Myocardial Injury Not Uncommon After Non-Cardiac Surgery

MedicalResearch.com Interview with:

Dr. PJ Devereaux MD, PhD, FRCP(C)</strong> Director of the Division of Cardiolog Scientific Leader of the Anesthesiology, Perioperative Medicine and Surgical Research Group at the Population Health Research Institute Professor and University Scholar in the Departments of Health Research Methods, Evidence, and Impact and Medicine McMaster University

Dr. Devereaux

Dr. PJ Devereaux MD, PhD, FRCP(C)
Director of the Division of Cardiolog
Scientific Leader of the Anesthesiology, Perioperative Medicine and
Surgical Research Group at the Population Health Research Institute
Professor and University Scholar in the Departments of Health Research Methods, Evidence, and Impact and Medicine
McMaster University
MedicalResearch.com: What is the background for this study?

Response: Although the majority of patients undergoing noncardiac surgery benefit from surgery and do well, even when a small proportion of these patients have a serious complication it represents a major population issue. A recent publication in JAMA Cardiology established that >5 million Americans age ≥45 years undergo major in-patient noncardiac surgery annually, and 1.3% of these patients die in the hospital. This means 65,000 of these patients die, and cardiovascular causes are a dominant cause.

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Process Refines Conversion of Skin Fibroblasts into Cardiac Blood Vessels

MedicalResearch.com Interview with:

Jalees Rehman, MD Director of Research, Division of Cardiology Associate Professor of Medicine and Pharmacology University of Illinois at Chicago College of Medicine Chicago, IL 60612

Dr. Rehman

Jalees Rehman, MD
Director of Research, Division of Cardiology
Associate Professor of Medicine and Pharmacology
University of Illinois at Chicago
College of Medicine
Chicago, IL 60612

MedicalResearch.com: What is the background for this study?

Response: Converting skin fibroblasts into regenerative blood vessel endothelial cells could be a valuable approach to repair diseased blood vessels in patients with cardiovascular disease and also to build new blood vessels in order to supply engineered tissues and organs.

Using skin fibroblasts is very well suited for personalized therapies because they can be obtained from a skin biopsy in an outpatient setting. The biopsied skin sample is used to extract the skin fibroblasts, which are then expanded in cell culture dishes before they are converted to endothelial cells. This allows for the generation of tens or hundreds of millions of cells that will likely be needed for blood vessel repair and regeneration. By converting skin fibroblasts of a patient, we can generate personalized endothelial cells with the same genetic signature as the patient so that they are less likely to be rejected if implanted back into the same patient after the conversion.

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iFR Can Assess Need For Coronary Revascularization Without Adenosine

MedicalResearch.com Interview with:

Dr. Justin Davies PhD Senior Reserch Fellow and Hononary Consultant Cardiologist National Heart and Lung Institute, Imperial College Londo

Dr. Davies

Dr. Justin Davies PhD
Senior Reserch Fellow and Hononary Consultant Cardiologist
National Heart and Lung Institute,
Imperial College London

MedicalResearch.com: What is the background for this study?

Response: We know from the FAME study that compared to angiography alone, FFR guided revascularization improves long-term clinical outcomes for our patients. Despite this, adoption of FFR into everyday clinical practice remains stubbornly low. One major factor for this is the need for adenosine (or other potent vasodilator medications) in order to perform an FFR measurement. Adenosine is expensive, unpleasant for the patient, time consuming and even potentially harmful.

iFR is a newer coronary physiology index that does not require adenosine for its measurement. In the prospective, multi center, blinded DEFINE FLAIR study, 2492 patients were randomly assigned to either FFR guided revascularisation or iFR guided revascularization and followed up for a period of 1 year.
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Cardiovascular Procedures That Push the Line: High-Risk or Futility of Care?

MedicalResearch.com Interview with:

Adam Skolnick, MD Cardiologist Associate professor of medicine NYU Langone Medical Center

Dr. Adam Skolnick

Adam Skolnick, MD
Cardiologist
Associate professor of medicine
NYU Langone Medical Center  

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: I am privileged to serve on the ACC Program Planning Committee and helped to design this important session that seeks to determine the line between when a cardiovascular procedure is high risk and when it is futile.    I am co-chairing the session with the incoming chair of the section on Geriatric Cardiology for the ACC, Dr. Karen Alexander from Duke.

We are practicing medicine at one of the most extraordinary times when there are so many devices and procedures to prolong and improve quality of life.    It is critical to assess a patient’s goals of care for a given intervention.   In some patients, particularly those who are multiple degenerative chronic conditions, are frail and/or have cognitive impairment it is difficult to know when a given procedure multiple medical conditions will achieve a patient’s goals.   When is a procedure high risk, and when is it simply futile?    This is the fine line upon which many cardiologists often find themselves.

The speakers present case examples of high risk patients considering TAVI, high risk PCI or CABG and mechanical support devices and with interaction from the audience work through when each procedure is high risk and when it is unlikely to achieve a patient’s goals of care.   We also have a dedicated talk on high risk procedures in patients with cognitive impairment, such as advanced dementia.

