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<1>
Accession Number
2014152764
Authors
Dayan V. Soca G. Cura L. Mestres C.A.
Institution
(Dayan, Soca, Cura) Centro Cardiovascular, Hospital de Clinicas, Facultad
de Medicina, Montevideo, Uruguay
(Mestres) Department of Cardiovascular Surgery, Hospital Clinico,
University of Barcelona, Barcelona, Spain
Title
Similar survival after mitral valve replacement or repair for ischemic
mitral regurgitation: A meta-analysis.
Source
Annals of Thoracic Surgery. 97 (3) (pp 758-765), 2014. Date of
Publication: March 2014.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background Ischemic mitral regurgitation (IMR) occurs in 20% of patients
after myocardial infarction. There is no agreement as to the best surgical
option. With no prospective randomized controlled trials available, our
objective was to perform a meta-analysis comparing replacement and repair.
Methods A literature search was performed in PubMed, EMBASE, Ovid, and
Google Scholar. The following keywords were included: "ischemic mitral
regurgitation" and "repair or replacement." Inclusion and exclusion
criteria were used to reflect current surgical practice (subvalvular
preservation, ring annuloplasty). Primary outcomes of interest were
operative mortality and survival. Secondary outcomes analyzed were change
in ejection fraction (EF), left ventricular (LV) dimensions, New York
Heart Association (NYHA) class, reoperation rate, and 2+ or greater
recurrence of mitral regurgitation. Results Of 280 articles, only 12
satisfied all inclusion and exclusion criteria. These articles included
2,508 patients, 64% of whom received valve replacement. Operative
mortality was lower after repair (odds ratio [OR], 0.56; 95% confidence
interval [CI], 0.38-0.85; p = 0.001); no difference was found when only
articles with patients operated on mainly after 1998 were included (OR,
0.70; 95% CI, 0.44 -1.12; p = 0.14). Survival was similar (hazard ratio
[HR], 0.86; 95% CI, 0.66-1.13; p = 0.28). No differences in EF,
ventricular dimensions, NYHA class, and reoperation were found.
Regurgitation recurrence was higher in the repair group (OR, 7.51; 95% CI,
3.7-15.23; p < 0.001). Conclusions Mitral valve repair is associated with
lower operative mortality but higher recurrence of regurgitation in
patients with ischemic mitral regurgitation. No differences were found
regarding survival, NYHA class, and functional indicators. 2014 by The
Society of Thoracic Surgeons.
<2>
Accession Number
2014139029
Authors
Bouri S. Shun-Shin M.J. Cole G.D. Mayet J. Francis D.P.
Institution
(Bouri, Shun-Shin, Cole, Mayet, Francis) International Centre for
Circulatory Health, National Heart and Lung Institute, St Mary's Hospital,
59-61 North Wharf Road, London W2 1LA, United Kingdom
Title
Meta-analysis of secure randomised controlled trials of beta-blockade to
prevent perioperative death in non-cardiac surgery.
Source
Heart. 100 (6) (pp 456-464), 2014. Date of Publication: March 2014.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background Current European and American guidelines recommend the
perioperative initiation of a course of beta-blockers in those at risk of
cardiac events undergoing high- or intermediate-risk surgery or vascular
surgery. The Dutch Echocardiographic Cardiac Risk Evaluation Applying
Stress Echocardiography (DECREASE) family of trials, the bedrock of
evidence for this, are no longer secure. We therefore conducted a
meta-analysis of randomised controlled trials of beta-blockade on
perioperative mortality, non-fatal myocardial infarction, stroke and
hypotension in non-cardiac surgery using the secure data. Methods The
randomised controlled trials of initiation of beta-blockers before
non-cardiac surgery were examined. Primary outcome was all-cause mortality
at 30 days or at discharge. The DECREASE trials were separately analysed.
Results Nine secure trials totalling 10 529 patients, 291 of whom died,
met the criteria. Initiation of a course of beta-blockers before surgery
caused a 27% risk increase in 30-day all-cause mortality ( p=0.04). The
DECREASE family of studies substantially contradict the meta-analysis of
the secure trials on the effect of mortality (p=0.05 for divergence). In
the secure trials, beta-blockade reduced non-fatal myocardial infarction
(RR 0.73, p=0.001) but increased stroke (RR 1.73, p=0.05) and hypotension
(RR 1.51, p<0.00001). These results were dominated by one large trial.
Conclusions Guideline bodies should retract their recommendations based on
fictitious data without further delay. This should not be blocked by
dispute over allocation of blame. The well-conducted trials indicate a
statistically significant 27% increase in mortality from the initiation of
perioperative beta-blockade that guidelines currently recommend. Any
remaining enthusiasts might best channel their energy into a further
randomised trial which should be designed carefully and conducted
honestly.
<3>
Accession Number
2014139015
Authors
Wolfrum M. Froehlich G.M. Knapp G. Casaubon L.K. DiNicolantonio J.J.
Lansky A.J. Meier P.
Institution
(Wolfrum) Department of Internal Medicine, Spital Zollikerberg,
Zollikerberg, Switzerland
(Froehlich, Meier) Heart Hospital, University College London Hospitals
UCLH, London, United Kingdom
(Knapp) Department of Statistics, TU University Dortmund, Dortmund,
Germany
(Casaubon) Division of Neurology, Stroke Program, Toronto Western
Hospital, Toronto, Canada
(DiNicolantonio) Wegmans Pharmacy, Ithaca, NY, United States
(Lansky, Meier) Division of Cardiology, Yale Medical School, New Haven,
CT, United States
Title
Stroke prevention by percutaneous closure of patent foramen ovale: A
systematic review and meta-analysis.
