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Top 10 Cardiology Articles of the week

Top 10 Cardiology Articles of the week (02.03.2015-08.03.2015)

1. Low-Level Transcutaneous Electrical Vagus Nerve Stimulation (LLTS) Suppresses Atrial Fibrillation

Conclusion: LLTS suppresses AF and decreases inflammatory cytokines in patients with paroxysmal AF. The results support the emerging paradigm of neuromodulation to treat AF.

2. Implantable Cardioverter-Defibrillator Therapy in Brugada Syndrome:A 20-Year Single-Center Experience

Background: Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications.

Objectives: The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome.

Methods: Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study.

Results A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence.

Conclusions: ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming.

3.Evaluation and Treatment of Patients With Lower Extremity Peripheral Artery Disease

The lack of consistent definitions and nomenclature across clinical trials of novel devices, drugs, or biologics poses a significant barrier to accrual of knowledge in and across peripheral artery disease therapies and technologies. Recognizing this problem, the Peripheral Academic Research Consortium, together with the U.S. Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, has developed a series of pragmatic consensus definitions for patients being treated for peripheral artery disease affecting the lower extremities. These consensus definitions include the clinical presentation, anatomic depiction, interventional outcomes, surrogate imaging and physiological follow-up, and clinical outcomes of patients with lower-extremity peripheral artery disease. Consistent application of these definitions in clinical trials evaluating novel revascularization technologies should result in more efficient regulatory evaluation and best practice guidelines to inform clinical decisions in patients with lower extremity peripheral artery disease.

4. Long-Term Survival Benefit of Revascularization Compared With Medical Therapy in Patients With Coronary Chronic Total Occlusion and Well-Developed Collateral Circulation

Objectives: The purpose of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) and well-developed collateral circulation treated with revascularization versus medical therapy.

Background: Little is known about the clinical outcomes and optimal treatment strategies of CTO with well-developed collateral circulation.

Methods: 2,024 consecutive patients with at least 1 CTO detected on coronary angiogram were screened. Of these, data was analyzed from 738 patients with Rentrop 3 grade collateral circulation who were treated with medical therapy alone (n = 236), coronary artery bypass grafting (n = 170) or percutaneous coronary intervention (n = 332; 80.1% successful). Patients who underwent revascularization and medical therapy (revascularization group, n = 502) were compared with those who underwent medical therapy alone (medication group, n = 236) in terms of cardiac death and major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and repeat revascularization.

Results: During a median follow-up duration of 42 months, multivariate analysis revealed a significantly lower incidence of cardiac death (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p < 0.01) and MACE (HR: 0.32; 95% CI: 0.21 to 0.49; p < 0.01) in the revascularization group compared with the medication group. After propensity score matching, the incidence of cardiac death (HR: 0.27; 95% CI: 0.09 to 0.80; p = 0.02) and MACE (HR: 0.44; 95% CI: 0.23 to 0.82; p = 0.01) were still significantly lower in the revascularization group than in the medication group.

Conclusions In patients with coronary CTO and well-developed collateral circulation, aggressive revascularization may reduce the risk of cardiac mortality and MACE.

5.Percutaneous Circulatory Assist Devices for High-Risk Coronary Intervention

A unifying definition of what constitutes high-risk percutaneous coronary intervention remains elusive. This reflects the existence of several recognized patient, anatomic, and procedural characteristics that, when combined, can contribute to elevating risk. The relative inability to withstand the adverse hemodynamic sequelae of dysrhythmia, transient episodes of ischemia-reperfusion injury, or distal embolization of atherogenic material associated with coronary intervention serve as a common thread to tie this patient cohort together. This enhanced susceptibility to catastrophic hemodynamic collapse has triggered the development of percutaneous cardiac assist devices such as the intra-aortic balloon pump, Impella (Abiomed Inc., Danvers, Massachusetts), TandemHeart (CardiacAssist, Inc., Pittsburgh, Pennsylvania), and extracorporeal membranous oxygenation to provide adjunctive mechanical circulatory support. In this state-of-the-art review, we discuss the physiology underpinning their application. Thereafter, we examine the results of several randomized multicenter trials investigating their use in high-risk coronary intervention to determine which patients would benefit most from their implantation and whether there is a signal to delineate whether they should be used in an elective pre-procedure, standby, rescue, or routine post-procedure fashion.

