In-Hospital Outcomes and 30-Day Readmission Rate After Transcatheter and Surgical Aortic Valve Replacement in Liver Cirrhosis: A Contemporary Propensity-Matched Analysis.

Background: Liver cirrhosis is not included in surgical risk prediction models despite being a significant risk factor associated with high periprocedural morbidity and mortality in patients undergoing cardiac surgery. Limited contemporary data exists assessing the outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with cirrhosis.

Methods: Patients with cirrhosis who underwent TAVR or SAVR were identified from the Nationwide Readmissions Database.

Early Clinical Outcomes of Patients With Stress-Induced Cardiomyopathy Receiving Acute Mechanical Support in the US.

Background: The role of acute mechanical circulatory support (aMCS) in patients with stress-induced cardiomyopathy (SIC) complicated by cardiogenic shock (CS) is not well studied. Here, we describe the incidence and outcomes of aMCS use in SIC-CS using a large national database.

Methods: Using the Nationwide Readmissions Database from January 2016 to November 2019, we identified patients hospitalized with SIC who received isolated intra-aortic balloon pump (IABP), microaxial flow pump (Impella, Abiomed), or extracorporeal membrane oxygenation (ECMO) during the index hospitalization.

Catecholaminergic Polymorphic Ventricular Tachycardia: Clinical Characteristics, Diagnostic Evaluation and Therapeutic Strategies.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a severe hereditary arrhythmia syndrome predominantly affecting children and young adults. It manifests through bidirectional or polymorphic ventricular arrhythmia, often culminating in syncope triggered by physical exertion or emotional stress which can lead to sudden cardiac death. Most cases stem from mutations in the gene responsible for encoding the cardiac ryanodine receptor (), or in the Calsequestrin 2 gene (), disrupting the handling of calcium ions within the cardiac myocyte sarcoplasmic reticulum.

Determining the Significance of Coronary Plaque Lesions: Physiological Stenosis Severity and Plaque Characteristics.

The evaluation of coronary lesions has evolved in recent years. Physiologic-guided revascularization (particularly with pressure-derived fractional flow reserve (FFR)) has led to superior outcomes compared to traditional angiographic assessment. A greater importance, therefore, has been placed on the functional significance of an epicardial lesion.

Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance.

Acute myocardial infarction (AMI) is one of the most common causes of death in both the developed and developing world. It has high associated morbidity despite prompt institution of recommended therapy. The focus over the last few decades in ST-segment elevation AMI has been on timely reperfusion of the epicardial vessel.

Complete versus culprit-only revascularisation in ST elevation myocardial infarction with multi-vessel disease.

Background: Multi-vessel coronary disease in people with ST elevation myocardial infarction (STEMI) is common and is associated with worse prognosis after STEMI. Based on limited evidence, international guidelines recommend intervention on only the culprit vessel during STEMI. This, in turn, leaves other significantly stenosed coronary arteries for medical therapy or revascularisation based on inducible ischaemia on provocative testing.

Stroke and a valvular lesion in a patient with stage IV non-small cell lung cancer.

The mechanism and severity of stroke varies in the setting of malignancy. We report a case of a 68-year-old man with lung adenocarcinoma, who experienced acute neurological symptoms. Imaging studies showed multiple acute ischaemic infarcts in cerebral and cerebellar hemispheres.

Serial evaluation of microcirculatory dysfunction in patients with Takotsubo cardiomyopathy by myocardial contrast echocardiography.

Background: Stress cardiomyopathy manifests as reversible left ventricular apical ballooning in the absence of epicardial coronary obstruction. Transient microcirculatory dysfunction has been proposed as a potential putative mechanism. This study aimed to understand the natural history of this dysfunction using readily available noninvasive methods.

Validity of Amino Terminal pro-Brain Natiuretic Peptide in a Medically Complex Elderly Population.

Background: The routine use of natiuretic peptides in severely dyspneic patients has recently been called into question. We hypothesized that the diagnostic utility of Amino Terminal pro Brain Natiuretic Peptide (NT-proBNP) is diminished in a complex elderly population.

Methods: We studied 502 consecutive patients in whom NT-proBNP values were obtained to evaluate severe dyspnea in the emergency department.

Does choice of antidiabetes therapy influence macrovascular outcomes?

Despite a clear epidemiologic relationship between hemoglobin A(1c) levels and the risk of cardiovascular (CV) disease in patients with type 2 diabetes mellitus (T2DM), prospective studies examining the benefit of intensive glucose lowering in reducing CV events have yielded conflicting results. Controversy over the choice of antidiabetic therapy for lowering macrovascular events has existed for nearly four decades, beginning with the potential risk of increased CV mortality with sulfonylurea use. Although sulfonylureas were subsequently felt to be safe, a more recent controversy was raised as to whether rosiglitazone use was associated with an increased risk of CV events.

