Current Issue : January - March Volume : 2019 Issue Number : 1 Articles : 5 Articles
Atrial fibrillation (AF) is a common arrhythmia for which the genetic studies mainly focused on the genes involved in electrical\nremodeling, rather than left atrial muscle remodeling. To identify rare variants involved in atrial myopathy using mutational\nscreening, a high-throughput next-generation sequencing (NGS) workflow was developed based on a custom AmpliSeq panel\nof 55 genes potentially involved in atrial myopathy. This workflow was applied to a cohort of 94 patients with AF, 76 with atrial\ndilatation and 18 without. Bioinformatic analyses used NextGENe software and in silico tools for variant interpretation. The\nAmpliSeq custom-made panel efficiently explored 96.58% of the targeted sequences. Based on in silico analysis, 11 potentially\npathogenic missense variants were identified that were not previously associated with AF. These variants were located in genes\ninvolved in atrial tissue structural remodeling. Three patients were also carriers of potential variants in prevalent arrhythmiacausing\ngenes, usually associated with AF. Most of the variants were found in patients with atrial dilatation (n=9, 82%). This NGS\napproach was a sensitive and specific method that identified 11 potentially pathogenic variants, which are likely to play roles in the\npredisposition to left atrial myopathy. Functional studies are needed to confirm their pathogenicity....
Introduction. The value of contact force information for ablation of LA anterior line is unknown. In a prospective randomized\nclinical trial,we investigated if information on contact force during left atrial (LA) anterior line ablation reduces total radiofrequency\ntime and results in higher rates of bidirectional line block in patients undergoing pulmonary vein isolation (PVI) plus substrate\nmodification. Methods. We included patients with indication for pulmonary vein isolation (PVI) and additional substrate\nmodification. For LA anterior line ablation, patients were randomized to contact force information visible (n=35) or blinded\n(n=37). Patients received contrast enhanced cardiac magnetic resonance imaging (cMRI) before and 3-6 months after ablation to\nvisualize the LA anterior line. Primary endpoint was radiofrequency time to achieve bidirectional line block. Secondary endpoints\nwere completeness of the LA anterior line on cMRI, distribution of contact force, procedural data, adverse events, and 12 months\nsuccess rate. Results. In 72 patients (64±9 years, 68% male), bidirectional LA anterior line block was achieved in 70 (97%) patients.\nRadiofrequency time to bidirectional block did not differ significantly across groups (contact force information visible 23±18min\nversus contact force information blinded 21±15min, p=0.50). The LA anterior line was discernable on cMRI in 40 patients (82%)\nwithout significant differences across randomization groups (p=0.46). No difference in applied contact force was found depending\non cMRI line visibility. Twelve-month success and adverse event rates were comparable across groups. Conclusion. Information on\ncontact force does not significantly improve the ablation of LA anterior lines. Clinical Trial Registration.The trial was registered at\nhttp://www.clinicaltrials.gov by identifier: NCT02217657....
Background: To develop an effective health education program to prevent\ncardiovascular disease in middle-aged residents after retirement in underpopulated\nareas, we explored the effects of a stress management program based\non the type A behavior pattern. Methods: This study was carried out in a rural\ncity in Japan recognized as underpopulated and participants were civil\nservants aged 45 - 64 who joined a stress management program offered as\npart of staff training. Learning materials for the program were developed\nbased on the type A behavior pattern. Measures for the impact evaluation\nwere Bloomâ??s learning domains and stage of change for stress management\npractice. Measures for the outcome evaluation were KGâ??s Daily Life Questionnaire\n(KG Questionnaire), the Hospital Anxiety and Depression Scale\n(HADS) and the Framingham 10-year cardiovascular risk score (CVD risk\nscore). We statistically analyzed changes in each item between time points.\nResults: Eighteen participants completed questionnaire surveys at pre-, post-,\nand 4 weeks post-program and eleven had complete blood pressure and\nweight measurements at pre- and post-program. In the impact evaluation, the\nFriedman test found significant differences between the three time points in\nall of Bloomâ??s learning domain scores and stage of change for stress management.\nIn the post hoc analysis, a significant increase was seen between preand\npost-program and between pre- and 4 weeks post-program in cognitive\ndomain score, psychomotor domain score and stage of change for stress\nmanagement. In the outcome evaluation, a significant decrease in systolic\nblood pressure was seen between pre- and post-program. Conclusion: The\npresent study suggested that a stress management program using learning materials based on type A behavior could promote stress management practices\nand reduce the risk of cardiovascular disease. This stress management\nprogram is expected to be useful as a health promotion activity for middle-\naged residents after retirement in underpopulated areas....
