ACC Current Journal Review

The Sunset for CJR…and the Dawn of CRJ!

Kim A. Eagle — 2005-12-01

Through ACC Current Journal Review (CJR) and its editorial team, the ACC strives to create for you the world’s premier cardiovascular review journal. Over the past 5 years CJR has expanded its content, reorganized its delivery, and increased the timeliness of its information to keep you up to the minute on important knowledge for the provision of outstanding cardiovascular care. As editor of CJR, I am excited to help you anticipate the next step in the process of making this review journal even more “state-of-the-art”.

Effect of Thrombolytic Therapy on the Risk of Cardiac Rupture and Mortality in Older Patients With First Acute Myocardial Infarction

H. Bueno, M. Martı́nez-Sellés, E. Pérez-David, López-Palop R. — 2005-12-01

To evaluate the effect of thrombolysis on mortality and its causes in older patients with acute myocardial infarction (AMI). The population consisted of all patients ≥75 years old admitted to the coronary care unit of Hospital General Universitario’ within 24 h from symptom onset with a definite diagnosis of first ST-segment elevation/left bundle branch block myocardial infarction. Clinical outcomes were analyzed according to the type of reperfusion therapy received by the patients.

Effect of Clopidogrel Pretreatment Before Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction Treated With Fibrinolytics: The PCI-CLARITY Study

2005-12-01

To determine whether clopidogrel pretreatment before PCI in patients with recent ST-segment elevation myocardial infarction (STEMI) is superior to clopidogrel treatment initiated at the time of PCI in preventing major adverse cardiovascular events.

Serum Soluble Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 Levels Are Elevated in Acute Coronary Syndrome: A Novel Marker for Early Diagnosis

K. Hayashida, N. Kume, T. Murase, et al. — 2005-12-01

What is the usefulness of lectin-like oxidized LDL receptor-1 (LOX-1) as an early diagnostic marker of ACS? The investigators examined serum sLOX-1 levels in 521 subjects, consisting of 427 consecutive patients undergoing coronary angiography, including 80 ACS patients, 173 symptomatic coronary heart disease patients, 122 patients with significant coronary stenosis without ischemia, and 52 patients without apparent coronary atherosclerosis plus 34 patients with noncardiac acute illness and 60 patients with noncardiac chronic illness. Time-dependent changes in sLOX-1 and TnT levels were analyzed in an additional 40 ACS patients.

Circulating Endothelial Progenitor Cells and Cardiovascular Outcomes

N. Werner, S. Kosiol, T. Schiegl, et al. — 2005-12-01

To assess the number of endothelial progenitor cells in patients with coronary artery disease (CAD) and prospectively analyze cardiovascular (CV) outcomes during a 12-month follow-up period.

Inflammation, Endothelial Cell Activation, and Coronary Microvascular Dysfunction in Women With Chest Pain and No Obstructive Coronary Artery Disease

O.C. Marroquin, K.E. Kip, S.R. Mulukutla, et al. — 2005-12-01

Is the syndrome of chest pain without obstructive coronary artery disease (CAD) associated with increased endothelial cell activity and inflammation? Ninety-four women in the NHLBI WISE study with chest pain in the absence of obstructive angiographic CAD (<50% diameter stenosis in all epicardial coronary arteries) underwent assessment of microvascular function or coronary flow reserve (CRF) using Doppler velocities and intracoronary adenosine, measurement of inflammatory markers (n=78) and endothelial cell activation.

Symptoms and Type of Symptom Onset in Acute Coronary Syndrome in Relation to ST Elevation, Sex, Age, and a History of Diabetes

M. Thuresson, M. Berglin Jarlöv, B. Lindahl, L. Svensson, C. Zedigh, J. Herlitz — 2005-12-01

Do presenting symptoms in patients with the acute coronary syndrome (ACS) vary by extent of infarction (NSTEMI vs. STEMI), gender, and diabetes? A total of 1939 patients at 11 hospitals in Sweden answered a questionnaire relating to the localization and intensity of symptoms, the presence of associated symptoms, the characteristics and experience of pain/symptoms, and the type of symptom onset.

Serum Blood Urea Nitrogen as an Independent Marker of Subsequent Mortality Among Patients With Acute Coronary Syndromes and Normal to Mildly Reduced Glomerular Filtration Rates

A.J. Kirtane, D.M. Leder, S.S. Waikar, et al. — 2005-12-01

Is elevated blood urea nitrogen (BUN) associated with adverse outcomes independent of serum creatinine (sCr)-based estimates of kidney function in patients with acute coronary syndromes (ACS)?

Impaired Endothelial Function in Coronary Heart Disease Patients With Depressive Symptomatology

A. Sherwood, A.L. Hinderliter, L.L. Watkins, R.A. Waugh, L.J.A. Blumenthal — 2005-12-01

What is the relationship between depressive symptoms and endothelial function in persons with coronary heart disease (CHD)? Flow-mediated dilation (FMD) of the brachial artery, a measure of endothelial function, was assessed in 143 patients with documented CHD (99 men, 44 women) and recent (≤1 year) evidence for exercise-induced myocardial ischemia. Antianginal medication was discontinued prior to the studies, which included stress testing for ischemia. Depression was assessed using the Beck Depression Inventory (BDI), a 21-item self-reported measure of symptoms. A score of 10 or greater is considered significant depression and associated with a poorer prognosis in CHD.

Sex and Racial Differences in the Management of Acute Myocardial Infarction, 1994 through 2002

2005-12-01

Does treatment of acute myocardial infarction (MI) differ in the United States based upon gender or race? The National Registry of Myocardial Infarction was used to examine gender and racial differences in the treatment of patients who were deemed to be “ideal candidates” for particular treatments and in deaths among 598,911 patients hospitalized with MI between 1994 and 2002.

Assessment of the Clinical Effectiveness of Pulmonary Artery Catheters in Management of Patients in Intensive Care (PAC-Man): A Randomised Controlled Trial

S. Harvey, D.A. Harrison, M. Singer, et al. — 2005-12-01

What is the impact of routine pulmonary artery catheter (PAC) usage on hospital mortality in patients admitted to the intensive care unit (ICU)? The investigators randomized 1041 patients admitted to 65 intensive care units (ICUs) in the United Kingdom to management with or without a PAC. Timing of PAC insertion and further therapeutic decision making was at the discretion of the treating physician.

