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Embase <1980 to 2015 Week 48>
Embase (updates since 2015-11-19)
<1>
Accession Number
2015488009
Authors
Hendriks A.A. Khan M. Geller L. Kardos A. de Vries L.J. Yap S.-C. Wijchers
S.A. Theuns D.A.M.J. Szili-Torok T.
Institution
(Hendriks, de Vries, Yap, Wijchers, Theuns, Szili-Torok) Erasmus Medical
Center, Department of Clinical Electrophysiology, Postbus 2040, Rotterdam
3015 CE, Netherlands
(Hendriks, Khan) Onze Lieve Vrouwe Gasthuis, Department of Clinical
Electrophysiology, Amsterdam, Netherlands
(Geller) Cardiovascular Center Semmelweis University, Department of
Clinical Electrophysiology, Budapest, Hungary
(Kardos) Hungarian National Institute of Cardiology, Department of
Clinical Electrophysiology, Budapest, Hungary
Title
Ventricular tachycardia in ischemic cardiomyopathy; a combined
endo-epicardial ablation as the first procedure versus a stepwise approach
(EPILOGUE) - study protocol for a randomized controlled trial.
Source
Trials. 16 (1) , 2015. Article Number: 487. Date of Publication: October
29, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: The role of epicardial substrate ablation of ventricular
tachycardia (VT) as a first-line approach in patients with ischemic heart
disease is not clearly defined. Epicardial ablation as a first-line option
is standard for patients with nonischemic dilated cardiomyopathy and
arrhythmogenic right ventricular cardiomyopathy. Several nonrandomized
studies, including studies on patients with ischemic heart disease, have
shown that epicardial VT ablation improves outcome but this approach was
often used after a failed endocardial approach. The aim of this study is
to determine whether a combined endo-epicardial scar homogenization as a
first-line approach will improve the outcome of VT ablation.
Methods/Design: The EPILOGUE study is a multicenter, two-armed,
nonblinded, randomized controlled trial. Patients with ischemic heart
disease who are referred for VT ablation will be randomly assigned to
combined endo-epicardial scar homogenization or endocardial scar
homogenization only (control group). The primary outcome is recurrence of
sustained VT during a 2-year follow-up. Secondary outcomes include
procedural success and safety. Discussion: This study is the first
randomized trial that evaluates the role of a combined endo-epicardial
scar homogenization versus endocardial scar homogenization for the
treatment of ischemic scar-related VT. Trial registration:NL4816807814v02
<2>
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Accession Number
2015473853
Authors
Turan A. Belley-Cote E.P. Vincent J. Sessler D.I. Devereaux P.J. Yusuf S.
Van Oostveen R. Cordova G. Yared J.-P. Yu H. Legare J.-F. Royse A. Rochon
A. Nasr V. Ayad S. Quantz M. Lamy A. Whitlock R.P.
Institution
(Turan, Sessler, Yared, Nasr, Ayad) Department of Outcomes Research,
Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
(Belley-Cote, Devereaux, Lamy, Whitlock) Departments of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
(Devereaux, Yusuf) Departments of Medicine, McMaster University, Hamilton,
ON, Canada
(Vincent, Devereaux, Yusuf, Lamy, Whitlock) Population Health Research
Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON,
Canada
(Van Oostveen, Cordova, Lamy, Whitlock) Department of Surgery, Population
Health Research Institute, McMaster University, Hamilton, ON, Canada
(Yu) Department of Anesthesiology, West China Hospital, Sichuan
University, Chengdu, China
(Legare) Division of Cardiac Surgery, Department of Surgery, Dalhousie
University, Halifax, NV, Canada
(Royse) Department of Surgery, Royal Melbourne Hospital, University of
Melbourne, Melbourne, Australia
(Rochon) Department of Anesthesiology, Montreal Heart Institute,
Universite de Montreal, Montreal, QC, Canada
(Quantz) Department of Surgery, London Health Sciences Centre, London, ON,
Canada
(Turan) Department of Outcomes Research, Cleveland Clinic, 9500 Euclid
Avenue, Cleveland, OH 44195, United States
Title
Methylprednisolone does not reduce persistent pain after cardiac surgery.
Source
Anesthesiology. 123 (6) (pp 1404-1410), 2015. Date of Publication: 01 Dec
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Persistent incisional pain is common after cardiac surgery and
is believed to be in part related to inflammation and poorly controlled
acute pain. Methylprednisolone is a corticosteroid with substantial
antiinflammatory and analgesic properties and is thus likely to ameliorate
persistent surgical pain. Therefore, the authors tested the primary
hypothesis that patients randomized to methylprednisolone have less
persistent incisional pain than those given placebo. Methods: One thousand
forty-three patients having cardiopulmonary bypass for cardiac surgery via
a median sternotomy were included in this substudy of Steroids in Cardiac
Surgery (SIRS) trial. Patients were randomized to 500 mg intraoperative
methylprednisolone or placebo. Incisional pain was assessed at 30 days and
6 months after surgery, and the potential risk factors were also
evaluated. Results: Methylprednisolone administration did not reduce pain
at 30 days or persistent incisional pain at 6 months, which occurred in 78
of 520 patients (15.7%) in the methylprednisolone group and in 88 of 523
patients (17.8%) in the placebo group. The odds ratio for
methylprednisolone was 0.93 (95% CI, 0.79 to 1.09, P = 0.37). Furthermore,
there was no difference in worst pain and average pain in the last 24 h,
pain interference with daily life, or use of pain medicine at 6 months.
Younger age, female sex, and surgical infections were associated with the
development of persistent incisional pain. Conclusions: Intraoperative
methylprednisolone administration does not reduce persistent incisional
pain at 6 months in patients recovering from cardiac surgery.
<3>
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Accession Number
2015448885
Authors
Bruce C.R. Liang C. Blumenthal-Barby J.S. Zimmerman J. Downey A. Pham L.
Theriot L. Delgado E.D. White D.
Institution
(Bruce, Liang, Blumenthal-Barby, Delgado) Department of Medicine, Center
for Medical Ethics and Health Policy, Baylor College of Medicine, Houston,
TX, United States
(Bruce) Department of Medicine, Houston Methodist Hospital System, Houston
Methodist Hospital System Biomedical Ethics Program, Houston, TX, United
States
(Zimmerman) Weill Cornell Medical College, New York, NY, United States
(Zimmerman) Division of Critical Care, Department of Medicine, Houston
Methodist Hospital, Houston, TX, United States
(Downey) Division of Palliative Care, Department of Nursing, Houston
Methodist Hospital, Houston, TX, United States
(Pham, Theriot) Division of Social Work, Department of Social Work and
Case Management, Houston Methodist Hospital, Houston, TX, United States
(White) Department of Critical Care Medicine, Program on Ethics and
Decision Making in Critical Illness, University of Pittsburgh Medical
Center, Pittsburg, PA, United States
Title
Barriers and facilitators to initiating and completing time-limited trials
in critical care.
