Clinical Cardiology
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Aggressive Afterload Reduction Does Not Improve Outcomes in Acute Decompensated Heart Failure
The authors of the GALACTIC trial found no benefit from an aggressive vasodilation approach for patients hospitalized with acute decompensated heart failure.
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Subclinical Atrial Fibrillation Detected By Implanted Loop Recorders: Common, But How Burdensome?
In older patients with risk factors for stroke drawn from the general population, previously undiagnosed and asymptomatic episodes of atrial fibrillation are detected frequently via implantable loop recorder monitoring, allowing for early initiation of anticoagulation therapy.
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Stenting Nonculprit Lesions After STEMI: Long-Term Data Support Complete Revascularization
Data from the CvLPRIT trial of complete vs. culprit-only percutaneous coronary intervention in ST-segment elevation myocardial infarction (MI) show a significantly lower rate of major adverse cardiovascular events, all-cause mortality, and lower composite MI in the complete revascularization group at a median follow-up of 5.6 years.
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Predicting the Progression of Chronic Aortic Regurgitation
A large database observational study of patients with chronic aortic mild or moderate regurgitation (AR) largely due to bicuspid aortic valve or aortic root dilatation showed that it was largely an indolent disease, with only 20% progressing to moderately severe AR in five years.
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Perioperative Management of Direct Oral Anticoagulants
A simple protocol for managing atrial fibrillation patients on direct oral anticoagulants perioperatively was shown to produce low levels of major bleeding and thromboembolism for 30 days postoperatively.
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CRT Nonresponders Experience Poor Outcomes, Warrant More Aggressive Management
The ADVANCE CRT registry revealed a significant minority of patients fail to respond to cardiac resynchronization therapy, conferring a worse prognosis.
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Is the Physical Exam an Anachronism in Heart Failure?
In the PARADIGM-HF trial, signs of congestion during physical exam were related to outcomes and the improved outcomes observed with valsartan/sacubitril vs. enalapril.
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CABG vs. PCI for Left Main Disease at 5 Years
Five years after randomizing 1,905 patients with left main disease to coronary artery bypass grafting or percutaneous coronary intervention, researchers found no significant difference in the primary composite outcome of death, stroke, or myocardial infarction.
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Anticoagulation Decisions in Atrial Fibrillation
Using the Delphi method of arriving at a consensus among clinicians concerning to whom with atrial fibrillation to recommend oral anticoagulants, the risk of stroke, the risk of hemorrhage, and patient-specific factors emerged. Many of these factors are not included in the guidelines and should be studied further.
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Optimizing AED Placement Locations
A study of the location of out-of-hospital cardiac arrests (OHCA) compared to the location of automatic external defibrillators (AED) in Denmark showed that if the placements of AEDs more closely matched the location of OHCAs, bystander defibrillation and 30-day survival would improve.