Ranolazine ineffective as antianginal following incomplete revascularization

Ranolazine is a novel anti-anginal medication that operates via late sodium channel blockade, reducing intracellular calcium during ischemia.  Prior studies suggest ranolazine is effective in reducing the symptoms of angina among patients with ischemic heart disease.  Although revascularization is often used to address symptoms, incomplete revascularization with residual ischemic symptoms is common.  In the current […]

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Repair versus replacement for ischemic mitral regurgitation

Whether repair or replacement is the preferred approach to surgical correction of ischemic mitral regurgitation is debated.  The Cardiothoracic Surgical Trials Network previously reported 1-year results of a randomized study of these two approached and found no differences echocardiographic or clinical outcomes. This paper reports the 2-year echocardiographic and clinical outcome results from this randomized […]

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SPRINT to lower blood pressure targets

Epidemiologic studies have demonstrated increasing cardiovascular risk at a systolic blood pressure above 115 mmHg.  However, blood pressure treatment targets are less clear with clinical trials limited to evidence of benefit below 150mmHg. The Systolic Blood Pressure Intervention Trial (SPRINT) sought to determine outcomes following treatment to a target of less than 120mmHg (intensive treatment) […]

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Increased radiation exposure with transradial access for coronary procedures

Compared with the transfemoral approach, coronary angiography and percutaneous coronary intervention (PCI) performed via transradial access reduces rates of bleeding and vascular complications.  However, the potential for increased radiation exposure to patients and operators may be a barrier to the adoption of the transradial approach.  In this systematic review and meta-analysis of 24 published studies […]

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Long-term data on fractional flow reserve guided PCI

The Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) trial was a landmark study of the use of fractional flow reserve (FFR) to guide coronary revascularization through the identification of ischemia-inducing stenosis at the time of coronary angiography. The previously published 1- and 2-year results of the FAME trial demonstrated fewer major adverse cardiac […]

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Sub-clinical valve thrombosis in the setting of bioprosthetic aortic valves

Bioprosthetic aortic valves have played a critical role in improving both quality of life and prognosis in patients with severe aortic valve disease. Implanted either surgically (SAVR) or percutaneously (TAVI), they provide restoration of valve function without the need for anticoagulation as required with mechanical valves.  This study was the result of clinical evaluation of […]

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Absorbable stents non-inferior….but is that enough?

A coronary artery stent that scaffolds the vessel immediately after angioplasty but disappears over time has been proposed as means to avoid complications of late stent thrombosis and restore physiological vasomotion.  Bioabsorbable platforms (termed scaffolds) are designed to slowly dissolve over 2 to 3 years, leaving little or no residue in the vessel.  However, conventional […]

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Similar Outcomes with Bivalirudin and Unfractionated Heparin During PCI for Acute Coronary Syndromes

Approximately two-thirds of all PCI are performed for acute coronary syndromes.  In this setting, the optimal balance of anticoagulation to avoid thrombosis against the risk of major bleeding is a pivotal area of procedural management.  Multiple clinical trials have compared bivalirudin and heparin (+/- IIb/IIIa inhibitor), but the optimal strategy remains debated.  In particular, changes […]

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The Natural History of Takotsubo Cardiomyopathy

In the 25 years since first being described, takotsubo (stress) cardiomyopathy has gained increasing recognition as a common clinical entity.  Despite this, our understanding of the natural history of takotsubo cardiomyopathy remains limited.  The International Takotsubo Registry has been gathering data on takotsubo cases since 1998 and this publication describes their findings to date.  Among […]

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Adaptive servo-ventilation increases mortality in systolic heart failure

Central sleep-apnea (CSA) with associated Cheyne-Stokes breathing patterns effects up to 40% of patients with low ejection fraction heart failure.   Given that CSA is an independent marker for poor prognosis and mortality, treatment of CSA has been identified as a potential target to improve heart failure outcomes.  This study randomized 1325 patients with low ejection […]

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