Background. It remains uncertain how advances in revascularization techniques, availability of new evidence, and updated guidelines have influenced the annual rates of coronary revascularization in the United States.Methods. We used the Nationwide Inpatient Sample data from 2005 to 2014 with appropriate weighting to determine national procedural volumes. To present accurately overall percutaneous coronary intervention (PCI) rates, PCI with same-day discharge numbers per year were estimated from the available literature and added to annual PCI procedures performed.Results. Annual PCI rate declined from 353 per 100,000 adults in 2005 to 277 per 100,000 adults in 2009 (P < .001) but remained stable thereafter (P [ .50). Annual coronary artery bypass grafting (CABG) rate declined steadily, at a shallower slope than PCI, from 120 per 100,000 in 2005 to 93 per 100,000 in 2009 (P [ .02) but remained stable thereafter (P [ .60). Similar trends were seen in men and

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Background: Amiodarone is associated with heart block in patients with atrial fibrillation and heart failure. The safety of amiodarone use in patients with amyloid is unknown. We sought to identify the prevalence of heart block in patients with amyloid and heart failure who received amiodarone and compare them to those without amyloid in elderly patients. Methods: We searched Explorys (Explorys Inc, Cleveland, Ohio), a database that aggregates electronic health records of 45 million patients from 23 integrated health systems in the United States. We included patients who are at least 55 years of age who have heart failure and atrial fibrillation and receive amiodarone therapy. We compared those to age adjusted controls with heart failure and atrial fibrillation without amyloidosis. Results: We identified 640 patients with amyloid and 87280 patients without amyloid. Prevalence of block was higher in patients with amyloid on amiodarone (43.8% vs 30.0%, p!0.0001). When adjusted for age, odds ratio of block was as follows: 55-59 (1..0-1.8], p50.052), and 90+ (1.2 [0.9-1.7], p50.25), figure. Conclusion: Elderly patients with amyloidosis and heart failure who receive amiodarone are at higher risk of developing heart block. Amiodarone in this population should be used with caution and risk-benefit ratio should be addressed.Introduction: New onset heart failure (HF) in orthotopic liver transplant (OLT) patients has been described in the literature as a relatively uncommon but highly mortal condition. The pathophysiology remains unknown with many proposed theories. Current guidelines recommend against transplanting patients with heart failure. However, to date, there are no evidence-based screening algorithms to identify patients at risk for this clinical entity. Aims: We aimed to retrospectively explore the risk factors of both early and late HF in OLT and the utility of Dobutamine stress echocardiogram (DSE) in this regard. Methods: Medical records of 488 patient who received cadaveric OLT during the period of Jan.2001-Dec.2013 were reviewed. Echocardiographic and clinical parameters were examined as predictors of new HF using logistic regression analysis. HF was defined as either left ventricular (LV) ejection fraction of ! 45% or having diagnostic clinical features. 30 days post operatively was the cut off for early vs late HF. Echocardiographic assessment of diastolic function was not included in the analysis. Results: 262 patients had complete records including pre and post-OLT echocardiograms. 63% were males and 85% were Caucasians. History of ischemic heart disease was present in 5% and none had prior HF. Incidence of early HF was 6.9% (18 patients) and 9.9% (25 patients) for late HF. Median time to follow up echocardiogram was 251 days (interquartile range 46-1170 days). Pre-transplantation DSE was performed in 60% of analyzed cases and none of its parameters was associated with post-OLT HF. Independent predictors of developing HF were pre-OLT LV ejection fraction (MD -2.7%, P 0.001), LV systolic diameter (MD 1.6...

Chemotherapy agents have greatly improved outcomes and survival of patients with cancer but have also been associated with significant cardiotoxicity. The advent of cardiotoxicity is detrimental to patients both during cancer therapy, by limiting the extent of therapy and therefore chance of cure, and also during cancer survivorship, by causing devastating cardiac morbidity and mortality. In this article, we not only review the types of agents most often associated with cardiotoxicity, proposed mechanisms of cardiac injury, but more importantly, how to attenuate or prevent it all together. We review the available data and evidence for different strategies to prevent cardiac damage during chemotherpathy and propose our own protocols for risk stratification, monitoring, and prevention of cardiotoxicity.

Since its initial approval, the number of transcatheter aortic valve replacement procedures performed has increased exponentially with evolving indications that now include patients at intermediate risk for perioperative mortality following surgery. Multiple studies and reports have observed the phenomenon of leaflet dysfunction and thrombosis on follow-up imaging that may be associated with serious adverse outcomes. This review provides an insight into the incidence, predictors, management, and follow-up of transcatheter heartvalve thrombosis.

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Background T1 mapping is a novel tool allowing robust quantification of myocardial damage. Purpose To quantify and compare the native T1 values in myocardial segments supplied by an infarct related artery (IRA) and stenotic and non-stenotic artery (non IRA). Methods Consecutive patients with first STEMI underwent primary PCI for IRA and some non IRA's a followed by cardiac MRI scan within 5±2 days. Obstructive coronary disease was defined as ≥50% stenosis. MRI studies (3T) included steady state free precession, late gadolinium enhancement and MOLLI T1 mapping. T1 mapping values were presented using a 16th segment AHA model. T1 segmental values were compared between the IRA and non IRA (stenotic and non-stenotic). Results The study cohort included 61 patients (mean age 59 y, male 90%). A total of 891 segments were analyzed (excluded segments (artifacts) N=85). Mean native T1 values for LAD IRA (stented), LAD non-IRA (≥50% stenosis) (not stented), LAD non IRA (≥50% stenosis) (stented) and LAD non IRA (&lt;50% stenosis) were 1455±72; 1321±44; 1322±22 and 1283±32, respectively, overall P&lt;0.001. For LCX IRA (stented), LCX non-IRA (≥50% stenosis) (not stented), LCX-non IRA (≥50% stenosis) (stented) and LCX non IRA (&lt;50% stenosis) were 1362±75; 1277±50; 1277±72 and 1289±77, respectively, overall P&lt;0.001. For RCA IRA (stented), RCA non-IRA (≥50% stenosis) (not stented), RCA-non IRA (≥50% stenosis) (stented) and RCA non IRA (&lt;50% stenosis) were 1438±92; 1334±43; 1374±101 and 1311±34, respectively, overall P&lt;0.001. Native T1 values in non-IRA LAD ≥50% stenosis vs LAD &lt;50% stenosis were 1321±40 and 1283±32, respectively P=0.02, whereas non-IRA RCA ≥50% stenosis vs RCA &lt;50% stenosis were 1345±61 and 1312±34 respectively, P=0.05. Conclusion As expected, the highest native T1 values were documented in the stented IRA's. However, native T1 values were also elevated in non IRA's (both stented and non-stented) with obstructive coronary disease (≥50% stenosis) in comparison with non-obstructive disease (&lt;50% stenosis, documenting the presence of myocardial damage in remote segments. This finding sheds new light on the issue of complete revascularization in STEMI patients. Funding Acknowledgement Type of funding source: None

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