Search

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Carpometacarpal osteoarthritis of the thumb (CMC OA) is treated with various therapeutic approaches. However, the literature remains inconclusive regarding the ideal procedure for each disease stage. In this study, we assessed the international application of surgical treatment options including CMC I implants and non-surgical treatment options for CMC OA depending on the disease stage, with a strong focus on the detection of geographical disparities. We conducted a large international online survey with members of hand surgical societies of the International Federation of Societies for Surgery of the Hand (IFSSH). The first part of the survey asked about general therapy options of CMC OA depending on the severity of the disease, whereas the second part specifically dealt with the use of prostheses. We could include 10 of 56 IFSSH member societies (6807 surgeons) and received answers from 1138 members (16.7%). Significant differences were detected in an increased use of corticosteroid injections in the USA, and a growing frequency of fat injections in Europe. Regarding use and frequency of the resection arthroplasty, we found similar results in all participating countries. Prosthetic implantation showed a significant difference between the USA and Europe, with far larger numbers stated by European hand surgeons. CMC OA is treated differently in the participating countries depending on the stage of the disease. We give an insight into geographical differences in treatment paradigms, with corticosteroid injections being more prevalent in the USA, and prosthesis implantation being more frequently chosen in the selected European countries. [ABSTRACT FROM AUTHOR]

This study investigated the association of cardiovascular cardiac magnetic resonance (CMR) feature tracking (FT) with outcome in a patient cohort with myocarditis and evaluated the possible incremental prognostic benefit beyond clinical features and traditional CMR features. CMR is used to diagnose and risk stratify patients with myocarditis. CMR-FT allows quantitative strain analysis of myocardial function; however, its prognostic benefit in myocarditis is unknown. Consecutive patients with clinically suspected myocarditis and presence of midmyocardial or epicardial late gadolinium enhancement (LGE) and/or myocardial edema in CMR were included. Clinical and CMR features were analyzed with regard to major adverse cardiovascular events (MACE) (i.e., hospitalization for heart failure, sustained ventricular tachycardia, and all-cause mortality). Of 740 patients with clinically suspected myocarditis, 455 (61%) met our final diagnostic criteria based on CMR tissue characterization. At a median follow-up of 3.9 years, MACE occurred in 74 (16%) patients. In the univariable analysis, CMR-FT global longitudinal peak strain (GLS) was significantly associated with MACE. In a multivariable model adjusting for clinical variables (age, sex, body mass index, and acuteness of symptoms) and traditional CMR features (left ventricular ejection fraction [LVEF] and LGE extent), GLS remained independently associated with outcome (GLS hazard ratio: 1.21; 95% confidence interval: 1.08 to 1.36; p = 0.001) and incrementally improved prognostication (chi-square increases from 42.6 to 79.8 to 88.5; p < 0.001). Myocardial strain using CMR-FT provides independent and incremental prognostic value over clinical features, LVEF, and LGE in patients with myocarditis. CMR-FT may serve as a novel marker to improve risk stratification in myocarditis. (CMR Features in Patients With Suspected Myocarditis [CMRMyo]; NCT03470571) [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• In fire investigation, knowledge is possessed by very experienced investigators. • Human factor has a huge impact in knowledge transmission. • Investigators use past cases to solve new problems. • Building a case library is a solution to manage fire investigation knowledge. The technique of fire investigation is a forensic domain in which expertise and analogies play a central role. To learn how fire investigators use these analogies to support their work, we conducted an ethnographic study in a Swiss forensic police department. To propose a suitable knowledge-management strategy, we also evaluated the knowledge conservation and sharing within the department. Our results highlighted that actionable knowledge is registered mainly in the investigators' memories of a few, very experienced, individuals. Without experience with fire-incident investigations, an agent generally requires help from a more experienced colleague, who will then use his memory to find a similar case, which can contribute to the solution of the ongoing one. The research also established that knowledge is exchanged orally during on-site investigations and that knowledge receivers are generally those who are present on the scene. Using these findings, we suggest building a case library to support the externalisation and sharing of knowledge. [ABSTRACT FROM AUTHOR]

