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<1>
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Accession Number
2015927652
Authors
Melloni C. Washam J.B. Jones W.S. Halim S.A. Hasselblad V. Mayer S.B.
Heidenfelder B.L. Dolor R.J.
Institution
(Melloni, Jones, Halim, Hasselblad, Heidenfelder, Dolor) Duke Clinical
Research Institute, Duke University, Medical Center, Box 3850, Durham, NC
27710, United States
(Washam) Duke Heart Center, Duke University, Medical Center, Durham, NC,
United States
(Mayer) Division of Endocrinology and Metabolism, Department of Medicine,
Virginia Commonwealth University, Richmond, United States
Title
Conflicting results between randomized trials and observational studies on
the impact of proton pump inhibitors on cardiovascular events when
coadministered with dual antiplatelet therapy: Systematic review.
Source
Circulation: Cardiovascular Quality and Outcomes. 8 (1) (pp 47-55), 2015.
Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Discordant results have been reported on the effects of
concomitant use of proton pump inhibitors (PPIs) and dual antiplatelet
therapy (DAPT) for cardiovascular outcomes. We conducted a systematic
review comparing the effectiveness and safety of concomitant use of PPIs
and DAPT in the postdischarge treatment of unstable
angina/non-ST-segment-elevation myocardial infarction patients. Methods
and Results: We searched for clinical studies in MEDLINE, EMBASE, and the
Cochrane Database of Systematic Reviews, from 1995 to 2012. Reviewers
screened and extracted data, assessed applicability and quality, and
graded the strength of evidence. We performed meta-analyses of direct
comparisons when outcomes and follow-up periods were comparable.
Thirty-five studies were eligible. Five (4 randomized controlled trials
and 1 observational) assessed the effect of omeprazole when added to DAPT;
the other 30 (observational) assessed the effect of PPIs as a class when
compared with no PPIs. Random-effects meta-analyses of the studies
assessing PPIs as a class consistently reported higher event rates in
patients receiving PPIs for various clinical outcomes at 1 year (composite
ischemic end points, all-cause mortality, nonfatal MI, stroke,
revascularization, and stent thrombosis). However, the results from
randomized controlled trials evaluating omeprazole compared with placebo
showed no difference in ischemic outcomes, despite a reduction in upper
gastrointestinal bleeding with omeprazole. Conclusions: Large,
well-conducted observational studies of PPIs and randomized controlled
trials of omeprazole seem to provide conflicting results for the effect of
PPIs on cardiovascular outcomes when coadministered with DAPT. Prospective
trials that directly compare pharmacodynamic parameters and clinical
events among specific PPI agents in patients with unstable
angina/non-ST-segment-elevation myocardial infarction treated with DAPT
are warranted.
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Accession Number
2015927819
Authors
Giannopoulos G. Kossyvakis C. Efremidis M. Katsivas A. Panagopoulou V.
Doudoumis K. Raisakis K. Letsas K. Rentoukas I. Pyrgakis V. Manolis A.S.
Tousoulis D. Stefanadis C. Deftereos S.
Institution
(Giannopoulos, Kossyvakis, Doudoumis, Raisakis, Rentoukas, Pyrgakis,
Deftereos) Department of Cardiology, Athens General Hospital G.
Gennimatas, 154 Mesogeion Ave., Athens 11527, Greece
(Efremidis, Letsas) 2nd Department of Cardiology, Evangelismos General
Hospital, Athens, Greece
(Katsivas) 1st Department of Cardiology, Red Cross Hospital, Athens,
Greece
(Panagopoulou, Manolis, Tousoulis, Stefanadis) 1st Department of
Cardiology, University of Athens Medical School, Hippokration Hospital,
Athens, Greece
Title
Central sympathetic inhibition to reduce postablation atrial fibrillation
recurrences in hypertensive patients: A randomized, controlled study.
Source
Circulation. 130 (16) (pp 1346-1352), 2014. Date of Publication: 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-The autonomic system is an important determinant of atrial
arrhythmogenesis. Current evidence indicates that a combined sympathovagal
drive is most commonly responsible for eliciting atrial fibrillation (AF)
episodes. The purpose of this study was to test whether moxonidine, a
centrally acting sympathoinhibitory agent, can lead to a reduction in
postablation AF recurrence. Methods and Results-This was a prospective,
double-blinded, randomized study of 291 hypertensive patients with
symptomatic paroxysmal AF who were scheduled to undergo pulmonary vein
isolation. Patients were randomly assigned to receive either moxonidine
(0.2-0.4 mg daily) or placebo, along with standard antihypertensive
treatment. No significant differences in blood pressure levels were
observed between the 2 groups. In the primary outcome analysis, mean
recurrence-free survival was 467 days (95% CI, 445-489 days) in the
moxonidine group as compared with 409 days (95% CI, 381-437 days) in
control subjects (log rank test, P=0.006). The calculated 12-month
recurrence rate estimates were 36.9% in the control group and 20.0% in the
moxonidine group (P=0.007). Moxonidine treatment was associated with lower
recurrence risk after adjustment for age, body mass index, number of AF
episodes in the previous year, and left atrial diameter (adjusted hazard
ratio, 0.35 [95% CI, 0.22-0.55]; P<0.001). Conclusions-Treatment with
moxonidine is associated with less AF recurrences after ablation treatment
for drug-refractory AF in patients with hypertension. The observed effect
does not appear to depend on the antihypertensive action of this agent.
<3>
Accession Number
2015928216
Authors
Jia Z. Guo M. Zhang Y.-Q. Liang H.-Q. Zhang L.-Y. Song Y.
Institution
(Jia, Guo, Zhang, Liang, Zhang, Song) TEDA International Cardiovascular
Hospital, Cardiovascular Clinical College, Tianjin Medical University, 61
the Third Street (China) E-Mail, Tianjin 300457, China
Title
Efficacy of intravenous levosimendan in patients with heart failure
complicated by acute myocardial infarction.
Source
Cardiology (Switzerland). 128 (2) (pp 195-201), 2014. Date of Publication:
2014.
Publisher
S. Karger AG
Abstract
Objectives: To evaluate the efficacy of a short-term intravenous infusion
of levosimendan in patients with heart failure due to acute myocardial
infarction (AMI). Methods: This was a randomized, single-center,
single-blind study that included 160 patients. Patients were randomly
divided into 2 groups: 1 received levosimendan (n = 80) and the other
received placebo (n = 80). The study included multiple primary end points
(death, myocardial ischemia or worsening heart at the 6 month follow-up)
and used a composite outcome. Results: The primary end point rate in the
levosimendan group was lower than that in placebo group (43.7 vs. 62.5%,
HR 0.636, 95% CI 0.413-0.981, p = 0.041). Moreover, the mortality rate at
6 months was similar between the 2 groups (17.5 vs. 22.5%, HR 0.786, 95%
CI 0.382-1.543, p = 0.458). There was a higher incidence of myocardial
ischemia in the levosimendan group at 14 days than in the placebo group
(11.2 vs. 7.5%, HR 1.510, p = 0.435), but between 15 and 180 days, it was
significantly lower in the levosimendan group than in the placebo group
(3.8 vs. 13.8%, HR 0.261, p = 0.036). Conclusion: Short-term intravenous
infusion of levosimendan appears to be more effective than placebo for
treating patients with heart failure complicated by AMI.
<4>
Accession Number
2015928215
Authors
Nasso G. Bonifazi R. Romano V. Bartolomucci F. Rosano G. Massari F.
Fattouch K. Del Prete G. Riccioni G. Del Giglio M. Speziale G.
Institution
(Nasso, Bonifazi, Romano, Del Prete, Speziale) Division of Cardiac
Surgery, Anthea Hospital, GVM Care and Research, Via Camillo Rosalba
35-37, Bari IT-70124, Italy
(Bartolomucci) Division of Cardiology, L. Bonomo Hospital, Andria, Italy
(Del Giglio) Division of Cardiac Surgery, Maria Cecilia Hospital, GVM Care
and Research, Cotignola, Italy
(Rosano) Department of Internal Medicine, IRCCS San Raffaele, Rome, Italy
(Massari) Division of Cardiology, 'Umberto i' Hospital, Altamura, Italy
(Fattouch) Division of Cardiac Surgery, Maria Eleonora Hospital, GVM Care
and Research, Palermo, Italy
(Riccioni) Division of Cardiology, San Camillo de Lellis Hospital, Foggia,
Italy
Title
Three-year results of repaired Barlow mitral valves via right
minithoracotomy versus median sternotomy in a randomized trial.
