Heartdrug : excellence in cardiovascular trials最新文献

{"title":"Hyperglycemia: An Upcoming Major Global Risk Factor for Cardiovascular Disease","authors":"K. Birkeland","doi":"10.1159/000082187","DOIUrl":"https://doi.org/10.1159/000082187","url":null,"abstract":"","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"175 - 176"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000082187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65255212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Surgery in Elderly Patients: What Is the Evidence?","authors":"G. Pettersson","doi":"10.1159/000078416","DOIUrl":"https://doi.org/10.1159/000078416","url":null,"abstract":"","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"131 - 132"},"PeriodicalIF":0.0,"publicationDate":"2004-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000078416","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65226696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrilin Dose Optimization Using Cone Plate Analyzer – What Have We Learned Thus Far","authors":"E. Kaluski, Ilia Malleihov, N. Savion, D. Varon, R. Winkler, Z. Vered, G. Cotter","doi":"10.1159/000079684","DOIUrl":"https://doi.org/10.1159/000079684","url":null,"abstract":"Objectives: To assess platelet inhibition by cone and plate analyzer (CPA) in patients with acute coronary syndromes (ACS) receiving eptifibatide (Integrilin). Background: With the current use of glycoprotein IIb/IIIa (GP-IIb/IIIa) inhibitors during ACS and percutaneous coronary interventions (PCI), the need to measure platelet activity and optimize dosing became apparent. CPA is a novel technique to assess platelet activity in high shear stress conditions, mimicking arterial flow. Method: 40 consecutive patients with ACS received eptifibatide [2 intravenous boluses (180 µg/kg each) spaced 10 min apart, and subsequently a maintenance drip (2 µg/kg/min)]. All patients received aspirin, clopidogrel and unfractionated heparin or enoxaparin in conventional doses. Blood was obtained at baseline, 30 min and 3 h, after eptifibatide initiation, and was sent out for CPA core lab, blinded to patient therapy, characteristics, and sampling time. Results: At 30 min and 3 h only 45 and 60% of patients, respectively, reached GP-IIb/IIIa blockade of ≧95%. 25 and 15%, respectively, had <85% GP-IIb/IIIa blockade. No demographic, clinical, or laboratory predictors for eptifibatide resistance could be identified. Conclusion: <85% GP-IIb/IIIa blockade occurs in a high proportion of patients with ACS treated with eptifibatide. The clinical significance of this phenomenon, and the optimal way to assess and treat it warrant additional research. It is essential, however, to measure platelet activity or GP-IIb/IIIa occupancy in response to therapy, since no demographic, clinical, and laboratory predictors of eptifibatide refractoriness can be identified at this time at the bedside.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"90 1","pages":"151 - 156"},"PeriodicalIF":0.0,"publicationDate":"2004-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000079684","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65238490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Colchicine in the Treatment of Recurrent Pericarditis Related to Postcardiac Injury (Postpericardiotomy and Postinfarcted) Syndrome: A Multicenter Analysis","authors":"A. Tenenbaum, N. Koren‐Morag, D. Spodick, A. Brucato, A. Bayés-de-Luna, G. Brambilla, E. Fisman, G. Artom, J. Guindo, A. Bayés‐Genís, E. Schwammenthal, Y. Adler","doi":"10.1159/000079123","DOIUrl":"https://doi.org/10.1159/000079123","url":null,"abstract":"Background: Pericarditis related to the postcardiac injury syndrome (PCIS) following myocardial infarction or cardiac surgery is a troublesome and often recurrent clinical entity resistant to therapeutic interventions. The usefulness of colchicine in the prevention of recurrent PCIS has not been evaluated. Objective: We performed a cumulative analysis of available multicenter data with the aim of evaluating the efficacy of colchicine in the treatment of recurrent PCIS. Methods and Results: The study was designed as a multicenter all-cases analysis. Researchers who had published studies and case reports on colchicine treatment in recurrent pericarditis related to PCIS during the last 15 years were approached and asked to contribute all available cases to the database. There were 28 patients, 18 male (64%) and 10 female (36%), ranging in age from 21 to 82 years (mean 53 ± 15 years). PCIS pericarditis was secondary to pericardiotomy in 19 patients and infarction in 9. In 21 patients (75%), colchicine therapy was discontinued during follow-up and renewed only in the case of relapse. In these patients, the total period of treatment was summed up for analysis. 7 patients (25%) were taking colchicine as a permanent treatment, and no colchicine-free follow-up was documented. In total, 130 recurrences (mean 4.64 ± 3.7 per patient, range 2–16) were noted before colchicine therapy was initiated. During colchicine treatment (mean duration of treatment 16.6 ± 13.5 months), a significant reduction in the number of recurrences was observed. Only 5 of 28 patients (18%) presented with new recurrences (mean 0.25 ± 0.59 vs. 4.64 ± 3.7 per patient in the precolchicine period, p < 0.001). The mean follow-up period after colchicine discontinuation (data were available for 21 patients) was 31.9 ± 28 months; during follow-up, 13 patients (62%) remained recurrence free and 8 of them (38%) experienced relapses (mean 0.43 ± 0.6 per patient, p < 0.001 vs. precolchicine). Conclusions: It seems that colchicine may be effective in preventing new relapses in patients with recurrent pericarditis related to postcardiac injury both during active therapy and after its discontinuation.