http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Wed, 03 Apr 2013 14:27:32 +0000 http://www.hindawi.com/journals/crp/2013/940170/ Background. Oxygen uptake at maximal exercise (VO2 max) is considered the best available index for assessment of exercise capacity. The purpose of this study is to determine if the use of actual versus ideal body weight in standard regression equations for predicted VO2 max results in differences in predicted VO2 max. Methods. This is a retrospective chart review of patients who were predominantly in active military duty with complaints of dyspnea or exercise tolerance and who underwent cardiopulmonary exercise testing (CPET) from 2007 to 2009. Results. A total of 230 subjects completed CPET on a bicycle ergometer with a male predominance (62%) and an average age of 37 ± 15 years. There was significant discordance between the measured VO2 max and predicted VO2 max when measured by the Hansen and Wasserman reference equations (). Specifically, there was less overestimation when predicted VO2 max was based on ideal body weight as opposed to actual body weight. Conclusion. Our retrospective analysis confirmed the wide variations in predicted versus measured VO2 max based on varying prediction equations and showed the potential advantage of using ideal body weight as opposed to actual body weight in order to further standardize reference norms. H. Reza Ahmadian, Joseph J. Sclafani, Ethan E. Emmons, Michael J. Morris, Kenneth M. Leclerc, and Ahmad M. Slim Copyright © 2013 H. Reza Ahmadian et al. All rights reserved. Sun, 31 Mar 2013 16:08:31 +0000 http://www.hindawi.com/journals/crp/2013/129369/ Objective. To evaluate the interrelation between serum uric acid and artery calcification in asymptomatic coronary artery disease subjects. Design and Methods. 126 subjects with previously documented asymptomatic coronary artery disease were enrolled in the study. Results. Mean value of serum uric acid level was 23.84 mmol/L (95% confidence interval (CI)  =  15.75–31.25 mmol/L). In multivariate Cox regression analysis, the results showed that serum uric acid levels (odds ratio , 95% CI = 1.20–1.82; ), osteopontin (, 95% CI = 1.12–1.25; ), osteoprotegerin (, 95% CI  =  1.20–1.89; ), type 2 diabetes mellitus (, 95% CI  =  1.20–1.72; ), and total cholesterol (, 95% CI = 1.10–1.22; ) were factors that independently associated with coronary artery calcification. The Cox models suggested that high quartile of serum uric acid level is very significant in predicting Agatston score index. In conclusion, we suggested that high quartile of serum uric acid level (cutoff point equaled 35.9 mmol/L) was a very significant predictor of coronary calcification examined by Agatston score index in subjects with asymptomatic coronary artery disease. A. E. Berezin and A. A. Kremzer Copyright © 2013 A. E. Berezin and A. A. Kremzer. All rights reserved. Wed, 06 Mar 2013 16:16:51 +0000 http://www.hindawi.com/journals/crp/2013/986847/ The objective of this study was to determine the optimal assessment of arterial stiffness that relates to diastolic dysfunction. Forty-one patients had measurements of brachial-ankle pulse wave velocity (baPWV), carotid-femoral pulse wave velocity (cfPWV), ankle brachial index (ABI), pulse pressure (PP), and augmentation index (AIx). Diastolic dysfunction was evaluated by echocardiographic indices of the ratio of the peak early diastolic mitral valve velocity and the peak late diastolic velocity (E/A ratio), left atrial diameter, and left atrial volume indexes. There was a significant () correlation between baPWV and E/A ratio with an inverse relationship indicating that higher arterial stiffness was associated with greater diastolic dysfunction. In contrast, there was no significant correlation between E/A ratio and cfPWV, PP, ABI, or AIx. After multivariate analysis, the relationship between baPWV and E/A ratio remained significant (), independent of age and systolic blood pressure (BP). There were no correlations between any index of vascular stiffness and left atrial dimension or volume. In summary, baPWV correlates with diastolic dysfunction, independent of a patient’s age and BP and is a better indicator of diastolic dysfunction than other indicators of arterial stiffness. baPWV has the utility of infering the presence of left ventricular diastolic dysfunction. Bryan Chow and Simon W. Rabkin Copyright © 2013 Bryan Chow and Simon W. Rabkin. All rights reserved. Tue, 05 Mar 2013 14:16:42 +0000 http://www.hindawi.com/journals/crp/2013/196506/ The aim of this study was to evaluate HRV in children requiring intensive care unit stays due to TCA poisoning between March 2009 and July 2010. In the time-domain nonspectral evaluation, the SDNN (), SDNNi (), RMSDD (), and pNN50 () were found to be significantly lower in the TCA intoxication group. The spectral analysis of the data recorded during the first 5 minutes after intensive care unit admission showed that the values of the nLF () and the LF/HF ratio () were significantly higher in the TCA intoxication group, while the nHF () values were significantly lower. The frequency-domain spectral