Source
Cardiology (Switzerland). 128 (2) (pp 97-105), 2014. Date of Publication:
2014.
Publisher
S. Karger AG
Abstract
Objectives: To clarify whether the results of repair of a complex mitral
lesion (Barlow valve) at the intermediate-term follow-up are independent
of the mode of surgical access [minithoracotomy vs. median sternotomy
(MS)]. Methods: In a prospective randomized study of mitral repair for
Barlow disease using either a minimally invasive (MI) approach or MS, we
achieved an average follow-up of 3 years (echocardiography, physical
examination and quality of life). Mitral repair was achieved with
polytetrafluoroethylene chordal implantation for both leaflets. Results:
Both groups included 80 patients. Mechanical ventilation time and
intensive care unit and hospital stay were shorter in the MI group (p =
0.01, p = 0.013 and p = 0.02, respectively). During the follow-up, 5
patients in each group (6.25%) displayed mild mitral regurgitation, while
2 patients in each group (2.5%) developed recurrent regurgitation graded
as at least moderate/severe. The rate of mitral reoperation was 2.5% in
the MI group and 1.25% in the MS group (p = 0.9). The overall follow-up
mortality was 3.75% in both the MI and the MS groups. Conclusions: The
3-year results of repair of Barlow valves were satisfactory irrespective
of the approach used to repair the valve. The advantages of MI surgery can
be achieved in patients with mitral Barlow disease without concerns over
the durability of repair.
<5>
Accession Number
2015962955
Authors
Dahl J.S. Videbaek L. Poulsen M.K. Pellikka P.A. Veien K. Andersen L.I.
Haghfelt T. Moller J.E.
Institution
(Dahl, Videbaek, Poulsen, Veien, Haghfelt) Department of Cardiology,
Odense University Hospital, Sdr. Boulevard, Odense C 5000, Denmark
(Pellikka) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
United States
(Andersen) Department of Thoracic Surgery, Odense University Hospital,
Denmark
(Moller) Department of Cardiology, Heart Center, Copenhagen University
Hospital Rigshospitalet, Denmark
Title
Prevention of atrial fibrillation in patients with aortic valve stenosis
with candesartan treatment after aortic valve replacement.
Source
International Journal of Cardiology. 165 (2) (pp 242-246), 2013. Date of
Publication: 10 May 2013.
Publisher
Elsevier Ireland Ltd
Abstract
Background Accumulating data has suggested that treatment with
Angiotensin-II receptor antagonists can prevent the new onset of atrial
fibrillation (AF). The aim of this study was to evaluate whether treatment
with candesartan on top of conventional treatment could prevent new onset
AF in patients with aortic valve stenosis (AS) after aortic valve
replacement. Methods and results The study was a single centre,
consecutive; investigator initiated study using a prospective randomised
blinded endpoint design. 91 patients with severe AS without known AF
scheduled for aortic valve replacement (AVR) were randomised to
candesartan 32 mg once daily on top of conventional treatment or
conventional therapy immediately after AVR. Patients were examined with
ECG 3, 6, 9 and 12 months after surgery, and Holter-ECG analysis after 3
and 12 months. Primary endpoint was episode of AF with a duration
exceeding 30 s, on the ECG or Holter-ECG and/or patients hospitalised due
to AF. 14 patients developed new onset AF during follow up. AF-free
survival was significantly higher (94% vs 74%, p = 0.02) in patients
treated with candesartan. Conclusion In patients with symptomatic severe
AS undergoing AVR, treatment with candesartan may prevent the new onset of
atrial fibrillation.
<6>
Accession Number
2015946630
Authors
Sabatine M.S. Giugliano R.P. Wiviott S.D. Raal F.J. Blom D.J. Robinson J.
Ballantyne C.M. Somaratne R. Legg J. Wasserman S.M. Scott R. Koren M.J.
Stein E.A.
Institution
(Sabatine, Giugliano, Wiviott) Sabatine at the TIMI Study Group, Division
of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St.,
Boston, MA 02115, United States
(Raal) Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
(Blom) Division of Lipidology, Department of Medicine, University of Cape
Town, Cape Town, South Africa
(Robinson) Departments of Epidemiology and Medicine, College of Public
Health, University of Iowa, Iowa City, United States
(Ballantyne) Sections of Cardiovascular Research and Cardiology,
Department of Medicine, Baylor College of Medicine, Houston, United States
(Somaratne, Legg, Wasserman, Scott) Amgen, Thousand OaksCAUnited States
(Koren) Jacksonville Center for Clinical Research, Jacksonville, FL,
United States
(Stein) Metabolic and Atherosclerosis Research Center, 5355 Medpace Way,
Cincinnati, OH 45225, United States
Title
Efficacy and safety of evolocumab in reducing lipids and cardiovascular
events.
Source
New England Journal of Medicine. 372 (16) (pp 1500-1509), 2015. Date of
Publication: 16 Apr 2015.
Publisher
Massachussetts Medical Society
Abstract
Background Evolocumab, a monoclonal antibody that inhibits proprotein
convertase subtilisin- kexin type 9 (PCSK9), significantly reduced
low-density lipoprotein (LDL) cholesterol levels in short-term studies. We
conducted two extension studies to obtain longer-term data. Methods In two
open-label, randomized trials, we enrolled 4465 patients who had completed
1 of 12 phase 2 or 3 studies ("parent trials") of evolocumab. Regardless
of studygroup assignments in the parent trials, eligible patients were
randomly assigned in a 2:1 ratio to receive either evolocumab (140 mg
every 2 weeks or 420 mg monthly) plus standard therapy or standard therapy
alone. Patients were followed for a median of 11.1 months with assessment
of lipid levels, safety, and (as a prespecified exploratory analysis)
adjudicated cardiovascular events including death, myocardial infarction,
unstable angina, coronary revascularization, stroke, transient ischemic
attack, and heart failure. Data from the two trials were combined. Results
As compared with standard therapy alone, evolocumab reduced the level of
LDL cholesterol by 61%, from a median of 120 mg per deciliter to 48 mg per
deciliter (P<0.001). Most adverse events occurred with similar frequency
in the two groups, although neurocognitive events were reported more
frequently in the evolocumab group. The risk of adverse events, including
neurocognitive events, did not vary significantly according to the
achieved level of LDL cholesterol. The rate of cardiovascular events at 1
year was reduced from 2.18% in the standard-therapy group to 0.95% in the
evolocumab group (hazard ratio in the evolocumab group, 0.47; 95%
confidence interval, 0.28 to 0.78; P = 0.003).
<7>
Accession Number
2015953230
Authors
Shammas N.W. Shammas G.A. Keyes K. Duske S. Kelly R. Jerin M.
Institution
(Shammas, Shammas, Duske, Kelly) Midwest Cardiovascular Research
Foundation, Davenport, IA, United States
(Keyes) Cardiovascular Medicine, Private Corporation, Davenport, IA,
United States
(Jerin) St Ambrose University, Davenport, IA, United States
Title
Ranolazine versus placebo in patients with ischemic cardiomyopathy and
persistent chest pain or dyspnea despite optimal medical and
revascularization therapy: Randomized, double-blind crossover pilot study.
Source
Therapeutics and Clinical Risk Management. 11 (pp 469-474), 2015. Date of
Publication: 23 Mar 2015.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Patients with ischemic cardiomyopathy (ICM) may continue to
experience persistent chest pain and/or dyspnea despite pharmacologic
therapy and revascularization. We hypothesized that ranolazine would
reduce anginal symptoms or dyspnea in optimally treated ICM
patients.Methods: In this randomized, double-blind, crossover-design pilot
study, 28 patients with ICM (ejection fraction less or equal 40%) were
included after providing informed consent. A total of 24 patients
completed both placebo and ranolazine treatments and were analyzed. All
patients were on treatment with a beta blocker, an angiotensin-converting
enzyme inhibitor (or angiotensin receptor blocker), and at least one
additional antianginal drug. After randomization, patients received up to
1,000 mg ranolazine orally twice a day, as tolerated, versus placebo. The
primary end point was change in angina as assessed by the Seattle Angina
Questionnaire (SAQ), or in dyspnea as assessed by the Rose Dyspnea Scale
(RDS). Change in the RDS and SAQ score from baseline was compared, for
ranolazine and placebo, using the Wilcoxon signed rank test or paired
t-test. Results: Patients had the following demographic and clinical
variables: mean age of 71.5 years; male (82.1%); prior coronary bypass
surgery (67.9%); prior coronary percutaneous intervention (85.7%); prior
myocardial infarction (82.1%); diabetes (67.9%); and mean ejection
fraction of 33.1%. No statistical difference was seen between baseline RDS
score and that after placebo or ranolazine (n=20) (P$0.05). There was
however, an improvement in anginal frequency (8/10 patients) (P=0.058),
quality of life (8/10 patients) (P=0.048), and mean score of all
components of the SAQ questionnaire (n=10) (P=0.047) with ranolazine
compared with placebo. Conclusion: In optimally treated ICM patients with
continued chest pain or dyspnea, ranola-zine possibly had a positive
impact on quality of life, a reduction in anginal frequency, and an
overall improvement in the mean SAQ component score compared with
baseline. Ranolazine did not change the dyspnea score compared with
baseline.
