ISRN Cardiology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Open versus Endovascular Repair of Abdominal Aortic Aneurysm in the Elective and Emergent Setting in a Pooled Population of 37,781 Patients: A Systematic Review and Meta-Analysis Wed, 02 Apr 2014 13:31:30 +0000 Background. We evaluated the incidence of mortality and myocardial infarction (MI) in endovascular repair (EVAR) as compared to open aneurysm repair (OAR) in both elective and ruptured abdominal aortic aneurysm (AAA ) setting. Methods. We analyzed the rates of 30-day mortality, 30-day MI, and hospital length of stay (LOS) based on comparative observation and randomized control trials involving EVAR and OAR. Results. 41 trials compared EVAR to OAR with a total pooled population of 37,781 patients. Analysis of elective and ruptured AAA repair favored EVAR with respect to 30-day mortality with a pooled odds ratio of 0.19 (95% CI 0.17–0.20; ; ). There were a total of 1,835 30-day MI events reported in the EVAR group as compared to 2,483 events in the OAR group. The pooled odds ratio for elective AAA was 0.74 (95% CI 0.58–0.96; ) in favor of EVAR. The average LOS was reduced by 296.75 hrs (95% CI 156.68–436.82 hrs; ) in the EVAR population. Conclusions. EVAR has lower rates of 30-day mortality, 30-day MI, and LOS in both elective and ruptured AAA repair. Dustin M. Thomas, Edward A. Hulten, Shane T. Ellis, David M. F. Anderson, Nathan Anderson, Fiora McRae, Jamil A. Malik, Todd C. Villines, and Ahmad M. Slim Copyright © 2014 Dustin M. Thomas et al. All rights reserved. Mouse Bone Marrow-Derived Endothelial Progenitor Cells Do Not Restore Radiation-Induced Microvascular Damage Thu, 27 Mar 2014 12:37:34 +0000 Background. Radiotherapy is commonly used to treat breast and thoracic cancers but it also causes delayed microvascular damage and increases the risk of cardiac mortality. Endothelial cell proliferation and revascularization are crucial to restore microvasculature damage and maintain function of the irradiated heart. We have therefore examined the potential of bone marrow-derived endothelial progenitor cells (BM-derived EPCs) for restoration of radiation-induced microvascular damage. Material & Methods. 16 Gy was delivered to the heart of adult C57BL/6 mice. Mice were injected with BM-derived EPCs, obtained from Eng+/+ or Eng+/− mice, 16 weeks and 28 weeks after irradiation. Morphological damage was evaluated at 40 weeks in transplanted mice, relative to radiation only and age-matched controls. Results. Cardiac irradiation decreased microvascular density and increased endothelial damage in surviving capillaries (decrease alkaline phosphatase expression and increased von Willebrand factor). Microvascular damage was not diminished by treatment with BM-derived EPCs. However, BM-derived EPCs from both Eng+/+ and Eng+/− mice diminished radiation-induced collagen deposition. Conclusion. Treatment with BM-derived EPCs did not restore radiation-induced microvascular damage but it did inhibit fibrosis. Endoglin deficiency did not impair this process. Ingar Seemann, Johannes A. M. te Poele, Saske Hoving, and Fiona A. Stewart Copyright © 2014 Ingar Seemann et al. All rights reserved. Exclusion of Left Atrial Appendage Thrombus Using Single Phase Coronary Computed Tomography as Compared to Transesophageal Echocardiography in Patients Undergoing Pulmonary Vein Isolation Thu, 20 Feb 2014 12:02:36 +0000 Background. Transesophageal echocardiography (TEE) is used for the evaluation of the presence of left atrial appendage (LAA) thrombus prior to pulmonary vein isolation (PVI), while coronary computed tomography angiography (CCTA) is used for anatomic mapping during PVI. Methods. We compared the diagnostic performance of single phase CCTA to TEE in excluding the presence of LAA thrombus in patients undergoing PVI in 172 subjects performed during index hospitalization. Results. The mean age was years, a median CHADS2 score of 1 [IQR25,75 0,1, range 0–3] and a mean periprocedural INR of . The prevalence of an LAA filling defect on single phase CCTA was 9.3% (6/183) and on TEE was 1.2% (2/183). Sensitivity, specificity, positive predictive value, and negative predictive value were 100% (95% CI, 19.8–100%), 91.8% (95% CI, 94–99%), 12.5% (95% CI, 60–76%), and 91.8% (95% CI, 97–100%) for the detection of LAA filling defect, respectively. Conclusion. Given the utility of a preprocedural single phase CCTA for the performance of PVI, the absence of a filling defect negates the need for a subsequent TEE as an adjunct for exclusion of LAA thrombus. Jason Saucedo, Shaun Martinho, Dianne Frankel, Ahmad M. Slim, and Robert E. Eckart Copyright © 2014 Jason Saucedo et al. All rights reserved. Abdominal Aortic Aneurysms and Coronary Artery Disease in a Small Country with High Cardiovascular Burden Thu, 20 Feb 2014 07:20:43 +0000 We aimed to evaluate the frequency, clinical profiles and outcomes of abdominal aortic aneurysms (AAA), and their association with coronary artery disease (CAD) in a small country with high cardiovascular burden. Methods. Data were collected for all adult patients who underwent abdominal computed tomography scans at Hamad General Hospital in Qatar between 2004 and 2008. Results. Out of 13,115 screened patients for various reasons, 61 patients (0.5%) had abdominal aneurysms. The majority of AAA patients were male (82%) with a mean age of 67 ± 12 years. The incidence of AAA substantially increased with age reaching up to 5% in