Download Cardiac Nurses Current Awareness Newsletter May 2016

Cardiac Nurses
Current Awareness Newsletter
May 2016
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Tables of Contents from relevant journals
If you require full articles please email: [email protected]
Journal of the American College of Cardiology
Vol. 67, No. 19, May 17, 2016
Circulation
Volume 133, Issue 19, May 10 2016
European Heart Journal
Volume 37, Issue 18, 7 May 2016
Latest Cochrane Systematic Reviews
Table of Contents: Issue 5, 2016
Methotrexate for polymyalgia rheumatica
Nataliya Milman, Samuel L Whittle, Catherine L Hill, Jinane El Sayad, George A Wells
Online Publication Date:
Methotrexate for giant cell arteritis
Nataliya Milman, Catherine L Hill, Samuel L Whittle, Jinane El Sayad, George A Wells
Online Publication Date: May 2016
Recent Research from Research Gate click here
New NICE Guidance
No new guidelines published in May
UptoDate
What's new in cardiovascular medicine
Authors
Gordon M Saperia, MD, FACC
Susan B Yeon, MD, JD, FACC
Brian C Downey, MD, FACC
Contributor disclosures
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Apr 2016. | This topic last updated: May 09, 2016.
The following represent additions to UpToDate from the past six months that were considered by the
editors and authors to be of particular interest. The most recent What's New entries are at the top of
each subsection.
ARRHYTHMIAS
Radiofrequency catheter ablation for patients with an ICD and recurrent shocks (May 2016)
Patients with an implantable cardioverter-defibrillator (ICD) who have recurrent ICD shocks due to
ventricular tachycardia (VT) experience significant discomfort and reduced quality of life, and the
effectiveness of antiarrhythmic drug therapy to prevent VT is limited. In the VANISH trial, a
multicenter, nonblinded trial of patients with prior myocardial infarction and an ICD who had at least
one episode of VT within the preceding six months while on antiarrhythmic drug therapy, patients
were randomized to radiofrequency catheter ablation (RFA) or escalated antiarrhythmic therapy [1].
Over a mean follow-up of 28 months, patients in the RFA group had significant reduction in the
composite primary outcome of death, VT storm, or appropriate ICD shocks, although there was no
difference in mortality alone. RFA is an option for reducing the morbidity associated with recurrent ICD
shocks in patients with ischemic cardiomyopathy who have recurrent VT despite antiarrhythmic drug
therapy. (See "Sustained monomorphic ventricular tachycardia in patients with a prior myocardial
infarction: Treatment and prognosis", section on 'Efficacy of catheter ablation'.)
CORONARY ARTERY BYPASS GRAFT SURGERY
Preoperative statin therapy does not decrease the risk of perioperative AF (May 2016)
Perioperative atrial fibrillation (AF) is common with cardiac surgery. Statins have been prescribed as
preventive therapy based on relatively weak evidence. In the STICS trial, 1922 patients in sinus
rhythm scheduled for elective cardiac surgery were randomly assigned to receive perioperative
rosuvastatin (20 mg daily) or placebo up to eight days before surgery [9]. There was no difference in
the rate of perioperative AF but a significant increase in the risk of acute kidney injury in the
rosuvastatin group. Based on available evidence, we do not start statins before cardiac surgery in
most cases. (See "Atrial fibrillation and flutter after cardiac surgery", section on 'Ineffective or possibly
effective therapies'.)
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Antiarrhythmic Drugs. N Engl J Med 2016.
2. Kudenchuk PJ, Brown SP, Daya M, et al. Amiodarone, Lidocaine, or Placebo in Out-of-Hospital
Cardiac Arrest. N Engl J Med 2016.
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Med 2016; 374:1744.
10. Velazquez EJ, Lee KL, Jones RH, et al. Coronary-Artery Bypass Surgery in Patients with
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18. Levine GN, Bates ER, Blankenship JC, et al. 2015 ACC/AHA/SCAI Focused Update on Primary
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Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. J Am Coll
Cardiol 2016; 67:1235.
19. McMurray J, Krum H, Abraham WT. Aliskiren, Enalapril, or Aliskiren and Enalapril in Heart
Failure. N Engl J Med 2016.
20. Nielsen PB, Larsen TB, Gorst-Rasmussen A, et al. β-Blockers in Atrial Fibrillation Patients With
or Without Heart Failure: Association With Mortality in a Nationwide Cohort Study. Circ Heart Fail
2016; 9:e002597.
21. Lu M, Du H, Gao Z, et al. Predictors of Outcome After Alcohol Septal Ablation for Hypertrophic
Obstructive Cardiomyopathy: An Echocardiography and Cardiovascular Magnetic Resonance
Imaging Study. Circ Cardiovasc Interv 2016; 9.
22. Behrens I, Basit S, Lykke JA, et al. Association Between Hypertensive Disorders of Pregnancy
and Later Risk of Cardiomyopathy. JAMA 2016; 315:1026.
23. Li L, Li S, Deng K, et al. Dipeptidyl peptidase-4 inhibitors and risk of heart failure in type 2
diabetes: systematic review and meta-analysis of randomised and observational studies. BMJ
2016; 352:i610.
24. Redfield MM, Anstrom KJ, Levine JA, et al. Isosorbide Mononitrate in Heart Failure with
Preserved Ejection Fraction. N Engl J Med 2015; 373:2314.
25. Liebregts M, Vriesendorp PA, Mahmoodi BK, et al. A Systematic Review and Meta-Analysis of
Long-Term Outcomes After Septal Reduction Therapy in Patients With Hypertrophic
Cardiomyopathy. JACC Heart Fail 2015; 3:896.
26. Cowie MR, Woehrle H, Wegscheider K, et al. Adaptive Servo-Ventilation for Central Sleep
Apnea in Systolic Heart Failure. N Engl J Med 2015; 373:1095.
27. Aurora RN, Bista SR, Casey KR, et al. Updated Adaptive Servo-Ventilation Recommendations
for the 2012 AASM Guideline: "The Treatment of Central Sleep Apnea Syndromes in Adults:
Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses". J Clin
Sleep Med 2016.
28. Black S, Nicolay U, Del Giudice G, Rappuoli R. Influence of Statins on Influenza Vaccine
Response in Elderly Individuals. J Infect Dis 2016; 213:1224.
29. Omer SB, Phadke VK, Bednarczyk RA, et al. Impact of Statins on Influenza Vaccine
Effectiveness Against Medically Attended Acute Respiratory Illness. J Infect Dis 2016; 213:1216.
30. Ware JS, Li J, Mazaika E, et al. Shared Genetic Predisposition in Peripartum and Dilated
Cardiomyopathies. N Engl J Med 2016; 374:233.
31. Howard G, Roubin GS, Jansen O, et al. Association between age and risk of stroke or death
from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from
four randomised trials. Lancet 2016; 387:1305.
