Publications by authors named "Mark Bowers"

40 Publications

Spatio-temporal focal spot characterization and modeling of the NIF ARC kilojoule picosecond laser.

Appl Opt 2021 Mar;60(8):2288-2303

The advanced radiographic capability (ARC) laser system, part of the National Ignition Facility (NIF) at Lawrence Livermore National Laboratory, is a short-pulse laser capability integrated into the NIF. The ARC is designed to provide adjustable pulse lengths of ∼1-38 in four independent beamlets, each with energies up to 1 kJ (depending on pulse duration). A detailed model of the ARC lasers has been developed that predicts the time- and space-resolved focal spots on target for each shot. Measurements made to characterize static and dynamic wavefront characteristics of the ARC are important inputs to the code. Modeling has been validated with measurements of the time-integrated focal spot at the target chamber center (TCC) at low power, and the space-integrated pulse duration at high power, using currently available diagnostics. These simulations indicate that each of the four ARC beamlets achieves a peak intensity on target of up to a few 10/.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1364/AO.416846DOI Listing
March 2021

High-Energy Achilles Tendon Rupture With Associated Medial Malleolus Fracture and Traumatic Peroneal Dislocation: A Case Report.

Foot Ankle Spec 2021 Feb 25:1938640021997285. Epub 2021 Feb 25.

UCHealth Steadman Hawkins Clinic, Denver, Colorado.

Fracture, Achilles tendon rupture, or traumatic dislocation of the peroneal tendons are often seen in isolation after a trauma or sports-related injury. However, in rare circumstances, a combination of these injuries can occur simultaneously. Multiple previous case reports describe a combination of 2 of these injuries. Missed or delayed diagnosis is common in these combination injuries and can lead to significant patient morbidity and result in long-term consequences. We report a case of a 35-year-old man who sustained an Achilles tendon rupture with an associated medial malleolus fracture and traumatic peroneal dislocation after a snowboarding injury. These injuries were treated surgically, and at 9 months postoperatively, the patient had returned to all activities. Clinicians should have a high index of suspicion for concomitant injuries with higher-energy trauma to the ankle and should perform a thorough history, physical examination, and plain radiographs at a minimum. LEVEL 5.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1938640021997285DOI Listing
February 2021

Concomitant Pulmonary Vein and Posterior Wall Isolation Using Cryoballoon With Adjunct Radiofrequency in Persistent Atrial Fibrillation.

JACC Clin Electrophysiol 2021 02 28;7(2):187-196. Epub 2020 Oct 28.

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.

Objectives: The aim of this multicenter, randomized, single-blind study was to prospectively evaluate the short-and long-term outcomes of pulmonary vein isolation (PVI) versus PVI with concomitant left atrial posterior wall isolation (PWI) using the cryoballoon in patients with symptomatic persistent/long-standing persistent atrial fibrillation (P/LSP-AF).

Background: Some studies have suggested a clinical benefit associated with PVI+PWI in patients with P/LSP-AF. However, there are limited safety and efficacy data on this approach using cryoballoon ablation.

Methods: The immediate and long-term outcomes in patients with P/LSP-AF randomized to PVI (n = 55) versus PVI+PWI (n = 55) using the cryoballoon were prospectively examined.

Results: Baseline characteristics were similar. PVI was achieved in all patients (21 ± 11 min). PWI was attained using 23 ± 8 min of cryoablation. Adjunct radiofrequency ablation was required in 4 of 110 patients (7.3%) to complete PVI (3 ± 2 min) and in 25 of 55 patients (45.5%) to complete PWI (4 ± 6 min). Although left atrial dwell time (113 ± 31 min vs. 75 ± 32 min; p < 0.001) and total procedure time (168 ± 34 min vs. 127 ± 40 min; p < 0.001) were longer with PVI+PWI, this cohort required fewer intraprocedural cardioversions (89.1% vs. 96.4%; p = 0.04). Adverse events occurred in 5.5% in each group (p = 1.00). However, the incidence of recurrent atrial fibrillation at 12 months was significantly lower with PVI+PWI (25.5% vs. 45.5%; p = 0.028). Additionally, in a multivariate analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial fibrillation (odds ratio: 3.67; 95% confidence interval: 1.44 to 9.34; p = 0.006).

Conclusions: In patients with P/LSP-AF, PVI+PWI using the cryoballoon is associated with a significant reduction in atrial fibrillation recurrence, but similar safety, as compared with PVI alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jacep.2020.08.016DOI Listing
February 2021

Catheter ablation of the atrioventricular node slow pathway sans fluoroscopy in a patient with situs inversus totalis.

HeartRhythm Case Rep 2020 Dec 19;6(12):965-967. Epub 2020 Aug 19.

Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrcr.2020.08.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749208PMC
December 2020

Same-day discharge after cryoballoon ablation of atrial fibrillation: A multicenter experience.

J Cardiovasc Electrophysiol 2021 Feb 29;32(2):183-190. Epub 2020 Dec 29.

Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA.

Background: It is common practice to observe patients during an overnight stay (ONS) following a catheter ablation procedure for the treatment of atrial fibrillation (AF).

Objectives: To investigate the safety and economic impact of a same-day discharge (SDD) protocol after cryoballoon ablation for treatment of AF in high-volume, geographically diverse US hospitals.

Methods: We retrospectively reviewed 2374 consecutive patients (1119 SDD and 1180 ONS) who underwent cryoballoon ablation for AF at three US centers. Baseline characteristics, acute procedure-related complications, and longer-term evaluations of safety were recorded during routine clinical follow-up. The mean cost of an ONS was used in a one-way sensitivity analysis to evaluate yearly cost savings as a function of the percentage of SDD cases per year.