analysis of the data recorded during the last 5 minutes showed a lower nHF () in the TCA intoxication group than in the controls, and the LF/HF ratio was significantly higher () in the intoxication group. The LF/HF ratio was higher in the seven children with seizures (). These findings provided us with a starting point for the value of HRV analysis in determining the risk of arrhythmia and convulsion in TCA poisoning patients. HRV can be used as a noninvasive testing method in determining the treatment and prognosis of TCA poisoning patients. Ener Cagri Dinleyici, Zubeyir Kilic, Sabiha Sahin, Rabia Tutuncu-Toker, Makbule Eren, Zeynel Abidin Yargic, Pelin Kosger, and Birsen Ucar Copyright © 2013 Ener Cagri Dinleyici et al. All rights reserved. Sun, 03 Mar 2013 09:28:09 +0000 http://www.hindawi.com/journals/crp/2013/142673/ Natig Gassanov, Evren Caglayan, Firat Duru, and Fikret Er Copyright © 2013 Natig Gassanov et al. All rights reserved. Wed, 27 Feb 2013 13:24:40 +0000 http://www.hindawi.com/journals/crp/2013/490705/ Dynamics of blood pressure (BP) and heart rate (HR) was traced by automatic monitoring every 30 min uninterruptedly along several months in a patient suffering from combined atrial fibrillation and heart failure during the development of disease and its therapeutic and surgical treatment (pacemaker implanting and atrioventricular ablation). Analyses of spectral components as well as signal’s shape revealed instabilities in circadian and semicircadian parameters. A new approach for signal’s form description without using cosine approximation is suggested. The meaning that referring a patient as dipper, night peaker, or nondipper might be useful at choosing tactics of his treatment is impugned, because all these “types” can transform themselves in the same person in few days. Optimization timing of treatment provides better results if not the “types” of daily profile would be taken to account but the real form of the BP-signal and timing its first and second derivatives. Sergey Chibisov, George Katinas, Inna Brodskaya, Aleksandr Ertman, Grigory Gromyko, Aleksandra Konradi, Oleg Mamontov, Anna Merkuryeva, Ekaterina Polunicheva, Evgeny Shlyakhto, Anna Soboleva, Sergey Yashin, and Bharadva Bhavdip Copyright © 2013 Sergey Chibisov et al. All rights reserved. Thu, 21 Feb 2013 08:42:12 +0000 http://www.hindawi.com/journals/crp/2013/127270/ Background. Acute Coronary Syndrome (ACS) is a clinical condition encompassing ST Segment Elevation Myocardial Infarction (STEMI), Non-ST Segment Elevation Myocardial Infarction (NSTEMI), and Unstable Angina (UA) and is characterized by ruptured coronary plaque, ischemic stress, and/or myocardial injury. Emergency department (ED) physicians are on the front lines of ACS management. The role of new antiplatelet agents ticagrelor and prasugrel in acute ED management of ACS has not yet been defined. Objective. To critically review clinical trials using ticagrelor and prasugrel in the treatment of ACS and inform practitioners of their potential utility in treating ACS in the ED. Results. Trials on the efficacy of ticagrelor and prasugrel achieve statistical significance in decreasing composite endpoints in select patient populations. Conclusion. The use of ticagrelor and prasugrel as first line ED treatment of ACS is not well established. Current evidence supports the use of several agents with the final decision based on treatment protocols conjointly developed between cardiology and emergency medicine (EM). Further clinical trials involving head-to-head trials or comparisons of drug-based strategies are required to show superiority in reducing cardiac endpoints with regard to ED initiation of treatment. M. Curial, E. Nath, and E. Lang Copyright © 2013 M. Curial et al. All rights reserved. Tue, 19 Feb 2013 09:25:09 +0000 http://www.hindawi.com/journals/crp/2013/195456/ Dual antiplatelet therapy with aspirin and a P2Y12 receptor inhibitor represents the cornerstone therapy for patients with acute coronary syndromes or undergoing percutaneous interventions, leading to a reduction of subsequent ischemic events. Variable response to clopidogrel has received close attention, and pharmacokinetic, pharmacodynamic, and pharmacogenomic factors have been identified as culprits. This led to the introduction of newer, potentially safer, and more effective antiplatelet agents (prasugrel and ticagrelor). Additionally, several point-of-care assays of platelet function have been developed in recent years to rapidly screen individuals on antiplatelet therapy. While the routine use of platelet function testing is uncertain and not currently recommended, it may be useful in instances when the degree of platelet inhibition may be uncertain such as high-risk patients undergoing percutaneous coronary intervention or when there may be a suspected pharmacodynamic interaction with other drugs. The current paper focuses on the P2Y12 receptor inhibitors and their pharmacogenetics and indications in patients with acute coronary syndromes or receiving percutaneous coronary interventions as well as the applicability of platelet function testing in this clinical