Results Generated From:
Embase <1980 to 2014 Week 51>
Embase (updates since 2014-12-12)
<1>
Accession Number
2014956420
Authors
Rajati F. Sadeghi M. Feizi A. Sharifirad G. Hasandokht T. Mostafavi F.
Institution
(Rajati) Department of Public Health, School of of Health, Kermanshah
University of Medical Sciences, Kermanshah, Iran, Islamic Republic of
(Sadeghi) Cardiac Rehabilitation Research Center, Isfahan Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Feizi) Department of Biostatistic, School of Public Health, Isfahan
University of MedicalSciences, Isfahan, Iran, Islamic Republic of
(Sharifirad) Department of Public Health, School of Health, Qom University
of Medical Sciences, Qom, Iran, Islamic Republic of
(Hasandokht) Department of Community Medicine, School of Medicine, Guilan
University of Medical Sciences, Rasht, Iran, Islamic Republic of
(Mostafavi) Department of Health Education and Promotion, School of
Health, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
Title
Self-efficacy strategies to improve exercise in patients with heart
failure: A systematic review.
Source
ARYA Atherosclerosis. 10 (6) (pp 319-333), 2014. Date of Publication:
2014.
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: Despite exercise is recommended as an adjunct to medication
therapy in patients with heart failure (HF), non-adherence to exercise is
a major problem. While improving self-efficacy is an effective way to
increase physical activity, the evidence concerning the relationship
between strategies to enhance self-efficacy and exercise among HF has not
been systematically reviewed. The objective of this systematic review is
to assess the effect of interventions to change the self-efficacy on
exercise in patients with HF.
METHODS: A systematic database search was conducted for articles reporting
exercise selfefficacy interventions. Databases such as PubMed, ProQuest,
CINAHL, Scopus, and PsycINFO, and the Cochrane Library were searched with
restrictions to the years 2000-June 2014. A search of relevant databases
identified 10 studies. Published randomized controlled intervention
studies focusing strategies to change self-efficacy to exercise adherence
in HF were eligible for inclusion. In addition, studies that have applied
self-efficacy-based interventions to improve exercise are discussed.
RESULTS: Limited published data exist evaluating the self-efficacy
strategies to improve exercise in HF. Dominant strategies to improve
patients' self-efficacy were performance accomplishments, vicarious
experience, verbal persuasion, emotional arousal.
CONCLUSION: Evidence from some trials supports the view that incorporating
the theory of selfefficacy into the design of an exercise intervention is
beneficial. Moreover, exercise interventions aimed at integrating the four
strategies of exercise self-efficacy can have positive effects on
confidence and the ability to initiate exercise andrecover HF symptoms.
Findings of this study suggest that a positive relationship exists
betweenself-efficacy and initiating and maintaining exercise in HF,
especially in the short-term period.
<2>
Accession Number
2014960432
Authors
Donohue J.M. Belnap B.H. Men A. He F. Roberts M.S. Schulberg H.C. Reynolds
C.F. Rollman B.L.
Institution
(Donohue, Men, Roberts) Department of Health Policy and Management,
University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA,
United States
(Belnap, Roberts, Rollman) Division of General Internal Medicine, Center
for Research on Health Care, University of Pittsburgh School of Medicine,
Pittsburgh, PA, United States
(He, Reynolds) Department of Psychiatry, University of Pittsburgh School
of Medicine, Pittsburgh, PA, United States
(Schulberg) Department of Psychiatry, Weill Cornell Medical College, White
Plains, NY, United States
Title
Twelve-month cost-effectiveness of telephone-delivered collaborative care
for treating depression following CABG surgery: A randomized controlled
trial.
Source
General Hospital Psychiatry. 36 (5) (pp 453-459), 2014. Date of
Publication: 2014.
Publisher
Elsevier Inc.
Abstract
Objective: To determine the 12-month cost-effectiveness of a collaborative
care (CC) program for treating depression following coronary artery bypass
graft (CABG) surgery versus physicians' usual care (UC). Methods: We
obtained 12 continuous months of Medicare and private medical insurance
claims data on 189 patients who screened positive for depression following
CABG surgery, met criteria for depression when reassessed by telephone 2
weeks following hospitalization (nine-item Patient Health Questionnaire >
10) and were randomized to either an 8-month centralized, nurse-provided
and telephone-delivered CC intervention for depression or to their
physicians' UC. Results: At 12 months following randomization, CC patients
had of sensitivity analyses produced no significant changes. The
incremental cost-effectiveness ratio of CC was -$9889 (-$11,940 to -$7838)
per additional quality-adjusted life-year (QALY), and there was 90%
probability it would be cost-effective at the willingness to pay threshold
of $20,000 per additional QALY. A bootstrapped cost-effectiveness plane
also demonstrated a 68% probability of CC "dominating" UC (more QALYs at
lower cost). Conclusions: Centralized, nurse-provided and
telephone-delivered CC for post-CABG depression is a quality-improving and
cost-effective treatment that meets generally accepted criteria for
high-value care.
<3>
Accession Number
2014958987
Authors
Wang L. Peng P. Zhang O. Xu X. Yang S. Zhao Y. Zhou Y.
Institution
(Wang, Peng, Zhang, Xu, Yang, Zhao, Zhou) Key Laboratory of
Remodeling-Related Cardiovascular Disease, Beijing Anzhen Hospital,
Ministry of Education, Beijing 100029, China
Title
High-dose statin pretreatment decreases periprocedural myocardial
infarction and cardiovascular events in patients undergoing elective
percutaneous coronary intervention: A meta-analysis of twenty-four
randomized controlled trials.
Source
PLoS ONE. 9 (12) , 2014. Article Number: e113352. Date of Publication: 04
Dec 2014.
Publisher
Public Library of Science
Abstract
Background: Evidence suggests that high-dose statin pretreatment may
reduce the risk of periprocedural myocardial infarction (PMI) and major
adverse cardiac events (MACE) for certain patients; however, previous
analyses have not considered patients with a history of statin maintenance
treatment. In this meta-analysis of randomized controlled trials (RCTs),
we reevaluated the efficacy of short-term high-dose statin pretreatment to
prevent PMI and MACE in an expanded set of patients undergoing elective
percutaneous coronary intervention.
Methods: We searched the PubMed/Medline database for RCTs that compared
high-dose statin pretreatment with no statin or low-dose statin
pretreatment as a prevention of PMI and MACE. We evaluated the incidence
of PMI and MACE, including death, spontaneous myocardial infarction, and
target vessel revascularization at the longest follow-up for each study
for subgroups stratified by disease classification and prior low-dose
statin treatment.
Results: Twenty-four RCTs with a total of 5,526 patients were identified.
High-dose statin pretreatment was associated with 59% relative reduction
in PMI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34-0.49;
P<0.00001) and 39% relative reduction in MACE (OR: 0.61; 95% CI:
0.45-0.83; P=0.002). The benefit of highdose statin pretreatment on MACE
was significant for statin-naive patients (OR: 0.69; 95% CI: 0.50-0.95;
P=0.02) and prior low dose statin-treated patients (OR: 0.28; 95% CI:
0.12-0.65; P=0.003); and for patients with acute coronary syndrome (OR:
0.52; 95% CI: 0.34-0.79; P=0.003), but not for patients with stable angina
(OR: 0.71; 95% CI 0.45-1.10; P=0.12). Long-term effects on survival were
less obvious.
Conclusions: High-dose statin pretreatment can result in a significant
reduction in PMI and MACE for patients undergoing elective PCI. The
positive effect of highdose statin pretreatment on PMI and MACE is
significant for statin-naive patients and patients with prior treatment.
The positive effect of high-dose statin pretreatment on MACE is
significant for patients with acute coronary syndrome.
<4>
Accession Number
2014956895
Authors
Vranckx P. Leonardi S. Tebaldi M. Biscaglia S. Parrinello G. Rao S.V.
Mehran R. Valgimigli M.
