Cardiac Nurses

Current Awareness Newsletter

May 2016

Outreach

We can help with literature searching, obtaining journal articles and books, and setting up individual current awareness alerts. We also offer one-to-one or small group training in literature searching, accessing electronic journals,

and critical appraisal.

Literature Searching

We provide a literature searching service for any library member. For those embarking on their own research it is advisable to book some time with one of the librarians for a 1 to 1 session where we can guide you through the process of creating a well-focused literature research and introduce you to the health

databases access via NHS Evidence. Please email requests to library@uhbristol.nhs.uk

Books

Books can be searched for using SWIMS our online catalogue at www.swims.nhs.uk.

Inter-Library Loans

Books and journals that are not available on site or electronically may be requested from other locations. Please email requests to:

ills@UHBristol.nhs.uk

Upcoming Lunchtime Drop-in Sessions

June (12pm)

Weds 8th Understanding articles

Thurs 16th Statistics

Fri 24th Information resources

May (1pm)

Weds 4th Understanding articles

Thurs 12th Statistics

Fri 20th Information resources

Tues 31st Literature Searching

The Library and Information Service provides free specialist information skills training for

all UHBristol staff and students. To book a place, email: library@uhbristol.nhs.uk

If you’re unable to attend we also provide one-to-one or small group sessions. Contact

library@uhbristol.nhs.uk or katie.barnard@uhbristol.nhs.uk to arrange a session.

Tables of Contents from relevant journals

If you require full articles please email: library@uhbristol.nhs.uk

Journal of the American College of Cardiology Vol. 67, No. 19, May 17, 2016

Circulation Volume 133, Issue 19, May 10 2016 European Heart Journal Volume 37, Issue 18, 7 May 2016

Latest Cochrane Systematic Reviews

Table of Contents: Issue 5, 2016

Methotrexate for polymyalgia rheumatica Nataliya Milman, Samuel L Whittle, Catherine L Hill, Jinane El Sayad, George A Wells Online Publication Date:

Methotrexate for giant cell arteritis Nataliya Milman, Catherine L Hill, Samuel L Whittle, Jinane El Sayad, George A Wells Online Publication Date: May 2016

Recent Research from Research Gate click here

New NICE Guidance

No new guidelines published in May

UptoDate What's new in cardiovascular medicine Authors Gordon M Saperia, MD, FACC Susan B Yeon, MD, JD, FACC Brian C Downey, MD, FACC Contributor disclosures

All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Apr 2016. | This topic last updated: May 09, 2016.

The following represent additions to UpToDate from the past six months that were considered by the

editors and authors to be of particular interest. The most recent What's New entries are at the top of

each subsection.

ARRHYTHMIAS

Radiofrequency catheter ablation for patients with an ICD and recurrent shocks (May 2016)

Patients with an implantable cardioverter-defibrillator (ICD) who have recurrent ICD shocks due to

ventricular tachycardia (VT) experience significant discomfort and reduced quality of life, and the

effectiveness of antiarrhythmic drug therapy to prevent VT is limited. In the VANISH trial, a

multicenter, nonblinded trial of patients with prior myocardial infarction and an ICD who had at least

one episode of VT within the preceding six months while on antiarrhythmic drug therapy, patients

were randomized to radiofrequency catheter ablation (RFA) or escalated antiarrhythmic therapy [1].

Over a mean follow-up of 28 months, patients in the RFA group had significant reduction in the

composite primary outcome of death, VT storm, or appropriate ICD shocks, although there was no

difference in mortality alone. RFA is an option for reducing the morbidity associated with recurrent ICD

shocks in patients with ischemic cardiomyopathy who have recurrent VT despite antiarrhythmic drug

therapy. (See "Sustained monomorphic ventricular tachycardia in patients with a prior myocardial

infarction: Treatment and prognosis", section on 'Efficacy of catheter ablation'.)

CORONARY ARTERY BYPASS GRAFT SURGERY

Preoperative statin therapy does not decrease the risk of perioperative AF (May 2016)

Perioperative atrial fibrillation (AF) is common with cardiac surgery. Statins have been prescribed as

preventive therapy based on relatively weak evidence. In the STICS trial, 1922 patients in sinus

rhythm scheduled for elective cardiac surgery were randomly assigned to receive perioperative

rosuvastatin (20 mg daily) or placebo up to eight days before surgery [9]. There was no difference in

the rate of perioperative AF but a significant increase in the risk of acute kidney injury in the

rosuvastatin group. Based on available evidence, we do not start statins before cardiac surgery in

most cases. (See "Atrial fibrillation and flutter after cardiac surgery", section on 'Ineffective or possibly

effective therapies'.)

REFERENCES

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15. Cung TT, Morel O, Cayla G, et al. Cyclosporine before PCI in Patients with Acute Myocardial Infarction. N Engl J Med 2015; 373:1021.

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17. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127:e362.

18. Levine GN, Bates ER, Blankenship JC, et al. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. J Am Coll Cardiol 2016; 67:1235.

19. McMurray J, Krum H, Abraham WT. Aliskiren, Enalapril, or Aliskiren and Enalapril in Heart Failure. N Engl J Med 2016.

20. Nielsen PB, Larsen TB, Gorst-Rasmussen A, et al. β-Blockers in Atrial Fibrillation Patients With or Without Heart Failure: Association With Mortality in a Nationwide Cohort Study. Circ Heart Fail 2016; 9:e002597.

21. Lu M, Du H, Gao Z, et al. Predictors of Outcome After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: An Echocardiography and Cardiovascular Magnetic Resonance Imaging Study. Circ Cardiovasc Interv 2016; 9.

22. Behrens I, Basit S, Lykke JA, et al. Association Between Hypertensive Disorders of Pregnancy and Later Risk of Cardiomyopathy. JAMA 2016; 315:1026.

23. Li L, Li S, Deng K, et al. Dipeptidyl peptidase-4 inhibitors and risk of heart failure in type 2 diabetes: systematic review and meta-analysis of randomised and observational studies. BMJ 2016; 352:i610.

24. Redfield MM, Anstrom KJ, Levine JA, et al. Isosorbide Mononitrate in Heart Failure with Preserved Ejection Fraction. N Engl J Med 2015; 373:2314.

25. Liebregts M, Vriesendorp PA, Mahmoodi BK, et al. A Systematic Review and Meta-Analysis of Long-Term Outcomes After Septal Reduction Therapy in Patients With Hypertrophic Cardiomyopathy. JACC Heart Fail 2015; 3:896.

26. Cowie MR, Woehrle H, Wegscheider K, et al. Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure. N Engl J Med 2015; 373:1095.

27. Aurora RN, Bista SR, Casey KR, et al. Updated Adaptive Servo-Ventilation Recommendations for the 2012 AASM Guideline: "The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses". J Clin Sleep Med 2016.