32. Rosenfield K, Matsumura JS, Chaturvedi S, et al. Randomized Trial of Stent versus Surgery for
Asymptomatic Carotid Stenosis. N Engl J Med 2016; 374:1011.
33. Bonaca MP, Gutierrez JA, Creager MA, et al. Acute Limb Ischemia and Outcomes With
Vorapaxar in Patients With Peripheral Artery Disease: Results From the Trial to Assess the
Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With AtherosclerosisThrombolysis in Myocardial Infarction 50 (TRA2°P-TIMI 50). Circulation 2016; 133:997.
34. Laird JR, Schneider PA, Tepe G, et al. Durability of Treatment Effect Using a Drug-Coated
Balloon for Femoropopliteal Lesions: 24-Month Results of IN.PACT SFA. J Am Coll Cardiol
2015; 66:2329.
35. Lonn EM, Bosch J, López-Jaramillo P, et al. Blood-Pressure Lowering in Intermediate-Risk
Persons without Cardiovascular Disease. N Engl J Med 2016.
36. Rana JS, Liu JY, Moffet HH, et al. Diabetes and Prior Coronary Heart Disease are Not
Necessarily Risk Equivalent for Future Coronary Heart Disease Events. J Gen Intern Med 2016;
31:387.
37. Siu AL, U S Preventive Services Task Force. Screening for Abnormal Blood Glucose and Type 2
Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern
Med 2015; 163:861.
38. Yeh RW, Secemsky EA, Kereiakes DJ, et al. Development and Validation of a Prediction Rule
for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary
Intervention. JAMA 2016; 315:1735.
39. Myles PS, Smith JA, Forbes A, et al. Stopping vs. Continuing Aspirin before Coronary Artery
Surgery. N Engl J Med 2016; 374:728.
40. Hermiller JB, Krucoff MW, Kereiakes DJ, et al. Benefits and Risks of Extended Dual Antiplatelet
Therapy After Everolimus-Eluting Stents. JACC Cardiovasc Interv 2016; 9:138.
41. Andò G, Capodanno D. Radial Versus Femoral Access in Invasively Managed Patients With
Acute Coronary Syndrome: A Systematic Review and Meta-analysis. Ann Intern Med 2015;
163:932.
42. Cassese S, Byrne RA, Ndrepepa G, et al. Everolimus-eluting bioresorbable vascular scaffolds
versus everolimus-eluting metallic stents: a meta-analysis of randomised controlled trials. Lancet
2016; 387:537.
43. Hong SJ, Kim BK, Shin DH, et al. Effect of Intravascular Ultrasound-Guided vs AngiographyGuided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial. JAMA
2015; 314:2155.
44. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or Surgical Aortic-Valve Replacement in
Intermediate-Risk Patients. N Engl J Med 2016; 374:1609.
45. Thourani VH, Kodali S, Makkar RR, et al. Transcatheter aortic valve replacement versus surgical
valve replacement in intermediate-risk patients: a propensity score analysis. Lancet 2016.
46. Smith PK, Puskas JD, Ascheim DD, et al. Surgical treatment of moderate ischemic mitral
regurgitation. N Engl J Med 2014; 371:2178.
47. Michler RE. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation.
N Engl J Med 2016.
48. Kodali S, Williams MR, Doshi D, et al. Sex-Specific Differences at Presentation and Outcomes
Among Patients Undergoing Transcatheter Aortic Valve Replacement: A Cohort Study. Ann
Intern Med 2016; 164:377.
49. Sorajja P, Mack M, Vemulapalli S, et al. Initial Experience With Commercial Transcatheter Mitral
Valve Repair in the United States. J Am Coll Cardiol 2016; 67:1129.
Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-Year Outcomes of Surgical Treatment of Severe
Ischemic Mitral Regurgitation. N Engl J Med 2016; 374:344.
Literature Search
Search History:
1. BNI, Medline, CINAHL; (((atrial AND fibrillation) OR (inherited AND channelopathies) OR (cardiac AND
resynchronisation AND therapy))).ti,ab;
2. BNI, Medline, CINAHL; 1 [Limit to: Publication Year 2016-2016];
1: The role of comprehensive geriatric assessment and functional status in evaluating
the patterns of antithrombotic use among older people with atrial fibrillation.
Source Archives of Gerontology & Geriatrics; Jul 2016 ; p. 248-254
Publication Date Jul 2016
Publication Type(s) Academic Journal
Publisher Elsevier Science
Authors Mazzone, A.; Bo, M.; Lucenti, A.; Galimberti, S.; Bellelli, G.; Annoni, G.
Database CINAHL
2: Underutilization of Anticoagulation for Stroke Prevention in Atrial Fibrillation.
Source Journal of the American College of Cardiology (JACC); May 2016 (no. 20); p. 24442446
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Elsevier Science
Authors Piazza, Gregory; Karipineni, Neelima; Goldberg, Howard S.; Jenkins, Kathryn L.;
Goldhaber, Samuel Z.
Database CINAHL
3: Comparing the ATRIA, CHADS2, and CHA2DS2-VASc Scores for Stroke Prediction in
Atrial Fibrillation.
Source Journal of the American College of Cardiology (JACC); May 2016 (no. 19); p. 23162317
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Elsevier Science
Authors Potpara, Tatjana S.; Olesen, Jonas B.
Database CINAHL
4: Reply: Comparing the ATRIA, CHADS2, and CHA2DS2-VASc Scores for Stroke Prediction
in Atrial Fibrillation.
Source Journal of the American College of Cardiology (JACC); May 2016 (no. 19); p. 23172318
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Elsevier Science
Authors van den Ham, Hendrika A.; Klungel, Olaf H.; Singer, Daniel E.; Leufkens, Hubert
G.M.; van Staa, Tjeerd P.
Database CINAHL
5: Recent Diabetes and Atrial Fibrillation Report Diverges From Pre-Existing Evidence.
Source Journal of the American College of Cardiology (JACC); May 2016 (no. 19); p. 23182319
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Elsevier Science
Authors Overvad, Thure Filskov; Brønnum Nielsen, Peter; Bjerregaard Larsen, Torben
Database CINAHL
6: Reply: Recent Diabetes and Atrial Fibrillation Report Diverges From Pre-Existing
Evidence.
Source Journal of the American College of Cardiology (JACC); May 2016 (no. 19); p. 23192319
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Elsevier Science
Authors Ashburner, Jeffrey M.; Singer, Daniel E.
Database CINAHL
7: Global longitudinal strain is associated with heart failure outcomes in hypertrophic
cardiomyopathy.
Source Heart; May 2016 (no. 10); p. 741-747
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher BMJ Publishing Group
Authors Reant, Patricia; Mirabel, Mariana; Lloyd, Guy; Peyrou, Jérôme; Lopez Ayala, JoseMaria; Dickie, Shaughan; Bulluck, Heeraj; Captur, Gabriella; Rosmini, Stefania; Guttmann,
Oliver; Demetrescu, Camelia; Pantazis, Antonis; Tome-Esteban, Maite; Moon, James C.;
Lafitte, Stephane; McKenna, William J.
