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https://www.readbyqxmd.com/read/27903589/impact-of-left-atrial-appendage-closure-during-cardiac-surgery-on-the-occurrence-of-early-postoperative-atrial-fibrillation-stroke-and-mortality-a-propensity-score-matched-analysis-of-10-633-patients
#1
Rowlens M Melduni, Hartzell V Schaff, Hon-Chi Lee, Bernard J Gersh, Peter A Noseworthy, Kent R Bailey, Naser M Ammash, Stephen S Cha, Kaniz Fatema, Waldemar E Wysokinski, James B Seward, Douglas L Packer, Charanjit S Rihal, Samuel J Asirvatham
BACKGROUND: -Prophylactic exclusion of the left atrial appendage (LAA) is often performed during cardiac surgery ostensibly to reduce the risk of stroke. However, the clinical impact of LAA closure in humans remains inconclusive. METHODS: -Out of 10,633 adults who underwent CABG and/or valve surgery between January 2000 and December 2005, 9,792 patients with complete baseline characteristics, surgery procedure and follow-up data were included in this analysis. A propensity-score matching analysis based on 28 pretreatment covariates was performed and 461 matching pairs were derived and analyzed to estimate the association of LAA closure with early postoperative atrial fibrillation (POAF) (AF ≤30 days of surgery), ischemic stroke and mortality...
November 30, 2016: Circulation
https://www.readbyqxmd.com/read/27888051/absence-of-oral-anticoagulation-and-subsequent-outcomes-among-outpatients-with-atrial-fibrillation
#2
Paul L Hess, Sunghee Kim, Gregg C Fonarow, Laine Thomas, Daniel E Singer, James V Freeman, Bernard J Gersh, Jack Ansell, Peter R Kowey, Kenneth W Mahaffey, Paul S Chan, Benjamin A Steinberg, Eric D Peterson, Jonathan P Piccini
BACKGROUND: Prior studies have shown a treatment gap in oral anticoagulation (OAC) use among patients with atrial fibrillation yet have incompletely characterized factors associated with failure to treat and subsequent outcomes in contemporary practice. METHODS: Using data collected between June 2010 and August 2011 from 174 ambulatory care sites in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we identified factors associated with absence of OAC via stratified logistic regression...
November 22, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27884252/differentiation-of-constriction-and-restriction-complex-cardiovascular-hemodynamics
#3
REVIEW
Jeffrey B Geske, Nandan S Anavekar, Rick A Nishimura, Jae K Oh, Bernard J Gersh
Differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) is a complex and often challenging process. Because CP is a potentially curable cause of heart failure and therapeutic options for RCM are limited, distinction of these 2 conditions is critical. Although different in regard to etiology, prognosis, and treatment, CP and RCM share a common clinical presentation of predominantly right-sided heart failure, in the absence of significant left ventricular systolic dysfunction or valve disease, due to impaired ventricular diastolic filling...
November 29, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27883166/effect-of-low-dose-rapamycin-on-senescence-markers-and-physical-functioning-in-older-adults-with-coronary-artery-disease-results-of-a-pilot-study
#4
M Singh, M D Jensen, A Lerman, S Kushwaha, C S Rihal, B J Gersh, A Behfar, T Tchkonia, R J Thomas, R J Lennon, L R Keenan, A G Moore, J L Kirkland
Rapamycin, an mTOR inhibitor affects senescence through suppression of senescence-associated secretory phenotype (SASP). We studied the safety and feasibility of low-dose rapamycin and its effect on SASP and frailty in elderly undergoing cardiac rehabilitation (CR). 13 patients; 6 (0.5mg), 6 (1.0mg), and 1 patient received 2mg oral rapamycin (serum rapamycin <6ng/ml) daily for 12 weeks. Median age was 73.9±7.5 years and 12 were men. Serum interleukin-6 decreased (2.6 vs 4.4 pg/ml) and MMP-3 (26 vs 23.5 ng/ml) increased...
2016: Journal of Frailty & Aging
https://www.readbyqxmd.com/read/27873763/pericardiectomy-as-a-diagnostic-and-therapeutic-procedure
#5
Ewa Konik, Jeffrey Geske, William Edwards, Bernard Gersh
A 70-year-old man presented with recent onset, predominantly right-sided heart failure. Echocardiogram demonstrated features of hypertensive heart disease and was suggestive of, but non-diagnostic for, constrictive pericarditis (CP). CT demonstrated mild pericardial thickening. Right heart catheterisation showed elevation and equalisation of diastolic pressures in all cardiac chambers with early rapid filling, minimal ventricular interdependence, and no dissociation of intrathoracic and intracardiac pressures...
