Showing papers by "Heart and Diabetes Center North Rhine-Westphalia published in 2012"
TL;DR: In this article, a review of the existing literature on the use of adaptive servoventilation (ASV) therapy in heart failure patients in general and with reduced ejection fraction in particular is presented.
Abstract: Sleep-disordered breathing (SDB) with predominant obstructive or central sleep apnea (OSA/CSA) with Cheyne-Stokes respiration (CSR) is a common, but underestimated and underappreciated, comorbidity in patients with heart failure (HF). Regardless of the type of HF (systolic or diastolic) or its etiology (ischemic, non-ischemic, valvular etc), the prevalence of SDB is remarkably high in this patient group, at 70-76%. Even more so in HF than in the general population, OSA and CSA in particular are independently associated with an impaired prognosis. This review details the pathophysiology of CSA-CSR in HF, highlights the challenges and tools available for diagnosis, explains the concept of adaptive servoventilation (ASV) therapy, and summarizes the existing literature on the use of ASV therapy in HF patients in general and HF with reduced ejection fraction in particular.
79 citations
TL;DR: Over a 2-year follow-up period overall survival, cerebrovascular and major adverse event rate were significantly lower in the lessOPCAB group, while the repeat revascularization rate was comparable.
Abstract: Background—This study aimed to assess if clampless off-pump coronary artery bypass grafting (CABG) decreases risk-adjusted mortality, stroke rate, and morbidity in unselected patients in comparison to conventional CABG. Methods and Results—Between July 2009 and November 2010, data of 1282 consecutive patients undergoing isolated CABG were prospectively recorded. In 30.8% (n=395), clampless off-pump revascularization was used, either with the PAS-Port automated central venous anastomosis system (n=310) or as total arterial revascularization without central anastomoses (n=85). Propensity score (PS) matching was performed based on 15 preoperative risk variables to correct for selection bias. In-hospital mortality and stroke rate as primary end point, as well as major complications and follow-up outcome of clampless off-pump (lessOPCAB) and conventional CABG (cCABG) were compared in 394 matched patient pairs (total: 788 patients). The clampless off-pump technique decreased the in-hospital rate of death (odds ...
70 citations
TL;DR: This study aimed to evaluate predictors of AF recurrence including impact of sleep‐disordered breathing (SDB) in patients with atrial fibrillation undergoing pulmonary vein isolation.
Abstract: Predictors of AF Recurrence After Cryoballoon PVI. Introduction: In patients with atrial fibrillation (AF) undergoing pulmonary vein isolation, cryoballoon technique (cryoPVI) has been adopted in many centers. This study aimed to evaluate predictors of AF recurrence including impact of sleep-disordered breathing (SDB).
Methods and Results: In 82 patients consecutively assigned to cryoPVI cardiorespiratory screening for SDB, assessment of medical history, ECG, echocardiography, standard laboratory measurement, and blood gas analysis were performed prior to intervention. After a 3-month blanking period, a 7-day Holter ECG was performed at 3, 6 and then every 6 months to determine AF recurrence. Seventy-five patients (69 paroxysmal AF, 6 persistent AF, 22 female, age 60 ± 9 years) completed at least 6-month follow-up. Median follow-up of 12 months (interquartile range 6–18 months) confirmed maintenance of sinus rhythm in 69.4% of these patients. Stepwise forward regression model revealed moderate to severe SDB (cut-off apnea-hypopnea-index (AHI) ≥ 15 per hour; Hazard Ratio (HR) 2.95, P = 0.04), early recurrence of AF (HR 8.74, P < 0.001), persistent AF (HR 7.16, P < 0.001), preprocedural class III-antiarrhythmic drug treatment (HR 3.63, P = 0.02), but not SDB per se (AHI ≥ 5 per hour) as independent predictors for AF recurrence.
Conclusion: Moderate to severe SDB is a treatable condition that independently predicts AF recurrence in patients undergoing cryoPVI. Screening for SDB and adequate treatment may improve long-term success of cryoPVI. (J Cardiovasc Electrophysiol, Vol. 23, pp. 18-25, January 2012)
67 citations
TL;DR: The data show that mild metabolic acidosis reduces cardiac contractility and significantly impairs the β-adrenergic force response in human failing myocardium, which could contribute to the still-controversial discussion about the therapy regimen of acidosis in patients with critical heart failure.
