Novel Wrist-Worn Transdermal Troponin-I-Sensor Assessment for Acute Myocardial Infarction
Wrist-worn transdermal infrared spectrophotometric sensor (ISS) model predicted elevated Trop-I with the area under the receiver operator characteristics of 0.89 and 0.92 for internal and external validation cohorts, respectively. In addition, a prediction of elevated Trop-I was associated with regional wall motion abnormalities and significant coronary stenosis.
Sotatercept With Background Therapy for the Treatment of Pulmonary Arterial Hypertension
STELLAR is a Phase III trial of Sotatercept in adults with Pulmonary Arterial Hypertension. Sotatercept provided broad therapeutic benefit across a range of effectiveness endpoints and significantly increased exercise capacity as measured by the 6MWD. The findings demonstrate the efficacy of Sotatercept as a novel mechanistic PAH treatment when used in conjunction with current PAH medications.
CVD Prevention in Asia- A Status Update and Future Directions
CVD mortality rate is increasing in Asia. It showed marked geographic differences due to the combined effects of age and other determinants including SES. Ischemic heart disease is the dominant type for CVD deaths in Central, Western and Southern Asia, stroke is common in Eastern Asia. Social aging, obesity and high salt intake become triple threats of CVD control in Asia, forming a vicious cycle.
Atrial Pacing for Heart Failure With Preserved Ejection Fraction
A study provides strong evidence that implantation of a cardiac pacemaker to increase exercise HR is not effective to improve submaximal or peak exercise capacity or functional status in patients with HFpEF and chronotropic incompetence. These results suggest that a lower than expected peak HR is a consequence of premature exercise cessation rather than a cause of exercise limitation.
Building Electronic Tools to Enhance and Reinforce Cardiovascular Recommendations for Heart Failure
68,000 preventable deaths occur yearly due to shortfalls in prescribing of therapies for HFrEF, particularly mineralocorticoid receptor antagonists (MRA). BETTER CARE-HF compared the effectiveness of an alert vs. message to improve MRA prescribing. The findings can be rapidly disseminated with the potential to improve morbidity and mortality for patients with HFrEF.
Should Leads be Extracted Before Tricuspid Valve Replacement - Con Jailing is Safer Than Extraction
ELECTRa study showed a higher risk of major complications or death in TR patients with TLE. Another study showed that TTVR in the setting of trans-TV pacemaker leads without lead extraction or re-replacement can be performed safely with a low risk for complications, offering an alternative to surgical TV replacement. The risk of CIED-related infection in jailing is 4.7 per 1000 person-years.
Management Of Atrial Fibrillation After Patent Foramen Ovale (PFO) Closure
Recent trials showed a benefit of PFO closure vs. medical therapy to prevent recurrent CVA in patients ≤ 60 years. Conditional recommendations for PFO closure: In patients > 60 years with a prior PFO-associated stroke; In persons with platypnea-orthodeoxia syndrome (POS) and without a prior PFO-associated stroke; In persons with systemic embolism and without a prior PFO-associated stroke.
Step by Step Initiation of HFrEF Quad Therapy for Optimization of Medical Management
Sequential HFrEF quad therapy initiation allows for personalization based on patient characteristics, medication factors and allows for shared-decision making. It is critical to identify improvement strategies i.e., GDMT titration clinics, HER interventions, telehealth, multidisciplinary HF management programs, electronically administered patient awareness tools.
Rapid Simultaneous Initiation of HFrEF Quad Therapy for Optimization of Medical Management
In patients with HFrEF, Quadruple GDMT i.e, ARNI, beta-blockers, MRA and SGLT2i are recommended. In patients with symptomatic HFrEF, SGLT2i are recommended to HHF and CV mortality, irrespective of presence of T2DM. In JAMA 2021 study, Dapagliflozin showed clinical benefit with significant reduction in risk of primary efficacy outcome of HHF and CV death or worsening HF by 4 weeks.
What is Needed in 2023 to Ensure Equitable Care for Patients with HF?
