01 noviembre 2015

CATHETERIZATION & CARDIOVASCULAR INTERVENTIONS. Novel X-ray imaging technology enables significant patient dose reduction in interventional cardiology while maintaining diagnostic image quality

Liesbeth Eloot MSC1,*, Hubert Thierens PhD1, Yves Taeymans MD, PhD2, Benny Drieghe MD2, Jan De Pooter MD2, Sylvie Van Peteghem MD2, Dimitri Buytaert MSC1, Thomas Gijs MSC1, Régine Lapere PhD1 andKlaus Bacher PhD1

Objectives: The purpose of this study was to quantify the reduction in patient radiation dose during coronary angiography (CA) by a new X-ray technology, and to assess its impact on diagnostic image quality.

15 noviembre 2015

CATHETERIZATION & CARDIOVASCULAR INTERVENTIONS. Patent foramen ovale closure following cryptogenic stroke or transient ischaemic attack: Long-term follow-up of 301 cases

Mikaeil Mirzaali BMBS1,*, Maureen Dooley MRCP2, Dylan Wynne MD2, Nina Cooter BSC2, Lorraine Lee BSC2, Peter Haworth MRCP2, Romi Saha PhD3, Nicola Gainsborough MD4 andDavid Hildick-Smith MD2

Abstract: Patent foramen ovale has been identified as a conduit for paradoxical embolism resulting in cryptogenic stroke or transient ischemic attack (TIA). We aimed to establish rates of death, recurrent stroke or TIA among patients undergoing PFO closure for stroke or TIA at our unit. A retrospective analysis of all PFO closure patients was performed between May 2004 and January 2013. Follow up was performed by mortality tracing using the Medical Research Information Service of the Office of National Statistics. With regard to stroke or TIA recurrence, written consent forms and questionnaires were mailed with follow up telephone calls. Medical notes and imaging records were consulted where adverse events were noted. 301 patients aged 48.6 ± 11.0 years, 54.4% male, with ≥1 thromboembolic neurovascular event had percutaneous PFO closure with one of eight devices, with successful implantation in 99% of cases. Follow-up duration was 40.2 ± 26.2 months (range 1.3–105.3); complete in 301 patients for mortality (100%) and 283 patients (94.0%) for neurovascular events. Two patients died during follow-up (respiratory failure n = 1; road traffic accident n = 1). Recurrent stroke (MRI or CT confirmed) was observed in five patients (0.5%; 0.55 per 100 person-years) and TIA in 9 (1.1%; 0.98 per 100 person-years). Atrial fibrillation requiring treatment was documented in 14 patients (1.7%). Percutaneous PFO closure in patients with cryptogenic stroke or TIA is a safe treatment with a low incidence of procedural complications and recurrent neurovascular events. Registry data like these may help to demonstrate the utility of PFO closure in stroke. © 2015 Wiley Periodicals, Inc.

01 diciembre 2014

CIRCULATION. Contemporary Reviews in Cardiovascular Medicine. Transcatheter Therapy of Mitral Regurgitation

Howard C. Herrmann, MD; Francesco Maisano, MD

The mitral valve apparatus is a complex structure that incorporates the leaflets, chordae tendinae, papillary muscles, annulus, and left ventricle (LV) in its function. As a result, diseases that affect any of these structures can result in severe mitral regurgitation (MR), which in turn, is associated with reduced survival.

04 septiembre 2014

CIRCULATION. Interventional Cardiology. Patient Access and 1-Year Outcomes of Percutaneous Coronary Intervention Facilities With and Without On-Site Cardiothoracic Surgery. Insights From the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) Program

Thomas M. Maddox, MD, MSc; Maggie A. Stanislawski, MS; Colin O’Donnell, MS; Mary E. Plomondon, PhD; Steven M. Bradley, MD, MPH; P. Michael Ho, MD, PhD; Thomas T. Tsai, MD, MSc; Adhir R. Shroff, MD; Bernadette Speiser, MSN, CCRN; Robert J. Jesse, MD, PhD; John S. Rumsfeld, MD, PhD

Background: The safety of percutaneous coronary intervention (PCI) at medical facilities without on-site cardiothoracic (CT) surgery has been established in clinical trials. However, the comparative effectiveness of this strategy in real-world practice, including impact on patient access and outcomes, is uncertain. The Veterans Affairs (VA) health care system has used this strategy, with strict quality oversight, since 2005, and can provide insight into this question.