Acute Aortic Dissection Presenting With Primarily Abdominal Pain: A Rare Manifestation of a Deadly Disease

2005-12-01

What is the morbidity and mortality of patients with acute thoracic aortic dissections who present primarily with abdominal pain? Patients with acute thoracic aortic dissection enrolled in the International Registry of acute Aortic Dissection (IRAD) were studied. The IRAD consists of 15 international referral centers in which hospital records of patients with acute aortic dissections are assessed and reviewed by physicians. Patient demographics, presenting symptoms, signs of aortic dissection, aortic pathology, and mortality were compared in patients presenting primarily with abdominal pain (group I, 46 patients, 4.6%) versus all others (group II).

As I Remember Michigan’s First Pacemaker

Richard D. Judge — 2005-12-01

Although it is true that I placed the first permanent, transvenous pacemaker at the University of Michigan, I would not want to give the impression that it was a bold, pioneering act. It was anything but this and was accomplished in association with two colleagues who, like me, had barely completed residency training. The experience altered the course of my professional career for the next 30 years. Perhaps this is why the memory of that experience is so vivid.

ACC Medical Directors＇ Institute, October 5—7, 2005

2005-12-01

Effect Size Estimates of Lifestyle and Dietary Changes on All-Cause Mortality in Coronary Artery Disease Patients

2005-12-01

What is the estimated risk reduction on all-cause mortality attributable to lifestyle changes in men and women with coronary heart disease (CHD)? A literature search was performed to find reports of the effect of 9 lifestyle and dietary changes on mortality in CHD; these included smoking cessation, exercise, alcohol in moderation, healthy weight, <10% saturated fat, oily fish weekly or more, >400 g fruits and vegetables, and limit salt to 5 g/day. Prospective cohort studies and randomized controlled trials of patients with established CHD were included if there were at least two randomized or cohort studies, the studies had at least 6 months’ follow-up, and they reported all-cause mortality.

Low HDL Cholesterol Levels

M. Ashen, R.S. Blumenthal — 2005-12-01

What is a reasonable approach to the patient with a low HDL-C level based upon available evidence? 10 points to remember:

C-Reactive Protein, Interleukin-6, and Soluble Adhesion Molecules as Predictors of Progressive Peripheral Atherosclerosis in the General Population. Edinburgh Artery Study

I. Tzoulaki, G.D. Murray, A.J. Lee, A. Rumley, G.D.O. Lowe, G.R. Fowkes — 2005-12-01

Is there a relationship between inflammatory markers and markers of endothelial cell activity and progression of peripheral vascular disease? The Edinburgh Artery Study is a population cohort analysis of 1592 men and women aged 55 to 74 years. C-reactive protein (CRP), interleukin-6 (IL-6), intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1), and E-selectin were measured at baseline. Valid ABI measurements were obtained on 1582, 1081, and 813 participants at baseline and 5-year and 12-year follow-up examinations, respectively.

Lipoprotein (a) and Coronary Heart Disease Among Women: Beyond a Cholesterol Carrier?

I. Shai, E.B. Rimm, S.E. Hankinson, et al. — 2005-12-01

Is lipoprotein (a) [Lp(a)] a risk factor for coronary heart disease (CHD) in women? Participants included a total of 121,700 women enrolled in the Nurses’ Health Study in the late 1970s; 32,826 women had Lp(a) measured in 1989 and 1990. There were 228 CHD events documented during 8 years of follow-up. Each case was compared with two matched controls. Lipid and nonlipid biomarkers and other CHD risk factors were available.

Plasma Oxidized Low-Density Lipoprotein, a Strong Predictor for Acute Coronary Heart Disease Events in Apparently Healthy, Middle-Aged Men From the General Population

C. Meisinger, J. Baumert, N. Khuseyinova, H. Loewel, W. Koenig — 2005-12-01

Is the level of circulating oxidized LDL (oxLDL) a marker of risk for an acute coronary syndrome in healthy men? A prospective, nested, case-control study was conducted in men without CHD or diabetes mellitus at baseline. Subjects came from two population-based MONICA/KORA Augsburg surveys conducted in the years 1989–1990 and 1994–1995, with follow-up in 1998 (mean follow-up, 5.6 ± 2.6 years). The oxLDL was determined by ELISA in 88 men who developed CHD and in 258 age- and survey-matched controls.

Incidence of Venous Thromboembolism in the Year Before the Diagnosis of Cancer in 528, 693 Adults

R.H. White, H.K. Chew, H. Zhou, et al. — 2005-12-01

How frequently does unprovoked venous thromboembolism (VTE) reflect the presence of an occult cancer? The investigators sought to determine whether patients with cancer suffer an increase in the standardized incidence of unprovoked VTE in the year before the cancer diagnosis. They used the California Cancer Registry to identify diagnosed cases of 19 common malignancies during a 6-year period. Cases were linked to a hospital discharge database to identify incident VTE events in the year before the cancer diagnosis date. The standardized incidence ratio (SIR) of unprovoked VTE was determined by using the age-, race-, and gender-specific incidence rates in California.

Role of Blood Pressure and Other Variables in the Differential Cardiovascular Event Rates Noted in the Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT-BPLA)

N.R. Poulter, H. Wedel, B. Dahlof, et al. — 2005-12-01

To what extent are differences in coronary and stroke events seen in the ASCOT-BPLA due to significant differences in blood pressures (BPs) and other clinical variables? The research team used data from the Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT-BPLA), a randomized, controlled study comparing an amlodipine-based antihypertensive regimen with an atenolol-based regimen. The ASCOT-BPLA study demonstrated a decrease in stroke, all-cause mortality, and the development of diabetes with an amlodipine plus perindopril regimen, compared with an atenolol plus bendroflumethiazide regimen. However, that study also demonstrated better BP control in the amlodipine arm. The investigators undertook the current analysis of the data to isolate the effect on outcomes of medication type. They compared differences in accumulated mean BP levels at sequential times in the trial with sequential differences in coronary and stroke events. Serial mean matching for differences in systolic BP was used to adjust hazard ratios (HRs) for differences in these events.

Quantification of Obstructive and Nonobstructive Coronary Lesions of 64-Slice Computed Tomography

A.W. Leber, A. Knez, F. Ziegler, et al. — 2005-12-01

What is the diagnostic accuracy of 64-slice computed tomography (64-CT) to diagnose obstructive coronary artery disease (CAD)? The 64-CT data were available in 55 of 59 patients undergoing coronary arteriography for angina pectoris; IVUS was performed in 32 vessels as well. Oral beta-blockers were used to reduce heart rate during the test when necessary. A 15-segment coronary model was used, and both proximal and distal segments were analyzed.

