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The goal of this study was to determine the safety and feasibility of a novel esophageal balloon retractor (DV8) for MED during PVI.

This study sought to determine the extent of lateral esophageal displacement required during mechanical esophageal deviation (MED) and to eliminate luminal esophageal temperature elevation (LETElev) during pulmonary vein (PV) isolation.

We studied the utility of multimarker risk stratification approach to predict cardiovascular outcomes in patients with stable coronary artery disease, undergoing elective percutaneous coronary intervention (PCI).

The purpose of this study was to determine the association of complete heart block (CHB) with outcomes and to examine temporal trends in the incidence and outcomes of CHB complicating ST-segment elevation myocardial infarction (STEMI).

AbstractBackground:Accelerated coronary atherosclerosis in patients with Kawasaki disease, in conjunction with coronary artery aneurysm and stenosis that characterise this disease, are potential risk factors for developing coronary artery disease in young adults. We aimed to determine the prevalence and predictors of coronary artery disease in adult patients with Kawasaki disease. Methods:All patients aged 18−55 years of age diagnosed with Kawasaki disease were sampled from Nationwide Inpatient Sample database using International Classification of Diseases 9th revision (ICD 9 code 446.1) from 2009 to 2010. Demographics, prevalence of coronary artery disease, and other traditional risk factors in adult patients with Kawasaki disease were analysed using ICD 9 codes. Results:The prevalence of Kawasaki disease among adults was 0.0005% (n=215) of all in-hospital admissions in United States. The mean age was 27.3 years with women (27.6 years) older than men (27.1 years). Traditional risk factors were hypertension (21%), hyperlipidaemia (15.6%), diabetes (11.5%), tobacco use (8.8%), and obesity (8.8%), with no significant difference between men and women. Coronary artery disease (32.4%), however, was more prevalent in men (44.7%) than in women (12.1%; p=0.03). In multivariate regression analysis, after adjusting for demographics and traditional risk factors, hypertension (OR=13.2, p=0.03) was an independent risk factor of coronary artery disease. Conclusion:There was increased preponderance of coronary artery disease in men with Kawasaki disease. On multivariate analysis, hypertension was found to be the only independent predictor of coronary artery disease in this population after adjusting for other risk factors.

Supplemental Digital Content is available in the text.

Peripartum cardiomyopathy (PPCM) is a serious pregnancy-associated disorder of unknown etiology. The precise cellular and molecular mechanisms underlying PPCM are unclear. A heightened awareness among health care providers can result in early diagnosis of heart failure in late pregnancy and the early postpartum period. Though the symptoms of dyspnea and fatigue can result from normal physiologic changes during pregnancy, an electrocardiogram and brain natriuretic peptide level should be obtained in these patients, in addition to baseline laboratory tests such as a complete blood count, and basic metabolic and hepatic function panels. If the electrocardiogram and brain natriuretic peptide level are abnormal, an echocardiogram should be obtained. The role of endomyocardial biopsy for the diagnosis of PPCM is controversial. Patients should be started on diuretics if volume overloaded, and beta-blockers (preferably metoprolol) if no contraindications exist; angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be avoided during pregnancy or lactation. There are no standard, universally accepted guidelines for the management of PPCM. Although experimental therapies like bromocriptine, pentoxifylline and immunoglobulins have shown promising results, large double-blind randomized trials are essential to confirm the results of smaller studies. In patients with persistent severe left ventricular (LV) dysfunction, advanced therapies like mechanical circulatory support and heart transplantation should be considered. Owing to recent data demonstrating deterioration of LV systolic function after initial recovery, it is essential to maintain long-term follow up of these patients regardless of initial recovery of LV function. We present a comprehensive review of the literature etiopathogenesis, diagnosis, and management of PPCM.

Mitral regurgitation (MR) is the most common cardiac valvular disease in the United States. Approximately 4 million people have severe MR and roughly 250,000 new diagnoses of MR are made each year. Mitral valve surgery is the only treatment that prevents progression of heart failure and provides sustained symptomatic relief. Mitral valve repair is preferred over replacement for the treatment of MR because of freedom from anticoagulation, reduced long-term morbidity, reduced perioperative mortality, improved survival, and better preservation of left ventricular function compared with valve replacement. A large proportion of patients in need of valve repair or replacement do not undergo such procedures because of a perceived unacceptable perioperative risk. Percutaneous catheter-based methods for valvular pathology that parallel surgical principles for valve repair have been developed over the last few years and have been proposed as an alternate measure in high-risk patients. The MitraClip (Abbott Labs) device is one such therapy and is the subject of this review.

Cardiac hemochromatosis or primary iron-overload cardiomyopathy is an important and potentially preventable cause of heart failure. This is initially characterized by diastolic dysfunction and arrhythmias and in later stages by dilated cardiomyopathy. Diagnosis of iron overload is established by elevated transferrin saturation (>55) and elevated serum ferritin (>300 ngmL). Genetic testing for mutations in the HFE(high iron) gene and other proteins, such as hemojuvelin, transferrin receptor, and ferroportin, should be performed if secondary causes of iron overload are ruled out. Patients should undergo comprehensive 2D and Doppler echocardiography to evaluate their systolic and diastolic function. Newer modalities like strain imaging and speckle-tracking echocardiography hold promise for earlier detection of cardiac involvement. Cardiac magnetic resonance imaging with measurement of T2 relaxation times can help quantify myocardial iron overload. In addition to its value in diagnosis of cardiac iron overload, response to iron reduction therapy can be assessed by serial imaging. Therapeutic phlebotomy and iron chelation are the cornerstones of therapy. The average survival is less than a year in untreated patients with severe cardiac impairment. However, if treated early and aggressively, the survival rate approaches that of the regular heart failure population.

