Defining Thresholds for Meaningful Health Status Changes Following Transfemoral Carotid Artery Stenting.

Background: Evaluating health status changes following transfemoral carotid artery stenting (TF-CAS) is essential for assessing procedural success, but meaningful clinical changes are unknown. We aimed to determine minimal clinically important differences (MCIDs) and quantify health status improvement or worsening rates after TF-CAS using the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) registry data.

Methods: The SAPPHIRE registry included patients undergoing TF-CAS from 2010 to 2014 for both symptomatic and asymptomatic carotid stenosis.

Lack of diversity in patients undergoing carotid artery stenting: Implications for the Distressed Community Index.

Introduction: As the role of social determinants in carotid artery stenting (CAS) outcomes remains unclear, we investigated the association between the Distressed Community Index (DCI) (zip-code based) and post-CAS mortality/stroke outcomes.

Methods: We analyzed patients undergoing CAS from 2015 to 2019 using the Medicare claims-linked Vascular Quality Initiative database. Patients were grouped based on high (DCI ⩾ 60) and low (DCI < 60) community distress.

Erroneous electrocardiographic interpretations and its clinical implications.

Introduction: The advancement of artificial intelligence (AI) has aided clinicians in the interpretation of electrocardiograms (ECGs) serving as an essential tool to provide rapid triage and care. However, in some cases, AI can misinterpret an ECG and may mislead the interpreting physician. Therefore, we aimed to describe the rate of ECG misinterpretation and its potential clinical impact in patient's management.

The Arrhythmogenicity of Sotalol and its Role in Heart Failure: A Literature Review.

According to the American Heart Association, approximately 6 million adults have been afflicted with heart failure in the United States in 2020 and are more likely to have sudden cardiac death accounting for approximately 50% of the cause of mortality. Sotalol is a nonselective β-adrenergic receptor antagonist with class III antiarrhythmic properties that has been mostly used for atrial fibrillation treatment and suppressing recurrent ventricular tachyarrhythmias. The use of sotalol in patients with left ventricular dysfunction is not recommended by the American College of Cardiology or American Heart Association because studies are inconclusive with conflicting results regarding safety.

A case report of deglutition triggered atrial fibrillation in a patient with Laing distal myopathy.

Background: Deglutition-induced atrial fibrillation is a rare clinical entity with a reported prevalence of 0.6%. Laing distal myopathy is a rare autosomal dominant muscular dystrophy that is the result of mutations within the slow skeletal muscle fibre myosin heavy chain gene (MYH7).

Design and rationale of the colchicine/statin for the prevention of COVID-19 complications (COLSTAT) trial.

Background: Despite improvement in the standard of care (SOC) for hospitalized COVID-19 patients, rates of morbidity and mortality remain high. There continues to be a need for easily available and cost-effective treatments. Colchicine and rosuvastatin are both safe and well-studied medications with anti-inflammatory and other pleiotropic effects that may provide additional benefits to hospitalized COVID-19 patients.

Long term outcomes of ultrathin versus standard thickness second-generation drug eluting stents: Meta-analysis of randomized trials.

Objective: Identify the effect of ultrathin drug eluting stents on long term outcomes in coronary artery disease.

Background: Although second-generation drug eluting stents (DES) are superior to first-generation DES, persistence of adverse outcomes has led to continued refinement in design. Ultrathin second-generation DES have been shown to improve outcomes at 1-year follow-up.

Impact of healthcare worker shift scheduling on workforce preservation during the COVID-19 pandemic.

Reducing severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infections among healthcare workers is critical. We ran Monte Carlo simulations modeling the spread of SARS-CoV-2 in non-COVID-19 wards, and we found that longer nursing shifts and scheduling designs in which teams of nurses and doctors co-rotate no more frequently than every 3 days can lead to fewer infections.

Do ICD diagnostics predict failure of ventricular tachycardia response to antitachycardia pacing and need for shock?

Background: Among heart failure patients with implantable cardioverter defibrillators (ICDs), monomorphic ventricular tachycardia (MMVT) failing antitachycardia pacing (ATP) and terminated by shock renders higher mortality as compared to MMVT terminated by ATP only. It is unknown if the higher mortality in ATP failure reflects decompensated heart failure.

Objective: It was the purpose of the present study to determine if ICD heart failure diagnostics can predict the failure of ATP and the need to shock to terminate MMVT.

Androgen Deprivation Therapy and Cognitive Function in Prostate Cancer.

Purpose Of Review: Androgen deprivation therapy (ADT) is widely used in prostate cancer. Interest in assessing how ADT impacts cognition is growing.

Recent Findings: Studies in animals and humans suggest that androgens may affect cognitive function.

Heart failure as a substrate and trigger for ventricular tachycardia.

Heart failure (HF) is a major cause of morbidity and mortality with more than 5.1 million individuals affected in the USA. Ventricular tachyarrhythmias (VAs) including ventricular tachycardia and ventricular fibrillation are common in patients with heart failure.

ICD shocks in LVAD patients are not associated with increased subsequent mortality risk.