Several operative approaches and various implants for osseous fixation have been described to achieve four-corner fusion of the wrist. Given the discordance and to aid in further standardizing the technique, this study directly compares the outcomes of K-wire, fusion plate, and headless retrograde compressive screw fixations to achieve four-corner arthrodesis. Sixty-four patients underwent four-corner fusion over a period of 5 years and were reviewed retrospectively. Twenty-one patients underwent bone fixation with conventional K-wires, 26 with locking plates, and 17 patients were treated by headless retrograde compressive screw fixations. Patients of the different groups were comparable regarding age, sex, hand dominance, and stage of disease. All study groups showed significant improvements in grip strength, decrease in pain (NRS) at rest and with activity, range-of-motion of the wrist, and wrist function (measured by the DASH-score). When evaluating the three groups amongst each other, overall complication and nonunion rates were low and revealed no significant differences between the groups of patients. However, regarding postoperative NRS at activity, dorsal flexion, and DASH-scores, the "screw" group showed significantly better results than the "wire" group. The results show that all examined techniques of four-corner fusion can improve wrist function when compared to preoperative baseline (NRS at rest and activity, postoperative DASH-scores). However, headless retrograde compressive screw fixation had significant better results regarding pain relief (NRS) at activity and postoperative DASH-scores. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The benefits of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) remain uncertain. We assessed the influence of total ischemic time (TIT) on clinical outcomes among STEMI patients undergoing manual TA during pPCI.Methods and Results: We conducted a retrospective study of patients enrolled in the Acute Myocardial Infarction in Switzerland Plus registry. STEMI patients undergoing pPCI with (TA group) or without (PCI-alone group) manual TA were stratified based on short (<3 hours), intermediate (3-6 hours), and long (>6 hours) TIT. The primary endpoint was in-hospital all-cause mortality. The secondary endpoint was in-hospital major adverse cardiac events (MACE), a composite of all-cause death, myocardial reinfarction and stroke. Between 2008 and 2014, 4'154 patients (TA 48%) were included. Risk-adjusted in-hospital all-cause mortality was not different between TA and PCI-alone groups (OR 1.29; 95%CI 0.83-1.98; p=0.26), whereas there was significantly increased risk of MACE (OR 1.52; 95%CI 1.05-2.19; p=0.03) in patients treated with manual TA compared with PCI-alone. There was no significant difference between manual TA and PCI-alone with respect to risk-adjusted all-cause mortality according to TIT groups, but risk-adjusted MACE rates were significantly higher in the group of patients with long TIT treated with manual TA compared with PCI-alone (OR 2.42; 95%CI 1.16-5.04; p=0.02).Conclusion: In a large registry of STEMI patients, manual TA was not associated with lower risk-adjusted in-hospital all-cause mortality compared with PCI-alone regardless of TIT but was associated with significantly greater risk of MACE. In patients with prolonged TIT, manual TA was associated with higher risk-adjusted MACE rates compared with PCI-alone. [ABSTRACT FROM AUTHOR]

Background: Whether patients with acute myocardial infarction presenting with new or presumed new left bundle-branch block (LBBB) should be treated in the same way as those presenting with ST-elevation (STE) is still a matter of debate.Methods: Data from 28,358 patients enrolled in AMIS Plus from 1997 to 2016 were analyzed to evaluate differences in treatment and outcome of patients presenting with LBBB (n=2295) or STE (n=26,090) on their initial electrocardiogram using descriptive statistics and multivariate logistic regression.Results: LBBB patients were older (75.0 vs 64.3 years, P<.001) with a greater burden of risk factors and comorbidities. They were admitted 80 minutes later and more frequently in Killip III/IV (20% vs 7%, P<.001). Even after adjustment for age and gender, LBBB patients were less likely to receive aspirin (odds ratio [OR] 0.40, 95% CI 0.34-0.47), P2Y12 inhibitors (OR 0.50, 95% CI 0.45-0.54), β-blockers (OR 0.81, 95% CI 0.76-0.89), and statins (OR 0.70, 95% CI 0.63-0.76) or undergo percutaneous coronary interventions (OR 0.38, 95% CI 0.35-0.42). Crude in-hospital mortality of patients with LBBB was 16.2% versus 6.5% for patients with STE, but adjusted OR was 1.07 (95% CI 0.93-1.24). Mortality of LBBB patients decreased from 22.6% in 1997-2001 to 11.9% in 2012-2016.Conclusions: Acute myocardial infarction patients with new or presumed new LBBB presence are at high risk of morbidity and mortality. They were treated less aggressively, and although mortality has halved during the last 20 years, there may be room for further improvement. Additional studies are needed to better identify those patients with LBBB who may maximally benefit from an early invasive treatment strategy. [ABSTRACT FROM AUTHOR]

Background Little is known about differences in therapies and outcomes of patients with first myocardial infarction (MI) or recurrent MI (reMI). This study aimed to evaluate the impact of prior MI on therapies and outcomes in patients who presented with ST-elevation MI (STEMI). Methods All STEMI patients enrolled from 2002 to 2014 in the AMIS Plus registry were included. Outcome was analyzed using logistic multivariate regression. Results From 19,665 STEMI patients, 2845 (14%) had reMI. These patients were older (69.5y vs. 64.2y; p < 0.001), more frequently male, with more risk factors (hypertension, dyslipidemia), and more comorbidities. Patients with reMI presented 25 min earlier than those with first MI, were more frequently in Killip class 3/4 (12% vs. 7%; p < 0.001), and were less likely to receive guideline-recommended drug therapy: aspirin (93% vs. 97%; p < 0.001), P2Y 12 inhibitors (76% vs. 83%; p < 0.001), or statins (73% vs. 77%; p < 0.001), or undergo primary percutaneous coronary intervention (77% vs. 87%; p < 0.001). These patients developed more frequently cardiogenic shock (7% vs. 5%; p < 0.001) and reinfarction (2% vs. 1%; p < 0.001) during hospitalization, and had higher crude mortality (10% vs. 5%; p < 0.001) than patients without prior MI. Prior MI was an independent predictor of in-hospital mortality in STEMI patients (OR 1.27; 95% CI 1.05–1.53; p < 0.001). A subgroup ( n = 4486) was followed 1 year after discharge (3893 with first MI and 593 with reMI at initial hospitalization). Crude mortality was 2.9% for patients with first MI vs. 6.7% for those with reMI (OR 1.68, 95% CI 1.14–2.47; p = 0.008). Conclusions Although patients with reMI are high-risk patients, they were less likely to receive evidence-based treatment and had worse in-hospital and 1-year outcomes compared to patients with first MI. Short- and long-term management of patients with recurring MI should be improved. [ABSTRACT FROM AUTHOR]

