Clinical Cardiology
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Benefits of Exercise in Established Atrial Fibrillation
A large, long-term, prospective, Norwegian population study of patients with established atrial fibrillation revealed physical activity at or above recommended levels reduces all-cause and cardiovascular mortality vs. atrial fibrillation patients who are inactive.
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Warfarin vs. DOAC for Left Ventricular Thrombi
A large, multicenter, observational study of the relative efficacy of warfarin vs. direct oral anticoagulants (DOACs) for left ventricular thrombi has shown that DOAC use is associated with a higher risk of embolic events than warfarin. Investigators advised caution with off-label use of DOACs.
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Does Anticoagulant Therapy Affect Outcomes in Left Ventricular Mural Thrombus Patients?
Left ventricular thrombus is an uncommon finding but one associated with a high incidence of all-cause mortality and major adverse cardiac and embolic events. Total regression of left ventricular thrombus on anticoagulant therapy reduced mortality.
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Many Serious Cardiac Complications of Pregnancy Are Preventable
Investigators determined about half of serious cardiac complications of pregnancy are preventable.
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Coronary CT Angiography to Identify Plaque Stabilization
Researchers identified subjects with no known coronary artery disease drawn from a large international, multicenter registry of coronary CT angiography. Subjects were divided into matched pairs with and without a subsequent acute coronary syndrome event. The authors demonstrated those with a high density of calcium plaques experienced the fewest events, suggesting high-density calcium plaques are stable.
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TAVR in Bicuspid Aortic Valves
Investigators assessed the Society of Thoracic Surgeons/American College of Cardiology transcatheter aortic valve replacement (TAVR) data, with a focus on the use of newer TAVR devices in patients with bicuspid aortic valve vs. tricuspid aortic valves. They found the outcomes post-procedure and for one year are not significantly different between the two types of native valve anatomy. -
Antiplatelet Agents Add to Bleeding Risk, Do Not Add Benefit in TAVR Patients Already on Oral Anticoagulation
In a randomized trial of patients already on anticoagulation undergoing transcatheter aortic valve replacement, adding clopidogrel to oral anticoagulation increased the incidence of serious bleeding vs. oral anticoagulation alone, but did not improve cardiovascular outcomes.
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Hyperdynamic Left Ventricular Function: Good or Bad News?
A large population study has shown a U-shaped relationship between left ventricular ejection fraction (EF) and mortality, with a nadir at 60-65%. The authors identified a new group at high risk for death: those with an EF ≥ 70%.
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Heart Failure Confers Increased Risk of Venous Thromboembolic Events
In the Atherosclerosis Risk in Communities (ARIC) cohort, incident heart failure hospitalization with either preserved or reduced ejection fraction was associated with long-term increased risk of venous thromboembolic events.
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Role of Cardiac MRI in Recurrent Pericarditis
This multicenter study revealed cardiac MRI may be useful in the diagnosis of difficult pericarditis cases, especially if pericardial edema and late gadolinium enhancement are found. Pericardial thickening and elevated C-reactive protein were found to be predictive of recurrent pericarditis and other complications.