[Antiplatelet or anticoagulative strategies after surgical/interventional valve treatment]. / Antithrombozytäre oder antikoagulative Strategie nach chirurgischer/interventioneller Klappenbehandlung.

At the end of August 2017 the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) published new joint guidelines for the treatment of valvular heart disease. These guidelines incorporate the scientific progress since the last version of the guidelines published in 2012. This article reviews current guideline recommendations for antiplatelet and anticoagulative therapy after surgical/interventional treatment of the aortic and mitral valves and discusses the underlying scientific evidence.

Interventional therapies in acute myocardial infarction complicated by cardiogenic shock.

Cardiogenic shock remains the most common cause of death in patients with acute myocardial infarction. Early revascularization of the infarct-related artery has been shown to reduce mortality and is the therapeutic cornerstone. The optimal revascularization strategy of additional non-culprit lesions remains yet to be determined. Further, uncertainties exist with respect to access site choice, antiplatelet regimen as well as mechanical support devices. This review outlines current evidence on the interventional management of cardiogenic shock complicating acute myocardial infarction.

Left ventricular global function index assessed by cardiovascular magnetic resonance for the prediction of cardiovascular events in ST-elevation myocardial infarction.

BACKGROUND: The left ventricular performance index (LVGFI) as a comprehensive marker of cardiac performance integrates LV structure with global function within one index. In a prospective cohort study of healthy individuals the LVGFI demonstrated a superior prognostic value as compared to LV ejection fraction (LVEF). In patients after ST-segment elevation myocardial infarction (STEMI), however, the role of the LVGFI is unknown. Aim of this study was to investigate the relationship between the LVGFI and infarct characteristics as well as prognosis in a large multicenter STEMI population. METHODS: In total 795 STEMI patients reperfused by primary angioplasty (<12 h after symptom onset) underwent cardiovascular magnetic resonance (CMR) at 8 centers. CMR was completed within one week after infarction using a standardized protocol including LV dimensions, mass and function for calculation of the LVGFI. The primary clinical endpoint of the study was the occurrence of major adverse cardiac events (MACE). RESULTS: The median LVGFI was 31.2 % (interquartile range 25.7 to 36.6). Patients with LVGFI < median had significantly larger infarcts, less myocardial salvage, a larger extent of microvascular obstruction, higher incidence of intramyocardial hemorrhage and more pronounced LV dysfunction (p < 0.001 for all). MACE and mortality rates were significantly higher in the LVGFI < median group (p < 0.001 and p = 0.003, respectively). The LVGFI had an incremental prognostic value in addition to LVEF for prediction of all-cause mortality. CONCLUSIONS: The LVGFI strongly correlates with markers of severe myocardial and microvascular damage in patients with STEMI, offering prognostic information beyond traditional cardiac risk factors including the LVEF. TRIALS REGISTRATION: ClinicalTrials.gov: NCT00712101.

[ESC guidelines 2015. Non-ST-elevation acute coronary syndrome]. / ESC-Leitlinien 2015. Akutes Koronarsyndrom ohne ST-Strecken-Hebung.

In August 2015 the European Society of Cardiology (ESC) published new guidelines for the management of acute coronary syndrome in patients presenting without persistent ST-segment elevation, which incorporate the scientific progress since 2011. The innovation with probably the most impact on the clinical practice is the introduction of 0 h/1 h protocols for exclusion or inclusion of myocardial infarction without ST-segment elevation. These 0 h/1 h protocols are equally recommended to the established 0 h/3 h protocol. For these protocols blood is drawn on admission and 1 h later and the troponin level is analyzed by means of highly sensitive troponin assays. Troponin cut-off values were validated in several large studies, therefore, now facilitating a faster exclusion of myocardial infarction with an equal negative predictive value to 3 h protocols. Additionally, access via the radial artery is recommended over a femoral artery access for coronary angiography and when necessary the subsequent coronary intervention. Other novel aspects apply to the anti-ischemic and anti-thrombotic medication.

[Timing of invasive treatment in NSTEMI: as fast as in STEMI?]. / Zeitpunkt der invasiven Therapie beim NSTEMI: So schnell wie beim STEMI?

The optimal timing of invasive diagnosis and therapy in patients with non-ST-elevation myocardial infarction (NSTEMI) is still a matter of debate. The European Society of Cardiology recommends invasive diagnosis evaluation and revascularization for practically all patients with NSTEMI within 72 h. High risk and very high risk patients should be evaluated invasively with coronary angiography within 24 h or 2 h, respectively. The risk of the individual patient should be stratified by means of the Global Registry of Acute Coronary Events (GRACE) risk score. The recommendations and guidelines are based on the results of several randomized, controlled trials and are in accordance with other retrospective studies. However, observational studies indicate that in real life many high risk patients are not evaluated invasively by coronary angiography as timely as recommended.

Regional assignment of 41 human DNA fragments on chromosome 7 by means of a somatic cell hybrid panel.

To detect new restriction fragment length polymorphisms that would cover human chromosome 7 with a network of genetic landmarks, a chromosome 7-specific phage gene library was screened for human single-copy fragments. With use of a somatic cell hybrid panel containing defined regions of human chromosome 7, 41 cloned human single-copy sequences were assigned to five regions of this chromosome. Of special importance are the cell hybrid clones GM1059Rag5 and 7851Rag10-1, derived from human cells with interstitial deletions spanning the bands 7q22-q32, within which the cystic fibrosis gene is located. Twelve new probes are described in 7q22-q32, five of which detect a total of six RFLPs.