Clinical Cardiology
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Do We Need to Stop Renin-Angiotensin Inhibition Before Non-Cardiac Surgery?
A randomized study of stopping vs. continuing renin-angiotensin system inhibitors prior to elective non-cardiac surgery in older patients did not decrease the incidence of myocardial injury and may have increased the incidence of hypertensive adverse events.
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Are Beta-Blockers Post-MI Still Necessary?
A large, multicenter, international, randomized clinical trial of long-term beta-blocker therapy vs. no such therapy in contemporary acute myocardial infarction patients who had coronary artery angiography-guided therapy and left ventricular ejection fractions ≥ 50% found no differences in the primary endpoint of all-cause mortality and recurrent myocardial infarction.
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Is Weight Loss the Key to Heart Health?
The second trial of semaglutide in obese patients with heart failure and preserved left ventricular ejection fraction, this one in people with type 2 diabetes, also has shown significant improvements in symptoms and exercise function with significantly fewer adverse effects than placebo-treated patients.
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Transcatheter Myotomy for Left Ventricular Outflow Tract Obstruction
Initial experience with a new transcutaneous transcatheter electrosurgery device using intramyocardial guidewires to create left ventricular upper septum myotomies to enlarge the outflow tract in symptomatic patients with hypertrophic cardiomyopathy, and potentially to enhance transcatheter left heart valve replacement when outflow tract obstruction compromises the procedure, is described in this report from a single center.
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Can Coronary Stenting in Stable Atherosclerotic Coronary Disease Prevent Future Adverse Events?
In this randomized, open-label trial of patients with primarily stable atherosclerotic coronary disease, stenting compared with medical therapy of nonobstructive lesions with imaging markers of plaque vulnerability resulted in a lower incidence of the composite endpoint of cardiac death, target-vessel myocardial infarction, ischemia-driven target vessel revascularization, or hospitalization for unstable or progressive angina at two years.
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Is Artificial Intelligence Coming for Your Job?
A retrospective analysis of plain chest X-ray images in the medical record using deep learning in patients suitable for risk assessment for atherosclerotic cardiovascular disease (ASCVD) has shown similar results as the American College of Cardiology/American Heart Association ASCVD risk calculator for determining who is at sufficient risk to consider statin therapy.
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Can Pulmonary Artery Pressure Help in the Decision to Operate in Chronic Aortic Regurgitation?
A large tertiary center retrospective observational study of patients with moderate to severe aortic regurgitation showed that 14% had significant pulmonary hypertension (PH) and that it was associated with symptoms and higher mortality. Aortic valve replacement abrogated PH in most patients by hospital discharge and improved survival regardless of the presence of PH.
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Combined TAVR and LAAO Studied in a Randomized Controlled Trial
In this randomized controlled trial of patients with atrial fibrillation undergoing transcatheter aortic valve replacement (TAVR), concomitant left atrial appendage occlusion at the time of TAVR was noninferior to TAVR plus medical therapy for a combined endpoint of death, stroke, and major bleeding at two years.
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Another Hemodynamic Variant of Aortic Stenosis
A large, retrospective, observational study of patients with aortic valve gradients in the severe aortic stenosis range but with aortic valve areas in the moderate range has shown that such patients are not uncommon. Their prognosis is similar to patients with high-gradient severe aortic stenosis.
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Clinical Features of Tachyarrhythmia-Induced Cardiomyopathy
A prospective observational study of patients with left ventricular dysfunction without known cause and tachyarrhythmias has shown that restoration of sinus rhythm significantly improves left ventricular function in more than 80% of such patients by six months and, initially, normal left ventricular size can be predictive of this response.