Clinical Cardiology Alert – April 1, 2018
April 1, 2018
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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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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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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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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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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.