Source
Critical Care Medicine. 43 (12) (pp 2535-2543), 2015. Date of Publication:
01 Dec 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: A time-limited trial is an agreement between clinicians and
patients or surrogate decision makers to use medical therapies over a
defined period of time to see if the patient improves or deteriorates
according to agreed-upon clinical milestones. Although time-limited trials
are broadly advocated, there is little empirical evidence of the benefits
and risks of time-limited trials, when they are initiated, when and why
they succeed or fail, and what facilitates completion of them. Our study
objectives were to 1) identify the purposes for which clinicians use
time-limited trials and 2) identify barriers and facilitators to
initiating and completing time-limited trials. Design: Semistructured
interviews: We analyzed interviews using qualitative description with
constant comparative techniques. Setting: Nine hundred-bed, academic,
tertiary hospital in Houston, Texas. Interviewees were from open medical,
surgical, neurosurgical, and cardiovascular ICUs. Subjects: Thirty
healthcare professionals were interviewed (nine surgeons, 16 intensivists,
three nurse practitioners, and two "other" clinicians). Interventions:
None. Measurements and Main Results: Interviewees reported initiating
time-limited trials for three different purposes: to prepare surrogates
and clinicians for discussion and possible shifts toward comfort-care only
therapies, build consensus, and refine prognostic information. The main
barriers to initiating time-limited trials involve clinicians' or
surrogate decision makers' disagreement on setting a time limit. Barriers
to completing time-limited trials include 1) requesting more time; 2)
communication breakdowns because of rotating call schedules; and 3)
changes in clinical course. Finally, facilitators to completing
time-limited trials include 1) having defined goals about what could be
achieved during an ICU stay, either framed in narrow, numeric terms or
broad goals focusing on achievable activities of daily living; 2) applying
time-limited trials in certain types of cases; and 3) taking ownership to
ensure completion of the trial. Conclusions: An understanding of barriers
and facilitators to initiating and completing time-limited trials is an
essential first step toward appropriate utilization of time-limited trials
in the ICUs, as well as developing educational or communication
interventions with clinicians to facilitate time-limited trial use. We
provide practical suggestions on patient populations in whom time-limited
trials may be successful, the setting, and clinicians likely to benefit
from educational interventions, allowing clinicians to have a fuller sense
of when and how to use time-limited trials.
<4>
Accession Number
2014741874
Authors
Torregrosa I. Montoliu C. Urios A. Andres-Costa M.J. Gimenez-Garzo C. Juan
I. Puchades M.J. Blasco M.L. Carratala A. Sanjuan R. Miguel A.
Institution
(Torregrosa, Juan, Puchades, Miguel) Servicio de Nefrologia, Hospital
Clinico Universitario de Valencia, Av Blasco Ibanez 17, Valencia 46010,
Spain
(Torregrosa, Puchades, Miguel) Departamento de Medicina, Universidad de
Valencia, Valencia, Spain
(Montoliu, Urios, Andres-Costa) Fundacion Investigacion Clinico de
Valencia Instituto de Investigacion Sanitaria, INCLIVA, Valencia, Spain
(Montoliu) Departamento de Patologia, Seccion Histologia, Facultad de
Medicina y Odontologia, Universidad de Valencia, Valencia, Spain
(Gimenez-Garzo) Laboratorio de Neurobiologia, Centro Investigacion
Principe Felipe, Valencia, Spain
(Blasco, Sanjuan) Unidad Coronaria, Hospital Clinico Universitario de
Valencia, Valencia, Spain
(Carratala) Laboratorio de Bioquimica Clinica y Patologia Molecular,
Hospital Clinico Universitario de Valencia, Valencia, Spain
Title
Urinary KIM-1, NGAL and L-FABP for the diagnosis of AKI in patients with
acute coronary syndrome or heart failure undergoing coronary angiography.
Source
Heart and Vessels. 30 (6) (pp 703-711), 2015. Date of Publication: 01 Nov
2015.
Publisher
Springer-Verlag Tokyo
Abstract
Acute kidney injury (AKI) is a common complication after coronary
angiography. Early biomarkers of this disease are needed since increase in
serum creatinine levels is a late marker. To assess the usefulness of
urinary kidney injury molecule-1 (uKIM-1), neutrophil
gelatinase-associated lipocalin (uNGAL) and liver-type fatty acid-binding
protein (uL-FABP) for early detection of AKI in these patients, comparing
their performance with another group of cardiac surgery patients.
Biomarkers were measured in 193 patients, 12 h after intervention. In the
ROC analysis, AUC for KIM-1, NGAL and L-FABP was 0.713, 0.958 and 0.642,
respectively, in the coronary angiography group, and 0.716, 0.916 and
0.743 in the cardiac surgery group. Urinary KIM-1 12 h after intervention
is predictive of AKI in adult patients undergoing coronary angiography,
but NGAL shows higher sensitivity and specificity. L-FABP provides
inferior discrimination for AKI than KIM-1 or NGAL in contrast to its
performance after cardiac surgery. This is the first study showing the
predictive capacity of KIM-1 for AKI after coronary angiography. Further
studies are still needed to answer relevant questions about the clinical
utility of biomarkers for AKI in different clinical settings.
<5>
Accession Number
2015511920
Authors
Ellis S.G. Kereiakes D.J. Metzger D.C. Caputo R.P. Rizik D.G. Teirstein
P.S. Litt M.R. Kini A. Kabour A. Marx S.O. Popma J.J. McGreevy R. Zhang Z.
Simonton C. Stone G.W.
