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

Introduction: Few studies have been published comparing the use of ultrafiltration (UF) versus intravenous diuretics for the treatment of patients with acute decompensated heart failure. The results have been mixed and the ideal management strategy is still not clear. We aimed to perform a meta-analysis of the published literature in this regard. Methods: We searched Pubmed, MEDLINE, EMBASE and Cochrane databases for terms "ultrafiltration", "diuretics", "heart failure" and their combinations. We included only randomized studies published in English language. Studies with less than 10 patients were excluded. Results: A total of 8 studies were included for analysis. Compared to intravenous diuretics, UF was not associated with any significant differences in length of hospitalization (Mean difference (MD) -1.96 days, 95% confidence interval (CI) -5.18-1.26, P = .23), heart failure readmissions (Odds ratio (OR) 0.76, 95% CI 0.42–1.40, P = .38) or mortality (OR 1.01, 95% CI 0.66–1.54, P = .97). However, UF was associated with significant decrease in 48 hour weight loss (MD 3.22 kg, 95% CI 0.23–6.21, P = .03) and fluid loss (MD 2.34 liters, 95% CI 1.09–3.59, P = .0002) when compared to intravenous diuretics.

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

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

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

Long-term superiority of mitral valve (MV) repair compared with replacement is well established in degenerative MV disease. In rheumatic heart disease, its advantages are unclear and it is often performed in conjunction with aortic valve (AV) replacement. Herein, we performed a systematic review and meta-analysis comparing outcomes of MV repair vs replacement in patients undergoing concomitant AV replacement. PubMed, Cochrane and Web of Science databases were searched up to 25 January 2014 for English language studies comparing outcomes of MV repair vs replacement in patients undergoing simultaneous AV replacement. Data of selected studies were extracted. Study quality, publication bias and heterogeneity were assessed. Analysis was performed using a random effects model (meta-analysis of observational studies in epidemiology recommendation). A total of 1202 abstracts/titles were screened. Of these, 20 were selected for full text review and 8 studies (3924 patients) were included in the final analysis: 1255 underwent MV repair and 2669 underwent replacement. Late outcome data were available in seven studies (cumulative follow-up: 15 654 patient-years). The early (in hospital and up to 30 days post-surgery) mortality [risk ratio (RR): 0.68, 95% confidence interval (CI): 0.53-0.87, P = 0.003] and late (>30 days post-surgery) mortality (RR: 0.76, 95% CI: 0.64-0.90 P = 0.001) were significantly lower in the MV repair group compared with the MV replacement group. The MV reoperation rate (RR: 1.89, 95% CI: 0.87-4.10, P = 0.108), thromboembolism (including valve thrombosis) (RR: 0.65, 95% CI: 0.38-1.13, P = 0.128) and major bleeding rates (RR: 0.88, 95% CI: 0.49-1.57, P = 0.659) were found to be comparable between the two groups. In a separate analysis of studies with exclusively rheumatic patients (n = 1106), the early as well as late mortality benefit of MV repair was lost (RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P = 0.199, respectively), whereas the MV reoperation rate became significantly higher (RR: 5.10, 95% CI: 1.62-16.05, P = 0.005) with MV repair. In patients undergoing concomitant mitral and AV surgery, MV repair is associated with improved early and late survival without any increased risk for mitral valve reoperation. However, in patients with rheumatic heart disease MV repair does not impart any survival advantage while the risk for MV reoperation remains significantly higher.

LARIAT is an endo-epicardial transcatheter left atrial appendage (LAA) exclusion technique that is increasingly being used for LAA exclusion. We searched for studies that reported the safety and outcomes of LAA exclusion using the LARIAT technique in PubMed, EBSCO and Google Scholar databases. Data

Interventions of the left main coronary artery are complex and require high degree of technical skills. Intravascular ultrasound (IVUS) can aid interventions of the left main coronary artery. We performed this meta-analysis to assess the efficacy of use of IVUS compared to angiographic-guided PCI.

Non sustained Ventricular arrhythmias (NSVA) are frequently noted in patients admitted with acute decompensated diastolic heart failure. However, the long term predictive value of NSVA in this setting is unclear. The objective was to elucidate the burden of ventricular arrhythmias in patients