Clinical Cardiology Alert – September 1, 2024

September 1, 2024

• Are Mineralocorticoid Receptor Antagonists Safe in Heart Failure Patients with Renal Dysfunction?

  A post hoc analysis of the RALES and EMPHASIS HF trials has shown that, although treatment of heart failure with reduced left ventricular ejection fraction patients with mineralocorticoid receptor antagonists can cause a significant deterioration in renal function, the benefits outweigh the adverse effects and should not lead to automatic therapy discontinuation.

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• Indications for Reduced-Dose Direct Oral Anticoagulants

  A subgroup analysis of the ENGAGE-AF TIMI 48 study of edoxaban 60 mg/day vs. 30 mg/day compared to warfarin in patients with atrial fibrillation of the group 80 years of age or older has shown that 30 mg/day results in less major bleeding without a concomitant increase in stroke risk compared to 60 mg/day or warfarin.

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• Is Anticoagulation Necessary for Post-CABG Surgery Atrial Fibrillation?

  A meta-analysis of non-randomized trials of oral anticoagulant use for new atrial fibrillation (AF) after coronary artery bypass surgery involving almost 1.7 million patients has shown that AF is frequent, but the incidence of thromboembolism, bleeding, and death are low. Oral anticoagulants, when given, do not significantly affect thromboembolism or mortality rates, but they do increase bleeding.

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• Outcomes of Low-Risk Bicuspid Aortic Valve Patients Undergoing TAVR

  In this prospective, multicenter, single-arm trial, low-surgical risk patients with bicuspid aortic valve anatomy treated with transcatheter aortic valve replacement showed favorable results at three years, with low rates of death and disabling stroke.

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• Is Endomyocardial Biopsy Still Necessary if Cardiac MRI Is Available?

  A multicenter registry study in Europe of patients with suspected myocarditis has shown that, compared to cardiac magnetic resonance imaging, endomyocardial biopsy still is the gold standard, and lower ejection fraction and need for immunosuppressant drugs predicted a worse outcome.

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