Institution
(Ellis) Cleveland Clinic, Cleveland, OH, United States
(Kereiakes) Christ Hospital, Heart and Vascular Center, Lindner Research
Center, Cincinnati, OH, United States
(Kini) Mercy St. Vincent's Medical Center, Toledo, OH, United States
(Metzger) Wellmont Holston Valley Medical Center, Kingsport, TN, United
States
(Caputo) St. Joseph's Hospital Health Center, Liverpool, NY, United States
(Rizik) Scottsdale Healthcare, Scottsdale, AZ, United States
(Teirstein) Scripps Clinic, San Diego, CA, United States
(McGreevy, Zhang, Simonton) Abbott Vascular, Santa Clara, CA, United
States
(Litt) Baptist Medical Center, Jacksonville, FL, United States
(Kabour) Mount Sinai Medical Center, New York, United States
(Marx, Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, 111 E. 59th St., New York, NY 10022, United States
(Stone) Cardiovascular Research Foundation, New York, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, United States
Title
Everolimus-eluting bioresorbable scaffolds for coronary artery disease.
Source
New England Journal of Medicine. 373 (20) (pp 1905-1915), 2015. Date of
Publication: 12 Nov 2015.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: In patients with coronary artery disease who receive metallic
drug-eluting coronary stents, adverse events such as late target-lesion
failure may be related in part to the persistent presence of the metallic
stent frame in the coronary-vessel wall. Bioresorbable vascular scaffolds
have been developed to attempt to improve long-term outcomes. METHODS: In
this large, multicenter, randomized trial, 2008 patients with stable or
unstable angina were randomly assigned in a 2:1 ratio to receive an
everolimus-eluting bioresorbable vascular (Absorb) scaffold (1322
patients) or an everolimus-eluting cobalt-chromium (Xience) stent (686
patients). The primary end point, which was tested for both noninferiority
(margin, 4.5 percentage points for the risk difference) and superiority,
was target-lesion failure (cardiac death, target-vessel myocardial
infarction, or ischemia-driven target-lesion revascularization) at 1 year.
RESULTS: Target-lesion failure at 1 year occurred in 7.8% of patients in
the Absorb group and in 6.1% of patients in the Xience group (difference,
1.7 percentage points; 95% confidence interval, -0.5 to 3.9; P = 0.007 for
noninferiority and P = 0.16 for superiority). There was no significant
difference between the Absorb group and the Xience group in rates of
cardiac death (0.6% and 0.1%, respectively; P = 0.29), target-vessel
myocardial infarction (6.0% and 4.6%, respectively; P = 0.18), or
ischemia-driven target-lesion revascularization (3.0% and 2.5%,
respectively; P = 0.50). Device thrombosis within 1 year occurred in 1.5%
of patients in the Absorb group and in 0.7% of patients in the Xience
group (P = 0.13). CONCLUSIONS: In this large-scale, randomized trial,
treatment of noncomplex obstructive coronary artery disease with an
everolimus-eluting bioresorbable vascular scaffold, as compared with an
everolimus-eluting cobalt-chromium stent, was within the prespecified
margin for noninferiority with respect to target-lesion failure at 1 year.
<6>
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Accession Number
2015517324
Authors
Fan Y. Jiang Y. Fu X. Cai J. Wang Y. Li W. Gu X. Xing K. Bai S. Bi X.
Institution
(Fan, Cai) Department of Cardiology, Xingtai People's Hospital, Xingtai,
China
(Jiang, Fu, Wang, Li, Gu, Xing, Bai, Bi) Department of Cardiology, Second
Hospital of Hebei Medical University, No. 215, Heping West Road,
Shijiazhuang 050000, China
Title
Effects of liposomal prostaglandin E1 on periprocedural myocardial injury
in patients with unstable angina undergoing an elective percutaneous
coronary intervention.
Source
Coronary Artery Disease. 26 (8) (pp 671-677), 2015. Date of Publication:
03 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives The aim of this study was to explore whether intravenous
administration of liposomal prostaglandin E1 (lipo-PGE1) can reduce the
incidence of periprocedural myocardial injury (PMI) in patients with
unstable angina undergoing an elective percutaneous coronary intervention
(PCI). Patients and methods In this randomized-controlled study, a total
of 219 patients were randomly assigned to a lipo-PGE1 group (n=110) and a
control group (n=109). Patients in the lipo-PGE1 group received 20 mu
g/day of lipo-PGE1 diluted in 10 ml of normal saline through an
intravenous injection over 5min starting at 3 days before PCI and
continuing for 4 days after PCI. In the control group, 10ml of normal
saline was administered using the same method. The primary end point was
the occurrence of PMI defined as an elevation of cardiac troponin I above
the upper limit of normal within 24 h after the procedure. The secondary
end points were (i) changes in inflammatory factors including plasma
high-sensitivity C-reactive protein, tumor necrosis factor a, and
interleukin 6 before and at 24 h after PCI; (ii) the incidence of major
adverse cardiac events in the patients during hospitalization and 30 days
of follow-up after discharge, including cardiac deaths, severe heart
failure, malignant arrhythmias, and target vessel revascularization.
Results Within 24 h after PCI, the incidence of PMI was significantly
lower in the lipo-PGE1 group compared with that in the control group (20
vs. 36.69%, P=0.009). Although the procedure induced a significant
increase in highsensitivity C-reactive protein, tumor necrosis factor a,
and interleukin 6 levels, the values were significantly lower in the
lipo-PGE1 group than those in the control group at 24 h after PCI
(P<0.05). The proportion of thrombolysis in myocardial infarction grade 3
in the lipo-PGE1 group was higher than that in the control group (92.72
vs. 82.56%, P=0.037). There were no significant differences between the
lipo-PGE1 group and the control group in the incidence of major adverse
cardiac events during hospitalization and 30 days of follow-up (2.1 vs.
4%, P=0.72). Multivariate logistic analysis showed that lipo-PGE1 was an
independent protective factor against PMI (odds ratio 0.385, 95%
confidence interval 0.195-0.760, P=0.006). Conclusion Intravenous
lipo-PGE1 can reduce the incidence of PMI following elective PCI in
patients with unstable angina. The benefit of lipo-PGE1 may be associated
with the effects of anti-inflammation as well as improvement in coronary
microvascular perfusion.
<7>
Accession Number
2015514938
Authors
Jedlicka P. Sanak D. Drac P. Utikal P. Kocher M. Cerna M. Bachleda P.
Institution
(Drac, Jedlicka, Utikal, Bachleda) Second Department of Surgery,
University Hospital Olomouc, Olomouc, Czech Republic
(Sanak) Comprehensive Stroke Center, Department of Neurology, University
Hospital Olomouc, Olomouc, Czech Republic
(Drac) Department of Trauma Surgery, University Hospital Olomouc, P.
Pavlova 6, Olomouc 775 20, Czech Republic
(Kocher, Cerna) Department of Radiology, University Hospital Olomouc,
Olomouc, Czech Republic
Title
Is carotid endarterectomy for severe asymptomatic stenosis prior to or
simultaneous with unrelated non-cardiac surgery beneficial?.
