Francisco Macedo

Neck Circumference Is Not Associated With Subclinical Atherosclerosis in Retired National Football League Players

Neck circumference (NC) is associated with metabolic syndrome (MetS) in the general population. It is not known if NC is associated with MetS and subclinical atherosclerosis in retired National Football League (NFL) players.

Pleiotropic effects of the 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors in pulmonary diseases: a comprehensive review.

The 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors (statins) are used extensively in the treatment of hyperlipidemia. They have also demonstrated a secondary benefit in a variety of other disease processes, actions which are known as pleiotropic effects. Review of the current pulmonary literature suggests a potential advantage of statin usage in a variety of pulmonary conditions. Our paper serves as a focused discussion on the pleiotropic effects of statins in the most common pulmonary disorders.

Evaluation of clinical and laboratory data for early diagnosis of heparin-induced thrombocytopenia.

PURPOSE Results of a study to determine the utility of combining laboratory values and clinical probability scores to improve the detection of heparin-induced thrombocytopenia (HIT) are reported. METHODS In a retrospective, single-site, chart review-based investigation, 156 cases in which patients with suspected HIT had positive results on a widely used diagnostic test (the anti-heparin/platelet factor 4, or anti-PF4, assay) were identified; in all cases, the blood specimens had been sent to a reference laboratory for confirmation of HIT via serotonin release assay (SRA). After investigator scoring of the clinical probability of HIT in each case by the 4Ts method, a multiple logistic regression model was used to evaluate the combined effect of 4Ts scores and anti-PF4 assay values in predicting SRA results. RESULTS 4Ts scores indicating an intermediate or high probability of HIT combined with high anti-PF4 test values (i.e., optical density [OD] value of ≥1.4) were strongly predictive of a positive SRA result, as were high-probability 4Ts scores alone. Low-probability 4Ts scores alone or in combination with anti-PF4 OD values of <1.4 were highly correlated with negative SRA results. Controlling for potential confounding factors, logistic regression analysis indicated that the 4Ts score was a better predictor of SRA results than the anti-PF4 test value. CONCLUSION The combination of anti-PF4 OD values and 4Ts scores accurately predicted SRA results, suggesting that the SRA may not be necessary to confirm HIT in patients with a relatively low 4Ts score and a low anti-PF4 OD value.

Device stratified comparison among transfemoral, transapical and transubclavian access for Transcatheter Aortic Valve Replacement (TAVR): A meta-analysis

a Department of Internal Medicine/Cardiology, University of Miami/Jackson Memorial Hospital, Miami, FL, United States b Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States c Department of Cardiology, Baylor College of Medicine, Houston, TX, United States d Department of Cardiology, Columbia College of Physicians and Surgeons, St. Lukes Hospital, New York, NY, United States

Vascular brachytherapy versus drug-eluting stents in the treatment of in-stent restenosis: A meta-analysis of long-term outcomes

Clinical trials have shown a short‐term benefit of drug‐eluting stents (DES) compared to vascular brachytherapy (VBT) for treatment of in‐stent restenosis (ISR). The long‐term benefits of DES vs. VBT are conflicting in the literature. This study aimed to do a meta‐analysis of long‐term outcomes of DES compared to VBT for treatment of ISR.

Outcomes of hemodynamic support with Impella in very high-risk patients undergoing balloon aortic valvuloplasty: Results from the Global cVAD Registry

BACKGROUND Reports on the role of hemodynamic support devices in patients with severe aortic stenosis (AS) and left ventricular (LV) dysfunction undergoing balloon aortic valvuloplasty (BAV) are limited. METHODS Patients were identified from the cVAD registry, an ongoing multicenter voluntary registry at selected sites in North America that have used Impella in >10 patients. RESULTS A total of 116 patients with AS who underwent BAV with Impella support were identified. Mean age was 80.41±9.03years and most patients were male. Mean STS score was 18.77%±18.32, LVEF was 27.14%±16.07, and 42% underwent concomitant PCI. In most cases Impella was placed electively prior to BAV, whereas 26.7% were placed as an emergency. The two groups had similar baseline characteristics except for higher prevalence of CAD and lower LVEF in the elective group, and higher STS score in the emergency group. Elective strategy was associated higher 1-year survival compared to emergency placement (56% vs. 29.2%, p=0.003). One-year survival was higher when BAV was used as a bridge to definitive therapy as opposed to palliative treatment (90% vs. 28%, p<0.001). On multivariate analysis, STS score and aim of BAV (bridge to definitive therapy vs. palliative indication) were independent predictors of mortality. CONCLUSION In this large cohort of patients with AS and severe LV dysfunction undergoing BAV, our results demonstrates feasibility and promising long-term outcomes using elective Impella support with the intention to bridge to a definitive therapy.