04 septiembre 2014

CIRCULATION. Interventional Cardiology. Impact of Annual Operator and Institutional Volume on Percutaneous Coronary Intervention Outcomes. A 5-Year United States Experience (2005–2009)

Apurva O. Badheka, MD*; Nileshkumar J. Patel, MD*; Peeyush Grover, MD*; Vikas Singh, MD*; Nilay Patel, MD; Shilpkumar Arora, MD; Ankit Chothani, MD; Kathan Mehta, MD; Abhishek Deshmukh, MD; Ghanshyambhai T. Savani, MD; Achint Patel, MD; Sidakpal S. Panaich, MD; Neeraj Shah, MD; Ankit Rathod, MD; Michael Brown, MD; Tamam Mohamad, MD; Frank V. Tamburrino, MD; Saibal Kar, MD; Raj Makkar, MD; William W. O’Neill, MD; Eduardo De Marchena, MD; Theodore Schreiber, MD; Cindy L. Grines, MD; Charanjit S. Rihal, MD; Mauricio G. Cohen, MD

Background: The relationship between operator or institutional volume and outcomes among patients undergoing percutaneous coronary interventions (PCI) is unclear.

01 diciembre 2014

CIRCULATION. Controversies in Cardiovascular Medicine. Novel Anticoagulants Eliminate the Need for Left Atrial Appendage Exclusion Devices

Michael D. Ezekowitz, MBChB, DPhil, FACC; Anthony P. Kent, BA

The justification for implanting a left atrial appendage (LAA) exclusion device is based on the assumption that the pathogenesis of stroke in every patient with atrial fibrillation (AF) is the embolism of clot from the LAA to the brain.

01 diciembre 2014

CIRCULATION. Controversies in Cardiovascular Medicine. Left Atrial Appendage Occlusion Addresses the Tremendous Unmet Needs of Stroke Prevention in Atrial Fibrillation That Persist Despite Recent Advances in Anticoagulation Therapy

Brian Whisenant, MD; Saibal Kar, MD; T. Jared Bunch, MD

Oral anticoagulation is the standard of care for stroke prevention in atrial fibrillation but falls short of providing an adequate solution to this common threat when considered from both efficacy and safety perspectives. Anticoagulation-associated treatment deficits include major and minor bleeding, refusal of anticoagulation based on anticoagulation risk, lack of medication adherence, personal and physician preference, and a persistent risk of ischemic stroke and major adverse cardiovascular events despite use.

28 agosto 2014

CIRCULATION. AHA Scientific Statement. Cardiovascular Disease Risk Factors in Youth With Diabetes Mellitus. A Scientific Statement From the American Heart Association

David M. Maahs, MD, PhD, Co-Chair; Stephen R. Daniels, MD, PhD, FAHA; Sarah D. de Ferranti, MD; Helén L. Dichek, MD; Joseph Flynn, MD, MS; Benjamin I. Goldstein, MD, PhD; Aaron S. Kelly, PhD, FAHA; Kristen J. Nadeau, MD, MS; Pamela Martyn-Nemeth, RN, PhD; Stavroula K. Osganian, MD, ScD; Laurie Quinn, PhD, RN, FAHA; Amy S. Shah, MD, MS; Elaine Urbina, MD, MS, FAHA, Chair; on behalf of the American Heart Association Atherosclerosis, Hypertension and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council for High Blood Pressure Research, and Council on Lifestyle and Cardiometabolic Health

The rates of both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) are increasing in youth.1 In the past 10 years, guidelines for the identification and management of cardiovascular disease (CVD) risk factors in youth with diabetes mellitus have been published by multiple professional organizations, including the American Diabetes Association (ADA),2,3 the American Heart Association (AHA),4,5 the American Academy of Pediatrics,6 the International Society of Pediatric and Adolescent Diabetes (ISPAD),7 and the Pediatric Cardiovascular Risk Reduction Initiative.

28 agosto 2014

CIRCULATION. Valvular Heart Disease. Left Ventricular Hypertrophy With Strain and Aortic Stenosis

Anoop S.V. Shah, MD*; Calvin W.L. Chin, MD*; Vassilis Vassiliou, MD; S. Joanna Cowell, MD, PhD; Mhairi Doris, MBChB; T’ng Choong Kwok, MBChB; Scott Semple, PhD; Vipin Zamvar, FRCS(CTh); Audrey C. White, CRCS-AE; Graham McKillop, MD; Nicholas A. Boon, MD; Sanjay K. Prasad, MD; Nicholas L. Mills, MD, PhD; David E. Newby, MD, PhD; Marc R. Dweck, MD, PhD

Background: ECG left ventricular hypertrophy with strain is associated with an adverse prognosis in aortic stenosis. We investigated the mechanisms and outcomes associated with ECG strain.

12 noviembre 2014

CIRCULATION. Health Services and Outcomes Research. Surgical Ineligibility and Mortality Among Patients With Unprotected Left Main or Multivessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Stephen W. Waldo, MD; Eric A. Secemsky, MD; Cashel O’Brien, BA; Kevin F. Kennedy, MS; Eugene Pomerantsev, MD, PhD; Thoralf M. Sundt III, MD; Edward J. McNulty, MD; Benjamin M. Scirica, MD, MPH; Robert W. Yeh, MD, MSc

Background: Decisions to proceed with surgical versus percutaneous revascularization for multivessel coronary artery disease are often based on subtle clinical information that may not be captured in contemporary registries. The present study sought to evaluate the association between surgical ineligibility documented in the medical record and long-term mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention.