Source
Italian Journal of Vascular and Endovascular Surgery. 22 (3) (pp 147-151),
2015. Date of Publication: September 2015.
Publisher
Edizioni Minerva Medica
Abstract
To date, no indication consent for carotid endarterectomy exists in
patients with asymptomatic severe carotid stenosis undergoing unrelated
noncardiac surgery. Aim of the paper was to critically review the
experience published in available world literature. The review of the
literature included relevant publications obtained within the last 15
years from these databases (and publications obtained from lists of their
references) were obtained from these databases: Medline/PubMed, Embase,
Scopus, Web of Science, Cochrane Library, DynaMed, UptoDate and from the
internet browser Google Scholar. Trials and case reports concerning the
topic were published in relatively small number, they have limitations and
their results are opposing. A sufficiently powerful prospective randomised
trial is needed to determine an optimal treatment strategy in patients
with asymptomatic severe carotid stenosis undergoing unrelated noncardiac
surgery.
<8>
Accession Number
2015514658
Authors
Gong Z. Xing S. Zheng F. Xing Q.
Institution
(Gong, Zheng, Xing) Department of Cardiology, Qianfoshan Hospital,
Shandong University, 16766 Jingshi Road, Jinan 250014, China
(Xing) Shandong University of Traditional Chinese Medicine, Jinan, China
Title
Increased expression of macrophage migration inhibitory factor in aorta of
patients with coronary atherosclerosis.
Source
Journal of Cardiovascular Surgery. 56 (4) (pp 631-637), 2015. Date of
Publication: August 2015.
Publisher
Edizioni Minerva Medica
Abstract
Aim: The aim of the present study was to investigate the changes of
macrophage migration inhibitory factor (MIF) in the aorta of patients with
coronary atherosclerosis and to evaluate the relationship between aortic
expression levels of MIF and atherosclerotic risk factors. Methods: We
collected discarded aortic specimens from patients (N.=36) undergoing
coronary artery bypass graft surgery (CABG), and studied the presence and
distribution of MIF by immunohistochemistry. The arterial tissues from 10
subjects without known atherosclerosis through the kidney donation program
were taken as control group. The preoperative serum triglycerides, total
cholesterol, low density lipoprotein cholesterol, high density lipoprotein
cholesterol, lipoprotein(a), apolipoprotein A, apolipoprotein B, total
bilirubin, direct bilirubin, and indirect bilirubin levels of patients
were examined and the coronary angiography was performed in order to
assess the severity of atherosclerotic lesions. Results: MIF was
detectable in aorta from CABG patients. The aortic MIF expression was
elevated in smokers, and patients with hypertension or diabetes. In
addition, the aortic MIF expression was associated with the levels of
triglycerides, total cholesterol, low density lipoprotein cholesterol,
lipoprotein (a), apolipoprotein B, total bilirubin, direct bilirubin,
indirect bilirubin and coronary severity scores in simple regression
analysis. However, the expression of MIF was only correlated to coronary
severity scores in multiple regression analysis. Conclusion: MIF is
overexpressed in aorta from patients with coronary atherosclerosis and the
aortic MIF expression is correlated with the severity of coronary artery
disease.
<9>
Accession Number
2015514657
Authors
Castano M. Gonzalez-Santos J.M. Lopez J. Garcia B. Centeno J.E. Aparicio
B. Bueno M.J. Diez R. Sagredo V. Rodriguez J.M. Garcia-Criado F.J.
Institution
(Castano) Department of Cardiac Surgery, Leon University Hospital, C/Altos
de Nava, s/n, Leon 24080, Spain
(Gonzalez-Santos, Lopez, Centeno, Bueno, Diez) Department of Cardiac
Surgery, Salamanca University Hospital, Salamanca, Spain
(Garcia, Garcia-Criado) Department of Surgery, School of Medicine,
University of Salamanca, Salamanca, Spain
(Aparicio) Department of Biochemistry, Salamanca University Hospital,
Salamanca, Spain
(Sagredo) Department of Intensive Care Medicine, Salamanca University
Hospital, Salamanca, Spain
(Rodriguez) Department and Anesthesiology, Salamanca University Hospital,
Salamanca, Spain
Title
Effect of preoperative oral pravastatin reload in systemic inflammatory
response and myocardial damage after coronary artery bypass grafting: A
pilot double-blind placebo-controlled study.
Source
Journal of Cardiovascular Surgery. 56 (4) (pp 617-629), 2015. Date of
Publication: August 2015.
Publisher
Edizioni Minerva Medica
Abstract
Aim: Statins exert pleiotropic effects that result in cardioprotective and
antiinflammatory properties. There is a lack of information about the
effect of preoperative reloading statin administration in surgical
coronary patients regarding myocardial protection, systemic inflammatory
response (SIR) attenuation and nitric oxide (NO) metabolism. Methods:
Thirty consecutive dyslipidemie patients under chronic treatment with
statins were randomized to orally receive pravastatin 80 mg (N.=10), 40 mg
(N.=10) or placebo (N.=10) two hours before anesthetic induction for
non-emergent on-pump coronary artery bypass grafting (CABG) procedures.
Perioperative peripheral venous and intraoperative CS blood samples were
collected for determination of drug-related adverse effects, NO metabolism
and both myocardial damage and SIR biomarkers. Results: Pravastatin
reloading resulted in a significant and dose-related intense attenuation
of SIR, but no differences in cardiac damage biomarker levels were
demonstrated. NO release and inducible nitric oxide synthase expression
was significantly reduced in both treatment groups. Highest pravastatin
doses significantly increased systemic creatine phosphokinase (CPK)
concentration compared with intermediate doses but no other adverse
effects were observed. Conclusion: Oral pravastatin reloading before
non-emergent CABG significantly attenuates postoperative SIR and systemic
NO/iNOS concentrations with no effect in perioperative myocardial damage.
Highest pravastatin doses increase CPK levels and must be avoided in
susceptible patients.
<10>
Accession Number
2015384044
Authors
Chong C.-R. Drury N.E. Licari G. Frenneaux M.P. Horowitz J.D. Pagano D.
Sallustio B.C.
