Clinical Cardiology
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Provocative Testing with Intracoronary Acetylcholine as Part of Cardiac Catheterization Evaluation
In this systematic review and meta-analysis of invasive coronary provocation testing, intracoronary acetylcholine was found to be a safe procedure, with low rates of major complications.
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Clinical Significance of Mitral Annular Calcification
Researchers found mitral annular calcification to be uncommon, and few experience associated moderate to severe mitral stenosis or regurgitation. However, the latter group recorded a high mortality rate over three years follow-up, which was significantly lower in those who underwent valve interventions, even when corrected for younger age, fewer comorbidities.
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Appropriate Management of Thoracic Aortic Aneurysms
Among patients with arch and descending thoracic aorta aneurysms followed over a mean 20 months, aneurysm-related mortality was predicted by the size and growth rate of the aneurysms, along with age and sex.
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Researchers Suggest Checking Blood Pressure in Both Arms
After taking two readings, use the higher measurement for diagnosis. Guidelines recommend this practice, but data were lacking.
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The Value of Stress Testing in Patients with Known Coronary Artery Disease
A comparison of adenosine stress singe photon emission CT, PET, and MRI in stable patients with known coronary artery disease (CAD) showed PET to be more sensitive for detecting invasive fractional flow reserve-identified ischemic lesions. However, the sensitivity was disappointing; thus, patients with known CAD and new symptoms should be referred directly to invasive coronary angiography.
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Rivaroxaban Monotherapy for Atrial Fibrillation in Coronary Artery Disease Patients
For patients with atrial fibrillation and stable coronary artery disease, rivaroxaban monotherapy was superior to dual therapy for preventing thrombotic and bleeding events and was associated with a lower mortality.
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Reducing the Need for Invasive Coronary Angiography Before TAVR
Among those undergoing evaluation for transcatheter aortic valve replacement, coronary CT angiography and CT-derived fractional flow reserve demonstrated good diagnostic performance, potentially preventing invasive coronary angiography for many patients.
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Measure Stroke Risk with Asymptomatic Severe Carotid Artery Stenosis
A community-based, retrospective, observational study of patients with asymptomatic severe carotid artery stenoses showed the crude stroke risk over five years was about 5%. Patients whose stenoses progress to high grade or start at that severity were at the highest risk for stroke.
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Echocardiographic Assessment of Right Ventricular Function
A study of a cardiac resynchronization therapy registry demonstrated right ventricular free wall strain by speckle tracking 2D echocardiography is more sensitive for detecting right ventricular dysfunction vs. other echo measures of right ventricular function.
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Echo vs. Cardiac MRI for Grading Mitral Regurgitation Severity
A comparison of echocardiographic-measured severity of mitral regurgitation with that of cardiac MRI-determined severity demonstrated poor agreement in the diagnosis of severe mitral regurgitation. Only cardiac MRI was predictive of left ventricular reverse remodeling after mitral valve surgery.