Results Generated From:
Embase <1980 to 2017 Week 21>
Embase <2017> (updates since 2017-05-11)
<1>
Accession Number
612895883
Author
Panosian J.; Ding S.-A.; Wewalka M.; Simonson D.C.; Goebel-Fabbri A.;
Foster K.; Halperin F.; Vernon A.; Goldfine A.B.
Institution
(Panosian, Ding, Wewalka, Goebel-Fabbri, Foster, Halperin, Goldfine)
Research Division, Section of Clinical Behavioral and Outcomes Research,
Joslin Diabetes Center, Boston, Mass, United States
(Ding, Wewalka, Simonson, Goebel-Fabbri, Halperin, Vernon, Goldfine)
Harvard Medical School, Boston, Mass, United States
(Simonson, Halperin, Vernon, Goldfine) Division of Endocrinology, Brigham
and Women's Hospital, Boston, Mass, United States
(Vernon) Division of General & Gastrointestinal Surgery, Department of
Surgery, Brigham and Women's Hospital, Boston, Mass, United States
Title
Physical Activity in Obese Type 2 Diabetes After Gastric Bypass or Medical
Management.
Source
American Journal of Medicine. 130 (1) (pp 83-92), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The purpose of this study was to compare effects of Roux-en-Y
gastric bypass versus a multidisciplinary, group-based medical diabetes
and weight management program on physical fitness and behaviors. Methods
Physical behavior and fitness were assessed in participants of the study
Surgery or Lifestyle With Intensive Medical Management in the Treatment of
Type 2 Diabetes (SLIMM-T2D) (NCT01073020), a randomized, parallel-group
trial conducted at a US academic hospital and diabetes clinic with 18- to
24-month follow-up. Thirty-eight type 2 diabetes patients with hemoglobin
A<inf>1c</inf> >6.5% and body mass index 30-42 kg/m<sup>2</sup> were
randomized to Roux-en-Y gastric bypass or the medical program. A 6-minute
walk test to evaluate fitness, self-reported physical activity,
standardized physical surveys, and cardiometabolic risk assessment were
performed at baseline and after intervention. Results Both groups
similarly improved 6-minute walk test distance, with greater improvements
in oxygen saturation and reduced heart rate after surgery. Self-reported
physical activity improved similarly at 18-24 months after interventions,
although exercise increased gradually after surgery, whereas early
substantial increases in the medical group were not fully sustained.
Self-reported total and physical health were similar by Short Form-36 but
improved more in the Impact of Weight on Quality of Life survey after
surgery. Improvement in cardiovascular risk scores, HbA<inf>1c</inf>, and
body mass index were greater after surgery. Conclusion In this small,
randomized study, both interventions led to therapeutic lifestyle changes
and improved objective and self-reported physical fitness. Greater
improvements in heart rate, oxygen saturation, and perceived impact of
weight on health were seen after surgery, which could be attributable to
greater weight loss. The clinical importance of these improvements with
greater weight loss warrants further investigation.<br/>Copyright ©
2016 Elsevier Inc.
<2>
Accession Number
612947356
Author
Fan Z.-G.; Ding G.-B.; Li X.-B.; Gao X.-F.; Gao Y.-L.; Tian N.-L.
Institution
(Fan, Li, Gao, Gao, Tian) Department of Cardiology, Nanjing First
Hospital, Nanjing Medical University, Nanjing, China
(Ding) Department of Cardiology, Taixing People's Hospital, Yangzhou
University, Taizhou, China
(Li, Gao, Tian) Department of Cardiology, Nanjing Heart Center, Nanjing,
China
Title
The clinical outcomes of triple antiplatelet therapy versus dual
antiplatelet therapy for high-risk patients after coronary stent
implantation: A meta-analysis of 11 clinical trials and 9,553 patients.
Source
Drug Design, Development and Therapy. 10 (pp 3435-3448), 2016. Date of
Publication: 20 Oct 2016.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: The optimal antiplatelet regimen after in-coronary
intervention among patients presenting with complex coronary artery
lesions or acute coronary syndrome (ACS) has remained unclear. This study
sought to evaluate the clinical outcomes of triple antiplatelet treatment
(TAPT) (cilostazol added to aspirin plus clopidogrel) in these patients.
Methods: The PubMed, EMBASE, MEDLINE, and other Internet sources were
searched for relevant articles. The primary end point was major adverse
cardiac events (MACE), including all-cause mortality, myocardial
infarction, and target vessel revascularization. The incidence of
definite/probable stent thrombosis and bleeding were analyzed as the
safety end points. Results: Eleven clinical trials involving 9,553
patients were analyzed. The risk of MACE was significantly decreased
following TAPT after stent implantation in the ACS subgroup (odds ratio
[OR]: 0.72; 95% confidence interval [CI]: 0.61-0.85; P,0.001), which might
mainly result from the lower risk of all-cause mortality in this subset
(OR: 0.62; 95% CI: 0.48-0.80; P,0.001). The risk of bleeding was not
increased with respect to TAPT. Conclusion: TAPT after stent implantation
was associated with feasible benefits on reducing the risk of MACE,
especially on reducing the incidence of all-cause mortality among patients
suffering from ACS, without higher incidence of bleeding. Larger and more
powerful randomized trials are still warranted to prove the superiority of
TAPT for such patients.<br/>Copyright © 2016 Fan et al.
<3>
Accession Number
614894903
Author
Jhaveri K.D.; Saratzis A.N.; Wanchoo R.; Sarafidis P.A.
Institution
(Jhaveri, Wanchoo) Division of Nephrology, Northwell Health, Hofstra
Northwell School of Medicine, Great Neck, New York, United States
(Saratzis) Leicester NIHR Cardiovascular Biomedical Research Unit,
University of Leicester, United Kingdom
(Sarafidis) Department of Nephrology, Hippokration Hospital, Aristotle
University of Thessaloniki, Greece
Title
Endovascular aneurysm repair (EVAR)- and transcatheter aortic valve
replacement (TAVR)-associated acute kidney injury.
Source
Kidney International. 91 (6) (pp 1312-1323), 2017. Date of Publication:
June 2017.
Publisher
Elsevier B.V.
Abstract
Acute kidney injury (AKI) after surgery or intervention is an important
complication that may impact mortality, morbidity, and health care costs.
Endovascular procedures are now performed routinely for a variety of
pathologies that were traditionally treated with open surgery because
randomized trials comparing endovascular and open surgery have shown at
least equally good results and reduced complication and hospitalization
rates with endovascular techniques. However, endovascular procedures have
been associated with an increased risk for postoperative AKI,
predominantly owing to contrast nephrotoxicity. Over the years,
endovascular techniques have progressively been applied for the treatment
of complex cardiovascular pathologies, and in recent years, nephrologists
have increasingly encountered patients who developed AKI after
endovascular aneurysm repair or transcatheter aortic valve replacement.
These 2 procedures typically involve high-risk patients who have several
established AKI risk factors prior to intervention. Several studies have
investigated the incidence, risk factors, and natural course of AKI after
endovascular aneurysm repair and transcatheter aortic valve replacement.
This review summarizes current data on incidence, risk factors,
pathophysiology, prognostic implications, and treatment of AKI associated
with endovascular aneurysm replacement and transcatheter aortic valve
replacement.<br/>Copyright © 2017 International Society of Nephrology
<4>
Accession Number
615095277
Author
Bytyci I.; Bajraktari G.; Bhatt D.L.; Morgan C.J.; Ahmed A.; Aronow W.S.;
Banach M.
Institution
(Bytyci, Bajraktari) Clinic of Cardiology, University Clinical Centre of
Kosovo, Prishtina, Serbia
(Bajraktari) Medical Faculty, University of Prishtina, Prishtina, Serbia
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
(Morgan) VA Medical Center and George Washington University, Washington,
DC, United States
(Ahmed) University of Alabama at Birmingham, Birmingham, AL, United States
(Aronow) Division of Cardiology, Department of Medicine, New York Medical
College, Valhalla, NY, United States
(Banach) Department of Hypertension, Medical University of Lodz, Lodz,
Poland
(Banach) Polish Mother's Memorial Hospital Research Institute (PMMHRI),
Lodz, Poland
(Banach) Cardiovascular Research Centre, University of Zielona Gora,
Zielona Gora, Poland
Title
Hydrophilic vs lipophilic statins in coronary artery disease: A
meta-analysis of randomized controlled trials.
Source
Journal of Clinical Lipidology. 11 (3) (pp 624-637), 2017. Date of
Publication: May 2017.
Publisher
Elsevier Ltd
Abstract
Introduction Some available experimental studies have reported that
hydrophilic statins might have advantages compared with lipophilic statins
in patients with coronary artery disease (CAD). Therefore, we performed a
meta-analysis of randomized controlled trials (RCTs) investigating the
potential differences of lipophilic and hydrophilic statins in patients
with CAD. Methods We systematically searched selected electronic databases
up to September 2016 to select RCTs, which compared clinical outcomes of
hydrophilic vs lipophilic statins. Primary endpoints were cardiovascular
(CV) events: major adverse cardiac events, myocardial infarction, cardiac
revascularization, stroke, CV death, CV hospitalization, and all-cause
mortality. Secondary endpoints were safety parameters: drug
discontinuation, statin-associated muscle symptoms and alanine
aminotransferase level increase. Results A total of 11,697 patients from
11 RCTs, randomly allocated to lipophilic (n = 5736) or hydrophilic
statins (n = 5961), with a mean follow-up 14 months, were included in the
meta-analysis. In comparison with hydrophilic, the lipophilic statins
showed similar risk reduction for major adverse cardiac events (relative
risk = 0.969, 95% confidence interval [CI], 0.835-1.125, P = .682),
myocardial infarction (0.880, 95% CI: 0.731-1.058, P = .174), CV death
(0.757, 95% CI: 0.486-1.180, P = .219), and all-cause mortality (0.797,
95% CI: 0.590-1.075, P = .137), as well as cardiac revascularization,
stroke, drug discontinuation, and statin-associated muscle symptoms. CV
hospitalization was lower (0.789, 95% CI: 0.643-0.969, P = .024) and
alanine aminotransferase elevation was higher (2.689, 95% CI: 1.841-3.954,
P < .001) in lipophilic than in hydrophilic-treated patients. Conclusions
In conclusion, similarity between hydrophilic and lipophilic statins holds
between various clinical CAD settings.<br/>Copyright © 2017 National
Lipid Association
<5>
Accession Number
616170683
Author
Sluijpers N.R.F.; Gelsomino S.; Heuts S.; Makhoul M.; Meani P.; Delnoij
T.S.; Sels J.W.; Van De Poll M.C.; Montalti A.; Roekaerts P.; Babar Z.U.;
Korver E.P.; Ganushchak Y.M.; Weerwind P.W.; Oude Lansink M.A.; Bidar E.;
Natour E.; Schreurs R.; Gilbers M.; Poels T.; Maessen J.G.; Lorusso R.
Institution
(Sluijpers, Gelsomino, Heuts, Makhoul, Babar, Korver, Ganushchak,
Weerwind, Bidar, Natour, Schreurs, Gilbers, Poels, Maessen, Lorusso)
Department of Cardio-Thoracic Surgery, Heart and Vascular Center,
Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
(Meani, Delnoij, Sels, Van De Poll) Department of Cardiolgy, Netherlands
(Delnoij, Sels, Montalti, Roekaerts) Department of Intensive Care
Medicine, Maastricht University Medical Center (MUMC+), Maastricht,
Netherlands
(Oude Lansink) Department of Intensive Care Medicine, University Medical
Center Groningen (UMCG), Groningen, Netherlands
Title
Veno-arterial extracorporeal membrane oxygenation support for
post-cardiotomy cardiogenic shock: A multicenter study.
Source
European Journal of Heart Failure. Conference: 6th Euro-ELSO Annual
Congress. Netherlands. 19 (pp 11), 2017. Date of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Introduction/Aim: The use of Post-Cardiotomy Veno-Arterial Extracorporeal
Membrane Oxygenation (PC VA ECMO) has exponentially increased, but at the
same time a decreasing survival to discharge trend has been observed. A
two-centre analysis of PC VA ECMO was performed to evaluate patient
outcome and characteristics. Methods: A retrospective analysis of 100
patients from two centers (Maastricht UniversityMedical Center and
UniversityMedical Center Groningen) was performed. Patients who received
PC VA ECMO between October 2007 and January 2017 were included.
Descriptive and frequency analysis were performed. Results: Mean age of
the patient population was 64.2 years, 65% were male. Pre-ECMO cardiac
procedures were isolated coronary artery bypass grafting (CABG) (30%),
isolated valve surgery (14%), thoracic aorta surgery (3%), a combination
of CABG and valve surgery (26%) or other surgery (27%). PC VA ECMO was
established via central cannulation in 27%, by peripheral cannulation in
59%, and by combined approach in 14%. Median PC VA ECMO duration was 4.0
days (IQR 2.0-7.8). Weaning was achieved in 50% of the patients, 37
patients (37%) survived to hospital discharge. Our cumulative series
confirmed an increased use of PC VA ECMO during the last 10 years and
showed an improving in-hospital survival trend (Figure 1). Conclusion:
According to the ELSO registry the use of VA ECMO support in a
post-cardiotomy setting has increased over the last 16 years. This is
accompanied by a trend of decreased in-hospital survival. Our data
confirmed increased application of PC VA ECMO, but showed an improving
survival trend.(Figure Presented).
<6>
Accession Number
616170758
Author
Meani P.; Natour E.; Pappalardo F.; Bidar E.; Makhoul M.; Raffa G.; Heuts
S.; Gelsomino S.; Lozekoot P.; Johnson D.; Kats S.; Stuijpers N.; Schreurs
R.; Gilbers M.; Delnoij T.; Montalti A.; Sels J.W.; Van De Poll M.;
Roekaerts P.; Weerwind P.; Ganushchak Y.; Korver E.; Babar Z.; Maessen J.;
Lorusso R.
Institution
(Natour, Bidar, Makhoul, Raffa, Heuts, Gelsomino, Lozekoot, Johnson, Kats,
Stuijpers, Schreurs, Gilbers, Weerwind, Ganushchak, Korver, Babar,
Maessen, Lorusso) Department of Cardiothoracic Surgery, Netherlands
(Meani, Delnoij, Sels) Cardiology Department, Netherlands
(Delnoij, Montalti, Sels, Van De Poll, Roekaerts) Intensive Care
Department, Heart and Vascular Centre, Maastricht University Medical
Center, Maastricht, Netherlands
(Pappalardo) Cardiac Surgery Intensive Care Unit, Sn Raphael Hospital,
Milan, Italy
Title
Left ventricle unloading in veno-arterial ECMO support: Literature review
for an unanswered dilemma.
Source
European Journal of Heart Failure. Conference: 6th Euro-ELSO Annual
Congress. Netherlands. 19 (pp 64-66), 2017. Date of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Introduction/Aim: VA ECMO support is increasingly used in refractory
cardiogenic shock and cardiac arrest, but characterized by increased
afterload of left ventricle (LV). The aim of this study was to provide a
comprehensive overview regarding the different LV venting techniques and
results available in the literature. Methods: A systematic literature
search was performed in the PubMed database: 207 articles published
between 1993 and 2016 were included. Papers dealing with pre-clinical
studies, overlapping series, and association with other assist devices
were excluded from the review, with 41 published papers finally selected.
Heterogeneous indications for LV unloading were reported. The selected
literature was divided in subgroups, according to the location or the
performed procedure for LV venting. Results: Case reports or case series
were present in 59% of the papers, while retrospective study represented
29% of them. Adult series were present in 65%, pediatric patients in 30%,
and mixed population in 5%. LV unloading was performed percutaneously in
83% of the cases. The most common locations of unloading was left atrium
(29%), followed by indirect unloading (IABP)(27%), trans-aortic (27%), LV
(12%), and pulmonary artery (5%). Percutaneous trans-septal approach was
reported in 22%. Finally, the unloading was conducted surgically in
17%(with open chest surgery in 71%, and minimally invasive surgery in
29%). Conclusion: Nowadays, a few data are available about left heart
unloading in VA ECMO support. Despite the well-known controversy, IABP
remains widely used in combination with VA ECMO. Percutaneous approach
with unloading devices seems to become an increasing option. However,
further studies are necessary to establish the best LV unloading method.
Table Presented.
<7>
Accession Number
616173822
Author
De Vecchis R.; Ariano C.; Cesaro A.; Giasi A.; Cioppa C.
Institution
(De Vecchis, Ariano, Giasi, Cioppa) Cardiology Unit, Presidio Sanitario
Intermedio Elena D'Aosta, Naples, Italy
(Cesaro) Department of Cardiology, Second University of Napoli, Monaldi
Hospital, Naples, Italy
Title
Ranolazine alone or as an add-on to amiodarone for both prevention and
cardioversion of atrial fibrillation in patients with or without chronic
heart failure: A metaanalysis of the literature.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 222), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Background: The possibility of using ranolazine as an antiarrhythmic drug
active against atrial fibrillation ( AF) has been investigated by several
recent studies. In our meta-analysis, we provide an overview of these
studies, taking into account also the efficacy demonstrated by ranolazine
in the course of AF that occurs during chronic heart failure. Methods: The
rhythm control strategy was adopted by the studies that used the
ranolazine as a therapeutical option against AF either alone or in
combination with amiodarone in patients with or without heart failure. In
this meta-analysis both randomized controlled trials (RCTs) and
observational prospective cohort studies were admitted. The effect size
was expressed using the risk ratio, with 95% confidence intervals.
Outcomes of interest: Efficacy endpoints. Five RCTs investigated the
preventive effect exerted by ranolazine against AF occuring in the
clinical setting of a recent coronary artery bypass graft (CABG)
(post-operative AF: 3 studies) or, in alternative, against AF occurring in
the absence of CABG( prophylaxis of non- postoperative AF: 2 studies). In
addition, 4 RCTs investigated the therapeutic effect of ranolazine on the
pharmacological cardioversion of recent-onset AF. Safety endpoints. The
investigated safety endpoints were death, adverse events, QTc prolongation
and hypotension. Results: Eight studies( 6 RCTs and 2 prospective cohort
studies) were collected on the whole. Ranolazine was effective in
preventing the occurrence of AF when compared to controls (RR= 0.60; 95%
CI: 0.43-0.83; p=0.002). Subgroup analysis showed a more pronounced
prophylactic effect of ranolazine against post-operative AF (RR= 0.39; 95%
CI: 0.18-0.84; p=0.02) when compared to non- postoperative AF (RR= 0.76;
95% CI: 0.63-0.92; p=0.04). Ranolazine increased the chances of successful
cardioversion when added to amiodarone over amiodarone alone (RR 1.27; 95%
CI: 1.08-1.50; p=0.004) and significantly decreased the time to
cardioversion(SMD= -2.83 h; 95% CI: -4.69 h to - 0.97 h; p < 0.001).
Overall risks of death, adverse events, and QTc prolongation were similar
when making a comparison between ranolazine and control group.
Conclusions: Ranolazine proved to be an useful and effective drug either
for prophylaxis or conversion to sinus rhythm of AF that occurs in
patients with or without chronic heart failure. Ranolazine use seems to be
safe and associated with relatively few adverse events.
<8>
Accession Number
616173817
Author
Nicolas Bonnet N.; Kerneis M.; Ouldamar S.; Huang F.; Laveau F.; Isnard
R.; Leprince P.; Collet J.P.; Varnous S.; Hammoudi N.
Institution
(Nicolas Bonnet, Kerneis, Ouldamar, Huang, Laveau, Isnard, Leprince,
Collet, Varnous, Hammoudi) Hospital Pitie-Salpetriere, Paris, France
Title
Multi-layer longitudinal strain for noninvasive diagnosis of coronary
allograft vasculopathy in heart transplant recipients: A comparative study
ultrasound versus angiography.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 221), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Background: Cardiac allograft vasculopathy (CAV) is associated with high
morbidity in heart transplant (Htx) recipient. Coronary angiography is the
reference method to diagnose CAV, however this procedure is invasive and
requires the use of nephrotoxic contrast agents. The multi-layer strain is
a new ultrasound technology allowing in particular the functional
assessment of the sub endocardial left ventricular layer which is very
sensitive to ischemia. The aim of the study was to evaluate the value of
multi-layer longitudinal strain to diagnose CAV in heart transplant
patients as compared to angiography. Methods: In this observational
prospective study, 106 HTx patients (mean age, 53+/- 11.2 years; years
since heart transplant=7.0+/- 5.3 years) referred for routine coronary
angiography were included. CAV was classified according to International
Society of Heart and Lung Transplantation guidelines. In addition, all
patients had an echocardiography within 24 hours before the angiography.
The examinations were analyzed off-line by an independent operator,
blinded to clinical history and coronary angiography results. The global
longitudinal strain (GLS) of the different myocardial layers was measured.
We included also 42 healthy subjects as control group. Results: Compared
to controls, sub-endocardial mid-myocardial and epicardial GLS were
reduced in HTx patients (all p values=0.0001). Among 106 HTx patients, CAV
was diagnosed in 47 (43 %) patients. Among CAV patients, 22 patients had
grade 1 CAV (CAV 1) and 25 patients had higher CAV grade (CAV 2-3). There
was no difference in sub-endocardial GLS between HTx patients with or
without CAV (-19.94 +/- 3.7% versus -19.43 +/- 3.0% respectively, p=0.45).
The GLS of the other myocardial layers was also similar in both groups.
Moreover, the GLS in HTx patients with CAV 2-3 was not different compared
to patients without CAV or patients with CAV 1. Conclusion: Compared with
controls, multi- layer GLS is reduced in HTx patient. However, in HTx this
technology appears not useful for the noninvasive diagnosis of CAV.
<9>
Accession Number
616173737
Author
Rui Azevedo Guerreiro R.A.; Pais J.; Congo K.; Bras D.; Carvalho J.;
Carrington M.; Neves D.; Santos A.R.; Picarra B.; Caeiro A.; Aguiar J.
Institution
(Rui Azevedo Guerreiro, Pais, Congo, Bras, Carvalho, Carrington, Neves,
Santos, Picarra, Caeiro, Aguiar) Hospital Espirito Santo De Evora,
Cardiology, Evora, Portugal
Title
Anaemia is associated with development of acute heart failure in patients
with acute coronary syndrome: Propensity-score matched study.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 568), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: Anaemia is a prevalent comorbidity in patients with heart
failure (HF), associated with worse prognosis as highlighted by 2016 ESC
guidelines of HF, which reinforced the importance of its treatment to
improve HF patients' outcomes. However, the role of anaemia in the
development of acute HF in patients with acute coronary syndrome (ACS) is
not well characterized. Purpose: Authors pretend to evaluate if anaemia at
admission for ACS is associated with in-hospital development of acute HF.
Methods: Observational retrospective study, with a sample of 594
consecutive patients admitted for ACS. Patients were divided in two
groups: with anaemia, defined as haemoglobin at admission less than 12
g/dL, and without anaemia. Propensity-score was calculated to each
patients taking into account age, sex, previous history of smoking,
arterial hypertension, diabetes mellitus, hyperlipidaemia, myocardial
infarction, percutaneous coronary intervention, coronary artery bypass
graft, heart failure, significant valvular disease, stroke, peripheral
artery disease, cancer, chronic obstructive pulmonary disease, dementia,
family history of coronary artery disease, type of acute coronary syndrome
justifying admission, severity of coronary artery disease, degree of
revascularization and value of creatinine at admission. Each patient with
anaemia was matched with a patient without anaemia with similar
propensity-score. Outcome of acute HF was defined as evolution in
Killip-Kimball classes 3 (acute pulmonary oedema) and 4 (cardiogenic
shock) during hospitalization. The association of anaemia with acute HF
was accessed in the matched-pairs with logistic regression and p<0.05 was
considered statistically significant. Results: From the study sample of
594 patients, 120 (20.2%) patients had anaemia at admission. Matching each
patient with anaemia with a patient without anaemia with similar
propensity-score resulted in 120 matched-pairs of patients and a study
sample of 202 patients, due to multiple matching of controls.
Matched-pairs on propensity-score were similar in every variable used in
the construction of the propensity-score, proving the correct
pseudo-randomization. Anaemia at admission was associated with the
development of in-hospital acute HF with an odds ratio (OR) of 1.11 (95%
CI 1.04 - 1.19, p=0.003). Conclusion: Patients with anaemia at admission
for ACS had in our propensity-score matched study a 11% greater
probability of developing acute HF during hospitalization.
<10>
Accession Number
616173670
Author
Shugushev Z.; Maximkin D.A.; Chernigina T.; Goloshchapo-Aksenov R.;
Faibushevich A.; Sturov N.; Bachoo R.; Nikitin A.
Institution
(Shugushev, Maximkin, Chernigina, Goloshchapo-Aksenov, Faibushevich,
Sturov, Bachoo) RUDN University, Moscow, Russian Federation
(Nikitin) Central Clinical Hospital, Russian Academy of Science, Moscow,
Russian Federation
Title
One-step or two-step myocardial revascularisation in patients with ACS
without ST-segment elevation with multivessel coronary artery disease.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 330), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Aims: to evaluate the results of endovascular treatment of patients with
acute coronary syndrome without ST-segment elevation with multivessel
coronary artery disease. Methods: AND RESULTS: 346 patients were enrolled
in the study and initially randomized into 3 groups. Group 1 included 100
patients in whom complete myocardial revascularization was performed
during initial PCI. Group 2 consisted of 124 patients, in whom complete
myocardial revascularization was performed during initial hospitalization
and group 3 included 122 patients in which complete revascularization was
performed at different periods after the initial hospitalization.
Criteria: patients with ACS without ST-segment elevation with multi-vessel
coronary artery lesion (SYNTAX score=23-32); high and medium risk on GRACE
scale; no history of myocardial revascularization. Long-term results were
assessed in 192 patients. After 12 months in patients of group 3 had
significantly more often cardiovascular complications and re-intervention
on the target vessel was needed. It was revealed that the implementation
of complete myocardial revascularization later than 30 days from a day of
diagnosed acute coronary syndrome, adversely affects the prognosis of the
disease (r=0,58, p<0,05). Risk factors that adversely affect the prognosis
of patients with ACS without ST-segment elevation with multi-vessel
coronary artery lesion include: Subtotal stenosis in asymptomatic
arteries, circulatory insufficiency- Killip class III, history of
myocardial infarction, high risk on the GRACE scale, the extent of lesions
in the asymptomatic arteries more than 20mm, diabetes, the degree of risk
on a SYNTAX scale score>25, overweight/obesity and
hypercholesterolemia>6.5 mmol/L. Conclusions: when performing PCI in
patients with ACS without ST-segment elevation with multi-vessel coronary
bed lesion, the implementation of complete myocardial revascularization
later than 30 days from a day of diagnosed acute coronary syndrome,
adversely affects the prognosis of the disease.
<11>
Accession Number
616173589
Author
Jin Joo Park J.J.; Ohn J.H.; Yoon C.H.; Park D.G.; Chae I.H.; Choi D.J.
Institution
(Jin Joo Park, Ohn, Yoon, Chae, Choi) Seoul National University Bundang
Hospital, Division of Cardiology, Seongnam, South Korea
(Park) Hangang Sacred Hospital, Division of Cardiology, Seoul, South Korea
Title
Safety of metformin use in hospitalized acute heart failure patients with
diabetes mellitus.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 22), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Background: Diabetes mellitus is a common comorbidity in heart failure
patients. Metformin is the drug of choice in diabetic patients; however,
in contrast to chronic stable heart failure patients, there exists concern
about lactic acidosis associated with metformin use in acute heart failure
requiring hospital admission. Methods: In Korea acute heart failure
registry, a total of 5,620 patients with confirmed diagnosis of acute
heart failure patients were consecutively enrolled at 10 university
hospitals. In this analysis we included only patients with diabetes
mellitus. The primary outcome was the composite of in-hospital all-cause
mortality or heart transplantation. Secondary outcomes included admission
to intensive care unit, the use of mechanical circulatory support,
mechanical ventilation, and renal replacement therapy. Results: Overall,
1,998 patients (35.5%) had diabetesmellitus. At hospital admission the
prescription rate of anti-diabetic medication was 46.4%, 35.3%, 35.2%,
1.8%, 8.3%, and 11.9% for insulin, sulfonylurea, metformin,
thiazolidinedione, acarbose, and DPP-4 inhibitor, respectively. Patients
with metformin use had lower all cause in-hospital death or urgent heart
transplantation than those without metformin use (2.1% vs. 7.4%, P <
0.001). The rate of ICU admission, cardiopulmonary resuscitation,
intravenous inotropes and vasopressor use did not differ between the
patients with and without metformin use. Interestingly, the use of
mechanical ventilation and renal replacement therapy, a potential outcome
variable for lactic acidosis, was lower in patients with metformin use.
After adjustment for significant covariates, metformin use was associated
with reduced risk for in-hospital death and heart transplantation (OR,
0.37; 95% CI, 0.17-0.82). Conclusions: Metformin use at admission for
acute heart failure was not associated with an excess risk of in-hospital
death or heart transplantation, suggesting that its use may be safe in
heart failure patients.
<12>
Accession Number
616173419
Author
Niels Grote Beverborg N.; Van Der Meer P.
Institution
(Niels Grote Beverborg, Van Der Meer) University Medical Center Groningen,
Cardiology, Groningen, Netherlands
Title
Definition of iron deficiency based on the gold standard of bone marrow
iron staining and treatment effect of ferric carboxymaltose in heart
failure patients.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 20-21), 2017.
Date of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Background: The most commonly used definition of iron deficiency (ID)
(ferritin< 100ng/ml or ferritin 100-300ng/ml and transferrin saturation
[TSAT]<20%) has not been validated in patients with heart failure (HF).
Purpose: We aimed to validate and possibly optimize the biomarker-based
definition of ID in HF, using bone marrow iron staining as the gold
standard. Second, we aimed to apply this optimized definition to the
treatment response to ferric carboxymaltose in patients with HF. Methods:
Bone marrow aspiration with iron staining was performed in 42 patients
with HF and a reduced ejection fraction (LVEF45%) undergoing median
sternotomy for coronary artery bypass grafting. Subsequently, an
individual patient data meta-analysis of clinical trials (N=837) on the
effects of intravenous ferric carboxymaltose in patients with HF was used
to test if the optimal definition of ID identified treatment responders
from non-responders on cardiovascular morbidity and mortality. Results:
Patients in the bone marrow study were mostly male (76%), mean age was
68+/-10 years, median NTproBNP 914ng/L [IQR:454-1755]. Bone marrow ID was
found in 17 (40%) of the HF patients. The most commonly used definition of
ID (ferritin<100ng/ml or ferritin 100-300ng/ml and TSAT<20%), had a
sensitivity of 82% and a specificity of 72%. A definition solely based on
TSAT (optimal cut-off 19.8%) had a sensitivity and specificity of 94% and
84% (p<0.05 compared to the former definition). In the meta-analysis,
TSAT19.8%, and not ferritin, distinguished responders from non-responders
to intravenous ferric carboxymaltose (interaction p=0.009; rate ratio for
cardiovascular morbidity and mortality [RR] (95%CI): 0.45 (0.290.71) for
patients with TSAT19.8% and RR (95% CI): 1.55 (0.693.47) for patients with
TSAT>19.8%). Conclusions: The conventional definition of ID performs
reasonably in diagnosing ID. However, a single value (TSAT19.8%) alone
performs at least as good in selecting patients with true ID and
identifies responders to ferric carboxymaltose. (Figure Presented).
<13>
Accession Number
616173213
Author
Jamal Uddin J.
Institution
(Jamal Uddin) Ibrahim Cardiac Hospital and Research Institute, Dhaka,
Bangladesh
Title
Effects of cardiac rehabilitation on exercise capacity and WHO-quality of
life undergoing CABG patients-A quasi-randomised controlled trial.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 464), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
The effect of home-based cardiac rehabilitation following coronary artery
bypass graft surgery in a low income country: A controlled trial.
Background: More than 85% of global cardiovascular disease deaths occur in
low and middle-income countries with coronary heart disease contributing
to more than half of these deaths. Few controlled trials of cardiac
rehabilitation (CR) have been conducted in low and middle income countries
to date. Methods: We undertook a quasi-randomized controlled trial design
and allocated patients 1:1 to either based CR program in addition to usual
care (CR group) or (UC group)usual care alone (UC group) according to
their date of surgery. We screened all patients who were admitted to the
Department of Cardiac Surgery at Ibrahim Cardiac Hospital and Research
Institute (ICHRI) in Bangladesh from July 2012 to July 2013. Male and
females patients were included if they were admitted for elective coronary
artery bypass graft (CABG) surgery aged 25 to 65 years. Patients allocated
to the CR group were offered an initial CR class, and provided with an
educational booklet that contained details of home-based exercise
programme, and received a monthly telephone call from a member CR team
over a 12-month period. Data on exercise capacity as measured by maximal
oxygen uptake (VO2max), coronary risk factors, health-related quality of
life, and mental health status were collected between 3-12-months follow
up. Differences in outcomes were compared between CR and UC groups in
patients with complete outcome data. Results: A total of 142 participants
participated in the trial - 71 allocated to CR group and 71 allocated to
UC group. At 12 months follow up, 61 (86%) and 40 (56%) patients
respectively provided complete outcome data. VO2max at 6-months follow up
was higher in the CR compared to UC group (mean difference: 7 ml/kg/min,
95% CI: 2 to 11, P=0.005). Compared to baseline, improvements in overall
and domain specific health-related on the WHO-QoL-BREF questionnaire,
PHQ-9 assessed mental well-being beingon PHQ-9, and CHD risk factors (body
mass index, blood pressure, HbA1C, lipids) were significantly greater (P <
0.05) for CR compared to UC group patients. Conclusions: The addition of a
home-based CR programme of an educational booklet supported by healthcare
professional telephone calls to usual care following CABG surgery was
shown to provide important patient benefits compared to usual care alone.
In the context of low or middle.
<14>
Accession Number
616173025
Author
Anna Slagman A.; Bolanaki M.; Frick J.; Holert F.; Mazelka M.; Neumeier
H.L.; Rabsch S.; Ruggaber F.; Searle J.; Thomas C.; Toro S.; Werk-Wenzel
C.; Mockel M.
Institution
(Anna Slagman, Mockel) Charite - Campus Virchow-Klinikum, Department of
Cardiology, Berlin, Germany
(Bolanaki, Frick, Holert, Mazelka, Neumeier, Rabsch, Ruggaber, Searle,
Thomas, Toro, Werk-Wenzel) Charite - Universitatsmedizin Berlin, Division
of Emergency Medicine (CVK, CCM); Department of Cardiology (CVK), Berlin,
Germany
Title
Screening for the Improve Management of heart failure with Procalcitonin
(IMPACT)-study.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 546-547), 2017.
Date of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Background: The IMPACT-study evaluates an advantage of PCT guided
antibiotic treatment over established treatment practice in patients with
acute decompensated heart failure. The primary endpoint is 90-day
all-cause mortality. Purpose: To investigate the proportion of
successfully screened patients and the main reasons for non-enrollment.
Methods: Patients who present to the Emergency Department (ED) with
leading symptom dyspnea and suspected or known heart failure are eligible
for the study. These patients were screened in two EDs of the
Universitatsmedizin between March 2015 and December 2016. Inclusion
criteria: 1. MR-proANP>300 pmol/L, BNP>350 ng/L or NT-proBNP>1800 ng/L; 2.
Patient has given written Informed consent within study timelines to allow
antibiotic treatment within 8 hours; 3. Adult patients (i.e. >18 years of
age); 4. Hospitalization for at least 1 overnight stay planned. Exclusion
criteria: 1. Patient participates in any other interventional clinical
trial; 2. Trauma related shortness of breath; 3. Patient diagnosed with
lung or thyroid cancer; 4. Known terminal disease with life expectancy of
less than 6 months, e.g. advanced metastasized cancer disease; 5. Organ
transplant requiring immunosuppression; 6. Abdominal, vascular or thorax
surgery within the last 30 days; 7. End stage/advanced HF - defined by
planned heart transplantation, or cardiogenic shock; 8. Female patients
who have given birth within 3 months before study enrolment; 9. Current
use of antibiotics or requirement of immediate antibiotic therapy before
randomization and measurement of PCT; 10. End stage renal failure
requiring dialysis; 11. Patient is not willing, or it is not possible or
advisable for the patient, to follow the study schedule, including
antibiotic therapy and 90 days follow up; 12. Patient has already
participated in the clinical trial previously; 13. Pregnant or lactating
women; 14. Patients who are institutionalized by official or judicial
order; 15. Dependants of the sponsor, the CRO, the study site or the
investigator Results: Overall, 1,918 patients were screened for the IMPACT
study within 22 months. Of these, 7.5% (n=143) were enrolled. The
proportion of enrolled patients differed between both study centres: 8.5%
of all screened patients were enrolled at the Campus Virchow Klinikum
(CVK; 112 out of 1,212) and 5.1% at the Campus Charite Mitte (CCM; 31 out
of 605). The main reason for non-enrollment were low values of natriuretic
peptides (26% at CVK and 30% at CCM). Other reasons for non-enrollment
differed only slightly between both EDs and are depicted in figure 1.
Conclusions: The IMPACT study is the first study to evaluate the concept
of PCT-guided antibiotic treatment applying a randomized design in this
specific setting. Despite the high number of patients with dyspnea in the
investigated EDS, many patients cannot be included especially due to low
natriuretic peptide values. (Figure Presented).
<15>
Accession Number
616173018
Author
Samer Alabed S.; Al Dakhoul S.; Sabouni A.; Bdaiwi Y.; Frobel-Mercier A.
Institution
(Samer Alabed) University of Sheffield, Academic Unit of Radiology,
Sheffield, United Kingdom
(Al Dakhoul) Leeds Teaching Hospitals NHS Trust, Paediatrics, Leeds,
United Kingdom
(Sabouni) Cairo University, Medicine, Cairo, Egypt
(Bdaiwi) Damascus Univeristy, Faculty of Medicine, Damascus, Syrian Arab
Republic
(Frobel-Mercier) AstraZeneca, Quantitative Clinical Pharmacology, Molndal,
Sweden
Title
Are beta-blockers effective in children with congestive heart failure?-A
Cochrane review.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 288), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: Beta-adrenergic blockers are considered a cornerstone in the
management of heart failure in adults. Beta-blockers reduce the heart rate
and contractility consequently lowering the workload of the heart and
improving its performance. This effect is estimated to be parallel in
children and beta-blockers are used clinically despite lack of proven
evidence to support such guidelines. Nevertheless, due to the variances in
aetiology, pharmacokinetics and comorbidities between adults and children
with congestive heart failure, it is fundamental to determine the safety
and effectiveness of beta-blockers in children in a systematic review.
Purpose: A Cochrane systematic review of all randomised controlled trials
(RCT) to assess the effect of beta-blockers in children with congestive
heart failure. Methods: The Cochrane Central Register of Controlled Trials
(CENTRAL), MEDLINE, EMBASE, and LILACS were search up to November 2015 for
relevant RCTs. Two review authors independently screened the search
results, extracted and assessed data from the included trials. Results:
The systematic review includes seven RCTs with a total of 420
participants. Four small studies with 20 to 30 children each, and two
larger studies of 80 children each, showed an improvement of congestive
heart failure with beta-blocker therapy. A larger study with 161
participants showed no evidence of benefit over placebo in a composite
measure of heart failure outcomes. The included studies showed no
significant difference in mortality or heart transplantation rates between
the beta-blocker and control groups. No significant adverse events were
reported with beta-blockers, apart from one episode of complete heart
block. A meta-analysis of left ventricular ejection fraction (LVEF) and
fractional shortening (LVFS) data showed a very small improvement with
beta-blockers. However, the primary outcomes could not be pooled in
meta-analyses. There were vast differences in the age, age range, and
health of the participants (aetiology and severity of heart failure;
heterogeneity of diagnoses and co-morbidities); there was a range of
treatments across studies (choice of beta-blocker, dosing, duration of
treatment); and a lack of standardised methods and outcome measures.
Conclusion: The available data suggests a trend that beta-blockers might
be beneficial in the treatment of paediatric congestive heart failure.
However, there is no sufficient evidence to recommend or discourage the
use of beta-blockers in children with congestive heart failure or to
propose a dosage scheme. (Table Presented).
<16>
Accession Number
616172906
Author
Nguyen L.S.; Squara P.; Amour J.; Cholley B.
Institution
(Nguyen, Squara) Clinique Medico-Chirurgicale Ambroise Pare, Critical Care
Department, Neuilly sur Seine, France
(Amour) Hospital Pitie-Salpetriere, Anesthesiology and Critical Care
Medicine Department, Paris, France
(Cholley) Hopital Europeen Georges Pompidou, Universite Paris Descartes,
Anesthesiology and Critical Care Medicine Department, Paris, France
Title
Intravenous ivabradine in low cardiac output syndrome treated by
dobutamine following cardiac surgery: A phase II trial.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 526-527), 2017.
Date of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Background: Dobutamine is the first-line treatment for low cardiac output
syndrome (LCOS) after cardiac surgery, but induces sinus tachycardia. We
aimed to assess the intravenous (i.v.) ivabradine in patients presenting
LCOS with dobutamine-induced tachycardia following elective coronary
artery bypass graft surgery. Methods: In a phase 2 multi-center randomized
placebo-controlled trial, i.v. ivabradine was infused in patients
presenting sinus tachycardia (heart rate (HR) > 100 bpm) after dobutamine
initiation. Primary endpoint was the number (%) of patients having their
HR reduced between 80 and 90 bpm for > 30 minutes. Secondary endpoints
were hemodynamic parameters measured by Swan-Ganz catheter. Results:
Thirteen (93%) patients treated by ivabradine reached the primary
endpoint, compared to 2 (40%) in the placebo group (p<0.05). Ivabradine
significantly decreased HR (112 to 86 bpm (p<0.001)) while increasing
cardiac index (2.5 to 2.9 l/min/m2 (p<0.05)), stroke volume (38.0 to 60.0
ml (p<0.001)) and systolic blood pressure (110 to 125 mmHg (p<0.05)).
These parameters remained similar in the placebo group. Five (35.7%)
patients developed atrial fibrillation in the ivabradine group.
Conclusion: Intravenous ivabradine reduced HR in patients presenting with
LCOS treated with dobutamine after CABG surgery, without impairing cardiac
output. This beneficial effect should be confirmed with larger trials.
(Table Presented).
<17>
Accession Number
616172851
Author
Olesya Shatova O.; Kurlianskaya A.; Rachok L.; Ostrovsky Y.
Institution
(Olesya Shatova, Kurlianskaya, Rachok, Ostrovsky) Republican Scientific
and Practical Centre of Cardiology, Heart Failure, Minsk, Belarus
Title
Differentiated approach to the treatment of patients with end-stage heart
failure.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 378-379), 2017.
Date of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Background: The life expectancy of patients with end-stage heart failure
is determined by the possibility of using different bridges to heart
transplantation (HT). Pharmaceutical and mechanical bridges to HT are
widely used nowadays. Surgical valve repair as the bridge to
transplantation is still not good investigated. Purpose: to access the
efficiency of surgical valve repair as the bridge to HT. Methods: Our
study includes 159 patients with end-stage heart failure in the clinical
status UNOS 2 during the period 2009-2015 years with the mean data end
diastolic volume=251+/-15,8 ml, end systolic volume=188+/-10,2ml, ejection
fraction=25,6+/-3,1%, proBNP level=1307+/-112pg/ml,
VO2peak=12,8+/-3,1l/min. All patients were included in the waiting list
and had medical unnecessary in surgical revascularization. Patients were
randomized into 2 groups: 77 patients from the 1 group underwent surgical
valve repair, 82 patients were on optimal medical treatment (2 group). In
the 1 group surgical valve correction was used as the bridge to the HT.
The patients' death and the HT are two endpoints of our study. The results
are presented as absolute and relative frequencies, standard error of the
proportion (p+/-Sp). Quantitative data are presented as median and
interquartile range (Me (LQ-UQ)). the comparative analysis indicates that
the median function of survival after surgical valve correction (without
HT) is 27 months (17,6-34,8) and is significantly higher than in patients
who receive an optimal medical therapy ( 4 months of 1.9 to 10.1)
(p<0.001). (Picture 1) The surgical valve correction in patients with
end-stage heart failure allows in 50% cases to delay the HT up to 2 years.
Conclusions: The data analysis of the results shows that the successful
applications of the surgical valve repair in patients with end-stage heart
failure with unnecessary of revascularization could be used as a bridge to
HT and in 50% cases allows to delay the HT up to 2 years. (Figure
presented).
<18>
Accession Number
616172850
Author
Martina Boscolo Berto M.; Putzu A.; Belletti A.; Pasotti E.; Cassina T.;
Moccetti T.; Pedrazzini G.
Institution
(Martina Boscolo Berto, Putzu, Pasotti, Cassina, Moccetti, Pedrazzini)
Cardiocentro Ticino, Cardiology, Lugano, Switzerland
(Belletti) San Raffaele Hospital of Milan (IRCCS), Intensive Care, Milan,
Italy
Title
Prevention of contrast-induced acute kidney injury by furosemide with
matched hydration in patients undergoing interventional procedures. A
systematic review and Meta-Analysis of randomized trials.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 102), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
The objective of this meta-analysis of randomized trials was to evaluate
if the administration of furosemide with matched hydration using the
RenalGuard System reduces contrast-induced acute kidney injury (CI-AKI) in
hight risk patients, undergoing interventional procedures- CI-AKI is a
serious complication following angiographic procedures and a powerful
predictor of unfavorable early and long-term outcomes.The primary outcome
was the incidence of CI-AKI, and the secondary outcomes were need for
renal replacement therapy, mortality, stroke, and adverse events. Four
trials (698 patients) published between 2011 and 2016 were included in the
analysis and included patients undergoing percutaneous coronary procedures
and transcatheter aortic valve replacement. RenalGuard therapy was
associated with a lower incidence of CI-AKI compared with control
treatment (27 of 348 [7.76%] vs. 75 of 350 [21.43%] patients; odds ratio:
0.31; 95% confidence interval: 0.19 to 0.50; I2=4%, p<0.00001) and with a
lower need for renal replacement therapy (2 of 346 [0.58%] vs. 12 of 348
[3.45%] patients; odds ratio: 0.19; 95% confidence interval: 0.05 to 0.76;
I2=0%, p=0.02). No major adverse events occurred in patients undergoing
RenalGuard therapy. The main finding of this meta-analysis is that
furosemide with matched hydration by the RenalGuard System may reduce the
incidence of CI-AKI in high-risk patients undergoing percutaneous coronary
intervention or transcatheter aortic valve replacement. However, further
independent high-quality randomized trials should elucidate the
effectiveness and safety of this prophylactic intervention in
interventional cardiology.
<19>
Accession Number
616172846
Author
Shaddy R.; Chen F.; Canter C.; Halnon N.; Rossano J.; Kantor P.; Bonnet
D.; Burch M.
Institution
(Shaddy, Rossano) Children's Hospital of Philadelphia, Philadelphia,
United States
(Chen) Novartis Pharmaceuticals Corporation, East Hanover, United States
(Canter) Washington University, MO, United States
(Halnon) UCLA, Los Angeles, United States
(Kantor) University of Alberta, Edmonton, Canada
(Bonnet) Necker Hospital University, Paris, France
(Burch) Great Ormond Street Hospital for Children, London, United Kingdom
Title
Effects of sacubitril/valsartan vs. Enalapril in paediatric patients with
heart failure due to systemic LV systolic dysfunction: Design and
rationale of the PANORAMA-HF study.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 411), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Background: Paediatric heart failure (HF) is characterised by significant
morbidity and mortality, frequent hospitalisation, and poor quality of
life. The rationale for medical therapy of paediatric HF primarily comes
from adult studies. Sacubitril/ valsartan (LCZ696) reduced mortality and
delayed HF progression vs. enalapril, and was generally well tolerated in
the PARADIGM-HF trial in adults with HF with reduced ejection fraction.
Study Design: This multicentre study will use an adaptive seamless,
two-stage design (Figure). In part 1, an open-label, single-dose study
with 36 paediatric HF patients (1 month to <18 years) stratified into 3
age groups (Group 1: 6 to <18 years; Group 2: 1 to <6 years; Group 3: 1
month to <1 year) will receive sacubitril/ valsartan in a sequential
overlapping fashion and in descending age group order. The doses for Group
1 and 2 (0.8 mg/kg and 3.1 mg/kg) corresponds to ~50 and 200 mg dose of
sacubitril/valsartan in an adult with 65kg bodyweight. Group 3 will only
be assessed with the 0.8 mg/kg dose of sacubitril/valsartan. The dose for
Group 2, and subsequently for Group 3, may be adjusted based on safety
information from the previous group(s). Pharmacokinetics/pharmacodynamics
and biomarkers (N-terminal pro-B-type natriuretic peptide and cyclic
guanosine monophosphate) will be evaluated. Part 2 is a 52-week
randomised, double-blind, parallel-group, active-controlled study.
Eligible patients (N=360) will be stratified by age and functional
classification and randomised to receive either sacubitril/valsartan or
enalapril (target dose: 0.2 mg/kg twice daily (b.i.d); maximum dose 10 mg
b.i.d). As there is no generally agreed, validated clinical efficacy
endpoint for this patient population, a Global Rank primary endpoint has
been developed; this will be derived by ranking patients (worst to best
outcome) according to clinical events such as death, listing for urgent
heart transplant or mechanical life support, worsening HF, and measures of
functional assessment (New York Heart Association/Ross) and
patient-reported outcomes (Patient Global Impression of Severity and the
paediatric Quality of Life Inventory [physical functioning]). Additional
patients will be enrolled to ensure that a minimum of 80 patients with
clinical events are obtained. Safety areas of interest include identified
risks common to both sacubitril/valsartan and enalapril such as
hypotension, hyperkalaemia, worsening renal function, and angioedema.
Conclusion: This adaptive study design will determine if
sacubitril/valsartan can offer a greater clinical benefit vs. enalapril in
children with HF.
<20>
Accession Number
616172827
Author
Karel Labr K.; Spinar J.; Parenica J.; Spinarova L.; Malek F.; Spinarova
M.; Ludka O.; Jarkovsky J.; Benesova K.; Labrova R.
Institution
(Karel Labr, Spinarova, Spinarova) St. Ann University Hospital, Masaryk
University, Brno, Czech Republic
(Spinar, Parenica, Ludka, Labrova) University Hospital Brno, Masaryk
University, Brno, Czech Republic
(Malek) Na Homolce Hospital, Prague, Czech Republic
(Jarkovsky, Benesova) Institute of Biostatistics, Analyses of Masaryk
University, Brno, Czech Republic
Title
Beta-blockers in chronic heart failure registry FAR NHL and one year
follow up.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 118-119), 2017.
