Postgraduate Portal

Department of Medicine, Faculty of Medicine & Health Sciences, Stell. Univ.

Table of contents and abstracts

  • Click on a journal down the left hand side to see its table of contents with abstracts on the right.
  • You can search the journal's article titles and abstracts.
  • If you would like to be emailed when the particular journal's contents are updated, just check the "box.  This is only visible after you have selected a journal by clicking on it.
  • If you know of a journal that should be included please email me with the link.
  • NB: Sometimes the first page of a journal's newsfeed is blank.  Just click on the Next link to see the contents.

Vertical Menu

Core Medical Journal Highlights

      
  • Categories
    • Academic Medicine
    • American Family Physician
    • American Heart Journal
    • American Journal of Cardiology
    • American Journal of Medicine
    • Annals of Internal Medicine
    • Archives of Internal Medicine
    • Archives of Neurology
    • Blood
    • British Medical Journal
    • Brain
    • CA: A Cancer Journal for Clinicians
    • Cancer Journal
    • Chest
    • Circulation
    • Diabetes Journal
    • Endocrinology
    • Gastroenterology
    • Gut
    • Heart & Lung - The Journal of Critical Care
    • Journal of the American Medical Association
    • Journal of Allergy and Clinical Immunology
    • Journal of Clinical Endocrinology and Metabolism
    • Journal of Clinical Investigation
    • Journal of Immunology
    • Journal of the Ameican College of Cardiology
    • Lancet
    • Mayo Clinic Proceedings
    • Medical Clinics of North America
    • Neurology
    • New England Journal of Medicine
    • Postgraduate Medicine
    • Rheumatology

Search
(Log-In to Subscribe)
Tuesday, 29 March 2016 02:00:00
Should Transcatheter Aortic Valve Replacement Be Performed in Nonagenarians? Insights From the STS/ACC TVT Registry
Background
Data demonstrating the outcome of transcatheter aortic valve replacement (TAVR) in the very elderly patients are limited, as they often represent only a small proportion of the trial populations.
Objectives
The purpose of this study was to compare the outcomes of nonagenarians to younger patients undergoing TAVR in current practice.
Methods
We analyzed data from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry. Outcomes at 30 days and 1 year were compared between patients ≥90 years versus <90 years of age using cumulative incidence curves. Quality of life was assessed with the 12-item Kansas City Cardiomyopathy Questionnaire.
Results
Between November 2011 and September 2014, 24,025 patients underwent TAVR in 329 participating hospitals, of which 3,773 (15.7%) were age ≥90 years. The 30-day and 1-year mortality rates were significantly higher among nonagenarians (age ≥90 years vs. <90 years: 30-day: 8.8% vs. 5.9%; p < 0.001; 1 year: 24.8% vs. 22.0%; p < 0.001, absolute risk: 2.8%, relative risk: 12.7%). However, nonagenarians had a higher mean Society of Thoracic Surgeons Predicted Risk of Operative Mortality score (10.9% vs. 8.1%; p < 0.001) and, therefore, had similar ratios of observed to expected rates of 30-day death (age ≥90 years vs. <90 years: 0.81, 95% confidence interval: 0.70 to 0.92 vs. 0.72, 95% confidence interval: 0.67 to 0.78). There were no differences in the rates of stroke, aortic valve reintervention, or myocardial infarction at 30 days or 1 year. Nonagenarians had lower (worse) median Kansas City Cardiomyopathy Questionnaire scores at 30 days; however, there was no significant difference at 1 year.
Conclusions
In current U.S. clinical practice, approximately 16% of patients undergoing TAVR are ≥90 years of age. Although 30-day and 1-year mortality rates were statistically higher compared with younger patients undergoing TAVR, the absolute and relative differences were clinically modest. TAVR also improves quality of life to the same degree in nonagenarians as in younger patients. These data support safety and efficacy of TAVR in select very elderly patients.

Read More

Tuesday, 29 March 2016 02:00:00
Contemporary Natural History and Management of Nonobstructive Hypertrophic Cardiomyopathy
Background
Left ventricular outflow tract gradients are absent in an important proportion of patients with hypertrophic cardiomyopathy (HCM). However, the natural course of this important patient subgroup remains largely unresolved.
Objectives
The authors systematically employed exercise (stress) echocardiography to define those patients without obstruction to left ventricular outflow at rest and/or under physiological exercise and to examine their natural history and clinical course to create a more robust understanding of this complex disease.
Methods
We prospectively studied 573 consecutive HCM patients in 3 centers (44 ± 17 years; 66% male) with New York Heart Association functional class I/II symptoms at study entry, including 249 in whom left ventricular outflow tract obstruction was absent both at rest and following physiological exercise (<30 mm Hg; nonobstructive HCM) and retrospectively assembled clinical follow-up data.
Results
Over a median follow-up of 6.5 years, 225 of 249 nonobstructive patients (90%) remained in classes I/II, whereas 24 (10%) developed progressive heart failure to New York Heart Association functional classes III/IV. Nonobstructive HCM patients were less likely to experience advanced limiting class III/IV symptoms than the 324 patients with outflow obstruction (1.6%/year vs. 7.4%/year rest obstruction vs. 3.2%/year provocable obstruction; p < 0.001). However, 7 nonobstructive patients (2.8%) did require heart transplantation for progression to end stage versus none of the obstructive patients. HCM-related mortality among nonobstructive patients was low (n = 8; 0.5%/year), with 5- and 10-year survival rates of 99% and 97%, respectively, which is not different from expected all-cause mortality in an age- and sex-matched U.S. population (p = 0.15).
Conclusions
HCM patients with nonobstructive disease appear to experience a relatively benign clinical course, associated with a low risk for advanced heart failure symptoms, other disease complications, and HCM-related mortality, and largely without the requirement for major treatment interventions. A small minority of nonobstructive HCM patients progress to heart transplant.