patients >80 yrs. Hypertension was the most prevalent risk factor for AAA followed by smoking, dyslipidemia, renal impairment, and diabetes mellitus. CAD and peripheral arterial disease (PAD) were observed in 36% and 13% of AAA patients, respectively. There were no significant correlations between CAD or PAD and site and size of AAA. Conclusion. This is the largest study in our region that describes the epidemiology of AAA with concomitant CAD. As the mortality rate is quite high in this high risk population, routine screening for AAA in CAD patients and vice versa needs further studies for proper risk stratification. Hassan Al-Thani and Ayman El-Menyar Copyright © 2014 Hassan Al-Thani and Ayman El-Menyar. All rights reserved. Myocardial Injury in Critically Ill Children: A Case Control Study Tue, 11 Feb 2014 00:00:00 +0000 Objectives. The aim of this study was to investigate the occurrence of myocardial injury in critically ill children through assessment of cardiac troponin T levels and whether levels are associated with disease severity and myocardial dysfunction measured by echocardiography. Methods. Over a 6-month period, this case control study included 50 patients admitted to Pediatric Intensive Care Unit of Zagazig University Children’s Hospital. Twenty-five healthy children were included as a control group. Demographic and clinical data including the pediatric index of mortality II score were recorded. Echocardiographic examination was done and level of cardiac troponin T was measured using Elecsys Troponin T STAT Immunoassay. Results. Cardiac troponin T levels were significantly higher in critically ill in comparison to healthy children (median 22 (18–28) pg/mL versus 10 (10-10) pg/mL, ). Cardiac troponin T levels correlated positively with duration of ventilation as well as with disease severity and correlated negatively with left ventricular fractional shortening. Moreover, cardiac troponin T levels were significantly higher in nonsurvivors when compared to survivors (median 34.5 (27.5–41.5) pg/mL versus 20 (18–24) pg/mL, ). Conclusion. In critically ill children, cardiac troponin T levels were elevated and were associated with duration of ventilation and disease severity. Basheir Hassan, Saed Morsy, Ahmed Siam, Al Shaymaa Ali, Mohamed Abdo, Mona Al Shafie, and Ahmad Hassaneen Copyright © 2014 Basheir Hassan et al. All rights reserved. Mitochondrial Morphofunctional Alterations in Smooth Muscle Cells of Aorta in Rats Thu, 06 Feb 2014 09:11:58 +0000 In an experimental model of atherogenesis induced by hyperfibrinogenemia (HF), the pharmacological response of vitamin E was studied in order to assess its antioxidant effect on the mitochondrial morphofunctional alterations in aortic smooth muscle cells. Three groups of male rats were used: (Ctr) control, (AI) atherogenesis induced for 120 days, and (AIE) atherogenesis induced for 120 days and treated with vitamin E. HF was induced by adrenalin injection (0.1 mg/day/rat) for 120 days. AIE group was treated with the administration of 3.42 mg/day/rat of vitamin E for 105 days after the first induction. Mitochondria morphology was analyzed by electronic microscopy (EM) and mitochondrial complexes (MC) by spectrophotometry. In group AI the total and mean number of mitochondria reduced significantly, the intermembranous matrix increased, and swelling was observed with respect to Ctr and AIE (). These damages were related to a significant decrease in the activity of citrate synthase and complexes I, II, III, and IV in group AI in comparison to Ctr (). Similar behavior was presented by group AI compared to AIE (). These results show that vitamin E produces a significative regression of inflammatory and oxidative stress process and it resolved the morphofunctional mitochondrial alterations in this experimental model of atherogenic disease. María del Carmen Baez, Mariana Tarán, Candelaria Llorens, Ariel Balceda, María de La Paz Scribano, Patricia Pons, and Mónica Moya Copyright © 2014 María del Carmen Baez et al. All rights reserved. Angiotensin Receptor Antagonists to Prevent Sudden Death in Heart Failure: Does the Dose Matter? Thu, 06 Feb 2014 08:54:39 +0000 International guidelines recommend ICD implantation in patients with severe left ventricular dysfunction of any origin only after careful optimization of medical therapy. Indeed, major randomized clinical trials suggest that suboptimal use of fundamental drugs, such as ACE inhibitors (ACE-i) and beta-blockers, may affect ICD shock-free survival, sudden cardiac death (SCD), and overall mortality. While solid evidence in favour of pharmacological therapy based on ACE-i with or without beta-blockers is available, data on SCD in HF patients treated with angiotensin receptor blockers (ARBs) are limited. The present paper systematically analyses the impact of ARBs on SCD in HF and reviews the contributory role of the renin-angiotensin system (RAS) to the establishment of arrhythmic substrates. The following hypothesis is supported: (1) the RAS is a critical component of the electrical remodelling of the failing myocardium, (2) RAS blockade reduces the risk of SCD, and (3) ARBs represent a powerful tool to improve overall survival and possibly reduce the risk of SCD provided that high doses are employed to achieve optimal AT1-receptor blockade. Pietro Francia, Francesca Palano, Giuliano Tocci, Carmen Adduci, Agnese Ricotta, Lorenzo Semprini, Massimo Caprinozzi, Cristina Balla, and