Thoracic versus nonthoracic MR imaging for patients with an MR nonconditional cardiac implantable electronic device.

BACKGROUND: Observational studies have explored the safety of magnetic resonance (MR) scanning of patients with cardiac implantable electronic devices (CIEDs) that are not Food and Drug Administration approved for MR scanning ("nonconditional"). However, concern has been raised that MR scanning that includes the thoracic region may pose a higher risk. This study examines the safety of MR scanning of thoracic versus nonthoracic regions of patients with CIEDs. METHODS: Patients underwent MR scanning utilizing an institutional protocol. CIED variables examined included sensing value, pacing capture threshold, lead impedance, and battery voltage. Regression analysis of the CIED variable differences (pre- to immediately post-MR and pre-MR to long-term follow-up) was performed to determine if CIED variable differences were dependent on region scanned (thoracic vs nonthoracic), time from CIED implant to MR scanning, or CIED type (pacemaker vs implantable cardioverter defibrillator). RESULTS: 238 patients (38% female, age 65 ± 15 years) underwent 339 MR scans, including 99 MR scans of the thoracic region. CIED variable differences to immediately post-MR or to long-term follow-up were not significantly different from zero (P > 0.05) and there was no dependence upon region scanned (thoracic vs nonthoracic), time from CIED implant to MR scan, or CIED type. One power-on reset occurred in a patient that underwent a cardiac MR and the CIED was successfully reprogrammed. There were no clinical adverse effects. CONCLUSIONS: CIED variable differences following MR scan were not dependent on the region scanned (thoracic vs nonthoracic) and there were no clinical adverse effects in this prospective cohort.

Contrast removal from coronary sinus for prevention of contrast-induced nephropathy: a review.

The occurrence of contrast-induced-nephropathy (CIN) is related to the amount of contrast administration. Any removal of contrast from systemic circulation before reaching the kidneys might be beneficial using a device that removes contrast from a coronary sinus (CS). This manuscript aims to review the available literature regarding contrast removal from CS during coronary angiography or intervention for the prevention of CIN.

Obesity is strongly and independently associated with a higher prevalence of pulmonary embolism.

BACKGROUND: Obesity is associated with many cardiovascular risk factors. This study aimed to evaluate the independent association between obesity and pulmonary embolism. METHODS: We used the International Classification of Diseases, Ninth Revision, Codes for obesity and pulmonary embolism from the Nationwide Inpatient Sample database. We randomly selected the 1992 and 2002 databases, which are 10 years apart, as the two independent population samples. We performed uni- and multivariate analyses to evaluate any association between obesity and pulmonary embolism. RESULTS: The 1992 database consisted of a total of 6,195,744 patients. Obesity was present in 93,568 patients. Pulmonary embolism occurred in 0.7% of obese patients vs. 0.3% of the control population (odds ratio [OR], 2.32; 95% confidence interval [CI] 2.2-2.4; p<0.0001). The 2002 database consisted of a total of 299,010 obese patients. Pulmonary embolism occurred in 0.9% of obese patients vs. 0.4% of the control population (OR, 2.36; 95% CI, 2.19-2.41; p<0.0001). After adjusting for age and many risk factors, obesity remained strongly associated with pulmonary embolism (for 1992, OR, 2.1; 95% CI, 2.0-2.3; p<0.0001 and for 2002, OR, 2.2; 95% CI, 2.1-2.3; p<0.0001). CONCLUSION: Obesity has been consistently associated with pulmonary embolism over the years studied using a large inpatient database. This association has been persistent over a period of 10 years and is consistent with the negative effects of obesity on the cardiopulmonary system.

Development of a bariatric surgery specific risk assessment tool for perioperative myocardial infarction.

BACKGROUND: Perioperative myocardial infarction (PMI) is a feared complication after surgery. Bariatric surgery, due to its intraabdominal nature, is traditionally considered an intermediate risk procedure. However, there are limited data on MI rates and its predictors in patients undergoing bariatric surgery. OBJECTIVES: To enumerate the prevalence of PMI after bariatric surgery and develop a risk assessment tool. SETTING: Bariatric surgery centers, United States. METHODS: Patients undergoing bariatric surgery were identified from the MBSAQIP participant use file (PUF) 2016. Preoperative characteristics, which correlated with PMI were identified by multivariable regression analysis. PUF 2015 was used to validate the scoring tool developed from PUF 2016. RESULTS: We identified 172,017 patients from PUF 2016. Event rate for MI within 30 days of the operation was .03%; with a mortality rate of 17.3% in patients with a PMI. Four variables correlated with PMI on regression, including history of a previous MI (odds ratio [OR] = 8.57, confidence interval [CI] = 3.4-21.0), preoperative renal insufficiency (OR = 3.83, CI = 1.2-11.4), hyperlipidemia (OR = 2.60, CI = 1.3-5.1), and age >50 (OR = 2.15, CI = 1.1-4.2). Each predicting variable was assigned a score and event rate for MI was assessed with increasing risk score in PUF 2015; the rate increased from 9.5 per 100,000 operations with a score of 0 to 3.2 per 100 with a score of 5. CONCLUSION: The prevalence of MI after bariatric surgery is lower than other intraabdominal surgeries. However, mortality with PMI is high. This scoring tool can be used by bariatric surgeons to identify patients who will benefit from focused perioperative cardiac workup.

Successful removal of an entrapped and kinked catheter during right transradial cardiac catheterization by snaring and unwinding the catheter via femoral access.

Since its introduction by Campeau in 1989, the transradial approach for coronary angiography has gained significant popularity among interventional cardiologists due to its lower access site complication rates, cost-effectiveness, and shorter hospital course. Although the transradial approach is much safer than the transfemoral approach, it has its own inherent rare complications including radial artery occlusion, thrombosis, nonocclusive radial artery injury, vasospasm, and compartment syndrome. Herein, we present an unusual case of entrapment and kinking of a catheter in the radial artery, which was successfully removed by using a gooseneck snare via the transfemoral route. The distal and proximal tips were then simultaneously rotated in opposite directions, allowing for the unkinking and removal of the catheter. To our knowledge, this is the first report of this rare complication.