ECG diagnosis and classification of acute coronary syndromes.

In acute coronary syndromes, the electrocardiogram (ECG) provides important information about the presence, extent, and severity of myocardial ischemia. At times, the changes are typical and clear. In other instances, changes are subtle and might be recognized only when ECG recording is repeated after changes in the severity of symptoms.

Disruption of endothelial adherens junctions by high glucose is mediated by protein kinase C-β-dependent vascular endothelial cadherin tyrosine phosphorylation.

Background: Hyperglycemia has been recognized as a primary factor in endothelial barrier dysfunction and in the development of micro- and macrovascular diseases associated with diabetes, but the underlying biochemical mechanisms remain elusive. Tyrosine phosphorylation of vascular endothelial cadherin (VE-cad) leads to the disruption of endothelial adherens junctions and increases the transendothelial migration (TEM) of leukocytes.

Methods: VE-cad tyrosine phosphorylation, adherens junction integrity and TEM of monocytes in human umbilical vein endothelial cells (HUVECs) treated with high-concentration glucose were evaluated.

Novel therapies for treating familial hypercholesterolemia.

Familial hypercholesterolemia is an inherited disorder associated with early accelerated atherosclerosis with morbidity and mortality resulting from premature cardiovascular disease. Affected individuals have extreme elevations in low-density lipoprotein cholesterol levels. Patients usually do not achieve target reductions in cholesterol levels with conventional antihyperlipidemic pharmacotherapy.

Ninety-day survival of a calf implanted with a continuous-flow total artificial heart.

We evaluated the effects of steady state flow and perfusion on end-organ function in a long-term calf model. The animal received a continuous-flow total artificial heart (CFTAH) that we created from two axial-flow ventricular assist devices. Pump flow, blood pressure, and other pump parameters were monitored throughout the study, as were arterial blood gas and hematologic values, including neurohormone levels.

Phased RF ablation in persistent atrial fibrillation.

Background: Persistent and long-standing persistent atrial fibrillation (AF) often requires extensive and/or repeat radiofrequency (RF) ablation procedures.

Objective: The Tailored Treatment of Persistent Atrial Fibrillation (TTOP-AF) study assessed the effectiveness and safety of the phased RF system in a randomized controlled comparison of medical therapy against phased RF ablation for the management of persistent and long-standing persistent AF.

Methods: Patients who had failed at least 1 antiarrhythmic drug (AAD) were randomized (2:1) to ablation management (AM) or medical management (MM).

Disruption of endothelial adherens junction by invasive breast cancer cells is mediated by reactive oxygen species and is attenuated by AHCC.

Aims: The effect of antioxidants on treatment of cancer is still controversial. Previously, we demonstrated that interaction of breast cancer cells with endothelial cells leads to tyrosine phosphorylation of VE-cadherin and disruption of endothelial adherens junction (EAJ). The molecular mechanism underlying the anti-metastatic effects of mushroom-derived active hexode correlated compound (AHCC) remains elusive.

Usefulness of T wave inversion in leads with ST elevation on the presenting electrocardiogram to predict spontaneous reperfusion in patients with anterior ST elevation acute myocardial infarction.

Inversion of the T waves (T-) in electrocardiographic leads with ST-segment elevation after the initiation of reperfusion therapy is considered a sign of reperfusion. However, the significance of T- on presentation before the initiation of reperfusion therapy is unclear. The aim of this study was to assess whether T- on presentation predicts patency of the infarct-related artery in patients with acute ST-segment elevation myocardial infarctions (STEMIs) who undergo primary percutaneous interventions.

Programming implantable cardioverter-defibrillators in patients with primary prevention indication to prolong time to first shock: results from the PROVIDE study.

Background: Shock therapy delivery by implantable cardioverter-defibrillators (ICD) can be painful and may have adverse consequences. Reducing shock burden for patients with ICDs would be beneficial.

Methods: PROVIDE was a prospective, randomized study of primary prevention ICD patients.

Topoisomerase 2β: a promising molecular target for primary prevention of anthracycline-induced cardiotoxicity.

Anthracyclines are powerful chemotherapy agents that are still widely used today. However, their clinical use is limited by the development of dose-dependent cardiotoxicity. Recently, we showed that topoisomerase 2β (Top2β) is required for anthracycline to induce DNA double-strand breaks and changes in the transcriptome, leading to mitochondrial dysfunction and generation of reactive oxygen species.

Ionic mechanisms underlying the effects of vasoactive intestinal polypeptide on canine atrial myocardium.

Background: Vasoactive intestinal polypeptide (VIP) is released from intracardiac neurons during vagal stimulation, ischemia, and heart failure, which are associated with increased vulnerability to atrial fibrillation. VIP shortens atrial effective refractory periods in dogs. Endogenous VIP contributes to vagally mediated acceleration of atrial electric remodeling.

Trends over time in the relative use and associated mortality of on-pump and off-pump coronary artery bypass grafting in the Veterans Affairs system.

Importance: Numerous studies have compared the results of on-pump and off-pump coronary artery bypass grafting (CABG), but little is known about how either the relative use of these procedures or their associated perioperative mortality have changed with time.

Objective: To examine trends in off- and on-pump CABG use and outcomes over time.

Design: Retrospective analysis of data from the Veterans Affairs Surgical Quality Improvement Program (VASQIP).

