Clinical Cardiology
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Does Ascending Aorta Size Predict Dissection?
A large Australian database study has shown that, because of the much larger number of patients without severe aortic dilatation, almost all fatal dissections occur in individuals with non-severely dilated aortas — the so-called aortic paradox.
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Chlorthalidone vs. Hydrochlorothiazide for Hypertension
A subgroup analysis of those with prior myocardial infarction or ischemic stroke in the Diuretic Comparison Project for the treatment of hypertension has found that this higher-risk group experiences fewer major adverse cardiovascular events while taking chlorthalidone compared to hydrochlorothiazide, but at the expense of more hypokalemia.
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CVD Risk from Ketogenic Diets
A recent analysis of the UK Biobank data found that subjects on a low-carbohydrate, high-fat diet had higher levels of low-density lipoprotein cholesterol and apolipoprotein B, and an increase in incident major adverse cardiovascular events over a 12-year follow-up than subjects on a standard diet.
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Risk of Atherosclerotic Coronary Artery Disease in Autoimmune Disorders
A large Danish registry study of patients with autoimmune disease referred for coronary computed tomography angiography compared to those without autoimmune disease has shown that autoimmune disease increases the incidence of atherosclerotic events and that the event rate is influenced by traditional atherosclerotic disease risk factors. These results support aggressive risk factor management in patients with autoimmune disease.
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The Role of Pulmonary Hypertension in the Decision to Intervene in Degenerative Mitral Regurgitation
A retrospective observational study of patients with degenerative mitral valve regurgitation has shown that Doppler echocardiographic-determined elevated pulmonary artery systolic pressure is related to mortality independent of the severity of mitral regurgitation, and that this excess mortality can be attenuated by mitral valve surgery.
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Cardioversion in Obese Patients
A multicenter, single-blind, randomized clinical trial of dual vs. single defibrillator shocks for cardioverting obese patients with atrial fibrillation showed that dual defibrillation was significantly more effective without any increase in adverse events.
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Are Women with Atrial Fibrillation Still at Higher Risk of Ischemic Stroke?
A Finnish national database study of newly diagnosed atrial fibrillation from 2007-2018 has shown that the independent association of ischemic stroke risk with female sex initially was high but trended downward to nonsignificant at the end of the study. This has implications for the risk stratification of atrial fibrillation patients regarding oral anticoagulation therapy.
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Insights from the Apixaban vs. Aspirin for Subclinical Atrial Fibrillation Trial
An analysis of the ARTESiA trial of apixaban vs. aspirin for stroke prevention in subclinical atrial fibrillation by CHA2DS2VASc score has shown that the benefits of apixaban outweigh the risk of major bleeding at scores > 4 and the opposite is true at scores < 4.
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Empagliflozin Post-Acute Myocardial Infarction
A prespecified further analysis of the EMPACT-MI trial has shown that patients within two weeks of an acute myocardial infarction who are at risk for heart failure who receive empagliflozin compared to placebo have significantly fewer episodes of heart failure hospitalizations over a median follow-up of 18 months.
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Impella Scores a Big Win in Infarct-Related Cardiogenic Shock, but with Big Caveats
In this randomized controlled trial of patients presenting with ST-elevation myocardial infarction and cardiogenic shock, use of the Impella microaxial flow pump resulted in improved survival but also higher adverse safety events compared with standard care.