Massimo Volpe Copyright © 2014 Pietro Francia et al. All rights reserved. Risks and Benefits of Thrombolytic, Antiplatelet, and Anticoagulant Therapies for ST Segment Elevation Myocardial Infarction: Systematic Review Thu, 06 Feb 2014 08:02:25 +0000 Objectives. Assess the impact of associating thrombolytics, anticoagulants, antiplatelets, and primary angioplasty (PA) on death, reinfarction (AMI), and major bleeding (MB) in STEMI therapy. Methods. Medline search was performed to identify randomized trials comparing these classes in STEMI treatment, at least 500 patients, providing death, AMI, and MB rates. Similar arms were grouped. Correlation between number of drugs and PA and the outcomes was evaluated, as well as correlation between the year of the study and the outcomes. Results. Fifty-nine papers remained after exclusions. 404.556 patients were divided into 35 groups of arms. There was correlation between the number of drugs and rates of death (, ) and MB (, ), confirmed by multivariate regression. This model also showed that PA is associated with lower mortality and increased MB. Year and period of publication correlated with the outcomes: death (, ), MB (, ), and AMI (, ). Conclusion. The increasing complexity of STEMI treatment has resulted in significant reduction in mortality along with increased rates of MB. Overall, however, the benefits of treatment outweigh the associated risks of MB. Bruno Ramos Nascimento, Marcos Roberto de Sousa, Fábio Nogueira Demarqui, and Antonio Luiz Pinho Ribeiro Copyright © 2014 Bruno Ramos Nascimento et al. All rights reserved. Evaluation of the Pericardium with CT and MR Wed, 29 Jan 2014 00:00:00 +0000 The pericardium plays an important role in optimizing cardiac motion and chamber pressures and serves as a barrier to pathology. In addition to pericardial anatomy and function, this review article covers a variety of pericardial conditions, with mention of potential pitfalls encountered during interpretation of diagnostic imaging. Normal and abnormal appearance of pericardium on CT and MR imaging is emphasized, including dynamic imaging correlates of pericardial pathophysiology. Julianna M. Czum, Anne M. Silas, and Morgan C. Althoen Copyright © 2014 Julianna M. Czum et al. All rights reserved. Doxapram Hydrochloride Aggravates Adrenaline-Induced Arrhythmias Accompanied by Bidirectional Ventricular Tachycardia Thu, 09 Jan 2014 07:38:10 +0000 Objectives. Doxapram hydrochloride is a respiratory stimulant that has an inhibitory effect on myocardial IK1 potassium channels and is thought to increase membrane instability and excitability in myocardial cells. We examined the arrhythmogenic effects of doxapram hydrochloride in a rat model of halothane adrenaline-induced arrhythmia. Methods. Thirteen female Wistar rats (12–14 weeks old) were used in the study. Animals were anesthetized with inhalation of halothane to permit observation of the effects of doxapram hydrochloride on halothane adrenaline-induced arrhythmia. Time-dependent changes in ECG repolarization characteristics (QT, QTc, JTp, JT, and Tp-e intervals) were studied. Results. Doxapram hydrochloride itself did not induce arrhythmia but did induce bidirectional ventricular tachycardia after addition of adrenaline. Conclusion. Drug-induced impairment of intracellular Ca2+ regulation caused BVT in the absence of genetic abnormalities in proteins in the sarcoplasmic reticulum. Shota Oikawa, Hiroko Nomura, Miki Nishio, Rina Nagata, and Tadayoshi Hata Copyright © 2014 Shota Oikawa et al. All rights reserved. Attitudes of Implanting Physicians about Cardiac Rhythm Management Devices and Their Features Thu, 26 Dec 2013 18:37:23 +0000 Modern cardiac rhythm management systems have become increasingly complex. The decision on which specific system to implant in a given patient often rests with the implanting physician. We conducted a multiple-choice survey to assess the opinions and preferences of cardiologists and electrophysiologists who implant and follow cardiac rhythm management systems. Reliability and battery longevity were viewed as the most important characteristics in device selection. Patient characteristics which most affected device choice were pacing indication and life expectancy. Remote technology was used in 47% of pacemaker patients, 64% of ICD patients, and 65% of CRT-D patients, with wireless (radiofrequency) remote patient monitoring associated with higher patient compliance rates (74% versus 64%, resp.). Wireless remote patient management with alerts for atrial tachyarrhythmias was felt to be important by 76% of respondents. When choosing an MR-conditional device, physicians deemed patients with prior orthopedic problems, a history of cancer, or neurological disorders to be more likely to require a future MRI. Device longevity and reliability remain the most important factors which influence device selection. Wireless remote patient monitoring with alerts is considered increasingly important when choosing a specific cardiac rhythm management system to implant. Darryl A. Elmouchi, Nagib Chalfoun, and Andre Gauri Copyright © 2013 Darryl A. Elmouchi et al. All rights reserved. The Role of BNP and CRP in Predicting the Development of Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Surgery Wed, 25 Dec 2013 15:59:48 +0000 Objective. To evaluate the association of BNP and CRP with the development of postoperative atrial fibrillation following coronary artery bypass grafting surgery. Methods. The