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Among patients with AF who are taking warfarin, the PINRR is a user-friendly alternative to TTR, having a high sensitivity and positive predictive value in predicting TTR. As with TTR, PINRR is associated with clinical adverse events, ie, ischemic stroke and intracranial hemorrhage.
Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. | 10.1016/j.cjca.2015.10.029
| Time in Therapeutic Range and Percentage of International Normalized Ratio in the Therapeutic Range as a Measure of Quality of Anticoagulation Control in Patients With Atrial Fibrillation. | The Canadian journal of cardiology |
Despite the minimally invasive nature of transcatheter aortic valve implantation (TAVI), the procedure is associated with several complications. We aimed to analyze the individual impact of bleeding events, hemoglobin (Hb) drop, and red blood cell (RBC) transfusions on prognosis and to evaluate the temporal trends in bleeding and RBC transfusions since the initiation of the TAVI program in our centre and onward.
Consecutive patients (n = 597) undergoing transfemoral TAVI were prospectively enrolled. Periprocedural Hb levels, RBC transfusions, and major/life-threatening bleeding events were documented and analyzed. | 10.1016/j.cjca.2015.10.032
| Impact of Hemoglobin Drop, Bleeding Events, and Red Blood Cell Transfusions on Long-term Mortality in Patients Undergoing Transaortic Valve Implantation. | The Canadian journal of cardiology |
In the entire cohort, mean Hb level decreased after TAVI (11.8 ± 1.4 to 9.5 ± 1.3 g/dL; P < 0.001). Major/life threatening bleeding occurred in 66 (10.1%) patients, and 179 (30%) patients received RBC transfusions. Major/life threatening bleeding was not independently associated with mortality when adjusted for Hb drop and RBC transfusion. Among patients with an Hb drop of < 3 g/dL, those who received RBC transfusions had a higher mortality (hazard ratio [HR], 1.9; confidence interval [CI], 95% CI, 1.2-2.9; P = 0.004). Among patients with an Hb drop of ≥ 3 g/dL, the Hb drop had no significant impact on survival (HR, 1.5; 95% CI, 0.7-2.9; P = 0.2); however, patients who received RBC transfusions had a significantly higher mortality (HR, 4.1; 95% CI, 2.2-7.7; P < 0.001). The use of RBC transfusions decreased gradually over the duration of the study. | 10.1016/j.cjca.2015.10.032
| Impact of Hemoglobin Drop, Bleeding Events, and Red Blood Cell Transfusions on Long-term Mortality in Patients Undergoing Transaortic Valve Implantation. | The Canadian journal of cardiology |
An Hb drop is frequently observed after TAVI. RBC transfusions are strongly associated with increased long-term mortality in these patients, regardless of the degree of Hb drop or major bleeding.
Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. | 10.1016/j.cjca.2015.10.032
| Impact of Hemoglobin Drop, Bleeding Events, and Red Blood Cell Transfusions on Long-term Mortality in Patients Undergoing Transaortic Valve Implantation. | The Canadian journal of cardiology |
The goal of this study was to interrelate N-terminal B-type natriuretic peptide (NT-proBNP) levels and cardiac magnetic resonance imaging-derived ventricular function, mass, and volumes in adults with pulmonary regurgitation after Fallot repair and to evaluate the prognostic relevance of these parameters regarding adverse clinical outcome.
Eighty-one patients (aged 26.3 ± 7.4 years; male sex, 45.7%; New York Heart Association class I, 72.8%; pulmonary valve velocity, < 3 m/s) were included. At baseline cardiac magnetic resonance imaging and NT-proBNP measurements were performed. | 10.1016/j.cjca.2015.11.013
| NT-proBNP Indicates Left Ventricular Impairment and Adverse Clinical Outcome in Patients With Tetralogy of Fallot and Pulmonary Regurgitation. | The Canadian journal of cardiology |
During a mean observation time of 6.9 ± 2.6 years, 13 patients (16.1%) had sustained supraventricular arrhythmias or heart failure (2.4 per 100 patient-years). Multivariate Cox analysis identified NT-proBNP, left ventricular (LV) end-systolic volume index and LV ejection fraction, right ventricular (RV) end-diastolic volume index, and tricuspid regurgitation as independent predictors of adverse events. NT-proBNP correlated with LV but not with RV parameters. In receiver operating characteristic curve analysis using significant variables of the multivariate analysis, NT-proBNP was superior to all other parameters to detect patients at risk (area under the curve [AUC], 0.873; 95% confidence interval, 0.772-0.974). LV end-systolic volume index (AUC, 0.734), RV end-diastolic volume index (AUC, 0.645) und tricuspid regurgitation (AUC, 0.747) showed lower diagnostic accuracy. | 10.1016/j.cjca.2015.11.013
| NT-proBNP Indicates Left Ventricular Impairment and Adverse Clinical Outcome in Patients With Tetralogy of Fallot and Pulmonary Regurgitation. | The Canadian journal of cardiology |
Even in mildly symptomatic patients with pulmonary regurgitation after Fallot repair NT-proBNP is a strong predictor of adverse outcome. It is rather associated with LV but not with RV impairment. In severe pulmonary regurgitation an increase in the level of NT-proBNP and LV impairment seem to provide additional useful information for the timing of pulmonary valve replacement.
Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. | 10.1016/j.cjca.2015.11.013
| NT-proBNP Indicates Left Ventricular Impairment and Adverse Clinical Outcome in Patients With Tetralogy of Fallot and Pulmonary Regurgitation. | The Canadian journal of cardiology |
The role of acute arterial hypertension in acute pulmonary edema (APE) as an associated or triggering phenomenon has been poorly investigated and is relevant to patient management.
This was a prospective observational study of clinical, electrocardiographic, and echocardiographic characteristics of patients with APE. Potential triggers, including acute coronary syndrome (ACS), rapid atrial fibrillation (AF) (≥ 120 bpm in AF), fever > 38°C or volume overload, isolated acute hypertension (systolic blood pressure ≥ 170 mm Hg), and unknown factors were investigated. | 10.1016/j.cjca.2015.10.030
| Acute Arterial Hypertension in Acute Pulmonary Edema: Mostly a Trigger or an Associated Phenomenon? | The Canadian journal of cardiology |
There were 742 patients, 578 with coronary artery disease (78%), 116 with valvular heart disease or cardiomyopathy (16%), and 47 without identifiable heart disease (6%). ACS was present in 482 (65%) patients (silent in 154 of them), AF was present in 76 (10%) patients, fever/volume overload was present in 62 (8%) patients, acute hypertension was present in 50 (7%) patients, and no apparent trigger was seen in 72 (10%) patients. Admission hypertension occurred in 260 patients (35%): 155 (60%) with ACS (silent in 49 [32%]), 36 (14%) with AF, 19 (7%) with fever/volume overload, and 59 (19%) as an isolated trigger. Similar results were obtained when analyzing patients using coronary angiography (467 patients [63%]). Acute hypertension was present more frequently in patients with severe hypoventilation (arterial Pco2 > 60 mm Hg) than in those without (57% vs 29%; P < 0.001) and in those without moderate-severe mitral regurgitation than in those with (51% vs 30%; P < 0.001). | 10.1016/j.cjca.2015.10.030
| Acute Arterial Hypertension in Acute Pulmonary Edema: Mostly a Trigger or an Associated Phenomenon? | The Canadian journal of cardiology |
In patients with APE, with or without ACS, acute hypertension is often present but mainly as an associated/reactive phenomenon and seems favoured by severe hypoventilation. Silent myocardial ischemia/necrosis deserves systematic investigation because it is not rare that it may be the underlying cause of APE.
Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. | 10.1016/j.cjca.2015.10.030
| Acute Arterial Hypertension in Acute Pulmonary Edema: Mostly a Trigger or an Associated Phenomenon? | The Canadian journal of cardiology |
Managing anticoagulation in pregnant women with mechanical heart valves remains challenging. Our aim was to evaluate the effectiveness and safety of 4 regimens in these women.
Relevant studies published before June 2015 were collected in several databases and analyzed with RevMan version 5.3 and SPSS version 19.0. Four regimens were defined as follows: a regimen of a vitamin K antagonist (VKA) throughout pregnancy; a heparin (H)/VKA regimen using VKAs except for unfractionated heparin (UFH) or low molecular weight heparin (LMWH) during 6-12 weeks of pregnancy; a LMWH regimen of adjusted LMWH doses throughout pregnancy; and a UFH regimen of adjusted UFH doses throughout pregnancy. The low warfarin dose in the VKA regimen was defined as 5 mg/d or less. | 10.1016/j.cjca.2015.11.005
| Anticoagulation Regimens During Pregnancy in Patients With Mechanical Heart Valves: A Systematic Review and Meta-analysis. | The Canadian journal of cardiology |
Fifty-one studies comprising 2113 pregnancies in 1538 women were included. The rate of fetal wastage was significantly higher in the high warfarin dose subgroup than in the low dose one. Compared with the H/VKA regimen, the rate of maternal major thromboembolic event in the low-dose VKA regimen group was significantly lower, although the fetal outcomes were similar. Compared with the H/VKA regimen, the rate of fetal wastage in the LMWH regimen group was significantly lower, and the maternal outcomes were similar. The UFH regimen presented the worst maternal and fetal outcomes.
In the absence of large prospective trials, this meta-analysis showed that the VKA regimen should be best for pregnant women with a low warfarin dose, and the H/VKA regimen might be reasonable for those with a high warfarin dose. The LMWH regimen could be used for those who refuse VKA.
Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. | 10.1016/j.cjca.2015.11.005
| Anticoagulation Regimens During Pregnancy in Patients With Mechanical Heart Valves: A Systematic Review and Meta-analysis. | The Canadian journal of cardiology |
There is a perception among Canadian physicians that coronary artery disease (CAD) and adverse cardiac events are more common in those of French Canadian heritage. We sought to compare the prevalence of CAD using coronary computed tomographic angiography (CCTA) in French Canadians and non-French white Canadians.