context. Adriana Dana Oprea and Wanda M. Popescu Copyright © 2013 Adriana Dana Oprea and Wanda M. Popescu. All rights reserved. Thu, 14 Feb 2013 15:17:17 +0000 http://www.hindawi.com/journals/crp/2013/895215/ Background. Although our comprehension of nonrheumatic aortic stenosis (NRAS) has increased substantially during the last decade, less is known about the histopathology of rheumatic aortic stenosis (RAS). The aim of this study was to investigate rheumatic aortic stenosis by means of analyses previously used in nonrheumatic stenosis. Material and Methods. Valve specimens were obtained from 39 patients referred to hospital due to significant aortic stenosis. According to established macroscopic criteria the valves were divided into two groups consisting of 29 NRAS and 10 RAS valves. Mononuclear inflammatory cells and apolipoproteins were investigated using immunohistochemical analyses. Results. The localisation of calcification differed in tricuspid nonrheumatic valves when compared to bicuspid nonrheumatic and rheumatic valves. The RAS valves revealed a lower degree of T lymphocyte infiltration compared with the NRAS valves. Infiltration of macrophages was seen in all valves and there were no differences regarding deposition of apolipoprotein. Conclusion. Rheumatic and nonrheumatic aortic stenotic valves show a similar and significant chronic inflammation. The similarities regarding the localisation of calcification indicate that the valve anomaly/morphology can influence the pathogenesis of aortic stenosis. Finally, our findings highlight the question of a postinflammatory valvular disease of other causes than rheumatic fever. Lars Wallby, Thora Steffensen, Lena Jonasson, and Mats Broqvist Copyright © 2013 Lars Wallby et al. All rights reserved. Thu, 31 Jan 2013 17:08:29 +0000 http://www.hindawi.com/journals/crp/2013/128795/ Background. The CYP2C19*2 allele may be associated with a reduced antiplatelet effect for clopidogrel. Here, we assessed whether CYP2C19*2 alleles correlate with clopidogrel responsiveness following the administration of clopidogrel in healthy Malaysian volunteers. Methods. Ninety volunteers were genotyped for CYP2C19*2 and CYP2C19*3 alleles. Forty-five of 90 volunteers were included in the clopidogrel response studies and triaged into three genotypes, namely, CYP2C19*1/*1 , CYP2C19*1/*2 and CYP2C19*2/*2 . All subjects received 300 mg of clopidogrel, and platelet reactivity was assessed after a four-hour loading utilizing the VerifyNow-P2Y12 assay. Platelet activity was reported using P2Y12 reaction units (PRUs), and nonresponder status was prespecified at PRU ≥ 230. Results. Following clopidogrel intake, CYP2C19*2/*2 carriers had a significantly higher mean PRU compared to the CYP2C19*1/*2 and CYP2C19*1/*1 (291.0 ± 62.1 versus 232.5 ± 81.4 versus 147.4 ± 87.2 PRU, ) carriers. Almost half of the participants (46.7%) were found to be nonresponders (3 were CYP2C19*1/*1, 11 were CYP2C19*1/*2, and 7 were CYP2C19*2/*2). Conclusion. In healthy Malaysian volunteers, CYP2C19*2 allele was associated with a decrease in platelet responsiveness to clopidogrel. However, clopidogrel nonresponders can be found not only in the carriers of CYP2C19*2/*2, but also in the carriers of CYP2C19*1/*2 and CYP2C19*1/*1. The present paper demonstrated that genotype information does not correlate with clopidogrel response, and genotyping may represent a less robust approach compared to platelet activity testing in guiding clopidogrel therapy. Yanti Nasyuhana Sani, Lim Sheau Chin, Lim Luen Hui, Nur Elyana Yazmin Mohd Redhuan Shah Edwin, Goh Teck Hwa, Victor L. Serebruany, and Yuen Kah Hay Copyright © 2013 Yanti Nasyuhana Sani et al. All rights reserved. Tue, 22 Jan 2013 11:21:37 +0000 http://www.hindawi.com/journals/crp/2013/976976/ The incidence and prevalence of atrial fibrillation (AF) are projected to increase significantly worldwide, imposing a significant burden on healthcare resources. The disease itself is extremely heterogeneous in its epidemiology, pathophysiology, and treatment options based on individual patient characteristics. Whilst ageing is well recognised to be an independent risk factor for the development of AF, this condition also affects the young in whom the condition is frequently symptomatic and troublesome. Traditional thinking suggests that the causal factors and pathogenesis of the condition in the young with structurally normal atria but electrophysiological “triggers” in the form of pulmonary vein ectopics leading to lone AF are in stark contrast to that in the elderly who have AF primarily due to an abnormal substrate consisting of fibrosed and dilated atria acting in concert with the pulmonary vein triggers. However, there can be exceptions to this rule as there is increasing evidence of structural and electrophysiological abnormalities in the atrial substrate in young patients with “lone AF,” as well as elderly patients who present with idiopathic AF. These reports seem to be blurring the distinction in the pathophysiology of so-called idiopathic lone AF in the young versus that in the elderly. Moreover with availability of improved