Patients at risk of HF (Stage A) with T2D/CVD risk, SGLT2i should be used to prevent HF hospitalizations. In Stage B patients with LVEF ≤ 40%, ACEi should be used. SGLT2i and ARNi are added in HFrEF stage C. In patients with stage D HF refractory to GDMT and device therapy awaiting MCS or cardiac transplantation, continuous intravenous inotropic support is reasonable as bridge therapy.
From Heresy to Necessity: Same Day Discharge for TAVR
The nationwide readmission database of SDD patients after transcatheter aortic valve replacement (TAVR) from 2015 to 2019 found that the SDD patients showed higher rate of readmissions as compared to non-SDD patients. The key points to be considered for the same day discharge (SDD) of patients are:- Patient and environmental factors- Procedural factors- Complications
Effect of Remogliflozin Compared To Empagliflozin in T2D patients With Chronic Heart Failure
A multicentric, prospective study showed that remogliflozin improved glycaemic parameters and NTproBNP in type 2 diabetes patients with Chronic Heart Failure (EF < 40%) in 3 months. Systolic BP reduced from 127±21 mmHg at baseline to 123±14 mmHg at 3 months in R group (p < 0.05). Remogliflozin was well tolerated and non-inferior to Empagliflozin in the patients.
Statins To Prevent The Cardiotoxicity From Anthracyclines: The STOP-CA Trial
Participants with lymphoma who were treated with anthracyclines, the prophylactic use of Atorvastatin over 12 months was associated with a lower rate of cardiac systolic dysfunction. At baseline, the LVEF was 63±4.6%. At 12 months, the LVEF was 59±5.9%. 46 participants (15%) had a decline in the LVEF of ≥ 10%. Adherence with study drug was documented in > 90%.
Tricuspid Valve Edge-to-Edge Repair For Tricuspid Regurgitation
TriClip therapy reduces tricuspid regurgitation in 87% patients, and reduction is sustained to 1- year follow-up. The degree of TR reduction is related to the degree of improvement in QOL. The 30-day MAE rate was only 1.7%, and death and pacemaker implant each occurred in 0.6%. Survival free of mortality and TV surgery are high at 1 year (~90%).
Bempedoic Acid and Cardiovascular Outcomes in Statin Intolerant Patients
The CLEAR OUTCOMES trial showed that bempedoic acid is well tolerated and reduces major adverse cardiovascular outcomes in patients intolerant to statins. It lowers LDL C by 21.7% and hsCRP by 22.2% with small increases in the incidence of gout and cholelithiasis. 4 component MACE are reduced by 13%, 3 component MACE by15%, myocardial infarction by 23% and coronary revascularization by 19%.
Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight
Among adults with overweight or obesity without diabetes, once-weekly subcutaneous semaglutide compared with once-daily subcutaneous liraglutide, added to counseling for diet and physical activity, resulted in significantly greater weight loss at 68 weeks.The mean weight change from baseline was –15.8% with semaglutide vs –6.4% with liraglutide (placebo was –1.9%).
Clopidogrel Monotherapy 1 Month After PCI Lowers Bleeding Regardless of Diabetes Status
The pooled cohort from the STOPDAPT-2 and STOPDAPT-2 ACS trials showed that clopidogrel monotherapy after 1 month of DAPT in patients who had PCI was associated with reduced bleeding risk regardless of diabetes status compared with 12-month DAPT. Whereas clopidogrel monotherapy after 1 month was noninferior to 12-month DAPT for ischemic events and a composite of ischemic and bleeding events.
Proton Pump Inhibitors Increase CVD, Mortality Risk for Adults with Type 2 Diabetes
Data from 19,229 adults with type 2 diabetes who participated in the UK Biobank showed that adults who used PPIs had higher risks for coronary artery disease (aHR = 1.27), myocardial infarction (aHR = 1.34), heart failure (aHR = 1.35) and all-cause mortality (aHR = 1.3) than nonusers. Physicians should enhance monitoring of CV phenotypes among patients with type 2 diabetes during PPI therapy.
