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<1>
Accession Number
2014622854
Authors
Rautiainen S. Lee I.-M. Rist P.M. Gaziano J.M. Manson J.E. Buring J.E.
Sesso H.D.
Institution
(Rautiainen) Department of Institute of Environmental Medicine, Karolinska
Institutet, Stockholm, Sweden
(Rautiainen, Lee, Rist, Gaziano, Manson, Buring, Sesso) Department of
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Rist) Department of Social and Behavioral Science, Harvard School of
Public Health, Boston, MA, United States
(Lee, Rist, Manson, Buring, Sesso) Department of Epidemiology, Harvard
School of Public Health, Boston, MA, United States
(Gaziano) VA Boston Healthcare System, Boston, MA, United States
(Rautiainen) Division of Preventive Medicine, Brigham and Women's
Hospital, 900 Commonwealth Avenue, Boston, MA 02215, United States
Title
Multivitamin use and cardiovascular disease in a prospective study of
women.
Source
American Journal of Clinical Nutrition. 101 (1) (pp 144-152), 2015. Date
of Publication: 01 Jan 2015.
Publisher
American Society for Nutrition
Abstract
Background: Although multivitamins are widely used, there are limited
prospective studies investigating their association with both long- and
short-term risk of cardiovascular disease (CVD). Objective: The objective
was to investigate how multivitamin use is associated with the long- and
short-term risk of CVD. Design: A prospective cohort study was conducted
of 37,193 women from the Women's Health Study aged <45 y and free of CVD
and cancer at baseline who were followed for an average of 16.2 y. At
baseline, women self-reported a wide range of lifestyle, clinical, and
dietary factors. Women were categorized into 1) no current use and 2)
current use of multivitamins. Duration and updated measures over the
course of the follow-up to address short-term effects were also
considered. Women were followed for major CVD events, including myocardial
infarction (MI), stroke, and CVD death. Results: During the follow-up,
1493 incident cases of CVD [defined as myocardial infarction (MI), stroke,
and CVD death] occurred. In multivariable analyses, multivitamin use
compared with no use was not associated with major CVD events (HR: 1.01;
95% CI: 0.89, 1.15), MI (HR: 1.04; 95% CI: 0.84, 1.27), stroke (HR: 0.99;
95% CI: 0.83, 1.18), or CVD death (HR: 1.10; 95% CI: 0.84, 1.45). A
nonsignificant inverse association was observed between baseline
multivitamin use and major CVD events among women aged >70 y
(P-interaction = 0.04) and those consuming < 3 servings/ d of fruit and
vegetables (P-interaction = 0.01). When updating information on
multivitamin use during the course of follow-up, no associations were
observed for major CVD events (HR: 0.91; 95% CI: 0.82, 1.02), MI (HR:
0.89; 95% CI: 0.74, 1.06), stroke (HR: 0.91; 95% CI: 0.78, 1.06), and CVD
death (HR: 0.91; 95% CI: 0.71, 1.16). Conclusions: In this study of
middle-aged and elderly women, neither baseline nor time-varying
multivitamin use was associated with the long-term risk of major CVD
events, MI, stroke, cardiac revascularizations, or CVD death. Additional
studies are needed to clarify the role of multivitamins on CVD.

<2>
Accession Number
2014719575
Authors
Lim J.Y. Deo S.V. Jung S.H. Altarabsheh S.E. Erwin P.J. Dillon J.J. Park
S.J.
Institution
(Lim, Jung) Asan Medical Center, Seoul, South Korea
(Deo) Adventist Wockhardt Heart Institute, Surat Gujarat, India
(Altarabsheh) Queen Alia Heart Institute, Amman, Jordan
(Erwin) Mayo Clinic, Rochester, MN, United States
(Dillon) Division of Nephrology and Hypertension, Mayo Clinic, Rochester,
MN, United States
(Deo, Park) Case Medical Center, Case Western Reserve University,
Cleveland, OH, United States
Title
Does Off-pump Coronary Artery Bypass Confer any Advantage in Patients with
End-stage Renal Failure? A Systematic Review and Meta-analysis.
Source
Heart Lung and Circulation. 24 (1) (pp 55-61), 2015. Date of Publication:
01 Jan 2015.
Publisher
Elsevier Ltd
Abstract
Objectives: Patients with end-stage renal disease (ESRD) are often
excluded from trials comparing off and on-pump coronary artery bypass
grafting (CABG). Thus data in this cohort is limited to small
retrospective studies. Hence we compared the adverse clinical events and
outcome in patients with ESRD undergoing off (OPCABG) and on-pump surgery
(ONCABG). Methods: Pubmed, Scopus and Web of Science were searched
(inception - June 2013) to identify studies comparing clinical results of
OPCABG and ONCABG in dialysis dependent patients. A random effect inverse
variance weighted meta-analysis was conducted. Results are presented as
risk ratios (RR) with 95% confidence intervals; p. <. 0.05 is significant.
Result: Ten retrospective studies (2762 OPCABG and 11310 ONCABG) fulfilled
criteria and were pooled. Patients undergoing off-pump surgery were less
than 100 in most of the articles. Early mortality [OPCABG (8.4%); ONCABG
(10.4%)] was comparable [RR 0.80(0.51-1.17); p=0.35; I²=30%].
Re-exploration for bleeding [RR 0.81(0.47-1.39); p=0.44] and blood
transfusion [RR 0.79(0.57-1.08); p=0.14] were also comparable. While
patients undergoing off-pump surgery were extubated earlier (p<0.01),
other post-operative events like stroke (p=0.34) and atrial fibrillation
(p=0.10) were similar. Mid-term survival (three to five years) was also
comparable. Conclusion: Patients with end-stage renal disease undergoing
coronary artery bypass grafting demonstrate comparable results
irrespective of method. While available data is limited to retrospective
studies, we failed to demonstrate any significant advantage for performing
OPCABG in this group of patients.