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SYNTAX Score Predicts Better Results With Bypass Surgery For Type II Diabetes

MedicalResearch.com Interview with:

Fumiaki Ikeno M.D. Program Director (U.S.) Japan Biodesign Stanford Biodesign Medical Director/Research Associate Experimental Interventional Laboratory Division of Cardiology Stanford University

Dr. Fumiaki Ikeno

Fumiaki Ikeno M.D.
Program Director (U.S.) Japan Biodesign
Stanford Biodesign
Medical Director/Research Associate
Experimental Interventional Laboratory
Division of Cardiology
Stanford University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We sought to determine whether the extent of coronary disease in terms of the number of lesions and their complexity in Type 2 Diabetes patients could predict major cardiovascular events, and hypothesized that revascularization would have greater effectiveness relative to medical therapy among patients with more number of lesions and higher complexity in coronary artery disease.

Coronary bypass surgery, catheter-based treatment, and medical therapy all had similar cardiovascular outcomes among patients with less complexity of coronary artery disease who had type 2 diabetes mellitus, stable ischemic heart disease, and no prior coronary revascularization. Among patients with mid or high complexity coronary artery disease, coronary revascularization with bypass surgery significantly reduced the rate of major cardiovascular events during 5 years of follow-up.

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JAMA Study Finds More Interventions and Increasing Survival After Out-of-Hospital Cardiac Arrests

MedicalResearch.com Interview with:
Nish Patel, MD and Nileshkumar J. Patel, MD
University of Miami Miller School of Medicine

MedicalResearch.com: What is the background for this study?

Response: Out of hospital cardiac arrest (OHCA) is estimated to affect approximately 300,000 people in the United States annually. Pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) contributes 23-54% of OHCA patients, with the median values at the lower end of this range. Coronary artery disease is thought to be responsible for up to 70% of these OHCA cases.

It has been suggested that urgent coronary intervention in unconscious patients after cardiac arrest may improve survival. In the 2015 American Heart Association (AHA) guidelines, coronary angiography is recommended in patients with OHCA patients with a suspected cardiac etiology and ST elevations (STE) on ECG (Class of recommendation I, Level of evidence B), and it should be considered in patients after cardiac arrest presenting without STE but with suspected cardiac etiology of cardiac arrest (Class of recommendation II a, Level of evidence B). However, there is paucity of information about the use of coronary angiography and percutaneous coronary intervention (PCI) and its potential benefit for the VT/VF OHCA patient population.

Therefore, we reviewed the Nationwide Inpatient Sample (NIS), to examine temporal trends of coronary angiography and PCI in VT/VF OHCA in the United States, for patients with and without STE. We also studied the temporal trends of survival to discharge in these patient populations.

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Despite Valuable Biomarkers Clinical Evaluation Still Important in Diagnosing Heart Attack

MedicalResearch.com Interview with:

Dr. Juan Sanchis Full professor of Medicine Cardiology Department, University Clinic Hospital. Medicine Department, University of Valencia Valencia. Spain

Dr. Juan Sanchis

Dr. Juan Sanchis
Full professor of Medicine
Cardiology Department, University Clinic
Hospital. Medicine Department, University of Valencia
Valencia. Spain

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Decision making in acute chest pain in the emergency departments
remains challenging despite the introduction of new troponin assays
(high-sensitivity assays) capable of detecting any amount of
myocardial damage.

The upper limit of normality of high-sensitivity
troponin is established at the 99th percentile of a normal reference
population. This is the limit for the diagnosis of acute myocardial
infraction. Detectable troponin levels below the 99th percentile,
though non diagnostic of acute myocardial infarction, might be
considered as of uncertain significance since some patients might
still suffer from unstable angina. Undetectable troponin (far below
the 99th percentile), however, could rule out unstable angina meaning
that such patients could safely be discharged from the emergency
department according to some studies. Therefore, if this were fully
demonstrated, clinical evaluation could play a secondary role.

We investigated clinical data in comparison to undetectable
high-sensitivity troponin in patients with normal high-senstivity
troponin levels (below the 99th percentile).

The main findings indicate that clinical data can guide decision making and perform at
least equally well as undetectable high-sensitivity troponin for
ruling out unstable angina, in patients presenting at the emergency
department with chest pain and normal troponin.

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HIV Treatment Does Not Reduce Cardiovascular Risk of HIV Infection

MedicalResearch.com Interview with:

Steven Grinspoon, MD Professor of Medicine, Harvard Medical School MGH Endowed Chair in Neuroendocrinology and Metabolism Director, MGH Program in Nutritional Metabolism and Nutrition Obesity Research Center at Harvard MGH Boston, MA 02114

Dr. Steven Kyle Grinspoon

Steven Grinspoon, MD
Professor of Medicine, Harvard Medical School
MGH Endowed Chair in Neuroendocrinology and Metabolism
Director, MGH Program in Nutritional Metabolism
and Nutrition Obesity Research Center at Harvard
MGH
Boston, MA 02114

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Grinspoon: Numerous epidemiologic studies have shown that people living with HIV face a 1.5 to 2-fold increased risk of heart attack, or myocardial infarction, as compared to individuals without the virus. Mechanisms underlying the increased risk of myocardial infarction in HIV are incompletely understood. It is possible that among people living with HIV, increased systemic immune activation fuels arterial inflammation. Arterial inflammation may, in turn, promote the development of high-risk morphology coronary atherosclerotic plaque, which is liable to rupture and result in myocardial infarction.

