EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2015717478
Author
Gupta A.; Smith D.A.
Institution
(Gupta) Division of Endocrinology, Diabetes, and Bone Diseases, Icahn
School of Medicine at Mount Sinai, Box 1055, New York, NY 10029, United
States
(Smith) Mount Sinai Heart, Icahn School of Medicine, Box 1014, 1 Gustave
Levy Place, New York, NY 10029-6574, United States
Title
The 2013 American college of cardiology/American heart association
guidelines on treating blood cholesterol and assessing cardiovascular
risk: A busy practitioner's guide.
Source
Endocrinology and Metabolism Clinics of North America. 43 (4) (pp
869-892), 2014. Date of Publication: 2014.
Publisher
W.B. Saunders
Abstract
The 2013 ACC/AHA risk assessment and cholesterol treatment guidelines
emphasize important core concepts and introduce new concepts for risk
assessment. They differ substantially from the previous ATP-III
guidelines, particularly with respect to primary prevention of CVD. The
ATP-III guidelines place more emphasis on levels of LDL-C to select
patients for statin therapy, whereas the new guidelines base the
recommendation solely on the 10-year ASCVD predicted risk, as long as the
LDL-C level is 70 to 189 mg/dL or higher. High-intensity statin treatment
is recommended in all people with known ASCVD irrespective of their LDL-C
levels and in those without such disease but at high LDL-C levels greater
than or equal to 190 mg/dL or with diabetes with increased ASCVD risk. The
guidelines have identified patient groups in which a more intensive
treatment is superior to a moderate treatment, and focus on statins as the
mainstay of therapy rather than clinically unproven lipid-lowering drug
combinations. These steps are important to simplify and improve care for
high-risk individuals. It is recommended that clinicians determine an
individual's absolute 10-year risk score by standard clinical testing in
order to engage in a meaningful clinician-patient discussion regarding the
potential for ASCVD risk reduction, treatment adverse effects, drug-drug
interactions, and patient preferences. The recommendation to treat
individuals with 10-year risks of 7.5% or greater has been boosted by the
newest validation study of REGARDS18; the validity of lifetime risk
prediction algorithms remain controversial but may help in stimulating
more serious conversations between doctors and patients at younger ages
when 10-year risk is low. According to these new guidelines, more than 30
million people without existing CVD might be candidates for statin
therapy. These large numbers should mobilize the medical community to
ientify potentially modifiable risk factors affected by lifestyle and
institute behavioral changes before starting statins in order to further
contain the epidemic of CVD. They are intended to guide decision making
but not replace clinical judgment

<2>
Accession Number
25596472
Author
van Osch D.; Dieleman J.M.; van Dijk D.; Jacob K.A.; Kluin J.; Doevendans
P.A.; Nathoe H.M.
Institution
(van Osch) Department of Cardiology, University Medical Center Utrecht,
Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
(Dieleman) Department of Anesthesiology and Intensive Care, University
Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The
Netherlands
(van Dijk) Department of Anesthesiology and Intensive Care, University
Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The
Netherlands
(Jacob) Department of Cardiothoracic surgery, University Medical Center
Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
(Kluin) Department of Cardiothoracic surgery, University Medical Center
Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
(Doevendans) Department of Cardiology, University Medical Center Utrecht,
Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
(Nathoe) Department of Cardiology, University Medical Center Utrecht,
Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Electronic address:
h.m.nathoe@umcutrecht.nl
Title
Dexamethasone for the prevention of postoperative atrial fibrillation.
Source
International journal of cardiology. 182 (pp 431-437), 2015. Date of
Publication: 01 Mar 2015.
Abstract
BACKGROUND: Postoperative atrial fibrillation (AF) is a common
complication after cardiac surgery. Inflammation is believed to play a
pivotal role in the etiology of postoperative AF. There is a suggestion
from small studies that perioperative treatment with corticosteroids may
reduce postoperative AF. The DExamethasone for Cardiac Surgery (DECS)
study was a large randomized trial showing no protective effect of
dexamethasone on major adverse events. The aim of this study was to
investigate the effect of dexamethasone treatment on the occurrence of AF
after cardiac surgery.
METHODS: The DECS study compared intra-operative dexamethasone (1mg/kg) or
placebo treatment in 4494 adult patients undergoing cardiac surgery. AF
was defined by the occurrence of any reported AF within 30days after
surgery. We also performed an in-depth analysis of a subset of 1565
patients on new-onset AF. Relative risks (RRs) with 95% confidence
intervals (CIs) were calculated.
RESULTS: The incidence of any AF in the main study of 4494 patients was
33.1% in the dexamethasone and 35.2% in the placebo group (RR 0.94, 95%
CI: 0.87-1.02, p=0.14). In the substudy of 1565 patients, the incidence of
new-onset AF was 33.0% vs. 35.5% (RR 0.93, 95% CI: 0.81-1.07, p=0.31),
respectively. There was no protective effect of dexamethasone across
clinically important patient subgroups.
CONCLUSION: Intraoperative administration of dexamethasone had no
protective effect on the occurrence of any or new-onset atrial
fibrillation after cardiac surgery. Therefore, the use of dexamethasone
for the reduction of postoperative AF should not be recommended.

<3>
Accession Number
25596468
Author
Reuter P.-G.; Rouchy C.; Cattan S.; Benamer H.; Jullien T.; Beruben A.;
Montely J.-M.; Assez N.; Raphael V.; Hennequin B.; Boccara A.; Javaud N.;
Soulat L.; Adnet F.; Lapostolle F.
Institution
(Reuter) Service des Urgences et Service d'Aide Medicale Urgente, Centre
Hospitalier Universitaire Avicenne, Assistance Publique-Hopitaux de Paris,
125 rue de Stalingrad, 93009 Bobigny Cedex, France; Universite Paris 13,
Sorbonne Paris Cite, EA 3509 Bobigny, France. Electronic address:
(Rouchy) Service des Urgences et Service d'Aide Medicale Urgente, Centre
Hospitalier de Chateauroux, 216 Avenue de Verdun, 36000 Chateauroux,
France
(Cattan) Departement de Cardiologie, Groupe Hospitalier Intercommunal Le
Raincy-Montfermeil, 10 Rue du General Leclerc, 93370 Montfermeil, France
(Benamer) Departement de Cardiologie, Clinique la Roseraie, 120 Avenue de
la Republique, 93300 Aubervilliers, France
(Jullien) Departement de Cardiologie, Centre Cardiologique du Nord, 36 Rue
des Moulins Gemeaux, 93200 Saint-Denis, France
(Beruben) Service Mobile d'Urgence et de Reanimation, Groupe Hospitalier
Intercommunal Le Raincy-Montfermeil, 10 Rue du General Leclerc, 93370
Montfermeil, France
(Montely) Departement de Cardiologie, Centre Hospitalier Intercommunal
Robert Ballanger, Boulevard Robert Ballanger, 93600 Aulnay-sous-Bois,
France
(Assez) Service d'Aide Medicale Urgente du Nord Pole de l'Urgence, Centre
Hospitalier Regional Universitaire de Lille, 5 avenue Oscar-Lambret, 59037
Lille Cedex, France
(Raphael) Service Mobile d'Urgence et de Reanimation, Centre Hospitalier
Intercommunal Robert Ballanger, Boulevard Robert Ballanger, 93600
Aulnay-sous-Bois, France
(Hennequin) Service Mobile d'Urgence et de Reanimation, Centre hospitalier
de Saint-Denis, 2 Rue du Docteur Delafontaine, 93200 Saint-Denis, France
(Boccara) Departement de Cardiologie, Centre Hospitalier Intercommunal
Andre Gregoire, 56 Boulevard de la Boissiere, 93100 Montreuil, France
(Javaud) Service des Urgences, Centre Hospitalier Universitaire Jean
Verdier, Assistance Publique-Hopitaux de Paris, Avenue du 14 Juillet,
93140 Bondy, France
(Soulat) Service des Urgences et Service d'Aide Medicale Urgente, Centre
Hospitalier de Chateauroux, 216 Avenue de Verdun, 36000 Chateauroux,
France
(Adnet) Service des Urgences et Service d'Aide Medicale Urgente, Centre
Hospitalier Universitaire Avicenne, Assistance Publique-Hopitaux de Paris,
125 rue de Stalingrad, 93009 Bobigny Cedex, France; Universite Paris 13,
Sorbonne Paris Cite, EA 3509 Bobigny, France
(Lapostolle) Service des Urgences et Service d'Aide Medicale Urgente,
Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hopitaux de
Paris, 125 rue de Stalingrad, 93009 Bobigny Cedex, France; Universite
Paris 13, Sorbonne Paris Cite, EA 3509 Bobigny, France
Title
Early invasive strategy in high-risk acute coronary syndrome without
ST-segment elevation. The Sisca randomized trial.
Source
International journal of cardiology. 182 (pp 414-418), 2015. Date of
Publication: 01 Mar 2015.
Abstract
BACKGROUND: The optimal therapeutic strategy for patients with high-risk
acute coronary syndrome without ST-segment elevation (NSTE-ACS) remains
unclear.
OBJECTIVE: Our aim was to compare the effectiveness of an early invasive
strategy and a delayed invasive strategy in the management of high-risk
NSTE-ACS patients.
METHODS: This randomized clinical trial in a primarily pre-hospital
setting enrolled patients with chest pain, electrocardiographic criteria
for an NSTE-ACS, and at least one criterion of severity (ESC criterion or
TIMI score >5). Patients were randomized to either an early invasive
strategy (tirofiban infusion and coronary angiography within 6h) or
delayed invasive strategy (as per guidelines and physician discretion;
coronary angiography within 6h was not advised). The primary endpoint was
the cumulative incidence of deaths, myocardial infarctions, or urgent
revascularizations at 30days of follow-up. Secondary endpoints were
failure of delayed management, length of hospital stay and long-term
mortality.
RESULTS: Between January 2007 and February 2010, 170 patients were
enrolled. The cumulative incidence of adverse outcomes was significantly
lower for early invasive than delayed management (2% [95% CI 0-9] vs. 24%
[95% CI 16-35], p<10(-4)). Delayed management failed in 24% of cases. The
length of hospital stay was significantly shorter in patients undergoing
angioplasty or treated with tirofiban within 6h (p=0.0003). Long-term
mortality was 16% in both arms after a median follow-up of 4.1years.
CONCLUSION: An early invasive strategy reduced major adverse cardiac
events in patients with high-risk NSTE-ACS. Early angiography or tirofiban
(GP IIb/IIIa inhibitor) infusion proved necessary in a quarter of patients
assigned to delayed management.

<4>
Accession Number
25617608
Author
Orlandini A.; Castellana N.; Pascual A.; Botto F.; Cecilia Bahit M.;
Chacon C.; Luz Diaz M.; Diaz R.
Institution
(Orlandini) ECLA (Estudios Clinicos Latino America), Argentina. Electronic
address: aorlandinimd@eclainternational.org
(Castellana) ECLA (Estudios Clinicos Latino America), Argentina
(Pascual) ECLA (Estudios Clinicos Latino America), Argentina
(Botto) ECLA (Estudios Clinicos Latino America), Argentina
(Cecilia Bahit) ECLA (Estudios Clinicos Latino America), Argentina
(Chacon) ECLA (Estudios Clinicos Latino America), Argentina
(Luz Diaz) ECLA (Estudios Clinicos Latino America), Argentina
(Diaz) ECLA (Estudios Clinicos Latino America), Argentina
Title
Myocardial viability for decision-making concerning revascularization in
patients with left ventricular dysfunction and coronary artery disease: a
meta-analysis of non-randomized and randomized studies.
Source
International journal of cardiology. 182 (pp 494-499), 2015. Date of
Publication: 01 Mar 2015.
Abstract
BACKGROUND: Myocardial viability tests have been proposed as a key factor
in the decision-making process concerning coronary revascularization
procedures in patients with left ventricular dysfunction and coronary
artery disease (LVD-CAD).
METHODS: We performed a systematic review and meta-analysis of studies
that compared medical treatment with revascularization in patients with
viable and non-viable myocardium and recorded mortality as outcome.
RESULTS: Thirty-two non-randomized (4328 patients) and 4 randomized (1079
patients) studies were analyzed. In non-randomized studies,
revascularization provided a significant mortality benefit compared with
medical treatment (p<0.05). Since the heterogeneity was significant
(p<0.05) a viability subgroup analysis was performed, showing that
revascularization provided a significant mortality benefit compared with
medical treatment in patients with viable myocardium (p<0.05) but not in
patients without (p=0.34). There was a significant subgroup effect
(p<0.05) related to the intensity of the effect, but not to the direction.
In randomized studies, revascularization did not provide a significant
mortality benefit compared with medical treatment in either patients with
viable myocardium or those without (p=0.21). There was no significant
subgroup effect (p=0.72). Neither non-randomized nor randomized studies
demonstrated any significant difference in outcomes between patients with
and without viable myocardium.
CONCLUSIONS: The available data are inconclusive regarding the usefulness
of myocardial viability tests for the decision-making process concerning
revascularization in LVD-CAD patients. Patients with viable myocardium
appear to benefit from revascularization, but similar benefits were
observed in patients without viable myocardium. Moreover, a neutral or
adverse effect of revascularization cannot be excluded in either group of
patients.

<5>
Accession Number
20160310678
Author
Zhang L.; Diao Y.; Chen G.; Tanaka A.; Eastwood G.M.; Bellomo R.
Institution
(Zhang, Diao) Department of Nephrology, West China Hospital of Sichuan
University, Sichuan, Chengdu, China
(Chen) Department of Anesthesiology, Austin Hospital, 145 Studley Road,
Heidelberg, VIC 3084, Australia
(Zhang, Tanaka, Eastwood, Bellomo) Department of Intensive Care Unit,
Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia
(Eastwood, Bellomo) Australian and New Zealand Intensive Care Research
Centre, Melbourne, VIC, Australia
Title
Remote ischemic conditioning for kidney protection: A meta-analysis.
Source
Journal of Critical Care. 33 (pp 224-232), 2016. Date of Publication: 01
Jun 2016.
Publisher
W.B. Saunders
Abstract
Background: Results from randomized controlled trials (RCTs) concerning
kidney effect of remote ischemic conditioning (RIC) are inconsistent.
Methods: We searched for relevant studies in Medline, Embase, the Cochrane
Library, Google Scholar and Chinese database (SinoMed), as well as
relevant references from their inception to November 2015. We performed a
systematic review and meta-analysis of all eligible RCTs of RIC with
kidney events. Results: We included 37 RCTs from 2007 to 2015 involving
8168 patients. Pooled analyses of all RCTs showed RIC significantly
reduced the incidence of investigator-defined acute kidney injury (AKI)
compared with control groups (RR 0.84, 95% CI 0.73-0.96, P =.009)
(I² = 25%). However, the difference was not significant when
only RIFLE (Risk, Injury, Failure, Loss, End Stage), AKIN (Acute Kidney
Injury Network), or KDIGO (Kidney Disease Improving Global Outcomes)
criteria were applied to the definition of AKI (RR 0.87, 95% CI 0.74-1.02,
P =.08) (I² = 22%). In subgroup analysis, RIC showed a
significant benefit on reducing investigator-defined AKI in patients
following percutaneous coronary intervention (RR 0.64, 95% CI 0.46-0.87),
but not after cardiac surgery (RR 0.93, 95% CI 0.82-1.06). There was no
difference for changes in the incidence of renal replacement therapy,
estimated glomerular filtration rate or serum creatinine. Conclusions: RIC
might be beneficial for the prevention of investigator-defined AKI;
however, the effect is likely small. Moreover, due to lack of an effect on
use of renal replacement therapy, estimated glomerular filtration rate,
RIFLE, AKIN, or KDIGO-defined AKI, and serum creatinine, the evidence for
RIC is not robust. Finally, recent large-scale RCTs of RIC focusing on
patient-centered outcomes do not support the wider application of RIC.

<6>
Accession Number
20160303586
Author
Poyrazoglu H.H.; Duman Z.; Demir S.; Avsar M.K.; Atalay A.; Ciftci B.;
Bayraktar I.; Tor F.
Institution
(Poyrazoglu, Duman, Atalay, Ciftci, Bayraktar, Tor) Department of
Cardiovascular Surgery, Cukurova University School of Medicine, Adana,
Turkey
(Demir) Department of Cardiology, Adana State Hospital, Adana, Turkey
(Avsar) Department of Cardiovascular Surgery, Medicana International
Hospital, Istanbul, Turkey
Title
Investigating the impacts of preoperative steroid treatment on tumor
necrosis factor-alpha and duration of extubation time underwent
ventricular septal defect surgery.
Source
Balkan Medical Journal. 33 (2) (pp 158-163), 2016. Date of Publication:
March 2016.
Publisher
AVES Ibrahim Kara (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey)
Abstract
Background: Cardiopulmonary bypass is known to cause inflammatory events.
Inflammation occurs due to many known important biological processes.
Numerous mechanisms are known to be responsible for the development of
inflammatory processes. Currently, there are many defined mediators as a
tumor necrosis factor-alpha (TNF-alpha) playing an active role in this
process. Aims: This research was to investigate the effects of
preoperative steroid use on inflammatory mediator TNF-alpha and on time to
extubation postoperatively in ventricular septal defect patients
undergoing cardiopulmonary bypass surgery. Study Design: Controlled
clinical study. Methods: This study included 30 patients. These patients
were assigned into two groups, each containing 15 patients. 5
micrograms/kg methylprednisolone was injected intravenously 2 hours before
the surgery to Group I, whereas there was no application to the patients
in Group II. TNF-alpha (pg/mL) level was measured in arterial blood
samples obtained at four periods including: the preoperative period (Pre
TNF); at the 5^th minute of cross-clamping (Per TNF); 2 hours
after termination of cardiopulmonary bypass (Post TNF); and at the
postoperative 24th hours in cardiovascular surgery intensive care unit
(Post 24 h TNF). Results: The mean cross-clamp time was 66+/-40 and
55+/-27 minutes in Group I and Group II respectively. No significant
difference was found between the groups in terms of cross-clamp time
(p>0.05). The mean time to extubation was 6.1+/-2.3 hours in Group I and
10.6+/-3.4 hours in Group II. Group I extubation time was significantly
shorter than Group II. Group I TNF-alpha levels at Post TNF and Post24h
TNF was lower than Group II. These differences are also statistically
significant (p<0.05). Conclusion: There is a strong indication that
preoperative steroid treatment reduced the TNF-alpha level together with
shortens duration of postoperative intubation and positively contributes
to extubation in ventricular septal defect patients operated in cardiac
surgery with cardiopulmonary bypass. (ClinicalTrials.gov Identifier:
TCTR20150930001).

<7>
Accession Number
20160292575
Author
Bernardi M.H.; Rinoesl H.; Dragosits K.; Ristl R.; Hoffelner F.; Opfermann
P.; Lamm C.; Preissing F.; Wiedemann D.; Hiesmayr M.J.; Spittler A.
Institution
(Bernardi, Rinoesl, Opfermann, Hiesmayr) Medical University of Vienna,
Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care
Medicine, Waehringer Guertel 18-20, Vienna A-1090, Austria
(Dragosits, Lamm, Preising, Spittler) Medical University of Vienna,
Department of Surgery, Research Laboratories, Lazarettgasse 14, Vienna
A-1090, Austria
(Ristl) Medical University of Vienna, Centre for Medical Statistics,
Informatics and Intelligent Systems, Spitalgasse 23, Vienna A-1090,
Austria
(Hoffelner, Wiedemann) Medical University of Vienna, Department of Cardiac
Surgery, Waehringer Guertel 18-20, Vienna A-1090, Austria
(Spittler) Medical University of Vienna, Core Facilities, Core Facility
Flow Cytometry, Lazarettgasse 14, Vienna 1090, Austria
Title
Effect of hemoadsorption during cardiopulmonary bypass surgery - a
blinded, randomized, controlled pilot study using a novel adsorbent.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 96. Date of
Publication: April 09, 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: Cardiopulmonary bypass (CPB) surgery initiates a systemic
inflammatory response, which is associated with postoperative morbidity
and mortality. Hemoadsorption (HA) of cytokines may suppress inflammatory
responses and improve outcomes. We tested a new sorbent used for HA
(CytoSorbTM; CytoSorbents Europe GmbH, Berlin, Germany) installed in the
CPB circuit on changes of pro- and anti-inflammatory cytokines levels,
inflammation markers, and differences in patients' perioperative course.
Methods: In this first pilot trial, 37 blinded patients were undergoing
elective CPB surgery at the Medical University of Vienna and were randomly
assigned to HA (n = 19) or control group (n = 18). The primary outcome was
differences of cytokine levels (IL-1beta, IL-6, IL-18, TNF-alpha, and
IL-10) within the first five postoperative days. We also analyzed whether
we can observe any differences in ex vivo lipopolysaccharide (LPS)-induced
TNF-alpha production, a reduction of high-mobility box group 1 (HMGB1), or
other inflammatory markers. Additionally, measurements for fluid
components, blood products, catecholamine treatment, bioelectrical
impedance analysis (BIA), and 30-day mortality were analyzed. Results: We
did not find differences in our primary outcome immediately following the
HA treatment, although we observed differences for IL-10 24 hours after
CPB (HA: median 0.3, interquartile range (IQR) 0-4.5; control: not
traceable, P = 0.0347) and 48 hours after CPB (median 0, IQR 0-1.2 versus
not traceable, P = 0.0185). We did not find any differences for IL-6
between both groups, and other cytokines were rarely expressed. We found
differences in pretreatment levels of HMGB1 (HA: median 0, IQR 0-28.1;
control: median 48.6, IQR 12.7-597.3, P = 0.02083) but no significant
changes to post-treatment levels. No differences in inflammatory markers,
fluid administration, blood substitution, catecholamines, BIA, or 30-day
mortality were found. Conclusions: We did not find any reduction of the
pro-inflammatory response in our patients and therefore no changes in
their perioperative course. However, IL-10 showed a longer-lasting
anti-inflammatory effect. The clinical impact of prolonged IL-10 needs
further evaluation. We also observed strong inter-individual differences
in cytokine levels; therefore, patients with an exaggerated inflammatory
response to CPB need to be identified. The implementation of HA during CPB
was feasible. Trial registration: ClinicalTrials.gov: NCT01879176,
registration date: June 7, 2013.