Institution
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Vranckx, Valgimigli) Department of Cardiology, Thoraxcentre, Erasmus
Medical Center, Rotterdam, Netherlands
(Leonardi) Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
(Tebaldi, Biscaglia) Department of Cardiology, University of Ferrara,
Ferrara, Italy
(Parrinello) Medical Statistics Unit, University of Brescia, Brescia,
Italy
(Rao) Duke Clinical Research Institute, Durham, NC, United States
(Mehran) Mount Sinai School of Medicine, New York, NY, United States
Title
Prospective validation of the bleeding academic research consortium
classification in the all-comer PRODIGY trial.
Source
European Heart Journal. 35 (37) (pp 2524-2529), 2014. Date of Publication:
01 Oct 2014.
Publisher
Oxford University Press
Abstract
Aims The Bleeding Academic Research Consortium (BARC) classification has
been proposed by consensus to standardize bleeding endpoint definition and
reporting in cardiovascular clinical trials. There are no prospective
studies on its prognostic impact.
Methods and results We explored the association of BARC-defined bleeding
with mortality and compared its prognostic value against two validated
bleeding scales: the Thrombolysis in Myocardial Infarction (TIMI) and the
Global Utilization of Streptokinase and Tissue Plasminogen Activator for
Occluded Coronary Arteries (GUSTO) scales. Non-coronary artery bypass
graft (CABG)-related bleedings within the PRODIGY trial were prospectively
adjudicated by a blinded Clinical Event Committee and analysed according
to multiple statistical modelling. At 2 years, bleeding occurred in 143
patients (7.1%) according to BARC Type 2, 3, or 5; in 50 patients (2.5%)
according to TIMI minor or major; and in 61 patients (3.1%) according to
GUSTO moderate or severe. One hundred sixty-three patients died (8.1%).
After multivariable modelling, BARC Type 2, 3, or 5 bleeding was
associated with increased 2-year mortality [hazard ratio (HR): 3.77; 95%
confidence interval (CI): 2.37-5.98]. Bleeding Academic Research
Consortium Type 3 or 5 was associated with an increased mortality rate at
2 years (adjusted HR: 7.72;95% CI: 4.75-12.54) similar to that provided by
TIMI (HR: 7.64,95% CI: 4.53-12.87) or GUSTO (HR: 7.36, 95% CI: 4.38-12.34)
criteria.
Conclusions In a contemporary, all-comer percutaneous coronary
intervention trial actionable BARC bleedings were associated with
increased risk of mortality with BARC Type 3 or 5 bleedings providing a
similar mortality risk to that posed by TIMI or GUSTO scales.
<5>
Accession Number
2014956894
Authors
Lincoff A.M. Roe M. Aylward P. Galla J. Rynkiewicz A. Guetta V. Zelizko M.
Kleiman N. White H. McErlean E. Erlinge D. Laine M. Dos Santos Ferreira
J.M. Goodman S. Mehta S. Atar D. Suryapranata H. Jensen S.E. Forster T.
Fernandez-Ortiz A. Schoors D. Radke P. Belli G. Brennan D. Bell G. Krucoff
M.
Institution
(Lincoff, Galla, McErlean, Brennan) Cleveland Clinic Coordinating Center
for Clinical Research (C5Research), Cleveland, OH, United States
(Roe, Krucoff) Duke Clinical Research Institute, Durham, NC, United States
(Aylward) Flinders University and Medical Centre, Adelaide, Australia
(Rynkiewicz) Department of Cardiology and Cardiosurgery, University of
Warmia and Mazury, Olsztyn, Poland
(Guetta) Heart Institute, Sheba Medical Center, Tel Hashomer, Israel
(Zelizko) Department of Cardiology, Institute for Clinical and
Experimental Medicine, Prague, Czech Republic
(Kleiman) Methodist DeBakey Heart and Vascular Center, Houston, TX, United
States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Erlinge) Department of Cardiology, Lund University, Lund, Sweden
(Laine) Division of Cardiology, Helsinki University Central Hospital,
Helsinki, Finland
(Dos Santos Ferreira) Department of Cardiology, Hospital Santa Cruz,
Carnaxide, Portugal
(Goodman) Canadian Heart Research Centre, St. Michael's Hospital
University of Toronto, Toronto, ON, Canada
(Mehta) Department of Cardiology, Hamilton General Hospital, Hamilton, ON,
Canada
(Atar) Department of Cardiology B, University of Oslo, Oslo University
Hospital, Norway, Oslo, Norway
(Suryapranata) Department of Cardiology, Radboud University Nijmegen
Medical Center, Netherlands
(Jensen) Department of Cardiology, Arhus University Hospital, Aalborg,
Denmark
(Forster) Medical Faculty, University of Szeged, Albert Szent-Gyorgyi
Medical and Pharmaceutical Center, Szeged, Hungary
(Fernandez-Ortiz) Coronary Care Unit, Hospital Clinico San Carlos, Madrid,
Spain
(Schoors) Interventional Department, Universitair Ziekenhuis Brussel,
Belgium
(Radke) Department of Cardiology, Angiology, Intensive Care Medicine,
University of Schleswig Holstein, Lubeck, Germany
(Belli) Unita Operativa di Emodinamica e Cardiologia, Invasiva Istitutio
Clinico Humanitas, Milano, Italy
(Bell) KAI Phamaceuticals, Department of Medicine, University of
California San Francisco, San Francisco, CA, United States
Title
Inhibition of delta-protein kinase C by delcasertib as an adjunct to
primary percutaneous coronary intervention for acute anterior ST-segment
elevation myocardial infarction: Results of the PROTECTION AMI randomized
controlled trial.
Source
European Heart Journal. 35 (37) (pp 2516-2523), 2014. Date of Publication:
01 Oct 2014.
Publisher
Oxford University Press
Abstract
Aims Delcasertib is a selective inhibitor of delta-protein kinase C
(delta-PKC), which reduced infarct size during ischaemia/ reperfusion in
animal models and diminished myocardial necrosis and improved reperfusion
in a pilot study during primary percutaneous coronary intervention (PCI)
for ST elevation myocardial infarction (STEMI).
Methods and results A multicentre, double-blind trial was performed in
patients presenting within 6 h and undergoing primary PCI for anterior
(the primary analysis cohort, n = 1010 patients) or inferior (an
exploratory cohort, capped at 166 patients) STEMI. Patients with anterior
STEMI were randomized to placebo or one of three doses of delcasertib
(50,150, or450 mg/h) by intravenous infusion initiated before PCI and
continued for ~2.5 h.There were no differences between treatment groups in
the primary efficacy endpoint of infarct size measured by creatine
kinaseMB fraction area under the curve (AUC) (median 5156, 5043, 4419, and
5253 ng h/mL in the placebo, delcasertib 50, 150, and 450 mg/mL groups,
respectively) in the anterior STEMI cohort. No treatment-related
differences were seen in secondary endpoints of infarct size,
electrocardiographic STsegment recovery AUC or time to stable ST recovery,
or left ventricular ejection fraction at 3 months. No differences in rates
of adjudicated clinical endpoints (death, heart failure, or serious
ventricular arrhythmias) were observed.
Conclusions Selective inhibition of delta-PKC with intravenous infusion of
delcasertib during PCI for acute STEMI in a population of patients treated
according to contemporary standard of care did not reduce biomarkers of
myocardial injury. Clinical trial registration ClinicalTrials.gov
Identifier: NCT00785954.
<6>
Accession Number
2014954272
Authors
Bove T. Zangrillo A. Guarracino F. Alvaro G. Persi B. Maglioni E. Galdieri
N. Comis M. Caramelli F. Pasero D.C. Pala G. Renzini M. Conte M.
Paternoster G. Martinez B. Pinelli F. Frontini M. Zucchetti M.C.
Pappalardo F. Amantea B. Camata A. Pisano A. Verdecchia C. Dal Checco E.
Cariello C. Faita L. Baldassarri R. Scandroglio A.M. Saleh O. Lembo R.
Calabro M.G. Bellomo R. Landoni G.
