%; p value 0.01; classical fail-safe number 5. The number needed to harm
(NNTH) is 87 (95% CI 390, 44). There was no statistical difference for
death at 30 days and 1 year, myocardial infarction at 30 days, and stroke
at 30 days. Continuing antiplatelet drugs increases blood loss, SMD 0.27
(95% CI 0.09, 0.45), I-square 73.1%; p = 0.003. Conclusions Continuing
antiplatelet therapy for patients undergoing surgery with CPB is
associated with a low risk for reexploration. 2014 Elsevier Inc.

<38>
Accession Number
23939326
Authors
Cacau L.A.P. Oliveira G.U. Maynard L.G. de Araujo Filho A.A. da Silva
Junior W.M. Cerqueria Neto M.L. Antoniolli A.R. Santana-Filho V.J.
Institution
(Oliveira, Maynard, de Araujo Filho, Antoniolli) Federal University of
Sergipe, Aracaju, SE, Brazil
(Cacau, da Silva Junior, Cerqueria Neto, Santana-Filho) Department of
Physical Therapy, Federal University of Sergipe, Aracaju, SE, Brazil
Title
The use of the virtual reality as intervention tool in the postoperative
of cardiac surgery.
Source
Brazilian Journal of Cardiovascular Surgery. 28 (2) (pp 281-289), 2013.
Date of Publication: April - June 2013.
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (Av. Juscelino Kubitschek
de Oliviera 1505, Sao Jose do Rio Preto 15091-450, Brazil)
Abstract
Introduction: Cardiac surgery has been the intervention of choice in many
cases of cardiovascular diseases. Susceptibility to postoperative
complications, cardiac rehabilitation is indicated. Therapeutic resources,
such as virtual reality has been helping the rehabilitational process. The
aim of the study was to evaluate the use of virtual reality in the
functional rehabilitation of patients in the postoperative period.
Methods: Patients were randomized into two groups, Virtual Reality (VRG, n
= 30) and Control (CG, n = 30). The response to treatment was assessed
through the functional independence measure (FIM), by the 6-minute walk
test (6MWT) and the Nottingham Health Profile (NHP). Evaluations were
performed preoperatively and postoperatively. Results: On the first day
after surgery, patients in both groups showed decreased functional
performance. However, the VRG showed lower reduction (45.7+2.3) when
compared toCG (35.06+2.09, P<0.05) in first postoperative day, and no
sig-nifcant difference in performance on discharge day (P>0.05). In
evaluating the NHP field, we observed a signifcant decrease in pain score
at third assessment (P<0.05). These patients also had a higher energy
level in the first evaluation (P<0.05). There were no differences with
statistical significance for emotional reactions, physical ability, and
social interaction. The length of stay was signifcantly shorter in
patients of VRG (9.4+0.5 days vs. 12.2 + 0.9 days, P<0.05), which also had
a higher 6MWD (319.9+19.3 meters vs. 263.5+15.4 meters,
P<0.02).Conclusion: Adjunctive treatment with virtual reality demonstrated
benefits, with better functional performance in patients undergoing
cardiac surgery.

<39>
Accession Number
23939325
Authors
Cueva C.N.C. Rocha M.S. Mendes C.M.C. de Freitas L.A.R. Baucia J.A. Badaro
R.
Institution
(Cueva) Medical School, Universidade Federal da Bahia (UFBA), Brazil
(Rocha) UFBA, Salvador, BA, Brazil
(Mendes) ICS/UFBA, Salvador, BA, Brazil
(de Freitas, Baucia, Badaro) Medical School, UFBA, Salvador, BA, Brazil
Title
Clinical and ultramicroscopic myocardial randomized study of beating
versus arrested heart for mitral surgery.
Source
Brazilian Journal of Cardiovascular Surgery. 28 (2) (pp 270-280), 2013.
Date of Publication: April - June 2013.
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular (Av. Juscelino Kubitschek
de Oliviera 1505, Sao Jose do Rio Preto 15091-450, Brazil)
Abstract
Introduction: Beating heart surgery on normothermic bypass simulates
physiologic cardiac status. Objectives: This study compared clinical and
transmission electron microscopic aspects of myocardial protection during
mitral valve replacement using warm retrograde perfusion in empty beating
versus arrested heart with cold blood antero-grade cardioplegia. Methods:
Randomized study to evaluate myocardial cellular ischemia-reperfusion of
both techniques to replace the mitral valve. Thirty-four patients were
randomly assigned into group A (beating heart) and group B (arrested
heart). The following parameters were assessed: echocardiography, blood
chemistry, hemoglobin, lactate. During the surgical procedure a total of
102 myocardial biopsies were performed for ultrastructural analysis from
anterior left ventricular wall: before cardiopulmonary bypass, before
aortic desclamping and 10 minutes after reperfusion. Results: Elevation of
lactate at 3 hours during the procedure was higher in group A, but similar
at the end of surgery (P=0.06). Cardioversion was necessary in 5/17 (A)
vs. 13/17 (B) P=0.07. Median intraoperative systemic temperature was
significantly lower in the group B compared to A (32<o<C vs. 36<o</C),
P<0.001. There was no significant difference of the ultramicro-scopic
aspects of the heart biopsies before, during and after surgery in both
groups. Cellular and mitochondrial transient abnormalities such as
mitochondrial swelling, glycogen loss and cytosol swelling were detected
independently of the moment of the biopsies. Conclusion: Myocardial
protection and ultrastructural abnormalities were similar for both types
of mitral valve replacement beating or arrested heart techniques.