Source
Heart. 100 (5) (pp 389-395), 2014. Date of Publication: March 2014.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Context The role of percutaneous closure of patent foramen oval (PFO) in
patients with cryptogenic stroke has been very controversial for years due
to a lack of clear evidence. Objective Systematic review and meta-analysis
of the effect of percutaneous PFO closure for secondary prevention of
cryptogenic strokes as compared to best medical therapy (BMT). Data
sources Trials were identified through a literature search until 28 May
2013. Study selection Controlled clinical trials (randomised and
non-randomised) comparing percutaneous PFO closure with BMT. Data
extraction and synthesis Main end point of interest was stroke. A random
effects model was used to calculate the pooled relative risks (RR) with
95% CIs. Results A total of 14 studies (three randomised controlled trials
(RCT) and 11 non-randomised observational studies (non-RCT)), and a total
of 4335 patients were included for this analysis. There was no significant
treatment effect of PFO closure regarding stroke among the RCT (RR 0.66,
95% CI 0.37 to 1.19, p=0.171). However, among non-RCT stroke was reduced
(RR 0.37, 95% CI 0.20 to 0.67, p<0.001) after PFO closure. A time-to-event
(stroke) analysis, combining all three RCT and the two non-RCT which
applied strict multivariate adjustments, showed a borderline significant
risk reduction after PFO closure (HR 0.58, 95% CI 0.33 to 0.99, p=0.047).
Neither risk of bleeding nor mortality differed significantly between the
groups. However, there was a higher incidence of new onset atrial
fibrillation in the closure group (RR 3.50, 95% CI 1.47 to 8.35, p=0.005).
Conclusions Percutaneous closure of PFO in patients with cryptogenic
stroke does not appear superior to medical therapy according to currently
available randomised data. Furthermore, it is associated with an increased
incidence of atrial fibrillation. However, there are signals pointing
towards a potential benefit and more research should be strongly
encouraged.
<4>
[Use Link to view the full text]
Accession Number
2014148978
Authors
Yoshimura T. Ueda K. Kakinuma A. Sawai J. Nakata Y.
Institution
(Yoshimura, Kakinuma, Sawai) Department of Anesthesiology, Teikyo
University Hospital, Tokyo, Japan
(Ueda) Department of Anesthesia, University of Iowa Roy J. and Lucille A.
Carver, College of Medicine, Iowa City, IA, United States
(Nakata) Graduate School of Public Health, Teikyo University, Tokyo, Japan
Title
Bronchial blocker lung collapse technique: Nitrous oxide for facilitating
lung collapse during one-lung ventilation with a bronchial blocker.
Source
Anesthesia and Analgesia. 118 (3) (pp 666-670), 2014. Date of Publication:
March 2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND:: Effective lung collapse of the nonventilated lung can
facilitate thoracic surgery. Previous studies showed that using a
bronchial blocker could delay the time of lung collapse compared with
using a double-lumen endotracheal tube. We hypothesized that the use of
nitrous oxide (N2O) in the inspired gas mixture during 2-lung ventilation
would lead to clinically relevant improvement of lung collapse during
subsequent 1-lung ventilation with a bronchial blocker. METHODS:: Fifty
patients were randomized into 2 groups: N2O (n =26) or O2 (n = 24). The
N2O group received a gas mixture of oxygen and N2O (FIO2 = 0.5), and the
O2 group received 100% oxygen until the start of 1-lung ventilation. Lung
isolation was achieved with an Arndt wire-guided bronchial blocker (Cook
Critical Care, Bloomington, IN. After turning patients to the lateral
decubitus position, the cuff of the bronchial blocker was inflated under
fiberoptic bronchoscopy surveillance, and thereafter, the dependent lung
was ventilated with 100% oxygen during 1-lung ventilation in both groups.
Surgeons blinded to the randomization evaluated the degree of lung
collapse by using a verbal rating scale (lung collapse scale, 0 = no
collapse to 10 = complete collapse) at 5 minutes after opening the pleura.
Also, as secondary outcomes, lung collapse at 1 and 10 minutes were
evaluated. RESULTS:: The score on the lung collapse scale in the N2O group
was significantly higher compared with the O2 group at 5 minutes after
opening the pleura (7 vs 5, P < 0.001, WMWodds = 7.3, 95% confidence
interval (CI), 6.0 to 9.0). It was also higher in the N2O group at 10
minutes (10 vs 7, P < 0.001, WMWodds = 10.1, 95% CI, 1.9-13.3). The lung
collapse scale between groups was not significant at 1 minute after
opening the pleura (2 vs 2, P = 0.76, WMWodds = 1.1, 95% CI, 0.96-1.2).
None of the patients developed hypoxia (SpO2 <92%) during 1-lung
ventilation. CONCLUSIONS:: Filling the lung with 50% N2O before 1-lung
ventilation facilitated lung collapse 5 minutes after opening the chest
compared with 100% oxygen when a bronchial blocker was used. The N2O/O2
mixture (FIO2 = 0.5) did not have a harmful effect on subsequent arterial
oxygenation during 1-lung ventilation. 2013 International Anesthesia
Research Society.
<5>
[Use Link to view the full text]
Accession Number
2014148977
Authors
Ferrando C. Mugarra A. Gutierrez A. Carbonell J.A. Garcia M. Soro M.
Tusman G. Belda F.J.
Institution
(Ferrando, Mugarra, Gutierrez, Carbonell, Garcia, Soro, Belda)
Anesthesiology and Critical Care Department, Hospital Clinico
Universitario of Valencia, Av. Blasco Ibanez, 17, Valencia, CP: 46010,
Spain
(Tusman) Department of Anesthesiology, Hospital Privado de Comunidad, Mar
de Plata, Argentina
Title
Setting individualized positive end-expiratory pressure level with a
positive end-expiratory pressure decrement trial after a recruitment
maneuver improves oxygenation and lung mechanics during one-lung
ventilation.
Source
Anesthesia and Analgesia. 118 (3) (pp 657-665), 2014. Date of Publication:
March 2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND:: We investigated whether individualized positive
end-expiratory pressure (PEEP) improves oxygenation, ventilation, and lung
mechanics during one-lung ventilation compared with standardized PEEP.
METHODS:: Thirty patients undergoing thoracic surgery were randomly
allocated to the study or control group. Both groups received an alveolar
recruitment maneuver at the beginning and end of one-lung ventilation.
After the alveolar recruitment maneuver, the control group had their lungs
ventilated with a 5 cmH2O PEEP, while the study group had their lungs
ventilated with an individualized PEEP level determined by a PEEP
decrement trial. Arterial blood samples, lung mechanics, and volumetric
capnography were recorded at multiple timepoints throughout the procedure.