Read More

Tuesday, 29 March 2016 02:00:00
Hypertrophic Cardiomyopathy Job Done or Work in Progress? ∗
Everything should be made as simple as possible but not simpler.Albert Einstein (1)
Read More

Tuesday, 29 March 2016 02:00:00
TAVR in Nonagenarians Pushing the Boundaries ∗
The introduction of transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, especially in high-risk patients and in the elderly. These patients would be considered either high risk or not eligible for surgical aortic valve replacement. The pivotal PARTNER-B (Placement of Aortic Transcatheter Valves) trial, which evaluated TAVR in high-risk U.S. patients, enrolled 358 patients (mean age 83 years) with aortic stenosis not considered to be suitable candidates for surgery and randomized them to TAVR versus continuing medical therapy (1). At 1 year, the death rate was 31% with TAVR versus 51% with medical therapy (p < 0.001). At 1 year, New York Heart Association functional class III or IV symptoms occurred in 25% of TAVR patients versus 58% of medical therapy patients (p < 0.001). However, at 30 days, major strokes occurred in 5.0% of TAVR patients versus 1.1% with medical therapy (p = 0.06). Thus, from the beginning, TAVR has been applied in an elderly population with good, although not perfect, results.
Read More

Tuesday, 29 March 2016 02:00:00
Coronary Microvascular Dysfunction as a Mechanism of Angina in Severe AS Prospective Adenosine-Stress CMR Study
Background
Although a common symptom in patients with severe aortic stenosis (AS) without obstructive coronary artery disease (CAD), little is known about the pathogenesis of exertional angina.
Objectives
This study sought to prove that microvascular dysfunction is responsible for chest pain in patients with severe AS and normal epicardial coronary arteries using adenosine-stress cardiac magnetic resonance (CMR) imaging.
Methods
Between June 2012 and April 2015, 117 patients with severe AS without obstructive CAD and 20 normal controls were enrolled prospectively. After exclusions, study patients were divided into 2 groups according to presence of exertional chest pain: an angina group (n = 43) and an asymptomatic group (n = 41), and the semiquantitative myocardial perfusion reserve index (MPRI) was calculated.
Results
MPRI values were significantly lower in severe AS patients than in normal controls (0.90 ± 0.31 vs. 1.25 ± 0.21; p < 0.001), and were much lower in the angina group than the asymptomatic group (0.74 ± 0.25 vs. 1.08 ± 0.28; p < 0.001). In logistic regression analysis, the only independent predictor for angina was MPRI (odds ratio: 0.003; p < 0.001). Univariate associations with MPRI were identified for diastolic blood pressure, E/e′ ratio, left ventricular volume and ejection fraction, cardiac index, presence of late gadolinium enhancement, and left ventricular mass index (LVMI). In multivariate analysis, LVMI was the strongest contributing factor to MPRI (standardization coefficient: -0.428; p < 0.001).
Conclusions
Our results suggest that, in patients with severe AS without obstructive CAD, angina is related to impaired coronary microvascular function along with LV hypertrophy detectable by semiquantitative MPRI using adenosine-stress CMR. Clinical Trial Registration: NCT02575768

Read More

Tuesday, 29 March 2016 02:00:00
Imaging Coronary Blood Flow in AS Let the Data Talk, Again ∗
In this issue of the Journal, Ahn et al. (1) correlate an index of relative myocardial perfusion reserve (MPRI) by magnetic resonance imaging (MRI) in patients with aortic stenosis (AS) and angina pectoris, those with AS without angina, and control patients without aortic stenosis. The results confirm previously established inverse relationships of coronary flow reserve (CFR), severity of AS, and left ventricular (LV) hypertrophy (LVH) or mass. They sorted data into 3 groups in Figure 4 (1): patients with the most severe AS with angina, those with less severe AS without angina, and control subjects with no AS, LVH, or angina for the expected continuum of clinical AS in Figure 5. On the basis of the reduced mean MPRI in the AS-angina group, the authors conclude that microvascular dysfunction explains angina in severe AS.
Read More