Database CINAHL
Abstract
Objective: We hypothesised that abnormal global longitudinal strain (GLS) would predict
outcome in hypertrophic cardiomyopathy (HCM) better than current echocardiographic
measures.Methods: Retrospective analysis of risk markers in relation to outcomes in 472
patients with HCM at a single tertiary institution (2006-2012). Exclusion criteria were left
ventricular (LV) hypertrophy of other origin, patients in atrial fibrillation, lost to follow-up
and insufficient image quality to perform strain analysis. Standardised echocardiogram
recordings were reviewed and standard variables and LV GLS were measured. The primary
end-point included all cardiac deaths, appropriate defibrillator shocks and heart failure
(HF) admissions. The secondary end-point was death by HF and admissions related to
HF.Results: Mean age was 50.0±15.0 years; 322 (68%) were men. At a median of 4.3 years
(IQR 0.1-7.8) follow-up, 21 (4.4%) patients experienced cardiovascular death: 6 (1.3%) died
from HF, 13 (2.7%) had sudden cardiac death and 2 (0.4%) died secondary to stroke. Four
(0.8%) patients experienced appropriate defibrillator shock, and 13 (2.7%) were admitted
for HF. On multivariate Fine-Gray proportional hazard analyses, GLS was significantly
associated with the primary end-point (HR=0.90, 95% CI 0.83 to 0.98, p=0.018)
independently of age, maximal provoked LV outflow-tract gradient and LV end-systolic
volume. Moreover, GLS was particularly associated with the secondary end-point
(HR=0.82, 95% CI 0.75 to 0.90, p<0.0001) independently of age, previous atrial fibrillation,
New York Heart Association (NYHA) class III-IV, LV end-systolic volume, E/E', and outflowtract gradient. Survival curves confirmed that GLS was associated with HF events (GLS
<15.6%, p=0.0035).Conclusions: In patients with HCM, reduced GLS is an independent
factor associated with poor cardiac outcomes, and particularly HF outcomes.
8: Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy.
Source Circulation; May 2016 (no. 19); p. 1901-1905
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Lippincott Williams & Wilkins
Authors MacIntyre, Ciorsti; Lakdawala, Neal K.
Database CINAHL
9: Predicting Stroke in Patients With Atrial Fibrillation: An Incomplete Picture Without
Considering Quality of Anticoagulation.
Source Journal of the American College of Cardiology (JACC); May 2016 (no. 18); p. 21922193
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Elsevier Science
Authors Safder, Taimur B.; Badgett, Robert G.
Database CINAHL
10: Rapid Ventricular Response or Tachycardia? The Three Faces of Atrial Fibrillation.
Source American Journal of Emergency Medicine; May 2016 (no. 5); p. 931-932
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Elsevier Inc.
Authors Ran, Ran; Kuang, Patricia; Mah, Nathan D.
Database CINAHL
11: A rare complication of scorpion venom: atrial fibrillation.
Source American Journal of Emergency Medicine; May 2016 (no. 5); p. 938.e1
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Elsevier Inc.
Authors Duman, Ali; Turkdogan, Kenan Ahmet; Akoz, Ayhan; Avcil, Mucahit; Dagli, Bekir;
Canakci, Selcuk Eren
Database CINAHL
12: Multiple Chronic Conditions in Older Adults with Acute Coronary Syndromes.
Source Clinics in Geriatric Medicine; May 2016 (no. 2); p. 291-303
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher W B Saunders
Authors Alfredsson, Joakim; Alexander, Karen P
Database CINAHL
Abstract
Older adults presenting with acute coronary syndromes (ACSs) often have multiple chronic
conditions (MCCs). In addition to traditional cardiovascular (CV) risk factors (ie,
hypertension, hyperlipidemia, and diabetes), common CV comorbidities include heart
failure, stroke, and atrial fibrillation, whereas prevalent non-CV comorbidities include
chronic kidney disease, anemia, depression, and chronic obstructive pulmonary disease.
The presence of MCCs affects the presentation (eg, increased frequency of type 2
myocardial infarctions [MIs]), clinical course, and prognosis of ACS in older adults. In
general, higher comorbidity burden increases mortality following MI, reduces utilization of
ACS treatments, and increases the importance of developing individualized treatment
plans.
13: Multimorbidity in Older Adults with Atrial Fibrillation.
Source Clinics in Geriatric Medicine; May 2016 (no. 2); p. 315-329
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher W B Saunders
Authors Chen, Michael A
Database CINAHL
Abstract
Older adults with atrial fibrillation often have multiple comorbid conditions, including
common geriatric syndromes. Pharmacologic therapy, whether for rate control or rhythm
control, can result in complications related to polypharmacy in patients who are often on
multiple medications for other conditions. Because of uncertainty about the relative risks
and benefits of rate versus rhythm control (including antiarrhythmic or ablation therapy),
anticoagulation, and procedural treatments (eg, ablation, left atrial appendage closure,
pacemaker placement) in older patients with multimorbidity, shared decision-making is
essential. However, this may be challenging in patients with cognitive dysfunction, high fall
risk, or advanced comorbidity.
14: Anticoagulation in Older Adults with Multimorbidity.
Source Clinics in Geriatric Medicine; May 2016 (no. 2); p. 331-346
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher W B Saunders
Authors Parks, Anna L; Fang, Margaret C
Database CINAHL
Abstract
The number of patients with atrial fibrillation (AF) who are of advanced age or have
multiple comorbidities is expected to increase substantially. Older patients with AF
generally gain a net benefit from anticoagulation. Guidelines typically recommend
anticoagulation. There are multiple challenges in the safe use of anticoagulation in frail
patients, including bleeding risk, monitoring and adherence, and polypharmacy. Although
there are options for chronic oral anticoagulation, clinicians must understand the unique
advantages and disadvantages of these medications when developing a management plan.
This article reviews issues surrounding the appropriate use and selection of anticoagulants
in complex older patients with AF.
15: New-Onset Atrial Fibrillation in Sepsis: So Common, but So Different.
Source Critical Care Medicine; May 2016 (no. 5)
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Lippincott Williams & Wilkins
Authors Guenancia, Charles; Laurent, Gabriel; Bruyère, Rémi; Quenot, Jean-Pierre
Database CINAHL
Abstract
A letter to the editor is presented in response to the article "Atrial fibrillation is an
independent predictor of mortality in critically ill patients" by Ciara M. Shaver and
colleagues that was published in the previous issue.
16: Increased P-wave dispersion a risk for atrial fibrillation in adolescents with anorexia
nervosa.
Source Eating Disorders; May 2016 (no. 3); p. 289-296
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Routledge
Authors Ertuğrul, İlker; Akgül, Sinem; Derman, Orhan; Karagöz, Tevfik; Kanbur, Nuray
Database CINAHL
17: Could Transthoracic Echocardiography Results Be Convincing Enough to Impact the
Management of Atrial Fibrillation?
