Herz
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The treatment of mitral regurgitation has changed in recent years because of improvements in the surgical treatment, in particular valve repair, and the advent of interventional techniques, mainly percutaneous edge-to-edge repair. Regardless of the technique used, better results are obtained for interventions in primary mitral regurgitation than in secondary mitral regurgitation, which remains a challenge. Further developments are expected in the future thanks to a better understanding of the epidemiology and the mechanisms of secondary mitral regurgitation, the development of interventional techniques, and a careful evaluation.
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The Osborn wave is a deflection with a dome-shaped configuration at the R-ST junction of the electrocardiogram. It is mainly encountered in hypothermic states but is also recognized in other nonhypothermic conditions. ⋯ Most important is its arrhythmogenic potential especially when observed in patients with myocardial ischemia where it was found to be a precursor of malignant ventricular arrhythmias. Herein, we provide a comprehensive review of the history, causes, electrocardiographic and electrophysiologic characteristics, as well as diagnostic and prognostic significance of the Osborn wave.
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Practice Guideline
[Diagnosis and management of acute pulmonary embolism. ESC guidelines 2014].
Acute pulmonary embolism (PE) still represents a challenge regarding a rapid diagnosis and a risk-adapted therapy. In the 2014 guidelines of the European Society of Cardiology (ESC) on the diagnosis and management of acute PE, several new recommendations have been issued based on new study data. Some established scores for risk stratification were developed further and there is now good evidence for the use of age-adjusted D-dimer cut-off levels. ⋯ For the treatment of patients with venous thromboembolism with or without PE, the non-vitamin K-dependent oral anticoagulants (NOACs) are a safe alternative to the standard anticoagulation regimen with heparin and vitamin K antagonists. Systemic thrombolytic therapy should be restricted to patients with high risk or intermediate high risk with hemodynamic instability. Finally, new recommendations for the diagnosis and therapy of patients with chronic thromboembolic pulmonary hypertension (CTEPH), with cancer or during pregnancy are given.
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Review Meta Analysis
Antithrombotic therapy after percutaneous coronary intervention in patients requiring oral anticoagulant treatment. A meta-analysis.
The aim of this meta-analysis was to evaluate the benefits and risks of triple therapy (TT) compared with dual therapy (DT) for patients with an indication for anticoagulation who had undergone percutaneous coronary intervention. ⋯ Our analysis found no statistically significant difference between TT and DT with regard to all-cause death and MACE/stroke risk. At the same time, the available data demonstrated that TT increased the risk of major bleeding. If the international normalized ratio is in the target range, the risk of bleeding may be lowered. The data from Asian countries were limited, and therefore we could not assess the difference between TT and DT in Asian populations. Finally,on the basis of our analysis, we do not recommend TT as conventional treatment for patients taking OACs and undergoing percutaneous coronary intervention.
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Chronic total occlusion (CTO) lesions are a challenging issue. When dealing with complex CTO lesions in patients undergoing percutaneous coronary intervention (PCI), it is important to evaluate not only the CTO lesion itself but also atherosclerotic lesions of the whole coronary artery tree. The utility of the SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Trial) score in patients with CTO undergoing PCI is unclear. ⋯ The SYNTAX score is predictive of procedural failure, as is the J-CTO score. Furthermore, a higher SYNTAX score is strongly associated with an increased risk of 30-day MACE. The SYNTAX score is useful for clinical decision making when treating patients with complex CTO lesions.