Results Generated From:
Embase <1980 to 2015 Week 52>
Embase (updates since 2015-12-22)
<1>
Accession Number
20151031313
Authors
Wolk R. Bertolet M. Brooks M.M. Pratley R.E. Sobel B.E. Frye R.L. Singh P.
Calvin A.D. Rutter M.K. Mooradian A.D. Somers V.K.
Institution
(Wolk, Frye, Singh, Calvin, Somers) Division of Cardiovascular Diseases,
Department of Medicine, Mayo Clinic, Rochester, United States
(Wolk) Pfizer Global Research and Development, Pfizer Inc., 445 Eastern
Point Rd, Grotona, CT 06340, United States
(Bertolet, Brooks) University of Pittsburgh, United States
(Pratley) Florida Hospital Diabetes and Translational Research Institutes,
Orlando, United States
(Sobel) University of Vermont, Burlington, United States
(Rutter) Endocrinology and Diabetes Research Group, Institute of Human
Development, Faculty of Medical and Human Sciences, University of
Manchester, United Kingdom
(Rutter) Manchester Diabetes Centre, Central Manchester University
Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre,
United Kingdom
(Mooradian) Division of Endocrinology, Diabetes and Metabolism, College of
Medicine-Jacksonville, University of Florida, United States
Title
Differential effects of insulin sensitization and insulin provision
treatment strategies on concentrations of circulating adipokines in
patients with diabetes and coronary artery disease in the BARI 2D trial.
Source
European Journal of Preventive Cardiology. 23 (1) (pp 50-58), 2016. Date
of Publication: 01 Jan 2016.
Publisher
SAGE Publications Inc.
Abstract
Aims To determine the effects of insulin sensitization (IS) and insulin
provision (IP) treatment strategies on adipokines associated with
cardiovascular disease in patients with type 2 diabetes mellitus and
coronary artery disease in the Bypass Angioplasty Revascularization
Investigation 2 Diabetes trial (BARI 2D). Methods and results Changes in
adipokine levels were compared in patients with type 2 diabetes mellitus
and coronary artery disease randomized to IS (n = 1037) versus IP (n =
1019) treatment strategies in BARI 2D. Circulating concentrations of
leptin, adiponectin, monocyte chemoattractant protein-1, tumor necrosis
factor-alpha, interleukin 6 and C-reactive protein were evaluated at
baseline and one year. IS and IP treatment strategies exerted significant
(p < 0.0001) differential effects on: leptin (IS: 0.02% decrease, p =
0.01; IP: 13% increase, p < 0.0001); adiponectin (IS: 73% increase, p <
0.0001; IP: no change, p = 0.52); interleukin 6 (IS: 14% decrease, p <
0.0001; IP: no change, p = 0.68). Changes in monocyte chemoattractant
protein-1 and tumor necrosis factor-alpha were not statistically different
between groups. C-reactive protein decreased, but the effect was
significantly greater in the IS group (-32%, p < 0.0001) than in the IP
group (-5%, p = 0.0005). Conclusion The IS and IP treatment strategies
exerted divergent effects on adipokine and inflammatory profile in
patients with type 2 diabetes mellitus and coronary artery disease. The IS
treatment strategy-induced changes may be more favorable than the IP
treatment strategy regarding cardiovascular pathophysiology.
<2>
Accession Number
20151020676
Authors
Mathew P.J. Sailam S. Sivasailam R. Thingnum S.K.S. Puri G.D.
Institution
(Mathew, Sailam, Sivasailam, Puri) Department of Anaesthesia and Intensive
Care, Postgraduate Institute of Medical Education and Research (PGIMER),
Chandigarh PIN-160012, India
(Thingnum) Department of Cardiothoracic Surgery, Postgraduate Institute of
Medical Education and Research (PGIMER), Chandigarh, India
Title
Performance of target-controlled infusion of propofol using two different
pharmacokinetic models in open heart surgery - A randomised controlled
study.
Source
Perfusion (United Kingdom). 31 (1) (pp 45-53), 2016. Date of Publication:
01 Jan 2016.
Publisher
SAGE Publications Ltd
Abstract
We compared the performance of a propofol target-controlled infusion (TCI)
using Marsh versus PGIMER models in patients undergoing open heart
surgery, in terms of measured plasma levels of propofol and objective
pharmacodynamic effect. Methods: Twenty-three, ASA II/III adult patients
aged 18-65 years and scheduled for elective open heart surgery received
Marsh or PGIMER (Postgraduate Institute of Medical Education and Research)
pharmacokinetic models of TCI for the induction and maintenance of
anaesthesia with propofol in a randomized, active-controlled,
non-inferiority trial. The plasma levels of propofol were measured at
specified time points before, during and after bypass. Results: The
performances of both the models were similar, as determined by the error
(%) in maintaining the target plasma concentrations: MDPE of -5.0 (-12.0,
5.0) in the PGIMER group vs -6.4 (-7.7 to 0.5) in the Marsh group and
MDAPE of 9.1 (5, 15) in the PGIMER group vs 8 (6.7, 10.1) in the Marsh
group. These values indicate that both models over-predicted the plasma
propofol concentration. Conclusions: The new pharmacokinetic model based
on data from Indian patients is comparable in performance to the
commercially available Marsh pharmacokinetic model.
<3>
Accession Number
20151020667
Authors
Stanzel R.D.P. Henderson M.
Institution
(Stanzel, Henderson) Nova Scotia Health Authority, Canada
Title
Clinical evaluation of contemporary oxygenators.
