Cardiac device implantations in obese patients: Success rates and complications.

BACKGROUND: Obesity is associated with increased complications and potentially worse outcomes for various cardiac interventions. This study analyzed the success rate and complication rates associated with implantation of cardiac implantable electronic devices (CIEDs) in obese patients. HYPOTHESIS: Success rates are lower and complication rates higher in obese patients. METHODS: Consecutive patients undergoing CIED implantation between 2011 and 2015 in our hospital were included. Patients were categorized into obese and nonobese groups according to body mass index (BMI); cutoff was 30 kg/m2 . Patient characteristics, complication rates, procedural duration, and fluoroscopy data were compared between the 2 groups. RESULTS: A total of 965 patients (mean age, 69.0 ± 12.9 years; 67% male) were included. Of these, 249 (25.8%) patients were classified obese and 716 (74.2%) nonobese. Mean BMI was 34.7 ± 4.7 kg/m2 vs 25.1 ± 3.0 kg/m2 , respectively. There was no difference in procedural success rates between the 2 groups (97.2% vs 97.1%, respectively). Major complications were significantly lower in the obese group compared with the nonobese group (11 [4.4%] vs 62 [8.7%]; P < 0.05). Procedural duration and fluoroscopy duration were not different between the 2 groups, but the total dose-area product was significantly higher in obese patients vs nonobese patients (4012 ± 5416 cGcm2 vs 2692 ± 5277 cGcm2 ; P < 0.005). CONCLUSIONS: CIED implantation can be safely and effectively achieved in patients with BMI >30 kg/m2 . However, total radiation dose was significantly higher in the obese group, emphasizing that efforts should be made to reduce radiation exposure in these patients.

Increased epoxyeicosatrienoic acids and reduced soluble epoxide hydrolase expression in the preeclamptic placenta.

BACKGROUND: Epoxyeicosatrienoic acids (EETs) derived from cytochrome P450 (CYP)-dependent metabolism of arachidonic acid are increased in the plasma of women with preeclampsia as compared with normal pregnancy and are significantly higher in fetal than in maternal plasma and erythrocytes. We hypothesized that differences in EET synthesis or metabolism in the feto-placental unit contributed to the observed differences in circulating EETs. METHOD: To evaluate EETs, formation as well as the expression of relevant CYP isoforms and the metabolizing enzyme, soluble epoxide hydrolase (sEH), biopsies of placenta were collected from 19 normal pregnancy and 10 preeclampsia at the time of cesarean section delivery. EETs were extracted from tissue homogenates and analyzed by liquid chromatography coupled with tandem mass spectrometry. RESULTS: Both cis-EETs and trans-EETs were detected in the placenta. Concentration of total EETs was higher in the placenta from preeclampsia compared with normal pregnancy (2.37 ±â€Š1.42 ng/mg vs. 1.20 ±â€Š0.72 ng/mg, mean ±â€ŠSD, P < 0.01), especially the 5,6-, 8,9- and 11,12-EETs, measured in a subgroup of tissue samples (normal pregnancy = 10, preeclampsia = 5). By immunohistochemistry, sEH, CYP2J2, CYP4A11 were present in placental villi with different pattern distribution, whereas CYP2C8 was not detectable. Neither were CYP2J2, CYP4A11, and CYP2C8 detected in the umbilical cord. Western blot analysis of placenta homogenates showed reduced expression of sEH in preeclampsia as compared with normal pregnancy. CONCLUSION: Increased EETs in the placenta and umbilical cord are associated with the presence of CYP2J2, whereas reduced expression of sEH in preeclampsia may be the key factor of increased EETs in the placenta.

Effect of CPAP on blood pressure in patients with OSA/hypopnea a systematic review and meta-analysis.

BACKGROUND: CPAP is considered the therapy of choice for OSA, but the extent to which it can reduce BP is still under debate. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to quantify the effect size of the reduction of BP by CPAP therapy compared with other passive (sham CPAP, tablets of placebo drug, conservative measures) or active (oral appliance, antihypertensive drugs) treatments. METHODS: We searched four different databases (MEDLINE, EMBASE, Web of Science, and the Cochrane Library) with specific search terms and selection criteria. RESULTS: From 1,599 articles, we included 31 RCTs that compared CPAP with either passive or active treatment. In a random-effects meta-analysis vs passive treatment (29 RCTs, 1,820 subjects), we observed a mean±SEM net difference in systolic BP of 2.6±0.6 mm Hg and in diastolic BP of 2.0±0.4 mm Hg, favoring treatment with CPAP (P<.001). Among studies using 24-h ambulatory BP monitoring that presented data on daytime and nighttime periods, the mean difference in systolic and diastolic BP was, respectively, 2.2±0.7 and 1.9±0.6 mm Hg during daytime and 3.8±0.8 and 1.8±0.6 mm Hg during nighttime. In meta-regression analysis, a higher baseline apnea/hypopnea index was associated with a greater mean net decrease in systolic BP (beta±SE, 0.08±0.04). There was no evidence of publication bias, and heterogeneity was mild ( I2, 34%-36%). CONCLUSIONS: Therapy with CPAP significantly reduces BP in patients with OSA but with a low effect size. Patients with frequent apneic episodes may benefit the most from CPAP.