Cardiology Topics
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Left Atrial vs. Left Ventricular Parameters for Intervention Decisions
A one-institution study of serial echocardiograms in patients with moderate to severe or severe aortic regurgitation demonstrated that changes in left atrial size and strain changed over time in a similar fashion regardless of sex and age, and were of incremental prognostic value compared to left ventricular size and function.
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Screening Relatives of Hypertrophic Cardiomyopathy Patients
A retrospective cohort study of the first-degree relatives of patients with hypertrophic cardiomyopathy (HCM) seen in screening clinics in Denmark has shown that the diagnostic yield of the first visit is 26% and subsequent visits add 4%. The best predictor of the development of HCM in relatives of families with negative genetic findings was maximal left ventricular wall thickness of ≥ 10 mm.
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Benefits of Early, Aggressive Cholesterol-Lowering After Myocardial Infarction
A large national registry study of myocardial infarction patients has shown that achieving target levels of non-high-density lipoprotein cholesterol by one month and maintaining them for at least one year reduces subsequent major adverse cardiac events and argues for aggressive early cholesterol management rather than the usual stepwise approach.
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Validation of the New American Heart Association’s PREVENT Equations
An analysis of the accuracy of the new American Heart Association PREVENT Equations for predicting 10-year cardiovascular disease mortality in the National Health and Nutrition Examination Survey population has shown excellent discrimination with only modest underprediction and supports its use vs. the pooled cohort equation, which is the current standard.
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Benefit of TAVR in Patients with Moderate Aortic Stenosis and Systolic Dysfunction
In this multicenter randomized trial of early transcatheter aortic valve replacement (TAVR) in patients with moderate aortic stenosis, TAVR was not superior to medical surveillance, with TAVR triggered by progression to severe aortic stenosis.
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A New Technique for Predicting Outcomes in Asymptomatic AS
An international study of patients with moderate or asymptomatic severe aortic stenosis has demonstrated that increased amounts of left ventricular fibrosis, as measured by cardiac magnetic resonance imaging, is associated with worse outcomes.
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PCI in TAVR Patients with Severe Coronary Lesions Shows Benefits
In this randomized trial of patients undergoing transcatheter aortic valve replacement (TAVR), with an average of one severe coronary stenosis, percutaneous coronary intervention in addition to TAVR reduced the incidence of the combined endpoint of all-cause mortality, myocardial infarction, and urgent revascularization at two years.
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Screening for Atrial Fibrillation in Older Adults
A two-week ambulatory electrocardiogram monitor in a large group of individuals 70 years of age or older with no history of atrial fibrillation (AF) showed a very low incidence of AF (4.4%), almost all of which was paroxysmal. In less than 2% of the subjects did it represent ≥ 2% of the monitoring time. However, some patients had hours of AF, raising a concern for thromboembolic risk.
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Biomarker Enhances Screening for Atrial Fibrillation
A large Swedish population study of screening for atrial fibrillation (AF) in 75-year-old individuals that was enhanced by N-terminal pro-B-type natriuretic peptide (NT-proBNP) stratification did not identify more AF cases or prevent thromboembolic outcomes compared to unscreened control subjects. However, a low NT-proBNP (< 125 ng/L) did identify individuals at low risk for AF and thromboembolic events in whom screening could be safely forfeited.
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A New Drug for Heart Failure with Preserved Ejection Fraction?
The addition of the nonsteroidal mineralocorticoid receptor antagonist finerenone to standard therapy reduced the incidence of recurrent heart failure and death compared to placebo in patients with heart failure and mildly reduced or preserved left ventricular ejection fraction and was generally well tolerated.