Source
Perfusion (United Kingdom). 31 (1) (pp 15-25), 2016. Date of Publication:
01 Jan 2016.
Publisher
SAGE Publications Ltd
Abstract
Advances in cardiopulmonary bypass equipment have played a critical role
in improving outcomes for cardiac surgery patients. Recent advancements
include reduced priming volumes, biocompatible coatings and gaseous
microemboli handling, as well as the incorporation of an arterial filter
into the oxygenator. The purpose of this study was to conduct a
comprehensive clinical evaluation of adult oxygenators on the market.
Oxygenators assessed included the Sorin Synthesis (n = 30), the Sorin
Inspire 6F (n = 10) and Inspire 8F (n = 30), the Terumo FX15 (n = 13) and
FX25 (n = 30), the Maquet Quadrox-i (n = 30) and the Medtronic Fusion (n =
30). Parameters assessed included functional prime volumes, gas exchange,
pressure gradients and the effects on patient hematology. The Synthesis
had the largest functional prime volume (1426 ml), the FX15 the lowest
(956 ml). The Inspire 6F, 8F and Fusion had the greatest O<inf>2</inf>
transfer. The Sorin oxygenators required the lowest sweep gas flows to
obtain a PaCO<inf>2</inf> of 40 mmHg. The Sorin oxygenators had the
largest pressure gradients. While no differences were observed for
hemoglobin and platelet levels post cross-clamp removal, the Sorin
Synthesis and Inspire 8F had the largest increases in white blood cell
(WBC) counts (122% and 141% of baseline, respectively) and neutrophils
(162% and 185% of baseline, respectively). The data demonstrate that no
single product is superior in all aspects. The choice of ideal oxygenator
depends on the aspect(s) of oxygenator performance the perfusion team
believes most clinically acceptable based on available data.
<4>
Accession Number
20151020664
Authors
Chew S.T.H. Ng R.R.G. Liu W. Goh S.G. Caleb M.G. Ti L.K.
Institution
(Chew) Department of Anaesthesiology, Singapore General Hospital, 20
College Road, Academia, Level 5, Singapore 169856, Singapore
(Chew) Department of Cardiovascular and Metabolic Disorders, Duke-National
University of Singapore, Graduate Medical School, Singapore, Singapore
(Ng, Liu, Ti) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore, Singapore
(Goh, Caleb) Department of Cardiac, Thoracic and Vascular Surgery,
National University Heart Centre, Singapore, Singapore
(Ti) Department of Anaesthesia, National University Health System,
Singapore, Singapore
Title
Miniaturized versus conventional cardiopulmonary bypass and acute kidney
injury after cardiac surgery.
Source
Perfusion (United Kingdom). 31 (1) (pp 60-67), 2016. Date of Publication:
01 Jan 2016.
Publisher
SAGE Publications Ltd
Abstract
Introduction: Acute kidney injury (AKI) is a serious complication after
coronary artery bypass grafting (CABG). There are conflicting reports
whether a miniaturized cardiopulmonary bypass (MCPB) system is associated
with a lower AKI incidence compared with conventional cardiopulmonary
bypass (CCPB). It is unknown if AKI risk factors differ between the two
groups. We assessed if MCPB decreases AKI after CABG and compared the risk
factors between both groups. Methods: Sixty-eight Asian patients
presenting for elective CABG at a tertiary heart centre were enrolled.
They were randomly assigned to MCPB (n=34) or CCPB group (n=34) and
followed up in a single-blinded, prospective, randomized, controlled
trial. The primary outcome was Acute Kidney Injury Network stage 1 AKI.
Results: The AKI incidence was 21.5% and was not significantly different
between patients undergoing MCPB versus CCPB (21.9% versus 21.2%,
p=0.948). The first CPB haematocrit was independently associated with AKI
in the MCPB group (Relative Risk [RR]=0.484, 95% Confidence Interval
[CI]=0.268-0.876, p=0.016); post-operative blood loss and inflammation
were independently associated with AKI in the CCPB group (RR=1.005,
95%CI=1.003-1.007, p<0.001; RR=1.018, 95%CI=1.010-1.028, p<0.001).
Conclusion: The MCPB system is not associated with a lower incidence of
AKI in Asian patients undergoing CABG. Risk factors for AKI differed
between patients using the MCPB and CCPB systems.
<5>
Accession Number
20151011127
Authors
Blaha J. Mraz M. Kopecky P. Strtesky M. Lips M. Matias M. Kunstyr J.
Porizka M. Kotulak T. Kolnikova I. Simanovska B. Zakharchenko M. Rulisek
J. Sachl R. Anyz J. Novak D. Lindner J. Hovorka R. Svacina S. Haluzik M.
Institution
(Blaha, Kopecky, Strtesky, Lips, Matias, Kunstyr, Porizka, Kotulak,
Kolnikova, Simanovska, Zakharchenko, Rulisek, Sachl) Department of
Anesthesia, Resuscitation and Intensive Medicine, General University
Hospital, Charles University in Prague First Faculty of Medicine, Prague 1
128 08, Czech Republic
(Mraz, Svacina, Haluzik) Third Department of Medicine-Department of
Endocrinology and Metabolism, General University Hospital, Charles
University in Prague First Faculty of Medicine, Prague 1 128 08, Czech
Republic
(Lindner) Second Department of Surgery- Department of Cardiovascular
Surgery, General University Hospital, Charles University in Prague First
Faculty of Medicine, Prague 1 128 08, Czech Republic
(Anyz, Novak) Department of Cybernetics, Faculty of Electrical
Engineering, Czech Technical University, Prague 2 121 35, Czech Republic
(Hovorka) Institute of Metabolic Science, University of Cambridge,
Cambridge CB2 3AD, United Kingdom
Title
Perioperative tight glucose control reduces postoperative adverse events
in nondiabetic cardiac surgery patients.