6.Porcelain Aorta: A Comprehensive Review

Calcification of the thoracic aorta is often associated with valvular and coronary calcification, reflecting an underlying atherosclerotic process. It has been found to be associated with an increased rate of mortality and cardiovascular disease. Porcelain aorta (PA) is extensive calcification of the ascending aorta or aortic arch that can be completely or near completely circumferential. This entity is rare in the general population, but it has an increasing incidence in older patients and in patients with coronary artery disease (CAD) or aortic stenosis (AS). The clinical relevance is based on the fact that it can complicate surgical aortic valve replacement (SAVR) for the treatment of severe AS by preventing safe access via the ascending aorta. PA is associated with increased morbidity and mortality, especially as a result of increased perioperative stroke risk. Recently, transcatheter aortic valve replacement (TAVR) has emerged as a less invasive and feasible treatment option in patients at high risk for conventional SAVR. In some series, ≈20% (5%–33%) of patients undergoing TAVR were diagnosed with PA. Inconsistencies in the definition and the use of different diagnostic modalities contribute to this wide range of PA prevalence. This article reviewed the available published data to seek a consistent, clinically relevant definition based on contemporary imaging, a firm understanding of the pathogenesis and associations, and the clinical implications of this disease entity.

7.Digoxin use in patients with atrial fibrillation and adverse cardiovascular outcomes: a retrospective analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)

Conclusion: Digoxin treatment was associated with a significant increase in all-cause mortality, vascular death, and sudden death in patients with AF. This association was independent of other measured prognostic factors, and although residual confounding could account for these results, these data show the possibility of digoxin having these effects. A randomised trial of digoxin in treatment of AF patients with and without heart failure is needed.

8.Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis

Background:Among patients with atrial fibrillation, the risk of stroke is highest for those with a history of stroke; however, oral anticoagulants can lower the risk of recurrent stroke by two-thirds. No consensus has been reached about how atrial fibrillation should be investigated in patients with stroke, and its prevalence after a stroke remains uncertain. The authors did a systematic review and meta-analysis to estimate the proportion of patients newly diagnosed with atrial fibrillation after four sequential phases of cardiac monitoring after a stroke or transient ischaemic attack.

Methods: The authors searched PubMed, Embase, and Scopus from 1980 to June 30, 2014 and included studies that provided the number of patients with ischaemic stroke or transient ischaemic attack who were newly diagnosed with atrial fibrillation. They stratified cardiac monitoring methods into four sequential phases of screening: phase 1 (emergency room) consisted of admission electrocardiogram (ECG); phase 2 (in hospital) comprised serial ECG, continuous inpatient ECG monitoring, continuous inpatient cardiac telemetry, and in-hospital Holter monitoring; phase 3 (first ambulatory period) consisted of ambulatory Holter; and phase 4 (second ambulatory period) consisted of mobile cardiac outpatient telemetry, external loop recording, and implantable loop recording. The primary endpoint was the proportion of patients newly diagnosed with atrial fibrillation for each method and each phase, and for the sequential combination of phases. For each method and each phase, they estimated the summary proportion of patients diagnosed with post-stroke atrial fibrillation using random-effects meta-analyses.

Findings:  The systematic review returned 28 290 studies, of which 50 studies (comprising 11 658 patients) met the criteria for inclusion in the meta-analyses. The summary proportion of patients diagnosed with post-stroke atrial fibrillation was 7·7% (95% CI 5·0–10·8) in phase 1, 5·1% (3·8–6·5) in phase 2, 10·7% (5·6–17·2) in phase 3, and 16·9% (13·0–21·2) in phase 4. The overall atrial fibrillation detection yield after all phases of sequential cardiac monitoring was 23·7% (95% CI 17·2–31·0).

Interpretation: By sequentially combining cardiac monitoring methods, atrial fibrillation might be newly detected in nearly a quarter of patients with stroke or transient ischaemic attack. The overall proportion of patients with stroke who are known to have atrial fibrillation seems to be higher than previously estimated. Accordingly, more patients could be treated with oral anticoagulants and more stroke recurrences prevented.

9.Comparative Outcomes of Catheter-Directed Thrombolysis Plus Anticoagulation Versus Anticoagulation Alone in the Treatment of Inferior Vena Caval Thrombosis

Conclusions—There has been a steady increase in the use of CDT in the treatment of patients with inferior vena cava thrombosis in the United States. This observational study showed no significant difference in mortality between CDT versus anticoagulation alone; however, the bleeding events and resource utilization were higher in the CDT group. Adequately powered randomized controlled trials are needed in this area.