Abstract: Pronounced extracellular acidosis reduces both cardiac contractility and the β-adrenergic response. In the past, this was shown in some studies using animal models. However, few data exist regarding how the human end-stage failing myocardium, in which compensatory mechanisms are exhausted, reacts to acute mild metabolic acidosis. The aim of this study was to investigate the effect of mild metabolic acidosis on contractility and the β-adrenergic response of isolated trabeculae from human end-stage failing hearts. Intact isometrically twitching trabeculae isolated from patients with end-stage heart failure were exposed to mild metabolic acidosis (pH 7.20). Trabeculae were stimulated at increasing frequencies and finally exposed to increasing concentrations of isoproterenol (0 to 1 × 10-6 M). A mild metabolic acidosis caused a depression in twitch-force amplitude of 26% (12.1 ± 1.9 to 9.0 ± 1.5 mN/mm2; n = 12; P < 0.01) as compared with pH 7.40. Force-frequency relation measurements yielded no further significant differences of twitch force. At the maximal isoproterenol concentration, the force amplitude was comparable in each of the two groups (pH 7.40 versus pH 7.20). However, the half-maximal effective concentration (EC50) was significantly increased in the acidosis group, with an EC50 of 5.834 × 10-8 M (confidence interval (CI), 3.48 × 10-8 to 9.779 × 10-8; n = 9), compared with the control group, which had an EC50 of 1.056 × 10-8 M (CI, 2.626 × 10-9 to 4.243 × 10-8; n = 10; P < 0.05), indicating an impaired β-adrenergic force response. Our data show that mild metabolic acidosis reduces cardiac contractility and significantly impairs the β-adrenergic force response in human failing myocardium. Thus, our results could contribute to the still-controversial discussion about the therapy regimen of acidosis in patients with critical heart failure.
53 citations
TL;DR: The concept of vitamin D safety consists of two models, the safe tolerable upper intake level (UL) method, and the idea of adequate circulating 25-hydroxyvitamin D (25[OH]D) levels, which are highlighted in this review article.
Abstract: Vitamin D deficiency is a re-emerging global health problem, which is primarily due to inadequate vitamin D synthesis in the skin. Supplement use is an effective measure to improve vitamin D status. However, some safety issues have to be considered, which are highlighted in this review article: The concept of vitamin D safety consists of two models, the safe tolerable upper intake level (UL) method, and the idea of adequate circulating 25-hydroxyvitamin D (25[OH]D) levels. Oral vitamin D intakes up to 250 μg/d have not been associated with harm. Hypercalcemia, the hallmark of vitamin D intoxication, may only occur if circulating 25(OH)D levels are consistently above 375-500 nmol/l. However, some observational studies indicate that already circulating 25(OH)D levels > 125 nmol/l are related to an increased morbidity and mortality risk. Therefore, the Institute of Medicine has set the UL for adults at 100 μg/d, and the adequate circulating 25(OH)D level at 50 to 125 nmol/l. In clinical practice, oral vitamin D dosing has to consider that the increment in circulating 25(OH)D depends on baseline 25(OH)D levels and the person's body weight. It is reasonable to assess 25(OH)D before and 3-6 months after initiation of oral vitamin D administration and to adjust the dose, if necessary. In future, two issues have to be clarified: First, would it be more appropriate to define instead of a fixed UL a variable UL, based on the individual's body weight? Second, what are the underlying mechanisms, if any, for potentially harmful vitamin D effects at circulating 25(OH)D levels between 125 and 375 nmol/l.
52 citations
49 citations
TL;DR: Circulating 1,25-dihydroxyvitamin D levels fluctuate in relation to cardiac surgery and are associated with inflammatory processes and age-related differences in clinical outcome.