November 14, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27873428/data-and-safety-monitoring-board-evaluation-and-management-of-a-renal-adverse-event-signal-in-topcat
#6
REVIEW
Michael R Bristow, Kavita Sharma, Susan F Assmann, Stuart Linas, Bernard J Gersh, Christine Grady, Madeline Murguia Rice, Steven Singh, Robin Boineau, Sonja M McKinlay, Barry H Greenberg
Clinical trial Data and Safety Monitoring Boards (DSMBs) have a primary obligation of ensuring study participant safety, while maintaining trial integrity. The role of DSMBs is expanding, and ideally should include post-hoc reporting of deliberative processes related to clinically important safety issues or factors that could impact on future trial designs. We describe how the TOPCAT DSMB detected, investigated, and adjudicated an unexpectedly large renal adverse event signal midway through the trial, and offer general guidelines for dealing with similar unanticipated occurrences in future trials...
November 21, 2016: European Journal of Heart Failure
https://www.readbyqxmd.com/read/27836132/gender-differences-in-associations-between-intraprocedural-thrombotic-events-during-percutaneous-coronary-intervention-and-adverse-outcomes
#7
Mikkel M Schoos, Roxana Mehran, George D Dangas, Jennifer Yu, Usman Baber, Peter Clemmensen, Frederick Feit, Bernard J Gersh, Giulio Guagliumi, E Magnus Ohman, Stuart J Pocock, Bernhard Witzenbichler, Gregg W Stone
Women are frequently reported to have increased morbidity after presentation with acute coronary syndromes and myocardial infarction; however, whether a greater thrombotic tendency contributes to gender differences in clinical outcomes of urgent percutaneous coronary intervention is unknown. Intraprocedural Thrombotic Events (IPTEs) are defined as new or increasing thrombus, abrupt vessel closure, no reflow or slow reflow, or distal embolization at any time during percutaneous coronary intervention. IPTEs were evaluated in this pooled analysis of 6,591 patients with stent implantation and blinded quantitative coronary angiography (QCA) analysis, from the ACUITY and HORIZONS-AMI trials...
October 11, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27823686/how-well-does-physician-risk-assessment-predict-stroke-and-bleeding-in-atrial-fibrillation-results-from-the-outcomes-registry-for-better-informed-treatment-of-atrial-fibrillation-orbit-af
#8
Benjamin A Steinberg, Peter Shrader, Sunghee Kim, Laine Thomas, Gregg C Fonarow, Jack Ansell, Peter R Kowey, Daniel E Singer, Bernard J Gersh, Kenneth W Mahaffey, Eric D Peterson, Jonathan P Piccini
BACKGROUND: Assessments of stroke and bleeding risks are essential to selecting oral anticoagulation in patients with atrial fibrillation (AF). We aimed to assess outcomes according to physician assessed risk, with comparison to empirical risk scores. METHODS: This was a prospective, observational study of 9,715 outpatients with AF enrolled in ORBIT-AF, a US national registry. Stroke and bleeding risks were quantified by physician assignment, CHADS2 and CHA2DS2-VASc stroke scores, and ATRIA and HAS-BLED bleeding scores...
November 2016: American Heart Journal
https://www.readbyqxmd.com/read/27788856/regression-to-the-mean-in-symplicity%C3%A2-htn-3-implications-for-design-and-reporting-of-future-trials
#9
REVIEW
Stuart J Pocock, George Bakris, Deepak L Bhatt, Sandeep Brar, Martin Fahy, Bernard J Gersh
Regression to the mean (RTM) describes the tendency for an extreme measurement on 1 occasion to become less extreme when measured again. RTM may affect clinical trial data interpretation when the outcome measure has high variability. We investigated RTM in the SYMPLICITY HTN-3 (Renal Denervation in Patients With Uncontrolled Hypertension) trial of renal denervation versus a sham procedure. Analysis of covariance was performed on the 6-month change in systolic blood pressure, estimating a mean treatment difference of -4...