Results: The SDD and ONS cohorts were predominately male (69% vs. 67%; p = .3), but SDD patients were younger (64 ± 11 vs. 66 ± 10; p < .0001) with lower body mass index (30 ± 6 vs. 31 ± 61; p < .0001) and CHA DS -VASc scores (1.4 ± 1.0 vs. 2.2 ± 1.4; p < .0002). There was no difference between SDD and ONS in the 30-day total complication rate (n = 15 [1.26%] versus n = 24 [2.03%]; p = .136, respectively). The most common complication was hematoma in both the SDD (n = 8; 0.67%) and ONS (n = 11; 0.93%) cohorts. Sensitivity analysis demonstrated that when 50% of every 100 patients treated were discharged the same day, hospital cost savings ranged from $45 825 to $83 813 per year across US hospitals.

Conclusions: SDD following cryoballoon ablation for AF appears to be safe and is associated with cost savings across different US hospitals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jce.14843DOI Listing
February 2021

Long-term durability of posterior wall isolation using the cryoballoon in patients with persistent atrial fibrillation: a multicenter analysis of repeat catheter ablations.

J Interv Card Electrophysiol 2020 Sep 30. Epub 2020 Sep 30.

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.

Purpose: There is a growing interest in performing pulmonary vein isolation (PVI) with concomitant posterior wall isolation (PWI) using the cryoballoon for the treatment of patients with persistent atrial fibrillation (AF). However, there is little known about the long-term durability of PWI using this approach.

Methods: In this multicenter study, we retrospectively examined the durability of PVI + PWI using the 28-mm cryoballoon by investigating the outcomes from consecutive patients referred for repeat catheter ablation.

Results: Altogether, 81/519 patients (15.6%) were referred for repeat catheter ablation. Repeat ablation was associated with a longer AF duration, hypertension, heart failure, multiple cardioversions, and antiarrhythmic therapy as well as larger left atrial (LA) diameters (49 ± 4 mm versus 43 ± 5 mm; P < 0.001) and greater need for "touch-up" (adjunct) radiofrequency ablation (44.4% versus 18.3%; P < 0.001). LA diameter also emerged as a significant predictor for adjunct radiofrequency ablation (P < 0.001). Durable PVI was observed in 66/81 patients (81.5%) and PWI in 67/81 patients (82.7%). Those with incomplete PWI exhibited larger LA diameters, particularly > 48 mm (negative predictive value = 89.7%). Lastly, an atypical LA posterior wall/roof flutter represented the third most common cause of arrhythmia recurrence and essentially every patient with incomplete PWI exhibited such an arrhythmia.

Conclusion: PWI performed using a 28-mm cryoballoon in conjunction with PVI exhibits long-term durability in the vast majority of patients with persistent AF. While LA diameter (particularly > 48 mm) is a significant predictor for the need for adjunct radiofrequency ablation when performing this technique, those with incomplete PWI invariably present with an atypical flutter using this substrate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10840-020-00887-8DOI Listing
September 2020

Ultrasound-Guided Peripheral Intravenous Catheter Insertion: The Nurse's Manual.

Crit Care Nurse 2020 Oct;40(5):38-46

Mark Bowers is a bedside nurse, 7 East Medical-Surgical, Lakeland Regional Health.

Peripheral intravenous catheter placement is a skill that is used daily in the hospital. However, many nurses face the challenge of cannulating increasingly complex and difficult-to-access vasculature. Although emergency department clinicians have been using ultrasound to facilitate this procedure for the last 18 years, ultrasound-guided peripheral intravenous catheter placement has not been as rapidly adopted in the critical and acute care nursing realms. Given the benefits of this procedure, including increased patient satisfaction and reduced use of central catheters, its use should be encouraged among all acute care clinicians. The aim of this article is to provide the bedside nurse with a basic understanding of the techniques involved in placing ultrasound-guided peripheral intravenous catheters in patients with difficult venous access.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4037/ccn2020240DOI Listing
October 2020

Injection laser system for Advanced Radiographic Capability using chirped pulse amplification on the National Ignition Facility.

Appl Opt 2019 Nov;58(31):8501-8510

We report on the design, performance, and qualification of the injection laser system designed to deliver joule-level chirped pulse beamlets arranged in dual rectangular beam formats into two main laser amplifier beamlines of the National Ignition Facility. The system is designed to meet the requirements of the Advanced Radiographic Capability upgrade with features that deliver performance, adjustability, and long-term reliability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1364/AO.58.008501DOI Listing
November 2019

Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: A multicenter experience.

Heart Rhythm 2018 08;15(8):1121-1129

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.

Background: Pulmonary vein isolation (PVI) in conjunction with isolation of the posterior left atrial wall (PVI+PWI) is associated with improved clinical outcomes in certain patients with atrial fibrillation (AF).

Objective: The purpose of this multicenter study was to evaluate the acute and long-term outcomes of PVI+PWI vs PVI alone performed using cryoballoon ablation in patients with persistent AF (persAF).

Methods: We examined the procedural safety and efficacy and short- and long-term outcomes in 390 consecutive patients with persAF who underwent a first-time cryoballoon ablation procedure using PVI+PWI (n = 222 [56.9%]) vs PVI alone (n = 168 [43.1%]).

Results: Acute isolation was achieved in 99.7% of all pulmonary veins (PVI+PWI = 99.8% vs PVI alone = 99.3%; P = .23) using 6.3 ± 1.4 applications and 17 ± 2 minutes of cryoablation. PWI was achieved using 13.7 ± 3.2 applications and 34 ± 10 minutes of cryoablation. Adjunct radiofrequency ablation was required in 1.8% of patients to complete PVI (4 ± 2 minutes) and in 32.4% to complete PWI (5 ± 2 minutes). PVI+PWI yielded significantly greater posterior wall (77.2% ± 6.4% vs 40.6% ± 4.9%; P < .001) and total left atrial (53.3% ± 4.2% vs 36.3% ± 3.8%; P < .001) isolation. In addition, PVI+PWI was associated with greater AF termination (19.8% vs 8.9%; P = .003) and conversion to atrial flutters (12.2% vs 5.4%; P = .02). Adverse events were similar in both groups, whereas recurrence of AF and all atrial arrhythmias was lower with PVI+PWI at 12 months of follow-up. Moreover, in a Cox regression analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial arrhythmias (hazard ratio: 2.04; 95% confidence interval: 1.15-3.61; P = .015).

