Arrhythmias in the muscular dystrophies.

In patients with muscular dystrophies, cardiac involvement leading to cardiomyopathy and arrhythmias occurs with variable prevalence, mirroring the phenotypic variability seen among and within the various hereditary myopathies. Knowledge of the incidence of arrhythmias and predictors of sudden death in the various hereditary myopathies can help guide screening and appropriate management of these patients, thereby improving survival. The noncardiac manifestations can lead to delayed recognition of symptoms, affect the decision to implant a prophylactic device, and once a decision is made to proceed with device implant, increase peri-procedural respiratory and anesthesia-related complications.

Arrhythmias in pulmonary arterial hypertension.

Cardiac arrhythmias are important contributors to morbidity and mortality in patients with pulmonary arterial hypertension (PAH). Such patients manifest a substrate resulting from altered autonomics, repolarization abnormalities, and ischemia. Supraventricular arrhythmias such as atrial fibrillation and flutter are associated with worsened outcomes, and maintenance of sinus rhythm is a goal. Sudden death is a relatively common issue, though the contribution of malignant ventricular arrhythmias versus bradyarrhythmias differs from non-PAH patients. Congenital heart disease patients with PAH benefit from catheter ablation of medically refractory arrhythmias. Clinical studies of defibrillator/pacemaker therapy for primary prevention against sudden death in PAH patients are lacking.

Mortality at long-term follow-up of patients with no, nonobstructive, and revascularized 1-, 2-, and 3-vessel obstructive coronary artery disease.

BACKGROUND: To investigate the 5-year survival of patients with coronary angiographic evidence of no coronary artery disease (CAD), nonobstructive CAD, and revascularized 1-vessel, 2-vessel, and 3-vessel obstructive CAD. MATERIAL/METHODS: Coronary angiography was performed in 2,057 unselected patients, mean age 69 years (57% men and 43% women), with an acute coronary syndrome (50%) or anginal chest pain.(50%). RESULTS: Of 2,057 patients, 760 (37%) had obstructive CAD with >50% obstruction of at least 1 major coronary artery (left anterior descending, left circumflex, and right coronary) and were revascularized, 695 (34%) had nonobstructive CAD (<50% obstruction), and 602 (29%) had normal coronary arteries. At 60+/-16-month follow-up, all-cause mortality occurred in 41 of 602 patients (7%) with no CAD (group 1), in 80 of 695 patients (12%) with nonobstructive CAD (group 2), in 50 of 302 patients (17%) with revascularized 1-vessel obstructive CAD (group 3), in 47 of 201 patients (23%) with 2-vessel revascularized obstructive CAD (group 4), and in 72 of 257 patients (28%) with 3-vessel revascularized obstructive CAD (group 4). Log-rank tests to compare survival curves among the 5 groups showed p=0.004 for groups 1 versus 2; p<0.0001 for groups 1 versus 3, 1 versus 4, 1 versus 5, 2 versus 4, and 2 versus 5; and p=0.007 for groups 3 versus 5. CONCLUSIONS: Patients with nonobstructive CAD had a worse survival than those with no CAD, a nonsignificant difference in survival than those with revascularized 1-vessel obstructive CAD, and a better survival than those with revascularized 2-vessel or 3-vessel obstructive CAD.

Vascular complications after percutaneous coronary intervention following hemostasis with the Mynx vascular closure device versus the AngioSeal vascular closure device.

UNLABELLED: We investigated the prevalence of vascular complications after PCI following hemostasis in 190 patients (67% men and 33% women, mean age 64 years) treated with the AngioSeal vascular closure device (St. Jude Medical, Austin, Texas) versus 238 patients (67% men and 33% women, mean age 64 years) treated with the Mynx vascular closure device (AccessClosure, Mountain View, California). RESULTS: Death, myocardial infarction or stroke occurred in none of the 190 patients (0%) treated with the AngioSeal versus none of 238 patients (0%) treated with the Mynx. Major vascular complications occurred in 4 of 190 patients (2.1%) treated with the AngioSeal versus 5 of 238 patients (2.1%) treated with the Mynx (p not significant). Major vascular complications in patients treated with the AngioSeal included removal of a malfunctioning device (1.1%), hemorrhage requiring intervention (0.5%) and hemorrhage with a loss of > 3g Hgb (0.5%). The major vascular complications in patients treated with the Mynx included retroperitoneal bleeding requiring surgical intervention (0.8%), pseudoaneurysm with surgical repair (0.8%) and hemorrhage with a loss of > 3g Hgb (0.4%). These complications were not significantly different between the two vascular closure devices (p = 0.77). Minor complications included hematoma > 5 cm (0.5%, n = 1) within the AngioSeal group, as well as procedure failure requiring > 30 minutes of manual compression after device deployment, which occurred in 7 out of 190 patients (3.7%) treated with the AngioSeal versus 22 of 238 patients with the Mynx (9.2%) (p = 0.033). CONCLUSIONS: Major vascular complications after PCI following hemostasis with vascular closure devices occurred in 2.1% of 190 patients treated with the AngioSeal vascular closure device versus 2.1% of 238 patients treated with the Mynx vascular closure device (p not significant). The Mynx vascular closure device appears to have a higher rate of device failure.

Relation of cardiac troponin I levels with in-hospital mortality in patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage.

Troponin I levels were drawn within 24 hours of stroke in 161 of 175 patients (92%) with ischemic stroke, 94 of 107 patients (88%) with intracerebral hemorrhage, and 96 of 96 patients (100%) with subarachnoid hemorrhage. A troponin level >0.4 ng/ml was considered increased. In patients with ischemic stroke, in-hospital mortality occurred in 15 of 23 patients (65%) with increased troponin I compared with 6 of 138 patients (4%) with normal troponin I (p <0.001). In patients with intracerebral hemorrhage, in-hospital mortality occurred in 9 of 14 patients (64%) with increased troponin I compared with 22 of 80 patients (28%) with normal troponin I (p <0.005). In patients with subarachnoid hemorrhage, in-hospital mortality occurred in 8 of 20 patients (40%) with increased troponin I compared with 8 of 76 patients (11%) with normal troponin I (p <0.005). In conclusion, patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage with elevated troponin I levels have increased in-hospital mortality.

Prevalence of obstructive coronary artery disease in patients with and without prior stroke undergoing coronary angiography for suspected coronary artery disease.

This study was conducted to investigate the prevalence and severity of obstructive coronary artery disease (CAD) in 64 men and 38 women (mean age 71+/-9 years) with previous stroke and in 102 age- and gender-matched patients with similar coronary risk factors without previous stroke who underwent coronary angiography for chest pain. Obstructive CAD was present in 100 of 102 patients (98%) with previous stroke and in 84 of 102 (82%) patients without previous stroke (p<0.001). Obstructive 3-vessel CAD was present in 56 of 102 patients (55%) with previous stroke and in 35 of 102 patients (34%) without previous stroke (p<0.005). The prevalence of 2-vessel CAD and of 1-vessel CAD was not significantly different between patients with and without previous stroke. In conclusion, patients with previous stroke have a significantly higher prevalence of obstructive CAD and of obstructive 3-vessel CAD than age- and gender-matched patients with similar coronary risk factors without previous stroke who undergo coronary angiography for chest pain.