Cardiac resynchronization therapy in patients with mild heart failure is a reversal therapy.

This systematic review with meta-analysis sought to determine the efficacy, safety of implantation of cardiac resynchronization therapy (CRT) in mild heart failure (HF). Medline, Embase, Elsevier, and Sciences online database as well as Google scholar literature were used for selecting appropriate studies with randomized controlled design. The literature search of all major databases retrieved 2035 studies. After screening, a total of 10 trials were identified that reported outcomes of interest. Pooled analysis was performed on left ventricular (LV) ejection fraction (P<0.001), LV end-diastolic volume (P<0.001), LV end-systolic volume (P<0.001), LV end-diastolic diameter (P<0.001), LV end-systolic diameter (P<0.001), incidence of progression of heart failure (P<0.001), mortality (P=0.06), infection (P=0.1), and pneumothorax (P=0.08). Overall, implantation of CRT in patients with asymptomatic and mild HF resulted in improved cardiac function, decreased progression of HF, trend to decrease of mortality in short to long-term follow-up.

Strategies Preventing Contrast-Induced Nephropathy After Coronary Angiography: A Comprehensive Meta-Analysis and Systematic Review of 125 Randomized Controlled Trials.

This systematic review with meta-analysis sought to determine the strength of evidence for the effects of hydration (sodium bicarbonate [SB] and normal saline [NS]), supplementations ( N-acetylcysteine [NAC] and vitamin C), and some common drugs (adenosine antagonists [AAs], statins, loop diuretics, and angiotensin-converting enzyme inhibitors [ACEIs]) on the incidence of contrast-induced nephropathy (CIN) and requirement for hemodialysis after coronary angiography. After screening, a total of 125 trials that reported outcomes were identified. Pooled analysis indicated beneficial effects of SB versus NS (odds ratio [OR] = 0.73; 95% confidence interval [CI]: 0.56-0.94; P = .01), NAC (OR = 0.79; 95% CI: 0.70-0.88; P = .001), vitamin C (OR = 0.64; 95% CI: 0.45-0.89; P = .01), statins (OR = 0.45; 95% CI: 0.35-0.57; P = .001), AA (OR = 0.28; 95% CI: 0.14-0.47; P = .001), loop diuretics (OR = 0.97; 95% CI: 0.33-2.85; P = .9), and ACEI (OR = 1.06; 95% CI: 0.69-1.61; P = .8). Overall, hydration with SB, use of supplements, such as NAC and vitamin C, and administration of statins and AA should always be considered for the prevention of CIN after coronary angiography.

Impact of antioxidant supplementations on cardio-renal protection in cardiac surgery: an updated and comprehensive meta-analysis and systematic review.

This systematic review with meta-analysis sought to determine the strength of evidence in terms of the impact of common antioxidant supplementations, such as N-acetylcysteine (NAC), vitamin C, and polyunsaturated fatty acids (PUFA) on perioperative outcomes after cardiac surgery with particular focus on the incidence of atrial fibrillation (AF) and acute kidney injury (AKI) with associated mortality. A total of 29 trials were identified that reported incidence of AF and 17 trials that reported incidence of AKI. Pooled analysis reported that NAC (OR=0.5; P=.001), vitamin C (OR=0.4; P=.001), and PUFA (OR=0.8; P=.01) administration were associated with significantly reduced incidence of AF. In terms of postoperative AKI, only NAC was shown to be a beneficial supplement that was able to significantly reduce the incidence of AKI (OR=0.7; P=.01), and NAC could also significantly decrease overall mortality (OR=0.3; P=.03) following cardiac surgery. The use of NAC in patients undergoing cardiac surgery should be strongly recommended due to its combined cardio-renal protective effects and reduced mortality. Also, PUFA and vitamin C might be able to significantly decrease the incidence of arrhythmia; however, reno-protective effects and impact on overall mortality of these supplements seem to be less impressive.

Safety and efficacy of glucose-insulin-potassium treatment in coronary artery bypass graft surgery and percutaneous coronary intervention.

