Search

Background The impact of left atrial appendage (LAA) exclusion, comparing an epicardial LAA or an endocardial LAA device, on systemic homeostasis remains unknown. Objectives This study compared the effects of epicardial or endocardial LAA devices on the neurohormonal profiles of patients, emphasizing the roles of the renin-angiotensin-aldosterone system and the autonomic nervous system. Methods This is a prospective, single-center, observational study including 77 patients who underwent LAA closure by an epicardial (n = 38) or endocardial (n = 39) device. Key hormones involved in the adrenergic system (adrenaline, noradrenaline), renin-angiotensin-aldosterone system (aldosterone, renin), metabolic system (adiponectin, free fatty acids, insulin, β-hydroxybutyrate, and free glycerols), and natriuresis (atrial and B-type natriuretic peptides) were assessed immediately before the procedure, immediately after device deployment, at 24 h, and at 3 months follow-up. Results In the epicardial LAA device group, when compared with baseline blood adrenaline, noradrenaline and aldosterone were significantly lower at 24 h and 3 months (p Conclusions There are substantial differences in hemodynamics and neurohormonal effects of LAA exclusion with epicardial and endocardial devices. Further studies are required to elucidate the underlying mechanism of these physiological changes.

The impact of left atrial appendage (LAA) exclusion, comparing an epicardial LAA or an endocardial LAA device, on systemic homeostasis remains unknown.This study compared the effects of epicardial or endocardial LAA devices on the neurohormonal profiles of patients, emphasizing the roles of the renin-angiotensin-aldosterone system and the autonomic nervous system.This is a prospective, single-center, observational study including 77 patients who underwent LAA closure by an epicardial (n = 38) or endocardial (n = 39) device. Key hormones involved in the adrenergic system (adrenaline, noradrenaline), renin-angiotensin-aldosterone system (aldosterone, renin), metabolic system (adiponectin, free fatty acids, insulin, β-hydroxybutyrate, and free glycerols), and natriuresis (atrial and B-type natriuretic peptides) were assessed immediately before the procedure, immediately after device deployment, at 24 h, and at 3 months follow-up.In the endocardial LAA device group, when compared with baseline blood adrenaline, noradrenaline and aldosterone were significantly lower at 24 h and 3 months (p 0.05). There was no significant change in levels post-endocardial LAA device implantation. After epicardial LAA device implantation, there were significant increases in adiponectin and insulin, with decreased free fatty acids at 3 months. There was no significant change in these levels post-endocardial LAA device. N-terminal pro-A-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide were significantly decreased in the acute phase after epicardial LAA device implantation, which subsequently normalized at 3 months. Post endocardial LAA device implantation, the levels increased immediately and normalized after 24 h. Systemic blood pressure was also significantly lower at all time points after epicardial LAA device implantation, which was not seen post-endocardial LAA device implantation.There are substantial differences in hemodynamics and neurohormonal effects of LAA exclusion with epicardial and endocardial devices. Further studies are required to elucidate the underlying mechanism of these physiological changes.

Atrial fibrillation and flutter are well known causes of stroke. Whether other atrial arrhythmias like paroxysmal supraventricular tachycardia (PSVT) is associated with stroke is not clear. We aimed to evaluate the association of PSVT with ischemic and embolic stroke and its impact on short term

Objectives The purpose of this study was to examine the impact of yoga on atrial fibrillation (AF) burden, quality of life (QoL), depression, and anxiety scores. Background Yoga is known to have significant benefit on cardiovascular health. The effect of yoga in reducing AF burden is unknown. Methods This single-center, pre-post study enrolled patients with symptomatic paroxysmal AF with an initial 3-month noninterventional observation period followed by twice-weekly 60-min yoga training for next 3 months. AF episodes during the control and study periods as well as SF-36, Zung self-rated anxiety, and Zung self-rated depression scores at baseline, before, and after the study phase were assessed. Results Yoga training reduced symptomatic AF episodes (3.8 ± 3 vs. 2.1 ± 2.6, p Conclusions In patients with paroxysmal AF, yoga improves symptoms, arrhythmia burden, heart rate, blood pressure, anxiety and depression scores, and several domains of QoL. (Yoga on Arrhythmia Burden and Quality of Life in Paroxysmal Atrial Fibrillation; NCT00798356 )