series consists of 125 patients (aged 65 ± 9 years), who underwent isolated CABG-surgery. BNP and CRP levels were measured pre- and 24 hours postoperatively and their correlation to the development of postoperative AF was analyzed. Results. Forty-four patients (35%) developed AF postoperatively. They were significantly older (68 ± 8 versus 63 ± 9, P = 0.01) and predominantly nonsmokers (18% versus 46%, P = 0.004), compared to the non-AF cases. In addition they showed significant higher preoperative mean BNP levels of 629 versus 373 pg/mL (P = 0.019). Postoperative BNP levels were significantly higher in both groups (AF-group: 1032 pg/mL versus non-AF group: 705 pg/mL; ), while there was a trend of more increased postoperative levels in AF-cases (P = 0.065). AF-episodes appeared significantly more frequent in the two highest quartiles of BNP levels with 44% (P = 0.035). On the contrary pre- and postoperative CRP levels were not associated with AF. Multivariable analysis revealed only increased preoperative BNP levels as independent predictor for postoperative AF (P = 0.036). Conclusion. Elevated preoperative BNP serum levels are associated with the development of post-CABG AF, while CRP does not seem to be influential. Nektarios D. Pilatis, Zacharias-Alexandros Anyfantakis, Kyriakos Spiliopoulos, Dimitrios Degiannis, Antigoni Chaidaroglou, Georgia Vergou, Konstantina Kimpouri, and Dennis V. Cokkinos Copyright © 2013 Nektarios D. Pilatis et al. All rights reserved. Hybrid Surgical and Catheter Treatment for Atrial Fibrillation Mon, 16 Dec 2013 10:02:21 +0000 Advances in surgery for atrial fibrillation from cut and sew technique to thoracoscopy and new energy source have enabled minimally invasive approach which avoids median sternotomy and cardiopulmonary bypass. However, minimally invasive approach is unable to match the outcome of classic surgical technique due to difficulty in creating some of linear ablation lines. Hybrid procedure using catheter mapping and ablation in addition to minimally invasive surgical ablation has gained interest to combine the advantages of both procedures. No large study has been conducted to date comparing this new technique to other existing treatments. The aim of this paper is to review the data on hybrid procedure for atrial fibrillation and assess its early outcome and efficacy. Tsuyoshi Kaneko and Sary F. Aranki Copyright © 2013 Tsuyoshi Kaneko and Sary F. Aranki. All rights reserved. Retracted: Intracoronary Adenosine versus Intravenous Adenosine during Primary PCI for ST-Elevation Myocardial Infarction: Which One Offers Better Outcomes in terms of Microvascular Obstruction? Sat, 14 Dec 2013 11:55:46 +0000 ISRN Cardiology Copyright © 2013 ISRN Cardiology. All rights reserved. Relationship of Plasma Adiponectin Levels with Acute Coronary Syndromes and Coronary Lesion Severity in North Indian Population Tue, 10 Dec 2013 18:07:45 +0000 Adiponectin is an adipocyte specific cytokine which, in contrast to other adipokines, has been described to have antiinflammatory, antithrombotic, and anti-atherogenic properties. This study evaluates the association between plasma adiponectin levels with acute coronary syndrome (ACS) and angiographic coronary lesion severity in Indian population. Ninety patients included in the study were divided in two groups in 1 : 1 ratio—patients admitted with a diagnosis of ACS and those without ACS. Adiponectin and other risk markers are measured in forty-five consecutive patients in each group undergoing coronary angiography. Patients without ACS were found to have higher adiponectin ( μg/mL) levels than patients with ACS ( μg/mL) (). In multiple regression analysis adjusted for all other risk markers, higher adiponectin levels remain positively associated with a lower risk of ACS ( value > 0.002). The greatest increase in risk for ACS was seen at adiponectin levels ≤12.20 μg/mL in study subjects. The adiponectin levels were inversely related to the angiographic severity of coronary artery stenosis increases ( value > 0.02). The study concluded that higher adiponectin levels are independently associated with lower risk of ACS, and patients with severe angiographic coronary artery disease have lower levels of adiponectin. Amit Mittal, Mohit D. Gupta, Girish Meennahalli Palleda, Aniruddha Vyas, and Sanjay Tyagi Copyright © 2013 Amit Mittal et al. All rights reserved. Risk Factors for Asymptomatic Ventricular Dysfunction in Rheumatoid Arthritis Patients Tue, 03 Dec 2013 14:16:34 +0000 Objective. The aim of the study was to describe echocardiographic abnormalities in patients with rheumatoid arthritis, concurrent systemic comorbidities, rheumatologic clinical activity, serologic markers of rheumatoid arthritis, and inflammatory activity. Methods. In an observational, cross-sectional study, rheumatoid arthritis outpatients were included (). Conventional transthoracic echocardiographic variables were compared between patients with arthritis and non-RA controls (). For rheumatoid arthritis patients, articular activity and rheumatologic and inflammatory markers were obtained. Results. Ventricular dysfunction was found in 54.3% of the population: systolic (18.1%), diastolic (32.4%), and/or right (24.8%), with lower ejection fraction (). Pulmonary hypertension was found in 46.9%. Other echocardiographic findings included increased left atrial diameter (), aortic diameter (), ventricular septum (), left ventricular posterior wall (), and right ventricular () and atrial diameters compared to control subjects. Rheumatoid factor and anti-CCP antibodies levels were significantly elevated in cases with ventricular dysfunction. Angina and myocardial infarction, diabetes, and dyslipidemia were the main risk factors for ventricular dysfunction. Conclusions. Ventricular dysfunction is common in rheumatoid arthritis and associated with longer disease duration and increased serologic markers of rheumatoid arthritis. Screening for cardiac abnormalities should be considered in this kind of patients. Carlos Garza-García, Sánchez-Santillán Rocío, Arturo Orea-Tejeda, Lilia Castillo-Martínez, Canseco Eduardo, José Luis López-Campos, and Candace Keirns-Davis Copyright © 2013 Carlos Garza-García et al. All rights reserved. Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin-Receptor Blockers (ARBs) in Patients at High Risk of Cardiovascular Events: A Meta-Analysis of 10 Randomised Placebo-Controlled Trials Wed, 06 Nov 2013 11:59:33 +0000 Context. Whether angiotensin converting-enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) are useful in high risk patients without heart failure is unclear. We perform a meta-analysis of prospective randomized placebo-controlled ACEI or ARB trials studying patients with a combination of risk factors to assess treatment impact on all cause mortality, cardiovascular mortality, nonfatal myocardial infarction (MI) and stroke. Method. A PubMed search was made for placebo-controlled trials recruiting at least 1,200 high risk patients randomized to either ACEI or ARB, with follow-up of at least 2 years. Meta-analysis was performed using the RevMan 5 program and Mantel-Haenszel analysis was done with a fixed effects model. Results. Ten trials recruiting 77,633 patients were reviewed. All cause mortality was significantly reduced by ACEI (RR 0.89; ), but not by ARB treatment (RR 1.00; ). Cardiovascular mortality and nonfatal MI were also reduced in the ACEI trials but not with ARB therapy. Stroke was significantly reduced in the ACEI trials (RR 0.75; ) and more modestly reduced in the ARB trials (RR 0.90; ). Conclusion. ACEI treatment reduced stroke, nonfatal MI, cardiovascular and total mortality in high risk patients, while ARB modestly reduced stroke with no effect on nonfatal MI, cardiovascular and total mortality. Hean Teik Ong, Loke Meng Ong, and Jacqueline Judith Ho Copyright © 2013 Hean Teik Ong et al. All rights reserved. Development of a Closed Chest Model of Chronic Myocardial Infarction in Swine: Magnetic Resonance Imaging and Pathological Evaluation Sun, 27 Oct 2013 13:19:10 +0000 Our aim was to develop an easy-to-induce, reproducible, and low mortality clinically relevant closed-chest model of chronic myocardial infarction in swine using intracoronary ethanol and characterize its evolution using MRI and pathology. We injected 3-4 mL of 100% ethanol into the mid-LAD of anesthetized swine. Heart function and infarct size were assessed serially using MRI. Pigs were euthanized on days 7, 30, and 90 ( at each timepoint). Postoperative MRI revealed compromised contractility and decreased ejection fraction, from 53.8% ± 6.32% to 43.79% ± 7.72% (). These values remained lower than baseline thorough the followup (46.54% ± 11.12%, 44.48% ± 7.77%, and 40.48% ± 6.40%, resp., ). Progressive remodeling was seen in all animals. Infarcted myocardium decreased on the first 30 days (from 18.09% ± 7.26% to 9.9% ± 5.68%) and then stabilized (10.2% ± 4.21%). Pathology revealed increasing collagen content and fibrous organization over time, with a rim of preserved endocardial cells. In conclusion, intracoronary ethanol administration in swine consistently results in infarction. The sustained compromise in heart function and myocardial thinning over time indicate that the model may be useful for the preclinical evaluation of and training in therapeutic approaches to heart failure. Verónica Crisóstomo, Juan Maestre, Manuel Maynar, Fei Sun, Claudia Báez-Díaz, Jesús Usón, and Francisco M. Sánchez-Margallo Copyright © 2013 Verónica Crisóstomo et al. All rights reserved. Human Immunodeficiency Virus and Pulmonary Arterial Hypertension Wed, 21 Aug 2013 13:45:37 +0000 Human immunodeficiency virus- (HIV-) related pulmonary arterial hypertension (PAH) is a rare complication of HIV infection. The pathophysiology of HIV-related PAH is complex, with viral proteins seeming to play the major role. However, other factors, such as coinfection with other microorganisms and HIV-related systemic inflammation, might also contribute. The clinical presentation of HIV-related PAH and diagnosis is similar to other forms of pulmonary hypertension. Both PAH-specific therapies and HAART are important in HIV-related PAH management. Future studies investigating the pathogenesis are needed to discover new therapeutic targets and treatments. Aibek E. Mirrakhimov, Alaa M. Ali, Aram Barbaryan, and Suartcha Prueksaritanond Copyright © 2013 Aibek E. Mirrakhimov et al. All rights reserved. Adequacy of Cancer Screening in Adult Women with Congenital Heart Disease Thu, 01 Aug 2013 11:14:57 +0000 Adults with congenital heart disease (ACHD) face noncardiac healthcare challenges as the population ages. We assessed whether women with ACHD have comparable cancer screening rates to non-ACHD women in a cardiac practice and to the general population. We performed a retrospective review of 175 adult women seen in a cardiac care center in 2009–2011. Data