Antidiabetic agents and cardiovascular risk in type 2 diabetes.

Despite the clear relationship between HbA(1c) levels and risk of cardiovascular disease in patients with type 2 diabetes mellitus (T2DM) in epidemiologic studies, prospective data on the role of glucose-lowering therapy in reducing cardiovascular events are equivocal. Initial studies of intensive glycemic control suffered from inadequate statistical power to show reductions in cardiovascular events, as well as a lack of durable glycemic control and relatively poor control of associated cardiovascular risk factors. Subsequently, controversy existed over whether rosiglitazone was associated with an increased risk of myocardial ischemic events.

Lowering glucose to prevent adverse cardiovascular outcomes in a critical care setting.

High admission blood glucose levels after acute myocardial infarction are common and associated with an increased risk of death in patients with or without diabetes. Hyperglycemia is associated with altered myocardial blood flow and energetics and can lead to a pro-oxidative/proinflammatory state. The use of intensive insulin treatment has shown superior benefits in the treatment of hyperglycemia versus glucose-insulin-potassium infusion, particularly in critical care settings.

Potential of glucose-lowering drugs to reduce cardiovascular events.

Although a clear relationship exists between glycosylated hemoglobin and cardiovascular (CV) disease in individuals with type 2 diabetes mellitus (T2DM) in epidemiologic studies, data from prospective studies are less clear. Earlier prospective studies examining intensive glucose lowering suffered from a lack of statistical power to show CV event reduction, as well as a lack of durable glycemic control and relatively poor control of associated CV risk factors. Although recent CV outcome trials comparing intensive glycemic compared with standard glycemic control have been disappointing, CV event rates appear to be declining substantially in T2DM individuals in the setting of aggressive global CV risk factor modification.

The role of aspirin resistance in the treatment of acute coronary syndromes.

The TIMI Risk Score recognizes prior aspirin use as an independent risk factor for adverse outcomes in subjects presenting with an acute coronary syndrome. The etiology of this increased risk awaits clarification, but prior aspirin use may be associated with altered thrombus composition which is more resistant to current treatment modalities as compared to thrombus formation in subjects without prior aspirin use. Post hoc analysis of acute coronary syndrome trials has shown that prior aspirin users treated with unfractionated heparin are at particularly high risk.

Mechanism by which hyperglycemia plays a role in the setting of acute cardiovascular illness.

Acute hyperglycemia is associated with excess morbidity and mortality in acute cardiovascular illness in both diabetic and nondiabetic patients. Hyperglycemia is associated with altered myocardial energetics, but abnormalities in glucose oxidation and glycolysis do not fully account for this excess risk. Hyperglycemia leads to a pro-oxidative/proinflammatory state that is associated with endothelial dysfunction, diminished coronary vasodilatory reserve, and a prothrombotic state.

The effect of a six-week program of yoga and meditation on brachial artery reactivity: do psychosocial interventions affect vascular tone?

Background: Chronic stress is estimated to increase the risk of cardiovascular (CV) events two-fold. Although stress reduction has been linked to a reduction in CV events, little is known regarding its exact mechanism of benefit.

Hypothesis: Yoga and meditation will improve parameters of endothelial function.

Cardiovascular risk factors in the metabolic syndrome: impact of insulin resistance on lipids, hypertension, and the development of diabetes and cardiac events.

Metabolic syndrome (MS) is associated with excess cardiovascular risk above and beyond the contribution of traditional risk factors. It is a proinflammatory and prothrombotic condition associated with underlying insulin resistance. Hypertension and hyperlipidemia in the setting of MS are also associated with excess cardiovascular risk, as is the development of new onset diabetes during the course of therapy.

Coronary thrombosis related to use of Xenadrine RFA.

Recently, ephedra was removed from the U.S. marketplace due to a heightened concern that dietary supplements containing ephedra may present "an unreasonable risk of illness or injury.

The role of intensive glycemic control in the management of patients who have acute myocardial infarction.

Hyperglycemia is associated with excess mortality in AMI and should be treated aggressively in the intensive care setting. The exact goal of therapy is unclear because different blood glucose targets were used in earlier studies (eg, 215 mg/dL in DIGAMI versus 110 mg/dL in the Belgian study of critically-ill patients). In the setting of AMI, it is prudent to avoid excessive hypoglycemia and, thus, more modest goals for blood glucose may be considered until more definitive data are present.

Effectiveness of a multidisciplinary quality improvement initiative in reducing door-to-balloon times in primary angioplasty.

Primary angioplasty (PA) for acute myocardial infarction (AMI) has emerged as the standard of care in hospitals with cardiac interventional facilities. The benefits from the PA are time dependent, but recent data raise concerns regarding the timeliness of delivery of care in AMI and the level of benefit achieved by current standards. We assessed the effectiveness of an extensive multidisciplinary quality improvement initiative in reducing door-to-balloon (DTB) times in PA.