<3>
Accession Number
2014631046
Authors
Krone R.J. Althouse A.D. Tamis-Holland J. Venkitachalam L. Campos A.
Forker A. Jacobs A.K. Ocampo S. Steiner G. Fuentes F. Pena Sing I.R.
Brooks M.M.
Institution
(Krone) Division of Cardiology, Washington University, St. Louis, MO,
United States
(Althouse, Brooks) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Tamis-Holland) Mount Sinai Saint Luke's Hospital, New York, NA, United
States
(Venkitachalam) Department of Biomedical and Health Informatics,
University of Missouri-Kansas City, Kansas City, MO, United States
(Campos, Ocampo) Department of Cardiology, Hospital de Especialidades,
Centro Medico La Raza, IMSS, MEX City, Mexico
(Forker) Mid America Heart Institute, University of Missouri-Kansas City,
Kansas City, MO, United States
(Jacobs) Boston University and Boston Medical Center, Boston, MA, United
States
(Steiner) The University of Toronto, Toronto, ON, Canada
(Fuentes) Division of Cardiology, The University of Texas Health Science
Center at Houston, Houston, TX, United States
(Pena Sing) Heart and Vascular Catheterization Laboratories, Nanticoke
Memorial Hospital, Seaford, DE, United States
(Pena Sing) New York University, New York, NY, United States
Title
Appropriate Revascularization in Stable Angina: Lessons From the BARI 2D
Trial.
Source
Canadian Journal of Cardiology. 30 (12) (pp 1595-1601), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Pulsus Group Inc.
Abstract
Background: The 2012 Guidelines for Diagnosis and Management of Patients
with Stable Ischemic Heart Disease recommend intensive antianginal and
risk factor treatment (optimal medical management [OMT]) before
considering revascularization to relieve symptoms. The Bypass Angioplasty
Revascularization Investigation 2 Diabetes (BARI 2D) trial randomized
patients with ischemic heart disease and anatomy suitable to
revascularization to (1) initial OMT with revascularization if needed or
(2) initial revascularization plus OMT and found no difference in major
cardiovascular events. Ultimately, however, 37.9% of the OMT group was
revascularized during the 5-year follow-up period. Methods: Data from the
1192 patients randomized to OMT were analyzed to identify subgroups in
which the incidence of revascularization was so high that direct
revascularization without a trial period could be justified. Multivariate
logistic analysis, Cox regression models of baseline data, and a landmark
analysis of participants who did not undergo revascularization at 6 months
were constructed. Results: The models that used only data available at the
time of study entry had limited predictive value for revascularization by
6 months or by 5 years; however, the model incorporating severity of
angina during the first 6 months could better predict revascularization (C
statistic= 0.789). Conclusions: With the possible exception of patients
with severe angina and proximal left anterior descending artery disease,
this analysis supports the recommendation of the 2012 guidelines for a
trial of OMT before revascularization. Patients could not be identified at
the time of catheterization, but a short period of close follow-up during
OMT identified the nearly 40% of patients who underwent revascularization.

<4>
Accession Number
2014631034
Authors
Qaddoura A. Kabali C. Drew D. van Oosten E.M. Michael K.A. Redfearn D.P.
Simpson C.S. Baranchuk A.
Institution
(Qaddoura, Drew, Michael, Redfearn, Simpson, Baranchuk) Department of
Medicine, Queen's University, Kingston, ON, Canada
(Kabali) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
(van Oosten) Department of Medicine, Western University, London, ON,
Canada
(Michael, Redfearn, Simpson, Baranchuk) Division of Cardiology, Kingston
General Hospital, Queen's University, Kingston, ON, Canada
Title
Obstructive Sleep Apnea as a Predictor of Atrial Fibrillation After
Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 30 (12) (pp 1516-1522), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Pulsus Group Inc.
Abstract
Background: Post-coronary artery bypass grafting atrial fibrillation
(PCAF) is associated with increased morbidity, mortality, and system
costs. Few studies have explored obstructive sleep apnea (OSA) as a risk
factor for PCAF. We aimed to systematically review and synthesize the
evidence associating OSA with PCAF. Methods: We conducted a search of
MEDLINE, EMBASE, Google Scholar, and Web of Science, as well as abstracts,
conference proceedings, and reference lists until June 2014. Eligible
studies were in English, were conducted in humans, and assessed OSA with
polysomnography (PSG) or a validated questionnaire. Two reviewers
independently selected studies, with disagreement resolved by consensus.
Piloted forms were used to extract data and assess risk of bias. Results:
Five prospective cohort studies were included (n= 642). There was
agreement in study selection ( statistic, 0.89; 95% confidence interval
[CI], 0.75-1.00). OSA was associated with a higher risk of PCAF (odds
ratio [OR], 1.86; 95% CI 1.24-2.80; P= 0.003; I²= 35%). We
conducted 3 subgroup analyses. The associations increased for data that
used PSG to assess OSA (OR, 2.34; 95% CI, 1.48-3.70), when severe OSA was
included from 1 study (OR, 2.59; 95% CI, 1.63-4.11), and when adjusted
analyses were pooled (OR, 2.38; 95% CI, 1.57-3.62; P < 0.001 in all), with
no heterogeneity detected in any subgroup analysis (I² < 0.01%
in all). Conclusions: OSA was shown to be a strong predictor of PCAF.

<5>
Accession Number
2014618409
Authors
Stangl V. Baldenhofer G. Laule M. Baumann G. Stangl K.
Institution
(Stangl, Baldenhofer, Laule, Baumann, Stangl) Medizinische Klinik fur
Kardiologie und Angiologie, Campus Mitte, Charite - Universitatsmedizin
Berlin, Schumannstr. 20-21, Berlin 10117, Germany
(Stangl) DZHK (German Center for Cardiovascular Research), Berlin, Germany
Title
Influence of sex on outcome following transcatheter aortic valve
implantation (TAVI): Systematic review and meta-analysis.
Source
Journal of Interventional Cardiology. 27 (6) (pp 531-539), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Blackwell Publishing Inc.
Abstract
Background Sex differences exist in pathogenesis, clinical presentation,
and outcome in aortic stenosis (AS). However, only limited information is
available concerning sex differences in transcatheter aortic valve
implantation (TAVI). The aim of the present study is a comprehensive
meta-analysis of studies that investigate differences between men and
women in outcome after TAVI.
Methods We screened PUBMED, MEDLINE, EMBASE, and the Cochrane Central
Register of Controlled Trials. Inclusion criteria were: AS treated with
all forms of TAVI, studies specifically targeting sex/gender differences,
and at least 2 of the following outcome data: 30-day all-cause death,
mortality during follow-up, major vascular complications, major bleeding,
pacemaker, or stroke rate (<30 days). Studies were excluded if they
considered female gender merely in subgroup analysis.
Results We included 14 observational studies with a total of 7,973
patients (4,242 women, 3,731 men). At 30 days (12 studies, 3,044 women,
2,784 men), female sex was associated with a significantly lower mortality
rate (odds ratio [95% confidence interval] 0.78 [0.64, 0.96]). Of the 14
studies included for analysis, 12 provided data on mortality during
follow-up that likewise show a survival advantage for women (OR 0.70
[0.59, 0.82]). Whereas the major vascular complication rate was greater in
women (11 studies, 3,731 women, 3,342 men; OR 1.72 [1.41, 2.09]), major
bleeding (8 studies, 2,124 women, 2,100 men; OR 1.13 [0.95, 1.33]) was
not. Pacemaker and stroke rate were not significantly different between
the groups.
Conclusion In treatment with TAVI, there is evidence for a significantly
greater overall survival benefit in women over men.

