Background Heart failure with preserved ejection fraction (HFPEF) is common and characterized by exercise intolerance and lack of proven effective therapies. Exercise training has been shown to be effective in improving cardiorespiratory fitness (CRF) in patients with systolic heart failure. In this meta-analysis, we aim to evaluate the effects of exercise training on CRF, quality of life and diastolic function in patients with HFPEF. Methods and Results Randomized controlled clinical trials that evaluated the efficacy of exercise training in patients with HFPEF were included in this meta-analysis. Primary outcome of the study was change in CRF (measured as change in peak oxygen uptake). Impact of exercise training on quality of life (estimated using Minnesota living with heart failure score), left ventricular systolic and diastolic function was also assessed. The study included 276 patients that were enrolled in 6 randomized controlled trials. In the pooled data analysis, HFPEF patients undergoing exercise training had significantly improved CRF (L/min) (Mean difference: 2.72; 95% CI: 1.79 to 3.65) and quality of life (Mean difference: −3.97; 95% CI: −7.21 to −0.72) as compared with the control group. However, no significant change was observed in the systolic function [Ejection Fraction – Weighted Mean difference (WMD): 1.26; 95% CI: −0.13% to 2.66%] or diastolic function [E/A - WMD: 0.08; 95% CI:−0.01 to 0.16] with exercise training in HFPEF patients. Conclusions Exercise training in patients with HFPEF is associated with an improvement in CRF and quality of life without significant changes in left ventricular systolic or diastolic function.

BackgroundThe impact of coronary artery disease (CAD) on outcomes after transcatheter aortic valve replacement (TAVR) is understudied. Literature on the prognostic role of CAD in the survival of patients undergoing TAVR shows conflicting results. This meta‐analysis aims to investigate how CAD impacts patient survival following TAVR.Methods and ResultsWe completed a comprehensive literature search of Embase, MEDLINE, and the Cochrane Library, and included studies reporting outcome of TAVR based on CAD status of patients for the analysis. From the initial 1631 citations, 15 studies reporting on 8013 patients were analyzed using a random‐effects model. Of the 8013 patients undergoing TAVR, with a median age of 81.3 years (79–85.1 years), 46.6% (40–55.7) were men and 3899 (48.7%) had CAD (ranging from 30.8% to 78.2% in various studies). Overall, 3121 SAPIEN/SAPIEN XT/SAPIEN 3 (39.6%) and 4763 CoreValve (60.4%) prostheses were implanted, with transfemoral access being the most frequently used approach for the implantation (76.1%). Our analysis showed no significant difference between patients with and without CAD for all‐cause mortality at 30 days post TAVR, with a cumulative odds ratio of 1.07 (95% confidence interval, 0.82–1.40; P=0.62). However, there was a significant increase in all‐cause mortality at 1 year in the CAD group compared with patients without CAD, with a cumulative odds ratio of 1.21 (95% confidence interval, 1.07–1.36; P=0.002).ConclusionsEven though coexisting CAD does not impact 30‐day mortality, it does have an impact on 1‐year mortality in patients undergoing TAVR. Our results highlight a need to revisit the revascularization strategies for concomitant CAD in patients with TAVR.

This study uniquely describes radiation dosimetry using contemporary equipment in a real-world setting. Extreme angulations were associated with high air kerma values. Fluoroscopy compared with acquisition was more sensitive to changes in angulation, with relatively larger increases in total air kerma with small increases in steepness of the angulation.

BackgroundSocioeconomic status (SES) as reflected by residential zip code status may detrimentally influence a number of prehospital clinical, access‐related, and transport variables that influence outcome for patients with ST‐elevation myocardial infarction (STEMI) undergoing reperfusion. We sought to analyze the impact of SES on in‐hospital mortality, timely reperfusion, and cost of hospitalization following STEMI.Methods and ResultsWe used the 2003–2011 Nationwide Inpatient Sample database for this analysis. All hospital admissions with a principal diagnosis of STEMI were identified using ICD‐9 codes. SES was assessed using median household income of the residential zip code for each patient. There was a significantly higher mortality among the lowest SES quartile as compared to the highest quartile (OR [95% CI]: 1.11 [1.06 to 1.17]). Similarly, there was a highly significant trend indicating a progressively reduced timely reperfusion among patients from lower quartiles (OR [95% CI]: 0.80 [0.74 to 0.88]). In addition, there was a lower utilization of circulatory support devices among patients from lower as compared to higher zip code quartiles (OR [95% CI]: 0.85 [0.75 to 0.97]). Furthermore, the mean adjusted cost of hospitalization among quartiles 2, 3, and 4, as compared to quartile 1 was significantly higher by $913, $2140, and $4070, respectively.ConclusionsPatients residing in zip codes with lower SES had increased in‐hospital mortality and decreased timely reperfusion following STEMI as compared to patients residing in higher SES zip codes. The cost of hospitalization of patients from higher SES quartiles was significantly higher than those from lower quartiles.

Using CT analysis, an SFAR of 1.45 and an SFAAR of 1.35 are each significant predictors of vascular complications among patients undergoing TF-TAVR. Utilization of CT-based area may provide a more accurate screen for patients undergoing evaluation for TF-TAVR as it takes into consideration the elliptical nature of the vessel. © 2014 Wiley Periodicals, Inc.

Background— X-ray use in the catheterization laboratory is guided by the principle of as low as reasonably achievable . In accordance with this principle, we reduced the default fluoroscopic frame rate from 10 to 7.5 frames/s and increased the emphasis on the use of low-dose acquisition starting January 1, 2013. We aimed to study the impact of these measures on the total air kerma during diagnostic catheterization (DC) and percutaneous interventions (PCI). Methods and Results— Propensity matching based on age, sex, body surface area, total fluoroscopy time, and total acquisition time was used to select matched patients for 2012 and 2013, further stratified by DC or PCI. The total air kerma was subsequently compared between 2012 and 2013, separately for DC and PCI. Median total air kerma during DC in 2013 was 625 mGy, which was significantly lower than the corresponding values in 2012 (median, 798 mGy; P <0.001). Similarly, median total air kerma during PCI in 2013 was 1675 mGy, which was significantly less than corresponding values in 2012 (median 2463 mGy, P <0.001). On comparison of air kerma rates between corresponding projections in 2 years, we observed a significant reduction in fluoroscopy- and acquisition-based air kerma rates in 2013, after institution of radiation reduction measures in all projections. Conclusions— With reduction in the default fluoroscopic frame rate and a greater use of low-dose acquisition, there has been a marked reduction in the total air kerma and air kerma rates for DC and PCI.

No abstract

Our systematic review suggested comparable efficacy of LAA occlusion devices compared with historical controls treated with adjusted-dose warfarin and other anticoagulation strategies for prevention of stroke in patients with NVAF.