Date of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Background: Beta-blockers (BB) decrease morbidity and mortality and are
part of the first line treatment of heart failure with reduced ejection
fraction (HFrEF). Purpose: We aimed to compare influence of beta-blocker
doses and other factors on hospitalization and mortality in heart failure
patients with systolic dysfunction. Methods: The data come from the
FARmacology and NeuroHumoraL activation multicenter registry (FAR NHL).
Patients with left ventricle ejection fraction (EF LK) under 50 % who were
at least one month stable were included. Results: 1100 patients were
included, mean age 65 years, 80.8 % were male. From those receiving beta
blockers 20 % received low dose (LD), 57 % medium dose (MD) and 17 % high
dose (HD). 6.2 % of patients were not treated by BB at all (O). The higher
the blood pressure (BP; LD 124/77; MD 129/80; HD 132/82 mm Hg, p < 0.001),
EF LK (LD 29.5; MD 30.5; HD 32.0 %, p=0.003), creatinine clearance rate
(CrCl; LD 78.7; MD 87.8; HD 91.1 ml/min, p=0.001) or patients weight (LD
83.2; MD 88.7; HD 93.5 kg, p < 0.001) was, the higher dose of BB they
received. The lower NT-proBNP was, the higher dose of BB they got (LD 767;
MD 456; HD 314 pg/ml, p < 0.001). At one year follow up 83 patients (7.5
%) died and 436 were hospitalized (39.6%). The higher was beta-blocker
dose, the lower was number of death (O 13.2; LD 10.7; MD 6.3; HD 5.9 %)
and hospitalized patients (O 45.6; LD 43.8; MD 38.0; HD 38.0 %). 17
patients underwent orthotopic heart transplant. Conclusions: According to
FAR NHL registry, nearly 94 % of HFrEF patients received BB. But only 17 %
received the high dose of BB. The more severe illness was, defined by
lower BP, CrCl, EF LK, body weight, or higher NT-proBNP, the lower dose of
BB patients got and tolerated. The higher was BB dose the lower was
all-cause mortality and hospitalization number.
<21>
Accession Number
616172713
Author
Monica Mariana Baluta M.M.; Panaitescu E.; Vintila M.M.
Institution
(Monica Mariana Baluta) Carol Davila University, Medicine-St Pantelimon
Clinical Emergency Hospital, Cardiology Department, Bucharest, Romania
(Panaitescu) Carol Davila University of Medicine and Pharmacy, Medical
Informatics and Biostatistics, Marketing, Medical Technology, Bucharest,
Romania
(Vintila) St. Pantelimon Emergency Hospital, Cardiology, Bucharest,
Romania
Title
Short-term mortality is not influenced by aminoglycozide decrease in renal
function during treatment of prosthetic valve endocarditis.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 574), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: Antibiotic therapy (AT) for prosthetic valve endocarditis
(PVE) is standardized by guidelines and depends on the etiology and on the
type of PVE. Aminoglycosides (AGs), especially Gentamicin is often
included in the antimicrobial combination for the management of PVE.
Purpose: The objective of our study is to quantify the potential
nephrotoxic effect of AGs and to verify those speculations from literature
about their relationship with mortality and about the safety and efficacy
of single dose administration in PVE patients. Methods: Retrospective
analysis of 56 patients admitted with PVE in two university hospitals over
5 years (2000-2004). We divided our patients in two groups: early and late
PVE related to time of surgery for valve replacement. We evaluate the
influence of antimicrobial therapy with AGs on renal function. Kidney
function abnormalities were determined by blood creatinine (Cre). We
defined renal injury as low (LRI: Cre<2 mg/dl), moderate (MRI: cre>2and <3
mg/dl) and severe (SRI:cre>3mg/dl). We analyzed (uni- and multivariate
analysis) if the absence of AGs or presence of AGs administered once or
multiple doses influenced the renal function. AGs were used according to
the antibiogram or with infectious specialist decision. AGs duration was
individualized according to renal function and guidelines. Results: We
found 52% patients with early vs 48% late PVE with high rate of negative
blood cultures 55.2%in early vs 48.2% late PVE. Patients outcome:
responders to antibiotics: 71%, in-hospital death 2%, transferred due to
complications 27%. AT was frequently changed due to side effects but the
type of combinations did not influence the overall efficacy of AT.
Amikacin was frequently used according to antibiogram but also for
negative blood culture endocarditis. LRI was observed fifth times higher
in patients with multiple dose AGs compared with those without AGs
(p=0.01, chi2=6.25, RR=2.3, OR= 5.56) and similar with them with single
dose (p=0.2, chi2=3.81). MRI was observed seventh times higher in patients
with multiple dose AGs compared with those without AGs (p=0.01, Fischer,
RR=3.6, OR=7.5) and similar with them with single dose (p >> 0.05). MRI
was more frequent with Imipenem-Amikacin association (p=0.008). SRI was
not influenced by type of administration (single dose p=0.2, chi2=3.81;
multiple doses p=0.1, Fischer). There was no statistical correlation
between mortality and renal impairment determined by AGs. Conclusions:
Multiple dose AGs administration determines more renal function impairment
than in patients treated without AGs. Nevertheless, in-hospital mortality
was not influenced by AGs decrease in renal function. Single dose AGs does
was safe without significant renal function impairment. Amikacin was safe
and effective including in negative blood culture PVE. Study limitation:
small number of patients and lots of negative blood cultures PVE.
<22>
Accession Number
616172659
Author
Nemkov A.; Komok V.; Beliy S.; Lukashenko V.; Zhang Y.I.; Kobak A.;
Babenko E.; Afanasiev B.
Institution
(Nemkov, Komok, Beliy, Lukashenko, Zhang, Kobak, Babenko, Afanasiev)
St-Petersburg State Pavlov Medical University, St-Petersburg, Russian
Federation
Title
Assessment of grafts patency and diastolic dysfunction in patients after
coronary artery bypass grafting and cell-based therapy.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 507), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Background: It is very little known about influence of cell-based therapy
on diastolic dysfunction in patients after coronary artery bypass grafting
(CABG) and intramyocardial injection of bone marrow stem cells (BMSC).
Purpose: Assessment of grafts patency and diastolic dysfunction in
patients after CABG and cell-based therapy. Methods: Patients with
coronary artery disease were randomly divided on 3 groups: group 0 -
control n=36, patients received only CABG; group 1- patients received CABG
and intramyocardial injections of BMSC n=25; group 2- patients received
CABG and intramyocardial and intracoronary injections of BMSC n=17. 1 year
after operation clinical assessment, echocardiography and angiography was
performed. Preliminary results. All patients are alive. Decreasing of
functional class of angina pectoris, graft patency, improvement of
diastolic dysfunction was more dramatically achieved in patients of group
2. Conclusion: intramyocardial and intracoronary injections of BMSC is a
safe and useful procedure during CABG for patients with coronary artery
disease and diastolic dysfunction.
<23>
Accession Number
616172353
Author
Mandel I.A.; Podoksenov Y.K.; Mikheev S.L.; Svirko Y.S.; Kamenschikov
N.O.; Sukhodolo I.V.; Shipulin V.M.
Institution
(Mandel) Federal Scientific Clinical Center of Specialized Methods Medical
Care, Medical Technology, Anesthesiology and Intensive Care, Moscow,
Russian Federation
(Podoksenov) Cardiology Research Institute, Anesthesiology and Intensive
Care, Tomsk, Russian Federation
(Mikheev, Svirko, Kamenschikov, Shipulin) Cardiology Research Institute,
Cardiovascular Surgery, Tomsk, Russian Federation
(Sukhodolo) Siberian State Medical University, Morphology and General
Pathology, Tomsk, Russian Federation
Title
Hypoxic-hyperoxic preconditioning: A novel technique for myocardial
protection against ischemia-reperfusion injury.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 349), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: Preconditioning by moderate hypoxia, as well as hyperoxia,
constitute an effective drug-free method to amplify adaptive response to
various negative influences of cardiopulmonary bypass (CPB) during cardiac
surgery. Purpose: The study aimed to assess the mechanisms and impact of
hypoxic-hyperoxic preconditioning (HHP) on functional state of myocardium
in patients with coronary artery disease (CAD) undergoing cardiac surgery
with CPB. Methods: The study included 120 patients randomly assigned to
two groups: 61 patients received hypoxic-hyperoxic preconditioning before
the CPB (HHP group) and 59 patients were not preconditioned (control
group). Coronary artery bypass grafting with CPB for multivessel coronary
artery disease was performed in all cases (2014-2016). Safety control of
the preconditioning procedure included ECG monitoring, invasive blood
pressure control, cardiac output, pulse oximetry, capnography, cerebral
oximetry, measurement of anaerobic threshold. To monitor acid-base status
and metabolic state we measured saturation of arterial and mixed venous
blood, lactate and glucose level, plasma pH every 10 min during the HHP
procedure; calculated oxygen consumption and delivery indices, ratio
between venous-to-arterial carbon dioxide difference to arteriovenous
oxygen content difference (DELTAPCO2/C(a-v)O2). Results and Conclusion:
Spontaneous sinus rhythm recovery after CPB was registered more often in
HHP group - 34 (55.7%) comparing to controls - 19 (32.2 %), X2=8.38,
p=0.015. The length of inotropic support in early postoperative period was
significantly lower in HHP group comparing to control group (12 [9; 15] vs
28 [24; 32] hours, U=98.1, p=0.001). Mechanical ventilation time in HHP
group was 10 [7.25; 15] hours comparing to 16 [10; 24] hours in control
group, (U=34.2, p=0.023). Thus, hypoxic-hyperoxic preconditioning with
individual parameters selection based on anaerobic threshold in patients
with CAD before the main stage of cardiac surgery enhances adaptive
response to the surgical stress, facilitates sinus rhythm recovery and
provides a faster recovery after surgery.
<24>
Accession Number
616172309
Author
Karl-Heinz Kuck K.-H.; Colombo A.; Alfieri O.; Vahanian A.; Baldus S.;
Maisano F.; Nickenig G.; Von Bardeleben R.S.; Van Der Heyden J.;
Hausleiter J.; Kerner A.; Tamburino C.
Institution
(Karl-Heinz Kuck) Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
(Colombo, Alfieri) San Raffaele Hospital of Milan (IRCCS), Milan, Italy
(Vahanian) Hospital Bichat-Claude Bernard, Paris, France
(Baldus) University Hospital, Cardiology, Cologne, Germany
(Maisano) University Hospital Zurich, Zurich, Switzerland
(Nickenig) University Hospital Bonn, Bonn, Germany
(Von Bardeleben) University Medical Center of Mainz, Mainz, Germany
(Van Der Heyden) St Antonius Hospital, Nieuwegein, Netherlands
(Hausleiter) Ludwig-Maximilians University, Munich, Germany
(Kerner) Rambam Health Care Campus, Haifa, Israel
(Tamburino) Ferrarotto Hospital, Catania, Italy
Title
Multicentre trial of a transfemoral mitral valve reconstruction system.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 349), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Background/Objective: The Cardioband system enables percutaneous
implantation of an adjustable "surgical-like" mitral annuloplasty ring
using a transseptal approach. The aim of this multicentre study was to
evaluate the feasibility, safety and outcomes up to 24 months of
Cardioband implantation in patients with secondary mitral regurgitation
(MR). Methods: Between February 2013 and June 2016, 61 high-risk patients
with significant secondary MR were enrolled at 11 European sites. All
patients were screened by a heart team using echocardiography and cardiac
CT. Results: Mean patient age was 72+/-7 years, 44 were males (72%). Mean
EuroSCORE II was 7.1%. At baseline, 53 patients (86%) were in NYHA
functional class III-IV, with a mean left ventricular ejection fraction of
33+/-11%. Device implantation was achieved in all patients but one. At
discharge, 51 patients (90%) had MR <2+. After device cinching, an average
30% reduction in septolateral mitral annular diameter was observed (from
37+/-4 mm to 26+/-4 mm; p<0.01). Thirty-day mortality was 3.3% (2
patients; death adjudicated as unrelated to the device). MR <2+ was
measured in 29/31 (93%) and 11/12 (92%) patients at 12 and 24 months of
follow-up, respectively (Figure). NYHA functional class I-II was present
in 26/33 (79%) and 11/15 (77%) at 12 and 24 months, respectively. A
significant improvement was observed at 12 months in the mean quality of
life score (Minnesota Living with Heart Failure Questionnaire) from 41 to
23 (p<0.01); and mean six-minute walk distance improved from 299 m to 372
m (p<0.01). Conclusions: Transseptal mitral repair with the Cardioband
device resulted in significant MR reduction by reconstruction of the
mitral annulus. Thirty-day mortality is comparable to other transcatheter
mitral procedures. MR severity reduction and clinical benefit remain
stable up to 24 months. (Figure presented).
<25>
Accession Number
616172151
Author
Jung-Hyun Choi J.-H.; Lee B.-J.; Shin M.-J.
Institution
(Jung-Hyun Choi, Lee, Shin) Busan National University Hospital, Busan,
South Korea
Title
Real-time monitoring of hemodynamic response during resistance exercise in
cardiac surgery patient.
Source
European Journal of Heart Failure. Conference: Heart Failure 2017 and the
4th World Congress on Acute Heart Failure. France. 19 (pp 143), 2017. Date
of Publication: May 2017.
Publisher
John Wiley and Sons Ltd
Abstract
Object: Coronary artery bypass grafting (CABG) is a surgery that improves
blood flow to the heart for the patient who have severe coronary artery
disease. After that surgery, the patient should be treated in intensive
care unit (ICU). During that period, physical functioning will be
impaired. Physical therapy interventions delivered in the ICU can reduce
these impairments, but the safety is not still established especially to
the patient who received CABG. We monitored the patients using a software
during exercise and this is the first attempt in Korea. Method: 4 patients
who received CABG, were extubated, had hemodynamic stability and proper
awareness to cooperate were enrolled to exercise. A low-intensity
resistance exercise was comprise of 3 sets of isokinetic knee extension,
10 times per each set, with 2-Kg sandbag at the patient's ankle. We use
the software named Datex-Ohmeda S/5 Collect to collect records of vital
signs from B650 monitoring system. (Fig 1) Result: All four patients had
the low intensity resistance exercise safely in ICU at post-operative day
3. In the patient 1, vital signs during exercise were as follow: at the
resting period, blood pressure (BP) was 137.93+/-1.02/84.98+/-0.62 mmHg
(mean BP : 103.39+/-0.75 mmHg). At the 1st, 2nd and 3rd exercise period,
BP were slightly increased to 142.35+/-0.67/87.96+/-0.30 mmHg,
142.42+/-0.91/88.76+/-0.33 mmHg, 144.73+/-0.90/82.29+/-0.56 mmHg,
respectively. The BP was decreased to 140.15+/-0.77/85.21+/-0.44 mmHg at
recovery period. Baseline heart rate (HR) was 78.83+/-0.55 beats/minute,
increased to 80.38+/-1.15 beats/minute at exercise period and decreased to
77.15+/-0.63 beats/minute at recovery. The blood oxygen saturation level
(SpO2) was maintained, between 97.95+/-0.13% and 98.51+/-0.02%. The
patient did not complained of chest pain, dyspnea, excessive fatigue, and
other symptoms during the entire period. Discussion: Exercise for
critically ill patients in ICU is important and necessary, but physicians
were passive to prescribe exercise because of safety issue by this time.
But using this type of monitoring system, we can monitor real-time vital
signs during interventions. In future, well-designed randomized study
involving more participants may be necessary to confirm the safety and
effectiveness of exercise during ICU hospitalization and early
post-operative days.
<26>
[Use Link to view the full text]
Accession Number
614824246
Author
Siscovick D.S.; Barringer T.A.; Fretts A.M.; Wu J.H.Y.; Lichtenstein A.H.;
Costello R.B.; Kris-Etherton P.M.; Jacobson T.A.; Engler M.B.; Alger H.M.;
Appel L.J.; Mozaffarian D.
Title
Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the
Prevention of Clinical Cardiovascular Disease: A Science Advisory from the
American Heart Association.
Source
Circulation. 135 (15) (pp e867-e884), 2017. Date of Publication: 11 Apr
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Multiple randomized controlled trials (RCTs) have assessed the effects of
supplementation with eicosapentaenoic acid plus docosahexaenoic acid
(omega-3 polyunsaturated fatty acids, commonly called fish oils) on the
occurrence of clinical cardiovascular diseases. Although the effects of
supplementation for the primary prevention of clinical cardiovascular
events in the general population have not been examined, RCTs have
assessed the role of supplementation in secondary prevention among
patients with diabetes mellitus and prediabetes, patients at high risk of
cardiovascular disease, and those with prevalent coronary heart disease.
In this scientific advisory, we take a clinical approach and focus on
common indications for omega-3 polyunsaturated fatty acid supplements
related to the prevention of clinical cardiovascular events. We limited
the scope of our review to large RCTs of supplementation with major
clinical cardiovascular disease end points; meta-analyses were considered
secondarily. We discuss the features of available RCTs and provide the
rationale for our recommendations. We then use existing American Heart
Association criteria to assess the strength of the recommendation and the
level of evidence. On the basis of our review of the cumulative evidence
from RCTs designed to assess the effect of omega-3 polyunsaturated fatty
acid supplementation on clinical cardiovascular events, we update prior
recommendations for patients with prevalent coronary heart disease, and we
offer recommendations, when data are available, for patients with other
clinical indications, including patients with diabetes mellitus and
prediabetes and those with high risk of cardiovascular disease, stroke,
heart failure, and atrial fibrillation.<br/>Copyright © 2017 American
Heart Association, Inc.
<27>
Accession Number
615893012
Author
Benstoem C.; Stoppe C.; Liakopoulos O.J.; Ney J.; Hasenclever D.; Meybohm
P.; Goetzenich A.
Institution
(Benstoem, Goetzenich) University Hospital Aachen, Department of
Cardiothoracic Surgery, Pauwelsstrasse 30, Aachen, North Rhine Westphalia
52074, Germany
(Stoppe) RWTH Aachen University, Department of Intensive Care Medicine,
Pauwelsstrasse 30, Aachen, North Rhine Westphalia 52074, Germany
(Liakopoulos) Heart Center, University of Cologne, Department of
Cardiothoracic Surgery, Kerpener Str. 62, Cologne 50937, Germany
(Ney) University Hospital RWTH Aachen, Department of Anaesthesiology,
Pauwelsstrasse 30, Aachen, Germany
(Hasenclever) University of Leipzig, Institute for Medical Informatics,
Statistics and Epidemiology (IMISE), Haertelstrasse 16-18, Leipzig,
Germany
(Meybohm) University Hospital Frankfurt, Department of Anaesthesiology,
Intensive Care and Pain Therapy, Theodor-Stern-Kai 7, Frankfurt am Main
60590, Germany
Title
Remote ischaemic preconditioning for coronary artery bypass grafting (with
or without valve surgery).
Source
Cochrane Database of Systematic Reviews. 2017 (5) (no pagination), 2017.
Article Number: CD011719. Date of Publication: 05 May 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Despite substantial improvements in myocardial preservation
strategies, coronary artery bypass grafting (CABG) is still associated
with severe complications. It has been reported that remote ischaemic
preconditioning (RIPC) reduces reperfusion injury in people undergoing
cardiac surgery and improves clinical outcome. However, there is a lack of
synthesised information and a need to review the current evidence from
randomised controlled trials (RCTs). Objectives: To assess the benefits
and harms of remote ischaemic preconditioning in people undergoing
coronary artery bypass grafting, with or without valve surgery. Search
methods: In May 2016 we searched CENTRAL, MEDLINE, Embase and Web of
Science. We also conducted a search of ClinicalTrials.gov and the
International Clinical Trials Registry Platform (ICTRP). We also checked
reference lists of included studies. We did not apply any language
restrictions. Selection criteria: We included RCTs in which people
scheduled for CABG (with or without valve surgery) were randomly assigned
to receive RIPC or sham intervention before surgery. Data collection and
analysis: Two review authors independently assessed trials for inclusion,
extracted data and checked them for accuracy. We calculated mean
differences (MDs), standardised mean differences (SMDs) and risk ratios
(RR) using a random-effects model. We assessed quality of the trial
evidence for all primary outcomes using the GRADE methodology. We
completed a 'Risk of bias' assessment for all studies and performed
sensitivity analysis by excluding studies judged at high or unclear risk
of bias for sequence generation, allocation concealment and incomplete
outcome data. We contacted authors for missing data. Our primary endpoints
were 1) composite endpoint (including all-cause mortality, non-fatal
myocardial infarction or any new stroke, or both) assessed at 30 days
after surgery, 2) cardiac troponin T (cTnT, ng/L) at 48 hours and 72
hours, and as area under the curve (AUC) 72 hours (mug/L) after surgery,
and 3) cardiac troponin I (cTnI, ng/L) at 48 hours, 72 hours, and as area
under the curve (AUC) 72 hours (mug/L) after surgery. Main results: We
included 29 studies involving 5392 participants (mean age = 64 years, age
range 23 to 86 years, 82% male). However, few studies contributed data to
meta-analyses due to inconsistency in outcome definition and reporting. In
general, risk of bias varied from low to high risk of bias across included
studies, and insufficient detail was provided to inform judgement in
several cases. The quality of the evidence of key outcomes ranged from
moderate to low quality due to the presence of moderate or high
statistical heterogeneity, imprecision of results or due to limitations in
the design of individual studies. Compared with no RIPC, we found that
RIPC has no treatment effect on the rate of the composite endpoint with RR
0.99 (95% confidence interval (CI) 0.78 to 1.25); 2 studies; 2463
participants; moderate-quality evidence. Participants randomised to RIPC
showed an equivalent or better effect regarding the amount of cTnT release
measured at 72 hours after surgery with SMD -0.32 (95% CI -0.65 to 0.00);
3 studies; 1120 participants; moderate-quality evidence; and expressed as
AUC 72 hours with SMD -0.49 (95% CI -0.96 to -0.02); 3 studies; 830
participants; moderate-quality evidence. We found the same result in
favour of RIPC for the cTnI release measured at 48 hours with SMD -0.21
(95% CI -0.40 to -0.02); 5 studies; 745 participants; moderate-quality
evidence; and measured at 72 hours after surgery with SMD -0.37 (95% CI
-0.59 to -0.15); 2 studies; 459 participants; moderate-quality evidence.
All other primary outcomes showed no differences between groups (cTnT
release measured at 48 hours with SMD -0.14, 95% CI -0.33 to 0.06; 4
studies; 1792 participants; low-quality evidence and cTnI release measured
as AUC 72 hours with SMD -0.17, 95% CI -0.48 to 0.14; 2 studies; 159
participants; moderate-quality evidence). We also found no differences
between groups for all-cause mortality after 30 days, non-fatal myocardial
infarction after 30 days, any new stroke after 30 days, acute renal
failure after 30 days, length of stay on the intensive care unit (days),
any complications and adverse effects related to ischaemic
preconditioning. We did not assess many
patient-centred/salutogenic-focused outcomes. Authors' conclusions: We
found no evidence that RIPC has a treatment effect on clinical outcomes
(measured as a composite endpoint including all-cause mortality, non-fatal
myocardial infarction or any new stroke, or both, assessed at 30 days
after surgery). There is moderate-quality evidence that RIPC has no
treatment effect on the rate of the composite endpoint including all-cause
mortality, non-fatal myocardial infarction or any new stroke assessed at
30 days after surgery, or both. We found moderate-quality evidence that
RIPC reduces the cTnT release measured at 72 hours after surgery and
expressed as AUC (72 hours). There is moderate-quality evidence that RIPC
reduces the amount of cTnI release measured at 48 hours, and measured 72
hours after surgery. Adequately-designed studies, especially focusing on
influencing factors, e.g. with regard to anaesthetic management, are
encouraged and should systematically analyse the commonly used medications
of people with cardiovascular diseases.<br/>Copyright © 2017 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
<28>
Accession Number
615827395
Author
Bravo C.A.; Hirji S.A.; Bhatt D.L.; Kataria R.; Faxon D.P.; Ohman E.M.;
Anderson K.L.; Sidi A.I.; Sketch M.H.; Zarich S.W.; Osho A.A.; Gluud C.;
Kelbaek H.; Engstrom T.; Hofsten D.E.; Brennan J.M.
Institution
(Bravo) Albert Einstein College of Medicine, Montefiore Medical Center,
Montefiore Einstein Center for Heart and Vascular Care, 111 East 210th
Street, Bronx, NY 10467, United States
(Hirji) Brigham and Women's Hospital, Harvard Medical School, Department
of Surgery, 75 Francis Street, Boston, MA 02115, United States
(Bhatt) Brigham and Women's Hospital, Heart and Vascular Centre, 75
Francis Street, Boston, MA 02115, United States
(Kataria) Yale New Haven Health System, Department of Internal Medicine,
267 Grant Street, Bridgeport, CT 06610, United States
(Faxon) Brigham and Women's Hospital, Cardiovascular Medicine, Brigham
Circle, 1620, Boston, MA 02120-1613, United States
(Ohman) Division of Cardiovascular Medicine, Duke Heart Center, Ambulatory
Care, Programme for Advanced Coronary Diseases, Duke University Medical
Center, Box 3126, Room 8676A HAFS Building, Durham, NC 27710, United
States
(Anderson) Duke University, School of Medicine, 201 Trent Drive, Durham,
NC 27705, United States
(Sidi) University of North Carolina, Department of Biology, 201 Councilman
court, Morrisville, NC 27560, United States
(Sketch, Brennan) Duke University School of Medicine, Department of
Medicine/Cardiology, DUMC 3157, Durham, NC 27710, United States
(Zarich) Yale New Haven Health System, Department of Cardiology, 267 Grant
St, Bridgeport, CT 06610, United States
(Osho) Massachusetts General Hospital, General Surgery, 55 Fruit Street,
Boston, MA 02114, United States
(Gluud) Copenhagen Trial Unit, Centre for Clinical Intervention Research,
Department 7812, Rigshospitalet, Copenhagen University Hospital, The
Cochrane Hepato-Biliary Group, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Kelbaek) Zealand University, Roskilde Hospital, Cardiac Catheterization
Laboratory, Kogevej 7-13, Roskilde 4000, Denmark
(Engstrom, Hofsten) Copenhagen University Hospital, Rigshospitalet,
Department of Cardiology, Blegdamsvej 9, Copenhagen 2100, Denmark
Title
Complete versus culprit-only revascularisation in ST elevation myocardial
infarction with multi-vessel disease.
Source
Cochrane Database of Systematic Reviews. 2017 (5) (no pagination), 2017.
Article Number: CD011986. Date of Publication: 04 May 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Multi-vessel coronary disease in people with ST elevation
myocardial infarction (STEMI) is common and is associated with worse
prognosis after STEMI. Based on limited evidence, international guidelines
recommend intervention on only the culprit vessel during STEMI. This, in
turn, leaves other significantly stenosed coronary arteries for medical
therapy or revascularisation based on inducible ischaemia on provocative
testing. Newer data suggest that intervention on both the culprit and
non-culprit stenotic coronary arteries (complete intervention) may yield
better results compared with culprit-only intervention. Objectives: To
assess the effects of early complete revascularisation compared with
culprit vessel only intervention strategy in people with STEMI and
multi-vessel coronary disease. Search methods: We searched the Cochrane
Central Register of Controlled Trials, MEDLINE, Embase, World Health
Organization International Clinical Trials Registry Platform Search
Portal, and ClinicalTrials.gov. The date of the last search was 4 January
2017. We applied no language restrictions. We handsearched conference
proceedings to December 2016, and contacted authors and companies related
to the field. Selection criteria: We included only randomised controlled
trials (RCTs), wherein complete revascularisation strategy was compared
with a culprit-only percutaneous coronary intervention (PCI) for the
treatment of people with STEMI and multi-vessel coronary disease. Data
collection and analysis: We assessed the methodological quality of each
trial using the Cochrane 'Risk of bias' tool. We resolved the
disagreements by discussion among review authors. We followed standard
methodological approaches recommended by Cochrane. The primary outcomes
were long-term (one year or greater after the index intervention)
all-cause mortality, long-term cardiovascular mortality, long-term
non-fatal myocardial infarction, and adverse events. The secondary
outcomes were short-term (within the first 30 days after the index
intervention) all-cause mortality, short-term cardiovascular mortality,
short-term non-fatal myocardial infarction, revascularisation,
health-related quality of life, and cost. We analysed data using
fixed-effect models, and expressed results as risk ratios (RR) with 95%
confidence intervals (CI). We used GRADE criteria to assess the quality of
evidence and we conducted Trial Sequential Analysis (TSA) to control risks
of random errors. Main results: We included nine RCTs, that involved 2633
people with STEMI and multi-vessel coronary disease randomly assigned to
either a complete (n = 1381) versus culprit-only (n = 1252)
revascularisation strategy. The complete and the culprit-only
revascularisation strategies did not differ for long-term all-cause
mortality (65/1274 (5.1%) in complete group versus 72/1143 (6.3%) in
culprit-only group; RR 0.80, 95% CI 0.58 to 1.11; participants = 2417;
studies = 8; I<sup>2</sup> = 0%; very low quality evidence). Compared with
culprit-only intervention, the complete revascularisation strategy was
associated with a lower proportion of long-term cardiovascular mortality
(28/1143 (2.4%) in complete group versus 51/1086 (4.7%) in culprit-only
group; RR 0.50, 95% CI 0.32 to 0.79; participants = 2229; studies = 6;
I<sup>2</sup> = 0%; very low quality evidence) and long-term non-fatal
myocardial infarction (47/1095 (4.3%) in complete group versus 70/1004
(7.0%) in culprit-only group; RR 0.62, 95% CI 0.44 to 0.89; participants =
2099; studies = 6; I<sup>2</sup> = 0%; very low quality evidence). The
complete and the culprit-only revascularisation strategies did not differ
in combined adverse events (51/2096 (2.4%) in complete group versus
57/1990 (2.9%) in culprit-only group; RR 0.84, 95% CI 0.58 to 1.21;
participants = 4086; I<sup>2</sup> = 0%; very low quality evidence).
Complete revascularisation was associated with lower proportion of
long-term revascularisation (145/1374 (10.6%) in complete group versus
258/1242 (20.8%) in culprit-only group; RR 0.47, 95% CI 0.39 to 0.57;
participants = 2616; studies = 9; I<sup>2</sup> = 31%; very low quality
evidence). TSA of long-term all-cause mortality, long-term cardiovascular
mortality, and long-term non-fatal myocardial infarction showed that more
RCTs are needed to reach more conclusive results on these outcomes.
Regarding long-term repeat revascularisation more RCTs may not change our
present result. The quality of the evidence was judged to be very low for
all primary and the majority of the secondary outcomes mainly due to risk
of bias, imprecision, and indirectness. Authors' conclusions: Compared
with culprit-only intervention, the complete revascularisation strategy
may be superior due to lower proportions of long-term cardiovascular
mortality, long-term revascularisation, and long-term non-fatal myocardial
infarction, but these findings are based on evidence of very low quality.
TSA also supports the need for more RCTs in order to draw stronger
conclusions regarding the effects of complete revascularisation on
long-term all-cause mortality, long-term cardiovascular mortality, and
long-term non-fatal myocardial infarction.<br/>Copyright © 2017 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
<29>
Accession Number
613916235
Author
Garg A.; Sharma A.; Krishnamoorthy P.; Garg J.; Virmani D.; Sharma T.;
Stefanini G.; Kostis J.B.; Mukherjee D.; Sikorskaya E.
Institution
(Garg) Department of Medicine, St. Peter's University Hospital,
Rutgers/Robert Wood Johnson Medical School, New Brunswick, NJ, United
States
(Sharma) Division of Cardiovascular Medicine, State University of New York
Downstate Medical Center, Brooklyn, NY, United States
(Krishnamoorthy) Department of Cardiovascular Medicine, Albert Einstein
Medical Center, Philadelphia, Penn, United States
(Garg) Department of Cardiology, Lehigh Valley Health Network, Allentown,
Penn, United States
(Virmani) Department of Medicine, Albert Einstein College of Medicine,
Bronx, NY, United States
(Sharma) Department of Medicine, Cleveland Clinic, Weston, Fla, United
States
(Stefanini) Division of Cardiology, Humanitas Research Hospital, Rozzano,
Italy
(Kostis) Division of Cardiology, Cardiovascular Institute, Rutgers/Robert
Wood Johnson Medical School, New Brunswick, NJ, United States
(Mukherjee) Division of Cardiology, Texas Tech University, El Paso, Tex,
United States
(Sikorskaya) Department of Internal Medicine, The Brooklyn Hospital
Center, Brooklyn, NY, United States
Title
Role of Niacin in Current Clinical Practice: A Systematic Review.
Source
American Journal of Medicine. 130 (2) (pp 173-187), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Niacin, a potent high-density lipoprotein cholesterol-raising
drug, seems an attractive approach to reduce cardiac events in patients
with or at risk of atherosclerotic cardiovascular disease. However,
previous evidence for niacin has been challenged recently by negative
outcomes in 2 large, randomized, controlled trials comparing niacin to
placebo with background statin therapy. We studied the currently available
evidence for the role of niacin treatment for reducing the risk of
cardiovascular events in current practice. Methods A systematic review of
randomized controlled trials in the MEDLINE, EMBASE, CINAHL, and Cochrane
databases comparing niacin alone or combined with statin therapy was
performed. We extracted trial level data, including basic characteristics
and number of patients enrolled, duration of follow up, occurrence of
adverse events, and cardiovascular-related outcomes. Random effects
meta-analysis was conducted to estimate the risk ratio (RR) for individual
trial endpoints. Results Thirteen trials (N = 35,206) were selected for
final analysis. The mean follow-up duration was 32.8 months. Overall,
niacin led to significant increases in serum high-density lipoprotein
cholesterol levels from baseline trial enrolment by 21.4%, 9.31 (95%
confidence interval [CI] 5.11-13.51) mg/dL. However, we did not observe
any differences in all-cause mortality rates (RR 0.99; 95% CI 0.88-1.12)
between niacin and control arms. Further, niacin treatment was associated
with a trend toward lower risk of cardiovascular mortality (RR 0.91; 95%
CI 0.81-1.02), coronary death (RR 0.93; 95% CI 0.78-1.10), nonfatal
myocardial infarction (RR 0.85; 95% CI 0.73-1.0), revascularization
(coronary and noncoronary) (RR 0.83; 95% CI 0.65-1.06), and stroke (RR
0.89; 95% CI 0.72-1.10), compared with control. Conclusion Niacin therapy
does not lead to significant reductions in total or cause-specific
mortality or recurrent cardiovascular events among persons with or at risk
of atherosclerotic cardiovascular disease.<br/>Copyright © 2016
Elsevier Inc.
<30>
Accession Number
615887375
Author
Tarasov R.S.; Ganyukov V.I.; Barbarash O.L.; Barbarash L.S.
Institution
(Tarasov, Ganyukov, Barbarash, Barbarash) State Research Institute for
Complex Issue of Cardiovascular Diseases, Kemerovo, Russian Federation
Title
Two preventive multivessel stenting strategy with zotarolimus eluting
stents in STelevation myocardial infarction patients: 12-month results of
randomized trial.
Source
Interventional Cardiology. 9 (2) (pp 57-63), 2017. Date of Publication:
2017.
Publisher
Pulsus Group Inc. (E-mail: info@futuremedicine.com)
Abstract
Background: Preventive multivessel percutaneous coronary interventions
(PCI) (in primary and staged revascularization) with second generation
drug eluting stents (DES) in patients with STelevation myocardial
infarction (STEMI) is unresolved and controversial issue of contemporary
interventional cardiology. Twelve-month results of our randomized trial
(NCT01781715) presented. Methods and findings: One-year outcomes of 136
consecutive patients with STEMI and multivessel coronary artery disease
(MVCAD) (SYNTAX Score 18.9+/-7.7 points) undergoing primary PCI with
zotarolimus-eluting stents (Resolute IntegrityTM Stent, Medtronic) were
evaluated. The patients were randomized into two groups of preventive
multivessel stenting: Multivessel primary stenting (MPS primary, n=67)
(the infarct-related artery (IRA) and non-IRA stenting during one PCI) and
multivessel stenting in staged revascularisation (MSS, n=69) (the IRA only
stenting during the primary PCI and non-IRA stenting during the same
hospital period (10.1+/-5.1 days between PCIs). Over the 12-month
observation there were no differences in adverse cardiovascular events
among MPS and MSS group. Fatality outcomes in both groups were not
exceeded 3%. No MI and re-PCI survival was 62 (92.5%) patients in MPS
group and 67 (97.1%) in MSS group p>0.05). In general study population
(n=136) MACE, re-MI, death and stent thrombosis obtained in 5.1%, 5.1%,
2.9% and 4.4% of patients, respectively. Conclusions: The use of similar
latest generation DES and preventive approach (MPS and MSS with 10.1+/-5.1
days between procedures) used in index hospitalization period made it
possible to obtain satisfactory results of revascularization compared to
most similar randomized trials.<br/>Copyright © 2017 Interv. Cardiol.
<31>
Accession Number
611513209
Author
Zhao N.; Xu J.; Singh B.; Yu X.; Wu T.; Huang Y.
Institution
(Zhao) Beijing Obstetrics and Gynecology Hospital, Capital Medical
University, Department of Anesthesiology, Beijing, China
(Zhao, Yu, Huang) Peking Union Medical College Hospital, Chinese Academy
of Medical Sciences and Peking Union Medical College, Department of
Anesthesiology, Beijing 100730, China
(Xu) Peking Union Medical College Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Emergency Department, No.1,
Shuaifuyuan, Dongcheng District, Beijing 100730, China
(Singh) University of North Dakota School of Medicine and Health Sciences,
1919 Elm Street N, Fargo, ND 58103, United States
(Wu) West China Hospital, Sichuan University, Chinese Clinical Trial
Registry, Chinese Ethics Committee of Registering Clinical Trials, No. 37,
Guo Xue Xiang, Chengdu, Sichuan 610041, China
Title
Nitrates for the prevention of cardiac morbidity and mortality in patients
undergoing non-cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2016 (8) (no pagination), 2016.
Article Number: CD010726. Date of Publication: 04 Aug 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Cardiac complications are not uncommon in patients undergoing
non-cardiac surgery, especially in patients with coronary artery disease
(CAD) or at high risk of CAD. Perioperative cardiac complications can lead
to mortality and morbidity, as well as higher costs for patient care.
Nitrates, which are among the most commonly used cardiovascular drugs,
perform the function of decreasing cardiac preload while improving cardiac
blood perfusion. Sometimes, nitrates are administered to patients
undergoing non-cardiac surgery to reduce the incidence of cardiac
complications, especially for patients with CAD. However, their effects on
patients' relevant outcomes remain controversial. Objectives: * To assess
effects of nitrates as compared with other interventions or placebo in
reducing cardiac risk (such as death caused by cardiac factors, angina
pectoris, acute myocardial infarction, acute heart failure and cardiac
arrhythmia) in patients undergoing non-cardiac surgery. * To identify the
influence of different routes and dosages of nitrates on patient outcomes.
Search methods: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL), MEDLINE, EMBASE and the Chinese BioMedical Database
until June 2014. We also searched relevant conference abstracts of
important anaesthesiology or cardiology scientific meetings, the database
of ongoing trials and Google Scholar. We reran the search in January 2016.
We added three potential new studies of interest to the list of "Studies
awaiting classification' and will incorporate them into our formal review
findings for the review update. Selection criteria: We included randomized
controlled trials (RCTs) comparing nitrates versus no treatment, placebo
or other pharmacological interventions in participants (15 years of age
and older) undergoing non-cardiac surgery under any type of anaesthesia.
Data collection and analysis: We used standard methodological procedures
as expected by Cochrane. Two review authors selected trials, extracted
data from included studies and assessed risk of bias. We resolved
differences by discussion and, when necessary, sought help and suggestions
from a third review author. We used a random-effects model for data
analysis. Main results: We included 27 randomized controlled trials (RCTs)
(8244 participants analysed). Investigators reported 12 different
comparisons of three different nitrates (nitroglycerin, isosorbide
dinitrate and nicorandil) versus no treatment, placebo or other
pharmacological interventions. All participants were older than 15 years
of age. More than half of the trials used general anaesthesia. Surgical
procedures in most trials were at low to moderate risk for perioperative
cardiac complications. Only two comparisons including three studies
reported the primary outcome - all-cause mortality up to 30 days post
operation. Researchers reported other morbidity outcomes and adverse
events in a variable and heterogeneous way, resulting in limited available
data for inclusion in the meta-analysis. We determined that the overall
methodological quality of included studies was fair to low, in accordance
with risk of bias in most domains. In summary, we found no difference in
the primary outcome - all-cause mortality up to 30 days post operation -
when nitroglycerin was compared with no treatment (one study, 60
participants, 0/30 vs 1/30; (risk ratio (RR) 0.33, 95% confidence interval
(CI) 0.01 to 7.87, very low-quality evidence based on GRADE criteria) or
with placebo (two studies, 89 participants, 1/45 vs 0/44; RR 2.81, 95% CI
0.12 to 63.83, very low-quality evidence). Regarding our secondary
outcomes, we noted no statistically significant differences in angina
pectoris, acute myocardial infarction, acute heart failure, cardiac
arrhythmia or cardiac arrest in any comparisons. In comparisons versus
nitroglycerin, although more events of cardiac ischaemia were observed in
participants receiving no treatment or placebo, we found no statistically
significant differences in any comparisons, except the comparison of
nicorandil versus placebo. One study revealed a potential dose-dependent
protective effect of nicorandil for cardiac ischaemia. Adverse events were
reported in a heterogeneous way among the comparisons. In general, more
participants treated with nitrates had hypotension, tachycardia and
headache, but investigators reported no statistically significant
differences between groups in any comparisons. Authors' conclusions: This
systematic review suggests that nitroglycerin or isosorbide dinitrate is
not associated with improvement in mortality and cardiac complications
among patients undergoing non-cardiac surgery. Limited evidence suggests
that nicorandil may reduce the risk of cardiac ischaemia in participants
undergoing non-cardiac surgery. Additional studies are needed to
consolidate the evidence. However, the data included in many of the
analyses in this review are sparse - that is, adequate data are few -
resulting in very low power to detect differences between nitrates and
comparators. Thus, a more objective conclusion would state that available
evidence is insufficient to show whether nitrates are associated with
improvement in mortality and cardiac complications among patients
undergoing non-cardiac surgery. Over the past decade, no high-quality
studies have focused on association of cardiac mortality and morbidity
with use of nitrates during non-cardiac surgery. This review underlines
the need for well-designed trials in this field.<br/>Copyright © 2016
The Cochrane Collaboration.
<32>
Accession Number
608161724
Author
Meng M.; Gao B.; Wang X.; Bai Z.-G.; Sa R.-N.; Ge B.
Institution
(Meng, Gao, Wang, Sa, Ge) Gansu Provincial Hospital, Department of
Pharmacy, Donggang West Road No. 204, Lanzhou, Gansu 730000, China
(Bai) Lanzhou University, Evidence-Based Medicine Center, Lanzhou, Gansu
730000, China
Title
Long-term clinical outcomes of everolimus-eluting stent versus
paclitaxel-eluting stent in patients undergoing percutaneous coronary
interventions: A meta-analysis.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 34. Date of Publication: February 09, 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Everolimus -eluting stent (EES) is common used in patients
undergoing percutaneous coronary interventions (PCI). Our purpose is to
evaluate long-term clinical outcomes of everolimus -eluting stent (EES)
versus paclitaxel-eluting stent (PES) in patients undergoing percutaneous
coronaryinterventions (PCI) in randomized controlled trials (RCTs).
Methods: We searched Medline, EMBASE, Cochrane Library, CNKI, VIP and
relevant websites (https://scholar-google-com.ezproxy.lib.usf.edu/ ) for
articles to compare outcomes between everolimus-eluting stent and
paclitaxel-eluting stent without language or date restriction. RCTs that
compared the use of everolimus -eluting stent and paclitaxel-eluting stent
in PCI were included. Variables relating to patient, study
characteristics, and clinical endpoints were extracted. Meta-analysis was
performed using RevMan 5.2 software. Results: We identified 6 published
studies (from three randomized trials) more on everolimus-eluting stent
(n=3352) than paclitaxel-eluting (n=1639), with follow-up duration ranging
from 3, 4 and 5years. Three-year outcomes of everolimus-eluting stent
compared to paclitaxel-eluting were as following: the everolimus-eluting
stent significantly reduced all-cause death (relative risk [RR]:0.63; 95%
confidence interval [CI]: 0.46. to 0.82), MACE (RR: 0.56; 95% CI: 0.41 to
0.77), MI (RR: 0.64; 95% CI: 0.48 to 0.86), TLR (RR: 0.72; 95% CI: 0.59 to
0.88), ID-TLR (RR: 0.74; 95% CI: 0.59 to 0.92) and ST (RR: 0.54; 95% CI:
0.32 to 0.90). There was no difference in TVR between the
everolimus-eluting and paclitaxel-eluting (RR: 0.76; 95% CI: 0.58 to
1.10); Four-year outcomes of everolimus-eluting compared to
paclitaxel-eluting: the everolimus-eluting significantly reduced MACE (RR:
0.44; 95% CI: 0.18 to 0.98) and ID-TLR (RR: 0.47; 95% CI: 0.23 to 0.97).
There was no difference in MI (RR: 0.48; 95% CI: 0.16 to 1.46), TLR (RR:
0.46; 95% CI: 0.20 to1.04) and ST ((RR: 0.34; 95% CI: 0.05 to 2.39).
Five-year outcomes of everolimus-eluting stent compared to
paclitaxel-eluting: There was no difference in ID-TLR (RR: 0.67; 95% CI:
0.45 to 1.02) and ST (RR: 0.71; 95% CI: 0.28 to1.80). Conclusions: In the
present meta-analysis, everolimus-eluting appeared to be safe and
clinically effective in patients undergoing PCI in comparison to PES in
3-year clinical outcomes; there was similar no difference in reduction of
ST between EES and PES in long-term(>4years) clinical follow-ups.
Everolimus-eluting is more safety than paclitaxel-eluting in long-term
clinical follow-ups, whether these effects can be applied to different
patient subgroups warrants further investigation.<br/>Copyright ©
2016 Meng et al.
<33>
[Use Link to view the full text]
Accession Number
608826633
Author
Han Y.; Xu B.; Xu K.; Guan C.; Jing Q.; Zheng Q.; Wang H.; Zhao X.; Li X.;
Yu P.; Zang H.; Wang Z.; Cao X.; Zhang J.; Pang W.; Li J.; Yang Y.; Dangas
G.D.
Institution
(Han, Xu, Jing, Li) Department of Cardiology, General Hospital of Shenyang
Military Region, 83, Wenhua Rd Shenhe District, Shenyang 110016, China
(Xu, Guan) Catheterization Laboratory, Fu Wai Hospital, National Center
for Cardiovascular Diseases, Beijing, China
(Yang) Department of Cardiology, Fu Wai Hospital, National Center for
Cardiovascular Diseases, Beijing, China
(Zheng) Department of Cardiology, Affiliated Tangdu Hospital, Fourth
Military Medical University, Xi'an, China
(Li) Department of Cardiology, Fourth Affiliated Hospital, Haerbin Medical
University, Haerbin, China
(Zhao) Department of Cardiology, Affiliated Changhai Hospital, Second
Military Medical University, Shanghai, China
(Wang) Department of Cardiology, Affiliated Xijing Hospital, Fourth
Military Medical University, Xi'an, China
(Zhao) Department of Cardiology, Jilin University First Hospital,
Changchun, China
(Li) Department of Cardiology, General Hospital of Jinan Military Region,
Jinan, China
(Yu) Department of Cardiology, Pingdu People's Hospital, Pingdu, China
(Zang) Department of Cardiology, NO. 463 Hospital of PLA, Shenyang, China
(Wang) Department of Cardiology, Xinxiang Central Hospital, Xinxiang,
China
(Cao) Department of Cardiology, NO. 252 Hospital of PLA, Baoding, China
(Zhang) Department of Cardiology, Cangzhou Central Hospital, Cangzhou,
China
(Pang) Department of Cardiology, Shengjing Hospital, Shenyang, China
(Dangas) Zena and Michael A. Wiener Cardiovascular Institute,
Interventional Cardiovascular Research and Clinical Trials Center, Mount
Sinai Medical Center, New York, United States
Title
Six versus 12 months of dual antiplatelet therapy after implantation of
biodegradable polymer sirolimus-eluting stent: Randomized substudy of the
I-LOVE-IT 2 trial.
Source
Circulation: Cardiovascular Interventions. 9 (2) (no pagination), 2016.
Article Number: e003145. Date of Publication: 01 Feb 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - There are no reports on a large-scale randomized trial
exploring optimal dual antiplatelet therapy (DAPT) duration after
biodegradable polymer sirolimus-eluting stent implantation. We sought to
report the outcomes of a randomized substudy of the prospective Evaluate
Safety and Effectiveness of the Tivoli DES and the Firebird DES for
Treatment of Coronary Revascularization (I-LOVE-IT 2) trial. Methods and
Results - In the prospective noninferiority randomized I-LOVE-IT 2 trial,
1829 patients allocated to the biodegradable polymer sirolimus-eluting
stent group were also randomized to receive either 6-month (n=909) or
12-month DAPT (n=920). The primary end points of this noninferiority
substudy were 12-month target lesion failure (composite of cardiac death,
target vessel myocardial infarction or clinically indicated target lesion
revascularization), and the major secondary end points were 12-month net
adverse clinical and cerebral events (composite of all-cause death, all
myocardial infarction, stroke, or major bleeding [Bleeding Academic
Research Consortium type >3]). The 12-month target lesion failure in
6-month DAPT group was comparable with the 12-month DAPT group (6.8%
versus 5.9%; difference and 95% confidence interval, 0.87% [-1.37% to
3.11%], P for noninferiority=0.0065). Further follow-up at 18 months
showed that incidence of target lesion failure and net adverse clinical
and cerebral events were similar between the 2 groups (7.5% versus 6.3%,
log-rank P=0.32; 7.8% versus 7.3%, log-rank P=0.60; respectively), as well
as their individual end point components. Conclusions - This study
indicated noninferiority in safety and efficacy of 6-month versus 12-month
DAPT after implantation of a novel biodegradable polymer sirolimus-eluting
stent.<br/>Copyright © 2016 American Heart Association, Inc.