<8>
Accession Number
2015928013
Authors
Grygier M. Araszkiewicz A. Lesiak M. Grajek S.
Institution
(Grygier, Araszkiewicz, Lesiak, Grajek) 1st Department of Cardiology,
Poznan University of Medical Sciences, Dluga 1, Poznan PL-61-848, Poland
Title
Effect of new method of intracoronary adenosine injection during primary
percutaneous coronary intervention on microvascular reperfusion
injury-clinical outcome and 1-year follow-up.
Source
Cardiology (Switzerland). 124 (3) (pp 199-206), 2013. Date of Publication:
2013.
Publisher
S. Karger AG
Abstract
Objectives: The aim of this single-center, randomized placebo-controlled
trial in 70 consecutive patients (64 +/- 14 years) with acute myocardial
infarction was to examine the role of a new protocol of adenosine
administration during primary angioplasty on immediate
electrocardiographic and angiographic results, clinical outcome and 1-year
follow-up. Methods: Group A (n = 35) twice received intracoronary
adenosine through the guiding catheter: immediately after crossing the
lesion of the infarct-related artery with guidewire and then after first
balloon inflation. Group B (n = 35) received placebo. Results: Resolution
of ST segment elevation was more frequently observed in the adenosine than
in the placebo group (p < 0.01). Percutaneous coronary intervention (PCI)
resulted in borderline better TIMI 3 flow after the procedure in the
adenosine group than in the placebo group. Myocardial blush grade 3 at the
end of the procedure was significantly improved in the adenosine compared
to the placebo group (p < 0.05). At 1-year the composite end-point of
death, recurrent myocardial infarction, heart failure and clinically
driven target vessel revascularization was present in 8 patients in the
adenosine group and 16 patients in placebo group (p < 0.05). Conclusions:
Intracoronary adenosine improved electrocardiographic and angiographic
results in patients undergoing primary PCI and seemed to be associated
with more favorable clinical course.
<9>
Accession Number
2015912588
Authors
Hu R.-F. Jiang X.-Y. Hegadoren K.M. Zhang Y.-H.
Institution
(Hu, Jiang) University Town, School of Nursing, Fujian Medical University,
1 Xue Yuan Road, Fuzhou 350108, China
(Hegadoren) University of Alberta, Faculty of Nursing, 11405 87 Avenue,
Edmonton, AB T6G 1C9, Canada
(Zhang) Fujian Province Hospital, Department of Nuclear Medicine, East
Street 134, Fuzhou 350001, China
Title
Effects of earplugs and eye masks combined with relaxing music on sleep,
melatonin and cortisol levels in ICU patients: A randomized controlled
trial.
Source
Critical Care. 19 (1) , 2015. Article Number: 115. Date of Publication:
March 27, 2015.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Intensive care unit (ICU) environmental factors such as
noise and light have been cited as important causes of sleep deprivation
in critically ill patients. Previous studies indicated that using earplugs
and eye masks can improve REM sleep in healthy subjects in simulated ICU
environment, and improve sleep quality in ICU patients. This study aimed
to determine the effects of using earplugs and eye masks with relaxing
background music on sleep, melatonin and cortisol levels in ICU patients.
Methods: Fifty patients who underwent a scheduled cardiac surgery and were
expected to stay at least 2 nights in Cardiac Surgical ICU (CSICU) were
included. They were randomized to sleep with or without earplugs and eye
masks combined with 30-minute relaxing music during the postoperative
nights in CSICU. Urine was analyzed for nocturnal melatonin and cortisol
levels. Subjective sleep quality was evaluated using the Chinese version
of Richards-Campbell Sleep Questionnaire (a visual analog scale, ranging
0-100). Results: Data from 45 patients (20 in intervention group, 25 in
control group) were analyzed. Significant differences were found between
groups in depth of sleep, falling asleep, awakenings, falling asleep again
after awakening and overall sleep quality (P < 0.05). Perceived sleep
quality was better in the intervention group. No group differences were
found in urinary melatonin levels and cortisol levels for the night before
surgery, and the first and second nights post-surgery (P > 0.05). The
urinary melatonin levels of the first and second postoperative nights were
significantly lower than those of the night before surgery (P = 0.01). The
opposite pattern was seen with urinary cortisol levels (P = 0.00).
Conclusion: This combination of non-pharmacological interventions is
useful for promoting sleep in ICU adult patients; however, any influence
on nocturnal melatonin levels and cortisol level may have been masked by
several factors such as the timing of surgery, medication use and
individual differences. Larger scale studies would be needed to examine
the potential influences of these factors on biological markers and
intervention efficacy on sleep. Trial registration: Chinese Clinical Trial
Registry: ChiCTR-IOR-14005511. Registered 21 November 2014.
<10>
Accession Number
2015930740
Authors
Mazzeffi M. Johnson K. Paciullo C.
Institution
(Mazzeffi, Johnson) Department of Anesthesiology, University of Maryland,
School of Medicine, Baltimore, MD, United States
(Paciullo) Department of Pharmacy, Emory University, School of Medicine,
Atlanta, GA, United States
Title
Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care
Unit: An evidence-based clinical review.
Source
Annals of Cardiac Anaesthesia. 18 (2) (pp 202-209), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Ketamine is a unique anesthetic drug that provides analgesia, hypnosis,
and amnesia with minimal respiratory and cardiovascular depression.
Because of its sympathomimetic properties it would seem to be an excellent
choice for patients with depressed ventricular function in cardiac
surgery. However, its use has not gained widespread acceptance in adult
cardiac surgery patients, perhaps due to its perceived negative
psychotropic effects. Despite this limitation, it is receiving renewed
interest in the United States as a sedative and analgesic drug for
critically ill-patients. In this manuscript, the authors provide an
evidence-based clinical review of ketamine use in cardiac surgery patients
for intensive care physicians, cardio-thoracic anesthesiologists, and
cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed
during the last 20 years in adult cardiac surgery patients were included
in the review.
<11>
Accession Number
2015930729
Authors
Kumar B. Chauhan P. Thinganam K.S.S.
Institution
(Kumar, Chauhan) Departments of Anaesthesia and Intensive Care, Post Grad.
Institute of Medical Education and Research, Chandigarh 160 012, India
(Thinganam) Cardiothoracic and Vascular Surgery, Post Grad. Institute of
Medical Education and Research, Chandigarh, India
Title
Comparative effects of propofol and nitroglycerine on efficacy of
rewarming in patients undergoing on-pump coronary artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 18 (2) (pp 145-152), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objectives: To compare the effects of propofol and nitroglycerine (NTG) on
the efficacy of rewarming, extra volume added during cardiopulmonary
bypass and extravascular lung water (EVLW) in patients undergoing on-pump
coronary artery bypass grafting. Materials and Methods: A prospective,
randomized, blinded trial, twenty adult patients were randomly assigned to
receive either NTG infusion (NTG group) or propofol infusion (propofol
group) during rewarming. Results: After drop in temperature at the end of
surgery and till 24 h were significantly less in propofol group compare to
NTG group (P < 0.025). Extra volume added during cardiopulmonary bypass
and net crystalloid balance till 24 h was less in the propofol group (P <
0.003). There was no difference in EVLW and postoperative outcome.
Conclusions: Propofol use during moderate hypothermic cardiopulmonary
bypass is associated with less after drop in temperature and less
requirement of extra fluid during the perioperative period.
<12>
Accession Number
2015930715
Authors
Kaushal R.P. Vatal A. Pathak R.
Institution
(Kaushal, Vatal, Pathak) Department Anesthesiology, Gandhi Medical
College, Bhopal, Madhya Pradesh, India
Title
Effect of etomidate and propofol induction on hemodynamic and endocrine
response in patients undergoing coronary artery bypass grafting/mitral
valve and aortic valve replacement surgery on cardiopulmonary bypass.