RESULTS:: The individualized PEEP values in study group were higher than
the standardized PEEP values (10 + 2 vs 5 cmH2O; P < 0.001). In both
groups, arterial oxygenation decreased when bilateral-lung ventilation was
switched to one-lung ventilation and increased after the alveolar
recruitment maneuver. During one-lung ventilation, oxygenation was
maintained in the study group but decreased in the control group. After
one-lung ventilation, arterial oxygenation was significantly higher in the
study group (306 vs 231 mmHg, P = 0.007). Static compliance decreased in
both groups when bilateral-lung ventilation was switched to one-lung
ventilation. Static compliance increased significantly only in the study
group (P < 0.001) after the alveolar recruitment maneuver and optimal PEEP
adjustment. The alveolar recruitment maneuver did not decrease cardiac
index in any patient. CONCLUSIONS:: During one-lung ventilation, the
improvements in oxygenation and lung mechanics after an alveolar
recruitment maneuver were better preserved by ventilation by using
individualized PEEP with a PEEP decrement trial than with a standardized 5
cmH2O of PEEP. 2013 International Anesthesia Research Society.
<6>
Accession Number
2014132453
Authors
Wohrle J. Werner G.S.
Institution
(Wohrle) Department of Internal Medicine II, University of Ulm,
Albert-Einstein-Allee 23, 89081 Ulm, Germany
(Werner) Medizinische Klinik i, Klinikum Darmstadt GmbH, Darmstadt,
Germany
Title
Paclitaxel-coated balloon with bare-metal stenting in patients with
chronic total occlusions in native coronary arteries.
Source
Catheterization and Cardiovascular Interventions. 81 (5) (pp 793-799),
2013. Date of Publication: 2013.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objectives: We sought to evaluate the efficacy and safety of
paclitaxel-coated balloon plus bare-metal stenting (BMS) in chronic total
occlusions (CTOs). Background: Drugeluting stent implantation after
recanalization of CTOs is limited by the occurrence of restenosis and risk
for late stent thromboses. Methods: In this prospective, bicenter trial we
treated 48 patients after successful chronic total occlusion (CTO)
recanalization in a native coronary artery with paclitaxel-coated balloon
plus BMS. Patients were matched according to stent length, reference
diameter, and diabetes mellitus with 48 patients treated with Taxus stent
implantation. Dual antiplatelet therapy was prescribed for 6 months.
Angiographic (clinical) follow-up was obtained after 6 (12) months.
Primary endpoint was in-stent late lumen loss. Results: There was no
difference in patient baseline characteristics or procedural results.
Stent length was 59.7 + 32.4 mm (16-151 mm) for paclitaxel-coated balloon
plus BMS versus 56.2 + 25.9 mm (16-132 mm) for Taxus stent. Late loss was
statistically not different within the stent with 0.64 + 0.69 mm versus
0.43 + 0.64 mm (difference 0.20 mm, 95% confidence interval 20.07 to 0.47,
P = 0.14) and at the occlusion site with 0.33 + 0.69 mm versus 0.26 + 0.70
mm, respectively. Restenosis rate was 27.7% compared with 20.8% (P 5 0.44)
and the combined clinical endpoint (cardiac death, myocardial infarction
attributed to the target vessel, target lesion revascularization) was
14.6% versus 18.8% (P 5 0.58), respectively. Conclusions: In conclusion,
for patients with complex CTOs in native coronary arteries the use of
paclitaxel-coated balloon after bare-metal stenting was associated with
similar clinical results and a nonsignificantly higher in-stent late loss
compared with a matched population with paclitaxel-eluting stent
implantation (ClinicalTrials.gov NCT00670436). 2012 Wiley Periodicals,
Inc.
<7>
Accession Number
2014132470
Authors
Dvir D. Sagie A. Porat E. Assali A. Shapira Y. Vaknin-Assa H. Shafir G.
Bental T. Nevzorov R. Battler A. Kornowski R.
Institution
(Dvir, Sagie, Assali, Shapira, Vaknin-Assa, Bental, Nevzorov, Battler,
Kornowski) Department of Cardiology, Tel Aviv University, Rabin Medical
Center, Petach Tikva 49100, Israel
(Porat) Department of Cadiothoracic Surgery, Rabin Medical Center, Petach
Tikva, Tel Aviv University, Tel Aviv, Israel
(Shafir) Department of Radiology, Rabin Medical Center, Petach Tikva, Tel
Aviv University, Tel Aviv, Israel
Title
Clinical profile and outcome of patients with severe aortic stenosis at
high surgical risk: Single-center prospective evaluation according to
treatment assignment.
Source
Catheterization and Cardiovascular Interventions. 81 (5) (pp 871-881),
2013. Date of Publication: 2013.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Background: The study sought to assess the clinical profile, outcome, and
predictors for mortality of ''real-world'' high-risk severe aortic
stenosis patients according to the mode of treatment assigned. Methods:
Patients were referred to a dedicated clinic for meticulous screening and
multidisciplinary team assessment and 343 were finally assigned treatment
(age 81.3 + 7.2 years, 42.3% men): transcatheter aortic valve replacement
(TAVR) with the Edwards SAPIEN or CoreValve device, 100 (29.2%); surgical
aortic valve replacement (SAVR), 61 (17.8%); balloon valvuloplasty (as
definitive therapy), 27 (7.9%); medication only, 155 (45.2%). No patient
was lost to follow-up. Results: The balloon valvuloplasty group had a
significantly higher 1-month mortality rate (18.5%) than the TAVR group
(3%, P = 0.006) and medical therapy group (3.9%; P = 0.004), without
significant difference from the SAVR group (11.5%, P = 0.5). Oneyear
cumulative survival was significantly higher in the TAVR group (92%) than
in the other groups (SAVR 71%, balloon valvuloplasty 61.5%, medication
65%; all P > 0.001). Among survivors, 1-year rates of high functional
class (NYHA I/II) were as follows: TAVR, 84.6%; SAVR, 63.3%; balloon
valvuloplasty, 18.2%; medication, 21.4% (TAVR vs. SAVR, P = 0.04; SAVR vs.
balloon valvuloplasty or medical therapy, P = 0.01). On multivariate
regression analysis, renal failure (hazard ratio [HR] = 5.3, P > 0.001),
not performing TAVR (HR = 4.9, P > 0.001), and pulmonary pressure (10 mm
Hg, HR = 1.2, P = 0.02) were independent predictors of 1-year mortality.