<40>
Accession Number
24383370
Authors
van Straten A.H. Safari M. Ozdemir H.I. Elenbaas T.W. Hamad M.A.
Institution
(van Straten, Safari, Ozdemir, Elenbaas, Hamad) Department of
Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Title
Does the body mass index predict mortality after isolated aortic valve
replacement?.
Source
The Journal of heart valve disease. 22 (5) (pp 608-614), 2013. Date of
Publication: Sep 2013.
Abstract
Data relating to the impact of body mass index (BMI) on outcomes after
isolated aortic valve replacement (AVR) are scarce and controversial. The
study aim was to investigate the predictive value of BMI for early and
late mortality after isolated AVR. Data obtained from patients who
underwent isolated AVR between January 1998 and December 2010 at the
authors' institution were analyzed retrospectively. Patients were
allocated to five groups according to the preoperative BMI: underweight
(BMI < 20 kg/m2); normal weight (BMI 20.0-24.9 kg/m2); overweight (BMI
25.0-29.9 kg/m2); obese (BMI 30.0-34.9 kg/m2); and morbidly obese (BMI >
34.9 kg/m2). Logistic and Cox regression analyses were performed to
identify the independent predictors of early and late mortality,
respectively. After excluding 20 patients who were lost to follow up, and
30 patients with missing preoperative BMI data, a total of 1,758 patients
was included in the analysis. The mean follow up was 5.6 +/- 3.5 years
(range: 0-13.4 years), and the mean BMI 26.8 +/- 4.3 kg/m2 (range: 17-52
kg/m2). Multivariate logistic regression analyses showed no association
between early mortality and the BMI groups. Multivariate Cox regression
analyses showed 'underweight' to be an independent predictor for late
mortality (hazard ratio 2.89; 95% confidence interval 1.63-5.13, p <
0.0001). 'Underweight' is an independent predictor for late mortality
after AVR surgery. Morbid obesity did not prove to be predictive of a
worse late survival.

<41>
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Accession Number
2014009278
Authors
Parker R. Armstrong M.J. Corbett C. Day E.J. Neuberger J.M.
Institution
(Parker, Armstrong, Corbett) National Institute for Health Research
Biomedical Research Unit, Centre for Liver Research, University of
Birmingham, Birmingham, United Kingdom
(Parker, Armstrong, Corbett, Neuberger) Liver Unit, University Hospitals
Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
(Day) Department of Neuropharmacology and Neurobiology, School of Clinical
and Experimental Medicine, University of Birmingham, Birmingham, United
Kingdom
(Neuberger) NHS Blood and Transplant, Bristol, United Kingdom
Title
Alcohol and substance abuse in solid-organ transplant recipients.
Source
Transplantation. 96 (12) (pp 1015-1024), 2013. Date of Publication: 27 Dec
2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
This review focuses on alcohol and substance abuse in the context of
solid-organ transplantation. Alcohol and substance abuse are common and
may lead to a need for solid-organ transplantation and may also contribute
to significant physical and psychologic problems that impact upon the
recipient. Damaging levels of alcohol intake can occur in the absence of
dependence. Alcohol or substance abuse after transplantation is associated
with poor medication compliance and this may increase risk of graft loss.
Intravenous drug use is associated with increased risk of infections
(especially secondary to opportunistic organisms-bacterial, viral,
protozoal, and others-and such infections may be more severe in the
immunosuppressed), but there is only anecdotal evidence that such behavior
has a worse outcome in transplant recipients. Whereas previous alcohol
excess and drug use in kidney recipients are both associated with a small
but statistically significantly increased risk of adverse outcomes (hazard
ratio, 1.16-1.56), alcohol use within recommended guidelines after
transplantation appears safe and possibly beneficial. Robust data are
lacking for other organs, but those available suggest that heart
transplantation is safe in individuals with a history of alcohol or
substance abuse. Health specialists in drug or alcohol addiction should
carefully screen all potential transplant candidates for these conditions,
and where there is evidence of dependency or abuse, effective psychologic
and physical treatment should be offered. Studies have shown that
interventions such as psychologic intervention have improved alcohol
behavior in the context of liver transplantation. Although there are no
comparable studies with other solid-organ recipients, it is reasonable to
expect transferable outcomes. 2013 Lippincott Williams and Wilkins.