<34>
Accession Number
609632624
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 (E-mail: plos@plos.org)
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.<br/>Copyright © 2016 Geng et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.
<35>
Accession Number
608113001
Author
Chatterjee S.; Tripathi B.; Virk H.U.H.; Ahmed M.; Bavishi C.;
Krishnamoorthy P.; Sardar P.; Giri J.; Omidvari K.; Chikwe J.
Institution
(Chatterjee, Tripathi, Virk, Ahmed, Bavishi, Omidvari, Chikwe)
Cardiovascular Diseases, Division of Cardiology, Mount Sinai St. Luke's
Roosevelt Hospitals, 1111 Amsterdam Avenue, Clark building 3rd floor, New
York, NY 10025, United States
(Krishnamoorthy) Division of Cardiology, Albert Einstein Medical Center,
Philadelphia, PA, United States
(Sardar) Division of Cardiology, University of Utah, Salt Lake City, UT,
United States
(Giri) Division of Cardiology, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA, United States
(Omidvari, Chikwe) Department of Cardiothoracic Surgery, Icahn School of
Medicine, Mount Sinai St. Luke's Roosevelt Hospital, New York, NY, United
States
Title
Does Surgical Repair of Moderate Ischemic Mitral Regurgitation Improve
Survival? A Systematic Review.
Source
Current Cardiology Reports. 18 (3) (pp 1-7), 2016. Article Number: 22.
Date of Publication: 01 Mar 2016.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Mitral regurgitation (MR) is one of the common complications in myocardial
infarction (MI) patients. Almost half of the post MI patients have MR
(ischemic MR)<sup>17</sup> which is moderate to severe (grade II-IV).
Whether there is a mortality benefit of performing mitral valve repair
(MVR) along with coronary artery bypass grafting (CABG) in patients with
post MI moderate MR remains inconclusive. Literature search was done from
PubMed, Google scholar, Ovid, and Medline databases. Studies which
included post MI patients with moderate ischemic MR and reported mortality
outcomes of performing CABG and MVR were chosen for the systematic review.
Our preliminary literature search identified 194 studies, of which 11
studies met our inclusion criteria. Nine studies showed no survival
benefit of performing simultaneous MVR and CABG. One study demonstrated
survival benefit of performing CABG plus MVR only in the New York Heart
Association (NYHA) class III-IV, and one study suggested survival benefit
of performing CABG plus MVR as compared to CABG alone in patient with
ischemic MR irrespective of preoperative NYHA functional class. Review of
current literature showed mixed results in terms of improvement in
functional status but failed to show any survival benefit of performing
MVR along with CABG. Limitations of studies include small sample size,
difference in baseline demographic variables, and short follow-up period
which might influence the outcome of the study. Prospective randomized
studies are required to establish clear benefit of performing MVR
simultaneously with CABG.<br/>Copyright © 2016, Springer
Science+Business Media New York.
<36>
Accession Number
608430351
Author
Yamamoto S.; Yamaga T.; Sakai Y.; Ishida T.; Nakasone S.; Ohira M.; Ota
E.; Mori R.
Institution
(Yamamoto, Yamaga, Sakai, Ishida, Nakasone) Shinshu University Hospital,
Department of Rehabilitation, 3-1-1 Asahi, Matsumoto-shi, Nagano 390-8621,
Japan
(Yamamoto, Ota, Mori) National Center for Child Health and Development,
Department of Health Policy, Tokyo, Japan
(Ohira) Shinshu University, Department of Physical Therapy, School of
Health Sciences, Nagano, Japan
Title
Association between physical performance and cardiovascular events in
patients with coronary artery disease: Protocol for a meta-analysis.
Source
Systematic Reviews. 5 (1) (no pagination), 2016. Article Number: 32. Date
of Publication: 18 Feb 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Physical performance such as muscle strength or walking speed
of patients with coronary artery disease (CAD) is lower than that of
people who do not have CAD and is related to mortality and re-admission
rates. Recent studies have shown that skeletal muscle strength, such as
grip strength, was closely associated with cardiac events. Physical
performance testing is quick, safe, and inexpensive and provides a
reliable assessment tool for routine clinical practice. The aim of this
meta-analysis is to clarify the association between physical performance
testing and the risk of cardiovascular events and mortality.
Methods/design: This meta-analysis will include male and female
participants of any age in community settings who have a history of the
following conditions or procedures: myocardial infarction, or coronary
revascularization (coronary artery bypass grafting, percutaneous
transluminal coronary angioplasty, or coronary artery stent), angina
pectoris, heart failure, heart transplant, or coronary artery disease
defined by angiography. We will search EMBASE and MEDLINE, PubMed, and the
Cochrane Library with no limitations on date, language, document type, or
publication status. Identified studies will be prospective and
retrospective cohort studies. Physical performance will be defined as
upper extremity strength, lower extremity strength, walking speed, or
other performance scale. Six review authors will independently extract
study characteristics from included studies. Participants will be divided
into subgroups according to age (middle-aged <65 years and elderly >65
years), diagnosis (coronary artery disease and heart failure) and
follow-up time (up to 12 months and over 12 months). We will pool hazard
ratios of Cox proportional hazard models after logarithmic transformation
and perform the meta-analysis by using inverse-variance method.
Discussion: To our knowledge, this meta-analysis will be the first report
to assess the association between physical performance and cardiovascular
events in CAD patients. We hope that these findings may help to estimate
the prognosis for CAD patients in clinical practice. Systematic review
registration: PROSPERO CRD42015020886.<br/>Copyright © 2016 Yamamoto
et al.
<37>
Accession Number
610489129
Author
Dyakova M.; Shantikumar S.; Colquitt J.L.; Drew C.M.; Sime M.; Maciver J.;
Wright N.; Clarke A.; Rees K.
Institution
(Dyakova, Shantikumar, Drew, Sime, Maciver, Clarke, Rees) Warwick Medical
School, University of Warwick, Division of Health Sciences, Gibbet Hill
Campus, Coventry, Warwickshire CV4 7AL, United Kingdom
(Colquitt) Effective Evidence LLP, 7 Bournemouth Road, Chandlers Ford,
Eastleigh, Hampshire SO53 3DA, United Kingdom
(Wright) NHS Warwickshire, Public Health Department, Warwick, United
Kingdom
Title
Systematic versus opportunistic risk assessment for the primary prevention
of cardiovascular disease.
Source
Cochrane Database of Systematic Reviews. 2016 (2) (no pagination), 2016.
Article Number: CD010411. Date of Publication: 29 Jan 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Screening programmes can potentially identify people at high
cardiovascular risk and reduce cardiovascular disease (CVD) morbidity and
mortality. However, there is currently not enough evidence showing clear
clinical or economic benefits of systematic screening-like programmes over
the widely practised opportunistic risk assessment of CVD in primary care
settings. Objectives: The primary objective of this review was to assess
the effectiveness, costs and adverse effects of systematic risk assessment
compared to opportunistic risk assessment for the primary prevention of
CVD. Search methods: We searched the Cochrane Central Register of
Controlled Trials (CENTRAL) on the Cochrane Library, MEDLINE, EMBASE on 30
January 2015, and Web of Science Core Collection and additional databases
on the Cochrane Library on 4 December 2014. We also searched two clinical
trial registers and checked reference lists of relevant articles. We
applied no language restrictions. Selection criteria: We selected
randomised controlled trials (RCTs) that assessed the effects of
systematic risk assessment, defined as a screening-like programme
involving a predetermined selection process of people, compared with
opportunistic risk assessment which ranged from no risk assessment at all
to incentivised case finding of CVD and related risk factors. Participants
included healthy adults from the general population, including those who
are at risk of CVD. Data collection and analysis: Two review authors
independently selected studies. One review author extracted data and
assessed them for risk of bias and a second checked them. We assessed
evidence quality using the GRADE approach and present this in a 'Summary
of findings' table. Main results: Nine completed RCTs met the inclusion
criteria, of which four were cluster-randomised. We also identified five
ongoing trials. The included studies had a high or unclear risk of bias,
and the GRADE ratings of overall quality were low or very low. The length
of follow-up varied from one year in four studies, three years in one
study, five or six years in two studies, and ten years in two studies.
Eight studies recruited participants from the general population, although
there were differences in the age ranges targeted. One study recruited
family members of cardiac patients (high risk assessment). There were
considerable differences between the studies in the interventions received
by the intervention and control groups. There was insufficient evidence to
stratify by the types of risk assessment approaches. Limited data were
available on all-cause mortality (risk ratio (RR) 0.97, 95% confidence
interval (CI) 0.92 to 1.02; 3 studies,103,571 participants, I2 = 0%;
low-quality evidence) and cardiovascular mortality (RR 1.00, 95% CI 0.90
to 1.11; 2 studies, 43,955 participants, I2 = 0%), and suggest that
screening has no effect on these outcomes. Data were also limited for
combined non-fatal endpoints; overall, evidence indicates no difference in
total coronary heart disease (RR 1.01, 95% CI 0.95 to 1.07; 4 studies, 5
comparisons, 110,168 participants, I2 = 0%; low-quality evidence),
non-fatal coronary heart disease (RR 0.98, 95% CI 0.89 to 1.09; 2 studies,
43,955 participants, I2 = 39%), total stroke (RR 0.99, 95% CI 0.90 to
1.10; 2 studies, 79,631 participants, I2 = 0%, low-quality evidence), and
non-fatal stroke (RR 1.17, 95% CI 0.94 to 1.47; 1 study, 20,015
participants). Overall, systematic risk assessment appears to result in
lower total cholesterol levels (mean difference (MD) -0.11 mmol/l, 95% CI
-0.17 to -0.04, 6 studies, 7 comparisons, 12,591 participants, I2 = 57%;
very low-quality evidence), lower systolic blood pressure (MD -3.05 mmHg,
95% CI -4.84 to -1.25, 6 studies, 7 comparisons, 12,591 participants, I2 =
82%; very low-quality evidence) and lower diastolic blood pressure (MD
-1.34 mmHg, 95% CI -1.76 to -0.93, 6 studies, 7 comparisons, 12,591
participants, I2 = 0%; low-quality evidence). One study assessed adverse
effects and found no difference in psychological distress at five years
(1126 participants). Authors' conclusions: The results are limited by the
heterogeneity between trials in terms of participants recruited,
interventions and duration of follow-up. Limited data suggest that
systematic risk assessment for CVD has no statistically significant
effects on clinical endpoints. There is limited evidence to suggest that
CVD systematic risk assessment may have some favourable effects on
cardiovascular risk factors. The completion of the five ongoing trials
will add to the evidence base.<br/>Copyright © 2016 The Cochrane
Collaboration.
<38>
Accession Number
608996436
Author
Lee T.W.R.; Kowalski S.; Falk K.; Maguire D.; Freed D.H.; HayGlass K.T.
Institution
(Lee, Kowalski, Maguire) Department of Anesthesia and Perioperative
Medicine, St. Boniface Hospital, University of Manitoba, Winnipeg, MB,
Canada
(Falk, HayGlass) Department of Immunology, University of Manitoba,
Winnipeg, MB, Canada
(Freed) Section of Cardiac Surgery, Department of Surgery, University of
Manitoba, Winnipeg, MB, Canada
(Freed) Division of Cardiac Surgery, University of Alberta, Edmonton,
Canada
Title
High spinal anesthesia enhances anti-inflammatory responses in patients
undergoing coronary artery bypass graft surgery and aortic valve
replacement: Randomized pilot study.
Source
PLoS ONE. 11 (3) (no pagination), 2016. Article Number: e0149942. Date of
Publication: 01 Mar 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Cardiac surgery induces many physiologic changes including
major inflammatory and sympathetic nervous system responses. Here, we
conducted a single-centre pilot study to generate hypotheses on the
potential immune impact of adding high spinal anaesthesia to general
anaesthesia during cardiac surgery in adults. We hypothesized that this
strategy, previously shown to blunt the sympathetic response and improve
pain management, could reduce the undesirable systemic inflammatory
responses caused by cardiac surgery. Methods This prospective randomized
unblinded pilot study was conducted on 14 patients undergoing cardiac
surgery for coronary artery bypass grafting and/or aortic valve
replacement secondary to severe aortic stenosis. The primary outcome
measures examined longitudinally were serum pro-inflammatory (IL-6, IL-1b,
CCL2), anti-inflammatory (IL-10, TNF-RII, IL-1Ra), acute phase protein
(CRP, PTX3) and cardiovascular risk (sST2) biomarkers. Results The
kinetics of pro- and anti-inflammatory biomarker was determined following
surgery. All pro-inflammatory and acute phase reactant biomarker responses
induced by surgical stress were indistinguishable in intensity and
duration between control groups and those who also received high spinal
anaesthesia. Conversely, IL-10 levels were markedly elevated in both
intensity and duration in the group receiving high spinal anesthesia (p =
0.005). Conclusions This hypothesis generating pilot study suggests that
high spinal anesthesia can alter the net inflammatory response that
results from cardiac surgery. In appropriately selected populations, this
may add incremental benefit by dampening the net systemic inflammatory
response during the week following surgery. Larger population studies,
powered to assess immune, physiologic and clinical outcomes in both acute
and longer term settings, will be required to better assess potential
benefits of incorporating high spinal anesthesia.<br/>Copyright ©
2016 Lee et al. This is an open access article distributed under the terms
of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original
author and source are credited.
<39>
[Use Link to view the full text]
Accession Number
609422819
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 (E-mail: kathiest.clai@apta.org)
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.<br/>Copyright © 2016 Wolters Kluwer Health, Inc. All rights
reserved.
<40>
Accession Number
607945497
Author
Fischer A.; Spiegl M.; Altmann K.; Winkler A.; Salamon A.; Themessl-Huber
M.; Mouhieddine M.; Strasser E.M.; Schiferer A.; Paternostro-Sluga T.;
Hiesmayr M.
Institution
(Fischer, Mouhieddine, Schiferer, Hiesmayr) Medical University of Vienna,
Division of Cardiothoracic and Vascular Anesthesia and Intensive Care
Medicine, Department of Anesthesia, General Intensive Care and Pain
Control, Wahringergurtel 18-20, Vienna 1090, Austria
(Spiegl) Kantonsspital Sankt Gallen, Rorschacherstrasse 95, St. Gallen
9007, Switzerland
(Altmann) Krankenhaus der Barmherzigen Schwestern Ried, Schlossberg 1,
Ried im Innkreis 4910, Austria
(Winkler) University Hospital Landeskrankenhaus Salzburg, Mullner
Hauptstrase 48, Salzburg 5020, Austria
(Salamon) Medical University of Vienna, Spitalgasse 23, Vienna 1090,
Austria
(Themessl-Huber) Medical University of Vienna, Center for Medical
Statistics, Informatics and Intelligent Systems, Spitalgasse 23, Vienna
1090, Austria
(Strasser) Kaiser-Franz-Josef-Spital Wien, Institute for Physical Medicine
and Rehabilitation, Kundratstrasse 3, Vienna 1100, Austria
(Paternostro-Sluga) Institute for Physical Medicine and Rehabilitation,
Donauspital Wien, Langobardenstrase 122, Vienna 1220, Austria
Title
Muscle mass, strength and functional outcomes in critically ill patients
after cardiothoracic surgery: Does neuromuscular electrical stimulation
help? The Catastim 2 randomized controlled trial.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 30. Date of
Publication: January 29, 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The effects of neuromuscular electrical stimulation (NMES) in
critically ill patients after cardiothoracic surgery are unknown. The
objectives were to investigate whether NMES prevents loss of muscle layer
thickness (MLT) and strength and to observe the time variation of MLT and
strength from preoperative day to hospital discharge. Methods: In this
randomized controlled trial, 54 critically ill patients were randomized
into four strata based on the SAPS II score. Patients were blinded to the
intervention. In the intervention group, quadriceps muscles were
electrically stimulated bilaterally from the first postoperative day until
ICU discharge for a maximum of 14 days. In the control group, the
electrodes were applied, but no electricity was delivered. The primary
outcomes were MLT measured by ultrasonography and muscle strength
evaluated with the Medical Research Council (MRC) scale. The secondary
functional outcomes were average mobility level, FIM score, Timed Up and
Go Test and SF-12 health survey. Additional variables of interest were
grip strength and the relation between fluid balance and MLT. Linear mixed
models were used to assess the effect of NMES on MLT, MRC score and grip
strength. Results: NMES had no significant effect on MLT. Patients in the
NMES group regained muscle strength 4.5 times faster than patients in the
control group. During the first three postoperative days, there was a
positive correlation between change in MLT and cumulative fluid balance
(r=0.43, P=0.01). At hospital discharge, all patients regained
preoperative levels of muscle strength, but not of MLT. Patients did not
regain their preoperative levels of average mobility (P=0.04) and FIM
score (P=0.02) at hospital discharge, independent of group allocation.
Conclusions: NMES had no effect on MLT, but was associated with a higher
rate in regaining muscle strength during the ICU stay. Regression of
intramuscular edema during the ICU stay interfered with measurement of
changes in MLT. At hospital discharge patients had regained preoperative
levels of muscle strength, but still showed residual functional disability
and decreased MLT compared to pre-ICU levels in both groups. Trial
registration: Clinicaltrials.gov identifier NCT02391103. Registered on 7
March 2015.<br/>Copyright © 2016 Fischer et al.
<41>
Accession Number
608829357
Author
Mariani J.; Macchia A.; De Abreu M.; Monte G.G.V.; Tajer C.
Institution
(Mariani, De Abreu, Monte, Tajer) Cardiology Department, Hospital El Cruce
Nestor Carlos Kirchner, Av. Calchaqui 5401 (B1888AAE), Florencio Varela,
Buenos Aires, Argentina
(Mariani, Macchia) Fundacion GESICA, Av. Rivadavia 2358 (C1034ACP), Ciudad
Autonoma de Buenos Aires, Argentina
Title
Multivessel versus single vessel angioplasty in non-ST elevation acute
coronary syndromes: A systematic review and metaanalysis.
Source
PLoS ONE. 11 (2) (no pagination), 2016. Article Number: e0148756. Date of
Publication: February 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Multivessel disease is common in acute coronary syndrome
patients. However, if multivessel percutaneous coronary intervention is
superior to culprit-vessel angioplasty has not been systematically
addressed. Methods A metaanalysis was conducted including studies that
compared multivessel angioplasty with culprit-vessel angioplasty among
non-ST elevation ACS patients. Since all studies were observational
adjusted estimates of effects were used. Pooled estimates of effects were
computed using the generic inverse of variance with a random effects
model. Results Twelve studies were included (n = 117,685). Median age was
64.1 years, most patients were male, 29.3%were diabetic and 36,9%had
previous myocardial infarction. Median follow- up was 12 months. There
were no significant differences in mortality risk (HR 0.79; 95% CI 0.58 to
1.09; I<sup>2</sup> 67.9%), with moderate inconsistency. Also, there were
no significant differences in the risk of death or MI (HR 0.90; 95% CI
0.69 to 1.17; I<sup>2</sup> 62.3%), revascularization (HR 0.76; 95% CI
0.55 to 1.05; I<sup>2</sup> 49.9%) or in the combined incidence of death,
myocardial infarction or revascularization (HR 0.83; 95% CI 0.66 to 1.03;
I<sup>2</sup> 70.8%). All analyses exhibited a moderate degree of
inconsistency. Subgroup analyses by design reduced the inconsistency of
the analyses on death or myocardial infarction, revascularization and
death, myocardial infarction or revascularization. There was evidence of
publication bias (Egger's test p = 0.097). Conclusion Routine multivessel
angioplasty in non-ST elevation acute coronary syndrome patients with
multivessel disease was not superior to culprit-vessel angioplasty.
Randomized controlled trials comparing safety and effectiveness of both
strategies in this setting are needed.<br/>Copyright © 2016 Mariani
et al. This is an open access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author
and source are credited.
<42>
Accession Number
615789821
Author
Tasca G.; Martino A.S.; Giannico F.; Riva B.; Redaelli P.; Lobiati E.;
Triggiani M.; Galanti A.; Gamba A.
Institution
(Tasca, Martino, Giannico, Redaelli, Triggiani, Galanti, Gamba)
Cardiovascular Department, Operative Unit of Cardiac Surgery, Ospedale 'A.
Manzoni' di Lecc, Via Dell'Eremo 9/11, Lecco 23900, Italy
(Riva, Lobiati) Operative Unit of Cardiology, Ospedale 'A. Manzoni' di
Lecco, Lecco, Italy
Title
Hemodynamic comparison between Trifecta and Freestyle valves implanted in
small aortic roots. One-year echocardiographic results from a prospective
randomized study.
Source
Journal of Heart Valve Disease. 24 (3) (pp 360-367), 2015. Date of
Publication: May 2015.
Publisher
ICR Publishers Ltd
Abstract
Background and aim of the study: Aortic valve replacement in patients with
a small aortic root may be associated to high residual gradients. In such
patients, both stentless valves and aortic annulus enlargement can reduce
these residual gradients. Several studies have reported that Trifecta
valves yield very good hemodynamic results. The aim of the present study
was to compare the hemodynamic performance of Trifecta vs. Freestyle
valves at one year in patients with an aortic annulus <2.3 cm. Methods:
Between September 2011 and September 2013, 40 patients with a native
aortic annulus diameter <2.3 cm and average age of 81+/-4 years, were
randomized to receive either a St-Jude Trifecta stented prosthesis (20
patients) or a Medtronic Freestyle stentless prosthesis (20 patients).
Results: No differences between Trifecta and Freestyle were found at one
year in mean gradient s: 6.1+/-3 mmHg and 6.6+/-3 mmHg (p=0.796) ;
effective ori fice area: 1.82+/-0.3 mmHg and 1.76+/-0.4 mmHg (p=0.676) or
regression of left ventricular mass: - 25%+/-14 vs. -19%+/-16 (p=0.204),
respectively. Only moderate patient -pro sthesis mismatch was found, which
affected 3 patient s in each group. Conclusion: At one year both stentless
and stented prostheses yielded comparable hemodynamic results. These data
suggest that Trifecta implantation is a valid means of avoiding patient
-prosthesis mismatch in aortic valve replacement in elderly patients with
a small native aortic annulus.<br/>© 2015 Copyright by ICR
Publishers.
<43>
Accession Number
616127668
Author
Ximenes N.N.; Borges D.L.; Lima R.O.; Barbosa e Silva M.G.; Silva L.N.;
Costa Md.eA.; Baldez T.E.; Nina V.J.
Institution
(Ximenes, Borges, Lima, Barbosa e Silva, Silva, Costa, Baldez, Nina)
Hospital Universitario, Universidade Federal do Maranhao, Sao Luis, MA,
Brazil
Title
Effects of Resistance Exercise Applied Early After Coronary Artery Bypass
Grafting: a Randomized Controlled Trial.
Source
Brazilian journal of cardiovascular surgery. 30 (6) (pp 620-625), 2015.
Date of Publication: 01 Nov 2015.
Abstract
METHODS: It is a randomized controlled trial with 34 patients undergoing
coronary artery bypass grafting between August 2013 and May 2014. Patients
were randomized into two groups by simple draw: a control group (n=17),
who received conventional physical therapy and an intervention group
(n=17), who received, additionally, resistance exercise. Pulmonary
function and functional capacity were evaluated in preoperative period and
hospital discharge by spirometry and the six-minute walk test. For
statistical analysis, we used the following tests: Shapiro-Wilk,
Mann-Whitney, Student'st and Fisher's exact. Variables with P<0.05 were
considered significant.
RESULTS: Groups were homogeneous in terms of demographic, clinical and
surgical variables. Resistance exercise exerted no effect on pulmonary
function of intervention group compared to control group. However,
intervention group maintained functional capacity at hospital discharge
measured by percentage of predict distance in 6MWT (54.122.7% vs.
52.515.5%,P=0.42), while control group had a significant decrease
(59.211.1% vs. 50.69.9%, P<0.016).
CONCLUSION: Our results indicate that resistance exercise, applied early,
may promote maintenance of functional capacity on coronary artery bypass
grafting patients, having no impact on pulmonary function when compared to
conventional physical therapy.
OBJECTIVE: To evaluate the effects of resistance exercise applied early
after coronary artery bypass grafting.
<44>
Accession Number
616127636
Author
Trevisan M.D.; Lopes D.G.; Mello R.G.; Macagnan F.E.; Kessler A.
Institution
(Trevisan) Universidade Catolica do Rio Grande do Sul, Porto Alegre, RS,
Brazil
(Lopes) Instituto de Geriatria e Gerontologia, Pontificia Universidade
Catolica do Rio Grande do Sul, Porto Alegre, RS, Brazil
(Mello, Kessler) Universidade Federal do Rio Grande do Sul, Porto Alegre,
RS, Brazil
(Macagnan) Pontificia Universidade Catolica do Rio Grande do Sul, Porto
Alegre, RS, Brazil
Title
Alternative Physical Therapy Protocol Using a Cycle Ergometer During
Hospital Rehabilitation of Coronary Artery Bypass Grafting: a Clinical
Trial.
Source
Brazilian journal of cardiovascular surgery. 30 (6) (pp 615-619), 2015.
Date of Publication: 01 Nov 2015.
Abstract
OBJECTIVE: To compare the efficacy of a cycle ergometer-based exercise
program to a standard protocol on the increment of the maximum distance
walked during the six-minute walk test in the postoperative rehabilitation
of patients submitted to coronary artery bypass grafting.
METHODS: A controlled clinical trial pilot, blinded to the outcome,
enrolled subjects who underwent coronary artery bypass grafting in a
hospital from Southern Brazil. Subjects were designated for the standard
physical rehabilitation protocol or to an alternative cycle
ergometer-based protocol through simple random sampling. The primary
outcome was the difference in the maximum distance walked in the
six-minute walk test before and after the allocated intervention.
RESULTS: Twenty-four patients were included in the analysis, 10 in the
standard protocol and 14 in the alternative protocol group. There was an
increment in the maximum distance walked in both groups, and borderline
superiority in the intervention group comparing to the control group
(312.2 vs. 249.7; P=0.06).
CONCLUSION: There was an increase in the maximum distance walked in the
alternative protocol compared to the standard protocol. Thus, it is
postulated that the use of a cycle ergometer can be included in physical
rehabilitation in the hospital phase of postoperative coronary artery
bypass grafting. However, randomized studies with larger sample size
should be conducted to assess the significance of these findings.
<45>
Accession Number
616151267
Author
Roshanov P.S.; Dennis B.B.; Pasic N.; Garg A.X.; Walsh M.
Institution
(Roshanov, Garg) London Kidney Clinical Research Unit, London Health
Sciences Centre, Westminster, 800 Commissioners Road East, London, ON N6A
4G5, Canada
(Roshanov, Walsh) Department of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, ON, Canada
(Roshanov, Pasic) Schulich School of Medicine and Dentistry, Western
University, London, ON, Canada
(Dennis) St. George's University of London, London, United Kingdom
(Garg) Institute for Clinical Evaluative Sciences, London, ON, Canada
(Garg) Department of Epidemiology and Biostatistics, Schulich School of
Medicine and Dentistry, Western University, London, ON, Canada
(Walsh) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Walsh) Population Health Research Institute, Hamilton, ON, Canada
Title
When is a meta-analysis conclusive? A guide to Trial Sequential Analysis
with an example of remote ischemic preconditioning for renoprotection in
patients undergoing cardiac surgery.
Source
Nephrology Dialysis Transplantation. 32 (pp ii23-ii30), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Regardless of whether a randomized trial finds a statistically significant
effect for an intervention or not, readers often wonder if the trial was
large enough to be conclusive. To answer this question, we can estimate
the required sample size for a trial by considering how commonly the
outcome occurs, the smallest effect of clinical importance and the
acceptable risk of falsely detecting or rejecting that effect. But when is
a meta-analysis conclusive? We explain and illustrate the interpretation
of Trial Sequential Analysis (TSA), a method increasingly used to answer
this question. We conducted a conventional meta-analysis which suggested
that, in adults undergoing cardiac surgery, remote ischemic
preconditioning does not provide a statistically significant reduction in
acute kidney injury (AKI) [12 trials, 4230 patients; relative risk 0.87
(95% confidence interval 0.74-1.02); P = 0.08; I<sup>2</sup>= 35%] or the
risk of receiving acute dialysis [5 trials, 2111 patients; relative risk
1.15 (95% confidence interval 0.42-3.19); P = 0.78; I<sup>2</sup> = 59%].
TSA demonstrates that as little as a 20% relative risk reduction in AKI is
unlikely. Reliably finding effects on acute dialysis and smaller effects
on AKI would require much more evidence. Notably, conventional
meta-analyses conducted at one of the two earlier time points may have
prematurely declared a statistically significant reduction in AKI, even
though at no point in the TSA was there sufficient evidence to support
such an effect. With this and other examples, we demonstrate that the TSA
can prevent premature conclusions from meta-analyses.<br/>Copyright ©
2017 The Author 2017. Published by Oxford University Press on behalf of
ERA-EDTA. All rights reserved.
<46>
Accession Number
616161456
Author
Sharma S.P.; Dahal K.; Khatra J.; Rosenfeld A.; Lee J.
Institution
(Sharma, Khatra) University of New England, LRGHealthcare, Laconia, NH,
United States
(Dahal) Division of Cardiology, Louisiana State University Health Science
Center, Shreveport, LA, United States
(Rosenfeld) Concord Cardiac Associates, Concord, NH, United States
(Lee) Division of Interventional Cardiology, Section of Cardiology,
University of Connecticut, Farmington, CT, United States
Title
Percutaneous coronary intervention vs coronary artery bypass grafting for
left main coronary artery disease? A systematic review and meta-analysis
of randomized controlled trials.
Source
Cardiovascular Therapeutics. 35 (3) (no pagination), 2017. Article Number:
e12260. Date of Publication: June 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: It is not clear whether percutaneous coronary intervention
(PCI) is as effective and safe as coronary artery bypass grafting (CABG)
for left main coronary artery disease. We aimed to perform a systematic
review and meta-analysis of all randomized controlled trials (RCTs) that
compared PCI and CABG in left main coronary disease. Methods: We searched
PubMed, EMBASE, Cochrane, Scopus and relevant references for RCTs
(inception through, November 20, 2016 without language restrictions) and
performed meta-analysis using random-effects model. All-cause mortality,
myocardial infarction, revascularization rate, stroke, and major adverse
cardiac and cerebrovascular events (MACCE) were the measured outcomes.
Results: Six RCTs with a total population of 4700 were analyzed. There was
no difference in all-cause mortality at 30-day, one-year, and five-year
(1.8% vs 1.1%; OR 0.60; 95% CI: 0.26-1.39; P=.23; I<sup>2</sup>=9%)
follow-up between PCI and CABG. CABG group had less myocardial infarction
(MI) at five-year follow-up than PCI (5% vs 2.5%; OR 2.04; CI: 1.30-3.19;
P=.002; I<sup>2</sup>=1%). Revascularization rate favored CABG in one-year
(8.6% vs 4.5%; OR 2; CI: 1.46-2.73; P<.0001; I<sup>2</sup>=45%) and
five-year (15.9% vs 9.9%; OR 1.73; CI: 1.36-2.20; P<.0001;
I<sup>2</sup>=0%) follow-up. Although stroke rate was lower in PCI group
at 1 year, there was no difference in longer follow-up. MACCE at 5 years
favored CABG (24% vs 18%; OR 1.45; CI: 1.19-1.76; P=.0001;
I<sup>2</sup>=0%). On subgroup analysis, MACCE were not different between
two groups in low-to-intermediate SYNTAX group while it was higher for PCI
group with high SYNTAX group. Conclusion: Percutaneous coronary
intervention could be as safe and effective as CABG in a select group of
left main coronary artery disease patients.<br/>Copyright © 2017 John
Wiley & Sons Ltd
<47>
Accession Number
616108932
Author
Wakeam E.; Acuna S.A.; Leighl N.B.; Giuliani M.E.; Finlayson S.R.G.;
Varghese T.K.; Darling G.E.
Institution
(Wakeam) Division of General Surgery, Department of Surgery, University of
Toronto, Toronto, Canada
(Wakeam, Darling) Division of Thoracic Surgery, Department of Surgery,
University of Toronto, Toronto, Canada
(Acuna) Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, Canada
(Leighl) Division of Medical Oncology, Department of Medicine, University
of Toronto, Toronto, Canada
(Giuliani) Department of Radiation Oncology, University of Toronto,
Toronto, Canada
(Finlayson, Varghese) Department of Surgery, University of Utah, Salt Lake
City, Utah, United States
(Varghese) Division of Thoracic Surgery, Department of Surgery, University
of Utah, Salt Lake City, Utah, United States
Title
Surgery Versus Chemotherapy and Radiotherapy For Early and Locally
Advanced Small Cell Lung Cancer: A Propensity-Matched Analysis of
Survival.
Source
Lung Cancer. 109 (pp 78-88), 2017. Date of Publication: 01 Jul 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The role of surgery in small cell lung cancer (SCLC) is
controversial. Survival outcomes for resection of stage I-IIIA SCLC
compared to chemotherapy-based non-surgical treatment (NST) were examined
using propensity matching. Methods 29,994 clinical stage I-IIIA SCLC
patients, including 2,619 undergoing surgery, were identified in the
National Cancer Database. Stage-specific propensity scores for receipt of
surgery were created. Resected patients were matched 1:1 to those
undergoing NST. Overall survival (OS) was assessed using Kaplan-Meier and
multivariable Cox models. A separate match was performed comparing Stage
I/II patients aged <85 with a Charlson score of 0 who underwent lobectomy
with adjuvant chemotherapy (and radiotherapy if node positive) to those
treated with multiagent chemotherapy and concurrent chest radiotherapy
(CRT) of at least 40 gray. Results 2,089 patients were matched, and
cohorts were well balanced. Surgery was associated with longer survival
for Stage I (median OS 38.6 months vs. 22.9 months, HR 0.62 95%CI
0.57-0.69, p < 0.0001), but survival differences were attenuated for Stage
II (median OS 23.4 months vs. 20.7 months, HR 0.84 95%CI 0.70-1.01, p =
0.06) and IIIA (median OS 21.7 vs. 16.0 months, HR 0.71 95%CI 0.60-0.83, p
< 0.0001). In analyses by T and N stage, longer OS was observed in
resected patients with stage T3/T4 N0 (median OS 33.0 vs. 16.8 months, p =
0.008) and node positivity(N1+ 24.4 vs. 18.3 months p = 0.03; N2+ 20.1 vs.
14.6 months p = 0.007). In the subgroup analysis, 507 stage I/II patients
receiving lobectomy and adjuvant chemotherapy were matched to patients
receiving concurrent CRT. In this cohort, lobectomy with adjuvant
chemotherapy was associated with significantly longer survival (median OS
48.6 vs. 28.7 months, p<0.0001). Conclusions Surgical resection is
associated with significantly longer survival for early SCLC. New
randomized trials should assess trimodality therapy in stages I/II, and in
node negative disease.<br/>Copyright © 2017 Elsevier B.V.
<48>
Accession Number
616158852
Author
Spaccarotella C.; Mongiardo A.; De Rosa S.; Indolfi C.
Institution
(Spaccarotella, Mongiardo, De Rosa, Indolfi) Department of Medical and
Surgical Sciences, Magna Graecia University, Catanzaro, Italy
(Indolfi) URT of IFC of the CNR, Magna Graecia University, Catanzaro,
Italy
Title
Transcatheter aortic valve implantation in patients at intermediate
surgical risk.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: February 09, 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Transcatheter Aortic Valve Implantation (TAVI) has revolutionized the
treatment of elderly patients with symptomatic severe aortic stenosis
(AS).Initially tested in unoperable or high surgical risk patients, the
safety and efficacy of TAVI has progressively improved, with increasing
operators' experience and continuous technical refinements of the devices
and of the delivery systems. Hence, the extension of clinical indications
for TAVI to the intermediate-risk population has been attracting
cardiologists in recent years. This idea was supported by the results of
recent studies suggesting that transfemoral TAVI might be associated with
a survival benefit in both high- and intermediate-risk patients with
severe AS.Therefore, the aim of this review is to summarize the currently
available evidence from multiple observational studies, substudies from
large country registries, mached group comparisons, a substudy of
randomized studies, and randomized trials, as well as in recent
meta-analyses on the use of TAVI in patient at intermediate-risk for
surgery.<br/>Copyright © 2017 Elsevier B.V.
<49>
Accession Number
608139604
Author
Won H.; Her A.-Y.; Kim B.-K.; Kim Y.H.; Shin D.-H.; Kim J.-S.; Ko Y.-G.;
Choi D.; Kwon H.M.; Jang Y.; Hong M.-K.
Institution
(Won) Cardiovascular and Arrhythmia Center, College of Medicine, Chung-Ang
University, Seoul, South Korea
(Her, Kim) Department of Medicine, School of Medicine, Kangwon National
University, Chuncheon, South Korea
(Kim, Shin, Kim, Ko, Choi, Jang, Hong) Division of Cardiology, Severance
Cardiovascular Hospital, Yonsei University Health System, Seoul, South
Korea
(Kim, Shin, Kim, Ko, Choi, Jang, Hong) Cardiovascular Research Institute,
Yonsei University College of Medicine, Seoul, South Korea
(Kwon) Division of Cardiology, Gangnam Severance Hospital, Yonsei
University College of Medicine, Seoul, South Korea
(Jang, Hong) Severance Biomedical Science Institute, Yonsei University
College of Medicine, Seoul, South Korea
Title
Percutaneous coronary intervention is more beneficial than optimal medical
therapy in elderly patients with angina pectoris.
Source
Yonsei Medical Journal. 57 (2) (pp 382-387), 2016. Date of Publication:
March 2016.
Publisher
Yonsei University College of Medicine
Abstract
Purpose: Data comparing the clinical benefits of medical treatment with
those of percutaneous coronary intervention (PCI) in an elderly population
with angina pectoris are limited. Therefore, we evaluated the efficacy of
elective PCI versus optimal medical treatment (OMT) in elderly patients
(between 75 and 84 years old) with angina pectoris. Materials and Methods:
One hundred seventy-seven patients with significant coronary artery
stenosis were randomly assigned to either the PCI group (n=90) or the OMT
group (n=87). The primary outcome was a composite of major adverse events
in the 1-year follow-up period that included cardiovascular death,
non-fatal myocardial infarction, coronary revascularization, and stroke.
Results: Major adverse events occurred in 5 patients (5.6%) of the PCI
group and in 17 patents (19.5%) of the OMT group (p=0.015). There were no
significant differences between the PCI group and the OMT group in cardiac
death [hazard ratio (HR) for the PCI group 0.454; 95% confidence interval
(CI) 0.041-5.019,p=0.520], myocardial infarction (HR 0.399; 95% CI
0.039-4.050, p=0.437), or stroke (HR 0.919; 95% CI 0.057-14.709, p=0.952).
However, the PCI group showed a significant preventive effect of the
composite of major adverse events (HR 0.288; 95% CI 0.106-0.785, p=0.015)
and against the need for coronary revascularization (HR 0.157; 95% CI
0.035-0.703, p=0.016). Conclusion: Elective PCI reduced major adverse
events and was found to be an effective treatment modality in elderly
patients with angina pectoris and significant coronary artery stenosis,
compared to OMT.<br/>Copyright © Yonsei University College of
Medicine 2016.
<50>
Accession Number
613271791
Author
Su X.; Meng Z.-T.; Wu X.-H.; Cui F.; Li H.-L.; Wang D.-X.; Zhu X.; Zhu
S.-N.; Maze M.; Ma D.
Institution
(Su, Meng, Wu, Cui, Wang) Department of Anaesthesiology and Critical Care
Medicine, Peking University First Hospital, Beijing, China
(Zhu) Department of Biostatistics, Peking University First Hospital,
Beijing, China
(Li, Zhu) Department of Critical Care Medicine, Peking University Third
Hospital, Beijing, China
(Maze) Department of Anesthesia and Perioperative Care, University of
California, San Francisco, CA, United States
(Ma) Section of Anaesthetics, Pain Management and Intensive Care,
Department of Surgery and Cancer, Imperial College London, Chelsea and
Westminster Hospital, London, United Kingdom
Title
Dexmedetomidine for prevention of delirium in elderly patients after
non-cardiac surgery: a randomised, double-blind, placebo-controlled trial.
Source
The Lancet. 388 (10054) (pp 1893-1902), 2016. Date of Publication: 15 Oct
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Delirium is a postoperative complication that occurs frequently
in patients older than 65 years, and presages adverse outcomes. We
investigated whether prophylactic low-dose dexmedetomidine, a highly
selective alpha<inf>2</inf> adrenoceptor agonist, could safely decrease
the incidence of delirium in elderly patients after non-cardiac surgery.
Methods We did this randomised, double-blind, placebo-controlled trial in
two tertiary-care hospitals in Beijing, China. We enrolled patients aged
65 years or older, who were admitted to intensive care units after
non-cardiac surgery, with informed consent. We used a computer-generated
randomisation sequence (in a 1:1 ratio) to randomly assign patients to
receive either intravenous dexmedetomidine (0.1 mug/kg per h, from
intensive care unit admission on the day of surgery until 0800 h on
postoperative day 1), or placebo (intravenous normal saline).
Participants, care providers, and investigators were all masked to group
assignment. The primary endpoint was the incidence of delirium, assessed
twice daily with the Confusion Assessment Method for intensive care units
during the first 7 postoperative days. Analyses were done by
intention-to-treat and safety populations. This study is registered with
Chinese Clinical Trial Registry, www.chictr.org.cn, number
ChiCTR-TRC-10000802. Findings Between Aug 17, 2011, and Nov 20, 2013, of
2016 patients assessed, 700 were randomly assigned to receive either
placebo (n=350) or dexmedetomidine (n=350). The incidence of postoperative
delirium was significantly lower in the dexmedetomidine group (32 [9%] of
350 patients) than in the placebo group (79 [23%] of 350 patients; odds
ratio [OR] 0.35, 95% CI 0.22-0.54; p<0.0001). Regarding safety, the
incidence of hypertension was higher with placebo (62 [18%] of 350
patients) than with dexmedetomidine (34 [10%] of 350 patients; 0.50,
0.32-0.78; p=0.002). Tachycardia was also higher in patients given placebo
(48 [14%] of 350 patients) than in patients given dexmedetomidine (23 [7%]
of 350 patients; 0.44, 0.26-0.75; p=0.002). Occurrence of hypotension and
bradycardia did not differ between groups. Interpretation For patients
aged over 65 years who are admitted to the intensive care unit after
non-cardiac surgery, prophylactic low-dose dexmedetomidine significantly
decreases the occurrence of delirium during the first 7 days after
surgery. The therapy is safe. Funding Braun Anaesthesia Scientific
Research Fund and Wu Jieping Medical Foundation, Beijing, China. Study
drugs were manufactured and supplied by Jiangsu Hengrui Medicine Co, Ltd,
Jiangsu, China.<br/>Copyright © 2016 Elsevier Ltd
<51>
Accession Number
613120301
Author
Wallentin L.; Lindhagen L.; Arnstrom E.; Husted S.; Janzon M.; Johnsen
S.P.; Kontny F.; Kempf T.; Levin L.-A.; Lindahl B.; Stridsberg M.; Stahle
E.; Venge P.; Wollert K.C.; Swahn E.; Lagerqvist B.
Institution
(Wallentin, Lindahl, Lagerqvist) Department of Medical Sciences, Uppsala
University, Uppsala, Sweden
(Wallentin, Lindhagen, Arnstrom, Lindahl, Lagerqvist) Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Stridsberg, Venge) Department of Medical Sciences, Clinical Chemistry,
Uppsala University, Uppsala, Sweden
(Stahle) Department of Surgical Sciences, Thoracic Surgery, Uppsala
University, Uppsala, Sweden
(Husted) Medical Department, Hospital Unit West, Herning/Holstebro,
Denmark
(Janzon, Levin, Swahn) Department of Cardiology and Department of Medical
and Health Sciences, Linkoping University, Linkoping, Sweden
(Janzon, Levin) Division of Health Care Analysis, Department of Medical
and Health Sciences, Center for Medical Technology Assessment, Linkoping
University, Linkoping, Sweden
(Johnsen) Department of Clinical Epidemiology, Aarhus University Hospital,
Aarhus, Denmark
(Kontny) Stavanger University Hospital, Department of Cardiology,
Stavanger, Norway
(Kontny) Drammen Heart Center, Drammen, Norway
(Kempf, Wollert) Department of Cardiology and Angiology, Hannover Medical
School, Hannover, Germany
Title
Early invasive versus non-invasive treatment in patients with
non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of
a prospective, randomised, multicentre study.
Source
The Lancet. 388 (10054) (pp 1903-1911), 2016. Date of Publication: 15 Oct
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background The FRISC-II trial was the first randomised trial to show a
reduction in death or myocardial infarction with an early invasive versus
a non-invasive treatment strategy in patients with non-ST-elevation acute
coronary syndrome. Here we provide a remaining lifetime perspective on the
effects on all cardiovascular events during 15 years' follow-up. Methods
The FRISC-II prospective, randomised, multicentre trial was done at 58
Scandinavian centres in Sweden, Denmark, and Norway. Between June 17,
1996, and Aug 28, 1998, we randomly assigned (1:1) 2457 patients with
non-ST-elevation acute coronary syndrome to an early invasive treatment
strategy, aiming for revascularisation within 7 days, or a non-invasive
strategy, with invasive procedures at recurrent symptoms or severe
exercise-induced ischaemia. Plasma for biomarker analyses was obtained at
randomisation. For long-term outcomes, we linked data with national
health-care registers. The primary endpoint was a composite of death or
myocardial infarction. Outcomes were compared as the average postponement
of the next event, including recurrent events, calculated as the area
between mean cumulative count-of-events curves. Analyses were done by
intention to treat. Findings At a minimum of 15 years' follow-up on Dec
31, 2014, data for survival status and death were available for 2421 (99%)
of the initially recruited 2457 patients, and for other events after 2
years for 2182 (89%) patients. During follow-up, the invasive strategy
postponed death or next myocardial infarction by a mean of 549 days (95%
CI 204-888; p=0.0020) compared with the non-invasive strategy. This effect
was larger in non-smokers (mean gain 809 days, 95% CI 402-1175;
p<inf>interaction</inf>=0.0182), patients with elevated troponin T (778
days, 357-1165; p<inf>interaction</inf>=0.0241), and patients with high
concentrations of growth differentiation factor-15 (1356 days, 507-1650;
p<inf>interaction</inf>=0.0210). The difference was mainly driven by
postponement of new myocardial infarction, whereas the early difference in
mortality alone was not sustained over time. The invasive strategy led to
a mean of 1128 days (95% CI 830-1366) postponement of death or next
readmission to hospital for ischaemic heart disease, which was consistent
in all subgroups (p<0.0001). Interpretation During 15 years of follow-up,
an early invasive treatment strategy postponed the occurrence of death or
next myocardial infarction by an average of 18 months, and the next
readmission to hospital for ischaemic heart disease by 37 months, compared
with a non-invasive strategy in patients with non-ST-elevation acute
coronary syndrome. This remaining lifetime perspective supports that an
early invasive treatment strategy should be the preferred option in most
patients with non-ST-elevation acute coronary syndrome. Funding Swedish
Heart-Lung Foundation, Swedish Foundation for Strategic Research, and
Uppsala Clinical Research Center.<br/>Copyright © 2016 Elsevier Ltd
<52>
[Use Link to view the full text]
Accession Number
608560984
Author
Meccariello A.; Buono F.; Verrengia E.; Orefice G.; Grieco F.; Romeo F.;
Trimarco B.; Morisco C.
Institution
(Meccariello, Buono, Verrengia, Orefice, Grieco, Morisco) Dipartimento di
Scienze Mediche Traslazionali, Universita FEDERICO II, Via S. Pansini n.
5, Naples 80131, Italy
(Trimarco) Dipartimento di Scienze Biomediche Avanzate, Universita
FEDERICO II, Naples, Italy
(Romeo) Daichi Sankyo Italia SPA, Rome, Italy
Title
Microalbuminuria predicts the recurrence of cardiovascular events in
patients with essential hypertension.
Source
Journal of Hypertension. 34 (4) (pp 646-653), 2016. Date of Publication:
01 Apr 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objectives: Microalbuminuria (MAU) is associated with an enhanced risk of
cardiovascular events. The prevalence of MAU and its prognostic impact has
an important role in the stratification of cardiovascular risk in patients
with essential hypertension. This is an observational, prospective study
performed by 13 general practitioners aiming at assessing the prevalence
and prognostic relevance of MAU in essential hypertension. Methods:
Patients with essential hypertension and with recent determination of MAU
were enrolled into the study by general practitioners, and were followed
up for 3 years. Primary end point was the occurrence of major
cardiovascular events during the follow-up. Results: Out of 1024
unselected patients, consecutively enrolled from January 2009 to March
2010, 804 completed the 3-year follow-up. Patients were categorized into
two groups according to the absence (n=523, 65%) or presence (n=281, 35%)
of MAU. During the follow-up, 41 cardiovascular events (1.69events/100
patient-years) were reported. The presence of MAU was not associated with
increased risk of cardiovascular events (adjusted hazard ratio=1.32; 95%
confidence interval 0.290-4.340, P=0.097). When the analysis was
restricted to the patients with previous cardiovascular event, MAU
(adjusted hazard ratio=2.18; 95% confidence interval 0.42-2.43, P=0.031),
together with age, metabolic syndrome, diabetes, and smoking,
independently predicted the occurrence of cardiovascular events.
Conclusion: Presence of MAU in patients with essential hypertension is not
associated with increased risks of cardiovascular events. At the variance,
in patients with previous cardiovascular events, MAU was found to predict
recurrent events. Thus, the assessment of MAU could be considered a useful
tool in secondary prevention.<br/>Copyright © 2016 Wolters Kluwer
Health, Inc.
<53>
Accession Number
613084042
Author
Matte G.S.; Connor K.R.; Liu H.; DiNardo J.A.; Faraoni D.; Pigula F.
Institution
(Matte, Connor, Liu) Department of Cardiac Surgery, Boston Children's
Hospital, Boston, MA, United States
(DiNardo, Faraoni) Department of Anesthesiology, Perioperative and Pain
Medicine, Harvard Medical School, Boston, MA, United States
(Pigula) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
Title
Arterial limb microemboli during cardiopulmonary bypass: Observations from
a congenital cardiac surgery practice.