Conclusions: TAVR, performed in carefully selected high-risk patients, is
associated with an excellent survival rate and high functional class.
Patients treated with another of the available modalities, including SAVR,
had a worse outcome, regardless of which alternative treatment they
receive. 2012 Wiley Periodicals, Inc.
<8>
Accession Number
2014147459
Authors
Garg A.X. Kurz A. Sessler D.I. Cuerden M. Robinson A. Mrkobrada M. Parikh
C. Mizera R. Jones P.M. Tiboni M. Rodriguez R.G. Popova E. Gomez M.F.R.
Meyhoff C.S. Vanhelder T. Chan M.T.V. Torres D. Parlow J. De Nadal
Clanchet M. Amir M. Bidgoli S.J. Pasin L. Martinsen K. Malaga G. Myles P.
Acedillo R. Roshanov P. Walsh M. Dresser G. Kumar P. Fleischmann E. Villar
J.C. Painter T. Biccard B. Bergese S. Srinathan S. Cata J.P. Chan V. Mehra
B. Leslie K. Whitlock R. Devereaux P.J.
Institution
(Garg, Mrkobrada, Jones, Acedillo, Roshanov, Dresser) Western University,
London Health Sciences Centre, London, ON, Canada
(Kurz, Sessler) Cleveland Clinic, Cleveland, OH, United States
(Cuerden) University of Waterloo, Waterloo, Canada
(Robinson, Mizera, Tiboni, Vanhelder, Walsh, Whitlock, Devereaux)
Population Health Research Institute, McMaster University, Hamilton Health
Sciences/St Joseph's Healthcare, Hamilton, ON, Canada
(Parikh) Yale University, CT, United States
(Rodriguez, Popova) Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
(Gomez) Fundacion Oftalmologica de Santander (FOSCAL), Bucaramanga,
Colombia
(Meyhoff) Copenhagen University Hospital Herlev, Herlev, Denmark
(Chan) Chinese University of Hong Kong, Hong Kong Special Administrative
Region, China
(Torres) Clinica Santa Maria, Santiago, Chile
(Parlow) Kingston General Hospital, Kingston, Canada
(De Nadal Clanchet) Hospital Vall d'Hebron, Barcelona, Spain
(Amir) Shifa International Hospitals Limited, Islamabad, Pakistan
(Bidgoli) CHU Brugmann, Brussels, Belgium
(Pasin) San Raffaele Scientific Institute, Milan, Italy
(Martinsen) Vejle Hospital, Vejle, Denmark
(Malaga) Hospital Nacional Cayetano Heredia, Lima, Peru
(Myles) Monash University, Melbourne, VIC, Australia
(Kumar) University of North Carolina Medical School, Chapel Hill, NC,
United States
(Fleischmann) Vienna General Hospital, Medical University of Vienna,
Vienna, Austria
(Villar) Fundacion Cardioinfantil (FCI), Bogota, Colombia
(Painter) Royal Adelaide Hospital, Adelaide, SA, Australia
(Biccard) Nelson R Mandela School of Medicine, Durban, South Africa
(Bergese) Ohio State University Medical Center, Columbus, OH, United
States
(Srinathan) University of Manitoba, Winnipeg, MB, Canada
(Cata) University of Texas, MD Anderson Cancer Center, Houston, TX, United
States
(Chan) University of Toronto, Toronto, ON, Canada
(Mehra) Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra,
India
(Leslie) Royal Melbourne Hospital, Melbourne, VIC, Australia
Title
Aspirin and clonidine in non-cardiac surgery: Acute kidney injury substudy
protocol of the Perioperative Ischaemic Evaluation (POISE) 2 randomised
controlled trial.
Source
BMJ Open. 4 (2) , 2014. Article Number: 004886. Date of Publication: 2014.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Introduction: Perioperative Ischaemic Evaluation-2 (POISE-2) is an
international 2x2 factorial randomised controlled trial of low-dose
aspirin versus placebo and low-dose clonidine versus placebo in patients
who undergo non-cardiac surgery. Perioperative aspirin (and possibly
clonidine) may reduce the risk of postoperative acute kidney injury (AKI).
Methods and analysis: After receipt of grant funding, serial postoperative
serum creatinine measurements began to be recorded in consecutive patients
enrolled at substudy participating centres. With respect to the study
schedule, the last of over 6500 substudy patients from 82 centres in 21
countries were randomised in December 2013. The authors will use logistic
regression to estimate the adjusted OR of AKI following surgery (compared
with the preoperative serum creatinine value, a postoperative increase
>26.5 mumol/L in the 2 days following surgery or an increase of >50% in
the 7 days following surgery) comparing each intervention to placebo, and
will report the adjusted relative risk reduction. Alternate definitions of
AKI will also be considered, as will the outcome of AKI in subgroups
defined by the presence of preoperative chronic kidney disease and
preoperative chronic aspirin use. At the time of randomisation, a
subpopulation agreed to a single measurement of serum creatinine between 3
and 12 months after surgery, and the authors will examine intervention
effects on this outcome. Ethics and dissemination: The authors were
competitively awarded a grant from the Canadian Institutes of Health
Research for this POISE-2 AKI substudy. Ethics approval was obtained for
additional kidney data collection in consecutive patients enrolled at
participating centres, which first began for patients enrolled after
January 2011. In patients who provided consent, the remaining longer term
serum creatinine data will be collected throughout 2014. The results of
this study will be reported no later than 2015. Clinical Trial
Registration Number: NCT01082874.
<9>
Accession Number
2014143102
Authors
Hoffmann R. Barletta G. Von Bardeleben S. Vanoverschelde J.L. Kasprzak J.
Greis C. Becher H.
