Clinical Cardiology
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A Review of Updated Guidelines Regarding Bradycardia and Cardiac Conduction Delay
The American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society have established updated guidelines on the evaluation and management of patients with bradycardia and conduction delays. Many key elements remain largely unchanged from prior guideline recommendations on pacemakers published in 2008 and 2012, but there also are important new definitions, recommendations, and areas of emphasis.
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Early Identification of Cardiac Amyloidosis in Carpal Tunnel Surgery Patients
In a cohort of older patients undergoing carpal tunnel release surgery, an analysis of tenosynovial tissue revealed amyloid deposits in 10% of patients. This development may facilitate early diagnosis of cardiac amyloidosis.
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Mitral Annulus Disjunction and Ventricular Arrhythmias
A patient cohort with mitral annular disjunction (MAD) identified by echo was characterized clinically and by MRI. Ventricular arrhythmias were common in MAD patients and related to the degree of MAD and papillary muscle fibrosis by MRI but not the presence of mitral valve prolapse.
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Detection of Prosthetic Heart Valve Endocarditis
A multicenter, retrospective, observational study of patients undergoing 18F-fluorodeoxyglucose PET/CT for prosthetic valve endocarditis or other indications showed that if certain obvious confounders are excluded, this imaging technique offers a high degree of accuracy for diagnosing prosthetic valve endocarditis, especially if performed early in the course of the disease.
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Study Adds Complexity to Post-TAVR Anticoagulation
In this large contemporary, prospective transcatheter aortic valve replacement registry, oral anticoagulation appears to be protective against valve degeneration but is associated with increased mortality. The strongest predictors of mortality at three years were male gender, renal failure, and atrial fibrillation.
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Telemedicine Improves Outcomes in Heart Failure
In patients with chronic heart failure, adding a remote patient management program to usual care was associated with improvement in unplanned cardiovascular hospitalization or death.
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Total Arterial Revascularization: Where Is It?
The results of a long-term follow-up study of matched pairs of patients undergoing surgical coronary artery revascularization showed that total arterial graft usage significantly reduced all-cause mortality vs. left internal mammary artery plus saphenous vein grafts.
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VEST: A Positively Negative Clinical Trial
In a randomized trial of the wearable cardioverter-defibrillator prescribed to patients with left ventricular dysfunction after acute myocardial infarction, overall compliance rates were low. The authors observed no significant improvement in arrhythmic death rates; yet, overall mortality was lower.
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LDL Cholesterol: How Low Do We Go?
A meta-analysis of 29 cholesterol-lowering outcome studies with baseline average low-density lipoprotein (LDL) cholesterol levels ≤ 70 mg/dL showed consistent major adverse cardiovascular event risk reductions down to average LDL levels of 21 mg/dL without any increase in adverse events.
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MitraClip Scores Big Win in COAPT
The largest trial to date of MitraClip in highly selected patients with congestive heart failure and functional mitral regurgitation revealed significant reductions in heart failure hospitalization and two-year mortality.