Journal of cardiovascular medicine
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J Cardiovasc Med (Hagerstown) · May 2013
Randomized Controlled Trial Multicenter Study Comparative StudyRandomized trial of standard versus ClearWay-infused abciximab and thrombectomy in myocardial infarction: rationale and design of the COCTAIL II study.
Patients with ST-elevation myocardial infarction (STEMI) are at substantial risk of suboptimal procedural results and late adverse events. Angiography and optical coherence tomography (OCT) studies have identified residual coronary thrombus and microcirculatory injury as potential culprits for these adverse outcomes. We hypothesized that coronary thrombectomy and local infusion of glycoprotein IIb/IIIa inhibitors by means of a dedicated infusion device can synergistically improve results of percutaneous coronary intervention (PCI) for STEMI, as appraised by OCT. ⋯ This trial will provide important mechanistic insights on the most appropriate invasive treatment strategy for patients with STEMI and significant thrombus burden, by exploiting its factorial design and reliance on sensitive OCT endpoints.
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J Cardiovasc Med (Hagerstown) · May 2013
Care of acute myocardial infarction in the coronary care units of Piedmont in 2007: results from the 'PRIMA_sweet' region-wide survey.
The treatment of acute myocardial infarction (AMI), both with ST-segment elevation [ST-elevation myocardial infarction (STEMI)] and non-ST-segment elevation [non-ST-elevation myocardial infarction (NSTEMI)], is evolving in Piedmont, with an increase in interventional procedures and hub-and-spoke networks. This new region-wide survey provides updated assessment of the management of STEMI and unprecedented data on NSTEMI. ⋯ There is room for improvement in the treatment of AMI in our region, with more extensive use of reperfusion therapy in STEMI, especially in the elderly, and early revascularization and optimal medical treatment in higher-risk NSTEMI.
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J Cardiovasc Med (Hagerstown) · Apr 2013
Adaptive servo ventilation reduces central sleep apnea in chronic heart failure patients: beneficial effects on autonomic modulation of heart rate.
Adaptive servo ventilation (ASV) is a method of ventilator support aimed to treat central sleep apnea (CSA). We investigated the effects of an acute use of ASV in chronic heart failure (CHF) patients with CSA and the potential influence on sympathetic nerve activity. ⋯ The acute use of ASV is effective on CSA by increasing oxygen saturation and reducing HR. Moreover, the significant improvement of HRV highlights ASV's benefit in moderating the sympathetic adrenergic tone.
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J Cardiovasc Med (Hagerstown) · Apr 2013
Long-term independent predictors of positive response to cardiac resynchronization therapy.
Cardiac resynchronization therapy (CRT) is currently considered an important breakthrough in the treatment of selected patients with refractory heart failure. However, long-term predictors of mortality, morbidity and time to recovery of ventricular function for those patients who respond positively to CRT remain poorly investigated. ⋯ A better selection of patients on the basis of cause, type of bundle-branch block and basal LVESV/BSA can increase the number of patients that would benefit from CRT.
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J Cardiovasc Med (Hagerstown) · Mar 2013
ReviewRemote ischemic preconditioning: the surgeon's perspective.
Since cardiac surgery began, surgeons have aimed to find methods of minimizing myocardial injury resulting from ischemia and reperfusion. The concept of somehow conditioning the heart in order to attenuate ischemia and reperfusion-related injury has evolved in cardiovascular research over decades, from ischemic preconditioning and postconditioning to, more recently, remote ischemic preconditioning (and postconditioning). ⋯ To date, the translation of this powerful innate mechanism of myocardial and/or multiorgan protection from the animal lab to the operating theatre, using transient occlusion of blood flow to the upper limb with a blood-pressure cuff before cardiac surgery, has shown promising results, with several proof-of-principle and first randomized controlled clinical trials reporting benefits for patients undergoing cardiac surgery. If the efficacy of remote ischemic preconditioning can be conclusively proven, the clinical applications in cardiac surgery could be almost infinite, providing multiorgan protection in various surgical scenarios.