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General cardiology

Heart’s Twitter Journal Club

1 Feb, 17 | by James Rudd

TwitterLogo_#55aceeJoin in our Journal Club on Twitter and engage with readers from across the world!

Each month we will discuss a paper from Heart.

We will select a recent paper ahead of time and then discuss four different aspects of it for about 15 minutes each.

The paper under discussion will be free to access for a week prior to the Journal Club.

Feel free to join the next journal club – they happen monthly, on the first Thursday of each month at 7PM GMT (8PM BST). All Welcome!

To join in you will need to have a Twitter account. To sign up to Twitter, click here (it doesn’t take long and make sure you follow us –@Heart_BMJ).

When it comes to the tweet chat itself, we suggest you use This is a specific site used for tweetchats as it cuts out all the other distractions on Twitter. Log into using your Twitter details, then type #HeartJC into the search bar. This pulls up all the tweets using the hashtag. You can tweet from here and it will automatically add the correct hashtag at the end of each tweet for those overexcited tweeps!

You can otherwise tweet using Twitter, but you need to make sure you add the hashtag to each tweet otherwise we won’t see it.

Follow Heart (@Heart_BMJ) for all the latest updates on Twitter. The Journal Club tweets can be identified by the hashtag #HeartJC

The following links take you to transcripts of the discussions and related Analytics, for those interested.


February 2nd – Transcript: All about Cardiac MRI and Analytics: Symplur

March 2nd – Transcript: Pregnancy and heart disease and Analytics: Symplur

April 6th – Transcript: POCUS and Analytics: Symplur

May 4th – Transcript: Saturated fat and CV disease and Analytics: Symplur

June 1st – Transcript: DAPT and Analytics: Symplur

July 6th – Transcript: Twitter at conferences and Analytics: Symplur


May 5th – Transcript: Chocolate and MI risk and Analytics: Symplur

June 2nd – Transcript: Exercise and Heart Disease and Analytics: Symplur

July 7th – Transcript: Gender differences in CAD and Analytics: Symplur

August 4th – Transcript:Loneliness and social isolation as risk factors for CHD and stroke and Analytics: Symplur

September 1st – Transcript: Troponins for MI diagnosis and Analytics: Symplur

October 6th – Transcript: Beta-blockers, COPD and Heart Failure and Analytics: Symplur

November 3rd – Transcript: Cardiac CT and Analytics: Symplur

December 1st – Transcript: Athletes and cardiac screening and Analytics: Symplur

Revascularization in response to identification of elevated high sensitivity troponin in stable patients does not improve outcomes

9 Oct, 15 | by flee

Among patients presenting with an acute coronary syndrome, cardiac troponin assays are the standard method for the identification of patients at high risk who benefit from early revascularization.  With advances in technology, high-sensitivity troponin (hsTn) assays are now available to identify levels of circulating troponin that were previously undetectable.  In this study, the authors sought to determine the impact of prompt revascularization on outcomes among patients with type 2 diabetes and stable ischemic heart disease. Utilizing patients from the BARI 2D study, a total of 2285 patients with stable ischemic heart disease and type 2 diabetes had hsTn measurements taken at baseline and 12 months.  Patients with an elevated hsTn were randomized to prompt revascularization or to ongoing medical therapy.  Over 5 years of follow-up from the point of revascularization, the primary composite end point was death from cardiovascular causes, myocardial infarction, or stroke.  A total of 897 (39.3%) patients were found to have a hsTn above the normal range (≥14 ng/l).  Compared with patients with normal hsTn levels, patients with elevated hsTn levels had a significantly increased risk for adverse events (27.1% vs 12.9% for the composite outcome; P<0.001) Early revascularization in response to elevated hsTn did not improve patient outcomes in this population of patients with stable ischemic heart disease. more…

Leadless pacemakers demonstrate promise

9 Oct, 15 | by flee

Approximately 10% of patients who receive a pacemaker experience complications related to the use of transvenous leads, the surgical pocket, or the pulse generator.  A leadless pacemaker inserted in the right ventricle by way of a transvenous catheter may result in lower complication rates. These leadless pacemakers include electronics, battery, and electrodes all in a single encapsulated device.  In this study, investigators report on a nonrandomized trial of nonsurgical implantation of a leadless cardiac pacemaker in patients who required permanent ventricular pacing.  The primary efficacy end-point was acceptable pacing and sensing thresholds with a safety end-point of device-related serious adverse events at 6 months.  Reporting on data from the initial 300 patients in the study, implantation was successful in 270 (90%) with 6.7% experiencing a device related complication by 6 months including dislodgement requiring percutaneous retrieval (1.7%), cardiac perforation and tamponade (1.2%) and pacing threshold increase requiring retrieval and repositioning (1.3%).  The study also suggested an operator learning curve with a complication rate of 6.8% for the initial 10 cases by each operator as compared with a 3.6% complication rate for subsequent implants. more…

