Clinical Cardiology
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Cardioversion in Obese Patients
A multicenter, single-blind, randomized clinical trial of dual vs. single defibrillator shocks for cardioverting obese patients with atrial fibrillation showed that dual defibrillation was significantly more effective without any increase in adverse events.
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Are Women with Atrial Fibrillation Still at Higher Risk of Ischemic Stroke?
A Finnish national database study of newly diagnosed atrial fibrillation from 2007-2018 has shown that the independent association of ischemic stroke risk with female sex initially was high but trended downward to nonsignificant at the end of the study. This has implications for the risk stratification of atrial fibrillation patients regarding oral anticoagulation therapy.
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Insights from the Apixaban vs. Aspirin for Subclinical Atrial Fibrillation Trial
An analysis of the ARTESiA trial of apixaban vs. aspirin for stroke prevention in subclinical atrial fibrillation by CHA2DS2VASc score has shown that the benefits of apixaban outweigh the risk of major bleeding at scores > 4 and the opposite is true at scores < 4.
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Empagliflozin Post-Acute Myocardial Infarction
A prespecified further analysis of the EMPACT-MI trial has shown that patients within two weeks of an acute myocardial infarction who are at risk for heart failure who receive empagliflozin compared to placebo have significantly fewer episodes of heart failure hospitalizations over a median follow-up of 18 months.
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Impella Scores a Big Win in Infarct-Related Cardiogenic Shock, but with Big Caveats
In this randomized controlled trial of patients presenting with ST-elevation myocardial infarction and cardiogenic shock, use of the Impella microaxial flow pump resulted in improved survival but also higher adverse safety events compared with standard care.
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Do We Need to Stop Renin-Angiotensin Inhibition Before Non-Cardiac Surgery?
A randomized study of stopping vs. continuing renin-angiotensin system inhibitors prior to elective non-cardiac surgery in older patients did not decrease the incidence of myocardial injury and may have increased the incidence of hypertensive adverse events.
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Are Beta-Blockers Post-MI Still Necessary?
A large, multicenter, international, randomized clinical trial of long-term beta-blocker therapy vs. no such therapy in contemporary acute myocardial infarction patients who had coronary artery angiography-guided therapy and left ventricular ejection fractions ≥ 50% found no differences in the primary endpoint of all-cause mortality and recurrent myocardial infarction.
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Is Weight Loss the Key to Heart Health?
The second trial of semaglutide in obese patients with heart failure and preserved left ventricular ejection fraction, this one in people with type 2 diabetes, also has shown significant improvements in symptoms and exercise function with significantly fewer adverse effects than placebo-treated patients.
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Transcatheter Myotomy for Left Ventricular Outflow Tract Obstruction
Initial experience with a new transcutaneous transcatheter electrosurgery device using intramyocardial guidewires to create left ventricular upper septum myotomies to enlarge the outflow tract in symptomatic patients with hypertrophic cardiomyopathy, and potentially to enhance transcatheter left heart valve replacement when outflow tract obstruction compromises the procedure, is described in this report from a single center.
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Can Coronary Stenting in Stable Atherosclerotic Coronary Disease Prevent Future Adverse Events?
In this randomized, open-label trial of patients with primarily stable atherosclerotic coronary disease, stenting compared with medical therapy of nonobstructive lesions with imaging markers of plaque vulnerability resulted in a lower incidence of the composite endpoint of cardiac death, target-vessel myocardial infarction, ischemia-driven target vessel revascularization, or hospitalization for unstable or progressive angina at two years.