Abstract: OBJECTIVE To investigate the interrelationship between cardiac surgery, age, circulating concentrations of the vitamin D hormone 1,25-dihydroxyvitamin D, and clinical outcome. DESIGN Prospective, monocentric, two-arm parallel study. SETTING Tertiary Heart and Diabetes Center in the Federal State of North Rhine-Westphalia, Germany. PATIENTS Twenty-nine cardiac surgical patients aged ≤ 65 yrs and 30 patients ≥ 75 yrs. MEASUREMENTS We assessed 1,25-dihydroxyvitamin D and other biochemical parameters of mineral metabolism (calcium, phosphate, 25-hydroxyvitamin D, and parathyroid hormone), various inflammatory markers (C-reactive protein, interleukin-6 and 8), and different immunological parameters (CD4 and CD8 cells, monocyte HLA-DR expression). We collected blood samples preoperatively, immediately after surgery, and on postoperative days 1, 5, and 30. In addition, we assessed adverse outcome until discharge as a composite of myocardial infarction, low cardiac output syndrome, infection, stroke, or in-hospital death. RESULTS There were significant transient cardiac surgery-related fluctuations in 1,25-dihydroxyvitamin D and the aforementioned parameters of mineral metabolism, inflammation, and immune status. Compared to younger patients, older patients had consistently lower 1,25-dihydroxyvitamin D and phosphate levels (p = .013 and p = .036, respectively) and significantly higher interleukin 6 and 8 levels (p = .008 and p < .001, respectively). Circulating 1,25-dihydroxyvitamin D was directly related to glomerular filtration rate (R(2) = .227; p < .001) and inversely related to interleukin 6 (R(2) = .105; p = .012). The rate of adverse outcome tended to be higher in older than in younger patients (20.0% vs. 3.5%; p = .081). In risk score-adjusted logistic regression analysis, adverse outcome risk decreased by 7.7% (SE: 3.7%) for each pmol/L increment in 1,25-dihydroxyvitamin D (p = .037). CONCLUSIONS Circulating 1,25-dihydroxyvitamin D levels fluctuate in relation to cardiac surgery. Low 1,25-dihydroxyvitamin D levels are associated with inflammatory processes and age-related differences in clinical outcome. Future studies should determine whether therapies aimed at treating low 1,25-dihydroxyvitamin D levels can improve the outcome in older cardiac surgery patients.
33 citations
TL;DR: Not only endurance training, but also sports activity with a relevant static component, like team handball, might predispose for AF above the age of 50.
Abstract: OBJECTIVE Cardiac adaptation to sports activity in endurance athletes is considerably different from that in power athletes. The effects of a high-level team sport like handball, one of the most popular sports in the world, performed at a younger age, on cardiac rhythm in individuals above the age of 50 have not been investigated to date. METHODS Thirty-three former top-level handball players from the first German league (6 former world champions and numerous Olympians) (57.5 +/- 5.5 y) joined our screening programme for former athletes and underwent electrocardiography, echocardiography and spiroergometry. Data were compared to 24 sedentary healthy controls. RESULTS Ten of the 33 athletes suffered from atrial fibrillation (AF). Left ventricular diameter was 53.68 +/- 4.88 mm in the athletes group and 50.58 +/- 4.12 mm in the healthy controls. Analysing the subgroups of handball players ('AF group' and 'non-AF group'), spiroergometry showed oxygen consumption at the anaerobic threshold of 27.54 +/- 6.77 ml/kg/min in the AF group and 31.24 +/- 10.33 ml/kg/min in the non-AF group (P = 0.228). Absolute left atrial diameter was 44.34 +/- 4.41 mm in the AF group (non-AF group 38.94 +/- 3.77 mm, P < 0.001) (healthy controls 37.54 +/- 4.34 mm, compared with all athletes P = 0.015). In all individuals left ventricular wall thickness was within normal limits. However, myocardial walls were thicker in the AF group (11.28 +/- 1.83 mm) than in the non-AF group (9.44 +/- 1.26 mm, P = 0.002). Athletes in the AF group (187.6 +/- 6.42 cm) were significantly taller than in the non-AF group (180.91 +/- 7.31 cm, P = 0.018). CONCLUSION Not only endurance training, but also sports activity with a relevant static component, like team handball, might predispose for AF above the age of 50. LA size, height and myocardial wall thickness seem to affect the risk of developing AF. More data in non-endurance sports are mandatory to confirm this hypothesis.
