Diuresis to decongest patients with acute heart failure (AHF) is particularly challenging in the setting of renal dysfunction, as these patients are at risk of worsening renal function. Small studies have suggested that low-dose dopamine or nesiritide may increase urine output and maintain renal function in such patients. The Renal Optimization Strategies Evaluation (ROSE) trial […]
Latest articles
Treatment of obstructive sleep apnea lowers blood pressure
More than 70% of patients with resistant hypertension have obstructive sleep apnea (OSA). However, whether continuous positive airway pressure (CPAP) for OSA improves blood pressure in patients with resistant hypertension is unknown. This was a randomized controlled trial of CPAP in 194 patients with resistant hypertension in the setting of OSA. The primary outcome was […]
Pre-hospital Epinephrine for Witnessed Cardiac Arrest: Improved Outcomes?
Epinepherine remains a common part of resuscitation care for cardiac arrest, despite a lack of clinical evidence to suggest it improves patient survival. This study was a retrospective cohort of patients in Japan with witnessed out-of-hospital cardiac arrest. From this cohort, 1990 matched pairs of patients with initial rhythm of ventricular tachycardia or ventricular fibrillation […]
Sudden increase in LVAD thrombosis rates
The left ventricular assist device (LVAD) has rapidly been incorporated into the management of patients with advanced heart failure. In response to an internal audit demonstrating a rapid increase in the incidence of pump thrombosis following implantation of HeartMate II LVADs, the authors pooled data from additional centers to investigate this trend. The resultant retrospective […]
Repair versus replacement for ischemic mitral regurgitation
Ischemic mitral regurgitation (MR) following myocardial infarction is common and presages a doubling in mortality for those with at least mild regurgitation. The disorder reflects disease of the myocardium, rather than an abnormality of the valve itself. Surgical practice guidelines support intervention for severe symptomatic ischemic MR, but evidence is lacking to inform whether valvular […]
Testosterone replacement associated with higher risk for adverse cardiovascular events
Despite limited data on cardiovascular safety, rates of testosterone therapy are increasing dramatically. In a retrospective cohort study of 8,709 male Veterans with a low testosterone level, the authors sought to determine the association between use of testosterone therapy following coronary angiography and patient outcomes of all-cause mortality, myocardial infarction and stroke. […]
No Benefit from Extended Dual Anti-Platelet Therapy?
The PARIS (patterns of non-adherence to anti-platelet regimens in stented patients) registry is a prospective observational study of patients from the US and Europe who were discharged on dual anti-platelet therapy (DAPT) following coronary stenting. Among 5018 patients from this registry, the rates of physician recommended discontinuation, brief interruption (i.e. for surgery), or disruption (ie […]
Weight reduction results in atrial fibrillation symptom improvement
Obesity is known risk factor for atrial fibrillation (AF). However, the effect of weight reduction on AF symptom burden is unknown. In this study, 150 patients with symptomatic AF who were overweight or obese were randomized to a physician led weight loss program (intervention arm) or self-directed general lifestyle measures (control arm). All patients received […]
Target cooling temperatures in cardiac arrest – should we just focus on avoiding fever instead?
Prior trials of out-of-hospital cardiac arrest of presumed cardiac etiology have demonstrated improved survival and neurologic function when patients are treated with therapeutic hypothermia. Questions remain as to the optimal target temperature for therapeutic hypothermia. In this international study of patients with out-of-hospital cardiac arrest, 950 patients were randomly assigned to therapeutic hypothermia at a […]
Pharmacogenetic warfarin dosing shows marginal to no benefit
The inter-individual variation in warfarin dosing requirements and narrow therapeutic index for anticoagulation necessitates a personalized dosing regimen. Variation in dosing requirements are in part explained by genetic polymorphism in CYP (involved in warfarin metabolism) and VKOR (a warfarin target) genes. A dosing strategy informed by these polymorphism may hold promise to improve anticoagulation control. […]