Source
Annals of Cardiac Anaesthesia. 18 (2) (pp 172-178), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: The concerns for induction of anaesthesia in patients
undergoing cardiac surgery include hemodynamic stability, attenuation of
stress response and maintenance of balance between myocardial oxygen
demand and supply. Various Intravenous anaesthetic agents like
Thiopentone, Etomidate, Propofol, Midazolam, and Ketamine have been used
for anesthetizing patients for cardiac surgeries. However, many authors
have expressed concerns regarding induction with thiopentone, midazolam
and ketamine. Hence, Propofol and Etomidate are preferred for induction in
these patients. However, these two drugs have different characteristics.
Etomidate is preferred for patients with poor left ventricular (LV)
function as it provides stable cardiovascular profile. But there are
concerns about reduction in adrenal suppression and serum cortisol levels.
Propofol, on the other hand may cause a reduction in systemic vascular
resistance and subsequent hypotension. Thus, this study was conducted to
compare induction with these two agents in cardiac surgeries. Methods:
Baseline categorical and continuous variables were compared using Fisher's
exact test and student's t test respectively. Hemodynamic variables were
compared using student's t test for independent samples. The primary
outcome (serum cortisol and blood sugar) of the study was compared using
Wilcoxon Rank Sum test. The P value less than 0.05 was considered
significant. Results: Etomidate provides more stable hemodynamic
parameters as compared to Propofol. Propofol causes vasodilation and may
result in drop of systematic BP. Etomidate can therefore be safely used
for induction in patients with good LV function for CABG/MVR/AVR on CPB
without serious cortisol suppression lasting more than twenty-four hours.
<13>
Accession Number
2015918861
Authors
Prandoni P.
Institution
(Prandoni) Department of Cardiothoracic and Vascular Sciences, Vascular
Medicine Unit, University Hospital of Padua, Via Giustiniani 2, Padua
35128, Italy
Title
The treatment of venous thromboembolism with novel oral anticoagulants:
Warnings and limitations.
Source
Blood Transfusion. 13 (2) (pp 178-180), 2015. Date of Publication: 2015.
Publisher
SIMTI Servizi Sri (Via Desiderio 21, Milan 20131, Italy)
<14>
Accession Number
2015919713
Authors
O'Neill B.P. Guerrero M. Thourani V.H. Kodali S. Heldman A. Williams M. Xu
K. Pichard A. Mack M. Babaliaros V. Herrmann H.C. Webb J. Douglas P.S.
Leon M.B. O'Neill W.W.
Institution
(O'Neill) Temple University, Philadelphia, PA, United States
(O'Neill, Heldman) University of Miami, Miami, FL, United States
(Guerrero, O'Neill) Henry Ford Health System, Detroit, MI, United States
(Thourani, Babaliaros) Emory University School of Medicine, Atlanta, GA,
United States
(Kodali, Williams, Leon) Columbia University Medical Center/New York
Presbyterian Hospital, New York, NY, United States
(Xu) Cardiovascular Research Foundation, New York, NY, United States
(Pichard) MedStar Washington Hospital Center, Washington, DC, United
States
(Mack) Baylor Healthcare System, Plano, TX, United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Webb) St. Paul's Hospital, Vancouver, BC, United States
(Douglas) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, United States
Title
Prognostic value of serial b-type natriuretic peptide measurement in
transcatheter aortic valve replacement (from the PARTNER Trial).
Source
American Journal of Cardiology. 115 (9) (pp 1265-1272), 2015. Date of
Publication: 01 May 2015.
Publisher
Elsevier Inc.
Abstract
B-type natriuretic peptide (BNP) levels have shown a correlation with
outcomes in studies of aortic valve surgery. Results from multicenter
trials of BNP in transcatheter aortic valve surgery (TAVR) are lacking.
The aim of this study was to investigate the prognostic role of serial
measurement of BNP in transfemoral TAVR. A total of 1,097 patients who
underwent TAVR via transfemoral access were analyzed by tertile of
baseline BNP. Of those, 933 with BNP levels at 30 days were divided into 2
groups on the basis of increases (334 patients) or decreases or no change
(599 patients) in BNP compared with baseline. Patients in the low-tertile
BNP group had a lower rate of death at 1 year than those in the higher
tertile group (15.0% vs 23.0%, p <0.01) which was not significant in
multivariate analysis. Over 1 year, BNP decreased from 1,258.13 +/-
2,988.33 to 594.37 +/- 1,087.30 (p <0.01) in the entire group. Patients in
the BNP-rise group had higher rates of death at 1 year (20.3% vs 11.4%, p
<0.01) and an overall increase in moderate or severe aortic regurgitation
over 1 year (p <0.01). Multivariate predictors of 1-year mortality were
moderate or severe aortic regurgitation (hazard ratio 2.04, 95% confidence
interval 1.36 to 3.05, p <0.01), increase in BNP at 30 days (hazard ratio
1.82, 95% confidence interval 1.26 to 2.62, p <0.01) and Society of
Thoracic Surgeons score (hazard ratio 1.05, 95% confidence interval 1.01
to 1.10, p = 0.03). In conclusion, increase in BNP at 30 days from
baseline and moderate or severe aortic regurgitation at 30 days in
patients who undergo transfemoral TAVR are independently associated with
1-year mortality. Increase in BNP at 30 days should prompt evaluation for
causes of elevated wall stress, including aortic regurgitation.
<15>
Accession Number
2015943442
Authors
Souvatzis X. Kalogridaki M. Mavrakis H.E. Kanoupakis E.M. Marouli D.
Vardas P. Askitopoulou H.
Institution
(Souvatzis, Kalogridaki) Department of Anaesthesiology, University
Hospital of Heraklion, Crete, Greece
(Mavrakis, Kanoupakis, Vardas) Department of Cardiology, University
Hospital of Heraklion, Crete, Greece
(Marouli) Department of Intensive Care Medicine, University Hospital of
Heraklion, Crete, Greece
(Askitopoulou) Anaesthesiology, University of Crete, Heraklion, Crete,
Greece
Title
Adding fentanyl to etomidate fails to reduce painful recall of external
direct current cardioversion in adults: A randomised trial.
Source
Hellenic Journal of Cardiology. 56 (2) (pp 142-148), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Hellenic Cardiological Society
Abstract
Introduction: External electrical cardioversion under hypnotics, even when
combined with opioids, has been consistently described as distressing or
painful. The main objective of the present study was to determine if
adding an opioid to a hypnotic, in comparison to the same hypnotic alone,
would decrease the incidence of unpleasant or painful recall during
anaesthesia for external electrical cardioversion. Methods: This was a
single-centre, prospective, randomised, double-blinded clinical trial that
took place from September 2011 to March 2012. Fifty-two adult patients
with persistent atrial fibrillation, scheduled for external direct current
cardioversion, were enrolled. Exclusion criteria were age >80 years,
previous cardiac surgery, implanted pacemaker or defibrillator, and
haemodynamic instability. Patients received intravenously either (group
EF) fentanyl 50 mug and after 60 s etomidate 0.1 mg/kg, or (group E) only
etomidate 0.1 mg/kg. If the patients did not lose their eyelid reflex,
repeated doses of etomidate 4 mg were given. Cardioversion was attempted
with an extracardiac biphasic electrical shock from 200 to 300 J, at most
three times. The primary endpoint was recall of something unpleasant or
painful. Secondary outcome measures were predictors of the requirement for
repeat doses of etomidate, and the number of shocks needed. Results:
Fifty-one patients (35 male, 16 female), aged 62.1 +/- 10.2 years,
completed the study. There were no differences between group EF and group
E regarding recall (unpleasant recall 0 vs. 2 patients, p=0.235; painful
recall 1 vs. 0 patients, p=0.510). The administration of etomidate alone
was a significant predictor for subsequent repeated doses of etomidate
(p=0.049, odds ratio 4.312, 95% confidence interval 1.007-18.460). The
number of shocks needed to restore sinus rhythm did not differ between the
groups (p=0.846). Conclusions: In the present study, the addition of
fentanyl to etomidate did not diminish distressing or painful experience
during anaesthesia for external cardioversion.
<16>
Accession Number
2015752768
Authors
Hui D.S. Morley J.E. Mikolajczak P.C. Lee R.
