An exaggerated blood pressure response to treadmill exercise does not increase the likelihood that exercise echocardiograms are abnormal in men or women.

Background: Some experts have suggested that patients with exaggerated blood pressure responses during exercise echocardiography are more likely to have abnormal exercise echocardiographic findings and less likely to have angiographically significant coronary artery disease than patients with normal blood pressure responses. The aim of this study was to evaluate the impact of exercise blood pressure on exercise echocardiographic findings and subsequent angiographic results in men and women.

Methods: In this retrospective study, clinical, exercise, and echocardiographic characteristics of patients who underwent treadmill exercise echocardiography over a 2-year period were examined, and the angiographic findings of the subgroup of patients who subsequently underwent coronary angiography within 30 days were analyzed.

Effects of vasodilation in heart failure with preserved or reduced ejection fraction implications of distinct pathophysiologies on response to therapy.

Objectives: The purpose of this study was to compare hemodynamic responses to vasodilator therapy in patients with heart failure (HF) and preserved ejection fraction (HFpEF) versus HF and reduced ejection fraction (HFrEF).

Background: There is no proven therapy for HFpEF. In the absence of data, medicines with established benefit in HFrEF such as vasodilators are frequently prescribed for HFpEF.

Current status of endomyocardial biopsy.

Endomyocardial biopsy (EMB) is widely used for surveillance of cardiac allograft rejection and for the diagnosis of unexplained ventricular dysfunction. Typically, EMB is performed through the jugular or femoral veins and is associated with a serious acute complication rate of less than 1% using current flexible bioptomes. Although it is accepted that EMB should be used to monitor for rejection after transplant, use of EMB for the diagnosis of various myocardial diseases is controversial.

Bedside assessment of cardiac hemodynamics: the impact of noninvasive testing and examiner experience.

Background: Knowledge of cardiac filling pressures is critical in the diagnosis and management of patients with dyspnea or heart failure. Echocardiography and B-natriuretic peptide (BNP) testing are commonly used to estimate these pressures, but their incremental value beyond physical examination remains unknown.

Methods: Right and left heart filling pressures were prospectively estimated as "normal" or "abnormal" by staff cardiologists and cardiovascular trainees based upon physical examination findings alone, or examination coupled with echocardiographic and BNP data in patients referred for cardiac catheterization.

Transradial access for renal artery intervention is feasible and safe.

Background: Transradial access for coronary intervention is associated with reduced access complications compared with transfemoral. Transradial access for renal artery intervention has been less well studied. Safety compared with transfemoral access is undetermined.

Minimally invasive transradial intervention using sheathless standard guiding catheters.

Objectives: We evaluated a sheathless transradial technique for interventions using standard five and six French nonhydrophilic guiding catheters.

Background: Miniaturization of transradial interventions may serve to improve patient comfort and reduce the risk of access-site complications. Guiding catheters carry an outer diameter approximately 2 Fr sizes smaller than their corresponding introducer sheaths.

Does a longer duration of oral factor Xa therapy increase the risk of bleeding or transaminitis?

Background: There is little data regarding the risk of bleeding or transaminitis with a longer duration of oral factor Xa therapy. Our goal was to analyze data from randomized trials to better define the relationship between drug duration and drug safety.

Methods: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and several internet sources of data from 1988 through the second week of March 2010.

Acute myocardial infarction due to left circumflex artery occlusion and significance of ST-segment elevation.

Acute occlusion of the left circumflex (LC) artery can be difficult to diagnose. The aim of the present study was to assess the incidence of LC occlusion in patients with acute myocardial infarction (AMI) requiring percutaneous coronary intervention (PCI), the frequency of ST-segment versus non-ST-segment elevation presentation among them, and to correlate the electrocardiographic findings with the outcomes. The clinical characteristics and outcomes of consecutive patients from November 2001 through December 2007 with AMI within 7 days before PCI of a single acutely occluded culprit vessel were included in the present analysis.

Sheathless transradial intervention using standard guide catheters.

Objectives: Our aim was to report our preliminary experience performing complex transradial interventions using a sheathless technique with standard large bore nonhydrophilic guiding catheters.

Background: A major limitation of transradial percutaneous coronary intervention (PCI) is the inability to use large guides because of the relatively small size of the radial artery.

Methods: We identified consecutive patients who had transradial PCI between September 2009 and March 2010 using large-bore guides (7 or 8 Fr) with a sheathless technique.

Likelihood of obstructive coronary disease in metabolic syndrome patients with abnormal stress echocardiography.

Background: Metabolic syndrome (MetSx) encompasses several risk factors for macrovascular coronary artery disease. An association between MetSx and coronary syndrome X has also been reported, suggesting that patients with MetSx are more likely to have endothelial dysfunction in the setting of angiographically normal coronary arteries. It remains unknown whether MetSx patients with abnormal stress echocardiography (SE) are more likely to have obstructive coronary disease (CAD) compared to patients without MetSx.

Iodixanol versus low-osmolar contrast media for prevention of contrast induced nephropathy: meta-analysis of randomized, controlled trials.

Background: Contrast-induced nephropathy (CIN) is associated with significant morbidity and mortality. The objective of our meta-analysis was to assess the efficacy of iodixanol compared with low-osmolar contrast media (LOCM) for prevention of CIN.

Methods And Results: We searched MEDLINE, the Cochrane Central Register of Controlled Trials, and internet sources of cardiology trial results for individual and relevant reviews of randomized, controlled trials, for the terms contrast media, contrast nephropathy, renal failure, iodixanol, Visipaque, and low-osmolar contrast media.

Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass surgery for multivessel coronary artery disease: a meta-analysis of data from the ARTS II, CARDia, ERACI III, and SYNTAX studies and systematic review of observational data.

