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NEWS - Cardiology

#ACC18 – Carvedilol for Prevention of Chemotherapy Related Cardiotoxicity – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentaries: Beta Blocker Shows Mixed Results in Protecting Against Chemo-Induced Heart Damage – American College of Cardiology (free) AND Carvedilol Effect in Preventing Chemotherapy Induced CardiotoxicitY – CECCY – American College of Cardiology (free)

Related study from #ACC18: Heart Drugs Prevented Cardiotoxicity in Breast Cancer Treated With Anthracycline and Trastuzumab – American College of Cardiology (free)

“According to the CECCY trial, carvedilol had no effect on left ventricular function in breast cancer patients treated w/ doxorubicin, but did result in a reduction in troponin I levels & diastolic dysfunction”. (via @ACCinTouch see Tweet)


#ACC18 – Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops – New England Journal of Medicine (free for a limited period)

Commentaries: Barbershop-Based Intervention Leads to Blood Pressure Reductions in African-American Men – American College of Cardiology (free) AND Mixing Haircuts and Hypertension Rx a ‘Home Run’ for Blood Pressure Control – TCTMD (free)

“Among black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists”.


#ACC18 – The ODYSSEY Trial Ends Well— But Will It Be Enough? – Cardiobrief (free) AND Ten Quick Thoughts on ODYSSEY – John Mandrola, via Medscape (free registration required)

“An absolute risk reduction of 1.6% in the primary endpoint translates to a number needed to treat of 64. Using the current price of $14,500 per year, Kaul calculated that preventing one event over the trial period of almost 3 years would cost about $2.6 million” (via John Mandrola). This study was presented at #ACC18 and has not been published yet. Among the many commentaries, these two were selected for a balanced point of view.


N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department – Journal of the Americana College of Cardiology (link to abstract – $ for full-text)

Commentary: NT-proBNP cutpoints validated for diagnosing and ruling out heart failure in the ED – ACP Hospitalist (free)

Related review: BNP in the emergency department: The evidence – First10EM (free)

“In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF”.


Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis – Heart (free)

Editorial: Pharmacological strategies in heart failure with preserved ejection fraction: time for an individualised treatment strategy? (free)

Commentary: Heartbeat: Is there any effective therapy for heart failure with preserved ejection fraction? (free)

In this meta-analysis of RCT testing treatments for patients with heart failure with preserved ejection fraction, only beta-blockers demonstrated reductions in all-cause and cardiovascular mortality.


Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial – The Lancet (free)

Commentaries: Hypertension: time for doctors to switch the driver’s seat? (free) AND Should home-based blood pressure monitoring be commonplace in NHS? – University of Oxford News & Events (free)

“Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings”.


Meta-analysis: Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentary: Long-Term Outcomes of On- vs. Off-Pump CABG – American College of Cardiology, Latest in Cardiology (free)

“Off pump CABG. probably best used in a limited set of patients…” (via @keaglemd see Tweet)


Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data – The Lancet (free)

This meta-analysis of randomized trials showed CABG had a mortality benefit over PCI in patients with multivessel disease, particularly those with diabetes and higher coronary complexity. There was no mortality benefit in patients with left main disease.


Readmissions Following a Hospitalization for Cardiovascular Events in Dialysis Patients: A Retrospective Cohort Study – Journal of the American Heart Association (free for a limited period)

“Roughly 1 in 3 CVD hospitalizations resulted in 30‐day readmission; nearly 1 in 20 was followed by death within 30 days”.


Outcomes of non-invasive diagnostic modalities for the detection of coronary artery disease: network meta-analysis of diagnostic randomised controlled trials – The BMJ (free)

Among patients with low risk acute coronary syndrome, stress echocardiography, cardiovascular magnetic resonance, and exercise electrocardiograms resulted in fewer invasive referrals for coronary angiography than coronary computed tomographic angiography, without apparent impact on the future risk of myocardial infarction. Similarly, for outpatients with suspected stable angina, an initial strategy based on functional testing might be preferable, resulting in fewer referrals for invasive coronary angiography and revascularization, without a statistically significant difference in the future risk of MI.


Systolic Blood Pressure and Outcomes in Patients With Heart Failure With Preserved Ejection Fraction – JAMA Cardiology (link to abstract – $ for full-text)

Commentaries: Aggressive Systolic Blood Pressure Control In Older Patients With HFpEF Should Be Avoided – MedicalResearch.com (free) AND Low blood pressure linked to worse outcomes in HFpEF patients – Cardiovascular Business (free)

“A systolic blood pressure level of less than 120 mm Hg identifies patients with heart failure with preserved ejection fraction at higher risk for short- and long-term mortality and emphasizes the need for future prospective studies to evaluate optimal systolic blood pressure treatment goals in this patient population”.