10.Drug-eluting stents versus bare metal stents prior to noncardiac surgery

DES implantation was not associated with higher adverse events after NCS. Moreover, the incidence of adverse events following NCS was lower when NCS was performed >90 days post-DES implantation suggesting that it may not be necessary to wait until 12 months post PCI with DES before NCS.

Top 10 Cardiology Articles of the week

Top 10 Cardiology Articles of the week  (24.11.14 – 30.11.14)

1. Transcatheter Closure of Large Atrial Septal Defects: Feasibility and Safety in a Large Adult and Pediatric Population

Conclusions—Closure of large atrial septal defects using the Amplatzer device is safe and effective in both adults and children. Superior and posterior rim deficiencies are associated with procedural failure. Closure can be performed under transthoracic  echocardiographic guidance in experienced centers. Early device migration is rare and can be safely managed by device extraction.  Long-term follow-up showed no deaths or major late complications in  311 patients.

2. Stent Coverage and Neointimal Proliferation in Bare Metal Stents Postdilated With a Paclitaxel-Eluting Balloon Versus Everolimus-Eluting Stents: Prospective Randomized Study Using Optical Coherence Tomography at 6-Month Follow-Up

Conclusions—Good stent strut coverage of >94% was found in both therapy groups. Despite greater suppression of global neointimal growth in DES, both DES and BMS+DEB effectively prevented clinically relevant focal restenosis at 6-month follow-up.

3. Multicenter Evaluation of a Next-Generation Balloon-Expandable Transcatheter Aortic Valve
Conclusions – This third-generation device addresses major deficiencies of earlier valves in terms of ease of use, accuracy of positioning, and paravalvular sealing. The rates of mortality and stroke with transfemoral access are among the lowest reported and support further evaluation as an alternative to open surgery in intermediate-risk patients.
(Safety and Performance Study of the Edwards SAPIEN 3 Transcatheter Heart Valve [SAPIEN3]; NCT01808287)

4. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

5. Percutaneous Left Atrial Appendage Closure: Procedural Techniques and Outcomes

6. Atenolol versus Losartan in Children and Young Adults with Marfan’s Syndrome

Conclusion – Among children and young adults with Marfan’s syndrome who were randomly assigned to losartan or atenolol, no significant difference was found in the rate of aortic-root dilatation between the two treatment groups over a 3-year period.

7. Inactivating Mutations in NPC1L1 and Protection from Coronary Heart Disease

Conclusion – Naturally occurring mutations that disrupt NPC1L1 function were found to be associated with reduced plasma LDL cholesterol levels and a reduced risk of coronary heart disease.

8. MagnaSafe: MRI safe for patients with pacemakers, ICDs

9. Catheter Ablation of Atrial Fibrillation in Patients with Left Ventricular Systolic Dysfunction: A Systematic Review and Meta-Analysis

10. Long-term Clinical and Angiographic Outcomes of the Mini-STAR Technique as a Bailout Strategy for Percutaneous Coronary Intervention of Chronic Total Occlusion

Top 10 Cardiology Articles of the week

Top 10 Cardiology Articles of the week (17.11.14-23.11.14)

1. A Polypill Strategy to Improve Adherence:Results From the FOCUS Project
Compared with the 3 drugs given separately, the use of a polypill strategy met the                   primary endpoint for adherence for secondary prevention following an acute MI

2. Six-month versus 24-month dual antiplatelet therapy after implantation of drug eluting    stents in patients non-resistant to aspirin: ITALIC, a randomized multicenter trial 
The ITALIC trial showed that rates of bleeding and of thrombotic events were not significantly different according to 6- versus 24-month DAPT after PCI with new-generation DES in good aspirin responders.

3.  First-in-Man Transseptal Implantation of a “Surgical-Like” Mitral Valve Annuloplasty Device for Functional Mitral Regurgitation

4.  Pressure-Wire-Guided Percutaneous Transluminal Pulmonary Angioplasty

5.  AVOIDing Oxygen in Suspected STEMI Tied to Smaller Infarcts, Less Recurrent MI

6.  Percutaneous Left Atrial Appendage Closure vs Warfarin for Atrial Fibrillation. A Randomized Clinical Trial

7.  Meta-analysis Questions One-Size-Fits-All Anticoagulant Strategy in STEMI Patients

8.  Periprocedural Complications and Long-Term Outcome After Alcohol Septal Ablation Versus Surgical Myectomy in Hypertrophic Obstructive Cardiomyopathy

9.  Spontaneous Coronary Artery Dissection Revascularization Versus Conservative Therapy

10.  Surgical Treatment of Moderate Ischemic Mitral Regurgitation

Top 10 Cardiology articles of the week

Top 10 Cardiology articles of the week (10.11.14-16.11.14)