Accuracy of MSCT Coronary Angiography With 64-Slice Technology: First Experience

S. Leschka, H. Alkadhi, A. Plass, et al. — 2005-12-01

To evaluate the accuracy of 64-slice computed tomography (64-CT) for detecting coronary artery stenosis (CAD). Both 64-CT and invasive coronary arteriography (ICA) were performed in 67 patients. Only vessels ≥1.5 mm diameter were considered in the assessment, and significant CAD was defined as diameter reduction >50%. Beta-blockers were not used to slow the heart rate for 64-CT.

Coronary Calcium Independently Predicts Incident Premature Coronary Heart Disease Over Measured Cardiovascular Risk Factors. Mean Three-Year Outcomes in the Prospective Army Coronary Calcium (PACC) Project

A.J. Taylor, J. Bindeman, I. Feuerstein, F. Cao, M. Brazaitis, P.G. O’Malley — 2005-12-01

Is the coronary calcium score (CCS) an independent predictor of coronary disease events/outcomes in healthy men and women aged 40 to 50 years? Approximately 2000 active-duty US Army men and women undergoing their periodic physical examinations between October 1998 and February 2003 underwent assessment of CCS by electron beam computed tomography, measure of other coronary risk variables, and by calculation of the Framingham Risk Score (FRS). Incident acute coronary syndromes and sudden cardiac death were ascertained via annual telephonic contacts, with follow-up (mean 3.0±1.4 years; range 1–6 years) in 99.2% of the cohort.

Papillary Muscle Dysfunction Attenuates Ischemic Mitral Regurgitation in Patients With Localized Basal Inferior Left Ventricular Remodeling

T. Uemura, Y. Otsuji, K. Nakashiki, et al. — 2005-12-01

To assess the relationship of papillary muscle (PM) systolic dysfunction (PMSD) to ischemic mitral regurgitation (MR) in subjects with a prior inferior myocardial infarction (IMI) and evidence of left ventricular (LV) remodeling.

Left Atrium Size and the Risk of Cardiovascular Death in Middle-aged Men

J.A. Laukkanen, S. Kurl, J. Eranen, et al. — 2005-12-01

To assess the relationship of left atrial (LA) size and left ventricular hypertrophy (LVH) to the risk of cardiovascular death. Follow-up was available on 830 men (age 50.5±6.6 years, range 42.0–60.9) all of whom underwent M-mode echocardiography for assessment of chamber sizes.

Prevalence and Clinical Significance of Left Atrial Remodeling in Competitive Athletes

A. Pelliccia, B.J. Maron, F.M. Di Paolo, et al. — 2005-12-01

What is the distribution and clinical significance of left atrial (LA) size in the context of athlete’s heart? Left atrial dimension and the prevalence of supraventricular tachyarrhythmias were assessed in 1777 competitive athletes (71% male) free of structural cardiovascular disease participating in 38 different sports.

Long-term, Clinical and Echocardiographic Results After Successful Mitral Balloon Valvotomy and Predictors of Long-term Outcome

M.E. Fawzy, H. Hegazy, M. Shoukri, et al. — 2005-12-01

To assess the long-term outcome of mitral balloon valvotomy (MBV) and identify predictors of restenosis- and event-free survival. The investigators report the immediate and long-term clinical and echocardiographic results in 493 patients, mean age 31±11 years, who underwent successful MBV and were followed-up for 0.5–15 years (median 5±3 years) with clinical and echocardiographic examination.

Electrocardiographic Damage Scores and Cardiovascular Mortality

K. Richardson, G. Engel, T. Yamazaki, et al. — 2005-12-01

To assess the ability of computerized damage scores from the 12-lead ECG to predict cardiovascular mortality (CVM). ECGs from 46,933 patients (90.1% male, age 57±15 years) were evaluated. A simplified Selvester score (SSS), cardiac infarction injury score (CIIS) and Q-wave score (QWS) were calculated.

Pioglitazone Decreases Carotid Intima-Media Thickness Independently of Glycemic Control in Patients With Type 2 Diabetes Mellitus: Results From a Controlled Randomized Study

M.R. Langenfeld, T. Forst, C. Hohberg, et al. — 2005-12-01

Will pioglitazone therapy decrease carotid intima-media thickness (IMT) in patients with type 2 diabetes, independently of glycemic control? The researchers performed a randomized controlled study in 173 thiazolidinedione-naïve, orally treated patients with type 2 diabetes. Subjects were randomized either to pioglitazone-based therapy (45 mg/d) or glimepiride-based treatment (1–6 mg/d, titrated for optimal glycemic control—mean dose of 2.7±1.6 mg/d) for 24 weeks. The IMT was measured at 12±2 and 24±4 weeks of therapy. End points evaluated were metabolic control (HbA1c), insulin resistance (homeostasis model assessment), and carotid IMT (B-mode ultrasonography). Treatment groups were compared at baseline by using a Wilcoxon rank-sum test for continuous variables and χ2 test for categorical variables. Statistical evaluation of changes from baseline was performed by means of ANCOVA models, with treatment group as a factor and baseline value as a covariate. Analysis of changes in carotid IMT was adjusted for statin use, and for use of renin-angiotensin system–inhibiting substances.

Aspirin Use in Older Patients With Heart Failure and Coronary Artery Disease. National Prescription Patterns and Relationship With Outcomes

F.A. Masoudi, P. Wolfe, E.P. Havranek, S.S. Rathore, J.M. Foody, H.M. Krumholz — 2005-12-01

What is the pattern of aspirin use and its relationship to outcomes in patients with CAD and HF? The investigators studied a national sample of Medicare beneficiaries ≥65 years old after hospitalization for HF with CAD and without aspirin contraindications between April 1998 and June 2001. Factors associated with aspirin prescription and the relationship between aspirin and outcomes were assessed in regression models accounting for differences in patient, physician, and hospital characteristics.

Aspirin Use in Chronic Heart Failure: What Should We Recommend to the Practitioner?

