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Heart International

Dawod Sharif, Amal Sharif-Rasslan, Camilia Shahla, Amin Khalil, Uri Rosenschein
BACKGROUND: Normal left anterior descending (LAD) coronary artery as determined by coronary angiography is considered not only to reflect normal angiography but also to correlate with normal anatomy and function. However, subjects who undergo coronary angiography may differ from those who do not need to have invasive evaluation even if their functional noninvasive studies like dobutamine stress echocardiography (DSE) were normal. AIM: LAD velocities in subjects with normal angiography and those with normal DSE are equal...
January 2015: Heart International
Abdulrahman Abdulbaki, Cyrus Kocherla, Kalgi Modi
Acute coronary syndrome (ACS) due to embolic phenomenon in the setting of peripartum cardiomyopathy (PPCM) and left ventricular mural thrombus is a rare occurrence. There have been two known cases described in medical literature. We present a unique case in which catheter-based aspiration thrombectomy was used to successfully treat a patient with ACS due to coronary emboli in the setting of PPCMand left ventricular mural thrombus. We believe this to be the first report of the use of aspiration thrombectomy in such a clinical case...
January 2015: Heart International
Valentina Orlando, Enrica Menditto, Francesca Guerriero, Raffaele Rotunno
AIMS: Non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors (COXIBs) may be associated with increased cardiovascular (CV) risk and mortality in CV patients. After the release of Note 66 by Agenzia Italiana del Farmaco (AIFA) to reduce inappropriate prescribing of NSAIDs and COXIBs, the CARDIOPAIN initiative was started in Italy to include such recommendations into the hospital discharge letter of patients with high CV risk. We evaluated the effect of the CARDIOPAIN initiative on the prescription of analgesic drugs by general practitioners (GPs)...
January 2015: Heart International
Pedro Rio, Ruben Ramos, Tiago Pereira-da-Silva, Carlos Barbosa, Duarte Cacela, António Fiarresga, Lídia de Sousa, Ana Abreu, Lino Patrício, Luís Bernardes, Rui Cruz Ferreira
PURPOSE: Noninvasive ischemia testing (NIST) is recommended for most patients suspected to have stable coronary artery disease (CAD) before invasive coronary angiography (ICA). We sought to assess the diagnostic predictive ability of NIST over clinical risk profiling in a contemporary sample of patients undergoing the currently recommended diagnostic triage strategy. METHODS: From 2006 to 2011, 2,600 consecutive patients without known CAD undergoing elective ICA in a single tertiary-care center were retrospectively identified and the prevalence of obstructive CAD determined...
January 2015: Heart International
Gabriele Messina, Silvia Forni, Francesca Collini, Antonello Galdo, Valeria Di Fabrizio, Nicola Nante
PURPOSE: Heart failure (HF) is recognized as a major problem in industrialized countries. Short-term adjusted outcomes are indicators of quality for care process during/after hospitalization. Our aim is to evaluate, for patients with principal diagnosis of HF, in-hospital mortality and 30-day readmissions for all-causes using two different risk adjustment (RA) tools. METHODS AND RESULTS: We used data from the hospital discharge abstract (HD) of a retrospective cohort of patients (2002-2007) admitted in Tuscan hospitals, Italy...
January 2015: Heart International
Pau Alonso, Ignacio Sanchez-Lazaro, Luis Almenar, Luis Martinez-Dolz, Ana Andres, Antonio Salvador, Anastasio Montero
BACKGROUND: Acute renal dysfunction (ARD) may appear in heart transplant (HTx) patients both in the early postoperative period and during follow-up, even after several years. CD25 is a subunit of the interleukin-2 receptor which is found exclusively on activated CD4 T lymphocytes. CD25 is crucial for clonal expansion of anti-allograft host lymphocytes that mediate in acute rejection. There are experiences supporting the use of Anti-CD25 monoclonal antibodies (MAb) immediately after HTx in patients with ARD as a bridge to renal function recovery, allowing the temporary suspension of treatment with CNI...
July 2014: Heart International
Gary L Murray, Joseph Colombo
BACKGROUND: Ranolazine (RAN) reduces cardiac sodium channel 1.5's late sodium current in congestive heart failure (CHF), reducing myocardial calcium overload, potentially improving left ventricular (LV) function. RAN blocks neuronal sodium channel 1.7, potentially altering parasympathetic and sympathetic (P&S) activity. The effects of RAN on LV ejection fraction (LVEF) and P&S function in CHF were studied. METHODS: Matched CHF patients were given open-label RAN (1000 mg po-bid) added to guideline-driven therapy (RANCHF, 41 systolic, 13 diastolic) or no adjuvant therapy (control, NORANCHF, 43 systolic, 12 diastolic)...