This study assessed opinions and experiences of healthcare professionals, former patients and family members during the first wave of the COVID-19 pandemic and focuses on challenges in family-centred care for intensive care unit patients and affected families. A two-round modified Delphi process assessed the opinions and experiences of experts such as healthcare professionals, former patients and their families (n = 151). This study was conducted across four countries in Europe. In total, 121 participants (response rate 80.13%) answered the first Delphi round; the second was answered by 131 participants (response rate 86.75%). Participants perceived family support in the intensive care unit as highly important during the COVID-19 pandemic. Enabling contact amongst patients, families and clinicians is regarded as essential to build hope and confidence in the treatment and the recovery process. The extraordinary situation led to the implementation of new communication structures such as video calls and websites. A consensus was reached between healthcare professionals that virtual contact is essential for patients with COVID-19 and their families during visit restrictions. This should be done to establish confidence in the treatment. [ABSTRACT FROM AUTHOR]

• Former patients want to be visually stimulated via photographs and television. • Virtual reality also shows potential for use visually stimulating patients. • If videos are shown, auditory stimuli should match the visual content. • Visual and auditory stimulation can give the patient orientation while in the ICU. • Duration of stimulation should be adjusted per patient but remain rather short, in general less than 30 min. To determine what type (e.g., television, photographs, music, etc), content (e.g., nature scenes, family members, etc), and duration of visual and auditory stimuli should be provided to intensive care unit patients during their hospitalisation. This mixed-methods study followed an exploratory-descriptive design. In total, 31 participants were interviewed: 19 were former critically ill patients in the intensive care unit and 12 were nursing experts, all from a university hospital in Switzerland. Based on current practice, patients and nurses were familiar with receiving and providing television, photographs, radio, and musical stimuli, with no specific exposure to virtual reality, aside from that in their personal lives. Data were collected from the former patients using structured interviews, whereas semi-structured interviews were used for the nursing experts. Overall, patient and expert opinions aligned well; both groups agreed that receiving visual and/or auditory stimuli would benefit patients. Photographs, television, and virtual reality were the visual stimuli most chosen by the patients, with an emphasis on nature-focused content. When appropriate, audio matching the content should be provided alongside the visual stimuli to act as a distraction from the hospital environment. Visual stimuli should not exceed 10–15 min, while auditory stimuli should not exceed one hour. Sensory overload and deprivation are common problems in the intensive care unit with negative effects on patient outcomes. Based on patient and expert opinions, visual and auditory stimuli are desired by patients and could help address these issues. [ABSTRACT FROM AUTHOR]

Summary Background Pain reduction as well as preservation and improvement in range of motion remain the main aims in the treatment of thumb carpometacarpal (CMC) osteoarthritis (OA). We performed a retrospective outcome analysis of patients with symptomatic stage II–III thumb CMC joint arthritis treated with denervation, joint lavage and capsular imbrication. Methods 73 patients with stage II to III OA of the thumb CMC-joint underwent the described technique. A total of 42 patients complied with follow-up assessment and were included in this study. Mean follow-up was 41.2 (range 12–81) months. Results Mean operative time was 28.4 (±6.5) minutes. The follow-up assessments showed a significant decrease in pain (preoperative Numerical Rating Scale (NRS): 7.5 – postoperative NRS: 1.1) (p < 0.0001) and a significant improvement in function of the thumb (preoperative DASH-Score: 46.8; Cooney-Wrist-Score: 35.4; Krimmer-Wrist-Score: 38.3 – postoperative DASH-Score: 18.1; Cooney-Wrist-Score: 73.7; Krimmer-Wrist-Score: 80.0) (p < 0.0001). Conclusion The findings of our study indicate that the presented treatment approach could be a good alternative to more invasive surgical options in patients with stage II–III CMC OA of the thumb, without impairing more invasive surgical options like trapeziectomy or arthroplasty for the future. [ABSTRACT FROM AUTHOR]

Introduction Mondor disease (MD), a superficial thrombophlebitis of the thoraco-epigastric veins and their confluents is rarely reported in the literature. The superior epigastric vein is the most affected vessel but involvement of the inferior epigastric vessels or their branches have also been described. There is no universal consensus on treatment in the literature but most authors suggest symptomatic treatment with non-steroid anti-inflammatory drugs (NSAIDs). Case report We report the case of a marathon runner who presented with right iliac fossa pain mimicking the clinical symptomatology of an acute appendicitis. The history and the calculated Alvarado score were not in favor of an acute appendicitis. This situation motivated multiple investigations and we finally arrived at the diagnosis of MD. Discussion Acute appendicitis (AA) is the most common cause of surgical emergencies and one of the most frequent indications for an urgent abdominal surgical procedure around the world. In some cases, right lower quadrant pain remains unclear in spite of US, CT scan, and exclusion of urological and gynecological causes, thus we need to think of some rare pathologies like MD. Conclusion MD is often mentioned in the differential diagnosis of breast pathologies but rarely in abdominal pain assessment. It should be mentioned in the differential diagnosis of the right lower quadrant pain when the clinical presentation is unclear and when acute appendicitis has been excluded. Awareness of MD can avoid misdiagnosis and decrease extra costs by sparing unnecessary imaging. [ABSTRACT FROM AUTHOR]