B.M. Massie — 2005-12-01

There has been ongoing controversy as to whether aspirin should be used in patients with chronic heart failure (CHF). The argument for aspirin is that many patients have underlying coronary disease, and aspirin prevents reinfarction and other vascular events. Arguments against the routine use of aspirin are that many CHF patients do not have underlying coronary disease, and that the benefit of aspirin lessens after the first 6 to 12 months after infarction. Also, several analyses suggest that aspirin may actually worsen outcomes in CHF patients, possibly because it inhibits prostaglandins, with resulting adverse hemodynamic and renal effects. Two recent prospective randomized studies have found that aspirin is associated with more frequent hospitalizations for worsening heart failure, although it did not have an adverse effect on vascular events. These results suggest that aspirin should not be routinely used in CHF patients and should be avoided in those with refractory CHF, but that it may be beneficial in patients with recent infarction or multiple vascular risk factors.

Adherence to Guidelines Is a Predictor of Outcome in Chronic Heart Failure: The MAHLER Survey

M. Komajda, P. Lapuerta, N. Hermans, et al. — 2005-12-01

Does adherence to the European guidelines for the treatment of chronic heart failure (CHF) impact on rates of CHF and CV hospitalizations? A total of 1410 evaluable patients (mean age 69 years; 69% males; New York Heart Association [NYHA] class II: 64%, class III: 34%, class IV: 2%) were enrolled and followed up for 6 months by 150 randomly selected cardiologists/cardiology departments from six European countries (France, Germany, Italy, The Netherlands, Spain, and UK). Class adherence indicators for angiotensin-converting enzyme inhibitors (ACE-I), beta-blockers, spironolactone, diuretics, and cardiac glycosides and group adherence indicators (GAI3 adherence to first three classes of HF medication, GAI5 adherence to five classes) were determined and outcomes assessed.

The Reproducibility and Sensitivity of the 6-min Walk Test in Elderly Patients With Chronic Heart Failure

L. Ingle, R.J. Shelton, A.S. Rigby, S. Nabb, A.L. Clark, J.G.F. Cleland — 2005-12-01

What are the reproducibility and sensitivity (to symptom change) of the 6-min walk test (6-MWT) in elderly patients with chronic heart failure (CHF) and what does this imply with respect to sample size calculations for clinical trials?

Anemia and Change in Hemoglobin Over Time Related to Mortality and Morbidity in Patients With Chronic Heart Failure: Results From Val-HeFT

I.S. Anand, M.A. Kuskowski, T.S. Rector, et al., Val-HeFT Investigators — 2005-12-01

What are the causes of anemia and prognostic implications of changes in hemoglobin (Hgb) over time in chronic heart failure (HF)? Data from Val-HeFT were reviewed. Characteristics of groups with or without anemia at baseline were compared. Logistic regression was used to identify variables that were independently related to the presence of anemia at baseline. Cox proportional-hazards regression models were used to relate anemia, change in Hgb, and other variables to time to death, hospitalization for HF, and first morbid event. Multiple linear regression was used to identify independent correlates of change in Hgb.

The Economic Effect of a Tertiary Hospital-Based Heart Failure Program

D. Gregory, D. DeNofrio, M.A. Konstam — 2005-12-01

What are the economic effects of a tertiary heart failure (HF) program at an academic medical center? The primary data source was a sample of 82 HF patients referred for cardiac transplant evaluation at an academic medical center during calendar years 2000 to 2001. Cumulative recurrent rates of utilization, cost, and reimbursement for hospital services were computed as functions of time using reliability models. The economic contribution of patients transplanted was contrasted with those not transplanted.

Relationship Between Operator Volume and Adverse Outcome in Contemporary Percutaneous Coronary Intervention Practice: An Analysis of a Quality-Controlled Multicenter Percutaneous Coronary Intervention Clinical Database

M. Moscucci, D. Share, D. Smith, et al. — 2005-12-01

To evaluate the volume-outcome relationship in a large, quality-controlled, contemporary percutaneous coronary interventions (PCI) database. Data on 18,504 consecutive PCIs performed by 165 operators in calendar year 2002 were prospectively collected in a regional consortium. Operators’ volume was divided into quintiles (1–33, 34–89, 90–139, 140–206, and 207–582 procedures/year). The primary end point was a composite of major adverse cardiovascular events (MACE) including death, coronary artery bypass grafting, stroke or transient ischemic attack, myocardial infarction, and repeat PCI at the same site during the index hospital stay.

Long-Term Cost Effectiveness of Early and Sustained Dual Oral Antiplatelet Therapy With Clopidogrel Given for Up to One Year After Percutaneous Coronary Intervention: Results From the Clopidogrel for the Reduction of Events During Observation (CREDO) Trial

S.C. Beinart, P. Kolm, E. Veledar, et al. — 2005-12-01

To evaluate the long-term cost-effectiveness of a clopidogrel loading strategy before percutaneous coronary intervention (PCI) followed by continued treatment for 1 year. Patients with coronary artery disease undergoing planned or probable PCI were randomized to clopidogrel loading (300 mg) 3 to 24 h before PCI plus 1 year of therapy with clopidogrel (75 mg daily) (n=1053) versus placebo for loading and after day 28 (n=1063). All hospitalizations were assigned a diagnosis-related group. Associated costs were estimated three ways (including professional costs): (1) Medicare costs, (2) MEDSTAT costs, and (3) blend with Medicare for those age ≥65 years and MEDSTAT for those age <65 years. Clopidogrel 75 mg cost $3.22. Life expectancy in trial survivors was estimated using external data. Confidence intervals were assessed by bootstrap.

Nine-Month Outcome of Patients Treated by Percutaneous Coronary Interventions for Bifurcation Lesions in the Recent Era: A Report From the Prevention of Restenosis With Tranilast and Its Outcomes (PRESTO) Trial

P. Garot, T. Lefèvre, M. Savage, et al. — 2005-12-01

To determine the influence of bifurcation lesions on the outcome of patients undergoing percutaneous coronary intervention (PCI) in the recent era. The 11,482 patients enrolled in the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) were stratified according to the presence (n=1412) or absence (n=10,068) of at least one bifurcation lesion treated by PCI. Baseline characteristics and outcome of patients undergoing PCI for bifurcation lesions were compared to those of patients treated for nonbifurcation lesions.

Effectiveness of Sirolimus-Eluting Stent Implantation for the Treatment of Ostial Left Anterior Descending Artery Stenosis With Intravascular Ultrasound Guidance

K.B. Seung, Y.H. Kim, D.W. Park, et al. — 2005-12-01

To evaluate the clinical and angiographic outcomes of sirolimus-eluting stent (SES) implantation for ostial left anterior descending (LAD) lesions compared with bare-metal stent (BMS) implantation.