<8>
Accession Number
20160281451
Author
Harvey A.; Modak A.; Dery U.; Roy M.; Rinfret S.; Bertrand O.F.; Larose
E.; Rodes-Cabau J.; Barbeau G.; Gleeton O.; Nguyen C.M.; Proulx G.; Noel
B.; Roy L.; Paradis J.-M.; De Larochelliere R.; Dery J.-P.
Institution
(Harvey, Dery, Roy, Rinfret, Bertrand, Larose, Rodes-Cabau, Barbeau,
Gleeton, Nguyen, Proulx, Noel, Roy, Paradis, De Larochelliere, Dery)
Centre de Recherche de l'Institut Universitaire de Cardiologie et
Pneumologie de Quebec, Quebec, QC, Canada
(Modak) Cambridge Isotope Laboratories Inc., Tewksbury, MA 01830, United
States
Title
Changes in CYP2C19 enzyme activity evaluated by the
[¹³C]-pantoprazole breath test after co-administration of
clopidogrel and proton pump inhibitors following percutaneous coronary
intervention and correlation to platelet reactivity.
Source
Journal of Breath Research. 10 (1) (no pagination), 2016. Article Number:
017104. Date of Publication: 27 Jan 2016.
Publisher
Institute of Physics Publishing
Abstract
Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is used for
the prevention of cardiovascular events following percutaneous coronary
intervention (PCI). These agents increase the risk of gastrointestinal
bleeding. To prevent these events, proton pump inhibitors (PPI) are
routinely prescribed. It has been reported that with the exception of
pantoprazole and dexlanzoprazole, PPIs can impede conversion of
clopidogrel by cytochrome P450 2C19 (CYP2C19) to its active metabolite, a
critical step required for clopidogrel efficacy. Changes in CYP2C19 enzyme
activity (phenotype) and its correlation with platelet reactivity
following PPI therapy has not yet been fully described. In this study we
attempted to determine if the [ ¹³C]-pantoprazole breath test
(Ptz-BT) can evaluate changes in CYP2C19 enzyme activity (phenoconversion)
following the administration of PPI in coronary artery disease (CAD)
patients treated with DAPT after PCI. Thirty (30) days after successful
PCI with stent placement, 59 patients enrolled in the Evaluation of the
Influence of Statins and Proton Pump Inhibitors on Clopidogrel
Antiplatelet Effects (SPICE) trial (ClinicalTrials.gov Identifier:
NCT00930670) were recruited to participate in this sub study. Patients
were randomized to one of 4 antacid therapies (omeprazole, esomeprazole.
pantoprazole or ranitidine). Subjects were administered the Ptz-BT and
platelet function was evaluated by vasodilator-stimulated phosphoprotein
(VASP) phosphorylation and light transmittance aggregometry before and 30
d after treatment with antacid therapy. Patients randomized to
esomeprazole and omeprazole had greater high on-treatment platelet
reactivity and lowering of CYP2C19 enzyme activity at Day 60 after 30 d of
PPI therapy. Patients randomized to ranitidine and pantoprazole did not
show any changes in platelet activity or CYP 2C19 enzyme activity. In
patients treated with esomeprazole and omeprazole, changes in CYP2C19
enzyme activity (phenoconversion) correlated well with changes in platelet
reactivity. Co-administration of omeprazole or esomeprazole in patients
treated with clopidogrel results in lower CYP2C19 enzyme activity and
increased platelet reactivity as measured by VASP phosphorylation test
while patients given pantoprazole or ranitidine did not show any
significant changes in CYP2C19 enzyme activity and platelet reactivity.

<9>
Accession Number
20160134815
Author
Damen T.; Reinsfelt B.; Redfors B.; Nygren A.
Institution
(Damen, Reinsfelt, Redfors, Nygren) Department of Anaesthesiology and
Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska
Academy, University of Gothenburg, Sahlgrenska University Hospital,
Section of Cardiothoracic Anaesthesia and Intensive Care, Gothenburg,
Sweden
(Damen, Reinsfelt, Redfors, Nygren) Section of Cardiothoracic Anaesthesia
and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
Title
Pressure-dependent changes in haematocrit and plasma volume during
anaesthesia, a randomised clinical trial.
Source
Acta Anaesthesiologica Scandinavica. 60 (5) (pp 560-568), 2016. Date of
Publication: 01 May 2016.
Publisher
Blackwell Munksgaard
Abstract
Background Induction of general anaesthesia has been shown to cause
haemodilution and an increase in plasma volume. The aim of this study was
to evaluate whether prevention of hypotension during anaesthesia induction
could avoid haemodilution. Methods Twenty-four cardiac surgery patients,
66 +/- 10 years, were randomised to receive either norepinephrine in a
dose needed to maintain mean arterial blood pressure (MAP) at
pre-anaesthesia levels after induction or to a control group that received
vasopressor if MAP decreased below 60 mmHg. No fluids were infused.
Changes in plasma volume were calculated with standard formula: 100 x
(Hct<inf>pre</inf>/Hct<inf>post</inf> - 1)/(1 - Hct<inf>pre</inf>).
Arterial blood gas was analysed every 10 minutes and non-invasive
continuous haemoglobin (SpHb) was continuously measured. Results
Pre-anaesthesia MAP was 98 +/- 7 mmHg. Ten minutes after anaesthesia
induction, the haematocrit decreased by 5.0 +/- 2.5% in the control group
compared with 1.2 +/- 1.4% in the intervention group, which corresponds to
increases in plasma volume by 310 ml and 85 ml respectively. MAP decreased
to 69 +/- 15 mmHg compared to 92 +/- 10 mmHg in the intervention group.
The difference maintained throughout the 70 min intervention period. The
change in haemoglobin level measured by blood gas analysis could not be
detected by SpHb measurement. The mean bias between the SpHb and blood gas
haemoglobin was 15 g/l. Conclusion During anaesthesia induction,
haematocrit decreases and plasma volume increases early and parallel to a
decrease in blood pressure. This autotransfusion is blunted when blood
pressure is maintained at pre-induction levels with norepinephrine.

<10>
Accession Number
20160315856
Author
Sihoe A.D.L.
Institution
(Sihoe) Department of Surgery, The University of Hong Kong, Hong Kong
(Sihoe) Department of Thoracic Surgery, The University of Hong Kong
Shenzhen Hospital, Shenzhen 518053, China
(Sihoe) Department of Thoracic Surgery, Shanghai Pulmonary Hospital,
Tongji University, Shanghai 200030, China
Title
Reasons not to perform uniportal VATS lobectomy.
Source
Journal of Thoracic Disease. 8 (pp S333-S343), 2016. Date of Publication:
01 Mar 2016.
Publisher
Pioneer Bioscience Publishing
Abstract
The uniportal video assisted thoracic surgery (VATS) approach to lung
lobectomy has generated phenomenal interest in recent years. It promises
to offer patients less morbidity and faster recovery, even when compared
to conventional multiportal VATS. However, critics of the Uniportal VATS
approach may raise concerns about whether this most minimally invasive
surgical approach for lung surgery may compromise safety and treatment
efficacy. This debate has great potential importance not only in
determining how patients are operated on, but in understanding how
'success' is gauged in major pulmonary surgery. This article explores both
sides of this debate, drawing on the experience of how clinical research
in multiportal VATS evolved over the years. Systematic generation of
clinical evidence with progressively increasing sophistication is required
to fairly evaluate the uniportal VATS approach. A review of the current
literature suggests that there remain many large gaps in the evidence
surrounding uniportal VATS. Hence, at the present time, the reasons voiced
by critics as to why Uniportal VATS should not be performed should not be
lightly dismissed. Instead, it behoves surgeons on both sides of the
debate to continue to generate good clinical evidence to resolve it.

<11>
Accession Number
20160309803
Author
Hu J.; Liu S.; Jia P.; Xu X.; Song N.; Zhang T.; Chen R.; Ding X.
Institution
(Hu, Liu, Jia, Xu, Song, Zhang, Chen, Ding) Fudan University, Division of
Nephrology, Zhongshan Hospital, No. 180, Fenglin Road, Xuhui District,
Shanghai 200032, China
(Hu, Liu, Jia, Xu, Song, Zhang, Chen, Ding) Shanghai Institute of Kidney
and Dialysis, Shanghai 200032, China
(Hu, Liu, Jia, Xu, Song, Zhang, Chen, Ding) Shanghai Key Laboratory of
Kidney and Blood Purification, Shanghai 200032, China
(Zhang) General Hospital of Ningxia Medical University, Department of
Nephrology, Ningxia 750004, China
Title
Protection of remote ischemic preconditioning against acute kidney injury:
A systematic review and meta-analysis.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 111. Date of
Publication: 20 Apr 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: Remote ischemic preconditioning (RIPC) is a promising approach
to preventing acute kidney injury (AKI), but its efficacy is
controversial. Methods: A systematic review of 30 randomized controlled
trials was conducted to investigate the effects of RIPC on the incidence
and outcomes of AKI. Random effects model meta-analyses and
meta-regressions were used to generate summary estimates and explore
sources of heterogeneity. The primary outcome was incidence of AKI and
hospital mortality. Results: The total pooled incidence of AKI in the RIPC
group was 11.5 %, significantly less than the 23.3 % incidence in the
control group (P = 0.009). Subgroup analyses indicated that RIPC
significantly reduced the incidence of AKI in the contrast-induced AKI
(CI-AKI) subgroup from 13.5 % to 6.5 % (P = 0.000), but not in the
ischemia/reperfusion-induced AKI (IR-AKI) subgroup (from 29.5 % to 24.7 %,
P = 0.173). Random effects meta-regression indicated that RIPC tended to
strengthen its renoprotective effect (q = 3.95, df = 1, P = 0.047) in
these trials with a higher percentage of diabetes mellitus. RIPC had no
significant effect on the incidence of stages 1-3 AKI or renal replacement
therapy, change in serum creatinine and estimated glomerular filtration
rate (eGFR), hospital or 30-day mortality, or length of hospital stay. But
RIPC significantly increased the minimum eGFR in the IR-AKI subgroup (P =
0.006) compared with the control group. In addition, the length of ICU
stay in the RIPC group was significantly shorter than in the control group
(2.6 vs 2.0 days, P = 0.003). Conclusions: We found strong evidence to
support the application of RIPC to prevent CI-AKI, but not IR-AKI.

<12>
Accession Number
20160302273
Author
Lurz P.; Luecke C.; Eitel I.; Fohrenbach F.; Frank C.; Grothoff M.; De
Waha S.; Rommel K.-P.; Lurz J.A.; Klingel K.; Kandolf R.; Schuler G.;
Thiele H.; Gutberlet M.
Institution
(Lurz, Fohrenbach, Rommel, Schuler) Department of Internal
Medicine/Cardiology, University of Leipzig, Heart Center,
Struempellstrasse 39, Leipzig 04289, Germany
(Luecke, Frank, Grothoff, Gutberlet) Department of Diagnostic and
Interventional Radiology, University of Leipzig, Heart Center, Leipzig,
Germany
(Eitel, De Waha, Thiele) University Heart Center Luebeck, University of
Schleswig-Holstein, Medical Clinic II (Cardiology, Angiology, Intensive
Care Medicine), Luebeck, Germany
(Eitel, De Waha, Thiele) German Centre for Cardiovascular Research (DZHK),
Partner Site Hamburg/Kiel/Lubeck, Luebeck, Germany
(Lurz) Department of Electrophysiology, University of Leipzig, Heart
Center, Leipzig, Germany
(Klingel, Kandolf) Department of Molecular Pathology, University Hospital
Tuebingen, Tuebingen, Germany
Title
Comprehensive Cardiac Magnetic Resonance Imaging in Patients with
Suspected Myocarditis the MyoRacer-Trial.
Source
Journal of the American College of Cardiology. 67 (15) (pp 1800-1811),
2016. Date of Publication: 19 Apr 2016.
Publisher
Elsevier USA
Abstract
Background Data suggest that T<inf>1</inf> and T<inf>2</inf> mapping have
excellent diagnostic accuracy in patients with suspected myocarditis.
However, the true diagnostic performance of comprehensive cardiac magnetic
resonance (CMR) mapping versus endomyocardial biopsy (EMB) has not been
determined. Objectives This study assessed the performance of CMR imaging,
including T<inf>1</inf> and T<inf>2</inf> mapping, compared with EMB in an
unselected, consecutive patient cohort with suspected myocarditis. It also
examined the potential role of CMR field strength by comparing 1.5-T
versus 3.0-T imaging. Methods Patients underwent biventricular EMB,
cardiac catheterization (for exclusion of coronary artery disease), and
CMR imaging on 1.5- and 3-T scanners. The CMR protocol included current
standard Lake Louise criteria (LLC) for myocarditis as well as native
T<inf>1</inf>, calculation of extracellular volume fraction (ECV), and
T<inf>2</inf> mapping (only on 1.5-T). Patients were divided into 2 groups
according to symptom duration (acute: <14 days vs. chronic: >14 days).
Results A total of 129 patients underwent 1.5-T imaging. In patients with
acute symptoms, native T<inf>1</inf> yielded the best diagnostic
performance as defined by the area under the curve (AUC) of
receiver-operating curves (0.82) followed by T<inf>2</inf> (0.81), ECV
(0.75), and LLC (0.56). In patients with chronic symptoms, only
T<inf>2</inf> mapping yielded an acceptable AUC (0.77). On 3.0-T, AUCs of
native T<inf>1</inf>, ECV, and LLC were comparable to 1.5-T with no
significant differences. Conclusions In patients with acute symptoms,
mapping techniques provide a useful tool for confirming or rejecting the
diagnosis of myocarditis and are superior to the LLC. However, only
T<inf>2</inf> mapping has acceptable diagnostic performance in patients
with chronic symptoms. (Magnetic Resonance Imaging in Myocarditis
[MyoRacer]; NCT02177630)

<13>
Accession Number
20160302258
Author
Williams M.C.; Hunter A.; Shah A.S.V.; Assi V.; Lewis S.; Smith J.; Berry
C.; Boon N.A.; Clark E.; Flather M.; Forbes J.; McLean S.; Roditi G.; Van
Beek E.J.R.; Timmis A.D.; Newby D.E.
Institution
(Williams, Hunter, Shah, Boon, Clark, Van Beek, Newby) British Heart
Foundation Centre for Cardiovascular Science, University of Edinburgh,
Chancellor's Building, Room SU314, 49 Little France Crescent, Edinburgh
EH16 4SA, United Kingdom
(Assi, Lewis) Centre for Population Health Sciences, University of
Edinburgh, Edinburgh, United Kingdom
(Smith) Health Economics Research Centre, University of Oxford, Oxford,
United Kingdom
(Berry, Roditi) Institute for Cardiovascular and Medical Sciences,
University of Glasgow, Glasgow, United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norwich,
United Kingdom
(Forbes) Health Research Institute, University of Limerick, Limerick,
Ireland
(McLean) National Health Service, Fife, United Kingdom
(Timmis) William Harvey Research Institute, Queen Mary University of
London, London, United Kingdom
Title
Use of Coronary Computed Tomographic Angiography to Guide Management of
Patients with Coronary Disease.
Source
Journal of the American College of Cardiology. 67 (15) (pp 1759-1768),
2016. Date of Publication: 19 Apr 2016.
Publisher
Elsevier USA
Abstract
Background In a prospective, multicenter, randomized controlled trial,
4,146 patients were randomized to receive standard care or standard care
plus coronary computed tomography angiography (CCTA). Objectives The
purpose of this study was to explore the consequences of CCTA-assisted
diagnosis on invasive coronary angiography, preventive treatments, and
clinical outcomes. Methods In post hoc analyses, we assessed changes in
invasive coronary angiography, preventive treatments, and clinical
outcomes using national electronic health records. Results Despite similar
overall rates (409 vs. 401; p = 0.451), invasive angiography was less
likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios
[HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but
more likely to show obstructive coronary artery disease (283 vs. 230; HR:
1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More
preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p <
0.001) were initiated after CCTA, with each drug commencing at a median of
48 to 52 days after clinic attendance. From the median time for preventive
therapy initiation (50 days), fatal and nonfatal myocardial infarction was
halved in patients allocated to CCTA compared with those assigned to
standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020).
Cumulative 6-month costs were slightly higher with CCTA: difference $462
(95% CI: $303 to $621). Conclusions In patients with suspected angina due
to coronary heart disease, CCTA leads to more appropriate use of invasive
angiography and alterations in preventive therapies that were associated
with a halving of fatal and non-fatal myocardial infarction. (Scottish
COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).

<14>
Accession Number
20160297594
Author
Geng J.; Qian J.; Cheng H.; Ji F.; Liu H.
Institution
(Geng, Qian, Cheng, Ji) Department of Anesthesiology, First Affiliated
Hospital of Soochow University, Suzhou, Jiangsu, China
(Cheng, Liu) Department of Anesthesiology and Pain Medicine, University of
California Davis Health System, Sacramento, CA, United States
Title
The influence of perioperative dexmedetomidine on patients undergoing
cardiac surgery: A meta-analysis.
Source
PLoS ONE. 11 (4) (no pagination), 2016. Article Number: e0152829. Date of
Publication: April 2016.
Publisher
Public Library of Science
Abstract
Background: The use of dexmedetomidine may have benefits on the clinical
outcomes of cardiac surgery. We conducted a meta-analysis comparing the
postoperative complications in patients undergoing cardiac surgery with
dexmedetomidine versus other perioperative medications to determine the
influence of perioperative dexmedetomidine on cardiac surgery patients.
Methods: Randomized or quasi-randomized controlled trials comparing
outcomes in patients who underwent cardiac surgery with dexmedetomidine,
another medication, or a placebo were retrieved from EMBASE, PubMed, the
Cochrane Library, and Science Citation Index. Results: A total of 1702
patients in 14 studies met the selection criteria among 1,535 studies that
fit the research strategy. Compared to other medications, dexmedetomidine
has combined risk ratios of 0.28 (95% confidence interval [CI] 0.15, 0.55,
P = 0.0002) for ventricular tachycardia, 0.35 (95% CI 0.20, 0.62, P =
0.0004) for postoperative delirium, 0.76 (95% CI 0.55, 1.06, P = 0.11) for
atrial fibrillation, 1.08 (95% CI 0.74, 1.57, P = 0.69) for hypotension,
and 2.23 (95% CI 1.36, 3.67, P = 0.001) for bradycardia. In addition,
dexmedetomidine may reduce the length of intensive care unit (ICU) and
hospital stay. Conclusions: This meta-analysis revealed that the
perioperative use of dexmedetomidine in patients undergoing cardiac
surgery can reduce the risk of postoperative ventricular tachycardia and
delirium, but may increase the risk of bradycardia. The estimates showed a
decreased risk of atrial fibrillation, shorter length of ICU stay and
hospitalization, and increased risk of hypotension with dexmedetomidine.

<15>
Accession Number
20160033846
Author
Ding S.-A.; Simonson D.C.; Wewalka M.; Halperin F.; Foster K.;
Goebel-Fabbri A.; Hamdy O.; Clancy K.; Lautz D.; Vernon A.; Goldfine A.B.
Institution
(Ding, Simonson, Wewalka, Halperin, Foster, Goebel-Fabbri, Hamdy, Lautz,
Vernon, Goldfine) Harvard Medical School, One Joslin Place, Boston, MA
02215, United States
(Ding, Wewalka, Foster, Goebel-Fabbri, Hamdy, Lautz, Goldfine) Joslin
Diabetes Center, Boston, MA 02215, United States
(Simonson, Halperin, Clancy, Vernon, Goldfine) Brigham and Women's
Hospital, Boston, MA 02115, United States
Title
Management in patients with type 2 diabetes: A randomized clinical trial.
Source
Journal of Clinical Endocrinology and Metabolism. 100 (7) (pp 2546-2556),
2015. Date of Publication: 01 Jul 2015.
Publisher
Endocrine Society
Abstract
Context: Recommendations for surgical, compared with lifestyle and
pharmacologically based, approaches for type 2 diabetes (T2D) management
remain controversial. Objective: The objective was to compare laparoscopic
adjustable gastric band (LAGB) to an intensive medical diabetes and weight
management (IMWM) program for T2D. Design: This was designed as a
prospective, randomized clinical trial. Setting: The setting was two
Harvard Medical School-affiliated academic institutions. Interventions and
Participants: A 12-month randomized trial comparing LAGB (n=23) vs IMWM
(n= 22) in persons aged 21-65 years with body mass index of 30-45 kg/m2,
T2D diagnosed more than 1 year earlier, and glycated hemoglobin (HbA1c)
6.5% on antihyperglycemic medication(s). Main Outcome Measure: The
proportion meeting the prespecified primary glycemic endpoint, defined as
HbA1c 6.5% and fasting glucose 7.0 mmol/L at 12 months, on or off
medication. Results: After randomization, five participants did not
undergo the surgical intervention. Of the 40 initiating intervention (22
males/18 females; age,51+/-10y;bodymassindex, 36.5+/-3.7kg/m2; diabetes
duration, 9 +/- 5 y; HbA1c, 8.2+/-1.2%; 40% on insulin), the proportion
meeting the primary glycemic endpoint was achieved in 33% of the LAGB
patients and 23% of theIMWMpatients (P<457). HbA1c reduction was similar
between groups at both 3 and 12 months (-1.2+/-0.3 vs 1.0+/-0.3%; P<496).
Weight loss was similar at 3 months but greater 12 months after LAGB
(-13.5+/-1.7 vs 8.5+/-1.6 kg; P .027). Systolic blood pressure reduction
was greater after IMWM than LAGB, whereas changes in diastolic blood
pressure, lipids, fitness, and cardiovascular risk scores were similar
between groups. Patient-reported health status, assessed using the Short
Form-36, Impact of Weight on Quality of Life, and Problem Areas in
Diabetes, all improved similarly between groups. Conclusions: LAGB and a
multidisciplinary IMWM program have similar 1-year benefits on diabetes
control, cardiometabolic risk, and patient satisfaction, which should be
considered in the context of other factors, such as personal preference,
when selecting treatment options with obese T2D patients. Longer duration
studies are important to understand emergent differences.

<16>
Accession Number
20160289144
Author
Amico F.; Amico A.; Mazzoni J.; Moshiyakhov M.; Tamparo W.
Institution
(Amico, Mazzoni, Moshiyakhov) Department of Cardiology, Deborah Heart Lung
and Center, Browns Mills, NJ, United States
(Amico) Department of Pharmacy, St Johns University, Queens, NY, United
States
(Tamparo) Department of Internal Medicine, New York Hospital Queens,
Flushing Queens, NY, United States
Title
The evolution of dual antiplatelet therapy in the setting of acute
coronary syndrome: Ticagrelor versus clopidogrel.
Source
Postgraduate Medicine. 128 (2) (pp 159-163), 2016. Date of Publication: 01
Jan 2016.
Publisher
Taylor and Francis Inc. (325 Chestnut St, Suite 800, Philadelphia PA
19106, United States)
Abstract
Review of: Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus
clopidogrel in patients with acute coronary syndromes. N Eng J Med 2009;
361(11): 1045-1057. For acute coronary syndrome (ACS), a dual antiplatelet
regimen comprised of treatment with aspirin and either P2Y12 adenosine
diphosphate receptor antagonists, clopidogrel, prasugrel or ticagrelor is
usually employed. This article compares clopidogrel with ticagrelor for
the prevention of vascular events and death in broad population of ACS
patients ranging from UA, NSTEMI to STEMI, utilizing planned strategies of
medical or invasive treatment strategy.

