Hospital Chronicles (E-Journal)
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Cardiac Contractility Modulation for Patients with Heart Failure
Get PDFA substantial proportion of patients with heart failure remain either not eligible for cardiac resynchronization therapy (CRT) or do not respond to this therapy. CRT is indicated in patients with prolonged QRS duration (>120 ms). However, up to 60% of patients with heart failure have a normal QRS duration and are not appropriate candidates for CRT. In addition, a significant number of patients (25-30%) who meet the current indications to CRT therapy are non-responders. New device-based therapies including cardiac contractility modulation (CCM) have been developed over the last decade.Â
Left Ventricle to Right Atrium Shunt Secondary to Blunt Chest Trauma. A Case Report
Get PDFIntracardiac shunts are rarely encountered as sequelae of non-penetrating heart trauma and their clinical manifestations may often be unrecognized in the multi-injured patient. However, they are serious complications and their diagnostic approach is not always feasible.Â
Is There an Obesity Paradox?
Get PDFObese people have excess body fat. Overweight people have excess weight (weight includes bone, fat and muscle). Currently overweight and obesity are defined by body mass index (BMI: weight in Kg/height in meters squared, kg/m2). In adults, overweight is defined as a BMI of 25-29.9 kg/m2; obesity is defined as a BMI >30 kg/m2. Other less commonly used indices, but possibly with more predictive power, include waist circumference, waste-to-hip ratio, weight-to-height ratio and body fat
Cardiology News /Recent Literature Review / First Two Quarters 2014
No full textCARDIOLOGY NEWS(Reproduced with permission from A.S. Manolis et al. Cardiology News / Recent Literature Review, Rhythmos 2014; 9: 29-35, & 46-53) (www.rhythmos.gr)Cardiology News /Recent Literature Review / First Quarter 2014Konstantinos Vlachos, MD, Kostas Letsas, MD, Antonis S. Manolis, MD, Evagelismos Hospital, Athens, Greece Athens Cardiology Update 2014: Athens (Crown Plaza Hotel), 10-12/4/2014HRS Meeting: San Francisco, 7-10/5/2014EuroPCR: Paris, 20-23/5/2014CardioStim: Nice, 18-21/6/2014ESC Congress: Barcelona, 30/8-3/9/14TCT: Washington, 12-17/9/14HCS Annual Meeting: Athens, 23-25/10/2014AHA: Chicago, 15-19/11/14Cutting Inappropriate ICD Shocks: Long Arrhythmia-Detection Time Strategy ConfirmedProgramming implantable cardioverter defibrillators (ICDs) to delay the time they take to treat ventricular arrhythmias cuts mortality by 23% and inappropriate shocks by more than one-half in a meta-analysis encompassing ~4900 patients. The included studies were prospective and multicenter and covered both primary and secondary prevention and patients with either ischemic or nonischemic cardiomyopathy. The risk of syncope did not rise significantly with longer detection times, despite traditional concerns that lots of patients would not tolerate prolonged arrhythmia exposure before their ICD is allowed to deliver therapy, either shocks or antitachycardia pacing (ATP). Instead, the extra time frequently gave devices a better chance to exclude non–life-threatening arrhythmias like atrial fibrillation and to let otherwise self-terminating ventricular arrhythmias play out on their own. Current nominal settings used by some ICD manufacturers are likely to be too aggressive, with arrhythmia detection times that in some cases may be as short as 1-3 s. These results highlight the importance of setting longer default ICD detection times. The analysis included 4896 patients from the MADIT-RIT, ADVANCE 3, and PROVIDE randomized trials and the RELEVANT nonrandomized study. Overall, 264 patients received appropriate shocks and 253 experienced inappropriate shocks at follow-up (12 - 17 months). The relative risk (RR) of death from any cause was 0.77 (p=0.02) in the prolonged-detection-time groups compared with controls; the risks of inappropriate shocks and appropriate and inappropriate ATP also fell significantly. Why there were fewer deaths with longer detection times is unclear but it may derive from less exposure to potential hazards of shocks and ATP; inappropriate shocks may up mortality, and ATP poses a small risk of inducing ventricular fibrillation; or it may be due to some other factor, e.g. avoidance of treatment for multiple ICD therapies (e.g., prescription of antiarrhythmic drugs) (Scott PA et al, Heart Rhythm 2014; DOI:10.1016/j.hrthm.2014.02.009. Epub 2014 Feb 12)... (excerpt
Bifocal Right Ventricular Pacing: Alternative to Biventricular Pacing for Cardiac Resynchronization Therapy?