Consecutive patients were prospectively enrolled in our institutional CCTA registry. Of 10,868 CCTA examinations, we analyzed white patients who identified themselves as French Canadian or non-French Canadian. These 2 groups were compared for baseline characteristics, cardiovascular risk factors, and routine markers for CAD on CTCA. Propensity score adjustments were also made to account for differences in demographics. | 10.1016/j.cjca.2015.11.006
| Coronary Artery Disease in French Canadians-Investigation of a Suggested Vulnerable Population. | The Canadian journal of cardiology |
We identified 1683 French Canadians (mean age, 58.5 ± 10.7 years; 54.2% men) and 5077 non-French white Canadians (mean age, 59.4 ± 11.4 years; 57.3% men). French Canadians were more likely to have a smoking history (64.1% vs 56.1%), diabetes (15.6% vs 13.6%), and a family history of premature CAD (53.3% vs 44.6%) (P < 0.05 for all). There was no significant difference in measures of CAD between French Canadians and non-French white Canadians in obstructive CAD (32.5% vs 32.2%; P = 0.997), total plaque score (4.6 ± 4.3 vs 4.5 ± 4.4; P = 0.616) and Agatston score (168.1 ± 319.8 vs 183.6 ± 433.7; P = 0.371). After propensity score adjustment, there was still no significant difference between the groups. | 10.1016/j.cjca.2015.11.006
| Coronary Artery Disease in French Canadians-Investigation of a Suggested Vulnerable Population. | The Canadian journal of cardiology |
Our study suggests that French Canadians in the Champlain region have a greater prevalence of cardiovascular risk factors compared with non-French Canadians; however, they do not appear to have a greater prevalence or severity of coronary atherosclerosis as assessed by CCTA.
Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. | 10.1016/j.cjca.2015.11.006
| Coronary Artery Disease in French Canadians-Investigation of a Suggested Vulnerable Population. | The Canadian journal of cardiology |
In this review, we discuss the most recent forms of exercise training available to patients with cardiac disease and their comparison or their combination (or both) during short- and long-term (phase II and III) cardiac rehabilitation programs. Exercise training modalities to be discussed include inspiratory muscle training (IMT), resistance training (RT), continuous aerobic exercise training (CAET), and high-intensity interval training (HIIT). Particular emphasis is placed on HIIT compared or combined (or both) with other forms such as CAET or RT. For example, IMT combined with CAET was shown to be superior to CAET alone for improving functional capacity, ventilatory function, and quality of life in patients with chronic heart failure. Similarly, RT combined with CAET was shown to optimize benefits with respect to functional capacity, muscle function, and quality of life | 10.1016/j.cjca.2016.01.017
| Comparison of Different Forms of Exercise Training in Patients With Cardiac Disease: Where Does High-Intensity Interval Training Fit? | The Canadian journal of cardiology |
Furthermore, in recent years, HIIT has emerged as an alternative or complementary (or both) exercise modality to CAET, providing equivalent if not superior benefits to conventional continuous aerobic training with respect to aerobic fitness, cardiovascular function, quality of life, efficiency, safety, tolerance, and exercise adherence in both short- and long-term training studies. Finally, short-interval HIIT was shown to be useful in the initiation and improvement phases of cardiac rehabilitation, whereas moderate- or longer-interval (or both) HIIT protocols appear to be more appropriate for the improvement and maintenance phases because of their high physiological stimulus. We now propose progressive models of exercise training (phases II-III) for patients with cardiac disease, including a more appropriate application of HIIT based on the scientific literature in the context of a multimodal cardiac rehabilitation program. | 10.1016/j.cjca.2016.01.017
| Comparison of Different Forms of Exercise Training in Patients With Cardiac Disease: Where Does High-Intensity Interval Training Fit? | The Canadian journal of cardiology |
Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. | 10.1016/j.cjca.2016.01.017
| Comparison of Different Forms of Exercise Training in Patients With Cardiac Disease: Where Does High-Intensity Interval Training Fit? | The Canadian journal of cardiology |
Sudden cardiac death (SCD) in an apparently healthy individual is a tragedy that prompts a series of investigations to identify the cause of death and to prevent SCD in potentially at-risk family members. Several inherited channelopathies and cardiomyopathies, including long QT syndrome (LQTS), catecholaminergic polymorphic ventricular cardiomyopathy (CPVT), hypertrophic cardiomyopathy (HCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC) are associated with exercise-related SCD. Exercise restriction has been a historical mainstay of therapy for these conditions. Syncope and cardiac arrest occur during exercise in LQTS and CPVT because of ventricular arrhythmias, which are managed with β-blockade and exercise restriction. Exercise may provoke hemodynamic or ischemic changes in HCM, leading to ventricular arrhythmias. ARVC is a disease of the desmosome, whose underlying disease process is accelerated by exercise. On this basis, expert consensus has erred on the side of caution, recommending rigorous exercise restriction for all inherited arrhythmias | 10.1016/j.cjca.2016.01.007
| Exercise and Inherited Arrhythmias. | The Canadian journal of cardiology |
With time, as familiarity with inherited arrhythmia conditions has increased and patients with milder forms of disease are diagnosed, practitioners have questioned the historical rigorous restrictions advocated for all. This change has been driven by the fact that these are often children and young adults who wish to lead active lives. Recent evidence suggests a lower risk of exercise-related arrhythmias in treated patients than was previously assumed, including those with previous symptoms managed with an implantable cardioverter-defibrillator. In this review, we emphasize shared decision making, monitored medical therapy, individual and team awareness of precautions and emergency response measures, and a more permissive approach to recreational and competitive exercise. | 10.1016/j.cjca.2016.01.007
| Exercise and Inherited Arrhythmias. | The Canadian journal of cardiology |
Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. | 10.1016/j.cjca.2016.01.007
| Exercise and Inherited Arrhythmias. | The Canadian journal of cardiology |
To evaluate the mid-term outcomes after percutaneous closure of the secundum atrial septal defects (ASD) using the Figulla-Occlutech device (FOD).
