European heart journal
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European heart journal · Apr 2010
Multicenter Study Comparative StudyAcute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement.
Very few data exist on the occurrence of acute kidney injury (AKI) associated with transcatheter aortic valve implantation (TAVI). The objectives of the present study were (i) to determine the incidence, predictive factors, and prognostic value of AKI following TAVI, and (ii) to compare the occurrence of AKI in TAVI vs. surgical aortic valve replacement (SAVR) in patients with pre-procedural chronic kidney disease (CKD). ⋯ Acute kidney injury occurred in 11.7% of the patients following TAVI and was associated with a greater than four-fold increase in the risk of postoperative mortality. Hypertension, chronic obstructive pulmonary disease, and blood transfusion were predictive factors of AKI. In those patients with pre-procedural CKD, TAVI was associated with a significant reduction of AKI compared with SAVR.
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European heart journal · Apr 2010
Multicenter StudyThe impact of early standard therapy on dyspnoea in patients with acute heart failure: the URGENT-dyspnoea study.
The vast majority of acute heart failure (AHF) trials to date have targeted dyspnoea. However, they enrolled patients relatively late and did not standardize their methods of dyspnoea measurement. URGENT Dyspnoea was designed to determine changes in dyspnoea in response to initial, standard therapy in patients presenting with AHF using a standardized approach. ⋯ When sitting upright, dyspnoea in the sitting position improves rapidly and substantially in patients with AHF after administration of conventional therapy, mainly intra-venous diuretics. However, many patients remain orthopnoeic. Improving the methodology of clinical trials in AHF by standardizing the conditions under which dyspnoea is assessed could enhance their ability to identify effective treatments. Relief of orthopnoea is clinically valuable and may represent a useful goal for clinical trials.
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European heart journal · Apr 2010
ReviewThe current and future management of acute heart failure syndromes.
Hospitalization for heart failure (HF) marks a substantial crossroad for patients, as greater than one-third will be re-hospitalized or dead within 90 days post-discharge. For patients with chronic HF who present with acute heart failure syndromes (AHFS), they transition from an arena of well-established and life-saving evidence-based therapies to one where early pharmacological management has changed little over the last 40 years. ⋯ Optimizing management of known targets with proven evidence-based therapy has the potential to reduce post-discharge event rates. In this inaugural issue of the Frontiers in Cardiovascular Therapy, we briefly review current in-hospital management of AHFS, introduce the concept of cardiac reconstruction, and focus on the potential of future management strategies and therapeutics to improve outcomes in AHFS.
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European heart journal · Apr 2010
Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort of Atrial Fibrillation.
Knowledge about stroke risk in paroxysmal atrial fibrillation (PxAF) is limited. Although current guideline recommendations advocate the same treatment as in permanent atrial fibrillation (PermAF), most patients with PxAF do not receive prophylactic anticoagulation. The aim of this study is to investigate whether there are differences in stroke risk between PxAF and PermAF. ⋯ Ischaemic stroke is about as common in PxAF as in PermAF, and about twice as common as in the general population. Yet, PxAF patients do not receive protective anticoagulant treatment as often as patients with PermAF do. It is therefore important to increase the use of anticoagulants among PxAF patients in accordance with current guideline recommendations.