Source
Translational Endocrinology and Metabolism. 100 (8) (pp 3081-3089), 2015.
Date of Publication: 2015.
Publisher
Endocrine Society
Abstract
Context: Tight glucose control (TGC) reduces morbidity and mortality in
patients undergoing elective cardiac surgery, but only limited data about
its optimal timing are available to date. Objective: The purpose of this
article was to compare the effects of perioperative vs postoperative
initiation of TGC on postoperative adverse events in cardiac surgery
patients. Design: This was a single center, single-blind, parallel-group,
randomized controlled trial. Settings: The setting was an academic
tertiary hospital. Participants: Participants were 2383 hemodynamically
stable patients undergoing major cardiac surgery with expected
postoperative intensive care unit treatment for at least 2 consecutive
days. Intervention: Intensive insulin therapy was initiated
perioperatively or postoperatively with a target glucose range of 4.4 to
6.1 mmol/L. Main Outcome Measures: Adverse events from any cause during
postoperative hospital stay were compared. Results: Inthewholecohort,
perioperatively initiatedTGCmarkedlyreducedthenumberofpostoperative
complications(23.2%vs34.1%,95%confidenceinterval[CI],0.60-0.78)despiteonly
minimalimprovement in glucose control (blood glucose, 6.6 +/- 0.7 vs 6.7
+/- 0.8 mmol/L, P < .001; time in target range, 39.3% +/-
13.7%vs37.3%+/-13.8%,P<.001).Thepositive effects ofTGConpostoperative
complicationsweredriven by nondiabetic subjects (21.3% vs 33.7%, 95% CI,
0.54-0.74; blood glucose 6.5+/-0.6 vs 6.6+/-0.8 mmol/L, not significant;
time in target range, 40.8% +/- 13.6% vs 39.7% +/- 13.8%, not
significant), whereas no significant effect was seen in diabetic patients
(29.4% vs 35.1%, 95% CI, 0.66-1.06) despite significantly better glucose
control in the perioperative group (blood glucose, 6.9+/-1.0 vs 7.1+/-0.8
mmol/L, P<.001; time in target range, 34.3%+/-12.7% vs 30.8%+/-11.5%,
P<.001). Conclusions: Perioperative initiation of intensive insulin
therapy during cardiac surgery reduces postoperative morbidity in
nondiabetic patients while having a minimal effect in diabetic subjects.
<6>
Accession Number
20151022946
Authors
Mansourian S. Bina P. Fehri A. Karimi A.A. Boroumand M.A. Abbasi K.
Institution
(Mansourian, Bina, Fehri, Karimi, Boroumand, Abbasi) Department of Cardiac
Surgery, Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Title
Preoperative oral pentoxifylline in case of coronary artery bypass
grafting with left ventricular dysfunction (ejection fraction equal to/
less than 30%).
Source
Anadolu Kardiyoloji Dergisi. 15 (12) (pp 1014-1019), 2015. Date of
Publication: 01 Dec 2015.
Publisher
AVES Ibrahim Kara (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey)
Abstract
Objective: Most coronary artery bypass grafts are done by applying
cardiopulmonary bypass, which usually induces unwanted inflammatory
reactions and impairs the outcomes. In order to minimize the perilous
response of cardiopulmonary bypass, pentoxifylline was getting used
orally. Methods: In a prospective, placebo-controlled, randomized clinical
trial, 178 coronary artery bypass graft candidates with ejection fraction
lower/equal to 30%, divided into two equal groups (pentoxifylline and
control), participated in the study. Pentoxifylline patients received 400
mg pentoxifylline 3 times a day for 3 days before operation. The outcomes
were compared between groups using student's t-test, Mann-Whitney U-test,
Pearson chi-square, or Fisher's exact test. Results: Pentoxifylline
administration did not significantly affect troponin-T (p=0.68), but it
reduced tumor necrosis factor-alpha (p=0.01) and interleukin- 6 (p=0.01).
It improved left ventricular ejection fraction significantly (p=0.01).
White blood cell and platelet counts, hemoglobin, and hematocrit were not
influenced by pentoxifylline. The drug did not affect blood urea nitrogen
and creatinine, occurrence of renal failure, cerebrovascular accidents,
and in-hospital mortality rate. The need for an intra-aortic balloon pump,
cardiopulmonary bypass, and aortic crossclamp times were not affected,
either. Pentoxifylline decreased the intensive care unit stay (p<0.001),
ventilation time, 10.4 hours in the pentoxifylline group against 14.7
hours in the control group (p=0.01), and the requirement of inotropic
agents (p=0.02) and blood transfusion (p=0.01). Conclusion: Pentoxifylline
has more beneficial potencies in reducing adverse events after coronary
artery bypass graft using cardiopulmonary bypass, than what are known.
<7>
Accession Number
2015317374
Authors
Miell J. Dhanjal P. Jamookeeah C.
Institution
(Miell) Department of Endocrinology, University Hospital Lewisham, London,
United Kingdom
(Dhanjal) Otsuka Pharmaceutical UK Limited, Gallions, Wexham Springs,
Framewood Road, Wexham SL3 6PJ, United Kingdom
(Jamookeeah) Otsuka Pharmaceutical Europe Limited, Wexham, United Kingdom
Title
Evidence for the use of demeclocycline in the treatment of hyponatraemia
secondary to SIADH: A systematic review.
Source
International Journal of Clinical Practice. 69 (12) (pp 1396-1417), 2015.
