Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Aug 2012
ReviewSilent brain injury after cardiac surgery: a review: cognitive dysfunction and magnetic resonance imaging diffusion-weighted imaging findings.
The appearance of cognitive dysfunction after cardiac surgery in the absence of focal neurologic signs, a poorly understood but potentially devastating complication, almost certainly results from procedure-related brain injury. Confirmation of the occurrence of perioperative silent brain injury has been developed through advances in magnetic resonance imaging (MRI) techniques. These techniques detect new brain lesions in 25% to 50% of patients after both coronary artery bypass graft and valve surgery. ⋯ It can be hypothesized that post-operative appearance of MRI lesions may serve as a more objective marker of brain injury in research efforts. If MRI examination can be used in this way, then 2 vitally important questions can be addressed. 1) What is the frequency of important, but silent, brain injury during cardiac surgery? 2) Does long-term cognitive impairment ensue? This review briefly discusses clinical features of post-operative cognitive dysfunction and reviews the evidence supporting a possible association with MRI evidence of perioperative brain injury and its potential for long-term dementia. We conclude that this association is plausible, but not yet firmly established.
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J. Am. Coll. Cardiol. · Aug 2012
Comparative StudyPerformance of the HEMORR(2)HAGES, ATRIA, and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation: the AMADEUS (evaluating the use of SR34006 compared to warfarin or acenocoumarol in patients with atrial fibrillation) study.
The objective of this study was to compare the predictive performance of bleeding risk-estimation tools in a cohort of patients with atrial fibrillation (AF) undergoing anticoagulation. ⋯ All 3 tested bleeding risk-prediction scores demonstrated only modest performance in predicting any clinically relevant bleeding, although the HAS-BLED score performed better than the HEMORR(2)HAGES and ATRIA scores, as reflected by ROC analysis, reclassification analysis, and decision-curve analysis. Only HAS-BLED demonstrated a significant predictive performance for intracranial hemorrhage. Given its simplicity, the HAS-BLED score may be an attractive method for the estimation of oral anticoagulant-related bleeding risk for use in clinical practice, supporting recommendations in international guidelines.
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J. Am. Coll. Cardiol. · Aug 2012
Pre-hospital electrocardiography by emergency medical personnel: effects on scene and transport times for chest pain and ST-segment elevation myocardial infarction patients.
This study sought to measure the impact of pre-hospital (PH) electrocardiography (ECG) on scene-to-hospital time for patients with chest pain of cardiac origin and those with ST-segment elevation myocardial infarction (STEMI). ⋯ Obtaining a PH ECG for patients with chest pain minimally prolongs scene and transport times. Further, for STEMI patients, both scene times and transport times are actually reduced leading to a potential reduction in total ischemic time.
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J. Am. Coll. Cardiol. · Aug 2012
Randomized Controlled Trial Multicenter StudyTadalafil for the treatment of pulmonary arterial hypertension: a double-blind 52-week uncontrolled extension study.
The aim of this study was to evaluate the long-term safety and durability of efficacy of tadalafil for pulmonary arterial hypertension. ⋯ Long-term treatment with tadalafil was well tolerated in patients with pulmonary arterial hypertension. In patients receiving either T20 mg or T40 mg, the improvements in 6MWD demonstrated in the 16-week PHIRST study appeared sustained for up to 52 additional weeks of treatment in PHIRST-2. (Pulmonary Arterial Hypertension and Response to Tadalafil Study; NCT00549302).