ObjectivesThis study sought to examine whether suppressing premature ventricular contractions (PVC) using radiofrequency ablation improves effectiveness of the cardiac resynchronization therapy (CRT) in nonresponders.BackgroundCRT is an effective strategy for drug refractory congestive heart failure. However, one-third of patients with CRT do not respond clinically, and the causes for nonresponse are poorly understood. Whether frequent PVC contribute to CRT nonresponse remains unknown.MethodsIn this multicenter study, CRT nonresponders with >10,000 PVC in 24 h who underwent PVC ablation were enrolled from a prospective database.ResultsSixty-five subjects (age 66.6 ± 12.4 years, 78% men, QRS duration of 155 ± 18 ms) had radiofrequency ablation of PVC from 76 foci. Acute and long-term success rates of ablation were 91% and 88% in 12 ± 4 months of follow-up. There was significant improvement in left ventricular (LV) ejection fraction (26.2 ± 5.5% to 32.7 ± 6.7 %, p < 0.001), LV end-systolic diameter (5.93 ± 0.55 cm to 5.62 ± 0.32 cm, p < 0.001), LV end-diastolic diameter (6.83 ± 0.83 cm to 6.51 ± 0.91 cm, p < 0.001), LV end-systolic volume (178 ± 72 to 145 ± 23 ml, p < 0.001), LV end-diastolic volume (242 ± 85 ml to 212 ± 63 ml, p < 0.001), and median New York Heart Association functional class (3.0 to 2.0, p < 0.001). Modeling of pre-ablation PVC burden revealed an improvement in ejection fraction when the pre-ablation PVC burden was >22% in 24 h.ConclusionsFrequent PVC is an uncommon yet significant cause of CRT nonresponse. Radiofrequency ablation of PVC foci improves LV function and New York Heart Association class and promotes reverse remodeling in CRT nonresponders. PVC ablation may be used to enhance CRT efficacy in nonresponders with significant PVC burden.

The effect of dual antiplatelet therapy (DAPT) or oral anticoagulation on long term incidence of acute coronary syndromes (ACS) in patients with coronary artery ectasia (CAE) and no significant occlusive CAD is not well known. We retrospectively analyzed 317 consecutive cases of CAE. CAE patients

Randomized controlled trials (RCTs) of bone marrow cell (BMC) therapy in patients with ischemic heart disease (IHD) have yielded variable results. This discrepancy has been partially attributed to the utilization of dissimilar cardiac imaging modalities. Magnetic resonance imagining (MRI) assessment

Randomized controlled trials (RCTs) evaluating the efficacy of bone marrow cells (BMCs) in patients with acute myocardial infarction (AMI) have yielded discordant results. These discrepant results may potentially be attributed to use of different cardiac imaging techniques. Most studies have

The relationship of serum lipid levels, aggressive statin use and progression of carotid stenosis (CS) severity has not been well studied. We assessed the correlation between aggressive risk modification, statin use, and lipid levels with progression of carotid artery stenosis and incidence of

Noncanonical Wnt11 signaling plays a key role in heart development. Very little is known about Wnt11 signaling in cardiomyocyte survival. We hypothesized that exposure to Wnt11 will induce a cytoprotective program and promote cardiomyocyte survival against oxidative stress. The effects of Wnt11 on

Recent studies have shown that prolonged rhythm monitoring results in increased detection of atrial fibrillation (AF) in patients with cryptogenic stroke (CS). We performed a systematic review and meta-analysis of all the randomized control trials (RCTs) that used prolonged rhythm monitoring

The molecular details of nuclear factor-kappaB (NF-kB) signaling during myocardial ischemia/reperfusion (I/R) injury remain poorly understood. We hypothesized that inhibition of NF-kB would prevent cell death. We used transgenic mice overexpressing a mutant IkBα with consequent cardiac-specific

