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Clinical Cardiology

Ru-Xing Wang, Hon-Chi Lee, Jia-Ping Li, David O Hodge, Yong-Mei Cha, Paul A Friedman, Thomas M Munger, Komandoor Srivathsan, Behzad B Pavri, Win-Kuang Shen
BACKGROUND: Although sudden death (SD) is a rare complication after atrioventricular junction (AVJ) ablation and permanent pacemaker implantation, the risk factors leading to this SD remain unknown. The purpose of this study was to investigate SD and its risk factors after ablate-and-pace strategy for rate control in atrial fibrillation (AF) patients during long-term follow-up. HYPOTHESIS: METHODS: From January 2005 to December 2009, we enrolled into this study 517 AF patients with AVJ ablation and right ventricular pacemaker implantation...
October 17, 2016: Clinical Cardiology
Yin-Jian Yang, Chao-Mei Fan, Jin-Qing Yuan, Hai-Bin Zhang, Fu-Jian Duan, Zhi-Min Wang, Xi-Ying Guo, Shan-Shan Zhai, Shuo-Yan An, Fei Hang, Yi-Shi Li
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is associated with poor prognosis. It has been reported that there is no difference in in-hospital mortality after acute myocardial infarction (AMI) between patients with and without HCM. However, whether there is a difference in long-term survival after AMI between patients with and without HCM remains unclear. HYPOTHESIS: Long-term survival after AMI is worse in patients with vs without HCM. METHODS: The clinical profiles of 91 consecutive patients with HCM and AMI (HCM group) and 91 sex- and age-matched patients with AMI without HCM (non-HCM group) were analyzed...
October 17, 2016: Clinical Cardiology
Rui-Tao Wang, Xue-Song Li, Ji-Rong Zhang, Yuxiang Sun, Kai-Jiang Yu, Tiemin Liu
BACKGROUND: Low bone mineral density (BMD) and left ventricular (LV) diastolic function are associated with heart failure. However, little is known about the association between BMD and LV diastolic function. HYPOTHESIS: BMD is independently related to LV diastolic function in women. METHODS: We conducted a cross-sectional study of 432 women. Brachial-ankle pulse wave velocity (baPWV) and BMD measurements were performed. LV diastolic function and structure were assessed by echocardiographic examination...
October 7, 2016: Clinical Cardiology
Ken Okumura, Masatsugu Hori, Norio Tanahashi, A John Camm
Nonvalvular atrial fibrillation (AF) is a risk factor for stroke in elderly patients. Although warfarin has been used to prevent AF-associated stroke for more than 50 years, non-vitamin K antagonist oral anticoagulants (NOACs) including dabigatran, rivaroxaban, apixaban, and edoxaban recently have been developed to overcome the disadvantages of warfarin. Based on the results of NOAC clinical trials, Savelieva and Camm made recommendations regarding selection of NOACs in patients with nonvalvular AF. Recent accumulating evidence indicates that NOACs work differently in Asian and non-Asian individuals...
October 7, 2016: Clinical Cardiology
Shunsuke Uetake, Mitsunori Maruyama, Teppei Yamamoto, Katsuhito Kato, Yasushi Miyauchi, Yoshihiko Seino, Wataru Shimizu
BACKGROUND: Left ventricular (LV) diastolic dysfunction depends on an impaired relaxation and stiffness. Abnormal LV relaxation contributes to the development of atrial fibrillation (AF), but the role of LV stiffness in AF remains unclear. HYPOTHESIS: Diastolic wall strain (DWS), a load-independent, noninvasive direct measure of LV stiffness, correlates with prevalent AF. METHODS: This study included 328 consecutive subjects with structurally normal hearts: 164 paroxysmal AF patients and 164 age- and sex-matched (1:1) controls...
October 7, 2016: Clinical Cardiology
Fatima Urooj, Abhishek Kulkarni, Dwight Stapleton, Edo Kaluski
The choice of an oral anticoagulant (OAC) for patients with nonvalvular atrial fibrillation (NVAF) is a major and complex clinical decision taking into account the individual risk-benefit ratio and bearing in mind the chronicity of therapy. This review focuses on the safety and efficacy of new oral anticoagulants (NOACs) compared with conventional vitamin K antagonists (VKA) in patients with NVAF. Current data suggest that NOACs are at least as effective and safe as VKAs for most NVAF subjects. The NOACs do not mandate dietary restrictions and regular pharmacodynamic monitoring, and they seem to have lesser incidence of intracranial or fatal bleeding when compared with VKAs...
October 7, 2016: Clinical Cardiology
Leo F Buckley, Eva Rybak, Ahmed Aldemerdash, Judy W M Cheng, John Fanikos
A growing number of patients with an indication for stroke prevention in atrial fibrillation have kidney-, age-, or weight-related alterations in pharmacokinetics that affect dosing of direct oral anticoagulants. Because these patients were excluded from or comprised a small number of patients in clinical trials, there is a lack of evidence to guide clinicians. As a consequence, many patients do not receive oral anticoagulation despite a high risk for atrial fibrillation-related stroke. Here, we present a review of direct oral anticoagulant pharmacokinetics and a review of the available clinical evidence in patients with weight-, kidney-, and age-related disease...
