J. Abbott

Calpain inhibition improves collateral-dependent perfusion in a hypercholesterolemic swine model of chronic myocardial ischemia

PURPOSE Calpain overexpression is implicated in aberrant angiogenesis. We hypothesized that calpain inhibition (MDL28170) would improve collateral perfusion in a swine model with hypercholesterolemia and chronic myocardial ischemia. METHODS Yorkshire swine fed a high cholesterol diet for 4 weeks underwent surgical placement of an ameroid constrictor to their left circumflex coronary artery. Three weeks later, animals received no drug, high cholesterol control group (n = 8); low-dose calpain inhibition (0.12 mg/kg; n = 9); or high-dose calpain inhibition (0.25 mg/kg; n = 8). The heart was harvested after 5 weeks. RESULTS Myocardial perfusion in ischemic myocardium significantly improved with high-dose calpain inhibition at rest and with demand pacing (P = .016 and .011). Endothelium-dependent microvessel relaxation was significantly improved with low-dose calpain inhibition (P = .001). There was a significant increase in capillary density, with low-dose calpain inhibition and high-dose calpain inhibition (P = .01 and .01), and arteriolar density with low-dose calpain inhibition (P = .001). Calpain inhibition significantly increased several proangiogenic proteins, including vascular endothelial growth factor (P = .02), vascular endothelial growth factor receptor 1 (P = .003), vascular endothelial growth factor receptor 2 (P = .003), and talin, a microvascular structural protein (P = .0002). There was a slight increase in proteins implicated in endothelial-dependent (nitric oxide mediated) relaxation, including extracellular signal-regulated kinase, phosphorylated extracellular signal-regulated kinase, and inducible nitric oxide synthase with calpain inhibition. CONCLUSIONS In the setting of hypercholesterolemia, calpain inhibition improved perfusion, with a trend toward increased collateralization on angiography and increased capillary and arteriolar densities in ischemic myocardium. Calpain inhibition also improved endothelium-dependent microvessel relaxation and increased expression of proteins implicated in angiogenesis and vasodilatation.

OUTCOMES FOLLOWING URGENT/EMERGENT TRANSCATHETER AORTIC VALVE REPLACEMENT: INSIGHTS FROM THE STS/ACC TVT REGISTRY

Data on urgent/emergent transcatheter aortic valve replacement (TAVR) as a rescue therapy for decompensated severe aortic stenosis (AS) are limited. The STS/ACC TVT Registry linked with Centers for Medicare and Medicaid Services claims was used to identify patients who underwent urgent/emergent vs

Risk of contrast‐induced acute kidney injury in ST‐elevation myocardial infarction patients undergoing multi‐vessel intervention‐meta‐analysis of randomized trials and risk prediction modeling study using observational data

Ascertaining risk of contrast induced acute kidney injury (CI‐AKI) in ST‐segment elevation myocardial infarction (STEMI) patients undergoing multi‐vessel percutaneous coronary intervention (MV‐PCI).

INTRAMYOCARDIAL AUTOLOGOUS CD34+ CELL THERAPY FOR REFRACTORY ANGINA: A META-ANALYSIS

Background: Intramyocardial injection of human CD34+ cells may improve outcomes in patients with chronic refractory angina not amenable to revascularization or standard medical therapy. We performed a meta-analysis to evaluate the effect of this therapy in patients with refractory angina. Methods:

INFECTIVE ENDOCARDITIS AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: INSIGHTS FROM THE NATIONWIDE READMISSIONS DATABASE

Background: Infective endocarditis (IE) is a serious complication in patients with prosthetic heart valves. There are limited available data on the incidence, clinical predictors, and outcomes of IE after transcatheter aortic valve replacement (TAVR) in the United States. Methods: Patients

Interventional Therapies for Heart Failure in Older Adults

Heart failure (HF) remains the leading cause of hospitalization in older adults and is associated with increased morbidity and mortality despite the use of guideline-directed medical therapy. There has been tremendous progress in the development of novel transcatheter and interventional therapies for HF over the past decade. The evolution of structural heart disease interventions and interventional HF has led to a multidisciplinary heart team approach in the management of HF patients. Careful selection of the appropriate patient population and end points in future randomized controlled trials will be crucial to demonstrate the potential efficacy of the novel interventional HF therapies.

SEX DIFFERENCES IN DISEASE SPECIFIC HEALTH STATUS MEASURES IN PATIENTS WITH SYMPTOMATIC PERIPHERAL ARTERIAL DISEASE

Peripheral arterial disease (PAD) is associated with poor overall function and quality of life (QOL). Whether sex differences exist in PAD-specific health status is unknown. We examined sex differences in PAD-specific physical function, symptom frequency, social function, treatment satisfaction, and

CULPRIT ONLY VERSUS MULTIVESSEL PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH CARDIOGENIC SHOCK COMPLICATING ACUTE MYOCARDIAL INFARCTION: A META-ANALYSIS OF OBSERVATIONAL STUDIES

In patients with cardiogenic shock complicating acute myocardial infarction (AMI), current guidelines allow for multivessel percutaneous coronary intervention (MV-PCI) during the primary procedure as a strategy to potentially improve outcomes. However, only limited observational data support this