Get PDFA 59-year-old patient with dilated cardiomyopathy, severe systolic left ventricular dysfunction and drug-refractory advanced heart failure (New York Heart Association-NYHA class III-IV symptoms) and prior history of mitral valve replacement was scheduled for implantation of a biventricular pacing system (cardiac resynchronization therapy-defibrillator or CRT-D device). The coronary sinus was cannulated after some effort and a venous coronary angiogram was performed. Although a posterolateral cardiac venous branch was identified to accommodate the left ventricular pacing lead, placement of the lead in this tributary was accompanied by phrenic nerve stimulation, which could not be remedied by moving to more proximal positions where the lead could not be stabilized. Having no other option except for sending the patient to surgery for epicardial lead placement, albeit most difficult and high-risk procedure due to prior history of cardiac surgery, we attempted bifocal right ventricular pacing by placing the composite pacing-defibrillating lead at a low septal position and the left ventricular lead at a very high right ventricular (RV) outflow tract position. The procedure was otherwise uncomplicated and the patient’s post-procedural course remained uneventful. The patient had a good clinical response to this type of bifocal RV pacing over the subsequent days and months with amelioration of his dyspneic symptoms and improvement of his quality of life. At the three-year follow-up he remains in NYHA class II category
Cardiology News /Recent Literature Review / Fourth Quarter 2013
Get PDFACC Congress 2014: Washington, DC, 29-31/3/2014 Athens Cardiology Update 2014: Athens (Crown Plaza Hotel), 10-12/4/2014HRS Meeting: San Francisco, 7-10/5/2014EuroPCR: Paris, 20-23/5/2014CardioStim 2014: Nice, 18-21/6/2014ESC Congress 2014 (Barcelona, 30/8-3/9/14)Only One Fifth of the Sudden Cardiac Arrest Victims in the Community are Eligible for a Primary Prevention ICD Before the Event, but Among These, a Small Proportion (13%) are Actually Implanted According to data from the Oregon Sudden Unexpected Death study, among 2093 victims of sudden cardiac arrest (SCA) over a decade, of 448 having information about left ventricular ejection fraction (LVEF), 92 (20.5%) were eligible for primary ICD implantation, 304 (67.9%) were ineligible because of LVEF>35%, & the remainder (52, 11.6%) had LVEF ≤35% but were ineligible on the basis of clinical criteria. Among eligible subjects, only 12 (13%) received a primary ICD. Compared with recipients, ICD nonrecipients were older (age at LVEF assessment, 67.1±13.6 vs 58.5±14.8 years, P=0.05), with 20% aged ≥80 years (vs 0% among recipients, P=NS). Additionally, a subgroup (26%) had either a clinical history of dementia or were undergoing chronic dialysis. The authors concluded that only one fifth of the SCA cases in the community were eligible for a primary prevention ICD before the event, but among these, a small proportion (13%) were actually implanted. Although older age and comorbidity may explain nondeployment in a subgroup of these cases, other determinants such as socioeconomic factors, health insurance, patient preference, and clinical practice patterns may play a role (Narayanan K, et al, Circulation 2013;128:1733-1738).Appropriate ICD Therapies over 10 Years are More Prevalent in Symptomatic Brugada Syndrome (19-48%) but Still Occur in Asymptomatic Patients (12%)A total of 378 patients (310 men; aged 46±13 years) with a type 1 Brugada ECG pattern were implanted with an implantable cardioverter-defibrillator-ICD; 31 for aborted sudden cardiac arrest, 181 for syncope, and 166 asymptomatic. During a mean follow-up of 77±42 months for 363 patients, 7 patients (2%) died (1 as a result of an inappropriate shock), and 46 patients (12%) had appropriate device therapy (5±5 shocks per patient). Appropriate device therapy rates at 10 years were 48% for patients whose ICD indication was aborted sudden cardiac arrest, 19% for those with syncope, and 12% for the asymptomatic patients. At 10 years, rates of inappropriate shock and lead failure were 37% and 29%, respectively. Inappropriate shock occurred in 91 patients (24%) because of lead failure (n=38), supraventricular tachycardia (n=20), T-wave oversensing (n=14), or sinus tachycardia (n=12). Reduced inappropriate shocks were noted with introduction of remote monitoring, programming a high single ventricular fibrillation zone (>210–220 bpm), and a long detection time. The authors concluded that appropriate therapies are more prevalent in symptomatic Brugada syndrome but are not insignificant in asymptomatic patients (1%/y). Optimal ICD programming and remote monitoring dramatically reduce inappropriate shocks. However, lead failure remains a major problem in this population (Sacher F et al, Circulation 2013;128: 1739-1747)... (excerpt
The Next Era of Transcatheter Aortic Valve Implantation (TAVI): Fully Repositionable, Re-Sheathable and Retrievable Prostheses?