<17>
Accession Number
20160277308
Author
Hussain M.A.; Bin-Ayeed S.A.; Saeed O.Q.; Verma S.; Al-Omran M.
Institution
(Hussain, Al-Omran) Division of Vascular Surgery, Li Ka Shing Knowledge
Institute, St. Michael's Hospital, 30 Bond St, Ste 7-074, Bond Wing,
Toronto, ON M5B 1W8, Canada
(Verma) Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Toronto, ON, Canada
(Hussain, Verma, Al-Omran) Department of Surgery, University of Toronto,
Toronto, ON, Canada
(Bin-Ayeed) Vascular Surgery Department, King Salman Heart Center, King
Fahad Medical City, Riyadh, Saudi Arabia
(Saeed) Department of Internal Medicine, McMaster University, Hamilton,
ON, Canada
(Verma, Al-Omran) King Saud University, Li Ka Shing Collaborative Research
Program, Department of Surgery, Riyadh, Saudi Arabia
Title
Impact of diabetes on carotid artery revascularization.
Source
Journal of Vascular Surgery. 63 (4) (pp 1099-1107e4), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Mosby Inc.
Abstract
Objective Diabetes has been suggested as a marker of higher operative risk
during carotid artery revascularization. The aim of this study was to
summarize the current evidence comparing the effectiveness of carotid
revascularization in diabetic vs nondiabetic patients. Methods We
conducted a systematic search of MEDLINE, Embase, and the Cochrane Library
databases (1946 to January 2015) for all studies comparing the clinical
outcomes of diabetic vs nondiabetic patients who underwent carotid
endarterectomy (CEA) or carotid artery stenting (CAS) in accordance with
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines. Two authors independently reviewed the studies for
inclusion and quality and extracted the data. A third author validated
study selection and data extraction. We calculated treatment effects as
odds ratios (ORs) and 95% confidence intervals (CIs). We quantified
heterogeneity using the I² statistic. All pooled analyses were
based on random-effects models. The predefined review protocol was
registered at the International Prospective Register of Systematic Reviews
(PROSPERO 2015:CRD42015015873). Results Of the 1241 abstracts screened, we
included 14 observational studies involving 16,264 patients. There was
excellent agreement in study selection between the two reviewers (kappa
statistic, 0.83; 95% CI, 0.72-0.94). CEA was used in 10 studies, CAS was
used in 3 studies, and both CEA and CAS were used in 1 study. All included
studies were published after 1984, and 93% were published after 1997.
Carotid revascularization in diabetic patients was associated with a
higher risk of the following outcomes: perioperative stroke (OR, 1.38; 95%
CI, 1.02-1.88; P =.04; I² =13%), death (OR, 1.94; 95% CI,
1.36-2.75; P =.0002; I² = 0%), composite risk of stroke or
death (OR, 1.80; 95% CI, 1.32-2.47; P =.0002; I² = 26%), and
long-term risk of death (OR, 1.57; 95% CI, 1.22-2.03; P =.0005;
I² = 0%). No association was found between diabetes and
perioperative risk of myocardial infarction (MI); composite risk of MI,
stroke, or death; and long-term risk of stroke. Study quality was limited
by selection bias, minimal control for confounders, and single-center
retrospective design. Sensitivity analyses excluding low-quality studies
did not change the effect of diabetes on the risk of stroke, death, or MI.
Conclusions Diabetic patients are at an increased risk of perioperative
stroke, death, and long-term mortality compared with nondiabetic patients
who undergo carotid artery revascularization. This knowledge can help
further risk stratify patients with carotid artery stenosis before
treatment. Future studies should focus on evaluating which mode of
revascularization (CEA or CAS) is more effective in diabetic patients with
carotid artery stenosis.

<18>
Accession Number
2015250863
Author
Gao Y.; Huang R.; Chen R.; Li J.; Luo W.
Institution
(Gao, Huang, Chen, Li, Luo) Department of Cardiothoracic Surgery, Xiangya
Hospital, Central South University, 87 Xiangya Road, Changsha 410008,
China
Title
Ischemic postconditioning altered microRNAs in human valve replacement.
Source
Journal of Surgical Research. 200 (1) (pp 28-35), 2016. Date of
Publication: 25 Feb 2015.
Publisher
Academic Press Inc.
Abstract
Background Although the involvement of microRNAs (miRNAs) has been
intensively studied in myocardial infarction, there is no report on the
regulation of miRNAs by ischemic postconditioning in patients undergoing
cardiac surgery. We aim to explore the regulation of miRNAs by ischemic
postconditioning in double valve replacement. Materials and methods In
this prospective, controlled clinical study, consecutive 30 patients
undergoing double valve replacement were enrolled. The patients were
randomized into two groups, namely an ischemic postconditioning (IPO)
group (n = 15) and a control (CON) group (n = 15). For ethical
considerations, samples of right atrial muscle were harvested,
respectively, 10 min before cardiopulmonary bypass (pre-CPB) and 5 min
after aortic declamping (post-CPB) for analysis of miRNAs, genes and
apoptosis. Results Compared with the CON group, miR-1 was downregulated,
whereas miR-21 was upregulated, and BCL2 messenger RNA (mRNA) was
upregulated, whereas BAX mRNA and programmed cell death 4 mRNA remained
unchanged in the IPO group. Likewise, a significant increase in BCL2
protein and a striking decrease in BAX protein were observed in the IPO
group when compared with those in the CON group. The IPO group showed a
significantly smaller increase of terminal deoxynucleotidyl
transferase-mediated dUTP nick-end labeling-positive myocytes after CPB
than CON group. Conclusions Ischemic postconditioning could regulate
miR-1, miR-21, and downstream effectors and resulted in actual attenuation
of apoptosis in patients undergoing valvular heart surgery.

<19>
Accession Number
20160273278
Author
Heatley G.; Sood P.; Goldstein D.; Uriel N.; Cleveland J.; Middlebrook D.;
Mehra M.R.
Institution
(Heatley, Sood, Middlebrook) St. Jude Medical, 23 Fourth Avenue,
Burlington, MA 01803, United States
(Goldstein) Department of Cardiothoracic Surgery, Montefiore Medical
Center, New York, NY, United States
(Uriel) Division of Cardiology, University of Chicago, Chicago, IL, United
States
(Cleveland) Department of Surgery, University of Colorado, Anschutz
Medical Center, Denver, CO, United States
(Mehra) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, Ma, United States
Title
Clinical trial design and rationale of the Multicenter Study of MagLev
Technology in Patients Undergoing Mechanical Circulatory Support Therapy
with HeartMate 3 (MOMENTUM 3) investigational device exemption clinical
study protocol.
Source
Journal of Heart and Lung Transplantation. 35 (4) (pp 528-536), 2016. Date
of Publication: 01 Apr 2016.
Publisher
Elsevier USA
Abstract
The HeartMate 3 left ventricular assist system (LVAS; St. Jude Medical,
Inc., formerly Thoratec Corporation, Pleasanton, CA) was recently
introduced into clinical trials for durable circulatory support in
patients with medically refractory advanced-stage heart failure. This
centrifugal, fully magnetically levitated, continuous-flow pump is
engineered with the intent to enhance hemocompatibility and reduce shear
stress on blood elements, while also possessing intrinsic pulsatility.
Although bridge-to-transplant (BTT) and destination therapy (DT) are
established dichotomous indications for durable left ventricular assist
device (LVAD) support, clinical practice has challenged the
appropriateness of these designations. The introduction of novel LVAD
technology allows for the development of clinical trial designs to keep
pace with current practices. The prospective, randomized Multicenter Study
of MagLev Technology in Patients Undergoing Mechanical Circulatory Support
Therapy With HeartMate 3 (MOMENTUM 3) clinical trial aims to evaluate the
safety and effectiveness of the HeartMate 3 LVAS by demonstrating
non-inferiority to the HeartMate II LVAS (also St. Jude Medical, Inc.).
The innovative trial design includes patients enrolled under a single
inclusion and exclusion criteria, regardless of the intended use of the
device, with outcomes ascertained in the short term (ST, at 6 months) and
long term (LT, at 2 years). This adaptive trial design includes a
pre-specified safety phase (n = 30) analysis. The ST cohort includes the
first 294 patients and the LT cohort includes the first 366 patients for
evaluation of the composite primary end-point of survival to transplant,
recovery or LVAD support free of debilitating stroke (modified Rankin
score >3), or re-operation to replace the pump. As part of the adaptive
design, an analysis by an independent statistician will determine whether
sample size adjustment is required at pre-specified times during the
study. A further 662 patients will be enrolled to reach a total of 1,028
patients for evaluation of the secondary end-point of pump replacement at
2 years.

<20>
Accession Number
20160190647
Author
Montalescot G.; Van 'T Hof A.W.; Bolognese L.; Cantor W.J.; Cequier A.;
Chettibi M.; Collet J.-P.; Goodman S.G.; Hammett C.J.; Huber K.; Janzon
M.; Lapostolle F.; Lassen J.F.; Licour M.; Merkely B.; Salhi N.; Silvain
J.; Storey R.F.; Ten Berg J.M.; Tsatsaris A.; Zeymer U.; Vicaut E.; Hamm
C.W.; Bougherbal R.; Bouafia M.T.; Nibouche D.; Moklati A.; Benalia A.;
Kaid O.; Krim M.; Hammett C.; Garrahy P.; Jayasinghe R.; Rashford S.;
Neunteufl T.; Brussee H.; Alber H.; Weidinger F.; Brunner M.; Sipoetz J.;
Prause G.; Baubin M.; Sebald D.; Cantor W.; Vijayaraghavan R.; Bata I.;
Lavoie A.; Ravkilde J.; Jensen L.O.; Christensen A.Mo.; Toftegaard M.;
Kohler D.; Ducrocq G.; Danchin N.; Henry P.; Livarek B.; Berthier R.;
Hovasse T.; Garot P.; Payot L.; Benamer H.; Esteve J.B.; Elhadad S.;
Teiger E.; Bonnet J.L.; Paganelli F.; Cottin Y.; Schiele F.; Thuaire C.;
Cayla G.; Coste P.; Ohlmann P.; Cudraz E.B.; Lantelme P.; Perret T.; Tron
C.; De Labriolle A.; Aptecar E.; Beliard O.; Varenne O.; El Mahmoud R.;
Filippi-Codaccioni E.; Angoulvant D.; Peycher P.; Poitrineau O.; Tabone
X.; Ecollan P.; Broche C.; Lambert Y.; Briole N.; Beruben A.; Porcher N.;
Auffray J.-P.; Freysz M.; Depardieu F.; Poubel D.; De La Cousaye J.-E.;
Bartier J.-C.; Jardel B.; Boulanger B.; Labourel H.; Soulat L.-C.; Julie
V.; Thicoipe M.; Capel O.; Stibbe O.; Carli P.; Tazarourte K.; Alcouffe
F.; Aboucaya D.; Aubert G.; Kierzek G.; Cahun-Giraud S.; Hamm C.; Dengler
T.; Prondzinsky R.; Biever P.M.; Schafer A.; Seyfarth M.; Lemke B.; Werner
G.; Nef H.; Steiger H.; Leschke M.; Munzel T.; Dell Orto M.C.; Loges C.;
Schinke M.; Koberne F.; Reiffen H.P.; Tiroch K.; Wierich D.; Kneussel M.;
Little S.; Sauer H.; Laufenberg-Feldmann R.; Ungi I.; Horvath I.; Edes I.;
Martai I.; Berti S.; Chiarella F.; Calabria P.; Fineschi M.; Galvani M.;
Valgimigli M.; Moretti L.; Tespili M.; Mando M.; Bermano F.; Biagioni R.;
Fabbri A.; Ricciardelli A.; Petroni M.R.; Vatteroni U.R.; Palumbo F.;
Willems F.F.; Al Mafragi A.; Heestermans T.A.A.C.M.; Van Eck M.J.; Heutz
W.M.J.M.; Meppelder H.H.; Jong A.R.-D.; Van De Pas H.; Fillat A.C.; Tenas
M.S.; Ferrer J.M.; Penaranda A.S.; Ferrer J.A.; Del Blanco B.G.; Guardiola
F.M.; Ruiz Nodar J.M.; Romo A.I.; Gonzalez N.V.; Nouche R.T.; De La Llera
L.D.; Hernandez Garcia J.M.; Rivero-Crespo F.; Hernandez F.H.; Zamorano
Gomez J.L.; Farega X.J.; Fernandez G.A.; Toboso J.L.; Carrasco M.;
Barreiro V.; Iglesias Vazquez J.A.; Montero M.D.M.R.; Ortiz F.R.; Escudero
G.G.; Ingelmo V.S.-B.; Garcia A.L.; Oldgren J.; Calais F.; Kastberg R.;
Bergsten P.-A.; Blomberg H.; Thorn K.; Skoog G.; Zaman A.; Gerber R.;
Ryding A.; Spence M.; Swanson N.; Been M.; Grosser K.; Schofield P.;
Mackin D.; Fell P.; Quinn T.; Foster T.; McManus D.; Carson A.
Institution
(Montalescot, Collet, Silvain) Universite Paris 6, ACTION Study Group,
Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire
Pitie-Salpetriere, INSERM UMRS 1166, 47 Boulevard de lHopital, Paris
75013, France
(Van 'T Hof) Department of Cardiology, Isala Clinics, Zwolle, Netherlands
(Bolognese) Cardiovascular and Neurological Department, Azienda
Ospedaliera Arezzo, Arezzo, Italy
(Cantor) Southlake Regional Health Centre, University of Toronto,
Newmarket, ON, Canada
(Cequier) Heart Disease Institute, Hospital Universitario de Bellvitge,
University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
(Chettibi) Centre Hospito-Universitaire Frantz Fanon, Blida, Algeria
(Goodman) Canadian Heart Research Centre, Division of Cardiology, St.
Michael's Hospital, University of Toronto, Toronto, Canada
(Hammett) Department of Cardiology, Royal Brisbane and Women's Hospital,
Brisbane, QLD, Australia
(Huber) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, Vienna, Austria
(Janzon) Department of Cardiology, Linkoping University, Linkoping, Sweden
(Lapostolle) SAMU 93 Hopital Avicenne, Bobigny, France
(Lassen) Department of Cardiology B, Aarhus University Hospital, Aarhus N,
Denmark
(Licour, Tsatsaris) AstraZeneca, Rueil Malmaison, France
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Salhi) AstraZeneca, Luton, United Kingdom
(Storey) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
(Ten Berg) Department of Cardiology, St. Antonius Hospital Nieuwegein,
Nieuwegein, Netherlands
(Zeymer) Klinikum Ludwigshafen, Institut fur Herzinfarktforschung
Ludwigshafen, Ludwigshafen, Germany
(Vicaut) Unite de Recherche Clinique, Universite Paris 7, Hopital
Lariboisiere, ACTION Study Group, Paris, France
(Hamm) Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim,
Germany
Title
Effect of Pre-Hospital Ticagrelor during the First 24 h after Primary
Percutaneous Coronary Intervention in Patients with ST-Segment Elevation
Myocardial Infarction the ATLANTIC-H²⁴ Analysis.
Source
JACC: Cardiovascular Interventions. 9 (7) (pp 646-656), 2016. Date of
Publication: 11 Apr 2016.
Publisher
Elsevier Inc.
Abstract
Objectives The aim of this landmark exploratory analysis,
ATLANTIC-H²⁴, was to evaluate the effects of pre-hospital
ticagrelor during the first 24 h after primary percutaneous coronary
intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the
cath Lab or in the Ambulance for New ST elevation myocardial infarction to
open the Coronary artery) study. Background The ATLANTIC trial in patients
with ongoing ST-segment elevation myocardial infarction showed that
pre-hospital ticagrelor was safe but did not improve pre-PCI coronary
reperfusion compared with in-hospital ticagrelor. We hypothesized that the
effect of pre-hospital ticagrelor may not have manifested until after PCI
due to the rapid transfer time (31 min). Methods The
ATLANTIC-H²⁴ analysis included 1,629 patients who underwent
PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction
flow grade 3, >70% ST-segment elevation resolution, and clinical endpoints
over the first 24 h. Results Following PCI, largest between-group
differences in platelet reactivity occurred at 1 to 6 h; coronary
reperfusion rates numerically favored pre-hospital ticagrelor, and the
degree of ST-segment elevation resolution was significantly greater in the
pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At 24 h, the
composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4%
vs. 13.7%; p = 0.039), as were individual endpoints of definite stent
thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All
endpoints except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital
ticagrelor, with no differences in bleeding events. Conclusions The
effects of pre-hospital ticagrelor became apparent after PCI, with
numerical differences in platelet reactivity and immediate post-PCI
reperfusion, associated with reductions in ischemic endpoints, over the
first 24 h, whereas there was a small excess of mortality. (Administration
of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation
myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580])

<21>
Accession Number
2015204493
Author
Hu Q.; Luo W.; Huang L.; Huang R.; Chen R.; Gao Y.
Institution
(Hu, Luo, Huang, Huang, Chen, Gao) Department of Cardiothoracic Surgery,
Xiangya Hospital, Central-South University, Changsha, Hunan, China
Title
Multiorgan protection of remote ischemic perconditioning in valve
replacement surgery.
Source
Journal of Surgical Research. 200 (1) (pp 13-20), 2016. Date of
Publication: 10 Mar 2015.
Publisher
Academic Press Inc.
Abstract
Background Remote ischemic perconditioning (RIPerc) is a new alternative
of remote ischemic conditioning and has not been well studied. RIPerc
attenuates myocardial injury when applied during cardiac surgery. However,
its protective effects on other organs remain unknown. Materials and
methods Patients with rheumatic heart disease undergoing valve replacement
surgery were randomized into the RIPerc group (n = 101) or the control
group (n = 100). RIPerc was achieved by three cycles of 5-min
ischemia-5-min reperfusion in the right thigh during surgery. Clinical
data and the levels of injury biomarkers for the heart, lungs, liver, and
kidneys within 48 h after surgery were compared using one-way or repeated
measurement analysis of variance. Results In the RIPerc group, the release
of serum cardiac troponin I (128.68 +/- 102.56 versus 172.33 +/- 184.38, P
= 0.04) and the inotropic score (96.4 +/- 73.8 versus 121.5 +/- 89.6, P =
0.032) decreased compared with that of the control; postoperative drainage
(458.2 +/- 264.2 versus 545.1 +/- 349.0 ml, P = 0.048) and the incidence
of acute lung injury was reduced (36.6% versus 51%, P = 0.04), and the
extent of hyperbilirubinemia was also attenuated. No significant
difference was observed in the levels of biomarkers for renal injury and
systemic inflammation response. Conclusions RIPerc applied during the
valve replacement surgery induced multiple beneficial effects
postoperatively including reduced drainage and myocardial damage, lower
incidence of acute lung injury, and attenuated hyperbilirubinemia.

<22>
[Use Link to view the full text]
Accession Number
20160273266
Author
Bundhun P.K.; Boodhoo K.D.; Long M.-Y.; Chen M.-H.
Institution
(Bundhun, Long, Chen) Institute of Cardiovascular Diseases, First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
530027, China
(Boodhoo) Department of Rheumatology, Xiangya Hospital, Central South
University, Changsha, Hunan, China
Title
Impact of antiphospholipid syndrome and/or systemic lupus erythematosus on
the long-term adverse cardiovascular outcomes in patients after
percutaneous coronary intervention a systematic review and meta-analysis.
Source
Medicine (United States). 95 (12) (no pagination), 2016. Article Number:
e3200. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are
2 rare autoimmune disorders which commonly affect women. Several previous
studies showed APS to have been evolved from SLE. Secondary APS often
coexists with SLE. One common feature relating these 2 diseases are the
antiphospholipid antibodies, which are found in most of the patients with
APS and in approximately 30% to 40% of patients with SLE, among which,
about 10% develop APS. The leading cause of death in these patients is
from cardiovascular disease due to accelerated atherosclerosis, which
often progresses more rapidly, compared with the general population.
However, the impact of APS and/or SLE on the cardiovascular outcomes in
patients undergoing percutaneous coronary intervention (PCI) is
controversial. Therefore, to solve this issue, we aim to compare the
longterm (>1 year) adverse cardiovascular outcomes after PCI, in patients
with APS and/or SLE, and those without these disorders. Medline and EMBASE
databases were searched for studies comparing the long-term adverse
cardiovascular outcomes between SLE and non-SLE, APS and non-APS, or SLE +
APS and non-SLE + non-APS after PCI. We calculated odd ratios (OR) and 95%
confidence intervals (CIs) for these categorical variables, and the pooled
analyses were performed with RevMan 5.3. Seven studies consisting of a
total of 253,436 patients (568 patients in the experimental group and
252,868 patients in the control group) were included in this
meta-analysis. During a follow-up period of >1 year, mortality and
myocardial Infarction (MI) were significantly higher in the experimental
group (OR 2.02, 95% CI 1.63-2.49, P<0.00001 and OR 1.59, 95% CI 1.23-2.05,
P=0.0004, respectively). Major adverse cardiac events and repeated
revascularization were also significantly higher in the SLE/APS group (OR
2.40, 95% CI 1.42-4.03, P=0.001 and OR 2.59, 95% CI 1.26-5.31, P=0.01,
respectively). Antiphospholipid syndrome and SLE are associated with
significantly higher long-term (>1 year) adverse cardiovascular outcomes
after PCI. However, because of the limited number of patients and
researches done, and due to a larger percentage of heterogeneity observed
among several subgroups, this analysis may not generate a powerful result.