Institution
(Hoffmann) Medical Clinic i, University RWTH Aachen, Pauwelsstrase 30,
52074 Aachen, Germany
(Barletta) Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
(Von Bardeleben) University Medicine, Johannes Gutenberg-University Mainz,
Mainz, Germany
(Vanoverschelde) Cliniques Universitaires Saint-Luc, Brussels, Belgium
(Kasprzak) Medical University, Lodz, Poland
(Greis) Bracco Imaging Deutschland, Konstanz, Germany
(Becher) University of Alberta, Edmonton, AB, Canada
Title
Analysis of left ventricular volumes and function: A multicenter
comparison of cardiac magnetic resonance imaging, cine ventriculography,
and unenhanced and contrast-enhanced two-dimensional and three-dimensional
echocardiography.
Source
Journal of the American Society of Echocardiography. 27 (3) (pp 292-301),
2014. Date of Publication: March 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background Contrast echocardiography improves accuracy and reduces
interreader variability on left ventricular (LV) functional analyses in
the setting of two-dimensional (2D) echocardiography. The need for
contrast imaging using three-dimensional (3D) echocardiography is less
defined. The aim of this multicenter study was to define the accuracy and
interreader agreement of unenhanced and contrast-enhanced 2D and 3D
echocardiography for the assessment of LV volumes and ejection fraction
(EF). Methods A multicenter, open-label study was conducted including 63
patients, using intrasubject comparisons to assess the agreement of
unenhanced and contrast-enhanced 2D and 3D echocardiography as well as
calibrated biplane cine ventriculography with cardiac magnetic resonance
for the determination of LV volumes and EF. Each of the imaging techniques
used to define LV function was assessed by two independent, off-site
readers unaware of the results of the other imaging techniques. Results LV
end-systolic and end-diastolic volumes were underestimated by 2D and 3D
unenhanced echocardiography compared with cardiac magnetic resonance.
Contrast enhancement resulted in similar significant increases in LV
volumes on 2D and 3D echocardiography. The mean percentage of interreader
variability for LV EF was reduced from 14.3% (95% confidence interval
[CI], 11.7%-16.8%) for unenhanced 2D echocardiography and 14.3% (95% CI,
9.7%-18.9%) for unenhanced 3D echocardiography to 8.0% (95% CI, 6.3%-9.7%;
P <.001) for contrast-enhanced 2D echocardiography and 7.4% (95% CI,
5.7%-9.1%; P <.01) for contrast-enhanced 3D echocardiography and thus to a
similar level as for cardiac magnetic resonance (7.9%; 95% CI,
5.4%-10.5%). A similar effect was observed for interreader variability for
LV volumes. Conclusions Contrast administration on 3D echocardiography
results in improved determination of LV volumes and reduced interreader
variability. The use of 3D echocardiography requires contrast application
as much as 2D echocardiography to reduce interreader variability for
volumes and EF. Copyright 2014 by the American Society of
Echocardiography.
<10>
Accession Number
2014143624
Authors
Fonseca A.L. Ozgediz D.E. Christison-Lagay E.R. Detterbeck F.C. Caty M.G.
Institution
(Fonseca, Ozgediz, Christison-Lagay, Caty) Department of Pediatric
Surgery, Yale School of Medicine, FMB 107, 333 Cedar Street, New Haven, CT
06511, United States
(Detterbeck) Department of Thoracic Surgery, Yale School of Medicine, New
Haven, CT, United States
Title
Pediatric thymomas: Report of two cases and comprehensive review of the
literature.
Source
Pediatric Surgery International. 30 (3) (pp 275-286), 2014. Date of
Publication: March 2014.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: Thymomas are rare pediatric malignancies with indolent behavior.
There are fewer than 50 reported cases and no comprehensive review. We
sought to evaluate our recent experience with pediatric thymomas, and
comprehensively review the extant literature. Methods: A systematic search
of the PubMed database was performed using keywords: "thymoma", "
pediatric", "juvenile", "childhood", and "child". Additional studies were
identified by a manual search of the reference list. Results: We report
two patients with thymomas. We identified 22 case reports or series that
described 48 patients; 62 % were male, 15 % presented with myasthenia
gravis. Fifty percent were Masaoka Stage I, 15 % were Stage II, 13 % were
Stage III, and 23 % were Stage IV. Four patients with early stage (I or
II) disease were treated with adjuvant therapies in addition to surgical
excision, while five patients with late stage (III or IV) disease treated
with surgical excision alone. Of studies reporting at least 2-year
follow-up, survival was 71 %. Conclusion: Pediatric thymomas are rare
tumors with a slight male predominance. Wide variations were observed in
the treatment of thymomas across all stages. Our review indicates a need
for large database and multi-institutional studies to clearly elucidate
clinical course, prognostic factors and outcome. 2013 Springer-Verlag
Berlin Heidelberg.
<11>
Accession Number
2014132241
Authors
Gustafsson F. Gude E. Sigurdardottir V. Aukrust P. Solbu D. Goetze J.-P.
Gullestad L.
Institution
(Gustafsson) Department of Cardiology Rigshospitalet, Copenhagen, Denmark
(Gude, Gullestad) Department of Cardiology, Oslo University Hospital
Rikshospitalet, Oslo, Norway
(Sigurdardottir) Transplant Institute, Sahlgrenska University Hospital
Gothenburg, Sweden
(Aukrust) Section of Clinical Immunology and Infectious Diseases, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Aukrust, Gullestad) Faculty of Medicine, University of Oslo, N-0027 Oslo,
Norway
(Solbu) Novartis Norway, Oslo, Norway
(Goetze) Department of Biochemistry Rigshospitalet, Copenhagen, Denmark
Title
Plasma NGAL and glomerular filtration rate in cardiac transplant
recipients treated with standard or reduced calcineurin inhibitor levels.
Source
Biomarkers in Medicine. 8 (2) (pp 239-245), 2014. Date of Publication:
February 2014.