Conclusion: PVI+PWI can be achieved safely and effectively using the cryoballoon. This approach appears superior to PVI alone in patients with persAF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrthm.2018.05.014DOI Listing
August 2018

Three-dimensional electroanatomical mapping to guide transseptal catheterization.

HeartRhythm Case Rep 2018 Jun 4;4(6):219-221. Epub 2018 Apr 4.

Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrcr.2018.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007799PMC
June 2018

Outcomes of catheter ablation of ventricular tachycardia with mechanical hemodynamic support: An analysis of the Medicare database.

J Cardiovasc Electrophysiol 2017 Nov 1;28(11):1295-1302. Epub 2017 Sep 1.

Division of Cardiology, Section of Electrophysiology, University of Pennsylvania Health System and School of Medicine, Philadelphia, PA, USA.

Introduction: There is a paucity of data in favor of mechanical support during catheter ablation of ventricular tachycardia (VT). This study investigated the outcomes of VT ablation associated with mechanical support using percutaneous ventricular assist device (PVAD) versus intra-aortic balloon pump (IABP).

Methods And Results: We retrospectively examined the outcomes of patients who underwent VT ablation associated with PVAD versus IABP from 2010 to 2013, captured by the Medicare Inpatient Standard Analytic File database. Data from 345 patients (PVAD = 230, IABP = 115) were examined. On admission, the incidence of heart failure was higher in PVAD (84.3% vs. 73.0%; P = 0.01) with similar rates of renal failure in PVAD versus IABP (33.0% vs. 37.4%; P = 0.42). However, PVAD was associated with reduced in-hospital cardiogenic shock (9.1% vs. 23.5%; P  <  0.001), renal failure (11.7% vs. 21.7%; P = 0.01), and length of stay (8.4 ± 7.9 vs. 10.6 ± 7.5; P < 0.001), but with greater hospital discharges to home/self-care (66.0% vs. 51.6%; P = 0.02). Index mortality (6.5% vs. 19.1%; P = 0.001) and mortality in patients with cardiogenic shock (18.2% vs. 41.2%; P = 0.03) were significantly lower with PVAD versus IABP. Furthermore, PVAD was associated with lower all-cause (27.0% vs. 38.7%; P = 0.04) and heart failure-related (21.4% vs. 33.3%; P = 0.03) 30-day hospital readmissions, but with similar redo-VT ablation rates at 1 year (10.2% vs. 14.0%; P = 0.34).

Conclusion: Among the cases captured by the Medicare database, catheter ablation of VT associated with mechanical support using PVAD was associated with reduced in-hospital cardiogenic shock, renal failure, length of stay, hospital readmissions and mortality, but no difference in redo-VT ablation at 1 year.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jce.13312DOI Listing
November 2017

Verification of a novel atrial fibrillation cryoablation dosing algorithm guided by time-to-pulmonary vein isolation: Results from the Cryo-DOSING Study (Cryoballoon-ablation DOSING Based on the Assessment of Time-to-Effect and Pulmonary Vein Isolation Guidance).

Heart Rhythm 2017 09 15;14(9):1319-1325. Epub 2017 Jun 15.

Virginia Commonwealth University Medical Center, Richmond, Virginia.

Background: There are no recommendations on the optimal dosing for cryoablation of atrial fibrillation (Cryo-AF).

Objective: The purpose of this study was to develop and prospectively test a Cryo-AF dosing protocol guided exclusively by time-to-pulmonary vein (PV) isolation (TT-PVI) in patients undergoing a first-time Cryo-AF.

Methods: In this multicenter study, we examined the acute/long-term safety/efficacy of Cryo-AF using the proposed dosing algorithm (Cryo-AF; n = 355) against a conventional, nonstandardized approach (Cryo-AF; n = 400) in a nonrandomized fashion.

Results: Acute PV isolation was achieved in 98.9% of patients in Cryo-AF (TT-PVI = 48 ± 16 seconds) vs 97.2% in Cryo-AF (P = .18). Cryo-AF was associated with shorter (149 ± 34 seconds vs 226 ± 46 seconds; P <.001) and fewer (1.7 ± 0.8 vs 2.9 ± 0.8; P <.001) cryoapplications, reduced overall ablation (16 ± 5 minutes vs 40 ± 14 minutes; P <.001), fluoroscopy time (13 ± 6 minutes vs 29 ± 13 minutes; P <.001), left atrial dwell time (51 ± 14 minutes vs 118 ± 25 minutes; P <.001), and total procedure time (84 ± 23 minutes vs 145 ± 49 minutes; P <.001) but similar nadir balloon temperature (-47°C ± 8°C vs -48°C ± 6°C; P = .41) and total thaw time (43 ± 27 seconds vs 45 ± 19 seconds; P = .09) as compared to Cryo-AF. Adverse events (2.0% vs 2.7%; P = .48), including persistent phrenic nerve palsy (0.6% vs 1.2%; P = .33) and 12-month freedom from all atrial arrhythmias (82.5% vs 78.3%; P = .14), were similar between Cryo-AF and Cryo-AF. However, Cryo-AF was specifically associated with fewer atypical atrial flutters/tachycardias during long-term follow-up (8.5% vs 13.5%; P = .02) as well as fewer late PV reconnections at redo procedures (5.0% vs 18.5%; P <.001).