22 citations
TL;DR: Percutaneous closure of left atrial appendage after transcatheter aortic valve implantation an interventional approach to avoid anticoagulation therapy in elderly patients: TAVI and closure of LAA to avoid warfarin therapy
Abstract: D O I: 10.4 2 4 4 /E IV7 11 A 13 *Corresponding author: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum , Georgstr. 11, 32545 Bad Oeynhausen, Germany. E-mail: akleemeyer@hdz-nrw.de Percutaneous closure of left atrial appendage after transcatheter aortic valve implantation an interventional approach to avoid anticoagulation therapy in elderly patients: TAVI and closure of LAA to avoid warfarin therapy
20 citations
TL;DR: A chosen group of nine patients with selective elevated Lp(a) illustrated both the influence on endothelial dysfunction, in the shape of sharply increased minimum coronary resistance, and the reduction through lipid apheresis, indicating that Lp seems to exert a similar effect on the vascular wall and vascular function as LDL cholesterol.
Abstract: In the treatment of homozygous and therapy-resistant hypercholesterolemia, lipid apheresis enables not only low density lipoprotein (LDL) cholesterol to be lowered by approximately 60%, but also oxidative stress factors to be influenced and adhesion molecules reduced. This was investigated in a group of 12 patients using the heparin-induced extracorporeal LDL precipitation (H.E.L.P.) procedure.
19 citations
TL;DR: HELP can reduce the burden of atherosclerosis, with no myocardial infarction and a low coronary intervention rate in the authors' patients, and is a safe, comfortable, and highly effective treatment in which adverse events are rare.
Abstract: Introduction
Low density lipoprotein (LDL-C) apheresis is a last treatment option for hypercholesterolemic patientsresistant to conservative lipid-lowering therapy. In a retrospective analysis of 8,533 heparin-induced extra-corporeal LDL precipitation apheresis treatments (HELP), we evaluated the efficacy of LDL reduction, the rate of adverse events, and the progression of atherosclerosis.
TL;DR: In this prospective, international, multicenter PRECISE registry, the use of the Premere™ PFO closure device for closure of PFO after stroke or TIA resulted in good clinical results with no recurrent event.
Abstract: Background
The Premere™ PFO closure device has a special design for closure of patent foramen ovale (PFO) including a flexible distance and angulation between the right and left disc providing minimal septal distortion. The primary objective of the study was to determine the degree of risk for stroke or transient ischemic attack (TIA) in patients after Premere™ PFO closure device implantation.
TL;DR: Use of the 7F EXOSEAL™ VCD was associated with short TTH and TTA, as well as low rates of procedural and 30-day access-related complications, which are associated with significantly shorter time-to-hemostasis and time- to-ambulation.
Abstract: Objective: This feasibility study examined safety and effectiveness of the new EXOSEAL™ Vascular Closure Device (VCD) designed to promote hemostasis and early ambulation after percutaneous procedures.
Background: Most VCDs currently approved by the United States FDA have been associated with significantly shorter time-to-hemostasis (TTH) and time-to-ambulation (TTA) compared to standard manual or mechanical compression, but their ease of use, patient comfort during deployment, and safety profiles are variable.
Methods: Patients underwent diagnostic or interventional procedures using 7F introducer sheaths. Primary safety endpoint was the 30-day combined rate of access-related complications and primary effectiveness endpoints were TTH and TTA.
Results: Sixty patients were enrolled prospectively (mean age 63.3 ± 11.3 year, 17% diabetics). Device and procedural success was achieved in 92% and 93%, respectively. Mean TTH and TTA was 3.2 ± 3.0 minutes and 3.0 ± 6.2 hours, respectively. No deaths or serious access-related adverse events occurred. A ≥6 cm access-site hematoma was the only adverse event, observed in 3 patients.
Conclusions: Use of the 7F EXOSEAL™ VCD was associated with short TTH and TTA, as well as low rates of procedural and 30-day access-related complications. (J Interven Cardiol 2012;25:518–525)
TL;DR: Overall, it can be expected that the next 10-15 years will provide an increased clarity concerning the role of vitamin D in CVD, provided that adequate statistical methods such as propensity score modelled analysis are applied.
Abstract: Aims Evidence is accumulating that vitamin D status may influence the risk of cardiovascular disease (CVD). Final confirmation for a causal relationship between vitamin D and CVD is however still lacking. The present viewpoint article outlines several future research directions to close this gap. Data synthesis Future directions include the need of performing large randomised controlled supplementation trials with vitamin D in specific risk groups. In addition, large register sets of data on vitamin D supplementation can be used, provided that adequate statistical methods such as propensity score modelled analysis are applied. To better understand vitamin D-mediated effects on CVD risk, the routine measurement of circulating levels of the hormonal vitamin D form, 1,25-dihydroxyvitamin D, is also necessary, in addition to the determination of its precursor 25-hydroxyvitamin D. Further, genetic association studies may help in clarifying the contribution of vitamin D to the development of CVD. Finally, the interrelationship of vitamin D with physical activity should be considered when studying CVD risk. Conclusions Overall, it can be expected that the next 10–15 years will provide an increased clarity concerning the role of vitamin D in CVD.