<42>
[Use Link to view the full text]
Accession Number
24014828
Authors
Linde C. Daubert C. Abraham W.T. St John Sutton M. Ghio S. Hassager C.
Herre J.M. Bergemann T.L. Gold M.R.
Institution
(Linde) Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden.
Title
Impact of ejection fraction on the clinical response to cardiac
resynchronization therapy in mild heart failure.
Source
Circulation. Heart failure. 6 (6) (pp 1180-1189), 2013. Date of
Publication: Nov 2013.
Abstract
Current guidelines recommend cardiac resynchronization therapy (CRT) in
mild heart failure (HF) patients with QRS prolongation and ejection
fraction (EF) <30%. To assess the effect of CRT in less severe systolic
dysfunction, outcomes in the REsynchronization reVErses Remodeling in
Systolic left vEntricular dysfunction (REVERSE) study were evaluated in
which patients with left ventricular (LV) ejection fraction (LVEF) >30%
were included. The results of patients with baseline EF >30% (n=177) and
those with EF <30% (n=431), as determined by a blinded core laboratory,
were compared. In the LVEF >30% subgroup, there was a trend for
improvement in the clinical composite response with CRT ON versus CRT OFF
(P=0.06) and significant reductions in LV end systolic volume index (-6.7
+ 21.1 versus 2.1 + 17.6 mL/m(2); P=0.01) and LV mass (-20.6 + 50.5 versus
5.0 + 42.4 g; P=0.04) after 12 months. The time to death or first HF
hospitalization was significantly prolonged with CRT (hazard ratio, 0.26;
P=0.012). In the LVEF <30% subgroup, significant improvements in clinical
composite response (P=0.02), reverse remodeling parameters, and time to
death or first HF hospitalization (hazard ratio, 0.58; P=0.047) were
observed. After adjusting for important covariates, the CRT ON assignment
remained independently associated with improved time to death or first HF
hospitalization (hazard ratio, 0.54; P=0.035), whereas there was no
significant interaction with LVEF. Among subjects with mild HF, QRS
prolongation, and LVEF >30%, CRT produced reverse remodeling and similar
clinical benefit compared with subjects with more severe LV systolic
dysfunction. CLINICAL TRIAL REGISTRATION- URL:
http://www.clinicaltrials.gov. Unique identifier: NCT00271154.

<43>
[Use Link to view the full text]
Accession Number
2014031477
Authors
Marx G.R. Shirali G. Levine J.C. Guey L.T. Cnota J.F. Baffa J.M. Border
W.L. Colan S. Ensing G. Friedberg M.K. Goldberg D.J. Idriss S.F. John J.B.
Lai W.W. Lu M. Menon S.C. Ohye R.G. Saudek D. Wong P.C. Pearson G.D.
Institution
(Marx, Levine, Colan) Boston Children's Hospital, Boston MA, United States
(Shirali) Children's Mercy Hospital and Clinics, Kansas City, MO, United
States
(Guey, Lu) New England Research Institutes, Watertown, MA, United States
(Cnota) Cincinnati Children's Hospital Medical Center, Cincinnati, OH,
United States
(Baffa) A.I. DuPont Hospital for Children, Wilmington, DE, United States
(Border) Emory University, School of Medicine, Atlanta, GA, United States
(Ensing, Ohye) University of Michigan, Ann Arbor, United States
(Friedberg) Hospital for Sick Children, University of Toronto, Toronto,
ON, Canada
(Goldberg) Department of Pediatrics, Children's Hospital of Philadelphia,
Philadelphia, PA, United States
(Idriss) Duke University Medical Center, Durham, NC, United States
(John) Congenital Heart Institute of Florida/Pediatric, Tampa, United
States
(Lai) Columbia University Medical Center, New York, NY, United States
(Menon) University of Utah, Salt Lake City, United States
(Saudek) Medical College of Wisconsin, Milwaukee, United States
(Wong) Children's Hospital Los Angeles, Los Angeles, CA, United States
(Pearson) National Heart, Lung, and Blood Institute, National Institutes
of Health, 6701 Rockledge Dr., Bethesda, MD 20892, United States
Title
Multicenter study comparing shunt type in the norwood procedure for
single-ventricle lesions three-dimensional echocardiographic analysis.