Conclusion: A novel Cryo-AF dosing algorithm guided by TT-PVI can help individualize the ablation strategy and yield improved procedural endpoints and efficiency as compared to a conventional, nonstandardized approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrthm.2017.06.020DOI Listing
September 2017

Catheter ablation using the third-generation cryoballoon provides an enhanced ability to assess time to pulmonary vein isolation facilitating the ablation strategy: Short- and long-term results of a multicenter study.

Heart Rhythm 2016 12 5;13(12):2306-2313. Epub 2016 Aug 5.

Virginia Commonwealth University Medical Center, Richmond, Virginia.

Background: Limited data exist on cryoablation of atrial fibrillation (Cryo-AF) using the newly available third-generation (Arctic Front Advance-Short Tip [AFA-ST]) cryoballoon.

Objective: In this multicenter study, we evaluated the safety and efficacy of Cryo-AF using the AFA-ST vs the second-generation (Arctic Front Advance [AFA]) cryoballoon.

Methods: We examined the procedural safety and efficacy and the short- and long-term clinical outcomes associated with a first-time Cryo-AF performed in 355 consecutive patients (254/355 [72%] with paroxysmal AF), using either the AFA-ST (n = 102) or the AFA (n = 253) cryoballoon catheters.

Results: Acute isolation was achieved in 99.6% of all pulmonary veins (PVs) (AFA-ST: 100% vs AFA: 99.4%; P = .920). Time to pulmonary vein isolation was recorded in 89.2% of PVs using AFA-ST vs 60.2% using AFA (P < .001). PVs targeted using AFA-ST required fewer applications (1.6 ± 0.8 vs 1.7 ± 0.8; P = .023), whereas there were no differences in the balloon nadir temperature (AFA-ST: -47.0°C ± 7.3°C vs AFA: -47.5°C ± 7.8°C; P = .120) or thaw time (AFA-ST: 41 ± 24 seconds vs AFA: 44 ± 28 seconds; P = .056). However, AFA-ST was associated with shorter left atrial dwell time (43 ± 5 minutes vs 53 ± 16 minutes; P < .001) and procedure time (71 ± 11 minutes vs 89 ± 25 minutes; P < .001). Furthermore, Cryo-AF using AFA-ST was completed more frequently by "single-shot" PV ablation (27.4% vs 20.2%; P = .031). Persistent phrenic nerve palsy (AFA-ST: 0% vs AFA: 0.8%; P = .507) and procedure-related adverse events (AFA-ST: 1.0% vs AFA: 1.6%; P = .554) were similar, as was the freedom from recurrent atrial arrhythmias at 10 months of follow-up (AFA-ST: 81.8% vs AFA: 79.9%; P = .658).

Conclusion: Cryo-AF using the AFA-ST cryoballoon offers an enhanced ability to assess time to pulmonary vein isolation, allowing for fewer cryoapplications and shorter left atrial dwell time and procedure time. Consequently, this allowed for procedural completion more frequently using a "single-shot" PV ablation with equivalent safety and efficacy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrthm.2016.08.011DOI Listing
December 2016

Pulmonary vein reconnection following catheter ablation of atrial fibrillation using the second-generation cryoballoon versus open-irrigated radiofrequency: results of a multicenter analysis.

J Interv Card Electrophysiol 2016 Dec 30;47(3):341-348. Epub 2016 Jul 30.

Heart Rhythm Management Center, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.

Purpose: Catheter ablation of atrial fibrillation (CAAF) using the cryoballoon has emerged as an alternate strategy to point-by-point radiofrequency. However, there is little comparative data on long-term durability of pulmonary vein (PV) isolation comparing these two modalities.

Methods: In this multicenter, retrospective analysis, the incidences/patterns of late PV reconnection following an index CAAF using the second-generation cryoballoon versus open-irrigated, non-force-sensing radiofrequency were examined.

Results: Of the 2002 patients who underwent a first-time CAAF, 186/1126 patients (16.5 %) ablated using cryoballoon and 174/876 patients (19.9 %) with non-contact force-guided radiofrequency required a repeat procedure at 11 ± 5 months. During follow-up, the incidence of atrial flutters/tachycardias was lower (19.9 vs. 32.8 %; p = 0.005) and fewer patients exhibited PV reconnection (47.3 vs. 60.9 %; p = 0.007) with cryoballoon versus radiofrequency. Additionally, fewer PVs had reconnected with cryoballoon versus radiofrequency (18.8 vs. 34.6 %; p < 0.001). With cryoballoon, the right inferior (p < 0.001) and left common (p = 0.039) PVs were more likely to exhibit late reconnection, versus the left superior PV with radiofrequency (p = 0.012). However, when comparing the two strategies, the left common PV was more likely to exhibit reconnection with cryoballoon, whereas all other PVs with the exception of the right inferior PV demonstrated a lower reconnection rate with cryoballoon versus radiofrequency. Lastly, in a logistic regression multivariate analysis, cryoballoon ablation and PV ablation time emerged as significant predictors of durable PV isolation at repeat procedure.

Conclusions: In this large multicenter, retrospective analysis, CAAF using the second-generation cryoballoon was associated with improved durability of PV isolation compared to open-irrigated, non-force-sensing radiofrequency.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10840-016-0172-zDOI Listing
December 2016

Impact of irrigation flow rate and intrapericardial fluid on cooled-tip epicardial radiofrequency ablation.

Heart Rhythm 2016 08 7;13(8):1602-11. Epub 2016 May 7.

Instituto de Pesquisa em Arritmia Cardiaca, Hospital Cardiologico, Florianopolis, Santa Catarina, Brazil.

Background: The optimal irrigation flow rate (IFR) during epicardial radiofrequency (RF) ablation has not been established.

Objective: This study specifically examined the impact of IFR and intrapericardial fluid (IPF) accumulation during epicardial RF ablation.