Hello friends , I have been busy for sometime. Now journal scan is back again after a brief interruption. I have chosen articles on general cardiology and interventional cardiology

1. The optimal management of anti-thrombotic therapy after valve replacement:                          certainties and uncertainties

2. Ivabradine in Stable Coronary Artery Disease without Clinical Heart Failure

3. The Unnatural History of Tetralogy of Fallot: Prospective Follow-Up of 40 Years After Surgical Correction

4. Clinical Outcomes and Improved Survival in Patients With Protein-Losing Enteropathy After the Fontan Operation

5. Immediate and midterm outcomes following primary PCI with bioresorbable vascular   scaffold implantation in patients with ST-segment myocardial
infarction: insights from the multicentre “Registro ABSORB Italiano” (RAI registry)

 

6. Second-Generation Drug-Eluting Stent Implantation Followed by 6- Versus 12-Month Dual Antiplatelet Therapy. The SECURITY Randomized Clinical Trial

7. Short- and Long-Term Cause of Death in Patients Treated With Primary PCI for STEMI

 

8. The QT Interval Is Associated With Incident Cardiovascular Events

9. Endovascular Treatment of Mycotic Aortic Aneurysms: A European Multicenter Study

10.Intracoronary Delivery of Injectable Bioabsorbable Scaffold (IK-5001) to Treat Left Ventricular Remodeling After ST-Elevation Myocardial Infarction. A First-in-Man Study

Top 10 Cardiology articles of the week (07.07.14-13.07.14)

1.Comprehensive Analysis of Mortality Among Patients Undergoing TAVR: Results of the PARTNER Trial
J Am Coll Cardiol. 2014;64(2):158-168

2. Glycosylated hemoglobin A1c as a marker predicting the severity of coronary artery disease and early outcome in patients with stable angina
Lipids Health Dis. 2014; 13: 89

3.Association Between Intensification of Metformin Treatment With Insulin vs Sulfonylureas and Cardiovascular Events and All-Cause Mortality Among Patients With Diabetes
JAMA. 2014;311(22):2288-2296

4.Association of Bariatric Surgery With Long-term Remission of Type 2 Diabetes and With Microvascular and Macrovascular Complications
JAMA. 2014;311(22):2297-2304

5.Prophylaxis against Venous Thromboembolism in Ambulatory Patients with Cancer

N Engl J Med 2014; 370:2515-2519

6.CardioDex: First human experience of thermal arterial closure

7. Minimizing femoral artery access complications during percutaneous coronary intervention: A comprehensive review

8.Complications related to transhepatic venous access in the catheterization laboratory—A single center 12-year experience of 124 procedures

9.Early outcomes of alcohol septal ablation for hypertrophic obstructive cardiomyopathy

10.Percutaneous Mitral Valve Repair for Mitral Regurgitation in High-Risk Patients Results of the EVEREST II Study
J Am Coll Cardiol. 2014;64(2):172-181

Top 10 Cardiology articles of the week (30.6.14- 6.7.14)

1. Prospective Randomized Evaluation of the Watchman Left Atrial Appendage Closure Device in Patients With Atrial Fibrillation Versus Long-Term Warfarin Therapy : The PREVAIL Trial.
In this trial, LAA occlusion was noninferior to warfarin for ischemic stroke                                      prevention or systemic embolism >7 days’ post-procedure. Although noninferiority                was not achieved for overall efficacy, event rates were low and numerically                                      comparable in both arms. Procedural safety has significantly improved. This trial provides additional data that LAA occlusion is a reasonable alternative to warfarin therapy for stroke prevention in patients with NVAF who do not have an absolute contraindication to short-term warfarin therapy.
Read more
2.Stent Thrombosis in New-Generation Drug-Eluting Stents in Patients With STEMI Undergoing Primary PCI A Report From SCAAR.

Patients treated with n-DES (new generation DES)  have a lower risk of early/late ST  (stent thrombosis) than patients treated with BMS. The risk of very late ST  is low and comparable between n-DES and BMS up to 3 years of follow-up, whereas o-DES  (older generation DES) treatment is associated with an increased risk of very late ST. The current STEMI guidelines might require an update in light of the results of this and other recent studies.