Institution
(Hui, Mikolajczak, Lee) Center for Comprehensive Cardiovascular Care,
Saint Louis University, St Louis, MO, United States
(Morley) Divisions of Geriatric Medicine and Endocrinology, Saint Louis
University School of Medicine, St Louis, MO, United States
Title
Atrial fibrillation: A major risk factor for cognitive decline.
Source
American Heart Journal. 169 (4) (pp 448-456), 2015. Date of Publication:
01 Apr 2015.
Publisher
Mosby Inc.
Abstract
Atrial fibrillation is a common disease of the elderly, conferring
considerable morbidity and mortality related to cardiovascular effects and
thromboembolic risks. Anticoagulation, antiarrhythmic medications, and
rate control are the cornerstone of contemporary management, whereas
ablation and evolving surgical techniques continue to play important
secondary roles. Growing evidence shows that atrial fibrillation is also a
risk factor for significant cognitive decline through a multitude of
pathways, further contributing to morbidity and mortality. At the same
time, cognitive decline associated with cryptogenic strokes may be the
first clue to previously undiagnosed atrial fibrillation. These
overlapping associations support the concept of cognitive screening and
rhythm monitoring in these populations. New research suggests modulating
effects of currently accepted treatments for atrial fibrillation on
cognition; however, there remains the need for large multicenter studies
to examine the effects of novel oral anticoagulants, rhythm and rate
control, and left atrial appendage occlusion on long-term cognitive
function.
<17>
Accession Number
2015949873
Authors
Lawley C.M. Lain S.J. Algert C.S. Ford J.B. Figtree G.A. Roberts C.L.
Institution
(Lawley, Lain, Algert, Ford, Roberts) Clinical Population Perinatal Health
Research Group, The Kolling Institute, University of Sydney at Royal North
Shore Hospital, Herbert Street, St Leonards, NSW 2065, Australia
(Lawley, Figtree) Department of Cardiology, Royal North Shore Hospital,
Herbert Street, St Leonards, NSW 2065, Australia
Title
Prosthetic heart valves in pregnancy: A systematic review and
meta-analysis protocol.
Source
Systematic Reviews. 3 (1) , 2014. Article Number: 8. Date of Publication:
January 21, 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Advances in surgical technique, prosthetic heart valve design,
and anticoagulation have contributed to an overall improvement in
morbidity and mortality in women with heart valve prostheses as well as
increased feasibility of pregnancy. Previous work investigating the
pregnancies of women with prosthetic valves has been directed largely
toward understanding the influence of anticoagulation regimen. There has
been little investigation on maternal and infant outcomes. The objective
of this systematic review will be to assess the outcomes of pregnancy in
women with heart valve prostheses in contemporary populations.
Methods/Design: A systematic search of Medline, Embase, Cumulative Index
to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library
will be undertaken. Article titles and abstracts will be evaluated by two
reviewers for potential relevance. Studies that include pregnancies
occurring from 1995 onwards and where there are six or more pregnancies in
women with heart valve prostheses included in the study population will be
reviewed for potential inclusion. Primary outcomes of interest will be
mortality (maternal and perinatal). Secondary outcomes will include other
pregnancy outcomes. No language restrictions will be applied.
Methodological quality and heterogeneity of studies will be assessed. Data
extraction from identified articles will be undertaken by two independent
reviewers using a uniform template. Meta-analyses will be performed to
ascertain risk of adverse events and, where numbers are sufficient, by
type of prosthesis and location as well as other subgroup analyses.
Discussion: Estimates of the risk of adverse events in recent pregnancies
of women with heart valve prosthesis will provide better information for
counselling and decision making. Given the improvements in prognosis of
heart valve prosthesis recipients and the paucity of definitive data
regarding optimal pregnancy management for these women, review of this
topic is pertinent. Review registration: This protocol has been registered
with the international prospective register of systematic reviews
(PROSPERO) as number CRD42013006187, accessible online at
http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013006187#.U
tk7qNJ9Lf8.
<18>
Accession Number
2015919533
Authors
Liang J. Wang Z. Shi D. Liu Y. Zhao Y. Han H. Li Y. Liu W. Zhang L. Yang
L. Zhou Y.
Institution
(Liang, Wang, Shi, Liu, Zhao, Han, Li, Liu, Zhang, Yang, Zhou) Department
of Cardiology, Anzhen Hospital, Capital Medical University, Anzhen Avenue
#2, Chaoyang District, Beijing 100029, China
Title
High clopidogrel dose in patients with chronic kidney disease having
clopidogrel resistance after percutaneous coronary intervention.
Source
Angiology. 66 (4) (pp 319-325), 2014. Date of Publication: 14 Apr 2015.
Publisher
SAGE Publications Inc.
Abstract
We evaluated the impact of clopidogrel 150 mg/d in patients with chronic
kidney disease (CKD) having clopidogrel resistance (CR) after percutaneous
coronary intervention (PCI); 1076 consecutive patients with coronary
artery disease (CAD) having CKD were enrolled. Maximal platelet
aggregation (MPA) was assessed before, 24 hours, and 30 days after a
300-mg loading dose of clopidogrel prior to PCI. After PCI, 370 patients
with CR were randomized to receive clopidogrel 75 mg/d (n = 184) or 150
mg/d (n = 186) for 30 days. Stent thrombosis (ST), major adverse cardiac
events (MACEs), and bleeding were analyzed after 1 month. Patients in the
150 mg group had significant lower rates of ST and MACE. There was no
significant difference in major or minor bleeding. Patients in the 150 mg
group had lower MPA and greater inhibition of platelet aggregation.
One-month administration of 150 mg/d of clopidogrel decreases the rate of
ST and MACE without increasing bleeding in patients with CKD having CR
after PCI.
<19>
Accession Number
2015925816
Authors
Frohlich G.M. Lansky A.J. Webb J. Roffi M. Toggweiler S. Reinthaler M.
Wang D. Hutchinson N. Wendler O. Hildick-Smith D. Meier P.
Institution
(Frohlich, Reinthaler, Meier) The Heart Hospital, University College
London Hospitals, London, United Kingdom
(Lansky, Meier) Division of Cardiology, Yale Medical School, New Haven,
CT, United States
(Webb) Department of Cardiology, St. Paul's Hospital, University of
British Columbia, Vancouver, BC, Canada
(Roffi) Department of Cardiology, University Hospital Geneva HUGE, Geneva,
Switzerland
(Toggweiler) Department of Cardiology, Kantonsspital Luzern, Lucerne,
Switzerland
(Wang) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine London, London, United Kingdom
(Hutchinson) Division of Anesthesiology, Brighton and Sussex University
Hospital, Brighton, United Kingdom
(Wendler) Department of Cardiothoracic Surgery, King's College Hospital,
London, United Kingdom
(Hildick-Smith) Division of Cardiology, Brighton and Sussex University
Hospital, Brighton, United Kingdom
Title
Local versus general anesthesia for transcatheter aortic valve
implantation (TAVR) - systematic review and meta-analysis.
Source
BMC Medicine. 12 (1) , 2014. Article Number: 41. Date of Publication:
March 10, 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: The hypothesis of this study was that local anesthesia with
monitored anesthesia care (MAC) is not harmful in comparison to general
anesthesia (GA) for patients undergoing Transcatheter Aortic Valve
Implantation (TAVR). Methods: This is a systematic review and
meta-analysis comparing MAC versus GA in patients undergoing transfemoral
TAVR. Trials were identified through a literature search covering
publications from 1 January 2005 through 31 January 2013. The main
outcomes of interest of this literature meta-analysis were 30-day overall
mortality, cardiac-/procedure-related mortality, stroke, myocardial
infarction, sepsis, acute kidney injury, procedure time and duration of
hospital stay. A random effects model was used to calculate the pooled
relative risks (RR) with 95% confidence intervals. Results: Seven
observational studies and a total of 1,542 patients were included in this
analysis. None of the studies were randomized. Compared to GA, MAC was
associated with a shorter hospital stay (-3.0 days (-5.0 to -1.0);
P=0.004) and a shorter procedure time (MD -36.3 minutes (-58.0 to -15.0
minutes); P <0.001). Overall 30-day mortality was not significantly
different between MAC and GA (RR 0.77 (0.38 to 1.56); P=0.460), also
cardiac- and procedure-related mortality was similar between both groups
(RR 0.90 (0.34 to 2.39); P=0.830). Conclusion: These data did not show a
significant difference in short-term outcomes for MAC or GA in TAVR. MAC
may be associated with reduced procedural time and shorter hospital stay.