Publisher
Future Medicine Ltd. (2nd Albert Place, Finchley Central, London N3 1QB,
United Kingdom)
Abstract
Aim: Predictors of renal recovery following conversion from calcineurin
inhibitor- to proliferation signal inhibitor-based therapy are lacking. We
hypothesized that plasma NGAL (P-NGAL) could predict improvement in
glomerular filtration rate (GFR) after conversion to everolimus. Patients
& methods: P-NGAL was measured in 88 cardiac transplantation patients
(median 5 years post-transplant) with renal dysfunction randomized to
continuation of conventional calcineurin inhibitor-based immunosuppression
or switching to an everolimus-based regimen. Results: P-NGAL correlated
with measured GFR (mGFR) at baseline (R = 0.21; p < 0.001). Randomization
to everolimus improved mGFR after 1 year (median [25-75 % percentiles]:
mGFR 5.5 [-0.5-11.5] vs -1 [-7-4] ml/min/1.73 m; p = 0.006). Baseline
P-NGAL predicted mGFR after 1 year (R = 0.18; p < 0.001), but this
association disappeared after controlling for baseline mGFR. Conclusion:
P-NGAL and GFR correlate with renal dysfunction in long-term heart
transplantation recipients. P-NGAL did not predict improvement of renal
function after conversion to everolimus-based immunosuppression. 2014
Future Medicine Ltd.
<12>
Accession Number
2014138799
Authors
Andalib A. Mamane S. Schiller I. Zakem A. Mylotte D. Martucci G. Lauzier
P. Alharbi W. Cecere R. Dorfmeister M. Lange R. Brophy J. Piazza N.
Institution
(Andalib, Mamane, Zakem, Mylotte, Martucci, Lauzier, Alharbi, Piazza)
Department of Medicine, Division of Cardiology, McGill University Health
Centre, 687 Pine Avenue West, Montreal, QC H3A 1A1, Canada
(Schiller, Brophy) Department of Epidemiology and Biostatistics, McGill
University Health Centre, Montreal, QC, Canada
(Cecere) Department of Cardiovascular Surgery, McGill University Health
Centre, Montreal, QC, Canada
(Dorfmeister, Lange, Piazza) Department of Cardiovascular Surgery, German
Heart Center Munich, Munich, Germany
Title
A systematic review and meta-analysis of surgical outcomes following
mitral valve surgery in octogenarians: Implications for transcatheter
mitral valve interventions.
Source
EuroIntervention. 9 (10) (pp 1225-1234), 2014. Date of Publication:
February 2014.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To evaluate the outcomes of mitral valve surgery in octogenarians
with severe symptomatic mitral regurgitation (MR). Methods and results: We
performed a systematic review and meta-analysis of data on octogenarians
who underwent mitral valve replacement (MVR) or mitral valve repair
(MVRpr). Our search yielded 16 retrospective studies. Using Bayesian
hierarchical models, we estimated the pooled proportion of 30-day
mortality, postoperative stroke, and long-term survival. The pooled
proportion of 30-day postoperative mortality was 13% following MVR (10
studies, 3,105 patients, 95% credible interval [CI] 9-18%), and 7%
following MVRpr (six studies, 2,642 patients, 95% CI: 3-12%). Furthermore,
pooled proportions of postoperative stroke were 4% (six studies, 2,945
patients, 95% CI: 3-7%) and 3% (three studies, 348 patients, 95% CI: 1-8%)
for patients undergoing MVR and MVRpr, respectively. Pooled survival rates
at one and five years following MVR (four studies, 250 patients) were 67%
(95% CI: 50-80%) and 29% (95% CI: 16-47%), and following MVRpr (three
studies, 333 patients) were 69% (95% CI: 50-83%) and 23% (95% CI: 12-39%),
respectively. Conclusions: Surgical treatment of MR in octogenarians is
associated with high perioperative mortality and poor long-term survival
with an uncertain benefit on quality of life. These data highlight the
importance of patient selection for operative intervention and suggest
that future transcatheter mitral valve therapies such as transcatheter
mitral valve repair (TMVr) and/or transcatheter mitral valve implantation
(TMVI), may provide an alternative therapeutic approach in selected
high-risk elderly patients. Europa Digital & Publishing 2014. All rights
reserved.
<13>
Accession Number
2014129523
Authors
Cai Y.-X. Fu X.-N. Xu Q.-Z. Sun W. Zhang N.
Institution
(Cai, Fu, Xu, Sun, Zhang) Department of Thoracic Surgery, Tongji Hospital,
Huazhong University of Science and Technology, Wuhan, China
Title
Thoracoscopic lobectomy versus open lobectomy in stage I non-small cell
lung cancer: A meta-analysis.
Source
PLoS ONE. 8 (12) , 2013. Article Number: e82366. Date of Publication: 31
Dec 2013.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
The objective of the present meta-analysis was to evaluate the survival,
recurrence rate, and complications in patients with stage I non-small cell
lung cancer (NSCLC) who received video-assisted thoracoscopic surgery
(VATS) or open lobectomy. A literature search was conducted on June 31,
2012 using combinations of the search terms video-assisted thoracic
surgery, open thoracotomy, lobectomy, and non-small-cell lung cancer
(NSCLC). Inclusion criteria were: 1) Compared video-assisted thoracic
surgery (VATS) lobectomy with open lobectomy. 2) Stage I NSCLC. 2) No
previous treatment for lung cancer. 4) Outcome data included 5-year
survival rate, complication, and recurrence rate. Tests of heterogeneity,
sensitivity, and publication bias were performed. A total of 23 studies
(21 retrospective and 2 prospective) met the inclusion criteria. VATS was
associated with a longer 5-year survival (odds ratio [OR] = 1.622, 95%
confidence interval [CI] 1.272 to 2.069; P<0.001), higher local recurrence
rate (OR = 2.152, 95% CI 1.349 to 3.434; P = 0.001), similar distant
recurrence rate (OR = 0.91, 95% CI 0.33 to 2.48; P = 0.8560), and lower
total complication rate (OR = 0.45, 95% CI 0.24 to 0.84; P = 0.013)
compared to open lobectomy. VATS was also associated with lower rates
arrhythmias, prolonged air leakage, and pneumonia but it did not show any
statistical significance. Patients with stage I NSCLC undergoing VATS
lobectomy had longer survival and fewer complications than those who
received open lobectomy. 2013 Cai et al.
<14>
Accession Number
2014126445
Authors
Aprigliano G. Palloshi A. Morici N. Ferraresi R. Bianchi M. Anzuini A.
Institution
(Aprigliano, Palloshi, Ferraresi, Bianchi) Interventional Cardiovascular
Unit, Cardiology Department, Istituto Clinico Citta Studi, Milan, Italy
(Morici) Cardiologia 1, Azienda Ospedaliera Ospedale Niguarda Ca' Granda,
Milan, Italy
(Anzuini) Cardiology Department, Istituto Clinico Mater Domini,
Castellanza, Italy
Title
Acute coronary syndrome in pre- and post-partum women - a review.
