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a new percutaneous edge-to-edge mitral valve repair (PMVR) has been developed over the past few years. The clip is deliverable using the transseptal approach. Combined fluoroscopic and echocardiographic guidance have been used to properly monitor the device position in the left atrium so that it can

Fur die Beurteilung des Schweregrades der rechtsventrikularen Druckuberlastung im Frankschen Vektorkardiogramm (VKG) bei der primar vaskularen pulmonalen Hypertonie (PPH) fehlen sichere Kriterien, da bis heute keine Untersuchungen uber ein groseres Krankengut von Erwachsenen bei isolierter rechtsventrikularer Druckbelastung vorliegen. Durch die in den letzten Jahren beobachtete Haufung der PPH, wahrscheinlich im Zusammenhang mit der Einnahme des Appetitzuglers Aminorex (2, 4), ist eine Analyse dieses Problems moglich geworden. Grundlage dieser Untersuchung bilden 77 Patienten mit PPH, 39 nach Einnahme von Aminorex, bei welchen ein Rechtsherzkatheterismus sowie ein VKG nach Frank durchgefuhrt wurde. 32 dieser Patienten wurden zum Teil mehrmals nachkontrolliert. Anhand dieses Krankengutes soll die Aussagekraft des VKGs mit derjenigen der Hamodynamik verglichen und der Wert der beiden Untersuchungsmethoden bezuglich der Prognose der PPH gepruft werden.

Background —Inflammation is an important component of ischemic heart disease. PTX3 is a long pentraxin whose expression is induced by cytokines in endothelial cells, mononuclear phagocytes, and myocardium. The possibility that PTX3 is altered in patients with acute myocardial infarction (AMI) has not yet been tested. Methods and Results —Blood samples were collected from 37 patients admitted to the coronary care unit (CCU) with symptoms of AMI. PTX3 plasma concentrations, as measured by ELISA, higher than the mean+2 SD of age-matched controls (2.01 ng/mL) were found in 27 patients within the first 24 hours of CCU admission. PTX3 peaked at 7.5 hours after CCU admission, and mean peak concentration was 6.94±11.26 ng/mL. Plasma concentrations of PTX3 returned to normal in all but 3 patients at hospital discharge and were unrelated to AMI site or extent, Killip class at entry, hours from symptom onset, and thrombolysis. C-reactive protein peaked in plasma at 24 hours after CCU admission, much later than PTX3 ( P 64 years old and women had significantly higher PTX3 concentrations at 24 hours ( P Conclusions —PTX3 is present in the intact myocardium, increases in the blood of patients with AMI, and disappears from damaged myocytes. We suggest that PTX3 is an early indicator of myocyte irreversible injury in ischemic cardiomyopathy.

A recent randomized, controlled trial, the Fifth Organization to Assess Strategies in Acute Ischemic Syndromes (OASIS 5) trial, reported that major bleeding was 2-fold less frequent with fondaparinux than with enoxaparin in acute coronary syndromes (ACS). Renal dysfunction increases the risk for major bleeding.To compare the efficacy and safety of fondaparinux and enoxaparin over the spectrum of renal dysfunction observed in the OASIS 5 trial.Subgroup analysis of a randomized, controlled trial.Patients presenting to the hospital with non-ST-segment elevation ACS.19,979 of the 20,078 patients in the OASIS 5 trial in whom creatinine was measured at baseline.Death, myocardial infarction, refractory ischemia, and major bleeding were evaluated separately and as a composite end point at 9, 30, and 180 days. Glomerular filtration rate (GFR) was calculated by using the Modification of Diet in Renal Disease formula.The absolute differences in favor of fondaparinux (efficacy and safety) were most marked in patients with a GFR less than 58 mL/min per 1.73 m2; the largest differences occurred in major bleeding events. At 9 days, death, myocardial infarction, or refractory ischemia occurred in 6.7% of patients receiving fondaparinux and 7.4% of those receiving enoxaparin (hazard ratio, 0.90 [95% CI, 0.73 to 1.11]); major bleeding occurred in 2.8% and 6.4%, respectively (hazard ratio, 0.42 [CI, 0.32 to 0.56]). Statistically significant differences in major bleeding persisted at 30 and 180 days. The rates of the composite end point were lower with fondaparinux than with enoxaparin in all quartiles of GFR, but the differences were statistically significant only among patients with a GFR less than 58 mL/min per 1.73 m2.Subgroup analyses warrant caution; the study was powered to detect noninferiority at 9 days. Fondaparinux is not approved for use in patients with ACS in the United States.The benefits of fondaparinux over enoxaparin when administered for non-ST-segment elevation ACS are most marked among patients with renal dysfunction and are largely explained by lower rates of major bleeding with fondaparinux.

Background: Acute myocardial infarction in younger patients is uncommon, occurring mainly in men. The recent introduction of thrombolysis improved survival, left ventricular function, and infarct size. Objective: To evaluate characteristics and clinical outcome of the patients younger than 50 years randomized in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico study. All patients received a thrombolytic treatment. Methods: The 11 483 patients were divided into 3 age subgroups: younger than 50 years (17.2%), between 50 and 70 years (60.2%), and older than 70 years (22.6%). All relations between variables were first determined by an unadjusted analysis. An adjusted analysis was performed by multiple logistic regression models for inhospital and 6-month mortality. Results: While older patients had a significantly higher rate of a history of hypercholesterolemia, diabetes, and hypertension, smoking and a positive family history were significantly more frequent in younger patients. Total inhospital and 6-month mortality were significantly lower in patients younger than 50 years (2.7% and 1.2%, respectively) than in patients between 50 and 70 years old (6.9% and 2.7%) and those older than 70 years (21.1% and 8.4%). After multivariate analysis, the predictive value of age was confirmed. Conclusions: Our findings, based on a large group of patients who received thrombolytic treatment, suggest that younger age is a significant independent indicator of a favorable prognosis after acute myocardial infarction. Arch Intern Med. 1997;157:865-869

The TRACER trial compared vorapaxar, a novel oral PAR-1 antagonist, with placebo, as add-on therapy to standard of care, among 12944 NSTE ACS patients who were predominantly treated with aspirin and clopidogrel. While vorapaxar was associated with a significant increase in major bleeding in the