28. Black S, Nicolay U, Del Giudice G, Rappuoli R. Influence of Statins on Influenza Vaccine Response in Elderly Individuals. J Infect Dis 2016; 213:1224.

29. Omer SB, Phadke VK, Bednarczyk RA, et al. Impact of Statins on Influenza Vaccine Effectiveness Against Medically Attended Acute Respiratory Illness. J Infect Dis 2016; 213:1216.

30. Ware JS, Li J, Mazaika E, et al. Shared Genetic Predisposition in Peripartum and Dilated Cardiomyopathies. N Engl J Med 2016; 374:233.

31. Howard G, Roubin GS, Jansen O, et al. Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials. Lancet 2016; 387:1305.

32. Rosenfield K, Matsumura JS, Chaturvedi S, et al. Randomized Trial of Stent versus Surgery for Asymptomatic Carotid Stenosis. N Engl J Med 2016; 374:1011.

33. Bonaca MP, Gutierrez JA, Creager MA, et al. Acute Limb Ischemia and Outcomes With Vorapaxar in Patients With Peripheral Artery Disease: Results From the Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With Atherosclerosis-Thrombolysis in Myocardial Infarction 50 (TRA2°P-TIMI 50). Circulation 2016; 133:997.

34. Laird JR, Schneider PA, Tepe G, et al. Durability of Treatment Effect Using a Drug-Coated Balloon for Femoropopliteal Lesions: 24-Month Results of IN.PACT SFA. J Am Coll Cardiol 2015; 66:2329.

35. Lonn EM, Bosch J, López-Jaramillo P, et al. Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. N Engl J Med 2016.

36. Rana JS, Liu JY, Moffet HH, et al. Diabetes and Prior Coronary Heart Disease are Not Necessarily Risk Equivalent for Future Coronary Heart Disease Events. J Gen Intern Med 2016; 31:387.

37. Siu AL, U S Preventive Services Task Force. Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2015; 163:861.

38. Yeh RW, Secemsky EA, Kereiakes DJ, et al. Development and Validation of a Prediction Rule for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary Intervention. JAMA 2016; 315:1735.

39. Myles PS, Smith JA, Forbes A, et al. Stopping vs. Continuing Aspirin before Coronary Artery Surgery. N Engl J Med 2016; 374:728.

40. Hermiller JB, Krucoff MW, Kereiakes DJ, et al. Benefits and Risks of Extended Dual Antiplatelet Therapy After Everolimus-Eluting Stents. JACC Cardiovasc Interv 2016; 9:138.

41. Andò G, Capodanno D. Radial Versus Femoral Access in Invasively Managed Patients With Acute Coronary Syndrome: A Systematic Review and Meta-analysis. Ann Intern Med 2015; 163:932.

42. Cassese S, Byrne RA, Ndrepepa G, et al. Everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting metallic stents: a meta-analysis of randomised controlled trials. Lancet 2016; 387:537.

43. Hong SJ, Kim BK, Shin DH, et al. Effect of Intravascular Ultrasound-Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial. JAMA 2015; 314:2155.

44. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med 2016; 374:1609.

45. Thourani VH, Kodali S, Makkar RR, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet 2016.

46. Smith PK, Puskas JD, Ascheim DD, et al. Surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med 2014; 371:2178.

47. Michler RE. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med 2016.

48. Kodali S, Williams MR, Doshi D, et al. Sex-Specific Differences at Presentation and Outcomes Among Patients Undergoing Transcatheter Aortic Valve Replacement: A Cohort Study. Ann Intern Med 2016; 164:377.

49. Sorajja P, Mack M, Vemulapalli S, et al. Initial Experience With Commercial Transcatheter Mitral Valve Repair in the United States. J Am Coll Cardiol 2016; 67:1129.

Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation. N Engl J Med 2016; 374:344.

Literature Search Search History: 1. BNI, Medline, CINAHL; (((atrial AND fibrillation) OR (inherited AND channelopathies) OR (cardiac AND

resynchronisation AND therapy))).ti,ab;

2. BNI, Medline, CINAHL; 1 [Limit to: Publication Year 2016-2016];

1: The role of comprehensive geriatric assessment and functional status in evaluating

the patterns of antithrombotic use among older people with atrial fibrillation. Source Archives of Gerontology & Geriatrics; Jul 2016 ; p. 248-254 Publication Date Jul 2016 Publication Type(s) Academic Journal Publisher Elsevier Science Authors Mazzone, A.; Bo, M.; Lucenti, A.; Galimberti, S.; Bellelli, G.; Annoni, G. Database CINAHL 2: Underutilization of Anticoagulation for Stroke Prevention in Atrial Fibrillation. Source Journal of the American College of Cardiology (JACC); May 2016 (no. 20); p. 2444-2446 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Elsevier Science Authors Piazza, Gregory; Karipineni, Neelima; Goldberg, Howard S.; Jenkins, Kathryn L.; Goldhaber, Samuel Z. Database CINAHL 3: Comparing the ATRIA, CHADS2, and CHA2DS2-VASc Scores for Stroke Prediction in Atrial Fibrillation. Source Journal of the American College of Cardiology (JACC); May 2016 (no. 19); p. 2316-2317 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Elsevier Science Authors Potpara, Tatjana S.; Olesen, Jonas B. Database CINAHL 4: Reply: Comparing the ATRIA, CHADS2, and CHA2DS2-VASc Scores for Stroke Prediction in Atrial Fibrillation. Source Journal of the American College of Cardiology (JACC); May 2016 (no. 19); p. 2317-2318 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Elsevier Science Authors van den Ham, Hendrika A.; Klungel, Olaf H.; Singer, Daniel E.; Leufkens, Hubert G.M.; van Staa, Tjeerd P. Database CINAHL 5: Recent Diabetes and Atrial Fibrillation Report Diverges From Pre-Existing Evidence. Source Journal of the American College of Cardiology (JACC); May 2016 (no. 19); p. 2318-2319 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Elsevier Science Authors Overvad, Thure Filskov; Brønnum Nielsen, Peter; Bjerregaard Larsen, Torben Database CINAHL 6: Reply: Recent Diabetes and Atrial Fibrillation Report Diverges From Pre-Existing Evidence. Source Journal of the American College of Cardiology (JACC); May 2016 (no. 19); p. 2319-2319 Publication Date May 2016

