Degenerative mitral stenosis (DMS) is an increasingly recognized cause of mitral stenosis. The goal of this study was to compare echocardiographic differences between DMS and rheumatic mitral stenosis (RMS), identify echocardiographic variables reflective of DMS severity, and propose a dimensionless mitral stenosis index (DMSI) for assessment of DMS severity.

Patients with cardiogenic shock (CGS) requiring ventricular assist device (VAD) or a transplant as a durable solution for their end-stage heart failure often require mechanical circulatory support (MCS) prior to surgery. Prolonged bedrest due to implantation of an intraaortic balloon pump (IABP) in

Patients with cardiogenic shock(CGS) that will require ventricular assist device (VAD) or a transplant as a durable solution for their end-stage heart failure often require mechanical circulatory support (MCS) for a prolonged period prior to surgery. While the axillary approach to intraaortic

Cardiovascular disease (CVD) comprises a vast spectrum of disease states ranging from hypertension (HTN) to valvular heart disease (VHD). CVD is known to be the leading cause of morbidity, mortality, and health‐care expenditure throughout the world. According to the World Health Organization, coronary artery disease (CAD) and stroke, both subsets of CVD, are the world's biggest killers, accounting for a combined 15 million deaths in 2015. These diseases have remained the leading causes of death globally in the last 15 years. In 2010, CAD alone was projected to cost the U.S. $108.9 billion including the cost of health‐care services, medications, and lost productivity. The presence of frailty significantly worsens outcomes for patients suffering from CAD. With just this one example of how frailty affects CVD, it is clear that understanding the impact of frailty upon patients afflicted with the spectrum of cardiovascular disease is integral for the care of this very significant patient population.

Transcaval access (TCA) is a novel alternative to the traditional transfemoral arterial approach for patients requiring large catheter-based percutaneous procedures such as transcatheter aortic valve implantation (TAVI), left ventricular assist device (LVAD) and thoracic endovascular aortic repair (

BACKGROUND:Handgrip strength (HGS) and gait speed (GS) are objective components of the frailty syndrome in the elderly, and are associated with increased all-cause mortality. However, their association with cardiovascular (CVD) mortality is less lucid. The present systematic review aims to summarize the available literature assessing HGS, GS and their association with CVD Mortality. METHODS:Medline and Embase databases were searched systematically using controlled vocabulary and free text terms. A total of 344 results were obtained and scanned for inclusion. Articles were included if they presented results of original research and provided information on HGS or GS and CVD mortality. RESULTS:A total of 19 studies (N=63,396) were included for review. Twelve studies examined hand grip strength with CVD mortality and 7 studies assessed gait speed. Almost all included studies demonstrated an association of HGS/GS with CVD mortality on univariate analyses. Decreased HGS or GS were associated with increased mortality in most studies (8/12 for HGS and 6/7 for GS). In most positive studies, the association of HGS/GS was usually found to be independent of traditional CVD risk factors. CONCLUSION:The present review demonstrates that decreased HGS and GS are associated with CVD mortality, with the association found to be more consistent for GS as compared to HGS. Both of these measures provide valuable prognostic information above and beyond traditional scoring methods and should be considered for implementation in clinical practice.

We highlight the presence of a calcified mass in the left main coronary artery without significant atherosclerosis seen in the other coronary arteries or in the peripheral large arteries. In our view, the calcified character of the obstruction and the calcification of the aortic valve are characteristic of a variant type of coronary artery disease (CAD) not associated with the same risk factors as diffuse coronary atherosclerosis, but, in this case, with rheumatic heart disease. This case report also emphasizes the interventional approach for patients with aortic valve stenosis secondary to rheumatic heart disease.