<23>
Accession Number
20160276498
Author
Uddin J.; Zwisler A.-D.; Lewinter C.; Moniruzzaman M.; Lund K.; Tang L.H.;
Taylor R.S.
Institution
(Uddin) Department of Cardiac Surgery, Ibrahim Cardiac Hospital and
Research Institute, Bangladesh
(Uddin, Zwisler, Taylor) National Institute of Public Health, University
of Southern Denmark, Denmark
(Lewinter) Department of Cardiology, Vejle Hospital, Vejle, Denmark
(Moniruzzaman) Non-communicable Disease Unit, World Health Organization
(WHO), Country Office for Bangladesh, Dhaka, Bangladesh
(Lund) Department of Physiotherapy and Occupational Therapy, Holbaek
Hospital, Denmark
(Tang) Heart Centre, Copenhagen University Hospital, Rigshospitalet,
Copenhagen, Denmark
(Tang) CopenRehab, Section of Social Medicine, Department of Public
Health, University of Copenhagen, Denmark
(Tang) Bachelor's Degree Programme in Physiotherapy, Dept. of
Rehabilitation and Nutrition, Faculty of Health and Technology,
Metropolitan University College, Copenhagen, Denmark
(Taylor) Department of Health Services Research, Institute of Health
Research, University of Exeter Medical School, South Cloisters, St Lukes
Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom
Title
Predictors of exercise capacity following exercise-based rehabilitation in
patients with coronary heart disease and heart failure: A meta-regression
analysis.
Source
European Journal of Preventive Cardiology. 23 (7) (pp 683-693), 2015. Date
of Publication: 2015.
Publisher
SAGE Publications Inc.
Abstract
Background The aim of this study was to undertake a comprehensive
assessment of the patient, intervention and trial-level factors that may
predict exercise capacity following exercise-based rehabilitation in
patients with coronary heart disease and heart failure. Design
Meta-analysis and meta-regression analysis. Methods Randomized controlled
trials of exercise-based rehabilitation were identified from three
published systematic reviews. Exercise capacity was pooled across trials
using random effects meta-analysis, and meta-regression used to examine
the association between exercise capacity and a range of patient (e.g.
age), intervention (e.g. exercise frequency) and trial (e.g. risk of bias)
factors. Results 55 trials (61 exercise-control comparisons, 7553
patients) were included. Following exercise-based rehabilitation compared
to control, overall exercise capacity was on average 0.95 (95% CI:
0.76-1.41) standard deviation units higher, and in trials reporting
maximum oxygen uptake (VO<inf>2</inf>max) was 3.3 ml/kg.min^-1
(95% CI: 2.6-4.0) higher. There was evidence of a high level of
statistical heterogeneity across trials (I² statistic > 50%).
In multivariable meta-regression analysis, only exercise intervention
intensity was found to be significantly associated with VO<inf>2</inf>max
(P = 0.04); those trials with the highest average exercise intensity had
the largest mean post-rehabilitation VO<inf>2</inf>max compared to
control. Conclusions We found considerable heterogeneity across randomized
controlled trials in the magnitude of improvement in exercise capacity
following exercise-based rehabilitation compared to control among patients
with coronary heart disease or heart failure. Whilst higher exercise
intensities were associated with a greater level of post-rehabilitation
exercise capacity, there was no strong evidence to support other
intervention, patient or trial factors to be predictive.

<24>
Accession Number
20160286619
Author
Vyas A.; El Accaoui R.; Blevins A.; Karrowni W.
Institution
(Vyas, El Accaoui, Karrowni) Division of Cardiovascular Medicine,
University of Iowa Hospitals and Clinics, Iowa City, IA, United States
(Blevins) Hardin Library of the Health Sciences, University of Iowa Carver
College of Medicine, Iowa City, IA, United States
Title
Outcome comparison of 600 mg versus 300 mg loading dose of clopidogrel for
patients with ST-Elevation myocardial infarction: A meta-analysis.
Source
Postgraduate Medicine. 126 (5) (pp 177-187), 2014. Date of Publication: 01
Jan 2014.
Publisher
Taylor and Francis Inc. (325 Chestnut St, Suite 800, Philadelphia PA
19106, United States)
Abstract
Background: A 600-mg loading dose (LD) of clopidogrel has been shown to be
superior to a 300-mg LD in inhibiting platelet function. However, data for
clinical superiority are limited, and there is a paucity of adequately
powered randomized trials investigating this issue. This meta-analysis was
performed to determine the optimal LD of clopidogrel in ST-elevation
myocardial infarction patients treated with primary percutaneous coronary
intervention. Methods: A meta-analysis of controlled trials and
observational studies was performed comparing 600-mg with 300-mg LDs of
clopidogrel. The primary efficacy end point was a major adverse cardiac
event (MACE), and the primary safety end point was major bleeding. Data
were extracted on an intention to treat basis. The X2 test was used to
evaluate heterogeneity. A random effects model was used, and odds ratios
(OR) were calculated using the Mantel-Haenszel method. Results: Nine
studies involving 18 623 patients were included in the efficacy analysis.
Mean duration of follow-up was 8 months. Four studies were eligible for
the safety analysis. The MACE risk was lower with a 600-mg LD (7.0%
[650/9231]) than with a 300-mg LD (9.2% [867/9392]; OR, 0.75; 95% CI,
0.63-0.91). On the other hand, there was no significant difference in the
major bleeding events between the 2 groups (2.5% [89/3551] with 600 mg vs
2.3% [63/2796] with 300 mg; OR, 0.84; 95% CI, (0.60-1.16). Conclusions: In
ST-elevation myocardial infarction patients treated with primary
percutaneous coronary intervention, administration of a 600-mg LD of
clopidogrel is associated with a lower risk of MACE than is administration
of a 300-mg LD, without increasing the risk of major bleeding.

<25>
Accession Number
72254272
Author
Jennings D.L.; Baker. W.L.
Institution
(Jennings) Department of Pharmacy, New York Presbyterian Columbia
University Medical Center, New York, NY, United States
(Baker.) Department of Pharmacy Practice, University of Connecticut,
Storrs, CT, United States
Title
Pre-transplant amiodarone exposure increases mortality in cardiac
transplant recipients: A meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 36th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2016 Washington, DC United States. Conference
Start: 20160427 Conference End: 20160430. Conference Publication:
(var.pagings). 35 (4 SUPPL. 1) (pp S420), 2016. Date of Publication: April
2016.
Publisher
Elsevier USA
Abstract
Purpose: Amiodarone remains a prevalent therapy for treatment of
arrhythmias in patients awaiting cardiac transplant, however the impact of
this medication on post-transplant outcomes is uncertain. We performed a
systematic review and meta-analysis of published studies evaluating the
impact of pre-implant amiodarone use on all-cause mortality rates
following cardiac transplantation. Methods: We searched Medline, SCOPUS
and the Cochrane Central Register of Controlled Trials from inception
through October 2015. Proceedings from related conferences over the prior
2 years were also manually reviewed. Studies, regardless their design,
were included if they were an evaluation of patients undergoing cardiac
transplantation who had received pre-implant amiodarone and reported
postoperative mortality. The earliest reported mortality rates from each
study were included. Outcomes were pooled using a random-effects model
producing odds ratios (OR) and 95% confidence intervals (CI). Statistical
heterogeneity was evaluating using the Cochrane Q statistic p-value and I2
value. Publication bias was assessed using Egger's weighted regression
statistic. Results: Six studies, including 869 participants, were
included. Follow-up times varied between the studies. Two reported
in-hospital mortality, three reported 1-month mortality, and the last had
5 years of follow-up. Use of pre-transplant amiodarone was associated with
a 2-fold increase in postoperative mortality versus control (OR 2.26, 95%
1.11 to 4.57;Figure). Neither appreciable statistical heterogeneity (I2 =
23.9%) nor publication bias (Egger's p = 0.66) was observed. Too few
studies reported mean amiodarone dose and/or duration to allow for
meta-regression analyses to be performed. Conclusion: Exposure to
amiodarone prior to cardiac transplantation is associated with a higher
rate of postoperative mortality. (Figure Presented).

<26>
Accession Number
72253642
Author
Foroutan F.; Alba A.; Ng Fat Hing N.; Fan C.; Manlhiot C.; Ross H.J.
Institution
(Foroutan, Alba, Ng Fat Hing, Ross) Cardiology, Toronto General Hospital,
Toronto, ON, Canada
(Fan, Manlhiot) Cardiovascular Data Management Centre, University of
Toronto, Toronto, ON, Canada
Title
Rejection and cardiac allograft vasculopathy are both associated with
increased incidence of sudden cardiac death post-heart transplant: A
meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 36th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2016 Washington, DC United States. Conference
Start: 20160427 Conference End: 20160430. Conference Publication:
(var.pagings). 35 (4 SUPPL. 1) (pp S199), 2016. Date of Publication: April
2016.
Publisher
Elsevier USA
Abstract
Purpose: Sudden cardiac death (SCD) is responsible for approximately 10%
of deaths post-heart transplant (HTx). We conducted a meta-analysis to
evaluate incidence and risk factors associated with increased risk of
post-tx SCD. Methods: We systematically searched electronic databases
including Medline, EMBASE, and CINAHL, and references of included studies.
We selected comparative observational studies on adult HTx recipients
reporting post-transplant SCD. We collected patient population
characteristics about the proportion of patients with CAV, rejection, mean
donor and recipient age, and recipient sex and pre-transplant
cardiomyopathy. We meta-analyzed the incidence of SCD in person-years
using random effect models and performed a meta-regression to evaluate the
association between SCD and population characteristics. Results: We
included 58 studies on 47,533 recipients. Median (25th - 75% percentile)
recipient age was 48 (42 - 52), donor age was 31 (29 - 38), proportion of
female was 22% (14% - 26%), proportion of patients with ischemic
cardiomyopathy was 29% (18% - 50%), patients with CAV was 19% (7% - 48%),
and patients with rejection was 9% (5% - 35%). The pooled incidence rate
of SCD was 2.82 (95% CI: 1.97 - 3.67) per 100 patient-years, with a high
heterogeneity (I2= 99%). An increase in CAV incidence and proportion of
patients with rejection were independently associated with an increase in
SCD incidence (0.21 per 100 person-years, 95% CI: 0.01 - 0.41, p= 0.04 and
10.7 per 1% increase in proportion of rejection, 95% CI: 1.04 - 20.3, p=
0.03). There was no association between SCD incidence rate and recipient
age, sex, and etiology of cardiomyopathy. Conclusion: Our study shows a
2.82 incidence per 100 patient-years of post-transplant SCD with high
heterogeneity across studies. This variation can partially be explained by
higher incidence of CAV, independently of rejection. The risk of SCD
should be separately evaluated in patients with CAV versus rejection.

<27>
Accession Number
72252776
Author
Cho S.; Deshpande A.; Pasupuleti V.; Diaz A.; Uchino K.
Institution
(Cho) Cleveland Clinic, Cleveland, OH, United States
(Deshpande, Pasupuleti, Diaz, Uchino) Cleveland Clinic Foundation,
Cleveland, OH, United States
Title
Radiographic and symptomatic brain embolism in cardiac interventions: A
systematic review and pooled analysis.
Source
Neurology. Conference: 68th American Academy of Neurology Annual Meeting,
AAN 2016 Vancouver, BC Canada. Conference Start: 20160415 Conference End:
20160421. Conference Publication: (var.pagings). 86 (16 SUPPL. 1) (no
pagination), 2016. Date of Publication: 05 Apr 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To describe the proportion of radiographic brain infarcts that
are symptomatic in cardiac procedures. Background: Reports vary in
incidence of silent brain infarcts after cardiovascular procedures. In a
systematic review we compared the rates of radiographic brain infarcts
(RBI) to clinical strokes across cardiac interventions: surgical aortic
valve replacement/repair (AVR), transcatheter aortic valve implantation
(TAVI), coronary artery bypass grafting (CABG), and cardiac catherization.
Methods: We searched MEDLINE and 4 other databases for subject headings
and text related to brain infarcts in carotid artery interventions from
inception through February 2015. We included articles with cardiac
interventions if brain MRI was performed systematically, RBI and stroke
incidence were reported. We compared infarct rates between the procedures.
Results: Of 6332 articles retrieved, 24 studies (1770 patients) met the
inclusion criteria. There were 5 cohorts in CABG, 11 cohorts in AVR/TAVI,
and 8 in cardiac catherization. MRI diffusion-weighted imaging scan was
performed pre-procedure in 22 studies and post-procedure in all studies.
Among 320 patients undergoing CABG, the incidence of RBI was 20[percnt]
(range 0-31[ percnt]) with clinical stroke incidence of 2[percnt] (range
0-7.6[ percnt]), indicating 7.9[percnt] of RBI being symptomatic. Among
617 persons undergoing AVR, the incidence of RBI was 68[percnt] (range
7.7-100[ percnt]) with clinical stroke incidence of 9.7[percnt] (range
0-17[ percnt]), indicating that 15[percnt] of RBIs were symptomatic. Among
833 persons undergoing cardiac catheterization, the incidence of RBI was
12[percnt] (range 0-22[ percnt]) with clinical stroke incidence rate of
1.0[percnt] (range 0-2.4[ percnt]) with 7.9[percnt] of RBIs being
symptomatic. Infarct incidence was significantly higher in TAVI (282/357,
79.0[percnt]) compared to AVR (136/260, 52.3[percnt], p < 0.05).
Conclusions: Most radiographic infarcts during CABG, and cardiac
catheterization remained silent. It appears that AVR might have both
higher rate of radiographic infarct but also higher proportions being
symptomatic.

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<1>
Accession Number
26303634
Author
Johnson J.T.; Sleeper L.A.; Chen S.; Ohye R.G.; Gaies M.G.; Williams I.A.;
Sachdeva R.; Pruetz J.D.; Tatum G.H.; Thacker D.; Brunetti M.A.; Frommelt
M.A.; Jacobs J.P.; Kirsh J.A.; Lambert L.M.; Newburger J.W.; Pemberton
V.L.; Zyblewski S.C.; Divanovic A.A.; Pinto N.M.
Institution
(Johnson) Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago,
Illinois. Electronic address: jtjohnson@luriechildrens.org
(Sleeper) New England Research Institutes, Inc., Watertown, Massachusetts
(Chen) New England Research Institutes, Inc., Watertown, Massachusetts
(Ohye) University of Michigan Health System, Ann Arbor, Michigan
(Gaies) University of Michigan Health System, Ann Arbor, Michigan
(Williams) Columbia University Medical Center, New York City, New York
(Sachdeva) Children's Healthcare of Atlanta, Emory University, Atlanta,
Georgia
(Pruetz) Children's Hospital Los Angeles, Los Angeles, California
(Tatum) Duke Children's Hospital and Health Center, Durham, North Carolina
(Thacker) Nemours/Alfred L. DuPont Hospital for Children, Wilmington,
Delaware
(Brunetti) Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
(Frommelt) Children's Hospital Wisconsin, Milwaukee, Wisconsin
(Jacobs) All Children's Hospital, St. Petersburg, Florida
(Kirsh) The Hospital for Sick Children, Toronto, Canada
(Lambert) University of Utah at Primary Children's Hospital, Salt Lake
City, Utah
(Newburger) Boston Children's Hospital, Boston, Massachusetts
(Pemberton) National Heart, Lung and Blood Institute, Bethesda, Maryland
(Zyblewski) Medical University of South Carolina, Charleston, South
Carolina
(Divanovic) Cincinnati Children's Hospital, Cincinnati, Ohio
(Pinto) University of Utah at Primary Children's Hospital, Salt Lake City,
Utah
Title
Associations Between Day of Admission and Day of Surgery on Outcome and
Resource Utilization in Infants With Hypoplastic Left Heart Syndrome Who
Underwent Stage I Palliation (from the Single Ventricle Reconstruction
Trial).
Source
The American journal of cardiology. 116 (8) (pp 1263-1269), 2015. Date of
Publication: 15 Oct 2015.
Abstract
Newborns with hypoplastic left heart syndrome and other single right
ventricular variants require substantial health care resources. Weekend
acute care has been associated with worse outcomes and increased resource
use in other populations but has not been studied in patients with single
ventricle. Subjects of the Single Ventricle Reconstruction trial were
classified by whether they had a weekend admission and by day of the week
of Norwood procedure. The primary outcome was hospital length of stay
(LOS); secondary outcomes included transplant-free survival, intensive
care unit (ICU) LOS, and days of mechanical ventilation. The Student's t
test with log transformation and the Wilcoxon rank-sum test were used to
analyze associations. Admission day was categorized for 533 of 549
subjects (13% weekend). The day of the Norwood was Thursday/Friday in 39%.
There was no difference in median hospital LOS, transplant-free survival,
ICU LOS, or days ventilated for weekend versus non-weekend admissions. Day
of the Norwood procedure was not associated with a difference in hospital
LOS, transplant-free survival, ICU LOS, or days ventilated. Prenatally
diagnosed infants born on the weekend had lower mean birth weight, younger
gestational age, and were more likely to be intubated but did not have a
difference in measured outcomes. In conclusion, in this cohort of patients
with single right ventricle, neither weekend admission nor end-of-the-week
Norwood procedure was associated with increased use of hospital resources
or poorer outcomes. We speculate that the complex postoperative course
following the Norwood procedure outweighs any impact that day of admission
or operation may have on these outcomes.

<2>
Accession Number
25418212
Author
Qi Z.; Duan F.; Liu S.; Lv X.; Wang H.; Gao Y.; Wang J.
Institution
(Qi) Department of Echocardiography, Fuwai Hospital & Cardiovascular
Institute, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Tsinghua University, Peking Union Medical College,
Beijing, China
(Duan) Department of Echocardiography, Fuwai Hospital & Cardiovascular
Institute, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Tsinghua University, Peking Union Medical College,
Beijing, China
(Liu) Department of Cardiovascular Surgery, Fuwai Hospital &
Cardiovascular Institute, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences & Tsinghua University, Peking Union
Medical College, Beijing, China
(Lv) Department of Echocardiography, Fuwai Hospital & Cardiovascular
Institute, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Tsinghua University, Peking Union Medical College,
Beijing, China
(Wang) Department of Echocardiography, Fuwai Hospital & Cardiovascular
Institute, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Tsinghua University, Peking Union Medical College,
Beijing, China
(Gao) Department of Echocardiography, Fuwai Hospital & Cardiovascular
Institute, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Tsinghua University, Peking Union Medical College,
Beijing, China
(Wang) Department of Echocardiography, Fuwai Hospital & Cardiovascular
Institute, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Tsinghua University, Peking Union Medical College,
Beijing, China
Title
Effects of Bone Marrow Mononuclear Cells Delivered through a Graft Vessel
for Patients with Previous Myocardial Infarction and Chronic Heart
Failure: An Echocardiographic Study of Left Ventricular Function.
Source
Echocardiography (Mount Kisco, N.Y.). 32 (6) (pp 937-946), 2015. Date of
Publication: 01 Jun 2015.
Abstract
OBJECTIVES: The graft of stem cells to treat ischemic cardiomyopathy is
popular in many clinical trials. The aim of this study was to evaluate the
effectiveness of isolated coronary artery bypass graft combined with bone
marrow mononuclear cells (BMMNC) delivered through graft vessels to
improve left ventricular function of patients with previous myocardial
infarction and chronic heart failure using echocardiography.
METHODS: Forty-two patients with previous myocardial infarction and
chronic heart failure were randomly allocated to one of the two groups:
CABG only (18 in CABG group), or CABG with BMMNC transplantation (24 in
CABG + BMMNC group). Echocardiographic parameters of systolic function
were measured on B-mode imaging, tissue Doppler imaging (TDI),
two-dimensional (2D) strain imaging, and 8 parameters were measured
totally. Echocardiographic parameters of diastolic function were measured
on pulsed-wave Doppler imaging, TDI, and 2D strain rate imaging; 17
parameters were measured totally.
RESULTS: Postoperative left ventricular ejection fraction (LVEF) versus
preoperative LVEF were 49.083 +/- 1.914% versus 36.042 +/- 1.185% (P <
0.05) in CABG + BMMMNC group and 41.389 +/- 2.210% versus 34.667 +/-
1.369% (P < 0.05) in CABG group, global longitudinal strain were -12.542
+/- 0.512% versus -7.083 +/- 0.583% (P < 0.05) in CABG + BMMMNC group and
-9.278 +/- 0.591% versus -7.000 +/- 0.673% (P < 0.05) in CABG group, mLsr1
were -0.108 +/- 0.018/sec versus -0.039 +/- 0.017/sec (P < 0.05) in
CABG+BMMMNC group and -0.048 +/- 0.021/sec versus 0.004 +/- 0.020/sec (P <
0.05) in CABG group, mLsr2 were -0.055 +/- 0.013/sec versus -0.009 +/-
0.015/sec (P < 0.05) in CABG + BMMMNC group and 0.004 +/- 0.015/sec versus
0.024 +/- 0.017/sec (P < 0.05) in CABG group, and Aa1 were 7.303 +/- 0.479
cm/sec versus 5.131 +/- 0.381 cm/sec (P < 0.05) in CABG + BMMMNC group and
7.908 +/- 0.553 cm/sec versus 6.764 +/- 0.440 cm/sec (P < 0.05) in CABG
group. Parameters above were significantly improved postoperatively in
both groups. The degree of the improvement was significantly different
between the two groups with the CABG + BMMNC group improved more versus
the group of CABG only (P < 0.05).
CONCLUSIONS: The improvement of left ventricular function in CABG + BMMNC
group is better than CABG group. 2D strain and strain rate imaging is a
more sensitive tool to evaluate left ventricular function.

<3>
Accession Number
25781147
Author
Tan T.P.; Arekapudi A.; Metha J.; Prasad A.; Venkatraghavan L.
Institution
(Tan) Department of Anaesthesia, Shepparton Hospital, Shepparton,
Victoria, Australia
(Arekapudi) Department of Anesthesia and Pain Management, Toronto Western
Hospital, University of Toronto, Toronto, Ontario, Canada
(Metha) Department of Anesthesia and Pain Management, Toronto Western
Hospital, University of Toronto, Toronto, Ontario, Canada
(Prasad) Department of Anesthesia and Pain Management, Toronto Western
Hospital, University of Toronto, Toronto, Ontario, Canada
(Venkatraghavan) Department of Anesthesia and Pain Management, Toronto
Western Hospital, University of Toronto, Toronto, Ontario, Canada
Title
Neutrophil-lymphocyte ratio as predictor of mortality and morbidity in
cardiovascular surgery: a systematic review.
Source
ANZ journal of surgery. 85 (6) (pp 414-419), 2015. Date of Publication: 01
Jun 2015.
Abstract
BACKGROUND: Neutrophil-lymphocyte ratio (NLR) is an emerging biomarker of
inflammation and predicts poorer outcome in cancer surgery. The prognostic
value of NLR in cardiovascular surgery is unclear.
METHODS: Systematic review and meta-analysis of studies of in
cardiovascular surgical patients were conducted to assess the role of
perioperative NLR in predicting post-operative mortality and morbidity.
Electronic searches were conducted on Ovid Medline, EMBASE, Cochrane
Central Register of Controlled Trials and Cochrane Database of Systemic
Reviews for all prospective clinical studies reporting on NLR and
post-operative morbidity and mortality in cardiovascular surgical patient
population. Our primary end point was all-cause post-operative mortality
and the secondary end point was post-operative morbidity. Mortality
outcome from prospective studies were pooled for a meta-analysis using a
random-effect model.
RESULTS: Of the 999 citations identified, five studies with 3487 patients
met the inclusion criteria. In a pooled analysis of three prospective
studies of 3108 patients, a preoperative increase in NLR (>3.3 in cardiac
surgery, >5 in vascular surgery) was associated with increased mortality
at a mean follow-up of 34.8 months (hazard ratio 1.85, 95% confidence
interval 1.46-2.36; P < 0.00001). Raised NLR value was also associated
with increased cardiac mortality, amputation in vascular operations and
raised risk of post-operative re-intubation.
CONCLUSIONS: Elevated NLR were associated with increased long-term
mortality and morbidity after major cardiac and vascular surgery. NLR may
guide perioperative management and risk-stratification of patients.