Publication Type(s) Academic Journal Publisher Elsevier Science Authors Ashburner, Jeffrey M.; Singer, Daniel E. Database CINAHL 7: Global longitudinal strain is associated with heart failure outcomes in hypertrophic cardiomyopathy. Source Heart; May 2016 (no. 10); p. 741-747 Publication Date May 2016 Publication Type(s) Academic Journal Publisher BMJ Publishing Group Authors Reant, Patricia; Mirabel, Mariana; Lloyd, Guy; Peyrou, Jérôme; Lopez Ayala, Jose-Maria; Dickie, Shaughan; Bulluck, Heeraj; Captur, Gabriella; Rosmini, Stefania; Guttmann, Oliver; Demetrescu, Camelia; Pantazis, Antonis; Tome-Esteban, Maite; Moon, James C.; Lafitte, Stephane; McKenna, William J. Database CINAHL Abstract Objective: We hypothesised that abnormal global longitudinal strain (GLS) would predict outcome in hypertrophic cardiomyopathy (HCM) better than current echocardiographic measures.Methods: Retrospective analysis of risk markers in relation to outcomes in 472 patients with HCM at a single tertiary institution (2006-2012). Exclusion criteria were left ventricular (LV) hypertrophy of other origin, patients in atrial fibrillation, lost to follow-up and insufficient image quality to perform strain analysis. Standardised echocardiogram recordings were reviewed and standard variables and LV GLS were measured. The primary end-point included all cardiac deaths, appropriate defibrillator shocks and heart failure (HF) admissions. The secondary end-point was death by HF and admissions related to HF.Results: Mean age was 50.0±15.0 years; 322 (68%) were men. At a median of 4.3 years (IQR 0.1-7.8) follow-up, 21 (4.4%) patients experienced cardiovascular death: 6 (1.3%) died from HF, 13 (2.7%) had sudden cardiac death and 2 (0.4%) died secondary to stroke. Four (0.8%) patients experienced appropriate defibrillator shock, and 13 (2.7%) were admitted for HF. On multivariate Fine-Gray proportional hazard analyses, GLS was significantly associated with the primary end-point (HR=0.90, 95% CI 0.83 to 0.98, p=0.018) independently of age, maximal provoked LV outflow-tract gradient and LV end-systolic volume. Moreover, GLS was particularly associated with the secondary end-point (HR=0.82, 95% CI 0.75 to 0.90, p<0.0001) independently of age, previous atrial fibrillation, New York Heart Association (NYHA) class III-IV, LV end-systolic volume, E/E', and outflow-tract gradient. Survival curves confirmed that GLS was associated with HF events (GLS <15.6%, p=0.0035).Conclusions: In patients with HCM, reduced GLS is an independent factor associated with poor cardiac outcomes, and particularly HF outcomes. 8: Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy. Source Circulation; May 2016 (no. 19); p. 1901-1905 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Lippincott Williams & Wilkins Authors MacIntyre, Ciorsti; Lakdawala, Neal K. Database CINAHL 9: Predicting Stroke in Patients With Atrial Fibrillation: An Incomplete Picture Without Considering Quality of Anticoagulation. Source Journal of the American College of Cardiology (JACC); May 2016 (no. 18); p. 2192-2193

Publication Date May 2016 Publication Type(s) Academic Journal Publisher Elsevier Science Authors Safder, Taimur B.; Badgett, Robert G. Database CINAHL 10: Rapid Ventricular Response or Tachycardia? The Three Faces of Atrial Fibrillation. Source American Journal of Emergency Medicine; May 2016 (no. 5); p. 931-932 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Elsevier Inc. Authors Ran, Ran; Kuang, Patricia; Mah, Nathan D. Database CINAHL 11: A rare complication of scorpion venom: atrial fibrillation. Source American Journal of Emergency Medicine; May 2016 (no. 5); p. 938.e1 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Elsevier Inc. Authors Duman, Ali; Turkdogan, Kenan Ahmet; Akoz, Ayhan; Avcil, Mucahit; Dagli, Bekir; Canakci, Selcuk Eren Database CINAHL 12: Multiple Chronic Conditions in Older Adults with Acute Coronary Syndromes. Source Clinics in Geriatric Medicine; May 2016 (no. 2); p. 291-303 Publication Date May 2016 Publication Type(s) Academic Journal Publisher W B Saunders Authors Alfredsson, Joakim; Alexander, Karen P Database CINAHL Abstract Older adults presenting with acute coronary syndromes (ACSs) often have multiple chronic conditions (MCCs). In addition to traditional cardiovascular (CV) risk factors (ie, hypertension, hyperlipidemia, and diabetes), common CV comorbidities include heart failure, stroke, and atrial fibrillation, whereas prevalent non-CV comorbidities include chronic kidney disease, anemia, depression, and chronic obstructive pulmonary disease. The presence of MCCs affects the presentation (eg, increased frequency of type 2 myocardial infarctions [MIs]), clinical course, and prognosis of ACS in older adults. In general, higher comorbidity burden increases mortality following MI, reduces utilization of ACS treatments, and increases the importance of developing individualized treatment plans. 13: Multimorbidity in Older Adults with Atrial Fibrillation. Source Clinics in Geriatric Medicine; May 2016 (no. 2); p. 315-329 Publication Date May 2016 Publication Type(s) Academic Journal Publisher W B Saunders Authors Chen, Michael A Database CINAHL Abstract Older adults with atrial fibrillation often have multiple comorbid conditions, including

common geriatric syndromes. Pharmacologic therapy, whether for rate control or rhythm control, can result in complications related to polypharmacy in patients who are often on multiple medications for other conditions. Because of uncertainty about the relative risks and benefits of rate versus rhythm control (including antiarrhythmic or ablation therapy), anticoagulation, and procedural treatments (eg, ablation, left atrial appendage closure, pacemaker placement) in older patients with multimorbidity, shared decision-making is essential. However, this may be challenging in patients with cognitive dysfunction, high fall risk, or advanced comorbidity. 14: Anticoagulation in Older Adults with Multimorbidity. Source Clinics in Geriatric Medicine; May 2016 (no. 2); p. 331-346 Publication Date May 2016 Publication Type(s) Academic Journal Publisher W B Saunders Authors Parks, Anna L; Fang, Margaret C Database CINAHL Abstract The number of patients with atrial fibrillation (AF) who are of advanced age or have multiple comorbidities is expected to increase substantially. Older patients with AF generally gain a net benefit from anticoagulation. Guidelines typically recommend anticoagulation. There are multiple challenges in the safe use of anticoagulation in frail patients, including bleeding risk, monitoring and adherence, and polypharmacy. Although there are options for chronic oral anticoagulation, clinicians must understand the unique advantages and disadvantages of these medications when developing a management plan. This article reviews issues surrounding the appropriate use and selection of anticoagulants in complex older patients with AF. 15: New-Onset Atrial Fibrillation in Sepsis: So Common, but So Different. Source Critical Care Medicine; May 2016 (no. 5) Publication Date May 2016 Publication Type(s) Academic Journal Publisher Lippincott Williams & Wilkins Authors Guenancia, Charles; Laurent, Gabriel; Bruyère, Rémi; Quenot, Jean-Pierre Database CINAHL Abstract A letter to the editor is presented in response to the article "Atrial fibrillation is an independent predictor of mortality in critically ill patients" by Ciara M. Shaver and colleagues that was published in the previous issue. 16: Increased P-wave dispersion a risk for atrial fibrillation in adolescents with anorexia nervosa. Source Eating Disorders; May 2016 (no. 3); p. 289-296 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Routledge Authors Ertuğrul, İlker; Akgül, Sinem; Derman, Orhan; Karagöz, Tevfik; Kanbur, Nuray Database CINAHL 17: Could Transthoracic Echocardiography Results Be Convincing Enough to Impact the Management of Atrial Fibrillation? Source Echocardiography; May 2016 (no. 5); p. 672-673 Publication Date May 2016