Date of Publication: 01 Dec 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Aims Hyponatraemia (HN) is the most common electrolyte balance disorder in
clinical practice. Since the 1970s, demeclocycline has been used in some
countries to treat chronic HN secondary to syndrome of inappropriate
antidiuretic hormone secretion (SIADH). The precise mechanism of action of
demeclocycline is unclear, but has been linked to the induction of
nephrogenic diabetes insipidus. Furthermore, the safety profile of
demeclocycline is variable with an inconsistent time to onset, and a
potential for complications. There has been no systematic evaluation of
the use of demeclocycline for the treatment of HN secondary to SIADH to
date. A systematic literature review was performed to obtain an insight
into the clinical safety and efficacy of demeclocycline for this
condition. Methods Embase<sup>TM</sup>, MEDLINE<sup></sup>,
MEDLINE<sup></sup> In-Process, and The Cochrane Library were searched on
two occasions using MeSH terms combined with free-text terms. References
were screened by two independent reviewers. Relevant publications were
then extracted by two independent reviewers, with a third reviewer
collating and finalising extractions. Results The searches returned a
total of 705 hits. 632 abstracts were screened after the removal of
duplicates. Following screening, 35 full-length publications were
reviewed. Of these, 17 were excluded, resulting in 18 studies deemed
relevant for data extraction. Two were randomised controlled trials
(RCTs), 16 were non-RCTs, and 10 were case reports. Discussion Although
most reports suggest that demeclocycline can address serum sodium levels
in specific patients with HN, efficacy is variable, and may depend upon
the underlying aetiology. Demeclocycline dose adjustments can be complex,
and as its use in clinical practice is not well defined, it can differ
between healthcare professionals. Conclusion There is a lack of clinical
and economic evidence supporting the use of demeclocycline for HN
secondary to SIADH. Patients receiving demeclocycline for HN secondary to
SIADH must be closely monitored.
<8>
Accession Number
20151021402
Authors
Laiq N. Majid A. Nawab J. Malik A.
Institution
(Laiq, Majid, Nawab, Malik) Department of Cardiothoracic Anaesthesia, Post
Graduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan
Title
Central venous catheterization and cardiac surgeries.
Source
Journal of Medical Sciences (Peshawar). 23 (3) (pp 137-140), 2015. Date of
Publication: July 2015.
Publisher
Khyber Medical College
Abstract
Objective: To compare the rate of complications and ease of insertion
between internal jugular vs subclavian central venous catheterization in
patients undergoing cardiac surgeries. Material and Methods: This
randomized clinical control study was conducted in the department of
Cardiothracic Anesthesia PGMI/Lady Reading Hospital, Peshawar from April
2013 to November 2014. A totol number of 200 patients were randomly
assigned in one of the two groups,i-e 100 in internal jugular group and
100 patients in subclavian group for central venous catheterization.
Patients's demographic data, rate of complications and ease of insertion
between the two groups were recorded and compared. Calculations were done
using the SPSS, software pakage, Version 17. Results: There was no
statistically significant difference between the Ages, sex, weight and the
type of surgery in the two studied groups. Efficacy in terms of ease of
insertion was more in internal jugular group as the number of attempts
were less, comared to subclavian group. Rate of complications were more in
subclavian group compared to internal jugular group (P value < 0.05)
except infection rate which was noted to be high in internal jugular group
(P value < 0.05). Conclusion: Internal jugular vein is an easy access
having less complications for central venous catheterization compared to
subclavian vein.
<9>
Accession Number
20151025848
Authors
Kadda O. Manginas A. Stavridis G. Balanos D. Kotiou M. Panagiotakos D.B.
Institution
(Kadda) Department of Critical Care, School of Medicine, University of
Athens, Athens, Greece
(Manginas) Department of Cardiology, Mediterraneo Hospital, Athens, Greece
(Stavridis, Balanos, Kotiou) Department of Cardiac Surgery, Onassis
Cardiac Surgery Center, Athens, Greece
(Panagiotakos) Department of Nutrition and Dietetics, School of Health
Science and Education, Harokopio University, 46 Paleon Polemiston St
Glyfada, Athens 166 74, Greece
Title
Gender Analysis in the Outcomes of a Lifestyle Intervention among Patients
Who Had an Open Heart Surgery.
Source
Angiology. 67 (1) (pp 66-74), 2016. Date of Publication: 01 Jan 2016.
Publisher
SAGE Publications Inc.
Abstract
The aim of this study was to evaluate the gender-oriented differences in
the outcomes of a lifestyle intervention trial (diet, smoking cessation,
and exercise) among patients who had open heart surgery. A randomized,
nonblind intervention study was performed on 500 patients who had open
heart surgery. Immediately after hospital discharge, 250 patients were
randomly allocated lifestyle intervention by receiving oral and written
information in the form of a booklet with specific educational information
for postoperative rehabilitation. The remaining 250 patients received the
regular oral instructions. The applied lifestyle intervention proved to be
beneficial only in men as far as quitting smoking (relative risk [RR]:
0.36, confidence interval [CI]: 0.16-0.80; P =.01) and returning to work
(RR: 0.35, CI: 0.13-0.92; P =.03) are concerned. For both genders, no
significant associations between dietary and physical activity
recommendations were observed. Conclusion: Lifestyle nursing intervention
immediately after open heart surgery had a beneficial effect on men 1 year
after the surgery but not on women. Thus, there is a need for
gender-specific studies among women.
<10>
Accession Number
20151020591
Authors
Healy D.A. Boyle E. McCartan D. Bourke M. Medani M. Ferguson J. Yagoub H.