Transcatheter closure has become the method of choice for most patients with ASD. Although the FOD may have some advantageous characteristics there is a paucity of data on later outcomes after the use of this relatively new device.
Observational, single arm study including 200 non-consecutive patients who underwent ASD closure between 04/09 and 07/15 in 2 centers. Device performance, deployment technique, and immediate and mid-term outcomes were assessed. | 10.1111/joic.12284
| Mid-Term Outcomes after Percutaneous Closure of the Secundum Atrial Septal Defect with the Figulla-Occlutech Device. | Journal of interventional cardiology |
Median age and weight were 24 years (4-72) and 58 kg (15-92), respectively. Single defects were observed in 171 patients (median size of 19 mm). The remainder had multiple or multifenestrated defects. Implantation of FOD (median size of 24 mm) was successful in all (99%), but 2 patients (1 with deficient postero-inferior rim; 1 with a large ASD for the size of the child). Embolization with device retrieval occurred in 2 (1%). Median follow-up of 36 months was obtained in 172 patients. Serial echocardiographic assessment showed complete closure in all but 2 patients, in whom an additional small non-significant posterior defect was purposely left untouched. There have been no episodes of late arrhythmias, device embolization, cardiac erosion, endocarditis, thromboembolism, wire fracture, or death.
Transcatheter closure of ASDs in older children, adolescents, and adults using the FOD was highly successful in a wide range of anatomical scenarios with high closure rates and no complications in mid-term follow-up.
© 2016, Wiley Periodicals, Inc. | 10.1111/joic.12284
| Mid-Term Outcomes after Percutaneous Closure of the Secundum Atrial Septal Defect with the Figulla-Occlutech Device. | Journal of interventional cardiology |
Atrial fibrillation is a supraventricular arrhythmia that increases the risk of ischemic stroke and other thromboembolic events. Recently new treatment options have emerged whose cost-effectiveness relative to conventional therapy (warfarin) is well demonstrated. This study compares the clinical benefits and economic costs associated with the new oral anticoagulants most used in Portugal: dabigatran and rivaroxaban.
The results of an indirect comparison of the RE-LY and ROCKET AF trials, which enabled differences in the efficacy of dabigatran and rivaroxaban to be determined, were used in a Markov model simulating patient outcomes in terms of ischemic and hemorrhagic stroke, transient ischemic attack, systemic embolism, acute myocardial infarction and intra- and extracranial bleeding.
The use of dabigatran is associated with better clinical results. The reduction in events is reflected in longer survival (8.41 vs. 8.26 years) and more quality-adjusted life years (5.87 vs. 5.74), while the lower daily treatment cost and the reduction in event-related costs lead to a saving of 367 euros per patient from a societal perspective. | 10.1016/j.repc.2015.09.009
| [Clinical and economic consequences of using dabigatran or rivaroxaban in patients with non-valvular atrial fibrillation]. | Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology |
The results show that dabigatran is a dominant alternative, i.e., it produces better clinical results at a lower cost. Sensitivity analysis demonstrates that the results are robust even considering the uncertainty inherent in an indirect comparison. It can thus be concluded that in clinical practice in Portugal the use of dabigatran is to be preferred to the use of rivaroxaban.
Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved. | 10.1016/j.repc.2015.09.009
| [Clinical and economic consequences of using dabigatran or rivaroxaban in patients with non-valvular atrial fibrillation]. | Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology |
Left ventricular noncompaction is a rare congenital anomaly characterized by excessive left ventricular trabeculation, deep intertrabecular recesses and a thin compacted layer due to the arrest of compaction of myocardial fibers during embryonic development. We report the case of a young patient with isolated left ventricular noncompaction, leading to refractory heart failure that required extracorporeal membrane oxygenation followed by emergency heart transplantation.
Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved. | 10.1016/j.repc.2015.09.015
| [Isolated left ventricular noncompaction causing refractory heart failure]. | Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology |
To investigate safety and efficacy of left Judkins (JL) catheter as a single multipurpose catheter in transradial coronary angiography (TRA).
Most operators use standard femoral catheters instead of special multipurpose transradial catheters during TRA.
