Device Sizing Guided by Echocardiography-Based Three-Dimensional Printing Is Associated with Superior Outcome after Percutaneous Left Atrial Appendage Occlusion.

Background: Left atrial appendage (LAA) occlusion is an alternative to anticoagulation for stroke prevention in patients with atrial fibrillation. Accurate device sizing is crucial for optimal outcome. Patient-specific LAA models can be created using three-dimensional (3D) printing from 3D transesophageal echocardiographic (TEE) images, allowing in vitro model testing for device selection.

Comparison of three left atrial appendage occlusion devices for stroke prevention in patients with non-valvular atrial fibrillation: a single-centre seven-year experience with WATCHMAN, AMPLATZER Cardiac Plug/Amulet, LAmbre: Comparison of three LAAO devices for stroke prevention.

Aims: We aimed to compare long-term "real-world" outcomes of three left atrial appendage occlusion (LAAO) devices for stroke prevention in a Chinese population with non-valvular atrial fibrillation (NVAF).

Methods And Results: Consecutive patients who underwent LAAO from June 2009 to October 2016 at a university-affiliated hospital were retrospectively analysed. In-hospital and major adverse events (MAE) including mortality, stroke and major bleeding rates were compared by LAAO device.

Occlusion of a Multilobed Shallow Left Atrial Appendage Using a Special LAmbre Device After Failed Watchman Implantation.

Although reported failure rates of the Watchman device are low, the ballshaped device is not suitable for shallow and multilobed left atrial appendages (LAAs). The LAmbre device is available in two configurations - standard (cover 4-6 mm larger in diameter than the umbrella) and special (cover 12- 14 mm larger than the umbrella) - which allows the closure of a wide range of LAA anatomies. This case illustrates that the LAmbre device can be used for complex LAA anatomies that are not suitable for the Watchman device.

Difference in prevalence and pattern of mechanical dyssynchrony in left bundle branch block occurring in right ventricular apical pacing versus systolic heart failure.

Background: This study compared the prevalence and pattern of mechanical dyssynchrony in patients with normal heart and right ventricular apical (RVA) pacing versus patients with systolic heart failure (SHF) and spontaneous left bundle branch block (LBBB).

Methods: A total of 112 patients having LBBB pattern on surface electrocardiogram were included (57 with ejection fraction>50% received RVA pacing; 55 had SHF with ejection fraction<35%). Using tissue Doppler imaging, systolic and diastolic dyssynchrony was defined by the standard deviation of the time to peak systolic and peak early diastolic velocity, respectively.

Left ventricular systolic dyssynchrony is a predictor of cardiac remodeling after myocardial infarction.

Objectives: We sought to determine whether early assessment of left ventricular (LV) dyssynchrony by tissue Doppler imaging may predict progressive ventricular enlargement and cardiac dysfunction after acute myocardial infarction (MI).

Methods: Forty-seven patients (mean age 59.9 +/- 11.

Aldosterone receptor antagonism induces reverse remodeling when added to angiotensin receptor blockade in chronic heart failure.

Objectives: The objective of this study was to determine if adding spironolactone to an angiotensin II receptor blocker improves left ventricular (LV) function, mass, and volumes in chronic heart failure.

Background: Add-on spironolactone therapy substantially improves clinical outcomes among patients with severe heart failure (HF) on standard therapy. However, the value of combining spironolactone with an angiotensin II receptor blocker on LV reverse remodeling in mild-to-moderate systolic HF is unclear.

Diagnostic dilemma in a middle-aged man with heart failure.

We report a middle-age man presented with shortness of breath. Echocardiography revealed globally hypokinetic LV with poor function. Coronary angiograms showed no obstructive coronary artery lesions but multiple coronary fistulae to pulmonary artery without significant left to right shunt.

Comparison of angiotensin-converting enzyme inhibitor alone and in combination with irbesartan for the treatment of heart failure.

Objective: Angiotensin-converting enzyme inhibitor (ACEI) is beneficial in patients with congestive heart failure (CHF). Some, but not all, angiotensin receptor blocker (ARB) was demonstrated to be effective as "add-on" therapy. We investigated whether irbesartan is useful as an add-on therapy in CHF.

Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease.

Background: Contrast-enhanced cardiac magnetic resonance imaging (CMR) can determine the extent of myocardial scar from infarction (MI). However, the prognostic significance of unrecognized myocardial scar by CMR in patients without a history of MI is unknown.