Source
Journal of Extra-Corporeal Technology. 48 (1) (pp 5-10), 2016. Date of
Publication: 2016.
Publisher
American Society of Extra-Corporeal Technology (E-mail: donna@amsect.org)
Abstract
Gaseous microemboli (GME) are known to be delivered to the arterial
circulation of patients during cardiopulmonary bypass (CPB). An increased
number ofGME delivered during adult CPB has been associated with brain
injury and postoperative cognitive dysfunction. The GME load in children
exposed to CPB and its consequences are not well characterized. We sought
to establish a baseline of arterial limb emboli counts during the conduct
of CPB for our population of patients requiring surgery for congenital
heart disease. We used the emboli detection and counting (EDAC) device to
measure GME activity in 103 consecutive patients for which an EDAC machine
was available. Emboli counts for GME < 40 mu and > 40 mu were quantified
and indexed to CPB time (minutes) and body surface area (BSA) to account
for the variation in patient size and CPB times. Patients of all sizes had
a similar embolic burden when indexed to bypass time and BSA. Furthermore,
patients of all sizes saw a three-fold increase in the < 40 mu embolic
burden and a five-fold increase in the > 40 mu embolic burden when regular
air was noted in the venous line. The use of kinetic venous-assisted
drainage did not significantly increase arterial limb GME. Efforts for
early identification and mitigation of venous line air are warranted to
minimize GME transmission to congenital cardiac surgery patients during
CPB.
<54>
Accession Number
611048906
Author
Faber M.M.; Noordzij P.G.; Hennink S.; Kelder H.; De Vroege R.; Waanders
F.G.; Daeter E.; Stehouwer M.C.
Institution
(Faber, Waanders, Stehouwer) Department of Extracorporeal Circulation, St.
Antonius Hospital, Nieuwegein, Netherlands
(Noordzij, Hennink) Department of Anaesthesiology, Intensive Care and Pain
Management, St. Antonius Hospital, Nieuwegein, Netherlands
(Kelder) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(De Vroege) Department of Extracorporeal Circulation, Haga Hospital, The
Hague, Netherlands
(Daeter) Department of Cardiothoracic Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
Title
Comparison of warm blood cardioplegia delivery with or without the use of
a roller pump.
Source
Journal of Extra-Corporeal Technology. 47 (4) (pp 209-216), 2015. Date of
Publication: 2015.
Publisher
American Society of Extra-Corporeal Technology (E-mail: donna@amsect.org)
Abstract
Various techniques for administration of blood cardioplegia are used
worldwide. In this study, the effect of warm blood cardioplegia
administration with or without the use of a roller pump on perioperative
myocardial injury was studied in patients undergoing coronary artery
bypass grafting using minimal extracorporeal circuits (MECCs). Sixty-eight
patients undergoing elective coronary bypass surgery with an MECC system
were consecutively enrolled and randomized into a pumpless group (PL
group: blood cardioplegia administration without roller pump) or roller
pump group (RP group: blood cardioplegia administration with roller pump).
No statistically significant differences were found between the PL group
and RP group regarding release of cardiac biomarkers. Maximum
postoperative biomarker values reached at T1 (after arrival intensive care
unit) for hearttype fatty acid binding protein (2.7 [1.5; 6.0] ng/mL PL
group vs. 3.2 [1.6; 6.3] ng/mL RP group, p = .63) and at T3 (first
postoperative day) for troponin T high-sensitive (22.0 [14.5; 29.3] ng/L
PL group vs. 21.1 [15.3; 31.6] ng/L RP group, p = .91), N-terminal
probrain natriuretic peptide (2.1 [1.7; 2.9] ng/mL PL group vs. 2.6 [1.6;
3.6] ng/mL RP group, p = .48), and C-reactive protein (138 [106; 175]
mug/mL PL group vs. 129 [105; 161] mug/mL RP group, p = .65). Besides
this, blood cardioplegia flow, blood cardioplegia line pressure, and
aortic root pressure during blood cardioplegia administration were similar
between the two groups. Administration of warm blood cardioplegia with or
without the use of a roller pump results in similar clinically acceptable
myocardial protection.
<55>
Accession Number
614921740
Author
Ohman E.M.; Roe M.T.; Steg P.G.; James S.K.; Povsic T.J.; White J.;
Rockhold F.; Plotnikov A.; Mundl H.; Strony J.; Sun X.; Husted S.; Tendera
M.; Montalescot G.; Bahit M.C.; Ardissino D.; Bueno H.; Claeys M.J.;
Nicolau J.C.; Cornel J.H.; Goto S.; Kiss R.G.; Guray U.; Park D.-W.; Bode
C.; Welsh R.C.; Gibson C.M.
Institution
(Ohman, Roe, Povsic, White, Rockhold) Duke Clinical Research Institute,
Duke University School of Medicine, Durham, NC, United States
(Steg) DHU FIRE, Universite Paris-Diderot, AP-HP and Inserm U-1148, Paris,
France
(Steg) NHLI Royal Brompton Hospital, Imperial College London, London,
United Kingdom
(James) Department of Medical Sciences and Uppsala Clinical Research
Center, Uppsala University, Uppsala, Sweden
(Plotnikov, Strony, Sun) Janssen Research and Development, Raritan, NJ,
United States
(Mundl) Bayer AG, Wuppertal, Germany
(Husted) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Tendera) 3rd Division of Cardiology, Medical University of Silesia,
Katowice, Poland
(Montalescot) Institut de Cardiologie, Groupe Hospitalier
Pitie-Salpetriere, Paris, France
(Bahit) INECO Neurociencias Orono, Rosario, Santa Fe, Argentina
(Ardissino) Divisione di Cardiologia, Policlinico San Matteo, Pavia, Italy
(Bueno) Spanish National Centre for Cardiovascular Research, Madrid, Spain
(Claeys) University Hospital Antwerp, Edegem, Belgium
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Cornel) Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar and
Dutch Network for Cardiovascular Research (WCN), Netherlands
(Goto) Department of Medicine (Cardiology), Tokai University School of
Medicine, Isehara, Japan
(Kiss) Department of Cardiology, Military Hospital, Budapest, Hungary
(Guray) Numune Education and Research Hospital, Department of Cardiology,
Ankara, Turkey
(Park) Division of Cardiology, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
(Bode) University of Freiburg, Freiburg, Germany
(Welsh) Mazankowski Alberta Heart Institute and University of Alberta,
Edmonton, AB, Canada
(Gibson) PERFUSE Study Group, Beth Israel Deaconess Hospital, Harvard
Medical School, Boston, MA, United States
Title
Clinically significant bleeding with low-dose rivaroxaban versus aspirin,
in addition to P2Y12 inhibition, in acute coronary syndromes
(GEMINI-ACS-1): a double-blind, multicentre, randomised trial.
Source
The Lancet. 389 (10081) (pp 1799-1808), 2017. Date of Publication: 06 May
2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Dual antiplatelet therapy (DAPT), aspirin plus a P2Y12
inhibitor, is the standard antithrombotic treatment following acute
coronary syndromes. The factor Xa inhibitor rivaroxaban reduced mortality
and ischaemic events when added to DAPT, but caused increased bleeding.
The safety of a dual pathway antithrombotic therapy approach combining
low-dose rivaroxaban (in place of aspirin) with a P2Y12 inhibitor has not
been assesssed in acute coronary syndromes. We aimed to assess rivaroxaban
2.5 mg twice daily versus aspirin 100 mg daily, in addition to clopidogrel
or ticagrelor (chosen at investigator discretion before randomisation),
for patients with acute coronary syndromes started within 10 days after
presentation and continued for 6-12 months. Methods In this double-blind,
multicentre, randomised trial (GEMINI-ACS-1) done at 371 clinical centres
in 21 countries, eligible patients were older than 18 years with unstable
angina, non-ST segment elevation myocardial infarction (NSTEMI) or ST
segment elevation myocardial infarction (STEMI), with positive cardiac
biomarkers and either ischaemic electrocardiographic changes or an
atherosclerotic culprit lesion identified during angiography. Participants
were randomly assigned (1:1) within 10 days after admission for the index
acute coronary syndromes event to either aspirin or rivaroxaban based on a
computer-generated randomisation schedule. Randomisation was balanced by
using randomly permuted blocks with size of four and was stratified based
on the background P2Y12 inhibitor (clopidogrel or ticagrelor) intended to
be used at the time of randomisation. Investigators and patients were
masked to treatment assignment. Patients received a minimum of 180 days of
double-blind treatment with rivaroxaban 2.5 mg twice daily or aspirin 100
mg daily. The choice of clopidogrel or ticagrelor during trial conduct was
not randomised and was based on investigator preference. The primary
endpoint was thrombolysis in myocardial infarction (TIMI) clinically
significant bleeding not related to coronary artery bypass grafting (CABG;
major, minor, or requiring medical attention) up to day 390. Primary
analysis was by intention to treat. This study is registered with
ClinicalTrials.gov, number NCT02293395. Findings Between April 22, 2015,
and Oct 14, 2016, 3037 patients with acute coronary syndromes were
randomly assigned; 1518 to receive aspirin and 1519 to receive
rivaroxaban. 1704 patients (56%) were in the ticagrelor and 1333 (44%) in
the clopidogrel strata. Median duration of treatment was 291 days (IQR
239-354). TIMI non-CABG clinically significant bleeding was similar with
rivaroxaban versus aspirin therapy (total 154 patients [5%]; 80
participants [5%] of 1519 vs 74 participants [5%] of 1518; HR 1.09 [95% CI
0.80-1.50]; p=0.5840). Interpretation A dual pathway antithrombotic
therapy approach combining low-dose rivaroxaban with a P2Y12 inhibitor for
the treatment of patients with acute coronary syndromes had similar risk
of clinically significant bleeding as aspirin and a P2Y12 inhibitor. A
larger, adequately powered trial would be required to definitively assess
the efficacy and safety of this approach. Funding Janssen Research &
Development and Bayer AG.<br/>Copyright © 2017 Elsevier Ltd
<56>
Accession Number
615948942
Author
Koulaxouzidis G.; Toufektzian L.; Ashrafian L.; Veres K.
Institution
(Koulaxouzidis) Department of Cardiothoracic Surgery, Freeman Hospital,
Newcastle upon Tyne, United Kingdom
(Toufektzian, Ashrafian, Veres) Department of Thoracic Surgery, Guy's
Hospital, London, United Kingdom
Title
Does the addition of postoperative radiotherapy to adjuvant chemotherapy
offer any benefit in patients with non-small cell lung cancer and
mediastinal lymphadenopathy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (4) (pp 625-630),
2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether the addition of
postoperative radiotherapy (PORT) to adjuvant chemotherapy offers any
benefit in patients undergoing curative resection for non-small cell lung
cancer found to harbour mediastinal lymphadenopathy. A total of 77 papers
were identified using the reported search, of which 11 represented the
best evidence to answer the clinical question. Only studies reporting on
survival data of patients receiving adjuvant chemotherapy with and without
PORT were included in this analysis. The authors, date, journal, country,
study type, population, outcomes and key results are tabulated. Six
studies reported a statistically significant positive impact of PORT on
long-Term or disease-free survival (DFS) (P = 0.048-0.0001). Five more
studies found no difference in terms of survival between patients
receiving and not receiving PORT. Among the 11 studies, only two were
randomized controlled, with one of them reporting improved disease-free (P
= 0.041) but not overall survival (P = 0.073), while the other finding no
difference in survival. Furthermore, three more studies reported on DFS
and/or locoregional recurrence of the disease. One of these studies
reported a significantly improved DFS among patients receiving PORT (P =
0.003), while two of them reported a reduced rate of locoregional
recurrence in this group (P = 0.032-0.009). Many studies report a positive
effect of PORT when combined in parallel or sequentially with adjuvant
chemotherapy in terms of long-Term, disease free survival or locoregional
control of the disease in patients who have undergone surgical resection
of NSCLC and are found to harbour N2 disease. However, these reports are
counterbalanced by an almost equal number of studies which show no
difference between PORT and no PORT. Only one study reported significantly
increased radiation related adverse effects in patients undergoing
chemotherapy and PORT.<br/>Copyright © 2016.The Author.
<57>
Accession Number
615948935
Author
Abdullahi Y.S.; Athanasopoulos L.V.; Casula R.P.; Moscarelli M.; Bagnall
M.; Ashrafian H.; Athanasiou T.
Institution
(Abdullahi, Athanasopoulos, Casula, Athanasiou) Department of
Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith
Hospital, Praed Street, London W2 1NY, United Kingdom
(Moscarelli) GVM Care and Research Unit, Anthea Hospital, Bari, Italy
(Bagnall, Ashrafian, Athanasiou) Department of Surgery and Cancer,
Imperial College London, London, United Kingdom
Title
Systematic review on the predictive ability of frailty assessment measures
in cardiac surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (4) (pp 619-624),
2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: Patient frailty is increasingly recognised as contributing to
adverse postoperative outcomes in cardiothoracic surgery. The goal of this
review is to evaluate the predictive ability of frailty scoring systems
and their limitations in risk assessment of patients undergoing cardiac
surgery. METHODS: Frailty studies were identified by searching electronic
databases. Studies in which the measuring instrument was defined as a
multidimensional tool focusing on a population undergoing cardiac
operations were included. The focus was on the predictive ability of
frailty in this population and a comparison with conventional risk scoring
systems. Unfortunately, the lack of a significant number of studies with
the same postoperative outcome precluded a formal meta-Analysis. RESULTS:
Of 783 studies identified in our initial search, 6 fulfilled our inclusion
criteria. Frailty was identified as a predictor of mortality, morbidity
and/or prolonged hospital stay in patients undergoing cardiac surgery. Our
systematic review revealed the increased application of frailty scores
compared to standardized risk stratification scores in cardiothoracic
patients. In approximately 50% of these studies, frailty scores continued
to be predictive even after adjusting for the conventional risk scoring
systems. CONCLUSIONS: The assessment of frailty may enhance the
preoperative workup and offer an optimized risk stratification measure in
patients undergoing cardiothoracic procedures even though the reporting
standards of calibration and classification measures have been relatively
poor.<br/>Copyright © 2016.The Author.
<58>
Accession Number
615948879
Author
De Vries A.J.; Lansink-Hartgring A.O.; Fernhout F.-J.; Huet R.C.G.; Van
Den Heuvel E.R.
Institution
(De Vries, Huet) Department of Anesthesiology, University Medical Center
Groningen, University of Groningen, RB Groningen 9700, Netherlands
(Lansink-Hartgring) Department of Critical Care, University Medical Center
Groningen, University of Groningen, Groningen, Netherlands
(Fernhout) Department of Cardiothoracic Surgery, University Medical Center
Groningen, University of Groningen, Groningen, Netherlands
(Van Den Heuvel) Department of Mathematics and Computer Science, Eindhoven
University of Technology, PO box 30.001, Eindhoven, Netherlands
Title
The activated clotting time in cardiac surgery: Should Celite or kaolin be
used?.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (4) (pp 549-554),
2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: Both kaolin- and Celite-activated clotting times (ACT) are
used to guide anticoagulation during cardiopulmonary bypass. It is unknown
whether these methods lead to similar management procedures for
anticoagulation in patients and are thus interchangeable in terms of bias,
precision and variability. METHODS: We randomized 97 patients undergoing
coronary artery bypass grafting or aortic valve replacement to either
kaolin- or Celite-guided anticoagulation. The ACT was measured
simultaneously with the other method. We administered 300 IU/kg heparin to
obtain initial ACT values greater than 400 s and additional heparin in
each group using the minimum value of duplicate measurements according to
a predefined protocol. The primary end point was the total heparin dose
and the number of heparin supplements. RESULTS: The total heparin dose per
patient in the 48 Celite-guided patients was 35 271 +/- 12 406 IU with 51
supplements and in the 49 kaolin-guided patients, 35 997 +/- 11 540 IU (P
= 0.77) with 56 supplements (P = 0.53). Postoperative thrombin generation
time, fibrinolytic response time, chest tube loss and transfusion
requirements were not different between the two groups. However, the
methods differed in individual patients with regard to supplemental
heparin (P = 0.002). Bias between methods at baseline was +10.3%, Celite
being higher, and changed to a value of -12.9% at 2 h bypass. The
coefficient of variation at baseline for individual patients was 2.6 times
larger with kaolin than with Celite (P < 0.001). Correlation between ACT
values at baseline was only 45%. CONCLUSIONS: Kaolin- and Celite-guided
management of anticoagulation is clinically not different, but the methods
are not interchangeable.<br/>Copyright © The Author 2017. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.
<59>
Accession Number
615885281
Author
Johl M.M.; Malhotra P.; Kehl D.W.; Rader F.; Siegel R.J.
Institution
(Johl, Malhotra) Department of Medicine, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
(Kehl, Rader, Siegel) Heart Institute, Cedars-Sinai Medical Center, 127 S
San Vincente Blvd, AHSP A3417, Los Angeles, CA 90048, United States
Title
Natriuretic peptides in the evaluation and management of degenerative
mitral regurgitation: A systematic review.
Source
Heart. 103 (10) (pp 738-744), 2017. Date of Publication: 01 May 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Progression of degenerative mitral regurgitation (MR) leads to
irreversible cardiac damage. Therefore, longitudinal follow up to
determine the optimal timing of surgery is critical. Current data
indicates that in addition to the standard of care - assessing for
symptoms and signs of left ventricular (LV) decompensation with routine
echocardiography - serial measurement of natriuretic peptides offers a
quantitative means to identify patients who may benefit from closer
supervision, if not surgery. Natriuretic peptide levels, and specifically
changes from baseline, identify both symptomatic patients and others
likely to develop cardiac dysfunction. Moreover, because natriuretic
peptides are complimentary to the echocardiographic assessment of MR.
Finally, changes in natriuretic peptides levels are predictive of pre- and
post-operative outcomes. In short, natriuretic peptides add objectivity to
the management of degenerative MR, which may aid practitioners in
identifying patients who could benefit from intensive monitoring, stress
testing, and perhaps mitral surgery.<br/>Copyright © 2017 Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article). All rights reserved.
<60>
Accession Number
615712486
Author
Zhang D.; Miao J.; Hu X.; Hu B.; Li H.
Institution
(Zhang, Miao, Hu, Hu, Li) Department of Thoracic Surgery, Beijing Chaoyang
Hospital, Capital Medical University, Beijing 100020, China
Title
A clinical study of efficacy of polyglycolic acid sleeve after
video-assisted thoracoscopic bullectomy for primary spontaneous
pneumothorax.
Source
Journal of Thoracic Disease. 9 (4) (pp 1093-1099), 2017. Date of
Publication: 01 Apr 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Primary spontaneous pneumothorax (PSP) is a common disease in
thoracic surgery, and a prolonged postoperative air leakage is the most
frequent and troublesome early complication after videoassisted
thoracoscopic (VATS) bullectomy. This study aimed to explore the efficacy
of polyglycolic acid (PGA) sleeve in preventing postoperative air leakage
after a VATS bullectomy for PSP. Methods: This study was a prospectively
randomised clinical study. The patients who underwent a VATS bullectomy
were continuously enrolled from January 2015 to June 2016 in the Beijing
Chaoyang Hospital and were randomly assigned to the experimental and
control groups. The experimental group applied a PGA sleeve combined with
an automatic stapler in the bullectomy, while in the control group, the
bullae were resected using an automatic stapler alone during the
operation. In addition, the staple lines in both groups were covered with
an absorbable polyglycolic acid sheet and both groups performed pleural
abrasion after the resection. Useful clinical data were recorded,
including the number of cases there was no air leakage immediately after
the operation and air leakage lasted more than 3 days, the average
postoperative air leakage, the drainage tube removal time, the
postoperative hospital stay, the postoperative complications, and the
postoperative recurrence. Results: A total of 134 patients were enrolled
in this study. The experimental group consisted of 60 subjects, and there
were 74 in the control group. No operative related mortality was observed
in either group. In the experimental group, 44 of the 60 patients did not
have an air leakage immediately after the operation, which was
significantly higher than the control group (73.33% vs. 54.05%, P =
0.031). Compared with the control group, the average postoperative air
leakage (0.57 +/- 1.11 days), the chest tube removal time (3.03 +/- 0.92
days), and the postoperative hospital stay (3.98+/-0.92 days) were all
significantly shorter in the experimental group (P = 0.048, P = 0.012, and
P = 0.010, respectively). Moreover, the rate of postoperative
complications in the experimental group was lower than the control group
(3.33% vs. 16.22%, P = 0.021). No postoperative recurrence was observed in
either group during the follow-up period that ranged from 8 to 25 months.
Conclusions: The use of PGA sleeve during surgery for PSP might
effectively prevent early postoperative air leakage, as well as reduce the
postoperative drainage tube removal time and the postoperative hospital
stay.<br/>Copyright © 2017. Journal of Thoracic Disease.
<61>
Accession Number
615712482
Author
Deng H.-Y.; Shi C.-L.; Li G.; Luo J.; Wang Z.-Q.; Lin Y.-D.; Liu L.-X.;
Zhou Q.-H.
Institution
(Deng, Li, Luo, Wang, Lin, Liu) Department of Thoracic Surgery, West China
Hospital, Sichuan University, Chengdu 610041, China
(Deng, Zhou) Lung Cancer Center, West China Hospital, Sichuan University,
Chengdu 610041, China
(Shi) Department of Thoracic Surgery, The Central Hospital of Bazhong,
Bazhong 636000, China
Title
The safety profile of preoperative administration of heparin for
thromboprophylaxis in Chinese patients intended for thoracoscopic major
thoracic surgery: A pilot randomized controlled study.
Source
Journal of Thoracic Disease. 9 (4) (pp 1065-1072), 2017. Date of
Publication: 01 Apr 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Patients undergoing major thoracic surgery especially for
cancers are at a high risk of perioperative thromboembolism. Current
guidelines recommended either heparin sodium (unfractionated heparin) or
low-molecular-weight heparin (LMWH) for those patients at high risk of
deep vein thrombosis (DVT). However, the rational timing of starting
heparin has not yet been well established, because DVT can be caused by
not only surgery but also comorbidities as well as prolonged hospital
stay, and thoracic surgeons always concerned about heparin-related
increased risk of intra- or post-operative bleeding. Therefore, this study
aimed to establish the safety profile of preoperative administration of
heparin for thromboprophylaxis in Chinese patients intended for
thoracoscopic major thoracic surgery. Methods: From June to August 2016,
patients intended for thoracoscopic lobectomy, esophagectomy, and
thymectomy were randomly assigned into two groups: the case group
(starting heparin sodium 5,000 U, bid preoperatively upon the admission
into our department) and the control group (starting heparin sodium 5,000
U, bid postoperatively from postoperative day 1). The baseline data
including demographic data and preoperative conditions were collected. The
end points included operation time, intraoperative bleeding volume,
postoperative chest tube drainage volume and duration as well as lab
coagulation function data. Results: A total of 58 qualified patients were
randomized into case group (29 patients) and control group (29 patients),
and after excluding 6 conversion patients, the case group and control
group each had 26 patients for analysis. The baseline data of the two
groups were comparable. Operation time (P=0.368), intraoperative bleeding
volume (P=0.231), postoperative drainage days (P=0.466), and mean drainage
volume per day (P=0.108) were not significantly increased in case group
compared with those of control group. Moreover, there were no significant
differences of perioperative coagulation function between these two
groups. Conclusions: Preoperative administration of heparin for
thromboprophylaxis in Chinese patients intended for thoracoscopic major
thoracic surgery was safe and feasible.<br/>Copyright © 2017. Journal
of Thoracic Disease.
<62>
[Use Link to view the full text]
Accession Number
615510276
Author
Saleh A.; Klika A.K.; Barsoum W.K.
Institution
(Saleh, Klika, Barsoum) Department of Orthopaedic Surgery, Cleveland
Clinic Foundation, Cleveland, OH, United States
Title
Reply to Letter: "glycopeptides Versus Beta-lactams for the Prevention of
Surgical Site Infections in Cardiovascular and Orthopedic Surgery: A
Meta-analysis".
Source
Annals of Surgery. 265 (5) (pp e71-e72), 2017. Date of Publication: 01 May
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
<63>
[Use Link to view the full text]
Accession Number
615510272
Author
Dellinger E.P.
Institution
(Dellinger) Division of General Surgery, University of Washington,
Seattle, WA, United States
Title
Glycopeptides Versus Beta-lactams for the Prevention of Surgical Site
Infections in Cardiovascular and Orthopedic Surgery: A Meta-analysis.
Source
Annals of Surgery. 265 (5) (pp e70-e71), 2017. Date of Publication: 01 May
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
<64>
Accession Number
615250695
Author
Whiting P.; Morden A.; Tomlinson L.A.; Caskey F.; Blakeman T.; Tomson C.;
Stone T.; Richards A.; Savovic J.; Horwood J.
Institution
(Whiting, Morden, Stone, Richards, Savovic, Horwood) Natl. Inst. for Hlth.
Research Collaboration for Leadership in Applied Health Research and Care
West, University Hospitals Bristol NHS Foundation Trust, Bristol, United
Kingdom
(Whiting, Morden, Caskey, Stone, Richards, Savovic, Horwood) School of
Social and Community Medicine, University of Bristol, Bristol, United
Kingdom
(Tomlinson, Caskey) UK Renal Registry, Bristol, United Kingdom
(Tomlinson) Department of Non-communicable Disease Epidemiology, London
School of Hygiene and Tropical Medicine, London, United Kingdom
(Blakeman) Centre for Primary Care, Institute of Population Health,
University of Manchester, Manchester, United Kingdom
(Blakeman) Natl. Inst. for Hlth. Res. Collaboration for Leadership in
Appl. Hlth. Res. and Care Gtr. Manchester, Centre for Primary Care,
University of Manchester, Manchester, United Kingdom
(Tomson) Department of Renal Medicine, Freeman Hospital, Newcastle Upon
Tyne Hospitals Foundation Trust, Tyne and Wear, United Kingdom
Title
What are the risks and benefits of temporarily discontinuing medications
to prevent acute kidney injury? A systematic review and meta-Analysis.
Source
BMJ Open. 7 (4) (no pagination), 2017. Article Number: e012674. Date of
Publication: 01 Apr 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To summarise evidence on temporary discontinuation of
medications to prevent acute kidney injury (AKI). Design Systematic review
and meta-Analysis of randomised and non-randomised studies. Participants
Adults taking diuretics, ACE inhibitors (ACEI), angiotensin receptor
blockers (ARB), direct renin inhibitors, non-steroidal
anti-inflammatories, metformin or sulfonylureas, experiencing intercurrent
illnesses, radiological or surgical procedures. Interventions Temporary
discontinuation of any of the medications of interest. Primary and
secondary outcome measures Risk of AKI. Secondary outcome measures were
estimated glomerular filtration rate and creatinine post-AKI, urea,
systolic and diastolic blood pressure, death, clinical outcomes and
biomarkers. Results 6 studies were included (1663 participants), 3
randomised controlled trials (RCTs) and 3 prospective cohort studies. The
mean age ranged from 65 to 73a ..years, and the proportion of women ranged
from 31% to 52%. All studies were in hospital settings; 5 evaluated
discontinuation of medication prior to coronary angiography and 1 prior to
cardiac surgery. 5 studies evaluated discontinuation of ACEI and ARBs and
1 small cohort study looked at discontinuation of non-steroidal
anti-inflammatory drugs. No studies evaluated discontinuation of
medication in the community following an acute intercurrent illness. There
was an increased risk of AKI of around 15% in those in whom medication was
continued compared with those in whom it was discontinued (relative risk
(RR) 1.17, 95% CI 0.99 to 1.38; 5 studies). When only results from RCTs
were pooled, the increase in risk was almost 50% (RR 1.48, 95% CI 0.84 to
2.60; 3 RCTs), but the CI was wider. There was no difference between
groups for any secondary outcomes. Conclusions There is low-quality
evidence that withdrawal of ACEI/ARBs prior to coronary angiography and
cardiac surgery may reduce the incidence of AKI. There is no evidence of
the impact of drug cessation interventions on AKI incidence during
intercurrent illness in primary or secondary care. Trial registration
number PROSPERO CRD42015023210.<br/>Copyright © Published by the BMJ
Publishing Group Limited. For permission to use (where not already granted
under a licence) please go to
http://www.bmj.com/company/products-services/rights-And-licensing/.
<65>
Accession Number
609356425
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 (E-mail: subscriptions@bmjgroup.com)
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 (I<sup>2</sup>=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.
<66>
Accession Number
608914712
Author
Smit B.; Smulders Y.M.; de Waard M.C.; Boer C.; Vonk A.B.A.; Veerhoek D.;
Kamminga S.; de Grooth H.-J.S.; Garcia-Vallejo J.J.; Musters R.J.P.;
Girbes A.R.J.; Oudemans-van Straaten H.M.; Spoelstra-de Man A.M.E.
Institution
(Smit, de Waard, de Grooth, Girbes, Oudemans-van Straaten, Spoelstra-de
Man) VU University Medical Center, Department of Intensive Care,
Amsterdam, Netherlands
(Smulders) VU University Medical Center, Department of Internal Medicine,
Amsterdam, Netherlands
(Boer, Kamminga) VU University Medical Center, Department of
Anaesthesiology, Amsterdam, Netherlands
(Vonk, Veerhoek) VU University Medical Center, Department of
Cardiothoracic Surgery, Amsterdam, Netherlands
(Garcia-Vallejo) VU University Medical Center, Department of Molecular
Cell Biology and Immunology, Amsterdam, Netherlands
(Musters) VU University Medical Center, Department of Physiology,
Amsterdam, Netherlands
Title
Moderate hyperoxic versus near-physiological oxygen targets during and
after coronary artery bypass surgery: A randomised controlled trial.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 55. Date of
Publication: March 10, 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The safety of perioperative hyperoxia is currently unclear.
Previous studies in patients undergoing coronary artery bypass surgery
suggest reduced myocardial damage when avoiding extreme perioperative
hyperoxia (>400 mmHg). In this study we investigated whether an
oxygenation strategy from moderate hyperoxia to a near-physiological
oxygen tension reduces myocardial damage and improves haemodynamics, organ
dysfunction and oxidative stress. Methods: This was a single-blind,
single-centre, open-label, randomised controlled trial in patients
undergoing elective coronary artery bypass surgery. Fifty patients were
randomised to a partial pressure of oxygen in arterial blood
(P<inf>a</inf>O<inf>2</inf>) target of 200-220 mmHg during cardiopulmonary
bypass and 130-150 mmHg during intensive care unit (ICU) admission
(control group) versus lower targets of 130-150 mmHg during
cardiopulmonary bypass and 80-100 mmHg at the ICU (conservative group).
Primary outcome was myocardial injury (CK-MB and Troponin-T) at ICU
admission and 2, 6 and 12 hours thereafter. Results: Weighted
P<inf>a</inf>O<inf>2</inf> during cardiopulmonary bypass was 220 mmHg
(interquartile range (IQR) 211-233) vs. 157 (151-162) in the control and
conservative group, respectively (P < 0.0001). During ICU admission,
weighted P<inf>a</inf>O<inf>2</inf> was 107 mmHg (86-141) vs. 90 (84-98)
(P = 0.03), respectively. Area under the curve of CK-MB was median 23.5
mug/L/h (IQR 18.4-28.1) vs. 21.5 (15.8-26.6) (P = 0.35) and 0.30 mug/L/h
(0.25-0.44) vs. 0.39 (0.24-0.43) (P = 0.81) for Troponin-T. Cardiac index,
systemic vascular resistance index, creatinine, lactate and F2-isoprostane
levels were not different between groups. Conclusions: Compared to
moderate hyperoxia, a near-physiological oxygen strategy does not reduce
myocardial damage in patients undergoing coronary artery bypass surgery.
Conservative oxygen administration was not associated with increased
lactate levels or hypoxic events. Trial registration: Netherlands Trial
Registry NTR4375 , registered on 30 January 2014<br/>Copyright © 2016
Smit et al.
<67>
Accession Number
609666288
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. (E-mail: info@biomedcentral.com)
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.<br/>Copyright © 2016 Bernardi et al.
<68>
Accession Number
613982512
Author
Andersen L.W.; Holmberg M.J.; Berg K.M.; Chase M.; Cocchi M.N.; Sulmonte
C.; Balkema J.; MacDonald M.; Montissol S.; Senthilnathan V.; Liu D.;
Khabbaz K.; Lerner A.; Novack V.; Liu X.; Donnino M.W.
Institution
(Andersen, Holmberg, Chase, Cocchi, Sulmonte, Balkema, MacDonald,
Montissol, Liu, Donnino) Center for Resuscitation Science, Department of
Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline
Avenue, Boston, MA 02215, United States
(Andersen) Department of Anesthesiology, Aarhus University Hospital,
Norrebrogade 44, Aarhus C 8000, Denmark
(Andersen, Holmberg) Research Center for Emergency Medicine, Aarhus
University Hospital, Norrebrogade 44, Aarhus C 8000, Denmark
(Berg, Donnino) Department of Medicine, Division of Pulmonary and Critical
Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston,
MA 02215, United States
(Cocchi) Department of Anesthesia Critical Care, Division of Critical
Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston,
MA 02215, United States
(Senthilnathan, Liu, Khabbaz) Department of Surgery, Division of
Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, 330
Brookline Avenue, Boston, MA 02215, United States
(Lerner) Department of Anesthesia, Beth Israel Deaconess Medical Center,
330 Brookline Avenue, Boston, MA 02215, United States
(Novack) Clinical Research Center, Soroka University Medical Center, POB
151, Beer-Sheva 84965, Israel
(Novack) Faculty of Health Sciences, Ben-Gurion University, POB 151,
Beer-Sheva 84965, Israel
Title
Thiamine as an adjunctive therapy in cardiac surgery: A randomized,
doubleblind, placebo-controlled, phase II trial.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 92. Date of
Publication: 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Thiamine is a vitamin that is essential for adequate aerobic
metabolism. The objective of this study was to determine if thiamine
administration prior to coronary artery bypass grafting would decrease
post-operative lactate levels as a measure of increased aerobic
metabolism. Methods: We performed a randomized, double-blind,
placebo-controlled trial of patients undergoing coronary artery bypass
grafting. Patients were randomized to receive either intravenous thiamine
(200 mg) or placebo both immediately before and again after the surgery.
Our primary endpoint was post-operative lactate levels. Additional
endpoints included pyruvate dehydrogenase activity, global and cellular
oxygen consumption, post-operative complications, and hospital and
intensive care unit length of stay. Results: Sixty-four patients were
included. Thiamine levels were significantly higher in the thiamine group
as compared to the placebo group immediately after surgery (1200 [683,
1200] nmol/L vs. 9 [8, 13] nmol/L, p < 0.001). There was no difference
between the groups in the primary endpoint of lactate levels immediately
after the surgery (2.0 [1.5, 2.6] mmol/L vs. 2.0 [1.7, 2.4], p = 0.75).
Relative pyruvate dehydrogenase activity was lower immediately after the
surgery in the thiamine group as compared to the placebo group (15 % [11,
37] vs. 28 % [15, 84], p = 0.02). Patients receiving thiamine had higher
post-operative global oxygen consumption 1 hour after the surgery
(difference: 0.37 mL/min/kg [95 % CI: 0.03, 0.71], p = 0.03) as well as
cellular oxygen consumption. We found no differences in clinical outcomes.
Conclusions: There were no differences in post-operative lactate levels or
clinical outcomes between patients receiving thiamine or placebo.
Post-operative oxygen consumption was significantly increased among
patients receiving thiamine.<br/>Copyright © 2016 Andersen et al.
<69>
Accession Number
611766319
Author
Wikkelso A.; Wetterslev J.; Moller A.M.; Afshari A.
Institution
(Wikkelso) Hvidovre Hospital, University of Copenhagen, Department of
Anaesthesiology and Intensive Care Medicine, Kettegard Alle 30, Hvidovre
2650, Denmark
(Wetterslev) Department 7812, Rigshospitalet, Copenhagen University
Hospital, Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Moller) University of Copenhagen Herlev Hospital, The Cochrane
Anaesthesia, Critical and Emergency Care Group, Herlev Ringvej, Herlev
2730, Denmark
(Afshari) Rigshospitalet, Copenhagen University Hospital, Juliane Marie
Centre - Anaesthesia and Surgical Clinic Department 4013, Copenhagen,
Denmark
Title
Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor
haemostatic treatment versus usual care in adults or children with
bleeding.
Source
Cochrane Database of Systematic Reviews. 2016 (8) (no pagination), 2016.
Article Number: CD007871. Date of Publication: 22 Aug 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Severe bleeding and coagulopathy are serious clinical
conditions that are associated with high mortality. Thromboelastography
(TEG) and thromboelastometry (ROTEM) are increasingly used to guide
transfusion strategy but their roles remain disputed. This review was
first published in 2011 and updated in January 2016. Objectives: We
assessed the benefits and harms of thromboelastography (TEG)-guided or
thromboelastometry (ROTEM)-guided transfusion in adults and children with
bleeding. We looked at various outcomes, such as overall mortality and
bleeding events, conducted subgroup and sensitivity analyses, examined the
role of bias, and applied trial sequential analyses (TSAs) to examine the
amount of evidence gathered so far. Search methods: In this updated review
we identified randomized controlled trials (RCTs) from the following
electronic databases: Cochrane Central Register of Controlled Trials
(CENTRAL; 2016, Issue 1); MEDLINE; Embase; Science Citation Index
Expanded; International Web of Science; CINAHL; LILACS; and the Chinese
Biomedical Literature Database (up to 5 January 2016). We contacted trial
authors, authors of previous reviews, and manufacturers in the field. The
original search was run in October 2010. Selection criteria: We included
all RCTs, irrespective of blinding or language, that compared transfusion
guided by TEG or ROTEM to transfusion guided by clinical judgement, guided
by standard laboratory tests, or a combination. We also included
interventional algorithms including both TEG or ROTEM in combination with
standard laboratory tests or other devices. The primary analysis included
trials on TEG or ROTEM versus any comparator. Data collection and
analysis: Two review authors independently abstracted data; we resolved
any disagreements by discussion. We presented pooled estimates of the
intervention effects on dichotomous outcomes as risk ratio (RR) with 95%
confidence intervals (CIs). Due to skewed data, meta-analysis was not
provided for continuous outcome data. Our primary outcome measure was
all-cause mortality. We performed subgroup and sensitivity analyses to
assess the effect based on the presence of coagulopathy of a TEG- or
ROTEM-guided algorithm, and in adults and children on various clinical and
physiological outcomes. We assessed the risk of bias through assessment of
trial methodological components and the risk of random error through TSA.
Main results: We included eight new studies (617 participants) in this
updated review. In total we included 17 studies (1493 participants). A
total of 15 trials provided data for the meta-analyses. We judged only two
trials as low risk of bias. The majority of studies included participants
undergoing cardiac surgery. We found six ongoing trials but were unable to
retrieve any data from them. Compared with transfusion guided by any
method, TEG or ROTEM seemed to reduce overall mortality (7.4% versus 3.9%;
risk ratio (RR) 0.52, 95% CI 0.28 to 0.95; I<sup>2</sup> = 0%, 8 studies,
717 participants, low quality of evidence) but only eight trials provided
data on mortality, and two were zero event trials. Our analyses
demonstrated a statistically significant effect of TEG or ROTEM compared
to any comparison on the proportion of participants transfused with pooled
red blood cells (PRBCs) (RR 0.86, 95% CI 0.79 to 0.94; I<sup>2</sup> = 0%,
10 studies, 832 participants, low quality of evidence), fresh frozen
plasma (FFP) (RR 0.57, 95% CI 0.33 to 0.96; I<sup>2</sup> = 86%, 8
studies, 761 participants, low quality of evidence), platelets (RR 0.73,
95% CI 0.60 to 0.88; I<sup>2</sup> = 0%, 10 studies, 832 participants, low
quality of evidence), and overall haemostatic transfusion with FFP or
platelets (low quality of evidence). Meta-analyses also showed fewer
participants with dialysis-dependent renal failure. We found no difference
in the proportion needing surgical reinterventions (RR 0.75, 95% CI 0.50
to 1.10; I<sup>2</sup> = 0%, 9 studies, 887 participants, low quality of
evidence) and excessive bleeding events or massive transfusion (RR 0.38,
95% CI 0.38 to 1.77; I<sup>2</sup> = 34%, 2 studies, 280 participants, low
quality of evidence). The planned subgroup analyses failed to show any
significant differences. We graded the quality of evidence as low based on
the high risk of bias in the studies, large heterogeneity, low number of
events, imprecision, and indirectness. TSA indicates that only 54% of
required information size has been reached so far in regards to mortality,
while there may be evidence of benefit for transfusion outcomes. Overall,
evaluated outcomes were consistent with a benefit in favour of a TEG- or
ROTEM-guided transfusion in bleeding patients. Authors' conclusions: There
is growing evidence that application of TEG- or ROTEM-guided transfusion
strategies may reduce the need for blood products, and improve morbidity
in patients with bleeding. However, these results are primarily based on
trials of elective cardiac surgery involving cardiopulmonary bypass, and
the level of evidence remains low. Further evaluation of TEG- or
ROTEM-guided transfusion in acute settings and other patient categories in
low risk of bias studies is needed.<br/>Copyright © 2016 The Cochrane
Collaboration.
<70>
Accession Number
616140770
Author
Hermes B.M.; Cardoso D.M.; Gomes T.J.; Santos T.D.; Vicente M.S.; Pereira
S.N.; Barbosa V.A.; Albuquerque I.M.
Institution
(Hermes, Santos, Vicente) Universidade Federal de Santa Maria, Santa
Maria, RS, Brazil
(Cardoso) Department of Physiotherapy, Universidade de Santa Cruz do Sul,
Santa Cruz do Sul, RS, Brazil
(Gomes) Department of Physiotherapy, Centro Universitario Franciscano,
UNIFRA, Santa Maria, RS, Brazil
(Pereira) Cardiac Rehabilitation Program, Hospital Universitario de Santa
Maria, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
(Barbosa, Albuquerque) Department of Physiotherapy and Rehabilitation,
Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
Title
Short-term inspiratory muscle training potentiates the benefits of aerobic
and resistance training in patients undergoing CABG in phase II cardiac
rehabilitation program.
Source
Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade
Brasileira de Cirurgia Cardiovascular. 30 (4) (pp 474-481), 2015. Date of
Publication: 01 Jul 2015.
Abstract
OBJECTIVE: To investigate the efficiency of short-term inspiratory muscle
training program associated with combined aerobic and resistance exercise
on respiratory muscle strength, functional capacity and quality of life in
patients who underwent coronary artery bypass and are in the phase II
cardiac rehabilitation program.
METHODS: A prospective, quasi-experimental study with 24 patients who
underwent coronary artery bypass and were randomly assigned to two groups
in the Phase II cardiac rehabilitation program: inspiratory muscle
training program associated with combined training (aerobic and
resistance) group (GCR + IMT, n=12) and combined training with respiratory
exercises group (GCR, n=12), over a period of 12 weeks, with two sessions
per week. Before and after intervention, the following measurements were
obtained: maximal inspiratory and expiratory pressures (PImax and PEmax),
peak oxygen consumption (peak VO2) and quality of life scores. Data were
compared between pre- and post-intervention at baseline and the variation
between the pre- and post-phase II cardiac rehabilitation program using
the Student's t-test, except the categorical variables, which were
compared using the Chi-square test. Values of P<0.05 were considered
statistically significant.
RESULTS: Compared to GCR, the GCR + IMT group showed larger increments in
PImax (P<0.001), PEmax (P<0.001), peak VO2 (P<0.001) and quality of life
scores (P<0.001).
CONCLUSION: The present study demonstrated that the addition of
inspiratory muscle training, even when applied for a short period, may
potentiate the effects of combined aerobic and resistance training,
becoming a simple and inexpensive strategy for patients who underwent
coronary artery bypass and are in phase II cardiac rehabilitation.
<71>
Accession Number
616140608
Author
Lima R.O.; Borges D.L.; Costa Md.eA.; Baldez T.E.; Barbosa e Silva M.G.;
Sousa F.A.; Soares Md.eO.; Pinto J.G.
Institution
(Lima, Borges, Costa, Baldez, Barbosa e Silva, Sousa, Soares) Hospital
Universitario, Universidade Federal do Maranhao, Sao Luis, MA, Brazil
(Pinto) Universidade Estadual do Piaui, Teresina, PI, Brazil
Title
Relationship between pre-extubation positive end-expiratory pressure and
oxygenation after coronary artery bypass grafting.
Source
Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade
Brasileira de Cirurgia Cardiovascular. 30 (4) (pp 443-448), 2015. Date of
Publication: 01 Jul 2015.
Abstract
INTRODUCTION: After removal of endotracheal tube and artificial
ventilation, ventilatory support should be continued, offering oxygen
supply to ensure an arterial oxygen saturation close to physiological.
OBJECTIVE: The aim of this study was to investigate the effects of
positive-end expiratory pressure before extubation on the oxygenation
indices of patients undergoing coronary artery bypass grafting.
METHODS: A randomized clinical trial with seventy-eight patients
undergoing coronary artery bypass grafting divided into three groups and
ventilated with different positive-end expiratory pressure levels prior to
extubation: Group A, 5 cm H2O (n=32); Group B, 8 cm H2O (n=26); and Group
C, 10 cm H2O (n=20). Oxygenation index data were obtained from arterial
blood gas samples collected at 1, 3, and 6 h after extubation. Patients
with chronic pulmonary disease and those who underwent off-pump,
emergency, or combined surgeries were excluded. For statistical analysis,
we used Shapiro-Wilk, G, Kruskal-Wallis, and analysis of variance tests
and set the level of significance at P<0.05.
RESULTS: Groups were homogenous with regard to demographic, clinical, and
surgical variables. There were no statistically significant differences
between groups in the first 6 h after extubation with regard to
oxygenation indices and oxygen therapy utilization.
CONCLUSION: In this sample of patients undergoing coronary artery bypass
grafting, the use of different positive-end expiratory pressure levels
before extubation did not affect gas exchange or oxygen therapy
utilization in the first 6 h after endotracheal tube removal.
<72>
Accession Number
616105917
Author
Borgermann J.; Holzhey D.M.; Thielmann M.; Girdauskas E.; Schroefel H.;
Hofmann S.; Treede H.; Matschke K.; Hilker M.; Strauch J.T.; Carrel T.;
Wahlers T.; Diegeler A.; Kempfert J.; Walther T.
Institution
(Borgermann) Clinic for Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
(Holzhey) Department of Cardiac Surgery, Heart Center Leipzig University,
Leipzig, Germany
(Thielmann) Department of Thoracic and Cardiovascular Surgery, West-German
Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
(Girdauskas) Department of Cardiac Surgery, Central Hospital Bad Berka,
Bad Berka, Germany
(Girdauskas, Treede) Department of Cardiovascular Surgery, University
Heart Center Hamburg, Hamburg, Germany
(Schroefel) Clinic for Cardiac Surgery, Karlsruhe, Germany
(Schroefel) Department of Cardiovascular Surgery, Heart Center Freiburg,
Bad Krozingen, Germany
(Hofmann) Schuchtermann-Schiller'sche Kliniken GmbH, Bad Rothenfelde,
Germany
(Treede) Department of Cardiac Surgery, Mid-German Heart Center,
University Hospital Halle, Halle, Germany
(Matschke) Department of Cardiac Surgery, University Heart Center Dresden,
Dresden, Germany
(Hilker) Department of Cardiothoracic Surgery, University Medical Center
Regensburg, Regensburg, Germany
(Strauch) Department of Cardiac and Thoracic Surgery, BG University
Hospital Bergmannsheil, Bochum, Germany
(Carrel) Clinic for Cardiovascular Surgery, Inselspital, Bern University
Hospital and University of Bern, Bern, Switzerland
(Wahlers) Department of Cardiothoracic Surgery, Heart Center, University
of Cologne, Cologne, Germany
(Diegeler) Department of Cardiovascular Surgery, Herz-und Gefassklinik Bad
Neustadt, Bad Neustadt a. d. Saale, Germany
(Kempfert) Department of Cardiac Surgery, KerckhoffHeart and Lung Center,
Bad Nauheim, Germany
(Kempfert, Walther) Department of Cardiovascular and Thoracic Surgery,
Deutsches Herzzentrum Berlin, Berlin, Germany
Title
Transcatheter aortic valve implantation using the ACURATE TA<sup>TM</sup>
system: 1-year outcomes and comparison of 500 patients from the SAVI
registries.
Source
European Journal of Cardio-thoracic Surgery. 51 (5) (pp 936-942), 2017.
Article Number: ezw423. Date of Publication: 01 May 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The ACURATE TA<sup>TM</sup> system is a self-expanding
transcatheter heart valve system designed for transapical access which has
been proven to be safe and effective in the controlled setting of clinical
trials. The SAVI-1 and SAVI-2 registries aimed to assess whether these
promising outcomes can be translated into all-comers clinical routine.
METHODS: From November 2011 to 2012 (SAVI-1), and November 2013 to 2014
(SAVI-2), a total of 500 patients were enrolled in the prospective,
all-comers, multicentre, multinational SAVI registries. Patients were
treated according to the standard of care at their respective hospitals.
We report and compare 30-day and 1-year clinical outcomes between SAVI-1
and -2. RESULTS: Patients were 80.8 +/- 6.1 years old, the mean logistic
EuroSCORE-I was 23.4 +/- 14.3%. Valves were deployed under rapid pacing in
71.3% of the procedures in SAVI-1, and in 3.6% in SAVI-2. There was no
relevant difference in clinical and echocardiographic outcomes between
SAVI-1 and SAVI-2. Overall mortality at 30 days and 1 year was 6.8% and
19.9%, the stroke rate was 2.2% and 3.7%, respectively; 10.2% of patients
had received a permanent pacemaker, and no transcatheter valve-related
complications after discharge were observed. Paravalvular leakage >2+ was
reported in 1.9% of the patients at the early follow-up, and in 2.6% at
the 1-year follow-up. CONCLUSIONS: The SAVI-registries have confirmed that
transapical implantation using the ACURATE TA<sup>TM</sup> device is safe
and effective in an all-comers setting with low complication rates and
stable performance outcomes at short-term and 1 year; outcomes were
similar between SAVI-1 and -2.<br/>Copyright © The Author 2017.
Published by Oxford University Press. All rights reserved.
<73>
Accession Number
616105914
Author
Bonaros N.; Petzina R.; Cocchieri R.; Jagielak D.; Aiello M.; Lapeze J.;
Laine M.; Chocron S.; Muir D.; Eichinger W.; Thielmann M.; Labrousse L.;
Bapat V.; Rein K.A.; Verhoye J.P.; Gerosa G.; Baumbach H.; Kofler M.;
Bramlage P.; Deutsch C.; Thoenes M.; Frank D.; Romano M.