TL;DR: Remote magnetic navigation for PVAI seems to be safe and feasible using an irrigated gold-tip catheter and there was a trend to a better outcome in patients without previous attempts of AF ablation.
Abstract: Magnetically guided irrigated ablation has been introduced for atrial fibrillation (AF) ablation. However, data on ablation of persistent AF is scarce, and first-generation platinum–iridium catheters were burdened by char formation at the catheter tip. Furthermore, energy transmission of these catheters may be suboptimal. Irrigated gold-tip catheters have been introduced to overcome these problems. Antral pulmonary vein (PV) isolation (PVAI) was performed using a 5-mm irrigated gold-tip magnetic catheter (power setting, 48 °C maximum, 50 W, 15 s lesion duration; flow-rate, 30 mL/min). The catheter tip was guided by a uniform magnetic field and a motor drive. Left atrial maps were created using an impedance-based left atrial reconstruction and fused with a preprocedural CT or an intraprocedural rotational angiography-based scan. Fifty-seven patients (42 male, 61.9 ± 8.8 years) underwent PVAI for symptomatic, drug-refractory persistent AF. PVAI was performed successfully in all patients confirmed by entrance block. Procedure time (skin-to-skin) was 214 ± 47 min (104–354 min). Fluoroscopy time was 31 ± 21 min. Ablation time was 4,153 ± 1,350 s. No char or thrombus formation was found at the catheter tip. One pericardial tamponade was observed. Freedom from atrial tachyarrhythmias could be achieved in 57.9 % of the patients included in a follow-up of 11.6 ± 4.2 month. There was a trend to a better outcome in patients without previous attempts of AF ablation (n = 48; 60.4 % vs. 44.4 %, p = 0.47). Remote magnetic navigation for PVAI seems to be safe and feasible using an irrigated gold-tip catheter. Effectiveness of this novel technique can be confirmed by mid-term outcome.
TL;DR: Mechanical resynchronization as defined by TDI translates into a significant survival benefit in CRT recipients.
Abstract: We sought to determine whether correction of mechanical left ventricular (LV) dyssynchrony as defined by tissue Doppler imaging (TDI) is predictive for transplant-free long-term survival in patients (pts.) undergoing cardiac resynchronization therapy (CRT). In 76 CRT recipients TDI curves from the septal, lateral, anterior, and inferior basal LV were obtained at baseline and after 6 ± 4 months. A time difference between regional electromechanical delays (EMD) of ≥40 ms was considered dyssynchronous. At follow-up, pts. were classified as TDI-responders (TDI-R: dyssynchrony at baseline, corrected by CRT) versus non-responders (TDI-NR: either not dyssynchronous at baseline, or persisting dyssynchrony). Pts. were then followed by standard echocardiography over 21 ± 6 months and were re-classified as LV remodelers (LV-R: LV volume reduction of >10%) versus non-remodelers (LV-NR). The end-point during clinical long-term follow-up of 65 ± 38 months was all-cause mortality or heart transplantation. 44 out of the 76 pts. (58%) were classified as TDI-R, 32 (42%) as TDI-NR. Significant reverse LV remodeling was observed in 41 (54%) pts., while 35 (46%) did not improve LV size and function. TDI-R was associated with LV-R in 35 pts. (85%; P < 0.001). During long-term follow-up, 38 pts. (50%) reached the end point, 11 (30%) in the TDI-R group, and 27 (70%) in the TDI-NR group (P < 0.0003). Mechanical resynchronization as defined by TDI translates into a significant survival benefit in CRT recipients.
Journal Article•
TL;DR: The etiology, treatment options and outcome of in stent restenosis is reviewed and an overview about the new developments in the field of stent technology is given.