Source Echocardiography; May 2016 (no. 5); p. 672-673
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Wiley-Blackwell
Authors Donal, Erwan; Colette, Edouard; Hubert, Arnaud
Database CINAHL
18: Clinical Relevance of Left Atrial Strain to Predict Recurrence of Atrial Fibrillation after
Catheter Ablation: A Meta-Analysis.
Source Echocardiography; May 2016 (no. 5); p. 724-733
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Wiley-Blackwell
Authors Ma, Xin-Xin; Boldt, Leif-Hendrik; Zhang, Yue-Li; Zhu, Meng-Ruo; Hu, Bing; Parwani,
Abdul; Belyavskiy, Evgeny; Radha Krishnan, Aravind K.; Krisper, Maximilian; Köhncke,
Clemens; Osmanoglou, Engin; Kropf, Martin; Lacour, Philipp; Blaschke, Florian; Edelmann,
Frank; Tschöpe, Carsten; Haverkamp, Wilhelm; Pieske-Kraigher, Elisabeth; Pieske, Burkert;
Morris, Daniel A.
Database CINAHL
19: First-degree atrioventricular block: risk marker or innocent finding?
Source Heart; May 2016 (no. 9); p. 655-656
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher BMJ Publishing Group
Authors Aro, Aapo L.
Database CINAHL
Abstract
The author reflects on the finding about the community risks brought by first-degree
atrioventricular (AV) block to the community. The author then stated the varying results
from different students conducted regarding the increased risk of first-degree AV block in
atrial fibrillation, heart failure and all-cause mortality to the population. The author also
presented the factors associated with PR prolongation and clinical importance.
20: Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes:
a systematic review and meta-analysis.
Source Heart; May 2016 (no. 9); p. 672-680
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher BMJ Publishing Group
Authors Chun Shing Kwok; Rashid, Muhammad; Beynon, Rhys; Barker, Diane; Patwala,
Ashish; Morley-Davies, Adrian; Satchithananda, Duwarakan; Nolan, James; Myint, Phyo K.;
Buchan, Iain; Loke, Yoon K.; Mamas, Mamas A.; Kwok, Chun Shing
Database CINAHL
Abstract
Objective: First-degree atrioventricular block is frequently encountered in clinical practice
and is generally considered a benign process. However, there is emerging evidence that
prolonged PR interval may be associated with adverse outcomes. This study aims to
determine if prolonged PR interval is associated with adverse cardiovascular outcomes
and mortality.Methods: We searched MEDLINE and EMBASE for studies that evaluated
clinical outcomes associated with prolonged and normal PR intervals. Relevant studies
were pooled using random effects meta-analysis for risk of mortality, cardiovascular
mortality, heart failure, coronary heart disease, atrial fibrillation and stroke or transient
ischaemic attack (TIA). Sensitivity analyses were performed considering the population
type and the use of adjustments.Results: Our search yielded 14 studies that were
undertaken between 1972 and 2011 with 400 750 participants. Among the studies that
adjusted for potential confounders, the pooled results suggest an increased risk of
mortality with prolonged PR interval risk ratio (RR) 1.24 95% CI 1.02 to 1.51, five studies.
Prolonged PR interval was associated with significant risk of heart failure or left ventricular
dysfunction (RR 1.39 95% CI 1.18 to 1.65, three studies) and atrial fibrillation (RR 1.45 95%
CI 1.23 to 1.71, eight studies) but not cardiovascular mortality, coronary heart disease or
myocardial infarction or stroke or TIA. Similar observations were recorded when limited to
studies of first-degree heart block.Conclusions: Data from observational studies suggests a
possible association between prolonged PR interval and significant increases in atrial
fibrillation, heart failure and mortality. Future prospective studies are needed to confirm
the relationships reported, consider possible mechanisms and define the optimal
monitoring strategy for such patients.
21: An intriguing intracardiac mass in a woman with atrial fibrillation.
Source Heart; May 2016 (no. 9); p. 693-695
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher BMJ Publishing Group
Authors Chirillo, Fabio; Fusaro, Michele; Morana, Giovanni; Olivari, Zoran
Database CINAHL
Abstract
Clinical Introduction: A 74-year-old hypertensive woman presented with shortness of
breath. There was no associated coughing, chest pain or fever. ECG identified atrial
fibrillation with rapid ventricular response. A transoesophageal echocardiogram was
scheduled to exclude thrombus before cardioversion (Figure 1A); however, an echogenic
structure was seen (Figure 1B arrow, see online supplementary video 1) between the left
atrium, the pulmonary artery and the aortic root.Question: Which of the following is the
most likely diagnosis? Aortic valve endocarditis with annular abscessLeft atrial appendage
thrombusLeft atrial myxomaPulmonary embolismFor the answer see page 727For the
question see page 693.
22: Spatial Relationship of Focal Impulses, Rotors and Low Voltage Zones in Patients
With Persistent Atrial Fibrillation.
Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 507-514
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Wiley-Blackwell
Authors SCHADE, ANJA; NENTWICH, KARIN; COSTELLO-BOERRIGTER, LISA C.; HALBFASS,
PHILIPP; MUELLER, PATRICK; ROOS, MARKUS; BARTH, SEBASTIAN; KRUG, JOACHIM;
SZOELLOESI, GEZA-ATILLA; LAPP, HARALD; DENEKE, THOMAS
Database CINAHL
23: Spatial Relation Between Left Atrial Anatomical Contact Areas and Circular Activation
in Persistent Atrial Fibrillation.
Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 515-523
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Wiley-Blackwell
Authors NAKAHARA, SHIRO; YAMAGUCHI, TAKANORI; HORI, YUICHI; ANJO, NAOFUMI;
HAYASHI, AKIKO; KOBAYASHI, SAYUKI; KOMATSU, TAKAAKI; SAKAI, YOSHIHIKO; FUKUI,
AKIRA; TSUCHIYA, TAKESHI; TAGUCHI, ISAO
Database CINAHL
24: Hybrid Procedure (Endo/Epicardial) versus Standard Manual Ablation in Patients
Undergoing Ablation of Longstanding Persistent Atrial Fibrillation: Results from a Single
Center.
Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 524-530
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Wiley-Blackwell
Authors EDGERTON, ZACHARY; PERINI, ALESSANDRO PAOLETTI; HORTON, RODNEY;
TRIVEDI, CHINTAN; SANTANGELI, PASQUALE; BAI, RONG; GIANNI, CAROLA; MOHANTY,
SANGHAMITRA; BURKHARDT, J. DAVID; GALLINGHOUSE, G. JOSEPH; SANCHEZ, JAVIER E.;
BAILEY, SHANE; LANE, MAEGEN; BIASE, LUIGI; SANTORO, FRANCESCO; PRICE, JUSTIN;
NATALE, ANDREA
Database CINAHL
25: Comparison of Radiofrequency Catheter Ablation Between Asymptomatic and
Symptomatic Persistent Atrial Fibrillation: A Propensity Score Matched Analysis.
Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 531-535
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Wiley-Blackwell
Authors WU, LINGMIN; LU, YANLAI; ZHENG, LIHUI; QIAO, YU; CHEN, GANG; DING, LIGANG;
HOU, BINGBO; SUN, WEI; LIEW, REGINALD; ZHANG, SHU; YAO, YAN
Database CINAHL
26: Catheter Ablation for 'Lone' Atrial Fibrillation: Efficacy and Predictors of Recurrence.
Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 536-541
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Wiley-Blackwell
Authors BUIATTI, A.; KAESS, B.; REENTS, T.; SEMMLER, V.; TELISHVESKA, M.; BOURIER, F.;
KORNMAYER, M.; KOTTMAIER, M.; HESSLING, G.; DEISENHOFER, I.
Database CINAHL
27: Coefficient of Variation of P-Wave Duration Is a Novel Atrial Heterogeneity Index to
Predict Recurrence of Atrial Fibrillation After Catheter Ablation.
Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 542-548
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Wiley-Blackwell
Authors NAKATANI, YOSUKE; SAKAMOTO, TAMOTSU; MIZUMAKI, KOICHI; NISHIDA,
KUNIHIRO; KATAOKA, NAOYA; TSUJINO, YASUSHI; YAMAGUCHI, YOSHIAKI; INOUE,
HIROSHI
Database CINAHL
28: Apixaban versus Warfarin for the Prevention of Periprocedural Cerebral
Thromboembolism in Atrial Fibrillation Ablation: Multicenter Prospective Randomized
Study.
Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 549-554
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Wiley-Blackwell
Authors KUWAHARA, TAISHI; ABE, MITSUNORI; YAMAKI, MASARU; FUJIEDA, HIROYUKI;
ABE, YUMIKO; HASHIMOTO, KATSUSHI; ISHIBA, MISAKO; SAKAI, HIROTSUKA; HISHIKARI,
KEIICHI; TAKIGAWA, MASATERU; OKUBO, KENJI; TAKAGI, KATSUMASA; TANAKA, YASUAKI;
NAKAJIMA, JUN; TAKAHASHI, ATSUSHI
Database CINAHL
29: Prevalences of Peripheral Arterial Disease Diagnosed by Computed Tomography
Angiography in Patients with Acute Ischemic Stroke.
Source Journal of Stroke & Cerebrovascular Diseases; May 2016 (no. 5); p. 1128-1134
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher W B Saunders
Authors Naito, Hiroyuki; Naka, Hiromitsu; Kobayashi, Megumi; Kanaya, Yuhei; Naito,
Kasane; Kurashige, Takashi; Tokinobu, Hiroshi; Matsumoto, Masayasu
Database CINAHL
Abstract
Background: Few studies have examined the prevalence of peripheral arterial disease
(PAD) with the use of computed tomography angiography (CTA) in patients with acute
ischemic stroke (AIS), although several reports have examined its prevalence using an
ankle brachial index (ABI). We aimed to determine the prevalence of PAD indicated by CTA
in patients with AIS and to clarify the prevalence of PAD in each clinical ischemic stroke
subtype.Methods: We included 199 consecutive patients with AIS admitted to our hospital
and divided them into PAD and non-PAD groups according to the CTA findings.Results: Of
the 199 patients, 40 (20.1%) had PAD; 27 (67.5%) of the PAD patients were asymptomatic.
The prevalence of abnormal ABI (≤.9) was 12.2%. Patients with PAD were older
(78.3 ± 10.2 versus 71.5 ± 10.9, P <.001) and had a significantly lower ABI value (.89 ± .24
versus 1.15 ± .09, P <.001) and higher prevalence of diabetes mellitus (50.0% versus 31.4%,
P = .028), atrial fibrillation (40.0% versus 16.4%, P = .001), coronary artery disease (32.5%
versus 8.2%, P <.001), and intracranial arterial stenosis (47.5% versus 28.9%, P = .025) than
patients without PAD. The prevalence of cerebral microbleeds was not different between
patients with PAD and those without PAD (25.6% versus 25.4%, P = .985). The prevalence
of PAD among ischemic stroke subtypes was highest in patients with cardioembolic
infarction (40.5%).Conclusions: Almost one fourth of the AIS patients examined had PAD
on CTA. Cardioembolic infarction patients showed the highest prevalence of PAD among
the clinical ischemic subtypes, suggesting the coexistence of atheromatous diseases and
atrial fibrillation.
30: Brain Natriuretic Peptide and Particular Left Ventricle Segment Asynergy Associated
with Cardioembolic Stroke from Old Myocardial Infarction.
Source Journal of Stroke & Cerebrovascular Diseases; May 2016 (no. 5); p. 1165-1171
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher W B Saunders
Authors Hosomi, Naohisa; Yoshimoto, Takeshi; Kanaya, Yuhei; Neshige, Shuichiro; Hara,
Naoyuki; Himeno, Takahiro; Kono, Ryuhei; Takeshima, Shinichi; Takamatsu, Kazuhiro; Ota,
Tomoko; Miyamoto, Yoshinori; Yasuda, Kotaro; Shimoe, Yutaka; Ota, Taisei; Kuriyama,
Masaru; Matsumoto, Masayasu
Database CINAHL
Abstract
Background: It is important to determine the usage of anticoagulants by defining the
actual risk of cardioembolic stroke in patients with old myocardial infarction. In the
present study, we aimed to more precisely evaluate the risks of each segment associated
with cardioembolic stroke using a 16-segment model. The usage of the plasma brain
natriuretic peptide (BNP) associated with cardioembolic stroke was also evaluated in
comparison with a left ventricle ejection fraction less than 40%.Methods: There were a
total of 190 ischemic stroke patients who had premorbid myocardial infarction. The study
included a total of 143 ischemic stroke patients with old myocardial infarction who were
available for evaluation and excluded patients with atrial fibrillation or acute myocardial
infarction. Their left ventricle wall motion abnormality and the level of plasma BNP at their
admission were analyzed.Results: Hypertension and a plasma BNP level of 206.9 pg/mL or
higher, determined from the receiver operating characteristic curve, were independently
associated with cardioembolic stroke (χ(2) = 35.6, R(2) = .30, P < .001). Adjusting for these
factors, statistically independent high risk was observed at the basal-inferior, basalinferolateral, mid-anterior, mid-anteroseptal, apical-anterior, and apical-septal left
ventricles.Conclusion: High plasma BNP levels and left ventricular wall motion
abnormalities in the segments perfused with left anterior descending coronary artery or
right coronary artery show a high risk for cardioembolic stroke in patients with old
myocardial infarction. Considering these factors, it could be possible to more precisely
define the risk of cardioembolic stroke and to perform appropriate antithrombotic
treatments in old myocardial infarction patients.
