Cardiac device complications in the cognitively impaired.

Background: Patients with preexisting mild cognitive impairment or dementia may be at increased risk for developing cardiac device complications due to an impaired ability to follow postimplant care instructions. We sought to determine whether rates of infection, lead dislodgement, or appropriate or inappropriate implantable cardioverter defibrillator (ICD) shocks are increased in this population.

Methods: Medical charts of 561 patients with mild cognitive impairment or dementia who underwent pacemaker (PM) or ICD implantation between January 2002 and October 2009 at Mayo Clinic were identified.

Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults.

Objectives: This study sought to identify the risk of sudden cardiac death (SCD) associated with obstructive sleep apnea (OSA).

Background: Risk stratification for SCD, a major cause of mortality, is difficult. OSA is linked to cardiovascular disease and arrhythmias and has been shown to increase the risk of nocturnal SCD.

Comprehensive hemodynamic assessment of 368 normal St. Jude Medical mechanical mitral valve prostheses based on early postimplantation echocardiographic studies.

Background: Two-dimensional and Doppler-derived echocardiographic data on normal St. Jude Medical mechanical mitral valve prosthesis function have been reported but remain limited.

Methods: Comprehensive retrospective two-dimensional and Doppler echocardiographic assessment of 368 normal St.

Electrophysiological and hemodynamic characteristics associated with obesity in patients with atrial fibrillation.

Objectives: The authors sought to characterize the left atrial (LA) and pulmonary vein (PV) electrophysiological and hemodynamic features in obese patients with atrial fibrillation (AF).

Background: Obesity is associated with increased risk for AF.

Methods: A total of 63 consecutive patients with AF who had normal left ventricular (LV) ejection fraction and who underwent catheter ablation were studied.

Comprehensive hemodynamic assessment of 305 normal CarboMedics mitral valve prostheses based on early postimplantation echocardiographic studies.

Background: Two-dimensional (2D) and Doppler-derived echocardiographic data on normal CarboMedics (CM) mechanical mitral valve prosthesis function have been reported but are limited.

Methods: Comprehensive retrospective 2D and Doppler echocardiographic assessment of 305 normal CM mechanical mitral valve prostheses (272 Standard and 33 Optiform) was performed early after implantation. The early postimplantation hemodynamic profiles of 80 patients were compared with profiles obtained by follow-up transthoracic echocardiography performed <1 year after implantation.

Atorvastatin for prevention of atrial fibrillation recurrence following pulmonary vein isolation: a double-blind, placebo-controlled, randomized trial.

Background: It is known that statins are effective in preventing atrial fibrillation (AF) in patients undergoing cardiac surgery.

Objective: The purpose of this study was to evaluate the efficacy of statins in preventing AF recurrence following left atrial ablation.

Methods: One hundred twenty-five patients who had no statin indication undergoing catheter ablation due to drug-refractory paroxysmal (n = 90) or persistent (n = 35) AF were randomized in a prospective, double-blind, placebo-controlled trial to receive 80 mg atorvastatin (n = 62) or placebo (n = 63) for 3 months.

Primary hyperoxaluria type III gene HOGA1 (formerly DHDPSL) as a possible risk factor for idiopathic calcium oxalate urolithiasis.

Background And Objectives: Primary hyperoxaluria types I and II (PHI and PHII) are rare monogenic causes of hyperoxaluria and calcium oxalate urolithiasis. Recently, we described type III, due to mutations in HOGA1 (formerly DHDPSL), hypothesized to cause a gain of mitochondrial 4-hydroxy-2-oxoglutarate aldolase activity, resulting in excess oxalate.

Design, Setting, Participants, & Measurements: To further explore the pathophysiology of HOGA1, we screened additional non-PHI-PHII patients and performed reverse transcription PCR analysis.

Left atrial blood stasis and Von Willebrand factor-ADAMTS13 homeostasis in atrial fibrillation.

Objective: Left atrial blood stasis is associated with increased risk for left atrial appendage thrombus (LAAT) and stroke in atrial fibrillation (AF). Von Willebrand factor (VWF) is associated with thromboembolism in AF. VWF thrombogenic activity is proportional to multimer size, which is regulated by VWF-cleaving protease (ADAMTS13).

Success of ablation for atrial fibrillation in isolated left ventricular diastolic dysfunction: a comparison to systolic dysfunction and normal ventricular function.

Background: The efficacy of radiofrequency ablation for atrial fibrillation (AF) in patients with left ventricular (LV) systolic dysfunction and isolated diastolic dysfunction is uncertain.