Methods: Altogether, 452 ex vivo RF applications (10 g for 60 seconds) delivered to the epicardial surface of bovine myocardium using 3 open-irrigated ablation catheters (ThermoCool SmartTouch, ThermoCool SmartTouch-SF, and FlexAbility) and 50 in vivo RF applications delivered (ThermoCool SmartTouch-SF) in 4 healthy adult swine in the presence or absence of IPF were examined. Ex vivo, RF was delivered at low (≤3 mL/min), reduced (5-7 mL/min), and high (≥10 mL/min) IFRs using intermediate (25-35 W) and high (35-45 W) power. In vivo, applications were delivered (at 9.3 ± 2.2 g for 60 seconds at 39 W) using reduced (5 mL/min) and high (15 mL/min) IFRs.

Results: Ex vivo, surface lesion diameter inversely correlated with IFR, whereas maximum lesion diameter and depth did not differ. While steam pops occurred more frequently at low IFR using high power (ThermoCool SmartTouch and ThermoCool SmartTouch-SF), tissue disruption was rare and did not vary with IFR. In vivo, charring/steam pop was not detected. Although there were no discernible differences in lesion size with IFR, surface lesion diameter, maximum diameter, depth, and volume were all smaller in the presence of IPF at both IFRs.

Conclusion: Cooled-tip epicardial RF ablation created using reduced IFRs (5-7 mL/min) yields lesion sizes similar to those created using high IFRs (≥10 mL/min) without an increase in steam pop/tissue disruption, whereas the presence of IPF significantly reduces the lesion size.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrthm.2016.05.008DOI Listing
August 2016

Impact of Pulmonary Vein Cryoballoon Ablation on Bronchial Injury.

J Cardiovasc Electrophysiol 2016 07 24;27(7):861-7. Epub 2016 May 24.

Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA.

Introduction: There is a paucity of data on the mechanisms of cough and hemoptysis that sometimes ensue from cryoballoon ablation of pulmonary veins (Cryo-PV). This study specifically examined the impact of ultra-cold (≤-60 °C, 3 minutes), prolonged (>-55 °C, 6 minutes), and conventional (>-55 °C, 3 minutes) Cryo-PV on lung/bronchial injury.

Methods And Results: Four healthy adult swine underwent Cryo-PV. Each animal received Cryo-PV to the inferior common trunk and the right superior PV. In 2 animals, 1 PV was treated with 2 ultra-cold (Cryo-AUltra-cold ) and the other with 2 conventional (Cryo-AConventional ) cryoapplications. In the other 2 animals, 1 PV was ablated using 2 prolonged (Cryo-BProlonged ) and the other with 2 conventional (Cryo-BConventional ) applications. The nadir cryoballoon temperatures were lower in Cryo-AUltra-cold versus Cryo-AConventional (-66 ± 6 °C vs. -45 ± 5 °C; P = 0.001), but did not differ between Cryo-BProlonged and Cryo-BConventional (-46 ± 3 °C vs. -49 ± 3 °C; P = 0.123). Post-ablation bronchoscopy revealed immediate mucosal edema and erythema with/without bleeding in the adjacent bronchi in 100% of Cryo-AUltra-cold and 50% of Cryo-AConventional /Cryo-BConventional and Cryo-BProlonged . At 4 hours post-ablation, there were marked increases in bronchoalveolar macrophages (P <0.001), lymphocytes (P = 0.035) and neutrophils (P = 0.001). Furthermore, Cryo-AUltra-cold yielded the largest increase in the macrophage (P = 0.005) and neutrophil (P = 0.034) cell counts. While similar trends were seen in Cryo-BProlonged , these did not reach statistical significance.

Conclusion: Cryo-PV can elicit acute bronchial inflammation, bleeding, and mucosal injury. While this was further augmented by ultra-cold cryoapplications, it was also evident to a lesser degree with prolonged and even conventional cryoapplications. The mechanism for this appears to be direct collateral injury.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jce.12983DOI Listing
July 2016

Exploring parents' understandings of their child's journey into offending behaviours: A narrative analysis.

Clin Child Psychol Psychiatry 2016 Jul 18;21(3):447-60. Epub 2015 Nov 18.

Child and Adolescent Mental Health Services, UK.

Parents are perhaps the best placed individuals to comment upon their child's life story, including early life experiences, transitions and their child's needs. However, research has rarely focussed on the views of parents of young people who have committed serious offences. This research aimed to explore parents' opinions of which factors may have led to their child becoming involved with the criminal justice system. Interviews were undertaken with six parents who were asked to narrate their child's life journey into offending behaviours. The data were then analysed using narrative analysis techniques, and a shared story was created which incorporated the main transitional stages in the children's journeys, as seen by the parents. The findings suggest that it is not just the child but the whole family who have been in a state of distress throughout the child's life. Systemic and environmental factors are argued to contribute to this distress, and the use of diagnosis for this population is critically evaluated. The research highlights a life story in which the child's and family's distress remains unheard and therefore unresolved. Clinical implications for working with this population are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1359104515614876DOI Listing
July 2016

Procedural and biophysical indicators of durable pulmonary vein isolation during cryoballoon ablation of atrial fibrillation.

Heart Rhythm 2016 Feb 28;13(2):424-32. Epub 2015 Oct 28.

Heart Rhythm Management Center, Vrije Universiteit Brussel, Brussels, Belgium.

Background: Limited data exist on procedural and biophysical indicators of pulmonary vein (PV) isolation durability after the cryoballoon ablation of atrial fibrillation (AF).

Objective: The aim of this study was to investigate the procedural and biophysical characteristics associated with late PV reconnection (PVR) and durable PV isolation (PVI) after cryoablation using the currently available second-generation cryoballoon.

Methods: Data from 435 PVs targeted in 112 consecutive patients who underwent a repeat procedure 14 ± 3 months after an index cryoablation of AF were examined.