<6>
Accession Number
2015637968
Authors
Cheungpasitporn W. Thongprayoon C. Brabec B.A. Edmonds P.J. O'Corragain
O.A. Erickson S.B.
Institution
(Cheungpasitporn, Thongprayoon, Brabec, Erickson) Division of Nephrology
and Hypertension, Mayo Clinic, Rochester, Minnesota, State University of
New York, SUNY Upstate Medical University, Syracuse, NY, United States
(Edmonds) University College Cork, Cork, Ireland
(O'Corragain) Division of Nephrology and Hypertension, Mayo Clinic, 200
First Street SW, Rochester, MN 55905, United States
Title
Oral hydration for prevention of contrast-induced acute kidney injury in
elective radiological procedures: A systematic review and meta-analysis of
randomized controlled trials.
Source
North American Journal of Medical Sciences. 6 (12) (pp 618-624), 2014.
Date of Publication: 2014.
Publisher
North American Journal of Medical Sciences
Abstract
Background: The reports on effi cacy of oral hydration treatment for the
prevention of contrast-induced acute kidney injury (CIAKI) in elective
radiological procedures and cardiac catheterization remain controversial.
Aims: The objective of this meta-analysis was to assess the use of oral
hydration regimen for prevention of CIAKI. Materials and Methods:
Comprehensive literature searches for randomized controlled trials (RCTs)
of outpatient oral hydration treatment was performed using MEDLINE,
EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register
of Controlled Trials Systematic Reviews, and clinicaltrials.gov from
inception until July 4th, 2014. Primary outcome was the incidence of
CIAKI. Results: Six prospective RCTs were included in our analysis. Of
513patients undergoing elective procedures with contrast exposures,45
patients (8.8%) had CIAKI. Of 241 patients with oral hydration regimen, 23
(9.5%) developed CIAKI. Of 272 patients with intravenous (IV) fl uid
regimen, 22 (8.1%) had CIAKI. Study populations in all included studies
had relatively normal kidney function to chronic kidney disease (CKD)
stage 3. There was no signifi cant increased risk of CIAKI in oral fl uid
regimen group compared toIV fl uid regimen group (RR = 0.94, 95% confi
dence interval, CI = 0.38-2.31). Conclusions: According to our
analysis,there is no evidence that oral fl uid regimen is associated with
more risk of CIAKI in patients undergoing elective procedures with
contrast exposures compared to IV fl uid regimen.This fi nding suggests
that the oral fl uid regimen might be considered as a possible outpatient
treatment option for CIAKI prevention in patients with normal to
moderately reduced kidney function.

<7>
Accession Number
2014621586
Authors
Manzano F. Colmenero M. Perez-Perez A.M. Roldan D. Jimenez-Quintana M.M.
Manas M.R. Sanchez-Moya M.A. Guerrero C. Moral-Marfil M.A.
Sanchez-Cantalejo E. Fernandez-Mondejar E.
Institution
(Manzano, Perez-Perez, Roldan, Jimenez-Quintana, Manas, Sanchez-Moya,
Guerrero, Moral-Marfil, Fernandez-Mondejar) Intensive Care Unit, Hospital
Universitario Virgen de las Nieves, C/Avenida de las Fuerzas Armadas, 2,
Granada 18014, Spain
(Colmenero) Intensive Care Unit, Hospital Universitario San Cecilio,
C/Avenida Dr. Oloriz 16, Granada 18012, Spain
(Sanchez-Cantalejo) Department of Statistics, Andalusian School of Public
Health, Granada, Spain
(Manzano, Colmenero, Perez-Perez, Roldan, Jimenez-Quintana, Manas,
Sanchez-Moya, Guerrero, Moral-Marfil, Sanchez-Cantalejo,
Fernandez-Mondejar) Instituto de Investigacion Biosanitario de Granada
(IBIG), Granada, Spain
Title
Comparison of two repositioning schedules for the prevention of pressure
ulcers in patients on mechanical ventilation with alternating pressure air
mattresses.
Source
Intensive Care Medicine. 40 (11) (pp 1679-1687), 2014. Date of
Publication: 15 Oct 2014.
Publisher
Springer Verlag
Abstract
Purpose: The objective was to compare the effectiveness of repositioning
every 2 or 4 h for preventing pressure ulcer development in patients in
intensive care unit under mechanical ventilation (MV).
Methods: This was a pragmatic, open-label randomized clinical trial in
consecutive patients on an alternating pressure air mattress (APAM)
requiring invasive MV for at least 24 h in a university hospital in Spain.
Eligible participants were randomly assigned to groups for repositioning
every 2 (n = 165) or 4 (n = 164) h. The primary outcome was the incidence
of a pressure ulcer of at least grade II during ICU stay.
Results: A pressure ulcer of at least grade II developed in 10.3 %
(17/165) of patients turned every 2 h versus 13.4 % (22/164) of those
turned every 4 h (hazard ratio [HR] 0.89, 95 % confidence interval [CI]
0.46-1.71, P = 0.73). The composite end point of device-related adverse
events was recorded in 47.9 versus 36.6 % (HR 1.50, CI 95 % 1.06-2.11, P =
0.02), unplanned extubation in 11.5 versus 6.7 % (HR 1.77, 95 % CI
0.84-3.75, P = 0. 13), and endotracheal tube obstruction in 36.4 versus
30.5 %, respectively (HR 1.44, 95 % CI 0.98-2.12, P = 0.065). The median
(interquartile range) daily nursing workload for manual repositioning was
21 (14-27) versus 11 min/patient (8-15) (P < 0.001).
Conclusions: A strategy aimed at increasing repositioning frequency (2
versus 4 h) in patients under MV and on an APAM did not reduce the
incidence of pressure ulcers. However, it did increase device-related
adverse events and daily nursing workload.

