Clinical Cardiology Alert – July 1, 2020
July 1, 2020
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Where Does Vericiguat Fit into the Heart Failure Medication Algorithm?
Vericiguat reduced cardiovascular death and heart failure hospitalization, although no reduction in overall mortality was observed over a short follow-up period.
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Subclinical Leaflet Thrombosis: Not Just a TAVR Phenomenon
Imaging-defined leaflet thrombosis was common and similar between transcatheter aortic valve replacement and surgical aortic valve replacement bioprosthetic valves. These findings showed no apparent relationship to valve hemodynamics or to clinical outcomes, including stroke.
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Coronary Calcium to Guide Aspirin Primary Prevention
Researchers analyzed the MESA study to determine the comparative value of the pooled risk equation vs. CT coronary artery calcium score for determining which aspirin-naïve patients < age 70 years without overt coronary artery disease would benefit most from primary prevention with aspirin. They found a calcium score of > 100 was superior for this determination.
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Clinical vs. Genetic Risk for Coronary Disease
A study of the utility of a polygenetic score for coronary artery disease risk was compared to the pooled cohort equation (PCE) for determining which primary prevention patients would benefit from statin use. Only at the top 5% risk stratum did the genetic score exceed an odds ratio for coronary disease of 2. Using these data would increase statin recommendations by 4% vs. the PCE.
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Is Exercise ECG Testing Dead?
A post-hoc analysis of the SCOT-HEART trial demonstrated exercise ECG is predictive of future coronary heart disease events and mortality. However, coronary CT angiography is more accurate for the detection of coronary artery disease and is more strongly associated with future coronary events.