31: Routine Troponin Measurements Are Unnecessary to Exclude Asymptomatic
Coronary Events in Acute Ischemic Stroke Patients.
Source Journal of Stroke & Cerebrovascular Diseases; May 2016 (no. 5); p. 1215-1221
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher W B Saunders
Authors Ali, Farwa; Young, Jimmy; Rabinstein, Alejandro A.; Flemming, Kelly D.; Fugate,
Jennifer E.
Database CINAHL
Abstract
Background: Obtaining serum troponin levels in every patient with acute stroke is
recommended in recent stroke guidelines, but there is no evidence that these contribute
positively to clinical care. We sought to determine the clinical significance of measuring
troponin levels in acute ischemic stroke patients.Methods: We reviewed 398 consecutive
patients with acute ischemic stroke at a large academic institution from 2010 to 2012.
Troponin levels were measured as a result of protocol in place during part of the study
period. The mean age was 70 years (standard deviation ±16 years) and 197 (49.5%) were
men.Results: Chronic kidney disease was present in 78 (19.6%), coronary artery disease in
107 (26.9%), and atrial fibrillation in 107 (26.9%). Serum troponin T was measured in 246
of 398 patients (61.8%). Troponin was elevated (>.01 ng/mL) at any point in 38 of 246
patients (15.5%) and was elevated in 28 patients at all 3 measurements (11.3% of those
with troponin measured). Only 4 of 246 patients (1.6%) had a significant uptrend. Two
were iatrogenic in the setting of hemodynamic augmentation using vasopressors to
maintain cerebral perfusion. One case was attributed to stroke and chronic kidney disease
and another case to heart failure from inflammatory fibrocalcific mitral valvular heart
disease.Conclusions: Serum troponin elevation in patients with ischemic stroke is not
usually caused by clinically significant acute myocardial ischemia unless iatrogenic in the
setting of vasopressor administration. Serum troponin levels should be measured
judicially, based on clinical context, rather than routinely in all stroke patients.
32: Quantification of Right Ventricular Volume and Function Using Single-Beat ThreeDimensional Echocardiography: A Validation Study with Cardiac Magnetic Resonance.
Source Journal of the American Society of Echocardiography; May 2016 (no. 5); p. 392-401
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Elsevier Science
Authors Park, Jun-Bean; Lee, Seung-Pyo; Lee, Ju-Hee; Yoon, Yeonyee E; Park, Eun-Ah; Kim,
Hyung-Kwan; Lee, Whal; Kim, Yong-Jin; Cho, Goo-Yeong; Sohn, Dae-Won
Database CINAHL
Abstract
Background: Because of the unique geometry of the right ventricle, assessment of right
ventricular (RV) volume and function is clinically challenging. The aim of this study was to
investigate the feasibility of single-beat three-dimensional echocardiography (sb3DE) for
RV volume and functional assessment in patients with dilated right ventricles.Methods:
Fifty-two patients with severe tricuspid regurgitation or atrial septal defects were enrolled.
Fifty patients underwent sb3DE and cardiac magnetic resonance (CMR) within 24 hours
under a euvolemic state, and the results of sb3DE were compared with those of CMR, the
reference method. Fifteen normal subjects were also recruited for a broader validation of
sb3DE.Results: Of the 67 individuals, data from 59 study participants (44 patients and 15
normal subjects) with adequate image quality were analyzed (mean age, 46.9 ± 19.3 years;
58% women). The correlation was excellent between sb3DE and CMR for measuring RV
volumes and RV ejection fraction (RVEF) (r = 0.96, r = 0.93, and r = 0.93 [P < .001 for all] for
RV end-diastolic volume, RV end-systolic volume, and RVEF, respectively). Bland-Altman
analysis revealed that RV volumes, but not RVEF, tended to be slightly underestimated by
sb3DE (-5.8 ± 9.6%, -3.8 ± 14.1%, and -1.2 ± 9.4% for RV end-diastolic volume, RV endsystolic volume, and RVEF, respectively). Intra- and interobserver variability was
acceptable for all indices (4.9% and 6.1% for RV end-diastolic volume, 4.2% and 7.9% for
RV end-systolic volume, and 5.7% and 2.8% for RVEF, respectively). Among patients with
RV dilation, the difference in RVEF between sb3DE and CMR was more pronounced in
patients with atrial fibrillation than those in sinus rhythm (-5.9% vs 0.9%,
P = .041).Conclusions: In patients with dilated right ventricles and in normal subjects,
assessment of RV volume and systolic function by sb3DE is feasible in terms of accuracy
and reproducibility. RV analysis using sb3DE can be performed in patients with atrial
fibrillation, with the possibility of RVEF underestimation.
33: Survival in Patients with Degenerative Mitral Stenosis: Results from a Large
Retrospective Cohort Study.
Source Journal of the American Society of Echocardiography; May 2016 (no. 5); p. 461-469
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Elsevier Science
Authors Pasca, Ioana; Dang, Patricia; Tyagi, Gaurav; Pai, Ramdas G
Database CINAHL
Abstract
Background: Severe mitral annular calcification causing degenerative mitral stenosis (DMS)
is increasingly encountered in patients undergoing mitral and aortic valve interventions.
However, its clinical profile and natural history and the factors affecting survival remain
poorly characterized. The goal of this study was to characterize the factors affecting
survival in patients with DMS.Methods: An institutional echocardiographic database was
searched for patients with DMS, defined as severe mitral annular calcification without
commissural fusion and a mean transmitral diastolic gradient of ≥2 mm Hg. This resulted
in a cohort of 1,004 patients. Survival was analyzed as a function of clinical,
pharmacologic, and echocardiographic variables.Results: The patient characteristics were
as follows: mean age, 73 ± 14 years; 73% women; coronary artery disease in 49%; and
diabetes mellitus in 50%. The 1- and 5-year survival rates were 78% and 47%, respectively,
and were slightly worse with higher DMS grades (P = .02). Risk factors for higher mortality
included greater age (P < .0001), atrial fibrillation (P = .0009), renal insufficiency (P = .004),
mitral regurgitation (P < .0001), tricuspid regurgitation (P < .0001), elevated right atrial
pressure (P < .0001), concomitant aortic stenosis (P = .02), and low serum albumin level
(P < .0001). Adjusted for propensity scores, use of renin-angiotensin system blockers
(P = .02) or statins (P = .04) was associated with better survival, and use of digoxin was
associated with higher mortality (P = .007).Conclusions: Prognosis in patients with DMS is
poor, being worse in the aged and those with renal insufficiency, atrial fibrillation, and
other concomitant valvular lesions. Renin-angiotensin system blockers and statins may
confer a survival benefit, and digoxin use may be associated with higher mortality in these
patients.
34: Impact of thyroidectomy on cardiac manifestations of Graves' disease.
