Recent updates in Cardiovascular Medicine
- CMR for Arrhythmic Risk Stratification in Nonischemic Cardiomyopathy JACC 2024
In the setting of non ischemic cardiomyopathy , myocardial fibrosis on CMR is associated with arrhythmic events, and larger fibrosis burden correlates with increased risk. - Sacubitril/Valsartan in Pediatric HF (PANORAMA-HF Trial) Circulation 2024
- Sacubitril/valsartan did not show superiority over enalapril in the treatment of children with HF attributable to LV systolic dysfunction using a prespecified global rank endpoint.
- Both treatment arms showed clinically meaningful improvements over 52 weeks.
- Family Screening in Hypertrophic Cardiomyopathy JACC 2024
- The overall diagnostic yield at baseline screening was 26%, highest in relatives of genotype-positive HCM probands.
- Furthermore, only an additional 4% received a diagnosis during the subsequent 7-year mean follow-up, again with the highest proportion in relatives of genotype-positive probands.
- A baseline maximum wall thickness of ≥10 mm was a strong predictive factor for development of HCM during 7 years of follow-up.
- Long-Term Outcomes After Septal Reduction in Obstructive HCM Circulation 2024
- In a retrospective, multicenter cohort study of 1,832 obstructive HCM patients who underwent septal reduction therapy (SRT) at HCM centers of excellence, 30-day survival after SRT was 0.4%, with a 5% risk for complications and 4% risk for pacemakers.
- SRT was associated with clinical improvement in 91% at 1 year and 88% were alive at 7 years.
- Over the long-term, 13% developed HF in 5 years, with older age at time of intervention and female sex predicting HF risk.
- Short-Term DAPT After DES in Patients With ACS(October JAMA)
- In patients with ACS undergoing PCI with DES, 1 month of DAPT followed by potent P2Y12 inhibitor monotherapy was associated with a reduction in major bleeding without increasing MACCE when compared with 12 months of DAPT.
- However, an increased risk of MACCE cannot be excluded, and 3 months of DAPT followed by potent P2Y12 inhibitor monotherapy was ranked as the best option to reduce MACCE.
- Because most patients receiving P2Y12 inhibitor monotherapy were taking ticagrelor, the safety of stopping aspirin in those taking clopidogrel remains unclear.
- HF Risk Assessment Using Biomarkers in Patients With AF( COMBINE AF JACC 2024)
- In patients with AF, elevated NT-proBNP, hs-cTnT, and GDF-15 levels are independently associated with a composite of hospitalizations for HF and CV death.
- The biomarkers improve risk prediction when added to clinical models.
- The value of biomarker use was seen across HF history, AF type, and LVEF subgroups.
- Bivalirudin vs. Heparin Anticoagulation in STEMI( JACC 2024)
- Bivalirudin improves all-cause mortality and bleeding as compared to heparin in patients with STEMI undergoing primary PCI.
- In an individual patient data meta-analysis of four trials, use of a high-dose post-PCI infusion of bivalirudin was associated with fewer thrombotic complications than heparin.
- The results of this meta-analysis provide external validation of the BRIGHT-4 trial, suggesting bivalirudin should now be first-line therapy for most patients undergoing primary PCI for STEMI.
- Meta-Analysis of Semaglutide and BP EHJ 2024)
- Systolic BP is lowered by about 5 mm Hg in patients taking semaglutide for weight loss.
- The full antihypertensive effect of semaglutide may be greater, as patients often had their antihypertension medications decreased during the trials.
- Semaglutide may be a particularly useful medication in patients with obesity and hypertension.