Institution
(Bove, Zangrillo, Pappalardo, Scandroglio, Saleh, Lembo, Calabro, Landoni)
IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132,
Italy
(Guarracino, Cariello, Baldassarri) University Hospital of Pisa, Pisa,
Italy
(Alvaro, Amantea, Faita) Mater Domini Hospital, Catanzaro, Italy
(Persi, Camata) Ospedale Civile Ca' Foncello di Treviso, Treviso, Italy
(Maglioni) Siena Hospital, Siena, Italy
(Galdieri, Pisano) A. O. R. N. dei Colli, Monaldi Hospital, Napoli, Italy
(Comis, Verdecchia) Mauriziano Hospital, Turin, Italy
(Caramelli, Dal Checco) S. Orsola-Malpighi University Hospital, Bologna,
Italy
(Pasero) Citta Della Salute e Della Scienza Hospital, University of Turin,
Turin, Italy
(Pala) Ospedale Civile SS Annunziata, Sassari, Italy
(Renzini) Ospedale Santa Maria Della Misericordia, Perugia, Italy
(Conte) Maria Cecilia Hospital-GVM Care and Research, Cotignola and Citta
di Lecce Hospital, Lecce, Italy
(Paternoster) A. O. Regionale San Carlo, Potenza, Italy
(Martinez) Santa Maria Della Misericordia University Hospital of Udine,
Udine, Italy
(Pinelli) Careggi University Hospital, Florence, Italy
(Frontini) A. O. Spedali Civili di Brescia, Brescia, Italy
(Zucchetti) A. O. Ospedali Riuniti Papardo-Piemonte, Messina, Italy
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Monash University, School of Public Health and Preventive Medicine,
Melbourne, VIC, Australia
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Title
Effect of fenoldopam on use of renal replacement therapy among patients
with acute kidney injury after cardiac surgery: A randomized clinical
trial.
Source
JAMA - Journal of the American Medical Association. 312 (21) (pp
2244-2253), 2014. Date of Publication: 03 Dec 2014.
Publisher
American Medical Association
Abstract
IMPORTANCE: No effective pharmaceutical agents have yet been identified to
treat acute kidney injury after cardiac surgery. OBJECTIVE: To determine
whether fenoldopam reduces the need for renal replacement therapy in
critically ill cardiac surgery patients with acute kidney injury. DESIGN,
SETTING, AND PARTICIPANTS: Multicenter, randomized, double-blind,
placebo-controlled, parallel-group study from March 2008 to April 2013 in
19 cardiovascular intensive care units in Italy. We randomly assigned 667
patients admitted to intensive care units after cardiac surgery with early
acute kidney injury (>50% increase of serum creatinine level from baseline
or oliguria for >6 hours) to receive fenoldopam (338 patients) or placebo
(329 patients). We used a computer-generated permuted block randomization
sequence for treatment allocation. All patients completed their follow-up
30 days after surgery, and data were analyzed according to the
intention-to-treat principle. INTERVENTIONS: Continuous infusion of
fenoldopam or placebo for up to 4 days with a starting dose of 0.1
mug/kg/min (range, 0.025-0.3 mug/kg/min). MAIN OUTCOMES AND MEASURES: The
primary end point was the rate of renal replacement therapy. Secondary end
points included mortality (intensive care unit and 30-day mortality) and
the rate of hypotension during study drug infusion. RESULTS: The study was
stopped for futility as recommended by the safety committee after a
planned interim analysis. Sixty-nine of 338 patients (20%) allocated to
the fenoldopam group and 60 of 329 patients (18%) allocated to the placebo
group received renal replacement therapy (P = .47). Mortality at 30 days
was 78 of 338 (23%) in the fenoldopam group and 74 of 329 (22%) in the
placebo group (P = .86). Hypotension occurred in 85 (26%) patients in the
fenoldopam group and in 49 (15%) patients in the placebo group (P = .001).
CONCLUSIONS AND RELEVANCE: Among patients with acute kidney injury after
cardiac surgery, fenoldopam infusion, compared with placebo, did not
reduce the need for renal replacement therapy or risk of 30-day mortality
but was associated with an increased rate of hypotension. TRIAL
REGISTRATION: clinicaltrials.gov Identifier: NCT00621790.
<7>
[Use Link to view the full text]
Accession Number
2014950147
Authors
Akeju O. Westover M.B. Pavone K.J. Sampson A.L. Hartnack K.E. Brown E.N.
Purdon P.L.
Institution
(Akeju, Pavone, Sampson, Hartnack, Brown, Purdon) Department of
Anesthesia, Critical Care, and Pain Medicine, Massachusetts General
Hospital, 149 13th Street, Rm 4005, Boston, MS 02129, United States
(Westover) Department of Neurology, Massachusetts General Hospital,
Boston, MS, United States
(Akeju, Brown, Purdon) Harvard Medical School, Boston, MS, United States
(Westover, Brown, Purdon) Department of Brain and Cognitive Science,
Massachusetts Institute of Technology, Cambridge, MS, United States
(Brown) Harvard-Massachusetts Institute of Technology Division of Health
Sciences and Technology, Massachusetts Institute of Technology, Cambridge,
MS, United States
(Brown) Institute for Medical Engineering and Sciences, Massachusetts
Institute of Technology, Cambridge, United States
Title
Effects of sevoflurane and propofol on frontal electroencephalogram power
and coherence.
Source
Anesthesiology. 121 (5) (pp 990-998), 2014. Date of Publication: 04 Nov
2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The neural mechanisms of anesthetic vapors have not been
studied in depth. However, modeling and experimental studies on the
intravenous anesthetic propofol indicate that potentiation of
?-Aminobutyric acid receptors leads to a state of thalamocortical
synchrony, observed as coherent frontal alpha oscillations, associated
with unconsciousness. Sevoflurane, an ether derivative, also potentiates
?-Aminobutyric acid receptors. However, in humans, sevoflurane-induced
coherent frontal alpha oscillations have not been well detailed.
Methods: To study the electroencephalogram dynamics induced by
sevoflurane, the authors identified age- and sex-matched patients in which
sevoflurane (n = 30) or propofol (n = 30) was used as the sole agent for
maintenance of general anesthesia during routine surgery. The authors
compared the electroencephalogram signatures of sevoflurane with that of
propofol using time-varying spectral and coherence methods.
Results: Sevoflurane general anesthesia is characterized by alpha
oscillations with maximum power and coherence at approximately 10 Hz,
(mean + SD; peak power, 4.3 + 3.5 dB; peak coherence, 0.73 + 0.1). These
alpha oscillations are similar to those observed during propofol general
anesthesia, which also has maximum power and coherence at approximately 10
Hz (peak power, 2.1 + 4.3 dB; peak coherence, 0.71 + 0.1). However,
sevoflurane also exhibited a distinct theta coherence signature (peak
frequency, 4.9 + 0.6 Hz; peak coherence, 0.58 + 0.1). Slow oscillations
were observed in both cases, with no significant difference in power or
coherence.
Conclusions: The study results indicate that sevoflurane, like propofol,
induces coherent frontal alpha oscillations and slow oscillations in
humans to sustain the anesthesia-induced unconscious state. These results
suggest a shared molecular and systems-level mechanism for the unconscious
state induced by these drugs. 2014, the American Society of
Anesthesiologists, Inc.
<8>
Accession Number
2014948788
Authors
Kumar A. Bhawani G. Kumari N. Murthy K.S.N. Lalwani V. Raju C.N.
Institution
(Kumar) Department of Cardiology, GSL Medical College and Hospital,
Rajahmundry, India
(Bhawani, Murthy) Department of Pharmacology, GSL Medical College and
Hospital, Rajahmundry, India
(Kumari) Department of Physiology, Sri Krishna Medical College,
Muzzafarpur, India
(Lalwani, Raju) Department of Cardiology, GSL Medical College,
Rajahmundry, India
Title
Comparative study of renal protective effects of allopurinol and
n-acetyl-cysteine on contrast induced nephropathy in patients undergoing
cardiac catheterization.
Source
Journal of Clinical and Diagnostic Research. 8 (12) (pp HC03-HC07), 2014.
Date of Publication: 05 Dec 2014.
Publisher
Journal of Clinical and Diagnostic Research (No 3, 1/9 Roop Nagar, G T
Road, Delhi 110007, India. E-mail: editor-in-chief@jcdr.net )
Abstract
Objectives: To evaluate the difference in the renal protective effects of
allopurinol and n-acetyl cysteine along with saline hydration in patients
of contrast induced nephropathy (CIN) post cardiac interventions.