The purpose of this meta-analysis was to evaluate protective effects of glucose-insulin-potassium (GIK) on outcomes after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). We systematically searched Medline/Pubmed, Elsevier, Embase, Web of Knowledge and Google Scholar. A total of 1206 studies were retrieved during the extensive literature search of all major databases; however, 38 trials reporting the end-point of interest were selected. We performed a pooled analysis of outcomes following PCI: incidence of cardiac arrest [odds ratio (OR) of 0.91; 95% confidence interval (CI): 0.76-1.09; P = 0.3], stroke (OR of 1.71; 95% CI: 0.37-1.37; P = 0.3), cardiogenic shock (OR of 1.02; 95% CI: 0.92-1.14; P = 0.6), reinfarction (OR of 0.95; 95% CI: 0.81-1.14; P = 0.5) and mortality (OR of 1.04; 95% CI: 0.96-1.13; P = 0.3); and following CABG: incidence of atrial fibrillation (OR of 0.86; 95% CI: 0.70-1.05; P = 0.1), incidence of ventricular fibrillation (OR of 0.83; 95% CI: 0.62-1.13; P = 0.2), reinfarction (OR of 0.97; 95% CI: 0.74-1.27; P = 0.8), infection (OR of 1.04; 95% CI: 0.67-1.62; P = 0.8), length of intensive care unit stay (LIS) [standard mean differences (SMD) of -0.27; 95% CI: -0.40 to -0.14; P = 0.000], length of hospital stay (LHS) (SMD of -0.035; 95% CI: -0.12 to -0.05; P = 0.4) and mortality (OR of 0.72; 95% CI: 0.41-1.26; P = 0.2). Our results showed that GIK did not have considerable cardioprotective effects. However, patients undergoing CABG seem to be better responders to GIK therapy compared with patients undergoing PCI. Furthermore, in contrast to CABG, GIK therapy in patients undergoing PCI might be associated with more complications rather than protective effects.

Protective effects of corticosteroids in coronary artery bypass graft surgery alone or combined with valvular surgery: an updated and comprehensive meta-analysis and systematic review.

This systematic review with meta-analysis sought to determine the protective effects of corticosteroids on clinical outcomes following coronary artery bypass grafting (CABG). Medline, Embase, Elsevier and Sciences online database as well as Google scholar literature were used for selecting appropriate studies with randomized controlled design. The effect sizes measured were odds ratio (OR) for categorical variables and weighted mean difference with 95% confidence interval (CI) for calculating differences between mean values of duration of hospitalization in intervention and control groups. Values of P < 0.1 for Q-test or I(2) > 50% indicated significant heterogeneity between the studies. The literature search of all major databases retrieved 3735 studies. After screening, a total of 45 trials were identified that reported outcomes. Pooled analysis was performed on incidence of atrial fibrillation (OR of 0.71; 95% CI: 0.59-0.86; P = 0.000), stroke (OR of 1.61; 95% CI: 0.63-4.1; P = 0.3), infection (OR of 1.03; 95% CI: 0.68-1.5; P = 0.8), re-infarction (OR of 0.88; 95% CI: 0.47-1.63; P = 0.6), length of ventilation time [weighted mean difference (WMD) of 0.257; 95% CI: 0.10-0.41; P = 0.00], length of hospital stay (WMD of -0.48; 95% CI: -0.66 to -0.3; P = 0.000), amount of blood loss (WMD of -124.05; 95% CI: -147.72 to -100.38; P = 0.00), re-exploration (OR of 1.25; 95% CI: 0.66-2.35; P = 0.4) and mortality (OR of 0.87; 95% CI: 0.46-1.64; P = 0.6). Overall, steroid prophylaxis in patients undergoing CABG could significantly reduce complications such as atrial fibrillation and length of hospital stay, but slightly increased the length of ventilation time. On the other hand, no significant impact on the incidence of infection was observed compared with the placebo.

Comparison of the Effectiveness of Continuous versus Intermittent Cefazolin for the Prevention of Infection after Off-Pump Coronary Artery Bypass Graft.

BACKGROUND: Surgical site infection is known as a common complication after cardiac surgery, and Cefazolin is the best prophylactic antibiotic to prevent this complication. The goal of this study was to evaluate the effect of continuous and intermittent Cefazolin for the prevention of superficial surgical site infection following off-pump coronary artery bypass (OPCAB). METHODS: This prospective randomized clinical trial study was conducted on 141 patients candidated for OPCAB and divided into two groups. This study was performed between February 2011 and February 2012 in the Iranian city of Yazd. Patients in both groups received 2 g of Cefazolin as a starting dose and at 30 minutes before incision. Definition of surgical site infections was according to the Centers for Disease Control and Prevention Criteria (CDC-criteria). In the continuous infusion group (n = 74), 3 g of Cefazolin was infused over a 24-hour period after surgery. In the intermittent group (n = 67), 1 g of Cefazolin was administered at 3, 11, and 19 hours after the starting dose. Hyperlipidemia, diabetes, hypertension, smoking, history of heart disease, and incidences of superficial infection were compared between the two groups. Duration of follow- up was 4 weeks. RESULTS: The mean age of the patients was 60.49 ± 10.63 years. The patients were 30.5% female and 69.5% male. There were no significant differences in age, body surface area, duration of operation, number of distal grafts, number of proximal grafts, and duration of hospital stay before heart surgery between two groups. The incidence of infection in intermittent group was (7.5%) and in continuous groups was (2.7%). There was no significant difference in the incidence of infection between the two groups (p value = 0.26). CONCLUSION: Our findings in this study showed no significant differences between continuous and intermittent Cefazolin for the prevention of superficial surgical site infections after OPCAB.

