Ahmad Khraisat

Stem cells improve left ventricular function in acute myocardial infarction.

Animal studies have suggested dramatic improvement in cardiac function after acute myocardial infarction (AMI) through regeneration of the myocardium or neovascularization by transfer of cells derived from bone marrow (BMC) generated clinical studies. Recently published small sized studies have yielded mixed results, leaving the question unanswered.

Pioglitazone and the risk of myocardial infarction and other major adverse cardiac events: a meta-analysis of randomized, controlled trials

A recent meta-analysis suggested that the use of rosiglitazone increases the risk of myocardial infarction (MI) in patients with type 2 diabetes mellitus. It is unclear whether this is a class effect of thiazolidinediones (TZD). We did a meta-analysis to evaluate cardiovascular outcomes with the use of pioglitazone. Randomized, controlled trials in which pioglitazone was compared with placebo or other hypoglycemic agents were considered for analysis. Studies were included if the data for MI were available. Studies were identified with use of relevant search words in Medline, Pubmed, EMBASE, CINAHL, and Cochrane databases. Data abstraction was done by 2 individual authors using a standardized protocol. The relative risk across all study groups was computed by the Mantel-Haenszel method, and interstudy heterogeneity was assessed by the χ2 method. All results were computed according to 95% confidence intervals. Five trials (N = 9965) met the inclusion criteria for analysis. The relative risk for MI was 0.86 (0.69-1.07; P = 0.17). The relative risks for stroke and revascularization were 0.79 (0.61-1.02; P = 0.07) and 0.40 (0.13-1.23; P = 0.11), respectively. Pioglitazone does not increase the risk for MI and may decrease the risk for stroke and revascularization.

Increased Incidence of In-Stent Thrombosis Related to Cocaine Use: Case Series and Review of Literature

The purpose of this article was to determine the incidence of in-stent thrombosis (IST) after coronary stent implantation in patients with cocaine abuse. A retrospective review was done of medical records of consecutive patients who underwent coronary stent implantation for obstructive coronary artery disease at a single inner-city institution from January 1997 to October 2006. Patients with temporal cocaine use were identified by positive urine drug screen. IST was confirmed angiographically. Of the 81 patients with active cocaine use that underwent coronary stent implantation, 4 (5%) suffered IST (mean period from stent implantation, 28.5 ± 14 days). All procedures were performed successfully and received intravenous IIb/IIIa antagonist intraprocedurally. All patients were prescribed dual antiplatelet therapy with aspirin and clopidogrel at discharge; however, all 4 patients that suffered from IST continued cocaine abuse were noncompliant with the prescribed dual antiplatelet therapy. Of these 4 patients, 2 presented with ST segment elevation myocardial infarction (50%), whereas 2 presented with non-ST-segment elevation myocardial infarction (50%). One was managed medically. Two received repeat percutaneous coronary intervention, and 1 underwent coronary artery bypass surgery. The patient that underwent surgery died in the postoperative period. The remaining 3 patients survived. Patients with active cocaine abuse who undergo successful coronary stent revascularization have a high (5%) incidence of stent thrombosis. A majority of patients that suffer stent thrombosis continue cocaine abuse and are noncompliant with antiplatelet therapy.

Left Ventricular End Diastolic Pressure and Serum Brain Natriuretic Peptide Levels in Patients with Abnormal Impedance Cardiography Parameters

BACKGROUND Distinct hemodynamic patterns determined by impedance cardiography (ICG) have been found to be superior to clinical assessment for the identification of patients at risk for heart failure decompensation in the outpatient setting. Correlation of these hemodynamic patterns with serum brain natriuretic peptides (BNP) and left ventricular end diastolic pressure (LVEDP) has not been established. We evaluated the correlation of low-, intermediate- and high-risk groups for acute decompensation of heart failure (ADHF) as determined by ICG parameters with LVEDP and serum BNP. METHODS Consecutive patients referred for cardiac catheterization with echocardiographic diagnosis of left ventricle dysfunction (systolic or diastolic) or history of congestive heart failure (CHF) underwent ICG evaluation, serum BNP measurement, and LVEDP by cardiac catheterization. Three groups at different levels of risk for ADHF were determined according to ICG parameters: thoracic fluid content (TFC) and stroke volume index (SVI); low risk (low TFC, high SVI), intermediate risk (low-low or high-high TFC and SVI, respectively), and high risk (high TFC and low SVI). RESULTS Sixty three patients were included in the present study. Mean LVEDP and serum BNP levels were 20.2 +/- 8.2 mmHg and 814 +/- 1005 pg/mL, respectively, in the high-risk group in comparison to 12.3 +/- 6.2 mmHg and 53 +/- 38 pg/mL in the low-risk group (p = 0.01 and p = 0.009). CONCLUSIONS Patients with ICG parameters that represent high risk for ADHF have higher levels of serum BNP and LVEDP in comparison with patients who have intermediate- or low-risk ICG parameters for ADHF.