Apixaban for Treatment of Embolic Stroke of Undetermined Source (ATTICUS) Randomized Trial
Despite the significant frequency of covert atrial fibrillation, secondary prophylaxis with aspirin is the current standard therapy for ESUS (AF). The efficacy of apixaban in 353 ESUS patients (68.5 yrs old, 51% male) was evaluated. 130 and 120 subjects from apixaban & ASA arms, respectively, complete study. By far, apixaban has been found to be better.
Quadruple UltrA-low-dose Treatment for Hypertension - QUARTET
The author presented that starting with standard dose monotherapy is more successful than starting with quarter standard doses of four types of blood pressure reducing drugs. By 12 weeks, 15% of intervention and 40% of control had uptitrated. Despite increased up titration in the usual care group, quadpill had better BP management. Their BP was lower day and night.
TOMAHAWK: Immediate Angiography After Out-of-Hospital Cardiac Arrest
The 30-day risk of all-cause death was not reduced by rapid unselected coronary angiography in patients with resucitated OHCA of suspected cardiac origin, shockable or non-shockable arrest rhythm, and no ST-elevation. Trial COACT of solely OHCA patients with shockable arrest rhythms reported no difference in clinical outcome between immediate and delayed coronary angiography at 90 days and 1 year.
Association of Coronary Artery Calcium Score Groups With Adverse Plaque
In a multicenter clinical trial, the author demonstrated the initial viability of electrical pulmonary vein isolation (PVI), procedural execution, and acute safety. The InspIRE clinical trial was designed to assess the safety and efficacy of a fully integrated biphasic PFA system. However, 1 in 6 patients with stable chest pain has CAD.
DBP and cardiovascular events in atrial fibrillation individuals with SBP < 130 mm Hg
Secondary analysis of the SPRINT and ACCORD-BP trials showed DBP < 60 mm Hg was related with a 74% increase in CV outcome, whereas DBP between 70 and 80 mm Hg was associated with the nominally lowest risk. Because ventricular perfusion occurs largely during diastole, reduced DBP may cause hypoperfusion & myocardial injury. So lowering DBP too much may negate the benefits of lowering SBP.
Individualizing the target Diastolic BP in patients being treated for HTN and Diabetes
Heart disease is more common in diabetics with HTN. DBP commonly rises to about 70 mm Hg during treatment. This post-hoc analysis of ACCORD -BP revealed that intensive SBP lowering (120 mmHg) did not diminish the risk of the primary clinical objective. For patients with CVD and DM, the ideal DBP treatment target is slightly lower than the current guideline range of 70-80 mm Hg.
Diastolic Blood Pressure: Should we care
BP is closely linked to vascular and total mortality, with no evidence of a threshold below 115/75 mmHg. The author concluded that excessive diastolic hypotension combined with antihypertensive medication enhanced CAD risk. According to author, reperfusion removes risk at low diastolic BP. CAD blockage raises diastolic BP whereas revascularization lowers it.
Prasugrel or Clopidogrel in Patients with Acute Coronary Syndromes at High Thrombotic Risk
PROMETHEUS compared Prasugrel and Clopidogrel in ACS patients having PCI. ACS patients should take P2Y12 inhibitors in addition to aspirin.The best antithrombotic therapy should be altered based on the patient's thrombotic and hemorrhagic risk due to complications. Prasugrel, unlike Clopidogrel, reduced the risk of ischemia events in both high and low-to-moderate thrombotic risk patients.
Short-term Pulse Pressure Variability Linked to cardiovascular death among normotensive adults
Short-term systolic & diastolic blood pressure variability is linked to worse CVD outcomes, especially with established CVD risk factors. But data on short-term pulse pressure variability and mortality are scarce. The study monitored 6,340 normotensive adults (20+) for an average of 22.3 yrs. According to NHANES data, 2 visit pulse pressure variability is associated with cardiovascular death.
