Cardiac-resynchronization therapy (CRT) has known benefits in patients with severe left ventricular systolic dysfunction and prolonged QRS duration (>120 ms). However, up to half of patients with systolic dysfunction appear to have left ventricular dyssynchrony by echocardiographic measures, despite a QRS duration of less than 120 ms. As a result, CRT is often used for […]
Category: General cardiology
Smoking and antiplatelet agents – smoke and mirrors or something more?
Many antiplatelet therapies are prodrugs that require metabolic activation. It has been hypothesized that smoking may activate this metabolic conversion for some antiplatelets (i.e. clopidogrel) more than others (i.e. prasugrel and ticagrelor). In this systematic review and meta-analysis, the authors identified 9 randomized controlled trials of clopidogrel, prasugrel, or ticagrelor which examined outcomes among subgroups […]
Blood pressure control, not the specific medication regimen, is what matters
The Blood Pressure Lowering Treatment Trialists’ Collaboration examined primary data from 23 trials as well as summary data from an additional 3 trials to define the cardiovascular effects of lowering blood pressure in people with and without chronic kidney disease. This study included randomized trials of drugs to lower blood pressure that were compared to […]
Low awareness, treatment and control of hypertension across the globe
Hypertension is associated with 7.6 million deaths worldwide and is the leading modifiable risk factor for cardiovascular disease (CVD). However, global studies of hypertension prevalence, awareness, treatment, and control are lacking. The PURE (Prospective Urban Rural Epidemiology) study involves urban and rural communities in 3 high-income, 10 middle-income, and 4 low-income countries. CVD risk factors […]
Guidelines match findings regarding early surgery for prosthetic valve endocarditis
Prosthetic valve endocarditis (PVE) occurs in 3-6% of patients within 5 years of valve implantation and is associated with significant morbidity and mortality. Studies comparing outcomes following early surgical intervention as compared with medical therapy in PVE patients have been conflicting. The ICE-PCS is a multinational prospective cohort study of patients with infective endocarditis. A […]
A Randomized Trial of the “Polypill” for Cardiovascular Risk Modification
Long-term use of recommended cardiovascular (CV) risk modifying medications is low among patients at high-risk for CV events. Fixed-dose drug combination (FDC) therapy may reduce treatment gaps by lowering non-adherence, cost, complexity and therapeutic inertia. However, FDC may also reduce tailoring of individual medications and thereby lead to suboptimal risk control. The UMPIRE (Use of […]
Colchicine Reduces Recurrent Pericarditis
Acute pericarditis is a common self-limiting illness which usually has few sequelae. However, in a small proportion of patients, pericarditis can become recurrent making treatment more challenging. The use of colchicine to treat acute pericarditis and prevent recurrence has been a topic of increasing interest in recent years. In this multicentre, double-blind trial, adults with […]
Treatment of bystander coronary disease in primary PCI improves outcomes
In patients with ST-elevation myocardial infarction (STEMI), current guidelines support PCI of the infarct related artery and medical management of flow-limiting lesions in non-infarct related vessels (so-called bystander disease). This paradigm is challenged in the Preventive Angioplasty in Acute Myocardial Infarction (PRAMI) study. In this single-blind trial performed at five UK centres, patients presenting with […]
Bilateral internal mammary grafts in diabetics: benefits outweigh perioperative risks
Patients with diabetes have more severe coronary disease at presentation and worse overall outcomes than their non-diabetic counterparts, even following surgical revascularisation. Whilst use of the left internal thoracic artery (LITA) is well established and improves event free survival when anastomosed to the LAD, the use of both right and left internal thoracic arteries in […]
New drug treatment for pulmonary hypertension show promise
Pulmonary hypertension is associated with high morbidity and a poor prognosis. Medical therapies including PDE-5 inhibitors and ET-1 antagonists have led to symptomatic gains in carefully selected groups of patients, but the need for further developments remains apparent. Riociguat, the first in class of a new group which act as stimulators of soluble guanylate cyclase, […]