Clinical Cardiology
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Permanent His-bundle Pacing Cardiac Resynchronization: The Way Nature Intended
When used as either a primary alternative to biventricular pacing or a rescue therapy for failed biventricular pacing, permanent His-bundle pacing was associated with significant QRS narrowing, an increase in left ventricular ejection fraction, and an improvement in New York Heart Association functional class.
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Age-stratified NT-proBNP Thresholds Identify Acute Heart Failure
In patients presenting to the ED with acute dyspnea, age-based NT-proBNP cutpoints help diagnose acute heart failure.
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Are Beta-blockers Indicated for Heart Failure at all LVEF Levels?
A meta-analysis of 11 trials of beta-blockers for heart failure showed that beta-blockers increased left ventricular ejection fraction and reduced cardiovascular mortality in patients in sinus rhythm with baseline ejection fractions < 50%, including those in the 40-49% range.
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CABG vs. PCI in Diabetes With Multivessel Coronary Artery Disease and LV Dysfunction
A propensity score-matching analysis of all patients undergoing coronary angiography in Alberta, Canada, identified a subgroup with diabetes, multivessel coronary artery disease, and left ventricular ejection fraction < 50% who were undergoing revascularization and could be separated into a group undergoing percutaneous coronary intervention (PCI) and another coronary artery bypass grafting (CABG). At five years' follow-up, the CABG group experienced significantly fewer major cardiac or cerebral vascular events compared to PCI and a low risk of stroke that was similar to that observed with PCI.
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TAVR in Lower-risk Patients: How Low Should We Go?
A meta-analysis of studies comparing transcatheter aortic valve replacement (TAVR) to surgical aortic valve replacement over a two-year follow-up in low surgical risk patients exhibits a higher mortality in the TAVR group, prompting the authors to recommend caution in applying TAVR to low-risk patients until randomized trials are completed.
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Stroke Risk in Atrial Fibrillation: A Moving Target?
An investigation of patients in a national database with atrial fibrillation and no comorbidities and not on aspirin or anticoagulants showed that the clinical features that make up the CHA2DS2-VASc score change over time and can increase a patient’s risk for stroke, which could affect therapy decisions.
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Physical Activity and Death in CAD Patients
An observational study of leisure time physical activity (LTPA) assessed at baseline and two years later in stable coronary artery disease patients, who then were followed for about five more years, showed that LTPA at baseline, at two years, and if it went from zero at baseline to some at two years was associated with lower rates of cardiac death compared to inactive patients.
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Accurately Diagnosing Aortic Dissection
A prospective study of patients with suspected acute aortic syndromes showed that a clinical risk score plus D-dimer testing carried a positive predictive value of 99.7% and a 0.3% incidence of false-negative studies. The authors recommended that this approach become the standard method for triage to imaging in patients with suspected acute aortic syndromes.
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What’s the Best Technique to Measure Low-flow, Low-gradient Aortic Stenosis?
In patients with low-flow, low-gradient aortic stenosis, current guideline-based criteria for identifying true severe aortic stenosis did not predict aortic stenosis severity or survival. Calculation of the projected aortic valve area at a normal transvalvular flow rate more accurately identifies true severe aortic stenosis and is a stronger predictor of outcomes.
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CASTLE-AF Supports Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure
Catheter ablation for atrial fibrillation in relatively young men with cardiomyopathy and heart failure is associated with a substantial reduction in arrhythmia burden, improvement in ejection fraction, and reduction in heart failure hospitalizations and mortality compared to medical therapy.