Acute kidney injury (AKI) is common during high-risk percutaneous coronary intervention (PCI) with high-risk clinical and anatomic features, particularly in patients with low ejection fractions (EF). This retrospective, single-center study tested the hypothesis that the Impella 2.5 protects against

Objectives The goal of this study was to investigate the effect of three different doses of acetylsalicylic acid (aspirin) (ASA) on the late phase of ischemic preconditioning (PC) against myocardial stunning. Background Although recent evidence indicates that the late phase of ischemic PC is mediated by cyclooxygenase-2 (COX-2), the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) that inhibit COX-2 activity on late PC has not been evaluated; ASA is the most widely used NSAID. Therefore, we determined whether ASA impedes the development of late PC. Methods Conscious rabbits underwent a protocol consisting of three days of six 4-min coronary occlusion/4-min reperfusion cycles. Results Neither 5 mg/kg nor 10 mg/kg × 3 of ASA interfered with the protective effects of late PC against stunning. In contrast, the late PC effect was completely abrogated by 25 mg/kg of ASA. Low-dose (5 mg/kg) ASA effectively inhibited platelet aggregation but did not prevent the increase in COX-2 activity, whereas the highest dose (25 mg/kg) completely blocked COX-2 activity. Conclusions The administration of ASA either at antithrombotic doses (5 mg/kg), which are widely used to prevent cardiovascular events in patients, or at analgesic/antipyretic doses (10 mg/kg) does not interfere with the cardioprotective effects of late PC against myocardial stunning. In contrast, high doses of ASA (25 mg/kg), which are used as antirheumatic therapy, abrogate both COX-2 activity and late PC, suggesting that nonselective doses of NSAIDs should be used with caution in patients with atherosclerotic cardiovascular disease because they may deprive the heart of its innate defensive response.

Background: Both ankle brachial index (ABI) and hemoglobin A1c (A1c) are independently associated with mortality. The combination of ABI and A1c with all-cause and cardiovascular (CV) mortality has not been examined. Methods: We followed 1,813 participants from NHANES for 11.5 years (median). We

Background: In patients with congestive heart failure (CHF), right heart catheterization (RHC) is recommended in certain situations. However, there remains uncertainty of its impact on mortality and other clinical outcomes. Methods: A secondary analysis of the United States National Inpatient

Background: Current guidelines discourage aortic stenosis (AS) evaluation by direct pressure measurement if echocardiography (echo) is adequate. However several studies show sizable differences between echo and catheterization (cath) lab measurements. Dobutamine Challenge is recommended for

Objectives: To assess the utility of CHADS2 score to predict the outcomes of pulmonary vein antral isolation (PVAI) in patients with atrial fibrillation (AF). Background: The CHADS2 score is a clinical classification scheme used for predicting stroke in patients (pts) with AF. In the current study

Background: Synthetic boron based hepatocyte growth factor memetic (HGF-m) may have a ischemic preconditioning effect on cardiomyocytes. Methods: Freshly isolated adult cardiomyocytes (ACM) were incubated overnight with/or without different concentrations of HGF-m. The cells were then subjected to

Background: Current guidelines discourage aortic stenosis (AS) evaluation by direct pressure measurement if echocardiography (echo) is adequate. However several studies show sizable discrepancies between echo and catheterization (cath) lab measurements. We wanted to investigate the impact of both

Background: Peripheral arterial disease (PAD) is a risk factor for increased long term mortality following heart transplantation (HT). However, data on the incidence of adverse events, length of hospitalization immediately following HT and long term graft survival time in patients with PAD is

Left atrial appendage (LAA) isolation is known to be an important adjunctive therapy to improve outcomes of pulmonary vein isolation in patients with persistent AF. Percutaneous endo-epicardial LAA closure system (LARIAT) can result in both mechanical and electrical exclusion of the LAA and may