<8>
Accession Number
2014616829
Authors
Gaudino M. Crea F. Cammertoni F. Mazza A. Toesca A. Massetti M.
Institution
(Gaudino) Department of Cardiovascular Medicine, University Hospital A.
Gemelli, Catholic University, Largo A. Gemelli, 8, Rome 00168, Italy
(Crea, Cammertoni, Mazza, Toesca, Massetti) Department of Anatomy,
Catholic University, Rome, Italy
Title
Technical issues in the use of the radial artery as a coronary artery
bypass conduit.
Source
Annals of Thoracic Surgery. 98 (6) (pp 2247-2254), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Elsevier USA
Abstract
The clinical and angiographic benefits related to the use of the radial
artery (RA) as a bypass conduit have extensively been proven. However, due
to its morpho-functional features and its anatomic position, successful
use of the RA requires careful consideration of several technical issues.
We herein summarize the current evidence on all the technical aspects
related to the RA use in coronary surgery such as the preoperative
evaluation of ulnar compensation, the different means of intraoperative
vasodilatation, and the various harvesting techniques.

<9>
Accession Number
2014616823
Authors
Jheon S. Lee S. Kim H.R. Cho S. Huh D.M. Lee E.B. Ryu K.M. Cho D.G. Paik
H.C. Kim D.K. Lee S.-H. Cho J.S. Lee J.I. Choi H. Kim K.
Institution
(Jheon) Department of Thoracic and Cardiovascular Surgery, Seoul National
University Bundang Hospital, Seoul National University College of
Medicine, #166, Gumiro, Bundang, Seungnam, Gyeonggi 463-707, South Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, Gangnam Severance
Hospital, Yonsei University College of Medicine, Seoul, South Korea
(Lee, Kim, Cho, Huh, Lee, Ryu, Cho, Paik, Kim, Lee, Cho, Lee, Choi, Kim)
Department of Thoracic and Cardiovascular Surgery, Ajou University
Hospital, Suwon; Asan Medical Center, Seoul; Daegu Fatima Hospital, Daegu;
Kyungpook National University Hospital, Daegu; Dankook University
Hospital, Cheonan; Catholic Saint Vincent Hospital, Suwon; Korea
University Anam Hospital, Seoul; Pusan National University Hospital,
Pusan; Gachon University Gil Hospital, Incheon; and Seoul National
University College of Medicine, Seoul, Korea
Title
Staple line coverage after bullectomy for primary spontaneous
pneumothorax: A randomized trial.
Source
Annals of Thoracic Surgery. 98 (6) (pp 2005-2011), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Elsevier USA
Abstract
Background Thoracoscopic wedge resection is generally accepted as a
standard surgical procedure for primary spontaneous pneumothorax. Because
of the relatively high recurrence rate after surgery, additional
procedures such as mechanical pleurodesis or visceral pleural coverage are
usually applied to minimize recurrence, although mechanical pleurodesis
has some potential disadvantages. The aim of this study was to clarify
whether an additional coverage procedure on the staple line after
thoracoscopic bullectomy prevents postoperative recurrence compared with
additional pleurodesis.
Methods A total of 1,414 patients in 11 hospitals with primary spontaneous
pneumothorax undergoing thoracoscopic bullectomy were enrolled. After
bullectomy with staplers, patients were randomly assigned to either the
coverage group (n = 757) or the pleurodesis group (n = 657). In the
coverage group, the staple line was covered with absorbable cellulose mesh
and fibrin glue. The pleurodesis group underwent additional mechanical
abrasion on the parietal pleura.
Results The coverage group and the pleurodesis group showed comparable
surgical outcomes. After a median follow-up of 19.5 months, the
postoperative 1-year recurrence rate was 9.5% in the coverage group and
10.7% in the pleurodesis group. The 1-year recurrence rate requiring
intervention was 5.8% in the coverage group and 7.8% in the pleurodesis
group. The coverage group showed better recovery from pain.
Conclusions In terms of postoperative recurrence rate, visceral pleural
coverage after thoracoscopic bullectomy was not inferior to mechanical
pleurodesis. Visceral pleural coverage may potentially replace mechanical
pleurodesis, which has potential disadvantages such as disturbed normal
pleural physiology.

<10>
Accession Number
2014616816
Authors
Parolari A. Barili F. Pilozzi A. Pacini D.
Institution
(Barili) Department of Cardiac Surgery, S. Croce Hospital, Via M. Coppino
26, Cuneo 12100, Italy
(Parolari, Pilozzi, Pacini) Department of Cardiovascular Sciences,
University of Milan, Milan; and Department of Cardiac Surgery, University
of Bologna, Italy
Title
Ring or suture annuloplasty for tricuspid regurgitation? A meta-analysis
review.
Source
Annals of Thoracic Surgery. 98 (6) (pp 2255-2263), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Elsevier USA
Abstract
We performed a meta-analysis of early and long-term outcomes after
tricuspid repair to compare the results of suture-based and prosthetic
ring annuloplasty with the employment of an algorithm that derives the
original patient time-to-event data. There was an advantage in early but
not in long-term survival with the use of the annuloplasty ring. The
freedom from moderate tricuspid regurgitation was significantly better in
patients with ring annuloplasty (78.9% + 5.0% at 15 years vs 60.0% + 4.2%,
log-rank p = 0.0107). The ring annuloplasty is associated to better
outcomes, being a protective factor for early mortality and long-term
recurrence of tricuspid regurgitation after surgery.