Patients undergoing TRA through right radial artery (RRA) were randomized into single-catheter approach with JL3.5 and two-catheter approach with JL3.5 and right Judkins 4.0 catheters. Primary outcome measures were rate of success in selective and stable engagement of both coronary arteries with JL catheter, procedure and fluoroscopy times. | 10.1111/joic.12286
| Effectiveness of Left Judkins Catheter as a Single Multipurpose Catheter in Transradial Coronary Angiography From Right Radial Artery: A Randomized Comparison With Conventional Two-Catheter Strategy. | Journal of interventional cardiology |
Of 314 patients enrolled, 206 patients (aged 60.3 ± 12.4 years, 36.9% female) were randomized. JL3.5 was successful in 66.0% of patients as a single catheter. Additional catheter was needed more frequently in single-catheter group (34 vs. 0.97%, P < 0.001). Single-catheter approach reduced procedure time significantly (6.7 ± 2.1 vs. 7.9 ± 3.3 minutes, P = 0.002). However on average there was 19.7% relative increase in fluoroscopy time (2.61 ± 1.38 vs. 2.18 ± 1.54 minutes, P = 0.035) with single-catheter approach. Radial artery spasm tended to develop more frequently in two-catheter group (22.3 vs. 12.6%, P = 0.067). In nearly half of the patients, procedure had been completed successfully with JL3.5 catheter within a fluoroscopy time similar to that of two-catheter group. | 10.1111/joic.12286
| Effectiveness of Left Judkins Catheter as a Single Multipurpose Catheter in Transradial Coronary Angiography From Right Radial Artery: A Randomized Comparison With Conventional Two-Catheter Strategy. | Journal of interventional cardiology |
In TRA from RRA, JL3.5 catheter can be very effective when dedicated multipurpose catheter is not available. As a single multipurpose catheter, JL works perfectly in nearly half of procedures without prolonging procedure and fluoroscopy times. However insisting on a single-catheter approach with JL could unnecessarily increase fluoroscopy time and, hence, radiation exposure. (J Interven Cardiol 2016;29:257-264).
© 2016, Wiley Periodicals, Inc. | 10.1111/joic.12286
| Effectiveness of Left Judkins Catheter as a Single Multipurpose Catheter in Transradial Coronary Angiography From Right Radial Artery: A Randomized Comparison With Conventional Two-Catheter Strategy. | Journal of interventional cardiology |
Soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2) contribute to experimental diabetic kidney disease, a condition with substantially increased cardiovascular risk when present in patients. Therefore, we aimed to explore the levels of sTNFRs, and their association with prevalent kidney disease, incident cardiovascular disease, and risk of mortality independently of baseline kidney function and microalbuminuria in a cohort of patients with type 2 diabetes. In pre-defined secondary analyses we also investigated whether the sTNFRs predict adverse outcome in the absence of diabetic kidney disease.
The CARDIPP study, a cohort study of 607 diabetes patients [mean age 61 years, 44 % women, 45 cardiovascular events (fatal/non-fatal myocardial infarction or stroke) and 44 deaths during follow-up (mean 7.6 years)] was used. | 10.1186/s12933-016-0359-8
| Association of soluble tumor necrosis factor receptors 1 and 2 with nephropathy, cardiovascular events, and total mortality in type 2 diabetes. | Cardiovascular diabetology |
Higher sTNFR1 and sTNFR2 were associated with higher odds of prevalent kidney disease [odd ratio (OR) per standard deviation (SD) increase 1.60, 95 % confidence interval (CI) 1.32-1.93, p < 0.001 and OR 1.54, 95 % CI 1.21-1.97, p = 0.001, respectively]. In Cox regression models adjusting for age, sex, glomerular filtration rate and urinary albumin/creatinine ratio, higher sTNFR1 and sTNFR2 predicted incident cardiovascular events [hazard ratio (HR) per SD increase, 1.66, 95 % CI 1.29-2.174, p < 0.001 and HR 1.47, 95 % CI 1.13-1.91, p = 0.004, respectively]. Results were similar in separate models with adjustments for inflammatory markers, HbA1c, or established cardiovascular risk factors, or when participants with diabetic kidney disease at baseline were excluded (p < 0.01 for all). Both sTNFRs were associated with mortality. | 10.1186/s12933-016-0359-8
| Association of soluble tumor necrosis factor receptors 1 and 2 with nephropathy, cardiovascular events, and total mortality in type 2 diabetes. | Cardiovascular diabetology |
Higher circulating sTNFR1 and sTNFR2 are associated with diabetic kidney disease, and predicts incident cardiovascular disease and mortality independently of microalbuminuria and kidney function, even in those without kidney disease. Our findings support the clinical utility of sTNFRs as prognostic markers in type 2 diabetes. | 10.1186/s12933-016-0359-8
| Association of soluble tumor necrosis factor receptors 1 and 2 with nephropathy, cardiovascular events, and total mortality in type 2 diabetes. | Cardiovascular diabetology |
The aim of this study was to investigate endothelial function and cardiovascular autonomic activity in patients with neurally mediated syncope (NMS).
