Cardiology (all articles)
Mean systolic blood pressure above the control threshold in people with treated uncontrolled hypertension in 55 countries
2 Mar, 2023 | 12:48h | UTC
RCT | Endovascular ultrasound renal denervation is modestly effective in the treatment of hypertension
1 Mar, 2023 | 14:11h | UTCSummary: The RADIANCE II randomized clinical trial investigated the efficacy and safety of endovascular ultrasound renal denervation in patients with hypertension without the influence of antihypertensive medications. The trial enrolled 224 patients who were withdrawn from such medications and randomly assigned to receive either ultrasound renal denervation or a sham procedure. Results showed that ultrasound renal denervation reduced ambulatory systolic blood pressure by 6.3 mmHg on average at 2 months, compared to the sham procedure, without any reported adverse events. While these findings suggest that ultrasound renal denervation may be modestly effective in the treatment of hypertension, the short-term follow-up period limits the generalizability of these results to daily practice. Additionally, the clinical relevance of a procedure that reduces blood pressure only after withdrawing blood pressure medications should be considered.
Article: Endovascular Ultrasound Renal Denervation to Treat Hypertension: The RADIANCE II Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: Is There a Role for Renal Denervation in the Treatment of Hypertension? – JAMA Cardiology (free for a limited period)
Pooled analysis of 3 sham-controlled trials on ultrasound renal denervation for patients with hypertension
1 Mar, 2023 | 14:10h | UTCSummary: The article reports a patient-level pooled analysis of 3 randomized clinical trials that aimed to determine the effectiveness and safety of ultrasound renal denervation (uRDN) in reducing blood pressure (BP) compared to a sham procedure. The analysis included 506 patients with varying severities of hypertension and found that uRDN was modestly effective in reducing daytime ambulatory systolic BP at 2 months compared to the sham procedure, with a mean difference of 5.9 mmHg. One of the limitations of this analysis is that its findings are restricted to a 2-month follow-up. Additional follow-up from the included trials will be required to examine the durability of the effect and safety data.
Editorial: Is There a Role for Renal Denervation in the Treatment of Hypertension? – JAMA Cardiology (free for a limited period)
Artificial sweetener erythritol possibly implicated in increased cardiovascular risk
1 Mar, 2023 | 14:08h | UTCSummary: A recent study published in Nature Medicine found that erythritol, a popular artificial sweetener, is possibly implicated with an increased risk of major adverse cardiovascular events (MACE) such as heart attack and stroke. Analyzing data from over 4,000 people in the US and Europe, the researchers found that those with higher blood erythritol levels were at a greater risk of MACE. The researchers also examined the effects of adding erythritol to whole blood or isolated platelets and found that it made platelets easier to activate and form clots. In addition, a pilot intervention study with healthy volunteers showed that erythritol ingestion led to a marked and sustained increase in plasma erythritol levels above those associated with heightened platelet reactivity and thrombosis potential. The authors note that further studies are needed to confirm their findings and assess the long-term safety of erythritol.
Article: The artificial sweetener erythritol and cardiovascular event risk – Nature Medicine (free for a limited period)
News Release: Cleveland Clinic study finds common artificial sweetener linked to higher rates of heart attack and stroke
Commentaries:
Zero-calorie sweetener linked to heart attack and stroke, study finds – CNN
Could a Common Sweetener Raise Heart Risks? – HealthDay
Commentary on Twitter
A study in @NatureMedicine suggests that a commonly used artificial sweetener—erythritol—may be linked to cardiovascular disease events. https://t.co/QrbtvCFDJ4 pic.twitter.com/WpM9cLnXh7
— Nature Portfolio (@NaturePortfolio) February 27, 2023
Review | Platelet aggregation inhibitors and anticoagulants in gastroenterological and visceral surgical procedures
1 Mar, 2023 | 14:03h | UTC
Cohort Study | Elevated uric acid linked to increased risk of new‐onset atrial fibrillation
1 Mar, 2023 | 13:54h | UTCNews Release: Uric acid linked to later risk for irregular heart rhythm – American Heart Association
Commentary: Elevated uric acid levels linked to new-onset AFib – Cardiovascular Business
Commentary on Twitter
Elevated Uric Acid Is Associated With New‐Onset Atrial Fibrillation: Results From the Swedish AMORIS Cohort #AHAJournals https://t.co/P4ydRLTBrH pic.twitter.com/XT3ifw0YEH
— JAHA (@JAHA_AHA) January 12, 2023
Choosing Wisely in Cardiology | New ACC list of five things physicians and patients should question
28 Feb, 2023 | 14:03h | UTCSummary: The American College of Cardiology (ACC) has released a list of “Five Things Physicians and Patients Should Question” in cardiology as part of the Choosing Wisely campaign, which encourages conversations between clinicians and patients about potentially unnecessary tests, treatments, and procedures. The list includes recommendations to:
- Avoid the routine use of invasive hemodynamic monitoring with pulmonary artery catheters in patients with uncomplicated acute decompensated heart failure.
- Avoid performing atrial fibrillation ablation for the sole purpose of discontinuing chronic anticoagulation.
- Avoid routine imaging stress tests or coronary CT angiography for the workup of palpitations or presyncope.
- Avoid obtaining a coronary artery calcium score in patients with known clinical atherosclerotic cardiovascular disease.
- Avoid obtaining routine serial echocardiograms for chronic heart failure if there has been no change in signs, symptoms, or management.
The recommendations are based on published national guidelines and aim to broadly represent the field of cardiology.