Background: The randomized BASKET-PROVE study showed no significant differences between sirolimus-eluting stents (SES), everolimus-eluting stents (EES), and bare-metal stents (BMS) with respect to the primary end point, rates of death from cardiac causes, or myocardial infarction (MI) at 2 years of follow-up, in patients requiring stenting of a large coronary artery. Clinical risk factors may affect clinical outcomes after percutaneous coronary interventions. We present a retrospective analysis of the BASKET-PROVE data addressing the question as to whether the optimal type of stent can be predicted based on a cumulative clinical risk score.Methods: A total of 2,314 patients (mean age 66 years) who underwent coronary angioplasty and implantation of ≥1 stents that were ≥3.0 mm in diameter were randomly assigned to receive SES, EES, or BMS. A cumulative clinical risk score was derived using a Cox model that included age, gender, cardiovascular risk factors (hypercholesterolemia, hypertension, family history of cardiovascular disease, diabetes, smoking), presence of ≥2 comorbidities (stroke, peripheral artery disease, chronic kidney disease, chronic rheumatic disease), a history of MI or coronary revascularization, and clinical presentation (stable angina, unstable angina, ST-segment elevation MI).Results: An aggregate drug-eluting stent (DES) group (n = 1,549) comprising 775 patients receiving SES and 774 patients receiving EES was compared to 765 patients receiving BMS. Rates of death from cardiac causes or nonfatal MI at 2 years of follow-up were significantly increased in patients who were in the high tertile of risk stratification for the clinical risk score compared to those who were in the aggregate low-mid tertiles. In patients with a high clinical risk score, rates of death from cardiac causes or nonfatal MI were lower in patients receiving DES (2.4 per 100 person-years, 95% CI 1.6-3.6) compared with BMS (5.5 per 100 person-years, 95% CI 3.7-8.2, hazard ratio 0.45, 95% CI 0.26-0.80, P = .007). However, they were not significantly different between receivers of DES and BMS in patients in the low-mid risk tertiles.Conclusions: This exploratory analysis suggests that, in patients who require stenting of a large coronary artery, use of a clinical risk score may identify those patients for whom DES use may confer a clinical advantage over BMS, beyond lower restenosis rates. [ABSTRACT FROM AUTHOR]

Background: N-Acetylcysteine (NAC) attenuates ischemia–reperfusion injury after lung transplantation in animal models. The purpose of this study is to evaluate a protective effect of NAC against acute lung rejection. Methods: Rat single-lung transplantation was performed in four groups (n = 7 per group). In NAC groups, donors and recipients received NAC 150 mg/kg per day intraperitoneally before transplantation and recipients thereafter until euthanasia. Control groups (CON) received 0.5 mL of 0.9% saline solution intraperitoneally instead of NAC. Animals were euthanized on day 1 (CON1, NAC1) or day 5 (CON5, NAC5) after transplantation. Lung tissue was assessed by histology, immunohistochemistry for CD68+/CD163+ macrophages and CD3+ T cells, immunofluorescence for interleukin 4 and interleukin 12, concentration of reduced glutathione, and activated nuclear factor-kappa B. Results: CD68+ macrophages in CON5 accumulated significantly compared with NAC5 grafts (p < 0.001). No significant difference was observed for CD163+ macrophages on day 5. T cells were significantly more frequent in NAC1 (p < 0.001), but significantly less in NAC5 (p < 0.001) compared with control groups, respectively. Interleukin 4 and interleukin 12 expression did not differ between groups. Treatment with NAC significantly influenced glutathione levels (p = 0.019) and reduced nuclear factor-kappa B activation (p = 0.034) in transplanted lungs. Conclusions: N-Acetylcysteine has the potential to attenuate acute pulmonary rejection by reduction of macrophage and T-cell infiltration, which is intimately linked to a reduced action of the nuclear factor-kappa B proinflammatory signaling pathway. In view of these observations, NAC should be considered a promising substance that could play a role in strategies for the prevention of acute rejection. [ABSTRACT FROM AUTHOR]

BACKGROUND/ OBJECTIVE: The purpose of the present study was to analyze the prevalence of physiologic and pathologic ECG abnormalities in a cohort of young conscripts that represents the whole young generation of today. METHODS: ECGs of all Swiss citizens who underwent conscription for the army during a 29-month period were analyzed manually. RESULTS: ECGs of 43,401 conscripts (mean age 19.2±1.1 years) were analyzed; 158 conscripts were female. Incomplete right bundle branch block was found in 5870 (13.5%) and left anterior fascicular block in 360 (0.83%). First-degree AV block was present in 329 (0.8%) and Mobitz type I (Wenckebach) second-degree AV block in 3 (0.01%). Early repolarization was observed in 1035 (2.4%), T-wave inversion in 39 (0.09%), and minor T-wave changes in 182 (0.42%). Brugada-like abnormalities were observed in 6 (0.01%). None of the conscripts had atrial fibrillation or flutter. CONCLUSION: ECG abnormalities can be found in a relatively large proportion of young individuals. Incomplete right bundle branch block, left fascicular block, and first-degree AV block are the most frequent findings. No conscript presented with atrial fibrillation or flutter. [Copyright &y& Elsevier]