Publication Type(s) Academic Journal Publisher Wiley-Blackwell Authors Donal, Erwan; Colette, Edouard; Hubert, Arnaud Database CINAHL 18: Clinical Relevance of Left Atrial Strain to Predict Recurrence of Atrial Fibrillation after Catheter Ablation: A Meta-Analysis. Source Echocardiography; May 2016 (no. 5); p. 724-733 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Wiley-Blackwell Authors Ma, Xin-Xin; Boldt, Leif-Hendrik; Zhang, Yue-Li; Zhu, Meng-Ruo; Hu, Bing; Parwani, Abdul; Belyavskiy, Evgeny; Radha Krishnan, Aravind K.; Krisper, Maximilian; Köhncke, Clemens; Osmanoglou, Engin; Kropf, Martin; Lacour, Philipp; Blaschke, Florian; Edelmann, Frank; Tschöpe, Carsten; Haverkamp, Wilhelm; Pieske-Kraigher, Elisabeth; Pieske, Burkert; Morris, Daniel A. Database CINAHL 19: First-degree atrioventricular block: risk marker or innocent finding? Source Heart; May 2016 (no. 9); p. 655-656 Publication Date May 2016 Publication Type(s) Academic Journal Publisher BMJ Publishing Group Authors Aro, Aapo L. Database CINAHL Abstract The author reflects on the finding about the community risks brought by first-degree atrioventricular (AV) block to the community. The author then stated the varying results from different students conducted regarding the increased risk of first-degree AV block in atrial fibrillation, heart failure and all-cause mortality to the population. The author also presented the factors associated with PR prolongation and clinical importance. 20: Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis. Source Heart; May 2016 (no. 9); p. 672-680 Publication Date May 2016 Publication Type(s) Academic Journal Publisher BMJ Publishing Group Authors Chun Shing Kwok; Rashid, Muhammad; Beynon, Rhys; Barker, Diane; Patwala, Ashish; Morley-Davies, Adrian; Satchithananda, Duwarakan; Nolan, James; Myint, Phyo K.; Buchan, Iain; Loke, Yoon K.; Mamas, Mamas A.; Kwok, Chun Shing Database CINAHL Abstract Objective: First-degree atrioventricular block is frequently encountered in clinical practice and is generally considered a benign process. However, there is emerging evidence that prolonged PR interval may be associated with adverse outcomes. This study aims to determine if prolonged PR interval is associated with adverse cardiovascular outcomes and mortality.Methods: We searched MEDLINE and EMBASE for studies that evaluated clinical outcomes associated with prolonged and normal PR intervals. Relevant studies were pooled using random effects meta-analysis for risk of mortality, cardiovascular mortality, heart failure, coronary heart disease, atrial fibrillation and stroke or transient

ischaemic attack (TIA). Sensitivity analyses were performed considering the population type and the use of adjustments.Results: Our search yielded 14 studies that were undertaken between 1972 and 2011 with 400 750 participants. Among the studies that adjusted for potential confounders, the pooled results suggest an increased risk of mortality with prolonged PR interval risk ratio (RR) 1.24 95% CI 1.02 to 1.51, five studies. Prolonged PR interval was associated with significant risk of heart failure or left ventricular dysfunction (RR 1.39 95% CI 1.18 to 1.65, three studies) and atrial fibrillation (RR 1.45 95% CI 1.23 to 1.71, eight studies) but not cardiovascular mortality, coronary heart disease or myocardial infarction or stroke or TIA. Similar observations were recorded when limited to studies of first-degree heart block.Conclusions: Data from observational studies suggests a possible association between prolonged PR interval and significant increases in atrial fibrillation, heart failure and mortality. Future prospective studies are needed to confirm the relationships reported, consider possible mechanisms and define the optimal monitoring strategy for such patients. 21: An intriguing intracardiac mass in a woman with atrial fibrillation. Source Heart; May 2016 (no. 9); p. 693-695 Publication Date May 2016 Publication Type(s) Academic Journal Publisher BMJ Publishing Group Authors Chirillo, Fabio; Fusaro, Michele; Morana, Giovanni; Olivari, Zoran Database CINAHL Abstract Clinical Introduction: A 74-year-old hypertensive woman presented with shortness of breath. There was no associated coughing, chest pain or fever. ECG identified atrial fibrillation with rapid ventricular response. A transoesophageal echocardiogram was scheduled to exclude thrombus before cardioversion (Figure 1A); however, an echogenic structure was seen (Figure 1B arrow, see online supplementary video 1) between the left atrium, the pulmonary artery and the aortic root.Question: Which of the following is the most likely diagnosis? Aortic valve endocarditis with annular abscessLeft atrial appendage thrombusLeft atrial myxomaPulmonary embolismFor the answer see page 727For the question see page 693. 22: Spatial Relationship of Focal Impulses, Rotors and Low Voltage Zones in Patients With Persistent Atrial Fibrillation. Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 507-514 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Wiley-Blackwell Authors SCHADE, ANJA; NENTWICH, KARIN; COSTELLO-BOERRIGTER, LISA C.; HALBFASS, PHILIPP; MUELLER, PATRICK; ROOS, MARKUS; BARTH, SEBASTIAN; KRUG, JOACHIM; SZOELLOESI, GEZA-ATILLA; LAPP, HARALD; DENEKE, THOMAS Database CINAHL 23: Spatial Relation Between Left Atrial Anatomical Contact Areas and Circular Activation in Persistent Atrial Fibrillation. Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 515-523 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Wiley-Blackwell Authors NAKAHARA, SHIRO; YAMAGUCHI, TAKANORI; HORI, YUICHI; ANJO, NAOFUMI; HAYASHI, AKIKO; KOBAYASHI, SAYUKI; KOMATSU, TAKAAKI; SAKAI, YOSHIHIKO; FUKUI,