<4>
Accession Number
25890367
Author
Hashim S.; Chin L.Y.; Krishnasamy S.; Sthaneswar P.; Raja Mokhtar R.A.
Institution
(Hashim) Division of Cardiothoracic Surgery, Department of Surgery,
University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia.
(Chin) Division of Cardiothoracic Surgery, Department of Surgery,
University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia.
y_chin1981@yahoo.com
(Krishnasamy) Division of Cardiothoracic Surgery, Department of Surgery,
University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia.
sivakumar@um.edu.my
(Sthaneswar) Department of Pathology, University Malaya, 50603, Kuala
Lumpur, Malaysia. pavai@um.edu.my
(Raja Mokhtar) Division of Cardiothoracic Surgery, Department of Surgery,
University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia.
ramin@um.edu.my
Title
Effect of sternal closure with biological bone adhesive on pain visual
analogue score and serum cytokine.
Source
Journal of cardiothoracic surgery. 10 (pp 32), 2015. Date of Publication:
2015.
Abstract
OBJECTIVES: Recently a biocompatible bone adhesive was introduced in
addition to the sternal wires to expedite sternal union and improve
patient recovery. In this study we aim to objectively assess the biomarker
of pain in patient who received the biocompatible bone adhesive.
METHODS: A total of 62 patients who underwent sternotomy were
prospectively randomised to receive either conventional wire closure
(CWC); 32 patients or adhesive enhanced closure in addition to sternal
wire (AEC); 30 patients. Patients were monitored postoperatively at
certain time intervals for incisional pain, serum Interleukin-6 (IL-6)
level, analgesia used and postoperative complications. All patients were
followed up for 4 weeks.
RESULTS: The post-operative pain scores with coughing were significantly
higher in the CWC group at 24 hours and 48 hours. The postoperative IL 6
levels were significantly higher in the CWC group in comparison with the
AEC group at 6 hours, 24 hours, and 48 hours. There were no significant
differences in term of additional analgesia used. No adverse events from
adhesive bone cement were observed during follow up.
CONCLUSIONS: Adhesive-enhanced sternal closure resulted in modest
reduction of pain confirmed by reduction of pain biomarker. Justification
of its routine use requires larger multicentre study.

<5>
Accession Number
26069175
Author
Zarrabi K.; Dehghani P.; Abdi Ardekani A.; Zarrabi M.A.; Zolghadrasli A.
Institution
(Zarrabi) Department of Cardiac Surgery, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran. zarrabisx@gmail.com
(Dehghani) Department of Cardiology, School of Medicine, Shiraz University
of Medical Sciences, Shiraz, Iran. p.dehghani@gmail.com
(Abdi Ardekani) Department of Cardiology, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran. ayat.dr@yahoo.com
(Zarrabi) Student Research Committee, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran. aminz487@gmail.com
(Zolghadrasli) Department of Cardiology, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran. abdolali.zolghadr@gmail.com
Title
The Comparison Between Two Surgical Methods for Left Internal Mammary
Artery (LIMA) Anastomosis on Left Anterior Descending (LAD) Artery in
Patients with Severe Diffuse Lesions: Short to Mid-Term Results.
Source
Acta medica Iranica. 53 (6) (pp 369-372), 2015. Date of Publication: 2015.
Abstract
Coronary artery disease is the leading cause of death worldwide. In this
study, we compared two surgical methods of left internal mammary artery
(LIMA) anastomosis on left anterior descending (LAD) artery in patients
with severe diffuse lesions. A total of 40 patients were included in our
study and randomly assigned into two groups. In group A, after a long
arteriotomy on LAD, the posterior surface of left internal mammary artery
(LIMA) was opened by the same length and was anastomosed along the LAD
course through normal and diseased parts. In group B instead of complete
opening of LAD, a small arteriotomy was done only in areas where the wall
of the vessel was nearly normal (especially the anterolateral wall), and
LIMA was anastomosed to these areas in a sequential (Jump) method. The
patients were then followed for post-operation results. The two groups
showed equal results regarding early mortality, post-operation bleeding,
and infection, pleural and pericardial effusion. There were two cases of
myocardial infarction (MI) in group A with one mortality after 18 months,
while no MI was reported in group B. Group B demonstrated significantly
superior results regarding the rise in ejection fraction and the
improvement in functional class. In this study it was demonstrated that
diffuse coronary artery lesions of LAD should be preferably operated using
LIMA with the sequential-jump anastomoses method and the surgeon should
avoid long arteriotomy with single long anastomosis because of lower
chance of long-term patency.

<6>
Accession Number
20160263772
Author
Berg D.D.; Bonaca M.P.; Braunwald E.; Corbalan R.; Goto S.; Kiss R.G.;
Murphy S.A.; Scirica B.M.; Spinar J.; Morrow D.A.
Institution
(Berg, Bonaca, Braunwald, Murphy, Scirica, Morrow) TIMI Study Group,
Cardiovascular Division, Department of Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Corbalan) Department of Cardiology, Catholic University School of
Medicine, Santiago, Chile
(Goto) Department of Medicine, Tokai University School of Medicine,
Isehara, Japan
(Kiss) Department of Cardiology, Military Hospital, Budapest, Hungary
(Spinar) Department of Cardiology, University Hospital, Jihlavska, Brno,
Czech Republic
Title
Outcomes in stable patients with previous atherothrombotic events
receiving vorapaxar who experience a new acute coronary event (from
TRA2degreeP-TIMI 50).
Source
American Journal of Cardiology. 117 (7) (pp 1055-1058), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Elsevier Inc.
Abstract
Vorapaxar is a first-in-class protease-activated receptor-1 antagonist
indicated for secondary prevention in stable patients with previous
myocardial infarction (MI) or peripheral artery disease and no
cerebrovascular disease. Vorapaxar is not recommended for initiation in
the acute phase of acute coronary syndromes (ACS) because of an
unfavorable balance between bleeding and efficacy when started in that
setting. The aim of this analysis was to investigate outcomes in patients
who experienced a new ACS while receiving vorapaxar for long-term
secondary prevention. Thrombin Receptor Antagonist in Secondary Prevention
of Atherothrombotic ischemic Events-Thrombolysis In Myocardial Infarction
50 was a randomized, double-blind, placebo-controlled trial of vorapaxar
(n = 26,449). We evaluated bleeding and ischemic events during the acute
care of patients with a new ACS during the trial. During a median
follow-up of 30 months, 799 patients (8.9%) randomized to vorapaxar and
913 (10.0%) to placebo had a new ACS event (p = 0.003); 87% and 86%,
respectively, were on study therapy at the time of the event. In a
landmark analysis through 7 days after ACS, the rates of Global Use of
Strategies to Open Occluded Coronary Arteries (GUSTO) severe bleeding were
0.8% versus 0.8% (hazard ratio [HR] 0.99, 95% CI 0.33 to 2.94) and GUSTO
moderate/severe bleeding were 2.5% versus 1.6% (HR 1.59, 95% CI 0.78 to
3.24) with vorapaxar versus placebo. The effect of vorapaxar on
cardiovascular death, MI, or stroke (2.4% vs 4.4%; HR 0.54, 95% CI 0.31 to
0.93; p = 0.027) was consistent with the overall trial result. In
conclusion, in patients who experience a new ACS event while receiving
vorapaxar for secondary prevention, continuing therapy was associated with
favorable efficacy without excess severe bleeding during the period of
acute ACS management.

<7>
Accession Number
20160263006
Author
Andreassen A.K.; Andersson B.; Gustafsson F.; Eiskjaer H.; Radegran G.;
Gude E.; Jansson K.; Solbu D.; Karason K.; Arora S.; Dellgren G.;
Gullestad L.
Institution
(Andreassen, Gude, Arora, Gullestad) Department of Cardiology, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Andersson, Karason) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Skejby,
Denmark
(Radegran) Section for Heart Failure and Valvular Disease, Skane
University Hospital, Department of Clinical Sciences, Cardiology, Lund
University, Lund, Sweden
(Jansson) Department of Cardiology, Heart and Medicine Center County
Council of Ostergotland, Linkoping University, Linkoping, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gullestad) K.G. Jebsen Cardiac Research Center, Center for Heart Failure
Research, Faculty of Medicine, University of Oslo, Oslo, Norway
Title
Everolimus Initiation with Early Calcineurin Inhibitor Withdrawal in de
Novo Heart Transplant Recipients: Three-Year Results from the Randomized
SCHEDULE Study.
Source
American Journal of Transplantation. 16 (4) (pp 1238-1247), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Blackwell Publishing Ltd
Abstract
In a randomized, open-label trial, de novo heart transplant recipients
were randomized to everolimus (3-6 ng/mL) with reduced-exposure
calcineurin inhibitor (CNI; cyclosporine) to weeks 7-11 after transplant,
followed by increased everolimus exposure (target 6-10 ng/mL) with
cyclosporine withdrawal or standard-exposure cyclosporine. All patients
received mycophenolate mofetil and corticosteroids. A total of 110 of 115
patients completed the 12-month study, and 102 attended a follow-up visit
at month 36. Mean measured GFR (mGFR) at month 36 was 77.4 mL/min
(standard deviation [SD] 20.2 mL/min) versus 59.2 mL/min (SD 17.4 mL/min)
in the everolimus and CNI groups, respectively, a difference of 18.3
mL/min (95% CI 11.1-25.6 mL/min; p < 0.001) in the intention to treat
population. Multivariate analysis showed treatment to be an independent
determinant of mGFR at month 36. Coronary intravascular ultrasound at 36
months revealed significantly reduced progression of allograft
vasculopathy in the everolimus group compared with the CNI group.
Biopsy-proven acute rejection grade >2R occurred in 10.2% and 5.9% of
everolimus- and CNI-treated patients, respectively, during months 12-36.
Serious adverse events occurred in 37.3% and 19.6% of everolimus- and
CNI-treated patients, respectively (p = 0.078). These results suggest that
early CNI withdrawal after heart transplantation supported by everolimus,
mycophenolic acid and steroids with lymphocyte-depleting induction is safe
at intermediate follow-up. This regimen, used selectively, may offer
adequate immunosuppressive potency with a sustained renal advantage.

<8>
Accession Number
20160264602
Author
Finsterer J.; Stollberger C.
Institution
(Finsterer) Rudolfstiftung Hospital, Postfach 20, Vienna 1180, Austria
(Stollberger) Second Medical Department with Cardiology and Intensive Care
Medicine, Rudolfstiftung Hospital, Vienna, Austria
Title
Neurological complications of cardiac disease (heart brain disorders).
Source
Minerva Medica. 107 (1) (pp 14-25), 2016. Date of Publication: February
2016.
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: Heart disease is a frequent cause of cerebral compromise. This
review aimed at summarising and discussing available data about heart
brain disorders. METHODS: We performed a literature search in conventional
databases. RESULTS: Frequent cerebral complications of cardiac disease
include embolic stroke, syncope, and intracerebral bleeding. Rare
complications are watershed infarction, brain abscess, meningitis,
metastasis, dementia, or aneurysm formation. The most frequent and most
well-known cardiac cause of neurological complications is cardiac
embolism. Cardiac emboli can be of different material and derive from the
left atrium, left atrial appendage, left ventricle, or the mitral or
aortic valves. Also arrhythmias such as atrial fibrillation or atrial
flutter may give rise to thrombus formation. Heart failure, myocardial
infarction, myocardial aneurysm, endocarditis/myocarditis, and
noncompaction are further causes of cerebral embolism. Another cardiac
cause of neurological complications is low output failure due to systolic
dysfunction, arrhythmias, or valve stenosis. Arrhythmias are not only
associated with intra-cardiac thrombus formation but may also lead to low
output failure and consecutively to watershed infarction, vertigo,
fainting, or syncope. Valve abnormalities can be another source of
neurological disease. CONCLUSION: The cardiologist must know about the
neurological complications of heart disease and the neurologist must know
about the cardiac causes of cerebral abnormalities. Heart-brain disorders
require a bidisciplinary diagnostic and therapeutic approach.

<9>
[Use Link to view the full text]
Accession Number
20160264500
Author
Huang F.-Y.; Huang B.-T.; Lv W.-Y.; Liu W.; Peng Y.; Xia T.-L.; Wang
P.-J.; Zuo Z.-L.; Liu R.-S.; Zhang C.; Gui Y.-Y.; Liao Y.-B.; Chen M.; Zhu
Y.
Institution
(Huang, Huang, Lv, Liu, Peng, Xia, Wang, Zuo, Liu, Zhang, Gui, Liao, Chen,
Zhu) Department of Cardiology, West China Hospital, Sichuan University, 37
Guoxue Street, Chengdu, Sichuan 610041, China
Title
The prognosis of patients with nonobstructive coronary artery disease
versus normal arteries determined by invasive coronary angiography or
computed tomography coronary angiography: A systematic review.
Source
Medicine (United States). 95 (11) (no pagination), 2016. Article Number:
e3117. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Limited data exist regarding the outcomes of patients with nonobstructive
coronary artery disease (CAD) detected by computed tomography coronary
angiography (CTCA) or invasive coronary angiography (ICA). Our aim was to
compare the prognosis of patients with nonobstructive coronary artery
plaques with that of patients with entirely normal arteries. The MEDLINE,
Cochrane Library, and Embase databases were searched. Studies comparing
the prognosis of individuals with nonobstructive CAD versus normal
coronary arteries detected by CTCA or ICA were included. The primary
outcome was major adverse cardiac events (MACE) including cardiac death,
nonfatal myocardial infarction, hospitalization due to unstable angina or
revascularization. A fixed effects model was chosen to pool the estimates
of odds ratios (ORs). Forty-eight studies with 64,905 individuals met the
inclusion criteria. Patients in the nonobstructive CAD arm had a
significantly higher risk of MACE compared to their counterparts in the
normal artery arm (pooled OR, 3.17, 95% confidence interval, 2.77-3.63).
When excluding revascularization as an endpoint, hard cardiac composite
outcomes were also more frequent among patients with nonobstructive CAD
(pooled OR, 2.10; 95%CI, 1.79-2.45). All subgroups (age, sex, follow-up
duration, different outcomes, diagnostic modality, and CAD risk factor)
consistently showed a poorer prognosis with nonobstructive CAD than with
normal arteries. When dividing the studies into a CTCA and ICA group for
further analysis based on the indications for diagnostic tests, we also
found nonobstructive CAD to be associated with a higher risk of MACE in
both stable and acute chest pain. Patients with nonobstructive CAD had a
poorer prognosis compared with their counterparts with normal arteries.

<10>
Accession Number
20160296976
Author
Wang Y.; Zhang J.; Zhang S.
Institution
(Wang, Zhang) Department of Anesthesiology, The First Affiliated Hospital
of Zhengzhou University, Zhengzhou 450052, China
(Zhang) Department of Hepatopancreatobiliary Surgery, The First Affiliated
Hospital of Zhengzhou University, Zhengzhou 450052, China
(Wang, Zhang, Zhang) Key-Disciplines Laboratory Clinical-Medicine Henan,
Zhengzhou 450052, China
Title
Influence of different anesthetic and analgesic methods on early cognitive
function of elderly patients receiving non-cardiac surgery.
Source
Pakistan Journal of Medical Sciences. 32 (2) (pp 369-372), 2016. Date of
Publication: 2016.
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Objective: To discuss over influence of two different anesthetic and
analgesic methods on early cognitive function of elderly patients who
received non-cardiac surgery. Methods: Two hundred and six elderly
patients who underwent non-cardiac surgery were selected as research
subjects. They were randomly divided into observation group (103 cases)
and control group (103 cases). Patients in observation group were given
combined spinal and epidural anesthesia and epidural analgesia, while
patients in control group adopted general anesthesia and intravenous
analgesia. Neurological function test was carried out one day before
surgery and on the 7^th day after surgery. Moreover, changes of
postoperative pain degree, neuropsychological function and cognitive
function were observed and compared. Results: On the 7^th day
after surgery, incidence of cognition impairment in observation group and
control group was 48.50% (50/103 cases) and 44.70% (46/103 cases), and
difference between groups had no statistical significance. Visual Analogue
Scale (VAS) Score of observation group was much lower than control group
in the 12^th, 24^th and 48^th h after
surgery (p < 0.05). Logistic regression analysis suggested that, short
education years and general surgery were independent risk factors for
early cognition impairment. Conclusion: About 46.60% elderly patients
undergoing non-cardiac surgery developed cognition impairment, but
influence of different anesthetic and analgesic methods on incidence of
postoperative cognition impairment of elderly patients had no significant
difference.

<11>
Accession Number
20160225382
Author
Kondur A.; Briasoulis A.; Palla M.; Penumetcha A.; Mallikethi-Reddy S.;
Badheka A.; Schreiber T.
Institution
(Kondur, Briasoulis, Palla, Penumetcha, Mallikethi-Reddy, Badheka,
Schreiber) Department of Cardiology, Detroit Medical Center, Wayne State
University, Detroit, MI, United States
Title
Meta-analysis of transcatheter aortic valve replacement versus surgical
aortic valve replacement in patients with severe aortic valve stenosis.
Source
American Journal of Cardiology. 117 (2) (pp 252-257), 2016. Date of
Publication: 2016.
Publisher
Elsevier Inc.
Abstract
Transcatheter aortic valve replacement (TAVR) is a viable option in the
treatment of severe aortic stenosis in patients at high risk for surgery.
We sought to further investigate outcomes in patients at low to
intermediate risk with aortic stenosis who underwent surgical aortic valve
replacement (SAVR) versus TAVR. We systematically searched the electronic
databases, MEDLINE, PubMed, EMBASE, and Cochrane for prospective cohort
studies of the effects of TAVR versus SAVR on clinical outcomes (30-day
mortality, all-cause mortality, stroke and myocardial infarction, major
vascular complications, paravalvular regurgitation, permanent pacemaker
implantation, major bleeding, and acute kidney injury). We identified 5
clinical studies, examining 1,618 patients in the TAVR group and 1,581
patients in the SAVR group with an average follow-up of 1.05 years. No
difference in all-cause mortality, stroke, and myocardial infarction
between the 2 approaches was found. TAVR was associated with higher rates
of vascular complications, permanent pacemaker implantation, and moderate
or severe paravalvular regurgitation (p <0.001 for all), whereas more
major bleeding events were seen in the SAVR group (p <0.001). In
conclusion, TAVR was found to have similar survival and stroke rates and
lower major bleeding rates as compared with SAVR in patients at low or
intermediate surgical risk. However, SAVR was associated with less
pacemaker placements and paravalvular regurgitation rates.

<12>
Accession Number
20160146393
Author
Rigattieri S.; Sciahbasi A.; Brilakis E.S.; Burzotta F.; Rathore S.;
Pugliese F.R.; Fedele S.; Ziakas A.G.; Zhou Y.J.; Guzman L.A.; Anderson
R.A.
Institution
(Rigattieri, Sciahbasi, Pugliese, Fedele) Emergency Department, Sandro
Pertini Hospital, Rome, Italy
(Brilakis) VA North Texas Healthcare System, University of Texas
Southwestern Medical Center, Dallas, TX, United States
(Burzotta) Institute of Cardiology, Catholic University of the Sacred
Heart, Rome, Italy
(Rathore) Department of Cardiology, Frimley Park Hospital NHS Foundation
Trust, London, United Kingdom
(Ziakas) Department of Cardiology, AHEPA Hospital, Thessaloniki, Greece
(Zhou) Department of Cardiology, An Zhen Hospital, Capital Medical
University, Beijing, China
(Guzman) University of Florida, College of Medicine, Jacksonville, FL,
United States
(Anderson) University Hospital of Wales, Cardiff, United Kingdom
Title
Meta-Analysis of Radial Versus Femoral Artery Approach for Coronary
Procedures in Patients with Previous Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. 117 (8) (pp 1248-1255), 2016. Date of
Publication: 15 Apr 2016.
Publisher
Elsevier Inc.
Abstract
Cardiac catheterization through the radial artery approach (RA) has been
shown to significantly reduce access-site complications compared with the
femoral artery approach (FA) in many clinical settings. However, in the
subset of patients with previous coronary artery bypass grafting (CABG),
optimal vascular access site for coronary angiography and intervention is
still a matter of debate. We aimed to perform a systematic review and
meta-analysis of available studies comparing RA with FA in patients with
previous CABG. Data were extracted by two independent reviewers; weighted
mean differences and 95% confidence interval (CI) were calculated for
continuous outcomes, whereas odds ratio (OR) and 95% CI were calculated
for dichotomous outcomes. Summary statistics were calculated by
random-effects model using Review Manager 5.3 software. The meta-analysis
included 1 randomized and 8 nonrandomized studies, with a total of 2,763
patients. Compared with FA, RA required similar procedural time (mean
difference 3.24 minutes, 95% CI -1.76 to 8.25, p = 0.20), fluoroscopy time
(mean difference 0.62 minutes, 95% CI -0.83 to 2.07, p = 0.40), and
contrast volume (mean difference -2.58 ml, 95% CI -18.36 to 13.20, p =
0.75) and was associated with similar rate of procedural failure (OR 1.32,
95% CI 0.63 to 2.80, p = 0.46), higher rate of crossover to another
vascular access (OR 7.0, 95% CI 2.74 to 17.87, p <0.0001), and lower risk
of access-site complications (OR 0.46, 95%CI 0.26 to 0.80, p = 0.006). In
conclusion, the present meta-analysis suggests that in patients with
previous CABG undergoing coronary procedures, RA, compared with FA, is
associated with increased crossover rate but may reduce access-site
complications.