Aims: The aim of this study was to systematically analyse the available data from trials comparing revascularisation by drug-eluting stent (DES) placement versus coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease (CAD).

Methods And Results: We searched PubMed, Medline and several internet sources for randomised controlled trials comparing DES placement to CABG in patients with multivessel coronary artery disease. There were no restrictions on journal type or population studied.

Heart failure with preserved ejection fraction: pathophysiology and emerging therapies.

Approximately half of patients with heart failure (HF) have a preserved ejection fraction (HFpEF). Morbidity and mortality are similar to HF with reduced EF (HFrEF), yet therapies with unequivocal benefit in HFrEF have not been shown to be effective in HFpEF. Recent studies have shown that the pathophysiology of HFpEF, initially believed to be due principally to diastolic dysfunction, is more complex.

Percutaneous revascularization for stable coronary artery disease temporal trends and impact of drug-eluting stents.

Objectives: We sought to determine the characteristics, outcomes, and temporal trends among patients undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) from a single-center registry.

Background: There is controversy regarding the generalizability of the findings from randomized trials of PCI for stable CAD to daily practice. An important perspective on the significance of the trial results can be achieved by clearly documenting past and present practice of PCI.

Characteristics and outcomes of patients with abnormal stress echocardiograms and angiographically mild coronary artery disease (<50% stenoses) or normal coronary arteries.

Background: Abnormal cardiac stress imaging findings are not always associated with angiographically significant coronary artery disease. The outcomes of patients with such false-positive findings have not been extensively examined. The aim of this retrospective study was to describe the characteristics and outcomes of patients with abnormal stress echocardiographic findings who had false-positive results compared with those who had true-positive results.

The development of heart failure in patients with diabetes mellitus and pre-clinical diastolic dysfunction a population-based study.

Objectives: The purpose of this study was to evaluate the outcomes of pre-clinical diastolic dysfunction in diabetic patients.

Background: Studies have reported a high prevalence of pre-clinical diastolic dysfunction among patients with diabetes mellitus.

Methods: We identified all diabetic patients with a tissue Doppler imaging assessment of diastolic function in Olmsted County, Minnesota, from 2001 to 2007.

Temporal trends and improved outcomes of percutaneous coronary revascularization in nonagenarians.

Objectives: The aim of this study was to describe the clinical characteristics and the outcomes of patients 90 years of age or older who were treated with percutaneous coronary intervention (PCI).

Background: There is a paucity of outcomes data among nonagenarians undergoing PCI.

Methods: We evaluated the outcomes of all patients 90 years of age or older in the Mayo Clinic PCI registry and examined trends over time.

Changes in diastolic dysfunction in diabetes mellitus over time.

Several studies have demonstrated evidence for preclinical left ventricular (LV) diastolic dysfunction in patients with diabetes mellitus (DM) independent of coronary disease or hypertension. The objectives of our study were to determine if LV diastolic dysfunction determined by tissue Doppler indexes worsens with duration of DM and to quantify severity of dysfunction as a function of DM duration. From 1996 to 2007, all Olmsted County, Minnesota, residents with DM free of heart failure who had a subsequent measurement of diastolic function using tissue Doppler echocardiography were identified.

Are some false-positive stress echocardiograms a forme fruste variety of apical ballooning syndrome?

The mechanisms for abnormal stress echocardiograms (SEs) in patients with normal coronary arteries have not been clearly elucidated. We hypothesized that in some patients, this phenomenon may represent a forme fruste of apical ballooning syndrome (ABS). The aim of the study was to evaluate the characteristics of patients with strongly false-positive SEs and determine whether there were similarities to ABS.

Mortality associated with nephropathy after radiographic contrast exposure.

Objective: To define outcomes from contrast-induced nephropathy (CIN) after both intra-arterial and intravenous administration of contrast medium.

Patients And Methods: We performed a retrospective case-matched cohort study at Mayo Clinic's site in Rochester, MN, from April 1, 2004, to March 31, 2006. All contrast procedures were evaluated for inclusion.

ANCA vasculitis in the elderly.

Background: In population-based estimates of disease, the incidence of ANCA-associated vasculitides is increasing, with the peak age of onset in middle aged and older adults. Clinical characteristics of the very elderly have not been fully elucidated.

Methods: Patients who met the criteria for Wegener granulomatosis and microscopic polyangiitis were included in the study.

Sodium bicarbonate is associated with an increased incidence of contrast nephropathy: a retrospective cohort study of 7977 patients at mayo clinic.

Background And Objectives: The role of sodium bicarbonate in preventing contrast nephropathy needs to be evaluated in clinical settings.

Design, Setting, Participants, & Measurements: We performed a retrospective cohort study at Mayo Clinic in Rochester, Minnesota, to assess the risk of contrast nephropathy associated with the use of sodium bicarbonate, N-acetylcysteine, and the combination of sodium bicarbonate with N-acetylcysteine from April 2004 to May 2005. Contrast nephropathy was defined as postexposure creatinine elevation of > or =25% or >0.

Relationship between low bone mineral density and exercise-induced myocardial ischemia.

Objective: To evaluate the relationship between bone mineral density (BMD) and ischemic heart disease and exercise capacity, as assessed by stress testing.

Patients And Methods: We retrospectively reviewed entries in the echocardiography database for 28,048 consecutive patients who underwent exercise echocardiography for standard clinical indications between August 1, 1998, and October 1, 2003, to determine which of these patients had also undergone dual-energy x-ray absorptiometry to measure femoral neck BMD before the procedure. Of the 1194 patients meeting both criteria, 28 were excluded because of missing data and 24 because they were tested with an exercise protocol other than the Bruce protocol, leaving 1142 patients to be included.