Clinical Cardiology
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Real-world Study of Left Atrial Appendage Occluder Devices Raises New Concerns
A large observational study from France of two devices used commonly for occlusion of the left atrial appendage in patients with atrial fibrillation showed that device-related thrombus was not uncommon and was associated with subsequent stroke.
The Pulmonary Embolism Rule-out Criteria in Low-risk Patients
A cluster randomized trial of the pulmonary embolism rule-out criteria (PERC) compared to usual care for patients estimated to be at low risk of pulmonary embolus (PE) in EDs showed that PERC was non-inferior to usual care at identifying patients who would be free of symptomatic PE at three months, resulting in less use of healthcare resources.
Risk of Endocarditis Revisited
The authors of a population-wide study of hospitalizations and deaths from infective endocarditis (IE) in England confirmed the high risk of IE in certain cardiac conditions, but showed that other conditions thought to be low risk also are at higher risk and found new higher-risk categories not previously identified. Investigators suggested these data should be considered when the antibiotic prophylaxis guidelines are revised.
Coffin Nail for Omega-3 Fatty Acids?
A meta-analysis of 10 randomized, controlled trials of omega-3 fatty acids for the prevention of coronary heart disease and major vascular events showed no significant effect on fatal and non-fatal coronary heart disease or any major vascular event. These results do not support the use of omega-3 fatty acids supplements in patients with prior coronary heart disease.
Methamphetamine-associated Pulmonary Hypertension and Cardiomyopathy Are Distinct Diseases
In a large study of methamphetamine users, female sex was associated with presence of pulmonary hypertension, whereas male sex, hypertension, and alcoholism were associated with cardiomyopathy. Both pulmonary hypertension and cardiomyopathy patients exhibited substantially increased mortality.
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.
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.
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.
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.
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.