Short‐Term and Long‐Term Reproducibility of Hypertension Phenotypes Obtained by Office and Ambulatory Blood Pressure Measurements

The authors aimed to assess the reproducibility of normotension and white‐coat, masked, and sustained hypertension in 839 untreated patients who underwent two separate assessments (median, 3; interquartile range, 0–13 months) by both office and ambulatory blood pressure (BP) monitoring (ABPM). The proportion of patients falling into the same category in the two assessments was: 52% normotension and 55% white‐coat, 47% masked, and 82% sustained hypertension. The most frequent switch was to sustained hypertension (26% of white‐coat and 33% of masked hypertension). No clinical factors predicted the change in category, except for higher office diastolic BP in patients with masked hypertension who developed sustained hypertension, compared with those who remained with masked hypertension (84±4 mm Hg vs 80±5 mm Hg; P=.006). The reproducibility of hypertension phenotypes was highly dependent on the time between assessments. The authors conclude that white‐coat and masked hypertension phenotypes are only reproducible in the short‐term, while they frequently shift towards sustained hypertension in the long‐term.     

Results of Short‐Term and Long‐Term Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation Using Duty‐Cycled Bipolar and Unipolar Radiofrequency Energy

PV Isolation Using Bipolar/Unipolar RF Energy . Background: Electrical disconnection of the pulmonary veins (PV) plays an important role in the ablation of paroxysmal atrial fibrillation (AF). Antral ablation using a conventional steerable ablation catheter often is technically challenging and time consuming. Methods: Eighty‐eight patients (mean age 58 ± 11 years) with symptomatic paroxysmal AF underwent ablation with a circular mapping/ablation decapolar catheter (PVAC). Ablation was performed in the antral region of the PVs with a power‐modulated bipolar/unipolar radiofrequency (RF) generator using 8–10 W delivered simultaneously through 2–10 electrodes, as selected by the operator. Seven‐day Holter monitor recordings were performed off antiarrhythmic drugs at 3‐, 6‐, and 12‐month follow‐up, and patients were requested to visit the hospital in the event of ongoing palpitations. All follow‐up patients were divided into 2 groups: Group 1 with a follow‐up of less than 1 year and group 2 patients completing a 1‐year follow‐up. Results: Overall, 338 of 339 targeted PVs (99%) were isolated with the PVAC with a mean of 24 ± 9 RF applications per patient, a mean total procedure time of 125 ± 28 minutes, and a mean fluoroscopy time of 21 ± 13 minutes. Freedom from AF off antiarrhythmic drugs was found in 82 and 79% of group 1 and group 2 patients, respectively. No procedure‐related complications were observed. Conclusion: PV isolation by duty‐cycled unipolar/bipolar RF ablation can be effectively and safely performed with a circular, decapolar catheter. Twelve‐month follow‐up data compare favorably with early postablation results, indicating stable effects over time. (J Cardiovasc Electrophysiol, Vol. 21, pp. 399–405, April 2010)     

Long‐Term Clinical Outcomes of a Biodegradable Polymer‐Based Biolimus‐Eluting Stent

Objectives

To investigate the long‐term clinical outcomes of biolimus‐eluting stents with biodegradable polymers in real‐world clinical practice.

Background

Long‐term clinical outcomes of biolimus‐eluting stents have not been clearly established.

Methods

A total of 824 all‐comer patients (971 lesions) treated with unrestricted implantation of a biolimus‐eluting stent with a biodegradable polymer were prospectively enrolled. Patients were divided into complex (413 patients) versus noncomplex (411 patients) groups according to the complexity of coronary lesions. Long‐term clinical outcomes for stent efficacy (target lesion revascularization) and safety (composite of cardiac death, target lesion‐related myocardial infarction, and definite or probable stent thrombosis) were compared between the two groups during 5 years of follow‐up.

Results

The complex group showed higher rates of decreased left ventricular ejection fraction, impaired renal function, previous history of myocardial infarction, and diabetes mellitus compared to the noncomplex group. In the overall population, the 5‐year cumulative rate of target lesion revascularization was 4.8% (8.3% in the complex group vs 1.6% in the noncomplex group, P < 0.001). For stent safety, the 5‐year cumulative rate for a composite of cardiac death, target lesion‐related myocardial infarction, and stent thrombosis was 2.5% overall (3.9% in the complex group vs 1.1% in the noncomplex group, P = 0.010). Overall 5‐year cumulative rate of stent thrombosis was 0.4% (0.5% in the complex vs 0.2% in the noncomplex group, P = 0.561) with no very late stent thrombosis (VLST).

Conclusions

Biodegradable polymer‐based biolimus‐eluting stents showed favorable efficacy and safety in all‐comer patients during 5 years of follow‐up. (J Interven Cardiol 2016;29:162–167)

     

Long‐Term Results after Carotid Stent Implantation

Background

Though carotid artery stenting (CS) has gained popularity as an alternative to carotid endarterectomy, studies examining long‐term results are limited.

Methods

All consecutive patients who underwent unilateral CS between 7/1993 and 8/2005 with no or non‐significant contralateral stenosis were included. Follow‐up with duplex sonography and/or angiography and neurological assessment was performed at 6 and/or 12 months. Thereafter, annually, a questionnaire was sent to the patients and their referring physicians.