Bashar K. O'Donnell M. Newell J. Canning C. McMonagle M. Dowdall J. Cross
S. O'Daly S. Manning B. Fulton G. Kavanagh E.G. Burke P. Grace P.A.
Moloney M.C. Walsh S.R.
Institution
(Healy, Bashar, Canning, Kavanagh, Burke, Grace) Department of Vascular
Surgery, University Hospital Limerick, Limerick, Ireland
(Boyle, Manning, Fulton) Department of Surgery Cork, University Hospital,
Cork, Ireland
(McCartan, Bourke, Medani, McMonagle, Dowdall, Cross) Department of
Surgery, University Hospital Waterford, Waterford, Ireland
(Ferguson, Yagoub) Department of Medicine, Graduate Entry Medical School,
University of Limerick, Limerick, Ireland
(O'Donnell, Newell, O'Daly) Clinical Research Facility, National
University of Ireland Galway, Galway, Ireland
(Moloney) Health Research Institute, University of Limerick, Limerick,
Ireland
(Walsh) Department of Surgery, National University of Ireland Galway,
Galway, Ireland
Title
A multicenter pilot randomized controlled trial of remote ischemic
preconditioning in major vascular surgery.
Source
Vascular and Endovascular Surgery. 49 (8) (pp 220-227), 2015. Date of
Publication: 01 Nov 2015.
Publisher
SAGE Publications Inc.
Abstract
A pilot randomized controlled trial that evaluated the effect of remote
ischemic preconditioning (RIPC) on clinical outcomes following major
vascular surgery was performed. Eligible patients were those scheduled to
undergo open abdominal aortic aneurysm repair, endovascular aortic
aneurysm repair, carotid endarterectomy, and lower limb revascularization
procedures. Patients were randomized to RIPC or to control groups. The
primary outcome was a composite clinical end point comprising any of
cardiovascular death, myocardial infarction, new-onset arrhythmia, cardiac
arrest, congestive cardiac failure, cerebrovascular accident, renal
failure requiring renal replacement therapy, mesenteric ischemia, and
urgent cardiac revascularization. Secondary outcomes were components of
the primary outcome and myocardial injury as assessed by serum troponin
values. The primary outcome occurred in 19 (19.2%) of 99 controls and 14
(14.1%) of 99 RIPC group patients (P =.446). There were no significant
differences in secondary outcomes. Our trial generated data that will
guide future trials. Further trials are urgently needed.
<11>
Accession Number
20151020459
Authors
Amoli A.I. Bozorgi A. Talasaz A.H. Omran A.S. Mortazavi S.H. Jalali A.
Nasirpour S. Jenab Y.
Institution
(Amoli, Bozorgi, Talasaz, Omran, Mortazavi, Jalali, Nasirpour, Jenab)
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Title
Efficacy of colchicine versus placebo for the treatment of pericardial
effusion after open-heart surgery: A randomized, placebo-controlled trial.
Source
American Heart Journal. 170 (6) (pp 1195-1201), 2015. Date of Publication:
01 Dec 2015.
Publisher
Mosby Inc.
Abstract
Background Pericardial effusion (PE), a common complication after
open-heart surgery, accounts for 50% to 85% of patients. Although
reversible in most of the cases, it could be life threatening in the
occurrence of tamponade in large effusions. We aimed to determine the
therapeutic efficacy of colchicine on PE after open-heart surgery. Methods
The study is a prospective, randomized, triple-blind, placebo-controlled
single-center trial at Tehran Heart Center. A total of 149 patients with
mild or moderate PE in transthoracic echocardiography were randomly
assigned to receive 1 mg/d colchicine (n = 74) or 1 tablet of placebo (n =
75) for 2 weeks and then underwent follow-up echocardiography. Results
Baseline and clinical characteristics were not significantly different
between the 2 study groups except for age (P =.02) and graft numbers (P
=.005). There was no significant difference in pretreatment and
posttreatment PE sizes between the 2 study groups (P =.440 and.844,
respectively). Median (25th-75th percentiles) of effusion changes was 5 mm
(1-7.6 mm) in the colchicine group and 5 mm (1-6.6 mm) in the placebo
group (P =.932). Intervention had no significant impact on pretreatment
and posttreatment effusion values and changes in isolated coronary artery
bypass graft surgery patients (P =.607,.539, and.628, respectively). After
adjustment for possible confounders, there was still no significant
difference in postoperative PE between the 2 study groups (t = -0.285, P
=.776). Conclusion We concluded that prescription of colchicine does not
seem to be effective in treatment of asymptomatic postoperative PE. This
could be justified in case that the etiology of most of the PEs might be
contribution of noninflammatory factors which are better to be dealt with
observational approaches.
<12>
Accession Number
20151020450
Authors
Nicholls S.J. Lincoff A.M. Barter P.J. Brewer H.B. Fox K.A.A. Gibson C.M.
Grainger C. Menon V. Montalescot G. Rader D. Tall A.R. McErlean E.
Riesmeyer J. Vangerow B. Ruotolo G. Weerakkody G.J. Nissen S.E.
Institution
(Nicholls) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide, SA 5001, Australia
(Lincoff, Menon, McErlean, Nissen) Cleveland Clinic Coordinating Center
for Clinical Research, Department of Cardiovascular Medicine, Cleveland
Clinic, Cleveland, OH, United States
(Barter) University of New South Wales, Sydney, Australia
(Brewer) Medstar Research Institute, Hyattsville, MD, United States
(Fox) University of Edinburgh, Edinburgh, United Kingdom
(Gibson) Harvard Medical School, Boston, MA, United States
(Grainger) Duke Clinical Research Institute, Durham, NC, United States
(Montalescot) Pitie-Salpetriere University Hospital, Paris, France
(Rader) University of Pennsylvania, Philadelphia, PA, United States
(Tall) Columbia University, New York City, NY, United States
(Riesmeyer, Vangerow, Ruotolo, Weerakkody) Eli Lilly and Company,
Indianapolis, IN, United States
Title
Assessment of the clinical effects of cholesteryl ester transfer protein
inhibition with evacetrapib in patients at high-risk for vascular
outcomes: Rationale and design of the ACCELERATE trial.