Institution
(Chong, Drury, Licari, Horowitz, Sallustio) Cardiology and Clinical
Pharmacology Departments, Basil Hetzel Institute, Queen Elizabeth
Hospital, Woodville South, SA, Australia
(Chong, Horowitz) Medicine, University of Adelaide, Adelaide, SA,
Australia
(Drury, Pagano) Department of Cardiothoracic Surgery, Queen Elizabeth
Hospital Birmingham, Birmingham, United Kingdom
(Drury, Pagano) School of Clinical and Experimental Medicine, University
of Birmingham, Birmingham, United Kingdom
(Frenneaux) Norwich Medical School, University of East Anglia, Norwich,
United Kingdom
(Licari, Sallustio) Pharmacology, University of Adelaide, Adelaide, SA,
Australia
Title
Stereoselective handling of perhexiline: Implications regarding
accumulation within the human myocardium.
Source
European Journal of Clinical Pharmacology. 71 (12) (pp 1485-1491), 2015.
Date of Publication: 01 Dec 2015.
Publisher
Springer Verlag
Abstract
Purpose: Perhexiline is a prophylactic anti-ischaemic agent with weak
calcium antagonist effect which has been increasingly utilised in the
management of refractory angina. The metabolic clearance of perhexiline is
modulated by CYP2D6 metaboliser status and stereoselectivity. The current
study sought to (1) determine whether the acute accumulation of
perhexiline in the myocardium is stereoselective and (2) investigate the
relationship between duration of short-term therapy and the potential
stereoselective effects of perhexiline within myocardium. Method: Patients
(n = 129) from the active arm of a randomised controlled trial of
preoperative perhexiline in cardiac surgery were treated with oral
perhexiline for a median of 9 days. Correlates of atrial and ventricular
concentrations of enantiomers were sought via univariate followed by
multivariate analyses. Results: Myocardial uptake of both (+) and (-)
perhexiline was greater in ventricles than in atria, and there was more
rapid clearance of (-) than (+) perhexiline. The main determinants of
atrial uptake of both (+) and (-) perhexiline were the plasma
concentrations [(+) perhexiline: beta = -0.256, p = 0.015; (-)
perhexiline: beta = -0.347, p = 0.001] and patients' age [(+) perhexiline:
beta = 0.300, p = 0.004; (-) perhexiline: beta = 0.288, p = 0.005]. Atrial
uptake of (+) enantiomer also varied directly with duration of therapy
(beta = 0.228, p = 0.025), while atrial uptake of (-) perhexiline varied
inversely with simultaneous heart rate (beta = -0.240, p = 0.015).
Conclusion: (1) Uptake of both perhexiline enantiomers into atrium is
greater with advanced age and displays evidence of both saturability and
minor stereoselectivity. (2) Atrial uptake of (-) perhexiline may
selectively modulate heart rate reduction.
<11>
Accession Number
2015346043
Authors
Fairley J. Glassford N.J. Zhang L. Bellomo R.
Institution
(Fairley) Alfred Hospital, Prahran, VIC 3004, Australia
(Fairley) School of Public Health and Preventive Medicine, Monash
University, Prahran, VIC, Australia
(Glassford, Zhang, Bellomo) Department of Intensive Care, Austin Hospital,
Melbourne, VIC, Australia
(Glassford, Bellomo) Australian and New Zealand Intensive Care Research
Centre, School of Public Health and Preventive Medicine, Monash
University, Prahran, VIC, Australia
(Zhang) Department of Nephrology, West China Hospital of Sichuan
University, Chengdu, Sichuan, China
Title
Magnesium status and magnesium therapy in critically ill patients: A
systematic review.
Source
Journal of Critical Care. 30 (6) (pp 1349-1358), 2015. Article Number:
51907. Date of Publication: December 2015.
Publisher
W.B. Saunders
Abstract
Purpose: Magnesium is frequently measured and administered in general
intensive care unit patients. However, magnesium status, its association
with outcomes, and therapeutic utility in such patients are unclear. We
performed a systematic review of the relevant literature to define current
knowledge in this field. Materials and Methods: We searched MEDLINE,
CENTRAL, and EMBASE from 1975 to July 2014 for adult English language
articles excluding obstetric, non-intensive care unit based, and specific
population (poisoning, cardiothoracic, and neurosurgery) studies. We
identified articles on magnesium measurement, associations, and therapy.
We calculated pooled effect estimates from reported adjusted risk
estimates. Results: We identified 34 relevant studies. Total serum total
magnesium was the most commonly measure of magnesium status. Risk of
mortality was significantly increased with hypomagnesemia (odds ratio,
1.85; 95% confidence interval, 1.31-2.60). No consistent associations
existed between magnesemia or magnesium administration and any other
outcomes. Conclusions: Total serum magnesium levels are generally used to
estimate magnesium status in critical illness. Hypomagnesemia appears
associated with greater risk of mortality, but the efficacy of magnesium
administration is open to challenge.
<12>
[Use Link to view the full text]
Accession Number
2015447694
Authors
Davis J. Sanford D. Schilling J. Hardi A. Colditz G.
Institution
(Davis, Schilling) Division of Cardiology, Department of Internal
Medicine, United States
(Sanford, Colditz) Department of Surgery, United States
(Hardi) Becker Library, Washington University School of Medicine, St.
Louis, MO, United States
Title
Systematic review of outcomes after noncardiac surgery in patients with
implanted left ventricular assist devices.
Source
ASAIO Journal. 61 (6) (pp 648-651), 2015. Date of Publication: 03 Nov
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
The number of patients supported with left ventricular assist devices
(LVADs) is rising rapidly, and noncardiac surgery (NCS) in these patients
presents unique challenges. Given the controversy regarding the safety and
timing of elective NCS, we performed a systematic review examining the
perioperative morbidity and mortality of NCS in stable patients with
LVADs. The published literature was searched using strategies created by a
medical librarian. All reports involving five or more patients with
implanted LVAD undergoing NCS were eligible for inclusion. One hundred and
sixty one patients who underwent 252 surgeries were included from seven
studies. Cohort size ranged from 8 to 47 patients undergoing 12 to 67 NCS.
Median age ranged from 50.1 to 68 years and 75 to 100% were male. Thirty
day postoperative mortality ranged from 6.4 to 16.7%, although four
studies reported no deaths. Due to the small number of included studies
with relative few patients and widely heterogeneous reporting of outcomes
a formal quantitative meta-analysis was not performed. Noncardiac surgery
in patients with LVADs appears to be safe and feasible in select patients.
Future studies should use standard study design and reporting parameters
to facilitate the systematic examination of safety and outcomes for
elective NCS in LVAD patients.