Background: CIN remains a common complication of cardiac procedures. Radio
contrast agents can cause a reduction in renal function that may be
related to oxidative stress underlining various patho- physiologies.
Conflicting evidence suggests that administration of allopurinol, a
xanthine oxidase inhibitor can prevent CIN.
Materials and Methods: This is a study of 500 patients undergoing
angiography and coronary revascularisation in patients showing significant
coronary block. The angiography positive patients (275) were prospectively
randomised to different treatment protocol to study for their
reno-protective effect. The patients received either of the three drugs
saline hydration (SH, 1ml/kg/hr), n-acetylcysteine (SH+NAC, 600 mg bd) or
Allopurinol (SH+ALLP, 300 mg/day) 12 hours before and after administration
of radio contrast agent. Levels of serum creatinine and blood urea of the
275 patients recorded at 24 hour interval were noted post angioplasty over
a course of 5 days in patients receiving either omnipaque (125) or
visipaque (150) contrast media. All the 500 patients were also assessed
for development of any kind of adverse drug effects/reactions with the two
contrast media.
Results: CIN occurred in 56 of 500 the patients (10.6%) who underwent
angiography and 49 of 275 patients (17.8%) who underwent angioplasty. In
the omnipaque group CIN occurred in 16/40, 8/40, nil/45 in patients
receiving SH, NAC plus SH and SH plus ALLP respectively. In the visipaque
group CIN occurred in 15/50, 10/50, nil/50 in the three treatments groups
respectively. Allopurinol maintained a consistent fall in the serum
creatinine & blood urea levels from the baseline values from the end of
the 1st day (P <.01 &.001) in both the category. Visipaque proved to be
better dye than omnipaque with less adverse drug effects/ reactions.
Conclusion: Prophylactic oral administration of allopurinol (300 mg/day)
along with hydration is better than n-acetylcysteine and saline hydration
alone for protection against CIN in patients undergoing coronary
procedures.
<9>
Accession Number
2014953220
Authors
Cowie D.A. Nazarethi J. Story D.A.
Institution
(Cowie, Nazarethi, Story) Department of Anaesthesia, Austin Health,
Heidelberg, VIC, Australia
(Cowie, Nazarethi, Story) Faculty of Medicine, Dentistry and Health
Sciences, University of Melbourne, Parkville, VIC, Australia
Title
Cerebral oximetry to reduce perioperative morbidity.
Source
Anaesthesia and Intensive Care. 42 (3) (pp 310-314), 2014. Date of
Publication: 01 May 2014.
Publisher
Australian Society of Anaesthetists
Abstract
The use of cerebral oximetry to guide intraoperative management has been
shown to improve patient outcomes in cardiac surgery. This pilot trial
assessed the feasibility of performing a similar study of outcome in
patients over the age of 70 years undergoing non-cardiac surgery. Patients
over the age of 70 years undergoing total knee or hip arthroplasty or
bowel resection surgery were randomly assigned to have cerebral oximetry
values monitored (intervention group) or not monitored (control) while
under general anaesthesia. Indicators of proof of concept were: rate of
complications, rate of cerebral desaturation, relationship between
cerebral desaturation and complications, and anaesthetist response to
cerebral desaturation. Forty patients were recruited and randomised to a
control group (n=20) or an intervention group (n=20). The proportion of
the study population who had a complication was 40% (95% confidence
interval [CI] 26% to 55%). Cerebral desaturation (<75% of baseline)
occurred in only two patients (5.0% (CI 1.4% to 16%)), one in each group,
and neither of those patients recorded a complication. Changes to
anaesthetic management on the basis of cerebral oximetry values occurred
in only two patients in the intervention group (10% (CI 2.8% to 30%)).
Maintenance of cerebral oximetry values appeared to be closer to baseline
in the intervention group than in the control group but this difference
was not significant (P=0.15). Our results indicated that complications
occurred frequently in the study population but did not appear to be
associated with cerebral desaturation events. These findings do not
support a larger intervention study using the current study population.
<10>
Accession Number
71712972
Authors
Chakravarty T. Cheng R. Abramowitz Y. Noheria A. Jilaihawi H. Doctor N.
Cheng W. Makkar R.R.
Institution
(Chakravarty, Abramowitz, Jilaihawi, Doctor, Cheng, Makkar) Cardiology,
Cedars-Sinai Med Cntr, Los Angeles, CA, United States
(Cheng) Internal Medicine, Cedars-Sinai Med Cntr, Los Angeles, CA, United
States
(Noheria) Cardiology, Mayo Clinic, Rochester, MN, United States
Title
Incidence, clinical outcomes and factors influencing permanent pacemaker
implantation after transcatheter aortic valve replacement-a meta-analysis
of 93 studies including 37,836 patients.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The impact of transcatheter aortic valve replacement (TAVR)
strategy, valve type (balloon-expandable Edwards (ES) valve or
self-expanding Medtronic CoreValve (MCV)) and geographical differences
(USA or Europe) on new permanent pacemaker (PPM) implantation is unclear.
Similarly, the impact of PPM implantation on mortality after TAVR is
unclear. We perform the first meta-analysis of incidence, clinical
outcomes and factors influencing PPM implantation after TAVR. Methods and
Results: A total of 93 non-overlapping studies including 37,836 patients
reporting 30-day PPM implantation rates post-TAVR were included.
Random-effects model was used to calculate pooled estimates and risk
ratios, summarized in Table 1. MCV (n=8076) was associated with increased
PPM implantation rates compared to ES valve (n=20,280) (22.5%, 95% CI
19.4-25.9% vs. 6.5%, 95% CI 5.7-7.4%, p < 0.01). Among patients undergoing
ES valve implantation, transapical (TA) approach was associated with
increased PPM implantation rates compared to transfemoral (TF) approach
(9.1%, 95% CI 6.5-11.5% vs. 4.8%, 95% CI 2.9-7.4%; p=0.02). Among patients
undergoing TAVR by TF approach, MCV implantation was associated with
increased PPM rates, compared to ES valve (22.51%, 95% CI 18.7-25.9% vs.
4.8%, 95% CI 2.9-7.4%; p<0.01). PPM implantation rates associated with ES
or MCV were not statistically different between US or European studies.
Compared to patients not requiring PPM post-TAVR, the need for new PPM
implantation was not associated with increased 30-day mortality
(Risk-ratio 0.84 95% CI 0.61-1.15, p=0.27) or 1-year mortality (Risk-ratio
0.94 95% CI 0.74-1.19, p=0.60). Conclusions: PPM implantation is a
frequent complication after TAVR. This is more commonly associated with
MCV and TA approach for ES valve and is not influenced by geographical
zones. Despite the high incidence of PPM implantation associated with
TAVR, the need for new PPM does not influence 30-day or 1-year mortality.
<11>
Accession Number
71712969
Authors
Bhatheja S. Panchal H.B. Barry N. Patel P. Albalbissi K. Paul T.
Institution
(Bhatheja, Albalbissi, Paul) Div of Cardiology, Dept of Internal Medicine,
East Tennessee State Univ, Johnson City, TN, United States
(Panchal, Barry) Dept of Internal Medicine, East Tennessee State Univ,
Johnson City, TN, United States
(Patel) Dept of Pathology, Univ of Tennessee, Knoxville, TN, United States
Title
Comparison of post-procedural echocardiographic valvular performance after
transcatheter aoritc valve implantation using edwards sapien valve versus
medtronic corevalve for severe aortic stenosis: A meta-analysis.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In patients with severe aortic stenosis (AS) who are at high
risk for surgical aortic valve replacement, transcatheter aortic valve
implantation (TAVI) is an emerged alternative procedure. TAVI can be
performed using a balloon-expandable Edwards SAPIEN valve (EV) or
self-expandable Medtronic CoreValve (CV). The objective of this
meta-analysis is to compare post-procedural left ventricular ejection
fraction and other echocardiographic valvular performance in patients who
underwent TAVI using EV and CV. Methods: PubMed and the Cochrane Center
Register of Controlled Trials were searched through May 2014. Eleven
studies (n=1513) comparing TAVI procedures that used EV (n=774) and CV
(n=739) were included. End points were left ventricular ejection fraction,
aortic valve effective orifice area, and mean and peak trans-aortic
pressure gradients. The mean difference (MD) with 95% confidence interval
(CI) was computed and p<0.05 was considered as a level of significance.