<11>
Accession Number
2014616767
Authors
Riber L.P. Larsen T.B. Christensen T.D.
Institution
(Riber, Larsen, Christensen) Department of Cardiothoracic and Vascular
Surgery and Institute of Clinical Medicine, Odense University Hospital,
Odense, and Department of Cardiology, Center for Cardiovascular Research,
and Department of Cardiothoracic and Vascular Surgery and Institute of
Clinical Medicine, Aalborg University Hospital, and Aalborg Thrombosis
Research Centre, Department of Clinical Medicine, Faculty of Health
Aalborg University, Aalborg, Denmark
Title
Postoperative atrial fibrillation prophylaxis after lung surgery:
Systematic review and meta-analysis.
Source
Annals of Thoracic Surgery. 98 (6) (pp 1989-1997), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Elsevier USA
Abstract
Background Atrial fibrillation after thoracic surgery is frequent and
increases morbidity and mortality. A number of trials have investigated
medical prophylaxis for the prevention of atrial fibrillation after
surgery for lung cancer. However, the literature is diverse and hence
difficult to review. The aim of this study was to evaluate the safety and
efficacy of reducing the risk of postoperative atrial fibrillation by the
use of medical prophylaxis in patients undergoing surgery for lung cancer.
Methods A systematic review and meta-analysis of randomized, controlled
trials investigating prophylactic medical interventions to reduce the risk
of postoperative atrial fibrillation was performed.
Results A total number of 10 trials were identified. A significant
reduction in the risk of postoperative atrial fibrillation was found with
a relative risk of 0.53 (95% confidence interval, 0.42 to 0.67) and a
number needed-to-treat of 8.5 (95% confidence interval, 6.4 to 13.3).
Amiodarone was found to be the most effective prophylactic agent with a
relative risk of 0.32 (95% confidence interval, 0.19 to 0.50) and a number
needed-to-treat of 4.8 (95% confidence interval, 3.7 to 7.6) and regarded
as safe, with no severe adverse events registered. The risk of atrial
fibrillation was overall reduced from 25.1% to 13.4% (p < 0.001) and for
amiodarone as a single therapy from 30.4% to 9.6% (p < 0.001).
Conclusions Medical prophylaxis with calcium-channel blockers, magnesium
sulfate, or amiodarone significantly reduces the risk of developing atrial
fibrillation after lung reduction surgery. However, amiodarone and
magnesium sulfate were the most effective and safest drugs causing no
increased risk of adverse events.

<12>
Accession Number
2014620649
Authors
Morichau-Beauchant T. Boule S. Guedon-Moreau L. Finat L. Botcherby E.J.
Perier M.-C. Salleron J. Guibout C. Marquie C. Klug D. Kouakam C.
Wissocque L. Brigadeau F. Lacroix D. Kacet S.
Institution
(Morichau-Beauchant, Boule, Guedon-Moreau, Finat, Botcherby, Marquie,
Klug, Kouakam, Wissocque, Brigadeau, Lacroix, Kacet) Lille University
Hospital, Department of Cardiovascular Medicine, Lille 59037, France
(Perier, Guibout) Inserm U970, Paris Cardiovascular Research Centre, Paris
Descartes University, Sorbonne Paris Cite, Paris 75015, France
(Salleron) Lille University Hospital, Biostatistics Unit, Lille 59037,
France
(Klug, Wissocque, Lacroix, Kacet) University of Lille 2, Faculty of
Medicine, Lille 59045, France
Title
Remote monitoring of patients with implantable
cardioverter-defibrillators: Can results from large clinical trials be
transposed to clinical practice?.
Source
Archives of Cardiovascular Diseases. 107 (12) (pp 664-671), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France. E-mail: infos@masson.fr)
Abstract
Background. - Remote monitoring (RM) is increasingly used to follow up
patients withimplantable cardioverter-defibrillators (ICDs). Randomized
control trials provide evidence forthe benefit of this intervention, but
data for RM in daily clinical practice with multiple-brandsand unselected
patients is lacking.Aims. - To assess the effect of RM on patient
management and clinical outcome for recipientsof ICDs in daily
practice.Methods. - We reviewed ICD recipients followed up at our
institution in 2009 with RM or withtraditional hospital only (HO)
follow-up. We looked at the effect of RM on the number of sched-uled
ambulatory follow-ups and urgent unscheduled consultations, the time
between onset ofasymptomatic events to clinical intervention and the
clinical effectiveness of all consultations.We also evaluated the
proportion of RM notifications representing clinically relevant
situations.Results. - We included 355 patients retrospectively (RM: n =
144, HO: n = 211, 76.9% male,60.3 + 15.2 years old, 50.1% with ICDs for
primary prevention and mean left ventricular ejec-tion fraction 35.5 +
14.5%). Average follow-up was 13.5 months. The RM group required
lessscheduled ambulatory follow-up consultations (1.8 vs.
2.1/patient/year; P < 0.0001) and a farlower median time between the onset
of asymptomatic events and clinical intervention (7 vs.76 days; P =
0.016). Of the 784 scheduled ambulatory follow-up consultations carried
out, only152 (19.4%) resulted in therapeutic intervention or ICD
reprogramming. We also found that thevast majority of RM notifications
(61.9%) were of no clinical relevance.Conclusion. - RM allows early
management of asymptomatic events and a reduction in sched-uled ambulatory
follow-up consultations in daily clinical practice, without compromising
safety,endorsing RM as the new standard of care for ICD recipients.

<13>
Accession Number
2014626736
Authors
Bethlehem I. Wierda K. Visser C. Jekel L. Koopmans M. Kuiper M.A.
Institution
(Bethlehem, Wierda, Visser) Department of Extracorporeal Circulation,
Medical Centre Leeuwarden, Leeuwarden, Netherlands
(Jekel) Department of Cardiothoracic Surgery, Medical Centre Leeuwarden,
Leeuwarden, Netherlands
(Koopmans, Kuiper) Department of Intensive Care, Medical Centre
Leeuwarden, Leeuwarden, Netherlands
Title
Influence of two colloidal extracorporeal primes on coagulation of cardiac
surgical patients: A prospectively randomized open-label pilot trial.
Source
Journal of Extra-Corporeal Technology. 46 (4) (pp 293-299), 2014. Date of
Publication: 2014.
Publisher
American Society of Extra-Corporeal Technology
Abstract
The search for the ideal priming fluid continues as more evidence is
discovered about side effects of volume expanders.With the availability
ofmodern, balanced hydroxyethyl starch (HES) solutions with less side
effects than former HES solutions, we considered to replace our gelatin-
(modified gelatin) based extracorporeal circuit prime for a HES (130/.42)
prime. Therefore, we studied the influence of two colloidal priming fluids
on postoperative coagulation in patients undergoing cardiac surgery. The
primary endpoint was to compare clot formation time between the HES group
and the gelatin group with rotational thromboelastometry (ROTEM).
Additionally we compared colloid osmotic pressure and fluid balance of
both groups. Forty patients, undergoing elective first time coronary
artery bypass grafting or single-valve surgery, were included in this
prospectively randomized open-label pilot study. Laboratory data and ROTEM
data were collected and analyzed for differences between the two groups.
ROTEM data show significantly more prolongation in Extem clot formation
time and significant more decrease in Extem alpha in the HES group. Fibtem
maximum clot firmness was significantly smaller in the HES group; this was
consistent with fibrinogen concentration measurement, which decreased more
in the HES group than in the gelatin group and recovered more over time in
the gelatin group. We found no significant difference in colloid osmotic
pressure between the groups. In this trial, HES (130/.42) impairs
coagulation significantly more compared with gelatin. These differences in
influence on coagulation did not lead to a difference in blood loss or
fluid balance, so clinical relevance could not be proven.