Abstract: The implementation of bare metal stents and later drug eluting stents (DES) proved to be an important step forward in reducing rates of restenosis after percutaneous coronary intervention. Despite all the benefits of DES, concerns have been raised over their long term safety as especially stent thrombosis sets patients at risk. In view of the overall low frequency of stent thrombosis, large sample sizes are needed to evaluate accurately treatment differences between stents. However, a consistent finding from randomized, controlled trials of DES versus bare metal stents is the significantly reduced reintervention rate associated with DES use. The clinical presentation of restenosis is recurrent angina or acute coronary syndrome. Optimal implantation of the stent in the vessel and adequate antiplatelet therapy are of utmost significance to provide best results. Intravascular imaging often helps to provide optimal delivery of the stent. Newer stents have now been developed. Especially DES with biogradable polymers, novel coatings of the stent, and polymer free DES have to be mentioned and early results seem to be promising. The perspective of bioresorbable DES platforms includes the additional benefits of improved recovery in vessel function and the potential for reducing the requirement for prolonged dual antiplatelet therapy. This article reviews the etiology, treatment options and outcome of in stent restenosis and gives an overview about the new developments in the field of stent technology.
TL;DR: There is a relatively close association between CysC-eGFR and circulating 1,25(OH)2D in cardiac surgical patients and the SCr-based formula is probably too imprecise for estimating GFR in the early postoperative period correctly.
Abstract: Background Renal impairment is a risk factor for poor clinical outcome in cardiac surgical patients and low circulating levels of the vitamin D hormone 1,25-dihydroxyvitamin D (1,25[OH]2D) may contribute to this risk Methods We investigated the association between glomerular filtration rate (GFR) and 1,25(OH)2D in 151 heart transplant recipients and 59 other cardiac surgical patients in postoperative week 1 and at postoperative month 1 GFR estimates (eGFR) were calculated from cystatin C (CysC) and serum creatinine (SCr)-based formulas Results With both formulas, linear models provided a better fit between eGFR and circulating 1,25(OH)2D than nonlinear models Nonetheless, the association between 1,25(OH)2D and eGFR in the early postoperative period was stronger with the CysC-based formula (r = 0560; P <0001) than with the SCr-based equation (r = 0386; P <0001) CysC-eGFR and SCr-eGFR displayed considerably lack of agreement in the early postoperative period, especially in heart transpla
TL;DR: In professional handball players early repolarisation abnormalities were less frequent and LVmass was increased when compared with soccer players and the need for normal values for different types of sports is crucial to guarantee a proper evaluation of athletes.
Abstract: The key challenge in athlete's screening is the distinction between abnormal and normal which is hindered by the fact that the adaptation to sports activity in endurance athletes is different to that in power athletes. Especially cardiomyopathies provoke changes in ECG and echocardiography (echo) at an early stage when clinical symptoms are absent. ECG and echo data and their relationship to fitness peculiar to top handball players have never been described. We studied 291 male first league handball players (32 Olympians/47 national players) (25.3±4.4 years). Check up consisted of ECG, spiroergometry and echocardiography. None had T-wave inversions, 3.1% showed early repolarisation abnormalities in the precordial leads. Sokolow-Lyon voltage criterion for left ventricular hypertrophy was positive in 19.3%. Spiroergometry showed a maximum oxygen uptake (peakVO₂) of 50.3±7.7 ml/min/kg body weight. LVmass was increased in comparison to normal values. There was a correlation between peakVO₂ and LVindex (p<0.001, r=0.341), (LVmass/peak VO₂ p=0.053, r=0.125). A relationship between cardiac dimensions and peakVO₂ could not be confirmed. In professional handball players early repolarisation abnormalities were less frequent and LVmass was increased when compared with soccer players. The need for normal values for different types of sports is crucial to guarantee a proper evaluation of athletes.
TL;DR: A 47-year-old male complained of persistent cough and computed tomography revealed a mass in the right atrium, histologically and immunohistochemically diagnosed as undifferentiated pleomorphic sarcoma, which is very rare and usually found in the left atrium.
Abstract: Primary cardiac tumors are rare with an incidence ranging from 0.001% to 0.03% in autopsy series. The prognosis of cardiac sarcomas remains poor because it proliferates rapidly and distant metastases are often found at diagnosis. A 47-year-old male complained of persistent cough. The chest roentgenogram was normal. Subsequent computed tomography revealed a mass in the right atrium. Echocardiography and magnetic resonance imaging confirmed also a right atrial mass (34 x 35 mm) infiltrating the atrial septum. The tumor was completely resected en bloc, including the anterior and lateral right atrial walls, the left atrial dome, and a large segment of the superior vena cava, and reconstructed the atria and superior vena cava with bovine pericardium. The tumor was histologically and immunohistochemically diagnosed as undifferentiated pleomorphic sarcoma. This type of cardiac sarcoma is very rare and usually found in the left atrium. Twenty-seven months after surgery, the patient is doing well without metastasis or local tumor recurrence.