Comparison of a Polymer-Based Paclitaxel-Eluting Stent With a Bare Metal Stent in Patients With Complex Coronary Artery Disease: A Randomized Controlled Trial

G.W. Stone, S.G. Ellis, L. Cannon, et al., TAXUS V Investigators — 2005-12-01

To investigate the safety and efficacy of the polymer-based, slow-release paclitaxel-eluting stent in a patient population with more complex lesions than previously studied. This was a prospective, placebo-controlled, double-blind, multicenter randomized trial with 1156 patients who underwent stent implantation in a single coronary artery stenosis, including 664 patients (57.4%) with complex or previously unstudied lesions (requiring 2.25-mm, 4.0-mm, and/or multiple stents) and 9-month clinical and angiographic follow-up. Patients were randomly assigned to receive either one or more bare metal stents (n=579) or identical-appearing paclitaxel-eluting stents (n=577). The primary outcome was ischemia-driven target vessel revascularization (TVR) at 9 months.

Prevention of Restenosis by a Novel Drug-Eluting Stent System With a Dose-Adjustable, Polymer-Free, On-Site Stent Coating

2005-12-01

To assess the feasibility, safety, and efficacy of a polymer-free, on-site stent coating with increasing rapamycin doses. The present study was a prospective, open-label, dose-finding study for the evaluation of four sequentially increasing rapamycin doses in a polymer-free stent coating for the prevention of restenosis. In this dose-finding analysis, 602 patients were sequentially enrolled in four groups: microporous bare metal stent (BMS), drug-eluting stents (DES) coated with a 0.5%, 1.0% and 2.0% rapamycin solution. The angiographic in-segment restenosis rate at follow-up angiography was the primary study end point.

Long-Term Results (Three to Five Years) of the Restenosis Intrastent: Balloon Angioplasty Versus Elective Stenting (RIBS) Randomized Study

F. Alfonso, J.M. Augé, J. Zueco, et al. — 2005-12-01

To analyze the very late outcomes of patients treated for in-stent restenosis (ISR) according to treatment allocation and 10 prespecified variables. The Restenosis Intrastent: Balloon angioplasty versus elective Stenting (RIBS) randomized study compared balloon angioplasty versus elective stenting in 450 patients with ISR. The primary end point was recurrent restenosis rate at 6 months. The composite of death, MI, and target vessel revascularization was a prespecified secondary study end point.

Incremental Cost-Effectiveness of Drug-Eluting Stents Compared With a Third-Generation Bare-Metal Stent in a Real-World Setting: Randomised Basel Stent Kosten Effektivitats Trial (BASKET)

C. Kaiser, H.P. Brunner-La Rocca, P.T. Buser, et al., BASKET Investigators — 2005-12-01

What is the cost-effectiveness of using drug-eluting stents (DES) instead of bare metal stents (BMS) in patients undergoing PCI in daily interventional practice? The investigators randomized 826 patients undergoing PCI of 1281 lesions to either sirolimus-eluting stent (Cypher), paclitaxel-eluting stent (Taxus) or a bare metal cobalt chromium stent (Vision). The primary end point was cost-effectiveness after 6 months with clinical effectiveness defined by reduction in cardiovascular events.

Late Incomplete Stent Apposition After Sirolimus-Eluting Stent Implantation: A Serial Intravascular Ultrasound Analysis

J. Ako, Y. Morino, Y. Honda, et al. — 2005-12-01

To identify the frequency of incomplete stent apposition (ISA) in sirolimus-eluting stents (SES) and clarify its findings and clinical sequelae. From the SIRIUS trial, a randomized, multicenter study comparing SES and BMS, serial qualitative intravascular ultrasound (IVUS; at stent implantation and 8-month follow-up) was available in 141 patients (BMS: n=61; SES: n=80). The IVUS images were reviewed for the presence of ISA.

Early Invasive Versus Selectively Invasive Management for Acute Coronary Syndromes

2005-12-01

To test the hypothesis that an early invasive strategy is superior to a selectively invasive strategy for patients who have acute coronary syndromes (ACS) without ST-segment elevation and with an elevated cardiac troponin T level.

Facilitated Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction: Results From the Prematurely Terminated ADdressing the Value of facilitated ANgioplasty after Combination therapy or Eptifibatide monotherapy in acute Myocardial Infarction (ADVANCE MI) Trial

The ADVANCE MI Investigators — 2005-12-01

To evaluate the efficacy and safety of facilitated PCI with simultaneous administration of GpIIb/IIIa inhibitors + reduced-dose fibrinolytics before primary PCI in the ADVANCE MI trial by using a previously tested regimen of eptifibatide + reduced-dose tenecteplase.

Is Primary Angioplasty More Effective Than Prehospital Fibrinolysis in Diabetics With Acute Myocardial Infarction? Data From the CAPTIM Randomized Clinical Trial

E. Bonnefoy, P. Gabriel Steg, S. Chabaud, et al., CAPTIM Investigators — 2005-12-01

To examine the impact of diabetic status on the relative benefits of the reperfusion strategies defined in the CAPTIM study. The CAPTIM study randomized patients managed within 6 h of acute ST-segment elevation myocardial infarction to primary angioplasty or prehospital fibrinolysis (rt-PA), with immediate transfer to a center with interventional facilities. The relationship of diabetic status (diabetics, n=103; nondiabetics, n=731) and treatment strategy with the occurrence of the primary end point and of death was analyzed in this substudy.

5-Year Outcome of an Interventional Strategy in Non-ST-Elevation Acute Coronary Syndrome: The British Heart Foundation RITA-3 Randomized Trial

K.A. Fox, P. Poole-Wilson, T.C. Clayton, et al. — 2005-12-01

What is the impact of an early invasive strategy on long-term outcome in patients with non-ST elevation myocardial infarction (NSTEMI)? The RITA-3 trial randomized 1810 patients with NSTEMI to an early invasive therapy versus a conservative therapy (ischemia or symptom driven). Patients in the invasive arm underwent coronary angiography within 72 h of chest pain. Among patients in the invasive arm, 38% underwent PCI while 26% underwent CABG following initial angiography.