Source
Interventional Cardiology (London). 8 (1) (pp 8-13), 2013. Date of
Publication: March 2013.
Publisher
Touch Briefings (Saffron House, 6-10 Kirby St, London EC1N 8TS, United
Kingdom)
Abstract
Acute coronary syndrome (ACS) during pregnancy and the post-partum period
are weighed by a high mortality rate for the mother and foetus. They
should be considered as multifactorial diseases with a special role for
sexual hormones. In this setting, ACS is mostly related to an early
atherosclerotic disease, even if other conditions are responsible. Indeed,
an important part is due to spontaneous coronary artery dissection, more
common during delivery and the post-partum period. In the remaining
situation, an isolated intracoronary thrombus or a normal angiographic
pattern can be found at angiography. Pathophysiology is still uncertain
with different hypothetical mechanisms. Prompt diagnosis of ACS and
aetiology are essential for an optimal therapeutic strategy. Difficulties
in treatment management is a matter for debate, especially in pre-partum
women. In the last two decades improvements of diagnostic tools, coronary
angiography and subsequent percutaneous treatment have changed the natural
history of this rare condition. RADCLIFFE 2013.
<15>
Accession Number
71359114
Authors
Andreassen A. Andersson B. Eiskjaer H. Radegran G. Gustafsson F. Gude E.
Jansson K. Solbu D. Sigurdadottir V. Dellgren G. Gullestad L.
Institution
(Andreassen, Gude, Gullestad) Oslo University Hospital, Rikshospitalet,
Norway
(Andersson, Sigurdadottir, Dellgren) Sahlgrenska University Hospital,
St.Gothenburg, Sweden
(Eiskjaer) Skejby University Hospital, Aarhus, Denmark
(Radegran) Skane University Hospital, Lund University, Copenhagen, Denmark
(Gustafsson) Copenhagen University Hospital, Copenhagen, Denmark
(Jansson) Heart Center Univeristy Hospital, Linkoping, Sweden
(Solbu) Novartis Norway, Oslo, Norway
Title
Early calcineurin inhibitors avoidance improves renal function in de novo
heart transplant recipients: The results of a randomized controlled trial
(schedule trial).
Source
Transplant International. Conference: 16th Congress of the European
Society for Organ Transplantation, ESOT Vienna Austria. Conference Start:
20130908 Conference End: 20130911. Conference Publication: (var.pagings).
26 (pp 46), 2013. Date of Publication: November 2013.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Calcineurin inhibitors remain crucial following heart
transplantation, but are associated with significant side effects. We
conducted a randomized, open-label, parallel group clinical trial to
assess whether early introduction of everolimus followed by withdrawal of
cyclosporine (CsA) would lead to superior renal function in de novo heart
transplant (HTx) recipients, compared to a standard CsA-based protocol.
Methods: A total of 115 patients were randomly assigned within 5 days
postoperatively to low dose everolimus and reduced dose CsA (n = 56) or
standard CsA dosage (n = 59). All received mycophenolate mofetil and
corticosteroids. In the former group, CsA was withdrawn and full-dose
everolimus initiated after 7-11 weeks. The primary efficacy end point was
renal function assessed by measured glomerular filtration rate (mGFR)
after 12 months. Secondary objectives were progression of
cardiac-allograft vasculopathy (as assessed by intravascular ultrasound
(IVUS)), left ventricular function (assessed by echocardiography and
NT-proBNP), number of rejections and serious adverse effects. Results: At
12 months, mGFR was significantly higher in the everolimus group compared
to standard CsA-based group (80 ml/kg/1.73 m2 vs. 62 ml/kg/ 1.73 m2; p <
0.0001; Intention To Treat population)). A significantly higher incidence
of acute cellular rejection was observed in the everolimus group, while
left ventricular dimension and function (assessed by echocardiography and
NT-proBNP), were similar between the two groups. With similar rates of
bacterial infection, cytomegalovirus infection was significantly less
common in everolimus treated patients (n = 3 (5.4%) vs. n = 18 (30.5%); p
< 0.001). IVUS data, not yet ready, will be presented. Conclusions: Early
elimination of CsA and replacement with an everolimusbased
immunosuppressive strategy was associated with significant and clinically
important improvement in renal function in HTx patients.
<16>
Accession Number
71358138
Authors
Bandong I. Fuentes R.
Institution
(Bandong, Fuentes) St. Luke's Medical Center, Quezon City, Philippines
Title
Positron emission tomography versus cardiac magnetic resonance imaging for
the assessment of myocardial viability: A meta-analysi.
Source
European Journal of Nuclear Medicine and Molecular Imaging. Conference:
26th Annual Congress of the European Association of Nuclear Medicine, EANM
2013 Lyon France. Conference Start: 20131019 Conference End: 20131023.
Conference Publication: (var.pagings). 40 (pp S327-S328), 2013. Date of
Publication: October 2013.
Publisher
Springer Verlag
Abstract
Background: Ischemic heart disease is now the leading cause of death
worldwide, and it is expected that the rate of coronary artery disease
will only accelerate in the next decade with the burden shifting
progressively to lower socioeconomic groups. Chronic ischemic heart
disease with left ventricular dysfunction is present in a number of
clinical syndromes in which myocardial revascularization results in an
improvement of patient's survival. Over the past two decades, positron
emission tomography (PET) imaging has become more widely accessible for
the management of ischemic heart disease. Cardiac magnetic resonance (CMR)
is an emerging diagnostic test for the detection of viable myocardium.
Several studies comparing cardiac MRI with PET have been done the
evaluation of myocardial viability, but each has considered few subjects,
thus leaving uncertainty about the diagnostic accuracy of these two
modalities. The purpose of this study was to evaluate the diagnostic
accuracy of cardiac magnetic resonance (CMR) imaging for the assessment of
myocardial viability compared with the gold standard of positron emission
tomography (PET) Methodology: We searched Medline for literature that
evaluated myocardial viability among patients with chronic ischemic heart
disease and left ventricular dysfunction using cardiac magnetic resonance
imaging (CMI) and positron emission tomography (PET). Data were pooled.