Source
Circulation: Cardiovascular Imaging. 6 (6) (pp 934-942), 2013. Date of
Publication: November 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-The Pediatric Heart Network's Single Ventricle Reconstruction
(SVR) trial randomized infants with single right ventricles (RVs)
undergoing a Norwood procedure to a modified Blalock-Taussig or
RV-to-pulmonary artery shunt. This report compares RV parameters in the 2
groups using 3-dimensional echocardiography. Methods and
Results-Three-dimensional echocardiography studies were obtained at 10 of
15 SVR centers. Of the 549 subjects, 314 underwent 3-dimensional
echocardiography studies at 1 to 4 time points (pre-Norwood, post-Norwood,
pre-stage II, and 14 months) for a total of 757 3-dimensional
echocardiography studies. Of these, 565 (75%) were acceptable for
analysis. RV volume, mass, mass:volume ratio, ejection fraction, and
severity of tricuspid regurgitation did not differ by shunt type. RV
volumes and mass did not change after the Norwood, but increased from
pre-Norwood to pre-stage II (end-diastolic volume [milliliters]/body
surface area [BSA]^1.3, end-systolic volume
[milliliters]/BSA^1.3, and mass [grams]/BSA^1.3 mean
difference [95% confidence interval]=25.0 [8.7-41.3], 19.3 [8.3-30.4], and
17.9 [7.3-28.5], then decreased by 14 months (end-diastolic
volume/BSA^1.3, end-systolic volume/BSA^1.3, and
mass/BSA^1.3 mean difference [95% confidence interval]=-24.4
[-35.0 to -13.7], -9.8 [-17.9 to -1.7], and -15.3 [-22.0 to -8.6].
Ejection fraction decreased from pre-Norwood to pre-stage II (mean
difference [95% confidence interval]=-3.7 [-6.9 to -0.5]), but did not
decrease further by 14 months. Conclusions-We found no statistically
significant differences between study groups in 3-dimensional
echocardiography measures of RV size and function, or magnitude of
tricuspid regurgitation. Volume unloading was seen after stage II, as
expected, but ejection fraction did not improve. This study provides
insights into the remodeling of the operated univentricular RV in infancy.
2013 American Heart Association, Inc.

<44>
Accession Number
2013807490
Authors
Duraes A.R. Duraes M.A.O. Correia L.C.L. Aras R.
Institution
(Duraes, Duraes, Correia, Aras) Roque Aras Hospital Ana Nery, Salvador,
BA, Brazil
Title
Antithrombotic strategy in the three first months following bioprosthetic
heart valve implantation.
Source
Arquivos Brasileiros de Cardiologia. 101 (5) (pp 466-471), 2013. Date of
Publication: 2013.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
Heart valve prosthesis unquestionably improve quality of life and survival
of patients with severe valvular heart disease, but the need for
antithrombotic therapy to prevent thromboembolic complications is a major
challenge to clinicians and their patients. Of the articles analyzed, most
were retrospective series of cases or historical cohorts obtained from the
database. The few published randomized trials showed no statistical power
to assess the primary outcome of death or thromboembolic event. In this
article, we decided to perform a systematic literature review, in an
attempt to answer the following question: what is the best antithrombotic
strategy in the first three months after bioprosthetic heart valve
implantation (mitral and aortic)? After two reviewers applying the
extraction criteria, we found 1968 references, selecting 31 references
(excluding papers truncated, which combined bioprosthesis with mechanical
prosthesis, or without follow-up). Based on this literature review, there
was a low level of evidence for any antithrombotic therapeutic strategy
evaluated. Its therefore interesting to use aspirin 75 to 100 mg/day as
antithrombotic strategy after bioprosthesis replacement in the aortic
position, regardless of etiology, for patients without other risk factors
such as atrial fibrillation or previous thromboembolic event. In the
mitral position, the risk of embolism, although low, is more relevant than
in the aortic position, according to published series and retrospective
cohorts comprised mostly of elderly non-rheumatic patients. The current
evidence is limited to have a consistent and safe level of evidence
regarding the best therapeutic strategy. Based on these studies, 75 to 100
mg/day of aspirin is interesting as antithrombotic strategy after
implantation of aortic bioprosthesis, regardless of etiology, for patients
with no other risk factors such as atrial fibrillation or previous
thromboembolic event. As for mitral bioprosthesis, the risk of embolism,
although low, is more relevant than in the aortic position, according to
published series and retrospective cohorts - usually elderly non rheumatic
patients.

<45>
[Use Link to view the full text]
Accession Number
24132734
Authors
Molina K.M. Shrader P. Colan S.D. Mital S. Margossian R. Sleeper L.A.
Shirali G. Barker P. Canter C.E. Altmann K. Radojewski E. Tierney E.S.
Rychik J. Tani L.Y. Pediatric Heart Network Investigators
Institution
(Molina) University of Utah School of Medicine, Salt Lake City.
Title
Predictors of disease progression in pediatric dilated cardiomyopathy.
Source
Circulation. Heart failure. 6 (6) (pp 1214-1222), 2013. Date of
Publication: Nov 2013.