<13>
Accession Number
20160098685
Author
Sharma A.; Lavie C.J.; Helft G.; Chatterjee S.; Goel S.; Garg A.;
Mukherjee D.; Marmur J.D.
Institution
(Sharma, Marmur) Division of Cardiovascular Medicine, State University of
New York Downstate Medical Center, New York, NY, United States
(Lavie) Department of Cardiovascular Diseases, John Ochsner Heart and
Vascular Institute, Ochsner Clinical School, University of Queensland
School of Medicine, New Orleans, LA, United States
(Helft) Division of Cardiology, Institut de Cardiologie, Hopital
Pitie-Salpetriere, Assistance Publique Hopitaux de Paris, Universite
Pierre et Marie Curie, Boulevard de l'Hopital, Paris, France
(Helft) Institute of Cardiometabolism and Nutrition, Hopital
Pitie-Salpetriere, Paris, France
(Chatterjee) Division of Cardiovascular Diseases, St. Luke's-Roosevelt
Hospital Center of the Mount Sinai Health System, New York, NY, United
States
(Goel) Department of Medicine, Maimonides Medical Center, New York, NY,
United States
(Garg) Department of Medicine, James J. Peters Veterans Affairs Medical
Center, Mount Sinai School of Medicine, New York, NY, United States
(Mukherjee) Division of Cardiology, Texas Tech University, El Paso, TX,
United States
Title
Role of vorapaxar after coronary revascularization.
Source
American Journal of Cardiology. 117 (7) (pp 1059-1064), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Elsevier Inc.
Abstract
We aim to evaluate the potential benefit and risk of addition of vorapaxar
to standard medical therapy in patients who underwent coronary
revascularization with either percutaneous coronary revascularization or
coronary artery bypass graft surgery. We searched PubMed, EMBASE, the
Cochrane Central Register of Controlled trials, and the clinical trial
registry maintained at clinicaltrials.gov for randomized control trials
evaluating the safety and efficacy of vorapaxar in patients who underwent
coronary revascularization procedures with either percutaneous coronary
revascularization or coronary artery bypass graft surgery. Event rates
were compared using a Forest plot of relative risk using a random-effects
model. The 5 studies (n = 24,025) that met all criteria were included in
the final analysis. After coronary revascularization procedures, addition
of vorapaxar to standard medical therapy was associated with reduction in
the risk of myocardial infarction (MI; risk ratio 0.83 [0.75 to 0.92]) and
ischemic stroke (0.011 [0.007 to 0.016]); however, it also resulted in
significant increase risk of hemorrhagic stroke (1.57 [1.01 to 2.44]) and
Thrombolysis In Myocardial Infarction major and minor bleeds (1.36 [1.07
to 1.70]). There was no significant difference in the risk of
cardiovascular mortality (0.90 [0.73 to 1.09]), repeat revascularization
(0.78 [0.23 to 2.70]), and stent thrombosis (0.95 [0.62 to 1.45]) in the
vorapaxar and control groups. In conclusion, after coronary
revascularization procedures, addition of vorapaxar to standard medical
therapy was associated with reduction in the risk of MI and ischemic
stroke and increase in risk of hemorrhagic stroke and Thrombolysis In
Myocardial Infarction major and minor bleeds.

<14>
Accession Number
20160276702
Author
Fiedler K.A.; Ndrepepa G.; Schulz S.; Floh S.; Hoppmann P.; Kufner S.;
Bernlochner I.; Byrne R.A.; Schunkert H.; Laugwitz K.-L.; Kastrati A.
Institution
(Fiedler, Ndrepepa, Schulz, Floh, Kufner, Byrne, Schunkert, Kastrati)
Deutsches Herzzentrum, Technische Universitat, Lazarettstrasse 36, Munchen
80636, Germany
(Hoppmann, Bernlochner, Laugwitz) Medizinische Klinik, Klinikum Rechts der
Isar, Technische Universitat, Munich, Germany
(Schunkert, Laugwitz, Kastrati) DZHK (German Centre for Cardiovascular
Research), Partner Site Munich Heart Alliance, Munich, Germany
Title
Impact of bivalirudin on post-procedural epicardial blood flow, risk of
stent thrombosis and mortality after percutaneous coronary intervention.
Source
EuroIntervention. 11 (11) (pp e1275-e1282), 2016. Date of Publication:
February 2016.
Publisher
EuroPCR
Abstract
Aims: We aimed to assess the association of bivalirudin with
post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow, acute
(<24 hours) and 30-day stent thrombosis (ST), and one-year mortality.
Methods and results: The study included 11,623 patients undergoing
percutaneous coronary intervention (PCI). The primary outcomes were
post-procedural TIMI flow grade <2 and definite acute ST. In groups
treated with bivalirudin (n=3,135), abciximab plus unfractionated heparin
(UFH; n=3,539) and UFH alone (n=4,949), post-procedural TIMI was <2 in
5.2%, 3.2% and 3.2% of patients, respectively (adjusted odds ratio
[OR]=1.96 [95% confidence interval] 1.47-2.56 for bivalirudin versus
abciximab plus UFH and OR=1.56 [1.20-2.04] for bivalirudin versus UFH).
Definite acute ST occurred in two patients (0.06%) treated with
bivalirudin, two patients (0.06%) treated with abciximab plus UFH, and
seven patients (0.14%) treated with UFH (p=0.47). Bivalirudin was not
associated with increased risk of 30-day ST (hazard ratio [HR]=1.20
[0.59-2.43] versus abciximab plus UHF, and HR=0.93 [0.48-1.82] versus UFH)
or one-year mortality (HR=0.95 [0.70-1.28] versus abciximab plus UHF, and
HR=1.05 [0.78-1.41] versus UFH). Conclusions: Bivalirudin was associated
with higher risk of suboptimal post-PCI TIMI flow but not with increased
risk of acute or 30-day definite ST or one-year mortality compared with
abciximab plus UFH or UFH alone.

<15>
Accession Number
20160274792
Author
Jia R.; Nie X.; Li H.; Zhu H.; Pu L.; Li X.; Han J.; Yang D.; Meng S.; Jin
Z.
Institution
(Jia, Li, Zhu, Pu, Li, Han, Yang, Meng, Jin) Thirty-three ward, Department
of emergency cardiology, Beijing Anzhen hospital, Capital Medical
University, Beijing 100029, China
(Nie) Center of Clinical Epidemiology and Evidence-based Medicine, Beijing
Children's Hospital, Capital Medical University, Beijing 100045, China
Title
Impact of attenuated plaques on TIMI grade flow and clinical outcomes of
coronary artery disease patients: A systematic review and meta analysis.
Source
Journal of Thoracic Disease. 8 (3) (pp 527-536), 2016. Date of
Publication: 01 Mar 2016.
Publisher
Pioneer Bioscience Publishing
Abstract
Background: Plaques with a large necrotic core or lipid pool and thin-cap
fibroatheroma manifest as attenuated plaques on intravascular ultrasound
(IVUS). Their impact on TIMI grade flow and clinical outcomes remains
undefined. We performed a systematic review and meta-analysis to summarize
the association between attenuated plaque and distal embolization and
clinical outcomes of coronary artery disease (CAD) from pooled data of
published eligible cohort studies. Methods: We searched the literature on
TIMI grade flow and clinical outcomes on PubMed, Ovid, EMBASE, the
Cochrane Library, CNKI and WanFang databases. Study heterogeneity and
publication bias were estimated. Results: A total of 3,833 patients were
enrolled in nine studies. Five studies investigated TIMI grade flow and
attenuated plaques. They revealed no difference in TIMI grade flow before
percutaneous coronary intervention (PCI) between the attenuated and
non-attenuated plaque group (RR =1.25; 95% CI: 0.65 to 2.41; P=0.50).
After balloon dilation and stent implantation, the incidence of TIMI 0~2
grade flow in the attenuated plaque group was statistically significant
higher than that of the non-attenuated plaque group (RR =4.73; 95% CI:
3.03 to 7.40; P < 0.001). Five other studies investigated major
cardiovascular events (MACEs) and attenuated plaques and found no
difference in MACE rates within three years of follow up. Conclusions: Our
study presents the evidence that plaque with ultrasound signal attenuation
would induce slow/no reflow phenomenon and distal embolization during PCI,
but this appearance has no impact on MACE rates within three years.

<16>
Accession Number
20160260234
Author
Song Y.B.; Park T.K.; Hahn J.-Y.; Yang J.H.; Choi J.-H.; Choi S.-H.; Lee
S.H.; Gwon H.-C.
Institution
(Song, Park, Hahn, Yang, Choi, Choi, Lee, Gwon) Division of Cardiology,
Department of Internal Medicine, Heart Vascular and Stroke Institute,
Samsung Medical Center, Sungkyunkwan University, School of Medicine,
Seoul, South Korea
Title
Optimal Strategy for Provisional Side Branch Intervention in Coronary
Bifurcation Lesions: 3-Year Outcomes of the SMART-STRATEGY Randomized
Trial.
Source
JACC: Cardiovascular Interventions. 9 (6) (pp 517-526), 2016. Date of
Publication: 28 Mar 2016.
Publisher
Elsevier Inc.
Abstract
Objectives This study compared the long-term follow-up results of
conservative versus aggressive strategies for provisional side branch (SB)
intervention in coronary bifurcation lesions. Background The appropriate
criteria for provisional SB ballooning or stenting have not been
established. Methods A total of 258 patients with a large bifurcation
lesion were randomized to a conservative or aggressive SB intervention
strategy. Different criteria applied for the initiation of SB intervention
after main vessel stenting in the conservative and aggressive groups were
Thrombolysis In Myocardial Infarction flow grade lower than 3 versus a
stenosis diameter >75% for non-left main bifurcations, and a stenosis
diameter >75% versus a stenosis diameter >50% for left main bifurcations.
The primary endpoint was target vessel failure (TVF), defined as a
composite of cardiac death, spontaneous myocardial infarction, or target
vessel revascularization at 3 years. Results At 3 years, TVF occurred in
11.7% of the conservative group versus 20.8% of the aggressive group (p =
0.049). Although no significant differences were observed in the incidence
of TVF between groups at 1 year (9.4% vs. 9.2%; p = 0.97), landmark
analysis between 1 and 3 years showed significantly less TVF in patients
assigned to the conservative strategy (2.6% vs. 12.7%; p = 0.004). The
crossover to the 2-stent technique was an independent predictor of TVF
(hazard ratio: 5.42, 95% confidence interval: 2.03 to 14.5; p < 0.001).
There was no interaction between left main bifurcation and treatment
effects for TVF (p for interaction = 0.8). Conclusions A conservative
strategy compared with an aggressive strategy for provisional SB
intervention is associated with long-term benefits for patients with a
large bifurcation lesion. (Optimal Strategy for Side Branch Stenting in
Coronary Bifurcation Lesion; NCT00794014).

<17>
Accession Number
20151044711
Author
Ng V.G.; Baumbach A.; Grinfeld L.; Lincoff A.M.; Mehran R.; Stone G.W.;
Lansky A.J.
Institution
(Ng, Lansky) Division of Cardiovascular Medicine, Department of Internal
Medicine, Yale University, School of Medicine, New Haven, CT, United
States
(Baumbach) Bristol Heart Institute, University Hospitals Bristol, Bristol,
United Kingdom
(Grinfeld) Department of Interventional Cardiology, Hosp Italiano, Buenos
Aires, Argentina
(Lincoff) Department of Cardiovascular Medicine, Cleveland Clinic
Foundation, Cleveland, OH, United States
(Mehran, Stone) Columbia University Medical Center, Cardiovascular
Research Foundation, New York, NY, United States
Title
Impact of bleeding and bivalirudin therapy on mortality risk in women
undergoing percutaneous coronary intervention (from the REPLACE-2, ACUITY,
and HORIZONS-AMI Trials).
Source
American Journal of Cardiology. 117 (2) (pp 186-191), 2016. Date of
Publication: 2016.
Publisher
Elsevier Inc.
Abstract
Women have higher bleeding complication and mortality rates after
percutaneous coronary interventions (PCI). The contribution of female
gender to bleeding and mortality is poorly understood. We evaluated the
effect of gender and bleeding on outcomes of patients treated with
bivalirudin during PCI by performing a patient-level pooled analysis of 3
randomized controlled trials (the Randomized Evaluation in PCI Linking
Angiomax to Reduced Clinical Events, Acute Catheterization and Urgent
Intervention Triage strategY, and Harmonizing Outcomes with
Revascularization and Stents in Acute Myocardial Infarction) comparing
bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor (GPI)
treatment in patients undergoing PCI. Of 14,784 patients, 7,413 patients
received bivalirudin (1,870 women) and 7,371 patients received heparin +
GPI (1,910 women). Women had significantly higher 30-day non-coronary
artery bypass grafting (CABG)-related major bleeding rates (7.6% vs 3.8%,
p <0.0001). After multivariate adjustment, female gender increased the
hazard of major bleeding by 80% (hazard ratio 1.80, 95% confidence
interval 1.52 to 2.11, p <0.001). Furthermore, women had a higher 1-year
mortality rate (3.7% vs 2.7%, p = 0.002) than men; 30-day major bleeding
was the strongest independent predictor of 1-year mortality in women
(hazard ratio 2.48, 95% confidence interval 1.57 to 3.91, p = 0.001).
Bivalirudin therapy in women reduced 30-day non-CABG-related major
bleeding (5.6% vs 9.7%, p <0.0001) and 1-year mortality (2.9% vs 4.4%, p =
0.02) compared to standard therapy. In conclusion, in this cohort of
patients treated for acute coronary syndrome and ST-segment elevation
myocardial infarction, women have a near 2-fold increase in bleeding
complications compared to men after PCI. Bleeding complications rather
than gender is the strongest independent predictor of 1-year mortality in
patients undergoing PCI. Furthermore, we observed a more pronounced
clinical benefit in women treated with bivalirudin including a 44%
reduction in major bleeding and a significant reduction in mortality rates
at 1 year.

<18>
[Use Link to view the full text]
Accession Number
20151016496
Author
Osawa E.A.; Rhodes A.; Landoni G.; Galas F.R.B.G.; Fukushima J.T.; Park
C.H.L.; Almeida J.P.; Nakamura R.E.; Strabelli T.M.V.; Pileggi B.; Leme
A.C.; Fominskiy E.; Sakr Y.; Lima M.; Franco R.A.; Chan R.P.C.; Piccioni
M.A.; Mendes P.; Menezes S.R.; Bruno T.; Gaiotto F.A.; Lisboa L.A.; Dallan
L.A.O.; Hueb A.C.; Pomerantzeff P.M.; Kalil Filho R.; Jatene F.B.; Junior
J.O.C.A.; Hajjar L.A.
Institution
(Osawa, Galas, Fukushima, Park, Almeida, Nakamura, Strabelli, Pileggi,
Leme, Lima, Franco, Chan, Piccioni, Mendes, Menezes, Bruno, Junior,
Hajjar) Surgical Intensive Care Unit, Department of Anesthesiology, Heart
Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da
Universidade de Sao Paulo, Sao Paulo, Brazil
(Rhodes) Department of Intensive Care Medicine, St George's Healthcare NHS
Trust, St George's University of London, London, United Kingdom
(Landoni, Fominskiy) Department of Anesthesia and Intensive Care, IRCCS
San Raffaele Scientific Institute, Vita-Salute San Raffaele Scientific
Institute, Milan, Italy
(Sakr) Department of Anesthesiology and Intensive Care, Friedrich Schiller
University Hospital, Jena University, Jena, Germany
(Gaiotto, Lisboa, Dallan, Hueb, Pomerantzeff, Kalil Filho, Jatene)
Department of Cardiopneumology, Heart Institute (InCor), Hospital das
Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo,
Brazil
Title
Effect of Perioperative Goal-Directed Hemodynamic Resuscitation Therapy on
Outcomes Following Cardiac Surgery: A Randomized Clinical Trial and
Systematic Review.
Source
Critical Care Medicine. 44 (4) (pp 724-733), 2016. Date of Publication: 01
Apr 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: To evaluate the effects of goal-directed therapy on outcomes
in high-risk patients undergoing cardiac surgery. Design: A prospective
randomized controlled trial and an updated metaanalysis of randomized
trials published from inception up to May 1, 2015. Setting: Surgical ICU
within a tertiary referral university-affiliated teaching hospital.
Patients: One hundred twenty-six high-risk patients undergoing coronary
artery bypass surgery or valve repair. Interventions: Patients were
randomized to a cardiac output-guided hemodynamic therapy algorithm
(goal-directed therapy group, n = 62) or to usual care (n = 64). In the
goal-directed therapy arm, a cardiac index of greater than 3
L/min/m² was targeted with IV fluids, inotropes, and RBC
transfusion starting from cardiopulmonary bypass and ending 8 hours after
arrival to the ICU. Measurements and Main Results: The primary outcome was
a composite endpoint of 30-day mortality and major postoperative
complications. Patients from the goal-directed therapy group received a
greater median (interquartile range) volume of IV fluids than the usual
care group (1,000 [625-1,500] vs 500 [500-1,000] mL; p < 0.001], with no
differences in the administration of either inotropes or RBC transfusions.
The primary outcome was reduced in the goal-directed therapy group (27.4%
vs 45.3%; p = 0.037). The goal-directed therapy group had a lower
occurrence rate of infection (12.9% vs 29.7%; p = 0.002) and low cardiac
output syndrome (6.5% vs 26.6%; p = 0.002). We also observed lower ICU
cumulative dosage of dobutamine (12 vs 19 mg/kg; p = 0.003) and a shorter
ICU (3 [3-4] vs 5 [4-7] d; p < 0.001) and hospital length of stay (9
[8-16] vs 12 [9-22] d; p = 0.049) in the goal-directed therapy compared
with the usual care group. There were no differences in 30-day mortality
rates (4.8% vs 9.4%, respectively; p = 0.492). The metaanalysis identified
six trials and showed that, when compared with standard treatment,
goal-directed therapy reduced the overall rate of complications
(goal-directed therapy, 47/410 [11%] vs usual care, 92/415 [22%]; odds
ratio, 0.40 [95% CI, 0.26-0.63]; p < 0.0001) and decreased the hospital
length of stay (mean difference,-5.44 d; 95% CI,-9.28 to-1.60; p = 0.006)
with no difference in postoperative mortality: 9 of 410 (2.2%) versus 15
of 415 (3.6%), odds ratio, 0.61 (95% CI, 0.26-1.47), and p = 0.27.
Conclusions: Goal-directed therapy using fluids, inotropes, and blood
transfusion reduced 30-day major complications in high-risk patients
undergoing cardiac surgery.

<19>
[Use Link to view the full text]
Accession Number
20151016449
Author
Berg R.A.; Nadkarni V.M.; Clark A.E.; Moler F.; Meert K.; Harrison R.E.;
Newth C.J.L.; Sutton R.M.; Wessel D.L.; Berger J.T.; Carcillo J.; Dalton
H.; Heidemann S.; Shanley T.P.; Zuppa A.F.; Doctor A.; Tamburro R.F.;
Jenkins T.L.; Dean J.M.; Holubkov R.; Pollack M.M.
Institution
(Berg, Nadkarni, Sutton, Zuppa) Department of Anesthesiology and Critical
Care, Children's Hospital of Philadelphia, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA, United States
(Clark, Dean, Holubkov) Department of Pediatrics, University of Utah
School of Medicine, Salt Lake City, UT, United States
(Moler, Shanley) Department of Pediatrics, University of Michigan, Ann
Arbor, MI, United States
(Meert, Heidemann) Department of Pediatrics, Children's Hospital of
Michigan, Detroit, MI, United States
(Harrison) Department of Pediatrics, University of California at Los
Angeles, Los Angeles, CA, United States
(Newth) Department of Anesthesiology and Critical Care Medicine,
Children's Hospital Los Angeles, Los Angeles, CA, United States
(Wessel, Berger) Department of Pediatrics, Children's National Medical
Center, Washington, DC, United States
(Carcillo) Department of Critical Care Medicine, Children's Hospital of
Pittsburgh, Pittsburgh, PA, United States
(Dalton) Department of Child Health, Phoenix Children's Hospital,
University of Arizona, College of Medicine-Phoenix, Phoenix, AZ, United
States
(Doctor) Departments of Pediatrics and Biochemistry, Washington University
School of Medicine, St. Louis, MO, United States
(Tamburro, Jenkins) Branch of Trauma and Critical Illness, Eunice Kennedy
Shriver National Institutes of Child Health and Human Development,
National Institutes of Health, Bethesda, MD, United States
(Pollack) Department of Pediatrics, Children's National Medical Center,
George Washington University School of Medicine, Washington, DC, United
States
Title
Incidence and Outcomes of Cardiopulmonary Resuscitation in PICUs.
Source
Critical Care Medicine. 44 (4) (pp 798-808), 2016. Date of Publication: 01
Apr 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: To determine the incidence of cardiopulmonary resuscitation in
PICUs and subsequent outcomes. Design, Setting, and Patients: Multicenter
prospective observational study of children younger than 18 years old
randomly selected and intensively followed from PICU admission to hospital
discharge in the Collaborative Pediatric Critical Care Research Network
December 2011 to April 2013. Results: Among 10,078 children enrolled, 139
(1.4%) received cardiopulmonary resuscitation for more than or equal to 1
minute and/or defibrillation. Of these children, 78% attained return of
circulation, 45% survived to hospital discharge, and 89% of survivors had
favorable neurologic outcomes. The relative incidence of cardiopulmonary
resuscitation events was higher for cardiac patients compared with
non-cardiac patients (3.4% vs 0.8%, p <0.001), but survival rate to
hospital discharge with favorable neurologic outcome was not statistically
different (41% vs 39%, respectively). Shorter duration of cardiopulmonary
resuscitation was associated with higher survival rates: 66% (29/44)
survived to hospital discharge after 1-3 minutes of cardiopulmonary
resuscitation versus 28% (9/32) after more than 30 minutes (p < 0.001).
Among survivors, 90% (26/29) had a favorable neurologic outcome after 1-3
minutes versus 89% (8/9) after more than 30 minutes of cardiopulmonary
resuscitation. Conclusions: These data establish that contemporary PICU
cardiopulmonary resuscitation, including long durations of cardiopulmonary
resuscitation, results in high rates of survival-to-hospital discharge
(45%) and favorable neurologic outcomes among survivors (89%). Rates of
survival with favorable neurologic outcomes were similar among cardiac and
noncardiac patients. The rigorous prospective, observational study design
avoided the limitations of missing data and potential selection biases
inherent in registry and administrative data.