Standard approach for meta-analysis for diagnostic tests and a bivariate
analysis of sensitivity, specificity, positive predictive value (PPV), and
negative predictive value (NPV) were done. Results: From the 17 citations
identified, 7 relevant original articles were selected. Only 3 fulfilled
all of the inclusion criteria, and presented data on segment-based
analysis. The overall segment-based analysis demonstrated a sensitivity of
91% (95% C1: 90-92%), specificity of 88% (95% Cl: 85-91%), positive
predictive value of 97%, negative predictive value of 69%, positive
likelihood ratio of 7.8 and negative predictive value of 0.10 Conclusion:
CMR is highly sensitive for detection of viable myocardium but its
specificity remains moderate.
<17>
Accession Number
71350089
Authors
Clive A.O. Standen S. Maskell N.
Institution
(Clive, Standen, Maskell) Academic Respiratory Unit, University of
Bristol, United Kingdom
Title
Surgical and large bore pleural interventions in malignant pleural
mesothelioma and radiotherapy trial (the SMART trial).
Source
Lung Cancer. Conference: 12th Annual British Thoracic Oncology Group
Conference, BTOG 2014 Dublin Ireland. Conference Start: 20140129
Conference End: 20140131. Conference Publication: (var.pagings). 83 (pp
S81), 2014. Date of Publication: 29 Jan 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Malignant pleural mesothelioma is universally fatal tumour,
the incidence of which continues to rise. 'Procedure tract metastasis'
(PTM) may develop at the site of previous pleural interventions and
prophylactic radiotherapy has previously been used to minimise this
complication. However, three small trials already conducted in this area
showed conflicting results with regards to its efficacy. This has led to
significant variation in practice around the UK and confusion regarding
the optimal treatment strategy for these patients. The SMART trial is a
suitably powered, multi-centre study, designed to conclusively answer this
much debated research question. Methods: 203 patents with a
histo-cytologically proven diagnosis of malignant pleural mesothelioma,
who have undergone a large bore pleural intervention (thoracic surgical
procedure, large bore chest drain, indwelling pleural catheter or local
anaesthetic thoracoscopy) in the previous 35 days will be recruited to the
study. Written informed consent will be taken. Patients will be randomised
to either receive immediate radiotherapy (21 Gy in 3#s within 42 days of
the pleural intervention) or deferred radiotherapy (21 Gy in 3#s given in
the event of a PTM developing). Patients will be followed up for 12
months. Data regarding the incidence of PTM, quality of life data and
chest pain scores will be collected. Results: 25 UK centres are currently
open to recruitment and since the trial opened in December 2011, 134
patients have been recruited to the study. Conclusion: This randomised
controlled clinical trial is currently recruiting in centres around the UK
and 66% of the required patients have already been enrolled.
<18>
Accession Number
71350544
Authors
Wong E.H. Martin J. Fang J.-Y. Bainbridge D. Cheng D.C.
Institution
(Wong, Martin, Bainbridge, Cheng) Department of Anesthesia and
Perioperative Medicine, London Health Sciences Centre, University
Hospital, London, ON, Canada
(Fang) Department of Anesthesia, First Affiliated Hospital, Sun Yat-sen
University, Guangzhou, Guangdong, China
Title
Levosimendan for heart failure and cardiac surgery: A meta-analysis.
Source
Canadian Journal of Anesthesia. Conference: 2013 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS Calgary, AB Canada. Conference
Start: 20130621 Conference End: 20130624. Conference Publication:
(var.pagings). 60 (1 SUPPL. 1) (pp S16), 2013. Date of Publication: June
2013.
Publisher
Springer New York
Abstract
Introduction: Conventional inotropes have long been associated with
hemodynamic benefit, but not survival benefit (1-5). Levosimendan is a
novel inotrope that functions as a calcium sensitizer. It enhances
myocardial contractility but also produces both coronary and peripheral
vasodilation (6). Recent meta-analyses have suggested that levosimendan
may have long-term survival benefits in various patient populations
(7-10). Our meta-analysis seeks to determine the effect of levosimendan on
mortality in two specific patient populations: cardiac surgery patients
and non-surgical inpatients with heart failure. Methods: The primary
outcome of interest was mortality at maximum follow-up available.
Secondary outcomes included atrial fibrillation, hypotension, length of
stay, NYHA class, and ejection fraction. A comprehensive search was
undertaken to identify all randomized control trials of levosimendan use
in post-operative cardiac surgery patients ("CS") and non-surgical
inpatients with heart failure ("HF"). MEDLINE, Cochrane CENTRAL, EMBASE,
and ClinicalTrials.gov were comprehensively searched until August 2012.
All randomized control trials comparing levosimendan to a control and
reporting at least one outcome of interest were included. Odds ratios (OR,
95% confidence intervals [CI]) and weighted mean differences (WMD, 95% CI)
were calculated for discrete and continuous outcomes, respectively. All of
the studies included in this review had approval from their local ethics
board. Results: A total of 48 trials with 4946 patients was included. When
compared to placebo, levosimendan is associated with a non-significant
reduction in mortality for both HF patients (OR 0.71, 95% CI 0.48 - 1.05,
P value for effect 0.09) and CS patients (OR 0.98, 95% CI 0.44 - 2.18, P
value for effect 0.96). When compared to dobutamine/dopamine, levosimendan
is associated with significant reduction in mortality for both HF (OR
0.53, 95% CI 0.31 - 0.89, P value for effect 0.02) and CS patients (OR
0.33, 95% CI 0.13 - 0.84, P value for effect 0.02). However, for HF
patients, there is strong evidence of unpublished negative studies within
both our placebo and dobutamine/dopamine subgroups. Discussion: In either
HF or CS patients, there is no definitive proof that levosimendan has a
survival benefit relative to placebo. This is especially true for HF
patients, due to the high likelihood of unpublished negative studies. When
compared to dobutamine/dopamine, while we cannot rule out a survival
benefit, the significant reduction in mortality with levosimendan in HF
patients needs to be tempered by suspected publication bias. However,
levosimendan may be associated with a survival benefit relative to
dobutamine/dopamine in CS patients.
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