Objective. To test if splenic Doppler resistive index (SDRI) allows noninvasivemonitoring of changes in stroke volume and regional\nsplanchnic perfusion in response to fluid challenge. Design and Setting. Prospective observational study in cardiac intensive care\nunit. Patients. Fifty-three patients requiring mechanical ventilation and fluid challenge for hemodynamic optimization after cardiac\nsurgery. Interventions. SDRI values were obtained before and after volume loading with 500 mL of normal saline over 20 min\nand compared with changes in systemic hemodynamics, determined invasively by pulmonary artery catheter, and arterial lactate\nconcentration as expression of splanchnic perfusion. Changes in stroke volume >10% were considered representative of fluid\nresponsiveness. Results. A <4% SDRI reduction excluded fluid responsiveness, with 100% sensitivity and 100% negative predictive\nvalue. A >9% SDRI reduction was amarker of fluid responsiveness with 100%specificity and 100%positive predictive value. A >4%\nSDRI reductionwas always associatedwithanimprovement of splanchnic perfusionmirrored by an increase in lactate clearance and\na reduction in systemic vascular resistance, regardless of fluid responsiveness. Conclusions. This study shows that SDRI variations\nafter fluid administration is an effective noninvasive tool to monitor systemic hemodynamics and splanchnic perfusion upon\nvolume administration, irrespective of fluid responsiveness in mechanically ventilated patients after cardiac surgery....
Background: There is a need for data on epidemiological, clinical and therapeutic\naspects of ventricular septal defect among children in Sub-Saharan Africa.\nObjective: The aim of this study was to determine the prevalence, epidemioclinical,\nechocardiographic, therapeutic and evolutionary aspects of\nventricular septal defects (VSD) in the pediatric department of the University\nHospital Center (CHUSS) of Bobo-Dioulasso. Methods: This study was a\ndescriptive cross-sectional study, conducted from November 2013 to December\n2016. All children aged 1 to 179 months seen at the pediatric consultation\nin CHUSS were included. CIV was confirmed with Doppler echocardiography.\nResults: Out of 36,240 children who received consultation in the\npediatric ward of CHUSS during the study period, one hundred (100) cases of\nthem had congenital heart disease representing a hospital prevalence of\n2.76%. This was diagnosed with Doppler echocardiography. Of these, 88%\nwere VSD isolated or associated with other cardiac malformations. Isolated\nform was reported in 54.3% of cases. The average age at diagnosis was 39.6\nmonths. The sex ratio was 1.05. Perimembranous topography and hemodynamic\ntype 2 were the highest, representing 56.8% and 35.2% respectively.\nThe indication for surgical repair was recommended for 81.8% of the cases,\nbut only 9.7% of these cases benefited from cardiac surgery. The rest were for medicalcare with a high proportion of lost to follow-up (48.9%). Conclusion:\nVSD is the most common congenital heart disease. Its care is mainly\nsurgical. This cardiac surgery is non-existent in Burkina Faso. The design\nof multidisciplinary strategies associated with an optimization of the means\nof the countries of Sub-Saharan Africa could improve the management of\nthis cardiopathy....
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