Results: Altogether, 111 PVs (25.5%) in 71 patients (63.4%) demonstrated PVR, whereas 324 PVs (74.5%) exhibited PVI. The number and duration of cryoballoon applications did not differ between PVR and PVI. However, the time to PV isolation (time to effect) was considerably shorter (39.1 ± 11.7 seconds vs 67.6 ± 19.7 seconds; P < .001), the balloon temperature at time to effect was significantly warmer (-32.1°C ± 7.8°C vs -39.4°C ± 5.8°C; P < .001), the balloon nadir temperature was slightly cooler (-48.7°C ± 4.6°C vs -47.8°C ± 2.9°C; P = .034), and the total thaw time (56.5 ± 25.4 seconds vs 34.8 ± 9.1 seconds; P < .001) and interval thaw times at 0°C (iTT0; 14.8 ± 10.9 seconds vs 7.1 ± 2.0 seconds; P < .001) and 15°C (54.2 ± 25.4 seconds vs 33.3 ± 9.1 seconds; P < .001) were notably longer with PVI than with PVR. However, only a time to effect of ≤60 seconds and an iTT0 of ≥10 seconds emerged as significant predictors of PV isolation durability. Consequently, in a multivariate model, presence of both criteria predicted <1% and their mere absence ~75% likelihood of PVR.

Conclusion: A time to effect of ≤60 seconds and an iTT0 of ≥10 seconds significantly predict PV isolation durability after the cryoballoon ablation of AF. If both criteria are met, the likelihood of PV reconnection may be exceedingly low.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrthm.2015.10.033DOI Listing
February 2016

Outcomes Of Cryoballoon Ablation Of Atrial Fibrillation: A Comprehensive Review.

J Atr Fibrillation 2015 Aug-Sep;8(2):1231. Epub 2015 Aug 31.

Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California.

Over the last decade, cryoballoon ablation has emerged as an effective alternate strategy to point-by-point radiofrequency ablation for treatment of symptomatic atrial fibrillation. There are several reasons for this. First, the acute and long-term safety and efficacy associated with cryoablation appear comparable to that of radiofrequency ablation in patients with both paroxysmal and also persistent atrial fibrillation. Second, cryoablation offers certain advantages over conventional radiofrequency ablation including a gentler learning curve, shorter ablation and procedure times as well as lack of need for costly electroanatomical mapping technologies commonly utilized with radiofrequency ablation. Lastly, with the recent advent of the second-generation cryoballoon, the effectiveness of cryoablation has further improved dramatically. This comprehensive review examines the gradual evolution of the cryoablation tools as well as the rationale and data in support of the currently-available cryoballoon technologies for catheter ablation of atrial fibrillation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4022/jafib.1231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135165PMC
August 2015

Use of Antimicrobial Envelope as Standard of Care for Cardiac Implantable Electronic Device Implantation: Preventing Infection or Promoting Inflation?

J Cardiovasc Electrophysiol 2015 Oct 22;26(10):E12. Epub 2015 Aug 22.

Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jce.12728DOI Listing
October 2015

Association between incomplete surgical ligation of left atrial appendage and stroke and systemic embolization.

Heart Rhythm 2015 Jul 18;12(7):1431-7. Epub 2015 May 18.

Instituto de Pesquisa em Arritmia Cardiaca, Hospital Cardiologico-Florianopolis, Florianopolis, Santa Catarina, Brazil.

Background: Surgical exclusion of the left atrial appendage (LAA) can frequently yield incomplete closure.

Objective: We evaluated the ischemic stroke/systemic embolization (SSE) risk in patients with atrial fibrillation (AF) and complete LAA closure (cLAA) vs incompletely surgically ligated LAA (ISLL) and LAA stump after surgical suture ligation.

Methods: Seventy-two patients (CHA2DS2-VASc score 4.1 ± 1.9) underwent surgical LAA ligation in conjunction with mitral valve/AF surgery and postoperative LAA evaluation using computerized tomographic angiography.

Results: Overall, cLAA was detected in 46 of 72 patients (64%), ISLL in 17 patients (24%), and LAA stump in 9 patients (12%). The incidences of oral anticoagulation (OAC) and recurrent AF were similar among the 3 groups during 44 ± 19 months of follow-up. SSE occurred in 2% of patients with cLAA vs 24% with ISLL and 0% with LAA stump (P = .006). None of the patients with SSE were receiving OAC, and all had recurrent AF during follow-up. Additionally, patients with SSE exhibited a significantly smaller ISLL neck diameter (2.8 ± 1.0 vs 7.1 ± 2.1 mm; P = .002). The annualized SSE risk was 1.9% (entire cohort), 6.5% (ISLL patients), 14.4% (ISLL patients not receiving OAC), and 19.0% (ISLL neck diameter ≤5.0 mm) per 100 patient-years of follow-up. The latter risk was nearly 5 times greater than predicted by conventional risk-stratification schemes. Moreover, ISLL emerged as an independent predictor of SSE in univariate analyses and as the sole predictor of SSE in a multivariate analysis.

Conclusion: In patients with AF, ISLL is a predictor of SSE, independent of conventional risk stratification schemes. Consequently, OAC should be strongly considered in this high-risk cohort.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hrthm.2015.03.028DOI Listing
July 2015

Acute and Long-Term Outcomes of Catheter Ablation of Atrial Fibrillation Using the Second-Generation Cryoballoon versus Open-Irrigated Radiofrequency: A Multicenter Experience.

J Cardiovasc Electrophysiol 2015 Aug 4;26(8):832-839. Epub 2015 Jun 4.

Regional Cardiology Associates and Dignity Health Heart & Vascular Institute, Sacramento, California, USA.

Introduction: There are limited comparative data on catheter ablation of atrial fibrillation (CAAF) using the second-generation cryoballoon (CB-2) versus point-by-point radiofrequency (RF). This study examines the acute/long-term CAAF outcomes using these 2 strategies.