AKIRA; TSUCHIYA, TAKESHI; TAGUCHI, ISAO Database CINAHL 24: Hybrid Procedure (Endo/Epicardial) versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation: Results from a Single Center. Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 524-530 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Wiley-Blackwell Authors EDGERTON, ZACHARY; PERINI, ALESSANDRO PAOLETTI; HORTON, RODNEY; TRIVEDI, CHINTAN; SANTANGELI, PASQUALE; BAI, RONG; GIANNI, CAROLA; MOHANTY, SANGHAMITRA; BURKHARDT, J. DAVID; GALLINGHOUSE, G. JOSEPH; SANCHEZ, JAVIER E.; BAILEY, SHANE; LANE, MAEGEN; BIASE, LUIGI; SANTORO, FRANCESCO; PRICE, JUSTIN; NATALE, ANDREA Database CINAHL 25: Comparison of Radiofrequency Catheter Ablation Between Asymptomatic and Symptomatic Persistent Atrial Fibrillation: A Propensity Score Matched Analysis. Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 531-535 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Wiley-Blackwell Authors WU, LINGMIN; LU, YANLAI; ZHENG, LIHUI; QIAO, YU; CHEN, GANG; DING, LIGANG; HOU, BINGBO; SUN, WEI; LIEW, REGINALD; ZHANG, SHU; YAO, YAN Database CINAHL 26: Catheter Ablation for 'Lone' Atrial Fibrillation: Efficacy and Predictors of Recurrence. Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 536-541 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Wiley-Blackwell Authors BUIATTI, A.; KAESS, B.; REENTS, T.; SEMMLER, V.; TELISHVESKA, M.; BOURIER, F.; KORNMAYER, M.; KOTTMAIER, M.; HESSLING, G.; DEISENHOFER, I. Database CINAHL 27: Coefficient of Variation of P-Wave Duration Is a Novel Atrial Heterogeneity Index to Predict Recurrence of Atrial Fibrillation After Catheter Ablation. Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 542-548 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Wiley-Blackwell Authors NAKATANI, YOSUKE; SAKAMOTO, TAMOTSU; MIZUMAKI, KOICHI; NISHIDA, KUNIHIRO; KATAOKA, NAOYA; TSUJINO, YASUSHI; YAMAGUCHI, YOSHIAKI; INOUE, HIROSHI Database CINAHL 28: Apixaban versus Warfarin for the Prevention of Periprocedural Cerebral Thromboembolism in Atrial Fibrillation Ablation: Multicenter Prospective Randomized Study. Source Journal of Cardiovascular Electrophysiology; May 2016 (no. 5); p. 549-554 Publication Date May 2016

Publication Type(s) Academic Journal Publisher Wiley-Blackwell Authors KUWAHARA, TAISHI; ABE, MITSUNORI; YAMAKI, MASARU; FUJIEDA, HIROYUKI; ABE, YUMIKO; HASHIMOTO, KATSUSHI; ISHIBA, MISAKO; SAKAI, HIROTSUKA; HISHIKARI, KEIICHI; TAKIGAWA, MASATERU; OKUBO, KENJI; TAKAGI, KATSUMASA; TANAKA, YASUAKI; NAKAJIMA, JUN; TAKAHASHI, ATSUSHI Database CINAHL 29: Prevalences of Peripheral Arterial Disease Diagnosed by Computed Tomography Angiography in Patients with Acute Ischemic Stroke. Source Journal of Stroke & Cerebrovascular Diseases; May 2016 (no. 5); p. 1128-1134 Publication Date May 2016 Publication Type(s) Academic Journal Publisher W B Saunders Authors Naito, Hiroyuki; Naka, Hiromitsu; Kobayashi, Megumi; Kanaya, Yuhei; Naito, Kasane; Kurashige, Takashi; Tokinobu, Hiroshi; Matsumoto, Masayasu Database CINAHL Abstract Background: Few studies have examined the prevalence of peripheral arterial disease (PAD) with the use of computed tomography angiography (CTA) in patients with acute ischemic stroke (AIS), although several reports have examined its prevalence using an ankle brachial index (ABI). We aimed to determine the prevalence of PAD indicated by CTA in patients with AIS and to clarify the prevalence of PAD in each clinical ischemic stroke subtype.Methods: We included 199 consecutive patients with AIS admitted to our hospital and divided them into PAD and non-PAD groups according to the CTA findings.Results: Of the 199 patients, 40 (20.1%) had PAD; 27 (67.5%) of the PAD patients were asymptomatic. The prevalence of abnormal ABI (≤.9) was 12.2%. Patients with PAD were older (78.3 ± 10.2 versus 71.5 ± 10.9, P <.001) and had a significantly lower ABI value (.89 ± .24 versus 1.15 ± .09, P <.001) and higher prevalence of diabetes mellitus (50.0% versus 31.4%, P = .028), atrial fibrillation (40.0% versus 16.4%, P = .001), coronary artery disease (32.5% versus 8.2%, P <.001), and intracranial arterial stenosis (47.5% versus 28.9%, P = .025) than patients without PAD. The prevalence of cerebral microbleeds was not different between patients with PAD and those without PAD (25.6% versus 25.4%, P = .985). The prevalence of PAD among ischemic stroke subtypes was highest in patients with cardioembolic infarction (40.5%).Conclusions: Almost one fourth of the AIS patients examined had PAD on CTA. Cardioembolic infarction patients showed the highest prevalence of PAD among the clinical ischemic subtypes, suggesting the coexistence of atheromatous diseases and atrial fibrillation. 30: Brain Natriuretic Peptide and Particular Left Ventricle Segment Asynergy Associated with Cardioembolic Stroke from Old Myocardial Infarction. Source Journal of Stroke & Cerebrovascular Diseases; May 2016 (no. 5); p. 1165-1171 Publication Date May 2016 Publication Type(s) Academic Journal Publisher W B Saunders Authors Hosomi, Naohisa; Yoshimoto, Takeshi; Kanaya, Yuhei; Neshige, Shuichiro; Hara, Naoyuki; Himeno, Takahiro; Kono, Ryuhei; Takeshima, Shinichi; Takamatsu, Kazuhiro; Ota, Tomoko; Miyamoto, Yoshinori; Yasuda, Kotaro; Shimoe, Yutaka; Ota, Taisei; Kuriyama, Masaru; Matsumoto, Masayasu Database CINAHL Abstract