and modern investigational and diagnostic techniques, novel causes of AF are being reported thereby seemingly consigning the diagnosis of “lone AF” to a rather mythical existence. We shall also elucidate in this paper the differences seen in the epidemiology, causes, pathogenesis, and clinical features of AF in the young versus that seen in the elderly, thereby requiring clearly defined management strategies to tackle this arrhythmia and its associated consequences. Rajiv Sankaranarayanan, Graeme Kirkwood, Katharine Dibb, and Clifford J. Garratt Copyright © 2013 Rajiv Sankaranarayanan et al. All rights reserved. Mon, 31 Dec 2012 16:49:34 +0000 http://www.hindawi.com/journals/crp/2012/729670/ Dietary modification and supplementation play an increasingly important role in the conservative treatment of cardiovascular disease. Current interest has focused on n-3 polyunsaturated fatty acids (PUFA) and vitamin D. Clinical trial results on this subject are contradictory in many aspects. Several studies indicate that n-3 PUFA consumption improves vascular and cardiac hemodynamics, triglycerides, and possibly endothelial function, autonomic control, inflammation, thrombosis, and arrhythmia. Experimental studies show effects on membrane structure and associated functions, ion channel properties, genetic regulation, and production of anti-inflammatory mediators. Clinical trials evaluating a possible reduction in cardiovascular disease by n-3 PUFA have shown different results. Supplementation of vitamin D is common regarding prevention and treatment of osteoporosis. But vitamin D also seems to have several effects on the cardiovascular system. Vitamin D deficiency appears to be related to an increase in parathyroid hormone levels and can predispose to essential hypertension and left ventricular hypertrophy, increased insulin resistance, and eventually to atherosclerosis and adverse cardiovascular events. Randomized prospective clinical trials are needed to determine whether vitamin D and omega-3 FA supplementation therapy should be recommended as a routine therapy for primary or secondary prevention of cardiovascular disease. Norbert Güttler, Kirila Zheleva, Mariana Parahuleva, Ridvan Chasan, Mehmet Bilgin, Christiane Neuhof, Mehmet Burgazli, Bernd Niemann, Ali Erdogan, and Andreas Böning Copyright © 2012 Norbert Güttler et al. All rights reserved. Mon, 31 Dec 2012 16:02:31 +0000 http://www.hindawi.com/journals/crp/2012/201742/ Background. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. A previous rat study revealed an ADMA lowering effect following treatment with omega-3 polyunsaturated fatty acids (n-3 PUFAs). We sought to examine if an association between plasma ADMA and risk of acute myocardial infarction (AMI) was modified by serum n-3 PUFA status. Methods. The cohort included 1364 patients who underwent coronary angiography for suspected coronary artery disease in 2000-2001. Fatal and nonfatal AMI events were registered until December 31, 2006. Risk associations with AMI were estimated across ADMA quartiles (linear trend) and the upper decile. Results. No association between concentration of any n-3 PUFA and ADMA was observed. Only ADMA levels in upper decile were significantly associated with AMI with a multivariate adjusted hazard ratio (HR) (95% confidence interval) versus the rest of the population of 2.11 (1.34, 3.32). The association was strengthened among patients with below median levels of α-linolenic acid (ALA) (HR 3.12 (1.64, 5.93)), but was only influenced by longer chain n-3 PUFA after additional adjustments for HbA1c, estimated glomerular filtration rate, and hypercholesterolemia. Conclusions. The association of ADMA with risk of AMI is influenced by serum n-3 PUFA and particularly ALA. Heidi Borgeraas, Elin Strand, Eva Ringdal Pedersen, Jutta Dierkes, Per Magne Ueland, Reinhard Seifert, Eirik Rebnord Wilberg, Pavol Bohov, Rolf K. Berge, Dennis W. T. Nilsen, and Ottar Nygård Copyright © 2012 Heidi Borgeraas et al. All rights reserved. Wed, 26 Dec 2012 16:02:46 +0000 http://www.hindawi.com/journals/crp/2012/754181/ We investigated the effects of purified eicosapentaenoic acid (EPA) on vascular endothelial function and free fatty acid composition in Japanese hyperlipidemic subjects. In subjects with hyperlipidemia (total cholesterol  mg/dL and/or triglycerides  mg/dL), lipid profile and forearm blood flow (FBF) during reactive hyperemia were determined before and 3 months after supplementation with 1800 mg/day EPA. Peak FBF during reactive hyperemia was lower in the hyperlipidemic group than the normolipidemic group. EPA supplementation did not change serum levels of total, HDL, or LDL cholesterol, apolipoproteins, remnant-like particle (RLP) cholesterol, RLP triglycerides, or malondialdehyde-modified LDL cholesterol. EPA supplementation did not change total free fatty acid levels in serum, but changed the fatty acid composition, with increased EPA and decreased linoleic acid, γ-linolenic acid, and dihomo-γ-linolenic acid. EPA supplementation recovered peak FBF after 3 months. Peak FBF recovery was correlated positively with EPA and EPA/arachidonic acid