<13>
Accession Number
2015512125
Authors
Acipayam M. Uncu H. Taraktas M. Altinay L. Hakan Zor M. Dotan P. Ozsoyler
I.
Institution
(Acipayam, Altinay) Mustafa Kemal University, School of Medicine,
Department of Cardiovascular Surgery Zulufluhan Koyu, Antakya, Hatay
31000, Turkey
(Uncu, Ozsoyler) Adana Numune Education and Research Hospital, Department
of Cardiovascular Surgery, Adana 01173, Turkey
(Taraktas) Hatay Antakya Government Hospital, Department of Cardiology,
Antakya, Hatay 31040, Turkey
(Hakan Zor) Gazi University, School of Medicine, Department of
Cardiovascular Surgery, Ankara 06500, Turkey
(Dotan) Adana Numune Education and Research Hospital, Department of
Anesthesiology, Adana 01173, Turkey
Title
Short-term graft patency of sequential and Y-graft in open heart surgery
with transit time flow measurement.
Source
Journal of Cardiovascular Surgery. 56 (5) (pp 793-797), 2015. Date of
Publication: October 2015.
Publisher
Edizioni Minerva Medica
Abstract
Aim: In this prospective study, we aimed to compare flow characteristics
and the short term patency of sequential and y-grafts by intraoperative
transit time flow measurement. Methods: Sixty patients were selected from
1374 isolated coronary bypass operations. Group 1 (N.=36) consisted of
sequential grafted, Group 2 (N.=24) consisted of y-grafted patients.
Intraoperative graft flow measurement was done with a transit time flow
meter at stable hemodynamic conditions. We follow up the groups at the
30<sup>th</sup> day of the operation. Results: The mean flows at
measurement set up were 43-2+/-19-7 niL/min in Group 1 and 43.6+/-21.7
ml/min in Group 2. After distal graft clamp removal the same values were
63.4+/-20.9 niL/min in Group 1 and 67.3+/-35.3 ml/mins in Group 2. At the
30<sup>th</sup> day of the operation no patients died, and none of them
had an acute myocardial infarction. Conclusion: The percent of flow
increase in sequential graft group was higher but the difference of the
percent of flow increase between groups was not statistically significant.
<14>
Accession Number
2015512132
Authors
Koutsoumpelis A. Kouvelos G. Peroulis M. Tzilalis V. Matsagkas M.
Institution
(Koutsoumpelis, Kouvelos, Peroulis, Matsagkas) Department of Surgery, Unit
of Vascular Surgery, Medical School, University of Ioannina, Ioannina
University Campus, S. Niarchos Avenue, Ioannina 45110, Greece
(Tzilalis) Division of Vascular Surgery, Department of Surgery, 401
General Military Hospital of Athens, Athens, Greece
Title
Surgical and endovascular intervention on internal carotid artery near
occlusion.
Source
International Angiology. 34 (2) (pp 172-181), 2015. Date of Publication:
April 2015.
Publisher
Edizioni Minerva Medica
Abstract
Therapeutic strategy for treating carotid artery near occlusion (CANO) has
been controversial. The aim of this study was to review the literature
concerning the invasive treatment of atherosclerotic CANO. A review was
conducted of the English medical literature from 1980 to 2013 using
Pub-Medand EMBASE database to find studies involving open or endovascular
management of CANO. The search identified 20 reports describing invasive
treatment of CANO encompassing 770 patients (77.7% men; mean age
66.3+/-5.2 years). A typical appearance of string sign was noted in nearly
60% of the patients. The vast majority (92.6%) were symptomatic. 479
(62.2%) patients underwent an open procedure, while 291 (38.8%) were
treated endovascularly. The technical success rate for the endovascular
procedures was 99%, while distal embolic protection devices were applied
in most patients (66%). The 30 days procedural stroke rate was 2.1% and
2.4% for open and endovascular repair respectively. During a follow-up
period spanning an average of approximately two years the ipsilateral
cerebrovascular event rate was 5% and 1.2% for open and endovascular
treatmentrespectively. Twenty five (5.2%) restenosis or occlusions were
reported for the open procedures, while 13 (5.4%) were also documented for
endovascular repair. The current literature concerning the invasive
treatment of CANO is weak and cannot support any evidence based
recommendation. The necessity to intervene as well as the best therapeutic
strategy remains controversial. This review shows that the interventionon
symptomatic CANO may consist a relatively safe and effective therapeutic
strategy with low perioperative cerebrovascular morbidity for both
treatment modalities, although durability and long-term outcomes should be
further affirmed. The low incidence of this entity and the dearth of clear
evidence support the need for a large multicenter registry to clarify the
absolute indications for intervention and define the best therapeutic
approach.
<15>
Accession Number
2015502612
Authors
Probst S. Cech C. Haentschel D. Scholz M. Ender J.
Institution
(Probst, Cech, Ender) University of Leipzig, Department of Anaesthesiology
and Intensive Care Medicine II, Leipzig Heart Centre, Struempellstrasse
39, Leipzig 04289, Germany
(Cech) University of Leipzig, Medical Faculty, Department of
Anaesthesiology and Intensive Care Medicine, Liebigstrasse 20, Leipzig
04103, Germany
(Haentschel) Heart Centre Coswig, Department of Anaesthesiology and
Intensive Care Medicine, Lerchenfeld 1, Coswig 06869, Germany
(Scholz) University of Leipzig, Institute of Medical Informatics,
Statistics and Epidemiology, Hartelstrase 16-18, Leipzig 04107, Germany
Title
A specialized post-anaesthetic care unit improves fast-track management in
cardiac surgery: A prospective randomized trial.
Source
Critical Care. 18 (4) , 2014. Article Number: 468. Date of Publication:
August 15, 2014.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Fast-track treatment in cardiac surgery has become the
global standard of care. We compared the efficacy and safety of a
specialised post-anaesthetic care unit (PACU) to a conventional intensive
care unit (ICU) in achieving defined fast-track end points in adult
patients after elective cardiac surgery. Methods: In a prospective,
single-blinded, randomized study, 200 adult patients undergoing elective
cardiac surgery (coronary artery bypass graft (CABG), valve surgery or
combined CABG and valve surgery), were selected to receive their
postoperative treatment either in the ICU (n = 100), or in the PACU (n =
100). Patients who, at the time of surgery, were in cardiogenic shock,
required renal dialysis, or had an additive EuroSCORE of more than 10 were
excluded from the study. The primary end points were: time to extubation
(ET), and length of stay in the PACU or ICU (PACU/ICU LOS respectively).