Methods And Results: In this multicenter, retrospective, nonrandomized analysis, procedural and clinical outcomes of 1,196 patients (76% with paroxysmal AF) undergoing CAAF using CB-2 (n = 773) and open-irrigated, non-force sensing RF (n = 423) were evaluated. Pulmonary vein isolation was achieved in 98% with CB-2 and 99% with RF (P = 0.168). CB-2 was associated with shorter ablation time (40 ± 14 min vs. 66 ± 26 min; P < 0.001) and procedure time (145 ± 49 minutes vs. 188 ± 42 minutes; P < 0.001), but greater fluoroscopic utilization (29 ± 13 minutes vs. 23 ± 14 minutes; P < 0.001). While transient (7.6% vs. 0%; P < 0.001) and persistent (1.2% vs. 0%; P = 0.026) phrenic nerve palsy occurred exclusively with CB-2, other adverse event rates were similar between CB-2 (1.6%) and RF (2.6%); P = 0.207. However, freedom from AF/atrial flutter/tachycardia at 12 months following a single procedure without antiarrhythmic therapy was greater with CB-2 (76.6%) versus RF (60.4%); P < 0.001. While this difference was evident in patients with paroxysmal AF (P < 0.001), it did not reach significance in those with persistent AF (P = 0.089). Additionally, CB-2 was associated with reduced long-term need for antiarrhythmic therapy (16.7% vs. 22.0%; P = 0.024) and repeat ablations (14.6% vs. 24.1%; P < 0.001).

Conclusion: In this multicenter, retrospective, nonrandomized study, CAAF using CB-2 coupled with RF as occasionally required was associated with greater freedom from atrial arrhythmias at 12 months following a single procedure without antiarrhythmic therapy when compared to open-irrigated, non-force sensing RF, alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jce.12695DOI Listing
August 2015

Direct recording of concealed ventricular extrasystoles producing pacer inhibition.

J Cardiovasc Electrophysiol 2013 Oct 18;24(10):1179-82. Epub 2013 Apr 18.

University of Michigan Hospital and Health Systems, Ann Arbor, Michigan, USA.

We report a case of concealed extrasystoles recorded from a pacing lead. The concealed extrasystoles were observed with right ventricular pacing, biventricular unipolar, and biventricular bipolar pacing. The simultaneous surface EKG did not show manifest ventricular extrasystoles with the concealed intracardiac potentials. This case highlights a cause of oversensing that has been theoretically reported in the literature but never directly observed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jce.12146DOI Listing
October 2013

Prone positioning for surgery.

Authors:
Mark Bowers

J Perioper Pract 2012 May;22(5):157-62

School of Health and Social Care, Oxford Brookes University, Headington Campus, Gipsy Lane, Oxford OX3 0BP.

The role of the registered perioperative practitioner (Operating Department Practitioner or Registered Nurse) includes the responsibility for safely positioning patients for surgery. The prone position is in common use for a variety of surgical procedures. The formal term for this surgical position is ventral decubitus (meaning laying face down).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/175045891202200504DOI Listing
May 2012

Measurement of the repeatability of the prompt flashlamp-induced wavefront aberration on beamlines at the National Ignition Facility.

Appl Opt 2011 Aug;50(22):4382-8

Lawrence Livermore National Laboratory, Livermore, California 94550, USA.

We have undertaken a measurement campaign to determine the repeatability of the prompt flashlamp-induced wavefront aberration on beamlines at the National Ignition Facility (NIF) and determine the extent to which shot-to-shot variations in this aberration may degrade the performance of a proposed adaptive optics system for the short-pulse Advanced Radiographic Capability beamline on NIF. In this paper we will describe the unique NIF configuration that was required to make this measurement, present the results of the experiment, and discuss the implications of these results for the adaptive optics system design.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1364/AO.50.004382DOI Listing
August 2011

Carotid plaque regression following 6-month statin therapy assessed by 3T cardiovascular magnetic resonance: comparison with ultrasound intima media thickness.

J Cardiovasc Magn Reson 2011 Aug 3;13:37. Epub 2011 Aug 3.

Department of Medicine, Marquette University, 1120 W, Wisconsin Avenue, Wilwaukee, WI 53233, USA.

Background: Cardiovascular magnetic resonance (CMR) allows volumetric carotid plaque measurement that has advantage over 2-dimensional ultrasound (US) intima-media thickness (IMT) in evaluating treatment response. We tested the hypothesis that 6-month statin treatment in patients with carotid plaque will lead to plaque regression when measured by 3 Tesla CMR but not by IMT.

Methods: Twenty-six subjects (67 ± 2 years, 7 females) with known carotid plaque (> 1.1 mm) and coronary or cerebrovascular atherosclerotic disease underwent 3T CMR (T1, T2, proton density and time of flight sequences) and US at baseline and following 6 months of statin therapy (6 had initiation, 7 had increase and 13 had maintenance of statin dosing). CMR plaque volume (PV) was measured in the region 12 mm below and up to 12 mm above carotid flow divider using software. Mean posterior IMT in the same region was measured. Baseline and 6-month CMR PV and US IMT were compared. Change in lipid rich/necrotic core (LR/NC) and calcification plaque components from CMR were related to change in PV.

Results: Low-density lipoprotein cholesterol decreased (86 ± 6 to 74 ± 4 mg/dL, p = 0.046). CMR PV decreased 5.8 ± 2% (1036 ± 59 to 976 ± 65 mm3, p = 0.018). Mean IMT was unchanged (1.12 ± 0.06 vs. 1.14 ± 0.06 mm, p = NS). Patients with initiation or increase of statins had -8.8 ± 2.8% PV change (p = 0.001) while patients with maintenance of statin dosing had -2.7 ± 3% change in PV (p = NS). There was circumferential heterogeneity in CMR plaque thickness with greatest thickness in the posterior carotid artery, in the region opposite the flow divider. Similarly there was circumferential regional difference in change of plaque thickness with significant plaque regression in the anterior carotid region in region of the flow divider. Change in LR/NC (R = 0.62, p = 0.006) and calcification (R = 0.45, p = 0.03) correlated with PV change.