Direct thrombolytic therapy for thrombosis of a centrifugal flow left ventricular assist device.

In patients receiving left ventricular assistance for end-stage heart failure, pump-related thrombosis is a potentially fatal complication that may manifest as hemolysis and abnormally high pump power consumption. The optimal approach to treat this complication is unclear, especially in patients who are not heart transplant candidates or who have a high surgical risk. We report the successful use of direct thrombolytic therapy for recurrent hemolysis and thrombosis-related pump failure in a patient with the HeartWare ventricular assist device (HVAD), a third-generation, centrifugal flow pump.

Total aortic arch replacement: current approach using the trifurcated graft technique.

Since the pioneering work of DeBakey, Cooley, and colleagues more than 50 years ago, surgical treatment of aneurysms involving the transverse aortic arch has been associated with substantial morbidity and mortality. Over the past 15 years, techniques for replacing the diseased aortic arch have evolved substantially. Previously, our approach to these operations involved femoral cannulation, profound-to-deep hypothermic circulatory arrest and retrograde cerebral perfusion, and the island technique for reattaching the brachiocephalic vessels.

Results of open thoracoabdominal aortic aneurysm repair.

Background: Open surgical repair of thoracoabdominal aortic aneurysms (TAAAs) enables the effective replacement of the diseased aortic segment and reliably prevents aneurysm rupture. However, these operations also carry substantial risk of perioperative morbidity and mortality, principally caused by the associated ischemic insult involving the spinal cord, kidneys, and other abdominal viscera. Here, we describe the early outcomes of a contemporary series of open TAAA repairs.

Platelet activity measured by a rapid turnaround assay identifies coronary artery bypass grafting patients at increased risk for bleeding and transfusion complications after clopidogrel administration.

Background: We sought to establish a metric for easily estimating bleeding and transfusion risks for cardiac surgery patients after antiplatelet agent use.

Methods: Deidentified records of patients who underwent coronary artery bypass grafting (CABG) at our institution (January 2010-June 2011) were searched for patients without identified risk factors for excessive bleeding who underwent documented P2Y12 testing after clopidogrel administration (n = 276). Clinical outcomes were analyzed according to whether preoperative platelet function was higher (platelet reactivity units [PRUs], ≥237) or lower (PRU, <237) and according to preoperative PRU cutoffs: high (>290, or no clopidogrel), intermediate (200-290), or low (<200).

Granulomatous myocarditis in severe heart failure patients undergoing implantation of a left ventricular assist device.

Background: Granulomatous myocarditis may develop into cardiomyopathy and severe congestive heart failure that requires implantation of a left ventricular assist device (LVAD).

Methods: Left ventricular (LV) core samples were collected from 177 patients with severe heart failure at the time of LVAD implantation, and samples were histologically examined and graded for severity of hypertrophy and fibrosis. Granulomatous myocarditis incidentally seen in a subset of samples was characterized by staining and culturing for mycobacteria and fungi.

Evaluation of a subject specific dual-transmit approach for improving B1 field homogeneity in cardiovascular magnetic resonance at 3T.

Background: Radiofrequency (RF) shading artifacts degrade image quality while performing cardiovascular magnetic resonance (CMR) at higher field strengths. In this article, we sought to evaluate the effect of local RF (B1 field) shimming by using a dual-source-transmit RF system for cardiac cine imaging and to systematically evaluate the effect of subject body type on the B1 field with and without local RF shimming.

Methods: We obtained cardiac images from 37 subjects (including 11 patients) by using dual-transmit 3T CMR.

Weight loss caused by visceral artery disease.

Dramatic unintentional weight loss can be caused by a spectrum of diseases ranging from very serious to benign and treatable. We describe the case of a 70-year-old woman with an extensive history of cardiovascular disease who presented with unintentional weight loss. Although she was diagnosed and treated for colitis, the patient continued to lose 50 pounds over 8 months, which prompted an angiogram.

Safety and feasibility of mapping and stem cell delivery in the presence of an implanted left ventricular assist device: a preclinical investigation in sheep.

The objective of this study was to determine the safety and feasibility of performing transendocardial electromechanical mapping and mesenchymal precursor stem cell injections after left ventricular assist device (LVAD) implantation in a sheep model of acute myocardial infarction. Six sheep were assigned to either an acute or chronic group. Then we created an acute myocardial infarction in each by occluding the distal left anterior descending coronary artery with a balloon for 90 minutes.

Cirrhosis as a moderator of outcomes in coronary artery bypass grafting and off-pump coronary artery bypass operations: a 12-year population-based study.

Background: Cirrhosis substantially affects morbidity and mortality in patients who undergo complex surgical procedures. However, cirrhosis is not included as a parameter in standardized perioperative cardiac risk assessment models. We sought to identify the impact of cirrhosis on coronary artery bypass grafting (CABG) and off-pump CABG (OPCAB) outcomes.

Osmotic drug delivery to ischemic hindlimbs and perfusion of vasculature with microfil for micro-computed tomography imaging.

Preclinical research in animal models of peripheral arterial disease plays a vital role in testing the efficacy of therapeutic agents designed to stimulate microcirculation. The choice of delivery method for these agents is important because the route of administration profoundly affects the bioactivity and efficacy of these agents(1,2). In this article, we demonstrate how to locally administer a substance in ischemic hindlimbs by using a catheterized osmotic pump.