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Open Heart

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[This corrects the article DOI: 10.1136/openhrt-2017-000668.][This corrects the article DOI: 10.1136/openhrt-2017-000668.].
2018: Open Heart
(no author information available yet)
[This corrects the article DOI: 10.1136/openhrt-2017-000672.][This corrects the article DOI: 10.1136/openhrt-2017-000672.].
2018: Open Heart
Nils Perrin, Tilman Perrin, Anne-Lise Hachulla, Angela Frei, Hajo Müller, Marco Roffi, Mustafa Cikirikcioglu, Christoph Ellenberger, Marc-Joseph Licker, Haran Burri, Stephane Noble
Aim: We compared early postprocedural and midterm evolution of atrioventricular and intraventricular conduction disorders following implantation of the new generation Evolut R (ER) prosthesis in comparison with the previous generation CoreValve (CV) system using routinely recorded ECG up to 6-month follow-up. Methods: All consecutive patients treated by transcathether aortic valve implantation (TAVI) using the Medtronic self-expanding devices for symptomatic severe aortic stenosis in a single centre between October 2011 and February 2016 were considered for inclusion...
2018: Open Heart
Paul Michael Galdas, Alexander Stephen Harrison, Patrick Doherty
Objective: To determine whether there are gender differences in the factors that predict attendance at the initial cardiac rehabilitation baseline assessment (CR engagement) after referral. Methods: Using data from the National Audit of Cardiac Rehabilitation, we analysed data on 95 638 patients referred to CR following a cardiovascular diagnosis/treatment between 2013 and 2016. Eighteen factors that have been shown in previous research to be important predictors of CR participation were investigated and grouped into four categories: sociodemographic factors, cardiac risk factors, patient medical status and service-level factors...
2018: Open Heart
Khaled Alfakih, Jonathan Byrne, Mark Monaghan
The UK National Institute for Health and Care Excellence (NICE) have just updated their guideline on new-onset stable chest pain, recommending that all patients should be investigated with a CT coronary angiography (CTCA). In a separate guideline, NICE recommended CT fractional flow reserve (CT-FFR), to assess coronary stenoses, found on CTCA, stating that this would reduce the need for invasive coronary angiography and hence reduce cost. We discuss the evidence base for CT-FFR and emphasise that we already have established functional imaging tests, with extensive evidence base for efficacy and prognosis and that CT-FFR should be compared with this standard of care and not with the much more expensive and invasive fractional flow reserve undertaken during invasive coronary angiography...
2018: Open Heart
Henrik Hultkvist, Jonas Holm, Rolf Svedjeholm, Farkas Vánky
Objectives: To describe the dynamics of N-terminal pro-B-type natriuretic peptide (NT-proBNP) from preoperative evaluation to 6-month follow-up in patients undergoing aortic valve intervention, and to evaluate NT-proBNP with regard to 1-year mortality. Methods: At preoperative evaluation, we prospectively included 462 patients accepted for aortic valve intervention. The median time to surgical aortic valve replacement (SAVR; n=336) or transcatheter aortic valve implantation (TAVI; n=126) was 4 months...
2018: Open Heart
Jingwen Jessica Chen, Kathryn Gamble, Lisa Graham-Wisener, Kieran McGlade, Jennifer Doherty, Patrick Donnelly, Carol A Stone
Objective: To assess the adequacy of community-based services available in Northern Ireland (NI) and to meet the multidimensional needs of patients living with New York Heart Association Stage III and IV heart failure (HF), as experienced and perceived by general practitioners (GP). Methods: Semistructured interviews were conducted with GPs recruited via the University Department of General Practice and Northern Ireland Medical and Dental Agency. Interviews were transcribed, independently coded and analysed using a six-step thematic analysis approach...
2018: Open Heart
Juan Carlos Kaski, Steffen Gloekler, Roberto Ferrari, Kim Fox, Bernard I Lévy, Michel Komajda, Panos Vardas, Paolo G Camici
In chronic stable angina, elevated heart rate contributes to the development of symptoms and signs of myocardial ischaemia by increasing myocardial oxygen demand and reducing diastolic perfusion time. Accordingly, heart rate reduction is a well-known strategy for improving both symptoms of myocardial ischaemia and quality of life (QOL). The heart rate-reducing agent ivabradine, a direct and selective inhibitor of the I f current, decreases myocardial oxygen consumption while increasing diastolic time, without affecting myocardial contractility or coronary vasomotor tone...
