International journal of cardiology

Publisher: Elsevier


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    International journal of cardiology (Online)
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    Document, Periodical, Internet resource
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    Internet Resource, Computer File, Journal / Magazine / Newspaper

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background An accurate prognostic stratification is essential for optimizing the clinical management and treatment decision-making of patients with chronic heart failure (HF). Among the best available models, we used the Cardiac and Comorbid Conditions HF (3C-HF) Score, to predict all-cause mortality in patients with CHF. Methods: we selected and characterized the subgroup of patients at very high risk with the worst mid-term prognosis belonging to the highest decile of 3C-HF score with the aim to assess predictors of survival in subjects with an expected probability of 1-year mortality near to 45%. Methods and Results We recruited 1777 consecutive chronic HF patients at 3 Italian Cardiology Units. Median age was 76 ± 10 years, 43% were female, 32% had preserved ejection fraction. Subjects belonging to the highest decile of 3C-HF score were 246 (13.8% of total population). During a median follow-up of 21 [12-40] months, 110 of these patients (45%) survived and 136 (55%) died. The variables that contributed to survival prediction emerged by Cox regression multivariate analysis were the lower degree of renal dysfunction and higher body mass index. Conclusions The prognostic stratification of chronic HF patients allows in daily practice to select patients at different risk for death and identify prognosticators of survival in outliers at very high risk of death. The reasons why these patients outlive the matching part of subjects who expectedly die are related to the maintenance of a satisfactory renal function and body mass index.
    International journal of cardiology 09/2014;
  • International journal of cardiology 08/2014;
  • International journal of cardiology 08/2014;
  • International journal of cardiology 07/2014;
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    ABSTRACT: Background Currently, the appropriateness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for patients with diabetes (DM) and multi-vessel disease (MVD) is disputed due to limited evidence from few randomised controlled trials (RCT’s). We aimed to compare the clinical effectiveness of CABG versus PCI-DES in DM-MVD patients using an evidence-based approach. Methods A systematic review and meta-analyses were conducted to compare the risk of all-cause mortality, myocardial infarction (MI), repeat revascularisation, cerebrovascular events (CVE), and major adverse cardiac or cerebrovascular events (MACCE). Results A total of 1,837 and 3,052 DM-MVD patients were pooled from four RCTs (FREEDOM, SYNTAX, VA CARDS, CARDia) and five non-randomised studies. At mean follow-up of three years, CABG compared with PCI-DES was associated with a lower risk of all-cause mortality and MI in RCTs. By contrast, no significant differences were observed in the mean 3.5-year risk of all-cause mortality and MI in non-randomised trials. However, risk of repeat revascularisations following PCI-DES compared with CABG was 2.3 (95% CI: 1.8-2.8) and 3.0 (2.3- 4.2) folds higher in RCT’s and non-randomised trials, respectively. Accordingly, the risk of MACCE at three years following CABG compared with PCI-DES was lower in both RCT’s and non-randomised trials [0.65 (: 0.55-0.77); and 0.77 (0.60-0.98), respectively]. Conclusions CABG compared with PCI-DES is recommended for patients with DM-MVD, based on our results from pooled analyses of RCTs. Although non-randomised trials suggest no additional survival-, MI-, and CVE- benefit from CABG over PCI-DES, these results should be interpreted with care.
    International journal of cardiology 07/2014;
  • International journal of cardiology 06/2014;
  • International journal of cardiology 05/2014;
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    ABSTRACT: Previous studies have shown an upward trend in the prevalence of hypertension, but data on trend of incidence of hypertension are lacking. We seek to investigate the trends in incidence of hypertension and control of incident hypertension among Chinese adults during 1991-1997 and 2004-2009. Within the China Health and Nutrition Survey (1991-2009), we identified five cohorts of adults (age≥18years) who were free of hypertension at baseline of each cohort: cohorts 1991-1997 (n=4107), 1993-2000 (n=4068), 1997-2004 (n=4141), 2000-2006 (n=4695), and 2004-2009 (n=4523). Data on demographics, smoking, alcohol intake, physical activity, body mass index (BMI), and blood pressure were collected through interviews and clinical examination. Hypertension was defined as blood pressure≥140/90mmHg or currently using antihypertensive drugs. Multiple generalized estimation equations and Coxregression models were used to test the trends in blood pressure, incidence of hypertension, use of antihypertensive drugs, and control status of incident hypertension. After controlling for potential confounders, incidence of hypertension (per 100 person-years) significantly increased from 2.9 in 1991-1997 to 5.3 in 2004-2009 (ptrend=0.024); the linear trend was statistically or marginally significant in the age group of 18-39 years, in women, in rural residents, and in adults with normal BMI. The overall rates of antihypertensive treatment and control of incident hypertension increased significantly from 5.7% and 1.7% in 1991-1997 to 19.9% and 7.6% in 2004-2009, respectively (ptrend<0.001). The incidence of hypertension has increased in Chinese adults since early 1990s. The treatment and control status of incident hypertension, while improved, remain very poor.
    International journal of cardiology 05/2014;