<20>
Accession Number
2015522752
Author
Nguyen B.A.V.; Fiorentino F.; Reeves B.C.; Baig K.; Athanasiou T.;
Anderson J.R.; Haskard D.O.; Angelini G.D.; Evans P.C.
Institution
(Nguyen, Baig, Haskard) Cardiovascular Sciences Unit, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Fiorentino, Athanasiou, Anderson, Angelini) Department of Cardiothoracic
Surgery, Imperial College London, London, United Kingdom
(Reeves, Angelini) Bristol Heart Institute and Clinical Trials and
Evaluation Unit, University of Bristol, Bristol, United Kingdom
(Evans) Department of Cardiovascular Science, University of Sheffield,
Beech Hill Rd, Sheffield S10 2RX, United Kingdom
Title
Mini Bypass and Proinflammatory Leukocyte Activation: A Randomized
Controlled Trial.
Source
Annals of Thoracic Surgery. 101 (4) (pp 1454-1463), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Elsevier USA
Abstract
Background Coronary artery bypass grafting (CABG) with conventional
cardiopulmonary bypass (CPB) induces systemic inflammation. Miniaturized
CPB may attenuate systemic inflammatory activation. The intracellular
signaling pathways promoting inflammation in cardiac operations and the
relative effects of CPB on these processes are uncertain. In this study,
induction of reactive oxygen species (ROS) and activation of nuclear
factor (NF)-kappaB, p38 mitogen-activated protein kinase (MAPK) within
leukocytes, and leukocyte accumulation in cantharidin-induced blisters was
compared in patients exposed to miniaturized CPB (mCPB) and those who
underwent conventional CPB (cCPB). Methods Patients undergoing CABG were
randomized to receive either cCPB (n = 13) or mCPB (n = 13). Blood samples
were collected preoperatively and 5 times after initiating CPB (up to 5
hours) and analyzed by flow cytometry for intracellular markers of
activation (ROS, p38-MAPK, and NF-kappaB phosphorylation). Results ROS in
lymphocytes were elevated in cCPB compared with mCPB (p < 0.01), whereas
ROS in granulocytes and monocytes were similar between groups. After
initiation of CPB, p38-MAPK was higher in patients receiving cCPB compared
with those receiving mCPB (p < 0.05). NF-kappaB phosphorylation in
leukocyte subsets was similar in patients exposed to cCPB and those
exposed to mCPB. Leukocyte accumulation in cantharidin-induced blisters,
white cell counts, and serum C-reactive protein (CRP) was enhanced in
response to cardiac operations, but no differences were observed between
mCPB and cCPB groups. Postoperative serum creatinine levels were reduced
in the mCPB group compared with the cCPB group (p < 0.05). Conclusions
Both p38-MAPK activation and ROS were attenuated with the use of mCPB
compared with cCPB, providing a potential mechanism for reduced
inflammation in association with CPB miniaturization.

<21>
[Use Link to view the full text]
Accession Number
2015473843
Author
Ziegler T.R.; May A.K.; Hebbar G.; Easley K.A.; Griffith D.P.; Dave N.;
Collier B.R.; Cotsonis G.A.; Hao L.; Leong T.; Manatunga A.K.; Rosenberg
E.S.; Jones D.P.; Martin G.S.; Jensen G.L.; Sax H.C.; Kudsk K.A.; Galloway
J.R.; Blumberg H.M.; Evans M.E.; Wischmeyer P.E.
Institution
(Ziegler, Hebbar, Hao) Division of Endocrinology, Metabolism and Lipids,
Department of Medicine, Emory University, School of Medicine, Atlanta, GA,
United States
(Ziegler, Galloway) Center for Clinical and Molecular Nutrition, Emory
University, School of Medicine, Atlanta, GA, United States
(Ziegler, Hebbar, Griffith, Dave, Galloway) Emory University Hospital,
Nutrition and Metabolic Support Service, Atlanta Clinical and
Translational Science Institute, 1364 Clifton Rd, Atlanta, GA 30322,
United States
(May, Collier) Department of Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Easley, Cotsonis, Leong, Manatunga) Department of Biostatistics and
Bioinformatics, Rollins School of Public Health, Emory University,
Atlanta, GA, United States
(Collier) Department of Surgery, Virginia Technical Institute Carilion,
School of Medicine, Roanoke, VA, United States
(Rosenberg) Department of Epidemiology, Rollins School of Public Health,
Emory University, Atlanta, GA, United States
(Jones) Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, Emory University, School of Medicine, Atlanta, GA,
United States
(Martin) Department of Nutritional Sciences, Pennsylvania State
University, University Park, PA, United States
(Jensen, Blumberg) Department of Surgery, Miriam Hospital, Providence, RI,
United States
(Sax) Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA,
United States
(Sax) Department of Surgery, University of Wisconsin, Schools of Medicine
and Public Health, Madison, WI, United States
(Kudsk) Department of Surgery, Emory University, School of Medicine,
Atlanta, GA, United States
(Galloway) Division of Infectious Diseases, Department of Medicine, Emory
University, School of Medicine, Atlanta, GA, United States
(Evans) Hubert Department of Global Health Rollins, School of Public
Health, Emory University, Atlanta, GA, United States
(Wischmeyer) National Institutes of Health, National Institute of Diabetes
and Digestive and Kidney Diseases, Bethesda, MD, United States
(Wischmeyer) Department of Anesthesiology, University of Colorado, School
of Medicine, Aurora, CO, United States
Title
Efficacy and safety of glutamine-supplemented parenteral nutrition in
surgical ICU patients: An American mul ticenter rand omized controlled
trial.
Source
Annals of Surgery. 263 (4) (pp 646-655), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To determine whether glutamine (GLN)-supplemented parenteral
nutrition (PN) improves clinical outcomes in surgical intensive care unit
(SICU) patients. Summary Background Data: GLN requirements may increase
with critical illness. GLN-supplemented PN may improve clinical outcomes
in SICU patients. Methods: A parallel-group, multicenter, double-blind,
randomized, controlled clinical trial in 150 adults after
gastrointestinal, vascular, or cardiac surgery requiring PN and SICU care.
Patients were without significant renal or hepatic failure or shock at
entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids
(AAs) and energy at 1.3x estimated basal energy expenditure]. Controls (n
= 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75)
received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally
replacing AA in PN (GLN-PN). Enteral nutrition (EN) was advanced and PN
weaned as indicated. Hospital mortality and infections were primary
endpoints. Results: Baseline characteristics, days on study PN and daily
macronutrient intakes via PN and EN, were similar between groups. There
were 11 hospital deaths (14.7%) in the GLN-PN group and 13 deaths in the
STD-PN group (17.3%; difference,-2.6%; 95% confidence interval,-14.6% to
9.3%; P = 0.66). The 6-month cumulative mortality was 31.4% in the GLN-PN
group and 29.7% in the STD-PN group (P = 0.88). Incident bloodstream
infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and
STD-PN groups, respectively (P = 0.73). Other clinical outcomes and
adverse events were similar. Conclusions: PN supplemented with GLN
dipeptide was safe, but did not alter clinical outcomes among SICU
patients.

<22>
Accession Number
20160260418
Author
Koning N.J.; Overmars M.A.H.; Van Den Brom C.E.; Van Bezu J.; Simon L.E.;
Vonk A.B.A.; Girbes A.R.J.; Van Nieuw Amerongen G.P.; Boer C.
Institution
(Koning, Overmars, Van Den Brom, Simon, Boer) Department of
Anesthesiology, VU University Medical Centre, De Boelelaan 1117,
Amsterdam, HV 1081, Netherlands
(Van Bezu, Van Nieuw Amerongen) Laboratory for Physiology, Institute for
Cardiovascular Research, VU University Medical Centre, De Boelelaan 1117,
Amsterdam, HV 1081, Netherlands
(Vonk) Department of Cardio-thoracic Surgery, VU University Medical
Centre, De Boelelaan 1117, Amsterdam, HV 1081, Netherlands
(Girbes) Department of Intensive Care Medicine, VU University Medical
Centre, De Boelelaan 1117, Amsterdam, HV 1081, Netherlands
Title
Endothelial hyperpermeability after cardiac surgery with cardiopulmonary
bypass as assessed using an in vitro bioassay for endothelial barrier
function.
Source
British Journal of Anaesthesia. 116 (2) (pp 223-232), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Oxford University Press
Abstract
Background: The mechanisms causing increased endothelial permeability
after cardiopulmonary bypass (CPB) have not been elucidated. Using a
bioassay for endothelial barrier function, we investigated whether
endothelial hyperpermeability is associated with alterations in plasma
endothelial activation and adhesion markers and can be attenuated by the
use of pulsatile flow during CPB. Methods: Patients undergoing cardiac
surgery were randomized to non-pulsatile (n=20) or pulsatile flow CPB
(n=20). Plasma samples were obtained before (pre-CPB) and after CPB
(post-CPB), and upon intensive care unit (ICU) arrival. Changes in plasma
endothelial activation and adhesion markers were determined by
enzyme-linked immunosorbent assay. Using electric cell-substrate impedance
sensing of human umbilical vein endothelial monolayers, the effects of
plasma exposure on endothelial barrier function were assessed and
expressed as resistance. Results: Cardiopulmonary bypass was associated
with increased P-selectin, vascular cell adhesion molecule-1, and von
Willebrand factor plasma concentrations and an increase in the
angiopoietin-2 to angiopoietin-1 ratio, irrespective of the flow profile.
Plasma samples obtained after CPB induced loss of endothelial resistance
of 21 and 23% in non-pulsatile and pulsatile flow groups, respectively.
The negative effect on endothelial cell barrier function was still present
with exposure to plasma obtained upon ICU admission. The reduction in
endothelial resistance after exposure to post-CPB plasma could not be
explained by CPB-induced haemodilution. Conclusions: The change in the
plasma fingerprint during CPB is associated with impairment of in vitro
endothelial barrier function, which occurs irrespective of the application
of a protective pulsatile flow profile during CPB.

<23>
Accession Number
20160260416
Author
Jeppsson A.; Walden K.; Roman-Emanuel C.; Thimour-Bergstrom L.; Karlsson
M.
Institution
(Jeppsson, Roman-Emanuel, Thimour-Bergstrom) Department of Cardiothoracic
Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
(Jeppsson) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Walden) Department of Anaesthesia and Intensive Care, Eastern Hospital,
Gothenburg, Sweden
(Karlsson) Department of Medicine, Skaraborg Hospital, Lidkoping, Sweden
Title
Preoperative supplementation with fibrinogen concentrate in cardiac
surgery: A randomized controlled study.
Source
British Journal of Anaesthesia. 116 (2) (pp 208-214), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Oxford University Press
Abstract
Background: Bleeding remains a severe complication in cardiac surgery.
Several studies have found an association between the preoperative plasma
concentration of fibrinogen and postoperative bleeding in cardiac surgery
patients. This raises the question of whether preoperative supplementation
with fibrinogen concentrate can reduce postoperative blood loss. Methods:
An investigator-initiated, prospective, randomized double-blind
placebo-controlled study, was performed in 48 low-risk, coronary artery
bypass grafting patients. Subjects were randomized to infusion of 2 g
fibrinogen or placebo immediately before surgery, after induction of
anaesthesia. The primary endpoint was blood loss during the first 12 h
postoperatively. Secondary endpoints included the proportion of transfused
subjects, the number of transfused allogeneic blood products (red blood
cells, plasma and platelets), and haemoglobin concentration after surgery.
Student's t-test and Mann-Whitney U-test was used to compare continuous
data and chi²-test to compare categorical data between groups.
Results: Median postoperative bleeding was not significantly different
between the fibrinogen and placebo groups [650 (25/75th percentile
500-835) ml compared with 730 (543-980) ml, P=0.29]. The proportion of
transfused subjects (33 vs 29%, P=0.76), number of perioperative
transfusions of allogeneic blood products (0 (0-2 vs 0 (0-3), P=0.76) and
haemoglobin concentration 24 h after surgery (107 (sd 11) vs 100 (12) g
L-1, P=0.07) were not significantly different between the fibrinogen and
placebo group, respectively. Conclusions: Preoperative supplementation
with 2 g fibrinogen concentrate did not significantly influence
postoperative bleeding, in coronary artery bypass grafting patients
without documented hypofibrinogenaemia.

<24>
Accession Number
20160275776
Author
Docherty A.B.; O'Donnell R.; Brunskill S.; Trivella M.; Doree C.; Holst
L.; Parker M.; Gregersen M.; De Almeida J.P.; Walsh T.S.; Stanworth S.J.
Institution
(Docherty, Walsh) Centre for Inflammation Research, University of
Edinburgh, Edinburgh, United Kingdom
(Docherty, O'Donnell, Walsh) Critical Care Department, Royal Infirmary
Edinburgh, Edinburgh, United Kingdom
(Brunskill, Trivella, Stanworth) Systematic Review Initiative, NHS Blood
and Transplant, John Radcliffe Hospital, Oxford, United Kingdom
(Doree) Centre for Statistics in Medicine, University of Oxford, Oxford,
United Kingdom
(Holst) Department of Intensive Care, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
(Parker) Department of Orthopaedics, Peterborough and Stamford Hospitals,
NHS Trust, Peterborough, United Kingdom
(Gregersen) Department of Geriatrics, Aarhus University, Aarhus, Denmark
(De Almeida) Surgical Intensive Care Unit, Department of Anesthesiology,
Cancer Institute, Hospital das Clinicas da Faculdade de Medicina,
Universidade de Sao Paulo, Sao Paulo, Brazil
(Stanworth) Department of Haematology, NHS Blood and Transplant, Oxford
University, Hospitals NHS Trust, Oxford, United Kingdom
Title
Effect of restrictive versus liberal transfusion strategies on outcomes in
patients with cardiovascular disease in a non-cardiac surgery setting:
Systematic review and meta-analysis.
Source
BMJ (Online). 352 (no pagination), 2016. Article Number: i1351. Date of
Publication: 29 Mar 2016.
Publisher
BMJ Publishing Group
Abstract
OBJECTIVE: To compare patient outcomes of restrictive versus liberal blood
transfusion strategies in patients with cardiovascular disease not
undergoing cardiac surgery. DESIGN: Systematic review and meta-analysis.
DATA SOURCES: Randomised controlled trials involving a threshold for red
blood cell transfusion in hospital. We searched (to 2 November 2015)
CENTRAL, Medline, Embase, CINAHL, PubMed, LILACS, NHSBT Transfusion
Evidence Library, ClinicalTrials.gov, WHO International Clinical Trials
Registry Platform, ISRCTN Register, and EU Clinical Trials Register.
Authors were contacted for data whenever possible. TRIAL SELECTION:
Published and unpublished randomised controlled trials comparing a
restrictive with liberal transfusion threshold and that included patients
with cardiovascular disease. DATA EXTRA CTION AND SYNTHESIS: Data
extraction was completed in duplicate. Risk of bias was assessed using
Cochrane methods. Relative risk ratios with 95% confidence intervals were
presented in all meta-analyses. Mantel-Haenszel random effects models were
used to pool risk ratios. MAIN OUTCOME MEASURES: 30 day mortality, and
cardiovascular events. RESULTS: 41 trials were identified; of these, seven
included data on patients with cardiovascular disease. Data from a further
four trials enrolling patients with cardiovascular disease were obtained
from the authors. In total, 11 trials enrolling patients with
cardiovascular disease (n=3033) were included for meta-analysis
(restrictive transfusion, n=1514 patients; liberal transfusion, n=1519).
The pooled risk ratio for the association between transfusion thresholds
and 30 day mortality was 1.15 (95% confidence interval 0.88 to 1.50,
P=0.50), with little heterogeneity (I²=14%). The risk of acute
coronary syndrome in patients managed with restrictive compared with
liberal transfusion was increased (nine trials; risk ratio 1.78, 95%
confidence interval 1.18 to 2.70, P=0.01, I2=0%). CONCLUSIONS: The results
show that it may not be safe to use a restrictive transfusion threshold of
less than 80 g/L in patients with ongoing acute coronary syndrome or
chronic cardiovascular disease. Effects on mortality and other outcomes
are uncertain. These data support the use of a more liberal transfusion
threshold (>80 g/L) for patients with both acute and chronic
cardiovascular disease until adequately powered high quality randomised
trials have been undertaken in patients with cardiovascular disease.

<25>
Accession Number
20160279801
Author
Kehinde O.; Kunle R.
Institution
(Kehinde) Division of Pharmacy, School of Medicine, University of
Tasmania, Nigeria
(Kunle) Department of Pharmacology, College of Medicine, University of
Lagos, Nigeria
Title
Vorapaxar: A novel agent to be considered in the secondary prevention of
myocardial infarction.
Source
Journal of Pharmacy and Bioallied Sciences. 8 (2) (pp 98-105), 2016. Date
of Publication: April-June 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Patients receiving therapy for the secondary prevention of myocardial
infarction (MI) are still at high risk of a major cardiovascular event or
death despite the use of currently available treatment strategy.
Vorapaxar, an oral protease-activated receptor antagonist, is a novel
antiplatelet drug that has been recently approved to provide further risk
reduction. The results of two Phase III trials (thrombin receptor
antagonists for clinical event reduction and the TRA 2 degreeP-TIMI 50)
have showed that vorapaxar, in addition to standard of care therapy, has
the potential to provide further risk reduction in patients with prior MI.
A search was made on PubMed on articles related to clinical trials and
clinical consideration with the use of vorapaxar. This review article
summarizes the results of Phase II trials, Phase III trials, subgroup
analysis, precautions, and drug interaction with the use of vorapaxar.

<26>
Accession Number
20160146349
Author
Hillebrand J.; Rouhollahpour A.; Zierer A.; Moritz A.; Martens S.
Institution
(Hillebrand, Martens) Department of Cardiothoracic Surgery, Division of
Cardiac Surgery, University Hospital, Westfaelische Wilhelms-University
Muenster, Albert-Schweitzer-Campus 1, Muenster D-48159, Germany
(Rouhollahpour, Zierer, Moritz) Department of Thoracic and Cardiovascular
Surgery, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main,
Germany
Title
Digital carotid compression: A simple method to reduce solid cerebral
emboli during cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (2) (pp 304-308),
2016. Date of Publication: 01 Apr 2016.
Publisher
W.B. Saunders
Abstract
Objectives Serious neurologic injury can be attributed to embolization of
solid particles into cerebral vessels during cardiac surgery. Previous
studies using transcranial Doppler (TCD) identified arterial cannulation
and aortic declamping to be associated with cerebral embolization. The
purpose of this study was to investigate the impact of transient
compression of the carotid arteries during these maneuvers on the embolic
load during cardiac surgery with cardiopulmonary bypass. Design
Prospective, randomized, clinical trial/pilot study. Setting Single-center
study at a university hospital. Participants Patients with multiple types
of procedures were included and they were prospectively, randomly assigned
to group I (n = 20, carotid compression during arterial cannulation and
aortic declamping) and group II (n = 20, no carotid compression).
Interventions Bilateral continuous monitoring of the middle cerebral
arteries was performed with a multirange, multifreqency transcranial
Doppler (DopplerBoxX, DWL, Singen, Germany), allowing for discrimination
between solid and gaseous emboli. For aortic cannulation the carotid
arteries were compressed for 5 seconds and for declamping for 3 seconds,
and microemboli signals were detected within the following 45 seconds.
Measurements and Main Results A reduction of intraoperative solid emboli
was detected in group I compared with group II (26+/-16 v 38+/-18; p =
0.04). Looking specifically at the maneuver of arterial cannulation, the
observed difference was 0.5+/-0.8 in group I versus 5.7+/-5.8 in group II
(p<0.0001). During aortic declamping, 6.6+/-6.2 emboli were encountered in
group I and 10.8+/-5.2 in group II (p = 0.02). The incidence of neurologic
events was not significantly different between groups (2 patients in group
II had pathologic changes on magnetic resonance imaging). Conclusions The
data of this preliminary trial demonstrated that transient compression of
the carotid arteries during arterial cannulation and aortic declamping led
to a decreased number of solid cerebral emboli. Further prospective,
randomized clinical studies should be undertaken to investigate the
influence of transient carotid artery compression during specific surgical
procedures.

<27>
Accession Number
20160262618
Author
Kara I.; Koksal C.; Erkin A.; Sacli H.; Demirtas M.; Percin B.; Diler
M.S.; Kirali K.
Institution
(Kara, Erkin, Sacli, Percin, Diler, Kirali) Department of Cardiovascular
Surgery, Sakarya University, Faculty of Medicine, Adnan Menderes Cad,
Saglik Sok, No. 195, Adapazari, Sakarya 54000, Turkey
(Koksal) Department of Cardiovascular Surgery, Kartal Kosuyolu Research
and Training Hospital, Kartal, Istanbul, Turkey
(Demirtas) Department of Cardiovascular Surgery, State Hospital of
Beyhekim, Konya, Turkey
Title
Outcomes of mild to moderate functional tricuspid regurgitation in
patients undergoing mitral valve operations: A meta-analysis of 2,488
patients.
Source
Annals of Thoracic Surgery. 100 (6) (pp 2398-2407), 2015. Date of
Publication: 2015.
Publisher
Elsevier USA
Abstract
This meta-analysis examined the prognosis of patients who were found to
have mild to moderate functional tricuspid regurgitation during mitral
valve operations. Overall, this meta-analysis included 2,488 patients in
10 studies. Compared with the group without tricuspid valve annuloplasty,
the probability of not progressing to moderate to severe functional
tricuspid regurgitation was significantly higher in the tricuspid valve
annuloplasty group. A more aggressive surgical approach involving
concomitant tricuspid repair with mitral valve operations may be
considered to avoid the development of moderate to severe functional
tricuspid regurgitation in the follow-up.

<28>
Accession Number
20160262616
Author
Luthra S.; Leiva-Juarez M.M.; Taggart D.P.
Institution
(Luthra, Leiva-Juarez) Division of Cardiac Surgery, Corrigan Minehan Heart
Center, Massachusetts General Hospital, Boston, MA, United States
(Taggart) Oxford Heart Center, John Radcliffe Hospital, Headley Way,
Oxford, United Kingdom
Title
Systematic review of therapies for stable coronary artery disease in
diabetic patients.
Source
Annals of Thoracic Surgery. 100 (6) (pp 2383-2397), 2015. Date of
Publication: 2015.
Publisher
Elsevier USA
Abstract
Diabetes mellitus is a significant risk modifier for stable coronary
artery disease, causing patients to have more extensive and diffuse
lesions. Opposing treatment strategies remain a matter of debate. A
multiple database search was conducted and outcomes, lesion, and patient
characteristics were compared. Overall mortality, cardiac death, major
adverse cardiovascular and cerebrovascular events, and need for
revascularization were higher with percutaneous coronary intervention than
with coronary artery bypass graft surgery. Multivessel disease and high
Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac
Surgery (SYNTAX) scores were associated with better outcomes for coronary
artery bypass graft surgery.