Source
American Heart Journal. 170 (6) (pp 1061-1069), 2015. Date of Publication:
01 Dec 2015.
Publisher
Mosby Inc.
Abstract
Background Potent pharmacologic inhibition of cholesteryl ester
transferase protein by the investigational agent evacetrapib increases
high-density lipoprotein cholesterol by 54% to 129%, reduces low-density
lipoprotein cholesterol by 14% to 36%, and enhances cellular cholesterol
efflux capacity. The ACCELERATE trial examines whether the addition of
evacetrapib to standard medical therapy reduces the risk of cardiovascular
(CV) morbidity and mortality in patients with high-risk vascular disease.
Study Design ACCELERATE is a phase 3, multicenter, randomized,
double-blind, placebo-controlled trial. Patients qualified for enrollment
if they have experienced an acute coronary syndrome within the prior 30 to
365 days, cerebrovascular accident, or transient ischemic attack; if they
have peripheral vascular disease; or they have diabetes with coronary
artery disease. A total of 12,092 patients were randomized to evacetrapib
130 mg or placebo daily in addition to standard medical therapy. The
primary efficacy end point is time to first event of CV death, myocardial
infarction, stroke, hospitalization for unstable angina, or coronary
revascularization. Treatment will continue until 1,670 patients reached
the primary end point; at least 700 patients reach the key secondary
efficacy end point of CV death, myocardial infarction, and stroke, and the
last patient randomized has been followed up for at least 1.5 years.
Conclusions ACCELERATE will establish whether the cholesteryl ester
transfer protein inhibition by evacetrapib improves CV outcomes in
patients with high-risk vascular disease.
<13>
Accession Number
20151020442
Authors
Celano C.M. Millstein R.A. Bedoya C.A. Healy B.C. Roest A.M. Huffman J.C.
Institution
(Celano, Millstein, Bedoya, Huffman) Department of Psychiatry,
Massachusetts General Hospital, 55 Fruit Street/Blake 11, Boston, MA,
United States
(Celano, Millstein, Bedoya, Healy) Harvard Medical School, Boston, MA,
United States
(Healy, Huffman) Department of Neurology, Massachusetts General Hospital,
Boston, MA, United States
(Roest) Interdisciplinary Center Psychopathology and Emotion Regulation,
Department of Psychiatry, University of Groningen, University Medical
Center Groningen, Groningen, Netherlands
Title
Association between anxiety and mortality in patients with coronary artery
disease: A meta-analysis.
Source
American Heart Journal. 170 (6) (pp 1105-1115), 2015. Date of Publication:
01 Dec 2015.
Publisher
Mosby Inc.
Abstract
Background Depression and anxiety are common in patients with coronary
artery disease (CAD). Although depression clearly has been associated with
mortality in this population, the relationship between anxiety and
mortality is less clear. Accordingly, we performed a series of
meta-analyses to (1) examine the relationship between anxiety and
mortality in patients with established CAD and (2) determine if this
relationship differs in patients with stable CAD compared to those who
have just had an acute coronary syndrome (ACS). Methods and results
Systematic literature searches identified 44 articles (total N = 30,527)
evaluating the prospective relationship between anxiety and mortality in
individuals with established CAD. A series of 8 adjusted and unadjusted
meta-analyses were performed to examine this relationship across all
patients, with sensitivity analyses completed in post-ACS and stable CAD
cohorts. In unadjusted analyses, anxiety was associated with a moderate
increase in mortality risk (odds ratio 1.21 per SD increase in anxiety).
However, when adjusting for covariates, nearly all associations became
nonsignificant. In sensitivity analyses, anxiety was associated with an
increased risk of poor outcomes in the stable CAD - but not post-ACS -
cohort. Conclusions These analyses confirm that anxiety is associated with
increased risk of mortality in patients with CAD; however, this
relationship is not as strong as that of depression and may be explained
partly by other clinical factors. If anxiety screening is performed, it
should be performed during a period of clinical stability and should
target anxiety disorders rather than anxiety symptoms alone.
<14>
Accession Number
20151020441
Authors
Prati F. Romagnoli E. Limbruno U. Pawlowski T. Fedele S. Gatto L. Di Vito
L. Pappalardo A. Ramazzotti V. Picchi A. Trivisonno A. Materia L.
Pfiatkosky P. Paoletti G. Marco V. Tavazzi L. Versaci F. Stone G.W.
Institution
(Prati, Gatto, Di Vito, Pappalardo, Ramazzotti) San Giovanni Hospital,
Rome, Italy
(Prati, Romagnoli, Gatto, Materia, Paoletti, Marco) Centro per la Lotta
Contro l'Infarto-CLI Foundation, Rome, Italy
(Limbruno, Picchi) Misericordia Hospital, Grosseto, Italy
(Pawlowski, Pfiatkosky) Central Clinical Hospital, Ministry of Interior,
Warsaw, Poland
(Fedele) Sandro Pertini Hospital, Rome, Italy
(Trivisonno, Versaci) Ospedale Civile Ferdinando Veneziale, Isernia, Italy
(Tavazzi) GVM Care and Research, E.S. Health Science Foundation,
Cotignola, Italy
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, New York, NY, United States
Title
Randomized evaluation of intralesion versus intracoronary abciximab and
aspiration thrombectomy in patients with ST-elevation myocardial
infarction: The COCTAIL II trial.