Arrhythmia and cardiomyopathy in Heritable Thoracic Aortic Disease
The study indicated that patients with an ACTA2 mutation had no myocardial dysfunction or arrhythmia. Patients with FBN1 and LDS gene variants had myocardial dysfunction. In patients with HTAD, myocardial dysfunction and arrhythmia are rare features. They occur predominantly in patients with a variant in FBN1 and LDS genes, but were not seen in patients carrying a variant in the ACTA2 gene.
Clinical Outcomes in COVID-19 Patients with In-hospital Cardiac Arrest
The study showed that critically sick patients with COVID-19 had high rate of cardiac arrest & poor effects in those who received CPR. A non-shockable initial rhythm designates that non-cardiac reasons might be playing a major role. These include acute respiratory insufficiency, severe sepsis, or multiorgan failure. These data should inform end-of-life care discussions.
Cardiovascular Protection by Combination of Finerenone and Empagliflozin
Non-steroidal MR antagonism with Finerenone and SGLT2 inhibition with Empagliflozin provide cardiovascular protection in preclinical hypertensive-induced cardiorenal disorder. Combination of these 2 modes of action at low dosages showed effectual decrease in blood pressure, cardiac lesions and mortality specifying a strong prospective for combined clinical usage in cardiorenal patient populations
Replacing the pill: Future of CVD therapy
Gene replacement therapy involves augmenting calsequestrin in cDNA plasma & injecting in AAV virus and delivered to heart. It leads to reduced percentage of arrhythmias. Although gene therapy has advanced in several fields, cardiac gene therapy has been slowed down due to challenges faced by CUPID studies. Further studies are needed to understand delivery/vectors/dosing.
Quantum Genomics Firibastat (QGC001) or Ramipril to prevent left ventricular dysfunction
The primary objective of QUORUM trial was to compare the effects of two oral doses of Firibastat to those of Ramipril in Left Ventricular Ejection Fraction (LVEF). The study concluded that Firibastat (100mg or 500mg BID) was not superior to active comparator ramipril (5 mg BID) to prevent left ventricular dysfunction after first acute anterior MI
ACCOST-HH: Adrecizumab in cardiogenic shock
Cardiogenic shock is a serious medical condition with high mortality and morbidity. ACCOST-HH trial evaluated the safety, tolerability and efficacy of Adrecizumab on top of standard of care in patients with cardiogenic shock. Adrecizumab was found to be well-tolerated in patients with cardiogenic shock. But it did not reduce the need for cardiovascular organ support or improve survival.
Effect of Dapagliflozin on mortality in HFrEF patients
The DAPA-HF trial examined the effect of Dapagliflozin on ventricular arrhythmia, resuscitated cardiac arrest or sudden death in HFrEF patients. The study shows the beneficial impacts of SGLT2i in HFrEF and generates one prospective procedure for how these drugs reduce mortality in HFrEF.
Effect of Valsartan in early-stage sarcomeric hypertrophic cardiomyopathy
Sarcomeric hypertrophic cardiomyopathy raises the risk of HF, AF, and sudden death. VANISH trial tried to examine whether angiotensin II receptor blocker, Valsartan, could slow the development. It was found that treatment showed positive effects on cardiac structure and function.
Effect of Empagliflozin on Adverse Renal Outcomes in Chronic Heart Failure
Milton Packer presented the pooled analysis of EMPEROR-Reduced and EMPEROR-Preserved at the ESC Congress 2021. Both the trials showed that Empagliflozin reduced the risk of heart failure hospitalisation by 30% in patients with a reduced and preserved ejection fraction. The drug effect was similar across ejection fractions < 65%, with the drug effect attenuating at higher levels (65% or greater)
Effect of Empagliflozin on cardiovascular death and hospitalization in heart failure patients
EMPEROR-Preserved trial is the first trial to show unequivocal clinical benefits of Empagliflozin in patients with heart failure and a preserved ejection fraction. The trial demonstrated that Empagliflozin reduces the risk of a composite of cardiovascular death or hospitalisation for heart failure in patients with heart failure and a preserved ejection fraction with or without diabetes.
