Search

Objectives To perform a meta-analysis including all available randomized controlled trials (RCTs) to date comparing transcatheter aortic valve replacement (TAVR) to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) and low surgical risk. Background Current guidelines recommend SAVR for patients with severe symptomatic AS and low surgical risk. A few RCTs have evaluated TAVR in low surgical risk patients but equipoise exists related to TAVR valve durability, paravalvular leak (PVL) and role of TAVR in younger, low surgical risk patients. Methods Five databases were analyzed from January-2000 to March-2019 for RCTs comparing SAVR to TAVR in low-risk severe AS patients. Results Four RCTs on low-risk TAVR patients with 2887 patients were included. Mean follow-up was ~24.1 ± 24 months. Early mortality was lower with TAVR compared to SAVR (RR: 0.44, 95% CI: 0.20–0.95, P = 0.038) whereas long-term mortality was similar (RR: 0.67, 95% CI: 0.39–1.14, P = 0.141). Both early and long-term stroke rates were similar. TAVR was associated with lower risk of atrial fibrillation, major bleeding, acute kidney injury (AKI) and rehospitalization, but higher rates of permanent pacemaker implantation (PPM) and moderate or severe PVL. There was no difference in major vascular complications, myocardial infarction, endocarditis, aortic valve gradients and valve area at follow-up. Conclusions In low-risk patients with severe AS, TAVR has a lower early mortality compared to SAVR with no difference in long-term mortality. Although complication rates varied between TAVR and SAVR, our study findings suggest that transfemoral-TAVR is an appropriate treatment option for severe symptomatic AS in patients with low surgical risk.

Infective endocarditis (IE) is the infection of the endocardial surface of the heart, native valves, prosthetic valves, and indwelling cardiac devices. IE can result in injury to multiple organ systems of the body and is associated with high mortality and morbidity unless treated early and properly. IE was described as early as 16th century. In 1885, Sir William Osler described this disease as malignant endocarditis in Gulstonian lectures. Since that time the pattern of this disease has continuously changed.

Current guidelines recommend surgical aortic valve replacement (SAVR) for patients with severe symptomatic aortic stenosis (AS) and low surgical risk. A few randomized controlled trial (RCTs) have evaluated transcatheter aortic valve replacement (TAVR) in patients at low surgical risk, but equipoise

A 73-year-old male underwent cardiac catheterization and received two Everolimus drug eluting stents for 80 % stenotic lesions in the left anterior descending and right coronary arteries. He was discharged on aspirin and ticagrelor. He started noticing progressive multiple painful hemorrhagic bullae on the palms of both hands. Biopsy showed lesions consistent with Sweet Syndrome (SS). He was started on steroids and ticagrelor was switched to Clopidogrel with improvement in rash without recurrence. SS is an inflammatory disorder characterized by the abrupt appearance of painful, edematous, and erythematous lesions on the skin. This is the first reported case of SS associated with ticagrelor.

A high serum chloride concentration has been associated with the development of acute kidney injury in critically ill patients. However, the association between hyperchloremia and acute kidney injury (AKI) in patients admitted with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) is unknown. A retrospective analysis of consecutive patients admitted with the diagnosis of STEMI and treated with PCI was performed. Subjects were classified as having hyper- or normochloremia based upon their admission serum chloride level. Multivariable logistic regression analyses were employed for the primary and secondary outcomes. The primary analysis evaluated whether high serum chloride on admission was associated with the development of AKI after adjusting for age, diabetes mellitus, admission systolic blood pressure, contrast volume used during angiography, Killip class, and need for vasopressor therapy or intraaortic balloon pump. The secondary analyses evaluated whether high serum chloride was associated with sustained ventricular tachycardia or fibrillation. Of 291 patients (26.1% female, mean age of 59.9 ± 12.6 years, and mean body mass index of 29.3 ± 6.1 kg/m(2)), 25 (8.6%) developed AKI. High serum chloride on admission did not contribute significantly to the development of AKI (odds ratio, 95%; confidence interval, 0.90 to 1.24). In addition, serum chloride on admission was not significantly associated with sustained ventricular tachycardia or fibrillation after adjusting for demographic and clinical covariates. In conclusion, our study demonstrated no association between baseline serum hyperchloremia and an increased risk of AKI in patients admitted with STEMI treated with PCI.

Introduction: Overt hyperthyroidism is a well-known risk factor for development of atrial fibrillation (AF). On the other hand, studies assessing risk of AF in patients with subclinical hyperthyroidism (SCH), have reported conflicting results on the directionality and the strength of this association. We therefore systematically reviewed published literature and performed a quantitative analysis to assess the risk of AF in these patients. Methods: A comprehensive search of articles assessing the risk of AF in patients with SCH was done in PUBMED and COCHRANE databases through May 2015. SCH was defined as decreased Thyroid stimulating hormone (TSH) level accompanied by normal concentrations of serum thyroid hormone in asymptomatic patients. After screening abstracts, full texts of potentially relevant studies were reviewed independently by two authors. Data was extracted on standardized forms. Meta-analysis was performed using random effects model (DerSimonian Laird). The main measure of association was relative risk with 95% confidence intervals. Results: A total of 7119 patients with SCH and 588,839 controls across 4 studies were included in the analysis based on predefined inclusion and exclusion criteria. The relative risk for AF was significantly increased in patients with SCH compared to controls [relative risk: 2.48 (CI: 1.50-4.09; p< 0.001)] during a mean follow up of 5.5 years. There was no significant heterogeneity or publication bias. Sensitivity analysis by exclusion of individual studies had no impact on the summary effect estimate. One study reviewed but not included in the quantitative analysis demonstrated increased risk of AF in patients with low normal TSH compared to mid normal range. Conclusion: This analysis demonstrates that the risk of AF is >2 fold higher in the presence of SCH. It remains to be seen whether treatment of these patients before development of overt hyperthyroidism decreases the risk of AF.

Non sustained Ventricular arrhythmias (NSVA) are frequently noted in patients admitted with acute decompensated diastolic heart failure. However, the long term predictive value of NSVA in this setting is unclear. The objective was to elucidate the burden of ventricular arrhythmias in patients

We present a case of reversible stress cardiomyopathy in a surgical patient, described here as a forme fruste due to its atypical features. It is important to recognize such unusual presentation of stress cardiomyopathy that mimics acute coronary syndrome. Stress cardiomyopathy commonly presents as acute coronary syndrome and is characterized by typical or atypical variants of regional wall motion abnormalities. We report a 60-year-old Caucasian male with reversible stress cardiomyopathy following a sternal fracture fixation. Although the patient had several typical features of stress cardiomyopathy including physical stress, ST-segment elevation, elevated cardiac biomarkers and normal epicardial coronaries, there were few features that were atypical, including unusual age, gender, absence of regional wall motion abnormalities, high lateral ST elevation, and high troponin-ejection fraction product. In conclusion, this could represent a forme fruste of stress cardiomyopathy.

Transradial approach to coronary interventions is associated with improved patient outcomes. However, there is scarcity of studies evaluating the feasibility of radial approach to high-speed rotational coronary atherectomy (HSRCA) due to various technical reasons. Thus further studies are needed to

A 79-year-old Caucasian man presented with multiple leg abscesses due to Nocardia pseudobrasiliensis. He was on chronic steroid therapy for myasthenia gravis. We present the difficulties in diagnosis and treatment of this rare organism. N. pseudobrasiliensis is a new emerging species that was previously thought to belong to the N. brasiliensis species. The distinction between the two species is extremely important given the different antibiotic susceptibility pattern and association of N. pseudobrasiliensis with more invasive and disseminated disease.