Evaluation of the Safety and Effectiveness of Renal Artery Stenting After Unsuccessful Balloon Angioplasty. The ASPIRE-2 Study

K. Rocha-Singh, M.R. Jaff, K. Rosenfield, ASPIRE-2 Trial Investigators — 2005-12-01

What is the safety and long-term outcome of renal artery stenting after unsuccessful angioplasty? This study enrolled 208 patients with ≥70% aorto-ostial renal artery stenosis; patients underwent implantation of a balloon-expandable stent after unsuccessful renal angioplasty. Renal angioplasty was deemed unsuccessful if the residual stenosis was ≥50% or if there was a persistent translesional pressure gradient ≥20 mm Hg, or a flow-limiting dissection. The primary end point was the 9-month quantitative angiographic or duplex ultrasonography restenosis rate adjudicated by core laboratory analysis. Secondary end points included renal function, blood pressure, and cumulative incidence of major adverse events and target lesion revascularization at 24 months.

Jupiter II

2005-12-01

Basket

2005-12-01

Basket

2005-12-01

Primary Prophylaxis With the Implantable Cardioverter-Defibrillator. The Need for Improved Risk Stratification

A. Gehi, D. Haas, V. Fuster — 2005-12-01

Should ejection fraction (EF) by itself be the basis for deciding whether or not a patient qualifies for an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden death (SD)?

Safety Issues Involving Medical Devices. Implications of Recent Implantable Cardioverter-Defibrillator Malfunctions

W.H. Maisel — 2005-12-01

How can the medical-device reporting and notification systems be improved? In the 1980s, several manufacturers of medical devices were criticized for inadequately reporting adverse events to the FDA. Congress reacted by enacting the Safe Medical Devices Act of 1990 and the Medical Device Amendments of 1992. These acts required healthcare facilities to report serious device-related injuries and for manufacturers to report any device malfunctions that caused or could cause serious injury. However, a recent highly publicized instance of implantable cardioverter-defibrillator (ICD) malfunction that resulted in the death of a young man indicates the need for improving the current reporting and notification system.

Incidence and Clinical Relevance of Slow Ventricular Tachycardia in Implantable Cardioverter-Defibrillator Recipients. An International Multicenter Prospective Study

N. Sadoul, R. Mletzko, F. Anselme, et al. — 2005-12-01

How often does slow ventricular tachycardia (VT, rate <149 bpm) occur in implantable cardioverter-defibrillator (ICD) recipients and how effectively is it treated by antitachycardia pacing (ATP)?

Reversal of Cardiomyopathy in Patients With Repetitive Monomorphic Ventricular Ectopy Originating From the Right Ventricular Outflow Tract

R.K. Yarlagadda, S. Iwai, K. Stein, et al. — 2005-12-01

Can frequent ventricular ectopy cause a cardiomyopathy? Left ventricular ejection fraction (EF) was measured before and after radiofrequency ablation of frequent ventricular premature depolarizations (VPDs) arising in the right ventricular outflow tract (RVOT) in 27 patients (mean age 47 years). None of the patients had any identifiable structural heart disease.

Risk Factors for Out-of-Hospital Cardiac Arrest: The Reykjavik Study

G. Thorgeirsson, G. Thorgeirsson, H. Sigvaldason, J. Witteman — 2005-12-01

What are the strongest predictors of out-of-hospital cardiac arrest (OOHCA)? The Reykjavik study was a longitudinal, population-based analysis of 18,912 people born between 1907 and 1935. Participants entered the study between 1967 and 1991. Upon entry, a physical examination, chest X-ray, electrocardiogram (ECG) and several blood tests were performed. This cohort analysis focused on 137 men and 44 women in the Reykjavik study who experienced OOHCA during follow-up.

Response of Atrial Fibrillation to Pulmonary Vein Antrum Isolation Is Directly Related to Resumption and Delay of Pulmonary Vein Conduction

A. Verma, F. Kilicaslan, E. Pisano, et al. — 2005-12-01

Is the clinical efficacy of pulmonary vein antrum isolation (PVAI) for atrial fibrillation (AF) associated with the status of pulmonary vein (PV) conduction? The PVs were mapped 2–6 months after PVAI in three groups of patients: group I, 26 patients without recurrent AF; group II, 37 patients with recurrent AF controlled by antiarrhythmic medications; group III, 44 patients with recurrent AF unresponsive to antiarrhythmic medications. The end point of the first PVAI procedure was complete isolation of the four PVs and superior vena cava.

Pulmonary Vein Isolation as an End Point for Left Atrial Circumferential Ablation of Atrial Fibrillation

K. Lemola, H. Oral, A. Chugh, et al. — 2005-12-01

Is elimination of pulmonary vein (PV) arrhythmogenicity necessary for the efficacy of left atrial circumferential ablation (LACA) for atrial fibrillation (AF)? In 60 consecutive patients with paroxysmal (n=39) or chronic (n=21) AF (mean age 53±12 years), LACA to encircle the left- and right-sided PVs, with additional lines in the posterior left atrium and along the mitral isthmus, was performed under the guidance of an electroanatomic navigation system. The PVs were mapped with a decapolar ring catheter before and after LACA. If PV isolation was incomplete, no attempts at complete isolation were made.

Spectral Analysis Identifies Sites of High-Frequency Activity Maintaining Atrial Fibrillation in Humans

P. Sanders, O. Berenfeld, M. Hocini, et al. — 2005-12-01

How important is high-frequency activity for the maintenance of atrial fibrillation (AF)? In 32 patients undergoing catheter ablation of AF (paroxysmal in 19, chronic in 13), mapping was performed at a mean of 126 points in the atria and coronary sinus. Five-second bipolar electrogram samples during AF were subjected to spectral analysis, and dominant frequency (DF) maps were constructed. Ablation was performed without regard to the DF maps and consisted of complete PV isolation, then left atrial ablation if AF was still present. Changes in AF cycle length (AFCL) in the coronary sinus and termination of AF were monitored during ablation.

Exercise-Test–Induced Arrhythmias: A Focused Review

James Beckerman, Victor F. Froelicher — 2005-12-01

Exercise testing is frequently used by clinicians as a noninvasive assessment of myocardial ischemia that, along with patient history and physical examination, helps characterize cardiovascular risk. In addition, exercise testing can be used to identify cardiac arrhythmias, particularly those brought on by exercise. There has been no consensus regarding the significance of exercise test induced arrhythmias (ETIA) because of conflicting results from previous research studies. However, recent studies with longer follow up and improved technology provide motivation to review the literature to determine whether consensus is now possible. summarizes the 22 studies we identified using Pub Med (keywords: exercise test, arrhythmias, and prognosis) along with their critical features.

