Clinical Cardiology
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Uncertainties in Assessing Stroke Risk in Atrial Fibrillation
An analysis of 34 randomized trials in atrial fibrillation patients not on anti-coagulation showed considerable variation in stroke rates corresponding to their predicted risk by the CHA2DS2-VASc scores. When these scores are 2 or less, stroke rates are low enough to question the benefit versus risk of anti-coagulation therapy.
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Study Challenges Orthodoxy of IV Hydration for Prevention of Contrast Nephropathy
This trial randomized 660 patients with chronic kidney disease and a planned procedure requiring intravascular iodinated contrast to prophylactic hydration or to no hydration. No hydration was found to be non-inferior for prevention of contrast-induced nephropathy and saved significant costs.
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Diastolic Stress Testing Improves Diagnostic Accuracy in Evaluation of Heart Failure With Preserved Ejection Fraction
Adding echocardiographic assessment of diastolic function during exercise improves the accuracy of current algorithms for evaluating suspected heart failure with preserved ejection fraction.
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Left Ventricular Diastolic Function in the Elderly
Analysis of the ability of echo Doppler measures of diastolic function to predict heart failure and death in community subjects > 65 years of age was improved by applying age-adjusted normal values for e’, which are considerably lower than those recommended in the American Society of Echocardiography guidelines.
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High-sensitivity Cardiac Troponin
In a recent trial, the use of high-sensitivity troponin T did not increase the use of coronary angiography or stress testing, but did reduce ED length of stay and costs.
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Hemoconcentration Associated with Lower Mortality in Acute Heart Failure
Among patients hospitalized for acute heart failure, hemoconcentration was associated with reduced 90-day mortality and may be a useful marker for guiding therapy.
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Mechanical Circulatory Support in Cardiogenic Shock: Can Any Device Move the Mortality Needle?
In a small randomized trial of patients with cardiogenic shock secondary to acute myocardial infarction, the Impella heart pump failed to improve mortality compared with intra-aortic balloon counterpulsation.
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ECG Screening of Athletes
T-wave inversion confined to ECG leads V1-V2 is a normal variant, but T-wave inversion beyond V2 is rare and may warrant further investigation.
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Weight Loss to Make You Feel Better, Live Longer, and Lower Your Risk of Atrial Fibrillation
Significant and sustained weight loss through bariatric surgery reduced the risk of developing new-onset atrial fibrillation in a Swedish cohort of obese individuals.
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Troponin Highly Prognostic in Decompensated Heart Failure with Preserved Ejection Fraction
Among patients with acute decompensated heart failure and preserved ejection fraction, elevated troponin is associated with worse in-hospital outcomes and long-term survival, independent of other predictors.