Among patients with heart failure and secondary mitral regurgitation, transcatheter mitral-valve repair resulted in a lower rate of hospitalization for heart failure and lower mortality than medical ...therapy alone. The goal for freedom from device-related complications was exceeded.
In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, transcatheter mitral valve repair (TMVr) ...resulted in fewer heart failure hospitalizations (HFHs) and lower mortality at 24 months in patients with heart failure (HF) with mitral regurgitation (MR) secondary to left ventricular dysfunction compared with guideline-directed medical therapy (GDMT) alone.
This study determined if these benefits persisted to 36 months and if control subjects who were allowed to cross over at 24 months derived similar benefit.
This study randomized 614 patients with HF with moderate-to-severe or severe secondary MR, who remained symptomatic despite maximally tolerated GDMT, to TMVr plus GDMT versus GDMT alone. The primary effectiveness endpoint was all HFHs through 24-month follow-up. Patients have now been followed for 36 months.
The annualized rates of HFHs per patient-year were 35.5% with TMVr and 68.8% with GDMT alone (hazard ratio HR: 0.49; 95% confidence interval CI: 0.37 to 0.63; p < 0.001; number needed to treat (NNT) = 3.0; 95% CI: 2.4 to 4.0). Mortality occurred in 42.8% of the device group versus 55.5% of control group (HR: 0.67; 95% CI: 0.52 to 0.85; p = 0.001; NNT = 7.9; 95% CI: 4.6 to 26.1). Patients who underwent TMVr also had sustained 3-year improvements in MR severity, quality-of-life measures, and functional capacity. Among 58 patients assigned to GDMT alone who crossed over and were treated with TMVr, the subsequent composite rate of mortality or HFH was reduced compared with those who continued on GDMT alone (adjusted HR: 0.43; 95% CI: 0.24 to 0.78; p = 0.006).
Among patients with HF and moderate-to-severe or severe secondary MR who remained symptomatic despite GDMT, TMVr was safe, provided a durable reduction in MR, reduced the rate of HFH, and improved survival, quality of life, and functional capacity compared with GDMT alone through 36 months. Surviving patients who crossed over to device treatment had a prognosis comparable to those originally assigned to transcatheter therapy. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation COAPT; NCT01626079).
Background Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin ...levels. Methods We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin <10 g/dL. Patients in the liberal transfusion strategy received one or more units of blood to raise the hemoglobin level ≥10 g/dL. Patients in the restrictive transfusion strategy were permitted to receive blood for symptoms from anemia or for a hemoglobin <8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization. Results Baseline characteristics were similar between groups except age (liberal, 67.3; restrictive, 74.3). The mean number of units transfused was 1.6 in the liberal group and 0.6 in the restrictive group. The primary outcome occurred in 6 patients (10.9%) in the liberal group and 14 (25.5%) in the restrictive group (risk difference = 15.0%; 95% confidence interval of difference 0.7% to 29.3%; P = .054 and adjusted for age P = .076). Death at 30 days was less frequent in liberal group (n = 1, 1.8%) compared to restrictive group (n = 7, 13.0%; P = .032). Conclusions The liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial.
Reduced leaflet motion was detected on computed tomography in 22 patients in a clinical trial of transcatheter aortic-valve replacement (TAVR) and in 17 patients in two registries. The condition ...resolved with anticoagulation.
Transcatheter aortic-valve replacement (TAVR) is a recent innovation in the management of aortic stenosis. The efficacy and safety of this therapeutic intervention have been studied in several randomized clinical trials.
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The Portico Re-sheathable Transcatheter Aortic Valve System U.S. Investigational Device Exemption (PORTICO IDE) study is an ongoing, prospective clinical trial to evaluate TAVR with either a Portico valve (St. Jude Medical) or a commercially available valve.
As specified in the PORTICO IDE protocol, computed tomography (CT) was performed in a subgroup of patients to assess the stent frame of the implanted valve. A finding of reduced leaflet motion on . . .