A reversal agent for dabigatran

9 Oct, 15 | by flee

Unlike warfarin, non-vitamin K antagonist oral anticoagulants lack reversal agents for administration in the case of severe bleeding or perioperative management. Idarucizumab is a monoclonal antibody fragment that was developed to reverse the anticoagulant effects of the direct thrombin inhibitor dabigatran.  In this safety and efficacy study, idarucizumab was tested in a cohort of patients on dabigatran who either required an urgent surgical procedure or who had developed major bleeding. In an analysis of 90 patients (51 with hemorrhage and 39 requiring surgery) 5g of intravenous idarucizumab was administered to assess the impact on coagulation measures that included dilute thrombin time and ecarin clotting time.  Idarucizumab proved safe and effective with a median maximum percentage reversal of clotting measures of 100% within minutes of administration. Concentrations of free dabigatran remained essentially undetectable at 24 hours in 79% of patients.  Clinical hemostasis was achieved at a median of 11.4 hours in the hemorrhagic group and 3 (7.7%) patients in the surgical group had mild or moderately impaired hemostasis. more…

Informed Decision Making for Percutaneous Coronary Intervention for Stable Coronary Disease

10 Sep, 15 | by flee

Prior studies suggest patients are often misinformed about the anticipated benefits of PCI for stable coronary disease.  However, there is little data on patient-provider discussions that may explain discrepancies in patient understanding about the limited benefits of PCI in this setting.   Rothberg and colleagues performed a cross-sectional analysis of 59 conversations between providers and patients about PCI.  The conversations included 23 cardiologists (all male, 6 interventionalists, median 19 years experience) representing all regions of the United States from 2008 to 2012.  Conversations were analyzed for discussion of 7 elements central to shared-decision making: more…

Lipid lowering drugs and risk of vascular events in older patients

7 Jul, 15 | by Alistair Lindsay

Although elderly patients are at higher risk of cardiovascular events, the majority cardiovascular trials exclude these patients.  Accordingly, little is known about the use of lipid lowering medications for prevention of cardiovascular events in elderly populations. This prospective cohort study evaluated the association between use of statins or fibrates for prevention of vascular events among a random sample of 7484 patients aged 65 years of older without prior vascular disease living in three French cities recruited from 1999-2000.  Patients were followed for a median of 9.1 years, with 732 vascular events (440 coronary events, 292 strokes) occurring during the study period.  The study found that 27.4% (n=2084) of patients reported baseline lipid lowering medication use (13.5% statins, 13.9% fibrates).   more…

Investigating chest pain: anatomy or function?

22 May, 15 | by Alistair Lindsay

Among patients with chest pain, it is unclear if anatomic assessment of coronary obstruction or functional assessment with stress testing leads to better patient outcomes. In this randomized controlled trial of 10,003 symptomatic patients, individuals were randomly assigned in a 1:1 fashion to either anatomical testing with coronary CT angiography (CTA) or to functional testing by one of several different modalities (exercise ECG (10%), nuclear stress testing (67%) or stress echo (23%)).  Instead of diagnostic accuracy, as is seen with most such studies, the trial was powered for clinical outcomes with a primary composite endpoint of death, myocardial infarction, hospitalization for unstable angina, or major procedural complication.  more…

Antiplatelet therapy in long-term risk reduction after myocardial infarction

22 May, 15 | by Alistair Lindsay

The activated platelet is central to development of ischemic cardiovascular events. Guidelines recommend treatment with a P2Y12 receptor antagonist for 1-year after myocardial infarction (MI) to reduce the risk of recurrent events.  The PEGASUS trial sought to determine the impact of using the P2Y12 antagonist ticagrelor as part of long-term therapy after MI.  In this trial, a total of 21,162 clinically stable patients with a MI in the prior 1 to 3 years (median 18 months) were randomized in a 1:1:1 fashion to either placebo, ticagrelor 90mg twice daily, or ticagrelor 60mg twice daily.  All patients remained on aspirin and standard secondary prevention as tolerated.  Follow up was for a median of 33 months with the primary outcome being a composite of cardiovascular death, myocardial infarction, or stroke and the primary safety end-point of bleeding.  more…

Relationship Between Physical Activity and Mortality     

5 May, 15 | by Alistair Lindsay


The 2008 Physical Activity Guidelines for Americans recommended 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity aerobic activity weekly for optimal health. However, these guidelines acknowledged uncertainty on the upper threshold of benefit or potential harms of high activity levels.  Using data from 6 pooled cohorts from the National Cancer Institute Cohort Consortium (baseline 1992-2003) with self-reports of leisure-time physical activity (LTPA), Arem and colleagues aimed to address this question. The total cohort consisted of 661,137 men and women with a median age of 62 years and a median follow-up of 14.2 years in which 116,686 deaths were accrued. more…

Second-generation stents fail to BEST CABG

16 Apr, 15 | by Alistair Lindsay

The technology of drug eluting stents for percutaneous coronary intervention (PCI) has improved over time with resultant improvements in patient outcomes.  Although prior studies have demonstrated the benefit of surgical coronary artery bypass grafting (CABG) over transcatheter PCI among patients with multivessel coronary artery disease (CAD), these studies did not incorporate newer generation drug-eluting stents.  The multicenter BEST trial randomized 880 patients with multivessel CAD to PCI with an everolimus-eluting stent or to CABG. The primary end point for this non-inferiority study was a composite of death, myocardial infarction, or target-vessel revascularization at 2 years.  The results of the study non-significantly favored CABG at 2 years of follow-up with the primary end-point occurring in 7.9% of the CABG group and 11% of the PCI group.  more…

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