好像每期circulation, circ res，JACC都有精选，但是没有EHJ，因此发了最新一期EHJ，不知道大家有没有兴趣
Coronary heart disease
Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T
Conor J. McCann, Ben M. Glover, Ian B.A. Menown, Michael J. Moore, Jane McEneny, Colum G. Owens, Bernie Smith, Peter C. Sharpe, Ian S. Young, and Jennifer A. Adgey
Aims: To evaluate the role of novel biomarkers in early detection of acute myocardial infarction (MI) in patients admitted with acute chest pain.
Methods and results: A prospective study of 664 patients presenting to two coronary care units with chest pain was conducted over 3 years from 2003. Patients were assessed on admission: clinical characteristics, ECG (electrocardiogram), renal function, cardiac troponin T (cTnT), heart fatty acid binding protein (H-FABP), glycogen phosphorylase-BB, NT-pro-brain natriuretic peptide, D-dimer, hsCRP (high sensitivity C-reactive protein), myeloperoxidase, matrix metalloproteinase-9, pregnancy associated plasma protein-A, soluble CD40 ligand. A 12 h cTnT sample was also obtained. MI was defined as cTnT 0.03 µg/L. In patients presenting <4 h of symptom onset, sensitivity of H-FABP for MI was significantly higher than admission cTnT (73 vs. 55%; P = 0.043). Specificity of H-FABP was 71%. None of the other biomarkers challenged cTnT. Combined use of H-FABP and cTnT (either one elevated initially) significantly improved the sensitivities of H-FABP or cTnT (85%; P 0.004). This combined approach also improved the negative predictive value, negative likelihood ratio, and the risk ratio.
Conclusion: Assessment of H-FABP within the first 4 h of symptoms is superior to cTnT for detection of MI, and is a useful additional biomarker for patients with acute chest pain.
Bone marrow cells are a rich source of growth factors and cytokines: implications for cell therapy trials after myocardial infarction
Mortimer Korf-Klingebiel, Tibor Kempf, Thomas Sauer, Eva Brinkmann, Philipp Fischer, Gerd P. Meyer, Arnold Ganser, Helmut Drexler, and Kai C. Wollert
Aims: Results from clinical trials suggest that cardiac function after acute myocardial infarction (AMI) can be enhanced by an intracoronary infusion of autologous unselected nucleated bone marrow cells (BMCs). Release of paracrine factors has been proposed as a mechanism for these therapeutic effects; however, this hypothesis has not been tested in humans.
Methods and results: BMCs and peripheral blood leucocytes (PBLs) were obtained from 15 patients with AMI and cultured in serum-free medium to obtain conditioned supernatants (SN). BMC-SN stimulated human coronary artery endothelial cell proliferation, migration, and tube formation, and induced cell sprouting in a mouse aortic ring assay. Moreover, BMC-SN protected rat cardiomyocytes from cell death induced by simulated ischaemia or ischaemia followed by reperfusion. While PBL-SN promoted similar effects on endothelial cells and cardiomyocytes, BMC-SN and PBL-SN in combination promoted synergistic effects. As shown by ProteinChip and GeneChip array analyses (each performed in triplicate), BMCs and PBLs expressed distinct patterns of pro-angiogenic and cytoprotective secreted factors.
Conclusion: Our data support the paracrine hypothesis and suggest that characterization of the BMC secretome may lead to an identification of factors with therapeutic potential after AMI.
医药家园
医药家园 博客
Interventional cardiology
Randomized trial on routine vs. provisional T-stenting in the treatment of de novo coronary bifurcation lesions
Miroslaw Ferenc, Michael Gick, Rolf-Peter Kienzle, Hans-Peter Bestehorn, Klaus-Dieter Werner, Thomas Comberg, Piotr Kuebler, Heinz Joachim Büttner, and Franz-Josef Neumann
Aims: We investigated whether routine T-stenting reduces restenosis of the side branch as compared with provisional T-stenting in patients with de novo coronary bifurcation lesions.
Methods and results: Our randomized study assigned 101 patients with a coronary bifurcation lesion to routine T-stenting with sirolimus-eluting stents (SES) in both branches and 101 patients to provisional T-stenting with SES placement in the main branch followed by kissing-balloon angioplasty and provisional SES placement in the side branch only for inadequate results. Primary endpoint was per cent diameter stenosis of the side branch at 9 month angiographic follow-up. Angiographic follow-up in 192 (95%) patients revealed a per cent stenosis of the side branch of 23.0 ± 20.2% after provisional T-stenting (19% with side-branch stent) and of 27.7 ± 24.8% (P = 0.15) after routine T-stenting (98.2% with side-branch stent). The corresponding binary restenosis rates were 9.4 and 12.5% (P = 0.32), prompting re-intervention in 5.0 and 7.9% (P = 0.39), respectively. In the main branch, binary restenosis rates were 7.3% after provisional and 3.1% after routine T-stenting (P = 0.17). The overall 1 year incidence of target lesion re-intervention was 10.9% after provisional and 8.9% after routine T-stenting (P = 0.64).
