Clinical Cardiology
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A New Technique for Predicting Outcomes in Asymptomatic AS
An international study of patients with moderate or asymptomatic severe aortic stenosis has demonstrated that increased amounts of left ventricular fibrosis, as measured by cardiac magnetic resonance imaging, is associated with worse outcomes.
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PCI in TAVR Patients with Severe Coronary Lesions Shows Benefits
In this randomized trial of patients undergoing transcatheter aortic valve replacement (TAVR), with an average of one severe coronary stenosis, percutaneous coronary intervention in addition to TAVR reduced the incidence of the combined endpoint of all-cause mortality, myocardial infarction, and urgent revascularization at two years.
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Screening for Atrial Fibrillation in Older Adults
A two-week ambulatory electrocardiogram monitor in a large group of individuals 70 years of age or older with no history of atrial fibrillation (AF) showed a very low incidence of AF (4.4%), almost all of which was paroxysmal. In less than 2% of the subjects did it represent ≥ 2% of the monitoring time. However, some patients had hours of AF, raising a concern for thromboembolic risk.
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Biomarker Enhances Screening for Atrial Fibrillation
A large Swedish population study of screening for atrial fibrillation (AF) in 75-year-old individuals that was enhanced by N-terminal pro-B-type natriuretic peptide (NT-proBNP) stratification did not identify more AF cases or prevent thromboembolic outcomes compared to unscreened control subjects. However, a low NT-proBNP (< 125 ng/L) did identify individuals at low risk for AF and thromboembolic events in whom screening could be safely forfeited.
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A New Drug for Heart Failure with Preserved Ejection Fraction?
The addition of the nonsteroidal mineralocorticoid receptor antagonist finerenone to standard therapy reduced the incidence of recurrent heart failure and death compared to placebo in patients with heart failure and mildly reduced or preserved left ventricular ejection fraction and was generally well tolerated.
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How Old Is Atherosclerosis?
Computed tomography of mummified human remains exhibits vascular calcium in almost 40% across multiple eras and geographies, which included <br />non-elites.
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Marantic Endocarditis Revisited
A single institution case series of cancer-associated thrombotic endocarditis has shown that it most frequently presents as a systemic embolism and is detected largely by transesophageal echocardiography, which displays mobile masses attached to thickened mitral and aortic valves.
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Clarifying the Risk of Aortic Aneurysm Development
A large, cross-sectional study of adults by aortic computed tomography angiography has shown that aortic aneurysms (AAs) are more frequent in men than women. While increasing age and body surface area were common risk factors for AA, hypertension was associated with thoracic AA and hypercholesterolemia and smoking were risk factors for abdominal AA.
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Antithrombotic Treatment for Atrial Fibrillation After Acute Coronary Events
An analysis of the AUGUSTUS trial comparing a P2Y12 inhibitor plus four combinations of double or triple therapy with apixaban, aspirin, and a vitamin K antagonist in patients with atrial fibrillation and a recent acute coronary event or percutaneous coronary intervention has shown that a P2Y12 inhibitor plus apixaban exhibited the lowest rate of major adverse events and major bleeding events.
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Poor Diabetes Control Associated with Poorer Coronary Stent Outcomes
In this large, observational study of diabetic patients with coronary stents, poorer glycemic control as measured by hemoglobin A1c was associated with stepwise hazard for stent failure over a period of more than six years, primarily driven by in-stent restenosis.