Results

Two‐hundred and seventy‐nine patients underwent CS. In 99% of procedures stent delivery was successful. The periprocedural major and minor stroke rates were 2.2%, respectively. The periprocedural major stroke or death rate was 2.9%. Median clinical follow‐up was 49 ± 32 months (range: 30 days–12.1 years). Excluding perioperative (<30 days) events, the annual major and minor stroke rate was 1.3% and the annual ipsilateral major and minor stroke rate was 0.6%. In symptomatic and asymptomatic patients, the annual major and minor stroke rates were 2.2% and 0.8%, respectively, and the ipsilateral major and minor stroke rates were 1.1% and 0.3%, respectively. There was no significant difference between ipsilateral and contralateral major or minor strokes at long‐term follow‐up. At last sonographic follow‐up (median 36 ± 32 months), restenosis rates for symptomatic and asymptomatic stenoses were 5% and 3%, respectively.

Conclusion

The results of our study demonstrate very low long‐term cerebral event rates after CS supporting the long‐term safety of CS. Importantly, there was no significant difference in long‐term ipsilateral versus contralateral cerebral events lending support to the hypothesis of plaque stabilization.

     

Norovirus Infections in Long‐Term Care Facilities

Noroviruses have emerged as one of the leading causes of viral gastroenteritis worldwide, affecting community‐dwelling and institutionalized older adults. Recent global epidemics present a growing challenge to the healthcare system and to long‐term care facilities. Noroviruses spread readily and rapidly through multiple routes (e.g., person‐to‐person contact, contact with contaminated surfaces, airborne dissemination of vomitus) and thus are able to sustain an epidemic efficiently and successfully. Although norovirus gastroenteritis is a short self‐limited illness in healthy immunocompetent individuals, it can result in significant morbidity and mortality in vulnerable compromised persons such as frail elderly persons and older residents of nursing homes. Diagnosis is made by clinical assessment and confirmed primarily by stool evaluation using polymerase chain reaction. Treatment is confined to supportive measures. Public health prevention and control strategies provide guidance regarding surveillance and the necessary steps to curb the clinical effect and spread of norovirus infections in various settings, including long‐term care.     

Long‐Term Follow‐Up of Patients with Syncope Evaluated by Head‐Up Tilt Test

Background: Clinicians may be tempted to consider a positive head‐up tilt test (HUTT) an unfavorable prognostic indicator. We investigated whether results of routine HUTT predict long‐term recurrence of syncope. Methods: We analyzed syncope recurrence at long‐term among 107 patients (mean age 51 ± 20 years) receiving HUTT for diagnostic evaluation of unexplained/suspected neurocardiogenic syncope in our Institute. Results: HUTT was positive in 76 patients (vasodepressive response, n = 58; cardioinhibitory, n = 5; mixed, n = 13). During a median follow‐up of 113 months (range, 7–161), 34 (32%) patients experienced recurrence (24 [32%] with positive HUTT during 110 months (7–159); 10 [32%] with negative HUTT during 120 [22–161] months). Actuarial freedom from recurrence at 10 years did not significantly differ for patients with positive/negative test results (after passive/active phases) or with different positive response patterns (vasodepressive, cardioinhibitory, mixed). By contrast, history of >4 syncopes in the 12 months preceding HUTT stratified risk of recurrence, irrespective of HUTT positivity/negativity. At Cox proportional hazards analysis, history of >4 syncopes in the 12 months preceding HUTT was the single independent risk factor for recurrence both in the overall study population (HR, 1.7; 95% CI, 1.07–2.69) and within the subset of patients who tested positive (HR, 1.83; 95% CI, 1.07–3.17). Conclusions: This long‐term follow‐up study reinforces the concept that a positive HUTT should not be considered an unfavorable prognostic indicator; frequency of recent occurrences may be a more valid predictor. Ann Noninvasive Electrocardiol 2010;15(2):101–106     

Ethanol Acutely Modulates mGluR1‐Dependent Long‐Term Depression in Cerebellum

Background: Acute and chronic ethanol exposure produces profound impairments in motor functioning. Individuals with lower sensitivity to the acute motor impairing effects of ethanol have an increased risk of developing alcohol dependence and abuse, and infants with subtle delays in motor coordination development may have an increased risk for subsequently developing alcoholism. Thus, understanding the mechanism by which ethanol disrupts motor functioning is very important. Methods: Parasagittal slices of the cerebellar vermis (250 μM thick) were prepared from P17 to 20 Sprague–Dawley rats. Whole‐cell recordings of Purkinje cells were obtained with an Axopatch 200B amplifier. Parallel fiber‐Purkinje cell synaptic currents were sampled at 1 kHz and digitized at 10 kHz, and synaptic long‐term depression (LTD) was observed in either external or internal application of ethanol for comparison. Results: We determined whether ethanol acutely affects parallel fiber LTD using whole‐cell patch‐clamp recordings from Purkinje cells. Application of ethanol both externally (50 mM) and internally (17 and 10 mM) significantly suppressed mGluR‐mediate slow currents. Short‐term external ethanol exposure (50 but not 17 mM) during tetanus blocked mGluR‐dependent parallel fiber LTD. Furthermore, internal 17 and 10 mM ethanol completely inhibited this LTD. Conclusions: The results of the current study demonstrate that ethanol acutely suppresses parallel fiber LTD and may influence the mGluR‐mediated slow current intracellularly. This study, plus previous evidence by Carta and colleagues (2006) and Belmeguenai and colleagues (2008), suggests significant actions of ethanol on mGluR‐mediated currents and its dependent plasticity in brain.