<14>
Accession Number
2014898645
Authors
Sekercioglu N. Spencer F.A. Lopes L.C. Guyatt G.H.
Institution
(Sekercioglu, Guyatt) Department of Clinical Epidemiology and
Biostatistics, McMaster University, 1280 Main Street, Hamilton, ON L8S 4
K1, Canada
(Spencer, Guyatt) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Lopes) Pharmaceutical Sciences Postgraduate Course, University of
Sorocaba (UNISO), Brazil
Title
Culprit vessel only vs immediate complete revascularization in patients
with acute ST-segment elevation myocardial infarction: Systematic review
and meta-analysis.
Source
Clinical Cardiology. 37 (12) (pp 765-772), 2014. Date of Publication: 01
Dec 2014.
Publisher
John Wiley and Sons Inc.
Abstract
Although multivessel coronary artery disease has been associated with poor
health outcomes in patients with acute ST-segment elevation myocardial
infarction (STEMI), the optimal approach to revascularization remains
uncertain. The objective of this review was to determine the benefits and
harms of culprit vessel only vs immediate complete percutaneous coronary
intervention (PCI) in patients with acute STEMI. We searched MEDLINE,
EMBASE, the Cochrane Register of Controlled Trials, and the Cumulative
Index to Nursing and Allied Health Literature (CINAHL) for randomized
controlled trials (RCTs). Teams of 2 reviewers, independently and in
duplicate, screened titles and abstracts, completed full-text reviews, and
abstracted data. We calculated pooled risk ratios (RRs) and associated 95%
confidence intervals (CIs) using random-effect models for nonfatal
myocardial infarction (MI), revascularization, cardiovascular mortality,
all-causemortality, and adverse events, and used the GRADE approach to
rate confidence in estimates of effect. Of 341 patients randomized to
complete revascularization and followed to study conclusion, 31
experienced revascularization, as did 80 of 324 randomized to culprit
vessel only revascularization (RR: 0.35, 95% CI: 0.24-0.53). Ten patients
in the complete revascularization group and 28 patients in the culprit
vessel only revascularization group experienced nonfatal MI (RR: 0.35, 95%
CI: 0.17-0.72). All-cause mortality and cardiac deaths did not differ
between groups (RR: 0.69, 95% CI: 0.40-1.21 for all-cause mortality; RR:
0.48, 95% CI: 0.22-1.04 for cardiac deaths). Pooled data from 3 RCTs
suggest that immediate complete revascularization probably reduces
revascularization in patients with acute STEMI; although results suggest
possible benefits on MI and death, confidence in estimates is low.

<15>
Accession Number
2014620446
Authors
Wijeysundera D.N. Choi P.T. Badner N.H. Brasher P.M. Dresser G.K. Delgado
D.H. Beattie W.S.
Institution
(Wijeysundera, Beattie) Department of Anesthesia, Toronto General Hospital
and University of Toronto, Eaton Wing 3-450, 200 Elizabeth Street,
Toronto, ON M5G 2C4, Canada
(Wijeysundera) Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Toronto, ON, Canada
(Choi, Badner) Department of Anesthesiology, Pharmacology & Therapeutics,
University of British Columbia, Vancouver, BC, Canada
(Choi, Brasher) Centre for Clinical Epidemiology and Evaluation, Vancouver
Coastal Health Research Institute, Vancouver, BC, Canada
(Choi) Department of Anesthesiology and Perioperative Care, Vancouver
Acute, Vancouver, BC, Canada
(Badner) Department of Anesthesia and Perioperative Medicine, University
of British Columbia, Kelowna, BC, Canada
(Brasher) Department of Statistics, University of British Columbia,
Vancouver, BC, Canada
(Dresser) Department of Medicine, Western University, London, ON, Canada
(Delgado) Division of Cardiology, Peter Munk Cardiac Centre, Toronto
General Hospital, University Health Network, Toronto, ON, Canada
Title
A randomized feasibility trial of clonidine to reduce perioperative
cardiac risk in patients on chronic beta-blockade: the EPIC study.
Source
Canadian Journal of Anesthesia. 61 (11) (pp 995-1003), 2014. Date of
Publication: 11 Oct 2014.
Publisher
Springer New York LLC
Abstract
Purpose: Clonidine may help prevent cardiac complications in patients
undergoing non-cardiac surgery and receiving chronic beta-blocker therapy.
We conducted a multicentre pilot randomized trial to estimate recruitment
rates for a full-scale trial and to assess the safety and tolerability of
combining clonidine with chronic beta-blockade.
Methods: Patients who were at elevated perioperative cardiac risk,
receiving chronic beta-blockade, and scheduled for major non-cardiac
surgery were recruited in a blinded (participants, clinicians, outcome
assessors) placebo-controlled randomized trial at three Canadian
hospitals. Participants were randomized to clonidine (0.2 mg oral tablet
one hour before surgery, plus 0.2 mgday^-1 transdermal patch
placed one hour before surgery and removed four days after surgery or
hospital discharge, whichever came first) or matching placebo. Feasibility
was evaluated based on recruitment rates, with each centre being required
to recruit 50 participants within 12-18 months. Additionally, we reviewed
study drug withdrawals and safety outcomes, including clinically
significant hypotension or bradycardia.
Results: Eighty-two of the 168 participants were randomized to receive
clonidine and 86 to receive placebo. The average time to recruit 50
participants at each centre was 14.3 months. Six patients (7%) withdrew
from clonidine, while four (5%) withdrew from placebo. Based on
qualitative review, there were no major safety concerns related to
clonidine. There was a moderate overall rate of cardiac morbidity, with 18
participants (11%) suffering postoperative myocardial infarction.
Conclusion: This pilot randomized trial confirmed the feasibility, safety,
and tolerability of a full-scale trial of oral and transdermal clonidine
for reducing the risk of cardiac complications during non-cardiac surgery.
This trial was registered at www.clinicaltrials.gov: NCT00335582.