Results: There was no significant difference in left ventricular ejection
fraction (MD: 1.02, CI: -1.25 to 3.28, p=0.38) and aortic valve effective
orifice area (MD: -0.06, CI: -0.17 to 0.06, p=0.04) between EV and CV
groups. Mean and peak trans-aortic pressure gradient were significantly
higher in CV group compared to EV group (MD: 1.42, CI: 0.4-2.44, p=0.007)
(Figure) and (MD: 4.21, CI: 2.33-6.09, p<0.0001) respectively. Conclusion:
The results of our meta-analysis suggest that TAVI procedures using CV and
EV provide clinically similar valvular performance with possibly
clinically insignificant subtle differences in mean and peak trans-aortic
pressure gradients in patients with severe aortic stenosis. Further
randomized studies are needed for long term echocardiographic outcomes to
evaluate valvular performance.
<12>
Accession Number
71712968
Authors
Panchal H.B. Barry N. Bhatheja S. Albalbissi K. Ramu V. Paul T.
Institution
(Panchal, Barry) Dept of Internal Medicine, East Tennessee State Univ,
Johnson City, TN, United States
(Bhatheja, Albalbissi, Ramu, Paul) Div of Cardiology, Dept of Internal
Medicine, East Tennessee State Univ, Johnson City, TN, United States
Title
Post-procedural aortic regurgitation in patients undergoing transcatheter
aoritc valve implantation with edwards sapien valve versus medtronic
corevalve for severe aortic stenosis: A meta-analysis.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is performed
using an Edwards SAPIEN valve (EV) or Medtronic CoreValve (CV) in patients
with severe aortic stenosis who are not a candidate for surgical aortic
valve replacement. The objective of this meta-analysis is to compare
post-procedural aortic regurgitation (AR) in patients who underwent TAVI
using EV and CV. Methods: PubMed and the Cochrane Center Register of
Controlled Trials were searched through May 2014. Twelve studies (n=3245)
comparing TAVI procedure that used EV (n=1490) and CV (n=1755) were
included. End point was post-procedural aortic valve regurgitation. The
odds ratio (OR) with 95% confidence interval (CI) was computed and p<0.05
was considered as a level of significance. Results: The studies were
homogeneous. AR grade 2 or more (moderate to severe) was significantly
higher in CV group compared to EV group (OR: 2.25, CI: 1.72-2.95,
p<0.00001) (Figure). AR grade 3 or more (severe) was not significantly
different between two groups (OR: 2.20, CI: 1.01-4.79, p=0.05).
Conclusion: The results of our meta-analysis of 3245 patients suggest that
TAVI procedure using CV may have two times higher incidence of moderate to
severe post-procedural AR compared to TAVI procedure using EV. Our study
also suggests that TAVI procedure using CV may have two times higher
incidence of severe post-procedural AR compared to TAVI procedure using
EV, but this outcome had a borderline statistical significance. This could
be secondary to lower number of studies with insufficient sample size (7
studies, n=1444) available for severe AR outcome which may cause a
beta-error. Randomized controlled trials with large patient population are
needed to further evaluate post-procedural AR outcome at long term.
<13>
Accession Number
71712857
Authors
Yousif A. Addison D. Lakkis N. Rosengart T. Birnbaum Y. Virani S.S. Hamzeh
I. Alam M.
Institution
(Yousif) Dept of Internal Medicine, College of Medicine, Houston, TX,
United States
(Addison, Lakkis, Birnbaum, Virani, Hamzeh, Alam) Dept of Cardiology,
College of Medicine, Houston, TX, United States
(Rosengart) Dept of Surgery, College of Medicine, Houston, TX, United
States
Title
Is Coronary Artery Bypass Grafting (CABG) with cardiopulmonary bypass
support (On-pump) Superior to CABG without bypass support (off-pump) in
the high-risk?: A meta-analysis of randomized controlled trials (rcts).
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Data from RCTs regarding the efficacy of on- vs. off-pump CABG
remain inconclusive. This is especially true of high-risk patient
populations. Current practice guidelines from the ACC/AHA in collaboration
with Thoracic Surgical Societies do not make specific recommendations for
the choice of on- vs. off-pump CABG, but leave the decision to the primary
operator. This study was undertaken to compare the efficacy of on- vs.
off-pump CABG in higher surgical risk patients. Methods: We selected RCTs
comparing on- and off-pump CABG, focusing on high-risk patient
populations. Studies were included if the patient population was described
as "high-risk" or included "high-risk" features: European System of
Cardiac Operative Risk Evaluation (EuroScore) >6, age >70 years,
pre-existing renal insufficiency, history of stroke(s), and the presence
of left ventricular dysfunction. A PubMed literature search was performed
for all publications between 1/1/2000 and 12/31/2013 with search terms:
on-pump, off-pump, coronary artery bypass, high-risk, left ventricular
dysfunction, elderly, aged, and renal insufficiency. A total of 64
publications were screened, of which 9 articles met the inclusion
criteria. We evaluated for the endpoints of cardiovascular (CV) and
all-cause mortality, non-fatal myocardial infarction (MI), stroke, need
for repeat revascularization, renal failure, and length of hospital stay
(LOS). Results: A total of 11,374 patients with a mean age of 70 years
were enrolled. On-pump CABG was not associated with improved CV (RR 0.82;
95% CI 0.38-1.73) and all-cause mortality (RR 1.02; 95% CI 0.80-1.32). No
statistically significant reduction seen in development of non-fatal MI
(RR 1.17; 95% CI 0.78-1.75) and renal failure (RR 1.48; 95% CI 0.94-2.32),
while the need for repeat revascularization by 1-year was reduced (RR
0.69; 95% 0.50-0.97). However, on-pump CABG was associated with an
increased risk of stroke (RR 1.34; 95% 1.02-1.76) and LOS (mean difference
2.24 days; 95% CI 0.34-4.14). Conclusion: In high-risk patients, on-pump
CABG is associated with a reduced risk for repeat revascularization by
1-year but at a cost of increased risk of stroke and longer
hospitalization. On-pump and off-pump CABG have comparable all-cause and
CV mortality.
<14>
Accession Number
71712806
Authors
Deppe A.C. Liakopoulos O.J. Choi Y.-H. Kuhn E.W. Slottosch I. Scherner M.
Rahmanian P.B. Wahlers T.
Institution
(Deppe, Liakopoulos, Choi, Kuhn, Slottosch, Scherner, Rahmanian, Wahlers)
Cardiothoracic surgery, Univ Hosp Cologne, Cologne, Germany
Title
Single vessel disease-surgical or interventional treatment a systematic
review with meta-analysis of 3,491 patients.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Minimally invasive direct coronary artery bypass grafting
(MIDCAB) and percutaneous coronary intervention (PCI) are both established
therapeutic options for single vessel disease of the left anterior
descending artery (LAD). Internal mammary artery grafts (IMA) has proven
survival benefits and 10 year patency rates greater than 90% after LAD
revascularization. However, due to lower costs, quicker recovery and
lesser invasiveness PCI with stenting it the most common used treatment
for isolated LAD stenosis. Hypothesis: The present systematic review with
meta-analysis aims to determine the current evidence for MIDCAB or PCI for
revascularization of the LAD. Methods: We performed a meta-analysis of
randomized (RCT) and observational trials (OT) that reported clinical
outcome after isolated LAD revascularization. Pooled treatment effects
(odds ratio (OR) or weighted mean difference (WMD), 95% confidence
intervals (95%CI)) were assessed using a fixed or random effects model.