Institution
(Bonaros, Kofler) Department of Cardiac Surgery, Medical University
Innsbruck, Innsbruck, Austria
(Petzina) Department of Cardiovascular Surgery, University Hospital
Schleswig-Holstein, Kiel, Germany
(Cocchieri) Heart Center, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Jagielak) Department of Cardiac and Vascular Surgery, Medical University
of Gdansk, Gdansk, Poland
(Aiello) Department of Cardiothoracic Surgery, Foundation IRCCS
Policlinico S. Matteo, Pavia, Italy
(Lapeze) Department of Cardivascular Surgery, Hospital Louis Pradel, Lyon,
France
(Laine) Division of Cardiology, Helsinki University Central Hospital,
Helsinki, Finland
(Chocron) Cardiothoracic Surgery, Hospital Jean Minjoz, University
Hospital of Besancon, Besancon, France
(Muir) Cardiothoracic Division, James Cook Hospital, Middlesbrough, United
Kingdom
(Eichinger) Department of Cardiothoracic Surgery, Klinikum Bogenhausen,
Munich, Germany
(Thielmann) Department of Thoracic and Cardiovascular Surgery, University
Hospital Essen, Essen, Germany
(Labrousse) Department of Cardiovascular Surgery, CHU Hospital of
Bordeaux, Bordeaux, France
(Bapat) St. Thomas' Hospital, London, United Kingdom
(Rein) Department of Cardiothoracic Surgery, Rikshospital Oslo, Oslo,
Norway
(Verhoye) Department of Cardiovascular Surgery, CHU Rennes, Rennes, France
(Gerosa) Department of Cardiac Surgery, University of Padova, Padova,
Italy
(Baumbach) Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus
Stuttgart, Stuttgart, Germany
(Bramlage, Deutsch) Institute for Pharmacology and Preventive Medicine,
Cloppenburg, Germany
(Thoenes) Edwards Lifesciences, Medical Affairs/Professional Education,
Nyon, Switzerland
(Frank) Department of Internal Medicine III, GBRSH, Campus Kiel, Germany
(Romano) Institut Hospitalier Jacques Cartier, Massy, France
Title
Transaortic transcatheter aortic valve implantation as a first-line choice
or as a last resort? An analysis based on the ROUTE registry.
Source
European Journal of Cardio-thoracic Surgery. 51 (5) (pp 919-926), 2017.
Article Number: ezw406. Date of Publication: 01 May 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Objectives: Transaortic transcatheter aortic valve implantation (TAo-TAVI)
is a recently developed alternative to transapical (TA) or transfemoral
(TF) TAVI. We aimed to analyse the effectiveness and safety of TAo-TAVI as
a first line approach and to compare it to patients receiving TAo-TAVI as
a last resort, which is current practice. Methods: ROUTE is a prospective,
multicentre registry to assess the clinical outcomes of TAo-TAVI. Patients
without contraindications for TA- and TF-TAVI (TAo-first) were compared to
patients with contraindications for both of these access routes
(TAo-last). Outcome analysis was based on VARC II defined clinical
end-points. ResultS: Three hundred and one patients were included, of
which 224 patients met TAo-first and 77 TAo-last criteria. The valve was
delivered and catheter retrieved successfully in all patients. In the
TAo-first group, rates of conversion to open surgery and requirement for a
second valve were low and not different compared to TAo-last patients (1%
vs. 3%, P = 0.46 and 1% vs. 3%, P = 0.46, respectively). This was also
true for the rate of paravalvular regurgitation (>moderate: 4% vs. 3%).
All-cause mortality at 30-days was 6% vs. 5% (P = 0.76), rates of stroke
2% vs. 0% (P = 0.24), pacemaker implantation (11% vs. 4%, P = 0.093), and
life-threatening bleeding 4% vs. 3% (P = 0.70). Valve safety (both 85%, P
= 0.98) and clinical efficacy (80% vs. 82%; P = 0.73) did not differ
between groups. Conclusions: Although comparative data to TA and TF
procedures were not available in the present analysis, findings suggest
that TAo may be considered not only as a last resort strategy when
classical access routes are deemed unfeasible, but also as a potential
first-line option, with only low rates of paravalvular regurgitation and
permanent pacemaker implantation. Clinicaltrials.gov:
NCT01991431.<br/>Copyright © The Author 2017. Published by Oxford
University Press. All rights reserved.
<74>
Accession Number
616105905
Author
Bosseau C.; Lelong B.; Pattier S.; Trochu J.-N.; Roussel J.-C.; Sirinelli
A.; Aupartd M.; Chabanne C.; Dorente R.; Cantrellee C.; Mabo P.; Leclercqa
C.; Verhoye J.-P.; Flecherb E.
Institution
(Bosseau, Aupartd, Dorente, Cantrellee, Mabo, Leclercqa) Department of
Cardiology and CIC-IT 804, CHU Rennes, France
(Lelong, Chabanne, Verhoye, Flecherb) Department of Cardiac Surgery and
Heart Transplantation Unit, CHU Rennes, France
(Pattier, Trochu, Roussel) Department of Cardiology and Heart
Transplantation Unit, CHU Nantes, France
(Sirinelli) French Biomedicine Agency-Agence de la Biome decine,
Saint-Denis, France
Title
Heart transplantation in selected patients aged 60 years and older: A
two-decade retrospective and multicentre analysis.
Source
European Journal of Cardio-thoracic Surgery. 51 (5) (pp 893-901), 2017.
Article Number: ezx040. Date of Publication: 01 May 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: This study analysed survival and long-term outcomes of heart
transplantation in patients aged 60 years and older. We also analysed the
impact of a national graft allocation priority [Super Emergency (SE)] and
compared survival with younger patients in our centres and in France.
METHODS: We performed a multicentre (University Hospitals in Nantes,
Rennes and Tours), 2-decade retrospective study between 1 January 1994 and
31 December 2013. Elderly recipients were placed on the same list as
younger patients; the use of marginal donors remained occasional. RESULTS:
A total of 212 patients aged between 60 and 68 years were included. The
1-, 5-, and 10-year survival rates were 83.2%, 77.4% and 63.8%,
respectively, which were significantly worse than those of recipients aged
>60 years (1-, 5-, and 10-year survival rates of 87.3%, 80.4% and 68.0%,
respectively). The postoperative course was acceptable. The main cause of
death was malignancy (29.8% in our cohort). Survival was similar between
the first and second decades and among the SE group. Our population
exhibited better survival than patients >60 years transplanted in France
during the same period with 1-, 5-, and 10-year survival rates of 76.8%,
68.0% and 56.3%, respectively. Predictors of survival in the multivariate
analysis included ischaemic cardiomyopathy [hazard ratio (HR) 4.1] and
postoperative complications, such as dialysis (HR 9.5) and mechanical
circulatory support (HR 4.2). CONCLUSIONS: We report positive
postoperative course and long-term outcomes after heart transplantation in
older recipients using conventional donors. Our satisfactory outcomes may
be explained by the stringent selection of recipients combined with
regular follow-up.<br/>Copyright © The Author 2017. Published by
Oxford University Press. All rights reserved.
<75>
Accession Number
616123710
Author
Abawi M.; Agostoni P.; Kooistra N.H.M.; Samim M.; Nijhoff F.; Voskuil M.;
Nathoe H.; Doevendans P.A.; Chamuleau S.A.; Urgel K.; Hendrikse J.; Leiner
T.; Abrahams A.C.; van der Worp B.; Stella P.R.
Institution
(Abawi, Agostoni, Kooistra, Nijhoff, Voskuil, Nathoe, Doevendans,
Chamuleau, Urgel, Stella) Department of Cardiology, University Medical
Centre Utrecht, Utrecht, Netherlands
(Agostoni, Samim) Department of Cardiology, St. Antonius Hospital,
Nieuwegein, Netherlands
(Hendrikse, Leiner) Department of Radiology, University Medical Centre
Utrecht, Utrecht, Netherlands
(Abrahams) Department of Nephrology and Hypertension, University Medical
Centre Utrecht, Utrecht, Netherlands
(van der Worp) Department of Neurology, University Medical Centre Utrecht,
Utrecht, Netherlands
Title
Rationale and design of the edwards SAPIEN-3 periprosthetic leakage
evaluation versus medtronic corevalve in transfemoral aortic valve
implantation (ELECT) trial: A randomised comparison of balloon-expandable
versus self-expanding transcatheter aortic valve prostheses.
Source
Netherlands Heart Journal. 25 (5) (pp 318-329), 2017. Date of Publication:
May 2017.
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Background and objectives Periprosthetic aortic regurgitation (PPR) after
transcatheter aortic valve implantation (TAVI) remains an important issue
associated with impaired long-term outcomes. The current randomised study
aims to evaluate potential differences between the balloon-expandable
Edwards SAPIEN-3 and the self-expanding Medtronic CoreValve system with
the main focus on post-TAVI PPR by means of novel imaging endpoints, and
an additional focus on other clinical endpoints. Endpoints The primary
endpoint of this study is quantitative assessment of the severity of
post-procedural PPR using cardiac magnetic resonance imaging. Several
other novel imaging modalities (X-ray contrast angiography,
echocar-diography) are used as secondary imaging modalities for the
assessment of PPR following TAVI. Secondary objectives of the study
include clinical outcomes such as cerebral and kidney injury related to
TAVI, and quality of life. Methods and design The ELECT study is a
single-centre, prospective, two-armed randomised controlled trial. For the
purpose of this study, 108 consecutive adult patients suitable for
transfemoral TAVI will be randomly allocated to receive the SAPIEN-3 (n =
54) or the CoreValve system (n = 54). Discussion The ELECT trial is the
first randomised controlled trial to quantitatively compare the extent of
post-TAVI PPR between the SAPIEN-3 and CoreValve. Furthermore, it will
evaluate potential differences between the two prostheses with regard to
mid-term clinical outcome and quality of life.<br/>Copyright © The
Author(s) 2017.
<76>
Accession Number
615953753
Author
Wei S.; Chen M.; Chen N.; Liu L.
Institution
(Wei, Chen, Liu) Sichuan University, Department of Thoracic surgery, West
China Hospital, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
(Chen) Guangdong Women and Children Hospital, Center for Reproductive
Medicine, Guangzhou 510010, China
(Wei, Chen, Liu) Sichuan University, Western China Collaborative
Innovation Center for Early Diagnosis, Multidisciplinary Therapy of Lung
Cancer, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
Title
Feasibility and safety of robot-assisted thoracic surgery for lung
lobectomy in patients with non-small cell lung cancer: A systematic review
and meta-analysis.
Source
World Journal of Surgical Oncology. 15 (1) (no pagination), 2017. Article
Number: 98. Date of Publication: 08 May 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The aim of this study is to evaluate the feasibility and
safety of robot-assisted thoracic surgery (RATS) lobectomy versus
video-assisted thoracic surgery (VATS) for lobectomy in patients with
non-small cell lung cancer (NSCLC). Methods: An electronic search of six
electronic databases was performed to identify relevant comparative
studies. Meta-analysis was performed by pooling the results of reported
incidence of overall morbidity, mortality, prolonged air leak, arrhythmia,
and pneumonia between RATS and VATS lobectomy. Subgroup analysis was also
conducted based on matched and unmatched cohort studies, if possible.
Relative risks (RR) with their 95% confidence intervals (CI) were
calculated by means of Revman version 5.3. Results: Twelve retrospective
cohort studies were included, with a total of 60,959 patients. RATS
lobectomy significantly reduced the mortality rate when compared with VATS
lobectomy (RR = 0.54, 95% CI 0.38-0.77; P=0.0006), but this was not
consistent with the pooled result of six matched studies (RR = 0.12, 95%
CI 0.01-1.07; P=0.06). There was no significant difference in morbidity
between the two approaches (RR = 0.97, 95% CI 0.85-1.12; P=0.70).
Conclusions: RATS lobectomy is a feasible and safe technique and can
achieve an equivalent short-term surgical efficacy when compared with
VATS, but its cost effectiveness also should be taken into
consideration.<br/>Copyright © 2017 The Author(s).
<77>
Accession Number
616133266
Author
Schmidt T.; Pargger H.; Seeberger E.; Eckhart F.; von Felten S.; Haberthur
C.
Institution
(Schmidt, Eckhart, Haberthur) Department for Anesthesia, Intensive Care
Medicine and Rescue Medicine, Lucerne Cantonal Hospital, Lucerne,
Switzerland
(Pargger, Seeberger) Department of Anesthesiology, Operative Intensive
Care, Preclinical Emergency Medicine and Pain Management, University
Hospital Basel, Switzerland
(von Felten) Department of Clinical Research, Clinical Trial Unit,
University Hospital Basel, Switzerland
(Haberthur) Department of Anesthesiology and Intensive Care Medicine,
Hirslanden Clinic, Zurich, Switzerland
Title
Effect of high-dose sodium selenite in cardiac surgery patients: A
randomized controlled bi-center trial.
Source
Clinical Nutrition. (no pagination), 2017. Date of Publication: January
24, 2017.
Publisher
Churchill Livingstone
Abstract
Background & aims: Cardiac surgery is accompanied by oxidative stress and
systemic inflammatory response, which may be associated with organ
dysfunction and increased mortality. Selenium and selenoenzymes are
important constituents of anti-oxidative defense. We hypothesized that
high-dose sodium selenite supplementation can attenuate the postoperative
inflammation and might, therefore, improve clinical outcome. Methods:
Randomized, placebo-controlled, double-blinded, bi-center study on 411
adult patients undergoing elective cardiac surgery. Patients received an
intravenous bolus of 4000 mug selenium (in the form of sodium selenite) or
placebo after induction of anesthesia and 1000 mug/d selenium or placebo
during their intensive care unit (ICU) stay. Primary outcome measure was
the Sequential Organ Failure Assessment (SOFA) score on the second
postoperative day. Secondary endpoints included the change in
perioperative selenium levels, change of inflammatory and cardiac markers,
use of vasoactive medication, incidence of acute kidney injury, ICU and
hospital length of stay, and mortality. Results: The perioperative
administration of high-dose sodium selenite prevented the postoperative
drop of blood and serum selenium levels, reduced the number of patients
depending on postoperative vasoactive support but failed to reduce the
postoperative SOFA score and its related organ-specific scores compared to
placebo. Except for an increase of postoperative procalcitonin and
bilirubin levels in the sodium selenite group, other inflammatory markers,
organ function variables and clinical endpoints remained unchanged.
Conclusions: The perioperative administration of high-dose sodium selenite
in cardiac surgery patients prevented the postoperative fall of blood
selenium levels and reduced the need for postoperative vasoactive support
by a yet unknown mechanism. Trial registration: Registered under
ClinicalTrials.gov Identifier no. NCT01141556.<br/>Copyright © 2017
Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.
<78>
Accession Number
616133199
Author
Jahangirifard A.; Razavi M.R.; Ahmadi Z.H.; Forozeshfard M.
Institution
(Jahangirifard) Cardiac Anesthesiology Tracheal Diseases Research Center
NRITLD Shaheed Beheshti University of Medical Sciences Tehran Iran
(Razavi) Nursing Care Research Center Semnan University of Medical
Sciences Semnan Iran
(Ahmadi) Department of Surgery Masih Daneshvari Hospital Shaheed Beheshti
University of Medical Sciences Tehran Iran
(Forozeshfard) Cancer Research Center and Department of Anesthesiology
Semnan University of Medical Sciences Semnan Iran
Title
Effect of Desmopressin on the Amount of Bleeding and Transfusion
Requirements in Patients Undergoing Heart Transplant Surgery.
Source
Basic and Clinical Pharmacology and Toxicology. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
One of the most common risks after a heart transplant is bleeding. In this
study, the effect of desmopressin administration on the amount of bleeding
and transfusion requirements after heart transplant surgery was
investigated. In a double-blind clinical trial, 48 patients who were
candidates for heart transplant surgery were randomly assigned to two
groups. In the intervention group, patients received desmopressin of 0.3
mug/kg, 30 min. before surgery. Patients in the control group received
normal saline at the same amount and time. Homeostasis was evaluated using
activated clotting time (ACT), PT, PTT and PLT before, 12 and 24 hr after
surgery, and also, chest tube drainage, blood products transfusion
requirements during the first day in both groups. No significant
differences were found between the groups in terms of ACT, PT, PTT and PLT
at all times. Transfusion of packed red blood cells and the mean drainages
of chest tube during the first 24 hr after surgery were significantly
lower in the desmopressin group compared to the saline group. Desmopressin
may reduce post-operative bleeding in patients undergoing heart transplant
surgery. Further studies are required to confirm the potential effect of
desmopressin on establishing haemostasis after heart
transplantation.<br/>Copyright © 2017 Nordic Pharmacological Society.
<79>
Accession Number
616132945
Author
Pagnesi M.; Montalto C.; Mangieri A.; Agricola E.; Puri R.; Chiarito M.;
Ancona M.B.; Regazzoli D.; Testa L.; De Bonis M.; Moat N.E.; Rodes-Cabau
J.; Colombo A.; Latib A.
Institution
(Pagnesi, Montalto, Mangieri, Ancona, Regazzoli, Colombo, Latib)
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan,
Italy
(Agricola) Echocardiography Laboratory, San Raffaele Scientific Institute,
Milan, Italy
(Puri, Rodes-Cabau) Quebec Heart and Lung Institute, Laval University,
Quebec City, Canada
(Chiarito) Division of Clinical and Interventional Cardiology, Humanitas
Research Hospital, Milan, Italy
(Testa) Department of Cardiology, IRCCS Policlinico San Donato, Milan,
Italy
(De Bonis) Department of Cardiovascular and Thoracic Surgery, San Raffaele
Scientific Institute, Milan, Italy
(Moat) Department of Cardiothoracic Surgery, Royal Brompton Hospital,
London, United Kingdom
(Colombo) Vita-Salute San Raffaele University, Milan, Italy
(Colombo, Latib) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, Milan, Italy
Title
Tricuspid annuloplasty versus a conservative approach in patients with
functional tricuspid regurgitation undergoing left-sided heart valve
surgery: A study-level meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: April 04, 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Tricuspid valve (TV) repair at the time of left-sided valve
surgery is indicated in patients with either severe functional tricuspid
regurgitation (TR) or mild-to-moderate TR with coexistent tricuspid
annular dilation or right heart failure. We assessed the benefits of a
concomitant TV repair strategy during left-sided surgical valve
interventions, focusing on mortality and echocardiographic TR-related
outcomes. Methods: A meta-analysis was performed of studies reporting
outcomes of patients who underwent left-sided (mitral and/or aortic) valve
surgery with or without concomitant TV repair. Primary endpoints were
all-cause and cardiac-related mortality; secondary endpoints were the
presence of more-than-moderate TR, TR progression, and TR severity grade.
All endpoints were evaluated at the longest available follow-up. Results:
Fifteen studies were included for a total of 2840 patients. TV repair at
the time of left-sided valve surgery was associated with a significantly
lower risk of cardiac-related mortality (odds ratio [OR] 0.38; 95%
confidence interval [CI]: 0.25-0.58; p. <. 0.001), with a trend towards a
lower risk of all-cause mortality (OR 0.57; 95% CI: 0.32-1.05; p = 0.07)
at a mean weighted follow-up of 6. years. The presence of
more-than-moderate TR (OR 0.19; 95% CI: 0.12-0.30; p. <. 0.001), TR
progression (OR 0.03; 95% CI: 0.01-0.05; p. <. 0.001), and TR grade
(standardized mean difference -1.11; 95% CI: -1.57 to -0.65; p. <. 0.001)
were significantly lower in the TV repair group at a mean weighted
follow-up of 4.7. years. Conclusions: A concomitant TV repair strategy
during left-sided valve surgery is associated with a reduction in
cardiac-related mortality and improved echocardiographic TR outcomes at
follow-up.<br/>Copyright © 2017 Elsevier Ireland Ltd.
<80>
Accession Number
608849690
Author
Martindale J.L.; Wakai A.; Collins S.P.; Levy P.D.; Diercks D.; Hiestand
B.C.; Fermann G.J.; Desouza I.; Sinert R.
Institution
(Martindale, Desouza, Sinert) Department of Emergency Medicine, SUNY
Downstate Medical Center, New York, NY, United States
(Wakai, Sinert) Emergency Care Research Unit, Royal College of Surgeons in
Ireland, Dublin, Ireland
(Collins) Department of Emergency Medicine, Vanderbilt University,
Nashville, TN, United States
(Levy) Department of Emergency Medicine, Wayne State University, School of
Medicine, Detroit, MI, United States
(Diercks) Department of Emergency Medicine, University of Texas
Southwestern, Dallas, TX, United States
(Hiestand) Department of Emergency Medicine, Wake Forest University,
School of Medicine, Winston-Salem, NC, United States
(Fermann) Department of Emergency Medicine, University of Cincinnati,
Cincinnati, OH, United States
Title
Diagnosing Acute Heart Failure in the Emergency Department: A Systematic
Review and Meta-analysis.
Source
Academic Emergency Medicine. 23 (3) (pp 223-242), 2016. Date of
Publication: 01 Mar 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background Acute heart failure (AHF) is one of the most common diagnoses
assigned to emergency department (ED) patients who are hospitalized.
Despite its high prevalence in the emergency setting, the diagnosis of AHF
in ED patients with undifferentiated dyspnea can be challenging.
Objectives The primary objective of this study was to perform a systematic
review and meta-analysis of the operating characteristics of diagnostic
elements available to the emergency physician for diagnosing AHF.
Secondary objectives were to develop a test-treatment threshold model and
to calculate interval likelihood ratios (LRs) for natriuretic peptides
(NPs) by pooling patient-level results. Methods PubMed, EMBASE, and
selected bibliographies were searched from January 1965 to March 2015
using MeSH terms to address the ability of the following index tests to
predict AHF as a cause of dyspnea in adult patients in the ED: history and
physical examination, electrocardiogram, chest radiograph (CXR), B-type
natriuretic peptide (BNP), N-terminal proB-type natriuretic peptide
(NT-proBNP), lung ultrasound (US), bedside echocardiography, and
bioimpedance. A diagnosis of AHF based on clinical data combined with
objective test results served as the criterion standard diagnosis. Data
were analyzed using Meta-DiSc software. Authors of all NP studies were
contacted to obtain patient-level data. The Quality Assessment Tool for
Diagnostic Accuracy Studies-2 (QUADAS-2) for systematic reviews was
utilized to evaluate the quality and applicability of the studies
included. Results Based on the included studies, the prevalence of AHF
ranged from 29% to 79%. Index tests with pooled positive LRs > 4 were the
auscultation of S3 on physical examination (4.0, 95% confidence interval
[CI] = 2.7 to 5.9), pulmonary edema on both CXR (4.8, 95% CI = 3.6 to 6.4)
and lung US (7.4, 95% CI = 4.2 to 12.8), and reduced ejection fraction
observed on bedside echocardiogram (4.1, 95% CI = 2.4 to 7.2). Tests with
low negative LRs were BNP < 100 pg/mL (0.11, 95% CI = 0.07 to 0.16),
NT-proBNP < 300 pg/mL (0.09, 95% CI = 0.03 to 0.34), and B-line pattern on
lung US LR (0.16, 95% CI = 0.05 to 0.51). Interval LRs of BNP
concentrations at the low end of "positive" results as defined by a cutoff
of 100 pg/mL were substantially lower (100 to 200 pg/mL; 0.29, 95% CI =
0.23 to 0.38) than those associated with higher BNP concentrations (1000
to 1500 pg/mL; 7.12, 95% CI = 4.53 to 11.18). The interval LR of NT-proBNP
concentrations even at very high values (30,000 to 200,000 pg/mL) was 3.30
(95% CI = 2.05 to 5.31). Conclusions Bedside lung US and echocardiography
appear to the most useful tests for affirming the presence of AHF while
NPs are valuable in excluding the diagnosis.<br/>Copyright © 2016 by
the Society for Academic Emergency Medicine.
<81>
Accession Number
614924738
Author
Dieleman J.M.; de Wit G.A.; Nierich A.P.; Rosseel P.M.; van der Maaten
J.M.; Hofland J.; Diephuis J.C.; de Lange F.; Boer C.; Neslo R.E.; Moons
K.G.; van Herwerden L.A.; Tijssen J.G.; Kalkman C.J.; van Dijk D.
Institution
(Dieleman, Kalkman, van Dijk) Department of Anesthesiology and Intensive
Care, University Medical Center, Utrecht, Netherlands
(de Wit, Neslo, Moons) Julius Center for Health Sciences and Primary Care,
University Medical Center, Utrecht, Netherlands
(Nierich) Department of Cardiothoracic Anesthesia, Isala Klinieken,
Zwolle, Netherlands
(Rosseel) Department of Cardiothoracic Anesthesia, Amphia Ziekenhuis,
Breda, Netherlands
(van der Maaten) Department of Anesthesiology, University Medical Center,
Groningen, Netherlands
(Hofland) Department of Cardiothoracic Anesthesia, Erasmus Medical Center,
Rotterdam, Netherlands
(Diephuis) Department of Cardiothoracic Anesthesia, Medisch Spectrum
Twente, Enschede, Netherlands
(de Lange) Department of Cardiothoracic Anesthesia, Medical Center,
Leeuwarden, Netherlands
(Boer) Department of Anesthesiology, Vrije Universiteit University Medical
Center, Amsterdam, Netherlands
(van Herwerden) Department of Cardiothoracic Surgery, University Medical
Center, Utrecht, Netherlands
(Tijssen) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
Title
Long-term outcomes and cost effectiveness of high-dose dexamethasone for
cardiac surgery: a randomised trial.
Source
Anaesthesia. 72 (6) (pp 704-713), 2017. Date of Publication: June 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Prophylactic intra-operative administration of dexamethasone may improve
short-term clinical outcomes in cardiac surgical patients. The purpose of
this study was to evaluate long-term clinical outcomes and cost
effectiveness of dexamethasone versus placebo. Patients included in the
multicentre, randomised, double-blind, placebo-controlled DExamethasone
for Cardiac Surgery (DECS) trial were followed up for 12 months after
their cardiac surgical procedure. In the DECS trial, patients received a
single intra-operative dose of dexamethasone 1 mg.kg<sup>-1</sup> (n =
2239) or placebo (n = 2255). The effects on the incidence of major
postoperative events were evaluated. Also, overall costs for the 12-month
postoperative period, and cost effectiveness, were compared between
groups. Of 4494 randomised patients, 4457 patients (99%) were followed up
until 12 months after surgery. There was no difference in the incidence of
major postoperative events, the relative risk (95%CI) being 0.86
(0.72-1.03); p = 0.1. Treatment with dexamethasone reduced costs per
patient by 921 [1084] (95%CI -1672 to -137; p = 0.02), mainly through
reduction of postoperative respiratory failure and duration of
postoperative hospital stay. The probability of dexamethasone being cost
effective compared with placebo was 97% at a threshold value of 17,000
[20,000] per quality-adjusted life year. We conclude that intra-operative
high-dose dexamethasone did not have an effect on major adverse events at
12 months after cardiac surgery, but was associated with a reduction in
costs. Routine dexamethasone administration is expected to be cost
effective at commonly accepted threshold levels for cost
effectiveness.<br/>Copyright © 2017 The Association of Anaesthetists
of Great Britain and Ireland
<82>
Accession Number
613258788
Author
Gonska B.; Seeger J.; Baarts J.; Rodewald C.; Scharnbeck D.; Rottbauer W.;
Wohrle J.
Institution
(Gonska, Seeger, Baarts, Rodewald, Scharnbeck, Rottbauer, Wohrle)
Department of Internal Medicine II - Cardiology, University of Ulm, Ulm
89081, Germany
Title
The balloon-expandable Edwards Sapien 3 valve is superior to the
self-expanding Medtronic CoreValve in patients with severe aortic stenosis
undergoing transfemoral aortic valve implantation.
Source
Journal of Cardiology. 69 (6) (pp 877-882), 2017. Date of Publication:
June 2017.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Residual paravalvular moderate or severe aortic regurgitation
(AR) has been an independent risk factor for mortality after transcatheter
aortic valve implantation (TAVI). The design of the third generation
Edwards Sapien 3 (ES3; Edwards Lifesciences, Irvine, CA, USA) valve was
optimized with an outer skirt to address the issue of paravalvular AR.
Methods and results We compared 100 consecutive patients treated with the
ES3 for severe aortic stenosis with 100 patients treated with the
Medtronic CoreValve (CV; Medtronic, Minneapolis, MN, USA) (Clinical Trial
Registration: NCT02162069). We evaluated post-procedural AR, rate of
permanent pacemaker implantation, device success, and 30-day clinical
outcome according to the criteria of the Second Valve Academic Research
Consortium (VARC-2). Frequency of post-procedural moderate or severe AR
was significantly lower with ES3 compared to CV (0% vs. 20%, p < 0.01),
none or trace AR significantly higher with ES3 (69% vs. 38%, p < 0.01) as
well as device success (97% vs. 73%, p < 0.01). There was a significantly
lower need for permanent pacemaker implantation with ES3 compared with CV
(14% vs. 31%, p < 0.01). Cardiovascular mortality at 30 days was
significantly lower with ES3 (0% vs. 6%, p = 0.01), and the combined
endpoint "early safety" was met significantly less with ES3 (10% vs. 21%
with CV, p = 0.03). Conclusions Transfemoral TAVI with the ES3 compared
with the CV was associated with a significantly lower rate of moderate or
severe AR, significantly lower need for pacemaker implantation, and a
significantly higher rate of device success according to
VARC-2.<br/>Copyright © 2016 Japanese College of Cardiology
<83>
Accession Number
615266779
Author
Sardar P.; Giri J.; Elmariah S.; Chatterjee S.; Kolte D.; Kundu A.;
Nairooz R.; Aronow W.S.; Owan T.; Mukherjee D.; Feldman D.N.; Abbott J.D.
Institution
(Sardar, Owan) Division of Cardiovascular Medicine, University of Utah,
Salt Lake City, Utah, United States
(Giri) Cardiovascular Division, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, United States
(Elmariah) Cardiology Division, Department of Medicine, Massachusetts
General Hospital, Harvard Medical School, Boston, Massachusetts, United
States
(Chatterjee) Cardiology Division, Temple University School of Medicine,
Philadelphia, Pennsylvania, United States
(Kolte, Abbott) Division of Cardiology, Brown Medical School, Rhode Island
Hospital, Providence, Rhode Island, United States
(Kundu) Department of Medicine, University of Massachusetts Medical
School, Worcester, Massachusetts, United States
(Nairooz) Division of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, Little Rock, Arizona, United States
(Aronow) Division of Cardiovascular Medicine, Westchester Medical
Center-New York Medical College, New York, New York, United States
(Mukherjee) Division of Cardiovascular Medicine, Texas Tech University
Health Sciences Center, El Paso, Texas, United States
(Feldman) Division of Cardiology, Weill Cornell Medical College, New York
Presbyterian Hospital, New York, New York, United States
Title
Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass
Grafting in Unprotected Left Main Coronary Narrowing.
Source
American Journal of Cardiology. 119 (11) (pp 1746-1752), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with unprotected left main coronary artery (ULMCA) disease are
increasingly treated with percutaneous coronary intervention (PCI) using
new-generation drug-eluting stents (DES); however, the benefits of DES
compared with coronary artery bypass grafting (CABG) in ULMCA remain
controversial. This meta-analysis evaluated the effects of PCI with DES
compared with CABG for the treatment of ULMCA stenosis. Databases were
searched through November 30, 2016. Randomized controlled trials (RCTs)
comparing DES with PCI versus CABG for ULMCA stenosis were identified. We
calculated summary odds ratios (ORs) and 95% CIs with the random-effects
model. The primary outcome was major adverse cardiovascular events,
defined as a composite of death from any cause, stroke, or myocardial
infarction (MI). The analysis included 4,612 patients from 5 RCTs.
Compared with CABG, patients assigned to PCI had a similar rate of major
adverse cardiovascular events (OR 1.06, 95% CI 0.79 to 1.43), all-cause
mortality (OR 1.03, 95% CI 0.79 to 1.35), cardiovascular death (OR 1.03,
95% CI 0.73 to 1.45), stroke (OR 0.81, 95% CI 0.38 to 1.76), and MI (OR
1.47, 95% CI 0.87 to 2.47). The risk of any repeat revascularization was
significantly greater in the PCI group than that in the CABG group (OR
1.85, 95% CI 1.53 to 2.24). In conclusion, our meta-analysis of RCTs
suggest that PCI with DES results in comparable mortality, stroke, and MI
compared with CABG for revascularization of ULMCA stenosis, with PCI
associated with higher rates of repeat revascularization.<br/>Copyright
© 2017 Elsevier Inc.
<84>
Accession Number
615207343
Author
Anderson L.; Nguyen T.T.; Dall C.H.; Burgess L.; Bridges C.; Taylor R.S.
Institution
(Anderson, Nguyen, Taylor) University of Exeter Medical School, Institute
of Health Research, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG,
United Kingdom
(Dall) Bispebjerg Hospital, University of Copenhagen, Dept. of Cardiology,
Dept. of Physical Therapy and IOC Sports Institute Copenhagen, Bispebjerg
Bakke 23, Copenhagen, Denmark
(Burgess) Wythenshawe Hospital, University Hospital of South Manchester
NHS Foundation Trust, Cardiac Rehabilitation, Manchester, United Kingdom
(Bridges) University College London, Farr Institute of Health Informatics
Research, 222 Euston Road, London NW1 2DA, United Kingdom
Title
Exercise-based cardiac rehabilitation in heart transplant recipients.
Source
Cochrane Database of Systematic Reviews. 2017 (4) (no pagination), 2017.
Article Number: CD012264. Date of Publication: 04 Apr 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Heart transplantation is considered to be the gold standard
treatment for selected patients with end-stage heart disease when medical
therapy has been unable to halt progression of the underlying pathology.
Evidence suggests that aerobic exercise training may be effective in
reversing the pathophysiological consequences associated with cardiac
denervation and prevent immunosuppression-induced adverse effects in heart
transplant recipients. Objectives: To determine the effectiveness and
safety of exercise-based rehabilitation on the mortality, hospital
admissions, adverse events, exercise capacity, health-related quality of
life, return to work and costs for people after heart transplantation.
Search methods: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL) in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid),
CINAHL (EBSCO) and Web of Science Core Collection (Thomson Reuters) to
June 2016. We also searched two clinical trials registers and handsearched
the reference lists of included studies. Selection criteria: We included
randomised controlled trials (RCTs) of parallel group, cross-over or
cluster design, which compared exercise-based interventions with (i) no
exercise control (ii) a different dose of exercise training (e.g. low-
versus high-intensity exercise training); or (iii) an active intervention
(i.e. education, psychological intervention). The study population
comprised adults aged 18 years or over who had received a heart
transplant. Data collection and analysis: Two review authors independently
screened all identified references for inclusion based on pre-specified
inclusion criteria. Disagreements were resolved by consensus or by
involving a third person. Two review authors extracted outcome data from
the included trials and assessed their risk of bias. One review author
extracted study characteristics from included studies and a second author
checked them against the trial report for accuracy. Main results: We
included 10 RCTs that involved a total of 300 participants whose mean age
was 54.4 years. Women accounted for fewer than 25% of all study
participants. Nine trials which randomised 284 participants to receive
exercise-based rehabilitation (151 participants) or no exercise (133
participants) were included in the main analysis. One cross-over RCT
compared high-intensity interval training with continued
moderate-intensity training in 16 participants. We reported findings for
all trials at their longest follow-up (median 12 weeks). Exercise-based
cardiac rehabilitation increased exercise capacity (VO<inf>2peak</inf>)
compared with no exercise control (MD 2.49 mL/kg/min, 95% CI 1.63 to 3.36;
N = 284; studies = 9; moderate quality evidence). There was evidence from
one trial that high-intensity interval exercise training was more
effective in improving exercise capacity than continuous
moderate-intensity exercise (MD 2.30 mL/kg/min, 95% CI 0.59 to 4.01; N =
16; 1 study). Four studies reported health-related quality of life (HRQoL)
measured using SF-36, Profile of Quality of Life in the Chronically Ill
(PLC) and the World Health Organization Quality Of Life (WHOQoL) - BREF.
Due to the variation in HRQoL outcomes and methods of reporting we were
unable to meta-analyse results across studies, but there was no evidence
of a difference between exercise-based cardiac rehabilitation and control
in 18 of 21 HRQoL domains reported, or between high and moderate intensity
exercise in any of the 10 HRQoL domains reported. One adverse event was
reported by one study. Exercise-based cardiac rehabilitation improves
exercise capacity, but exercise was found to have no impact on
health-related quality of life in the short-term (median 12 weeks
follow-up), in heart transplant recipients whose health is stable. There
was no evidence of statistical heterogeneity across trials for exercise
capacity and no evidence of small study bias. The overall risk of bias in
included studies was judged as low or unclear; more than 50% of included
studies were assessed at unclear risk of bias with respect to allocation
concealment, blinding of outcome assessors and declaration of conflicts of
interest. Evidence quality was assessed as moderate according to GRADE
criteria. Authors' conclusions: We found moderate quality evidence
suggesting that exercise-based cardiac rehabilitation improves exercise
capacity, and that exercise has no impact on health-related quality of
life in the short-term (median 12 weeks follow-up), in heart transplant
recipients. Cardiac rehabilitation appears to be safe in this population,
but long-term follow-up data are incomplete and further good quality and
adequately-powered trials are needed to demonstrate the longer-term
benefits of exercise on safety and impact on both clinical and
patient-related outcomes, such as health-related quality of life, and
healthcare costs.<br/>Copyright © 2017 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.
<85>
Accession Number
615933413
Author
Xiong J.; Tang X.; Hu Z.; Nie L.; Wang Y.; Zhao J.
Institution
(Xiong, Nie, Wang, Zhao) Department of Nephrology, Institute of Nephrology
of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military
Medical University, Chongqing, 400037, China
(Tang, Hu) Department of Nephrology, West China Hospital, Sichuan
University, Chengdu 610041, China
Title
The RIFLE versus AKIN classification for incidence and mortality of acute
kidney injury in critical ill patients: A meta-analysis.
Source
Scientific reports. 5 (pp 17917), 2015. Date of Publication: 07 Dec 2015.
Abstract
The sensitivity and accuracy of the Risk/Injury/Failure/Loss/End-stage
(RIFLE) versus acute kidney injury Network (AKIN) criteria for acute
kidney injury (AKI) in critically ill patients remains uncertain.
Therefore, we performed a systematic review and meta-analysis to
investigate the incidence and prognostic value of the RIFLE versus AKIN
criteria for AKI in critically ill patients. Literatures were identified
by searching Medline, Embase, PubMed, and China National Knowledge
Infrastructure (CNKI) database. Nineteen studies with 171,889 participants
were included. The pooled estimates of relative risk (RR) were analyzed.
We found that the RIFLE and AKIN criteria is different for the incidence
of AKI in intensive care unit (ICU) patients (P=0.02, RR=0.88), while not
for cardiac surgery patients (P=0.30, RR=0.93). For AKI-related hospital
mortality, the AKIN criteria did not show a better ability in predicting
hospital mortality in either ICU (P=0.19, RR=1.01) or cardiac surgery
patients (P=0.61, RR=0.98) compared to RIFLE criteria. Our findings
supported that the AKIN criteria can identify more patients in classifying
AKI compared to RIFLE criteria, but not showing a better ability in
predicting hospital mortality. Moreover, both RIFLE and AKIN criteria for
AKI in cardiac surgery patients had better predictive ability compared
with the ICU patients.
<86>
Accession Number
615953729
Author
Mendsaikhan N.; Gombo D.; Lundeg G.; Schmittinger C.; Dunser M.W.
Institution
(Mendsaikhan) Intermed Hospital, Intensive Care and Anesthesiology
Department, Chinggis Avenue 41, Duureg 15, Ulaanbaatar 17040, Mongolia
(Gombo) Mongolian National University of Medical Sciences, Public Health
School, Ulaanbaatar, Mongolia
(Lundeg) Mongolian National University of Medical Sciences, Division of
Emergency Medicine and Anesthesia, Ulaanbaatar, Mongolia
(Schmittinger) Kantonspital Luzern, Department of Anesthesiology, Luzern,
Switzerland
(Dunser) University College of London Hospital, Department of Critical
Care, London NW1 2BU, United Kingdom
Title
Management of potentially life-threatening emergencies at 74 primary level
hospitals in Mongolia: Results of a prospective, observational multicenter
study.
Source
BMC Emergency Medicine. 17 (1) (no pagination), 2017. Article Number: 15.
Date of Publication: 08 May 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: While the capacities to care for and epidemiology of emergency
and critically ill patients have been reported for secondary and tertiary
level hospitals in Mongolia, no data exist for Mongolian primary level
hospitals. Methods: In this prospective, observational multicenter study,
74 primary level hospitals of Mongolia were included. We determined the
capacities of these hospitals to manage medical emergencies. Furthermore,
characteristics of patients presenting with potentially life-threatening
emergencies to these hospitals were evaluated during a 6 month period.
Results: An emergency/resuscitation room was available in 62.2% of
hospitals. One third of the study hospitals had an operation theatre
(32.4%). No hospital ran an intensive care unit or had trained
emergency/critical care physicians or nurses available. Diagnostic
resources were inconsistently available (sonography, 59.5%;
echocardiography, 0%). Basic emergency procedures (wound care, 97.3%;
foreign body removal, 86.5%; oxygen application, 85.2%) were commonly but
advanced procedures (advanced cardiac life support, 10.8%; airway
management, 13.5%; mechanical ventilation, 0%; renal replacement therapy,
0%) rarely available. During 6 months, 14,545 patients were hospitalized
in the 74 study hospitals, of which 8.7% [n = 1267; median age, 34 (IQR
18-53) years; male gender, 54.4%] were included in the study. Trauma
(excl. brain trauma) (20.4%), acute abdomen (16.9%) and heart failure
(9.6%) were the most common conditions. Five-hundred-thirty patients
(41.8%) were transferred to a secondary level hospital. The hospital
mortality of patients not transferred was 3.2%. Conclusions: Capacities of
Mongolian primary level hospitals to manage life-threatening emergencies
are highly limited. Trauma, surgical and medical conditions make up the
most common emergencies. In view of the fact that almost half of the
patients with a potentially life-threatening emergency were transferred to
secondary level hospitals and the mortality of those hospitalized in
primary level hospitals was 3.2%, room for improvement is clearly evident.
Based on our findings, improvements could be obtained by strengthening
inter-hospital transfer systems, training staff in emergency/critical care
skills and by making mechanical ventilation and advanced life support
techniques available at the emergency rooms of primary level
hospitals.<br/>Copyright © 2017 The Author(s).
<87>
Accession Number
616072832
Author
den Boer S.L.; du Marchie Sarvaas G.J.; Klitsie L.M.; van Iperen G.G.;
Tanke R.B.; Helbing W.A.; Backx A.P.; Rammeloo L.A.; Dalinghaus M.; ten
Harkel A.D.
Institution
(den Boer, Helbing, Dalinghaus) Departments of Pediatrics Division of
Pediatric Cardiology Sophia Children's Hospital Erasmus University Medical
Center Rotterdam The Netherlands
(du Marchie Sarvaas) Departments of Pediatrics Division of Pediatric
Cardiology Beatrix Children's Hospital University Medical Center Groningen
Groningen The Netherlands
(Klitsie, ten Harkel) Departments of Pediatrics Division of Pediatric
Cardiology Leiden University Medical Center Leiden The Netherlands
(van Iperen) Departments of Pediatrics Division of Pediatric Cardiology
Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht
The Netherlands
(Tanke) Departments of Pediatrics Division of Pediatric Cardiology Radboud
University Medical Center Nijmegen The Netherlands
(Backx) Departments of Pediatrics Division of Pediatric Cardiology Emma
Children's Hospital Academic Medical Center Amsterdam The Netherlands
(Rammeloo) Departments of Pediatrics Division of Pediatric Cardiology Free
University Medical Center Amsterdam The Netherlands
Title
Distribution of strain patterns in children with dilated cardiomyopathy.
Source
Echocardiography. (no pagination), 2017. Date of Publication: 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: This study aimed to evaluate the predicting value of
quantitative and qualitative dyssynchrony parameters as assessed by
two-dimensional speckle tracking echocardiography (STE) on outcome in
children with dilated cardiomyopathy (DCM). Furthermore, the
reproducibility of these parameters was investigated. Background: In
previous studies in adults with heart failure, several dyssynchrony
parameters have been shown to be a valuable predictor of clinical outcome.
Methods: This multicenter, prospective study included 75 children with DCM
and 75 healthy age-matched controls. Using STE, quantitative (time to
global peak strain and parameters describing intraventricular time
differences) and qualitative dyssynchrony parameters (pattern analysis) of
the apical four-chamber, three-chamber, two-chamber views, and the short
axis of the left ventricle were assessed. Cox regression was used to
identify risk factors for the primary endpoints of death or heart
transplantation. Inter-observer and intra-observer variability were
described. Results: During a median of 21 months follow-up, 10 patients
(13%) reached an endpoint. Although quantitative dyssynchrony measures
were higher in patients as compared to controls, the inter-observer and
intra-observer variability were high. Pattern analysis showed mainly
reduced strain, instead of dyssynchronous patterns. Conclusions: In this
study, quantitative dyssynchrony parameters were not reproducible,
precluding their use in children. Qualitative pattern analysis showed
predominantly reduced strain, suggesting that in children with DCM
dyssynchrony may be a minor problem.<br/>Copyright © 2017, Wiley
Periodicals, Inc.
<88>
Accession Number
616063785
Author
Gaudino M.; Di Franco A.; Weltert L.; Benedetto U.; Lau C.; Gambardella
I.; De Paulis R.; Girardi L.N.
Institution
(Gaudino, Di Franco, Lau, Gambardella, Girardi) Department of
Cardio-Thoracic SurgeryWeill-Cornell Medical CenterNew York City, New York
(Weltert, De Paulis) Department of Cardiac SurgeryEuropean
HospitalRomeItaly
(Benedetto) Bristol Heart InstituteUniversity of BristolBristolUnited
Kingdom
Title
The role of neo-sinus reconstruction in aortic valve-sparing surgery.
Source
Journal of Cardiac Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Aims: The aim of this study was to evaluate the clinical and
echocardiographic results and the predictors of outcomes in patients
undergoing valve-sparing operation (VSO) at two aortic centers. In
addition, we sought to evaluate the potential effect of recreation of the
sinuses of Valsalva (SV) on the outcome of valve-sparing procedures.
Methods: During a 14-year period, 328 patients underwent aortic
valve-sparing root replacement at two institutions. Clinical and echo
evaluation was performed 6 months after surgery and every year thereafter
or in case of clinical symptoms. Propensity weighting and
propensity-weighted risk competing analysis were used. Results: No
operative mortality was reported; the most common complication was
revision for bleeding, occurring in 15 patients (4.6%). At a mean
follow-up of 30.0+/-33.9 months, two patients died (0.6%). Recurrent
aortic insufficiency (AI) >2+ was found in 11 patients (3.3%); five (1.5%)
underwent reoperation. Recreation of the SV did not affect clinical
outcome and aortic valve status. Need for aortic valve repair was the only
independent predictor of recurrent AI, whereas a bicuspid aortic valve was
a protective factor. Conclusions: Re-creation of the SV does not affect
short-term outcomes following VSO.<br/>Copyright © 2017 Wiley
Periodicals, Inc.
<89>
Accession Number
616059009
Author
Bleiziffer S.; Bosmans J.; Brecker S.; Gerckens U.; Wenaweser P.;
Tamburino C.; Linke A.
Institution
(Bleiziffer) Clinic for Cardiovascular Surgery, Department of
Cardiovascular Surgery, German Heart Center, Technical University Munich,
Lazarettstr. 36, Munich 80636, Germany
(Bosmans) Cardiovascular Diseases Department, Antwerp University Hospital,
Edegem, Belgium
(Brecker) Cardiology Clinical Academic Group, St. George's Hospital,
London, United Kingdom
(Gerckens) Cardiology Department, Gemeinschaftskrankenhaus, Bonn, Germany
(Wenaweser) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Tamburino) Cardiology Unit, Ferrarotto Hospital, University of Catania,
Catania, Italy
(Linke) Department of Internal Medicine and Cardiology, University of
Leipzig Heart Center, Leipzig, Germany
Title
Insights on mid-term TAVR performance: 3-year clinical and
echocardiographic results from the CoreValve ADVANCE study.
Source
Clinical Research in Cardiology. (pp 1-12), 2017. Date of Publication: 08
May 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Extensive evidence relating to transcatheter aortic valve
replacement (TAVR) has accumulated in recent years, but mid-term outcomes
are less reported. We investigated 996 patients after implantation of the
CoreValve prosthesis for severe aortic stenosis in a real-world setting.
Objective: To report clinical and echocardiographic 3-year results from
the ADVANCE study. Methods: ADVANCE is a prospective, multicenter, fully
monitored, nonrandomized clinical study. This analysis assessed
valve-related events, predictors of early and mid-term mortality after
TAVR, and systolic and diastolic prosthesis performance over 3 years.
Results: Three years after TAVR, the rate of major adverse
cardiac/cerebrovascular events was 38.5%. All-cause mortality was 33.7%;
cardiovascular mortality, 22.3%; cVARC-1 stroke, 6.5%; and New York Heart
Association class III/IV, 19.5%. Mean effective orifice area was
consistently 1.7 cm<sup>2</sup> from discharge to 3 years, and average
mean aortic valve gradient remained <10 mmHg. At 3 years, 12.6% of
patients had moderate and none had severe paravalvular regurgitation.
Multivariable analysis identified Society of Thoracic Surgeons (STS)
score, device migration, prior atrial fibrillation, and major vascular
complication as predictors of early mortality. Predictors of mid-term
mortality included male gender, STS score, history of chronic obstructive
pulmonary disease, history of cancer, stroke, life-threatening/disabling
or major bleeding, and valve deterioration. Conclusions: Our 3-year data
demonstrate significant hemodynamic benefits and durable symptom relief
after CoreValve prosthesis implantation. Postprocedural patient management
should be carefully considered, since postprocedural valve-related events
were identified as independent predictors of mid-term mortality. Trial
registration: ClinicalTrials.gov, NCT01074658.<br/>Copyright © 2017
Springer-Verlag Berlin Heidelberg
<90>
Accession Number
616058674
Author
Bjornnes A.K.; Parry M.; Falk R.; Watt-Watson J.; Lie I.; Leegaard M.