Abstract
Despite medical advances, children with dilated cardiomyopathy (DCM)
remain at high risk of death or need for cardiac transplantation. We
sought to identify predictors of disease progression in pediatric DCM. The
Pediatric Heart Network evaluated chronic DCM patients with prospective
echocardiographic and clinical data collection during an 18-month
follow-up. Inclusion criteria were age <22 years and DCM disease duration
>2 months. Patients requiring intravenous inotropic/mechanical support or
listed status 1A/1B for transplant were excluded. Disease progression was
defined as an increase in transplant listing status, hospitalization for
heart failure, intravenous inotropes, mechanical support, or death.
Predictors of disease progression were identified using Cox proportional
hazards modeling and classification and regression tree analysis. Of the
127 patients, 28 (22%) had disease progression during the 18-month
follow-up. Multivariable analysis identified older age at diagnosis
(hazard ratio=1.14 per year; P<0.001), larger left ventricular (LV)
end-diastolic M-mode dimension z-score (hazard ratio=1.49; P<0.001), and
lower septal peak systolic tissue Doppler velocity z-score (hazard
ratio=0.81; P=0.01) as independent predictors of disease progression.
Classification and regression tree analysis stratified patients at risk of
disease progression with 89% sensitivity and 94% specificity based on LV
end-diastolic M-mode dimension z-score >7.7, LV ejection fraction <39%, LV
inflow propagation velocity (color M-mode) z-score <-0.28, and age at
diagnosis >8.5 months. In children with chronic stable DCM, a combination
of diagnosis after late infancy and echocardiographic parameters of larger
LV size and systolic and diastolic function predicted disease progression.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00123071.

<46>
[Use Link to view the full text]
Accession Number
23983248
Authors
Eschalier R. Fertin M. Fay R. Bauters C. Zannad F. Pinet F. Rossignol P.
Institution
(Eschalier) INSERM, Centre d'Investigation Clinique CIC-P 9501, Nancy,
France.
Title
Extracellular matrix turnover biomarkers predict long-term left
ventricular remodeling after myocardial infarction: insights from the
REVE-2 study.
Source
Circulation. Heart failure. 6 (6) (pp 1199-1205), 2013. Date of
Publication: Nov 2013.
Abstract
Extracellular matrix turnover plays a key role in wound repair after
myocardial infarction (MI). The aim of the study was to evaluate whether
biomarkers of myocardial fibrosis measurements 1 month after MI may
predict left ventricular (LV) remodeling. This prospective multicenter
study included 246 patients with a first anterior Q-wave MI.
Echocardiographic studies were performed at hospital discharge and 12
months after MI. Brain natriuretic peptide as well as biomarkers of
myocardial fibrosis (type 1 collagen telopeptide, aminoterminal propeptide
of type I procollagen, aminoterminal propeptide of type III procollagen)
were measured 1 month after MI in 218 patients. In multivariate analysis,
aminoterminal propeptide of type III procollagen/type 1 collagen
telopeptide ratio <1 (odds ratio [95% confidence interval], 1.86
[1.02-3.39]; P=0.043) 1 month after MI and brain natriuretic peptide >100
pg/mL (2.35 [1.28-4.31]; P=0.006) were associated with a pejorative LV
remodeling, whereas LV ejection fraction at discharge (per 5% increment;
0.78 [0.65-0.94]; P=0.01) was independently associated with lower rates of
detrimental LV remodeling at 12 months. Patients with high brain
natriuretic peptide and aminoterminal propeptide of type III
procollagen/type 1 collagen telopeptide ratio <1, measured 1 month after
MI, had the highest risk of developing a primary composite event
(cardiovascular death or hospitalization for worsening heart failure; 14
events per 216 patients; P=0.0001) during a 3-year follow-up. Myocardial
fibrosis turnover after MI is associated with LV remodeling. Low
aminoterminal propeptide of type III procollagen/type 1 collagen
telopeptide ratio (<1) at 1 month is predictive, in addition to brain
natriuretic peptide and LV ejection fraction, of detrimental LV remodeling
as well as cardiovascular deaths and hospitalizations for heart failure.

<47>
Accession Number
2013804495
Authors
Fang Y. Qiu Z. Hu W. Yang J. Yi X. Huang L. Zhang S.
Institution
(Fang, Qiu, Hu, Yang, Yi, Huang, Zhang) Department of Neurology, Tongji
Hospital of Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, Hubei 430030, China
Title
Effect of piracetam on the cognitive performance of patients undergoing
coronary bypass surgery: A meta-analysis.
Source
Experimental and Therapeutic Medicine. 7 (2) (pp 429-434), 2014. Date of
Publication: 2014.