on Pap tests, mammography, and colonoscopies, were collected through electronic medical records and primary care provider records. Adequate documentation was available for 100 individuals with ACHD and 40 comparator cardiac patients. The adequacy of screening was determined using guidelines set forth by the American Cancer Society in 2010. Compared with the national average, ACHD patients had significantly lower rates of Pap tests (60% versus 83%, ) and mammography (48% versus 72%, ). Compared with non-ACHD women in the same practice, ACHD patients had consistently lower rates of mammography (48% versus 81%, ) and colonoscopies (54% versus 82%, ). As the population of ACHD individuals ages, attention to cancer screening becomes increasingly important but may be overlooked in this population. Primary care physicians and cardiologists should collaborate to ensure appropriate cancer screening for this growing population. Mitalee P. Christman, Margarita Castro-Zarraga, Doreen DeFaria Yeh, Richard R. Liberthson, and Ami B. Bhatt Copyright © 2013 Mitalee P. Christman et al. All rights reserved. Alcohol-Attributable Fraction of Ischemic Heart Disease Mortality in Russia Mon, 15 Jul 2013 12:22:20 +0000 Objective. The aim of the present study was to estimate the premature ischemic heart disease (IHD) mortality attributable to alcohol abuse in Russia on the basis of aggregate-level data of mortality and alcohol consumption. Method. Age-standardized sex-specific male and female IHD mortality data for the period 1980–2005 and data on overall alcohol consumption were analyzed by means of autoregressive integrated moving average (ARIMA) time series analysis. Results. The results of the analysis suggest that 41.1% of all male deaths and 30.7% of female deaths from IHD in Russia could be attributed to alcohol. The estimated alcohol-attributable fraction for men ranged from 24.0% (75+ age group) to 62.0% (15–29 age group) and for women from 20.0% (75+ age group) to 64.0% (30–44 age group). Conclusions. The outcomes of this study provide indirect support for the hypothesis that the high rate of IHD mortality in Russia may be related to alcohol, as indicated by a close aggregate-level association between number of deaths from IHD and overall alcohol consumption per capita. Y. E. Razvodovsky Copyright © 2013 Y. E. Razvodovsky. All rights reserved. Assessment of Risk Factor for Cardiovascular Disease Using Heart Rate Variability in Postmenopausal Women: A Comparative Study between Urban and Rural Indian Women Thu, 11 Jul 2013 08:16:34 +0000 Cardiovascular diseases are important causes of morbidity and mortality in postmenopausal women. A major determinant of cardiovascular health is the status of autonomic nervous system and assessment of Heart Rate Variability (HRV). Heart Rate Variability is a noninvasive and sensitive technique to evaluate cardiovascular autonomic control. Reduced HRV is an independent risk factor for the development of heart disease. This study evaluated the risk factors for cardiovascular diseases using HRV, between urban and rural Indian postmenopausal women ranging in age from 40 to 75 years. Findings of the analysis of HRV have showed that the total power which reflects overall modulation of cardiac autonomic activity (  versus ), the absolute power of high frequency which is surrogate of cardiovagal activity (  versus ), and low frequency that reflects cardiac sympathetic activity (  versus ) were significantly higher in urban women than that of their rural counterparts. Further, among the anthropometric measures, waist circumference was significantly correlated with indices of HRV. The study concludes that rural Indian women are associated with an additional risk beyond that of ageing and postmenopausal status when compared to the urban women. The higher central obesity could be the contributing factor for developing higher risk for cardiovascular disease among the rural women. Nikhil Narayanaswamy, Shailaja Moodithaya, Harsha Halahalli, and Amrit M. Mirajkar Copyright © 2013 Nikhil Narayanaswamy et al. All rights reserved. Association of Oral Health and Cardiovascular Disease Risk Factors “Results from a Community Based Study on 5900 Adult Subjects” Wed, 26 Jun 2013 15:18:03 +0000 Objectives. This study aimed to determine the association between some oral health status as a risk factor for cardiac diseases and other cardiovascular disease (CVD) risk factors in a sample of Iranian population in 2011. Methods. The study recruited 5900 inhabitants who aged 15–75 years old of Kerman city through a population based cluster sampling. Having collected informed consent, participants were interviewed for CVD risk factors. Some oral health indicators such as DMFT, Gingival Inflammation index, and Community Periodontal Index were assessed. The association between oral health indices and CVD risk factors was tested using multivariate regression models. Results. The mean age of participants was 33.5 years, and 45.1% were male. Moderate gingival inflammation was observed in 67.6% of participants. Presence of sub- or supragingival calculus was more common (90%) in participants. Older age (RR from 2.7 to 3.88), cigarette smoking (RR = 1.49), and high blood glucose (RR = 1.41) showed an increased risk for oral diseases after adjustment for different covariates including established CVD risk factors. Conclusion. The study results showed an increase in periodontal diseases in the presence of