Clinical Cardiology
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Spironolactone & the Potential Benefit for HFPEF Patients
No treatment has been shown to improve outcomes in heart failure with preserved ejection fraction.
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Revascularization for Isolated Proximal LAD Disease: PCI is Easiest, but is it Best?
Among patients with obstructive coronary disease requiring revascularization, guidelines would suggest a clear preference for coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) only in certain defined subsets, including those with left main disease and in diabetics with multi-vessel disease. Patients with isolated proximal LAD disease represent a unique high-risk subset of those with single-vessel disease, in that the size of the affected territory and associated ischemic risk makes CABG a viable option. In fact, U.S. guidelines currently assign a slight advantage to CABG with a left internal mammary graft to the left anterior descending (LAD) for such patients, rating this as a IIa indication vs a IIb recommendation for PCI. This is despite a relative paucity of data on this subset of patients, at least using contemporary treatments. In fact, of the nine randomized, controlled trials forming the basis for 17 published studies examining this question, most are quite small, and all but one were performed using bare-metal stents; the single small RCT incorporating drug-eluting stents (DES) used first-generation devices that are no longer part of the treatment landscape.
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Interventional vs Conservative Strategy for Non-ST Elevation Acute Coronary Syndrome
More recent trials, and meta-analyses of all trials, have shown a reduction in death and myocardial infarction (MI) with a routine invasive strategy vs an ischemia or symptom-driven invasive strategy over 6-24 months for patients with non-ST elevation (E) acute coronary syndrome (ACS). However, an increase in death during the initial hospitalization in the routine invasive arm makes long-term outcome data important. Thus, the British Heart Foundation RITA 3 trial 5-year data are of interest. -
Dual Therapy for Acute STEMI: Has The Time Arrived?
In patients presenting with high-risk STEMI, TNK plus immediate angioplasty reduced the risk of recurrent ischemic events compared with TNK alone and was not associated with an increase in major bleeding complications. -
Reversal of Cardiomyopathy in Patients With Repetitive Ventricular Ectopy
Arrhythmia is the primary problem rather than a marker of an underlying cardiomyopathy. -
Left Atrial Size in Competitive Athletes
Left atrial remodeling in competitive athletes may be regarded as a physiologic adaptation to exercise conditioning, largely without adverse clinical consequences. -
QRS Duration Does Not Predict Occurrence of VT in Patients with ICDs
QRS duration does not predict occurrence of VT or VF necessitating ICD therapy. -
Risk of Noncardiac Surgery with Aortic Stenosis
Aortic stenosis increases the risk of MI, but not overall mortality with noncardiac surgery. -
LVAD Platform for Long-Term Drug Therapy in Severe CHF
Stage D or class IV congestive heart failure (CHF) is an ominous clinical state associated with high mortality. -
Statins for Heart Failure
Among adults diagnosed with heart failure who had no prior statin use, incident statin use was independently associated with lower risks of death and hospitalization among patients with or without coronary heart disease.