International journal of cardiology
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Inappropriate shocks resulting from atrial tachyarrhythmias are highly problematic for patients with an implantable cardioverter defibrillator (ICD). We aimed to determine the effectiveness of catheter ablation of atrial fibrillation (AF) in preventing inappropriate shocks due to rapid AF in patients diagnosed with Brugada syndrome (BS) who were implanted with an ICD. ⋯ AF ablation in BS patients may be reasonable to prevent inappropriate ICD shocks resulting from rapid AF. However, ventricular extrastimuli just after the ablation had better be avoided in them.
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A review of cardiac point-of-care (POC) tests used to detect or exclude acute myocardial infarction (AMI) with a focus on test performance within 6 hours after the start of symptoms. ⋯ The ideal POC test for the diagnosis of AMI within 6 hours after the onset of symptoms does not yet exist. Evaluated POC tests were in general of poor methodological quality and reported too many false negatives to be considered as save for the assessment of patients suspected of AMI. A POC test of high-sensitive troponin could possibly fill the gap in the early hours after symptom onset, especially in those with non-definitive electrocardiography.
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Randomized Controlled Trial
Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain: results from the randomised, controlled trial: CArdiac cT in the treatment of acute CHest pain (CATCH).
In patients admitted on suspicion of acute coronary syndrome, with normal electrocardiogram and troponines, we evaluated the clinical impact of a Coronary CT angiography (CCTA)-strategy on referral rate for invasive coronary angiography (ICA), detection of significant coronary stenoses (positive predictive value [PPV]) and subsequent revascularisations, as compared to a function-based strategy (standard care). Secondarily we assessed intermediate term clinical events. ⋯ In patients with recent acute-onset chest pain, a CCTA-guided diagnostic strategy improves PPV for the detection of significant coronary stenoses, and increases the frequency of revascularisations, when compared to a conventional functional approach.
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Cardiac computed tomography angiography (CCTA) provides the simultaneous evaluation of the aortic valve, myocardium, and coronary arteries. In particular, aortic valve calcium score (AVCS) can be accurately measured on the same scanning sequence used to measure coronary artery calcification, with no additional cost or radiation exposure. We sought to evaluate the prognostic value of CCTA measures, including AVCS, in asymptomatic aortic stenosis (AS). ⋯ In patients with asymptomatic AS, CCTA measures of valve area, coronary stenosis, and calcification severity provide independent and incremental prognostic value after accounting for the echocardiographic severity of stenosis.
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Acute kidney injury (AKI) is associated with death, end-stage renal disease, and heart failure in patients with coronary heart disease. This study investigated the association between AKI and long-term risk of stroke. ⋯ The long-term risk of stroke is weakly associated with AKI after primary isolated CABG, but this association is attenuated and not significant when considering death as a competing risk.