Purpose: To analyze the anatomy and contribution of the oblique retinacular ligament (ORL) to distal interphalangeal (DIP) joint extension force with varying angles of proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joint flexion. Methods: Forty fresh-frozen fingers were dissected. The fingers were mounted in a custom jig, and the force required to flex the DIP joint was assessed with the PIP joint flexed 0°, 30°, 60°, and 90° and with the MCP joint flexed 0°, 45°, and 90°. The force was measured in the intact specimen, and then all measurements were repeated following sectioning of the ORL and then the central slip. Results: The ORL was present on the radial and ulnar aspects of all but 2 fingers. The ORL tended to be the most robust in the ring finger. In the intact specimen, DIP flexion resistance force was maximum at 30° of PIP joint flexion and minimum at 90° of PIP joint flexion. There was a significant difference between the 90° position and all other positions of the PIP joint with respect to flexion force in the intact specimen. This meant that less force was required to flex the DIP joint at 90° of PIP joint flexion. Sectioning of the ORL revealed that it contributed 25% to the total force required to flex the DIP joint with the PIP joint at 0°, 31% at 30°, 18% at 60°, and 3% at 90° of flexion. The MCP joint position had no effect. Sectioning the central slip produced a significant increase in force required to flex the DIP joint at 90° of PIP joint flexion. Conclusions: In this study, the ORL was usually present, and it contributed up to 30% of the passive resistance to DIP joint flexion. The intact central slip accounted for the decrease in DIP joint extensor tone at 90° of PIP joint flexion. Clinical relevance: The ORL plays a small role in passively resisting DIP flexion. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to assess outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) for unprotected left main (LM) disease. Background: Limited data are available on outcomes in patients with ST-segment elevation myocardial infarction undergoing LM PCI. Methods: Of 9,075 patients with ST-segment elevation myocardial infarction enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus registry between 2005 and June 30, 2010, 6,666 underwent primary PCI. Of them, 348 (5.2%; mean age: 63.5 ± 12.6 years) underwent LM PCI, either isolated (n = 208) or concomitant to PCI for other vessel segments (n = 140). They were compared with 6,318 patients (94.8%; mean age: 61.9 ± 12.5 years) undergoing PCI of non-LM vessel segments only. Results: The LM patients had higher rates of cardiogenic shock (12.2% vs. 3.5%; p < 0.001), cardiac arrest (10.6% vs. 6.3%; p < 0.01), in-hospital mortality (10.9% vs. 3.8%; p < 0.001), and major adverse cardiac and cerebrovascular events (12.4% vs. 5.0%; p < 0.001) than non-LM PCI. Rates of mortality and major adverse cardiac and cerebrovascular events were highest for concurrent LM and non-LM PCI (17.9% and 18.6%, respectively), intermediate for isolated LM PCI (6.3% and 8.3%, respectively), and lowest for non-LM PCI (3.8% and 5.0%, respectively). Rates of mortality and major adverse cardiac and cerebrovascular events for LM PCI were higher than for non-LM multivessel PCI (10.9% vs. 4.9%, p < 0.001, and 12.4% vs. 6.4%, p < 0.001, respectively). LM disease independently predicted in-hospital death (odds ratio: 2.36; 95% confidence interval: 1.34 to 4.17; p = 0.003). Conclusions: Emergent LM PCI in the context of acute myocardial infarction, even including 12% cardiogenic shock, appears to have a remarkably high (89%) in-hospital survival. Concurrent LM and non-LM PCI has worse outcomes than isolated LM PCI. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to evaluate whether platinum concentrations in chest wall tissue and in serum are optimized by intracavitary application of cisplatin loaded to a fibrin carrier compared with cisplatin solution in a randomized setting of a pig model. Methods: After left-sided pneumonectomy including parietal pleurectomy, pigs were randomly assigned to receive either 90 mg/m2 cisplatin intracavitary solution (n = 6) or to receive 5 mg cisplatin-fibrin (n = 5) applied on a predefined area of the chest wall. Platinum concentration in serum as well as in chest wall tissue was determined at several early time points until day 5 after treatment. Platinum levels were measured by inductively coupled plasma sector field mass spectrometric detection with a matrix-matched calibration procedure. Results: The dose- and surface-corrected (geometric) mean concentration of cisplatin in chest wall tissue 2 hours but also at day 5 after the application was doubled in animals treated with cisplatin-fibrin compared with the animals treated with cisplatin-solution. In serum, the dose- and surface-corrected exposure toward cisplatin (area under the curve0-5d) was significantly lower with cisplatin-fibrin than with cisplatin-solution (P < .0005). This is also reflected by significantly reduced serum creatinine and urea values in the cisplatin-fibrin group (P < .0001). Animals treated with cisplatin-fibrin additionally had a significantly better postoperative course as assessed by a well-being score (P < .001). Conclusions: After cisplatin-fibrin treatment, cisplatin tissue concentration was increased whereas systemic cisplatin concentrations were significantly reduced in comparison with cisplatin-solution treatment. This finding offers a clear advantage inasmuch as rate and severity of systemic adverse events can be reduced while local cytotoxic concentrations are at least maintained. [Copyright &y& Elsevier]