Secondary end points analysed were the incidences of: surgical
re-exploration, development of haemothorax, new-onset cardiac arrhythmia,
low cardiac output syndrome, need for cardiopulmonary resuscitation,
stroke, acute renal failure, and death. Results: Median time to extubation
was 90 [50; 140] min in the PACU vs. 478 [305; 643] min in the ICU group
(P <0.001). Median length of stay in the PACU was 3.3 [2.7; 4.0] hours vs.
17.9 [10.3; 24.9] hours in the ICU (P <0.001). Of the adverse events
examined, only the incidence of new-onset cardiac arrhythmia (25 in PACU
vs. 41 in ICU, P = 0.02) was statistically different between groups.
Conclusions: Treatment in a specialised PACU rather than an ICU, after
elective cardiac surgery leads to earlier extubation and quicker discharge
to a step-down unit, without compromising patient safety. Trial
registration:ISRCTN71768341.
<16>
Accession Number
72074702
Authors
Cantoni V. Green R. Acampa W. Petretta M. De Matteis G. Russo B. Mannarino
T. Salvatore M. Cuocolo A.
Institution
(Cantoni, Green, De Matteis, Russo, Mannarino, Cuocolo) Department of
Advanced Biomedical Sciences, University of Naples Federico II, Naples,
Italy
(Acampa) Institute of Biostructure and Bioimaging, National Council of
Research, Naples, Italy
(Petretta) Department of Translational Medical Sciences, University of
Naples 'Federico II', Naples, Italy
(Salvatore) IRCCS SDN, Naples, Italy
Title
Long-term prognostic value of stress myocardial perfusion imaging and
coronary computed tomography angiography: A meta-analysis.
Source
European Journal of Nuclear Medicine and Molecular Imaging. Conference:
28th Annual Congress of the European Association of Nuclear Medicine, EANM
2015 Hamburg Germany. Conference Start: 20151010 Conference End: 20151014.
Conference Publication: (var.pagings). 42 (1 SUPPL. 1) (pp S72-S73), 2015.
Date of Publication: October 2015.
Publisher
springer berlin
Abstract
Aim: Although stress myocardial perfusion imaging (MPI) by single photon
emission computed tomography and coronary computed tomography angiography
(CCTA) should be considered complementary, as the anatomical data provided
by CCTA differ from the functional information obtained by stress MPI, in
clinical these two imaging modalities are alternatively used. Thus, we
performed a meta-analysis of published studies, including patients with
suspected or known coronary artery disease (CAD), to compare the long-term
predictive value for adverse cardiac events of stress MPI and CCTA.
Material and methods: An English literature search was performed using the
PubMed, Cochrane, Web of Science, and Scopus database to identify articles
published between January 2000 and June 2014. To harmonize the predictors
of interest, a study was included if all of the following criteria were
met: 1) reported a prospective or retrospective analysis of subjects with
suspected or known CAD referred for stress MPI to search inducible
ischemia or CCTA to detect significant stenosis; 2) provided the
unadjusted and/or adjusted hazard ratio (HR) at Cox regression analyses of
dichotomous abnormal versus normal perfusion at MPI or coronary stenosis
>50% luminal narrowing at CCTA; 3) provided primary data on clinical
outcomes for adverse events with a follow-up >2.5 years; 4) included >100
patients. Results: Total of 20 articles (10 MPI and 10 CCTA) were finally
included, recruiting 22, 280 patients (13,484 in MPI and 8,796 in CCTA
studies). The pooled HR for the occurrence of the primary end point was
lower (P=0.04) for MPI (HR 2.60, 95% confidence interval, CI, 2.06-3.29)
compared to CCTA (HR 5.70, 95% CI 2.68- 12.1). Among the included
publications, 4 MPI and 4 CCTA studies reported the HR for the occurrence
of hard events (nonfatal myocardial infarction or cardiac death). The
pooled HR was comparable (P=0.11) for MPI (HR 2.75, 95%CI 2.11- 3.59) and
CCTA (HR 5.34, 95% CI 2.46-11.60) studies. The HR for the occurrence of a
combined end point including revascularization was reported in 5 MPI and 6
CCTA studies. The pooled HR was higher (P=0.002) for CCTA (HR 8.27, 95%
3.77-18.14) compared to MPI (HR 2.84, 95% CI 1.68- 4.79). Conclusion: CCTA
appears more predictive than MPI when coronary revascularization is
included in the end point. On the other hand, no differences exist in the
prognostic effectiveness of MPI and CCTA for the occurrence of hard
events.
<17>
Accession Number
72072375
Authors
Rossi C. Prefumo F.
Institution
(Rossi) Clinic of Obstetrics and Gynecology, Ospedale Delle Murge,
Altamura, Bari, Italy
(Prefumo) Clinic of Obstetrics and Gynecology, University of Brescia,
Brescia, Italy
Title
Longer term outcomes of cardiac function after laser therapy for twin-twin
transfusion syndrome: A systematic review of literature.
Source
Prenatal Diagnosis. Conference: 19th International Conference on Prenatal
Diagnosis and Theraphy, ISPD 2015 Washington, DC United States. Conference
Start: 20150712 Conference End: 20150715. Conference Publication:
(var.pagings). 35 (pp 95-96), 2015. Date of Publication: July 2015.
Publisher
John Wiley and Sons Ltd
Abstract
OBJECTIVES: To review literature about cardiac function at follow up in
twins treated with in-utero laser therapy for twin-twin transfusion
syndrome (TTTS). METHODS: A search in PubMed, Medline; EMBASE, reference
lists was performed to review articles that reported cardiological follow
up of twins treated with laser therapy for TTTS. Inclusion criteria for
study selection were: TTTS treated with laser therapy, cardiac assessment
after>28 days postnatally, data reported as proportional rates. Exclusion
criteria were: TTTS treated with amnioreduction or expectant management,
case reports, data reported in graphs or percentage. Type of cardiac
disease, length of follow up and cardiac morbidity rates were abstracted
from each article. RESULTS: From 5 articles, 248 twins treated with laser
therapy for TTTS were pooled. Length of follow up ranged from 21 to 120
months. Cardiac disease was present in 16 twins (6.4%), in which 40
defects were detected. Thus, at least 2 cardiac defects were detected in
each twin. Themost frequent cardiac anomaly was pulmonary stenosis (11/40,
27%), followed by patent ductus arteriosus (9/40; 22%), valvular defects
(9/40; 22%), atrial and ventricular septal defects (6/40; 15%), ductus
venosus negative A wave (4/40; 10%), and ventricular dilatation (1/40;
4%). Only 3 (18%) twins required surgery for cardiac disease, which was
successful in all cases. Four articles reported prenatal cardiac disease
after laser therapy. Of 227 twins, cardiacmorbidity was present at birth
in 61 (27%) cases and persisted at follow up in 16 twins (7%).