Carcinoid tumors are rare, indolent neuroendocrine tumors that are often associated with a syndrome characterized by episodic flushing, secretory diarrhea, bronchospasm, and hypotension—the carcinoid syndrome. Cardiac involvement occurs in one-half to two-thirds of patients with carcinoid syndrome and is associated with a worse clinical outcome. Carcinoid heart disease is characterized by endocardial plaque-like deposits found predominantly on right-sided heart valves, leading to the combination of valvular stenosis and regurgitation. Left-sided cardiac involvement can also occur in <10 of patients. Somatostatin analogs form the therapeutic cornerstone in the medical management of these patients. Cytotoxic chemotherapy has had only limited success in the treatment of metastatic carcinoid tumors. Hepatic resection or palliative cytoreduction may be of benefit in patients with limited hepatic disease. Hepatic artery embolization is usually applied if a patient is not eligible for surgical debulking. The development and progression of carcinoid heart disease are associated with an unfavorable outcome. In those patients having severe cardiac involvement and well-controlled systemic disease, valve replacement surgery has been found to be an effective treatment that can both relieve intractable symptoms and contribute to improved clinical outcomes.

Rheumatoid Arthritis (RA) is a chronic progressive inflammatory joint disorder that affects 0.5 – 1 of the general population. This review article discusses cardiovascular manifestations of rheumatoid arthritis, pathogenesis of these manifestations, and therapy. This disease not only affects the joints, but it also involves other organ systems. The majority of these patients suffer significant morbidity and mortality from cardiovascular disease. Cardiovascular manifestations of RA include predilection for accelerated atherosclerosis and endothelial dysfunction resulting in coronary artery disease (CAD), stroke, congestive heart failure, and peripheral arterial disease. Some studies have shown that the risk of developing CAD in RA patients is the same as for patients with diabetes mellitus. These patients should be treated with aggressive medical therapy such as disease modifying antirheumatic drugs, tumor necrosis factor alpha inhibitors, and corticosteroids and with appropriate control of risk factors such as smoking, dyslipidemia, hypertension, and obesity. Other manifestations include pericarditis, myocarditis, and vasculitis.

Supplemental Digital Content is available in the text.

Background:Hospitalized patients with heart failure (HF) are at increased risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), and these conditions are associated with increased in-hospital mortality, longer length of stay and higher healthcare costs. Guidelines have emphasized the need for DVT prophylaxis, but it is unclear if the incidence of VTE has changed or remained constant over the past years.

Background:The reported incidence of peripartum cardiomyopathy (PPCM) in the United States varies widely. Furthermore, limited information is available on the temporal trends in incidence and outcomes of PPCM.

Background:Early mechanical revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock is associated with improved survival. The current guidelines also recommend (Class IIa) the use of intra-aortic balloon pump (IABP) in patients with cardiogenic shock. However, the evidence supporting this recommendation is controversial.

Background:Medicaid enrollment and expenditures are projected to increase sharply with the Affordable Care Act’s eligibility expansions. However, the impact of these changes on outcomes after heart transplant procedure has not been studied before. The aim of this study was to analyze the relationship between payment source and outcomes following heart transplant in a national database.

Background:Stroke may be the presenting symptom of thrombotic thrombocytopenic purpura (TTP), but the predictors of stroke in patients with TTP are unknown. We sought to seek the differences in characteristics in TTP patients presenting with and without stroke.

Purpose:To investigate in patients hospitalized for syncope risk factors for rehospitalization for syncope and long-term mortality.

Purpose:To investigate the etiologies of syncope in patients hospitalized for syncope.

Warfarin affects the synthesis and function of the matrix Gla protein, a vitamin K–dependent protein, which is a potent inhibitor of tissue calcification. We aimed to study the association of use of warfarin with calcification of the mitral valve, mitral annulus, and aortic valve.We reviewed 1155 patient's charts with a diagnosis of nonvalvular atrial fibrillation. Based on the chart review, patients were grouped into the warfarin group and the no warfarin group. The following parameters were recorded in both groups: age, ethnicity, glomerular filtration rate, calcium-phosphate product, lipid profile, coronary artery disease, diabetes, hypertension and intake of medications including aspirin, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, statins, and beta blockers. All the echocardiograms were analyzed by two cardiologists blinded to the clinical details of subjects but alerted to evaluate for the presence of mitral valve calcium (MVC), mitral annular calcium (MAC), aortic valve calcium (AVC), or any of the three. Stepwise logistic regression analysis was used to identify significant independent risk factors associated with any calcification using twenty five variables.Out of 1155 patient records reviewed, 725(63%) were in the warfarin group and 430(37%) were in the no warfarin group. MVC, MAC, or AVC was present in 473 of 725 patients (65%) on warfarin versus 225 of 430 patients (52%) not on warfarin (p<0.0001). Stepwise logistic regression analysis showed significant independent risk factors for any valve calcification were use of warfarin (Odds ratio 1.972, p-value< 0.001), age (Odds ratio 1.078 per one year increase, p-value <0.001), dyslipidemia (Odds ratio 0.235,p-value <0.001), calcium-phosphate product (Odds ratio 1.015, p-value 0.024), and coronary artery disease ( Odds ratio 13.563, p-value <0.0001).Warfarin intake is associated with a significantly higher prevalence of MVC, MAC or AVC. Further studies are needed to confirm this association and the duration of warfarin intake for development of calcification. A pilot study has been started to study the effect of oral vitamin K on valvular calcification.Off Label Use: Oral Vitamin K in preventing calcification.

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