Updates in Cardiovascular Medicine
- Meta-Analysis of MRA Use in HF( Lancet 2024)
- MRA use compared to placebo in patients with HF reduces the risk of CV death or first HF hospitalization across the EF spectrum, with greater effects in HFrEF.
- MRA use reduces CV and all-cause death in HFrEF trials but not in the HFmrEF/HFpEF trials.
- MRA use increases the risk for hyperkalemia, but absolute risk of severe hyperkalemia is low.
- Temporal Trends in Takotsubo Syndrome( JACC 2024)
- The current analysis from the InterTAK registry of patients with Takotsubo syndrome (TTS) reported clinical trends spanning 15 years.
- There was an increase in TTS among men, although female patients represented 88% of the overall cohort.
- Nonapical variants were increasingly identified and physical triggers became more common than emotional triggers.
- Although there was no significant change in long-term mortality trends, there was an increase in TTS with cardiogenic shock and short-term mortality (60 days).
- Patiromer HF Medication Optimization for Hyperkalemia( JACC Heart failure 2024)
- In patients with HFrEF and current or past hyperkalemia, patiromer use compared to placebo (for optimization of RAASi therapy) is effective in reducing serum potassium levels in both patients with current hyperkalemia and past hyperkalemia.
- The effect of patiromer may be better at preventing reduction in target MRA dose in patients with current hyperkalemia compared to past hyperkalemia.
- Semaglutide and Diuretic Use in HFpEF With Obesity( EHJ 2024)
- In a prespecified analysis of the STEP-HFpEF program, semaglutide use compared to placebo was associated with improvement in health status, weight loss, BNP levels, and exercise function regardless of baseline diuretic dose.
- The benefit of semaglutide was more pronounced with increasing baseline diuretic dose and semaglutide was associated with higher odds for lowering loop diuretic dose compared to placebo.
- Serious adverse events were similar with semaglutide and placebo
- Features and Prognosis of High-Gradient Aortic Stenosis( JACC CV imaging 2024)
- This retrospective study evaluated the features and prognosis of patients with high-gradient (mean gradient >40 mm Hg, peak velocity >4.0 m/s) aortic stenosis (AS) with calculated aortic valve area (AVA) >1.0 cm2.
- Patients in this high-gradient AS group with an AVA >1.0 cm2 had:
- Higher mortality rates than the expected mortality of the general population.
- Lower mortality rates when compared to the other AS profiles (high-gradient with a calculated AVA <1.0 cm2 and low-gradient with a calculated AVA <1.0 cm2).
- Better survival outcomes when undergoing an AVR compared to those not undergoing AVR.
- Providers should not be falsely reassured by the presence of an AVA of 1.0 cm2 when patients have high gradients.
- LV Function Recovery and Outcomes in Takotsubo Syndrome( JACC 2024)
- This current retrospective analysis from the RETAKO registry (Spain and South America) of patients with Takotsubo syndrome aimed to define predictors of late LV function recovery and impact of early (<10 days) or late (>10 days) LV function recovery on mortality (n = 1,463).
- The majority of patients had early recovery (75%). Older age, history of neurological disorders, coronary artery disease, active cancer, physical triggers, elevated inflammatory biomarkers, cardiogenic shock, and lower LVEF at admission were independent predictors of late LV function recovery.
- Delayed LV function recovery was associated with higher long-term mortality compared to patients who had early recovery of LV function (16.0% vs. 8.6%, adjusted HR, 1.31; 95% CI, 1.12-1.60).
- Coronary Artery Calcium Density and Risk of CV Events( JACC CV imaging 2024)
- Very dense calcified coronary plaque on chest CT is associated with reduced CV events, and CV risk factors including diabetes are inversely associated with plaque density, while statins and physical activity are positively associated with plaque density.
- It is not reported but relatively simple to provide the density score. CAC density score = Agatston score ÷ area score.
- The clinical application of CAC density has yet to be defined. In the future, integrating common clinical risk predictors from the new AHA PREVENT and adding biomarkers hsCRP and Lp(a) and CAC density may provide a much more accurate CVD (coronary and stroke) risk assessment.