levels and correlated inversely with dihomo-γ-linolenic acid. EPA supplementation restores endothelium-dependent vasodilatation in hyperlipidemic patients despite having no effect on serum cholesterol and triglyceride patterns. These results suggest that EPA supplementation may improve vascular function at least partly via changes in fatty acid composition. Ken Yamakawa, Michio Shimabukuro, Namio Higa, Tomohiro Asahi, Kageyuki Ohba, Osamu Arasaki, Moritake Higa, Yoshito Oshiro, Hisashi Yoshida, Tohru Higa, Taro Saito, Shinichiro Ueda, Hiroaki Masuzaki, and Masataka Sata Copyright © 2012 Ken Yamakawa et al. All rights reserved. Mon, 24 Dec 2012 10:59:27 +0000 http://www.hindawi.com/journals/crp/2012/475094/ Sidney G. Shaw, David J. Abraham, Daryll M. Baker, and Janice Tsui Copyright © 2012 Sidney G. Shaw et al. All rights reserved. Thu, 20 Dec 2012 11:57:32 +0000 http://www.hindawi.com/journals/crp/2012/126324/ Gregory Giamouzis, George Giannakoulas, Javed Butler, John A. Elefteriades, Carsten Tschöpe, and Filippos Triposkiadis Copyright © 2012 Gregory Giamouzis et al. All rights reserved. Mon, 17 Dec 2012 13:58:13 +0000 http://www.hindawi.com/journals/crp/2012/306852/ Background. Peripheral arterial disease (PAD) often coexists with congestive heart failure (CHF) and can be masked by symptoms of CHF such as functional limitation (FL), a common manifestation for both. Therefore, we sought to estimate the prevalence of PAD and its independent association with FL in CHF. Methods. We conducted a cross-sectional study on National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004 to quantify weighted prevalence of CHF and PAD. Study cohort consisted of 7513, with ankle brachial index (ABI) measurements at baseline. Independent association of PAD (ABI ≤ 0.9) with FL in CHF was determined with multivariate logistic regression (MVLR). Results. Overall weighted PAD prevalence was 5.2%. CHF was present in 305 participants, and the weighted prevalence of PAD in this subgroup was 19.2%. When compared, participants with CHF and PAD were more likely to be older (), hypertensive () and hypercholesterolemic () than participants with CHF alone. MVLR showed that PAD (adjusted OR = 5.15; 95% CI: 2.2, 12.05: ) and arthritis (adjusted OR = 2.36; 95% CI: 1.10, 5.06: ) were independently associated with FL in CHF. Conclusion. Independent association of PAD with FL suggests the need for reinforced screening for PAD in individuals with CHF. Bamidele A. Adesunloye, Ravinder Valadri, Nkechi M. Mbaezue, and Anekwe E. Onwuanyi Copyright © 2012 Bamidele A. Adesunloye et al. All rights reserved. Thu, 13 Dec 2012 15:42:43 +0000 http://www.hindawi.com/journals/crp/2012/303456/ This paper reviews the current evidence regarding long-chained marine omega-3 polyunsaturated fatty acids (PUFAs) and cardiovascular disease (CVD), their possible mechanisms of action, and results of clinical trials. Also, primary and secondary prevention trials as studies on antiarrhythmic effects and meta-analyses are summarized. However, the individual bioavailability of n-3 PUFAs along with the highly different study designs and estimations of FAs intake or supplementation dosages in patient populations with different background intake of n-3 PUFAs might be some of the reasons for the inconsistent findings of the studies evaluating the impact of n-3 PUFAs on CVD. The question of an optimum dose of n-3 PUFAs or whether there exists a dose-response relation for n-3 PUFA supplementation is widely discussed. Moreover, the difficulties in interpreting meta-analyses are clearly demonstrated by two recently published meta-analyses (Rizos et al. and Delgado Lista et al.), evaluating the efficacy of n-3 PUFAs on CVD, including 12 common studies, but drawing opposite conclusions. We definitely need more large-scale, randomized clinical trials of long duration, also reporting harmful effects of n-3 PUFAs. Hildegunn Aarsetoey, Heidi Grundt, Ottar Nygaard, and Dennis W. T. Nilsen Copyright © 2012 Hildegunn Aarsetoey et al. All rights reserved. Wed, 05 Dec 2012 13:52:12 +0000 http://www.hindawi.com/journals/crp/2012/524961/ Significant strides have been made in the durability, portability, and safety of mechanical circulatory support devices (MCS). Although transplant is considered the standard treatment for advanced heart failure, limits in organ availability leave a much larger pool of recipients in need versus donors. MCS is used as bridge to transplantation and as destination therapy (DT) for patients who will have MCS as their final invasive therapy with transplant not being an option. Despite improvements in quality of life (QOL) and survival, defining the optimal candidate for DT may raise questions regarding the economics of this approach as well as ethical concerns regarding just distribution of goods and services. This paper highlights some of the key ethical issues related to justice and the costs of life-prolonging therapies with respect to resource allocations. Available literature, current debates, and future directions are discussed herein. Keith M. Swetz, John M. Stulak, Shannon M. Dunlay, and Ellin F. Gafford Copyright © 2012 Keith M. Swetz et al. All rights reserved. Thu, 22 Nov 2012 12:23:26 +0000 http://www.hindawi.com/journals/crp/2012/658937/ Atrial fibrillation (AF) is the most common cardiac arrhythmia and imposes a huge clinical and economic burden. AF is correlated with an increased morbidity and mortality, mainly due to stroke and heart failure. Cardiovascular imaging modalities, including echocardiography, computed tomography (CT), and cardiovascular magnetic resonance (CMR), play a central role in the workup and treatment of AF. One of the major advantages of CMR is the high contrast to noise ratio combined with good spatial and temporal resolution, without any radiation burden. This allows a detailed assessment of the structure and function of the left atrium (LA). Of particular interest is the ability to visualize the extent of LA wall injury. We provide a focused review of the value of CMR in identifying the underlying pathophysiological mechanisms of AF, its role in stroke prevention and in the guidance of radiofrequency catheter ablation. CMR is a promising technique that could add valuable information for therapeutic decision making in specific subpopulations with AF. Peter Haemers, Piet Claus, and Rik Willems Copyright © 2012 Peter Haemers et al. All rights reserved. Wed, 21 Nov 2012 10:24:00 +0000 http://www.hindawi.com/journals/crp/2012/142697/ Martin Misfeld, Ani C. Anyanwu, and Adrian H. Chester Copyright © 2012 Martin Misfeld et al. All rights reserved. Wed, 31 Oct 2012 16:17:14 +0000 http://www.hindawi.com/journals/crp/2012/145202/ The bicuspid aortic valve is the most common congenital cardiac anomaly in developed nations. The abnormal bicuspid morphology of the aortic valve results in valvular dysfunction and subsequent hemodynamic derangements. However, the clinical presentation of bicuspid aortic valve disease remains quite heterogeneous with patients presenting from infancy to late adulthood with variable degrees of valvular stenosis and insufficiency and associated abnormalities including aortic coarctation, hypoplastic left heart structures, and ascending aortic dilatation. Emerging evidence suggests that the heterogeneous presentation of bicuspid aortic valve phenotypes may be a more complex matter related to congenital, genetic, and/or connective tissue abnormalities. Optimal management of patients with BAV disease and associated ascending aortic aneurysms often requires a thoughtful approach, carefully assessing various risk factors of the aortic valve and the aorta and discerning individual indications for ongoing surveillance, medical management, and operative intervention. We review current concepts of anatomic classification, pathophysiology, natural history, and clinical management of bicuspid aortic valve disease with associated ascending aortic aneurysms. Katie L. Losenno, Robert L. Goodman, and Michael W. A. Chu Copyright © 2012 Katie L. Losenno et al. All rights reserved. Wed, 24 Oct 2012 11:32:39 +0000 http://www.hindawi.com/journals/crp/2012/498102/ Background. Falls and fractures in the elderly are among the leading causes of disability. We investigated whether pacemaker implantation prevents falls in patients with SND in a large cohort of patients. Methods. Patient demographics and medical history were collected prospectively. Fall history was retrospectively reconstituted from available medical records. The 10-year probability for major osteoporotic fractures was calculated retrospectively from available medical records using the Swiss fracture risk assessment tool FRAX-Switzerland. Results. During a mean observation period of 2.3 years after implantation, the rates of fallers and injured fallers with fracture were reduced to 15% and 6%, respectively. This corresponds to a relative reduction in the number of fallers of 75% () and of injured fallers of 63% () after pacemaker implantation. Similarly, the number of falls was reduced from 60 (48%) before pacemaker implantation to 22 (18%) thereafter (relative reduction 63%, ) and the number of falls with injury from 22 (18%) to 7 (6%), which corresponds to a relative reduction of 67%, . Conclusion. In patients with SND, pacemaker implantation significantly reduces the number of patients experiencing falls, the total number of falls, and the risk for osteoporotic fractures. Nazmi Krasniqi, Diana Segalada, Thomas F. Lüscher, Kurt Lippuner, Laurent Haegeli, Jan Steffel, Thomas Wolber, Corinna Brunckhorst, Johannes Holzmeister, David Hürlimann, and Firat Duru Copyright © 2012 Nazmi Krasniqi et al. All rights reserved. Tue, 16 Oct 2012 09:24:04 +0000 http://www.hindawi.com/journals/crp/2012/610827/ The public health burden of atrial fibrillation (AF) and associated thromboembolic stroke continues to grow at alarming rates. AF leads to a fivefold increase in the risk of stroke. Therefore, stroke prevention remains the most critical aspect of AF management. Current standard of care focuses on oral systemic anticoagulation, most commonly with warfarin and now with newer agents such as dabigatran, rivaroxaban, and apixaban. However, the challenges and limitations of oral anticoagulation have