Institution
(Bjornnes, Parry, Watt-Watson) Lawrence S. Bloomberg Faculty of Nursing,
University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8,
Canada
(Bjornnes) Division of Emergencies and Critical Care, Department of
Research and Development, Oslo University Hospital, Oslo, Norway
(Falk) Oslo Centre for Biostatistics and Epidemiology, Research Support
Services, Oslo University Hospital, Oslo, Norway
(Lie) Division of Cardiovascular and Pulmonary Diseases, Department of
Cardiothoracic Surgery, Ulleval/Center for Patient Centered Heart- and
Lung Research, Oslo University Hospital, Oslo, Norway
(Leegaard) Faculty of Health Sciences, Institute of Nursing, Oslo and
Akershus University College of Applied Sciences, Oslo, Norway
Title
Impact of marital status and comorbid disorders on health-related quality
of life after cardiac surgery.
Source
Quality of Life Research. (pp 1-14), 2017. Date of Publication: 08 May
2017.
Publisher
Springer International Publishing
Abstract
Purpose: To explore associations between HRQL, marital status, and
comorbid disorders in men and women following cardiac surgery. Method: A
secondary analysis was completed using data from a randomized controlled
trial in which 416 individuals (23% women) scheduled for elective coronary
artery bypass graft and/or valve surgery were recruited between March 2012
and September 2013. HRQL was assessed using the Health State Descriptive
System (15D) preoperatively, then at 2 weeks, and at 3, 6, and 12 months
following cardiac surgery. Linear mixed model analyses were performed to
explore associations between HRQL, social support, and comorbid disorders.
Results: The overall 15D scores for the total sample improved
significantly from 2 weeks to 3 months post surgery, with only a gradual
change observed from 3 to 12 months. Thirty percent (n = 92) of the total
sample reported a lower 15D total score at 12 months compared to
preoperative status, of whom 78% (n = 71) had a negative minimum important
differences (MID), indicating a worse HRQL status. When adjusted for age
and marital status, women had statistically significant lower 15D total
scores compared to men at 3, 6, and 12 months post surgery. Compared to
pre-surgery, improvement was demonstrated in 4 out of 15 dimensions of
HRQL for women, and in 6 out of 15 dimensions for men at 12 months post
surgery. Both men and women associated back/neck problems, depression, and
persistent pain intensity with lower HRQL; for women, not living with a
partner/spouse was associated with lower HRQL up to 12 months. Conclusion:
Women experienced decreased HRQL and a slower first-year recovery
following cardiac surgery compared to men. This study demonstrates a need
for follow-up and support to help women manage their symptoms and improve
their function within the first year after cardiac surgery. This was
particularly pronounced for those women living alone.<br/>Copyright ©
2017 Springer International Publishing Switzerland
<91>
Accession Number
608704755
Author
Fukada T.; Tsuchiya Y.; Iwakiri H.; Ozaki M.
Institution
(Fukada, Tsuchiya, Iwakiri, Ozaki) Department of Anesthesiology, Tokyo
Women's Medical University, School of Medicine, 8-1 Kawadacho Shinjukuku,
Tokyo 162-8666, Japan
Title
Is the Ambu aScope 3 Slim single-use fiberscope equally efficient compared
with a conventional bronchoscope for management of the difficult airway?.
Source
Journal of Clinical Anesthesia. 30 (pp 68-73), 2016. Date of Publication:
01 May 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study Objective The study objective was to evaluate whether the single-use
fiberoptic bronchoscope (FOB), Ambu aScope 3 Slim, was equally efficient
compared with the conventional reusable FOB, Olympus LF-GP, for nasal
fiberoptic intubation in a manikin. Design A randomized crossed-over
study. Setting The postanesthesia care unit of Tokyo Women's Medical
University Hospital. Subjects Twenty anesthesiologists who have
experienced > 50 one-lung ventilation thoracic surgery procedures were
invited to participate in this study. Interventions A 6.5-mm internal
diameter cuffed endotracheal tube (ET) was inserted into the manikin under
Ambu aScope 3 Slim (group A) or Olympus LF-GP (group C) guidance.
Measurements The following time parameters from the beginning of FOB
insertion through a nostril were compared between groups: until vocal cord
visualization (T1); visualization of the carina (T2); and proper ET
placement, as confirmed by the distance of the ET tip to carina (T3). Main
Results Mean (SD) T1 in group A and group C were 20 seconds (17 seconds)
and 14 seconds (12 seconds), respectively (P=.1050). Mean (SD) T2 in group
A and group C were 40 seconds (29 seconds) and 25 seconds (15 seconds),
respectively (P=.0287). Mean (SD) T3 in group A and group C were 70
seconds (33 seconds) and 50 seconds (22 seconds), respectively (P=.0098).
One case in group A had failed intubation Conclusions The Ambu aScope 3
Slim required more time to intubate than the conventional reusable FOB. It
requires more rigidity, similar to the conventional FOB for management of
the difficult airway.<br/>Copyright © 2016 The Authors.
<92>
[Use Link to view the full text]
Accession Number
607842051
Author
Zhang L.; Gao S.
Institution
(Zhang, Gao) Department of Cerebral Surgery, Cancer Hospital Chinese,
Academy of Medical Sciences, No. 17, Panjiayuan Chaoyang District, Beijing
100021, China
Title
Systematic review and meta-analysis of atrial fibrillation prophylaxis
after lung surgery.
Source
Journal of Cardiovascular Pharmacology. 67 (4) (pp 351-357), 2016. Date of
Publication: April 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Atrial fibrillation (AF), which increases morbidity and mortality, is a
common occurrence after thoracic surgery and pulmonary resection. Despite
several investigations on various prophylactic measures for AF prevention,
the studies were not uniform and do not use similar controls making it
difficult to arrive at a meaningful conclusion. In the present systematic
analysis review, we evaluated the efficacy of different prophylactic
approaches to prevent AF after lung surgery in randomized trials reported
during 1991-2014. A total of 12 trials were identified that met the
criteria set for this meta-analysis. Among different trials, amiodarone
was found to be most effective in preventing postoperative AF (risk ratio,
0.22; P < 0.0001;95% confidence interval: 0.09-0.54). There were no
significant prophylactic effects by MgSO4 (risk ratio, 1.24; P < 0.007;
95% confidence interval, 0.27-5.68), digoxin, or Ca<sup>2+</sup> blockers.
Single use of amiodarone was able to lower the incidence of AF from 39.2%
to 8.3% and seemed to be safe with no major complications. Although
several prophylactic measures have been tried to curtail the incidence of
AF in patients after lung surgery, prophylaxis with amiodarone seems to be
most effective of treatments studied.<br/>Copyright © 2016 Wolters
Kluwer Health, Inc. All rights reserved.
<93>
Accession Number
611171956
Author
Ostergaard B.; Holbaek E.; Sorensen J.; Steinbruchel D.
Institution
(Ostergaard) Research Unit of Nursing, Clinical Institute, University of
Southern Denmark, Campusvej 55, Odense M DK-5230, Denmark
(Holbaek) Department of Cardiothoracic Surgery, Heart Centre, Copenhagen
University Hospital, Rigshospitalet, Denmark
(Sorensen) Centre for Applied Health Services Research, University of
Southern, Denmark
(Steinbruchel) Emergency Department, Nykobing Falster Hospital, Denmark
Title
Health-related quality of life after off-pump compared with on-pump
coronary bypass grafting among elderly high-risk patients: A randomized
trial with eight years of follow-up.
Source
European Journal of Cardiovascular Nursing. 15 (2) (pp 126-133), 2016.
Date of Publication: 01 Apr 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Potential long-term gain in health-related quality of life
(HRQoL) using off-pump coronary revascularization in elderly patients >70
years has not yet been fully elucidated. Aim: We compared HRQoL in elderly
moderate- to high-risk patients 3 months, 12 months, and 8 years after
randomization to either off-pump or on-pump coronary artery bypass
grafting (CABG). Methods: After randomization and before heart surgery,
120 consecutive patients were asked to fill in the Medical Outcome Study
Short Form 36 (SF-36) and Major Depression Inventory diagnostic scale for
self-report of HRQoL. Postoperatively, the same questionnaires were mailed
to the patients. Results: No significant difference was found in the
change of SF-36 scores between the groups except in the social functioning
subscale, where the 8-year score was significantly higher for the on-pump
group than the off-pump group (p=0.038). In the on-pump group, all scores
improved from baseline to 8 years, with the highest improvement in most of
the domains after 8 years. In the off-pump group, there was an improvement
in four of the eight domains from baseline to 8 years, with the highest
improvement in most of the domains after 12 months. By contrast, there was
a noticeable decrease in bodily pain, social functioning, and mental
health at 8 years after off-pump operation. No patients showed signs of
depression after 8 years. Conclusion: HRQoL SF-36 scores seemed to improve
more in patients undergoing on-pump CABG compared with patients undergoing
off-pump surgery, although no long-term clinically relevant difference
between the groups could be demonstrated.<br/>Copyright © European
Society of Cardiology 2016.
<94>
Accession Number
608399521
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 (E-mail: info@mks.blackwellpublising.com)
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.<br/>Copyright © 2016 The Acta Anaesthesiologica
Scandinavica Foundation. Published by John Wiley & Sons Ltd.
<95>
Accession Number
610224124
Author
Amin N.; Tarwade P.; Shetmahajan M.; Pramesh C.; Jiwnani S.; Mahajan A.;
Purandare N.
Institution
(Amin, Tarwade, Shetmahajan) Department of Anesthesiology, Tata Memorial
Center, Mumbai, Maharashtra, India
(Pramesh, Jiwnani) Division of Thoracic Surgery, Tata Memorial Centre,
Mumbai, Maharashtra, India
(Mahajan) Department of Radiodiagnosis, Tata Memorial Centre, Mumbai,
Maharashtra, India
(Purandare) Department of Nuclear Medicine, Tata Memorial Centre, Mumbai,
Maharashtra, India
Title
A randomized trial to assess the utility of preintubation adult fiberoptic
bronchoscope assessment in patients for thoracic surgery requiring
one-lung ventilation.
Source
Annals of Cardiac Anaesthesia. 19 (2) (pp 251-255), 2016. Date of
Publication: April-June 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Confirmation of placement of Double lumen endobronchial tubes (DLETT) and
bronchial blockers (BBs) with the pediatric fiberoptic bronchoscope (FOB)
is the most preferred practice worldwide. Most centers possess standard
adult FOBs, some, particularly in developing countries might not have
access to the pediatric.sized devices. We have evaluated the role of
preintubation airway assessment using the former, measuring the distance
from the incisors to the carina and from carina to the left and right
upper lobe bronchus in deciding the depth of insertion of the lung
isolation device. Methods: The study was a randomized, controlled,
double.blind trial consisting of 84 patients (all >18 years) undergoing
thoracic surgery over a 12.month period. In the study group (n = 38),
measurements obtained during FOB with the adult bronchoscope decided the
depth of insertion of the lung isolation device. In the control group (n =
46), DLETTs and BBs were placed blindly followed by clinical confirmation
by auscultation. Selection of the type and size of the lung isolation
device was at the discretion of the anesthesiologist conducting the case.
In all cases, pediatric FOB was used to confirm accurate placement of
devices. Results: Of 84 patients (DLETT used in 76 patients; BB used in 8
patients), preintubation airway measurements significantly improved the
success rate of optimal placement of lung isolation device from 25%
(11/44) to 50% (18/36) (P = 0.04). Our incidence of failed device
placement at initial insertion was 4.7% (4/84). Incidence of malposition
was 10% (8/80) with 4 cases in each group. The incidence of suboptimal
placement was lower in the study group at 38.9% (14/36) versus 65.9%
(29/44). Conclusions: Preintubation airway measurements with the adult FOB
reduces airway manipulations and improves the success rate of optimal
placement of DLETT and BB.<br/>Copyright © 2016 Annals of Cardiac
Anaesthesia.
<96>
Accession Number
610223638
Author
Jain V.; Mehta Y.; Gupta A.; Sharma R.; Raizada A.; Trehan N.
Institution
(Jain) Department of Critical Care and Anaesthesiology, Medanta-The
Medicity, Cardiac Anaesthesia, Medanta-The Medicity, Sector-38 Gurgaon,
Haryana 122 001, India
(Mehta) Medanta Institute of Critical Care and Anaesthesia, Medanta-The
Medicity, Gurgaon, India
(Gupta) Department of Critical Care and Emergency, Sharda University,
Greater Noida, UP, India
(Sharma) Medanta Institute of Kidney and Urology, Medanta-The Medicity,
Gurgaon, India
(Raizada) Department of Biochemistry, Medanta-The Medicity, Gurgaon, India
(Trehan) CTVS, Medanta-The Medicity, Gurgaon, India
Title
The role of neutrophil gelatinase-associated lipocalin in predicting acute
kidney injury in patients undergoing off-pump coronary artery bypass
graft: A pilot study.
Source
Annals of Cardiac Anaesthesia. 19 (2) (pp 225-230), 2016. Date of
Publication: April-June 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: Acute kidney injury (AKI) is a commonly encountered
postoperative complication after cardiac surgery especially in high risk
patients. AKI though seen more commonly after conventional on pump
coronary artery bypass surgery (CCABG), is not uncommon after off pump
coronary bypass surgery (OPCAB). Various biomarkers have shown promise
over last one decade as an early marker for predicting AKI
postoperatively. NGAL is one such biomarker whose concentration is
increased in urine after any nephrotoxic and ischemic insult. The
objective of this study was to assess the role of urine NGAL in predicting
AKI after OPCAB in patients with increased risk of developing AKI. Design:
A prospective cohort study. Setting: A clinical study in a multi specialty
hospital. Participants: Eighty patients. Materials and Methods: study was
approved by the hospital research ethics committee. 80 patients posted for
OPCAB with an increased risk of developing AKI defined as having a
Cleveland Clinic Foundation Acute renal failure scoring System score of >6
were included in the study. Patients with coronary angiography (CAG)
within 48 hrs prior to surgery, pre-existing AKI, preoperative renal
replacement therapy (RRT) and CKD stage 5 were excluded. Urine NGAL level
before the start of surgery baseline and at 4 hrs post surgery were done.
Renal function tests were assessed on the day of surgery (4 hrs post
surgery) and on the next three days. Result: Seven patients developed AKI
as defined by acute kidney infection network (AKIN) and risk injury
failure loss end stage (RIFLE) criteria for AKI. NGAL value at 4 hrs in
patients who developed AKI was significantly higher than in those patients
who did not develop AKI (P < 0.05). Conclusion: urine NGAL is an early
biomarker of acute kidney injury in patients undergoing OPCAB surgeries.
However, large multicentre studies may be needed to confirm
it.<br/>Copyright © 2016 Annals of Cardiac Anaesthesia.
<97>
Accession Number
607551576
Author
Reynolds M.R.; Lei Y.; Wang K.; Chinnakondepalli K.; Vilain K.A.; Magnuson
E.A.; Galper B.Z.; Meduri C.U.; Arnold S.V.; Baron S.J.; Reardon M.J.;
Adams D.H.; Popma J.J.; Cohen D.J.
Institution
(Reynolds) Harvard Clinical Research Institute, 930 Commonwealth Avenue,
Boston, MA 02215, United States
(Reynolds) Department of Cardiology, Lahey Hospital and Medical Center,
Burlington, MA, United States
(Lei, Wang, Chinnakondepalli, Vilain, Magnuson, Arnold, Baron, Cohen)
Saint Luke's Mid America Heart Institute, Kansas City, KS, United States
(Lei) University of Kansas School of Medicine, Kansas City, KS, United
States
(Magnuson, Arnold, Baron, Cohen) University of Missouri-Kansas City,
Kansas City, MO, United States
(Galper) Brigham and Women's Hospital, Boston, MA, United States
(Meduri) Piedmont Heart Institute, Atlanta, United States
(Reardon) Houston Methodist DeBakey Heart and Vascular Center, Houston,
TX, United States
(Adams) The Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
Title
Cost-Effectiveness of Transcatheter Aortic Valve Replacement with a
Self-Expanding Prosthesis Versus Surgical Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 67 (1) (pp 29-38), 2016.
Date of Publication: 05 Jan 2016.
Publisher
Elsevier USA
Abstract
Background Previous studies of the cost-effectiveness of transcatheter
aortic valve replacement (TAVR) have been based primarily on a single
balloon-expandable system. Objectives The goal of this study was to
evaluate the cost-effectiveness of TAVR with a self-expanding prosthesis
compared with surgical aortic valve replacement (SAVR) for patients with
severe aortic stenosis and high surgical risk. Methods We performed a
formal economic analysis on the basis of individual, patient-level data
from the CoreValve U.S. High Risk Pivotal Trial. Empirical data regarding
survival and quality of life over 2 years, and medical resource use and
hospital costs through 12 months were used to project life expectancy,
quality-adjusted life expectancy, and lifetime medical costs in order to
estimate the incremental cost-effectiveness of TAVR versus SAVR from a
U.S. perspective. Results Relative to SAVR, TAVR reduced initial length of
stay an average of 4.4 days, decreased the need for rehabilitation
services at discharge, and resulted in superior 1-month quality of life.
Index admission and projected lifetime costs were higher with TAVR than
with SAVR (differences $11,260 and $17,849 per patient, respectively),
whereas TAVR was projected to provide a lifetime gain of 0.32
quality-adjusted life-years ([QALY]; 0.41 LY) with 3% discounting.
Lifetime incremental cost-effectiveness ratios were $55,090 per QALY
gained and $43,114 per LY gained. Sensitivity analyses indicated that a
reduction in the initial cost of TAVR by ~$1,650 would lead to an
incremental cost-effectiveness ratio <$50,000/QALY gained. Conclusions In
a high-risk clinical trial population, TAVR with a self-expanding
prosthesis provided meaningful clinical benefits compared with SAVR, with
incremental costs considered acceptable by current U.S. standards. With
expected modest reductions in the cost of index TAVR admissions, the value
of TAVR compared with SAVR in this patient population would become high.
(Safety and Efficacy Study of the Medtronic CoreValve System in the
Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High
Risk Subjects Who Need Aortic Valve Replacement [Medtronic CoreValve U.S.
Pivotal Trial]; NCT01240902)<br/>Copyright © 2016 American College of
Cardiology Foundation.
<98>
Accession Number
616062654
Author
Francis P.A.; Fleming G.F.; Regan M.M.; Pagani O.; Walley B.A.; Price
K.N.; Coates A.S.; Goldhirsch A.; Gelber R.
Title
Longterm follow-up of TEXT and SOFT trials of adjuvant endocrine therapies
for premenopausal women with HR+ early breast cancer.
Source
Cancer Research. Conference: 39th Annual CTRC-AACR San Antonio Breast
Cancer Symposium. United States. 77 (4 Supplement 1) (no pagination),
2017. Date of Publication: February 2017.
Publisher
American Association for Cancer Research Inc.
Abstract
Background First results of the TEXT and SOFT international phase III
trials were practicechanging, indicating that: i) 5y adjuvant
exemestane+ovarian function suppression (E+OFS) reduces recurrence risk
relative to tamoxifen(T)+OFS or to T alone, ii) T+OFS reduces recurrence
risk vs T in women who are at sufficient risk to warrant chemotherapy (CT)
and remain premenopausal afterwards, and iii) T alone remains appropriate
for some premenopausal women. However, median follow-up (FU) was only 5.5y
and <5% pts had died. FU is immature given the long natural history of HR+
disease and EBCTCG overviews showing overall survival (OS) improvements
for T vs no-T emerged during 5-15y. It is crucial to establish if changing
standard adjuvant endocrine therapy from T improves survival and if there
are associated late toxicities. Trial Design and Aims Premenopausal women
had invasive early breast cancer (BC) assessed as >10% ER and/or PgR. SOFT
was designed to determine the value of adding OFS to T, and the role of
E+OFS in two cohorts: women who remained premenopausal after completion of
neo/adjuvant CT, and women for whom adjuvant T alone was considered
suitable treatment. SOFT compares 5y of T to T+OFS or E+OFS. OFS was GnRH
analog triptorelin x5y, oophorectomy or ovarian irradiation. Median age
was 43y; 35% had N+ disease. 53% enrolled after prior neo/adjuvant CT.
TEXT was designed to determine the role of adjuvant E in premenopausal
women receiving OFS from the start of adjuvant therapy, comparing 5y of
E+OFS vs T+OFS. Patients enrolled at start of all adjuvant therapy; 60%
had CT concurrent with triptorelin after entry. Median age was 43y; 48%
had N+ disease. Secondary objectives include effects on OS, late side
effects of early menopause and late toxicities. Accruals TEXT: 2672 women,
Nov03Mar11 SOFT: 3066 women, Dec03Jan11 Statistical Methods The primary
endpoint, invasive diseasefree survival, is time from randomization to
invasive local, regional, or distant relapse, contralateral BC, second
non-BC malignancy, or death. Secondary endpoints are BC-free interval,
distant recurrencefree interval and OS. Primary results were reported in
2014, after ~5.5y median FU; 30% pts were still on 5y treatment and >90%
continued in FU. Longterm FU Updated results are planned for FU through
Dec16, with ~8y median FU. Pts finished 5y treatment by Apr16. Yearly
visits continue; data collection includes weight, performance status,
menstrual status, pregnancy attempts, GYN procedures, late AEs
(cardiovascular, bone fracture), extended adjuvant therapy, invasive
recurrence at first and subsequent sites, second non-BC malignancy, in
situ cancers, OS. FU through 2020 is planned, for min and median FU of 10
and 12y, roughly doubling the numbers of endpoints events since the first
report. This will be critical to determine whether shortterm treatment
benefits persist for late recurrence, improve power to detect treatment
effects on distant recurrence and OS endpoints with lower event rates
occurring later in FU, and define associated late toxicities and side
effects of early menopause. A consortium to fund longterm FU is being
pursued.
<99>
Accession Number
615804795
Author
Huang J.; Liu W.; Zhan Y.; Hou B.; Chen S.
Institution
(Huang, Liu, Zhan, Hou, Chen) The First Affiliated Hospital of Nanchang
University, Nanchang 330006, China
Title
The effects of dexmedetomidine on inflammatory responses in patients
undergoing valve replacement surgery with cardiopulmonary bypass.
Source
International Journal of Clinical and Experimental Medicine. 10 (4) (pp
6482-6488), 2017. Article Number: IJCEM0044763. Date of Publication: 30
Apr 2017.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: This prospective study was designed to research the effect of
dexmedetomidine (DEX) on reducing the inflammation responses of valve
replacement surgery patients under cardiopulmonary bypass (CPB) and
explore the safety, efficacy and clinical significance of DEX used in this
kind of cardiac surgery. Method: 30 patients were randomly divided into
two groups: patients in one group (Group D, n=15) received dexmedetomidine
0.5 mug.kg<sup>-1</sup>.h<sup>-1</sup> before incision and 0.5
mug.kg<sup>-1</sup>.h<sup>-1</sup> intra-operatively, while the control
group (Group C, n=15) received the same volume of saline. Venous blood was
collected at several time points for the serum content detection of
TNF-alpha, IL-6, SOD and MDA. Results: Compared with group C, the content
of TNF-alpha in group D declined significantly at time point
T<inf>2</inf>, T<inf>3</inf>, T<inf>4</inf>, T<inf>5</inf>. The content of
serum IL-6 in group D declined significantly at time point T<inf>4</inf>
and T<inf>5</inf>. Meanwhile, the serum SOD content in group D was
obviously elevated with a significant difference at time point
T<inf>2</inf>, T<inf>3</inf>, T<inf>4</inf> (P<0.05) and the content of
MDA in group D declined significantly at time point T<inf>3</inf>,
T<inf>4</inf> and T<inf>5</inf> (P<0.05). Furthermore, the extu-bation
time and the ICU care duration of group D were both significantly shorten
compared with group C (P<0.05). Conclusion: The continuous administration
of dexmedetomidine during valve replacement surgery with CPB suppressed
intraoperative and post-operative cytokine secretion, and improved
post-operative inflammatory response indices in the present study. These
results can be attributed to the anti-inflammatory effects of
dexmedetomidine.<br/>Copyright © 2017, E-Century Publishing
Corporation. All rights reserved.
<100>
Accession Number
615889001
Author
Frobert O.; Gotberg M.; Angeras O.; Jonasson L.; Erlinge D.; Engstrom T.;
Persson J.; Jensen S.E.; Omerovic E.; James S.K.; Lagerqvist B.; Nilsson
J.; Karegren A.; Moer R.; Yang C.; Agus D.B.; Erglis A.; Jensen L.O.;
Jakobsen L.; Christiansen E.H.; Pernow J.
Institution
(Frobert) Orebro University, Faculty of Health, Department of Cardiology,
Orebro, Sweden
(Gotberg, Erlinge) Department of Cardiology, University Hospital Lund,
Lund, Sweden
(Angeras, Omerovic) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Jonasson) Department of Cardiology, University Hospital Linkoping,
Linkoping, Sweden
(Engstrom) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Persson) Karolinska Institutet, Department of Clinical Sciences, Danderyd
University Hospital, Stockholm, Sweden
(Jensen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(James, Lagerqvist) Department of Cardiology, University Hospital Uppsala,
Uppsala, Sweden
(Nilsson) Cardiology, Heart Centre, department of Public Health and
Clinical Medicine, Umea University, Umea, Sweden
(Karegren) Department of Cardiology, Vesteras County Hospital, Vasteras,
Sweden
(Moer) The Feiring Clinic, Feiring, Norway
(Yang) Clinical Epidemiology and Biostatistics, School of Medical
Sciences, Orebro University, Orebro and Unit of Biostatistics, Institute
of Evironmental Medicine, Karolinska Institutet, Stockholm, Sweden
(Agus) University of Southern California, Lawrence J. Ellison Institute
for Transformative Medicine, CA, United States
(Erglis) Latvian Centre of Cardiology, Pauls Stradins Clinical University
Hospital, Riga, Latvia
(Jensen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Jakobsen, Christiansen) Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark
(Pernow) Karolinska Institutet, Cardiology Unit, Department of Medicine,
Karolinska University Hospital, Stockholm, Sweden
Title
Design and rationale for the Influenza vaccination After Myocardial
Infarction (IAMI) trial. A registry-based randomized clinical trial.
Source
American Heart Journal. 189 (pp 94-102), 2017. Date of Publication: 01 Jul
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Registry studies and case-control studies have demonstrated
that the risk of acute myocardial infarction (AMI) is increased following
influenza infection. Small randomized trials, underpowered for clinical
end points, indicate that future cardiovascular events can be reduced
following influenza vaccination in patients with established
cardiovascular disease. Influenza vaccination is recommended by
international guidelines for patients with cardiovascular disease, but
uptake is varying and vaccination is rarely prioritized during
hospitalization for AMI. Methods/design The Influenza vaccination After
Myocardial Infarction (IAMI) trial is a double-blind, multicenter,
prospective, registry-based, randomized, placebo-controlled, clinical
trial. A total of 4,400 patients with ST-segment elevation myocardial
infarction (STEMI) or non-STEMI undergoing coronary angiography will
randomly be assigned either to in-hospital influenza vaccination or to
placebo. Baseline information is collected from national heart disease
registries, and follow-up will be performed using both registries and a
structured telephone interview. The primary end point is a composite of
time to all-cause death, a new AMI, or stent thrombosis at 1 year.
Implications The IAMI trial is the largest randomized trial to date to
evaluate the effect of in-hospital influenza vaccination on death and
cardiovascular outcomes in patients with STEMI or non-STEMI. The trial is
expected to provide highly relevant clinical data on the efficacy of
influenza vaccine as secondary prevention after AMI.<br/>Copyright ©
2017 The Author(s)
<101>
Accession Number
608240297
Author
Wan Y.-D.; Sun T.-W.; Kan Q.-C.; Guan F.-X.; Liu Z.-Q.; Zhang S.-G.
Institution
(Wan, Sun, Liu, Zhang) Department of Integrated ICU, First Affiliated
Hospital of Zhengzhou University, Zhengzhou, China
(Kan) Pharmaceutical Department, First Affiliated Hospital of Zhengzhou
University, Zhengzhou, China
(Guan) Academy of Medical Science, Henan Province, Zhengzhou, China
Title
The Effects of Intra-Aortic Balloon Pumps on Mortality in Patients
Undergoing High-Risk Coronary Revascularization: A Meta-Analysis of
Randomized Controlled Trials of Coronary Artery Bypass Grafting and
Stenting Era.
Source
PLoS ONE. 11 (1) (no pagination), 2016. Article Number: e0147291. Date of
Publication: 01 Jan 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Intra-aortic balloon pumps (IABP) have generally been used for
patients undergoing highrisk mechanical coronary revascularization.
However, there is still insufficient evidence to determine whether they
can improve outcomes in reperfusion therapy patients, mainly by
percutaneous coronary intervention (PCI) with stenting or coronary artery
bypass graft (CABG). This study was designed to determine the difference
between high-risk mechanical coronary revascularization with and without
IABPs on mortality, by performing a metaanalysis on randomized controlled
trials of the current era. Methods Pubmed and Embase databases were
searched from inception to May 2015. Unpublished data were obtained from
the investigators. Randomized clinical trials of IABP and non-IABP in
high-risk coronary revascularization procedures (PCI or CABG) were
included. In the case of PCI procedures, stents should be used in more
than 80% of patients. Numbers of events at the short-term and long-term
follow-up were extracted. Results A total of 12 randomized trials
enrolling 2155 patients were included. IABPs did not significantly
decrease short-term mortality (relative risk (RR) 0.66; 95% CI, 0.42
1.01), or longterm mortality (RR 0.79; 95% CI, 0.47 1.35), with low
heterogeneity across the studies. The findings remained stable in patients
with acute myocardial infarction with or without cardiogenic shock. But in
high-risk CABG patients, IABP was associated with reduced mortality (71
events in 846 patients; RR 0.40; 95%CI 0.25 0.67). Conclusion In patients
undergoing high-risk coronary revascularization, IABP did not
significantly decrease mortality. But high-risk CABG patients may be
benefit from IABP. Rigorous criteria should be applied to the use of
IABPs.<br/>Copyright: 2016 Wan et al. This is an open access article
distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are credited.
<102>
Accession Number
607550370
Author
Costa R.A.; Abizaid A.; Mehran R.; Schofer J.; Schuler G.C.; Hauptmann
K.E.; Magalhaes M.A.; Parise H.; Grube E.
Institution
(Costa, Abizaid) Department of Invasive Cardiology, Institute Dante
Pazzanese of Cardiology, Cardiovascular Research Center, Rua Dr. Altolfo
Araujo, 521Vila Mariana, Sao Paulo, SP 04012-070, Brazil
(Costa, Abizaid, Magalhaes) Cardiovascular Research Center, Sao Paulo,
Brazil
(Mehran, Parise) Cardiovascular Research Foundation, New York, NY, United
States
(Schofer) Medical Care Center, Hamburg University Cardiovascular Center,
Hamburg, Germany
(Schuler) Herzzentrum Leipzig GmbH, Leipzig, Germany
(Hauptmann) Krankenhaus der Barmherzigen Bruder, Trier, Germany
(Grube) University of Bonn, Bonn, Germany
Title
Polymer-Free Biolimus A9-Coated Stents in the Treatment of de Novo
Coronary Lesions 4- and 12-Month Angiographic Follow-Up and Final 5-Year
Clinical Outcomes of the Prospective, Multicenter BioFreedom FIM Clinical
Trial.
Source
JACC: Cardiovascular Interventions. 9 (1) (pp 51-54), 2016. Date of
Publication: 11 Jan 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The purpose of this study was to evaluate the efficacy and
long-term outcomes of a novel polymer/carrier-free drug-coated stent (DCS)
in patients with de novo coronary lesions. Background The BioFreedom (BFD)
DCS incorporates a low-profile, stainless-steel platform, with a surface
that has been modified to create a selectively microstructured abluminal
surface that allows adhesion and further release of Biolimus A9
(Biosensors Europe SA, Morges, Switzerland). Methods A total of 182
patients (183 lesions) were randomized into a 1:1:1 ratio for treatment
with BFD "standard dose" (BFD) or BFD "low dose" (BFD-LD) versus
first-generation paclitaxel-eluting stents (PES) at 4 sites in Germany.
Results Baseline and procedural characteristics were well matched. At
4-month angiographic follow-up (Cohort 1, n = 75), in-stent late lumen
loss (LLL) was significantly lower with BFD and BFD-LD versus PES (0.08
and 0.12 mm vs. 0.37 mm, respectively; p < 0.0001 for BFD vs. PES, and p =
0.002 for BFD-LD vs. PES). At 12 months (Cohort 2, n = 107), in-stent LLL
(primary endpoint) was 0.17 mm in BFD versus 0.35 mm in PES (p = 0.001 for
noninferiority; p = 0.11 for superiority); however, the BFD-LD (0.22 mm)
did not reach noninferiority (p = 0.21). At 5 years (175 of 182), there
were no significant differences in major adverse cardiac events (23.8%,
26.4%, and 20.3%) and clinically indicated target lesion revascularization
(10.8%, 13.4%, and 10.2%) for BFD, BFD-LD, and PES, respectively; also,
there was no definite/probable stent thrombosis reported. Conclusions The
BFD, but not the BFD-LD, demonstrated noninferiority versus PES in terms
of in-stent LLL, a surrogate of neointimal hyperplasia, at 12-month
follow-up. At 5 years, clinical event rates were similar, without
occurrence of stent thrombosis in all groups. (BioFreedom FIM Clinical
Trial; NCT01172119)<br/>Copyright © 2016 American College of
Cardiology Foundation.
<103>
Accession Number
607548882
Author
Bundhun P.K.; Wu Z.J.; Chen M.-H.
Institution
(Bundhun, Wu, Chen) Institute of Cardiovascular Diseases, The First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
530027, China
Title
Coronary artery bypass surgery compared with percutaneous coronary
interventions in patients with insulin-treated type 2 diabetes mellitus: A
systematic review and meta-analysis of 6 randomized controlled trials.
Source
Cardiovascular Diabetology. 15 (1) (no pagination), 2016. Article Number:
2. Date of Publication: January 06, 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Data regarding the long-term clinical outcomes in patients
with insulin-treated type 2 diabetes mellitus (ITDM) revascularized by
either coronary artery bypass surgery (CABG) or percutaneous coronary
intervention (PCI) are still controversial. We sought to compare the
long-term (>1year) adverse clinical outcomes in patients with ITDM who
underwent revascularization by either CABG or PCI. Methods: Randomized
Controlled Trials (RCTs) comparing the long-term clinical outcomes in
patients with ITDM and non-ITDM revascularized by either CABG or PCI were
searched from electronic databases. Data for patients with ITDM were
carefully retrieved. Odd Ratio (OR) with 95% confidence interval (CI) was
used to express the pooled effect on discontinuous variables and the
pooled analyses were performed with RevMan 5.3. Results: Six RCTs
involving 10 studies, with a total of 1297 patients with ITDM were
analyzed (639 patients from the CABG group and 658 patients from the PCI
group). CABG was associated with a significantly lower mortality rate
compared to PCI with OR: 0.59, 95% CI 0.42-0.85; P=0.004. Major adverse
cardiovascular and cerebrovascular events as well as repeated
revascularization were also significantly lower in the CABG group with OR:
0.51, 95% CI 0.27-0.99; P=0.03 and OR 0.34, 95% CI 0.24-0.49; P<0.00001
respectively. However, compared to PCI, the rate of stroke was higher in
the CABG group with OR: 1.41, 95% CI 0.64-3.09; P=0.40, but this result
was not statistically significant. Conclusion: CABG was associated with
significantly lower long-term adverse clinical outcomes compared to PCI in
patients with ITDM. However, due to an insignificantly higher rate of
stroke in the CABG group, further researches with a larger number of
randomized patients are required to completely solve this
issue.<br/>Copyright © 2016 Bundhun et al.
<104>
Accession Number
607428099
Author
You Z.; Huang L.; Cheng X.; Wu Q.; Jiang X.; Wu Y.
Institution
(You, Huang, Cheng, Wu, Jiang, Wu) Department of Cardiology, The Second
Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
Title
Effect of milrinone on cardiac functions in patients undergoing coronary
artery bypass graft: A meta-analysis of randomized clinical trials.
Source
Drug Design, Development and Therapy. 10 (pp 53-58), 2015. Date of
Publication: 24 Dec 2015.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background and aim: Inotropes are commonly used to treat myocardial
dysfunction, which is the major complication after coronary artery bypass
graft (CABG). Milrinone, a phosphodiesterase 3 inhibitor, is one of these
inotropes. Recently, a number of clinical studies have been carried out to
evaluate the effects of milrinone on cardiac function in patients with low
ventricular ejection fraction undergoing CABG. However, it has been
inconclusive because of the inconsistent results. In addition, some
studies found that milrinone increased the incidence of postoperative
atrial arrhythmias and did not show any long-term beneficial effects on
survival. Therefore, it is very important to perform a meta-analysis to
summarize the results so as to determine the clinical efficacy and safety
of milrinone. Method: Several databases and websites for clinical trials
were searched until October 2015 for prospective clinical studies
comparing milrinone versus placebo on cardiac functions in patients
undergoing CAGB. Results: Four articles were identified by our search
strategy. 1) Milrinone decreased incidence of myocardial ischemia and
myocardial infarction (15.6% versus 44.4%; 4.7% versus 18% in milrinone
and control group respectively). 2) Milrinone decreased duration of
inotropic support (95% confidence interval [CI]: -6.52 to -1.68; P=0.0009)
and mechanical ventilation (h) support (95% CI -5.00 to -0.69; P=0.010),
but did not decrease the requirement for intra-aortic balloon pump or
inotropic support (P>0.05). 3) Milrinone did not decrease the overall
mortality or morbidity, intensive care unit stay (P>0.05). Conclusion:
Perioperative continuous infusion of milrinone is effective to lower
incidence of myocardial ischemia and myocardial infarction in patients
post-CABG, but it was unable to improve the overall morbidity and
mortality or decreased duration of intensive care unit stay. The available
sample size is small; therefore, future studies should be directed toward
a better understanding of the benefit of milrinone to CABG
patients.<br/>Copyright © 2016 You et al.
<105>
Accession Number
608798321
Author
Herbison P.; Wong C.-K.
Institution
(Herbison) Department of Preventive and Social Medicine, Dunedin School of
Medicine, University of Otago, Dunedin, New Zealand
(Wong) Department of Medicine, Dunedin School of Medicine, University of
Otago, Dunedin, New Zealand
(Wong) Department of Medicine and Therapeutics, Chinese University of Hong
Kong Shatin, New Territories, Hong Kong
Title
Has the difference in mortality between percutaneous coronary intervention
and coronary artery bypass grafting in people with heart disease and
diabetes changed over the years? A systematic review and meta-regression.
Source
BMJ Open. 5 (12) (no pagination), 2015. Article Number: e010055. Date of
Publication: 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: To examine the difference in outcome between percutaneous
coronary intervention (PCI) and coronary artery bypass grafting (CABG), to
see if it has changed over the years in diabetics deemed eligible for both
treatments; and to contrast the long-term mortality findings with those in
non-diabetics. Design: Meta-analyses using data from randomised controlled
trials found by searches on MEDLINE, EMBASE and the Cochrane Controlled
Trials Register, from their inception until March 2015. Setting: Studies
had to be randomised controlled trials comparing PCI with CABG.
Participants: Those taking part in the studies had to have multivessel
cardiac or left main artery cardiac disease and be deemed eligible for
both treatments. Interventions: PCI or CABG. Primary and secondary
outcomes: The primary outcome was all cause mortality. Secondary outcomes
were a composite of mortality, stroke and myocardial infarction;
cardiovascular death; and MACCE (Major Adverse Cardiac or Cerebrovascular
Event). The longest follow-up was used in the analysis. Results: Among 14
studies (4868 diabetics) reported over three decades, meta-regression
shows no relationship between the year of publication and the difference
in long term all cause mortality between PCI and CABG. CABG has maintained
an approximately 30% mortality advantage compared to PCI. The other
outcomes used showed the same lack of change over the years. These
findings held true among insulin-requiring and non-insulin-requiring
diabetics. However, among non-diabetics included in the 14 studies, there
was no difference in mortality outcome between PCI and CABG. Conclusions:
The difference in outcome between PCI and CABG in diabetics has not
narrowed from the beginning-with balloon angioplasty to current PCI- with
the second generation of drug eluting stents. In contrast to the
non-diabetics, there is a persistent 30% benefit in all cause mortality
favouring CABG in diabetics, and this should be a major factor in
treatment recommendation.
<106>
Accession Number
616041547
Author
Blanke P.; Pibarot P.; Hahn R.; Weissman N.; Kodali S.; Thourani V.;
Parvataneni R.; Dvir D.; Naoum C.; Norgaard B.L.; Douglas P.; Jaber W.;
Khalique O.K.; Jilaihawi H.; Mack M.; Smith C.; Leon M.; Webb J.; Leipsic
J.
Institution
(Blanke, Dvir, Naoum, Webb, Leipsic) Centre for Heart Valve Innovation and
Department of Radiology and Division of Cardiology, St Paul Hospital &
University of British Columbia, Vancouver, Canada
(Pibarot) Division of Cardiology, Quebec Heart & Lung Institute, Laval
University, Quebec, Canada
(Hahn, Kodali, Khalique, Smith, Leon) Division of Cardiology, Columbia
University Medical Center/NY Presbyterian Hospital, New York, United
States
(Weissman) Division of Cardiology, Medstar Health Research Institute and
Georgetown University, Washington, DC, United States
(Thourani) Department of Cardiac Surgery, Emory University School of
Medicine, Atlanta, Georgia
(Parvataneni) Cardiovascular Research Foundation, New York, United States
(Norgaard) Division of Cardiology, Aarhus University, Aarhus, Denmark
(Douglas) Division of Cardiology, Duke Clinical Research Institute,
Durham, North Carolina, United States
(Jaber) Division of Cardiology, Cleveland Clinic Foundation, Cleveland,
Ohio, United States
(Jilaihawi) Division of Cardiology, Cedars-Sinai Medical Center,
California and NYU Langone Medical Center, New York, United States
(Mack) Department of Surgery, Baylor Scott and White Health, Plano, Texas,
United States
Title
Computed Tomography-Based Oversizing Degrees and Incidence of Paravalvular
Regurgitation of a New Generation Transcatheter Heart Valve.
Source
JACC: Cardiovascular Interventions. 10 (8) (pp 810-820), 2017. Date of
Publication: 24 Apr 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of the study was to investigate the influence of the
extent of computed tomography (CT)-based area and perimeter oversizing on
the incidence and severity of paravalvular aortic regurgitation (PAR) for
the Edwards SAPIEN 3 (Edwards Lifesciences, Irvine, California) device,
using CT data and echocardiographic outcome data of the PARTNER II
(Placement of AoRTic TraNscathetER Valves Trial II) SAPIEN 3
intermediate-risk cohort. Background Transcatheter heart valve (THV)
sizing algorithms are device specific, requiring refinements for new valve
designs. Methods A total of 835 intermediate-risk patients with severe,
symptomatic aortic stenosis enrolled in a multicenter, nonrandomized
registry at 57 sites in the United States and Canada with available
systolic CT data and echocardiographic follow-up were included in this
analysis. THV size selection was primarily CT guided based on annular
area. Area-based and perimeter-based oversizing was calculated using
systolic annular CT dimensions and nominal dimensions of the implanted THV
size. PAR was assessed at 30 days according to a 5-class scheme. Results
Mean oversizing by area was 7.7 +/- 9.4% and mean oversizing by perimeter
was 1.7 +/- 4.4%. An inverse proportional relationship between degree of
oversizing and frequency and severity of PAR was observed for both area
and perimeter oversizing. Perimeter and area oversizing confer similar
predictive capacity in regard to the occurrence of PAR after THV
implantation (area under the curve: 0.78 [95% confidence interval: 0.70 to
0.85] vs. area under the curve: 0.78 [95% confidence interval: 0.72 to
0.85]; p < 0.0001). No aortic root ruptures were observed. Conclusions For
the SAPIEN 3 THV, the frequency and extent of PAR is inversely related to
the degree of oversizing with acceptable rates of PAR being achieved at
lower degrees of oversizing. Perimeter and area oversizing confer similar
predictive capacity in regard to the occurrence of PAR after implantation
of the SAPIEN 3 THV. Therefore, the SAPIEN 3 THV may offer the opportunity
to reduce the risk of annular rupture associated with more significant
degrees of oversizing in borderline annular anatomy. (The PARTNER II
Trial: Placement of AoRTic TraNscathetER Valves [PARTNER II];
NCT01314313)<br/>Copyright © 2017 American College of Cardiology
Foundation
<107>
Accession Number
616041459
Author
Abdallah M.S.; Wang K.; Magnuson E.A.; Osnabrugge R.L.; Kappetein A.P.;
Morice M.-C.; Mohr F.A.; Serruys P.W.; Cohen D.J.
Institution
(Abdallah) Robert and Suzanne Tomsich Department of Cardiovascular
Medicine, Cleveland Clinic, Cleveland, Ohio, United States
(Wang, Magnuson, Cohen) Saint Luke's Mid America Heart Institute, Kansas
City, Missouri, United States
(Magnuson, Cohen) University of Missouri-Kansas City School of Medicine,
Kansas City, Missouri, United States
(Osnabrugge, Kappetein, Serruys) Erasmus University Medical Center,
Rotterdam, Netherlands
(Morice) Hopital Prive Jacques Cartier, Massy, France
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
Title
Quality of Life After Surgery or DES in Patients With 3-Vessel or Left
Main Disease.
Source
Journal of the American College of Cardiology. 69 (16 Supplement) (pp
2039-2050), 2017. Date of Publication: 25 Apr 2017.
Publisher
Elsevier USA
Abstract
Background In the SYNTAX (Synergy Between Percutaneous Coronary
Intervention With Taxus and Cardiac Surgery) trial, patients with 3-vessel
or left main coronary artery disease (CAD) had improved long-term outcomes
with coronary artery bypass graft (CABG) surgery compared with
percutaneous coronary intervention (PCI) with drug-eluting stents (DES),
improvements driven mainly by differences in myocardial infarction and
repeat revascularization. Objectives This study compared the long-term
quality-of-life benefits of DES-PCI versus CABG for patients with 3-vessel
or left main CAD. Methods Between 2005 and 2007, the SYNTAX trial
randomized 1,800 patients with 3-vessel or left main CAD to either CABG or
DES-PCI. Health status was assessed at baseline and at 1, 6, 12, 36, and
60 months by using the Seattle Angina Questionnaire (SAQ) and the 36-Item
Short Form Health Survey. Results At 5-year follow-up, CABG was superior
to DES-PCI on several SAQ domains including angina frequency and physical
function, as well as the role physical and role emotional scales of the
36-Item Short Form Health Survey. Subgroup analysis demonstrated a
significant interaction between angiographic complexity (as assessed by
the SYNTAX score) and angina relief (mean difference in the SAQ angina
frequency score for CABG vs. PCI of -0.9, 3.3, and 3.9 points for low,
intermediate, and high SYNTAX score patients, respectively; p = 0.048 for
interaction). Conclusions Among patients with 3-vessel or left main CAD,
both CABG and DES-PCI were associated with substantial and sustained
quality-of-life benefits over 5 years of follow-up. In general, CABG
resulted in greater angina relief, although the absolute treatment benefit
was small. Angina relief at 5 years was enhanced with CABG among patients
with high SYNTAX scores, a finding reinforcing the recommendation that
CABG should be strongly preferred for such patients. (Synergy Between
Percutaneous Coronary Intervention With Taxus and Cardiac Surgery
[SYNTAX]; NCT00114972)<br/>Copyright © 2017 American College of
Cardiology Foundation
<108>
Accession Number
616041411
Author
Palmerini T.; Bacchi Reggiani L.; Della Riva D.; Romanello M.; Feres F.;
Abizaid A.; Gilard M.; Morice M.-C.; Valgimigli M.; Hong M.-K.; Kim B.-K.;
Jang Y.; Kim H.-S.; Park K.W.; Colombo A.; Chieffo A.; Ahn J.-M.; Park
S.-J.; Schupke S.; Kastrati A.; Montalescot G.; Steg P.G.; Diallo A.;
Vicaut E.; Helft G.; Biondi-Zoccai G.; Xu B.; Han Y.; Genereux P.; Bhatt
D.L.; Stone G.W.
Institution
(Palmerini, Bacchi Reggiani, Della Riva, Romanello) Dipartimento
Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy
(Feres, Abizaid) Istituto Dante Pazzanese de Cardiologia, Sao Paulo,
Brazil
(Gilard) Department of Cardiology, Brest University, Brest, France
(Morice) Generale de Sante, Institut Cardiovasculaire Paris Sud, Massy,
France
(Valgimigli) Swiss Cardiovascular Center, Bern, Switzerland
(Hong, Kim, Jang) Severance Cardiovascular Hospital, Yonsei University
College of Medicine, Seoul, South Korea
(Kim, Park) Department of Internal Medicine, Seoul National University
Hospital, Seoul, South Korea
(Colombo, Chieffo) San Raffaele Scientific Institute, Milan, Italy
(Ahn, Park) The Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Schupke, Kastrati) ISAResearch Center, Deutsches Herzzentrum and
Deutsches Zentrum fur Herz-Kreislauf-Forschung, partner site Munich Heart
Alliance, Munich, Germany
(Montalescot) Sorbonne Universite-Paris 6, ACTION Study Group, Institut de
Cardiologie, Centre Hospitalier Universitaire Pitie-Salpetriere, Paris,
France
(Steg) Hopital Bichat, Assistance Publique-Hopitaux de Paris, Paris,
France
(Diallo, Vicaut) Unite de Recherche Clinique Lariboisiere Saint-Louis
Hopital Fernand Widal, Assistance Publique-Hopitaux de Paris, Paris,
France
(Helft) Institut de Cardiologie, Hopital Pitie-Salpetriere, Assistance
Publique-Hopitaux de Paris, Paris, France
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, and Department of
AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
(Xu) Catheterization Laboratory, Fu Wai Hospital, National Center for
Cardiovascular Diseases, Beijing, China
(Han) Department of Cardiology, General Hospital of Shenyang Military
Region, Shenyang, China
(Genereux, Stone) Columbia University Medical Center/New York-Presbyterian
Hospital and the Cardiovascular Research Foundation, New York, New York,
United States
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center and Harvard
Medical School, Boston, Massachusetts, United States
Title
Bleeding-Related Deaths in Relation to the Duration of Dual-Antiplatelet
Therapy After Coronary Stenting.