Conclusions: Six month statin therapy in patients with carotid plaque led to reduced plaque volume by 3T CMR, but ultrasound posterior IMT did not show any change. The heterogeneous spatial distribution of plaque and regional differences in magnitude of plaque regression may explain the difference in findings and support volumetric measurement of plaque. 3T CMR has potential advantage over ultrasound IMT to assess treatment response in individuals and may allow reduced sample size, duration and cost of clinical trials of plaque regression.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1532-429X-13-37DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166901PMC
August 2011

Tetrahydrobiopterin attenuates superoxide-induced reduction in nitric oxide.

Front Biosci (Schol Ed) 2011 Jun 1;3:1263-72. Epub 2011 Jun 1.

Cardiovascular Research Institute and Department of Systems Biology and Translational Medicine, Texas A and M Health Science Center, Temple, TX 76504, USA.

NADPH oxidase, a source of superoxide anion (·O2(-)), can be stimulated by oxidized low-density lipoprotein (OxLDL). We examined whether tetrahydrobiopterin (BH4) could reduce OxLDL-induced ·O2(-) production by NADPH oxidase, increasing nitric oxide (NO) synthesis. Endothelial cells incubated with OxLDL produced more ·O2(-) (35-67%) than untreated cells, with the highest increase 1 hour after OxLDL addition. The elevated ·O2(-) production correlated with the translocation of the p47phox subunit of NADPH oxidase from the cytosol to the membrane. Cells exhibited a marked decrease in both BH4 (83 per cent) and NO (54 per cent) in the same hour following exposure to OxLDL. An NADPH oxidase inhibitor, apocynin, or antioxidant, N-acetyl-L-cysteine, substantially attenuated the reduction in both BH4 and NO. The ·O2(-) production was increased when cells were pretreated with an inhibitor of BH4 synthesis and decreased following pretreatment with a BH4 precursor, suggesting that NADPH oxidase-induced imbalance of endothelial NO and ·O2(-) production can be modulated by BH4 concentrations. BH4 may be critical in combating oxidative stress, restoring proper redox state, and reducing risk for cardiovascular disease including atherosclerosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2741/s224DOI Listing
June 2011

Time-efficient patient-specific quantification of regional carotid artery fluid dynamics and spatial correlation with plaque burden.

Med Phys 2010 Feb;37(2):784-92

Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin 53233, USA.

Purpose: Low wall shear stress (WSS) and high oscillatory shear index (OSI) influence plaque formation, yet little is known about their role in progression/regression of established plaques because of lack of practical means to calculate them in individual patients. Our aim was to use computational fluid dynamics (CFD) models of patients with carotid plaque undergoing statin treatment to calculate WSS and OSI in a time-efficient manner, and determine their relationship to plaque thickness (PT), plaque composition (PC), and regression.

Methods: Eight patients (68 +/- 9 yr, one female) underwent multicontrast 3 T MRI at baseline and six-month post statin treatment. PT and PC were measured in carotid segments (common-CC, bifurcation-B, internal-IC) and circumferentially in nonoverlapping 600 angles and correlated with CFD models created from MRI, ultrasound, and blood pressure.

Results: PT was highest in B (2.42 +/- 0.98 versus CC: 1.60 +/- 0.47, IC: 1.62 +/- 0.52 mm, p < 0.01). Circumferentially, plaque was greatest opposite the flow divider (p < 0.01), where the lowest WSS and highest OSI were observed. In B and IC, PT was inversely related to WSS (R = -0.28 and -0.37, p < 0.01) and directly related to OSI (R = 0.22 and 0.52, p < 0.05). The total plaque volume changed from 1140 +/- 437 to 974 +/- 587 mm3 at six months (p = 0.1). Baseline WSS, but not OSI, correlated with changes in PT, necrotic tissue, and hemorrhage in B and IC, but not CC. CFD modeling took 49 +/- 18 h per patient.

Conclusions: PT and PC correspond to adverse WSS and OSI in B and IC, and WSS is modestly but significantly related to changes in PT after short-term statin treatment. Regional hemodynamics from CFD can feasibly augment routine clinical imaging for comprehensive plaque evaluation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826384PMC
http://dx.doi.org/10.1118/1.3292631DOI Listing
February 2010

Left ventricular ejection time on echocardiography predicts long-term mortality in light chain amyloidosis.

J Am Soc Echocardiogr 2009 Dec 31;22(12):1396-402. Epub 2009 Oct 31.

Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.

Objective: Light chain amyloidosis (AL) is associated with high mortality. The aim was to identify echocardiographic parameters that predict AL long-term mortality.

Methods: Forty-two subjects with biopsy-proven AL (43% were female; aged 61 +/- 12 years) underwent echocardiography and were followed 29 +/- 16 months (median 29.4 months). Standard echocardiographic and clinical parameters and heart failure (HF) class were tested using univariate/multivariable Cox proportional hazard regression analyses to identify markers of mortality.

Results: Twenty-three subjects died, with a 1-year mortality of 44%. Univariate predictors of mortality were HF class (P < .001), left ventricular systolic ejection time (ET) (P = .002), alkaline phosphatase (P < .001), and aspartate and alanine aminotransferase (P = .003 each). On multivariable analysis, only HF class (hazard ratio [HR] 4.86; 95% confidence interval [CI], 1.58-14.9; P = .006), ET (10 ms increase; HR 0.87; CI, 0.78-0.97; P = .01), and alkaline phosphatase (10 U/L increase; HR 1.04; CI, 1.01-1.06; P = .01) were prognostic. ET
Conclusion: AL amyloidosis was associated with high long-term mortality. Among echocardiographic and clinical parameters, only ET and alkaline phosphatase had incremental value to HF class in predicting mortality. This may be useful to identify high-risk patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.echo.2009.09.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2787973PMC
December 2009