Circulation journal : official journal of the Japanese Circulation Society
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Multicenter Study Comparative Study Clinical Trial
Regional variation in survival following pediatric out-of-hospital cardiac arrest.
Although regional variation in outcome after adult out-of-hospital cardiac arrest (OHCA) is known, no clinical studies have assessed this in pediatric OHCA. ⋯ According to Japanese nationwide OHCA registry data there are significant regional variations in the outcome of pediatric OHCA.
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Cardiac resynchronization therapy (CRT) is an effective therapy for advanced heart failure (HF) patients. The indications are well defined in recent guidelines and broadly indicate that CRT is suitable for chronic HF patients with left ventricular ejection fraction (EF) ≤35% and in NYHA class III or IV (Class I), and those with prolonged QRS duration ≥120 ms with left bundle branch block (LBBB) QRS morphology, or QRS duration ≥150 ms irrespective of QRS morphology (Class IIa). ⋯ In this review, we summarize the role of CRT in some subgroups, including patients with mild and moderate HF, upgrading to CRT from right ventricular (RV) pacing, bradycardia patients with routine pacing indications, congenital heart disease and specific cardiomyopathies. It is possible that CRT can give symptomatic and mortality benefits in some of these subgroups in the future and further clinical trials are warranted.
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Fractional flow reserve (FFR) has become an increasingly important index for decision making with respect to revascularization of coronary artery stenosis. It is the gold standard to indicate whether a particular stenosis is responsible for inducible ischemia and it is generally accepted that a stenosis with an ischemic value of FFR is responsible for angina pectoris and a worse outcome, and should be revascularized, whereas lesions with a non-ischemic FFR have a more favorable prognosis and can better be treated medically. ⋯ Finally, a word of caution is given with respect to using resting pressure indexes, which seem attractive because they avoid the need for hyperemia, but negatively affect the accuracy of the measurements. This review can be read as an overview of the state-of-the-art of FFR and as a guide to further reading.