October 7, 2016: Clinical Cardiology
Ehud Chorin, Allison Padegimas, Ofer Havakuk, Edo Y Birati, Yacov Shacham, Anat Milman, Guy Topaz, Nir Flint, Gad Keren, Ori Rogowski
INTRODUCTION: Health care demand is increasing due to greater longevity of patients with chronic comorbidities. This increasing demand is occurring in a setting of resource scarcity. To address these changes, high-value care initiatives, such as telemedicine, are valuable resource-preservation strategies. This study introduces the Roth score as a telemedicine tool that uses patient counting times to accurately risk-stratify dyspnea severity in terms of hypoxia. HYPOTHESIS: The Roth score has correlation with dyspnea severity...
October 4, 2016: Clinical Cardiology
Robert Krysiak, Małgorzata Gilowska, Bogusław Okopień
BACKGROUND: Vitamin D is suggested to reduce cardiovascular risk. HYPOTHESIS: Circulating levels of plasma lipids and other cardiovascular risk factors may differ between statin-treated patients with different vitamin D status. METHODS: We studied 3 age- and weight-matched groups of men with elevated low-density lipoprotein cholesterol (LDL-C) levels: vitamin D-naïve men with vitamin D insufficiency (group A, n = 18), men with vitamin D deficiency/insufficiency effectively treated with vitamin D preparations (group B, n = 16), and vitamin D-naïve men with normal vitamin D status (group C, n = 16)...
September 26, 2016: Clinical Cardiology
Shuang Zhao, Keping Chen, Yangang Su, Wei Hua, Jiefu Yang, Silin Chen, Zhaoguang Liang, Wei Xu, Shu Zhang
BACKGROUND: Left ventricular ejection fraction (LVEF) ≤35% is the cutoff value used to identify patients at high risk of sudden cardiac death. However, whether patients who have moderate left ventricular dysfunction and left ventricular enlargement (LVE) have a high risk of ventricular arrhythmias (VAs) and cardiac death is unclear. HYPOTHESIS: Patients with moderate left ventricular dysfunction and LVE may have a high risk of VAs. METHODS: This study retrospectively analyzed the data of 853 patients who have an implantable cardioverter-defibrillator/cardiac resynchronization therapy cardioverter-defibrillator equipped with home monitoring...
September 9, 2016: Clinical Cardiology
Xu-Miao Chen, Cheng-Cheng Ji, Yun-Jiu Cheng, Li-Juan Liu, Wei-Qi Zhu, Ying Huang, Wei-Ying Chen, Su-Hua Wu
BACKGROUND: Just as high-risk populations for cardiac arrest exist in patients with Brugada syndrome or long QT syndrome, high-risk and low-risk populations for cardiac arrest also exist in patients with early repolarization pattern (ERP). HYPOTHESIS: Electrocardiographic (ECG) characteristics can aid the risk stratification of patients with ERP. METHODS: Electrocardiographic parameters such as magnitude of J-point elevation and J/R ratio were measured...
September 6, 2016: Clinical Cardiology
Alberto García-Lledó, José L Moya-Mur, Virginia Ponz-Mir, Susana Novo-Aparicio, Azucena Sanz-Barrio, Concepción Álvarez-Sanz, Ana de Santiago-Nocito
BACKGROUND: Risk score systems (RSS) were designed to estimate the risk of cardiac events. Their ability to predict coronary atherosclerosis (CA) has not been established. HYPOTHESIS: Risk score systems can predict presence of CA in patients without typical symptoms or ischemia. Because design of each RSS is different, their predictive value could also differ. METHODS: A retrospective analysis was done on patients from a low-risk region referred for cardiac multislice computed tomography (MSCT)...
September 6, 2016: Clinical Cardiology
Jérémie Abtan, Deepak L Bhatt, Yedid Elbez, Emmanuel Sorbets, Kim Eagle, Yasuo Ikeda, David Wu, Mary E Hanson, Hakima Hannachi, Puneet K Singhal, Philippe Gabriel Steg, Gregory Ducrocq
BACKGROUND: Although the rate of in-hospital ischemic events after myocardial infarction (MI) has dramatically decreased, long-term residual risk may remain substantial. However, most of the information on current residual risk is derived from highly selected randomized trials. HYPOTHESIS: In patients with previous MI and no prior ischemic stroke/transient ischemic attack (TIA), residual ischemic risk increases over time. METHODS: Using the international Reduction of Atherothrombosis for Continued Health (REACH) registry, we analyzed baseline characteristics and 4-year follow-up of patients with previous MI and no history of stroke/TIA to describe annual rates of recurrent ischemic events globally and by geography...