Publisher
Spandidos Publications Ltd. (10 Vriaxidos Street, Athens 11635, Greece)
Abstract
Cognitive impairments are observed in numerous patients following coronary
bypass surgery, and piracetam are nootropic compounds that modulate
cerebral functions by directly enhancing cognitive processes. The present
meta-analysis was conducted to evaluate the protective effect of piracetam
on the cognitive performance of patients undergoing coronary bypass
surgery. The relevant studies were identified by searching Medline,
EMBASE, PubMed and the Cochrane Library up to June 2013 and the pertinent
bibliographies from the retrieved studies were reviewed. Data were
selected from the studies according to predefined criteria. The
meta-analysis included two randomized control trials involving 184
patients and including the Syndrom-Kurz test (SKT). Findings of the
meta-analysis showed that following treatment the change from baseline
observed in five SKT subtest scores, conducted with piracetam patients,
indicated a significant advantage over those patients that were in the
placebo group. The subtests included immediate pictured object recall,
weighted mean difference (WMD)=0.91, 95% confidence interval (CI)
0.51-1.31, P<0.00001; delayed pictured object recall, WMD=0.74, 95% CI
0.19-1.28, P=0.008; delayed picture recognition, WMD=0.82, 95% CI
0.31-1.31, P=0.001; immediate word recall, WMD=0.87, 95% CI 0.47-1.28,
P<0.0001; and letter interference, WMD=3.46, 95% CI -5.69 to - - 1.23,
P=0.002. These results indicated that piracetam may have been effective in
improving the short-term cognitive performance of patients undergoing
coronary bypass surgery. High quality, well-controlled and longer
randomized trials are required to corroborate this result.

<48>
[Use Link to view the full text]
Accession Number
2014031515
Authors
Zhao Z.-G. Liao Y.-B. Peng Y. Chai H. Liu W. Li Q. Ren X. Wang X.-Q. Luo
X.-L. Zhang C. Lu L.-H. Meng Q.-T. Chen C. Chen M. Feng Y. Huang D.-J.
Institution
(Peng, Chai, Liu, Li, Ren, Wang, Luo, Zhang, Lu, Meng, Chen, Chen, Feng,
Huang) Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, China
(Zhao, Liao) Department of Cardiology, West China Hospital, Sichuan
University, 37 Guoxue St, Chengdu 610041, China
Title
Sex-Related differences in outcomes after transcatheter aortic valve
implantation a systematic review and meta-analysis.
Source
Circulation: Cardiovascular Interventions. 6 (5) (pp 543-551), 2013. Date
of Publication: October 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-There were considerable discrepancies with regard to
sex-related differences in complications and prognosis after transcatheter
aortic valve implantation. Methods and Results-The Cochrane library and
PubMed online databases were searched. Articles reporting sex-specific
post-transcatheter aortic valve implantation complications and mortality
were identified. Two authors selected studies and extracted data
independently. Random- and fixed-effects models were used depending on
between-study heterogeneity. There were 27 articles, a total of 9118
patients, enrolled in our systematic review and meta-analysis, including
4176 men and 4942 women. Pooled analyses suggested considerable
sex-related differences in complications and early as well as midterm
outcomes after transcatheter aortic valve implantation. The difference in
the risk for heart block requiring permanent pacemaker implantation was
noted to be significant only in the subgroup of the CoreValve-dominating
studies (pooled risk ratio [RR, men versus women], 1.29; 95% confidence
interval [CI], 1.13-1.47). Although men had significantly lower risks for
major/life- threatening bleeding (pooled RR, 0.81; 95% CI, 0.68-0.96) and
major vascular complications (pooled RR, 0.49; 95% CI, 0.37-0.66), they
had poorer prognosis. In fact, male sex was associated with significantly
higher risks for deaths at both 30 days (RR, 1.37; 95% CI, 1.07-1.76) and
1 year (RR, 1.30; 95% CI, 1.14-1.49). Conclusions-Although men had lower
risks for major/life-threatening bleeding and major vascular complications
after transcatheter aortic valve implantation, they had less favorable
short-term and midterm survival. (Circ Cardiovasc Interv. 2013;6:543-551.)
2013 American Heart Association, Inc.

<49>
[Use Link to view the full text]
Accession Number
2014031443
Authors
Gold M.R. Daubert J.-C. Abraham W.T. Hassager C. Dinerman J.L. Hudnall
J.H. Cerkvenik J. Linde C.
Institution
(Gold) Division of Cardiology, Medical University of South Carolina, 25
Courtenay Dr, ART 7031, Charleston, SC 29425-5920, United States
(Daubert) Department of Cardiology, University Hospital, Rennes, France
(Abraham) Division of Cardiovascular Medicine, Ohio State University,
Columbus, United States
(Hassager) Department of Cardiology, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark
(Dinerman) Department of Cardiology, Heart Center Research, Huntsville,
AL, United States
(Hudnall, Cerkvenik) CRDM Clinical Research, Medtronic Inc., Minneapolis,
MN, United States
(Linde) Department of Medicine, Karolinska University Hospital, Stockholm,
Sweden
Title
Implantable defibrillators improve survival in patients with mildly
symptomatic heart failure receiving cardiac resynchronization therapy
analysis of the long-term follow-up of remodeling in systolic left
ventricular dysfunction (reverse).