Breast arterial calcification (BAC), observed as an incidental finding on screening mammograms, represents degenerative calcific changes occurring in the mammary arteries, with increasing age. The aim of this review is to discuss relevant literature examining relation between BAC and atherosclerosis. After a thorough literature search, in OVID and PubMed, 199 studies were identified, of which 25 were relevant to our review. Data were abstracted from each study and statistical analysis was done, including calculation of odds ratios and construction of forest plots. A total of 35,542 patients were enrolled across 25 studies looking at an association between BAC and coronary artery disease, cardiovascular disease, stroke, cerebral artery disease, carotid and peripheral artery diseases, and coronary artery calcification. A majority of the studies showed a statistically significant relation between BAC and presence of coronary artery disease cardiovascular disease and associated mortality. Sensitivity of BAC in predicting cardiovascular events was low, but specificity was high. BAC was predictive of incident and prevalent stroke but not mortality of stroke. Similarly, BAC was predictive of cerebral, carotid, and peripheral artery diseases. The role of BAC as a surrogate marker of coronary and systemic atherosclerosis is currently uncertain. Its role may be further elucidated by more large-scale prospective studies and clinical experience.

INTRODUCTION:Catheter ablation is an evolving therapeutic strategy for the management of atrial fibrillation (AF). It is associated with a risk of thromboembolic events. The peri-procedural anticoagulation management with warfarin has been successful in mitigating this risk. However, introduction of novel oral anticoagulants like dabigatran offers more flexibility in anticoagulation approaches. Previous studies had evaluated the safety and efficacy of dabigatran in the radiofrequency ablation, but data related to cryoballoon ablation is lacking.METHODS AND RESULTS:We performed a retrospective observational study involving patients who underwent cryoballoon ablation for drug-refractory, symptomatic AF while on dabigatran in periprocedural period. Thromboembolic, hemorrhagic or other complications occurring within the first 30 days after the ablation procedure were analyzed. Our study population comprised of 50 patients with mean age of 58.96 ± 3.54 years with 76% (n=38) being male. We found 3 (6%) minor complications in peri-procedural period including 2 groin hematomas and 1 trace asymptomatic pericardial effusion. There were no major intraprocedural or post procedural hemorrhagic or thromboembolic events. None of patients with the minor complications required significant additional workup or extended hospital stay. All the patients were able to continue dabigatran for 30 days without any additional side effects or complications.CONCLUSION:Dabigatran is a safe and efficacious agent in patients undergoing cryoballoon AF ablation.

The neutrophil-lymphocyte ratio (NLR) is an inflammatory marker of major adverse cardiac events (MACEs) in both acute coronary syndromes and stable coronary artery disease. The use of NLR as a predictive tool for MACEs among diabetic patients has not been elucidated. An observational study included 338 diabetic patients followed at our clinic between 2007 and 2011. Patients were arranged into equal tertiles according to the 2007 NLR. The MACEs included acute myocardial infarction, coronary revascularization, and mortality. The lowest NLR tertile (NLR < 1.6) had fewer MACEs compared with the highest NLR tertile (NLR > 2.36; MACEs were 6 of 113 patients vs 24 of 112 patients, respectively; P < .0001). In a multivariate model, the adjusted hazard ratio of third NLR tertile compared with first NLR tertile was 2.8 (95% confidence interval 1.12-6.98, P = .027). The NLR is a significant independent predictor of MACEs in diabetic patients. Further studies with larger numbers are needed.

Warfarin's monopoly as an anticoagulation therapy for atrial fibrillation has been challenged recently. RE-LY trial has shown superiority of dabigatran over warfarin in prevention of stroke with significantly lower risk of intracranial hemorrhage in patients with non-valvular atrial

A 50 year old male HIV patient on antiretroviral therapy was admitted for chest pain. Upon admission, the patient was found to have elevated cardiac enzymes, acute thrombocytopenia, hemolytic anemia, acute pancreatitis and acute renal failure. The patient was diagnosed with thrombotic thrombocytopenic purpura/haemolytic uremic syndrome and emergency plasma exchange therapy was initiated along with aspirin, beta-blockers, steroids, and antiretroviral therapy. Patient responded well and demonstrated complete resolution of ischemic cardiomyopathy with left ventricular ejection fraction improving from 35% to 55% by the time of discharge. Essentially, prompt diagnosis and treatment can reverse cardiac damage induced by thrombotic thrombocytopenic purpura.