Conclusions: Routine T-stenting with SES did not improve the angiographic outcome of percutaneous coronary intervention of coronary bifurcation lesions as compared with stenting of the main branch followed by kissing-balloon angioplasty and provisional side-branch stenting.
Thrombosis and antithrombotic therapy
Comparison of four tests to assess inhibition of platelet function by clopidogrel in stable coronary artery disease patients
Marie Lordkipanidzé, Chantal Pharand, Thuy Anh Nguyen, Erick Schampaert, Donald A. Palisaitis, and Jean G. Diodati
Aims: We investigated the comparability of platelet function tests in quantifying platelet inhibition achieved by clopidogrel.
Methods and results: This pre-specified substudy of a randomized, double-blind trial included 116 patients with stable coronary artery disease requiring diagnostic angiography. Patients received clopidogrel for 1 (300 or 600 mg) or 7 days (300 + 75 or 150 mg daily) before the procedure. Blood samples obtained before clopidogrel initiation and before diagnostic coronary angiography were assayed using light transmission aggregometry [adenosine diphosphate (ADP) 5 and 20 µM as the agonist], whole-blood aggregometry (ADP 5 and 20 µM), PFA-100® (Collagen-ADP cartridge), and VerifyNow® P2Y12. Although all assays studied were found sensitive to clopidogrel ingestion, none could distinguish categorically between patients who had, or not, ingested clopidogrel. Agreement between assays to identify patients with insufficient inhibition of platelet aggregation by clopidogrel was low.
Conclusion: The assessment of platelet function inhibition by clopidogrel is highly test-specific. Decision to increase clopidogrel dosage may vary on the basis of the assay used, thus highlighting the need for unambiguous guidelines with respect to assay selection, as platelet function assays are not interchangeable. At present, platelet function testing evaluating clopidogrel efficacy cannot be recommended in routine clinical practice.
Arrhythmia/electrophysiology
Transvenous removal of pacing and implantable cardiac defibrillating leads using single sheath mechanical dilatation and multiple venous approaches: high success rate and safety in more than 2000 leads
Maria Grazia Bongiorni, Ezio Soldati, Giulio Zucchelli, Andrea Di Cori, Luca Segreti, Raffaele De Lucia, Gianluca Solarino, Alberto Balbarini, Mario Marzilli, and Mario Mariani
Aims: The aim of the present study was to describe a 10 years single-centre experience in pacing and defibrillating leads removal using an effective and safe modified mechanical dilatation technique.
Methods and results: We developed a single mechanical dilating sheath extraction technique with multiple venous entry site approaches. We performed a venous entry site approach (VEA) in cases of exposed leads and an alternative transvenous femoral approach (TFA) combined with an internal transjugular approach (ITA) in the presence of very tight binding sites causing failure of VEA extraction or in cases of free-floating leads. We attempted to remove 2062 leads [1825 pacing and 237 implantable cardiac defibrillating (ICD) leads; 1989 exposed at the venous entry site and 73 free-floating] in 1193 consecutive patients. The VEA was effective in 1799 leads, the TFA in 28, and the ITA in 205; in the overall population, we completely removed 2032 leads (98.4%), partially removed 18 (0.9%), and failed to remove 12 leads (0.6%). Major complications were observed in eight patients (0.7%), causing three deaths (0.3%).
Conclusion: Mechanical single sheath extraction technique with multiple venous entry site approaches is effective, safe, and with a good cost effective profile for pacing and ICD leads removal.
Rapid effects of air pollution on ventricular arrhythmias
Petter L.S. Ljungman, Niklas Berglind, Christina Holmgren, Fredrik Gadler, Nils Edvardsson, Göran Pershagen, Mårten Rosenqvist, Bengt Sjögren, and Tom Bellander
Aims: Air pollution has been associated with ventricular arrhythmias in patients with implantable cardioverter defibrillators (ICDs) for exposure periods of 24–48 h. Only two studies have investigated exposure periods <24 h. We aimed to explore such effects during the 2 and 24 preceding hours as well as in relation to distance from the place of the event to the air pollution monitor.
Methods and results: We used a case-crossover design to investigate the effects of particulate matter <10 µm in diameter (PM10) and nitrogen dioxide (NO2) in 211 patients with ICD devices in Gothenburg and Stockholm, Sweden. Events interpreted as ventricular arrhythmias were downloaded from the ICDs, and air pollution data were collected from urban background monitors. We found an association between 2 h moving averages of PM10 and ventricular arrhythmia [odds ratio (OR) 1.31, 95% confidence interval (CI) 1.00–1.72], whereas the OR for 24 h moving averages was 1.24 (95% CI 0.87–1.76). Corresponding ORs for events occurring closest to the air pollution monitor were 1.76 (95% CI 1.18–2.61) and 1.74 (95% CI 1.07–2.84), respectively. Events occurring in Gothenburg showed stronger associations than in Stockholm.