Source
Circulation: Arrhythmia and Electrophysiology. 6 (6) (pp 1163-1168), 2013.
Date of Publication: December 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Cardiac resynchronization therapy (CRT) decreases mortality,
improves functional status, and induces reverse left ventricular
remodeling in selected populations with heart failure. These benefits have
been noted with both CRT-pacemakers as well as those devices with
defibrillator backup (CRT-D). However, there are little data comparing
mortality between these 2 device types. Methods and
Results-REsynchronization reVErses Remodeling in Systolic left vEntricular
dysfunction (REVERSE) was a multicenter, randomized trial of CRT among
patients with mild heart failure. Long-term annual follow-up for 5 years
was preplanned. The present analysis was confined to the 419 patients who
were randomized to active CRT group. CRTpacemakers or CRT-D devices were
implanted based on national guidelines at the time of enrollment, with 74
patients receiving CRT pacemaker devices and the remaining 345 patients
receiving CRT-D devices. After 12 months of CRT, changes in the clinical
composite score, left ventricular end systolic volume index, 6-minute walk
time, and quality of life indices were similar between CRT pacemaker and
CRT-D patients. However, long-term follow-up showed lower morality in the
CRT-D group. Specifically, multivariable analysis showed that CRT-D
(hazard ratio, 0.35; P=0.003) was a strong independent predictor of
survival. Female sex, longer unpaced QRS duration, and smaller baseline
left ventricular end systolic volume index also were also associated with
better survival. Conclusions-REVERSE demonstrated that the addition of
implantable cardioverter-defibrillator therapy to CRT is associated with
improved long-term survival compared with CRT pacing alone in mild heart
failure. Clinical Trial Registration-URL: http://clinicaltrials.gov.
Unique Identifier: NCT00271154. 2013 American Heart Association, Inc.

<50>
Accession Number
2014032186
Authors
Yan Y.L. Qiu B. Hu L.J. Jing X.D. Liu Y.J. Deng S.B. Du J.L. She Q.
Institution
(Yan, Qiu, Hu, Jing, Liu, Deng, Du, She) Cardiovascular Department, Second
Affiliated Hospital, Chongqing Medical University, No.76, Linjiang Road
Yuzhong district, Chongqing, China
Title
Efficacy and safety evaluation of intensive statin therapy in older
patients with coronary heart disease: A systematic review and
meta-analysis.
Source
European Journal of Clinical Pharmacology. 69 (12) (pp 2001-2009), 2013.
Date of Publication: 2013.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: To reveal and evaluate the efficacy and safety of intensive
statin therapy in older patients (age >65 years) with coronary heart
disease (CHD). Methods: Electronic databases were searched for randomized
controlled trials (RCTs) that involved intensive statin therapy use in
older patients with CHD. Data was extracted and used to calculate risk
ratios (RR) by software Revman 5.1. Results: Five RCTs and 11,132 patients
were included in. Compared with non-intensive statin therapy, intensive
statin therapy had significant effect on reducing low density lipoprotein
cholesterol (LDL-C) levels (55.4 %) and total cholesterol (TC) and
triglyceride (Tg). Although the results showed that intensive statin
therapy had no superior effect on reduction of mortality (both all-cause
mortality [RR=0.97, p=0.65] and cardiac death [RR=0.95, p=0.57]) and
cardiac arrest (RR=1.09, p=0.81), it possessed significant effects on
prevention of nonfatal myocardial infarction (MI) (RR=0.78, p=0.008),
stroke (RR=0.72, p=0.02) and coronary revascularization (RR=0.69,
p=0.007). In terms of side effects, intensive statin therapy was
associated with small absolute increase in incidence of drug
discontinuation, due to adverse events (3.9 %) and liver enzymes
abnormalities (1.7 %). And the occurrence rates of myopathy,
rhabdomyolysis and creatine kinase (CK) elevation were very low.
Conclusions: This results show that intensive statin therapy has excellent
effects on reduction of serum lipid level including LDL-C, TC, Tg, and
also on prevention of nonfatal MI, stroke and coronary revascularization
with small absolute increased risk of side effects. Our analysis supports
the use of intensive statin therapy in patients >65 years old with CHD.
Springer-Verlag Berlin Heidelberg 2013.

<51>
Accession Number
2014030212
Authors
Yilmaz M.B. Grossini E. Silva Cardoso J.C. Edes I. Fedele F. Pollesello P.