For people diagnosed with HIV, the overall health benefits of immediate antiretroviral therapy (ART) are clear. However, the effects of newly-initiated antiretroviral therapy on arterial inflammation have not previously been studied. In this study, we set out to assess among a cohort of treatment-naive HIV-infected subjects, the effects of newly-initiated ART with a contemporary regimen on both immune function and arterial inflammation. We found that among treatment-naive HIV-infected individuals without clinical cardiovascular disease, newly initiated combined antiretroviral therapy has discordant effects to restore immune function without reducing the degree of arterial inflammation.

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CT Scans Reveal Black-White Differences in Cardiac Morphology

More on Heart Disease on MedicalResearch.com

MedicalResearch.com Interview with:
John Nance, MD
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science
Medical University of South Carolina
Charleston, South Carolina 

Medical Research: What is the background for this study? What are the main findings?

Dr. Nance: There are known ethnic and racial disparities in the burden, morbidity, and mortality of cardiovascular disease. The causes, of course, are multifactorial, and range from genetic differences to healthcare access issues. Our goal was to further explore these differences by utilize a dataset encompassing black and white patients who had undergone a coronary CT angiogram for the assessment of acute chest pain. We compared various measures of myocardial morphology and function, namely myocardial mass, interventricular septal wall thickness, left ventricular inner diameter in diastole and systole, and ejection fraction. We found that black patients had significantly higher myocardial mass than whites despite adjusting for age, gender, body mass index, and hypertension. Likewise, the septal wall was thicker in black patients. Interestingly, ejection fraction was slightly lower in black patients, but this finding was not statistically significant.  Continue reading

Gender Linked To Health-Related Quality of Life in Young Adults with Heart Disease

MedicalResearch.com Interview with:
Sylvie S.L. Leung Yinko, RD MSc Epidemiology ’14
Division of Clinical Epidemiology
Research Institute of McGill University Health Centre (RI MUHC)
Montreal (QC) H3A 1A1

Medical Research: What are the main findings of the study?

Answer: Our study indicates that young female patients with premature acute coronary syndrome (ACS) have lower health-related quality of life (HRQL) than their male counterparts. Whereas “sex” refers to whether an individual is biologically male or female, “gender” is a more complex term that refers to social norms, roles, and expectations that are traditionally ascribed to males and females in a society. We found that gender, rather than sex, may larger explain the differences in health-related quality of life between men and women. Particularly, higher femininity score, lower social support and greater housework responsibilities appear to be important gender-related factors linked with poorer HRQL post-ACS.

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Atrial Fibrillation: Ablation Found Superior to Conventional Drug Therapy

Carlos A. Morillo, MD, FRCPC, FACC, FHRS, FESC
 Professor Department of Medicine, Cardiology Division
 Program Director Cardiac Electrophysiology and Autonomic Physiology Fellowship
 Arrhythmia & Pacing Service McMaster University-HHSC
 Director Syncope and Autonomic Disorder Unit
 Senior Investigator, Arrhythmia & Global Health, Population Health Research Institute
 Hamilton, ON, CanadaMedicalResearch.com Interview with:
Carlos A. Morillo, MD, FRCPC, FACC, FHRS, FESC

Professor Department of Medicine, Cardiology Division
Program Director Cardiac Electrophysiology and Autonomic Physiology Fellowship
,Hamilton, ON, Canada

MedicalResearch.com: What are the main findings of the study?

Dr. Morillo: The main findings were that Ablation of atrial fibrillation was superior to conventional antiarrythmic drug therapy in patients with Paroxysmal atrial fibrillation that had not been treated with Antiarrhythmic medications. Ablation extended the time to first recurrence of atrial fibrillation within the 2 year follow-up of the study and significantly reduced the  recurrence of repeated episodes of AF.
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TAVR vs Surgical Aortic Valve Replacement for Aortic Stenosis with LV Dysfunction

Sammy Elmariah, MD, MPH Massachusetts General Hospital Boston, MAMedicalResearch.com Interview with:
Sammy Elmariah, MD, MPH
Massachusetts General Hospital
Boston, MA

 

MedicalResearch.com: What are the main findings of the study?

Dr. Elmariah: Within the randomized PARTNER I trial, we evaluated the effect of left ventricular (LV) dysfunction on clinical outcomes after transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively) and the impact of valve replacement technique on recovery of LV function. We found that LV dysfunction, defined as an LV ejection fraction < 50%, had no impact on 30-day and 1-year mortality after either TAVR or SAVR. In those with baseline LV dysfunction, marked improvement in LV ejection fraction was observed within 30-days of valve replacement in approximately half of patients, with an equivalent degree of improvement observed after TAVR and SAVR. Permanent pacemaker at study entry, low mean aortic valve gradient, and high LV ejection fraction were associated with reduced odds of LV functional recovery after valve replacement.

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