The authors retrospectively reviewed medical records of 150 patients who underwent deactivation of a pacemaker or implantable cardioverter-defibrillator in a four-year period at a single tertiary care center. These were older patients (median age 79) and 99% had a poor or terminal prognosis. More than half of the patients had an advance directive, yet only […]
Category: General cardiology
Mesenchymal stem cells may improve quality of life for patients with ischemic cardiomyopathy
In this study, patients with chronic ischemic cardiomyopathy and EF <50% on optimal medical therapy were randomized to autologous culture expanded mesenchymal cells (=22), autologous bone marrow mononuclear cells (n=22) or placebo vehicle (n=21) delivered by transendocardial stem cell injection (TESI). There were no serious adverse events among any patients undergoing a TESI procedure. Rates […]
Pre-hospital cooling with saline infusion does not improve cardiac arrest outcomes
Prior randomized trials have established hypothermia as a promising therapy to improve outcomes of cardiac arrest. It has been suggested that the benefit of hypothermia may be increased through early initiation of cooling in the field prior to hospital arrival. In this trial, 1,364 patients with out-of-hospital cardiac arrest were randomized to usual care or […]
Multivitamins of no benefit for secondary prevention
A healthy diet that includes foods rich in antioxidants and vitamins has consistently been associated with lower risk of atherosclerosis. Whether secondary risk reduction can be achieved with oral vitamin supplementation is unclear. The TACT (Trial to Assess Chelation Therapy) study was a 2×2 factorial design randomized trial to assess the impact of chelation therapy […]
Stenting of atherosclerotic renal artery disease fails to improve outcomes
Atherosclerotic renal-artery stenosis is common among patients with cardiovascular disease and the condition may contribute to hypertension. The impact of renal artery angioplasty or stenting on the risk of clinical events among patients with atherosclerotic renal disease remains poorly defined. In the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) study, 947 patients atherosclerotic renal-artery stenosis […]
No renal protection with low-dose dopamine or nesiritide in acute heart failure
Diuresis to decongest patients with acute heart failure (AHF) is particularly challenging in the setting of renal dysfunction, as these patients are at risk of worsening renal function. Small studies have suggested that low-dose dopamine or nesiritide may increase urine output and maintain renal function in such patients. The Renal Optimization Strategies Evaluation (ROSE) trial […]
Treatment of obstructive sleep apnea lowers blood pressure
More than 70% of patients with resistant hypertension have obstructive sleep apnea (OSA). However, whether continuous positive airway pressure (CPAP) for OSA improves blood pressure in patients with resistant hypertension is unknown. This was a randomized controlled trial of CPAP in 194 patients with resistant hypertension in the setting of OSA. The primary outcome was […]
Pre-hospital Epinephrine for Witnessed Cardiac Arrest: Improved Outcomes?
Epinepherine remains a common part of resuscitation care for cardiac arrest, despite a lack of clinical evidence to suggest it improves patient survival. This study was a retrospective cohort of patients in Japan with witnessed out-of-hospital cardiac arrest. From this cohort, 1990 matched pairs of patients with initial rhythm of ventricular tachycardia or ventricular fibrillation […]
Sudden increase in LVAD thrombosis rates
The left ventricular assist device (LVAD) has rapidly been incorporated into the management of patients with advanced heart failure. In response to an internal audit demonstrating a rapid increase in the incidence of pump thrombosis following implantation of HeartMate II LVADs, the authors pooled data from additional centers to investigate this trend. The resultant retrospective […]
Repair versus replacement for ischemic mitral regurgitation
Ischemic mitral regurgitation (MR) following myocardial infarction is common and presages a doubling in mortality for those with at least mild regurgitation. The disorder reflects disease of the myocardium, rather than an abnormality of the valve itself. Surgical practice guidelines support intervention for severe symptomatic ischemic MR, but evidence is lacking to inform whether valvular […]