Now randomized trials are needed for further evaluation of MAC in the
setting of TAVR.
<20>
Accession Number
2015932205
Authors
Craven D.E. Hudcova J. Lei Y.
Institution
(Craven, Lei) Center for Infectious Diseases and Prevention, Lahey Medical
Center and Hospital, 41 Mall Road, Burlington, MA 01805, United States
(Craven, Hudcova) Tufts University School of Medicine, 800 Washington
Street, Boston, MA 02115, United States
(Hudcova, Lei) Department of Surgical Critical Care, Lahey Medical Center
and Hospital, 41 Mall Road, Burlington, MA 01805, United States
(Lei) Department of Pulmonary and Critical Care Medicine, Lahey Medical
Center and Hospital, 41 Mall Road, Burlington, MA 01805, United States
Title
Ventilator-associated tracheobronchitis: Pre-emptive, appropriate
antibiotic therapy recommended.
Source
Critical Care. 18 (6) , 2014. Article Number: 627. Date of Publication:
November 19, 2014.
Publisher
BioMed Central Ltd.
Abstract
Nseir and colleagues presented data from a large multicenter study of
patients with ventilator-associated tracheobronchitis (VAT), demonstrating
that appropriate antibiotic therapy for VAT was an independent predictor
for reducing transition to pneumonia (ventilator-associated pneumonia, or
VAP). These data added to the growing evidence supporting the use of
appropriate antibiotic therapy for VAT as a standard of care to prevent
VAP and improve patient outcomes.
<21>
Accession Number
2014752956
Authors
Shorrock D. Michael T.T. Patel V. Kotsia A. Rangan B.V. Abdullah S.A.
Grodin J.M. Banerjee A. Brilakis E.S.
Institution
(Shorrock, Michael, Patel, Kotsia, Rangan, Abdullah, Grodin, Banerjee,
Brilakis) VA North Texas Healthcare System, Dallas, TX, United States
(Shorrock, Michael, Patel, Kotsia, Rangan, Abdullah, Grodin, Banerjee,
Brilakis) University of Texas, Southwestern Medical Center, Dallas, TX,
United States
Title
Frequency and outcomes of aortocoronary dissection during percutaneous
coronary intervention of chronic total occlusions: A Case Series and
Systematic Review of the Literature.
Source
Catheterization and Cardiovascular Interventions. 84 (4) (pp 670-675),
2014. Date of Publication: 01 Oct 2014.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background Aortocoronary dissection can complicate percutaneous coronary
intervention (PCI) of chronic total occlusions (CTOs). Methods We
retrospectively examined the frequency and outcomes of aortocoronary
dissection among 336 consecutive CTO PCIs performed at our institution
between 2005 and 2012 and performed a systematic review of the published
literature. Results Aortocoronary dissection occurred in six patients
(1.8%, 95% confidence intervals 0.7%, 3.8%). All aortocoronary dissections
occurred in the right coronary artery (CTO target vessel in five patients
and donor vessel in one patient). The baseline clinical characteristics of
patients with and without aortocoronary dissection were similar. Compared
to patients without, those with aortocoronary dissection were more likely
to undergo crossing attempts using the retrograde approach (25% vs. 67%, P
= 0.036) and experience a major complication (2.4% vs. 33.3%, P = 0.008).
Technical and procedural success rates were similar in both groups. Of the
six patients with aortocoronary dissection one underwent emergency
coronary bypass graft surgery (CABG), four were treated with ostial
stenting, and one was treated conservatively without subsequent adverse
clinical outcomes. Systematic literature review provided 107 published
cases of aortocoronary dissection during PCI, that occurred mainly in the
right coronary artery (74.8%) and were treated with stenting (49.5%),
emergency CABG (29%), or conservatively (21.5%). Conclusions Aortocoronary
dissection is an infrequent complication of CTO PCI and although it can be
treated with stents in most patients, it may infrequently require
emergency CABG.
<22>
Accession Number
2015903591
Authors
Stammers A.N. Kehler D.S. Afilalo J. Avery L.J. Bagshaw S.M. Grocott H.P.
Legare J.-F. Logsetty S. Metge C. Nguyen T. Rockwood K. Sareen J. Sawatzky
J.-A. Tangri N. Giacomantonio N. Hassan A. Duhamel T.A. Arora R.C.
Institution
(Stammers, Kehler, Duhamel, Arora) Faculty of Kinesiology and Recreation
Management, Health, Leisure and Human Performance Research Institute,
University of Manitoba, Winnipeg, MB, Canada
(Stammers, Kehler, Sawatzky, Duhamel, Arora) Institute of Cardiovascular
Sciences, St. Boniface Hospital Research Centre, Winnipeg, MB, Canada
(Afilalo) Division of Cardiology and Clinical Epidemiology, Jewish General
Hospital, McGill University, Montreal, QC, Canada
(Avery, Metge) Winnipeg Regional Health Authority Cardiac Sciences
Program, Winnipeg, MB, Canada
(Bagshaw) Division of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, AB, Canada
(Grocott, Logsetty, Arora) Department of Surgery, Faculty of Medicine,
University of Manitoba, Winnipeg, MB, Canada
(Grocott) Department of Anesthesia and Perioperative Medicine, Faculty of
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Legare) Division of Cardiac Surgery, Department of Surgery, Dalhousie
University, Halifax, NS, Canada
(Metge, Sareen) Department of Community Health Sciences, Faculty of
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Nguyen) Section of Cardiology, Faculty of Medicine, University of
Manitoba, Winnipeg, MB, Canada
(Rockwood) Division of Geriatric Medicine, Department of Medicine,
Dalhousie University, Halifax, NS, Canada
(Sareen) Department of Psychiatry, Faculty of Medicine, University of
Manitoba, Winnipeg, MB, Canada
(Sawatzky) Faculty of Health Sciences, College of Nursing, University of
Manitoba, Winnipeg, MB, Canada
(Tangri) Section of Nephrology, Faculty of Medicine, University of
Manitoba, Winnipeg, MB, Canada
(Giacomantonio) Division of Cardiology, Department of Medicine, Dalhousie
University, Halifax, NS, Canada
(Hassan) Department of Cardiac Surgery, New Brunswick Heart Centre, Saint
John Regional Hospital, Saint John, NB, Canada
(Duhamel) Department of Physiology, University of Manitoba, Winnipeg, MB,
Canada
Title
Protocol for the PREHAB study - Pre-operative Rehabilitation for reduction
of Hospitalization after coronary Bypass and valvular surgery: A
randomised controlled trial.
Source
BMJ Open. 5 (3) , 2015. Article Number: e007250. Date of Publication:
2015.
Publisher
BMJ Publishing Group
Abstract
Introduction: Frailty is a geriatric syndrome characterised by reductions
in muscle mass, strength, endurance and activity level. The frailty
syndrome, prevalent in 25-50% of patients undergoing cardiac surgery, is
associated with increased rates of mortality and major morbidity as well
as function decline postoperatively. This trial will compare a
preoperative, interdisciplinary exercise and health promotion intervention
to current standard of care (StanC) for elective coronary artery bypass
and valvular surgery patients for the purpose of determining if the
intervention improves 3-month and 12-month clinical outcomes among a
population of frail patients waiting for elective cardiac surgery. Methods
and analysis: This is a multicentre, randomised, open end point,
controlled trial using assessor blinding and intent-to-treat analysis.
Two-hundred and forty-four elective cardiac surgical patients will be
recruited and randomised to receive either StanC or StanC plus an 8-week
exercise and education intervention at a certified medical fitness
facility. Patients will attend two weekly sessions and aerobic exercise
will be prescribed at 40-60% of heart rate reserve. Data collection will
occur at baseline, 1-2 weeks preoperatively, and at 3 and 12 months
postoperatively. The primary outcome of the trial will be the proportion
of patients requiring a hospital length of stay greater than 7 days.
Potential impact of study: The healthcare team is faced with an
increasingly complex older adult patient population. As such, this trial
aims to provide novel evidence supporting a health intervention to ensure
that frail, older adult patients thrive after undergoing cardiac surgery.
Ethics and dissemination: Trial results will be published in peer-reviewed
journals, and presented at national and international scientific meetings.
The University of Manitoba Health Research Ethics Board has approved the
study protocol V.1.3, dated 11 August 2014 (H2014:208). Trial registration
number: The trial has been registered on ClinicalTrials.gov, a registry
and results database of privately and publicly funded clinical studies
(NCT02219815).