Adult-onset hearing loss is very common, but we know little about the underlying molecular pathogenesis impeding the development of therapies. We took a genetic approach to identify new molecules ...involved in hearing loss by screening a large cohort of newly generated mouse mutants using a sensitive electrophysiological test, the auditory brainstem response (ABR). We review here the findings from this screen. Thirty-eight unexpected genes associated with raised thresholds were detected from our unbiased sample of 1,211 genes tested, suggesting extreme genetic heterogeneity. A wide range of auditory pathophysiologies was found, and some mutant lines showed normal development followed by deterioration of responses, revealing new molecular pathways involved in progressive hearing loss. Several of the genes were associated with the range of hearing thresholds in the human population and one, SPNS2, was involved in childhood deafness. The new pathways required for maintenance of hearing discovered by this screen present new therapeutic opportunities.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In this trial, obese or overweight adults were randomly assigned to receive the selective serotonin 2C receptor agonist lorcaserin or placebo for 52 weeks, along with diet and exercise counseling. ...Lorcaserin use, in conjunction with behavioral modification, was associated with significant weight loss, improved maintenance of weight loss, and improved levels of cardiovascular biomarkers.
In obese or overweight adults, lorcaserin use in conjunction with behavioral modification was associated with significant weight loss, improved maintenance of weight loss, and improved levels of cardiovascular biomarkers.
Activation of the 5-hydroxytryptamine (5-HT, or serotonin) receptor 5-HT
2C
decreases food intake through the proopiomelanocortin system of neurons.
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Lorcaserin is a small-molecule agonist of the serotonin 2C (5-HT
2C
) receptor designed to promote weight loss. Study of the nonselective serotonergic agonists fenfluramine and dexfenfluramine, which enhance presynaptic serotonin release and block its reuptake, validated serotonin receptors as pharmacologic targets for weight loss.
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Unfortunately, use of these agents increases the risk of serotonin-associated valvulopathy,
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which is thought to occur through agonism of 5-HT
2B
receptors expressed on cardiac valvular interstitial cells.
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Lorcaserin was designed to selectively . . .
Electric Vehicles (EVs) replace fossil fuel vehicles in effort towards having more sustainable transport systems. The battery of an EV is recharged at a charging point using electricity. While some ...recharging will be required at locations where vehicles are normally parked, other recharging could be necessary at strategic locations of vehicular travel. Certain locations are suitable for EV charging station deployment, others are not. A multi-stage decision analysis methodology for selecting suitable locations for installing EV charging station is presented. The multi-stage approach makes it possible to select critical criteria with respect to any defined objectives of the EV charging station and techno-physio-socio-economic factors without which the EV charging station could not be deployed or would not serve its designated purpose. In a case, the type of charging station is specified, and a purpose is defined: rapid EV charging stations intended for public use within and across border regions. Applied in siting real EV charging stations at optimal locations, stages in the methodology present additional techno-physio-socio-economic factors in deploying the type of EV charging stations at optimal locations and keep the EV charging stations operating within acceptable standards. Some locations were dropped at the critical analysis stage; others were dropped at the site-specific analysis stage and replacement sites were required in certain instances. Final locations included most optimal, less optimal, least optimal, and strategic or special need locations. The average distances between contiguous recharging locations were less than 60 miles. Using any specified separation standard, the number of additional EV charging stations required between EV charging stations were determinable with the Pool Box. The Overall Charging Station Availability quadrants suggest that the overall user experience could get worse as less-standardized additional EV charging stations are deployed.
Eruptive xanthomas are localized lipid deposits in the dermis and an important early clue to severe hypertriglyceridemia. These small erythematous or yellow papules that localize to the extensor ...surfaces of extremities, buttocks, and the back are often overlooked during routine visits secondary to poor familiarity and limited skin examinations. We present 3 cases of patients with eruptive xanthomas and severe hypertriglyceridemia who underwent skin biopsy and waited weeks to years before receiving effective treatment. We suggest the following to minimize the delay between presentation and effective management. First, perform a comprehensive skin examination. Second, be mindful of the association between metabolic syndrome or diabetes with severe hypertriglyceridemia. Third, evaluate the Four D's of secondary hypertriglyceridemia: Diet/Lifestyle, Drugs/Medications, and Diseases/Disorders of metabolism. Finally, initiate effective treatment promptly after recognition. This includes beginning with a minimal fat diet and appropriate pharmacological intervention to control triglycerides as outlined in recent guidelines.
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