2018: Open Heart
Sara Di Marino, Nicola Viceconte, Angelo Lembo, Vincenzo Summa, Gaetano Tanzilli, Valeria Raparelli, Giovanni Truscelli, Enrico Mangieri, Carlo Gaudio, Daniel Oscar Cicero
Objective: Balloon-induced transient coronary ischaemia represents a model of myocardial ischaemia and reperfusion. We are interested in the very early systemic metabolic response to this event. Methods: Blood samples of patients with stable angina (SA) were collected before and after coronary angioplasty. Serum metabolic profiles were obtained using nuclear magnetic resonance spectroscopy. Univariate and multivariate analyses were used to investigate changes in metabolite concentrations...
2018: Open Heart
Stephen Hamshere, Alex Byrne, Tawfiq Choudhury, Sean M Gallagher, Krishnaraj S Rathod, Julia Lungley, Charles J Knight, Akhil Kapur, Daniel A Jones, Anthony Mathur
Background: To date, there have been limited comparisons performed between everolimus-eluting stents (EES) and zotarolimus-eluting stents (ZES) in patients with diabetes mellitus (DM). The objectives of this study was to assess the use of second-generation drug-eluting stents in patients with DM, using optical coherence tomography (OCT) to compare the level of stent coverage of Boston Scientific Promus Element EES compared with Medtronic Resolute Integrity ZES.( number NCT02060357)...
2018: Open Heart
Mariko W Harper, Daniel Z Uslan, Arnold J Greenspon, Larry M Baddour, Roger G Carrillo, Stephan B Danik, Jose M Tolosana, Katherine Le, Jose M Miro, Christoph K Naber, James Peacock, Muhammad Rizwan Sohail, Holenarasipur R Vikram, Jordan M Prutkin
Objective: To explore differences in clinical manifestations and outcomes in those patients who develop infection after undergoing initial implantation versus reoperation. Methods: We compared cases of cardiac implantable electronic device (CIED) infection based on initial implantation versus reoperation from 11 centres. Results: There were 432 patients with CIED infection, 178 occurring after initial device placement and 254 after repeat reoperation...
2018: Open Heart
Mary Wang, David J Birnkrant, Dennis M Super, Irwin B Jacobs, Robert C Bahler
Objective: To describe the natural history of cardiomyopathy in patients with Duchenne muscular dystrophy (DMD) who are receiving contemporary therapies. Methods: This is a single-institution retrospective cohort study of 57 patients aged >15 years with DMD. Serial digital echocardiograms were performed over a median follow-up of 8 years. Left ventricular dysfunction (LVD) was defined as shortening fraction (SF) <29% plus focal wall motion abnormalities...
2018: Open Heart
David R Dobies, Kimberly R Barber
Evidence-based medicine (EBM) provides clinicians with beneficial information. Nonetheless, study findings are often arbitrary, speculative or provisional. The current state of misleading evidence exists in all applications, including those for guideline recommendations. We conductedan appraisal of the American College of Cardiologyand European Society of Cardiology Guidelines for revascularisation of complex coronary anatomy to determine the veracity of the evidence that recommendations were based on. Study-specific critical appraisals were conducted by the authors on the 5-year Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) and future revascularisation evaluation in patients with diabetes mellitus: optimal management of multivessel disease (FREEDOM) Trials...
2018: Open Heart
Erin Amanda Fender, Pranav Chandrashekar, Jackson J Liang, Priyank R Dhar, Terence T Sio, John M Stulak, Ryan J Lennon, Joshua P Slusser, Jonathan B Ashman, Robert C Miller, Joerg Herrmann, Abhiram Prasad, Gurpreet S Sandhu
Background and aim: Thoracic radiation therapy (XRT) for cancer is associated with the development of significant coronary artery disease that may require coronary artery bypass grafting surgery (CABG). Contemporary acute surgical outcomes and long-term postoperative survival of patients with prior XRT have not been well characterised. Methods: This was a retrospective, single-centre study of patients with a history of thoracic XRT who required CABG and who were propensity matched against 141 controls who underwent CABG over the same time period...