Results: A total of 3,491 patients from 13 studies (6 RCT, 7 OT) were
identified. Increased incidence for repeat target vessel revascularization
(TVR) after PCI was already in existence six month after the procedure (OR
1.98; 95%CI 1.45-2.69; plt;0.001). Subgroup analysis of studies using
drug-eluting stents (n=1.547) revealed a significant absolute risk
reduction of 8.8% (p=0.008). Only subgroup analysis of studies rated as
being of high quality revealed an impact on all-cause mortality in a
median follow-up of 4.7 years (OR 1.46; 95%CI 1.03-2.06; plt;0.029). No
differences with regard to stroke were observed between both
revascularization strategies. Conclusions: Current evidence reported in
this systematic review suggests MIDCAB for treatment of single vessel
disease of the LAD.
<15>
Accession Number
71712706
Authors
Bavishi C. Sawant A. Ather S. Tamis-Holland J.E.
Institution
(Bavishi, Sawant) Internal Medicine, Mount Sinai St. Luke's Hosp, New
York, NY, United States
(Ather) Cardiology, Univ of Alabama, Sch of Medicine, Birmingham, AL,
United States
(Tamis-Holland) Cardiology, Mount Sinai St. Luke's Hosp, New York, NY,
United States
Title
Safety and efficacy of triple versus dual anti-platelet therapy after
stent implantation in patients requiring chronic anticoagulation: A
meta-analysis of observational studies.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The optimal anti-thrombotic strategy for patients requiring
chronic anticoagulation and undergoing PCI remains unclear. Dual
anti-platelet therapy (DAPT) alone is less effective for stroke
prevention, yet triple therapy (TT) (dual anti-platelet plus warfarin)
carries increased bleeding risk. We performed a meta-analysis to evaluate
the benefits and risks of DAPT versus TT. Methods: A systematic search of
PubMed, EMBASE and Scopus was performed. Studies comparing all-cause
mortality between patients using DAPT and TT were selected. Secondary
end-points of MI, stent thrombosis, stroke and major bleeding were also
evaluated. Pooled effect estimates were calculated using random effects
model. Results: We identified 13 studies (n=14,994) that compared outcomes
between TT and DAPT. The mean duration of follow-up ranged from 0.5 to 1.6
years. Indications for anticoagulation included atrial fibrillation
(75.6%), prosthetic valve (1.2%), DVT/PE (0.9%), LV clot/prophylaxis
(0.6%) and other (21.7%). There were no significant differences in
all-cause mortality [pooled RR: 0.90 (0.59-1.35), p=0.60], MI [RR: 1.08
(0.63 - 1.87), p=0.77] or stent thrombosis [RR: 0.80 (0.34 - 1.93),
p=0.63] among patients treated with TT, as compared to DAPT. However
patients treated with TT had significantly lower risk of stroke [RR: 0.51
(0.28 - 0.91), p=0.02] and a significantly increased risk of major
bleeding [RR: 1.55 (1.03 - 2.35), p=0.04]. Furthermore, there was no
significant difference in Net adverse cardiovascular events (death, MI,
stroke or major bleeding) between TT and DAPT [RR: 1.24 (0.85 - 1.81, p
=0.26]. Conclusions: The beneficial effect of TT for stroke reduction is
compromised by a relative increased risk of major bleeding. It is
important to individualize care when choosing antiplatelet and
anticoagulant therapy for patients following stent implantation, with
careful consideration of each patient's individual risk for stroke and
major bleeding.
<16>
Accession Number
71712652
Authors
Kanmanthareddy A. Reddy M. Koripalli V.S. Buddam A. Adabala N. Janga P.
Bickel T. Gutovitz C. Bommana S. Atkins D. Lakkireddy D.
Institution
(Kanmanthareddy, Reddy, Koripalli, Buddam, Adabala, Janga, Bickel,
Gutovitz, Bommana, Atkins, Lakkireddy) Cardiology, Univ of Kansas Med
Cntr, Kansas City, KS, United States
Title
New onset atrial fibrillation after transcatheter aortic valve
implantation: A pooled meta-analysis.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Atrial fibrillation (AF) after cardiac surgery is associated
with increased morbidity and mortality. Data comparing the occurrence of
AF after transcatheter aortic valve implantation (TAVI) and surgical
aortic valve replacement (SAVR) is unknown. Methods: We identified all
studies reporting outcomes after TAVI in all available electronic
databases. Meta-analysis of all the studies was performed using random
effects model to a) evaluate the incidence of AF and b) compare the
incidence of AF between TAVI and SAVR. Results: The incidence of AF was
reported in 7 studies, 5 prospective observational studies and 2
randomized controlled studies. The cumulative event rate for new onset AF
at 30 days after TAVI was 0.1 (95% CI; 0.06 -0.17). Three studies reported
incidence of AF after TAVI and SAVR. The odds ratio (OR) of developing new
onset AF with TAVI compared to SAVR was 0.3 (95% CI; 0.10 - 0.88) at 30
days. One year outcome of new onset AF was reported in only two studies.
Although, the incidence of AF was lower in the TAVI group, this did not
reach statistical significance (OR 0.7, 95% CI; 0.46 -1.07). Conclusion:
The incidence of new onset AF after TAVI is 10% within the first 30 days.
This risk is 70% lower in patients undergoing TAVI compared to SAVR. The
impact of AF after TAVI in terms of stroke, mortality and future
recurrences of AF are unknown. Further studies are therefore necessary to
study these outcomes.
<17>
Accession Number
71712418
Authors
Munoz-Mendoza J. Miranda V.A.P. Tamariz L.J. Mendoza C.E.
Institution
(Munoz-Mendoza, Miranda, Tamariz) Dept of Medicine, Univ of Miami, Jackson
Memorial Hosp, Miami, FL, United States
(Mendoza) Dept of Medicine, Cardiovascular Div, Jackson Memorial Hosp,
Miami, FL, United States
Title
Effect of pregnancy on structural valve deterioration of bioprosthetic
valves: A systematic review and meta-analysis.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In the 1980s case series suggested that pregnancy may hasten
structural valve deterioration (SVD) of bioprosthesis; however, later
studies have had discordant results. We conducted a meta-analysis to
determine if SVD is more common in women who become pregnant after
bioprosthesis implantation and identify predictors of this association.
Methods: Using the search terms "structural valve deterioration",
"structural valve degeneration", and "pregnancy", MEDLINE, EMBASE, CINAHL,
and Cochrane Library databases were reviewed from inception till October
2013. Cohort and case control studies assessing SVD in women of
childbearing age with bioprosthesis were included. We calculated the
relative risk (RR) and 95% confidence interval (CI) of having SVD by
pregnancy status using the DerSimonian-Laird method. Meta-regression
examined the RR of SVD by age, number of pregnancies and time from valve
replacement to delivery. Results: Our search strategy yielded 23 articles;
7 studies met our selection criteria, including a total of 856 patients.
Group 1 consisted of 234 women who had been pregnant and Group 2 of 622
who had not. The RR of having SVD of Group 1 was 1.73; 95% CI 1.22-2.43;
p<0.01 (Figure). None of the factors evaluated in meta-regression were
statistically significant, however less pregnancies and less time from
replacement to delivery had a trend towards significance. Conclusion:
Pregnancy does increase the risk of SVD. Pregnancy in women with
bioprosthesis is carried out with increased risk of morbidity related to
the implanted valve.
<18>
Accession Number
71712079
Authors
Aggarwal S. Gupta N. Loomba R.S. Al-Khafaji N. Agarwal A. Ismail I.
Kaushik M. Saurav A. Alla V. Arora R.R.
Institution
(Aggarwal, Al-Khafaji, Ismail, Arora) Medicine, Chicago Med Sch, North
Chicago, IL, United States
(Gupta) Medicine, Med College of Wisconsin, Milwaukee, WI, United States
(Loomba) Pediatrics, Med College of Wisconsin, Wauwatosa, WI, United
States
(Agarwal) Medicine, Aurora/St Luke's Health Cntr, Milwaukee, WI, United
States
(Kaushik, Saurav, Alla) Medicine, Creighton Univ, Sch of Medicine, Omaha,
NE, United States
Title
Everolimus versus mycophenolate for cardiac transplantation.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Abstract The role of everolimus in cardiac transplantation is being
increasingly recognized.Multiple studies have been published comparing the
use of everolimus and mycophenolate with varying results. We aimed to
perform a meta-analysis of the published literature. We searched Pubmed,
EBSCO and Cochrane databases for terms "everolimus", "mycophenolate",
"heart transplantation", "cardiac transplantation" and their combinations.