Tuesday, 29 March 2016 02:00:00
A New Electrocardiographic Marker of Sudden Death in Brugada Syndrome The S-Wave in Lead I
Background
Risk stratification in asymptomatic patients remains by far the most important yet unresolved clinical problem in the Brugada syndrome (BrS).
Objectives
This study sought to analyze the usefulness of electrocardiographic parameters as markers of sudden cardiac death (SCD) in BrS.
Methods
This study analyzed data from 347 consecutive patients (78.4% male; mean age 45 ± 13.1 years) with spontaneous type 1 BrS by ECG parameters but with no history of cardiac arrest (including 91.1% asymptomatic at presentation, 5.2% with a history of atrial fibrillation [AF], and 4% with a history of arrhythmic syncope). Electrocardiographic characteristics at the first clinic visit were analyzed to predict ventricular fibrillation (VF)/SCD during follow-up.
Results
During the follow-up (48 ± 38 months), 276 (79.5%) patients remained asymptomatic, 39 (11.2%) developed syncope, and 32 (9.2%) developed VF/SCD. Patients who developed VF/SCD had a lower prevalence of SCN5A gene mutations (p = 0.009) and a higher prevalence of positive electrophysiological study results (p < 0.0001), a family history of SCD (p = 0.03), and AF (p < 0.0001). The most powerful marker for VF/SCD was a significant S-wave (≥0.1 mV and/or ≥40 ms) in lead I. In the multivariate analysis, the duration of S-wave in lead I ≥40 ms (hazard ratio: 39.1) and AF (hazard ratio: 3.7) were independent predictors of VF/SCD during follow-up. Electroanatomic mapping in 12 patients showed an endocardial activation time significantly longer in patients with an S-wave in lead I, mostly because of a significant delay in the anterolateral right ventricular outflow tract.
Conclusions
The presence of a wide and/or large S-wave in lead I was a powerful predictor of life-threatening ventricular arrhythmias in patients with BrS and no history of cardiac arrest at presentation. However, the prognostic value of a significant S-wave in lead I should be confirmed by larger studies and by an independent confirmation cohort of healthy subjects.

Read More

Tuesday, 29 March 2016 02:00:00
Risk Stratification in Brugada Syndrome The “Impossible” Made Possible? ∗
The cardiac rhythm disorder Brugada syndrome (BrS) is characterized by a signature electrocardiogram (ECG) characterized by coved-type right precordial ST-segment elevation, has a presumed prevalence of 1:2,000, and is associated with a relatively high incidence of ventricular fibrillation (VF)–related sudden cardiac death (SCD) in the absence of overt structural heart disease (13). Whereas the high-risk BrS patient is universally recognized (either resuscitated or experiencing suspicious symptoms) (3,4), risk stratification in asymptomatic patients is ill-defined. As such, the problem is not much different from predicting SCD in the general population in which noninvasive (and invasive) risk assessment identifies only a very small portion of all future SCDs with sufficient specificity to justify implantable cardioverter-defibrillator (ICD) therapy (5). Indeed, the vast majority of noninvasive tests have a low positive predictive value (but a relatively high negative predictive value) (5).
Read More

Tuesday, 29 March 2016 02:00:00
Acute Treatment With Omecamtiv Mecarbil to Increase Contractility in Acute Heart Failure The ATOMIC-AHF Study
Background
Omecamtiv mecarbil (OM) is a selective cardiac myosin activator that increases myocardial function in healthy volunteers and in patients with chronic heart failure.
Objectives
This study evaluated the pharmacokinetics, pharmacodynamics, tolerability, safety, and efficacy of OM in patients with acute heart failure (AHF).
Methods
Patients admitted for AHF with left ventricular ejection fraction ≤40%, dyspnea, and elevated plasma concentrations of natriuretic peptides were randomized to receive a double-blind, 48-h intravenous infusion of placebo or OM in 3 sequential, escalating-dose cohorts.
Results
In 606 patients, OM did not improve the primary endpoint of dyspnea relief (3 OM dose groups and pooled placebo: placebo, 41%; OM cohort 1, 42%; cohort 2, 47%; cohort 3, 51%; p = 0.33) or any of the secondary outcomes studied. In supplemental, pre-specified analyses, OM resulted in greater dyspnea relief at 48 h (placebo, 37% vs. OM, 51%; p = 0.034) and through 5 days (p = 0.038) in the high-dose cohort. OM exerted plasma concentration-related increases in left ventricular systolic ejection time (p < 0.0001) and decreases in end-systolic dimension (p < 0.05). The adverse event profile and tolerability of OM were similar to those of placebo, without increases in ventricular or supraventricular tachyarrhythmias. Plasma troponin concentrations were higher in OM-treated patients compared with placebo (median difference at 48 h, 0.004 ng/ml), but with no obvious relationship with OM concentration (p = 0.95).
Conclusions
In patients with AHF, intravenous OM did not meet the primary endpoint of dyspnea improvement, but it was generally well tolerated, it increased systolic ejection time, and it may have improved dyspnea in the high-dose group. (Acute Treatment with Omecamtiv Mecarbil to Increase Contractility in Acute Heart Failure [ATOMIC-AHF]; NCT01300013)

Read More

First Prev Page: 1 of 5 Next Last

Copyright © 2012. All Rights Reserved.