been well documented. Given the critical role of the left atrial appendage (LAA) in the genesis of AF-related thromboembolism, recent efforts have targeted removal or occlusion of the LAA as an alternative strategy for stroke prevention, particularly in patients deemed unsuitable for oral anticoagulation. This paper highlights recent advances in mechanical exclusion of the LAA. The problem of AF and stroke is briefly summarized, followed by an explanation for the rationale behind LAA exclusion for stroke prevention. After briefly reviewing the history of LAA exclusion, we highlight the most promising LAA exclusion devices currently available. Finally, we discuss future challenges and opportunities in this growing field. Taral K. Patel, Clyde W. Yancy, and Bradley P. Knight Copyright © 2012 Taral K. Patel et al. All rights reserved. Mon, 08 Oct 2012 15:22:35 +0000 http://www.hindawi.com/journals/crp/2012/616940/ Objective. We examined the cause of transfer delay in patients with an acute ST-segment myocardial infarction (STEMI) from non percutaneous coronary intervention (PCI) capable to PCI capable hospitals. We then implemented a novel, simple, and reliable initiative to improve the transfer process. Background. Guidelines established by the ACC/AHA call for door-to-balloon times of ≤90 minutes for patients with STEMI. When hospital transfer is necessary, this is only met in 8.6% of cases. Methods. All patients presenting with STEMI to a non-PCI capable hospital from April 2006 to February 2009 were analyzed retrospectively. After identifying causes of transfer delay the “Register and Roll” initiative was developed. An analysis of effect was conducted from March 2009 to July 2011. Results. 144 patients were included, 74 pre-initiative and 70 post- initiative. Time to EMS activation was a major delay in patient transfer. After implementation, the EMS activation time has significantly decreased and time to reperfusion approaches recommended goal (Median 114 min versus 90 min, ), with 55% in <90 minutes. Conclusion. “Register and Roll” streamlines the triage process and improves hospital transfer times. This initiative is easily instituted and reliable in a community hospital setting where resources are limited. Sachin Kumar Amruthlal Jain, Yousif Ismail, Michael Shaw, Shukri David, and Patrick Alexander Copyright © 2012 Sachin Kumar Amruthlal Jain et al. All rights reserved. Wed, 03 Oct 2012 08:00:23 +0000 http://www.hindawi.com/journals/crp/2012/392457/ Previous studies have shown that red palm oil (RPO) supplementation protected rat hearts against ischaemia-reperfusion injury. Evidence from these studies suggested that Akt may be partly responsible for the observed protection. The aim of the current study was therefore to prove or refute the involvement of Akt in the RPO-induced cardioprotection by administration of a specific Akt inhibitor (A6730). Male Wistar rats were randomly divided into 2 groups: a control group receiving standard rat chow and an experimental group receiving standard rat chow plus 2 mL RPO for six weeks. Hearts were excised and mounted on the Langendorff perfusion system. Functional recovery was documented. A different set of hearts were freeze-clamped to assess total and phosphorylation status of Akt. Another set of hearts were subjected to the same perfusion conditions with addition of A6730. Hearts from this protocol were freeze-clamped and assessed for total and phospho-Akt. RPO improved functional recovery which was associated with increased phosphorylation of Akt on Ser473 and Thr308 residues. Blockade of Akt phosphorylation caused poor functional recovery. For the first time, these results prove that Akt plays an important role in the RPO-induced cardioprotection. Emma Katengua-Thamahane, Anna-Mart Engelbrecht, Adriaan J. Esterhuyse, and Jacques Van Rooyen Copyright © 2012 Emma Katengua-Thamahane et al. All rights reserved. Tue, 02 Oct 2012 08:50:06 +0000 http://www.hindawi.com/journals/crp/2012/645469/ Purpose. Acute healthcare utilization of stroke and bleeding has been previously examined among patients with nonvalvular atrial fibrillation (NVAF). The long-term cost of such outcomes over several years is not well understood. Methods. Using 1999–2009 Medicare medical and enrollment data, we identified incident NVAF patients without history of stroke or bleeding. Patients were followed from the first occurrence of ischemic stroke, major bleeding, or intracranial hemorrhage (ICH) resulting in hospitalization. Those with events were matched with 1–5 NVAF patients without events. Total incremental costs of events were calculated as the difference between costs for patients with events and matched controls for up to 3 years. Results. Among the 25,465 patients who experienced events, 94.5% were successfully matched. In the first year after event, average incremental costs were $32,900 for ischemic stroke, $23,414 for major bleeding, and $47,640 for ICH. At 3 years after these events, costs remained elevated by $3,156–$5,400 per annum. Conclusion. While the costs of stroke and bleeding among patients with NVAF are most dramatic in the first