Source Laryngoscope; May 2016 (no. 5); p. 1256-1259
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Wiley-Blackwell
Authors Gauthier, Jason M.; Mohamed, Hossam Eldin; Noureldine, Salem I.; Nazari-Shafti,
Timo Z.; Thethi, Tina K.; Kandil, Emad
Database CINAHL
Abstract
Objectives/hypothesis: Graves' disease (GD) has multiple adverse effects on the
cardiovascular system. We aimed to examine the outcome of thyroidectomy in patients
with cardiac manifestations of GD and evaluate their associated postoperative
complications.Study Design: Retrospective analysis using a prospectively collected
database.Methods: A retrospective analysis of our prospectively collected thyroid surgery
database was performed. Forty patients with hyperthyroidism due to GD were identified,
and each was appropriately age matched to a euthyroid patient with multinodular goiter
(MNG). All patients underwent total thyroidectomy. Data relating to cardiac comorbidities
were collected from preoperative and postoperative clinic notes, hospital admissions,
electrocardiograms, echocardiograms, and blood work. Perioperative biochemical,
cardiovascular, and postoperative outcomes were analyzed.Results: Twenty-four (60%) GD
patients and 14 (35.0%) MNG patients had cardiac manifestations (P = .001). Hypertension
resolved in 41.7% of GD patients and 7.7% of MNG patients (P = .00002). Two of the three
GD patients with congestive heart failure (CHF) had resolution of CHF with significant
improvement in ejection fraction, whereas the one MNG patient with CHF saw no change.
Additionally, the majority of GD patients saw a resolution of their tachycardia (68.8%) and
atrial fibrillation (100%). Four postoperative complications occurred in both the GD and
MNG groups (4/40, 10%).Conclusions: Surgical treatment of GD in patients with cardiac
manifestations offers rapid clinical improvement of hypertension, impaired left ventricular
systolic function, and arrhythmias. When performed by a high-volume surgeon, the
complication rate is similar to thyroidectomy for other benign disease.Level Of Evidence:
4. Laryngoscope, 126:1256-1259, 2016.
35: Temporal Trends in the Use of Investigations After Stroke or Transient Ischemic
Attack.
Source Medical Care; May 2016 (no. 5); p. 430-434
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Lippincott Williams & Wilkins
Authors Ng, Vivian T.; Bayoumi, Ahmed M.; Jiming Fang; Burton, Kirsteen R.; Stamplecoski,
Melissa; Edwards, Jodi D.; Kapral, Moira K.; Fang, Jiming
Database CINAHL
Abstract
Background: Guidelines recommend that patients with stroke or transient ischemic attack
(TIA) undergo neuroimaging and cardiac investigations to determine etiology and guide
treatment. It is not known how the use of these investigations has changed over time and
whether there have been associated changes in management.Objectives: To evaluate
temporal trends in the use of brain and vascular imaging, echocardiography, and
antithrombotic and surgical therapy after stroke or TIA.Research Design: We analyzed
42,738 patients with stroke or TIA presenting to any of the 11 regional stroke centers in
Ontario, Canada between 2003 and 2012 using the Ontario Stroke Registry database. The
study period was divided into 1-year intervals and we used the Cochran-Armitage test to
determine trends over time.Results: Between 2003/2004 and 2011/2012, the proportion
of patients undergoing brain imaging increased from 96% to 99%, as did the proportion
receiving ≥3 brain scans (21%-39%), magnetic resonance imaging (13%-50%), vascular
imaging (62%-88%), or echocardiography (52%-70%) (P<0.0001 for all comparisons). There
was an increase in the proportion receiving any antithrombotic therapy (83%-91%,
P<0.0001) but no change in use of anticoagulation (25% overall and 68% in subgroup with
atrial fibrillation) or carotid revascularization (1.4%-1.5%, P=0.49).Conclusions: The use of
investigations after stroke has increased over time without concomitant changes in
medical or surgical management. Although initial neurovascular imaging is in accordance
with practice guidelines, the use of multiple imaging procedures and routine
echocardiography are of uncertain clinical effectiveness.
36: Novel Percutaneous Epicardial Autonomic Modulation in the Canine for Atrial
Fibrillation: Results of an Efficacy and Safety Study.
Source Pacing & Clinical Electrophysiology; May 2016 (no. 5); p. 407-417
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Wiley-Blackwell
Authors MADHAVAN, MALINI; VENKATACHALAM, K.L.; SWALE, MATTHEW J.; DESIMONE,
CHRISTOPHER V.; GARD, JOSEPH J.; JOHNSON, SUSAN B.; SUDDENDORF, SCOTT H.; MIKELL,
SUSAN B.; LADEWIG, DOROTHY J.; NOSBUSH, TONI GRABINGER; DANIELSEN, ANDREW J.;
KNUDSON, MARK; ASIRVATHAM, SAMUEL J.
Database CINAHL
37: Redefining Valvular Atrial Fibrillation: Safety of Novel Oral Anticoagulants beyond
Mitral Stenosis and Prosthetic Valves...Leef G, Qin D, Althouse A, Alam MB, Rattan R,
Munir MB, Patel D et al. Risk of Stroke and Death in Atrial Fibrillation By Type of
Anticoagulation: A Propensity-Matched Analysis. Pacing Clin Electrophysiol
2015;38:1310–1316.
Source Pacing & Clinical Electrophysiology; May 2016 (no. 5); p. 511-512
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Wiley-Blackwell
Authors CHUGH, YASHASVI; FAILLACE, ROBERT T.
Database CINAHL
38: Letter by Doğanay et al Regarding Article, "Preexisting Heart Disease Underlies
Newly Diagnosed Atrial Fibrillation After Acute Ischemic Stroke".
Source Stroke (00392499); May 2016 (no. 5)
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Lippincott Williams & Wilkins
Authors Doğanay, Fatma; Katlandur, Hüseyin; Özdil, Hüseyin; Rizos, Timolaos; Veltkamp,
Roland
Database CINAHL
39: Response to Letter Regarding Article, "Preexisting Heart Disease Underlies Newly
Diagnosed Atrial Fibrillation After Acute Ischemic Stroke".
Source Stroke (00392499); May 2016 (no. 5)
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Lippincott Williams & Wilkins
Authors Rizos, Timolaos; Veltkamp, Roland
Database CINAHL
40: Obstructive Sleep Apnea in Acute Stroke: A Role for Systemic Inflammation.