Source
American Heart Journal. 170 (6) (pp 1116-1123), 2015. Date of Publication:
01 Dec 2015.
Publisher
Mosby Inc.
Abstract
Background Thrombus burden and distal embolization are predictive of
no-reflow during primary percutaneous coronary intervention (PCI) in
patients with acute ST-elevation myocardial infarction (STEMI). We sought
to compare the efficacy of pharmacological and catheter-based strategies
for thrombus in patients with STEMI and high atherothrombotic burden.
Methods Between January 2012 and December 2013, 128 STEMI patients
undergoing primary PCI at 5 centers were randomly assigned in a 2 x 2
factorial design to intracoronary (IC) abciximab bolus (via the guide
catheter) versus intralesion (IL) abciximab bolus, each with versus
without aspiration thrombectomy (AT). Study end points were residual
intrastent atherothrombotic burden, defined as the number of
cross-sections with residual tissue area >10% as assessed by optical
coherence tomography, and indices of angiographic and myocardial
reperfusion. Results Residual intrastent atherothrombotic burden did not
significantly differ with IL versus IC abciximab (median [interquartile
range] 6.0 [1-15] vs 6.0 [2-11], P =.806) and with AT versus no aspiration
(6.0 [1-13] vs 6.0 [2-12], P =.775). Intralesion abciximab administration
was associated with improved angiographic myocardial reperfusion in terms
of thrombolysis in myocardial infarction (TIMI) flow (3 [3-3] vs 3 [2-3],
P =.040), corrected TIMI frame count (12 +/- 5 vs 17 +/- 16, P =.021), and
myocardial blush grade (3 [2-3] vs 3 [2-3], P =.035). In particular, IL
abciximab was associated with higher occurrence of final TIMI 3 flow (90%
vs 73.8%, P =.032) and myocardial blush grade 3 (71.6% vs 52.4%, P =.039).
Conversely, AT had no significant effect on indices of angiographic or
myocardial reperfusion. Conclusions In patients with STEMI and high
thrombotic burden, neither IL versus IC abciximab nor AT versus no
aspiration reduced postprocedure intrastent atherothrombotic burden in
patients with STEMI undergoing primary PCI. However, IL abciximab improved
indices of angiographic and myocardial reperfusion compared to IC
abciximab, benefits not apparent with AT.
<15>
Accession Number
20151020439
Authors
Spencer F.A. Sekercioglu N. Prasad M. Lopes L.C. Guyatt G.H.
Institution
(Spencer, Guyatt) Department of Medicine, McMaster University, Faculty of
Health Sciences, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada
(Sekercioglu, Guyatt) Department of Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, ON, Canada
(Prasad) Department of Community Medicine, Pt. B. D. Sharma Postgraduate
Institute of Medical Sciences, Rohtak Haryana, India
(Lopes) University of Sorocaba, UNISO, Sorocaba, Brazil
Title
Culprit vessel versus immediate complete revascularization in patients
with ST-segment myocardial infarction - A systematic review.
Source
American Heart Journal. 170 (6) (pp 1133-1139), 2015. Date of Publication:
01 Dec 2015.
Publisher
Mosby Inc.
Abstract
Background Guidelines suggest percutaneous intervention (PCI) of only the
culprit artery in patients presenting with ST-segment elevation myocardial
infarction (STEMI) and multivessel coronary artery disease. However,
recent randomized controlled trials (RCTs) suggest benefit to performing
PCI of other stenotic vessels at the same time as culprit vessel PCI.
Methods We conducted a systematic review with complete case meta-analysis
and sensitivity analyses. Data sources included MEDLINE, EMBASE, Cochrane
Register of Controlled Trials, and CINAHL from 1946 to March 2014; MEDLINE
and EMBASE from March 2014 to March 2015; and scanning of literature for
new studies until August 2015. All RCTs comparing multivessel versus
culprit-only PCI in patients with STEMI were eligible. The primary
outcomes of interest were recurrent myocardial infarction (MI), recurrent
revascularization, and mortality. We combined data from trials to estimate
the pooled risk ratio (RR) and associated 95% CIs using random-effects
models. Results Five RCTs including 1,606 patients of whom 1,568 had
complete data proved eligible. Multivessel revascularization was
associated with decreased risk of repeat revascularization (RR 0.36, 95%
CI 0.27-0.49, risk difference 9.7% over 2 years) and recurrent nonfatal MI
(RR 0.58, 95% CI 0.36-0.93, risk difference 1.8% over 2 years), without
increase in mortality (RR 0.82, 95% CI 0.53-1.26) or other adverse events.
Conclusions Pooled data provide moderate-certainty evidence that
performance of multivessel PCI will provide an appreciable reduction in
nonfatal MI and high-certainty evidence that it will reduce need for
repeat revascularization. Patients are likely to place a high value on
these benefits.
<16>
Accession Number
72115664
Authors
Westerdahl E.
Institution
(Westerdahl) Orebro University, Orebro, Sweden
Title
Deep breathing techniques after cardiac surgery.
Source
Physiotherapy (United Kingdom). Conference: World Confederation for
Physical Therapy Congress 2015 Singapore Singapore. Conference Start:
20150501 Conference End: 20150504. Conference Publication: (var.pagings).
101 (pp eS1622-eS1623), 2015. Date of Publication: May 2015.