Medical News & Perspectives: Do All Patients Need β-Blockers After a Heart Attack? – JAMA (free for a limited period)


Transcatheter versus surgical aortic valve replacement in patients at low surgical risk: A meta-analysis of randomized trials and propensity score matched observational studies – Catheterization Cardiovascular Interventions (link to abstract – $ for full-text)

Commentary: Meta-Analysis Raises ‘Red Flag’ on TAVR in Low-Risk Patients – TCTMD (free)

“Data from six studies show that while short-term mortality is similar between TAVR and SAVR, more low-risk TAVR patients die by 2 years” (from TCTMD)


Polygenic Contribution in Individuals With Early-Onset Coronary Artery Disease – Circulation: Genomic and Precision Medicine (free)

Commentary: Genetic Risk Score May Best FH Variant for Predicting Early-Onset CAD – Medscape (free registration required)

“Another study suggests CAD will soon be predicted not by 1 gene (like FH) but groups of genes that can be combined into risk scores” (via @drjohnm see Tweet)


Direct Oral Anticoagulants in Addition to Antiplatelet Therapy for Secondary Prevention After Acute Coronary Syndromes: A Systematic Review and Meta-analysis – JAMA Cardiology (link to abstract – $ for full-text)

Commentaries: Could NOACs Have a Role for Secondary Prevention After STEMI? – TCTMD (free) AND Meta-Analysis: ACS Type Matters for DOAC Use in Secondary Prevention – MedPage Today (free registration required) AND Adding DOACs Beneficial for STEMI — Not Non-STEMI — But with Bleeding Risk – Physician’s First Watch (free)

“63 STEMI patients would need to receive a DOAC to prevent one cardiovascular event, while 96 would need to be treated to cause one major bleeding event”. (from Physician’s First Watch)


Catheter Ablation for Atrial Fibrillation with Heart Failure – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Catheter ablation better than pharmacological atrial fibrillation therapies – University of Utah Health, via EurekAlert (free)

“In patients w/heart failure & atrial fibrillation, catheter ablation lowers rate of death and hospitalization for worsening HF vs. medical therapy”. (via @NEJM see Tweet)


Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks: Meta-analysis of 10 Trials Involving 77 917 Individuals – JAMA Cardiology (free)

Commentary: Omega-3 Supplements Don’t Protect Against Heart Disease – The New York Times (10 articles per month are free)

Omega-3 fatty acids did not prevent fatal or nonfatal coronary heart disease or any major vascular events.


Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection – New England Journal of Medicine (link to abstract – $ for full-text)

Quick Take Video Summary: Myocardial Infarction after Influenza Infection (free)

Commentaries: Flu infection raises risk of heart attack in week after diagnosis – STAT (free) AND Flu Virus Can Trigger A Heart Attack – NPR (free) AND Flu increases the risk of heart attack – Reuters (free)

The researchers identified a six-fold increased risk of heart attack in the 7 days after a flu diagnosis.


Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis – BMC Medicine (free)

Commentary : Age itself is not a risk factor for complications after surgery among older patients – OnMedica (free)

“Q: What predicts poor outcome after elective surgery in older people?

A: Frailty, cognitive impairment, depression, smoking but NOT age per se”. (via @trishgreenhalgh see Tweet)


USPSTF Not Backing Ankle-Brachial Index, CRP, or Coronary Calcium – MedPage Today (free registration required) AND No Change in USPSTF’s Stance on Using Nontraditional Risk Factors to Assess CV Risk – Physician’s First Watch (free)

Draft Recommendation Statement 1: Cardiovascular Disease: Risk Assessment With Nontraditional Risk Factors – USPSTF (free)

Draft Recommendation Statement 2: Peripheral Artery Disease and Cardiovascular Disease: Screening and Risk Assessment With the Ankle-Brachial Index (free)

“The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adding the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP), or coronary artery calcification (CAC) score to traditional risk assessment for cardiovascular disease (CVD) in asymptomatic adults to prevent CVD events”.


Which stent is best for heart attacks? – Evidently Cochrane (free)

Original article: Drug-eluting stents versus bare-metal stents for acute coronary syndrome – Cochrane Library (free)

“The current review suggests that using DES rather than BMS may reduce the need for future coronary procedures but there is no evidence that it saves lives or reduces major cardiovascular events”.


Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia – Stroke (free)

Source: EvidenceAlerts

Short-run AT seems to increase the risk of stroke. Randomized controlled trials to find out which group of patients would benefit from anticoagulation are warranted.


Prescribing Cascade in a Cardiology Practice – American College of Cardiology, Latest in Cardiology (free)

“Before starting a medication to treat a new medical condition, consider whether this condition could be a drug-related adverse event. Specifically, consider whether this could represent a prescribing cascade”.


Effect of PCSK9 Inhibitors on Clinical Outcomes in Patients With Hypercholesterolemia: A Meta‐Analysis of 35 Randomized Controlled Trials – Journal of the American Heart Association (free)

PCSK9 inhibitors were associated with reduced incidence of myocardial infarction (2.3% vs 3,6%), stroke (1.0% vs 1.4%) and coronary revascularization (4,2% vs 5,8%). Overall, no significant change was observed in cardiovascular or all-cause mortality.


Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study – Journal of the American Heart Association (free)

“Composite rates of recurrence and major bleeding were 12.4% in patients who initiated NOACs within 2 days after acute stroke, 2.1% in those who initiated NOACs between 3 and 14 days, and 9.1% in patients who initiated NOACs >14 days after acute stroke. Future randomized studies to assess timing of initiation and choice of agent in patients with acute stroke and AF are warranted”.


Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: A ‘Game Changer’ for Patients With Irregular Heart Rhythm – The New York Times (10 articles per month are free)

“The use of stereotactic radiotherapy in five patients with refractory ventricular tachycardia (VT) showed a 99.9% reduction in VT burden”. (via @NEJM see Tweet with infographic)


All-cause mortality and major cardiovascular outcomes comparing percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: a meta-analysis of short-term and long-term randomised trials – OpenHeart (free)

“PCI is associated with a reduction in the risk of major cardiovascular outcomes at short-term follow-up in patients with LMCA stenosis; but at long term, MACCE rate is increased for PCI”


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