<16>
Accession Number
2014616100
Authors
Mylotte D. Lefevre T. Sondergaard L. Watanabe Y. Modine T. Dvir D. Bosmans
J. Tchetche D. Kornowski R. Sinning J.-M. Theriault-Lauzier P. O'Sullivan
C.J. Barbanti M. Debry N. Buithieu J. Codner P. Dorfmeister M. Martucci G.
Nickenig G. Wenaweser P. Tamburino C. Grube E. Webb J.G. Windecker S.
Lange R. Piazza N.
Institution
(Mylotte) Department of Cardiology, University Hospital Galway, Galway,
Ireland
(Mylotte, Sinning, Theriault-Lauzier, Buithieu, Martucci, Piazza) Division
of Cardiology, McGill University Health Centre, Montreal, QC, Canada
(Lefevre, Watanabe, Sinning) Department of Interventional Cardiology,
Hopital Jacques Cartier, Massy, France
(Sondergaard) Department of Cardiology, Rigshospitalet, Copenhagen,
Denmark
(Modine, Debry) Department of Cardiovascular Surgery, Hopital
Cardiologique, Lille, France
(Dvir, Webb) Department of Cardiology, St. Paul's Hospital, Vancouver, BC,
Canada
(Bosmans) Department of Cardiology, University Hospital Antwerp, Wilrijk,
Belgium
(Tchetche) Department of Interventional Cardiology, Clinique Pasteur,
Toulouse, France
(Kornowski, Codner) Department of Cardiology, Rabin Medical Center and
Tel-Aviv University, Tel-Aviv, Israel
(Nickenig, Grube) Department of Cardiology, Universitatsklinikum Bonn,
Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
(O'Sullivan, Wenaweser, Windecker) Department of Cardiology, Bern
University Hospital, Bern, Switzerland
(Barbanti, Tamburino) Department of Cardiology, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Dorfmeister, Lange, Piazza) Department of Cardiovascular Surgery, German
Heart Center, Munich, Germany
Title
Transcatheter aortic valve replacement in bicuspid aortic valve disease.
Source
Journal of the American College of Cardiology. 64 (22) (pp 2330-2339),
2014. Date of Publication: 09 Dec 2014.
Publisher
Elsevier USA
Abstract
Results A total of 139 patients underwent TAV-in-BAV with the
balloon-expandable transcatheter heart valve (THV) (n = 48) or
self-expandable THV (n = 91) systems. Patient mean age and Society of
Thoracic Surgeons predicted risk of mortality scores were 78.0 + 8.9 years
and 4.9 + 3.4%, respectively. BAV stenosis occurred in 65.5%,
regurgitation in 0.7%, and mixed disease in 33.8% of patients. Incidence
of type 0 BAV was 26.7%; type 1 BAV was 68.3%; and type 2 BAV was 5.0%.
Multislice computed tomography (MSCT)-based TAV sizing was used in 63.5%
of patients (77.1% balloon-expandable THV vs. 56.0% self-expandable THV, p
= 0.02). Procedural mortality was 3.6%, with TAV embolization in 2.2% and
conversion to surgery in 2.2%. The mean aortic gradient decreased from
48.7 + 16.5 mm Hg to 11.4 + 9.9 mm Hg (p < 0.0001). Post-implantation
aortic regurgitation (AR) grade >2 occurred in 28.4% (19.6%
balloon-expandable THV vs. 32.2% self-expandable THV, p = 0.11) but was
prevalent in only 17.4% when MSCT-based TAV sizing was performed (16.7%
balloon-expandable THV vs. 17.6% self-expandable THV, p = 0.99). MSCT
sizing was associated with reduced AR on multivariate analysis (odds ratio
[OR]: 0.19, 95% confidence intervals [CI]: 0.08 to 0.45; p < 0.0001).
Thirty-day device safety, success, and efficacy were noted in 79.1%,
89.9%, and 84.9% of patients, respectively. One-year mortality was 17.5%.
Major vascular complications were associated with increased 1-year
mortality (OR: 5.66, 95% CI: 1.21 to 26.43; p = 0.03).
Conclusions TAV-in-BAV is feasible with encouraging short- and
intermediate-term clinical outcomes. Importantly, a high incidence of
post-implantation AR is observed, which appears to be mitigated by
MSCT-based TAV sizing. Given the suboptimal echocardiographic results,
further study is required to evaluate long-term efficacy.
Background Limited information exists describing the results of
transcatheter aortic valve (TAV) replacement in patients with bicuspid
aortic valve (BAV) disease (TAV-in-BAV).
bjectives This study sought to evaluate clinical outcomes of a large
cohort of patients undergoing TAV-in-BAV.
Methods We retrospectively collected baseline characteristics, procedural
data, and clinical follow-up findings from 12 centers in Europe and Canada
that had performed TAV-in-BAV.