All studies in which everolimus was compared to mycophenolate were
included. Studies in language other than English were excluded. Rates of
biopsy proven acute rejection (OR 0.82 CI 0.67 to 1.00, p = 0.05),
hemodynamically significant rejection (OR 0.76, CI 0.39 to 1.50, p =
0.43)or change in glomerular filtration rate (GFR) (mean difference -1.91,
CI -6.90 to 3.08, p = 0.45) were similar between everolimus and
mycophenolate groups. Everolimus use was associated with significant
reduction in average maximal intimal thickness (mean difference -0.04 CI
-0.06 to -0.02, p = 0.001) and cytomegalovirus antigenemia (OR 0.38, CI
0.28 to 0.53, p < 0.00001). There was no significant heterogeneity for any
endpoint except change in GFR. As compared to mycophenolate, everolimus
use is associated with similar antirejection outcomes after cardiac
transplantation but with reduced maximal intimal thickness and
cytomegalovirus antigenemia.
<19>
Accession Number
71711650
Authors
Shantha G.P.S. Pancholy D. Pancholy S.B.
Institution
(Shantha, Pancholy) Internal Medicine, Wright Cntr for Graduate Med
Education, Scranton, PA, United States
(Pancholy) Cardiovascular Medicine, Wright Cntr, Graduate Med Education,
Scranton, PA, United States
Title
Post-operative atrial fibrillation after coronary artery bypass graft
surgery and stroke risk: A systematic review and meta-analysis.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: New-onset post-operative atrial fibrillation (AF) occurs in
nearly 20% of patients undergoing coronary artery bypass graft surgery
(CABG). Though, most studies supported the association between AF and
incident stroke in patients undergoing CABG, some refuted it. A systematic
review of this topic is unavailable in the literature. Hypothesis: We
systematically reviewed the literature and pooled evidence that has
associated AF and incident stroke in patients undergoing CABG. Methods:
Medline, Embase, Cochrane central library, and electronic databases were
searched for relevant studies in all languages and without time
restriction. Studies were included if: 1) they studied patients undergoing
CABG, 2) reported rates of AF post-CABG and 3) reported rates of incident
stroke. We excluded studies in which participants underwent concomitant
valve surgeries and CABG. Results: From a total of 3176 retrieved
citations, 13 observational studies were included representing 86,537
CABGs. Of these 23,259 developed AF and 63,278 remained in sinus rhythm
(SR). Stroke occurred in 1079 (4.6%) of the 23,259 patients with AF and in
2038 (3.2%) of the 63,278 patients with SR. In the pooled analysis, AF
significantly increased stroke risk post CABG [risk ratio (RR): 2.36, 95%
CI: 1.81 - 3.06, P < 0.001, I2: 88%, 13 included studies)]. The
association between AF and incident stroke remained robust in a
sensitivity analysis restricted to studies prior to 2006 (RR: 3.72, 95%
CI: 1.61 - 8.63, P = 0.02, I2: 83%, 4 included studies) and post 2006 (RR:
2.11, 95% CI: 1.57 - 2.83, P < 0.001, I2: 89%, 9 included studies)
(arbitrary dichotomization to account for temporal trends in advancement
in post cardiac surgery care). Factors namely; age, gender, diabetes
diagnosis, hypertension diagnosis, aspirin use, and statin use did not
account for between study heterogeneity. Conclusions: AF is strongly
associated with risk of stroke post CABG even in the era of defined
guidelines for anticoagulation in patients with post-operative AF.
Refinement of risk stratification tools and revised strategies for long
term anticoagulation are needed to effectively reduce stroke risk in this
population.
<20>
Accession Number
71711517
Authors
Kanmanthareddy A. Buddam A. Sharma S. Afzal R. Koripalli V.S. Adabala N.
Martin M. Ries G. Bommana S. Atkins D. Reddy M. Lakkireddy D.
Institution
(Kanmanthareddy, Buddam, Sharma, Afzal, Koripalli, Adabala, Martin, Ries,
Bommana, Atkins, Reddy, Lakkireddy) Cardiology, Univ of Kansas Med Cntr,
Kansas City, KS, United States
Title
Complete heart block after transcatheter aortic valve implantation: A
meta-analysis.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Both transcatheter aortic valve implantation (TAVI) surgical
aortic valve replacement (SAVR) are associated with risk of complete heart
block requiring a pacemaker. Pooled meta-analysis was performed to
evaluate the relative risk of developing complete heart block with the
above procedures. Methods: All electronic databases were queried and
studies reporting outcomes of heart block in patients undergoing TAVI and
SAVR were included. Exclusion criteria applied was: studies lacking SAVR
as controls, studies comparing trans-apical versus trans-femoral TAVI
procedures and studies not reporting on the outcome of heart block or
pacemaker implantation. Meta-analysis was done using Mantel-Haenszel
random effects model. Results: A total of 21 studies with a total of 5061
patients were included in the study. TAVI was done in 2692 patients. The
risk of AV heart block necessitating pacemaker implantation was very high
in the patients undergoing TAVI compared to SAVR (OR 3.5, 95% CI 2.4 -
5.1). Majority of the pacemaker implantations were done immediately after
the TAVI procedure. Trans-femoral TAVI's were associated with higher risk
(OR 8.6, 95% CI 3.1 - 28.3) of developing permanent heart block compared
to transapical route (OR 2.4, 95% CI, 1.3 - 4.3). CoreValve use was
associated with a higher risk of developing permanent heart block (OR 2.4,
95% CI 1.6 - 3.6) than Edward Sapiens Valve (OR 1.9, 95% CI 1.2 - 2.8)
compared to SAVR. Conclusion: TAVI increases the risk of permanent heart
block by 3.5 times and this risk is higher when CoreValve is used and when
performed by the transfemoral route. The predictors of development of
heart block with TAVI procedure needs further investigation.
<21>
Accession Number
71711470
Authors
El-Hayek G. Dominguez A.C. Pierce M. Benjo A. Garcia D. Herzog E. Barrett
C. Altman R. Danik J.S. Danik S.
Institution
(El-Hayek, Dominguez, Pierce, Herzog, Barrett, Altman, Danik, Danik)
Cardiology, Mount Sinai St Luke's Hosp, New York, NY, United States
(Benjo) Cardiology, Ochsner Med Cntr, New Orleans, LA, United States
(Garcia) Cardiology, Univ of Miami, Jackson Memorial Hosp, Miami, FL,
United States
Title
Oral anticoagulation continuation vs heparin bridging during cardiac
rhythm device procedures: Less pocket hematomas-meta-analysis of
randomized trials.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Objectives: Management of patients with high
thrombo-embolic (TE) risk on long-term oral anticoagulation (OAC) during
cardiac rhythm devices procedures is controversial. Current guidelines
recommend discontinuation of OAC and bridging with heparin; however recent
studies reported an increased risk of bleeding associated with heparin
bridging. We performed a meta-analysis of randomized controlled trials
(RCTs) to compare these 2 strategies for bleeding and TE outcomes.
Methods: We searched PubMed and Scopus databases till May 2014 for RCTs
that compared OAC continuation versus interruption with heparin bridging
in high risk patients on OAC during devices procedures. Odds ratios (ORs)
with 95% confidence interval (CI) for clinically significant pocket
hematomas and TE events were calculated using fixed-effects model. We used
mean difference to study the difference in length of stay (LOS) in the
hospital between the 2 groups. Results: Four RCTs were included in this
analysis with 444 patients assigned to the OAC continuation group and 436
patients to the bridging group. We observed a 79% reduction in the odds of
clinically significant hematomas (OR: 0.21, 95% CI, 0.11-0.37; p<0.00001)
and a significant decrease in LOS (mean difference -1.28, 95% CI -2.02 to
-0.55, p=0.0006) in the OAC group compared to heparin bridging. There was
no difference in the rate of TE events between the 2 groups (p=0.19).
