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ESTUDIOS


01 enero 2017

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Post-Approval U.S. Experience With Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation

Vivek Y. Reddy, Douglas N. Gibson, Saibal Kar, William O’Neill, Shephal K. Doshi, Rodney P. Horton, Maurice Buchbinder, Nicole T. Gordon and David R. Holmes

Background: Left atrial appendage closure (LAAC) was approved by the U.S. Food and Drug Administration (FDA) as a stroke prevention alternative to warfarin for patients with nonvalvular atrial fibrillation. However, clinical decision-making is confounded by the fact that although LAAC attenuates the anticoagulant-related lifetime risk of bleeding, implantation is associated with upfront complications. Thus, enthusiasm for LAAC as a treatment option has been appropriately tempered, particularly as the therapy is introduced beyond the clinical trial sites into general clinical practice.

01 marzo 2017

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Valvular Heart Disease

Giulia Renda, Fabrizio Ricci, Robert P. Giugliano and Raffaele De Caterina

Background: Valvular heart disease (VHD) and atrial fibrillation (AF) often coexist. Phase III trials comparing non–vitamin K antagonist oral anticoagulants (NOACs) with warfarin excluded patients with moderate/severe mitral stenosis or mechanical heart valves, but variably included patients with other VHD and valve surgeries.

01 marzo 2017

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Valvular Heart Disease Patients on Edoxaban or Warfarin in the ENGAGE AF-TIMI 48 Trial

Raffaele De Caterina, Giulia Renda, Anthony P. Carnicelli, Francesco Nordio, Marco Trevisan, Michele F. Mercuri, Christian T. Ruff, Elliott M. Antman, Eugene Braunwald and Robert P. Giugliano

Background: The use of non-vitamin K antagonist oral anticoagulants (NOACs) instead of vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and coexisting valvular heart disease (VHD) is of substantial interest.

01 abril 2017

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Early Invasive Versus Selective Strategy for Non–ST-Segment Elevation Acute Coronary Syndrome

Niels P.G. Hoedemaker, Peter Damman, Pier Woudstra, Alexander Hirsch, Fons Windhausen, Jan G.P. Tijssen, Robbert J. de Winter, ICTUS Investigators, R.J.G. Peters, P.H.J.M. Dunselman, F.W.A. Verheugt, C.L. Janus, V. Umans, P.E.F. Bendermacher, H.R. Michels, A. Sadée, D. Hertzberger, R.J. Peters, P.A.R.M. de Miliano, A.H. Liem, R. Tjon Joe Gin, M. van der Linde, D. Lok, G. Hoedemaker, M. Pieterse, L. van den Merkhof, M. Daniëls, M. van Hessen, W. Hermans, C.E. Schotborgh, C. de Zwaan, A. Bredero, P. de Jaegere, M. Janssen, J. Louwerenburg, M. Veerhoek, M. Schalij, A. de Porto, F. Zijlstra, J. Winter, P. de Feyter, R. Robles de Medina, P. Withagen, M. Sedney, H. Thijssen, C. van Rees, P. van den Bergh, C. de Cock, A. van ’t Hof, M.J. Suttorp, R.J. de Winter, F. Windhausen, J.H. Cornel, J.G.P. Tijssen, F.W.A. Verheugt, P.H.J.M. Dunselman, P.J. de Feyter, H.R. Michels, R.J. de Winter, F. Windhausen, J.G.P. Tijssen, D. Düren, K. Liem, G.T.B. Sanders, J. Fischer and J. van Straalen

Background: The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS) and an elevated cardiac troponin T. No long-term benefit of an early invasive strategy was found at 1 and 5 years.

01 abril 2017

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Left Ventricular Assist Device as a Bridge to Recovery for Patients With Advanced Heart Failure

Djordje G. Jakovljevic, Magdi H. Yacoub, Stephan Schueler, Guy A. MacGowan, Lazar Velicki, Petar M. Seferovic, Sandeep Hothi, Bing-Hsiean Tzeng, David A. Brodie, Emma Birks and Lip-Bun Tan

Background: Left ventricular assist devices (LVADs) have been used as an effective therapeutic option in patients with advanced heart failure, either as a bridge to transplantation, as destination therapy, or in some patients, as a bridge to recovery.

01 mayo 2017

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

Sung-Han Yoon, Sabine Bleiziffer, Ole De Backer, Victoria Delgado, Takahide Arai, Johannes Ziegelmueller, Marco Barbanti, Rahul Sharma, Gidon Y. Perlman, Omar K. Khalique, Erik W. Holy, Smriti Saraf, Florian Deuschl, Buntaro Fujita, Philipp Ruile, Franz-Josef Neumann, Gregor Pache, Masao Takahashi, Hidehiro Kaneko, Tobias Schmidt, Yohei Ohno, Niklas Schofer, William K.F. Kong, Edgar Tay, Daisuke Sugiyama, Hiroyuki Kawamori, Yoshio Maeno, Yigal Abramowitz, Tarun Chakravarty, Mamoo Nakamura, Shingo Kuwata, Gerald Yong, Hsien-Li Kao, Michael Lee, Hyo-Soo Kim, Thomas Modine, S. Chiu Wong, Francesco Bedgoni, Luca Testa, Emmanuel Teiger, Christian Butter, Stephan M. Ensminger, Ulrich Schaefer, Danny Dvir, Philipp Blanke, Jonathon Leipsic, Fabian Nietlispach, Mohamed Abdel-Wahab, Bernard Chevalier, Corrado Tamburino, David Hildick-Smith, Brian K. Whisenant, Seung-Jung Park, Antonio Colombo, Azeem Latib, Susheel K. Kodali, Jeroen J. Bax, Lars Søndergaard, John G. Webb, Thierry Lefèvre, Martin B. Leon and Raj Makkar

Background: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS).