2018: Open Heart
Jocasta Ball, Maja-Lisa Løchen, Melinda J Carrington, Joshua F Wiley, Simon Stewart
Objective: Mild cognitive impairment (MCI) is prevalent in atrial fibrillation (AF) and has the potential to contribute to poor outcomes. We investigated the influence of MCI on survival and rehospitalisation in patients with chronic forms of AF undergoing a home-based, AF-specific disease management intervention (home-based intervention (HBI)) or standard management (SM). Methods: The Montreal Cognitive Assessment tool was administered at baseline (a score of <26/30 indicated MCI) in patients with AF randomised to HBI versus SM...
2018: Open Heart
Tasalak Thonghong, Ole De Backer, Lars Søndergaard
New European guidelines on the management of valvular heart disease-supported by the European Society of Cardiology (ESC) and European Association of CardioThoracic Surgery (EACTS)-were recently published. Although these guidelines are very comprehensive, these typically are not very inviting to read. In this document, we aimed to distil all the information about transcatheter aortic valve replacement (TAVR) in the new 2017 ESC/EACTS guidelines to the essential and give additional comments on the position of TAVR in 2017...
2018: Open Heart
Ralph A H Stewart, Dominika Szalewska, Amanda Stebbins, Hussein R Al-Khalidi, John G H Cleland, Andrzej Rynkiewicz, Mark H Drazner, Harvey D White, Daniel B Mark, Ambuj Roy, Dragana Kosevic, Miroslaw Rajda, Marek Jasinski, Chua Yeow Leng, Wiwun Tungsubutra, Patrice Desvigne-Nickens, Eric J Velazquez, Mark C Petrie
Background: In patients with ischaemic left ventricular dysfunction, coronary artery bypass surgery (CABG) may decrease mortality, but it is not known whether CABG improves functional capacity. Objective: To determine whether CABG compared with medical therapy alone (MED) increases 6 min walk distance in patients with ischaemic left ventricular dysfunction and coronary artery disease amenable to revascularisation. Methods: The Surgical Treatment in Ischemic Heart disease trial randomised 1212 patients with ischaemic left ventricular dysfunction to CABG or MED...
2018: Open Heart
David Binas, Hanna Daniel, Anette Richter, Volker Ruppert, Klaus-Dieter Schlüter, Bernhard Schieffer, Sabine Pankuweit
Objective: Several studies indicate a prognostic value of sST2 and galectin-3 in heart failure (HF). While previous studies focused on ischaemic cause of HF, we investigated the role of sST2 and galectin-3 in patients with non-ischaemic dilated cardiomyopathy (DCM). Methods: sST2 and galectin-3 serum concentrations were measured in 262 subjects with DCM. Survival rates were determined for all-cause mortality (ACM) and cardiac mortality (CM). Results: In a univariate model, sST2 as a continuous variable was a predictor of ACM (HR 1...
2018: Open Heart
Yuchi Han, Paul R Forfia, Anjali Vaidya, Jeremy A Mazurek, Myung H Park, Gautam Ramani, Stephen Y Chan, Aaron B Waxman
Introduction: A major determining factor on outcomes in patients with pulmonary arterial hypertension (PAH) is right ventricular (RV) function. Ranolazine, which is currently approved for chronic stable angina, has been shown to improve RV function in an animal model and has been shown to be safe in small human studies with PAH. We aim to study the effect of ranolazine on RV function using cardiovascular magnetic resonance (CMR) in patients with pulmonary hypertension (non-group 2 patients) and monitor the effect of ranolazine on metabolism using metabolic profiling and changes of microRNA...
2018: Open Heart
Paul Abraham, Diego A Arroyo, Raphael Giraud, Henri Bounameaux, Karim Bendjelid
While systemic intravenous thrombolysis decreases mortality in patients with high-risk pulmonary embolism (PE), it clearly increases haemorrhagic risk. There are many contraindications to thrombolysis, and efforts should aim at selecting those patients who will benefit most, without suffering complications. The current review summarises the evidence for the use of thrombolytic therapy in PE. It clarifies the pathophysiological mechanisms in PE and acute cor pulmonale that increase the risk of bleeding following thrombolysis...
2018: Open Heart
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