Background: It is important to determine the usage of anticoagulants by defining the actual risk of cardioembolic stroke in patients with old myocardial infarction. In the present study, we aimed to more precisely evaluate the risks of each segment associated with cardioembolic stroke using a 16-segment model. The usage of the plasma brain natriuretic peptide (BNP) associated with cardioembolic stroke was also evaluated in comparison with a left ventricle ejection fraction less than 40%.Methods: There were a total of 190 ischemic stroke patients who had premorbid myocardial infarction. The study included a total of 143 ischemic stroke patients with old myocardial infarction who were available for evaluation and excluded patients with atrial fibrillation or acute myocardial infarction. Their left ventricle wall motion abnormality and the level of plasma BNP at their admission were analyzed.Results: Hypertension and a plasma BNP level of 206.9 pg/mL or higher, determined from the receiver operating characteristic curve, were independently associated with cardioembolic stroke (χ(2) = 35.6, R(2) = .30, P < .001). Adjusting for these factors, statistically independent high risk was observed at the basal-inferior, basal-inferolateral, mid-anterior, mid-anteroseptal, apical-anterior, and apical-septal left ventricles.Conclusion: High plasma BNP levels and left ventricular wall motion abnormalities in the segments perfused with left anterior descending coronary artery or right coronary artery show a high risk for cardioembolic stroke in patients with old myocardial infarction. Considering these factors, it could be possible to more precisely define the risk of cardioembolic stroke and to perform appropriate antithrombotic treatments in old myocardial infarction patients. 31: Routine Troponin Measurements Are Unnecessary to Exclude Asymptomatic Coronary Events in Acute Ischemic Stroke Patients. Source Journal of Stroke & Cerebrovascular Diseases; May 2016 (no. 5); p. 1215-1221 Publication Date May 2016 Publication Type(s) Academic Journal Publisher W B Saunders Authors Ali, Farwa; Young, Jimmy; Rabinstein, Alejandro A.; Flemming, Kelly D.; Fugate, Jennifer E. Database CINAHL Abstract Background: Obtaining serum troponin levels in every patient with acute stroke is recommended in recent stroke guidelines, but there is no evidence that these contribute positively to clinical care. We sought to determine the clinical significance of measuring troponin levels in acute ischemic stroke patients.Methods: We reviewed 398 consecutive patients with acute ischemic stroke at a large academic institution from 2010 to 2012. Troponin levels were measured as a result of protocol in place during part of the study period. The mean age was 70 years (standard deviation ±16 years) and 197 (49.5%) were men.Results: Chronic kidney disease was present in 78 (19.6%), coronary artery disease in 107 (26.9%), and atrial fibrillation in 107 (26.9%). Serum troponin T was measured in 246 of 398 patients (61.8%). Troponin was elevated (>.01 ng/mL) at any point in 38 of 246 patients (15.5%) and was elevated in 28 patients at all 3 measurements (11.3% of those with troponin measured). Only 4 of 246 patients (1.6%) had a significant uptrend. Two were iatrogenic in the setting of hemodynamic augmentation using vasopressors to maintain cerebral perfusion. One case was attributed to stroke and chronic kidney disease and another case to heart failure from inflammatory fibrocalcific mitral valvular heart disease.Conclusions: Serum troponin elevation in patients with ischemic stroke is not usually caused by clinically significant acute myocardial ischemia unless iatrogenic in the setting of vasopressor administration. Serum troponin levels should be measured judicially, based on clinical context, rather than routinely in all stroke patients.

32: Quantification of Right Ventricular Volume and Function Using Single-Beat Three-Dimensional Echocardiography: A Validation Study with Cardiac Magnetic Resonance. Source Journal of the American Society of Echocardiography; May 2016 (no. 5); p. 392-401 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Elsevier Science Authors Park, Jun-Bean; Lee, Seung-Pyo; Lee, Ju-Hee; Yoon, Yeonyee E; Park, Eun-Ah; Kim, Hyung-Kwan; Lee, Whal; Kim, Yong-Jin; Cho, Goo-Yeong; Sohn, Dae-Won Database CINAHL Abstract Background: Because of the unique geometry of the right ventricle, assessment of right ventricular (RV) volume and function is clinically challenging. The aim of this study was to investigate the feasibility of single-beat three-dimensional echocardiography (sb3DE) for RV volume and functional assessment in patients with dilated right ventricles.Methods: Fifty-two patients with severe tricuspid regurgitation or atrial septal defects were enrolled. Fifty patients underwent sb3DE and cardiac magnetic resonance (CMR) within 24 hours under a euvolemic state, and the results of sb3DE were compared with those of CMR, the reference method. Fifteen normal subjects were also recruited for a broader validation of sb3DE.Results: Of the 67 individuals, data from 59 study participants (44 patients and 15 normal subjects) with adequate image quality were analyzed (mean age, 46.9 ± 19.3 years; 58% women). The correlation was excellent between sb3DE and CMR for measuring RV volumes and RV ejection fraction (RVEF) (r = 0.96, r = 0.93, and r = 0.93 [P < .001 for all] for RV end-diastolic volume, RV end-systolic volume, and RVEF, respectively). Bland-Altman analysis revealed that RV volumes, but not RVEF, tended to be slightly underestimated by sb3DE (-5.8 ± 9.6%, -3.8 ± 14.1%, and -1.2 ± 9.4% for RV end-diastolic volume, RV end-systolic volume, and RVEF, respectively). Intra- and interobserver variability was acceptable for all indices (4.9% and 6.1% for RV end-diastolic volume, 4.2% and 7.9% for RV end-systolic volume, and 5.7% and 2.8% for RVEF, respectively). Among patients with RV dilation, the difference in RVEF between sb3DE and CMR was more pronounced in patients with atrial fibrillation than those in sinus rhythm (-5.9% vs 0.9%, P = .041).Conclusions: In patients with dilated right ventricles and in normal subjects, assessment of RV volume and systolic function by sb3DE is feasible in terms of accuracy and reproducibility. RV analysis using sb3DE can be performed in patients with atrial fibrillation, with the possibility of RVEF underestimation. 33: Survival in Patients with Degenerative Mitral Stenosis: Results from a Large Retrospective Cohort Study. Source Journal of the American Society of Echocardiography; May 2016 (no. 5); p. 461-469 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Elsevier Science Authors Pasca, Ioana; Dang, Patricia; Tyagi, Gaurav; Pai, Ramdas G Database CINAHL Abstract Background: Severe mitral annular calcification causing degenerative mitral stenosis (DMS) is increasingly encountered in patients undergoing mitral and aortic valve interventions. However, its clinical profile and natural history and the factors affecting survival remain poorly characterized. The goal of this study was to characterize the factors affecting survival in patients with DMS.Methods: An institutional echocardiographic database was searched for patients with DMS, defined as severe mitral annular calcification without