<29>
Accession Number
2015322935
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Suntogun, Shizuoka 411-8611, Japan
Title
Coexisting mitral regurgitation impairs survival after transcatheter
aortic valve implantation.
Source
Annals of Thoracic Surgery. 100 (6) (pp 2270-2276), 2015. Date of
Publication: 2015.
Publisher
Elsevier USA
Abstract
Background It remains unclear whether coexisting and untreated mitral
regurgitation (MR) affects survival after transcatheter aortic valve
implantation (TAVI) for aortic stenosis (AS). To summarize contemporary
evidence, we performed the first metaanalysis of adjusted observational
studies reporting post-TAVI mortality in patients with various grades of
MR. Methods MEDLINE and EMBASE were searched until February 2015, with a
bibliographic review of secondary sources. Eligible studies were
observational studies enrolling patients undergoing TAVI for AS and
reporting adjusted odds ratios (ORs), hazard ratios (HRs), or both for
early (30-day or in-hospital) all-cause mortality, overall all-cause
mortality, or both in patients with apparent (significant) versus
unapparent (nonsignificant) MR as outcomes. Results Sixteen eligible
studies enrolling a total of 13,672 patients undergoing TAVI for AS were
identified and included. Pooled analyses of eight studies (representing
9,356 patients) and 14 studies (representing 7,405 patients) respectively
demonstrated a statistically significant increase in early (OR 2.17; 95%
confidence interval [CI] 1.50 to 3.14; p < 0.0001) and overall all-cause
mortality (HR 1.81; 95% CI 1.37 to 2.40; p < 0.0001) in patients with
apparent relative to unapparent MR. The exclusion of any single study from
the analyses did not substantively alter the overall results of our
analyses, and there was no evidence of significant publication bias.
Conclusions Coexisting and untreated apparent (usually moderate or severe)
MR appears to be associated with an increase in both early and overall
mortality after TAVI for AS.

<30>
Accession Number
2015312263
Author
Chaudhry U.A.R.; Harling L.; Sepehripour A.H.; Stavridis G.; Kokotsakis
J.; Ashrafian H.; Athanasiou T.
Institution
(Chaudhry, Harling, Sepehripour, Ashrafian, Athanasiou) Imperial College
London, Department of Surgery and Cancer, QEQM Bldg, St. Mary s Hospital,
London W2 1NY, United Kingdom
(Stavridis) Onassis Cardiac Surgery Centre, Athens, Greece
(Kokotsakis) Evangelismos General Hospital, Athens, Greece
Title
Beating-heart versus conventional on-pump coronary artery bypass grafting:
A meta-analysis of clinical outcomes.
Source
Annals of Thoracic Surgery. 100 (6) (pp 2251-2260), 2015. Date of
Publication: 2015.
Publisher
Elsevier USA
Abstract
Background Beating-heart on-pump coronary artery bypass grafting
(BH-ONCAB) offers a hybrid coronary revascularization technique that may
confer the benefits of an "off-pump" operation while maintaining the
hemodynamic stability and mechanical support of conventional on-pump CABG
(C-ONCAB). This study aimed to identify whether BH-ONCAB confers a
morbidity or mortality benefit over C-ONCAB in the immediate and midterm
postoperative period. Methods A systematic literature review identified 13
studies incorporating 3,930 patients (937 BH-ONCAB; 2,993 C-ONCAB)
fulfilling our inclusion criteria. Outcomes were meta-analyzed using
random-effects modelling. Between-study heterogeneity was investigated
through quality assessment, subgroup, and risk of bias analysis. Results
No difference was seen in overall 30-day mortality (13 studies; odds
ratio, 0.60; 95% confidence interval, 0.32 to 1.14; p = 0.12), or midterm
survival (5 studies; hazard ratio, 0.65; 95% confidence interval, 0.22 to
1.88; p = 0.43) between BH-ONCAB and C-ONCAB. BH-ONCAB was associated with
significantly fewer postoperative myocardial infarction events (odds
ratio, 0.32; 95% confidence interval, 0.11 to 0.92; p = 0.03); however, no
significant difference was observed in other postoperative morbidity
outcomes. Intraoperatively, BH-ONCAB resulted in significantly less
intraaortic balloon pump use, shorter cardiopulmonary bypass time, and
less blood loss. The number of anastomoses and vessels grafted were not
significantly different between BH-ONCAB and C-ONCAB. Conclusions BH-ONCAB
is a safe and comparable alternative to C-ONCAB in terms of early
mortality and late survival. Furthermore, BH-ONCAB may confer a particular
advantage in preventing perioperative myocardial infarction and reducing
overall blood loss. Future work should focus on larger matched studies and
multicenter randomized controlled trials that risk-stratify patients
according to preoperative ventricular function and renal insufficiency to
allow us to optimize our surgical revascularization strategy in these
high-risk patients.

<31>
Accession Number
20160277989
Author
Umpierrez G.; Cardona S.; Pasquel F.; Jacobs S.; Peng L.; Unigwe M.;
Newton C.A.; Smiley-Byrd D.; Vellanki P.; Halkos M.; Puskas J.D.; Guyton
R.A.; Thourani V.H.
Institution
(Umpierrez, Cardona, Pasquel, Jacobs, Unigwe, Newton, Smiley-Byrd,
Vellanki) Department of Medicine, Emory University, Atlanta, GA, United
States
(Peng) Rollins School of Public Health, Emory University, Atlanta, GA,
United States
(Halkos, Puskas, Guyton, Thourani) Joseph B. Whitehead Department of
Surgery, Emory University, Atlanta, GA, United States
Title
Randomized controlled trial of intensive versus conservative glucose
control in patients undergoing coronary artery bypass graft surgery:
GLUCOCABG trial.
Source
Diabetes Care. 38 (9) (pp 1665-1672), 2015. Date of Publication: September
2015.
Publisher
American Diabetes Association Inc.
Abstract
OBJECTIVE The optimal level of glycemic control needed to improve outcomes
in cardiac surgery patients remains controversial. RESEARCH DESIGN AND
METHODS We randomized patients with diabetes (n = 152) and without
diabetes (n = 150) with hyperglycemia to an intensive glucose target of
100-140 mg/dL (n = 151) or to a conservative target of 141-180 mg/dL (n =
151) after coronary artery bypass surgery (CABG) surgery. After the
intensive care unit (ICU), patients received a single treatment regimen in
the hospital and 90 days postdischarge. Primary outcome was differences in
a composite of complications, including mortality, wound infection,
pneumonia, bacteremia, respiratory failure, acute kidney injury, and major
cardiovascular events. RESULTS Mean glucose in the ICU was 132 +/- 14
mg/dL (interquartile range [IQR] 124-139) in the intensive and 154 +/- 17
mg/dL (IQR 142-164) in the conservative group (P < 0.001). There were no
significant differences in the composite of complications between
intensive and conservative groups (42 vs. 52%, P = 0.08). We observed
heterogeneity in treatment effect according to diabetes status, with no
differences in complications among patients with diabetes treated with
intensive or conservative regimens (49 vs. 48%, P = 0.87), but a
significant lower rate of complications in patients without diabetes
treated with intensive compared with conservative treatment regimen (34
vs. 55%, P = 0.008). CONCLUSIONS Intensive insulin therapy to target
glucose of 100 and 140mg/dL in the ICU did not significantly reduce
perioperative complications compared with target glucose of 141 and
180mg/dL after CABG surgery. Subgroup analysis showed a lower number of
complications in patients without diabetes, but not in patients with
diabetes treated with the intensive regimen. Large prospective randomized
studies are needed to confirm these findings.

<32>
Accession Number
20160257877
Author
Ali-Faisal S.F.; Scott L.B.; Johnston L.; Grace S.L.
Institution
(Ali-Faisal) York University, Toronto, ON, Canada
(Ali-Faisal, Scott) Stony Brook University, Program in Public Health,
Stony Brook Medicine, School of Health, Technology and Management, Stony
Brook, NY, United States
(Johnston, Grace) School of Kinesiology and Health Science, York
University, Toronto, ON, Canada
Title
Cardiac rehabilitation referral and enrolment across an academic health
sciences centre with eReferral and peer navigation: A randomised
controlled pilot trial.
Source
BMJ Open. 6 (3) (no pagination), 2016. Article Number: e010214. Date of
Publication: 2016.
Publisher
BMJ Publishing Group
Abstract
Objectives: To describe (1) cardiac rehabilitation (CR) referral across
cardiac units in a tertiary centre with eReferral; (2) characteristics
associated with CR referral and enrolment and (3) the effects of peer
navigation (PN) on referral and enrolment. This pilot was a 2
parallel-arm, randomised, single-blind trial with allocation concealment.
Setting: 3 cardiac units (ie, interventional, general cardiology, and
cardiac surgery) in 1 of 2 hospitals of a tertiary centre. Participants:
CR-eligible adult cardiac inpatients were randomised to PN or usual care.
94 (54.7%) patients consented, of which 46 (48.9%) were randomised to PN.
Outcomes were ascertained in 76 (80.9%) participants. Intervention: The PN
(1) visited participant at the bedside, (2) mailed a card to participant's
home reminding about CR and (3) called participant 2 weeks postdischarge
to discuss CR barriers. Outcome measures: The primary outcome of enrolment
was defined as participant attendance at a scheduled CR intake appointment
(yes/no). The secondary outcome was referral. Blinded outcome assessment
was conducted 12 weeks postdischarge, via CR chart extraction. Results:
Those who received care on the cardiac surgery unit (77.9%) were more
likely to be referred than those treated on the general cardiology (61.1%)
or interventional unit (33.3%; p=0.04). Patients who had cardiac surgery,
hypertension and hyperlipidaemia were significantly more likely, and those
with congenital heart disease, cancer and a previous cardiac diagnosis
were less likely to be referred. Participants referred to a site closer to
home (76.2% of those referred) were more likely to enrol than those not
(23.7%, p<0.05). PN had no effect on referral (77.6%, p=0.45) or enrolment
(46.0%, p=0.24). Conclusions: There is wide variability in CR referral,
even within academic centres, and despite eReferral. Referral was quite
high, and thus, PN did not improve CR utilisation. Results support
triaging patients to the CR programme closest to their home.

<33>
Accession Number
20151051433
Author
Finsterer J.; Stollberger C.
Institution
(Finsterer) Krankenanstalt Rudolfstiftung, Vienna, Austria
(Stollberger) 2^nd Medical Department with Cardiology and
Intensive Care Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
Title
Review of Cardiac Disease in Nemaline Myopathy.
Source
Pediatric Neurology. 53 (6) (pp 473-477), 2015. Date of Publication: 2015.
Publisher
Elsevier Inc.
Abstract
Objectives Little is known about the type, frequency, severity, treatment,
and outcome of cardiac disease in nemaline myopathy. This review
summarizes and discusses findings concerning the type, prevalence,
diagnosis, treatment, and outcome of cardiac involvement in nemaline
myopathy. Methods Review of publications about nemaline myopathy and
cardiac disease. Results Altogether, 35 patients with nemaline myopathy
with cardiac disease were identified. Age at presentation ranged from 0 to
62 years. In 30 individuals whose gender was described, 22 were male and
eight were female. Onset was congenital in 16 patients, infantile in five,
and adult in four. Nine patients presented with dilated cardiomyopathy,
six with hypertrophic cardiomyopathy, and one with nonspecific
cardiomyopathy. Among those with cardiomyopathy, four developed heart
failure. One patient experienced sudden cardiac death. A ventricular
septal defect was described in two patients. Cardiac treatment included
drugs for heart failure (eight patients), implantable
cardioverter-defibrillator implantation (one patient), and heart
transplant (three patients). Four patients received noninvasive
positive-pressure ventilation and two continuous positive-pressure
ventilation. The outcome was fatal in 11 patients. Conclusions Cardiac
disease in nemaline myopathy manifests as cardiomyopathy leading to heart
failure. If respiratory muscles are affected, the right side of the heart
may be secondarily involved. Early detection of cardiac involvement is
essential since effective treatment for cardiac disease in nemaline
myopathy may be available.

<34>
Accession Number
20151009212
Author
De Waha S.; Allali A.; Buttner H.-J.; Toelg R.; Geist V.; Neumann F.-J.;
Khattab A.A.; Richardt G.; Abdel-Wahab M.
Institution
(De Waha, Allali, Toelg, Geist, Richardt, Abdel-Wahab) Department of
Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Am Kurpark
1, Bad Segeberg 23795, Germany
(Buttner, Neumann) Department of Cardiology, University Heart Centre
Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Khattab) Department of Cardiology, University of Bern, Bern, Switzerland
Title
Rotational atherectomy before paclitaxel-eluting stent implantation in
complex calcified coronary lesions: Two-year clinical outcome of the
randomized ROTAXUS trial.
Source
Catheterization and Cardiovascular Interventions. 87 (4) (pp 691-700),
2016. Date of Publication: 01 Mar 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background In the randomized ROTAXUS trial, routine lesion preparation of
complex calcified coronary lesions using rotational atherectomy (RA) prior
to paclitaxel-eluting stent implantation did not reduce the primary
endpoint of angiographic late lumen loss at 9 months compared to stenting
without RA. So far, no long-term data of prospective head-to-head
comparisons between both treatment strategies have been reported. Methods
and Results ROTAXUS randomly assigned patients with complex calcified
coronary lesions to RA followed by stenting (n = 120) or stenting without
RA (n = 120). The primary endpoint of the current analysis was the
occurrence of major adverse cardiac events (MACE) at 2-year follow-up
defined as the composite of death, myocardial infarction, and target
vessel revascularization (TVR). At 2 years, MACE occurred in 32 patients
in the RA group and 37 patients in the standard therapy group (29.4% vs.
34.3%, P = 0.47). The rates of death (8.3% vs. 7.4%, P = 1.00), myocardial
infarction (8.3% vs. 6.5%, P = 0.80), target lesion revascularization
(TLR, 13.8% vs. 16.7%, P = 0.58), and TVR (19.3% vs. 22.2%, P = 0.62) were
similar in both groups. Conclusion Despite high rates of initial
angiographic success, nearly one third of patients enrolled in ROTAXUS
experienced MACE within 2-year follow-up, with no differences between
patients treated with or without RA.

<35>
Accession Number
20160289085
Author
Arora K.S.; Khan N.; Abboudi H.; Khan M.S.; Dasgupta P.; Ahmed K.
Institution
(Arora, Khan, Abboudi, Khan, Dasgupta, Ahmed) Department of Urology,
King's Health Partners, MRC Centre for Transplantation, King's College
London, Guy's Hospital, St Thomas Street, London, United Kingdom
Title
Learning curves for cardiothoracic and vascular surgical procedures - a
systematic review.
Source
Postgraduate Medicine. 127 (2) (pp 202-214), 2015. Date of Publication: 01
Jan 2015.
Publisher
Taylor and Francis Inc. (325 Chestnut St, Suite 800, Philadelphia PA
19106, United States)
Abstract
Objectives. The aim of this systematic review is to evaluate the learning
curve (LC) literature and identify the LC of cardiothoracic and vascular
surgical procedures. Summary and background. The LC describes an
observation that a learner's performance improves over time during
acquisition of new motor skills. Measuring the LC of surgical procedures
has important implications for surgical innovation, education, and patient
safety. Numerous studies have investigated LCs of isolated operations in
cardiothoracic and vascular surgeries, but a lack of uniformity in the
methods and variables used to measure LCs has led to a lack of systematic
reviews. Methods. The MEDLINE, EMBASE^TM, and PsycINFO databases
were systematically searched until July 2013. Articles describing LCs for
cardiothoracic and vascular procedures were included. The type of
procedure, statistical analysis, number of participants, procedure
setting, level of participants, outcomes, and LCs were reviewed. Results.
A total of 48 studies investigated LCs in cardiothoracic and vascular
surgeries. Based on operating time, the LC for coronary artery bypass
surgery ranged between 15 and 100 cases; for endoscopic vessel harvesting
and other cardiac vessel surgery between 7 and 35 cases; for valvular
surgery, which included repair and replacement, between 20 and 135 cases;
for video-assisted thoracoscopic surgery, between 15 and 35 cases; for
vascular neurosurgical procedures between 100 and 500 cases, based on
complications; for endovascular vessel repairs between 5 and 40 cases; and
for ablation procedures between 25 and 60 cases. However there was a
distinct lack of standardization in the variables/outcome measures used,
case selection, prior experience, and supervision of participating
surgeons and a range of statistical analyses to compute LCs was noted.
Conclusion. LCs in cardiothoracic and vascular procedures are hugely
variable depending on the procedure type, outcome measures, level of prior
experience, and methods/statistics used. Uniformity in methods, variables,
and statistical analysis is needed to derive meaningful comparisons of
LCs. Acknowledgment and application of learning processes other than those
reliant on volume-outcomes relationship will benefit LC research and
training of surgeons.

<36>
Accession Number
72247365
Author
Martorella G.; Boitor M.; Gelinas C.
Institution
(Martorella, Boitor, Gelinas) McGill University, Montreal, QC, Canada
Title
Hand massage therapy for pain management after cardiac surgery:
Acceptability and feasibility in the intensive care unit.
Source
Journal of Pain. Conference: 35th Annual Scientific Meeting of the
American Pain Society Austin, TX United States. Conference Start: 20160511
Conference End: 20160514. Conference Publication: (var.pagings). 17 (4
SUPPL. 1) (pp S113), 2016. Date of Publication: April 2016.
Publisher
Churchill Livingstone Inc.
Abstract
The purpose was to evaluate the acceptability and feasibility of hand
massage after cardiac surgery in the intensive care unit (ICU). Clinical
guidelines suggest the use of non-pharmacological interventions for pain
management in ICU adults. Massage has been shown to have numerous effects
and could potentially decrease pain perception. However, very few studies
have been conducted with ICU patients and none of them has completed a
formal assessment of its acceptability and feasibility. The results are
secondary to a pilot randomized controlled trial evaluating the
preliminary effectiveness of hand massage on pain after cardiac surgery.
Both groups i.e., experimental (EG) and control (CG) (n=40) received 2-3
treatments in the 24h following their ICU admission. In the EG, the
trained therapist held the patient's hand for 5 s and applied lavender
cream, before performing the hand massage for 5 min. The same procedure
was repeated on the second hand, which was followed by a 30-min rest
period. In the CG, the treatment was identical with the massage replaced
by hand holding. A qualitative descriptive design was used. Acceptability
was evaluated using individual interviews with participants in both
groups. Feasibility was examined using field notes and video recordings.
While participants receiving the massage perceived it as appropriate and
effective for addressing pain relief, the CG suggested different dosages
and body areas. Regardless of the treatment received, it was not found to
be intrusive but rather pleasant. These suggest that the provision of
massage in the ICU is acceptable. Results also underline that barriers
(e.g. noise, numerous clinical activities) need to be overcome to address
feasibility. Increasing staff acceptance, reducing the rest period,
involving families, and repeating the treatment are avenues to consider.
Accommodating patients' preferences should be considered as well, since
they could influence therapeutic effects.

<37>
Accession Number
72244935
Author
Mohee K.; Zhang J.; Cleland J.G.; Clark A.L.
Institution
(Mohee) Castle Hill Hospital, United Kingdom
(Zhang) Department of Cardiology, Castle Hill Hospital, United Kingdom
(Cleland) National Heart and Lung Institute, Royal Brompton and Harefield
Hospitals, Imperial College, United Kingdom
(Clark) Department of Cardiology, Castle Hill Hospital, Hull York Medical
School, United Kingdom
Title
Use of colchicine in cardiovascular diseases-a systematic review.
Source
Heart. Conference: British Cardiovascular Society Annual Conference 2015
Manchester United Kingdom. Conference Start: 20150608 Conference End:
20150610. Conference Publication: (var.pagings). 101 (pp A91-A92), 2015.
Date of Publication: June 2015.
Publisher
BMJ Publishing Group
Abstract
Introduction Colchicine, commonly classified as an anti-inflammatory
agent, is a mainstay for the treatment of gout and a second- line therapy
for other conditions, including pericarditis, familial Mediterranean fever
and Behcet's disease. Recent studies suggest that colchicine may be
beneficial in a wide spectrum of cardiovascular diseases. We carried out a
systematic review to investigate whether, in randomised controlled trials,
colchicine has an effect on the rate of cardiovascular events. Method
Controlled clinical studies were searched in BioMed- Central, the Cochrane
Collaboration Database of Randomised Trials (CENTRAL), ClinicalTrials.gov,
Google Scholar, MEDLINE/ PubMed, Scopus and EMBASE provided they focused
on whether colchicine had an effect on primary or secondary prevention of
cardiovascular events The PubMed search was performed with the term
'colchicine' and 'randomised'. Results From 244 citations, eleven
randomised controlled trials were identified, of which seven were
double-blind. Four trials focussed on the effects of colchicine on
coronary atheroma, three on pericarditis, two on atrial fibrillation, one
on both pericarditis and atrial fibrillation and one on chronic heart
failure. Altogether, 1360 patients were assigned to control and 1323 to
colchicine. One substantial trial (n = 523 followed for a median of 3
years) showed that colchicine 0.5 mg/day reduced vascular events (hazard
ratio: 0.33; 95% confidence interval [CI] 0.18 to 0.59; p < 0.001).
However, a trial of colchicine 0.5 mg/day in 278 patients with chronic
heart failure failed to demonstrate an effect on death or heart failure
hospitalisation. Meta-analytic pooling showed that colchicine use was
associated with a reduced risk of overall cardiovascular events (ACS,
in-stent restenosis, postop AF, postop pericardiotomy, postop pericardial
effusions, pericarditis and death) with a similar risk of adverse events
as placebo. Focussing on the composite of acute vascular occlusion (MI,
CVA or CV death), there were 78 events in control groups versus 50 on
colchicine. There were 21 deaths in patients assigned to control compared
to thirteen assigned to colchicine. Conclusion Long-term prophylaxis with
low-dose colchicine appears safe and may be effective for a number of
cardiovascular conditions. Whether colchicine can modify the course of
coronary artery disease or heart failure, two cardiovascular conditions
associated with activation of inflammatory pathways, deserves further
investigation.