Methods And Results: A prospective cohort of patients with normal and abnormal LV function underwent ablation for antiarrhythmic drug (AAD)-refractory AF. Three groups were compared: 111 patients with systolic dysfunction, defined as LV ejection fraction (LVEF) ≤40%; 157 patients with isolated diastolic dysfunction but preserved LVEF ≥50%; and 100 patients with normal LV function.

Cardiac sympathetic reserve and response to cardiac resynchronization therapy.

Background: The objective of the present study was to investigate the effect of cardiac resynchronization therapy (CRT) on cardiac autonomic function.

Methods And Results: This prospective study included 45 consecutive patients with heart failure who received CRT devices with defibrillator and 20 age-matched, healthy control subjects. At baseline and 3 months and 6 months after CRT, we assessed New York Heart Association (NYHA) class, 6-minute walk distance, plasma sympathetic biomarker nerve growth factor, echocardiography, heart rate variability and cardiac presynaptic sympathetic function determined by iodine 123 metaiodobenzylguanidine scintigraphy.

Comprehensive echocardiographic assessment of mechanical tricuspid valve prostheses based on early post-implantation echocardiographic studies.

Background: Doppler-derived hemodynamic data for normal tricuspid mechanical valve prostheses are limited.

Methods: A comprehensive retrospective Doppler echocardiographic assessment of 78 normal St. Jude Medical Standard (St.

Comprehensive echocardiographic assessment of the hemodynamic parameters of 285 tricuspid valve bioprostheses early after implantation.

Background: Doppler-derived hemodynamic data for normal tricuspid valve bioprostheses are limited.

Methods: A comprehensive retrospective Doppler echocardiographic assessment of 285 normal Carpentier-Edwards Duraflex, Medtronic Mosaic, St. Jude Medical Biocor, Carpentier-Edwards Perimount, and Medtronic Hancock II tricuspid valve bioprostheses was performed early after implantation.

Dyssynchrony indices to predict response to cardiac resynchronization therapy: a comprehensive prospective single-center study.

Background: Whether mechanical dyssynchrony indices predict reverse remodeling (RR) or clinical response to cardiac resynchronization therapy (CRT) remains controversial. This prospective study evaluated whether echocardiographic dyssynchrony indices predict RR or clinical response after CRT.

Methods And Results: Of 184 patients with heart failure with anticipated CRT who were prospectively enrolled, 131 with wide QRS and left ventricular ejection fraction <35% had 6-month follow-up after CRT implantation.

Comprehensive echocardiographic assessment of normal mitral Medtronic Hancock II, Medtronic Mosaic, and Carpentier-Edwards Perimount bioprostheses early after implantation.

Background: Normal Doppler-derived hemodynamic data for mitral valve bioprostheses are limited.

Methods: To establish parameters for identifying normal function for each of the 3 types of bioprostheses examined, we conducted a comprehensive, retrospective, two-dimensional, and Doppler echocardiographic assessment of 179 patients who underwent implantation of the Medtronic Hancock II or the Medtronic Mosaic (Medtronic, Inc, Minneapolis, MN) porcine mitral valve bioprosthesis or the Carpentier-Edwards Perimount (Edwards Lifesciences LLC, Irvine, CA) bovine pericardial mitral valve bioprosthesis.

Results: All bioprostheses were normal by clinical examination, intraoperative transesophageal echocardiography, and postoperative transthoracic echocardiography.

Role of smoking in the recurrence of atrial arrhythmias after cardioversion.

We aimed to determine whether smoking status affects the recurrence of atrial fibrillation or atrial flutter in patients after cardioversion. The clinical data of patients undergoing cardioversion for atrial flutter from January 1, 2000 to December 31, 2005 were prospectively collected. Arrhythmia recurrences were detected by retrospective review of comprehensive medical records and were determined using electrocardiography.

Doppler echocardiography of 240 normal Carpentier-Edwards Duraflex porcine mitral bioprostheses: a comprehensive assessment including time velocity integral ratio and prosthesis performance index.

Normal Doppler-derived echocardiographic data for Carpentier-Edwards Duraflex (Edwards Lifesciences, Irvine, CA) porcine bioprosthesis function in the mitral position are limited to 2 small series that did not include all Doppler-derived variables. The purpose of this study was to provide a comprehensive Doppler echocardiographic assessment of normal Carpentier-Edwards Duraflex mitral bioprosthesis function in a large number of patients assessed in the early postoperative phase. All of the important Doppler-derived hemodynamic variables reported to date were used.

Doppler echocardiography of 79 normal CarboMedics mitral prostheses: a comprehensive assessment including time-velocity integral ratio and prosthesis performance index.

