Transcatheter aortic valve replacement (TAVR) is increasingly being used for high and intermediate surgical risk aortic stenosis patients. Second generation TAVR valves (G2) with improved design have sought to address the drawbacks associated with first generation TAVR valves (G1). Electronic

Background: Sotalol is a class III anti-arrhythmic drug. According to the 2014 AHA/ACC/HRS guidelines on atrial fibrillation (AF), sotalol has a class I recommendation for use in maintenance of sinus rhythm but there are no recommendations regarding its use for pharmacologic cardioversion in AF.

Clopidogrel is metabolized by CYP2C19 enzyme to its active metabolite and omeprazole is a strong inhibitor of this enzyme and therefore is speculated to decrease the antiplatelet activity of clopidogrel. We searched PubMed, EBSCO and Google Scholar databases to identify studies assessing platelet

Appropriate sizing of the TAVR annular ring is crucial to prevent paravalvular aortic regurgitation (PAR). Multiple studies have been done comparing the use of conventional 2-D transesophageal echocardiography (TEE) versus multidetector computed tomography (MDCT) for appropriate sizing, on the PAR outcomes after TAVR. We aimed to perform a meta-analysis of the published studies. Pubmed, Embase and Cochrane databases were searched using the search terms multidetector computed tomography, transesophageal echocardiography, transcatheter aortic valve replacement, paravalvular aortic regurgitation and various combinations. The fixed effects model was used for analysis of homogenous endpoints, and the random effects model for heterogeneous endpoints. Forest plots were drawn. P < 0.05 was considered significant. Compared to TEE-based annular ring sizing, MDCT was associated with a significant decrease in greater than mild PAR (odds ratio (OR) 0.42; 95% confidence interval (CI) 0.28 to 0.63; p < 0.0001) and severe PAR (OR 0.41; 95% CI 0.17 to 0.96; p = 0.04). No significant differences were found in rates of annular rupture (OR 0.96; 95% CI 0.25 to 3.72; p = 0.95), no PAR (OR 1.43; 95% CI 0.98 to 2.08; p = 0.06), mild PAR (OR 1.21; 95% CI 0.85 to 1.73; p = 0.28), need for pacemaker implantation (OR 1.00; 95% CI 0.58 to 1.73; p = 0.99) and procedural mortality (OR 0.99; 95% CI 0.23 to 4.26; p = 0.99). Heterogeneity analysis showed none of the endpoints had significant heterogeneity. MDCT-based annular ring sizing was associated with significant decreases in greater than mild and severe paravalvular aortic regurgitation after TAVR, when compared to 2D TEE.

Objective Infective endocarditis is associated with high morbidity and mortality and optimal timing for surgical intervention is unclear. We performed a systematic review and meta-analysis to compare early surgical intervention with conservative therapy in patients with infective endocarditis.Methods PubMed, Cochrane, EMBASE, CINAHL and Google-scholar databases were searched from January 1960 to April 2015. Randomised controlled trials, retrospective cohorts and prospective observational studies comparing outcomes between early surgery at 20 days or less and conservative management for infective endocarditis were analysed.Results A total of 21 studies were included. OR of all-cause mortality for early surgery was 0.61 (95% CI 0.50 to 0.74, p<0.001) in unmatched groups and 0.41 (95% CI 0.31 to 0.54, p<0.001) in the propensity-matched groups (matched for baseline variables). For patients who had surgical intervention at 7 days or less, OR of all-cause mortality was 0.61 (95% CI 0.39 to 0.96, p=0.034) and in those who had surgical intervention within 8-20 days, the OR of mortality was 0.64 (95% CI 0.48 to 0.86, p=0.003) compared with conservative management. In propensity-matched groups, the OR of mortality in patients with surgical intervention at 7 days or less was 0.30 (95% CI 0.16 to 0.54, p<0.001) and in the subgroup of patients who underwent surgery between 8 and 20 days was 0.51 (95% CI 0.35 to 0.72, p<0.001). There was no significant difference in in-hospital mortality, embolisation, heart failure and recurrence of endocarditis between the overall unmatched cohorts.Conclusion The results of our meta-analysis suggest that early surgical intervention is associated with significantly lower risk of mortality in patients with infective endocarditis.

We sought to compare the long term outcomes of Percutaneous Coronary Revascularization (PCI) Vs CABS (Coronary Artery Bypass Surgery) for coronary stenoses with low (0-22) & intermediate (23-32) SYNTAX score PubMed & Web of Science were searched up to 15th October 2015 for studies comparing long