Source
Journal of the American College of Cardiology. 69 (16 Supplement) (pp
2011-2022), 2017. Date of Publication: 25 Apr 2017.
Publisher
Elsevier USA
Abstract
Background Although some randomized controlled trials (RCTs) and
meta-analyses have suggested that prolonged dual-antiplatelet therapy
(DAPT) may be associated with increased mortality, the mechanistic
underpinnings of this association remain unclear. Objectives The aim of
this study was to analyze the associations among bleeding, mortality, and
DAPT duration after drug-eluting stent implantation in a meta-analysis of
RCTs. Methods RCTs comparing different DAPT durations after drug-eluting
stent placement were sought through the MEDLINE, Embase, and Cochrane
databases and the proceedings of international meetings. Deaths were
considered possibly bleeding related if occurring within 1 year of the
episodes of bleeding. Primary analysis was by intention-to-treat.
Secondary analysis was performed in a modified intention-to-treat
population in which events occurring when all patients were on DAPT were
excluded. Results Individual patient data were obtained for 6 RCTs, and
aggregate data were available for 12 RCTs. Patients with bleeding had
significantly higher rates of mortality compared with those without, and
in a time-adjusted multivariate analysis, bleeding was an independent
predictor of mortality occurring within 1 year of the bleeding episode
(hazard ratio: 6.93; 95% confidence interval: 4.53 to 10.60; p < 0.0001).
Shorter DAPT was associated with lower rates of all-cause death compared
with longer DAPT (hazard ratio: 0.85; 95% confidence interval: 0.73 to
1.00; p = 0.05), which was driven by lower rates of bleeding-related
deaths with shorter DAPT compared with prolonged DAPT (hazard ratio: 0.65;
95% confidence interval: 0.43 to 0.99; p = 0.04). Mortality unrelated to
bleeding was comparable between the 2 groups. Similar results were
apparent in the modified intention-to-treat population. Conclusions
Bleeding was strongly associated with the occurrence of mortality within 1
year after the bleeding event. Shorter compared with longer DAPT was
associated with lower risk for bleeding-related death, a finding that may
underlie the lower all-cause mortality with shorter DAPT in the RCTs of
different DAPT durations after DES.<br/>Copyright © 2017 American
College of Cardiology Foundation
<109>
Accession Number
615953030
Author
Vaquero Roncero L.M.; Sanchez Poveda D.; Valdunciel Garcia J.J.; Sanchez
Barrado M.E.; Calvo Vecino J.M.
Institution
(Vaquero Roncero, Sanchez Poveda, Valdunciel Garcia, Sanchez Barrado,
Calvo Vecino) Service of Anesthesiology, Reanimation and Pain Medicine,
Complejo Asistencial Universitario de Salamanca, CAUSA, Spain
Title
Perioperative use of angiotensin-converting-enzyme inhibitors and
angiotensin receptor antagonists.
Source
Journal of Clinical Anesthesia. 40 (pp 91-98), 2017. Date of Publication:
01 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective Clinical repercussions of perioperative treatment with
ACEIs/ARBs. Design Systematic review according to PRISMA statement.
Setting Perioperative period. Patients 29 studies 11 cases/cases series,
12 observational studies and 6 randomized studies. Measurements Arterial
blood pressure differences, refractory hypotension, other comorbidities.
Main results The studies show different results regarding the topics
measured. They are divided in the results regarding blood pressure, long
term morbidities and effects in neuraxial anesthesia. Conclusions
Withholding AECI/ARBs on the morning prior to surgery could be recommended
as a potentially effective measure, with a low level of evidence, in order
to reduce the appearance of hypotension in the perioperative period of
non-cardiac surgery.<br/>Copyright © 2017 Elsevier Inc.
<110>
Accession Number
616039972
Author
Sardar P.; Kundu A.; Bischoff M.; Chatterjee S.; Owan T.; Nairooz R.; Giri
J.; Halkos M.E.; Liberman H.; Douglas J.S.; Mukherjee D.
Institution
(Sardar, Owan) Division of Cardiovascular MedicineUniversity of UtahSalt
Lake City, Utah
(Kundu) Department of MedicineUniversity of Massachusetts Medical
SchoolWorcester, Massachusetts
(Bischoff) Department of MedicineUniversity of UtahSalt Lake City, Utah
(Chatterjee) Division of Cardiovascular MedicineTemple University School
of MedicinePhiladelphia, Pennsylvania
(Nairooz) Division of Cardiovascular MedicineUniversity of Arkansas for
Medical SciencesLittle Rock, Arkansas
(Giri) Cardiovascular DivisionHospital of the University of
PennsylvaniaPhiladelphia, Pennsylvania
(Halkos) Division of Cardiothoracic SurgeryEmory University School of
MedicineAtlanta, Georgia
(Liberman, Douglas) Clinical Research Unit, Division of CardiologyEmory
University School of MedicineAtlanta Georgia
(Mukherjee) Division of Cardiovascular MedicineTexas Tech University
Health Sciences CenterEl Paso, Texas
Title
Hybrid coronary revascularization versus coronary artery bypass grafting
in patients with multivessel coronary artery disease: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This meta-analysis evaluated the effectiveness of hybrid
coronary revascularization (HCR) compared to coronary artery bypass
grafting (CABG) for the treatment of multivessel coronary artery disease
(MVCAD). Background: HCR involves a combination of surgical and
percutaneous techniques, which in selected patients may present an
alternative to conventional CABG. Methods: Databases were searched through
June 30, 2016, and studies comparing HCR with CABG for treatment of MVCAD
were selected. We calculated summary odds ratios (ORs) and 95% CIs with
the random-effects model. The primary outcome of interest was the
occurrence of major adverse cardiac and cerebrovascular events (MACCE),
defined as a composite of all cause mortality, myocardial infarction, and
stroke. Results: The analysis included 2,245 patients from 8 studies (1
randomized controlled trial and 7 observational studies). The risk of
MACCE with HCR and CABG were 3.6% and 5.4%, respectively (OR, 0.53; 95%
CI, 0.24-1.16). Compared to CABG group, patients in HCR group had similar
risk of all cause mortality (OR, 0.85; 95% CI, 0.38-1.88), myocardial
infarction (OR, 0.72; 95% CI, 0.31-1.64), stroke (OR, 0.53; 95% CI,
0.23-1.20), and repeat revascularization (OR, 1.28; 95% CI, 0.58-2.83).
The need for postoperative blood transfusions (OR, 0.29; 95% CI,
0.14-0.59) and hospital stay (weighted mean difference -1.20 days; 95% CI
-1.52 to -0.88 days) was significantly lower in the HCR group. Conclusion:
HCR appears to be safe, and has similar outcomes when compared with
conventional CABG. HCR can be a suitable alternative to conventional CABG
in select patients with MVCAD.<br/>Copyright © 2017 Wiley
Periodicals, Inc.
<111>
Accession Number
616039960
Author
Gray R.G.; Menon S.C.; Johnson J.T.; Armstrong A.K.; Bingler M.A.;
Breinholt J.P.; Kenny D.; Lozier J.; Murphy J.J.; Sathanandam S.K.;
Taggart N.W.; Trucco S.M.; Goldstein B.H.; Gordon B.M.
Institution
(Gray, Menon) University of UtahSalt Lake City, Utah
(Johnson) Division of Pediatric CardiologyAnn and Robert H. Lurie
Children's Hospital of Chicago Illinois
(Armstrong) Division of Pediatric CardiologyC.S. Mott Children's
HospitalAnn Arbor, Michigan
(Bingler) Division of Pediatric CardiologyUniversity of MissouriKansas
City, Missouri
(Breinholt) Division of Pediatric CardiologyUniversity of Texas Health
Science CenterHouston, Texas
(Kenny) Rush University Medical CenterChicago, Illinois
(Lozier) Division of Pediatric CardiologyMercy Medical CenterDes Moines,
Iowa
(Murphy) Division of Pediatric CardiologySt Louis Children's HospitalSt
Louis, Missouri
(Sathanandam) Division of Pediatric CardiologyLe Bonheur Children's
Medical Center Tennessee
(Taggart) Mayo ClinicRochester, Minnesota
(Trucco) Division of Pediatric CardiologyChildren's Hospital of
UPMCPittsburgh, Pennsylvania
(Goldstein) Division of Pediatric CardiologyCincinnati Children's Hospital
Medical Center Ohio
(Gordon) Division of Pediatric CardiologyLoma Linda University Children's
Hospital California
Title
Acute and midterm results following perventricular device closure of
muscular ventricular septal defects: A multicenter PICES investigation.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To describe acute and mid-term results of hybrid
perventricular device closure of muscular ventricular septal defects
(mVSDs). Background: Perventricular device closure of mVSDs can mitigate
technical limitations of percutaneous closure and need for cardiopulmonary
bypass or ventriculotomy with a surgical approach. Methods: This is a
multicenter retrospective cohort study of patients undergoing hybrid
perventricular mVSD device closure from 1/2004 to 1/2014. Procedural
details, adverse events, outcomes, and follow-up data were collected.
Patients were divided into two groups: (1) simple (mVSD closure alone) and
(2) complex (mVSD closure with concomitant cardiac surgery). Results:
Forty-seven patients (60% female) underwent perventricular mVSD device
closure at a median age of 5.2 months (IQR 1.8-8.9) and weight of 5.1 kg
(IQR 4.0-6.9). Procedural success was 91% [100% (n=22) simple and 84%
(n=21/25) complex]. Adverse events occurred in 19% (9/47) [9% (2/22)
simple and 28% (7/25) complex]. Hospital length of stay (LOS) was shorter
in the simple vs. complex group (4 vs. 14 days, P<0.01). At mid-term
follow-up of 19.2 months (IQR 2.3-43) 90% of pts had complete mVSD
closure; none developed late heart block, increased atrioventricular (AV)
valve insufficiency or ventricular dysfunction. Conclusions:
Perventricular device closure of simple mVSD was associated with a high
rate of procedural success, few adverse events, and short hospital LOS.
Procedural adverse events were associated with the presence of concomitant
complex surgery. Residual mVSD, AV valve insufficiency, or ventricular
dysfunction were uncommon at mid-term follow-up.<br/>Copyright © 2017
Wiley Periodicals, Inc.
<112>
Accession Number
614302509
Author
Ando T.; Takagi H.
Institution
(Ando) Detroit Medical Center, Department of Cardiology, Detroit, MI,
United States
(Takagi) Shizuoka Medical Center, Department of Cardiovascular Surgery,
Shizuoka, Japan
Title
Comparison of late mortality after transcatheter aortic valve implantation
versus surgical aortic valve replacement: Insights from a meta-analysis.
Source
European Journal of Internal Medicine. 40 (pp 43-49), 2017. Date of
Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) has shown
non-inferior late mortality in severe aortic stenosis (AS) patients in
intermediate to inoperable risk for surgery compared to surgical aortic
valve replacement (SAVR). Late outcome of TAVI compared to SAVR is crucial
as the number of TAVI continues to increase over the last few years.
Methods A comprehensive literature search of PUBMED and EMBASE were
conducted. Inclusion criteria were that [1] study design was a randomized
controlled trial (RCT) or a propensity-score matched (PSM) study: [2]
outcomes included > 2-year all-cause mortality in both TAVI and SAVR. The
random-effects model was utilized to calculate an overall effect size of
TAVI compared to SAVR in all-cause mortality. Publication bias was
assessed quantitatively with Egger's test. Results A total of 14 studies
with 6503 (3292 TAVI and 3211 SAVR, respectively) were included in the
meta-analysis. There was no difference in late all-cause mortality between
TAVI and SAVR (HR 1.17, 95%CI 0.98-1.41, p = 0.08, I<sup>2</sup> = 61%).
The sub-group analysis of all-cause mortality of RCT (HR 0.93 95%CI
0.78-1.10, p = 0.38, I<sup>2</sup> = 40%) and PSM studies (HR 1.44 95%CI
1.15-1.80, p = 0.02, I<sup>2</sup> = 35%) differed significantly (p for
subgroup differences = 0.002). Meta-regression implicated that increased
age and co-existing CAD may be associated with more advantageous effects
of TAVI relative to SAVR on reducing late mortality. There was no evidence
of significant publication bias (p = 0.19 for Egger's test). Conclusions
TAVI conferred similar late all-cause mortality compared to SAVR in a
meta-analysis of RCT but had worse outcomes in a meta-analysis of
PSM.<br/>Copyright © 2017 European Federation of Internal Medicine
<113>
Accession Number
614031379
Author
Nappi F.; Spadaccio C.; Nenna A.; Lusini M.; Fraldi M.; Acar C.; Chello M.
Institution
(Nappi, Spadaccio, Nenna, Lusini, Chello) Department of Cardiovascular
Surgery, Universita Campus Bio-Medico di Roma, Rome, Italy
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Fraldi) Department of Structures for Engineering and Architecture and
Interdisciplinary Research Center for Biomaterials, Universita di Napoli
"Federico II", Naples, Italy
(Acar) Department of Cardiac Surgery, Hopital La Pitie Salpetriere, Paris,
France
Title
Is subvalvular repair worthwhile in severe ischemic mitral regurgitation?
Subanalysis of the Papillary Muscle Approximation trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (2) (pp 286-295.e2),
2017. Date of Publication: 01 Feb 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective The symmetry of mitral valve tethering and regional left
ventricle wall dysfunction are reported to play a fundamental role in the
outcomes and long-term durability of surgical repair in ischemic mitral
regurgitation (IMR). We recently demonstrated in a randomized clinical
trial (the Papillary Muscle Approximation trial) the superiority of
papillary muscle approximation (PMA) in combination with standard
restrictive annuloplasty (RA) in severe IMR over annuloplasty alone in
terms of adverse left ventricular remodeling and mitral regurgitation (MR)
recurrence. This approach, however, failed to produce a survival advantage
and was still plagued by a high incidence of reoperation. We therefore
performed a subanalysis of the PMA trial on the basis of preoperative
parameters to elucidate the value of subvalvular surgery in certain
subcategories of patients with the aim of creating a decisional algorithm
on the best operative strategy. Methods We performed a subanalysis of PMA
trial, evaluating 96 patients with severe IMR and eligible for myocardial
revascularization randomized to PMA + RA (n = 48) versus RA alone (n = 48)
in association with coronary artery bypass grafting. Endpoints included
left ventricular remodeling, MR recurrence, overall mortality,
reoperation, and a composite cardiac endpoint (cardiac death, stroke,
reintervention, hospitalization for heart failure, or New York Heart
Association class worsening). Stratification variables were preoperative
symmetry of mitral valve tethering and regional wall motion abnormality.
Results PMA improved ventricular remodeling and recurrence of MR in both
preoperative symmetric and asymmetric tethering and in case of inferior
wall dyskinesia but did not produce an additional benefit in anterolateral
wall dysfunction. Conclusions Preoperative symmetric and asymmetric
tethering and isolated inferior wall dyskinesia are an indication for
subvalvular apparatus surgery in IMR.<br/>Copyright © 2016 The
American Association for Thoracic Surgery
<114>
Accession Number
607628955
Author
Katsanos K.; Spiliopoulos S.; Diamantopoulos A.; Siablis D.; Karnabatidis
D.; Scheinert D.
Institution
(Katsanos, Diamantopoulos) Department of Interventional Radiology, Guy's
and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners,
London, United Kingdom
(Katsanos, Spiliopoulos, Siablis, Karnabatidis) Department of
Interventional Radiology, Patras University Hospital, School of Medicine,
Rion, Greece
(Scheinert) Department of Angiology, Park Hospital and
Universitatsklinikum, Leipzig, Germany
Title
Wound Healing Outcomes and Health-Related Quality-of-Life Changes in the
ACHILLES Trial: 1-Year Results From a Prospective Randomized Controlled
Trial of Infrapopliteal Balloon Angioplasty Versus Sirolimus-Eluting
Stenting in Patients With Ischemic Peripheral Arterial Disease.
Source
JACC: Cardiovascular Interventions. 9 (3) (pp 259-267), 2016. Date of
Publication: 08 Feb 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors sought to report the wound healing outcomes,
health-related quality-of-life changes and quality-adjusted life-years
(QALYs) gain in the 2 treatment arms of the ACHILLES (Comparing
Angioplasty and DES in the Treatment of Subjects With Ischemic
Infrapopliteal Arterial Disease) multicenter randomized trial. Background
The ACHILLES randomized trial has previously shown that sirolimus-eluting
stents (SES) may achieve lower vessel restenosis and higher event-free
survival rates compared with plain balloon angioplasty (PTA) for
infrapopliteal lesions. Methods A total of 200 patients were randomly
assigned between SES and PTA for the treatment of infrapopliteal arterial
occlusive lesions. Progression of wound healing was serially assessed by
digital photography. Health-related quality-of-life scores were assessed
with the self-administered EQ-5D questionnaire up to 1 year from
randomization. QALYs gained were calculated with a standard multiplicative
model using distribution-free Bayesian modeling. Results In total, 109
open wounds (n = 54 in SES; n = 55 in PTA) were documented at baseline. At
6 months, wound volume reduction (%) was significantly higher in the SES
group (95% healing [95% confidence interval (CI): 80% to 99%] compared
with 60% healing [95% CI: 13% to 90%] in the PTA group; p = 0.048). At 1
year, rates of complete wound closure were higher in the case of SES
(72.9% vs. 55.6% closed wounds in PTA; p = 0.088). The recorded weighted
EQ-5D score improved significantly up to 1 year in case of SES (p <
0.0001), but not in case of PTA. There was a trend of more QALYs gained
with SES compared with PTA up to 1 year after randomization. Relative QALY
gain was 0.10 (95% CI: -0.01 to 0.21; p = 0.08) in the whole study and
0.17 (95% CI: -0.03 to 0.35; p = 0.09) in the wound subgroups comparison.
Conclusions Infrapopliteal SES accelerates wound healing and may improve
quality of life compared with PTA. (Comparing Angioplasty and DES in the
Treatment of Subjects With Ischemic Infrapopliteal Arterial Disease
[ACHILLES]; NCT00640770)<br/>Copyright © 2016 American College of
Cardiology Foundation
<115>
Accession Number
607830564
Author
Brenner C.; Adrion C.; Grabmaier U.; Theisen D.; Von Ziegler F.; Leber A.;
Becker A.; Sohn H.-Y.; Hoffmann E.; Mansmann U.; Steinbeck G.; Franz
W.-M.; Theiss H.D.
Institution
(Brenner, Franz) Department of Internal Medicine III, Cardiology and
Angiology, Medical University of Innsbruck, Anichstr. 35, Innsbruck 6020,
Austria
(Brenner, Grabmaier, Von Ziegler, Becker, Steinbeck, Franz, Theiss)
Department of Internal Medicine i, Klinikum Grosshadern,
Ludwig-Maximilians-University, Munich, Germany
(Adrion, Mansmann) Institute for Medical Informatics, Biometry und
Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany
(Leber, Hoffmann) Department of Cardiology, Klinikum Bogenhausen, Munich,
Germany
(Theisen) Institute of Clinical Radiology, Ludwig-Maximilians-University,
Munich, Germany
(Sohn) Department of Cardiology, Klinikum Innenstadt,
Ludwig-Maximilians-University, Munich, Germany
Title
Sitagliptin plus granulocyte colony-stimulating factor in patients
suffering from acute myocardial infarction: A double-blind, randomized
placebo-controlled trial of efficacy and safety (SITAGRAMI trial).
Source
International Journal of Cardiology. 205 (pp 23-30), 2016. Date of
Publication: 15 Feb 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective In animal models, G-CSF based progenitor cell mobilization
combined with a DPP4 inhibitor leads to increased homing of bone marrow
derived progenitor cells to the injured myocardium via the SDF1/CXCR4 axis
resulting in improved ejection fraction and survival after acute
myocardial infarction (AMI). Research design and methods After successful
revascularization in AMI, 174 patients were randomized 1:1 in a
multi-centre, prospective, placebo-controlled, parallel group, double
blind, phase III efficacy and safety trial to treatment with G-CSF and
Sitagliptin (GS) or placebo. Diabetic and non-diabetic patients were
included in our trial. The primary efficacy endpoint hierarchically
combined global left and right ventricular ejection fraction changes from
baseline to 6 months of follow-up (DELTA<inf>LVEF</inf>,
DELTA<inf>RVEF</inf>), as determined by cardiac MRI. Results At follow-up
DELTA<inf>LVEF</inf> as well as DELTA<inf>RVEF</inf> did not differ
between the GS and placebo group. Patients in the placebo group had a
similar risk for a major adverse cardiac event within 12 months of
follow-up as compared to patients under GS. Conclusion Progenitor cell
therapy comprising the use of G-CSF and Sitagliptin after successfully
revascularized acute myocardial infarction fails to show a beneficial
effect on cardiac function and clinical events after 12 months. (EudraCT:
2007-003,941-34; ClinicalTrials.gov: NCT00650143, funding: Heinz-Nixdorf
foundation).<br/>Copyright © 2015 Published by Elsevier Ireland Ltd.
<116>
Accession Number
608238044
Author
Hermiller J.B.; Krucoff M.W.; Kereiakes D.J.; Windecker S.; Steg P.G.; Yeh
R.W.; Cohen D.J.; Cutlip D.E.; Massaro J.M.; Hsieh W.-H.; Mauri L.
Institution
(Hermiller) St. Vincent Heart Center, Indianapolis, IN, United States
(Krucoff) Department of Medicine, Duke University Medical Center, Durham,
NC, United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Lindner Center for
Research and Education, Cincinnati, OH, United States
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Steg) Universite Paris-Diderot, INSERM U-1148, Hopital Bichat,
Departement Hospitalo-Universitaire FIRE, Assistance Publique-Hopitaux de
Paris, Paris, France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Yeh) Smith Center for Outcomes Research in Cardiology, Beth Israel
Deaconess Medical Center, Boston, MA, United States
(Yeh, Cutlip, Mauri) Harvard Medical School, Boston, MA, United States
(Yeh, Cutlip, Massaro, Hsieh, Mauri) Harvard Clinical Research Institute,
Boston, MA, United States
(Cohen) Department of Cardiology, Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City, School of Medicine, Kansas
City, MO, United States
(Cutlip) Department of Medicine, Cardiology Division, Beth Israel
Deaconess Medical Center, Boston, MA, United States
(Massaro) School of Public Health, Boston University, School of Medicine,
Boston, MA, United States
(Mauri) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Womens Hospital, 75 Francis Street, Bostona, MA 02115, United
States
Title
Benefits and Risks of Extended Dual Antiplatelet Therapy after
Everolimus-Eluting Stents.
Source
JACC: Cardiovascular Interventions. 9 (2) (pp 138-147), 2016. Date of
Publication: 25 Jan 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The purpose of this study was to characterize outcomes for
everolimus-eluting stent (EES)-treated subjects according to treatment
with continued thienopyridine plus aspirin versus aspirin alone 12 to 30
months after stenting. Background In the DAPT (Dual Antiplatelet Therapy)
study, continued thienopyridine plus aspirin beyond 1 year after coronary
stenting reduced ischemic events. Given low rates of stent thrombosis and
myocardial infarction (MI) for current drug-eluting stents, we examined
outcomes among EES-treated subjects in the DAPT study. Methods The DAPT
study enrolled 25,682 subjects (11,308 EES-treated) after coronary
stenting. Following 12 months of treatment with thienopyridine and
aspirin, eligible subjects continued treatment with aspirin and 9,961
(4,703 with EES) were randomized to 18 months of continued thienopyridine
or placebo. Stent type was not randomized, and the EES subset analysis was
post hoc. Results Among EES-treated patients, continued thienopyridine
reduced stent thrombosis (0.3% vs. 0.7%, hazard ratio [HR]: 0.38, 95%
confidence interval [CI]: 0.15 to 0.97; p = 0.04) and MI (2.1% vs. 3.2%,
HR: 0.63, 95% CI: 0.44 to 0.91; p = 0.01) versus placebo but did not
reduce a composite of death, MI, and stroke (4.3% vs. 4.5%, HR: 0.89, 95%
CI: 0.67 to 1.18; p = 0.42), and increased moderate/severe bleeding (2.5%
vs. 1.3%, HR: 1.79, 95% CI: 1.15 to 2.80; p = 0.01), and death (2.2% vs.
1.1%, HR: 1.80, 95% CI: 1.11 to 2.92; p = 0.02). Death due to cancer and
not related to bleeding was increased (0.64% vs. 0.17%; p = 0.01).
Conclusions In EES-treated subjects, significant reductions in stent
thrombosis and MI and an increase in bleeding were observed with continued
thienopyridine beyond 1 year compared with aspirin alone. (The Dual
Antiplatelet Therapy Study [DAPT Study]); NCT00977938)<br/>Copyright
© 2016 American College of Cardiology Foundation.
<117>
Accession Number
607816722
Author
Sahu M.K.; Das A.; Malik V.; Subramanian A.; Singh S.P.; Hote M.
Institution
(Sahu, Das, Singh, Hote) Department of Cardiothoracic and Vascular
Surgery, CN Centre, All India Institute of Medical Sciences, New Delhi 110
029, India
(Malik, Subramanian) Departments of Cardiac Anaesthesia, All India
Institute of Medical Sciences, New Delhi, India
Title
Comparison of levosimendan and nitroglycerine in patients undergoing
coronary artery bypass graft surgery.
Source
Annals of Cardiac Anaesthesia. 19 (1) (pp 52-58), 2016. Date of
Publication: January-March 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Levosimendan a calcium ion sensitizer improves both systolic
and diastolic functions. This novel lusitropic drug has predictable
antiischemic properties which are mediated via the opening of
mitochondrial adenosine triphosphate-sensitive potassium channels. This
action of levosimendan is beneficial in cardiac surgical patients as it
improves myocardial contractility, decreases systemic vascular resistance
(SVR), and increases cardiac index (CI) and is thought to be
cardioprotective. We decided to study whether levosimendan has any impact
on the outcomes such as the duration of ventilation, the length of
Intensive Care Unit (ICU) stay, and the hospital stay when compared with
the nitroglycerine (NTG), which is the current standard of care at our
center. Materials and Methods: Forty-seven patients undergoing elective
coronary artery bypass surgery were randomly assigned to two groups
receiving either levosimendan or NTG. The medications were started before
starting surgery and continued until 24 h in the postoperative period.
Baseline hemodynamic parameters were evaluated before beginning of the
operation and then postoperatively at 3 different time intervals.
N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) levels
were also measured in both groups. Results: In comparison to the NTG
group, the duration of ventilation and length of ICU stay were
significantly less in levosimendan group (P < 0.05, P = 0.02). NT-proBNP
level analysis showed a slow rising pattern in both groups and a
statistically significant rise in the levels was observed in NTG group (P
= 0.03, P = 0.02) in postoperative period when compared to levosimendan
group of patients. Conclusion: Levosimendan treatment in patients
undergoing surgical revascularization resulted in improved CI, decreased
SVR and lower heart rate. And, thereby the duration of ventilation and
length of ICU stay were significantly less in this group of patients when
compared with NTG group.<br/>Copyright © 2016 Annals of Cardiac
Anaesthesia.
<118>
Accession Number
607816720
Author
Tempe D.K.; Chaudhary K.; Diwakar A.; Datt V.; Virmani S.; Tomar A.S.;
Mohandas A.; Mohire V.B.
Institution
(Tempe) Department of Anaesthesiology and Intensive Care, Maulana Azad
Medical College and Assoc. Lok Nayak Hospital, GB Pant and GNEC Hospitals,
MAMC Complex, New Delhi, India
(Chaudhary) Department of Anaesthesiology and Intensive Care, Lady
Hardinge Medical College and Assoc. Hospitals, New Delhi, India
(Diwakar, Datt, Virmani, Tomar, Mohandas, Mohire) Department of
Anaesthesiology and Intensive Care, GB Pant Hospital, Maulana Azad Medical
College, New Delhi, India
Title
Comparison of hemodynamic responses to laryngoscopy and intubation with
Truview PCDTM , McGrath and Macintosh laryngoscope in patients undergoing
coronary artery bypass grafting: A randomized prospective study.
Source
Annals of Cardiac Anaesthesia. 19 (1) (pp 68-75), 2016. Date of
Publication: January-March 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Context: We hypothesized that reduced oropharyngolaryngeal stimulation
with video laryngoscopes would attenuate hemodynamic response to
laryngoscopy and intubation. Aim: Comparison of hemodynamic response to
laryngoscopy and intubation with video laryngoscopes and Macintosh (MC)
laryngoscope. Setting and Design: Superspecialty tertiary care public
hospital; prospective, randomized control study. Methods: Sixty adult
patients undergoing elective coronary artery bypass grafting (CABG) were
randomly allocated to three groups of 20 each: MC, McGrath (MG), and
Truview (TV). Hemodynamic parameters were serially recorded before and
after intubation. Laryngoscopic grade, laryngoscopy, and tracheal
intubation time, ST segment changes, and intra-/post-operative
complications were also recorded and compared between groups. Statistical
Analysis: SPSS version 17 was used, and appropriate tests applied. P <
0.05 was considered significant. Results: Heart rate and diastolic
arterial pressure increased at 0 and 1 min of intubation in all the three
groups (P < 0.05) while mean arterial pressure increased at 0 min in the
MG and TV groups and at 1 min in all three groups (P < 0.05). A
significant increase in systolic arterial pressure was only observed in TV
group at 1 min (P < 0.05). These hemodynamic parameters returned to
baseline by 3 min of intubation in all the groups. The intergroup
comparisons of all hemodynamic parameters were not significant at any time
of observation. Highest intubation difficulty score was observed with MC
(2.16 +/- 1.86) as compared with MG (0.55 +/- 0.88) and TV (0.42 +/- 0.83)
groups (P = 0.003 and P = 0.001, respectively). However, duration of
laryngoscopy and intubation was significantly less in MC (36.68 +/- 16.15
s) as compared with MG (75.25 +/- 30.94 s) and TV (60.47 +/- 27.45 s)
groups (P = 0.000 and 0.003, respectively). Conclusions: Video
laryngoscopes did not demonstrate any advantage in terms of hemodynamic
response in patients with normal airway undergoing CABG.<br/>Copyright
© 2016 Annals of Cardiac Anaesthesia.
<119>
Accession Number
607816686
Author
Das S.; Nanda S.K.; Bisoi A.K.; Wadhawan A.N.
Institution
(Das, Nanda) Department of Cardiac Anaesthesia, Cardio Thoracic Sciences
Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
110 029, India
(Bisoi) Departments of Cardio Thoracic Vascular Surgery, All India
Institute of Medical Sciences, New Delhi, India
(Wadhawan) Department of Clinical Psychology, Neurosciences Center, All
India Institute of Medical Sciences, New Delhi, India
Title
Effect of preoperative statin therapy on early postoperative memory
impairment after off-pump coronary artery bypass surgery.
Source
Annals of Cardiac Anaesthesia. 19 (1) (pp 38-44), 2016. Date of
Publication: January-March 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Context: Frequent incidence of early postoperative memory impairment
(POMI) after cardiac surgery remains a concern because of associated
morbidity, impaired quality of life, and increased health care cost. Aim:
To assess the effect of preoperative statin therapy on POMI in patients
undergoing off-pump coronary artery bypass (OPCAB) surgery. Setting and
Design: Prospective observational study in a tertiary level hospital.
Methods: Sixty patients aged 45-65 years undergoing OPCAB surgery were
allocated into two groups of 30 each. Group A patients were receiving
statin and Group B patients were not receiving statins. All patients
underwent memory function assessment preoperatively after admission to
hospital and on the 6 <sup>th</sup> postoperative day using postgraduate
institute memory scale. Statistical Analysis: Appropriate tests were
applied with SPSS 20 to compare both groups. The value P < 0.05 was
considered statistically significant. Multiple regression analysis was
performed with confounding factors to determine the effect on memory
impairment. Results: Patients in Group A showed significant postoperative
deterioration in 6 of the 10 functions and in Group B showed deterioration
in 9 of 10 functions tested compared to preoperative scores. Intergroup
comparison detected less POMI in Group A compared to Group B and was
statistically significant in 8 memory functions. Multiple regression
analysis detected statin as an independent factor in preventing memory
impairment. Conclusions: Preoperative statin therapy attenuates the early
POMI in patients undergoing OPCAB. Future long-term studies will define
the efficacy of statin on POMI.<br/>Copyright © 2016 Annals of
Cardiac Anaesthesia.
<120>
Accession Number
607948435
Author
Webb J.G.; Doshi D.; Mack M.J.; Makkar R.; Smith C.R.; Pichard A.D.;
Kodali S.; Kapadia S.; Miller D.C.; Babaliaros V.; Thourani V.; Herrmann
H.C.; Bodenhamer M.; Whisenant B.K.; Ramee S.; Maniar H.; Kereiakes D.; Xu
K.; Jaber W.A.; Menon V.; Tuzcu E.M.; Wood D.; Svensson L.G.; Leon M.B.
Institution
(Webb, Wood) St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z
1Y6, Canada
(Doshi, Smith, Kodali, Leon) Columbia University Medical Center, New York,
NY, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Makkar) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Pichard) Medstar Washington Hospital Center, Washington, DC, United
States
(Kapadia, Jaber, Menon, Tuzcu, Svensson) Cleveland Clinic, Cleveland, OH,
United States
(Miller) Stanford University, Stanford, CA, United States
(Babaliaros, Thourani) Emory University, School of Medicine, Atlanta, GA,
United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Bodenhamer) Oklahoma Heart Hospital, Oklahoma City, OK, United States
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Ramee) Ochsner Clinic, New Orleans, LA, United States
(Maniar) Washington University School of Medicine, Saint Louis, MO, United
States
(Kereiakes) Christ Hospital, Cincinnati, OH, United States
(Xu) Cardiovascular Research Foundation, New York, NY, United States
Title
A Randomized Evaluation of the SAPIEN XT Transcatheter Heart Valve System
in Patients with Aortic Stenosis Who Are Not Candidates for Surgery.
Source
JACC: Cardiovascular Interventions. 8 (14) (pp 1797-1806), 2015. Date of
Publication: 21 Dec 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The purpose of this study was to determine the safety and
effectiveness of the SAPIEN XT versus SAPIEN systems (Edwards
Lifesciences, Irvine, California) in patients with symptomatic, severe
aortic stenosis (AS) who were not candidates for surgery. Background
Transcatheter aortic valve replacement (TAVR) has become the standard of
care for inoperable patients with severe, symptomatic AS. In the PARTNER
(Placement of Aortic Transcatheter Valves) IB trial, a reduction in
all-cause mortality was observed in patients undergoing TAVR with the
balloon-expandable SAPIEN transcatheter heart valve compared with standard
therapy, but the SAPIEN valve was associated with adverse periprocedural
complications, including vascular complications, major bleeding, and
paravalvular regurgitation. The newer, low-profile SAPIEN XT system was
developed to reduce these adverse events. Methods A total of 560 patients
were enrolled at 28 sites in the United States from April 2011 to February
2012. Patients were randomized to receive the SAPIEN or SAPIEN XT systems.
The primary endpoint was a nonhierarchical composite of all-cause
mortality, major stroke, and rehospitalization at 1 year in the
intention-to-treat population, assessed by noninferiority testing.
Pre-specified secondary endpoints included cardiovascular death, New York
Heart Association functional class, myocardial infarction, stroke, acute
kidney injury, vascular complications, bleeding, 6-min walk distance, and
valve performance (by echocardiography). Results Both overall and major
vascular complications were higher at 30 days in patients undergoing TAVR
with SAPIEN compared with SAPIEN XT (overall: 22.1% vs. 15.5%; p = 0.04;
major: 15.2% vs. 9.5%; p = 0.04). Bleeding requiring blood transfusions
was also more frequent with SAPIEN compared with SAPIEN XT (10.6% vs.
5.3%; p = 0.02). At 1-year follow-up, the nonhierarchical composite of
all-cause mortality, major stroke, or rehospitalization was similar (37.7%
SAPIEN vs. 37.2% SAPIEN XT; noninferiority p value <0.002); no differences
in the other major pre-specified endpoints were found. Conclusions In
inoperable patients with severe, symptomatic AS, the lower-profile SAPIEN
XT is noninferior to SAPIEN with fewer vascular complications and a lesser
need for blood transfusion. (The PARTNER II Trial: Placement of AoRTic
TraNscathetER Valves; NCT01314313).<br/>Copyright © 2015 American
College of Cardiology Foundation.
<121>
[Use Link to view the full text]
Accession Number
613274103
Author
Quyyumi A.A.; Vasquez A.; Kereiakes D.J.; Klapholz M.; Schaer G.L.;
Abdel-Latif A.; Frohwein S.; Henry T.D.; Schatz R.A.; DIb N.; Toma C.;
Davidson C.J.; Barsness G.W.; Shavelle D.M.; Cohen M.; Poole J.; Moss T.;
Hyde P.; Kanakaraj A.M.; Druker V.; Chung A.; Junge C.; Preti R.A.; Smith
R.L.; Mazzo D.J.; Pecora A.; Losordo D.W.
Institution
(Quyyumi, Poole) Emory Clinical Cardiovascular Research Institute,
Cardiology Division, Emory University School of Medicine, 1364 Clifton Rd
NE, Atlanta, GA 30322, United States
(Poole) Athens Regional Cardiology, GA, United States
(Vasquez) Division of Cardiology, Huntsville Hospital, Huntsville, AL,
United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Cincinnati, OH,
United States
(Klapholz) Rutgers University, New Jersey Medical School, Newark, United
States
(Schaer) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
(Abdel-Latif) Department of Medicine, Division of Cardiology, University
of Kentucky, Lexington, United States
(Frohwein) Emory St. Joseph's Hospital, Atlanta, GA, United States
(Henry) Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles,
CA, United States
(Schatz) Scripps Health, San Diego, CA, United States
(DIb) Heart Sciences Center, Gilbert, AZ, United States
(Toma) University of Pittsburgh Medical Center, PA, United States
(Davidson) Bluhm Cardiovascular Institute Northwestern Memorial Hospital,
Chicago, IL, United States
(Barsness) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Shavelle) Cardiovascular Medicine, University of Southern California, Los
Angeles, CA, United States
(Cohen) Westchester Heart and Vascular, Westchester Medical Center,
Valhalla, NY, United States
(Moss, Hyde, Kanakaraj, Druker, Chung, Junge, Preti, Smith, Mazzo, Pecora,
Losordo) Caladrius Biosciences Inc, Basking Ridge, NJ, United States
(Preti) PCT, LLC, A Caladrius Company, Allendale, NJ, United States
Title
PreSERVE-AMI: A Randomized, Double-Blind, Placebo-Controlled Clinical
Trial of Intracoronary Administration of Autologous CD34+ Cells in
Patients with Left Ventricular Dysfunction Post STEMI.
Source
Circulation Research. 120 (2) (pp 324-331), 2017. Date of Publication: 20
Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Rationale: Despite direct immediate intervention and therapy,
ST-segment-elevation myocardial infarction (STEMI) victims remain at risk
for infarct expansion, heart failure, reinfarction, repeat
revascularization, and death. Objective: To evaluate the safety and
bioactivity of autologous CD34+ cell (CLBS10) intracoronary infusion in
patients with left ventricular dysfunction post STEMI. Methods and
Results: Patients who underwent successful stenting for STEMI and had left
ventricular dysfunction (ejection fraction<48%) >4 days poststent were
eligible for enrollment. Subjects (N=161) underwent mini bone marrow
harvest and were randomized 1:1 to receive (1) autologous CD34+ cells
(minimum 10 mol/L+/-20% cells; N=78) or (2) diluent alone (N=83), via
intracoronary infusion. The primary safety end point was adverse events,
serious adverse events, and major adverse cardiac event. The primary
efficacy end point was change in resting myocardial perfusion over 6
months. No differences in myocardial perfusion or adverse events were
observed between the control and treatment groups, although increased
perfusion was observed within each group from baseline to 6 months
(P<0.001). In secondary analyses, when adjusted for time of ischemia, a
consistently favorable cell dose-dependent effect was observed in the
change in left ventricular ejection fraction and infarct size, and the
duration of time subjects was alive and out of hospital (P=0.05). At 1
year, 3.6% (N=3) and 0% deaths were observed in the control and treatment
group, respectively. Conclusions: This PreSERVE-AMI (Phase 2, randomized,
double-blind, placebo-controlled trial) represents the largest study of
cell-based therapy for STEMI completed in the United States and provides
evidence supporting safety and potential efficacy in patients with left
ventricular dysfunction post STEMI who are at risk for death and major
morbidity.
Copyright © 2016 American Heart Association, Inc.
<122>
Accession Number
614009009
Author
Gryka R.J.; Buckley L.F.; Anderson S.M.
Institution
(Gryka) Pharmaceutical Sciences Department, School of Pharmacy, Cedarville
University, 251 North Main Street, Cedarville, OH 45314, United States
(Buckley) Department of Pharmacotherapy and Outcomes Science, School of
Pharmacy, Virginia Commonwealth University, Cedarville, OH, United States
(Anderson) Center for Pharmacy Care, Duquesne University, Pittsburgh, PA,
United States
Title
Vorapaxar: The Current Role and Future Directions of a Novel
Protease-Activated Receptor Antagonist for Risk Reduction in
Atherosclerotic Disease.
Source
Drugs in R and D. 17 (1) (pp 65-72), 2017. Date of Publication: 01 Mar
2017.
Publisher
Springer International Publishing
Abstract
Introduction: Despite the current standard of care, patients with
cardiovascular disease remain at a high risk for recurrent events.
Inhibition of thrombin-mediated platelet activation through
protease-activated receptor-1 antagonism may provide reductions in
atherosclerotic disease beyond those achievable with the current standard
of care. Objective: Our primary objective is to evaluate the clinical
literature regarding the role of vorapaxar (ZontivityTM) in the reduction
of cardiovascular events in patients with a history of myocardial
infarction and peripheral artery disease. In particular, we focus on the
potential future directions for protease-activating receptor antagonists
in the treatment of a broad range of atherosclerotic diseases. Data
Sources: A literature search of PubMed and EBSCO was conducted to identify
randomized clinical trials from August 2005 to June 2016 using the search
terms: 'vorapaxar', 'SCH 530348', 'protease-activated receptor-1
antagonist', and 'ZontivityTM'. Bibliographies were searched and
additional resources were obtained. Results: Vorapaxar is a
first-in-class, protease-activated receptor-1 antagonist. The Thrombin
Receptor Antagonist for Clinical Event Reduction (TRACER) trial did not
demonstrate a significant reduction in a broad primary composite endpoint.
However, the Thrombin-Receptor Antagonist in Secondary Prevention of
Atherothrombotic Ischemic Events (TRA 2degreeP-TIMI 50) trial examined a
more traditional composite endpoint and found a significant benefit with
vorapaxar. Vorapaxar significantly increased bleeding compared with
standard care. Ongoing trials will help define the role of vorapaxar in
patients with peripheral arterial disease, patients with diabetes
mellitus, and other important subgroups. The use of multivariate modeling
may enable the identification of subgroups with maximal benefit and
minimal harm from vorapaxar. Conclusion: Vorapaxar provides clinicians
with a novel mechanism of action to further reduce the burden of ischemic
heart disease. Identification of patients with a high ischemic risk and
low bleeding risk would enable clinicians to maximize the utility of this
unique agent.
Copyright © 2017, The Author(s).
<123>
[Use Link to view the full text]
Accession Number
613579638
Author
Schuyler Jones W.; Baumgartner I.; Hiatt W.R.; Heizer G.; Conte M.S.;
White C.J.; Berger J.S.; Held P.; Katona B.G.; Mahaffey K.W.; Norgren L.;
Blomster J.; Millegard M.; Reist C.; Patel M.R.; Fowkes F.G.R.
Institution
(Schuyler Jones, Heizer, Reist, Patel) Duke Clinical Research Institute,
Duke University, School of Medicine, Department of Medicine, Box 3330,
Durham, NC 27710, United States
(Baumgartner) Swiss Cardiovascular Centre, Inselspital, Bern University
Hospital, University of Bern, Switzerland
(Hiatt) University of Colorado, School of Medicine, CPC Clinical Research,
Aurora, United States
(Conte) Department of Surgery, University of California San Francisco,
United States
(White) Department of Cardiology, Ochsner Clinical School, University of
Queensland, Australia
(White) Ochsner Medical Center, New Orleans, LA, United States
(Berger) Departments of Medicine and Surgery, New York University, School
of Medicine, United States
(Held, Blomster, Millegard) AstraZeneca Gothenburg, Molndal, Sweden
(Katona) AstraZeneca Gaithersburg, MD, United States
(Mahaffey) Stanford Center for Clinical Research, Stanford University,
School of Medicine, CA, United States
(Norgren) Faculty of Medicine and Health, Orebro University, Sweden
(Fowkes) Usher Institute of Population Health Sciences and Informatics,
University of Edinburgh, United Kingdom
Title
Ticagrelor Compared with Clopidogrel in Patients with Prior Lower
Extremity Revascularization for Peripheral Artery Disease.
Source
Circulation. 135 (3) (pp 241-250), 2017. Date of Publication: 17 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: In patients with symptomatic peripheral artery disease with a
history of limb revascularization, the optimal antithrombotic regimen for
long-term management is unknown. Methods: The EUCLID trial (Examining Use
of Ticagrelor In PAD) randomized 13 885 patients with peripheral artery
disease to treatment with ticagrelor 90 mg twice daily or clopidogrel 75
mg daily. Patients were enrolled based on an abnormal ankle-brachial index
<0.80 or a previous lower extremity revascularization. This analysis
focuses on the 7875 (57%) patients enrolled based on the previous lower
extremity revascularization criterion. Patients could not be enrolled
within 30 days of most recent revascularization, and patients with an
indication for dual antiplatelet therapy were excluded. The primary
efficacy end point was a composite of cardiovascular death, myocardial
infarction, or ischemic stroke. The primary safety end point was major
bleeding. Results: Patients with a previous revascularization had a mean
age of 66 years, 73% were male, and the median baseline ankle-brachial
index was 0.78. After adjustment for baseline characteristics, patients
enrolled based on previous revascularization had similar rates of the
primary composite end point (hazard ratio [HR] 1.10, 95% confidence
interval [CI] 0.98-1.23, P=0.12) and statistically significantly higher
rates of myocardial infarction (HR 1.29, 95% CI 1.08-1.55, P=0.005) and
acute limb ischemia (HR 4.23, 95% CI 2.86-6.25, P<0.001) when compared
with patients enrolled based on ankle-brachial index criteria. No
differences in ticagrelor- versus clopidogrel-treated patients were found
for the primary efficacy end point (11.4% vs 11.3%; HR 1.01, 95% CI
0.88-1.15; P=0.90), all-cause mortality (9.2% vs 9.2%; HR 0.99, 95% CI
0.86-1.15; P=0.93), acute limb ischemia (2.5% vs 2.5%; HR 1.03, 95% CI
0.78-1.36; P=0.84), or major bleeding (1.9% vs 1.8%; HR 1.15, 95% CI
0.83-1.59; P=0.41). The median duration of follow-up was =30 months.
Conclusions: After adjustment for baseline characteristics, patients
enrolled based on previous revascularization for peripheral artery disease
had higher rates of myocardial infarction and acute limb ischemia, with
similar composite rates of cardiovascular death, myocardial infarction,
and stroke when compared with patients enrolled based on the
ankle-brachial index criterion. No significant differences were found
between ticagrelor and clopidogrel for reduction of cardiovascular or
acute limb events.
Copyright © 2017 American Heart Association, Inc.
<124>
Accession Number
615243502
Author
Hu X.; Zhuang X.-D.; Li Y.; Li F.-F.; Guo Y.; Du Z.-M.; Liao X.-X.
Institution
(Hu, Zhuang, Li, Li, Guo, Du, Liao) Department of Cardiology, The First
Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Title
A nomogram to predict contrast induced nephropathy in patients undergoing
percutaneous coronary intervention: Is the "anti-aging" agent klotho a
candidate predictor?.
Source
International Heart Journal. 58 (2) (pp 191-196), 2017. Date of
Publication: 2017.
Publisher
International Heart Journal Association (E-mail: : jhj-office@umin.ac.jp)
Abstract
Contrast-induced nephropathy (CIN) is the third leading cause of
hospital-acquired acute kidney injury (AKI). Emerging evidence has
revealed that soluble klotho (sklotho) could be a novel biomarker for
early AKI diagnosis. The aims of this study were to assess the predictive
role of sklotho for CIN and to develop a prediction nomogram in patients
undergoing percutaneous coronary intervention (PCI). This study is
registered on Clinicaltrials.gov (NCT 02650336). Patients aged 18 years or
older undergoing planned PCI were prospectively recruited between May 2014
and July 2015. CIN was defined as an increase in serum creatinine of 0.5
mg/dL within 48-72 hours after the procedure. Plasma sklotho was measured
by enzyme linked immunosorbent assay (ELISA). Stratified analysis,
interaction test, covariate screening, and curve fitting were performed to
explore the association between sklotho and CIN. A nomogram was then
developed and validated using the bootstrapped technique. A total of 192
patients aged 54.75 +/- 12.19 years were selected, 32 (16.7%) of whom were
diagnosed with CIN. A logistic regression model indicated significant
associations between CIN and sklotho, age > 75 years, diabetes, and the
Mehran risk score. Saturation effects analysis detected a two-stage change
between sklotho and CIN, with the inflection point was 477.4 pg/mL. The
area under the ROC curve was 0.758 and the sensitivity and specificity of
this point were 90.6% and 53.9%, respectively. A nomogram was developed
for the prediction of CIN and showed a bootstrapped-cor-rected area under
the curve value of 0.913. In addition, sklotho significantly increased the
predictive value of the nomogram. A strong association between sklotho and
CIN was identified in patients undergoing elective PCI. A lower level of
sklotho would be well correlated with CIN. The nomogram with sklotho is a
useful tool to predict CIN in patients who will undergo PCI. (Int Heart J
2017; 58: 191-196)
Copyright © 2017, International Heart Journal Association. All rights
reserved.
<125>
Accession Number
615243491
Author
Wu X.; Liu G.; Lu J.; Zheng X.-X.; Cui J.-G.; Zhao X.-Y.; Huang X.-H.
Institution
(Wu, Lu, Zheng, Cui, Zhao, Huang) Department of Cardiology, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Science and Peking Union Medical College, Beijing, China
(Liu) Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen
University, Guangzhou, China
Title
Administration of ticagrelor and double-dose clopidogrel based on platelet
reactivity determined by verifynow-P2Y12 for chinese subjects after
elective PCI.