July 2014: Heart International
Gary L Murray, Joseph Colombo
BACKGROUND: The effect of ranolazine (RAN) on cardiac autonomic balance in congestive heart failure (CHF) was studied. METHODS: Fifty-four CHF patients were randomized to (1) open-label RAN (RANCHF) added to usual therapy vs. (2) usual therapy (NORANCHF). Parasympathetic and sympathetic (P&S) measurements were taken at baseline and at 12 months. RESULTS: A total of 16/27 (59%) patients in both groups had initially abnormal P&S measures, including high sympathovagal balance (SB), cardiovascular autonomic neuropathy (CAN) or both...
July 2014: Heart International
Muhammad Sharoz Rabbani, Irfan Qadir, Yasir Ahmed, Marrium Gul, Hasanat Sharif
BACKGROUND: This is a validation study comparing the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II with the previous additive (AES) and logistic EuroSCORE (LES) and the Society of Thoracic Surgeons' (STS) risk prediction algorithm, for patients undergoing valve replacement with or without bypass in Pakistan. PATIENTS AND METHODS: Clinical data of 576 patients undergoing valve replacement surgery between 2006 and 2013 were retrospectively collected and individual expected risks of death were calculated by all four risk prediction algorithms...
July 2014: Heart International
Nicholas L DePace, Joy P Mears, Michael Yayac, Joseph Colombo
BACKGROUND: Coronary heart disease (CHD) is a major health concern, affecting nearly half the middle-age population and responsible for nearly one-third of all deaths. Clinicians have several major responsibilities beyond diagnosing CHD, such as risk stratification of patients for major adverse cardiac events (MACE) and treating risks, as well as the patient. This second of a two-part review series discusses treating risk factors, including autonomic dysfunction, and expected outcomes...
July 2014: Heart International
Nicholas L DePace, Joy P Mears, Michael Yayac, Joseph Colombo
BACKGROUND: Coronary heart disease (CHD) is a major health concern, affecting nearly half the middle-age population and responsible for nearly one-third of all deaths. Clinicians have responsibilities beyond diagnosing CHD, including risk stratification of patients for major adverse cardiac events (MACE), modifying the risks and treating the patient. In this first of a two-part review, identifying risk factors is reviewed, including more potential benefit from autonomic testing. METHODS: Traditional and non-traditional, and modifiable and non-modifiable risk factors for MACE where compared, including newer risk factors, such as inflammation, carotid intimal thickening, ankle-brachial index, CT calcium scoring, and autonomic function testing, specifically independent measurement of parasympathetic and sympathetic (P&S) activity...
July 2014: Heart International
Conrad Genz, Hans D Esperer, Alexander Schmeisser, Ruediger C Braun-Dullaeus, Samir M Said
Dronedarone is a relatively new antiarrhythmic drug and is held to be less proarrhythmic than comparable compounds, although its proarrhythmia potential in humans has not been sufficiently evaluated. We describe a so far unreported dronedarone effect, namely a significant alteration of both the morphology and the duration of the QRS complex on the electro cardiogram in a 41-year old patient with symptomatic paroxysmal atrial fibrillation.
January 2014: Heart International
Anthony W A Wassef, Malek Kass, Gurpreet Parmar, Amir Ravandi
We describe the case of a patient with a previously placed Port-A-Cath who was admitted to hospital for new onset of non-flushing catheter and palpitations with ventricular tachycardia. A chest X-ray and a linogram showed a Port-A-Cath fracture and distal embolization into the right ventricle resulting in ventricular tachycardia. The catheter was removed percutaneously using a Goose Neck snare with no complications and resolution of the ventricular tachycardia. The removed segment demonstrated thrombus. Prompt removal of the embolized catheter fragments should be undertaken given the subtle nature of the embolization and the potential complications...