Costochondritis caused by Aspergillus flavus following cardiac surgery.

Mediastinitis is an infrequent complication after coronary artery bypass graft (CABG) that is associated with prolonged intensive care unit and hospital stay, and increased early and late morbidity and mortality. Patients with mediastinitis have an osteoporotic, fragile, and broken sternum. All foreign bodies as well as infected tissue should be removed. Osteomyelitis of sternum often perseveres after debridement for mediastinitis. In this report, we describe an unusual case of costochondritis caused by aspergillosis following off pump CABG surgery in a male patient in Yazd-Iran.

Relationship of admission mean platelet volume, platelet distribution width and white blood cells with ST resolution in patients with acute ST segment elevation myocardial infarction treated with streptokinase without history of previous cardiovascular surgery.

BACKGROUND: Mean platelet volume (MPV) and platelet distribution width (PDW), markers of platelet reactivity, and white blood cell count (WBC-C), a marker of inflammation, have been shown to be predictive of unfavorable outcomes among survivors of ST elevation myocardial infarction (STEMI). we aimed to evaluate the value of admission of MPV, PDW and WBC-C for the prediction of ST segment resolution, in patient with acute STEMI treated with Streptokinase. MATERIALS AND METHODS: This cross sectional study conducted on 280 patients with STEMI treated with streptokinase, from August 2009 until August 2011, in Afshar cardiovascular center, Yazd, Iran. Blood samples were obtained on admission in 280 patients with STEMI. According to sum of ST segment resolution and Schroder's method, patients divided two groups ((patients with ST resolution≥ 70% versus group with ST resolution < 70%)). The best cut off value of MPV, PDW and WBC-C for prediction of ST resolution (STR) were identified by using the receiver operating characteristic curve. The optimum cut off level was determined by selecting points of test value that provided the greatest sum of sensitivity and specificity. RESULTS: Of 280 patients enrolled this study, 39.3% of the patients with STR≥70% and in 60.7% with STR<70% were found. Patients in the STR < 70% group had higher admission MPV (10.6 ± 0.8 vs. .9.5 ± 0.8, P = 0.00) and higher PDW (13.8 ± 1.8 vs. 11.8 ± 1.7, P = 0.00)and higher WBC-C (12.1 ± 3.1 vs. 10.5 ± 2.5, P = 0.00) compare with patients with ST resolution ≥ 70%. The best cut off value of MPV for predicting STR < 70%was 10/05 fl (sensitivity 71/8 and specificity 80.9%) and for PDW was 12.85 fl (sensitivity 71.2% and specificity 83.6%) and for WBC-C was 12.65 × 1000 (sensitivity 42.9% and specificity 82.7%). The greatest area under the receiver operating characteristic (ROC) curve and greatest predicting value for ST resolution lower 70% was due to PDW (area = 0.812, P = 0/00). CONCLUSION: MPV, PDW and WBC-C at admission might be valuable in the prediction of impaired STR and in planning the need for adjunctive therapy to improve outcomes with STEMI treated with Streptokinase. We can speculate that acute STEMI patients having MPV-PDW and WBC-C values above their's cut off patients should be considered for stronger antiplatelet and helps anti inflammation treatment to be able to attain a favorable ST resolution and better clinical outcome.

Can preoperative serum level of creatinine predict new-onset atrial fibrillation in non-diabetic male patients undergoing open heart surgery? A retrograde view.

Renal dysfunction is a risk marker in patients who candidate for coronary artery bypass graft (CABG). Renal disorder is associated with prolonged stays in intensive care unit and hospital, morbidity and mortality. Aim of this study is specific evaluation of association between preoperative creatinine (Cr) with atrial fibrillation (AF) after elective off-pump CABG in non-diabetic male patients with normal ejection fraction. Two hundred non-diabetic male patients with normal ejection fraction undergoing elective off pump CABG surgery enrolled in this cross-sectional study and were stratified by present or absence of postoperative atrial fibrillation: patients with postoperative new-onset atrial fibrillation (n=100) as group 1 and patients without new-onset postoperative atrial fibrillation as group 2 (n=100). Preoperative serological test of the participants, such as serum creatinine, were recorded in their medical dossiers. Data were analyzed in SPSS-16 software and tested for association between atrial fibrillation with creatinine level by using student t test, chi-square test or logistic regression. Cr level in patients with and without AF three days before surgery were 1.8±0.3 and 1.0±0.4 respectively (P value for Cr=0.00). On surgical day, mean Cr level in patients with and without AF were 1.6±0.2 and 1.1±0.5 respectively (P value for Cr = 0.00). Of the 100, male patients with postoperative AF, duration and frequency of recurrence of AF were not associated with Cr at three days before surgery and on surgical days (P>0.05). Patients with postoperative AF had unsuitable status of renal function compare to patients without AF; however, preoperative serum creatinine cannot associate with duration and frequency of recurrence of AF.