CONCLUSIONS: Cardiac function improves after laser therapy for TTTS. Only
in a minority of cases, cardiac disease persists at follow up and might
require surgical intervention.
<18>
Accession Number
72072173
Title
Sleep Down Under 2015, Cycles, 27th ASM of Australasian Sleep Association
and Australasian Sleep Technologists Association.
Source
Sleep and Biological Rhythms. Conference: 27th ASM of Australasian Sleep
Association and Australasian Sleep Technologists Association: Cycles,
Sleep DownUnder 2015 Melbourne, VIC Australia. Conference Start: 20151022
Conference End: 20151024. Conference Publication: (var.pagings). 13 ,
2015. Date of Publication: October 2015.
Publisher
Blackwell Publishing
Abstract
The proceedings contain 265 papers. The topics discussed include: role of
inflammation in the cardiometabolic co-morbidities of sleep apnoea;
effects of evening versus morning administration of an ace-inhibitor on 24
hour blood pressure control in patients with obstructive sleep apnoea and
hypertension: a double blind randomised controlled trial; how the brain
controls upper airway muscles to maintain airway patency; arousal induced
hypocapnia is not detrimental to genioglossus muscle activity following
the return to sleep in obstructive sleep apnea; zopiclone increases the
respiratory arousal threshold without impairing genioglossus muscle
activity in obstructive sleep apnoea; the effect of obstructive sleep
apnoea on the relationship between sigma power and memory performance in
mild cognitive impairment; elimination of central sleep apnoea by cardiac
valve replacement in patients with rheumatic valvular heart disease; and
insights into heart failure related sleep disordered breathing from
exercise and sleep monitoring.
<19>
Accession Number
26079777
Authors
Blaha J. Mraz M. Kopecky P. Stritesky 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) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Mraz) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Kopecky) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Stritesky) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Lips) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Matias) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Kunstyr) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Porizka) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Kotulak) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Kolnikova) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Simanovska) Department of Anesthesia, Resuscitation and Intensive
Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S.,
M.Z., J.R., R.S.), Third Department of Medicine-Department of
Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of
Surgery- Department of Cardiovascular Surgery (J.L.), General University
Hospital, Charles University in Prague First Faculty of Medicine, 128 08
Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty
of Electrical Engineering, Czech Technical University, 121 35 Prague 2,
Czech Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Zakharchenko) Department of Anesthesia, Resuscitation and Intensive
Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S.,
M.Z., J.R., R.S.), Third Department of Medicine-Department of
Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of
Surgery- Department of Cardiovascular Surgery (J.L.), General University
Hospital, Charles University in Prague First Faculty of Medicine, 128 08
Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty
of Electrical Engineering, Czech Technical University, 121 35 Prague 2,
Czech Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Rulisek) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Sachl) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Anyz) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Novak) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Lindner) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Hovorka) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Svacina) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
(Haluzik) Department of Anesthesia, Resuscitation and Intensive Medicine
(J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R.,
R.S.), Third Department of Medicine-Department of Endocrinology and
Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery-
Department of Cardiovascular Surgery (J.L.), General University Hospital,
Charles University in Prague First Faculty of Medicine, 128 08 Prague 1,
Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of
Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech
Republic; and Institute of Metabolic Science (R.H.), University of
Cambridge, Cambridge CB2 3AD, United Kingdom
Title
Perioperative Tight Glucose Control Reduces Postoperative Adverse Events
in Nondiabetic Cardiac Surgery Patients.
Source
The Journal of clinical endocrinology and metabolism. 100 (8) (pp
3081-3089), 2015. Date of Publication: 01 Aug 2015.
Abstract
RESULTS: In the whole cohort, perioperatively initiated TGC markedly
reduced the number of postoperative complications (23.2% vs 34.1%, 95%
confidence interval [CI], 0.60-0.78) despite only minimal improvement 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% vs 37.3% +/- 13.8%, P < .001).
The positive effects of TGC on postoperative complications were driven 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.
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.
<20>
Accession Number
23907693
Authors
Schneider R. Schneider C. Bansch D.
Institution
(Schneider, Schneider, Bansch) Heart Center Rostock, Department of
Cardiology, University of Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock,
Germany
Title
Spontaneous left atrial reentry tachycardias : radiofrequency ablation and
outcome.
Source
Herz. 40 (1) (pp 66-72), 2015. Date of Publication: 01 Feb 2015.
Abstract
AIMS: Spontaneous left atrial reentry tachycardias (LART) in patients
without previous cardiac surgical or catheter ablation are rare. Several
therapeutic concepts of catheter ablation have been suggested: linear
lesions (LL), circumferential pulmonary vein isolation (PVI), and both (LL
+ PVI).
METHODS AND RESULTS: In all, 28 consecutive symptomatic patients with 51
LARTs presented to our institution for catheter ablation.
Electroanatomical mapping was performed on 25 patients. Three patients
were ablated conventionally during LART; 25 patients (89.3%) had extensive
low-voltage areas in the left atrium (atrial myopathy). One of the
following ablation strategies was applied: first, LL (n=8), second, PVI +
LL (n=11), and third PVI alone (n=9). Fourteen patients (50%) had a
recurrent arrhythmia during a mean follow-up of 12.2+/-11.1 months. Six
patients presented with a recurrent LART (21.4%), 4 with LART and atrial
fibrillation (Afib) (14.3%), and 4 with Afib (14.3%). The recurrence rate
of any arrhythmia (LART and Afib) was 37.5% in the LL group, 44.4% in the
PVI group, and 63.6% in the PVI + LL group (ns); the recurrence rate of
LARTs was 12.5% in the LL group, 22.2% in the PVI group, and 63.6% in the
PVI + LL group (p<0.05).
CONCLUSION: Atrial tachyarrhythmia recurrence after ablation of
spontaneous LART in mid-term is considerable. Stable LARTs are effectively
treated by LL. PVI alone may be an acceptable alternative, especially in
patients with unstable LARTs and Afib. However, the risk of recurrent
LARTs after a more extensive strategy with PVI and LL is considerable,
probably due to proarrhythmic effects of long linear lesions.
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