简介：Themanagementofpatientswithseveresymptomaticaorticstenosisandahightransvalvulargradientisstraightforward.Itrequiresaorticvalvereplacement.Managementofaorticstenosispatientswithlowflow,lowejectionfractionandlowgradientisfraught.Suchpatientsrarelyfulfillallthetenetsof“severity”andalsohavesevereleftventriculardysfunction.Bothcircumstancesmaketheoutcomeofaorticvalvereplacementuncertain.Thusthemanagementofthisgroupofpatientsrequiresintegrationofalldiagnosticmodalitiesavailable.Thephysicalexamination,degreeofvalvecalcification,theappearanceofthevalveduringsonographicexaminationandthepresenceofinotropicreserveallcontributeimportantlyinjudgingstenosisseverityandthelikelihoodofsuccessfulvalvereplacement.

简介：Itisestimatedthatmorethanonemillionheartfailurehospitalizationsoccureachyear.Systolicheartfailureandheartfailurewithpreservedejectionfractioncontributeequallytoheartfailurehospitalizations.Heartfailurereadmissionratescontinuetobeabout25%.Strategiestoreduceheartfailurereadmissionarekeytoreducinghospitalizationrates.Thestrategiestoreduceheartfailurehospitalizationareasfollows:(1)Duringhospitalization,diuresistotheeuvolemicstateisessential.Fiftypercentofdischargedheartfailurepatientshaveminimalweightlossduringthehospitalization,representingminimaldiuresis,butstillfluidoverload.(2)Duringhospitalization,interrogatethedefibrillatororbiventricularpacemaker(ifapplicable)toensurethatthereisnorightventricularpacingandthereisappropriatebiventricularpacing.Interrogationofdevicescanidentifyarrhythmiaorsuboptimalbiventricularpacing,whichcancontributetodecompensation.(3)Beforedischarge,identifythereasonfordecompensation,suchasatrialfibrillation,infection,pulmonaryembolism,ornoncompliance.(4)Beforedischargeamultidisciplinaryteamisneededtoeducatethepatientondiet,medications,fluidweightsurveillance,andexercise.(5)Apostdischargevisitshouldoccurwithin10daysandwithemphasisonuptitrationofneurohormonalblockersandcontinuedcongestionmanagement.Suchinterventionsconductedbyamultidisciplinaryteamhavethepotentialtoreduceheartfailurehospitalizationrates.

简介：BackgroundTheCHA2DS2-VAScschemahasrecentlybeenintroducedtocomplementtheCHADS2scoreandimprovetheidentificationofatrialfibrillation(AF)patientsat'trulylowrisk'forthromboembolism.WetestedthepredictiveabilityoftheCHA2DS2-VASc,CHADS2andvanWalravenriskstratificationschemesinacohortof'lone'AFpatientswitha12-yearfollow-up.MethodsandResultsWeconductedaregistry-based,observationalcohortstudyof345patientsinitiallydiagnosedwith'lone'AFbetween1992and2007.Atbaseline,allpatientshadtheCHADS2andvanWalravenscoresof0,and262(75.9%)hadaCHA2DS2VAScscore=0.Duringfollow-up(orwithinayearpriortostroke),228(66.1%),234(67.8%)and150patients(43.5%)retainedtheCHADS2,vanWalravenandCHA2DS2VAScscoresof0,respectively.Theoverallrateofischemicstrokewas0.19(95%CI:0.18-0.20)per100patient-years.Inthemultivariableanalysis,onlytheCHA2DS2-VAScscoreof0wassignificantlyrelatedtotheabsenceofstroke(OR5.1,95%CI:1.5-16.8,P=0.008).OnlytheCHA2DS2-VAScscorehadasignificantpredictionability(c-statistic0.72[0.61-0.84],P=0.031).ConclusionsTheCHA2DS2-VAScscorereliablyidentifiedthe'lone'AFpatientswhowereat'trulylowrisk'forthromboembolism,andwastheonlytestedriskstratificationschemewithasignificantpredictiveabilityforthromboembolismamongstloneAFpatients.