<17>
Accession Number
2014611002
Authors
Kalantarian S. Ay H. Gollub R.L. Lee H. Retzepi K. Mansour M. Ruskin J.N.
Institution
(Kalantarian, Mansour, Ruskin) Cardiac Arrhythmia Service, Massachusetts
General Hospital, 55 Fruit Street, Boston, MA 02114, United States
(Ay, Gollub, Retzepi) Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, 149 Thirteenth Street, Charlestown, MA
02129, United States
(Lee) Department of Biostatistics, Massachusetts General Hospital, 50
Staniford Street, Boston, MA 02114, United States
Title
Association between Atrial fibrillation and silent cerebral infarctions: A
systematic review and meta-analysis.
Source
Annals of Internal Medicine. 161 (9) (pp 650-658), 2014. Date of
Publication: 04 Nov 2014.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Atrial fibrillation (AF) is a common cause of stroke. Silent
cerebral infarctions (SCIs) are known to occur in the presence and absence
of AF, but the association between these disorders has not been
well-defined.
Purpose: To estimate the association between AF and SCIs and the
prevalence of SCIs in stroke-free patients with AF.
Data Sources: Searches of MEDLINE, PsycINFO, Cochrane Library, CINAHL, and
EMBASE from inception to 8 May 2014 without language restrictions and
manual screening of article references.
Study Selection: Observational studies involving adults with AF and no
clinical history of stroke or prosthetic valves who reported SCIs.
Data Extraction: Study characteristics and study quality were assessed in
duplicate.
Data Synthesis: Eleven studies including 5317 patients with mean ages from
50.0 to 83.6 years reported on the association between AF and SCIs.
Autopsy studies were heterogeneous and low-quality; therefore, they were
excluded from the meta-analysis of the risk estimates. When computed
tomography (CT) and magnetic resonance imaging (MRI) studies were
combined, AF was associated with SCIs in patients with no history of
symptomatic stroke (odds ratio, 2.62 [95% CI, 1.81 to 3.80]; I²
= 32.12%; P for heterogeneity = 0.118). This association was independent
of AF type (paroxysmal vs. persistent). The results were not altered
significantly when the analysis was restricted to studies that met at
least 70% of the maximum possible quality score (odds ratio, 3.06 [CI,
2.24 to 4.19]). Seventeen studies reported the prevalence of SCIs. The
overall prevalence of SCI lesions on MRI and CT among patients with AF was
40% and 22%, respectively.
Limitation: Most studies were cross-sectional, and autopsy studies were
heterogeneous and not sufficiently sensitive to detect small lesions.
Conclusion: Atrial fibrillation is associated with more than a 2-fold
increase in the odds for SCI.

<18>
Accession Number
2014611241
Authors
Ozturk S. Ozturk I. Ilhan S.
Institution
(Ozturk) Clinic of Cardiovascular Surgery, Diskapi Yildirim Beyazit
Training and Research Hospital, Ankara, Turkey
(Ozturk) Goztepe Training and Research Hospital, Clinic of Anesthesiology
and Reanimation, Istanbul, Turkey
(Ilhan) Department of Anesthesiology and Reanimation, Uludat University,
Faculty of Medicine, Bursa, Turkey
Title
Does obesity predict postoperative mediastinitis after cardiac surgery? A
systematic review and meta-analysis.
Source
Turkiye Klinikleri Cardiovascular Sciences. 26 (3) (pp 111-117), 2014.
Date of Publication: 17 Dec 2014.
Publisher
Turkiye Klinikleri (Turkocagi Caddesi No. 30, Balgat 06520, Turkey)
Abstract
Objective: Mediastinitis following cardiac surgery, is an important
complication. Many of risk factors that may cause mediastinitis analysed
in three groups as preoperative, intraoperative and postoperative
variables. The preoperative risk factors are especially important to
predict development of mediastinitis before surgery and also to plan the
preventive interventions. In this meta analysis, we aimed to analyze
whether preoperative obesity was a risk factor for development of
mediastinitis after open cardiac surgery or not.
Material and Methods: The literature screening was performed at Pubmed,
Ovid and Science direct databases without date limitation. The results of
trials were evaluated with random or fixed effect model according to the
heterogenity. The statistical evaluation was performed by using
Comprehensive Meta Analysis version 2 programme.
Results: Records identified through database searching were 5009 and
records identified through database searching with filter were 999. After
duplicates were removed, 374 records remained. Unrelated records (n=255)
were excluded after screening. Full-text of 119 articles were assessed for
eligibility and 97 of them were excluded because of absence of detailed
data. Twenty-two articles were included to meta-analysis which contain
86367 patients and inclusion criteria. The rate of mediastinitis was 2%
(1798 of 86367). Effect size was observed as heterogeneous (Q:50,
df(Q):21, p:0.00, I2:58.06%). Results of analysis according to random
effect model were (OR 2.33, 95% CI 1.91-2.83, Z:8.4 and p:0.00 (p>0.05).
Conclusion: The results of quantitative analysis showed that the
preoperative obesity can predict development of mediastinitis after
cardiac surgery. However, further randomised controlled trials are needed
for analysis to decrease the heterogeneity.

<19>
Accession Number
2014620004
Authors
Shivamurthy P. Parker M.W.
Institution
(Shivamurthy) Department of Medicine, University of Connecticut Health
Center, 263 Farmington Avenue, Farmington, CT 06030-1235, United States
(Parker) University of Connecticut Health Center, Hartford Hospital 80
Seymour Street, PO Box 5037, Hartford, CT 06102-5037, United States
Title
Cardiac manifestations of myasthenia gravis: A systematic review.
Source
IJC Metabolic and Endocrine. 5 (pp 3-6), 2014. Date of Publication: 01
Nov 2014.
Publisher
Elsevier Ireland Ltd (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Introduction: Myasthenia gravis is an autoimmune disorder targeting
skeletal muscles. Striated cardiac muscle can be a target for immune
attack manifesting as heart failure, arrhythmia, and sudden death. We
aimed to review cardiac manifestations of myasthenia gravis, its
underlying pathogenesis and clinical relevance. Method: We searched
literature published from 2003 to 2013 on cardiac involvement in
myasthenia gravis using PubMed, Scopus and Ovid databases using the terms
'heart failure'; 'cardiomyopathy'; 'myocarditis'; 'arrhythmia';
'coronary'; 'heart' and 'myasthenia gravis'. Forty-one articles were
chosen comprising of 29 case reports, 4 review articles and 8
retrospective/prospective studies. Result: Fifteen percent of myasthenia
cases had thymoma. Most of them (97%) had antibodies against striated
muscle (anti-titin, anti-ryanodine and anti-Kv 1.4 antibodies). Older age,
severe myasthenia and myocarditis appeared to be associated with
anti-striational antibodies. Takotsubo cardiomyopathy was the most
commonly reported cardiomyopathy. Giant cell myocarditis was a rare but
fatal manifestation associated with striational antibodies however
in-vitro study failed to produce their cytotoxic effects. T wave changes,
QT prolongation, anticholinesterase induced atrioventricular block and
sudden death were less commonly reported. Abnormal vasoconstrictive
coronary response to acetylcholine, development of pericarditis and
cardiac surgery leading to myasthenia gravis has been reported.
Conclusion: Heart muscle is a target for autoimmune inflammation in
myasthenia gravis. Advancing age, thymoma, and anti-Kv1 antibodies
appeared to be risk factors. Symptom overlap with myasthenia may result in
failure to recognize cardiac involvement. Prospective studies are needed
to establish causal link with striational antibodies and to make screening
recommendations for cardiac involvement.