commissural fusion and a mean transmitral diastolic gradient of ≥2 mm Hg. This resulted in a cohort of 1,004 patients. Survival was analyzed as a function of clinical, pharmacologic, and echocardiographic variables.Results: The patient characteristics were as follows: mean age, 73 ± 14 years; 73% women; coronary artery disease in 49%; and diabetes mellitus in 50%. The 1- and 5-year survival rates were 78% and 47%, respectively, and were slightly worse with higher DMS grades (P = .02). Risk factors for higher mortality included greater age (P < .0001), atrial fibrillation (P = .0009), renal insufficiency (P = .004), mitral regurgitation (P < .0001), tricuspid regurgitation (P < .0001), elevated right atrial pressure (P < .0001), concomitant aortic stenosis (P = .02), and low serum albumin level (P < .0001). Adjusted for propensity scores, use of renin-angiotensin system blockers (P = .02) or statins (P = .04) was associated with better survival, and use of digoxin was associated with higher mortality (P = .007).Conclusions: Prognosis in patients with DMS is poor, being worse in the aged and those with renal insufficiency, atrial fibrillation, and other concomitant valvular lesions. Renin-angiotensin system blockers and statins may confer a survival benefit, and digoxin use may be associated with higher mortality in these patients. 34: Impact of thyroidectomy on cardiac manifestations of Graves' disease. Source Laryngoscope; May 2016 (no. 5); p. 1256-1259 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Wiley-Blackwell Authors Gauthier, Jason M.; Mohamed, Hossam Eldin; Noureldine, Salem I.; Nazari-Shafti, Timo Z.; Thethi, Tina K.; Kandil, Emad Database CINAHL Abstract Objectives/hypothesis: Graves' disease (GD) has multiple adverse effects on the cardiovascular system. We aimed to examine the outcome of thyroidectomy in patients with cardiac manifestations of GD and evaluate their associated postoperative complications.Study Design: Retrospective analysis using a prospectively collected database.Methods: A retrospective analysis of our prospectively collected thyroid surgery database was performed. Forty patients with hyperthyroidism due to GD were identified, and each was appropriately age matched to a euthyroid patient with multinodular goiter (MNG). All patients underwent total thyroidectomy. Data relating to cardiac comorbidities were collected from preoperative and postoperative clinic notes, hospital admissions, electrocardiograms, echocardiograms, and blood work. Perioperative biochemical, cardiovascular, and postoperative outcomes were analyzed.Results: Twenty-four (60%) GD patients and 14 (35.0%) MNG patients had cardiac manifestations (P = .001). Hypertension resolved in 41.7% of GD patients and 7.7% of MNG patients (P = .00002). Two of the three GD patients with congestive heart failure (CHF) had resolution of CHF with significant improvement in ejection fraction, whereas the one MNG patient with CHF saw no change. Additionally, the majority of GD patients saw a resolution of their tachycardia (68.8%) and atrial fibrillation (100%). Four postoperative complications occurred in both the GD and MNG groups (4/40, 10%).Conclusions: Surgical treatment of GD in patients with cardiac manifestations offers rapid clinical improvement of hypertension, impaired left ventricular systolic function, and arrhythmias. When performed by a high-volume surgeon, the complication rate is similar to thyroidectomy for other benign disease.Level Of Evidence: 4. Laryngoscope, 126:1256-1259, 2016. 35: Temporal Trends in the Use of Investigations After Stroke or Transient Ischemic Attack. Source Medical Care; May 2016 (no. 5); p. 430-434

Publication Date May 2016 Publication Type(s) Academic Journal Publisher Lippincott Williams & Wilkins Authors Ng, Vivian T.; Bayoumi, Ahmed M.; Jiming Fang; Burton, Kirsteen R.; Stamplecoski, Melissa; Edwards, Jodi D.; Kapral, Moira K.; Fang, Jiming Database CINAHL Abstract Background: Guidelines recommend that patients with stroke or transient ischemic attack (TIA) undergo neuroimaging and cardiac investigations to determine etiology and guide treatment. It is not known how the use of these investigations has changed over time and whether there have been associated changes in management.Objectives: To evaluate temporal trends in the use of brain and vascular imaging, echocardiography, and antithrombotic and surgical therapy after stroke or TIA.Research Design: We analyzed 42,738 patients with stroke or TIA presenting to any of the 11 regional stroke centers in Ontario, Canada between 2003 and 2012 using the Ontario Stroke Registry database. The study period was divided into 1-year intervals and we used the Cochran-Armitage test to determine trends over time.Results: Between 2003/2004 and 2011/2012, the proportion of patients undergoing brain imaging increased from 96% to 99%, as did the proportion receiving ≥3 brain scans (21%-39%), magnetic resonance imaging (13%-50%), vascular imaging (62%-88%), or echocardiography (52%-70%) (P<0.0001 for all comparisons). There was an increase in the proportion receiving any antithrombotic therapy (83%-91%, P<0.0001) but no change in use of anticoagulation (25% overall and 68% in subgroup with atrial fibrillation) or carotid revascularization (1.4%-1.5%, P=0.49).Conclusions: The use of investigations after stroke has increased over time without concomitant changes in medical or surgical management. Although initial neurovascular imaging is in accordance with practice guidelines, the use of multiple imaging procedures and routine echocardiography are of uncertain clinical effectiveness. 36: Novel Percutaneous Epicardial Autonomic Modulation in the Canine for Atrial Fibrillation: Results of an Efficacy and Safety Study. Source Pacing & Clinical Electrophysiology; May 2016 (no. 5); p. 407-417 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Wiley-Blackwell Authors MADHAVAN, MALINI; VENKATACHALAM, K.L.; SWALE, MATTHEW J.; DESIMONE, CHRISTOPHER V.; GARD, JOSEPH J.; JOHNSON, SUSAN B.; SUDDENDORF, SCOTT H.; MIKELL, SUSAN B.; LADEWIG, DOROTHY J.; NOSBUSH, TONI GRABINGER; DANIELSEN, ANDREW J.; KNUDSON, MARK; ASIRVATHAM, SAMUEL J. Database CINAHL 37: Redefining Valvular Atrial Fibrillation: Safety of Novel Oral Anticoagulants beyond Mitral Stenosis and Prosthetic Valves...Leef G, Qin D, Althouse A, Alam MB, Rattan R, Munir MB, Patel D et al. Risk of Stroke and Death in Atrial Fibrillation By Type of Anticoagulation: A Propensity-Matched Analysis. Pacing Clin Electrophysiol 2015;38:1310–1316. Source Pacing & Clinical Electrophysiology; May 2016 (no. 5); p. 511-512 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Wiley-Blackwell Authors CHUGH, YASHASVI; FAILLACE, ROBERT T. Database CINAHL

