International journal of cardiology
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Takotsubo syndrome is an increasingly recognized acute cardiac affliction which is characterized by severe regional left ventricular dysfunction that cannot be explained by one or more occlusive culprit lesions of a coronary artery. A preceding somatic and/or emotional stressor can be identified in a majority of these patients and older women are overrepresented among the afflicted. Catecholamine levels are elevated in patients with takotsubo and exogenous catecholamine administration may cause or exacerbate the condition. ⋯ Five distinct hypotheses have been postulated which attempt to explain why specific regions within the left ventricle are affected in takotsubo. In this manuscript we critically review these hypotheses in light of the available data. We discuss how the different hypotheses may be complementary to each other and to which extent they are contradicting one another.
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Randomized Controlled Trial Multicenter Study
Acute decompensated heart failure patients admitted to critical care units: insights from ASCEND-HF.
Little is known about global patterns of critical care unit (CCU) care and the relationship with outcomes in patients with acute decompensated heart failure (ADHF). Whether a ward or a CCU admission is associated with better outcomes is unclear. ⋯ Management of patients with ADHF varies significantly, and after adjustment, CCU care was associated with higher risk of early mortality, not explained by international differences. These findings may help to improve the early decisions regarding risk stratification of patients hospitalized with ADHF.
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Concerns regarding the use of selected bone marrow stem cells (BMSCs) in the field of cardiac repair after acute ischemic events have been raised. The current meta-analysis aimed to assess the efficacy and safety of selected BMSC transplantation in patients with acute myocardial infarction (AMI) based on published randomized controlled trials (RCTs). ⋯ Transplantation of selected BMSCs for patients with AMI is safe and induces a significant increase in LVEF with a limited impact on left ventricular remodeling.
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This study aimed to compare the accuracy of ECG interpretation for diagnosis of STEMI by different groups of healthcare professionals involved in the STEMI program at our institution. ⋯ Our study showed that healthcare profession and number of ECGs reviewed per week are predictive of the accuracy of ECG interpretation of STEMI. Cardiologists are the most accurate diagnosticians, and are the least likely to falsely activate the CCL. Weekly exposure of ≥ 20 ECGs may improve diagnostic accuracy regardless of underlying experience.
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Despite the widespread use of Inferior vena cava (IVC) filters, there is no quality evidence to demonstrate their efficacy for routine use, nor there is a consensus on their appropriate indications among major medical societies. The introduction of retrievable filters led to further increase in the utilization of these devices. However, several studies have shown that retrievable filters are rarely retrieved. ⋯ Food and Drug Administration has recently issued a safety alert advocating for consideration of filter retrieval when the protection offered by the filter is no longer needed. The controversies surrounding IVC filter placement and retrieval, however, will likely to continue in the absence of good evidence on their efficacy and side effects. Time has come for initiatives to conduct well designed trials based on agreed-upon criteria to settle this debate.