Publisher
Elsevier Ltd
Abstract
Background: Chest physiotherapy is routinely prescribed in order to reduce
or prevent pulmonary impairments after cardiac surgery. Besides early
mobilization, positioning and shoulder girdle exercises, various breathing
exercises are recommended to the spontaneously breathing postoperative
patient. Different breathing exercises are recommended in different parts
of the world, and there is no consensus about the most effective breathing
technique after cardiac surgery. Purpose: The purpose of this review is to
provide a brief overview of postoperative breathing exercises for patients
undergoing cardiac surgery via sternotomy, and to discuss and suggest an
optimal technique for the performance of deep breathing exercises.
Methods: A narrative systematic review approach. Results: Deep breathing
exercises with or without mechanical devices have been shown to have
positive effects on atelectasis, lung volumes, oxygenation and dyspnoea.
However, arbitrary instructions are given, and recommendations on
performance and duration vary. Scientific evidence for the efficacy has
been lacking until recently, and there is a lack of trials describing how
postoperative breathing exercises actually should be performed. A maximal
slow inspiration with an inspiratory hold at peak inspiration is
advocated. Teaching of deep breathing exercises should be based on a
maximal slow inspiration. An inspiratory hold at peak inspiration is
advocated to promote airway opening and resolve atelectasis. A positive
expiratory pressure on expiration decreases respiratory rate and increases
lung volumes, and thus consequently may improve gas exchange. The
postoperative breathing technique is feasible and easily performed by
cardiac surgical patients. Conclusion(s): There is evidence that chest
physiotherapy and deep breathing exercises in the early postoperative
course after cardiac surgery can improve recovery. However, there is a
need for further research to discover whether mechanical devices have a
physiological effect on pulmonary postoperative recovery or if it is
rather a question of breathing technique. Implications: Postoperative deep
breathing exercises are used to treat existing pulmonary impairments
gained during the surgery and to prevent further postoperative
deterioration. One feasible suggestion is to perform slow deep breaths,
with or without the aid of a mechanical device, hourly during waking hours
the first postoperative days after cardiac surgery.
<17>
Accession Number
72114350
Authors
Hong S. Alison J. Milross M. Dignan R.
Institution
(Hong) Liverpool Hospital, Physiotherapy, Sydney, Australia
(Alison, Milross) University of Sydney, Physiotherapy, Sydney, Australia
(Alison) Royal Prince Alfred Hospital, Physiotherapy, Sydney, Australia
(Dignan) Liverpool Hospital, Cardiothoracic Surgery, Sydney, Australia
Title
Does regional anaesthesia after coronary artery bypass graft surgery
improve pain control and walking distance? a RCT.
Source
Physiotherapy (United Kingdom). Conference: World Confederation for
Physical Therapy Congress 2015 Singapore Singapore. Conference Start:
20150501 Conference End: 20150504. Conference Publication: (var.pagings).
101 (pp eS586-eS587), 2015. Date of Publication: May 2015.
Publisher
Elsevier Ltd
Abstract
Background: Pain after coronary artery bypass graft (CABG) surgery affects
early rehabilitation1. Previous studies using continuous local anaesthetic
in cardiac surgery2 have assessed resting pain2 and time to ambulate2. No
studies have evaluated the effect of regional anaesthesia on walking
distance and pain scores during physiotherapy sessions post cardiac
surgery. Purpose: To determine the effect of continuous infusion of
ropivacaine (ropivacaine group) compared to placebo infusion (placebo
group) or usual care (usual care group) in patients after CABG surgery on
distance walked, pain scores before and after physiotherapy treatment and
number of patients discharged from physiotherapy by postoperative day 4.
Methods: Multicentre, double blind, randomised controlled trial.
Participants: Low to moderate risk CABG surgery patients with at least one
internal mammary artery graft. Intervention: Before sternotomy closure
patients were randomised. For the ropivacaine group and the placebo group
two catheters from the On-Q Pain Buster device were tunnelled
parasternally and the device filled with either 0.5% ropivacaine
(ropivacaine group) or normal saline (placebo group) with continuous
infusion at fixed rate of 4 mL/h for 96 hours for both. Usual care group
did not receive a device. All groups had patient-controlled analgesia and
or oral analgesia. Outcome measures: Walking distance on postoperative
days (POD) 1 to 4, pain scores using 10 cm visual analogue scale (VAS)
before and after morning and afternoon physiotherapy sessions each day,
and the proportion of patients discharged from physiotherapy on POD 4.
Analysis: Repeated measures ANOVA and Chi square for proportions were
used. Results: Seventy-five participants with mean age 60 (SD 11) years
were randomised into ropivacaine group (n = 26), placebo group (n = 25),
and control group (n = 24). There were no significant differences in
distance walked or pain scores on any post-operative day between groups.
46% of patients in ropivacaine group were discharged from physiotherapy on
POD4, 32% in placebo and 33% in usual care with no significant differences
between groups. Group as a whole (n = 72) showed walking distance
increased from 1 meter on POD1 to 183 meters on POD4; and linear reduction
in pain score from 42 millimetres on POD1 to 15 millimetres on POD4, p <
0.001 for both. The VAS pain scores were significantly higher after
physiotherapy sessions, p<0.001. The difference in mean VAS pain score
before and after physiotherapy sessions decreased linearly across days, p
< 0.01. Conclusion(s): Infusion of ropivacaine post CABG surgery did not
increase distance walked, reduce pain after physiotherapy sessions or
increase number of patients discharged from physiotherapy by POD4 compared
to placebo or control. Implications: Current pain management of CABG is as
effective as continuous local anaesthetic infusion in subpectoral
position. Pain relief should be considered prior to physiotherapy
sessions.
