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Surgical Repair of Moderate Mitral Regurgitation at the Time of CABG Lacks Clear Benefit

17 Feb, 15 | by Alistair Lindsay

Ischemic mitral regurgitation (MR) is common and associated with poor outcomes among patients undergoing bypass surgery.  However, it remains unknown whether repair of ischemic MR concurrent to CABG leads to better patient outcomes.  To address this important clinical question, this multi-center study randomly assigned 301 patients with moderate ischemic MR to CABG alone or CABG plus mitral valve repair.  The primary end-point was the echocardiographic parameter of left ventricular end-systolic volume index (LVESVI) at 1-year, which is a measure of left ventricular remodeling and is a known predictor of poor outcomes. Secondary end-points included major adverse cardiac or cerebrovascular events and functional assessments using the Minnesota heart failure questionnaire. more…

Benefits of beta-blockade in stable coronary disease may be overestimated

8 Nov, 12 | by Alistair Lindsay

While the benefits of beta-blockade following myocardial infarction (MI) are well known, these benefits have been extrapolated to all patients with coronary artery disease (CAD), and even to high risk patients without coronary artery disease. However, beta-blockers also have a number of side effects and their tolerability is not ideal. Therefore, the objective of this study was to evaluate the differential association of beta-blocker use on long-term cardiovascular outcomes in patients with known prior MI, in patients with CAD without MI, and in patients with only risk factors for CAD. more…

High sensitivity troponin detects subclinical cardiovascular disease

4 Jan, 11 | by Alistair Lindsay

Although most commonly used in the setting of acute coronary syndromes, it is also recognised that elevated troponin levels are seen in other clinical scenarios such as chronic kidney disease, heart failure, and chronic kidney disease.  Troponin T (TnT) is occasionally detectable in individuals from the general population, and although this has been associated with an increased risk of death and adverse cardiovascular events, the low prevalence of detection with current assays would prevent its widespread application.  This study examined the use of a new high-sensitivity assay to predict mortality in the general population. more…

Depression and reduced survival among patients with heart failure

14 Mar, 09 | by Alistair Lindsay

In order to evaluate the association of long-term mortality with antidepressant use and severity of depression, assessed using the Beck Depression Inventory (BDI), O’Connor and colleagues studied 1,006 patients, aged 18 years or older who were admitted to hospital with clinical (NYHA ≥ II) and/or echocardiographic evidence of systolic heart failure (left ventricular ejection fraction (LVEF) of ≤ 35%). more…

Fractional Flow Reserve achieves FAME at last

15 Feb, 09 | by Alistair Lindsay

Fractional flow reserve (FFR), calculated using a coronary presure wire, is an index of the physiological significance of a coronary stenosis and is defined as the ratio of maximal blood flow in a stenotic artery to normal maximal flow.  FFR in a normal artery is 1.0 – a value <0.80 identifies ischaemia causing lesions with a diagnostic accuracy of 90%, is more specific than that from myocardial perfusion studies and has a better spatial resolution. In patients with multivessel disease (MVD), identifying a percutaneous coronary intervention (PCI) approach allowing targeted use of stents whilst achieving relief of myocardial ischaemia could both improve clinical outcomes and decrease health costs. more…

Exercise caution when using treadmill ECGs for angina assessment

15 Feb, 09 | by Alistair Lindsay

Prompt assessment and risk stratification is fundamental to the early management of patients presenting for the first time with suspected angina. Within the setting of rapid access chest pain clinics (RACPC), risk stratification is traditionally achieved by history taking, examination, resting ECG and exercise ECG (ex-ECG). However, it remains unclear whether the inclusion of resting and exercise ECG adds incrementally to the prognostic value achieved by history taking and physical examination alone. more…

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