Acute weight gain and diastolic dysfunction as a potent risk complex for post stem cell transplant atrial fibrillation.

The management of atrial fibrillation (AF) following stem cell transplant (SCTX) is often challenging because of the universal presence of profound bone marrow suppression. The incidence of and risk factors for AF/flutter following SCTX are not well known. A total of 395 multiple myeloma (MM) patients consecutively underwent SCTX between 2002 and 2005 at the Mayo Clinic, and 383 of whom, mean age 57 +/- 9 years, had no history of evidence of AF/flutter constituted the study population.

Outcomes of a system-wide protocol for elective and nonelective coronary angioplasty at sites without on-site surgery: the Mayo Clinic experience.

Objective: To compare outcomes of percutaneous coronary interventions (PCIs) at 2 community hospitals without on-site surgery (Franciscan Skemp Healthcare and Immanuel St. Joseph's Hospital) with a center with on-site surgery (Saint Marys Hospital).

Patients And Methods: Using a matched case-control design, we studied 1842 elective and 667 nonelective PCI procedures (myocardial infarction [MI]/cardiogenic shock) performed from January 1, 1999, through December 31, 2007.

Effect of septal ablation on myocardial relaxation and left atrial pressure in hypertrophic cardiomyopathy an invasive hemodynamic study.

Objectives: The objective of this study was to examine the effects of septal ablation on diastolic function with the use of invasive hemodynamics.

Background: Septal ablation is an alternative therapy for patients with obstructive hypertrophic cardiomyopathy (HCM). However, its beneficial effect on diastolic function, by relieving the systolic contraction load, may be countered by adverse effects from the infarction on left ventricular mechanics.

Outcomes following pre-operative clopidogrel administration in patients with acute coronary syndromes undergoing coronary artery bypass surgery: the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial.

Objectives: This study sought to evaluate the impact of upstream clopidogrel in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) requiring coronary artery bypass grafting (CABG) from the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial.

Background: Despite benefits of clopidogrel in patients with NSTE-ACS undergoing percutaneous coronary intervention, this agent is often not administered upstream (before angiography) as recommended by the American College of Cardiology/American Heart Association guidelines because of potential bleeding in the minority of patients who require CABG.

Methods: The ACUITY trial enrolled 13,819 patients with NSTE-ACS undergoing early invasive management.

Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction.

Background: There is no consensus regarding the safety and efficacy of drug-eluting stents, as compared with bare-metal stents, in patients with ST-segment elevation myocardial infarction who are undergoing primary percutaneous coronary intervention (PCI).

Methods: We randomly assigned, in a 3:1 ratio, 3006 patients presenting with ST-segment elevation myocardial infarction to receive paclitaxel-eluting stents (2257 patients) or otherwise identical bare-metal stents (749 patients). The two primary end points of the study were the 12-month rates of target-lesion revascularization for ischemia (analysis powered for superiority) and a composite safety outcome measure of death, reinfarction, stroke, or stent thrombosis (powered for noninferiority with a 3.

Advanced age, antithrombotic strategy, and bleeding in non-ST-segment elevation acute coronary syndromes: results from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.

Objectives: This study sought to evaluate the impact of age on outcomes in patients with moderate- and high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) enrolled in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.

Background: Aging-associated changes in physiology and metabolism may alter the risk and benefit of therapeutic strategies from that observed in younger people.

Methods: We performed a pre-specified analysis of 30-day and 1-year outcomes in 4 age groups, overall and among those undergoing percutaneous coronary intervention (PCI).

Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications.

Atrial fibrillation (AF), the most commonly encountered clinical arrhythmia, often complicates acute myocardial infarction (AMI) with an incidence between 6 and 21%. Predictors of the arrhythmia in the setting of AMI include advanced age, heart failure symptoms, and depressed left ventricular function. The bulk of evidence demonstrates that AF in patients hospitalized for AMI has serious adverse prognostic implications regarding in-hospital, but also long-term mortality.

Pathophysiology of concomitant atrial fibrillation and heart failure: implications for management.

Atrial fibrillation (AF) and heart failure (HF) are two conditions regularly encountered in clinical practice. They share many common risk factors, and are often seen concurrently in an individual patient. Global aging of the population is likely to lead to an increase in the prevalence of both AF and HF alone, as well as in their combined state.

Sudden death after myocardial infarction.

Context: Sudden cardiac death after myocardial infarction (MI) has not been assessed recently in the community. Risk stratification for sudden cardiac death after MI commonly relies on baseline characteristics and little is known about the relationship between recurrent ischemia or heart failure and sudden cardiac death.

Objective: To evaluate the risk of sudden cardiac death after MI and the impact of recurrent ischemia and heart failure on sudden cardiac death.

Long-term risk of atrial fibrillation with symptomatic gastroesophageal reflux disease and esophagitis.

The mechanisms underlying the triggers and maintenance of atrial fibrillation (AF) are not fully understood. One potential unproved mechanism is that gastroesophageal reflux disease (GERD), in which acid reflux induces local and systemic inflammation, may increase triggered activity in the myocardium and pulmonary veins and increase AF risk. A self-report questionnaire was mailed to a random sample of 5,288 residents of Olmsted County, Minnesota, aged 25 to 74 years to assess the presence and frequency of GERD from 1988 to 1994.

Usefulness of proteinuria as a prognostic marker of mortality and cardiovascular events among patients undergoing percutaneous coronary intervention (data from the Evaluation of Oral Xemilofiban in Controlling Thrombotic Events [EXCITE] trial).

Proteinuria was associated with cardiovascular events and mortality in community-based cohorts. The association of proteinuria with mortality and cardiovascular events in patients undergoing percutaneous coronary intervention (PCI) was unknown. The association of urinary dipstick proteinuria with mortality and cardiovascular events (composite of death, myocardial infarction, or nonhemorrhagic stroke) in 5,835 subjects of the EXCITE trial was evaluated.

Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study.

Aims: In the setting of percutaneous coronary intervention (PCI), due to a paucity of data, the optimal dose of aspirin is uncertain. We evaluated the safety of different doses of aspirin after PCI.

Methods And Results: In the PCI-CURE study, 2658 patients with acute coronary syndromes undergoing PCI were stratified into three aspirin dose groups >/=200 mg (high, n = 1064), 101-199 mg (moderate, n = 538), and View Article and Find Full Text PDF

Circadian rhythm of appropriate implantable cardioverter defibrillator discharges in patients with hypertrophic cardiomyopathy.

Aims: To characterize the circadian pattern of implantable cardioverter defibrillators (ICD) discharges in patients with hypertrophic cardiomyopathy (HCM) without previous surgical myectomy or percutaneous alcohol septal ablation.

Methods And Results: HCM patients without previous surgical myectomy or percutaneous alcohol septal ablation having undergone ICD insertion at Mayo Clinic from 1992 to 2005 were studied. Analysis of appropriate ICD discharges with respect to time of day was performed.

A randomized comparative study of patients undergoing myocardial revascularization with or without cardiopulmonary bypass surgery: The MASS III Trial.

Unlabelled: The MASS III Trial is a large project from a single institution, The Heart Institute of the University of Sao Paulo, Brazil (InCor), enrolling patients with coronary artery disease and preserved ventricular function. The aim of the MASS III Trial is to compare medical effectiveness, cerebral injury, quality of life, and the cost-effectiveness of coronary surgery with and without of cardiopulmonary bypass in patients with multivessel coronary disease referred for both strategies. The primary endpoint should be a composite of cardiovascular mortality, cerebrovascular accident, nonfatal myocardial infarction, and refractory angina requiring revascularization.

Changing trends of hospital utilization in patients after their first episode of atrial fibrillation.

A marked increase in hospitalization for patients with atrial fibrillation (AF) has previously been noted. Whether this increase is related to a change in the prevalence of AF or a change in the pattern of practice with respect to the management of AF remains unclear. To determine the trends in hospital utilization after first AF in a community-based setting (Olmsted County, Minnesota), residents diagnosed with first AF from 1980 to 2000 were identified and followed until 2004.

From randomized trials to registry studies: translating data into clinical information.

All clinicians face the challenge of practicing evidence-based medicine and are confronted with data from a variety of studies, ranging from prospective randomized and registry studies to retrospective analyses. Unfortunately, the data frequently provide conflicting recommendations. How then should one interpret the information so that study findings can be applied directly in patient care? To evaluate the relevance of the abundance of studies published and how they apply to an individual patient, physicians must understand subtle nuances of study design and their effect on the interpretation of the results.

Clinical characteristics and outcomes of patients with hypertrophic cardiomyopathy with latent obstruction.

Background: The purpose of this article is to describe the demographic and clinical features of patients with hypertrophic cardiomyopathy (HCM) and latent obstruction, with an emphasis on identifying factors associated with disease progression and survival. The presence of a resting left ventricular outflow obstruction in patients with HCM has been well described and is associated with increased symptoms and adverse long-term outcomes. However, less is known about patients with latent obstruction.

Obesity as a risk factor for the progression of paroxysmal to permanent atrial fibrillation: a longitudinal cohort study of 21 years.

Aims: Obesity has been shown to be a risk factor for first atrial fibrillation (AF), but whether it is associated with progression from paroxysmal to permanent AF is unknown.

Methods And Results: In this longitudinal cohort study, Olmsted County, MN residents confirmed to have developed paroxysmal AF during 1980-2000 were identified and followed passively to 2006. The interrelationships of body mass index (BMI), left atrial (LA) size, and progression to permanent AF were analysed.

Outcome of alcohol septal ablation for obstructive hypertrophic cardiomyopathy.

Background: The clinical efficacy of alcohol septal ablation for drug-refractory hypertrophic cardiomyopathy remains unclear. This study examines the outcome of alcohol septal ablation performed at a tertiary hypertrophic cardiomyopathy referral center.

Methods And Results: Among 601 patients with severely symptomatic obstructive hypertrophic cardiomyopathy referred for alcohol septal ablation or myectomy from 1998 to 2006, 138 patients (median age, 64 years; 39% men) chose to undergo ablation.

Effect of radiofrequency ablation of atrial flutter on the natural history of subsequent atrial arrhythmias.

Unlabelled: Flutter Ablation and Subsequent Arrhythmia.

Introduction: Patients with atrial flutter (AFL) treated medically are at high risk for subsequent development of atrial fibrillation (AF). Whether curative radiofrequency ablation of AFL can modify the natural history of arrhythmia progression is not clear.

Mortality differences between men and women after percutaneous coronary interventions. A 25-year, single-center experience.

Objectives: Our aim was to examine whether gender-based differences in mortality after percutaneous coronary interventions (PCIs) have changed in the past 25 years.

Background: Women with coronary artery disease have a higher risk of adverse outcomes after PCIs than do men. Recent temporal trends in short-term and long-term mortality in women after PCIs are unknown.

Cardiomyopathy induced by pulmonary vein tachycardia cured by catheter ablation.

Background: A 51-year-old male was referred for consideration for heart transplantation because of recently diagnosed congestive heart failure refractory to medical therapy. Previous echocardiography demonstrated a left ventricular ejection fraction of approximately 15% with global hypokinesia. Coronary angiography did not reveal any clinically significant obstructive coronary artery disease and an electrocardiogram documented atrial fibrillation with a rapid ventricular rate of 130 beats/min.