Methods And Results: One hundred ninety-five patients without a known prior MI underwent CMR for assessment of left ventricular (LV) function and late gadolinium enhancement (LGE).

Magnetic resonance angiography of coronary arteries with a 3-dimensional magnetization-prepared true fast imaging with steady-state precession sequence compared with conventional coronary angiography.

Background: The aim of the study was to compare the detection of clinically significant coronary artery stenosis using a magnetic resonance 3-dimensional (3D) breath-hold true fast imaging with steady-state precession (trueFISP) sequence with conventional coronary angiography.

Methods: Twenty-nine patients who were scheduled to undergo or had recently undergone diagnostic conventional coronary angiogram participated in this study. The left main, left anterior descending, left circumflex, and right coronary arteries were studied using the 3D breath-hold trueFISP technique.

Strain rate imaging differentiates transmural from non-transmural myocardial infarction: a validation study using delayed-enhancement magnetic resonance imaging.

Objectives: The aim of this study was to determine if strain rate imaging (SRI) correlates with the transmural extent of myocardial infarction (MI) measured by contrast-enhanced magnetic resonance imaging (Ce-MRI).

Background: Identification of the transmural extent of myocardial necrosis and degree of non-viability after acute MI is clinically important.

Methods: Tissue Doppler echocardiography with SRI and Ce-MRI were performed in 47 consecutive patients with a first acute MI between days 2 and 6 and compared to 60 age-matched healthy volunteers.

Left ventricular systolic asynchrony after acute myocardial infarction in patients with narrow QRS complexes.

Background: The aim of the study was to assess the degree of left ventricular (LV) asynchrony after myocardial infarction (MI) in patients with a narrow QRS complex using tissue Doppler imaging (TDI) and correlate this with the site and extent of the infarction measured by contrast-enhanced magnetic resonance imaging (Ce-MRI).

Methods: Echocardiography with TDI and Ce-MRI was performed within 6 days of acute MI in 47 patients and compared with 69 age-matched healthy volunteers. Regional myocardial velocities were assessed in 12 segments, and the corresponding systolic velocity (Sm), early diastolic velocity (Em), as well as the time to peak Sm (Ts) and time to peak Em (Te) were measured.

Effect of N-acetylcysteine for prevention of contrast nephropathy in patients with moderate to severe renal insufficiency: a randomized trial.

Background: The effect of N-acetylcysteine (NAC) to prevent contrast nephropathy (CN) in patients with moderate to severe renal insufficiency undergoing coronary angiography or interventions is not clear.

Methods: This is a prospective, open-label, randomized, controlled trial. Ninety-one consecutive patients with a serum creatinine level of 1.

Homocysteine, endothelial dysfunction, and coronary artery disease: emerging strategy for secondary prevention.

Atherosclerosis is an important medical problem of the 21st century, but traditional risk factors could only account for 50% of the problem. Hyperhomocysteinemia is emerging as an independent atherosclerosis risk factor, associated with folate deficiency, renal failure, and relative deficiency of MTHFR (C677T polymorphism) or other enzymes depending on gender, age, and smoking status. Hyperhomocysteinemia has been reported to occur in 11-22% of western people, in 3-5% of normal asymptomatic Chinese subjects aged 18-70 years in Hong Kong, Macau, Sydney, and San Francisco, 23-36% of Chinese in Hong Kong with premature coronary artery disease, and 29% of a nonselective series of coronary subjects in Hong Kong.

NF-kappaB plays a key role in hypoxia-inducible factor-1-regulated erythropoietin gene expression.

Objective: The aim of this study was to further define the signal transduction pathways leading to hypoxia-inducible factor-1 (HIF-1) erythropoietin (EPO) gene expression.

Materials And Methods: Human hepatocellular carcinoma cells (Hep3B) were exposed to hypoxia (1% oxygen) and examined for mRNA expression, as well as gene transactivation with RT-PCR and luciferase reporter gene assays, respectively.

Results: Treatment with LY294002 (a selective pharmacological inhibitor of phosphatidylinositol 3-kinase) significantly inhibited EPO protein and mRNA expression in Hep3B cells exposed to hypoxia for 24 hours, while treatment with PD098059 or SB203580 (selective pharmacological inhibitors of the MEK and p38 mitogen-activated protein kinase pathways, respectively) had no significant effects.