Conclusion: Moderate increases in air pollution appear to be associated with ventricular arrhythmias in ICD patients already after 2 h, although future studies including larger numbers of events are required to confirm these findings. Representative geographical exposure classification seems important in studies of these effects.
Imaging
Computed tomographic angiography or conventional coronary angiography in therapeutic decision-making
Lieuwe H. Piers, Riksta Dikkers, Tineke P. Willems, Bart J.G.L. de Smet, Matthijs Oudkerk, Felix Zijlstra, and René A. Tio
Aims: To evaluate non-invasive angiography using dual-source computed tomography (CT) for the determination of the most appropriate therapeutic strategy in patients with suspected coronary artery disease (CAD).
Methods and results: CT angiography (Dual Source CT, Somatom Definition, Siemens Medical Systems, Forchheim, Germany) was performed in 60 consecutive patients [51 men, median age 64 (57–70) years] scheduled for elective coronary angiography. Both techniques were used to evaluate the presence of CAD, significant stenosis, and the need for revascularization therapy. Sensitivity and specificity for the presence of significant stenosis were: per segment (n = 766) 62% (95% CI 50–72) (64/104) and 79% (95% CI 74–84) (526/662), respectively; per patient (n = 60) 100% (95% CI 91–100) (38/38) and 45% (95% CI 24–68) (10/22), respectively. In therapeutic decision-making based on CT angiography, sensitivity, specificity, positive and negative predictive values for intervention were 97% (95% CI 84–100) (36/37), 48% (95% CI 27–69) (11/23), 75% (95% CI 60–86) (36/48), and 92% (95% CI 60–100) (11/12), respectively. If a revascularization procedure was needed, the CT angiographic data indicated the appropriate modality (percutaneous coronary intervention or coronary artery bypass grafting) in 70% (26/36) of patients.
Conclusion: Although imaging qualities have improved considerably, CT angiography cannot be used for definitive therapeutic decision-making with regard to revascularization procedures in patients with suspected CAD.
ESC GUIDELINES
Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology
Authors/Task Force Members, Frans Van de Werf, Jeroen Bax, Amadeo Betriu, Carina Blomstrom-Lundqvist, Filippo Crea, Volkmar Falk, Gerasimos Filippatos, Keith Fox, Kurt Huber, Adnan Kastrati, Annika Rosengren, P. Gabriel Steg, Marco Tubaro, Freek Verheugt, Franz Weidinger, Michael Weis, ESC Committee for Practice Guidelines (CPG), Alec Vahanian, John Camm, Raffaele De Caterina, Veronica Dean, Kenneth Dickstein, Gerasimos Filippatos, Christian Funck-Brentano, Irene Hellemans, Steen Dalby Kristensen, Keith McGregor, Udo Sechtem, Sigmund Silber, Michal Tendera, Petr Widimsky, José Luis Zamorano, Document Reviewers, Sigmund Silber, Frank V. Aguirre, Nawwar Al-Attar, Eduardo Alegria, Felicita Andreotti, Werner Benzer, Ole Breithardt, Nicholas Danchin, Carlo Di Mario, Dariusz Dudek, Dietrich Gulba, Sigrun Halvorsen, Philipp Kaufmann, Ran Kornowski, Gregory Y. H. Lip, and Frans Rutten
http://g.zhubajie.com/urllink.php?id=339320673k3×13v38irsorl
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Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T
http://g.zhubajie.com/urllink.php?id=3396065n7yt4xxvppe0fvi2
Bone marrow cells are a rich source of growth factors and cytokines: implications for cell therapy trials after myocardial infarction
http://g.zhubajie.com/urllink.php?id=3396071ozi4gd1×8jga5wgu
Randomized trial on routine vs. provisional T-stenting in the treatment of de novo coronary bifurcation lesions
http://g.zhubajie.com/urllink.php?id=3396076w64mzz4xq20blta6
Culotte stenting technique in coronary bifurcation disease: angiographic follow-up using dedicated quantitative coronary angiographic analysis and 12-month clinical outcomes
http://g.zhubajie.com/urllink.php?id=3396078okwb1h7c8bj50yst
Comparison of four tests to assess inhibition of platelet function by clopidogrel in stable coronary artery disease patients
http://g.zhubajie.com/urllink.php?id=33960840xsihl92ko97121g
继续
Transvenous removal of pacing and implantable cardiac defibrillating leads using single sheath mechanical dilatation and multiple venous approaches: high success rate and safety in more than 2000 leads
http://g.zhubajie.com/urllink.php?id=3396092pcenwqq6l1u3dknr
Rapid effects of air pollution on ventricular arrhythmias
http://g.zhubajie.com/urllink.php?id=33961026oi5nws8n3toj87o
Computed tomographic angiography or conventional coronary angiography in therapeutic decision-making
http://g.zhubajie.com/urllink.php?id=33961073gpntakryo1aqr49