Sofa

2005-12-01

Five-Year Follow-up of the Argentine Randomized Trial of Coronary Angioplasty. With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease (ERACI II)

A.E. Rodríguez, J. Balde, C.F. Pereira, et al., ERACI II Investigators — 2005-12-01

To report the 5-year follow-up results of the ERACI II trial. A total of 450 patients were randomly assigned to undergo either PCI (n=225) or CABG (n=225). Only patients with multivessel disease were enrolled. Clinical follow-up during 5 years was obtained in 92% of the total population after hospital discharge. The primary end point of the study was to compare freedom from major adverse cardiovascular events (MACE) at 30 days, 1 year, 3 years, and 5 years of follow-up.

Five-Year Outcomes After Coronary Stenting Versus Bypass Surgery for the Treatment of Multivessel Disease: The Final Analysis of the Arterial Revascularization Therapies Study (ARTS) Randomized Trial

P.W. Serruys, A.T.L. Ong, L.A. van Herwerden, et al. — 2005-12-01

To compare results of treatment of multivessel coronary artery disease with stenting or coronary artery bypass grafting (CABG) and assess 5-year survival and event-free survival of the patients enrolled in the Arterial Revascularization Therapies Study (ARTS) trial.

Five-Year Clinical Effect of Coronary Stenting and Coronary Artery Bypass Grafting in Renal Insufficient Patients With Multivessel Coronary Artery Disease: Insights From ARTS Trial

J. Aoki, A.T.L. Ong, A. Hoye, et al. — 2005-12-01

To compare coronary stent implantation and bypass surgery for multivessel coronary disease in patients with renal insufficiency. The Arterial Revascularization Therapies Study (ARTS) trial was a randomized analysis comparing CABG and coronary stenting for the treatment of patients with multivessel coronary artery disease. In the ARTS trial, 142 moderate renal-insufficient patients (Ccr < 60 mL/min) with multivessel coronary disease were randomly assigned either to stent implantation (n=69) or CABG (n=73). The primary end point was defined as the absence of any of the following major adverse cardiac and cerebrovascular events (MACCE) within 5 years after randomization: death cerebrovascular accident (CVA), documented nonfatal MI adjudicated by either new abnormal Q wave or predefined enzymatic changes, or repeat revascularization by coronary stenting or CABG.

One-year Outcomes of Coronary Artery Bypass Graft Surgery Versus Percutaneous Coronary Intervention With Multiple Stenting for Multisystem Disease: A Meta-analysis of Individual Patient Data From Randomized Clinical Trials

N. Mercado, W. Wijns, P.W. Serruys, et al. — 2005-12-01

To provide a quantitative analysis of the 1-year clinical outcomes of patients with multisystem coronary artery disease (CAD) who were included in recent randomized trials of percutaneous coronary intervention (PCI) with multiple stenting versus coronary artery bypass graft surgery (CABG).

Are Even Impaired Fasting Blood Glucose Levels Preoperatively Associated With Increased Mortality After CABG Surgery?

R.E. Anderson, K. Klerdal, T. Ivert, N. Hammar, G. Barr, A. Öwall — 2005-12-01

Are elevations in preoperative fasting blood glucose (not meeting criteria for diabetes mellitus) associated with increased mortality after coronary artery bypass grafting (CABG)?

Racial Trends in the Use of Major Procedures Among the Elderly

A.K. Jha, E.S. Fisher, Z. Li, E.J. Orav, A.M. Epstein — 2005-12-01

To examine how racial differences in the receipt of nine major surgical procedures among Medicare beneficiaries have changed over the past decade. The investigators examined data for men and women enrolled in Medicare from 1992 through 2001 on annual age-standardized rates of receipt of nine surgical procedures previously shown to have disparities in the rates at which they were performed in black patients and in white patients. They also examined data according to hospital-referral region for three of the nine procedures: coronary-artery bypass grafting (CABG), carotid endarterectomy, and total hip replacement.

Risk Factors for Late Stroke After Coronary Artery Bypass Grafting

T. Schachner, A. Zimmer, G. Nagele, G. Laufer, J. Bonatti — 2005-12-01

What factors predict occurrence of stroke late after coronary artery bypass grafting (CABG)? Three hundred and eighty seven patients undergoing intraoperative epi-aortic ultrasound during CABG were followed for a median of 52 months.

Open Repair Versus Endovascular Treatment for Asymptomatic Popliteal Artery Aneurysm: Results of a Prospective Randomized Study

M. Antonello, P. Frigatti, P. Battocchio, et al. — 2005-12-01

What is the relative risk/benefit of treating popliteal artery aneurysms with open repair versus endovascular treatment? In a prospective randomized single-center study, 30 patients with popliteal aneurysms suitable for endovascular therapy were randomized either to endovascular therapy using the Hemobahn graft or surgical therapy in the form of bypass and aneurysm exclusion with direct endoaneurysmorrhaphy. Inclusion criteria were a popliteal artery aneurysm with a diameter ≥2 cm by CT angiography, and proximal and distal neck of the aneurysm with a length of >1 cm to offer a secure site of fixation of the stent graft. Exclusion criteria were age <50 years old, poor distal runoff, contraindication to antiplatelet, anticoagulant, or thrombolytic therapy, and symptoms of nerve and vein compression.

Infrarenal Abdominal Aortic Aneurysm Repair via Endovascular Versus Open Retroperitoneal Approach

M. Mehta, S.P. Roddy, R.C. Darling, et al. — 2005-12-01

What is the short-term outcome of infrarenal abdominal aortic aneurysm (AAA) repair via an endovascular approach with that of an open retroperitoneal approach? From October 2001 to April 2003, patients with infrarenal AAA >5 cm were offered repair via an endovascular approach (group I) with a variety of industry-made stent grafts or via an open retroperitoneal surgical approach (group II). High-risk patients were offered endovascular repair, and lower-risk patients were offered either open or endovascular repair. Data were prospectively collected and complications analyzed. Data comparison between the two groups was done using chi-square analysis and two-tailed Student t-test. Statistical significance was identified at p<0.05. The mean follow-up for groups I and II was 18 (range, 12–30) months and 19 (range, 12–30) months, respectively.