January 2014: Heart International
Anthony W Wassef, Iain Kirkpatrick, Kunal Minhas, Amrit Malik, Malek Kass, Farrukh Hussain
Guide catheter induced dissection of coronary arteries is an uncommon, but serious complication of coronary angioplasty. Treatment can include emergent coronary artery bypass grafting to the affected vessel or percutaneous intervention including wiring the true lumen and exclusion stenting of the dissection flap to prevent further propagation. Detailed descriptions have been published of techniques of intentional passage of guide wires into the false lumen and reentry into the true lumen with chronic total occlusions...
January 2014: Heart International
Luis Almenar Bonet, Rosario Vicente Guillén, Ignacio Sánchez Lázaro, Carmen de la Fuente, Faisa Osseyran, Luis Martínez Dolz, Mónica Montero Hernández, Manuel Portolés Sanz, Miguel Rivera Otero, Antonio Salvador Sanz
The objective of the present work is to describe the experience with intravenous (IV) sildenafil in heart transplant (HT) patients with reactive pulmonary hypertension (PH) who developed right ventricular dysfunction (RVD) in the immediate postoperative period. The first 5 patients who received IV sildenafil followinga HT are presented. The HTs took place between March 2011 and September 2012 in patients aged 37 to 64 years; all patients were male. Prior to the HT, mean pulmonary artery pressure (mPAP) was 32-56 mmHg...
January 2014: Heart International
Heather L Bloom, Aaron I Vinik, Joe Colombo
BACKGROUND: Cardiovascular autonomic neuropathy (CAN) is recognized as a significant health risk, correlating with risk of heart disease, silent myocardial ischemia or sudden cardiac death. Beta-blockers are often prescribed to minimize risk. OBJECTIVES: In this second of two articles, the effects on parasympathetic and sympathetic activity of the alpha/beta-adrenergic blocker, Carvedilol, are compared with those of the selective beta-adrenergic blocker, Metoprolol...
January 2014: Heart International
Aaron I Vinik, Heather L Bloom, Joe Colombo
BACKGROUND: Cardiovascular autonomic neuropathy (CAN) is recognized as a significant health risk. Specific and sensitive measures of CAN are needed for early identification and treatment to avoid complications, preferably in the preclinical state. OBJECTIVES: In this first of two articles, the patient cohort is described and two measures of autonomic function are reviewed: the traditional heart rate variability (HRV)-alone method and the newer parasympathetic and sympathetic (P&S) Method...
January 2014: Heart International
Yutaka Tanami, Julie M Miller, Andrea L Vavere, Carlos E Rochitte, Marc Dewey, Hiroyuki Niinuma, Melvin E Clouse, Christopher Cox, Jeffrey Brinker, Joao A C Lima, Armin Arbab-Zadeh
We investigated the diagnostic accuracy of computed tomography angiography (CTA) versus myocardial perfusion imaging (MPI) for detecting obstructive coronary artery disease (CAD) as defined by conventional quantitative coronary angiography (QCA). Sixty-three patients who were enrolled in the CorE-64 multicenter study underwent CTA, MPI, and QCA imaging. All subjects were referred for cardiac catheterization with suspected or known coronary artery disease. The diagnostic accuracy of quantitative CTA and MPI for identifying patients with 50% or greater coronary arterial stenosis by QCA was evaluated using receiver operating characteristic (ROC) analysis...
January 2014: Heart International
Amit K Pahwa, Armin Arbab-Zadeh, Daniel J Brotman, Leonard S Feldman
Perioperative cardiac events can be a major consequence of surgery. The American College of Cardiology Foundation/American Heart Association has set out guidelines to aid physicians in identifying patients at the highest risk for these events. The guidelines do recommend for some patients to undergo non-invasive cardiac stress testing for further risk stratification, but their sensitivity and specificity for predicting cardiac events is not optimal. With more data emerging of the superior performance of computed coronary tomography angiography (CCTA) compared to non-invasive stress testing, CCTA could be more useful in risk stratification for these patients...
January 22, 2013: Heart International
Mohammad Yusuf Beebeejaun, Aleksandra Malec, Ravi Gupta, Hassan Alkhawam
Aortic dissection is one of the most common aortic emergencies affecting around 2000 Americans each year. It usually presents in the acute state but in a small percentage of patients aortic dissections go unnoticed and these patients survive without any adequate therapy. With recent advances in medical care and diagnostic technologies, aortic dissection can be successfully managed through surgical or medical options, consequently increasing the related survival rate. However, little is known about the optimal long-term management of patients suffering from chronic aortic dissection...
2013: Heart International
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