year, utilization remained elevated at 3 years. Cost consequences extend beyond the initial year after these events and should be accounted for when assessing the cost-effectiveness of treatment regimens for stroke prevention. Catherine J. Mercaldi, Kimberly Siu, Stephen D. Sander, David R. Walker, You Wu, Qian Li, and Ning Wu Copyright © 2012 Catherine J. Mercaldi et al. All rights reserved. Tue, 25 Sep 2012 13:57:43 +0000 http://www.hindawi.com/journals/crp/2012/135819/ Background. We established a dedicated cardiac oncology clinic in 2008 for the rapid diagnosis and treatment of cardiotoxicity related to cancer therapy. In this retrospective observational study, we report on clinical outcomes in women with early-stage breast cancer (EBC) referred to this clinic. Methods. Patients with EBC treated with chemotherapy/trastuzumab and referred between October 2008 and December 2010. Data included patient demographics, staging, cancer treatment/completion, dose delays, left ventricular ejection fraction (LVEF) and cardiac treatment. Results. Forty eight patients: median age 55.5 years, stage I/II disease (77%) and HER-2 positive (98%). The majority of women () were referred for decreases in LVEF (from baseline). Overall, 37 (77%) patients experienced at least one drop in LVEF while on treatment, of which 22 patients (59%) experienced a ≥10 percentage point drop. The majority of patients (30/37; 81%) experienced declines in LVEF while on trastuzumab. Interventions included trastuzumab delays (/48; 33%) and cardiac medication (12/48: 25%). A total of 81% of patients completed ≥90% of trastuzumab therapy and 15% of patients discontinued therapy due to cardiotoxicity. Conclusion. The majority of patients referred to our clinic completed therapy. Further studies are needed to determine the impact of this multidisciplinary approach on treatment completion and cardiac outcomes. Susan Dent, Sean Hopkins, Nadine Graham, Christopher Johnson, Angeline Law, Michelle Campbell, Freya Crawley, Kathleen Allen, and Michele Turek Copyright © 2012 Susan Dent et al. All rights reserved. Thu, 20 Sep 2012 17:18:04 +0000 http://www.hindawi.com/journals/crp/2012/313879/ Preventive surgical repair of the moderately dilated ascending aorta/aortic root in patients with bicuspid aortic valve (BAV) is controversial. Most international reference centers are currently proposing a proactive approach for BAV patients with a maximum ascending aortic/root diameter of 45 mm since the risk of dissection/rupture raises significantly with an aneurysm diameter >50 mm. Current guidelines of the European Society of Cardiology (ESC) and the joint guidelines of the American College of Cardiology (ACC)/American Heart Association (AHA) recommend elective repair in symptomatic patients with dysfunctional BAV (aortic diameter ≥45 mm). In asymptomatic patients with a well-functioning BAV, elective repair is recommended for diameters ≥50 mm, or if the aneurysm is rapidly progressing (rate of 5 mm/year), or in case of a strong family history of dissection/rupture/sudden death, or with planned pregnancy. As diameter is likely not the most reliable predictor of rupture and dissection and the majority of BAV patients may never experience an aortic catastrophe at small diameters, an overly aggressive approach almost certainly will put some patients with BAV unnecessarily at risk of operative and early mortality. This paper discusses the indications for preventive, elective repair of the aortic root, and ascending aorta in patients with a BAV and a moderately dilated—or ectatic—ascending aorta. Christian D. Etz, Martin Misfeld, Michael A. Borger, Maximilian Luehr, Elfriede Strotdrees, and Friedrich-Wilhelm Mohr Copyright © 2012 Christian D. Etz et al. All rights reserved. Thu, 20 Sep 2012 10:33:15 +0000 http://www.hindawi.com/journals/crp/2012/246710/ Over the last twenty years, revolutionary advances in biomedicine including gene therapy, stem cell research, proteomics, genomics and nanotechnology have highlighted the progressive need to restructure traditional approaches to basic and clinical research in order to facilitate the rapid, efficient integration and translation of these new technologies into novel effective therapeutics. Over the past ten years, funding bodies in the USA and UK such as the National Institutes of Health (NIH) and the Medical Research Council (MRC) have been driving translational research by defining and tackling the hurdles but more still remains to be achieved. This article discusses the ongoing challenges translational researchers face and outlines recent initiatives to tackle these including the new changes to translational funding schemes proposed by the NIH and the MRC and the launch of the “European Advanced Translational Research InfraStructure in Medicine” (EATRIS). It is anticipated that initiatives such as these will not only strengthen translational biomedical research programmes already initiated but should lead to rapid benefits to patients and society. Shervanthi Homer-Vanniasinkam and Janice Tsui Copyright © 2012 Shervanthi Homer-Vanniasinkam and Janice Tsui. All rights reserved.