Patients with a typical history of NMS were divided according to the result of a head-up tilt (HUT) test. There were 25 patients each in the HUT-positive (HUT+), HUT-negative (HUT-) and control groups. Flow-mediated dilation (FMD) and 24-hour ambulatory electrocardiography (AECG) were performed before the HUT tests. | 10.1159/000443519
| Endothelial Function and Cardiovascular Autonomic Activity in Neurally Mediated Syncope. | Cardiology |
The HUT+ group had a significantly higher FMD than that of the HUT- group and the control group (8.8 ± 3.3 vs. 6.4 ± 2.9%, p = 0.006, and 8.8 ± 3.3 vs. 5.7 ± 2.2%, p = 0.001, respectively). On a 24-hour AECG, the parasympathetic indexes of time domain, such as rMSSD and the pNN50, were significantly higher in the HUT+ group than in the HUT- group (39.0 ± 9.6 vs. 31.6 ± 9.6 ms, p = 0.016, and 16.5 ± 8.1 vs. 10.2 ± 7.2%, p = 0.002, respectively) and the control group (39.0 ± 9.6 vs. 28.9 ± 9.6%, p = 0.001 and 16.5 ± 8.1 vs. 8.7 ± 6.7%, p = 0.001, respectively). High-frequency spectra (parasympathetic activity) of the frequency domain showed similar results. | 10.1159/000443519
| Endothelial Function and Cardiovascular Autonomic Activity in Neurally Mediated Syncope. | Cardiology |
Not only parasympathetic activity, but also endothelial function may affect the results of HUT tests in patients with NMS.
© 2016 S. Karger AG, Basel. | 10.1159/000443519
| Endothelial Function and Cardiovascular Autonomic Activity in Neurally Mediated Syncope. | Cardiology |
To evaluate 90-day cardiovascular outcome in patients after myocardial infarction (MI) in relation to different subtypes of atrial fibrillation (AF) and MI.
We studied 155 071 hospital survivors of MI between 2000 and 2009 in Swedish registries. AF subtypes were defined according to history of AF and in-hospital ECG recordings. Clinical outcomes were evaluated with multivariable Cox models. | 10.1136/heartjnl-2015-308678
| All types of atrial fibrillation in the setting of myocardial infarction are associated with impaired outcome. | Heart (British Cardiac Society) |
AF was documented in 24 023 (15.5%) cases. The AF subtypes were new-onset AF with sinus rhythm at discharge (3.7%), new-onset AF with AF at discharge (3.9%), paroxysmal AF (4.9%) and chronic AF (3.0%). The event rate per 100 person-years for the composite cardiovascular outcome (all-cause mortality, MI or ischaemic stroke) was 90.9 in patients with any type of AF versus 45.2 in patients with sinus rhythm, adjusted hazard ratio with 95% CI (HR) 1.28 (1.19 to 1.37). There were no significant differences in the composite cardiovascular outcome between AF subtypes. AF was associated with higher risk of mortality, HR 1.59 (1.41 to 1.80), reinfarction, HR 1.14 (1 | 10.1136/heartjnl-2015-308678
| All types of atrial fibrillation in the setting of myocardial infarction are associated with impaired outcome. | Heart (British Cardiac Society) |
80), reinfarction, HR 1.14 (1.05 to 1.24), and ischaemic stroke, HR 2.29 (1.92 to 2.74), respectively. In subgroup analysis, AF was associated with a higher risk of composite cardiovascular outcome in the non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) cohort, HR 1.24 (1.13 to 1.36) and HR 1.34 (1.21 to 1.48), respectively, with p value for interaction=0.23. | 10.1136/heartjnl-2015-308678
| All types of atrial fibrillation in the setting of myocardial infarction are associated with impaired outcome. | Heart (British Cardiac Society) |
AF is common in the setting of MI and is associated with a higher risk of composite cardiovascular outcome and the individual components; mortality, reinfarction and ischaemic stroke, respectively. No major difference in outcome was observed between AF subtypes. No difference in outcome for AF was observed between the NSTEMI and STEMI cohort.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ | 10.1136/heartjnl-2015-308678
| All types of atrial fibrillation in the setting of myocardial infarction are associated with impaired outcome. | Heart (British Cardiac Society) |
Diagnostic models used in the management of suspected angina provide no explicit information about prognosis. We present a new prognostic model of 10-year coronary mortality in patients presenting for the first time with suspected angina to complement the Diamond-Forrester diagnostic model of disease probability.
A multicentre cohort of 8762 patients with suspected angina was followed up for a median of 10 years during which 233 coronary deaths were observed. Developmental (n=4412) and validation (n=4350) prognostic models based on clinical data available at first presentation showed good performance with close agreement and the final model utilised all 8762 patients to maximise power. The prognostic model showed strong associations with coronary mortality for age, sex, chest pain typicality, smoking status, diabetes, pulse rate, and ECG findings. Model discrimination was good (C statistic 0.83), patients in the highest risk quarter accounting for 173 coronary deaths (10-year risk of death: 8.7%) compared with a total of 60 deaths in the three lower risk quarters. When the model was simplified to incorporate only Diamond-Forrester factors (age, sex and character of symptoms) it underestimated coronary mortality risk, particularly in patients with reversible risk factors. | 10.1136/heartjnl-2015-308994
| A 10-year prognostic model for patients with suspected angina attending a chest pain clinic. | Heart (British Cardiac Society) |
For the first time in patients with suspected angina, a prognostic model is presented based on simple clinical factors available at the initial cardiological assessment. The model discriminated powerfully between patients at high risk and lower risk of coronary death during 10-year follow-up. Clinical utility was reflected in the prognostic value it added to the updated Diamond-Forrester diagnostic model of disease probability.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ | 10.1136/heartjnl-2015-308994
| A 10-year prognostic model for patients with suspected angina attending a chest pain clinic. | Heart (British Cardiac Society) |
Previous studies investigating the prognostic value of HbA1c in patients undergoing coronary angiography reported a mixed pattern of results. Therefore, we aimed to better define the prognostic power of HbA1c among coronary catheterized patients.