01 mayo 2016

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Diagnostic Ultrasound Impulses Improve Microvascular Flow in Patients With STEMI Receiving Intravenous Microbubbles

Wilson Mathias Jr., Jeane M. Tsutsui, Bruno G. Tavares, Feng Xie, Miguel O.D. Aguiar, Diego R. Garcia, Mucio T. Oliveira Jr., Alexandre Soeiro, Jose C. Nicolau, Pedro A. Lemos Neto, Carlos E. Rochitte, José A.F. Ramires, Roberto Kalil Filho and Thomas R. Porter

Background: Pre-clinical trials have demonstrated that, during intravenous microbubble infusion, high mechanical index (HMI) impulses from a diagnostic ultrasound (DUS) transducer might restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI).

01 mayo 2016

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Impact of Ejection Fraction and Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Replacement

Suzanne J. Baron, Suzanne V. Arnold, Howard C. Herrmann, David R. Holmes Jr., Wilson Y. Szeto, Keith B. Allen, Adnan K. Chhatriwalla, Sreekaanth Vemulapali, Sean O’Brien, Dadi Dai and David J. Cohen

Background: In patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), studies have suggested that reduced left ventricular (LV) ejection fraction (LVEF) and low aortic valve gradient (AVG) are associated with worse long-term outcomes. Because these conditions commonly coexist, the extent to which they are independently associated with outcomes after TAVR is unknown.

01 mayo 2016

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Papillary Muscle Approximation Versus Restrictive Annuloplasty Alone for Severe Ischemic Mitral Regurgitation

Francesco Nappi, Mario Lusini, Cristiano Spadaccio, Antonio Nenna, Elvio Covino, Christophe Acar and Massimo Chello

Background: Guidelines recommend surgery for patients with severe ischemic mitral regurgitation (MR). Nonrandomized studies suggest that subvalvular repair is associated with longer survival, but randomized studies are lacking.

01 mayo 2016

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Biodegradable Polymer-Based Sirolimus-Eluting Stents With Differing Elution and Absorption Kinetics: The PANDA III Trial

Bo Xu, Runlin Gao, Yuejin Yang, Xuebin Cao, Lei Qin, Yi Li, Zhanquan Li, Xueqi Li, Hailong Lin, Yong Guo, Yitong Ma, Jian’an Wang, Shaoping Nie, Liang Xu, Eric Cao, Changdong Guan, Gregg W. Stone and on behalf of the PANDA III Investigators

Background: Whether the rate of drug elution and polymer absorption affects clinical outcomes of biodegradable polymer-based drug-eluting stents (DES) is unknown. The widely used polylactide polymer-based Excel stent (JW Medical, Weihai, China) elutes sirolimus within 180 days, and the polylactide polymer is completely absorbed within 6 to 9 months. In contrast, the poly-lactide-co-glycolide polymer-based BuMA stent (Sino Medical, Tianjin, China) elutes sirolimus within 30 days, and the poly-lactide-co-glycolide polymer is completely absorbed within 3 months. Thus, both metallic DES elute sirolimus, isolating major differences to the polymer and elution kinetics.

01 mayo 2016

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents: Risk Scores From PARIS

Usman Baber, Roxana Mehran, Gennaro Giustino, David J. Cohen, Timothy D. Henry, Samantha Sartori, Cono Ariti, Claire Litherland, George Dangas, C. Michael Gibson, Mitchell W. Krucoff, David J. Moliterno, Ajay J. Kirtane, Gregg W. Stone, Antonio Colombo, Alaide Chieffo, Annapoorna S. Kini, Bernhard Witzenbichler, Giora Weisz, Philippe Gabriel Steg and Stuart Pocock

Background: Dual-antiplatelet therapy with aspirin and clopidogrel after percutaneous coronary intervention reduces the risk for coronary thrombotic events (CTEs) at the expense of increasing risk for major bleeding (MB). Metrics to accurately predict the occurrence of each respective event and inform clinical decision making are lacking.

01 abril 2016

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease

Michelle C. Williams, Amanda Hunter, Anoop S.V. Shah, Valentina Assi, Stephanie Lewis, Joel Smith, Colin Berry, Nicholas A. Boon, Elizabeth Clark, Marcus Flather, John Forbes, Scott McLean, Giles Roditi, Edwin J.R. van Beek, Adam D. Timmis, David E. Newby and on behalf of the SCOT-HEART Investigators

Background: In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA).

01 abril 2016

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. Transcatheter Therapies for Treating Tricuspid Regurgitation

Josep Rodés-Cabau, Rebecca T. Hahn, Azeem Latib, Michael Laule, Alexander Lauten, Francesco Maisano, Joachim Schofer, Francisco Campelo-Parada, Rishi Puri and Alec Vahanian

Tricuspid valve (TV) disease has been relatively neglected, despite the known association between severe tricuspid regurgitation (TR) and mortality. Few patients undergo isolated tricuspid surgery, which remains associated with high in-hospital mortality rates, particularly in patients with prior left-sided valve surgery. Patients with severe TR are often managed medically for years before TV repair or replacement. Current guidelines recommend TV repair in the presence of a dilated tricuspid annulus at the time of a left-sided valve surgical intervention, even if regurgitation is mild. This proposed algorithm aims to prevent the inevitable progression to severe TR and the need for a second surgical intervention. Recently, novel transcatheter treatment options were developed for treating patients with severe TR and right heart failure with prohibitive surgical risk. Here we describe currently available transcatheter treatment options for severe TR implanted at different levels: the junction between vena cavae and right atrium; the tricuspid annulus; or between TV leaflets, improving coaptation.

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