07 octubre 2014

STROKE. Clinical Sciences. Recurrent Stroke and Patent Foramen Ovale

Aristeidis H. Katsanos, MD; J. David Spence, MDBA, MBA, MD, FRCPC; Chrysi Bogiatzi, MD; John Parissis, MD, PhD; Sotirios Giannopoulos, MD, PhD; Alexandra Frogoudaki, MD, PhD; Apostolos Safouris, MD; Konstantinos Voumvourakis, MD, PhD; Georgios Tsivgoulis, MD, PhD, FESO

Background and Purpose: Recurrent cerebrovascular events are frequent in medically treated patients with patent foramen ovale (PFO), but it still remains unclear whether PFO is a causal or an incidental finding. Further uncertainty exists on whether the size of functional shunting could represent a potential risk factor. The aim of the present study was to evaluate if the presence of PFO is associated with an increased risk of recurrent stroke or transient ischemic attack and to investigate further if this relationship is related to the shunt size.

01 julio 2014

JACC. Detection of Myocardial Injury by CMR After Transcatheter Aortic Valve Replacement

Won-Keun Kim, MD∗; Andreas Rolf, MD∗; Christoph Liebetrau, MD∗; Arnaud Van Linden, MD∗; Johannes Blumenstein, MD∗; Jörg Kempfert, MD†; Georg Bachmann, MD§; Holger Nef, MD‡; Christian Hamm, MD∗; Thomas Walther, MD†; Helge Möllmann, MD∗

Background: Myocardial injury after transcatheter aortic valve replacement (TAVR) is common, but its cause and relationship to the extent of myocardial tissue loss remain unclear.

01 julio 2014

JACC. Variability of Individual Platelet Reactivity Over Time in Patients Treated With Clopidogrel. Insights From the ELEVATE–TIMI 56 Trial

Willibald Hochholzer, MD∗; Christian T. Ruff, MD, MPH†; Robert A. Mesa, BS†; John F. Mattimore, BA†; John F. Cyr, PA†; Lanyu Lei, MS‡; Andrew L. Frelinger, III, PhD§; Alan D. Michelson, MD§; David D. Berg, MD†; Dominick J. Angiolillo, MD, PhD‖; Michelle L. O´Donoghue, MD, MPH†; Marc S. Sabatine, MD, MPH†; Jessica L. Mega, MD, MPH†

Background: The degree of antiplatelet response to clopidogrel has been associated with clinical outcomes. Studies have investigated whether adjustment of antiplatelet therapies based on a single platelet function test is beneficial.

01 agosto 2014

JACC. Prognostic Value of Site SYNTAX Score and Rationale for Combining Anatomic and Clinical Factors in Decision Making. Insights From the SYNTAX Trial

Yao-Jun Zhang, PhD∗; Javaid Iqbal, MRCP, PhD∗; Carlos M. Campos, MD∗; David V. Klaveren, MSc‡; Christos V. Bourantas, MD∗; Keith D. Dawkins, MD§; Adrian P. Banning, MD‖; Javier Escaned, MD, PhD¶; Ton de Vries, MSc#; Marie-Angèle Morel, BSc#; Vasim Farooq, MD∗; Yoshinobu Onuma, MD∗; Hector M. Garcia-Garcia, MD, PhD∗; Gregg W. Stone, MD∗∗; Ewout W. Steyerberg, PhD‡; Friedrich W. Mohr, MD††; Patrick W. Serruys, MD, PhD∗

Background The results of SYNTAX trial have been reported based on “corelab” calculated SS (cSS). It has been shown that reproducibility of SS is better among the core laboratory technicians than interventional cardiologists. Thus, the prognostic value and clinical implication of the “site” SYNTAX SS (sSS) remain unknown.

01 agosto 2014

JACC. Early Safety and Efficacy of Percutaneous Left Atrial Appendage Suture Ligation. Results From the U.S. Transcatheter LAA Ligation Consortium

Matthew J. Price, MD∗; Douglas N. Gibson, MD∗; Steven J. Yakubov, MD†; Jason C. Schultz, MD∗; Luigi Di Biase, MD, PhD‡; Andrea Natale, MD‡; J. David Burkhardt, MD‡; Ashish Pershad, MD§; Timothy J. Byrne, DO§; Brett Gidney, MD‖; Joseph R. Aragon, MD¶; Jeffrey Goldstein, MD#; Kriegh Moulton, MD#; Taral Patel, MD∗∗; Bradley Knight, MD∗∗; Albert C. Lin, MD∗∗; Miguel Valderrábano, MD††

Background: Transcatheter left atrial appendage (LAA) ligation may represent an alternative to oral anticoagulation for stroke prevention in atrial fibrillation.