<23>
Accession Number
2015938364
Authors
Ozturk T. Agdanli D. Bayturan O. Cikrikci C. Keles G.T.
Institution
(Ozturk, Agdanli, Cikrikci, Keles) Department of Anesthesiology and
Reanimation, School of Medicine, Celal Bayar University, Manisa, Turkey
(Bayturan) Department of Cardiology, School of Medicine, Celal Bayar
University, Manisa, Turkey
Title
Effects of conventional vs high-dose rocuronium on the QTc interval during
anesthesia induction and intubation in patients undergoing coronary artery
surgery: A randomized, double-blind, parallel trial.
Source
Brazilian Journal of Medical and Biological Research. 48 (4) (pp 370-376),
2015. Date of Publication: 2015.
Publisher
Associacao Brasileira de Divulgacao Cientifica
Abstract
Myocardial ischemia, as well as the induction agents used in anesthesia,
may cause corrected QT interval (QTc) prolongation. The objective of this
randomized, double-blind trial was to determine the effects of high- vs
conventional-dose bolus rocuronium on QTc duration and the incidence of
dysrhythmias following anesthesia induction and intubation. Fifty patients
about to undergo coronary artery surgery were randomly allocated to
receive conventional-dose (0.6 mg/kg, group C, n=25) or high-dose (1.2
mg/kg, group H, n=25) rocuronium after induction with etomidate and
fentanyl. QTc, heart rate, and mean arterial pressure were recorded before
induction (T0), after induction (T1), after rocuronium (just before
laryngoscopy; T2), 2 min after intubation (T3), and 5 min after intubation
(T4). The occurrence of dysrhythmias was recorded. In both groups, QTc was
significantly longer at T3 than at baseline [475 vs 429 ms in group C
(P=0.001), and 459 vs 434 ms in group H (P=0.005)]. The incidence of
dysrhythmias in group C (28%) and in group H (24%) was similar. The QTc
after high-dose rocuronium was not significantly longer than after
conventional-dose rocuronium in patients about to undergo coronary artery
surgery who were induced with etomidate and fentanyl. In both groups,
compared with baseline, QTc was most prolonged at 2 min after intubation,
suggesting that QTc prolongation may be due to the nociceptive stimulus of
intubation.
<24>
Accession Number
71857032
Authors
Nagarathna R. Rao P.V. Swarnagowri M.V. Patil S. Chaku R. Kulkarni R.
Bhagavan B. Bhargav H. Nagendra H.R.
Institution
(Nagarathna, Swarnagowri, Patil, Chaku, Kulkarni, Bhagavan, Bhargav,
Nagendra) Division of Yoga and Life Sciences, Swami Vivekananda Yoga
Anusandhana Samsthana University, 19 Eknath Bhavan Gavipuram Circle,
Kempegowda Nagar, Bangalore, Karnataka, India
(Rao, Patil) Deparment of Cardiology, Narayana Hrudayalaya Institute of
Cardiac Sciences, No. 258/A, Bommasandra Industrial Area, Hosur Road,
Anekal Taluk, Karnataka, India
Title
Yoga based Cardiac rehabilitation after coronary artery bypass surgery:
One-year results on LVEF, lipid profile, psychological states-a randomized
controlled study.
Source
Indian Journal of Physiology and Pharmacology. Conference: 59th Annual
Conference of Association of Physiologists and Pharmacologists of India,
APPI 2013 Bengaluru India. Conference Start: 20131128 Conference End:
20131130. Conference Publication: (var.pagings). 57 (5 SUPPL. 1) (pp
18-19), 2013. Date of Publication: 2013.
Publisher
Association of Physiologists and Pharmacologists of India
Abstract
Objective: To compare the long term effects of yoga based cardiac
rehabilitation program with only physiotherapy based program on risk
factors after coronary artery bypass graft (CABG) surgery. Methods: In
this single blind prospective randomized parallel two armed active control
study, 1026 patients posted for CABG at Narayana Hrudayalaya Institute of
Cardiac Sciences, Bengaluru (India) were screened. Of these, 250 male
participants (35-65 years) who satisfied the selection criteria and
consented, were randomized into two groups. Yoga group practiced
integrated yogic relaxation techniques consisting of physical movements,
breathing techniques and meditation. Within and between group comparisons
were done on data obtained at three points of follow up i.e. 6th week (A),
6th month (B), and 12th month (C) by using Wilcoxon's signed ranks test
and Mann Whitney U test respectively. Results: Yoga group had
significantly (p =0.001, Mann Whitney) better improvement in LVEF than
control group in those with low baseline EF (< 53%) after 12months. There
was a better reduction in yoga group (p=0.038, between groups) at one year
in those with high baseline BMI (>23).Yoga group showed significant
(p=0.008, Wilcoxon's) reduction in blood glucose at one year in those with
high baseline FBS > 110mg/dl. There was significantly better improvement
in yoga than the control group in HDL (p=0.003), LDL (p=0.01) and VLDL
(p=0.03) in those with abnormal baseline values. There was significantly
better improvement (p=0.02, between groups) in positive affect in yoga
group.Within Yoga group, there was significant decrease in perceived
stress (p=0.001), hospital Anxiety(p=0.001), Depression (p=0.001), and
Negative affect (p=0.03) while in the Control group there was increase
(p=0.003) only in scores on hospital Anxiety. Conclusion: Addition of yoga
based relaxation to conventional post CABG cardiac rehabilitation helps in
better management of risk factors in those with abnormal baseline values
and may help in preventing recurrence.
<25>
Accession Number
71856404
Authors
Kim C. Placide S. Marcantonio E.R. Afilalo J. Popma J. Kim D.
Institution
(Kim, Placide, Marcantonio, Popma, Kim) Medicine, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Afilalo) Cardiology, Jewish General Hospital, Montreal, QC, Canada
Title
Frailty assessment predicts long-term mortality after cardiac surgery: A
systematic review.
Source
Journal of the American Geriatrics Society. Conference: 2015 Annual
Scientific Meeting of the American Geriatrics Society National Harbor, MD
United States. Conference Start: 20150515 Conference End: 20150517.
Conference Publication: (var.pagings). 63 (pp S234), 2015. Date of
Publication: April 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background: Frailty is highly prevalent in patients with cardiovascular
disease, ranging from 25% to 50%. With rapidly expanding aging population
and advancements in cardiovascular treatments, more number of older
patients are referred for cardiac interventions than ever before. Current
preoperative risk scores for cardiac surgery estimate short-term mortality
and major complications but perform poorly in predicting long-term
mortality. Frailty has emerged as a potential predictor of long-term
outcome in older adults undergoing cardiac surgery. Methods: We conducted
a systematic search of Medline and EMBASE, from inception to 4/2014, to
identify prospective studies that evaluated preoperative measurements of
frailty in relation to longterm mortality (>6 months) in populations (mean
age >60 years) undergoing coronary artery bypass graft or valve surgery.
Results: Of the 12 measures of frailty evaluated, 11 were associated with
mortality beyond 6 months (relative risk [RR] range: 1.2-3.5 comparing the
most frail vs the least frail), after adjusting for demographic
characteristics and comorbidities. The frailty measurement frequently
involved mobility (Timed Up-and-Go test, 6-minute walk test, gait speed;
RR: 1.7-6.7 in 9 studies), self-reported functional status (activities of
daily living, mobility disability; 1.5-3.6 in 7 studies), nutritional
status (Mini Nutritional Assessment, serum albumin, weight loss; 3.4-6.7
in 5 studies), muscle strength (grip strength, chair rise; 1.6 in 3
studies), and cognition (Mini-Mental State Examination; 3.0 in 3 studies).
Conclusion: Presence of preoperative frailty is a strong predictor of
long-term mortality after cardiac surgery, independent of comorbid
conditions. Although the choice of measurements will depend on resources
available, a mobility assessment is a simple, standardized, most widely
studied test of frailty. The comparative performance of each frailty
measurement and the optimal index of frailty remain to be established.
With approximately 25% of the cardiac surgery patients being >75 years of
age, geriatricians could play a valuable role by addressing frailty
preoperatively to assist cardiologists and cardiothoracic surgeons in risk
stratification and decision-making process.
<26>
Accession Number
71852393
Authors
Rashidi M. Esmaily S. Fiane A.E. Gustafsson F. Eiskjaer H. Radegran G.
Dellgren G.