Few reports have been published on the normal Doppler-derived echocardiographic data for CarboMedics (CarboMedics Inc., Austin, TX) prosthesis function in the mitral position. The purpose of this study was to provide a comprehensive Doppler echocardiographic assessment of normal CarboMedics mitral prosthesis function in a large number of patients.

Prognostic value of ankle-brachial index and dobutamine stress echocardiography for cardiovascular morbidity and all-cause mortality in patients with peripheral arterial disease.

Background: Peripheral arterial disease (PAD) is associated with an excessive risk for cardiovascular events and mortality. To determine measures prognostic of adverse events, ankle-brachial index (ABI) was compared with dobutamine stress echocardiography (DSE) in patients referred to our vascular center for the evaluation of PAD.

Methods: The medical records of consecutive patients referred for the concurrent evaluation of PAD and coronary artery disease (CAD) between 1992 and 1995 were reviewed for subsequent cardiovascular events and death.

Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation.

Objectives: This study sought to identify whether obesity and obstructive sleep apnea (OSA) independently predict incident atrial fibrillation/flutter (AF).

Background: Obesity is a risk factor for AF, and OSA is highly prevalent in obesity. Obstructive sleep apnea is associated with AF, but it is unknown whether OSA predicts new-onset AF independently of obesity.

Trends in prevalence and outcome of heart failure with preserved ejection fraction.

Background: The prevalence of heart failure with preserved ejection fraction may be changing as a result of changes in population demographics and in the prevalence and treatment of risk factors for heart failure. Changes in the prevalence of heart failure with preserved ejection fraction may contribute to changes in the natural history of heart failure. We performed a study to define secular trends in the prevalence of heart failure with preserved ejection fraction among patients at a single institution over a 15-year period.

The effect of patient sex on recurrence of atrial fibrillation following successful direct current cardioversion.

Background: The effect of patient sex on recurrence of atrial fibrillation after a successful direct current cardioversion is unknown.

Methods: This prospective study included 773 patients (486 [63%] men and 287 [37%] women) undergoing successful direct current cardioversion of atrial fibrillation between May 2000 and July 2003. Patient characteristics at presentation were recorded.

Secular trends in renal dysfunction and outcomes in hospitalized heart failure patients.

Background: Renal dysfunction and worsening renal function (WRF) during heart failure (HF) therapy predict outcomes. We determined whether the severity of renal dysfunction, the incidence of WRF or outcomes have changed over time (secular trends) in patients hospitalized for HF therapy.

Methods And Results: A total of 6440 consecutive unique patients admitted for HF to Mayo Clinic Hospitals Rochester, MN, January 1, 1987, to December 31, 2002, were identified and data extracted from electronic databases.

Relapse and mortality following cardioversion of new-onset vs. recurrent atrial fibrillation and atrial flutter in the elderly.

Aims: Trials of rate control vs. rhythm control for atrial fibrillation or flutter included few patients with new-onset arrhythmia. Our objective was to assess the relapse rate and the effect of the relapse of new-onset atrial arrhythmias on mortality after direct-current cardioversion (DCCV).

Safety of expedited anticoagulation in patients undergoing transesophageal echocardiographic-guided cardioversion.

Background: In patients undergoing transesophageal echocardiography-guided cardioversion, we evaluated the use and safety of an expedited in-hospital anticoagulation regimen that incorporates shorter-than-standard durations of precardioversion intravenous unfractionated heparin and postcardioversion bridging therapy with a low-molecular-weight heparin.

Methods: Adult patients who underwent successful transesophageal echocardiography-guided cardioversion for atrial fibrillation or atrial flutter between May 2000 and August 2003 were classified into 2 groups by duration of intravenous unfractionated heparin therapy (<24 h or > or =24 h) before transesophageal echocardiography and cardioversion. Safety end points evaluated included all-cause death, stroke or other thromboembolic events, and major bleeding complications within 1 month after successful cardioversion.

Doppler echocardiography of normal Starr-Edwards mitral prostheses: a comprehensive function assessment including continuity equation and time-velocity integral ratio.

The purpose of this study was to provide comprehensive Doppler echocardiographic assessment of the function of the normal Starr-Edwards mitral valve prosthesis using all the Doppler hemodynamic variables described to date, including the mitral valve prosthesis time-velocity integral (TVI)/left ventricular outflow tract TVI ratio and the prosthesis performance index. All patients had a peak early mitral diastolic velocity of no more than 2 m/s or a pressure half-time that was less than 130 milliseconds. All but one patient had either a peak early mitral diastolic velocity of no more than 2 m/s or a mitral valve prosthesis TVI/left ventricular outflow tract TVI ratio of less than 2.