Clinical characteristics and outcomes of patients with and without diabetes in the Surgical Treatment for Ischemic Heart Failure (STICH) trial.

Aims: Hypothesis 1 of the Surgical Treatment for Ischemic Heart Failure (STICH) trial enrolled 1212 patients with an LVEF of ≤35% and CAD amenable to coronary artery bypass grafting (CABG). Patients were randomized to CABG and optimal medical therapy (MED) or MED alone. The objective was to assess whether or not patients with diabetes mellitus (DM) enrolled in the STICH trial would have greater benefit from CABG than patients without DM.

Myocardial mitochondrial dysfunction in mice lacking adiponectin receptor 1.

Hypoadiponectinemia is an independent predictor of cardiovascular disease, impairs mitochondrial function in skeletal muscle, and has been linked to the pathogenesis of Type 2 diabetes. In models of Type 2 diabetes, myocardial mitochondrial function is impaired, which is improved by increasing serum adiponectin levels. We aimed to define the roles of adiponectin receptor 1 (AdipoR1) and 2 (AdipoR2) in adiponectin-evoked regulation of mitochondrial function in the heart.

Ring-Noose-String Technique Allows Adjustable Papillary Muscle Repositioning During Minimally Invasive Mitral Valve Repair in Patients with Functional/Ischemic Mitral Regurgitation.

In patients with functional/ischemic mitral regurgitation (FMR/IMR), mitral annuloplasty alone frequently results in recurrent regurgitation because of ongoing left ventricular dilatation and recurrent leaflet tethering. Adjunctive subvalvular approaches exist, but the technical shortcomings limit their clinical acceptance. A novel adjunctive technique was applied in three patients: A polytetrafluoroethylene string and noose were anchored to the posteromedial and anterolateral papillary muscle, respectively.

Myocardial mitochondrial and contractile function are preserved in mice lacking adiponectin.

Adiponectin deficiency leads to increased myocardial infarct size following ischemia reperfusion and to exaggerated cardiac hypertrophy following pressure overload, entities that are causally linked to mitochondrial dysfunction. In skeletal muscle, lack of adiponectin results in impaired mitochondrial function. Thus, it was our objective to investigate whether adiponectin deficiency impairs mitochondrial energetics in the heart.

A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement.

Background: Minimally invasive surgical procedures (MIS) may offer several advantages over conventional full sternotomy (FS) aortic valve replacement (AVR). A novel class of aortic valve prostheses has been developed for rapid-deployment AVR (RDAVR). We report a randomized, multicenter trial comparing the outcomes for MIS-RDAVR with those of conventional FS-AVR.

Diaphragm muscle weakness in mice is early-onset post-myocardial infarction and associated with elevated protein oxidation.

Heart failure induced by myocardial infarction (MI) causes diaphragm muscle weakness, with elevated oxidants implicated. We aimed to determine whether diaphragm muscle weakness is 1) early-onset post-MI (i.e.

Optimal prosthesis sizing in transcatheter aortic valve implantation by exclusive use of three-dimensional transoesophageal echocardiography.

Purpose: The assessment of aortic annular size is critical, and inappropriate sizing is thought to be a main reason of paravalvular aortic regurgitation. Multidetector computed tomograph is associated with the risk of contrast nephropathy. For optimal evaluation of the complex structure of the aortic annulus, three-dimensional (3D)-methods should be used.

Preoperative atrial fibrillation and outcome in patients undergoing on-pump or off-pump coronary bypass surgery: lessons learned from the GOPCABE trial.

Objectives: Patients undergoing coronary bypass grafting (CABG) are at higher risk if they suffer from atrial fibrillation (AF). It was suggested that performing CABG without the use of cardiopulmonary bypass (off-pump) would reduce perioperative risk. We assessed the influence of preoperative AF on outcome in a randomized cohort of patients above the age of 75 undergoing either on-pump or off-pump CABG.

Novel thoughts on patient-prosthesis mismatch in aortic valve replacement: the rationale for the PAR I trial.

The hemodynamic performance of prosthetic tissue valves is influenced by valve design and valve-specific sizing strategies. Design determines the actual geometric opening area (GOA) of the prosthetic valve and sizing strategy its actual chosen size. Currently, hemodynamic performance is assessed by determining the effective orifice area (EOA; derived from the continuity equation by relating flow velocities with the area of the left ventricular outflow tract [LVOTA]).

Mitochondrial reactive oxygen species production and respiratory complex activity in rats with pressure overload-induced heart failure.

We investigated the impact of cardiac reactive oxygen species (ROS) during the development of pressure overload-induced heart failure. We used our previously described rat model where transverse aortic constriction (TAC) induces compensated hypertrophy after 2 weeks, heart failure with preserved ejection fraction at 6 and 10 weeks, and heart failure with systolic dysfunction after 20 weeks. We measured mitochondrial ROS production rates, ROS damage and assessed the therapeutic potential of in vivo antioxidant therapies.