Read more

 

3.Clinical Outcomes and Improved Survival in Patients With Protein-Losing Enteropathy After the Fontan Operation.

http://content.onlinejacc.org/article.aspx?articleID=1886825
4.Hypertrophic Cardiomyopathy Present and Future, With Translation Into Contemporary Cardiovascular Medicine
http://content.onlinejacc.org/article.aspx?articleID=1886834

 
5.Dual antiplatelet therapy in patients with stable coronary artery disease in modern practice: Prevalence, correlates and impact on prognosis
(from the CORONOR study)
About one-quarter of patients with stable coronary artery disease (CAD) are prescribed dual antiplatelet therapy (DAPT), probably due to factors such as MI or revascularization within recent years, diffuse atherosclerosis, and DES implantation. Nonetheless, these patients are no more likely to be protected against future ischemic events than those receiving aspirin or clopidogrel alone.

Read more
6.Use of the REG1 anticoagulation system in patients with acute coronary syndromes undergoing percutaneous coronary intervention:results from the phase II RADAR-PCI study.
High-level factor IXa inhibition in ACS patients undergoing PCI, with at least 50% reversal, has a favourable bleeding profile and appears effective at suppressing ischaemic events and thrombotic complications. Larger phase trials in PCI are warranted.
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7.Sitagliptin Use in Patients With Diabetes and Heart Failure: A Population-Based Retrospective Cohort Study.
There is considerable uncertainty about the safety of sitagliptin in patients with T2DM and HF, and current guidelines from the American Diabetes Association suggest caution with the use of antihyperglycemics in patients with HF. This study adds to the mounting evidence that DPP-4 inhibitors may increase the risk of HF, challenging a platform of basic science data that DPP-4 inhibition may actually have a beneficial impact on cardiovascular function.
Read more

 
8.Lifetime Prevalence of Congenital Heart Disease in the General Population from 2000 to 2010

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9.Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial

 

 
10.Long-term Survival in Patients Undergoing Percutaneous Interventions With or Without Intracoronary Pressure Wire Guidance or Intracoronary Ultrasonographic Imaging: A Large Cohort Study
In this large observational study, FFR-guided PCI and IVUS-guided PCI were not associated with improved long-term survival compared with standard angiography-guided PCI. The use of FFR was associated with the implantation of fewer stents.
Read more

 

Top 10 Cardiology articles of the week (23.6.14-29.6.14)

Top cardiology publications of the week

The below is given a list of top 10 cardiology articles which are clinically relevant and have a potential to influence practice

1. Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Ischemic         Heart Disease: A Consensus Statement From the American Heart Association

2. Efficacy and Safety of Rivaroxaban Compared with Warfarin among Elderly Patients with        Nonvalvular Atrial Fibrillation in the ROCKET AF Trial

3. Atrial Fibrillation in Patients with Cryptogenic Stroke

4. Cryptogenic Stroke and Underlying Atrial Fibrillation

5.  STARTS-2 Long-Term Survival With Oral Sildenafil Monotherapy in Treatment-Naive                    Pediatric Pulmonary Arterial Hypertension

6.  Haemodynamic-guided fluid administration for the prevention of contrast-induced                 acute kidney injury: the POSEIDON randomised controlled trial

7. Effect of Evolocumab or Ezetimibe Added to Moderate- or High-Intensity Statin Therapy        on LDL-C Lowering in Patients With Hypercholesterolemia The LAPLACE-2 Randomized          Clinical Trial

8. Prognostic Value of Echocardiography in Normotensive Patients With Acute Pulmonary          Embolism

9.  First human experience of thermal arterial closure

10.  Clinical Profile and Prognostic Value of Anemia at the Time of Admission and                                Discharge Among Patients Hospitalized for Heart Failure With Reduced Ejection                           Fraction Findings From the EVEREST Trial

Genetic mutation in Metabolic Syndrome

A Form of the Metabolic Syndrome Associated with Mutations in DYRK1B — NEJM.

 

A founder mutation was identified in DYRK1B, substituting cysteine for arginine at position 102 in the highly conserved kinase-like domain. The mutation precisely cosegregated with the clinical syndrome. Functional characterization of the disease gene revealed that nonmutant protein encoded by DYRK1B inhibits the SHH (sonic hedgehog) and Wnt signaling pathways and consequently enhances adipogenesis. Furthermore, DYRK1B promoted the expression of the key gluconeogenic enzyme glucose-6-phosphatase. The R102C allele showed gain-of-function activities by potentiating these effects. A second mutation, substituting proline for histidine 90, was found to cosegregate with a similar clinical syndrome in an ethnically distinct family.

Conclusions

These findings indicate a role for DYRK1B in adipogenesis and glucose homeostasis and associate its altered function with an inherited form of the metabolic syndrome.