Source Stroke (00392499); May 2016 (no. 5); p. 1207-1212
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Lippincott Williams & Wilkins
Authors Ifergane, Gal; Ovanyan, Andrey; Toledano, Ronen; Goldbart, Aviv; Abu-Salame,
Ibrahim; Tal, Asher; Stavsky, Moshe; Novack, Victor
Database CINAHL
Abstract
Background and Purpose: Sleep-disordered breathing is common among patients with
stroke resulting in 4- to 6-fold higher prevalence of obstructive sleep apnea (OSA). We
prospectively evaluated clinical characteristics and laboratory markers of inflammation
and coagulability associated with OSA severity during the acute post stroke
period.Methods: Consecutive patients admitted to the department of Neurology after an
acute ischemic stroke were evaluated during the first 48 hours of symptom onset using
Watch peripheral arterial tonometry, a wrist-worn ambulatory sleep study device that
utilizes peripheral arterial tonometry. Morning blood samples of the patient were tested
for tumor necrosis factor, interleukin-6, and plasminogen activator inhibitor-1
levels.Results: A total of 43 patients with acute stroke were admitted during the study
period, 22 (51%) of which have been found to have moderate sleep apnea (apnea
hypopnea index [AHI]≥15), AHI≥5 was found in 86% of the patients, and severe OSA
(AHI≥30) in 32.5%. Patients with OSA (AHI≥15) did not differ from the rest in stroke
severity or symptoms, yet they had higher prevalence of recurrent stroke and atrial
fibrillation. All 3 biomarkers levels were higher among patients with AHI≥15: tumor
necrosis factor (6.39 versus 3.57 pg/mL), interleukin-6 (6.64 versus 3.14 pg/mL), and
plasminogen activator inhibitor-1 (176.64 versus 98.48 pg/mL). After the stratification of
AHI into 3 groups (AHI<5, 5-14, and ≥15), the analysis showed that only the highest AHI
group differed from the other 2 groups in biomarkers levels.Conclusions: Use of bed-side
somnography technology revealed that in an unselected sample of patients with acute
ischemic stroke, almost 90% had sleep-disordered breathing with third having severe form
of the disorder. Sleep-disordered breathing was associated with significantly increased
levels of inflammatory biomarkers, providing possible pathophysiological explanation of
OSA-associated stroke risk. These results warrant prospective screening of patients with
stroke for the presence of sleep-disordered breathing and lay the rationale for an
interventional trial.
41: Ischemic Stroke Risk in Patients With Atrial Fibrillation and CHA2DS2-VASc Score of
1: Systematic Review and Meta-Analysis.
Source Stroke (00392499); May 2016 (no. 5); p. 1364-1367
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Lippincott Williams & Wilkins
Authors Joundi, Raed A.; Cipriano, Lauren E.; Sposato, Luciano A.; Saposnik, Gustavo
Database CINAHL
Abstract
Background and Purpose: The CHA2DS2-VASc score aims to improve risk stratification of
ischemic stroke among patients with atrial fibrillation to identify those who can safely
forego oral anticoagulation. Oral anticoagulation treatment guidelines remain uncertain
for CHA2DS2-VASc score of 1. We conducted a systematic review and meta-analysis of the
risk of ischemic stroke for patients with atrial fibrillation and CHA2DS2-VASc score of 0, 1,
or 2 not treated with oral anticoagulation.Methods: We searched MEDLINE, Embase,
PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic
Reviews, and Web of Science from the start of the database up until April 15, 2015. We
included studies that stratified the risk of ischemic stroke by CHA2DS2-VASc score for
patients with nonvalvular atrial fibrillation. We estimated the summary annual rate of
ischemic stroke using random effects meta-analyses and compared the estimated stroke
rates with published net-benefit thresholds for initiating anticoagulants.Results: 1162
abstracts were retrieved, of which 10 met all inclusion criteria for the study. There was
substantial heterogeneity among studies. The summary estimate for the annual risk of
ischemic stroke was 1.61% (95% confidence interval 0%-3.23%) for CHA2DS2-VASc score of
1, meeting the theoretical threshold for using novel oral anticoagulants (0.9%), but below
the threshold for warfarin (1.7%). The summary incident risk of ischemic stroke was 0.68%
(95% confidence interval 0.12%-1.23%) for CHA2DS2-VASc score of 0 and 2.49% (95%
confidence interval 1.16%-3.83%) for CHA2DS2-VASc score of 2.Conclusions: Our metaanalysis of ischemic stroke risk in atrial fibrillation patients suggests that those with
CHA2DS2-VASc score of 1 may be considered for a novel oral anticoagulant, but because
of high heterogeneity, the decision should be based on individual patient characteristics.
42: Doppler Tissue Evaluation of Atrial Conduction Properties in Patients With Nonalcoholic Fatty-liver Disease.
Source Ultrasonic Imaging; May 2016 (no. 3); p. 225-235
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Sage Publications Inc.
Authors Ozveren, Olcay; Izgi, Cemil; Eroglu, Elif; Simsek, Mustafa Aytek; Turer, Ayca;
Kucukdurmaz, Zekeriya; Cinar, Veysel; Degertekin, Muzaffer
Database CINAHL
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver
disease in clinical practice, and there is an increasing trend in its prevalence in the general
population. Recent studies have demonstrated increased risk of atrial fibrillation (AF) in
NAFLD. However, information on the mechanism of increased risk of AF in NAFLD is
lacking. Impaired atrial conduction is an important factor in the pathophysiology of AF. We
aimed to investigate atrial conduction properties in patients with NAFLD by tissue Doppler
echocardiography. Fifty-nine ultrasound diagnosed NAFLD patients without clinical
diagnosis of hypertension, diabetes mellitus, or cardiac disease and 22 normal subjects as
controls were included in this study. Atrial conduction properties were assessed by
electromechanical delay (EMD) derived from Doppler tissue echocardiography
examination and P-wave dispersion (PWD) calculated from the 12-lead electrocardiogram.
Inter-atrial and intra-atrial EMD intervals were significantly longer in NAFLD patients than
in controls (inter-atrial EMD, 31.9 ± 8.5 ms vs. 23.4 ± 4.6 ms,p= 0.0001, and intra-atrial
EMD, 14.3 ± 5.2 vs. 10.2 ± 4.0 ms,p= 0.001). Similarly, PWD was significantly higher in
NAFLD patients compared with controls (49.2 ± 6.3 ms vs. 43.3 ± 4.2 ms,p= 0.0001).
Maximum left atrial volume was also significantly higher in the NAFLD group than in
controls (51 ± 11 mL vs. 34 ± 9 mL,p< 0.0001). This study demonstrated that atrial
conduction is impaired in patients with NAFLD. Also, in a patient population of NAFLD
without any clinical diagnosis of cardiac disease, diabetes, or hypertension, left atrial
volume was increased compared with controls. These findings suggest impaired atrial
conduction as a factor in increased risk of AF in NAFLD.
43: Quality of Life Experiences among Women with Atrial Fibrillation: Findings from an
Online Survey.
Source Women's Health Issues; May 2016 (no. 3); p. 288-297
Publication Date May 2016
Publication Type(s) Academic Journal
Publisher Elsevier Science
Authors Macario, Everly; Schneider, Yukari T.; Campbell, Susan M.; Volgman, Annabelle
Santos
Database CINAHL
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