Pseudoaneurysm formation in infective endocarditis.

Left ventricular pseudoaneurysms that develop in the setting of infective endocarditis are believed to result from remodeling of extravalvular abscesses. The high pressure generated by the left ventricle is thought to dissect into the abscess causing it to form a characteristic sac-like protuberance readily recognized echocardiographically. Left ventricular pseudoaneurysms most often arise from abscesses in the mitral-aortic intervalvular fibrosa and protrude external to the aorta.

Risk factor control for coronary artery disease secondary prevention in large randomized trials.

Objectives: This study evaluated data from 3 federally funded trials that focused on optimal medical therapy to determine if formalized attempts at risk factor control within clinical trials are effective in achieving guideline-driven treatment goals for diabetic patients with coronary artery disease (CAD).

Background: Despite clear evidence of benefit for CAD secondary prevention, the level of risk factor control in clinical practice has been disappointing.

Methods: We obtained data from the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) diabetes subgroup, (n = 766 of 2,287), the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial (n = 2,368), and the FREEDOM (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes) trial (n = 1,900) to evaluate the proportion of patients achieving guideline-based, protocol-driven treatment targets for systolic blood pressure, low-density lipoprotein cholesterol, smoking cessation, and hemoglobin A1c.

Biomarkers after risk stratification in acute chest pain (from the BRIC Study).

Current models incompletely risk-stratify patients with acute chest pain. In this study, N-terminal pro-B-type natriuretic peptide and cystatin C were incorporated into a contemporary chest pain triage algorithm in a clinically stratified population to improve acute coronary syndrome discrimination. Adult patients with chest pain presenting without myocardial infarction (n = 382) were prospectively enrolled from 2008 to 2009.

Clustering of metabolic abnormalities among obese patients and mortality after percutaneous coronary intervention.

Although current literature demonstrates metabolic abnormalities are associated with mortality, obese patients who tend to have more metabolic abnormalities paradoxically have lower overall mortality rates compared to their normal-weight counterparts. In this study, we examined the prevalence of metabolic abnormality clustering and its relation to mortality in obese and normal-weight patients after percutaneous coronary intervention (PCI). Patients (n = 9,673) undergoing elective PCI from October 2003 through December 2006 at a single urban hospital were categorized by body mass index (BMI) levels of 18.

Platelet perturbations in diabetes: implications for cardiovascular disease risk and treatment.

The prevalence of Type 2 diabetes mellitus (DM) continues to increase globally and brings with it a parallel increase in the associated cardiovascular disease complications. Despite advances in evidence-based therapies for cardiovascular disease risk modification, many of which are especially effective among patients with DM, there remains a residual degree of cardiovascular disease risk associated with DM, yielding opportunity for continued clinical advances. Given the myriad perturbations of platelet function associated with DM, improvements in antiplatelet therapies hold particular promise for this high-risk population of patients, with emerging data from ex vivo assessments and clinical outcomes trials providing a basis of support for this concept.

Cardiomyopathy in type 2 diabetes: update on pathophysiological mechanisms.

Type 2 diabetes mellitus (DM) is associated with increased risk for developing heart failure (HF) and worse outcomes once HF is present. While the exact mechanisms underpinning these observations remain poorly understood, several metabolic perturbations associated with DM have been implicated as contributors to the HF risk, including alterations of cardiomyocyte metabolic substrate switching between free fatty acid (FFA) and glucose metabolism; increased FFA exposure and cellular accumulation; and alterations in peroxisome proliferator-activated receptor-(PPAR-)alpha activity, among others. The commonly coincident conditions of left ventricular hypertrophy and ischemic heart disease likely confound the metabolic derangements further increasing HF risk.

Drug eluting stents for below the knee lesions in patients with critical limb ischemia : long-term follow-up.

Objectives: The purpose of this study was to assess the long-term limb preservation and/or healing of ulcers in patients with critical limb ischemia (CLI) and severe infrapopliteal atherosclerotic disease treated with drug eluting stents (DES).

Background: Percutaneous revascularization has become an effective treatment for CLI in patients with infrapopliteal atherosclerotic disease. Recent reports using DES in patients with CLI have documented excellent short-term infrapopliteal vessel patency.