Glomerular Filtration Rate Is Superior to Serum Creatinine for Prediction of Mortality After Thoracoabdominal Aortic Surgery

T.T.T. Huynh, R.G. Statius van Eps, C.C. Miller, et al. — 2005-12-01

Is GFR, calculated by the Cockcroft-Gault equation, a better predictor than serum creatinine (Cr) of 30-day mortality after thoracoabdominal aortic aneurysm surgery? The investigators analyzed data from 1106 thoracoabdominal and descending thoracic aortic aneurysm repairs between 1991 and 2004 at a single academic medical center. All data were collected prospectively and by chart review for missing data. The estimated GFR by using the Cockcroft-Gault equation; they then divided patients into quartiles based on baseline Cr and baseline GFR, and estimated the association of the quartiles with 30-day postoperative mortality by chi-square testing. They further subdivided the subjects into those with and without clinically evident renal disease, defined as a Cr level greater than 1.5 mg/dL on admission, a history of renal insufficiency, or a requirement for dialysis. The analyses were repeated in patients without clinically apparent disease (n=869).

Preoperative Clinical Factors Predict Postoperative Functional Outcomes After Major Lower Limb Amputation: An Analysis of 553 Consecutive Patients

S.M. Taylor, C.A. Kalbaugh, D.W. Blackhurst, et al. — 2005-12-01

What is the relationship between preoperative clinical characteristics and postoperative functional outcomes after major lower limb amputation? Postoperative functional status was assessed for consecutive patients undergoing major lower extremity amputations from January 1998 through December 2003 at a single nonuniversity teaching center. A retrospective review was performed correlating various preoperative clinical factors such as age at presentation, race, medical co-morbidities, preoperative ambulatory status, and preoperative independent living status, with postoperative functional end points of prosthetic usage, survival, maintenance of ambulation, and maintenance of independent living status. Kaplan-Meier survival curves were constructed and compared by using the log-rank test. Odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals were constructed by using multiple logistic regressions and Cox proportional hazards models.

Carotid Revascularization Using Endarterectomy or Stenting Systems (CaRESS) Phase I Clinical Trial: 1-Year Results

CaRESS Steering Committee — 2005-12-01

How does protected carotid stenting (CAS) compare to carotid endarterectomy (CEA) among patients at usual surgical risk? This was a multicenter, prospective, nonrandomized trial in which 397 patients with symptomatic (with >50% stenosis) or asymptomatic (with >75% stenosis) carotid stenosis were entered into the study in a 2:1 ratio of carotid stent and GuardWire Plus distal protection device versus CEA. The primary end points included death and stroke at 30 days and a composite 1-year end point of death, stroke, or myocardial infarction (MI) from 0 to 30 days and death or stroke from 31 days to 1 year.

International Subarachnoid Aneurysm Trial (ISAT) of Neurosurgical Clipping Versus Endovascular Coiling in 2143 Patients With Ruptured Intracranial Aneurysms: A Randomised Comparison of Effects on Survival, Dependency, Seizures, Rebleeding, Subgroups, and Aneurysm Occlusion

2005-12-01

Although surgical clipping of ruptured intracranial subarachnoid aneurysms has long been the standard of care, the relatively new technique of endovascular coiling of these aneurysms has gained popularity secondary to its less invasive nature. The present study sought to determine whether endovascular coiling was as effective as clipping in both the short and long term.

Current Management of Severe Congenital Mitral Stenosis: Outcomes of Transcatheter and Surgical Therapy in 108 Infants and Children

2005-12-01

To describe outcomes of children with severe congenital mitral stenosis following treatment with transcatheter and/or surgical intervention, and to determine whether outcomes have improved over time.

Interdigitating Arch Reconstruction Eliminates Recurrent Coarctation After the Norwood Procedure

H.M. Burkhart, D.A. Ashburn, I.E. Konstantinov, et al. — 2005-12-01

To compare the outcomes of three types of aortic arch reconstruction (AAR) utilized during the Norwood operation. Records from patients who underwent the Norwood procedure at the Hospital for Sick Children between 1991 and 2002 were reviewed. Three methods were used for AAR: 1) the classic technique included incision across the coarctation and utilized a homograft patch; 2) the autologous technique included excision of the coarctation site and ductal tissue and arch reconstruction with anastomosis of the distal aorta, aortic arch and main pulmonary artery; and 3) the interdigitating technique includes excision of the coarctation, extended end-to-end anastomosis of the back of the aortic arch, and suturing homograft patch from the anterolateral aspect of the descending aorta to the underside of the arch. To compare the incidence of postoperative aortic arch obstruction (AAO), measurement of the aortic arch dimensions was performed at cardiac catheterization, and the coarctation index (CI) was calculated (the ratio of the distal neoaortic anastomosis diameter to the descending aorta diameter). In addition, need for intervention was compared between subgroups.

Real-time Magnetic Resonance Imaging-guided Stenting of Aortic Coarctation With Commercially Available Catheter Devices in Swine

A.N. Raval, J.D. Telep, M.A. Guttman, et al. — 2005-12-01

What is the feasibility and safety of catheter-based vascular intervention using real-time magnetic resonance imaging (MRI)? Coarctation stenting was performed wholly under real-time MRI guidance in 13 swine. Eight swine were intervened upon using active guidewires, incorporating MRI antennas while nitinol guidewire was used in the remainder. Four animals were treated with oversized stents to deliberately create focal aortic rupture or dissections.

Percutaneous Pulmonary Valve Implantation in Humans: Results in 59 Consecutive Patients

S. Khambadkone, L. Coats, A. Taylor, et al. — 2005-12-01

To report the immediate, early, and medium-term clinical results of a valve stent in patients with right ventricular outflow tract (RVOT) reconstruction. Patients with pulmonary regurgitation with or without stenosis after repair of congenital heart disease had percutaneous pulmonary valve implantation (PPVI). Mortality, hemodynamic improvement, freedom from explantation, and subjective and objective changes in exercise tolerance were end points.

Effects of Long-Term Bosentan in Children With Pulmonary Arterial Hypertension

E. Berman Rosenzweig, D. Ivy, A. Widlitz, et al. — 2005-12-01

What is the long-term safety and effectiveness of the endothelin antagonist bosentan in children with pulmonary arterial hypertension (PAH) used as a solo agent or in combination with a prostacyclin?

Variations in Adult Congenital Heart Disease Training in Adult and Pediatric Cardiology Fellowship Programs

M.Z. Gurvitz, R. Chang, F.J. Ramos, V. Allada, J.S. Child, T.S. Klitzner — 2005-12-01

To study fellowship training for care of adults with congenital heart disease (CHD) in both adult and pediatric cardiology training programs. Adult and pediatric cardiology fellowship program directors were surveyed. Questions were aimed at learning more about program demographics, didactic lectures, special fellowship training in adult CHD, and the number of fellows receiving additional training in adult CHD.