Systemic effects of controlled exposure to diesel exhaust: a meta-analysis from randomized controlled trials

Abstract Introduction: Ambient air pollution is associated with adverse cardiovascular events. This meta-analysis aimed to investigate the short-term association between air pollution and cardiovascular effects on healthy volunteers. Methods: We searched databases to identify randomized trials with controlled human exposures to either of two models for studying ambient particulate matter: diesel-exhaust or concentrated ambient particles. Estimates of size effect were performed using standardized mean difference (SMD). Heterogeneity was assessed with I2 statistics. Outcomes were vascular function estimated by forearm blood flow (FBF), blood pressure, heart rate, and blood analysis. Results: Database searches yielded 17 articles (n = 342) with sufficient information for meta-analyses. High levels of heterogeneity for the some outcomes were analyzed using random-effects model. The pooled effect estimate showed that short-term exposure to air pollution impaired FBF response from 2.7 to 2.5 mL/100 mL tissue/min (SMD 0.404; p = .006). There was an increase in 5000 platelet/mm3 following pollution exposure (SMD 0.390; p = .050) but no significant differences for other outcomes. Conclusion: Controlled human exposures to air pollution are associated with the surrogates of vascular dysfunction and increase in platelet count, which might be related to adverse cardiovascular events. Given the worldwide prevalence of exposure to air pollution, these findings are relevant for public health. KEY MESSAGES Controlled exposure to air pollution impairs vasomotor response, which is a surrogate for adverse cardiovascular events. This is the first meta-analysis from randomized clinical trials showing short-term association between air pollution and cardiovascular effects on healthy volunteers. Given the worldwide prevalence of exposure to air pollution, this finding is important for public health.

TCT-136 Outcomes of Hemodynamic Support with Impella in very high-risk patients undergoing Balloon Aortic Aortic Valvuloplasty: Results From the Global cVAD Registry

TCT-135 Increased circulating plasma-free hemoglobin levels, not lactate dehydrogenase, levels identify hemolysis among patients with cardiogenic shock treated with an Impella micro-axial flow catheter Michele Esposito, Ryan O’Kelly, Nima Aghili, Shiva Annamalai, Anas Hamadeh, Michael Kiernan, Amanda Vest, David DeNofrio, Navin Kapur Hospital U. Central de la Defensa “Gómez Ulla”, Boston, Massachusetts, United States; Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany; Tufts Medical Center, Boston, Massachusetts, United States; Departmenf of Cardiac and Thoracic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany; 2 Dept. of Cardiology-Fondazione IRCCS Policlinico San Matteo, Pavia/Italy; Hospital U. Central de la Defensa “Gómez Ulla”; University Clinic of Jena, 1st Medical Department; University Clinic of Jena, 1st Medical Department; Tufts Medical Center, Boston, Massachusetts, United States

Screening Strategies for Coronary Artery Disease (CAD) in Candidates for Kidney Transplants

The number of patients in the US with end stage kidney disease (ESKD) is ever increasing. Risk factors such as diabetes, hypertension, and obesity predispose patients to both kidney and heart disease. Additionally, the complex physiologies of ESKD and renal replacement therapy also significantly increase the risk of heart disease to the point that ESKD has been deemed a cardiovascular disease equivalent. Those patients that receive a kidney transplant hope for improved quality of life and extended life-spans. But despite the well documented correlation of ESKD and cardiovascular disease, the leading cause of death in the post-transplant patient remains cardiovascular complications. While the need for coronary artery disease screening strategies in this population is at an all-time high, an effective method has yet to be developed, and the AHA/ACC does not have enough evidence to recommend for or against any particular screening test in asymptomatic ESKD patients. We reviewed the advantages and disadvantages of available screening modalities from the least invasive history and physical to the most invasive coronary angiography as well as the available evidence that might support and effective screening strategy. Currently, no method of screening has been shown to decrease cardiovascular deaths in this population, and until that time, no specific strategy can be recommended.

CORRELATION OF RIGHT ATRIAL ENLARGEMENT ON ECG TO RIGHT ATRIAL VOLUME BY ECHOCARDIOGRAPHY IN PATIENTS WITH PULMONARY HYPERTENSION

Background: Previous attempts to validate ECG criteria for right atrial (RA) enlargement (RAE) have been limited by sample sizes and lack of accepted standards for measuring RA size. New guidelines have recommended that RA volume be used to determine RA size. Since these guidelines were released, no