some CVD risk factors. Therefore there may be a bilateral but independent association for both conditions and common risk factor approach preventive program is highly recommended. Hamid Najafipour, Tayebeh Malek Mohammadi, Foad Rahim, Ali Akbar Haghdoost, Mitra Shadkam, and Mahdi Afshari Copyright © 2013 Hamid Najafipour et al. All rights reserved. Left-to-Right Shunt with Congenital Heart Disease: Single Center Experience Sun, 23 Jun 2013 14:00:33 +0000 Objective. The objective of this study was to determine the frequency of pulmonary arterial hypertension (PAH) in congenital heart disease (CHD) with an isolated, large left-to-right shunt and to indicate the factors in the development of PAH. Methods. The pressure measurements in the cardiac chambers and the calculations based on the Fick’s principle were compared among 3 separate groups of patients, respectively, with PAH, with hyperkinetic pulmonary hypertension (HPH), and with neither PAH nor HPH. Results. PAH was diagnosed in 30 (12.3%) patients, HPH in 35 (14.4%), while 177 (73.1%) were free of either. The highest risk for the development of PAH was found in the presence of perimembranous ventricular septal defect. A statistically significant difference was seen among these groups as to their left atrial pressure () and the mean pulmonary arterial pressure (PAPmean; ). While a correlation was present between RpI on one hand and age on the other (), a multiple linear regression could not evidence any correlation among age (), gender (). Conclusion. Our findings do not allow establishing a correlation between the duration of the high pulmonary flow and pulmonary vascular resistance increase or PAH development in isolated left-to-right shunts with congenital heart diseases. Ayhan Cevik, Rana Olgunturk, Serdar Kula, Berna Saylan, Ayhan Pektas, Deniz Oguz, and Sedef Tunaoglu Copyright © 2013 Ayhan Cevik et al. All rights reserved. Risk Factors for Coronary Drug-Eluting Stent Thrombosis: Influence of Procedural, Patient, Lesion, and Stent Related Factors and Dual Antiplatelet Therapy Sun, 23 Jun 2013 08:29:38 +0000 The complication of stent thrombosis (ST) emerged at a rate of 0.5% annually for first-generation drug-eluting stents (DES), often presenting as death or myocardial infarction. Procedural factors such as stent underexpansion and malapposition are risk factors for ST in patients. The type of lesion being treated and lesion morphology also influence healing after treatment with DES and can contribute to ST. Second-generation DES such as the XIENCE V everolimus-eluting stent differ from the first-generation stents with respect to antiproliferative agents, coating technologies, and stent frame. Improvements in stent structure have resulted in a more complete endothelialization, thereby decreasing the incidence of ST. Bioresorbable scaffolds show promise for restoring vasomotor function and minimizing rates of very late ST. Post-PCI treatment with aspirin and clopidogrel for a year is currently the standard of care for DES, but high-risk patients may benefit from more potent antiplatelet agents. The optimal duration of DAPT for DES is currently unclear and will be addressed in large-scale randomized clinical trials. Krishnankutty Sudhir, James B. Hermiller, Joanne M. Ferguson, and Charles A. Simonton Copyright © 2013 Krishnankutty Sudhir et al. All rights reserved. A Review of Most Relevant Complications of Transcatheter Aortic Valve Implantation Sun, 12 May 2013 10:04:16 +0000 Transcatheter aortic valve implantation (TAVI) has emerged for treating aortic stenosis in patients who are poor candidates for surgical aortic valve replacement. Currently, the balloon-expandable Edwards Sapien valve—which is usually implanted via a transfemoral or transapical approach—and the self-expanding CoreValve ReValving system—which is designed for retrograde application—are the most widely implanted valves worldwide. Although a promising approach for high-risk patients, the indication may be expanded to intermediate- and eventually low-risk patients in the future; however, doing so will require a better understanding of potential complications, risk factors for these complications, and strategies to individualize each patient to a different access route and a specific valve. This paper reviews the most relevant complications that may occur in patients who undergo catheter-based aortic valve implantation. Siyamek Neragi-Miandoab and Robert E. Michler Copyright © 2013 Siyamek Neragi-Miandoab and Robert E. Michler. All rights reserved. The Transaxial Orientation Is Superior to Both the Short Axis and Horizontal Long Axis Orientations for Determining Right Ventricular Volume and Ejection Fraction Using Simpson's Method with Cardiac Magnetic Resonance Sun, 14 Apr 2013 18:55:05 +0000 We sought to determine which of the three orientations is the most reliable and accurate for quantifying right ventricular (RV) volume and ejection fraction (EF) by cardiac magnetic resonance using Simpson’s method. We studied 20 patients using short axis (SA), transaxial (TA), and horizontal long axis (HLA) orientations. Three readers independently traced RV endocardial contours at end-diastole and end-systole for each orientation. End-diastolic volumes (EDVs), end-systolic volumes (ESVs), and EF were calculated and compared with the 3D piecewise smooth subdivision surface (PSSS) method. The intraclass correlation coefficients among the 3 readers for EDV, ESV, and EF were 