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[Coronary wire entrapment and unintended extraction of a just deployed stent]
No full textA 53-year-old male was admitted to our department for unstable angina. Coronary angiography showed a subocclusive stenosis in the ostial-proximal tract of an intermediate branch in the context of a left dominance system. We proceeded with an ad hoc percutaneous coronary intervention considering this intermediate branch lesion in the setting of a bifurcation (Medina 0,0,1), where the proximal and distal main branches were represented by the left main and left anterior descending (LAD) arteries, respectively. After pre-dilation of the intermediate branch lesion, we advanced a "safety balloon" in order to protect the LAD branch and, simultaneously, we deployed a 3.0/22 mm drug-eluting stent in the intermediate branch. After in-stent post-dilation, we felt a strong resistance during the guidewire removal from the LAD indicating a wire entrapment. After a vigorous traction of the jailed guidewire, we observed the accidental removal of the just deployed stent from the guiding catheter. We re-advanced a guidewire on the LAD and a 3.25/23 mm drug-eluting stent was successfully implanted on the intermediate branch. We briefly discuss the occurred complication and some technical aspects regarding this case
Prominent basal and middle strain longitudinal involvement in newly-diagnosed and never treated hypertensive patients without clear-cut hypertrophy
No full textTime-to-first clinical benefit in heart failure with preserved ejection fraction: A reconstructed time-to-event meta-analysis of randomized controlled trials
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Low-dose Rivaroxaban plus Aspirin in Patients with Peripheral Artery Disease Undergoing Lower Extremity Revascularization with and without Concomitant Coronary Artery Disease: Insights from VOYAGER PAD
Full text linkBackground
Patients with peripheral artery disease (PAD) are at heightened risk of both major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Rivaroxaban 2.5 mg BID with aspirin versus aspirin alone reduced major adverse limb and cardiovascular events in PAD patients after lower extremity revascularization (LER) in the VOYAGER PAD trial. The concomitant presence and related risk of known coronary artery disease (CAD) in PAD patients is not well understood leading differences in adverse event risk between PAD patients. Therefore, efficacy and safety of rivaroxaban 2.5 mg BID in PAD patients with and without CAD after LER has not yet been described.
Methods
VOYAGER PAD randomized patient with PAD undergoing LER to rivaroxaban 2.5 mg twice daily plus aspirin versus aspirin alone. The primary endpoint was a composite of acute limb ischemia, major amputation of vascular cause, myocardial infarction, ischemic stroke, or cardiovascular death. The principal safety outcome was TIMI major bleeding. This is a pre- planned subgroup analysis investigating the contribution of concomitant CAD on efficacy and safety endpoints.
Results
Among 6,564 randomized patients, 2084 (32%) had CAD at baseline. In the placebo group, the 3-year Kaplan-Meier estimate of primary endpoint was 24.4% in those with concomitant PAD and CAD versus 17.9% in PAD only while MALE was 8.9% versus 10.2%, respectively.
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Rivaroxaban decreased the rates of both MACE and MALE in each group particularly in those with concomitant PAD and CAD (HR 0.79, 95% CI 0.62-1.00) for MACE with a significant p- interaction of 0.03 considering MACE. The risk of bleeding was increased with rivaroxaban regardless of the presence of CAD.
Conclusions
In PAD patients underwent to LER, the presence of concomitant CAD leads to MACE events and confers an increased risk in PAD patients. Treatment with low-dose rivaroxaban and aspirin reduces the risk of MACE and MALE regardless of the presence of CAD; moreover, those with concomitant PAD and CAD derive a greater benefit with rivaroxaban in reducing MACE events versus those with PAD alone
Left atrial remodeling in heart failure: the role of sphericity index (the SPHERICAT-HF study)
No full text: Left atrial sphericity index (LASI) is an echocardiographic index easily obtained; its use in patients with heart failure (HF) has never been investigated so far. This single-centre study aimed to investigate the usefulness of LASI in an unselected cohort of patients hospitalized for acute HF, and its potential correlation with the amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) levels and with New York Heart Association (NYHA) functional class. Ninety-four consecutive HF patients underwent a transthoracic echocardiogram with a detailed study of the left atrium (LA) including LASI (calculated from the apical four-chamber view as the ratio between the transverse and longitudinal diameters), and blood tests (including NT-proBNP) on the same day. Median age was 75.5 (interquartile range-IQR 62-82) years and 55% were males, 58.5% had a NYHA class III-IV, and median NT-proBNP was 3284 (IQR 1215-7055) pg/ml. The LA was dilated in 94%, and median biplane LA volume index was 62 ml/m2. Patients with advanced NYHA class showed more advanced LA remodeling. Mean LASI was 0.78 ± 0.09 and did not correlate with NT-proBNP levels (r 0.03; p 0.75) or with patient NYHA class (R2 0.011; p 0.287). None of the echocardiographic indices of LA structural and functional remodeling proved to be independently associated with a high NYHA class on multivariate regression analysis. In conclusion, LA remodeling is almost invariably present in patients with HF. LASI does not correlate with NT-proBNP levels or with NYHA functional class. Further studies are needed to describe the complex patterns of atrial remodeling in HF
Crosslink between atrial fibrillation and cancer: a therapeutic conundrum
No full text: Atrial fibrillation (AF) is more common in patients with malignancies than in general population. The pathophysiological processes include the pro-inflammatory condition and the exaggerated inflammatory reaction to chemotherapy, radiotherapy, and surgery interventions. Thus, it is pivotal to decrease morbidity and mortality in this group by providing appropriate care and prevention. In this subset, the risk of thromboembolic and bleeding events is high and the common risk score such as CHA2DS2-VASc and HAS-BLED employed in non-oncologic patients have limited evidence in cancer patients. A paucity of evidence in the setting in individuals having both malignancies and atrial fibrillation entangle the clinician when it comes to therapeutic management. Tailored management is recommended of anticoagulation treatment could be difficult, and there is. In this review, we try to explain the mechanism of AF in cancer patients as well as its management in this setting
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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