简介：BackgroundIt'sestablishedthatLectin-likeoxidizedlow-densitylipoproteinreceptor-1(LOX-1)isinvolvedinintimalhyperplasiaafterballooninjury.Therecentevidencealsosuggeststhatvalsartanhasanantiatheroscleticeffect.Inthisstudy,theexpressionofLOX-1andtheeffectofvalsartanonitsexpressionwasinvestigatedinrataortaafterballooninjury.MethodsRatmodelofaorticendothelialdenudationwasinducedby2Fballooncatheter.Ratswererandomlydividedintothreegroups:control,operationandvalsartantreatment.Theaortictissuesweretakenfromratsineachgroupondays14and28aftersurgery.ThethicknessofvascularwallwasmeasuredwithHEstain,LOX-1mRNAandproteinweredeterminedbyreversetranscription-polymersechainreaction(RT-PCR)andimmunohistochemistry,respectively.ResultsComparedwiththecontrolgroup,significantintimalthickeningwasobservedatday14and28afterinjury.Comparedwiththeoperationgroup,intimalthicknessofeachtimepointwassignificantlydecreasedinvalsartantreatmentgroup.Atday14and28afterballooninjury,theexpressionlevelsofLOX-1mRNAandproteinweresignificantlyincreased,andweregreatlydecreasedaftervalsartantreatment.ConclusionsTheexpressionofLOX-1isincreasedafterendothelialinjury.Valsartaninhibitsaorticintimalthickeninginducedbyendothelialdenudation,whichisassociatedwiththedownregulationofLOX-1expression.

简介：BackgroundPriorrandomizedtrialshaveshownreducedbleedingwithbivalirudincomparedwithunfractionatedheparin(UFH)inpatientsundergoingpercutaneouscoronaryintervention(PCI).However,itisnotknownifthisbenefitisalsopresentwhenUFHdosesaremoretightlycontrolled(asmeasuredbyactivatedclot-tingtime,ACT).MethodsandResultsPatientsenrolledintheEVENT(EvaluationofDrug-ElutingStentsandIschemicEvents)registry,weredividedinto3groups,basedontheantithromboticdrugusedduringPCI(UFHmonotherapy,UFH+glycoproteinIIb-IIIareceptorinhibitor[GPI],orbivalirudinalone).Propensityscorematchingwasusedtoadjustformeasuredcovariates(89variables)andtocomparebivalirudinversusUFHmonotherapyandbivalirudinversusUFH+GPIgroups.TheUFHgroupswerestratifiedbasedonACTachieved(optimalACTdefinedas250-300forUFHmonotherapyand200-250whenGPIwasalsoused).Theprimarybleedingoutcomewasin-hospitalcompositebleeding,definedaseventsofaccesssitebleeding,ThrombolysisInMyocardialInfarctionmajor/minorbleeding,ortransfusion.Primary(in-hospitaldeath/myocardialinfarction)andsecondaryischemicoutcomes(death/MI/unplannedrepeatrevascularizationat12months)werealsoevaluated.Propensityscorematchingyielded3022patientsfortheUFHmonotherapyversusbivalirudincomparisonand3520patientsfortheUFH+GPIversusbivalirudincomparison.BivalirudinusewasassociatedwithnumericallylowerbleedingratesatallcategoriesofachievedACTwhencomparedwithUFH(low,optimal,highACT:2.5%versus4.7%,1.9%versus6.0%,3.1%versus4.8%,respectively)orheparin+GPIgroups(low,optimal,highACT:0.0%versus2.7%,2.7%versus5.2%,2.4%versus6.1%,respectively)andwasnotassociatedwithanystatisticallysignificantincreaseineitherprimaryorsecondaryischemicoutcomes.ConclusionsAmongunselectedpatientsundergoingPCI,bivalirudinuseduringPCIwasassociatedwithalowerriskofbleedingatall