0.92, 0.82, and 0.42, respectively, for SA, 0.95, 0.92, and 0.67 for TA, and 0.85, 0.93, and 0.69 for HLA. For mean data there was no significant difference between TA and PSSS for EDV (−2.6%, 95% CI: −8.2 to 3.3%), ESV (−5.9%, −15.2 to 4.5%), and EF (1.7%, −1.5 to 4.9%). HLA was accurate for ESV (−8.9%, −18.5 to 1.8%) and EF (−0.7%, −3.8 to 2.5%) but significantly underestimated EDV (−9.8, −16.6 to −2.4%). SA was accurate for EDV (0.5%, −6.0 to 7.5%) but overestimated ESV (10.5%, 0.1 to 21.9%) and had poor interrater reliability for EF. Conclusions. The TA orientation provides the most reliable and accurate measures of EDV, ESV, and EF. Michael K. Atalay, Kevin J. Chang, David J. Grand, Shawn Haji-Momenian, Jason T. Machan, and Florence H. Sheehan Copyright © 2013 Michael K. Atalay et al. All rights reserved. Elevated Cardiac Troponins in Setting of Systemic Inflammatory Response Syndrome, Sepsis, and Septic Shock Thu, 11 Apr 2013 12:00:09 +0000 Elevation of cardiac troponins and creatinine kinase is frequently observed in setting of systemic inflammatory response syndrome (SIRS), sepsis, or septic shock. Underlying pathophysiologic mechanism for such troponin leak, its clinical significance, and what different could be done in such settings remain elusive. In this paper we have briefly overviewed the proposed pathogenic mechanisms for SIRS, sepsis, or septic shock-related troponin elevation (SRTE) and have provided brief overview on its clinical significance. Upon review of the relevant literature we found that majority of patients with the SRTE with no prior history of coronary artery disease (CAD) upon testing are found not to have any CADs. We have also briefly discussed the possible pharmacologic agents and potential targets which are important from pathophysiologic and pharmacologic point of view that may alter the outcomes of SRTE-related myocardial depression in near future. Nasir Hussain Copyright © 2013 Nasir Hussain. All rights reserved. Dual Antiplatelet Therapy Can Be Discontinued at Three Months after Implantation of Zotarolimus-Eluting Stent in Patients with Coronary Artery Disease Thu, 04 Apr 2013 17:52:48 +0000 Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention increases the risk of bleeding. We studied the safety and clinical outcomes of switching from DAPT to aspirin monotherapy at 3 months after ZES implantation. We retrospectively evaluated 168 consecutive patients with coronary artery disease who had been implanted with a ZES from June 2009 through March 2010. After excluding 40 patients according to exclusion criteria such as myocardial infarction, 128 patients were divided into a 3-month DAPT group (67 patients, 88 lesions) and a 12-month conventional DAPT group (61 patients, 81 lesions). Coronary angiographic followup and clinical followup were conducted at more than 8 months and at 12 months after ZES implantation, respectively. Minor and major bleeding events, stent thrombosis (ST), and major adverse cardiac events (MACE) (death, myocardial infarction, cerebrovascular accident, target lesion revascularization, and target vessel revascularization) were evaluated. There were no statistically significant differences in the incidences of ST and MACE between the two groups. The incidence of bleeding events was significantly lower in the 3-month group than in the 12-month group (1.5% versus 11.5%, ). DAPT can be safely discontinued at 3 months after ZES implantation, which reduces bleeding risk. Tadashi Wada, Makoto Nakahama, Hironobu Toda, Atsuyuki Watanabe, Katsushi Hashimoto, Ritsuko Terasaka, Kazufumi Nakamura, Nobuyuki Yamada, and Hiroshi Ito Copyright © 2013 Tadashi Wada et al. All rights reserved. Hyperoxic Vasoconstriction of Human Pulmonary Arteries: A Novel Insight into Acute Ventricular Septal Defects Sun, 31 Mar 2013 16:15:05 +0000 Objectives. Acute rises in pulmonary artery pressures following postinfarction ventricular septal defects present a challenge. We hypothesised that the abnormally high oxygen content exposure to the pulmonary arteries may be a factor. We investigated the contractile responses of human pulmonary arteries to changes in oxygen tension. Methods. Isometric tension was measured in large and medium sized pulmonary artery rings obtained from lung resections for patients with bronchial carcinoma (). Fresh rings were mounted in organ baths bubbled under basal conditions with hyperoxic or normoxic gas mixes and the gas tensions varied during the experiment. We studied whether voltage-gated calcium channels and nitric oxide signalling had any role in responses to oxygen changes. Results. Hypoxia caused a net mean relaxation of 18.1% 15.5 () from hyperoxia. Subsequent hyperoxia caused a contraction of 19.2% 13.5 (). Arteries maintained in normoxia responded to hyperoxia with a mean constriction of 14.8% 3.9 (). Nifedipine inhibited the vasoconstrictive response () whilst L-NAME had no effect on any hypoxic vasodilatory response. Conclusions. We demonstrate that hyperoxia leads to vasoconstriction in human pulmonary arteries. The mechanism appears to be dependent on voltage-gated calcium channels. Hyperoxic vasoconstriction may contribute to acute rises in pulmonary artery pressures. Priyadharshanan Ariyaratnam, Mahmoud Loubani, Robert Bennett, Steven Griffin, Mubarak A. Chaudhry, Michael E. Cowen, Levant Guvendik, Alexander R. J. Cale, and Alyn H. Morice Copyright © 2013 Priyadharshanan Ariyaratnam et al. All rights reserved.