  • International journal of cardiology 05/2014;
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    ABSTRACT: Beta Blocker in childhood heart failure: Why not? R. Buchhorn (1), M.E. McConnell(2); 1) Klinik für Kinder- und Jugendmedizin, Caritas Krankenhaus, Bad Mergentheim, Germany 2) Sibley Heart Center Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA. Today in cardiology the efficacy of beta blockers in patients with conges-tive heart failure is beyond all doubt. Beta blockers, as a class, provide mortality benefits in comparison with placebo or standard treatment in patients with mild to severe heart failure. Based upon the disappointing results of the two biggest US studies in children with heart failure beta blockers as well as ACE inhibitors seem to be ineffective. However, looking at the details researchers found the greatest benefit of beta blockers in patients with the most severe heart failure. Therefore,the US-Carvedilol trial in children is clearly underpowered. This trial recruited only children with mild heart failure indicated by very low mean BNP levels(110pg/ml). In the CHF-Pro-Infant trial in infants with congenital heart disease with severe heart failure and high neurohormonal activity we showed significant beneficial effects on Ross Score and neurohormonal activity. Our results are now confirmed by the prospective randomized trial VSD-PHF in 80 infants with VSD from India. Propranolol is the only drug that was successful in prospective randomized trials in infants with congenital heart disease (N=100). Today mortality due to heart failure in infants with congenital heart disease remains a dangerous problem. Sommers, et al in 2005 showed that 111 of 1755 unselected children with heart disease died within 10 years, 67% within the first year of life. Despite high level surgery the cause of death was heart failure in 74%. We respectfully submit that there is significant evidence to support the use of beta blockers in children with heart failure, and to withhold this potentially lifesaving therapy based on underpowered negative studies is unwarranted.
    International journal of cardiology 05/2014;
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    ABSTRACT: Levosimendan is used in acute heart failure (HF) and increasingly as planned repetitive infusions in stable chronic HF, but the extent of this practice is unknown. The aim was to assess the use of levosimendan vs. conventional inotropes and the use as planned repetitive vs. acute treatment, in Sweden. We performed a descriptive study with individual patient validation assessing the use of levosimendan and conventional intravenous inotropes, indications for levosimendan, clinical characteristics and survival in the Swedish Heart Failure Registry between 2000 and 2011. For repetitive levosimendan, we assessed potential indications for alternative interventions. Of 53,548 total registrations, there were 655 confirmed with inotrope use (597 levosimendan, 37 conventional, 21 both) from 22 hospitals responding to validation, and 6069 in-patient controls with New York Heart Association III-IV and ejection fraction <40%. The indications for levosimendan were acute HF in 384 registrations (306 patients), and planned repetitive in 234 registrations (87 patients). Planned repetitive as a proportion of total levosimendan registrations ranged 0-65% and of total levosimendan patients ranged 0-54% in different hospitals. Of planned repetitive patients without existing cardiac resynchronization therapy, implantable cardioverter defibrillator, transplant and/or assist device, 46-98% were potential candidates for such interventions. In HF in cardiology and internal medicine in Sweden, levosimendan was the overwhelming inotrope of choice, and the use of planned repetitive levosimendan was extensive, highly variable between hospitals and may have pre-empted other interventions. Potential effects of and indications for planned repetitive levosimendan need to be evaluated in prospective studies.
    International journal of cardiology 04/2014;
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    ABSTRACT: Left heart catheterisation with coronary angiography (CA) may lead to cognitive dysfunction, as a result of neurological injury. The aim was to assess the incidence of cognitive dysfunction in elderly patients three months after CA and investigate any association between cognitive dysfunction and microembolic count during CA. This was a prospective observational study with a control cohort. Cognitive testing was undertaken at baseline and at 3months using a battery of 8 neuropsychological tests. Subjects comprised 51 CA patients, aged≥50years, with normal baseline cognition, and 31 community control participants. Microemboli were measured by Transcranial Doppler throughout the procedure. All patients underwent trans-femoral CA with aortography and ventriculography. Cognitive dysfunction was defined in an individual when their reliable change index score was less than -1.96 on 2 or more tests and/or their combined z score was less than -1.96. Microembolic count was assessed by off-line manual counting and automatic software was also used to count and differentiate gaseous from solid microemboli. Cognitive dysfunction was identified in 15.7% of patients at 3months. Microemboli were detected in all patients, predominantly during aortography and ventriculography. The median total embolic count was 365 (IQR 192, 574), the majority being gaseous (84%). There was no multivariable association between cognitive dysfunction at 3months and microembolic count. This study demonstrated that cognitive dysfunction following CA is not associated with microembolic load. Cognitive dysfunction occurs in 15.7% of patients at 3months. This is reassuring for the proceduralist and suggests that other perioperative elements are involved.
    International journal of cardiology 04/2014;