Background: Patients with left ventricular noncompaction (LVNC) have an increased risk for life-threatening ventricular arrhythmias. The benefit from implantable cardioverter-defibrillators (ICD) in these patients has been investigated only in small series. Therefore, the aim of the present study was to analyze the clinical outcome of a larger population of patients with LVNC who were treated with an ICD. Methods: Thirty patients (mean age 48 ± 14) with LVNC who underwent ICD implantation for secondary (n = 12) or primary (n = 18) prevention were included in the study. The mean follow-up period was 40 ± 34 months. Results: During follow-up, 11 patients (37%) presented with appropriate ICD therapies: three with antitachycardia pacing, four with ICD shocks, and four with both antitachycardia pacing and ICD shocks. Of these 11 patients, five received the ICD for secondary prevention and six for primary prevention. In six patients, in whom a biventricular ICD was implanted, functional New York Heart Association (NYHA) class improved from 2.5 ± 0.5 to 1.6 ± 0.8. Conclusions: In the present study, with the largest cohort of LVNC patients with ICD to date, we demonstrate that such therapy is effective in these patients with an indication for secondary or primary prevention of sudden cardiac death. However, no clinical predictors for appropriate ICD therapy could have been elaborated in these patients. Cardiac resynchronization therapy improves functional NYHA class in patients with LVNC and may hence be considered in patients with a left ventricular ejection fraction ≤35% and signs of ventricular dyssynchrony. [ABSTRACT FROM AUTHOR]

Background: Abnormally long and short QT intervals are recognized to be associated with an increased risk for life-threatening ventricular arrhythmias. It is therefore important to define the upper and lower border of the normal QT. Objective: The aim of this study was to describe the normal distribution of the QT interval in a contemporary population of young conscripts and to define long and short limits of the QT interval. Methods: In Switzerland, all young male citizens must undergo compulsory conscription for the Swiss Army at the age of 18 to 19 years. In every conscript, an electrocardiogram (ECG) is performed. Retrospectively, 41,767 consecutive ECGs of Swiss citizens who underwent conscription for the army between March 1, 2004, and July 31, 2006, were analyzed. Results: The mean QTc Bazett interval was 394 ± 22 ms. One percent of the conscripts had a Bazett QTc shorter than 347 ms, and one percent had a Bazett QTc longer than 445 ms, respectively. None of the subjects presented a QTc Bazett < 300 ms; the prevalence of a QTc Bazett < 320 ms was 0.02%. Conclusion: The present study shows the distribution of QT intervals in an unselected young population. Because none of the subjects presented a QTc < 300 ms, it may be concluded that the short QT syndrome is a very rare entity in the population of young male adults. [Copyright &y& Elsevier]

Objectives: This study aimed to evaluate the degradation rate and long-term vascular responses to the absorbable metal stent (AMS). Background: The AMS demonstrated feasibility and safety at 4 months in human coronary arteries. Methods: The PROGRESS-AMS (Clinical Performance and Angiographic Results of Coronary Stenting) was a prospective, multicenter clinical trial of 63 patients with coronary artery disease who underwent AMS implantation. Angiography and intravascular ultrasound (IVUS) were conducted immediately after AMS deployment and at 4 months. Eight patients who did not require repeat revascularization at 4 months underwent late angiographic and IVUS follow-up from 12 to 28 months. Results: The AMS was well-expanded upon deployment without immediate recoil. The major contributors for restenosis as detected by IVUS at 4 months were: decrease of external elastic membrane volume (42%), extra-stent neointima (13%), and intra-stent neointima (45%). From 4 months to late follow-up, paired IVUS analysis demonstrated complete stent degradation with durability of the 4-month IVUS indexes. The neointima was reduced by 3.6 ± 5.2 mm3, with an increase in the stent cross sectional area of 0.5 ± 1.0 mm2 (p = NS). The median in-stent minimal lumen diameter was increased from 1.87 to 2.17 mm at long-term follow-up. The median angiographic late loss was reduced from 0.62 to 0.40 mm by quantitative coronary angiography from 4 months to late follow-up. Conclusions: Intravascular ultrasound imaging supports the safety profile of AMS with degradation at 4 months and maintains durability of the results without any early or late adverse findings. Slower degradation is warranted to provide sufficient radial force to improve long-term patency rates of the AMS. [Copyright &y& Elsevier]

Abstract: Background: Despite its shortcomings, ejection fraction (EF) is widely used to detect left ventricular systolic dysfunction (LVSD) as has prolonged QRS duration as indirect evidence of LVSD. However, acoustic cardiography provides other parameters for detecting LVSD without these limitations. One parameter, the electromechanical activation time (EMAT), is prolonged in LVSD. We compared the abilities of acoustic cardiography, EF, and QRS duration to detect LVSD. Methods and Results: We studied a sample of 108 patients who underwent elective diagnostic cardiac catheterization. The diagnostic findings included left ventricular filling pressures, angiographic EF, and maximum left ventricular dP/dt. We defined LVSD as a maximum left ventricular dP/dt of <1600 mm Hg/s. At thresholds of 35% and 50% to detect LVSD, the sensitivities of angiographic EF were 39% and 74%; specificities were 89% and 70%, respectively. At QRS duration thresholds of 100 and 120 ms, sensitivities were 63% and 35%; specificities, 63% and 89%, respectively. At thresholds of 100 and 110 ms, EMAT had sensitivities of 53% and 42%, and specificities of 90% and 100%, respectively. EMAT performed better than LV EF or QRS duration in hemodynamic subgroups. Conclusions: Acoustic cardiography is a convenient, automated diagnostic method whose performance for detecting LVSD exceeds both angiographic EF and QRS duration alone. [Copyright &y& Elsevier]