November 1, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27747305/detection-and-management-of-geographic-disparities-in-the-topcat-trial-lessons-learned-and-derivative-recommendations
#10
Michael R Bristow, Jorge Silva Enciso, Bernard J Gersh, Christine Grady, Madeline Murguia Rice, Steven Singh, George Sopko, Robin Boineau, Yves Rosenberg, Barry H Greenberg
TOPCAT was a multinational clinical trial of 3,445 heart failure with preserved ejection fraction (HFpEF) patients that enrolled in 233 sites in six countries in North America, Eastern Europe and South America. Patients with a heart failure hospitalization in the last 12 months or an elevated B-type natriuretic peptide (BNP) were randomized to the mineralocorticoid receptor antagonist spironolactone vs. placebo. Sites in Russia and the Republic of Georgia provided the majority of early enrollment, primarily based on the hospitalization criterion since BNP levels were initially unavailable there...
April 2016: JACC. Basic to Translational Science
https://www.readbyqxmd.com/read/27712639/antithrombotic-approaches-in-acute-coronary-syndromes-optimizing-benefit-vs-bleeding-risks
#11
Mandeep Singh, Deepak L Bhatt, Gregg W Stone, Charanjit S Rihal, Bernard J Gersh, Ryan J Lennon, Jagat Narula, Valentin Fuster
It is estimated that in the United States, each year, approximately 620,000 persons will experience an acute coronary syndrome and approximately 70% of these will have non-ST-elevation acute coronary syndrome. Cardiovascular disease still accounts for 1 of every 3 deaths in the United States, and there is an urgent need to improve the prognosis of patients presenting with acute coronary syndrome. Cardiovascular mortality and ischemic complications are common after acute coronary syndrome, and the advent of newer antithrombotic therapies has reduced ischemic complications, but at the expense of greater bleeding...
October 2016: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/27639738/design-and-rationale-for-a-randomised-comparison-of-everolimus-eluting-stents-and-coronary-artery-bypass-graft-surgery-in-selected-patients-with-left-main-coronary-artery-disease-the-excel-trial
#12
Arie Pieter Kappetein, Patrick W Serruys, Joseph F Sabik, Martin B Leon, David P Taggart, Marie-Claude Morice, Bernard J Gersh, Stuart J Pocock, David J Cohen, Lars Wallentin, Ori Ben-Yehuda, Gerrit-Anne van Es, Charles A Simonton, Gregg W Stone
AIMS: Coronary artery bypass graft (CABG) surgery is the standard of care for revascularisation of patients with left main coronary artery disease (LMCAD). Recent studies have suggested that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may provide comparable outcomes in selected patients with LMCAD without extensive CAD. We therefore designed a trial to investigate whether PCI with XIENCE cobalt-chromium everolimus-eluting stents (CoCr-EES) would result in non-inferior or superior clinical outcomes to CABG in selected patients with LMCAD...
September 18, 2016: EuroIntervention
https://www.readbyqxmd.com/read/27532922/stability-of-international-normalized-ratios-in-patients-taking-long-term-warfarin-therapy
#13
Sean D Pokorney, DaJuanicia N Simon, Laine Thomas, Bernard J Gersh, Elaine M Hylek, Jonathan P Piccini, Eric D Peterson
No abstract text is available yet for this article.
August 9, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27462051/ruminations-about-renal-denervation
#14
Deepak L Bhatt, Bernard J Gersh
No abstract text is available yet for this article.
July 26, 2016: Circulation
https://www.readbyqxmd.com/read/27438106/differences-in-clinical-and-functional-outcomes-of-atrial-fibrillation-in-women-and-men-two-year-results-from-the-orbit-af-registry
#15
Jonathan P Piccini, DaJuanicia N Simon, Benjamin A Steinberg, Laine Thomas, Larry A Allen, Gregg C Fonarow, Bernard Gersh, Elaine Hylek, Peter R Kowey, James A Reiffel, Gerald V Naccarelli, Paul S Chan, John A Spertus, Eric D Peterson
IMPORTANCE: Despite the frequency of atrial fibrillation (AF) in clinical practice, relatively little is known about sex differences in symptoms and quality of life and how they may affect treatment and outcomes. OBJECTIVE: To determine whether symptoms, quality of life, treatment, and outcomes differ between women and men with AF. DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study included 10 135 patients with AF. The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation is a prospective, nationwide, multicenter outpatient registry of patients with incident and prevalent AF enrolled at 176 sites between June 2010 and August 2011...