September 2, 2016: Clinical Cardiology
Christopher P Cannon, Savion Gropper, Deepak L Bhatt, Stephen G Ellis, Takeshi Kimura, Gregory Y H Lip, Ph Gabriel Steg, Jurriën M Ten Berg, Jenny Manassie, Jörg Kreuzer, Jon Blatchford, Joseph M Massaro, Martina Brueckmann, Ernesto Ferreiros Ripoll, Jonas Oldgren, Stefan H Hohnloser
Antithrombotic management of patients with atrial fibrillation (AF) undergoing coronary stenting is complicated by the need for anticoagulant therapy for stroke prevention and dual antiplatelet therapy for prevention of stent thrombosis and coronary events. Triple antithrombotic therapy, typically comprising warfarin, aspirin, and clopidogrel, is associated with a high risk of bleeding. A modest-sized trial of oral anticoagulation with warfarin and clopidogrel without aspirin showed improvements in both bleeding and thrombotic events compared with triple therapy, but large trials are lacking...
August 26, 2016: Clinical Cardiology
Andrew Kei-Yan Ng, Man-Hong Jim
In the era of drug-eluting stents, the provisional stenting strategy has been established as the default strategy in percutaneous coronary intervention for bifurcation lesions. However, emerging evidence shows that, in selected situations, the complex strategy of stenting both vessels regardless could reduce side-branch restenosis without penalty. In particular, the double kissing crush technique has been proven to outperform the provisional strategy and other complex strategies in randomized trials. In this review, we present the evidence comparing the 2 strategies and individual stenting techniques and discuss the roles of other optimization techniques such as final kissing balloon inflation, proximal optimization technique, intravascular ultrasonography, and optical coherence tomography...
August 24, 2016: Clinical Cardiology
İbrahim Halil Tanboğa, Selim Topçu, Enbiya Aksakal, Oktay Gulcu, Emrah Aksakal, Uğur Aksu, Vecih Oduncu, Fatih Rıfat Ulusoy, Serdar Sevimli, Cihangir Kaymaz
Recent trials reported that risk of atrial fibrillation (AF) is increased in patients using ivabradine compared with controls. We performed this meta-analysis to investigate the risk of AF association with ivabradine treatment on the basis of data obtained from randomized controlled trials (RCTs). We searched PubMed, EMBASE, Scopus, and the Cochrane Library for RCTs that comprised >100 patients. The incidence of AF was assessed. We obtained data from European Medicines Agency (EMA) scientific reports for the RCTs in which the incidence of AF was not reported...
August 11, 2016: Clinical Cardiology
Antonio Rapacciuolo, Stefano Maffè, Pietro Palmisano, Anna Ferraro, Antonella Cecchetto, Antonio D'Onofrio, Francesco Solimene, Paola Musatti, Paola Paffoni, Francesca Esposito, Umberto Parravicini, Alessia Agresta, Giovanni Luca Botto, Maurizio Malacrida, Giuseppe Stabile
BACKGROUND: Because 20% to 40% of patients undergoing cardiac resynchronization therapy (CRT) do not respond to it, identification of potential factors predicting response is a relevant research topic. HYPOTHESIS: There is a possible association between right ventricular function and response to CRT. METHODS: We analyzed 227 patients from the Cardiac Resynchronization Therapy Modular Registry (CRT-MORE) who received CRT according to current guidelines from March to December 2013...
July 28, 2016: Clinical Cardiology
D Edmund Anstey, Shuang Li, Laine Thomas, Tracy Y Wang, Stephen D Wiviott
BACKGROUND: Race and sex have been shown to affect management of myocardial infarction (MI); however, it is unclear if such disparities exist in contemporary care of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). HYPOTHESIS: Disparities in care will be less prevalent in more heavily protocol-driven management of STEMI than the less algorithmic care of NSTEMI. METHODS: Data were collected from the ACTION Registry-GWTG database to assess care differences related to race and sex of patients presenting with NSTEMI or STEMI...
July 28, 2016: Clinical Cardiology
Minyoung Oh, Cheol Whan Lee, Hyo Sang Lee, Mineok Chang, Jung-Min Ahn, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Dae Hyuk Moon, Seong-Wook Park, Seung-Jung Park
BACKGROUND: Platelets play an important role in inflammation. Inhibitors of the P2Y12 receptor, which is involved in platelet activation, may have a direct effect on carotid atherosclerotic plaque inflammation. HYPOTHESIS: We compared the effects of clopidogrel and ticagrelor therapy for carotid atherosclerotic plaque inflammation using (18) F-fluorodeoxyglucose ( (18) FDG) positron emission tomography (PET) imaging. METHODS: Fifty patients with acute coronary syndrome and ≥1 (18) FDG uptake in the carotid artery (target-to-background ratio [TBR] ≥1...
July 26, 2016: Clinical Cardiology
Rina Mauricio, Monvadi B Srichai, Leon Axel, Judith S Hochman, Harmony R Reynolds
BACKGROUND: In a prospective study, cardiac MRI (CMR) and intravascular ultrasound were performed in women with myocardial infarction (MI) and nonobstructive coronary artery disease (MINOCA). Forty participants underwent adenosine-stress CMR (sCMR). HYPOTHESIS: Abnormal perfusion may co-localize with ischemic late gadolinium enhancement (LGE) and T2-weighted signal hyperintensity (T2+), suggesting microvascular dysfunction contributed to MI. METHODS: Qualitative perfusion analysis was performed by 2 independent readers...
July 26, 2016: Clinical Cardiology
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