Institution
(Rashidi, Fiane) Cardiothoracic Unit, Oslo University, Hospital
Rikshospitalet, Oslo, Norway
(Esmaily, Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gustafsson) Department of Cardiology, Copenhagen University Hospital,
Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Skejby University Hospital, Aarhus,
Denmark
(Radegran) Clinic for Heart Failure and Valvular Disease, Skane University
Hospital, Lund University, Lund, Sweden
Title
The effect of everolimus vs. Calcineurin inhibitors on surgical
complications: The results of a de novo heart transplant randomized
controlled trial (schedule trial).
Source
Journal of Heart and Lung Transplantation. Conference: 35th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2015 Nice France. Conference Start: 20150415
Conference End: 20150418. Conference Publication: (var.pagings). 34 (4
SUPPL. 1) (pp S132-S133), 2015. Date of Publication: April 2015.
Publisher
Elsevier USA
Abstract
Purpose: Due to long-term complications of calcineurin inhibitors (CNI),
there has been an increasing interest in CNI-free regimens with
introduction of rapamycin inhibitors (mTOR). However, these agents have
been associated with adverse effects, and one of the concerns has been
wound healing. We examined surgical complications related to tissue
healing in The Scandinavian heart transplant everolimus (EVE) de novo
study with early CNI avoidance (SCHEDULE) trial. Methods: A total of 115
patients (mean age 51+/-13 years, 27% women) were randomized within 5 days
post transplant to low dose EVE and reduced dose Cyclosporin (CsA)
followed by CsA withdrawal week 7-11 post transplant (EVE group; n= 56) or
standard CsA regime (CsA group; n= 59). The primary efficacy end-point was
renal function at 12 and 36 months. Secondary objectives were number of
rejections and adverse/ serious adverse events (AE/SAE). Surgical
complications related to tissue healing during the first postoperative
year, such as wound healing were assessed (only calculating first event in
each category and patient), through patient files by two independent,
blinded surgeons. Results: During the first 12 months the EVE group
compared with the CsA group demonstrated improved renal function and
reduced progression of coronary artery vasculopathy (CAV) and similar
rates of SAE, while the number of biopsy proven rejections were increased.
There was no difference between groups regarding individual parameters
such as superficial (p= 0.92) or deep (p= 0.92) sternal wound infections,
wound dehiscence (p= 0.29), lymphocele (p= 0.14) or groin fistula (p=
0.29). However, in the EVE group vs CsA group, there was a significantly
higher number of total surgical complications [39(71%) vs 30(51%),p=
0.029] and healing related AE [23(42%) vs 14(24%),p= 0.039]. The complete
data regarding pleural and pericardial effusions as well as cumulative
surgical complications will also be presented at the meeting. Conclusion:
Early introduction of EVE with CsA elimination has shown significantly
increased number of surgical complications primarily related to wound
dehiscence. Despite superior primary endpoint in this study,
immunosuppressive strategy is challenged by the known antiproliferative
properties of EVE.
<27>
Accession Number
71852362
Authors
Grov I. Relbo A. Karason K. Gustafsson F. Eiskjaer H. Radegran G. Gude E.
Jansson K. Solbu D. Arora S. Dellgren G. Andreassen A. Gullestad L.
Institution
(Grov, Relbo, Gude, Arora, Andreassen, Gullestad) Oslo University,
Hospital Rikshospitalet, Oslo, Norway
(Karason) Sahlgrenska University Hospital, Gothenburg, Sweden
(Gustafsson) Copenhagen University Hospital, Copenhagen, Denmark
(Eiskjaer) Skejby University Hospital, Aarhus, Denmark
(Radegran) Skane University Hospital, Lund University Hospital, Lund,
Sweden
(Jansson) Linkoping University Hospital, Linkoping, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
Title
The effect of everolimus vs. Calcineurin inhibitors on quality of life
during 3 Years Follow Up: The Result of a Randomized Controlled Trial
(SCHEDULE Trial).
Source
Journal of Heart and Lung Transplantation. Conference: 35th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2015 Nice France. Conference Start: 20150415
Conference End: 20150418. Conference Publication: (var.pagings). 34 (4
SUPPL. 1) (pp S121-S122), 2015. Date of Publication: April 2015.
Publisher
Elsevier USA
Abstract
Purpose: Due to long term complications of calcineurin inhibitors (CNI),
there has been an increasing interest in CNI free regimens with
introduction of rapamycin inhibitors (mTor). However, these agents have
been associated with a number of adverse effects which may reduce quality
of life (QoL). We examined QoL in The Scandinavian heart transplant
everolimus de novo study with early CNI avoidance (SCHEDULE) trial 1 and 3
years after HTx. Methods: 115 patients (mean age 51+/-13 years, 27 %
women) were randomly assigned within 5 days postoperatively to low dose
EVR and reduced dose CsA followed by CsA withdrawal in week 7-11 (EVE
group; n= 56) or standard CsA dosage (CsA group; n= 59). The primary
endpoint was renal function assessed by measured glomerular filtration
rate (mGFR) at 12 and 36 months. Secondary objectives were number of
rejections, serious adverse events (SAE) and QoL. QoL was assessed pre
HTx,12 and 36 months post HTx by the Short Form-36, 21-item Beck
Depression Inventory (BDI) and Euroqual (EQ 5D). Results: During the first
12 months the EVR group compared with the CNI group demonstrated improved
renal function and reduced progression of coronary artery vasculopathy
(CAV), similar rates of SAE, while the number of biopsy proven rejections
were increased. QoL increased significantly during the first year, with no
significant differences between the two treatment regimens after 12
months. The 3-year follow up is completed in November 2014, and the
results of the QoL-trial as well as the influence of renal function, CAV
and SAE will be presented. Conclusion: In spite of increased number of
rejections on QoL with EVR we found that early elimination of CsA and
replacement with an EVR-based immunosuppression, resulted in a similar
improvement in QoL as treatment with conventional CNI-regimen 1 year after
HTx. Due to the significant improvement of renal function and less CAV
with EVR, the evolution of QoL is of interest.
<28>
Accession Number
71852195
Authors
Doumouras B.S. Alba A.C. Foroutan F. Burchill L.J. Dipchand A.I. Ross H.J.
Institution
(Doumouras, Alba, Foroutan, Ross) Heart Failure and Transplantation
Program, Toronto General Hospital, University Health Network, Toronto, ON,
Canada
(Burchill) Knight Cardiovascular Institute, Oregon Health and Science
University, Portland, OR, United States
(Dipchand) Hospital for Sick Children, Toronto, ON, Canada
Title
Outcomes in adult congenital heart failure patients undergoing heart
transplantation: A systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 35th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2015 Nice France. Conference Start: 20150415
Conference End: 20150418. Conference Publication: (var.pagings). 34 (4
SUPPL. 1) (pp S59-S60), 2015. Date of Publication: April 2015.
Publisher
Elsevier USA
Abstract
Purpose: Advances in the treatment of congenital heart disease (CHD) have
led to a growing population of adult CHD patients, many of whom will
develop late onset complications prompting consideration for heart
transplantation. Studies comparing mortality and morbidity in CHD and
non-CHD transplant recipients are limited in number and scope. Our aim was
to conduct a systematic review and meta-analysis comparing post-transplant
outcomes in adult CHD versus non-CHD patients. Methods: We conducted a
systematic search of the electronic databases Medline, EMBASE, and CINAHL
and references of included studies. We selected comparative observational
studies evaluating post-transplant clinical outcomes, including overall
mortality, cause-specific mortality, and risk of reoperation and renal
failure in adult CHD versus non-CHD patients. We used random-effects
models for the meta-analysis. Results: We identified fourteen studies
including 2733 CHD and 127070 non-CHD patients. Thirty-day and one-year
mortality were significantly higher in CHD versus non-CHD patients (RR
2.34, 95% CI 1.80-3.04, I2 = 29% and RR 1.33, 95% CI 1.15-1.55, I2 = 32%
respectively). Five-year mortality was not significantly different between
the CHD and non-CHD population (RR 1.09, 95% CI 0.97-1.24, I2 = 34%). In
contrast, ten-year mortality was significantly less in CHD patients (RR
0.87, 95% CI 0.79-0.97, I2 = 38%). Mortality secondary to infection and
malignancy was significantly lower in the CHD group, while death secondary
to stroke and hemorrhage was significantly higher. Risk of reoperation and
renal failure/dialysis were not statistically different between the two
groups. Conclusion: Our study suggests that while CHD patients tend to
have higher early mortality, post-transplantation long-term survival is
improved. Given our findings, it would suggest that concerns regarding
early mortality in the adult CHD population should not preclude listing
for transplantation.
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