Conclusion: OAC continuation in patient on chronic anticoagulation during
cardiac device procedures is safe and associated with decreased LOS in the
hospital.
<22>
Accession Number
71711210
Authors
Manlhiot C. Gruenwald C.E. Holtby H.M. Brandao L.R. Van Arsdell G.S.
McCrindle B.W.
Institution
(Manlhiot, Gruenwald, Holtby, Brandao, Van Arsdell, McCrindle) Labatt
Family Heart Cntr, Hosp for Sick Children, Toronto, Canada
Title
Challenges of anticoagulation during cardiopulmonary bypass in children:
Impact of low antithrombin levels.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Heparin-based anticoagulation in children is challenging as
they have a high prevalence of heparin resistance. Antithrombin, one of
the main natural anticoagulant inhibitors that potentiate heparin
anticoagulation activity, might be a critical component of heparin
response and anticoagulation effectiveness. Objectives: Determine the
impact of antithrombin levels on anticoagulation (heparin sensitivity and
effectiveness) during cardiopulmonary bypass (CPB) in children <1 year
old. Methods: Secondary analysis of a randomized controlled trial of
individualized vs weight based heparin management in 90 infants
<1-year-old undergoing cardiac surgery. All analyses combined both patient
groups and were used linear regression models. Results: As expected, older
patients had higher blood antithrombin levels (relative increase of 16+6%
for patients >6 months old vs. those <6 month old, p=0.009). Response to
heparin, reflected by change in anti-Xa levels from baseline after the
initial heparin bolus (a laboratory measure of heparin sensitivity), was
highest in patients with higher baseline antithrombin circulating levels
(top tier: +0.94(0.16) U/ml per 100U/kg heparin vs. middle tier:
+0.89(0.19) U/ml vs. lowest tier: +0.77(0.20) U/ml, p<0.001). Those
patients with very low antithrombin levels during CPB (<0.35U/ml) had much
greater heparin requirements (+165(30) U/kg/hr representing an increase of
243%, p<0.001) indicating greater heparin resistance. Insufficient
anticoagulation on bypass (as measured by end of bypass anti-Xa level) was
associated with higher clotting potential, reflected by higher plasma
levels of thrombin-antithrombin complexes (+4.8(2.4) ng/ml per anti-Xa
U/ml, p=0.05), and prothrombin activation fragment 1.2 (+85(32) pg/ml per
anti-Xa U/ml, p=0.008). Moreover, lower circulating antithrombin level was
associated with increased D-dimer levels after CPB (+53(25) ng/ml per 0.1
U/ml antithrombin, p=0.03). Conclusions: Low antithrombin level is
associated with resistance to heparin and decreased anticoagulation
activity, ultimately leading to lower ability to suppress thrombin
generation during CPB. Antithrombin supplementation may potentially
individualize and improve anticoagulation.
<23>
Accession Number
71710616
Authors
Le V.T. McCubrey R.O. Bair T.L. Horne B.D. May H.T. Knight S. Muhlestein
J.B. Anderson J.L.
Institution
(Le, McCubrey, Bair, May) Intermountain Heart Institute, Intermountain Med
Cntr, Murray, UT, United States
(Horne, Knight, Muhlestein, Anderson) Intermountain Heart Institute,
Intermountain Med Cntr, Univ of Utah, Murray, UT, United States
Title
Is the association of statin use and incident diabetes mellitus still
significant in primary prevention treatment when accounting for incident
cardiovascular events?.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Abstract Background: Statins are first line therapy for hyperlipidemia and
the preferred treatment for primary and secondary prevention of
cardiovascular disease (CVD). Meta-analyses of prior statin studies
suggest an association of statin use with incident diabetes (DM). It is
unknown whether incident co-morbid disease plays a role in this observed
increase in incident DM amongst statin users. We examined the risk of
incident DM using a competing risk of time to first event model. Method:
Patients from an integrated health care system were included if they were
> 45 years of age, had no prior history of either CVD or DM and who were
started on a statin medication for primary prevention. Patients were
followed from January 2002 to November 2012 and assessed at 1, 5, and 10
years (n=14736, 10305, and 2541 respectively) for the association of
continuous statin use and incident DM or CV event (MI, CVA, AF, CHF, or
coronary revascularization). Time until first event was examined using a
competing risks statistical model, where the outcome was incident DM a
first CV event, or neither. Risk estimates were adjusted using propensity
scores of sex, age, hypertension, hyperlipidemia, renal failure, or
tobacco use. Results: Patients averaged 55+6 years and were 56% male.
Though not statistically significant, 1-yr follow-up of statin use trended
toward an association with incident DM (HR=1.68, 95% CI (0.978, 2.89),
p=0.06). 5-yr follow-up of statin use was significantly associated with
incident DM (HR=1.48, 95% CI (1.11, 1.97), p =0.008). 10-yr follow-up of
statin use was not significantly associated with incident DM (HR=1.01, 95%
CI (0.687, 1.47), p =0.97). Conclusion: Using a competing risks model, an
association between continuous statin use at 5-years and incident DM was
observed, with a trend toward an association at 1-year. Although
continuous statin treatment through 5 years was associated with risk of DM
, these results do not reveal whether that risk outweighs the expected
benefit of statin therapy for primary prevention.
<24>
Accession Number
71710574
Authors
Everett B.M. Brooks M. Vlachos H. Chaitman B. Frye R. Bhatt D.
Institution
(Everett, Bhatt) Medicine, Brigham and Womens Hosp, Boston, MA, United
States
(Brooks, Vlachos) Epidemiology, Univ of Pittsburgh, Pittsburgh, PA, United
States
(Chaitman) Medicine, Univ of St. Louis, St. Louis, MO, United States
(Frye) Medicine, Mayo Clinic, Rochester, MN, United States
Title
Effects of glucose control and coronary revascularization strategies on
cardiac troponin and natriuretic peptide levels in patients with type 2
diabetes and stable ischemic heart disease: A BARI-2D substudy.
Source
Circulation. Conference: American Heart Association's 2014 Scientific
Sessions and Resuscitation Science Symposium Chicago, IL United States.
Conference Start: 20141115 Conference End: 20141118. Conference
Publication: (var.pagings). 130 , 2014. Date of Publication: 25 Nov 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Abstract Background: : High-sensitivity cardiac troponin T (hsTnT) and
B-type natriuretic peptides (NT-proBNP) are strongly associated with death
and major cardiovascular (CV) events, and are often elevated in patients
with T2D and stable ischemic heart disease (SIHD). Whether these
biomarkers change over time or are altered by revascularization or glucose
control strategies has not been well studied. Methods and Results: We
measured hsTnT and NT-proBNP at baseline and after 1 year of follow up in
1984 patients enrolled in BARI-2D (NCT00006305), a 2x2 factorial
randomized controlled trial in patients with T2D and SIHD of insulin
sensitization (IS) vs. insulin provision (IP) and initial
revascularization vs. medical therapy. At baseline, all 1984 patients had
a detectable hsTnT (>3 ng/L) or NT-proBNP (>5 ng/L). There was a modest
but significant increase in both markers with a median (IQR) increase of
3.4% (-4.8, 11.1) in log(hsTnT) and 3.5% (-7.7, 16.3) in log(NT-proBNP)
(each P<0.001). We observed no significant differences in the percent
change in log(hsTnT) when the IS group was compared to the IP group
(P=0.39), or when revascularization was compared to medical therapy
(P=0.40; Figure). The median (IQR) percent change in log(NT-proBNP)
concentrations in the IS group [6.1% (-5.7, 19.5)] was significantly
greater than in the IP group [1.6% (-10.3, 12.7); P<0.001; Figure], but no
significant differences were noted when initial revascularization was
compared to medical therapy (P=0.08; Figure). Conclusions: A high
proportion of patients with T2D and SIHD have measurable circulating
cardiac troponin and NT-proBNP levels. The change in cardiac troponin
concentrations does not differ by insulin sensitization vs. provision
strategies for T2D, or by initial revascularization vs. medical therapy
for SIHD. By contrast, we observed NT-proBNP concentrations increased at
1-year among those randomized to an insulin sensitization compared to
those an insulin provision strategy.
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