June 1, 2016: JAMA Cardiology
https://www.readbyqxmd.com/read/27412902/no-decline-in-the-risk-of-stroke-following-incident-atrial-fibrillation-since-2000-in-the-community-a-concerning-trend
#16
Alanna M Chamberlain, Robert D Brown, Alvaro Alonso, Bernard J Gersh, Jill M Killian, Susan A Weston, Véronique L Roger
BACKGROUND: While atrial fibrillation is a recognized risk factor for stroke, contemporary data on trends in stroke incidence after the diagnosis of atrial fibrillation are scarce. METHODS AND RESULTS: Olmsted County, MN residents with incident atrial fibrillation or atrial flutter (collectively referred to as AF) from 2000 to 2010 were identified. Cox regression determined associations of year of AF diagnosis with ischemic stroke and transient ischemic attack (TIA) occurring through 2013...
June 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27400294/remote-ischemic-preconditioning-in-patients-undergoing-cardiovascular-surgery-evidence-from-a-meta-analysis-of-randomized-controlled-trials
#17
Partha Sardar, Saurav Chatterjee, Amartya Kundu, Habib Samady, Theophilus Owan, Jay Giri, Ramez Nairooz, Craig H Selzman, Gerd Heusch, Bernard J Gersh, J Dawn Abbott, Debabrata Mukherjee, James C Fang
BACKGROUND: Remote ischemic preconditioning (RIPC) has been associated with reduced risk of myocardial injury in patients undergoing cardiovascular surgery, but uncertainty about clinical outcomes remains, particularly in the light of 2 recent large randomized clinical trials (RCTs) which were neutral. We performed a meta-analysis to evaluate the efficacy of RIPC on clinically relevant outcomes in patients undergoing cardiovascular surgery. METHODS: We searched PubMed, Cochrane CENTRAL, EMBASE, EBSCO, Web of Science and CINAHL databases from inception through November 30, 2015...
October 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27354052/the-pathophysiology-of-acute-myocardial-infarction-and-strategies-of-protection-beyond-reperfusion-a-continual-challenge
#18
Gerd Heusch, Bernard J Gersh
The incidence of ST segment elevation myocardial infarction (STEMI) has decreased over the last two decades in developed countries, but mortality from STEMI despite widespread access to reperfusion therapy is still substantial as is the development of heart failure, particularly among an expanding older population. In developing countries, the incidence of STEMI is increasing and interventional reperfusion is often not available. We here review the pathophysiology of acute myocardial infarction and reperfusion, notably the temporal and spatial evolution of ischaemic and reperfusion injury, the different modes of cell death, and the resulting coronary microvascular dysfunction...
June 26, 2016: European Heart Journal
https://www.readbyqxmd.com/read/27319336/renal-denervation-in-the-era-of-htn-3-comprehensive-review-and-glimpse-into-the-future
#19
REVIEW
Joana Delgado Silva, Marco Costa, Bernard J Gersh, Lino Gonçalves
The pathophysiological role of sympathetic overactivity in conditions such as hypertension has been well documented. Catheter-based renal denervation (RDN) is a minimally invasive percutaneous procedure which aims to disrupt sympathetic nerve afferent and efferent activity through the application of radiofrequency energy directly within the renal artery wall. This technique has emerged as a very promising treatment with dramatic effects on refractory hypertension but also in other conditions in which a sympathetic influence is present...
August 2016: Journal of the American Society of Hypertension: JASH
https://www.readbyqxmd.com/read/27311527/revascularization-in-patients-with-severe-left%C3%A2-ventricular-dysfunction-is-the-assessment-of-viability-still-viable
#20
REVIEW
Nandan S Anavekar, Panithaya Chareonthaitawee, Jagat Narula, Bernard J Gersh
Myocardial viability assessment is typically reserved for patients with coronary artery disease and significant left ventricular dysfunction. In this setting, there is myocardial adaptation to an altered physiological state that is potentially reversible. Imaging can characterize different parameters of cardiac function; however, despite previously published appraisals of different imaging modalities, there is still uncertainty regarding the role of these tests in clinical practice. The purpose of this review is to reflect on the physiological basis of myocardial viability, discuss the imaging tests available that characterize myocardial viability, and summarize the current published reports on the use of these tests in clinical practice...
June 21, 2016: Journal of the American College of Cardiology
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