Background: Based on a subgroup analysis of 18-month BAsel Stent Kosten Effektivitäts Trial (BASKET) outcome data, we hypothesized that very late (>12 months) stent thrombosis occurs predominantly after drug-eluting stent implantation in large native coronary vessel stenting. Methods: To prove or refute this hypothesis, we set up an 11-center 4-country prospective trial of 2260 consecutive patients treated with ≥3.0-mm stents only, randomized to receive Cypher (Johnson & Johnson, Miami Lakes, FL), Vision (Abbott Vascular, Abbott Laboratories, IL), or Xience stents (Abbott Vascular). Only patients with left main or bypass graft disease, in-stent restenosis or stent thrombosis, in need of nonheart surgery, at increased bleeding risk, without compliance/consent are excluded. All patients are treated with dual antiplatelet therapy for 12 months. The primary end point will be cardiac death/nonfatal myocardial infarction after 24 months with further follow-up up to 5 years. Results: By June 12, 229 patients (10% of the planned total) were included with a baseline risk similar to that of the same subgroup of BASKET (n = 588). Conclusions: This study will answer several important questions of contemporary stent use in patients with large native vessel stenting. The 2-year death/myocardial infarction—as well as target vessel revascularization—and bleeding rates in these patients with a first- versus second-generation drug-eluting stent should demonstrate the benefit or harm of these stents compared to cobalt-chromium bare-metal stents in this relevant, low-risk group of everyday patients. In addition, a comparison with similar BASKET patients will allow to estimate the impact of 12- versus 6-month dual antiplatelet therapy on these outcomes. [Copyright &y& Elsevier]

Abstract: Background: The purpose of this pilot study was to determine the utility of acoustic cardiography for the optimization of atrioventricular (AV) and interventricular (VV) delays in cardiac resynchronization therapy (CRT). Methods and Results: We evaluated 14 patients (86% male, mean age 64 ± 9 years, mean time since implant 15 ± 18 months). Subjects were enrolled >10 weeks after CRT implant. Spiroergometry and 2-dimensional/3-dimensional echocardiography were used to assess cardiac performance for “out-of-the-box” settings (baseline settings: AV 120 ms, VV 0 ms) versus optimal settings (determined by acoustic cardiography). Cardiac performance measurements were performed 6 weeks after settings were modified. Optimal AV/VV settings were determined based on the lowest electromechanical activation time (EMAT, the time from the onset of QRS to the mitral valve component of the first heart sound). Statistical analysis was performed using a paired 2-tailed Student''s t-test. In comparison to “out-of-the-box” settings, AV/VV delay optimization with acoustic cardiography improved cardiac performance as indicated by significant changes in work capacity, maximum oxygen uptake, oxygen pulse, ejection fraction, end-systolic volume, and velocity-time integral in left ventricular outflow tract. Conclusions: AV and VV optimization by acoustic cardiography produces significant improvements in objective clinical and hemodynamic parameters in comparison to typical “out-of-the-box” settings. [Copyright &y& Elsevier]

Synchronized Diaphragmatic Stimulation (SDS) produces localized diaphragmatic contractions gaited to the cardiac cycle that transiently modulate intra-thoracic pressure, thereby affecting ventricular preload and afterload. This study prospectively evaluated the safety and effectiveness of delivering SDS therapy in HFrEF (NCT03484780). Chronic SDS therapy improves symptoms, exercise capacity and hemodynamics in patients with HFrEF. Symptomatic patients with an LVEF<= 35% who were in sinus rhythm, but did not have ventricular dyssynchrony, underwent laparoscopic implantation of the VisONE SDS system, comprising an implantable pulse generator and leads affixed to the inferior side of the diaphragm. Other exclusion criteria included severe COPD and contraindications to laparoscopy. Therapy was programmed to deliver SDS at imperceptible outputs. Patients were followed at 1, 3, 6 and 12-months to observed effects on symptoms, quality of life (SF36), exercise capacity (6-minute walk test), cardiac function (echocardiography) and safety. Nineteen patients were screened and 15 men (60 [56, 67] years, LV EF 27 [23, 33] %, 100% ischemic etiology, NYHA class II [53%] / III [47%], QRSd 117 [100, 125] ms, NT-proBNP 1779 [911, 2072] pg/ml) were enrolled and successfully implanted. For all patients, a threshold SDS stimulus that caused imperceptible localized diaphragmatic contraction could be identified. All patients were discharged without therapy-related complications. No procedure or therapy related AEs occurred through 12 months. Between discharge with SDS off and SDS on at 3, 6 and 12 months, improvements were seen in exercise capacity, SF-36 and LVEF with larger effects when diaphragmatic synchronization was >80% (Figure). These encouraging effects on symptoms and exercise capacity should now be investigated in adequately powered randomized trials. [ABSTRACT FROM AUTHOR]