38: Letter by Doğanay et al Regarding Article, "Preexisting Heart Disease Underlies Newly Diagnosed Atrial Fibrillation After Acute Ischemic Stroke". Source Stroke (00392499); May 2016 (no. 5) Publication Date May 2016 Publication Type(s) Academic Journal Publisher Lippincott Williams & Wilkins Authors Doğanay, Fatma; Katlandur, Hüseyin; Özdil, Hüseyin; Rizos, Timolaos; Veltkamp, Roland Database CINAHL 39: Response to Letter Regarding Article, "Preexisting Heart Disease Underlies Newly Diagnosed Atrial Fibrillation After Acute Ischemic Stroke". Source Stroke (00392499); May 2016 (no. 5) Publication Date May 2016 Publication Type(s) Academic Journal Publisher Lippincott Williams & Wilkins Authors Rizos, Timolaos; Veltkamp, Roland Database CINAHL 40: Obstructive Sleep Apnea in Acute Stroke: A Role for Systemic Inflammation. Source Stroke (00392499); May 2016 (no. 5); p. 1207-1212 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Lippincott Williams & Wilkins Authors Ifergane, Gal; Ovanyan, Andrey; Toledano, Ronen; Goldbart, Aviv; Abu-Salame, Ibrahim; Tal, Asher; Stavsky, Moshe; Novack, Victor Database CINAHL Abstract Background and Purpose: Sleep-disordered breathing is common among patients with stroke resulting in 4- to 6-fold higher prevalence of obstructive sleep apnea (OSA). We prospectively evaluated clinical characteristics and laboratory markers of inflammation and coagulability associated with OSA severity during the acute post stroke period.Methods: Consecutive patients admitted to the department of Neurology after an acute ischemic stroke were evaluated during the first 48 hours of symptom onset using Watch peripheral arterial tonometry, a wrist-worn ambulatory sleep study device that utilizes peripheral arterial tonometry. Morning blood samples of the patient were tested for tumor necrosis factor, interleukin-6, and plasminogen activator inhibitor-1 levels.Results: A total of 43 patients with acute stroke were admitted during the study period, 22 (51%) of which have been found to have moderate sleep apnea (apnea hypopnea index [AHI]≥15), AHI≥5 was found in 86% of the patients, and severe OSA (AHI≥30) in 32.5%. Patients with OSA (AHI≥15) did not differ from the rest in stroke severity or symptoms, yet they had higher prevalence of recurrent stroke and atrial fibrillation. All 3 biomarkers levels were higher among patients with AHI≥15: tumor necrosis factor (6.39 versus 3.57 pg/mL), interleukin-6 (6.64 versus 3.14 pg/mL), and plasminogen activator inhibitor-1 (176.64 versus 98.48 pg/mL). After the stratification of AHI into 3 groups (AHI<5, 5-14, and ≥15), the analysis showed that only the highest AHI group differed from the other 2 groups in biomarkers levels.Conclusions: Use of bed-side somnography technology revealed that in an unselected sample of patients with acute ischemic stroke, almost 90% had sleep-disordered breathing with third having severe form of the disorder. Sleep-disordered breathing was associated with significantly increased levels of inflammatory biomarkers, providing possible pathophysiological explanation of

OSA-associated stroke risk. These results warrant prospective screening of patients with stroke for the presence of sleep-disordered breathing and lay the rationale for an interventional trial. 41: Ischemic Stroke Risk in Patients With Atrial Fibrillation and CHA2DS2-VASc Score of 1: Systematic Review and Meta-Analysis. Source Stroke (00392499); May 2016 (no. 5); p. 1364-1367 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Lippincott Williams & Wilkins Authors Joundi, Raed A.; Cipriano, Lauren E.; Sposato, Luciano A.; Saposnik, Gustavo Database CINAHL Abstract Background and Purpose: The CHA2DS2-VASc score aims to improve risk stratification of ischemic stroke among patients with atrial fibrillation to identify those who can safely forego oral anticoagulation. Oral anticoagulation treatment guidelines remain uncertain for CHA2DS2-VASc score of 1. We conducted a systematic review and meta-analysis of the risk of ischemic stroke for patients with atrial fibrillation and CHA2DS2-VASc score of 0, 1, or 2 not treated with oral anticoagulation.Methods: We searched MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science from the start of the database up until April 15, 2015. We included studies that stratified the risk of ischemic stroke by CHA2DS2-VASc score for patients with nonvalvular atrial fibrillation. We estimated the summary annual rate of ischemic stroke using random effects meta-analyses and compared the estimated stroke rates with published net-benefit thresholds for initiating anticoagulants.Results: 1162 abstracts were retrieved, of which 10 met all inclusion criteria for the study. There was substantial heterogeneity among studies. The summary estimate for the annual risk of ischemic stroke was 1.61% (95% confidence interval 0%-3.23%) for CHA2DS2-VASc score of 1, meeting the theoretical threshold for using novel oral anticoagulants (0.9%), but below the threshold for warfarin (1.7%). The summary incident risk of ischemic stroke was 0.68% (95% confidence interval 0.12%-1.23%) for CHA2DS2-VASc score of 0 and 2.49% (95% confidence interval 1.16%-3.83%) for CHA2DS2-VASc score of 2.Conclusions: Our meta-analysis of ischemic stroke risk in atrial fibrillation patients suggests that those with CHA2DS2-VASc score of 1 may be considered for a novel oral anticoagulant, but because of high heterogeneity, the decision should be based on individual patient characteristics. 42: Doppler Tissue Evaluation of Atrial Conduction Properties in Patients With Non-alcoholic Fatty-liver Disease. Source Ultrasonic Imaging; May 2016 (no. 3); p. 225-235 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Sage Publications Inc. Authors Ozveren, Olcay; Izgi, Cemil; Eroglu, Elif; Simsek, Mustafa Aytek; Turer, Ayca; Kucukdurmaz, Zekeriya; Cinar, Veysel; Degertekin, Muzaffer Database CINAHL Abstract Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in clinical practice, and there is an increasing trend in its prevalence in the general population. Recent studies have demonstrated increased risk of atrial fibrillation (AF) in NAFLD. However, information on the mechanism of increased risk of AF in NAFLD is lacking. Impaired atrial conduction is an important factor in the pathophysiology of AF. We

aimed to investigate atrial conduction properties in patients with NAFLD by tissue Doppler echocardiography. Fifty-nine ultrasound diagnosed NAFLD patients without clinical diagnosis of hypertension, diabetes mellitus, or cardiac disease and 22 normal subjects as controls were included in this study. Atrial conduction properties were assessed by electromechanical delay (EMD) derived from Doppler tissue echocardiography examination and P-wave dispersion (PWD) calculated from the 12-lead electrocardiogram. Inter-atrial and intra-atrial EMD intervals were significantly longer in NAFLD patients than in controls (inter-atrial EMD, 31.9 ± 8.5 ms vs. 23.4 ± 4.6 ms,p= 0.0001, and intra-atrial EMD, 14.3 ± 5.2 vs. 10.2 ± 4.0 ms,p= 0.001). Similarly, PWD was significantly higher in NAFLD patients compared with controls (49.2 ± 6.3 ms vs. 43.3 ± 4.2 ms,p= 0.0001). Maximum left atrial volume was also significantly higher in the NAFLD group than in controls (51 ± 11 mL vs. 34 ± 9 mL,p< 0.0001). This study demonstrated that atrial conduction is impaired in patients with NAFLD. Also, in a patient population of NAFLD without any clinical diagnosis of cardiac disease, diabetes, or hypertension, left atrial volume was increased compared with controls. These findings suggest impaired atrial conduction as a factor in increased risk of AF in NAFLD. 43: Quality of Life Experiences among Women with Atrial Fibrillation: Findings from an Online Survey. Source Women's Health Issues; May 2016 (no. 3); p. 288-297 Publication Date May 2016 Publication Type(s) Academic Journal Publisher Elsevier Science Authors Macario, Everly; Schneider, Yukari T.; Campbell, Susan M.; Volgman, Annabelle Santos Database CINAHL

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