Get PDFTranscatheter aortic valve implantation (TAVI) is a great alternative treatment option in high surgical risk and inoperable patients with severe symptomatic aortic stenosis (AS). TAVI is a rapidly emerging technique with a constantly expanding body of evidence. However, the devices, which are commercially available and are currently used widely, have several major limitations. In particular, the inability to reposition/ retrieve/ resheath valves, in addition to several patient selection and procedural limitations, such as the occurrence of moderate to severe paravalvular regurgitation (PVR), the risk of annular rupture, atrioventricular (AV) conduction abnormalities with subsequent pacemaker requirement, vascular complications and associated bleeding, coronary ostial obstruction by the valve, stroke, as well as complex delivery processes, are expected to be overcome with the newer generation valves. Consequently, a number of new transcatheter valve choices have been developed either for clinical study or are in the pipeline, that it is hoped to bring meaningful clinical outcomes compared with the currently commercially available technology. Early data on design modifications have shown significant reductions in adverse outcomes from TAVI
Κάπνισμα και ÎŸÎ¾Ï Î£Ï„ÎµÏ†Î±Î½Î¹Î±Î¯Î¿ ΣÏνδÏομο: Η ΕμπειÏία μας από τη Μονάδα Στεφανιαίων Îοσημάτων του Î .Γ.Î. ΠατÏών
Get PDF«ΔιεÏωτάται κανείς πως οι άνθÏωποι εξακολουθοÏν να καπνίζουν ενώ γνωÏίζουν τις βλαβεÏÎÏ‚ συνÎπειες του καπνίσματος στην υγεία». Η αποÏία αυτή παÏαμÎνει και ενισχÏεται καθημεÏινά με νÎες αποκαλÏψεις που ÎÏχονται στο φως της δημοσιότητας για τις βλάβες που Ï€Ïοκαλεί το κάπνισμα σε όλα τα οÏγανικά συστήματα, και κυÏίως στο καÏδιαγγειακό σÏστημα
Novel Hypolipidemic Agents: the Role of PCSK9 Inhibitors
Get PDFHyperlipidemia is a major cause of cardiovascular disease despite the availability of first-line cholesterol lowering agents such as statins. Although statin therapy is very efficient to reduce cholesterol, nearly 10-20% of individuals on statins, experience side effects, such myopathy, which hinder the drugs ability to achieve target low-density lipoprotein (LDL) cholesterol (LDL-C) levels. Statin-intolerant patients require more effective therapies for lowering LDL-C. As proprotein convertase subtilisin kexin type 9 (PCSK9) promotes the degradation of the LDL receptor (LDLR) and prevents it from recycling to the membrane, a new therapeutic approach to lowering LDL-C acts by blocking LDL-receptor degradation by serum PCSK9. Humanized monoclonal antibodies which target PCSK9 and its interaction with the LDL receptor (REGN727/SAR23653, AMG145, and RN316), as well as agents that inhibit PCSK9 synthesis, such as ALN-PCS, are now in clinical trials. The latter is a small interfering RNA (siRNA) that directs sequence-specific messenger RNA for PCSK9 leading to reduced hepatocyte-specific synthesis of PCSK9. Ongoing phase III trials’ results are awaited with great interest in order to define these agents’ long-term safety, tolerability and efficacy for reducing cardiovascular events
Acute Aortic Syndromes: Newer Developments
Get PDFAcute aortic syndrome is a modern term that describes the acute presentation of patients with characteristic “aortic†pain caused by one of the life-threatening thoracic aortic conditions including aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer.Â