Patients undergoing coronary angiography (n = 3,749) were divided into four groups according to HbA1c levels (<5, 5-6, 6-7 and >7%). Cox regression models assessed long-term mortality after adjusting for multiple covariates. | 10.1159/000444008
| HbA1c Levels and Long-Term Mortality in Patients Undergoing Coronary Angiography. | Cardiology |
Baseline clinical profiles differed in HbA1c groups, with a higher prevalence of comorbidities in the groups with higher HbA1c levels. Median follow-up was 1,745 days (interquartile range 1,007-2,171). A J-shaped association curve was observed between HbA1c levels and all-cause mortality rates, with patients in the lowest and highest HbA1c groups suffering from significantly higher mortality rates compared to in-between groups (hazard ratio 1.9, 95% CI 1.32-2.74, p = 0.001, and hazard ratio 1.58, 95% CI 1.29-1.95, p < 0.001, for the lowest and highest HbA1c groups, respectively). This association persisted after adjustment for anemia, nutritional status, renal function, cardiovascular risk factors and inflammatory biomarkers.
HbA1c levels <5 or >7% are predictors of all-cause mortality in patients undergoing coronary angiography.
© 2016 S. Karger AG, Basel. | 10.1159/000444008
| HbA1c Levels and Long-Term Mortality in Patients Undergoing Coronary Angiography. | Cardiology |
Based on the 2011 American College of Cardiology/American Heart Association percutaneous coronary intervention (PCI) guideline, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, data suggest that there is no significant difference in clinical outcomes following primary or elective PCI between the two groups. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following PCI for acute coronary syndrome (ACS). | 10.1016/j.jjcc.2016.01.012
| Clinical outcomes of percutaneous coronary intervention for acute coronary syndrome between hospitals with and without onsite cardiac surgery backup. | Journal of cardiology |
From August 2008 to March 2011, subjects (n=3241) were enrolled from the Kumamoto Intervention Conference Study (KICS). Patients were assigned to two groups treated in hospitals with (n=2764) or without (n=477) onsite cardiac surgery. Clinical events were followed up for 12 months. Primary endpoint was in-hospital death, cardiovascular death, myocardial infarction, and stroke. And we monitored in-hospital events, non-cardiovascular deaths, bleeding complications, revascularizations, and emergent coronary artery bypass grafting (CABG). There was no overall significant difference in primary endpoint between hospitals with and without onsite cardiac surgery [ACS, 7.6% vs. 8.0%, p=0.737; ST-segment elevation myocardial infarction (STEMI), 10.4% vs. 7.5%, p=0.200]. There was also no significant difference when events in primary endpoint were considered separately | 10.1016/j.jjcc.2016.01.012
| Clinical outcomes of percutaneous coronary intervention for acute coronary syndrome between hospitals with and without onsite cardiac surgery backup. | Journal of cardiology |
There was also no significant difference when events in primary endpoint were considered separately. In other events, revascularization was more frequently seen in hospitals with onsite surgery (ACS, 20.0% vs. 13.0%, p<0.001; STEMI, 21.9% vs. 14.5%, p=0.009). We performed propensity score matching analysis to correct for the disparate patient numbers between the two groups, and there was also no significant difference for primary endpoint (ACS, 8.6% vs. 7.5%, p=0.547; STEMI, 11.2% vs. 7.5%, p=0.210). | 10.1016/j.jjcc.2016.01.012
| Clinical outcomes of percutaneous coronary intervention for acute coronary syndrome between hospitals with and without onsite cardiac surgery backup. | Journal of cardiology |
There is no significant difference in clinical outcomes following PCI for ACS between hospitals with and without onsite cardiac surgery backup in Japan.
Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. | 10.1016/j.jjcc.2016.01.012
| Clinical outcomes of percutaneous coronary intervention for acute coronary syndrome between hospitals with and without onsite cardiac surgery backup. | Journal of cardiology |
To determine whether caspase-1 is critical in chronic kidney disease (CKD)-mediated arterial neointimal hyperplasia (NH), we utilized caspase(-/-) mice and induced NH in carotid artery in a CKD environment, and uremic sera-stimulated human vascular smooth muscle cells (VSMC). We made the following findings: (1) Caspase-1 inhibition corrected uremic sera-mediated downregulation of VSMC contractile markers, (2) CKD-promoted NH was attenuated in caspase(-/-) mice, (3) CKD-mediated downregulation of contractile markers was rescued in caspase null mice, and (4) expression of VSMC migration molecule αvβ3 integrin was reduced in caspase(-/-) tissues. Our results suggested that caspase-1 pathway senses CKD metabolic danger signals. Further, CKD-mediated increase of contractile markers in VSMC and increased expression of VSMC migration molecule αvβ3 integrin in NH formation were caspase-1 dependent. Therefore, caspase-1 is a novel therapeutic target for the suppression of CKD-promoted NH. | 10.1007/s12265-016-9683-3
| Caspase-1 Plays a Critical Role in Accelerating Chronic Kidney Disease-Promoted Neointimal Hyperplasia in the Carotid Artery. | Journal of cardiovascular translational research |
Serum cystatin C, a novel marker of renal function has been shown to be superior to serum creatinine in predicting renal function decline and adverse outcomes of chronic kidney disease (CKD). Our aim was to investigate the association between cystatin C and retinopathy in adults without diabetes.
We examined 1725 Indian adults, aged 40-80 years who participated in the Singapore Indian Eye Study (2007-2009) and were free of diabetes mellitus. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2) determined from serum cystatin C (CKD-eGFRcys, n = 199), and serum creatinine (CKD-eGFRcr, n = 81). Retinopathy was assessed from digital fundus photographs of both eyes by trained graders using the modified Airlie House classification. The associations of CKD defined by the two markers alone and in combination (confirmed CKD, eGFRcr <60 and eGFRcys <60, n = 58) with retinopathy were examined using logistic regression models adjusted for potential confounding factors including preexisting cardiovascular disease and albuminuria. | 10.1177/2047487316637182
| Cystatin C, chronic kidney disease and retinopathy in adults without diabetes. | European journal of preventive cardiology |
The prevalence of retinopathy among those with CKD-eGFRcr and CKD-eGFRcys was 9.9% and 8.5%, respectively. In separate models, the associations of retinopathy with both CKD-eGFRcys (odds ratio (OR) (95% confidence interval (CI)) = 2.18 (1.14-4.16)) and CKD-eGFRcr were significant (OR (95% CI) = 2.63 (1.10-6.28)). In models including both markers, compared to optimal kidney function (eGFRcr ≥60 and eGFRcys ≥60), confirmed CKD was associated with a fourfold higher odds of retinopathy (OR (95% CI) = 4.01 (1.52-10.60)).
In a population-based sample of Indian adults without diabetes, CKD defined by both cystatin C and creatinine was strongly associated with retinopathy.
© The European Society of Cardiology 2016. | 10.1177/2047487316637182
| Cystatin C, chronic kidney disease and retinopathy in adults without diabetes. | European journal of preventive cardiology |
The purpose of this study was to investigate the consistency of the proportional effect of fixed-dose combination therapy (the 'polypill') on the use of recommended cardiovascular preventative medications among indigenous Māori and non-indigenous adults in New Zealand.
We randomised Māori and non-Māori primary care patients at high risk of cardiovascular disease (either because of a prior event or with an estimated 5-year risk of a first event of at least 15%) to a polypill (containing aspirin, statin and two antihypertensives) or usual care for a minimum of 12 months. All patients had indications for all polypill components according to their general practitioner, and all medications (including the polypill) were prescribed by the patient's general practitioner and dispensed at community pharmacies. The main outcome for this study was the use of all recommended medications (antiplatelet, statin and two antihypertensives) at 12 months. Heterogeneity in the effect of polypill-based care compared with usual care on this outcome by ethnicity was assessed by logistic regression. | 10.1177/2047487316637196
| Polypill-based therapy likely to reduce ethnic inequities in use of cardiovascular preventive medications: Findings from a pragmatic randomised controlled trial. | European journal of preventive cardiology |
Baseline use of recommended medications was 36% (93/257) among Māori and 51% (130/156) among non-Māori participants. Polypill-based care was associated with an increase in the use of recommended medications among Māori (relative risk [RR]: 1.87; 95% confidence interval [CI]: 1.50-2.34) and non-Māori (RR: 1.66; 95% CI: 1.37-2.00) when compared with usual care at 12 months, and there was no statistically significant heterogeneity in this outcome by ethnicity (p = 0.92).
Polypill-based care is likely to reduce absolute inequities between Māori and non-Māori in the use of recommended cardiovascular preventative medications given baseline absolute differences and the consistency of the proportional effect of this intervention by ethnicity in this pragmatic trial in primary care.
© The European Society of Cardiology 2016. | 10.1177/2047487316637196
| Polypill-based therapy likely to reduce ethnic inequities in use of cardiovascular preventive medications: Findings from a pragmatic randomised controlled trial. | European journal of preventive cardiology |
We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes. | 10.1093/ehjci/jew021
| Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients. | European heart journal. Cardiovascular Imaging |
Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient. | 10.1093/ehjci/jew021
| Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients. | European heart journal. Cardiovascular Imaging |
In these 13 cases of P-SCAD, clinical presentation commonly included acute myocardial infarction and cardiogenic shock. Multivessel dissections and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of P-SCAD for prompt diagnosis and management in these high-risk patients.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: [email protected]. | 10.1093/ehjci/jew021
| Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients. | European heart journal. Cardiovascular Imaging |
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