The birth of modern science was ushered in by the great intellectual revolution that occurred during the Renaissance, when irreverent thinkers began to question centuries-old dogmas imposed on the populace by an establishment of savants intent on maintaining their supremacy. The proclivity of

There is paucity of information with regard to current management practice and in-hospital outcomes in HIV seropositive patients presenting with acute ST-segment elevation myocardial infarction (STEMI). A secondary analysis of the national inpatient sample (NIS) database from 2008-2012 was

Duplex ultrasonography is used to identify asymptomatic carotid stenosis (ACS) patients at risk for ipsilateral ischemic stroke/transient ischemic attack (IIS/ TIA). Traditional parameters are not sensitive/ specific enough (as internal carotid stenosis severity/progression) or are impractical for

Contrast induced nephropathy (CIN) following cardiovascular angiography can lead to significant morbidity and mortality. Remote ischemic preconditioning (RIPC) may be effective in reducing the incidence of CIN, though randomized data is inadequate. We conducted a prospective, randomized, double

The role of endoplasmic reticulum (ER) stress in pressure overload-induced LV hypertrophy and dysfunction is poorly understood. The specific roles of CaMKII and p38 signaling remain unclear. Transverse aortic constriction (TAC) was performed in age-matched CHOP knockout (KO) mice and controls.

We investigated recent trends in-hospital outcomes and mortality in patients admitted with primary diagnosis of acute myocarditis. We performed a secondary analysis of the NIS (2008 to 2012) for patients with primary diagnosis of acute myocarditis. Various demographic/clinical parameters, including

Ankle-brachial index (ABI) is conventionally derived as the ratio of higher of the two systolic ankle blood pressures to the higher brachial pressure (HABI method). Alternatively, ABI may be derived using the lower of the two systolic ankle pressures (LABI method). The utility and difference between

Nuclear factor-kappaB (NF-kB), a stress-responsive transcription factor, has been implicated in various cardiovascular pathologies. Although NF-kB is necessary for late preconditioning, its summative role in myocardial ischemia/reperfusion (I/R) injury remains unclear. Using mice with cardiac

Presence of pericardial effusion (PCE) is associated with worse prognosis in patients with pulmonary hypertension (PHTN). The impact of PCE in PHTN is not well characterized. Retrospective review of all consecutive pts undergoing right heart catheterization at our institute from 2007 to 2011.

The purpose of this study was to examine the impact of yoga on atrial fibrillation (AF) burden, quality of life (QoL), depression, and anxiety scores.Yoga is known to have significant benefit on cardiovascular health. The effect of yoga in reducing AF burden is unknown.This single-center, pre-post study enrolled patients with symptomatic paroxysmal AF with an initial 3-month noninterventional observation period followed by twice-weekly 60-min yoga training for next 3 months. AF episodes during the control and study periods as well as SF-36, Zung self-rated anxiety, and Zung self-rated depression scores at baseline, before, and after the study phase were assessed.Yoga training reduced symptomatic AF episodes (3.8 ± 3 vs. 2.1 ± 2.6, p0.001), symptomatic non-AF episodes (2.9 ± 3.4 vs. 1.4 ± 2.0; p0.001), asymptomatic AF episodes (0.12 ± 0.44 vs. 0.04 ± 0.20; p0.001), and depression and anxiety (p0.001), and improved the QoL parameters of physical functioning, general health, vitality, social functioning, and mental health domains on SF-36 (p = 0.017, p0.001, p0.001, p = 0.019, and p0.001, respectively). There was significant decrease in heart rate, and systolic and diastolic blood pressure before and after yoga (p0.001).In patients with paroxysmal AF, yoga improves symptoms, arrhythmia burden, heart rate, blood pressure, anxiety and depression scores, and several domains of QoL.

The use of cardiac resynchronization therapy (CRT)-pacemaker (CRT-P) in the US is low when compared with CRT-defibrillator (CRT-D) therapy. Whether gender differences exist in the utilization of either type of CRT is unknown. We used the Nationwide Inpatient Sample (NIS) database (the largest all