Kivikko M. Harjola V.-P. Hasslacher J. Mebazaa A. Morelli A. Le Noble J.
Oldner A. Erroz I.O. Parissis J.T. Parkhomenko A. Poelzl G. Rehberg S.
Ricksten S.-E. Rodriguez Fernandez L.M. Salmenpera M. Singer M. Treskatsch
S. Vrtovec B. Wikstrom G.
Institution
(Yilmaz) Department of Cardiology, Cumhuriyet University, School of
Medicine, Sivas, Turkey
(Grossini) Laboratorio di Fisiologia, Dipartimento di Medicina
Traslazionale, Universita degli Studi del Piemonte Orientale A. Avogadro,
Piemonte, Italy
(Silva Cardoso) Faculdade de Medicina, Universidade do Porto, Porto,
Portugal
(Edes) Institute of Cardiology, Medical and Health Science Center,
University of Debrecen, Debrecen, Hungary
(Fedele, Morelli) Department of Cardiovascular, Respiratory,
Nephrological, and Geriatric Sciences, La Sapienza University of Rome,
Rome, Italy
(Pollesello, Kivikko) Cardiology and Critical Care, Orion Pharma, Espoo,
Finland
(Harjola) Departments of Cardiology, Helsinki University Hospital,
Helsinki, Finland
(Hasslacher) Internistische Intensiv- und Notfallmedizin,
Universitatsklinik fur Innere Medizin, Innsbruck, Austria
(Mebazaa) Department of Anaesthesia and Intensive Care, Lariboisiere
Hospital, University of Paris, Paris, France
(Le Noble) Department of Intensive Care, VieCuri Medical Center, Venlo,
Netherlands
(Oldner) Department of Physiology and Pharmacology, Section of
Anaesthesiology and Intensive CareMedicine, Karolinska Institute,
Stockholm, Sweden
(Erroz, Rodriguez Fernandez) Department of Pediatrics, Complejo
Asistencial Universitario de Leon, Leon, Spain
(Parissis) Heart Failure Unit, Attikon University Hospital, Athens, Greece
(Parkhomenko) Strazhesko Institute of Cardiology, National Scientific
Centre, Kiev, Ukraine
(Poelzl) Department of Cardiology, Medical University Innsbruck,
Innsbruck, Austria
(Rehberg) Department of Anesthesiology, Intensive Care and Pain Medicine,
University of Muenster, Muenster, Germany
(Ricksten) Department of Cardiothoracic Anesthesia and Intensive Care,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Salmenpera) Department of Anesthesiology and Intensive Care Medicine,
Helsinki University Hospital, Helsinki, Finland
(Singer) Intensive Care Medicine, University College London, London,
United Kingdom
(Treskatsch) Department of Anesthesiology and Intensive Care Medicine,
Charite - University Medicine Berlin, Campus Charite Mitte and Campus
Virchow-Klinikum, Berlin, Germany
(Vrtovec) Advanced Heart Failure and Transplantation Center, Department of
Cardiology, Ljubljana University Medical Center, Ljubljana, Slovenia
(Wikstrom) Kardiologkliniken, Akademiska Sjukhuset, Uppsala, Sweden
Title
Renal effects of levosimendan: A consensus report.
Source
Cardiovascular Drugs and Therapy. 27 (6) (pp 581-590), 2013. Date of
Publication: December 2013.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
Renal dysfunction is common in clinical settings in which cardiac function
is compromised such as heart failure, cardiac surgery or sepsis, and is
associated with high morbidity and mortality. Levosimendan is a calcium
sensitizer and potassium channel opener used in the treatment of acute
heart failure. This review describes the effects of the inodilator
levosimendan on renal function. A panel of 25 scientists and clinicians
from 15 European countries (Austria, Finland, France, Hungary, Germany,
Greece, Italy, Portugal, the Netherlands, Slovenia, Spain, Sweden, Turkey,
the United Kingdom, and Ukraine) convened and reached a consensus on the
current interpretation of the renal effects of levosimendan described both
in non-clinical research and in clinical study reports. Most reports on
the effect of levosimendan indicate an improvement of renal function in
heart failure, sepsis and cardiac surgery settings. However, caution
should be applied as study designs differed from randomized, controlled
studies to uncontrolled ones. Importantly, in the largest HF study (REVIVE
I and II) no significant changes in the renal function were detected. As
it regards themechanism of action, the opening of mitochondrial
K_ATP channels by levosimendan is involved through a
preconditioning effect. There is a strong rationale for randomized
controlled trials seeking beneficial renal effects of levosimendan. As an
example, a study is shortly to commence to assess the role of levosimendan
for the prevention of acute organ dysfunction in sepsis (LeoPARDS).
Springer Science+Business Media New York 2013.