Valve-in-valve transcatheter aortic valve implantation: the new playground for prosthesis-patient mismatch.

Transcatheter aortic valve implantation (TAVI) has become an established procedure for patients with aortic valve stenosis and significant comorbidities. One option offered by this technique is the implantation of a transcatheter valve inside a surgically implanted bioprosthesis. Many reports address the feasibility but also the pitfalls of these valve-in-valve (VIV) procedures.

The E-wave deceleration rate E/DT outperforms the tissue Doppler-derived index E/e' in characterizing lung remodeling in heart failure with preserved ejection fraction.

Background: Diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF) may result in pulmonary congestion and lung remodeling. We evaluated the usefulness of major diastolic echocardiographic parameters and of the deceleration rate of early transmitral diastolic velocity (E/DT) in predicting lung remodeling in a rat model of HFpEF.

Methods And Results: Rats underwent aortic banding (AoB) to induce pressure overload (PO).

Cardiac metabolism in heart failure: implications beyond ATP production.

The heart has a high rate of ATP production and turnover that is required to maintain its continuous mechanical work. Perturbations in ATP-generating processes may therefore affect contractile function directly. Characterizing cardiac metabolism in heart failure (HF) revealed several metabolic alterations called metabolic remodeling, ranging from changes in substrate use to mitochondrial dysfunction, ultimately resulting in ATP deficiency and impaired contractility.

Perioperative fluid therapy with tetrastarch and gelatin in cardiac surgery--a prospective sequential analysis*.

Objectives: To determine clinical outcomes of synthetic colloids, tetrastarch, and gelatin, used before and after cardiac surgery.

Design: Prospective observational cohort study.

Setting: Fifty-bed cardiac ICU.

Sizing strategy is a major determinant of postoperative pressure gradients in commonly implanted stented tissue valves.

Objective: We compared the haemodynamic performance of two pericardial aortic prostheses with the stent either on the outside (Perimount), or the inside (Mitroflow) of the valve cusps, with regard to sizing strategies and valve dimensions.

Methods: We analysed discharge echoes from all patients who received an isolated Perimount (n = 537) or Mitroflow (n = 164) between January 2007 and November 2010. We obtained outer valve diameters from the manufacturers, and measured sizer dimensions.

Glucagon-like peptide-1 reduces contractile function and fails to boost glucose utilization in normal hearts in the presence of fatty acids.

Unlabelled: GLP-1 and exendin-4, which are used as insulin sensitizers or weight reducing drugs, were shown to improve glucose uptake in the heart. However, the direct effects of GLP-1 or exendin-4 on normal hearts in the presence of fatty acids, the main cardiac substrates, have never been investigated. We therefore assessed the effects of GLP-1 or exendin-4 on myocardial glucose uptake (GU), glucose oxidation (GO) and cardiac performance (CP) under conditions of fatty acid utilization.

Influence of crossover on mortality in a randomized study of revascularization in patients with systolic heart failure and coronary artery disease.

Background: To assess the influence of therapy crossovers on treatment comparisons and mortality at 5 years in patients with ischemic heart disease and heart failure randomly assigned to medical therapy alone (MED) or to MED and coronary artery bypass graft (CABG) surgery in the Surgical Treatment for Ischemic Heart Failure (STICH) trial.

Methods And Results: The influence of early crossover (within the first year after randomization) on 5-year mortality was assessed using time-dependent multivariable Cox models. CABG was performed in 65/602 patients (10.

Sizing for mitral annuloplasty: where does science stop and voodoo begin?

The implantation of an improperly sized annuloplasty ring may result in an incompetent valve after surgical mitral valve repair. Consequently, the procedure of ring size selection is considered critical. Although a plethora of sizing strategies are described, the opinions on how to select the appropriate ring size differ widely and often appear arbitrary (ie, without scientific justification).

Echocardiography alone allows the determination of heart failure stages in rats with pressure overload.

Background: There is currently no standard for the assessment of contractile function in animals. We aimed to determine whether transthoracic echocardiography in rats with chronic pressure overload allows determining the stage of hypertrophy and heart failure (HF).

Methods: Pressure overload was created by placement of a metal clip around the thoracic aorta at a weight of 40 to 50 g.

Pressure overload differentially affects respiratory capacity in interfibrillar and subsarcolemmal mitochondria.

Years ago a debate arose as to whether two functionally different mitochondrial subpopulations, subsarcolemmal mitochondria (SSM) and interfibrillar mitochondria (IFM), exist in heart muscle. Nowadays potential differences are often ignored. Presumably, SSM are providing ATP for basic cell function, whereas IFM provide energy for the contractile apparatus.