Asymptomatic Diaphragmatic Stimulation (ADS) is a novel device-based HF therapy under investigation. Prior studies have shown that ADS transiently modulates intrathoracic pressure, thereby reducing intra-cardiac pressures and increasing stroke volume. Chronic ADS therapy using a novel system delivered via a trans-abdominal laparoscopic approach improves heart failure function and exercise tolerance in patients with HFrEF but without ventricular dyssynchrony. Patients with moderately severe symptoms, LVEF ≤35% but no evidence of ventricular dyssynchrony underwent laparoscopic implantation of the VisONE ADS system (NCT03484780). Post implant in-clinic tests were conducted to determine the acute effects of ADS on cardiac function at stimulation levels imperceptible to the patient. At discharge, therapy was programmed to chronically deliver ADS. Patients will be followed for 12 months to assess measures of cardiac function, HF status, diaphragmatic function, and standard safety measures. Baseline and one month data are reported as median [IQR]. Fifteen men (60 [56, 67] years, EF 27 [23, 33] %, NYHA class II (53%)/III (47%), 100% sinus rhythm) received implants. Temporary activation of ADS post implant while conscious increased CO (4.8 [4.0, 5.4] vs. 5.7 [4.5, 5.9] l/min, p<0.01, n=14) without change in HR. The time from implant to hospital discharge was 3.3 ± 2.4 days. All patients were discharged without therapy-related complications with ADS turned on at a confirmed imperceptible pacing output. At 1 month, 1 SAE (mild) and 3 AEs (1 mild, 1 moderate, 1 severe) were reported on 3 patients; none were device related. Between discharge with ADS off and one month with ADS on, SBP (123 [115, 127] vs. 122 [110, 140] mmHg, p=NS) did not change while heart rate fell (79 [74, 86] vs. 68 [64, 78] bpm, p<0.05). LVEF increased (26 [22, 38] vs. 30 [26, 43] %, p<0.05, n=11), while LVEDVI (183 [175, 221] vs. 193 [174, 225] ml/m2, p=NS, n=11) and NT-proBNP (1020 [858, 2068] vs. 1280 [898, 2001] pg/ml, p=NS) were unchanged but 6MWTD improved (315 [300, 330] vs. 323 [320, 337] m, p< 0.05) and LA Vol tended to decrease (84 [59, 101] vs. 66 [58, 101] ml, p=NS, n=13). These data suggest that the ADS system can be implanted safely with a short in-hospital stay. Acute improvements to cardiac output and key measures of heart failure after 1 month without ADS related events are encouraging. Further investigation of ADS in randomized clinical trials should be considered. [ABSTRACT FROM AUTHOR]

Background The tradeoff between stent thrombosis (ST) and major bleeding (MB) of 12- versus 6-month dual antiplatelet therapy (DAPT) after coronary stent implantation has not been clearly defined. Methods Definite/probable ST and MB (TIMI major and Bleeding Academic Research Consortium (BARC) ≥3) were compared in 2 subsequent trials with similar inclusion criteria but different DAPT duration, that is, BASKET (6 months; n = 557) and BASKET-PROVE (12 months; n = 2,314), between months 0 to 6 (DAPT in both trials), 7 to 12 (DAPT in BASKET-PROVE only), and 13 to 24 (aspirin in both trials) using propensity score-adjusted, time-stratified Cox proportional hazard models. Results Overall, event rates were low with fewer ST but similar MB in prolonged DAPT. Analysis of the 3 periods showed a uniform pattern for ST (interaction DAPT/period; P = .145) but an inconsistent pattern for MB (interaction DAPT/period; P < .001 for TIMI major and P = .046 for BARC ≥3), with more MB occurring during months 7 to 12 with prolonged DAPT. Considering observed case fatality rates of 31% with ST and 11% with MB, the extrapolated prevention of 27 ST deaths and the excess of 5 MB deaths resulted in an expected benefit of 22 survivors/10,000 patients treated over 2 years with prolonged DAPT. Conclusion Despite overall low event rates, prolonged DAPT was associated with more MB during months 7 to 12 according to the interaction DAPT/period. Given the higher observed case fatality rates of ST versus MB, 12- versus 6-month DAPT was associated with an extrapolated reduction in mortality. Effective treatment periods and case fatality rates seem important in the analysis of different DAPT durations, specifically with regard to ongoing trials. [ABSTRACT FROM AUTHOR]

Study objective: We evaluate changes in endotracheal tube intracuff pressures among intubated patients during aeromedical transport. We determine whether intracuff pressures exceed 30 cm H2O during aeromedical transport. Methods: During a 12-month period, a helicopter-based rescue team prospectively recorded intracuff pressures of mechanically ventilated patients before takeoff and as soon as the maximum flight level was reached. With a commercially available pressure manometer, intracuff pressure was adjusted to ≤25 cm H2O before loading of the patient. The endpoint of our investigation was the increase of endotracheal tube cuff pressure during helicopter transport. Results: Among 114 intubated patients, mean altitude increase was 2,260 feet (95% confidence interval [CI] 2,040 to 2,481 feet; median 2,085 feet; interquartile range [IQR] 1,477.5 to 2,900 feet). Mean flight time was 14.8 minutes (95% CI 13.1 to 16.4 minutes; median 13.5 minutes; IQR 10 to 16.1 minutes). Intracuff pressure increased from 28.7 cm H2O (95% CI 27.0 to 30.4 cm H2O [median 25 cm H2O; IQR 25 to 30 cm H2O]) to 62.6 cm H2O (95% CI 58.8 to 66.5 cm H2O; median 58; IQR 48 to 72 cm H2O). At cruising altitude, 98% of patients had intracuff pressures ≥30 cm H2O, 72% had intracuff pressures ≥50 cm H2O, and 20% even had intracuff pressures ≥80 cm H2O. Conclusion: Endotracheal cuff pressure during transport frequently exceeded 30 cm H2O during aeromedical transport. Hospital and out-of-hospital practitioners should measure and adjust endotracheal cuff pressures before and during flight. [Copyright &y& Elsevier]