Source
International Heart Journal. 58 (2) (pp 167-173), 2017. Date of
Publication: 2017.
Publisher
International Heart Journal Association (E-mail: : jhj-office@umin.ac.jp)
Abstract
Previous studies have identified high on treatment platelet reactivity
(HTPR) as a potent factor predicting ischemic events for patients with
coronary heart disease. We assessed the efficacy and safety of ticagrelor
(90 mg twice-daily) and double-dose of clopidogrel (150 mg once-daily)
among Chinese patients for elective percutaneous coronary intervention. We
enrolled 40 patients with HTPR from among 317 patients with non-ST-segment
elevation acute coronary syndromes after a successful elective
percutaneous coronary intervention (PCI). Platelet reactivity was measured
by VerifyNow P2Y12 assay. Platelet reactivity was significantly lower for
both groups when compared with baseline platelet reactivity after
medication adjustment (all P < 0.001). The mean platelet reactivity units
(PRU) was significantly lower for the ticagrelor group compared with that
of the clopidogrel group over time (all P < 0.001). The differences in the
rate of sustained HTPR at different time points between the two groups
were significant (2 hours: 0% versus 60%; 8 hours: 5.6% versus 50%; 24
hours: 5.9% versus 43.8%, all P < 0.05). Genetic variation of CYP2C19*2
had no impact on PRU means or rate of HTPR in the ticagrelor group (P >
0.05). During the 30-day follow-up, no MACE occurred in any patient, and
the overall risk of bleeding showed no difference between the two groups
(35% versus 21%, P = 0.48). Our results suggest that ticagrelor may
achieve a more rapid and greater platelet inhibition than double-dose
clopidogrel. Further studies are still needed to assess the differences in
efficacy and safety between ticagrelor and double-dose clopidogrel
administration for Chinese patients post elective PCI. (Int Heart J
Copyright © 2017, International Heart Journal Association. All rights
reserved.
<126>
[Use Link to view the full text]
Accession Number
614297940
Author
Gaudino M.; Puskas J.D.; Di Franco A.; Ohmes L.B.; Iannaccone M.; Barbero
U.; Glineur D.; Grau J.B.; Benedetto U.; D'Ascenzo F.; Gaita F.; Girardi
L.N.; Taggart D.P.
Institution
(Gaudino, Di Franco, Ohmes, Girardi) Department of Cardio-Thoracic
Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, United
States
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Iannaccone, Barbero, D'Ascenzo, Gaita) Citta della Scienza e della
Salute, Department of Cardiology, University of Turin, Italy
(Glineur, Grau) Division of Cardiac Surgery, University of Ottawa Heart
Institute, ON, Canada
(Benedetto) Bristol Heart Institute, University of Bristol, United Kingdom
(Taggart) Department of Cardiac Surgery, John Radcliffe Hospital,
University of Oxford, United Kingdom
Title
Three Arterial Grafts Improve Late Survival: A Meta-Analysis of
Propensity-Matched Studies.
Source
Circulation. 135 (11) (pp 1036-1044), 2017. Date of Publication: 14 Mar
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Little evidence shows whether a third arterial graft provides
superior outcomes compared with the use of 2 arterial grafts in patients
undergoing coronary artery bypass grafting. A meta-analysis of all the
propensity score-matched observational studies comparing the long-term
outcomes of coronary artery bypass grafting with the use of 2-arterial
versus 3-arterial grafts was performed. Methods: A literature search was
conducted using MEDLINE, EMBASE, and Web of Science to identify relevant
articles. Long-term mortality in the propensity score-matched populations
was the primary end point. Secondary end points were in-hospital/30-day
mortality for the propensity score-matched populations and long-term
mortality for the unmatched populations. In the matched population,
time-to-event outcome for long-term mortality was extracted as hazard
ratios, along with their variance. Statistical pooling of survival
(time-to-event) was performed according to a random effect model,
computing risk estimates with 95% confidence intervals. Results: Eight
propensity score-matched studies reporting on 10 287 matched patients
(2-arterial graft: 5346; 3-arterial graft: 4941) were selected for final
comparison. The mean follow-up time ranged from 37.2 to 196.8 months. The
use of 3 arterial grafts was not statistically associated with early
mortality (hazard ratio, 0.93; 95% confidence interval, 0.71-1.22;
P=0.62). The use of 3 arterial grafts was associated with statistically
significantly lower hazard for late death (hazard ratio, 0.8; 95%
confidence interval, 0.75-0.87; P<0.001), irrespective of sex and diabetic
mellitus status. This result was qualitatively similar in the unmatched
population (hazard ratio, 0.57; 95% confidence interval, 0.33-0.98;
P=0.04). Conclusions: The use of a third arterial conduit in patients with
coronary artery bypass grafting is not associated with higher operative
risk and is associated with superior long-term survival, irrespective of
sex and diabetic mellitus status.
Copyright © 2017 American Heart Association, Inc.
<127>
[Use Link to view the full text]
Accession Number
614341167
Author
Rao M.P.; Al-Khatib S.M.; Pokorney S.D.; She L.; Romanov A.; Nicolau J.C.;
Lee K.L.; Carson P.; Selzman C.H.; Stepinska J.; Cleland J.G.F.;
Tungsubutra W.; Desvigne-Nickens P.M.; Sueta C.A.; Siepe M.; Lang I.;
Feldman A.M.; Yii M.; Rouleau J.L.; Velazquez E.J.
Institution
(Rao, Al-Khatib, Pokorney, She, Lee, Velazquez) Duke Clinical Research
Institute, Duke University, School of Medicine, PO Box 17969, Durham, NC
27715, United States
(Lee) Departments of Biostatistics and Bioinformatics, Duke University
School of Medicine, Durham, United States
(Al-Khatib, Velazquez) Departments of Medicine, Duke University School of
Medicine, Durham, United States
(Romanov) State Research Institute of Circulation Pathology, Novosibirsk,
Russian Federation
(Nicolau) Heart Institute, University of Sao Paulo Medical School, Brazil
(Carson) Washington DC Veterans Affairs Medical Center, United States
(Selzman) Division of Cardiothoracic Surgery, University of Utah, Salt
Lake City, United States
(Stepinska) Institute of Cardiology, Warsaw, Poland
(Cleland) National Heart and Lung Institute, Royal Brompton and Harefield
Hospitals, Imperial College, London, United Kingdom
(Tungsubutra) Siriraj Hospital, Mahidol University, Bangkok, Thailand
(Desvigne-Nickens) Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, Bethesda, United States
(Sueta) University of North Carolina, Chapel Hill, United States
(Siepe) University Heart Center Freiburg-Bad Krozingen, Germany
(Lang) Medical University of Vienna, Austria
(Feldman) Department of Medicine, Temple University School of Medicine,
Philadelphia, United States
(Yii) St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia
(Rouleau) Department of Medicine, Montreal Heart Institute, University of
Montreal, QC, Canada
Title
Sudden cardiac death in patients with ischemic heart failure undergoing
coronary artery bypass grafting: Results from the STICH randomized
clinical trial (Surgical Treatment for Ischemic Heart Failure).
Source
Circulation. 135 (12) (pp 1136-1144), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The risk of sudden cardiac death (SCD) in patients with heart
failure after coronary artery bypass graft surgery (CABG) has not been
examined in a contemporary clinical trial of surgical revascularization.
This analysis describes the incidence, timing, and clinical predictors of
SCD after CABG. METHODS: Patients enrolled in the STICH trial (Surgical
Treatment of Ischemic Heart Failure) who underwent CABG with or without
surgical ventricular reconstruction were included. We excluded patients
with prior implantable cardioverter-defibrillator and those randomized
only to medical therapy. The primary outcome was SCD as adjudicated by a
blinded committee. A Cox model was used to examine and identify predictors
of SCD. The Fine and Gray method was used to estimate the incidence of SCD
accounting for the competing risk of other deaths. RESULTS: Over a median
follow-up of 46 months, 113 of 1411 patients who received CABG without (n
= 934) or with (n = 477) surgical ventricular reconstruction had SCD; 311
died of other causes. The mean left ventricular ejection fraction at
enrollment was 28-9%. The 5-year cumulative incidence of SCD was 8.5%.
Patients who had SCD and those who did not die were younger and had fewer
comorbid conditions than did those who died of causes other than SCD. In
the first 30 days after CABG, SCD (n=5) accounted for 7% of all deaths.
The numerically greatest monthly rate of SCD was in the 31- to 90-day time
period. In a multivariable analysis including baseline demographics, risk
factors, coronary anatomy, and left ventricular function, end-systolic
volume index and B-type natriuretic peptide were most strongly associated
with SCD. CONCLUSIONS: The monthly risk of SCD shortly after CABG among
patients with a low left ventricular ejection fraction is highest between
the first and third months, suggesting that risk stratification for SCD
should occur early in the postoperative period, particularly in patients
with increased preoperative end-systolic volume index or B-type
natriuretic peptide. CLINICAL TRIAL REGISTRATION: URL:
http://www.clinicaltrials.gov. Unique identifier: NCT0002359.
Copyright © 2017 American Heart Association, Inc.
<128>
Accession Number
615123475
Author
Tsilimigras D.I.; Antonopoulou A.; Ntanasis-Stathopoulos I.; Patrini D.;
Papagiannopoulos K.; Lawrence D.; Panagiotopoulos N.
Institution
(Tsilimigras, Antonopoulou, Patrini, Lawrence, Panagiotopoulos) Department
of Thoracic Surgery, University College London Hospitals (UCLH), London,
United Kingdom
(Tsilimigras, Ntanasis-Stathopoulos) School of Medicine, National and
Kapodistrian University of Athens, Athens, Greece
(Antonopoulou) School of Medicine, University of Patras, Patras, Greece
(Papagiannopoulos) Department of Thoracic Surgery, St. James's University
Hospital, Leeds, United Kingdom
Title
The role of BioGlue in thoracic surgery: A systematic review.
Source
Journal of Thoracic Disease. 9 (3) (pp 568-576), 2017. Date of
Publication: 01 Mar 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: BioGlue is a commonly used sealant in thoracic surgery.
Prolonged air leak and presence of bronchopleural fistulae (BPF) are often
encountered in clinical practice. We therefore, investigated the role and
the efficacy of BioGlue in these scenarios. Methods: A systematic review
was conducted by searching Medline [1966-2016] and Cochrane Central
Register of Controlled Trials (CENTRAL) [1999-2016] along with reference
lists of the included studies. Included studies reported on thoracic
surgery operations and use of BioGlue in thoracic surgical procedures,
whereas excluded studies met at least one of the following criteria:
non-English language studies, nonhuman population, studies on surgical
specialties other than Thoracic surgery, reviews and meta-analyses and
sealants other than BioGlue. Results: Twelve studies with a total number
of 194 patients were included. Amongst them, 178 were treated for alveolar
air leaks (AAL), 14 for BPF and 2 for lymphatic leaks. BioGlue was
utilized at the time of initial operation in 172 (96.7%) patients for AAL,
while at secondary intervention in 13 (92.9%) for BPF and 1 (50%) for
lymphatic leak. In terms of AAL, only 2 out of 4 studies showed
statistically significant reduction in duration of air leak, duration of
intercostal drainage and length of stay (LOS) when BioGlue was applied. No
complications were encountered after using BioGlue in sealing BPF, apart
from the re-application of BioGlue in 3 cases. Conclusions: Although
BioGlue has been shown to be efficient in treating AAL, it should be used
with caution against BPF, despite encouraging preliminary results.
Potential adverse effects must always be taken into consideration. Future
randomized controlled trials are warranted in an attempt to establish its
benefit in current clinical practice.
<129>
Accession Number
615708562
Author
Muetterties C.; Menon R.; Moser W.; Carroll N.; Marulanda K.; Choi M.;
Wheatley G.H.
Institution
(Muetterties, Carroll, Marulanda) Lewis Katz School of Medicine at Temple
University, Philadelphia, PA, United States
(Menon) Howard University College of Medicine, Washington, DC, United
States
(Moser) Division of Cardiovascular Surgery, Lewis Katz School of Medicine
at Temple University, Philadelphia, PA, United States
(Choi) Arizona State University, Phoenix, AZ, United States
(Wheatley) Centennial Heart and Vascular Center, Nashville, TN, United
States
Title
Multispecialty involvement in the management of type B aortic dissections
in the endovascular era-Implications for training cardiothoracic
residents.
Source
Journal of Cardiac Surgery. 32 (5) (pp 296-300), 2017. Date of
Publication: May 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Purpose: Involvement of qualified specialists with proficiency in
endovascular therapies has created flux regarding the role of
cardiothoracic surgeons, vascular surgeons, and other catheter-skilled
specialists in the management of type B aortic dissections. We used
manuscript authorship trends and recent match data in order to study how
multi-specialty involvement in treating aortic dissections has changed in
the endovascular era. Methods: A PubMed review of published literature
between 1998 and 2015 was performed with "aortic dissection" in the title.
Case studies and entries with incomplete author or identifying information
were excluded. Author number, specialty affiliation, and treatment focus
were recorded. Available residency match data were obtained from the
National Resident Matching Program (NRMP). Results: Cardiothoracic
surgeons represented 38.5% (10/23) of the authors for papers with an
endovascular focus in 1998 compared with 27.7% (59/213) in 2015. Vascular
surgeons represented 19.2% (5/23) and 37.1% (79/213) of authors in 1998
and 2015, respectively. Radiologists accounted for 30.4% (7/23) of
authorship in 1998 and 8.9% (19/213) in 2015. NRMP match data revealed a
10.6% decrease in thoracic surgery matches from 2004 to 2015, while
vascular surgery and interventional radiology increased by 74.7% and
191.1%, respectively. Conclusions: Endovascular technologies have resulted
in significant changes as to which specialties manage complicated type B
aortic dissections. Vascular surgeons, with both open and extensive
endovascular training are optimally positioned to assume a major role in
the care of aortic dissection patients. Continued emphasis on endovascular
training and multispecialty collaboration is essential for cardiothoracic
surgeons in the endovascular era.
Copyright © 2017 Wiley Periodicals, Inc.
<130>
Accession Number
615710919
Author
Mengesha H.G.; Weldearegawi B.; Petrucka P.; Bekele T.; Otieno M.G.; Hailu
A.
Institution
(Mengesha) Adigrat University, College of Health Science, Adigrat,
Ethiopia
(Weldearegawi) Mekelle University, College of Health Science, School of
Public Health, Mekelle, Ethiopia
(Petrucka) University of Saskatchewan, College of Nursing, Adjunct Nelson
Mandela African Institute of Science and Technology, Saskatoon, Canada
(Bekele) Haramaya University, College of Health Science, Department of
Pharmacy, Harar, Ethiopia
(Otieno) Mekelle University, College of Health Science, Department of
Medical Biochemistry, Mekelle, Ethiopia
(Hailu) Mekelle University, College of Health Science, Department of
Internal Medicine, Mekelle, Ethiopia
Title
Effect of ivabradine on cardiovascular outcomes in patients with stable
angina: Meta-analysis of randomized clinical trials.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 105. Date of Publication: 28 Apr 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Although there are established drugs for treatment of
cardiovascular diseases, due to adverse effects these drugs may not be
clinically applicable to all patients. Recent trends have seen the
emergence of drugs which act on funny current channels to induce selective
heart rate reduction. Ivabradine is one such drug developed for coronary
artery disease and heart failure. There is inconsistent evidence about the
effect of this selective inhibitor in reduction of cardiovascular related
mortality and morbidity. Such an inconsistency warrants the need for a
meta-analysis to consider the effectiveness and efficacy of Ivabradine in
the treatment of coronary artery disease and heart failure. Methods:
Randomized controlled trials with a minimum follow-up period of one year
were searched in Pub Med/Medline, Embase, Cochrane Central Register of
Controlled Trials published between 1980 and 2016.Each eligible study was
assessed for risk of bias by using the Cochrane Risk of Bias Assessment
tool. The outcomes assessed in this study included: all cause mortality,
cardiovascular-related mortality, hospitalization for new or worsening
heart failure, and adverse events. Subgroup analysis and publication bias
were assessed. We used Mantel-Haenszel method for random-effects. Analysis
was done using RevMan5.1TM.This study was registered in PROSPERO as
[PROSPERO 2016:CRD42016035597]. Result: Three trials with a total of
36,577 participants met the meta-analysis criteria. Pooled analysis showed
that ivabradine is not effective in reducing cardiovascular deaths (OR:
1.02; CI:0.91-1.15,P=0.74), all-cause mortality (OR:1.00;
CI:0.91-1.10,P=0.98), coronary revascularization (OR: 0.93, CI: 0.77-1.11,
P=0.41) and hospital admission for worsening of heart failure (OR: 0.94,
CI: 0.71-1.25, P=0.69). However, the drug was found to significantly
increase adverse events: phosphenes (OR:7.77, CI: 4.4-14.6,P<0.00001),
blurred vision (OR:3.07,CI:2.18-4.32,P<0.00001), symptomatic bradycardia
(OR: 6.23, CI: 4.2-9.26, P<0.00001), and atrial fibrillation (OR: 1.35,
CI: 1.19-1.53, P<0.0001). Subgroup analysis by duration of follow up on
cardiovascular outcomes found that there is no difference in effect of
ivabradine depending on the duration of follow up. There was no
publication bias in reporting of included studies. Conclusion: This
meta-analysis suggests that ivabradine is not effective in reducing
cardiovascular-related morbidity and mortality unless used for specific
conditions. On the contrary, the use of this drug was strongly associated
with the onset of untoward and new adverse events. This finding strongly
supports previous findings and further informs the rational and
evidence-informed clinical use of ivabradine.
Copyright © 2017 The Author(s).
<131>
Accession Number
615635715
Author
Kandasamy A.; Simon H.A.; Murthy P.; Annadurai M.; Ali M.M.; Ramanathan G.
Institution
(Kandasamy, Simon, Murthy, Annadurai, Ali, Ramanathan) Department of
Cardiothoracic Anesthesia, SRM Medical College Hospital and Research
Centre, SRM University, Kattankulathur, Chennai, Tamil Nadu, India
Title
Comparison of Levosimendan versus Dobutamine in Patients with Moderate to
Severe Left Ventricular Dysfunction Undergoing Off-pump Coronary Artery
Bypass Grafting: A Randomized Prospective Study.
Source
Annals of Cardiac Anaesthesia. 20 (2) (pp 200-206), 2017. Date of
Publication: April-June 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Context: Recent upsurge in referral of patients with compromised left
ventricular (LV) function for cardiac surgery has led to an increasing use
inotropes to achieve improvement of tissue perfusion in the perioperative
period. Aims and Objectives: To compare the hemodynamic effects and
immediate postoperative outcomes with levosimendan and dobutamine in
patients with moderate to severe LV dysfunction undergoing off-pump
coronary artery bypass grafting (OPCAB). Settings and Design: University
teaching hospital, randomized control study. Materials and Methods: Eighty
patients were randomly divided into two groups of 40 each. Group I
received levosimendan at 0.1 mug/kg/min and Group II received dobutamine
at 5 mug/kg/min. Hemodynamic data were noted at 30 min, during obtuse
marginal grafting, 1, 6, 12, and 24 h after surgery. Heart rate (HR), mean
arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP),
cardiac index (CI), systemic vascular resistance index (SVRI) and
pulmonary vascular resistance index (PVRI), left ventricular stroke work
index (LVSWI) and right ventricular stroke work index (RVSWI), mixed
venous oximetry (SvO<inf>2</inf>), and lactate were measured. Statistical
Analysis Used: Chi-square and Student's t-test. Results: The HR, MAP,
PCWP, SVRI, and PVRI were lower in Group I when compared to Group II.
Group I patients showed a statistically significant increase in LVSWI,
RVSWI, and CI, when compared to Group II. Comparatively, Group I patients
maintained higher SvO<inf>2</inf>and lower lactate levels. Duration of
ventilation, Intensive Care Unit (ICU), and hospital stay were lower in
Group I. Conclusions: Levosimendan was associated with statistically
significant increase in indices of contractility (CI, LVSWI, and RVSWI)
and decrease in PCWP during and after OPCAB. Levosimendan group had lower
incidence of atrial fibrillation, shorter length of ICU, and hospital
stay.
Copyright © 2017 Annals of Cardiac Anaesthesia
Published by Wolters Kluwer - Medknow.
<132>
Accession Number
615635700
Author
Modak S.D.; Kane D.G.
Institution
(Modak) Department of Anaesthesiology, Lokmanya Tilak Municipal Medical
and General Hospital, Sion, Switzerland
(Kane) Department of Anaesthesiology, Seth G. S. Medical College, KEM
Hospital, Parel, Mumbai, Maharashtra, India
Title
Conscious sedation for balloon mitral valvotomy: A comparison of fentanyl
versus sufentanil.
Source
Annals of Cardiac Anaesthesia. 20 (2) (pp 163-168), 2017. Date of
Publication: April-June 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Context: Analgesia and sedation are required for the comfort of patient
and the cardiologist during balloon mitral valvotomy. Aims: In this study,
efficacy of analgesia, sedation, and patient satisfaction with sufentanil
was compared with fentanyl. Settings and Design: Single-centered,
prospective single-blind study of sixty patients. Materials and Methods:
Patients between 15 and 45 years of rheumatic mitral stenosis with valve
area of 0.8-1 cm<sup>2</sup> undergoing elective balloon mitral valvotomy,
randomly divided to receive bolus injection fentanyl 1 mcg/kg (Group 1, n
= 30) followed by infusion at 1 mcg/kg/h or bolus of injection sufentanil
0.1 mcg/kg (Group 2, n = 30) followed by continuous infusion at 0.1 mcg/h.
Both the groups received injection midazolam bolus 0.02 mg/kg followed by
infusion at 15 mcg/kg/h. Pain intensity (by visual analog score [VAS]),
level of sedation (by Ramsay sedation scale), overall patient and
operator's satisfaction, effect on cardiorespiratory parameters, and
discharge score (by modified Aldrete score) were assessed. Statistical
Analysis Used: Statistical analysis used Student's unpaired t-test and
Chi-square test. P < 0.05 was considered statistically significant.
Results: Mean number of bolus doses in fentanyl group was 0.9 versus 0.13
in sufentanil group (P < 0.01). The mean value of mean blood pressure in
fentanyl group was 83.52 mmHg versus 88 mmHg in sufentanil group (P <
0.05), but the value was within normal range in both the groups. The mean
VAS - patient's opinion in fentanyl group was 8.97 versus 9.53 in
sufentanil group (P < 0.05). Mean discharge score in fentanyl group was
17.87 versus 18.23 in sufentanil group (P < 0.05). No statistically
significant difference was found with respect to heart rate, respiratory
rate, oxygen saturation, PaCO<inf>2</inf>values, and anxiety scores.
Conclusion: Sufentanil was found to be better with respect to analgesia,
patient satisfaction, and recovery however not cost-effective for
continuous infusion technique.
Copyright © 2017 Annals of Cardiac Anaesthesia
Published by Wolters Kluwer - Medknow.
<133>
Accession Number
615635697
Author
Kiran U.; Ladha S.; Makhija N.; Kapoor P.M.; Choudhury M.; Das S.; Gharde
P.; Malik V.; Airan B.
Institution
(Kiran, Ladha, Makhija, Kapoor, Choudhury, Das, Gharde, Malik, Airan)
Department of Cardiac Anaesthesia, Cardiothoracic Centre, All India
Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India
Title
The role of Rajyoga meditation for modulation of anxiety and serum
cortisol in patients undergoing coronary artery bypass surgery: A
prospective randomized control study.
Source
Annals of Cardiac Anaesthesia. 20 (2) (pp 158-162), 2017. Date of
Publication: April-June 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: Rajyoga meditation is a form of mind body intervention that
is promoted by the Brahma Kumaris World Spiritual University. This form of
meditation can be easily performed without rituals or mantras and can be
practiced anywhere at any time. The practice of Rajyoga meditation can
have beneficial effects on modulating anxiety and cortisol level in
patients undergoing major cardiac surgery. Materials and Methods: A
prospective randomized control study was carried out in a single tertiary
care center. One hundred and fifty patients undergoing elective coronary
artery bypass surgery were enrolled in the study. The patients were
randomized in two groups namely, Group 1 (Rajyoga group) and Group 2
(Control Group). Anxiety was measured on a visual analog scale 1-10 before
the start of Rajyoga training or patient counseling (T1), on the morning
of the day of surgery (T2), on the 2<sup>nd</sup> postoperative day (T3),
and on the 5<sup>th</sup> postoperative day (T4). The serum cortisol level
was measured in the morning of the day of surgery (T1), on the
2<sup>nd</sup> postoperative day (T2) and on the 5<sup>th</sup>
postoperative day (T3), respectively. Results: In the study, it was seen
that the anxiety level of the patients before the surgery (T<inf>1</inf>)
and on the day of surgery (T<inf>2</inf>) were comparable between the two
groups. However on the 2<sup>nd</sup> postoperative day (T<inf>3</inf>),
the patients who underwent Rajyoga training had lower anxiety level in
comparison to the control group (3.12 +/- 1.45 vs. 6.12 +/- 0.14, P <
0.05) and on the 5<sup>th</sup> postoperative day (T<inf>4</inf>) it was
seen that Rajyoga practice had resulted in significant decline in anxiety
level (0.69 +/- 1.1 vs. 5.6 +/- 1.38, P < 0.05). The serum cortisol level
was also favorably modulated by the practice of Rajyoga meditation.
Conclusion: Mindbody intervention is found to effective in reducing the
anxiety of the patients and modulating the cortisol level in patients
undergoing wellknown stressful surgery like coronary artery bypass
surgery.
Copyright © 2017 Annals of Cardiac Anaesthesia
Published by Wolters Kluwer - Medknow.
<134>
Accession Number
615635694
Author
Hashemian M.; Ahmadinejad M.; Mohajerani S.A.; Mirkheshti A.
Institution
(Hashemian, Ahmadinejad) Department of Anesthesiology and Pain Medicine,
Kerman University of Medical Sciences, Kerman, Iran, Islamic Republic of
(Mohajerani, Mirkheshti) Department of Anesthesiology, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Impact of dexmedetomidine on hemodynamic changes during and after coronary
artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 20 (2) (pp 152-157), 2017. Date of
Publication: April-June 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: To determine the effect of dexmedetomidine (Dex) on hemodynamic
changes during cardiopulmonary pump and postoperative period in coronary
artery bypass grafting (CABG). Methods and Design: This study is designed
as a double-blinded, randomized clinical trial. Setting: University
hospital and single center. Participants: patients candidate for elective
CABG. Intervention: Dex 0.5 mug/kg/h or placebo was infused from the
initiation of anesthesia up to extubation in Intensive Care Unit (ICU).
Measurements: Heart rate (HR) and blood pressure (BP), pain score, and
total morphine dose requirement were monitored and compared during cardiac
pump up to 12 h postoperative in ICU. Results: Mean arterial pressure was
significantly higher in Dex group in postoperation period at 1 (P = 0.010)
and 2 h (P = 0.002) compared to control group. HR was significantly lower
in Dex group in postcardiopulmonary bypass (CPB) time at 0 h (P = 0.001),
1 h (P = 0.0016), and 2 h (P = 0.001), and then in postoperative period in
ICU at 1 h (P = 0.025), 2 h (P = 0.0012), and 4 h (P = 0.0025) compared to
control group. Postoperative pain score was significantly lower during 12
h after surgery. Conclusion: Dex could effectively blunt hemodynamic
response to surgical stress, particularly during CPB pump and afterward.
Infusion of Dex maintains BP at higher range and HR at lower range
compared to placebo.
Copyright © 2017 Annals of Cardiac Anaesthesia
Published by Wolters Kluwer - Medknow.
<135>
Accession Number
607012717
Author
Lin H.M.; Seldin D.; Hui A.-M.; Berg D.; Dietrich C.N.; Flood E.
Institution
(Lin, Hui, Berg) Millennium Pharmaceuticals, Inc., A Wholly Owned
Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United
States
(Seldin) Boston Medical Center, Boston, MA, United States
(Dietrich, Flood) ICON PRO, 820 W Diamond Ave, Gaithersburg, MD 20878,
United States
Title
The patients perspective on the symptom and everyday life impact of AL
amyloidosis.
Source
Amyloid. 22 (4) (pp 244-251), 2015. Date of Publication: 02 Oct 2015.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Introduction: This study aimed to understand the symptomatic impact of
amyloid light-chain (AL) amyloidosis from the patients
perspective.Methods: Four data sources were included: a literature review,
review of online patient blogs, expert clinician interviews and patient
interviews. Patients were recruited through the Amyloidosis Foundation and
physician referral. Phone interviews were conducted and included
open-ended concept elicitation questions. Thematic analysis was performed
to identify symptoms and impacts. Descriptive statistics were used to
characterize the sample. A conceptual model was developed depicting the
impact of disease and treatment.Results: Two hundred seventy abstracts
were identified; 10 articles were deemed relevant. No qualitative studies
were identified, and only three studies included patient-reported
measures. Ten patients completed interviews (mean age 61 [+/-8]; 7 male).
Over 25 signs/symptoms were identified, including fatigue, weakness,
dyspnea, neuropathy, edema, dizziness/lightheadedness, anorexia, diarrhea
and constipation. Impacts included reduced physical and social
functioning, and emotional impacts, including frustration, anxiety and
depression. Findings from the blogs and expert interviews were consistent
with patient reports.Conclusion: Symptoms can vary widely, but a core set
of symptoms were common across patients. The conceptual model derived from
this study can be used to ensure a patient-centered approach to drug
development.
Copyright © 2015 Taylor & Francis.
<136>
Accession Number
608798600
Author
Tully P.J.; Baumeister H.
Institution
(Tully, Baumeister) Department of Rehabilitation Psychology and
Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg,
Germany
(Tully) Freemasons Foundation Centre for Men's Health, Discipline of
Medicine, School of Medicine, University of Adelaide, Adelaide, SA,
Australia
(Tully) INSERM, U897-Epidemiology and Biostatistics, Bordeaux, France
(Baumeister) Faculty of Medicine, Medical Psychology and Medical
Sociology, University of Freiburg, Freiburg, Germany
Title
Collaborative care for comorbid depression and coronary heart disease: A
systematic review and meta-analysis of randomised controlled trials.
Source
BMJ Open. 5 (12) (no pagination), 2015. Article Number: e009128. Date of
Publication: 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: To systematically review the efficacy of collaborative care
(CC) for depression in adults with coronary heart disease (CHD) and
depression. Design: Systematic review and meta-analysis. Data sources:
Electronic databases (Cochrane Central Register of Controlled Trials
MEDLINE, EMBASE, PsycINFO and CINAHL) were searched until April 2014.
Inclusion criteria: Population, depression comorbid with CHD;
intervention, randomised controlled trial (RCT) of CC; comparison, either
usual care, wait-list control group or no further treatment; and outcome,
(primary) major adverse cardiac events (MACE), (secondary) standardised
measure of depression, anxiety, quality of life (QOL) and
cost-effectiveness. Data extraction and analysis: RevMan V.5.3 was used to
synthesise the data as risk ratios (RRs), ORs and standardised mean
differences (SMD) with 95% CIs in random effect models. Results: Six RCTs
met the inclusion criteria and comprised 655 participants randomised to CC
and 629 participants randomised to the control group (total 1284).
Collaborative depression care led to a significant reduction in MACE in
the short term (three trials, RR 0.54; 95% CI 0.31 to 0.95, p=0.03) that
was not sustained in the longer term. Small reductions in depressive
symptoms were evident in the short term (6 trials, pooled SMD -0.31; 95%
CI -0.43 to -0.19, p<0.00001) and depression remission was more likely to
be achieved with CC (5 trials, OR 1.77; 95% CI 1.28 to 2.44, p=0.0005).
Likewise, a significant effect was observed for anxiety symptoms (SMD
-0.36) and mental QOL (SMD 0.24). The timing of the intervention was a
source of between-group heterogeneity for depression symptoms (between
groups p=0.04, I2=76.5%). Conclusions: Collaborative depression care did
not lead to a sustained reduction in the primary MACE end point. Small
effects were observed for depression, depression remission, anxiety and
mental QOL. Trials registration number: PROSPERO CRD42014013653.
<137>
Accession Number
606904854
Author
Simonini M.; Pozzoli S.; Bignami E.; Casamassima N.; Messaggio E.; Lanzani
C.; Frati E.; Botticelli I.M.; Rotatori F.; Alfieri O.; Zangrillo A.;
Manunta P.
Institution
(Simonini, Pozzoli, Casamassima, Messaggio, Lanzani, Botticelli, Manunta)
Genomics of Renal Diseases and Hypertension Department, Vita-Salute San
Raffaele University, Dept. of Nephrology, IRCCS San Raffaele Scientific
Institute, Milan 20132, Italy
(Bignami, Frati, Zangrillo) Anesthesia and Intensive Care Department,
Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific
Institute, Milan 20132, Italy
(Rotatori) SUNY Downstate Medical Center, State University of New York,
Brooklyn, NY 11203, United States
(Alfieri) Cardiac Surgery Department, Vita-Salute San Raffaele University,
IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
Title
Endogenous Ouabain: An Old Cardiotonic Steroid as a New Biomarker of Heart
Failure and a Predictor of Mortality after Cardiac Surgery.
Source
BioMed Research International. 2015 (no pagination), 2015. Article Number:
714793. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Cardiovascular diseases remain the main cause of mortality and morbidity
worldwide; primary prevention is a priority for physicians. Biomarkers are
useful tools able to identify high-risk individuals, guide treatments, and
determine prognosis. Our aim is to investigate Endogenous Ouabain (EO), an
adrenal stress hormone with hemodynamic effects, as a valuable biomarker
of heart failure. In a population of 845 patients undergoing elective
cardiac surgery, we have investigated the relationships between EO and
echocardiography parameters/plasmatic biomarker of cardiac function. EO
was found to be correlated negatively with left ventricular EF (p=0.001),
positively with Cardiac End-Diastolic Diameter (p=0.047), and positively
with plasmatic NT-proBNP level (p=0.02). Moreover, a different plasmatic
EO level (both preoperative and postoperative) was found according to NYHA
class (p=0.013). All these results have been replicated on an independent
cohort of patients (147 subjects from US). Finally, a higher EO level in
the immediate postoperative time was indicative of a more severe
cardiological condition and it was associated with increased perioperative
mortality risk (p=0.023 for 30-day morality). Our data suggest that
preoperative and postoperative plasmatic EO level identifies patients with
a more severe cardiovascular presentation at baseline. These patients have
a higher risk of morbidity and mortality after cardiac surgery.
Copyright © 2015 Marco Simonini et al.
<138>
Accession Number
607909911
Author
Younge J.O.; Wery M.F.; Gotink R.A.; Utens E.M.W.J.; Michels M.;
Rizopoulos D.; Van Rossum E.F.C.; Hunink M.G.M.; Roos-Hesselink J.W.
Institution
(Younge, Michels, Roos-Hesselink) Department of Cardiology, Erasmus MC,
University Medical Center Rotterdam, Rotterdam, Netherlands
(Younge, Wery, Gotink, Hunink) Department of Epidemiology, Erasmus MC,
University Medical Center Rotterdam, Rotterdam, Netherlands
(Gotink) Department of Psychiatry (Section Medical Psychology and
Psychotherapy), Erasmus MC Rotterdam, University Medical Center,
Rotterdam, Netherlands
(Utens) Department of Adolescent Psychiatry/Psychology, Erasmus MC
Rotterdam, University Medical Center, Rotterdam, Netherlands
(Gotink, Hunink) Department of Radiology, Erasmus MC, University Medical
Center Rotterdam, Rotterdam, Netherlands
(Rizopoulos) Department of Biostatistics, Erasmus MC, University Medical
Center Rotterdam, Rotterdam, Netherlands
(Van Rossum) Department of Internal Medicine, Erasmus MC, University
Medical Center Rotterdam, Rotterdam, Netherlands
(Hunink) Department of Health Policy and Management, Harvard T.H. Chan
School of Public Health, Boston, MA, United States
Title
Web-based mindfulness intervention in heart disease: A randomized
controlled trial.
Source
PLoS ONE. 10 (12) (no pagination), 2015. Article Number: e0143843. Date of
Publication: 01 Dec 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Evidence is accumulating that mindfulness training has
favorable effects on psychological outcomes, but studies on physiological
outcomes are limited. Patients with heart disease have a high incidence of
physiological and psychological problems and may benefit from mindfulness
training. Our aim was to determine the beneficial physiological and
psychological effects of online mindfulness training in patients with
heart disease. Methods The study was a pragmatic randomized controlled
single-blind trial. Between June 2012 and April 2014 we randomized 324
patients (mean age 43.2 years, 53.7%male) with heart disease in a 2:1
ratio (n = 215 versus n = 109) to a 12-week onlinemindfulness training in
addition to usual care (UC) compared to UC alone. The primary outcome was
exercise capacity measured with the 6 minute walk test (6MWT). Secondary
outcomes were other physiological parameters (heart rate, blood pressure,
respiratory rate, and NT-proBNP), subjective health status (SF-36),
perceived stress (PSS), psychological well-being (HADS), social support
(PSSS12) and a composite endpoint (all-cause mortality, heart failure,
symptomatic arrhythmia, cardiac surgery, and percutaneous cardiac
intervention). Linear mixed models were used to evaluate differences
between groups on the repeated outcome measures. Results Compared to UC,
mindfulness showed a borderline significant improved 6MWT (effect size,
meters: 13.2, 95%CI: -0.02; 26.4, p = 0.050). There was also a significant
lower heart rate in favor of the mindfulness group (effect size, beats per
minute: -2.8, 95%CI: -5.4;-0.2, p = 0.033). No significant differences
were seen on other outcomes. Conclusions Mindfulness training showed
positive effects on the physiological parameters exercise capacity and
heart rate and it might therefore be a useful adjunct to current clinical
therapy in patients with heart disease.
Copyright © 2015 Younge et al. This is an open access article
distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in
anymedium, provided the original author and source are credited.
<139>
Accession Number
607378089
Author
Gillies M.A.; Kakar V.; Parker R.J.; Honore P.M.; Ostermann M.
Institution
(Gillies) Royal Infirmary of Edinburgh, Department of Anaesthesia,
Critical Care and Pain Medicine, Edinburgh, United Kingdom
(Kakar) King's College Hospital NHS Foundation Hospital, Department of
Critical Care, London, United Kingdom
(Parker) Aintree University Hospital NHS Foundation Hospital, Department
of Critical Care Medicine, Liverpool, United Kingdom
(Honore) Vrije Universiteit Brussel (VUB University), Department of ICU,
Universitair Ziekenhuis Brussel, Brussels, Belgium
(Ostermann) Guy's and St Thomas' Foundation Hospital, Department of
Nephrology and Critical Care Medicine, King's College London, London,
United Kingdom
Title
Fenoldopam to prevent acute kidney injury after major surgery-a systematic
review and meta-analysis.
Source
Critical Care. 19 (1) (no pagination), 2015. Article Number: 449. Date of
Publication: December 25, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Acute kidney injury (AKI) after surgery is associated with
increased mortality and healthcare costs. Fenoldopam is a selective
dopamine-1 receptor agonist with renoprotective properties. We conducted a
systematic review and meta-analysis of randomised controlled trials
comparing fenoldopam with placebo to prevent AKI after major surgery.
Methods: We searched EMBASE, PubMed, meta-Register of randomised
controlled trials and Cochrane CENTRAL databases for trials comparing
fenoldopam with placebo in patients undergoing major surgery. The primary
outcome was incidence of new AKI. Secondary outcomes were requirement for
renal replacement therapy and hospital mortality. Results: Eighty-three
publications were screened; 23 studies underwent full data extraction and
scoring. Six trials were suitable for inclusion in the data synthesis
(total of 507 subjects undergoing cardiovascular surgery, partial
nephrectomy, liver transplant surgery). Five studies were rated at high
risk of bias. Data on post-operative incidence of AKI were available in
five of the six trials (total of 471 patients) but definitions of AKI
varied between studies. Of the 238 patients receiving fenoldopam, 45 (18.9
%) developed AKI compared to 62 (26.6 %) of the 233 patients who received
placebo (p = 0.004, I <sup>2</sup> = 0 %; random-effects model odds ratio
0.46, 95 % confidence interval 0.27-0.79). In patients treated with
fenoldopam, there was no difference in renal replacement therapy (n = 478;
p = 0.11, I <sup>2</sup> = 47 %; fixed-effect model odds ratio 0.27, 95 %
confidence interval 0.06-1.19) or hospital mortality (p = 0.60, I
<sup>2</sup> = 0 %; fixed-effect model odds ratio 1.0, 95 % confidence
interval 0.14-7.37). Conclusions: In this analysis, peri-operative
treatment with fenoldopam was associated with a significant reduction in
post-operative AKI but it had no impact on renal replacement therapy or
hospital mortality. Equipoise remains for further large trials in this
area since the studies were conducted in three types of surgery, the
majority of studies were rated at high risk of bias and the criteria for
AKI varied between trials.
Copyright © 2015 Gillies et al.
<140>
Accession Number
608798318
Author
Preston L.; Turner J.; Booth A.; O'Keeffe C.; Campbell F.; Jesurasa A.;
Cooper K.; Goyder E.
Institution
(Preston, Turner, Booth, O'Keeffe, Campbell, Jesurasa, Cooper, Goyder)
School for Health and Related Research (ScHARR), University of Sheffield,
Sheffield, United Kingdom
Title
Is there a relationship between surgical case volume and mortality in
congenital heart disease services? A rapid evidence review.
Source
BMJ Open. 5 (12) (no pagination), 2015. Article Number: e009252. Date of
Publication: 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To identify and synthesise the evidence on the relationship
between surgical volume and patient outcomes for adults and children with
congenital heart disease. Design: Evidence synthesis of interventional and
observational studies. Data sources: MEDLINE, EMBASE, CINAHL, Cochrane
Library and Web of Science (2009-2014) and citation searching, reference
lists and recommendations from stakeholders (2003-2014) were used to
identify evidence. Study selection: Quantitative observational and
interventional studies with information on volume of surgical procedures
and patient outcomes were included. Results: 31 of the 34 papers
identified (91.2%) included only paediatric patients. 25 (73.5%)
investigated the relationship between volume and mortality, 7 (20.6%)
mortality and other outcomes and 2 (5.9%) non-mortality outcomes only.
88.2% were from the US, 97% were multicentre studies and all were
retrospective observational studies. 20 studies (58.8%) included all
congenital heart disease conditions and 14 (41.2%) single conditions or
procedures. No UK studies were identified. Most studies showed a
relationship between volume and outcome but this relationship was not
consistent. The relationship was stronger for single complex conditions or
procedures. We found limited evidence about the impact of volume on
non-mortality outcomes. A mixed picture emerged revealing a range of
factors, in addition to volume, that influence outcome including condition
severity, individual centre and surgeon effects and clinical advances over
time. Conclusions: The heterogeneity of findings from observational
studies suggests that, while a relationship between volume and outcome
exists, this is unlikely to be a simple, independent and directly causal
relationship. The effect of volume on outcome relative to the effect of
other, as yet undetermined, health system factors remains a complex and
unresolved research question.
<141>
Accession Number
607918587
Author
Narayan O.; Leung M.C.H.; Wong D.T.L.; Meredith I.T.; Cameron J.D.
Institution
(Narayan, Leung, Wong, Meredith, Cameron) Monash Cardiovascular Research
Centre, MonashHeart and School of Clinical Sciences at Monash Health,
Monash University, Melbourne, Australia
Title
Percutaneous Coronary Intervention Enhances Accelerative Wave Intensity in
Coronary Arteries.
Source
PLoS ONE. 10 (12) (no pagination), 2015. Article Number: e0142998. Date of
Publication: 01 Dec 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The systolic forward travelling compression wave (sFCW) and
diastolic backward travelling decompression waves (dBEW) predominantly
accelerate coronary blood flow. The effect of a coronary stenosis on the
intensity of these waves in the distal vessel is unknown. We investigated
the relationship between established physiological indices of hyperemic
coronary flow and the intensity of the two major accelerative coronary
waves identified by Coronary Wave Intensity analysis (CWIA). Methodology /
Principal Findings Simultaneous intracoronary pressure and velocity
measurement was performed during adenosine induced hyperemia in 17
patients with pressure / Doppler flow wires positioned distal to the
target lesion. CWI profiles were generated from this data. Fractional Flow
Reserve (FFR) and Coronary Flow Velocity Reserve (CFVR) were calculated
concurrently. The intensity of the dBEW was significantly correlated with
FFR (R = -0.70, P = 0.003) and CFVR (R = -0.73, P = 0.001). The intensity
of the sFCW was also significantly correlated with baseline FFR (R = 0.71,
p = 0.002) and CFVR (R = 0.59, P = 0.01). Stenting of the target lesion
resulted in a median 178% (interquartile range 55-280%) (P0.0001) increase
in sFCW intensity and a median 117% (interquartile range 27-509%) (P =
0.001) increase in dBEW intensity. The increase in accelerative wave
intensity following PCI was proportionate to the baseline FFR and CFVR,
such that stenting of lesions associated with the greatest flow limitation
(lowest FFR and CFVR) resulted in the largest increases in wave intensity.
Conclusions Increasing ischemia severity is associated with proportionate
reductions in cumulative intensity of both major accelerative coronary
waves. Impaired diastolic microvascular decompression may represent a
novel, important pathophysiologic mechanism driving the reduction in
coronary blood flow in the setting of an epicardial stenosis.
Copyright © 2015 Narayan et al. This is an open access article
distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are credited.
<142>
Accession Number
615969785
Author
Safabakhsh L.; Jahantigh M.; Nosratzehi S.; Navabi S.
Institution
(Safabakhsh) Health Promotion Research Center, Zahedan University of
Medical Sciences, Zahedan, IR Iran.
Title
The Effect of Health Promoting Programs on Patient's Life Style After
Coronary Artery Bypass Graft-Hospitalized in Shiraz Hospitals.
Source
Global journal of health science. 8 (5) (pp 154-159), 2015. Date of
Publication: 28 Sep 2015.
Abstract
BACKGROUND: Health promotion is an essential strategy for reduction of
health disparities. Health promotion includes all activities that
encourage optimum physical, spiritual, and mental functions. The aim of
this study was to determine the impact of a Health Promotion Program (HPP)
on behavior in terms of the dimensions of the Health Promoting Lifestyle
Profile (HPLP) in patients after Coronary Artery Bypass Graft (CABG).
METHODS & MATERIALS: In this clinical trial study, 80 patients who had
undergone CABG surgery (2011-2012) were selected and randomly divided in
two groups: Experimental and Control that investigated by (HPLP II). Then
the experimental group was educated about diet, walking and stress
management. The program process was followed up for three months and after
tward whole variables were investigated again. The overall score and the
scores for the six dimensions of the HPLP (self actualization, health
responsibility, exercise, nutrition, interpersonal support and stress
management) were measured in the pre- and post-test periods. Data were
manually entered into SPSS version 21(IBM Corp, USA) by one the authors.
Statistical analysis was performed using Student's t-test and paired
t-test. Mean standard deviation and standard error of the mean (with 95%
Confidence Interval) were generated for each item.
RESULTS: Results showed that score of stress management (p=.036), diet
(p=.002), Spiritual Growth (p=.001) and interrelationship (p=002) increase
in experimental group after intervention. Average scores after three
months in the control group had no significant changes; except
responsibility for health (p<.05). Results of the study revealed that
comparison the scores of the experimental group were significantly
different from the control group in all lifestyle aspects except for
spiritual growth.
CONCLUSION: This study showed that HPP on lifestyle and health promotion
in patients who suffered from Coronary Heart Disease (CAD) could improve
the patient's awareness of healthy behaviors and well-being in the quality
of life.
<143>
Accession Number
615985103
Author
Bai A.D.; Steinberg M.; Showler A.; Burry L.; Bhatia R.S.; Tomlinson G.A.;
Bell C.M.; Morris A.M.
Institution
(Bai) Department of Medicine, Queen's University, Kingston, Ontario,
Canada
(Steinberg, Burry, Bell, Morris) Sinai Health System, Toronto, Ontario,
Canada
(Showler, Tomlinson, Bell, Morris) Department of Medicine, University of
Toronto, Toronto, Ontario, Canada
(Burry) Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto,
Ontario, Canada
(Bhatia) Women's College Hospital Institute for Health Systems Solutions
and Virtual Care, Toronto, Ontario, Canada
(Tomlinson, Bell, Morris) University Health Network, Toronto, Ontario,
Canada
(Bell) Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
Title
Diagnostic Accuracy of Transthoracic Echocardiography for Infective
Endocarditis Findings Using Transesophageal Echocardiography as the
Reference Standard: A Meta-Analysis.
Source
Journal of the American Society of Echocardiography. (no pagination),
2017. Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Echocardiography is important for the diagnosis of infective
endocarditis (IE), for which transesophageal echocardiography (TEE) is
superior to transthoracic echocardiography (TTE). Methods: A systematic
review and meta-analysis of observational studies was performed with the
objective of evaluating diagnostic properties of TTE, with transesophageal
findings of IE as the reference standard in patients with suspected IE.
Results: The literature search yielded 377 unique articles, of which 16
met the inclusion criteria. The 16 studies included 2,807 patients, of
whom 793 (28%) had vegetations on TEE. For detecting vegetations, harmonic
TTE had sensitivity of 61% (95% CI, 45%-75%) and specificity of 94% (95%
CI, 85%-98%) with a negative likelihood ratio (NLR) of 0.42 (95% CI,
0.26-0.61). NLR for harmonic TTE can be improved by including only
patients without prosthetic valves (NLR = 0.36; 95% CI, 0.22-0.55) or by
having strict criteria for conclusively negative results on TTE (NLR =
0.17; 95% CI, 0.10-0.28). In the setting of patients without prosthetic
valves, harmonic TTE had likelihood ratios of 0.14 (95% CI, 0.09-0.23) for
a conclusively negative result, 0.66 (95% CI, 0.53-0.81) for an
indeterminate result, and 14.60 (95% CI, 3.37-70.40) for a positive
result. Conclusions: Modern harmonic TTE still has the potential to miss
many vegetations detected on TEE. When limited to patients without
prosthetic valves, conclusively negative results on TEE recorded with
optimal imaging views greatly decrease the likelihood of IE. All other
transthoracic results are not useful for ruling out IE, and subsequent TEE
is almost always required.
Copyright © 2017 American Society of Echocardiography.
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