SESSION TITLE: Cardiovascular Disease SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Rates of readmission remain high following admission for acute decompensated heart failure (ADHF) and inadequate decongestion is one of the major contributors. While laboratory markers such as brain natriuretic peptide(BNP) have previously been identified, there is a need to identify additional clinical markers of adequate decongestion prior to discharge to improve outcomes. The purpose of this studywas to prospectively assess the utility of change (Δ) in QRS voltage (predischarge - baseline) and the 6-minute walk test (6-MWT) for predicting 1 year outcomes in patients admitted with ADHF. METHODS: This was a prospective observational study of patients admitted to the Creighton University Medical Center with ADHF (acute coronary syndrome excluded). An electrocardiogram (ECG) was obtained within 24 hours of admission and at discharge. The 6-MWT was administered on the day of discharge if the patient had no contraindications such as elevated fall risk. Follow up data were obtained by phone interview every 3 months for up to 12 months or until an occurrence of a primary outcome event (hospital and death records were reviewed where applicable). The primary outcome was a composite of all-cause mortality or readmission for heart failure (HF).ECG voltages were determined by 2 investigators blinded to the clincal and outcome data.6-MWT was administered by a trained nurse. RESULTS: Of the 46 patients enrolled, 1 withdrew consent leaving 45 for analysis. During 1 year of follow up, 25 (55%) had a primary outcome event. Nine (20%) died and 22 (49%) were readmitted for HF. Twenty eight (68%) had a decreased ejection fraction, 53% were male, Twenty eight (68%) had a decreased ejection fraction and 53% were male, 40% had diabetes, 89% had Hypertension 49% had coronary artery disease. There was no significant difference in Δ QRS voltage among those with and without the composite outcome. Patients with primary outcome event had a mean predischarge 6-MWT distance of 134±86 meters compared to 214±119 meters in those without. Advanced age, high creatinine level, non-use of angiotensin antagonists, and 6-MWT distance were predictors of primary outcome. A cut off of ≥100 meters on 6-MWT had a 73% sensitivity and 67% specificity for identifying freedom from the composite outcome at 1 year (area under the curve 0.78; p=0.01). CONCLUSIONS: In patients admitted with ADHF, pre-discharge 6-MWT distance was a predictor of the composite end point of all-cause mortality or re-hospitalization for HF, while ECG voltage changes were not. The independent utility of 6-MWT over and above existing predictors will need to be tested in future large prospective studies. CLINICAL IMPLICATIONS: In patients admitted for ADHF, predischarge 6-MWT can be a useful predictor of adeuqcy of decongestion and risk of readmission for HF. If the utility of this relatively inexpinsive and easily administered test is confirmed in larger studies, it can help identify patients who need further hospitalization and decongestion or close clinical follow up after discharge. DISCLOSURE: The following authors have nothing to disclose: Venkata Alla, Vimalkumar Veerappan Kandasamy, Janardhana Janardhana Gorthi, Manu Kaushik, Ajay Kaja, Zulie Zulkosky, Joshu teBensel, Tammy Burns, Mark Williams, Claire Hunter, Aryan Mooss, Dennis Esterbrooks No Product/Research Disclosure Information

There is limited data on recent trends of utilization and procedural outcomes of endomyocardial biopsy (EMB) in the United States. In this report we aim to study the nationwide trends in the performance EMB and in-hospital outcomes using the National Inpatient Sample (NIS) database. NIS data was

Introduction: Patients with myocardial infarction (MI) are at a higher risk of both ischemic and hemorrhagic cerebrovascular accidents (CVA). Data regarding trends and outcomes of patients hospitalized with MI and coexisting CVA remain scant. Hypothesis: Patients with MI with coexisting CVA have higher length and cost of hospitalization and higher in-hospital mortality compared to those without CVA. Methods: We assessed the incidence, trends and outcomes in patients with MI who had a CVA and compared this to patients with MI who did not have a CVA by utilizing nationwide inpatient sample database. Individual trends and outcomes of subarachnoid hemorrhage (SAH), hemorrhagic stroke (HS) and ischemic stroke (IS) were also assessed in patients with MI. Results: A total of 550,849 patients with a diagnosis of myocardial infarction were included in the analysis, out of which 84,981 patients had a coexisting diagnosis of CVA. The number of patients with coexisting MI and CVA increased significantly from 2005 to 2012 (10% vs 20%, p Conclusion: The rates of CVA in patients with MI have increased significantly in the United States. CVA is associated with a longer and costlier hospital stay and a higher in-hospital mortality in patients with MI.

Mitral annular calcification (MAC) & aortic valve sclerosis/stenosis (AS) are both known to be associated with increased risk of ischemic stroke. The independent association of MAC with stroke in the presence of severe AS is largely unknown, which we wanted to explore in this study. We

Pulmonary artery endarterectomy (PAE) is a complex curative surgery for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) and is performed in a limited number of centers across the United States. We used the nationwide inpatient sample (NIS), which is a 20% stratified sample of

Current ACC/AHA guidelines do not make recommendation to use Ezetimibe to reduce Atherosclerotic cardiovascular disease. Most recently, the IMPROVE-IT trial demonstrated improved cardiovascular outcomes with addition of Ezetimibe to statin (ES) compared to statin alone (S). We performed a Meta-

Evidence on cardiovascular outcomes with concomitant pharmacotherapy with proton pump inhibitors (PPI) and clopidogrel is mixed and varies across studies. We performed a meta-analysis of studies examining this relationship in both matched and unmatched cohorts. PubMed, Google Scholar and EBSCO

Recent randomized trials have raised concerns about the possibility of higher stent thrombosis (ST) with Bioabsorbable Vascular Scaffolds (BVS). We conducted this meta-analysis to further explore various types of ST rates with BVS in comparison to drug eluting stents (DES). PubMed, Web of Science