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"22 1","pages":"141 - 144"},"PeriodicalIF":0.0,"publicationDate":"2004-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000079123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65231879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACE Inhibitor, Angiotensin II Receptor Antagonist, Monotherapy or Combined Therapy?","authors":"F. Karlsen, A. Kamper","doi":"10.1159/000079541","DOIUrl":"https://doi.org/10.1159/000079541","url":null,"abstract":"The renin-angiotensin system (RAS) is activated in several diseases, and angiotensin II mediates a number of putative detrimental effects through activation of the angiotensin II type 1 receptor, while the clinical role of the type 2 receptor has not yet been settled. Inhibition of the RAS is either achieved by the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists (AIIA). Although a combined inhibitory therapy might seem attractive, thus far limited data has emerged to support such a strategy. In hypertension, losartan has proven slightly more efficient than atenolol to prevent cardiovascular complications, overall mortality was however identical. In heart failure, AIIA should only be considered in ACE inhibitor-intolerant patients. Both ACE inhibitors and AIIA have proven efficient in diabetic microalbuminuria and in proteinuria. ACE inhibitors are first-line treatment in type 1 diabetic nephropathy and in nondiabetic nephropathy, while AIIA are highly efficient in type 2 diabetic nephropathy. Combination therapy might be superior to monotherapy in nondiabetic nephropathy.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"145 - 150"},"PeriodicalIF":0.0,"publicationDate":"2004-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000079541","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65236467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence for the Benefits of the Low-Molecular-Weight Heparin Dalteparin in ‘High-Risk’ Patients with Acute Coronary Syndromes","authors":"S. Husted, B. Ziegler","doi":"10.1159/000079751","DOIUrl":"https://doi.org/10.1159/000079751","url":null,"abstract":"Acute coronary syndrome (ACS) is a clinical emergency that requires urgent assessment. ACS encompasses a variety of clinical symptoms of varying severity, and risk stratification is essential to enable triage of patients to the optimum level of care and specific therapy. The medical treatment of ACS is directed primarily at the dissolution of developing intracoronary thrombi by antiplatelet (e.g. aspirin and clopidogrel) and anticoagulant [e.g. low-molecular-weight heparin (LMWH) and unfractionated heparin] therapy. Recent data from clinical trials have shown that LMWH is at least as effective and safe as unfractionated heparin. Additionally, elevation of biochemical cardiac markers and ST segment changes provide powerful risk stratification tools. Data from the Fragmin during Instability in Coronary Artery Disease and Fragmin and Fast Revascularisation during Instability in Coronary Artery Disease studies have demonstrated that prolonged treatment with the LMWH dalteparin provides significant benefit in clinical outcome in patients stratified as ‘high risk’ by troponin measurement and ST monitoring. While an early invasive strategy is recommended in ‘high-risk’ patients with ACS, dalteparin treatment is also effective and safe for up to 45 days in patients awaiting revascularization, or in those for whom an early invasive treatment is not possible. This paper is a review of the evidence for the use of dalteparin in ACS.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"111 1","pages":"157 - 163"},"PeriodicalIF":0.0,"publicationDate":"2004-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000079751","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65238523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Molecular-Weight Heparin in Acute Coronary Syndromes","authors":"M. O’Donnell, A. Turpie","doi":"10.1159/000078147","DOIUrl":"https://doi.org/10.1159/000078147","url":null,"abstract":"Acute coronary syndrome (ACS) may be divided into two distinct conditions on the basis of the electrographical presence or absence of significant ST-segment elevation. Coronary arterial plaque rupture with subsequent thrombus formation is usually responsible for the development of ACS. A number of antithrombotic therapies have been developed to inhibit key steps in the sequential process of thrombus formation. Thrombin generation is of critical importance in the creation of intracoronary thrombosis. Heparins, in therapeutic doses, reduce the risk of death and myocardial infarction by about 50% in aspirin-treated patients presenting with ACS with non-ST-segment elevation. Low-molecular-weight heparin (LMWH) primarily targets the inhibition of factor Xa (and to a lesser extent thrombin) by binding with antithrombin. A number of well-designed, large randomized controlled trials have shown that LMWHs have at least comparable efficacy and safety to unfractionated heparin, but their superior practical advantages have made them a mainstay therapy in the treatment of ACS with non-ST-segment elevation. More recently, the role of LMWH in the treatment of ACS with ST elevation has been evaluated in a large randomized trial.