Background: Implantable cardioverter-defibrillator (ICD) shocks are associated with increased mortality risk in heart failure patients. Whether ICD shocks are associated with mortality in continuous flow LVAD (CF-LVAD) patients is unknown. We studied the relationship of ICD shocks and ventricular arrhythmias (VAs) to morbidity and mortality in CF-LVAD-supported patients in our institution.

Extracellular Matrix From Hypertrophic Myocardium Provokes Impaired Twitch Dynamics in Healthy Cardiomyocytes.

Hypertrophic cardiomyopathy (HCM) is often caused by single sarcomeric gene mutations that affect muscle contraction. Pharmacological correction of mutation effects prevents but does not reverse disease in mouse models. Suspecting that diseased extracellular matrix is to blame, we obtained myocardium from a miniature swine model of HCM, decellularized thin slices of the tissue, and re-seeded them with healthy human induced pluripotent stem cell-derived cardiomyocytes.

Clinical predictors of antitachycardia pacing response in implantable cardioverter defibrillator patients.

Background: Antitachycardia pacing (ATP) provides safe and painless termination of reentrant ventricular arrhythmias in patients with implantable cardioverter defibrillator (ICDs), improving their quality of life. Established predictors of ATP responsiveness are not well known; only longer ventricular tachycardia (VT) cycle length and higher ejection fraction have been found to predict ATP success.

Objective: To investigate clinical and ECG predictors of ATP response in ICD patients with monomorphic VT.

Systematic review and meta-analysis of catheter ablation of ventricular tachycardia in ischemic heart disease.

Background: Patients with ischemic heart disease (IHD) are at risk for ventricular tachycardia (VT). Catheter ablation (CA) may reduce this risk.

Objective: To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) of CA of VT in patients with IHD.

Probable Hypocalcemia Induced Ventricular Fibrillation and Torsades de Pointes following Blood Product Administration.

A 35-year-old male underwent open-heart surgery and required multiple blood product transfusions. Citrate, a preservative in blood products, caused serum ionized calcium chelation leading to hypocalcemia, a prolonged corrected QT (QTc) interval, and separate episodes of ventricular fibrillation and torsades de pointes (TdP). This case highlights an uncommon complication of blood product transfusion-induced hypocalcemia with precipitant arrhythmia.

Fibrostenotic eosinophilic esophagitis might reflect epithelial lysyl oxidase induction by fibroblast-derived TNF-α.

Background: Fibrosis and stricture are major comorbidities in patients with eosinophilic esophagitis (EoE). Lysyl oxidase (LOX), a collagen cross-linking enzyme, has not been investigated in the context of EoE.

Objective: We investigated regulation of epithelial LOX expression as a novel biomarker and functional effector of fibrostenotic disease conditions associated with EoE.

Ventricular electrical delay as a predictor of arrhythmias in patients with cardiac resynchronization implantable cardioverter defibrillator.

Background: Left ventricular (LV) remodeling and clinical response to cardiac resynchronization therapy (CRT) is inversely related to electrical dyssynchrony, measured as LV lead electrical delay (QLV). Presence of atrial or ventricular arrhythmia is correlated with worsening heart failure and LV remodeling.

Objective: We sought to assess the association of QLV with arrhythmic events in CRT recipients.

Ranolazine for Prevention of Atrial Fibrillation after Cardiac Surgery: A Systematic Review.

Postoperative atrial fibrillation (POAF) remains a major risk after cardiac surgery and is associated with an increased risk of stroke, length of stay, mortality, and cost. Ranolazine, an anti-anginal drug, also has anti-arrhythmic properties. The present study is to evaluate the effectiveness of ranolazine in preventing POAF after cardiac surgery.

Role of Antiplatelet Therapy in Stroke Prevention in Patients With Atrial Fibrillation.

Patients with atrial fibrillation are at increased risk of having a cardioembolic stroke. The use of oral anticoagulation is now well established to prevent strokes in patients with atrial fibrillation and a CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years [2 points], diabetes mellitus, prior stroke/transient ischemic attack or thromboembolism [2 points], vascular disease, age 65 to 74 years, and sex category) score of greater than 1, beyond sex. However, the role of antiplatelet therapy, specifically aspirin in low-risk patients or as an alternative to oral anticoagulation, remains controversial.

Ranolazine Therapy in Cardiac Arrhythmias.

Ranolazine is an antianginal medication originally granted approval by the U.S. Food and Drug Administration for therapeutic use in 2006.

Vitamin K antagonist use: evidence of the difficulty of achieving and maintaining target INR range and subsequent consequences.

Vitamin K antagonists (VKAs) are effective oral anticoagulants that are titrated to a narrow therapeutic international normalized ratio (INR) range. We reviewed published literature assessing the impact of INR stability - getting into and staying in target INR range - on outcomes including thrombotic events, major bleeding, and treatment costs, as well as key factors that impact INR stability. A time in therapeutic range (TTR) of ≥65 % is commonly accepted as the definition of INR stability.