TL;DR: The PRO-Kinetik coronary stent system was found to be safe and effective in patients with single de novo coronary lesions and included in a prospective international multicenter study.
TL;DR: An unusual case of massive thrombus formation following systemic thrombolytic therapy which happened twice after implantation of MCS is reported.
Abstract: The immediate complication after implantation of mechanical circulatory support (MCS) is more often bleeding than thromboembolic events. We report an unsual case of massive thrombus formation following systemic thrombolytic therapy which happened twice after implantation of MCS. Various mechanisms may contribute to this severe complication, but attention should be paid to patients who receive MCS after systemic thrombolysis because of the secondary hypercoagulability induced by this therapy.
TL;DR: As nearly independent of stroke volume and in consideration of VAexpected, VA seems to have become one of the preferable parameters for detecting pathological stenotic AVPs echocardiographically.
Abstract: Background: Dysfunction of heart valve prostheses (VP) is a life-threatening complication and the diagnosis remains difficult. The motivation for this study was to improve the detection of dysfunctional VP by optimizing application of the prosthetic effective orifice area (VA). For this reason the minimal expected normal VA (VAexpected) was introduced. Methods: We investigated echocardiographically 1,369 normally functioning aortic valve prostheses (AVP). Mean VA, transprosthetic peak (PPG) and mean pressure gradients (MPG) were evaluated to gain reference values depending on prosthetic size and construction principle. Mean VAexpected was calculated by applying a simple formula that was developed empirically using statistical analyses. The results were compared with those of 65 dysfunctional AVPs. Results: VAexpected can be applied as a threshold between normal and dysfunctional stenotic AVP and showed a correct estimation in 87% of all normally functioning and 100% of dysfunctional stenotic VPs. The sensitivity for all prosthetic sizes is 1.0, independently of the constructional principle of the VP. Specificity ranged between 0.8 and 1.0, dependent on VP size. The formula representing VAexpected is simple and can be executed easily. Conclusion: As nearly independent of stroke volume and in consideration of VAexpected, VA seems to have become one of the preferable parameters for detecting pathological stenotic AVPs echocardiographically. The additional application of PPG/MPG and other parameters permits prostheses with relevant isolated regurgitation and patient-prosthesis-mismatch to be distinguished. (Echocardiography 2012;29:713-719)
TL;DR: It is suggested that low-dose EVL may be as effective and safe as regular dose EVL and biochemical safety parameters were comparable in both groups.
Abstract: For cardiac transplant (CTx) recipients, the recommended everolimus (EVL) dose is 0.75 mg bid or 1.5 mg bid and the target trough blood level is 3–8 μg/L. We studied a cohort of 56 CTx patients with chronic kidney disease receiving 0.75 mg bid EVL to maintain blood levels of 5–8 ug/L (designated RD group) and a cohort of 51 CTx patients with chronic kidney disease receiving 0.5 mg bid to maintain blood levels of 3–5 ug/L (designated LD group). The primary endpoint was a composite of death, rejection and premature EVL discontinuation up to 1 year after introduction of EVL. The primary endpoint was reached by 32% of patients in the LD group and by 41.1% of patients in the RD group (𝑃=0.361). Biochemical safety parameters were comparable in both groups. Our results indicate that low-dose EVL may be as effective and safe as regular dose EVL.
TL;DR: An HOCM patient in whom marked regression of left ventricular hypertrophy occurred within two years following outflow desobliteration by percutaneous septal ablation is presented.
Abstract: We present an HOCM patient in whom marked regression of left ventricular hypertrophy occurred within two years following outflow desobliteration by percutaneous septal ablation. Maximum wall thickness (initially documented by both echo and MRI) decreased from 34 mm to 22 mm (followup by echo only due to presence of the ICD), crossing the threshold value of 30 mm which was one of the risk markers that had triggered the primary prophylactic ICD implantation in this case prior to septal ablation.