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"111 - 118"},"PeriodicalIF":0.0,"publicationDate":"2004-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000078147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65224666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Surgery in Elderly Patients: What Is the Evidence?","authors":"P. Matt, F. Bernet, M. Grapow, H. Zerkowski","doi":"10.1159/000078414","DOIUrl":"https://doi.org/10.1159/000078414","url":null,"abstract":"Coronary artery bypass surgery and aortic valve replacement can be performed with an acceptable operative risk in the elderly: the 30-day mortality ranges from 2 to 8%. However, the indication for surgery should be individualized based on the patient’s personal situation, physical condition, mental status, compliance and the comorbidities. The primary goal of open heart surgery in old patients should be the improvement in quality of life, and the secondary goal, the prognosis. Interestingly the mid- and long-term survival after cardiac surgery in the elderly corresponds to an age-adjusted population without heart disease.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"119 - 122"},"PeriodicalIF":0.0,"publicationDate":"2004-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000078414","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65226637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Comparison of the Minute Ventilation/Carbon Dioxide Production Ratio and Slope in Patients with Heart Failure","authors":"R. Arena, J. Myers, Syed Salman Aslam, Elsa B. Varughese, M. Peberdy","doi":"10.1159/000078907","DOIUrl":"https://doi.org/10.1159/000078907","url":null,"abstract":"Background: The relationship between minute ventilation (VE) and carbon dioxide production (VCO2) consistently demonstrates prognostic value in patients with heart failure (HF). This relationship has been expressed both as a VE/VCO2 slope during progressive exercise and a ratio at a given time point in previous investigations. Objectives: The purpose of this study was to compare the prognostic value of the VE/VCO2 slope and ratio in a group of patients with HF. Methods: 235 subjects (204 male/31 female) diagnosed with HF underwent exercise testing. Mean age and ejection fraction were 57.5 years (±13.5) and 32.1% (±12.1). The VE/VCO2 slope was calculated using data from the onset of exercise to peak. The VE/VCO2 ratio was calculated using 10-second averaged data at peak exercise. The ability of the VE/VCO2 slope and ratio to predict 1-year cardiac-related mortality and hospitalization were compared. Results: There were 65 hospitalizations and 16 deaths during the 1-year tracking period. Both VE/VCO2 expressions were significant predictors of 1-year cardiac-related hospitalization (χ2: slope = 56.4; ratio = 47.6, p < 0.001) and mortality (χ2: slope = 36.6; ratio = 31.6, p < 0.001). Receiver-operating characteristic curve analysis revealed the predictive power of VE/VCO2 slope and ratio classification schemes were not significantly different (hospitalization = 0.78 vs. 0.75; mortality = 0.87 vs. 0.85). Conclusion: These results indicate that, although not identical, VE/VCO2 slope and ratio provide similar prognostic information. Standardizing expression of the VE/VCO2 relationship may, however, enhance clinical application and should be considered.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"133 - 139"},"PeriodicalIF":0.0,"publicationDate":"2004-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000078907","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65231216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colchicine Treatment and Prevention of Recurrent Pericarditis","authors":"D. Spodick","doi":"10.1159/000079122","DOIUrl":"https://doi.org/10.1159/000079122","url":null,"abstract":"Accessible online at: www.karger.com/hed The efficacy of colchicine for familial Mediterranean fever (FMF) suggested its use in acute and recurrent pericarditis [1]. This remarkable agent has since entered the therapy of pericarditis of many kinds, but particularly stubborn recurrent cases and especially for patients ‘hooked’ on a corticosteroid [2]. Colchicine has been known for centuries as an effective agent for gout, but more recently its many remarkable actions have become apparent, including tubulin binding; inhibiting mitoses in the cell nucleus; inhibiting various polymorphonuclear leukocyte functions; stabilizing the cytoskeleton and cell membranes, and interfering with transcellular movement of collagen [3]. In these roles, colchicine may reduce or block immunologic triggering mechanisms when given early enough and probably has antifibroblastic and immunosuppressant properties when used early or late [3]. Tenenbaum et al. [4, this issue] with an international consortium contributing patient data have now demonstrated that colchicine appeared to prevent new relapses in patients with recurrent pericarditis related to postcardiac injury syndromes both during active therapy and subsequently. Because of the stubbornness of many forms of recurrent pericarditis (including incessant pericarditis [3]), this is a solid achievement, since most patients tolerate colchicine well with acute or chronic administration [2–4]. Moreover, colchicine tablets are convenient to take and inexpensive. Out of 21 patients who qualified for the investigation of Tenenbaum et al., 13 (62%) remained free of recurrences over a mean follow-up of 32 months, and retreatment has aided the others. It is significant that colchicine in this investigation may have been acting in several of its roles noted above, one of which may be as an immunosuppressant, since the postcardiac injury syndromes are considered to be immunopathic, In brief, colchicine appears to have been successful with patients acting as their own controls. However, as Tenenbaum et al. emphasize: as with nearly every treatment, this must remain sub judice pending an appropriately designed, prospective, randomized, double-blind controlled trial.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 1","pages":"140 - 140"},"PeriodicalIF":0.0,"publicationDate":"2004-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000079122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65232237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}