Commentary: ACC Releases New List of Choosing Wisely Recommendations – American College of Cardiology
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
RCT | Effects of an exercise and physical activity program in patients with atrial fibrillation
28 Feb, 2023 | 13:38h | UTCAn Exercise and Physical Activity Program in Patients With Atrial Fibrillation: The ACTIVE-AF Randomized Controlled Trial – JACC: Clinical Electrophysiology (link to abstract – $ for full-text)
Commentary: ACTIVE-AF Suggests Physical Activity May Reduce Atrial Fibrillation Risk – HCP Live
Cardiovascular disease related to immune therapy: JACC: CardioOncology special focus issue
28 Feb, 2023 | 13:37h | UTCCardiovascular Disease Related to Immune Therapy: JACC: CardioOncology Special Focus Issue – JACC: CardioOncology
Homepage: Special Focus Issue: Immune Therapy
Cancer Immunotherapy Beyond Checkpoint Blockade: JACC: CardioOncology State-of-the-Art Review
Cardiotoxicity of T-Cell Antineoplastic Therapies: JACC: CardioOncology Primer
Related:
Cardiovascular complications of immune checkpoint inhibitors for cancer – European Heart Journal
Cardiotoxicity of immune checkpoint inhibitors – ESMO Open
Cardiotoxicity from immune checkpoint inhibitors – IJC Heart & Vasculature
M-A | Effect of posterior pericardiotomy in cardiac surgery
28 Feb, 2023 | 13:34h | UTC
Guideline | Acute mechanical circulatory support
27 Feb, 2023 | 13:04h | UTC
Cohort Study | Lipoprotein(a) is linked to atherothrombosis and aortic valve stenosis independent of C-reactive protein
27 Feb, 2023 | 12:44h | UTCLipoprotein(a) is linked to atherothrombosis and aortic valve stenosis independent of C-reactive protein – European Heart Journal (link to abstract – $ for full-text)
Commentary: Lp(a) Is Linked to Atherothrombosis Independent of CRP – American College of Cardiology
[Not published yet] M-A | Too little sodium can be harmful to heart failure patients
24 Feb, 2023 | 13:59h | UTCSummary: New research presented at the American College of Cardiology’s annual scientific session suggests that heart failure patients restricting their dietary sodium intake to levels below the standard recommended maximum of 2.3 grams per day do not have additional benefits and may be at increased risk of death. The study analyzed nine randomized controlled trials that assessed different levels of sodium restriction and found that patients following a diet with a sodium intake target below 2.5 grams per day were 80% more likely to die than those following a diet with a target of 2.5 grams per day or more. The researchers recommend establishing a safe level of sodium consumption instead of overly restricting sodium.
News release: Too Little Sodium Can be Harmful to Heart Failure Patients – American College of Cardiology
Consensus Statement | Management of coronary artery disease in patients undergoing transcatheter aortic valve implantation
23 Feb, 2023 | 13:33h | UTC
Review | Brain monitoring after cardiac arrest
23 Feb, 2023 | 13:23h | UTCBrain monitoring after cardiac arrest – Current Opinion in Critical Care
Single-arm study | Andexanet Alfa seems effective for the reduction of bleeding associated with factor Xa inhibitors
22 Feb, 2023 | 12:29h | UTCFinal Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors – Circulation
Review | Excessive trabeculation of the left ventricle
22 Feb, 2023 | 12:18h | UTCNews Release: Review calls for a refreshed look at clinical approach to heart muscle disorder – Queen Mary, University of London
2023 ACC/AHA/SCAI Advanced training statement on interventional cardiology
21 Feb, 2023 | 11:52h | UTCSummary: The American College of Cardiology (ACC), the American Heart Association (AHA), and the Society for Cardiovascular Angiography and Interventions (SCAI) have issued a clinical document that outlines competency-based training requirements for interventional cardiology trainees. The report emphasizes the importance of a comprehensive training program that includes both didactic and hands-on training. The competencies required for interventional cardiologists include the ability to perform complex coronary, peripheral vascular, and structural heart interventions and manage and treat complications that may arise during these procedures.
Commentaries:
Interventional Cardiology Training Needs Defined for the First Time – TCTMD
Sleep irregularity linked to subclinical markers of cardiovascular disease
21 Feb, 2023 | 11:51h | UTCSummary: The study examined the association between sleep irregularity and subclinical markers of cardiovascular disease in a population of over 2000 participants with a mean age of 68. The participants completed 7-day wrist actigraphy that detected when they were asleep and awake. The results showed that sleep irregularity, particularly sleep duration irregularity, was associated with subclinical atherosclerosis, including high coronary artery calcium burden and abnormal ankle-brachial index. These associations persisted even after adjusting for cardiovascular disease risk factors and other sleep characteristics such as obstructive sleep apnea, sleep duration, and sleep fragmentation. While it is important to note that observational studies like this one cannot establish causation and may be subject to residual confounding, the findings suggest that promoting regular sleep schedules could be an essential aspect of lifestyle recommendations for preventing cardiovascular disease.
News Release: Irregular sleeping habits may increase risk of atherosclerosis in older adults – American Heart Association
Commentaries:
Sleep Irregularity Linked to Measures of Subclinical Atherosclerosis – HealthDay
Irregular sleep may be harmful to your heart, study finds – CNN
Guideline Synopsis | Management of thoracic aortic dissection
21 Feb, 2023 | 11:48h | UTCManagement of Thoracic Aortic Dissection – JAMA (free for a limited period)
Original Guidelines:
Consensus Statement | Renal denervation in the management of hypertension in adults
21 Feb, 2023 | 11:45h | UTC
AHA Scientific Statement | Anesthetic care of the pregnant patient with cardiovascular disease
20 Feb, 2023 | 12:29h | UTCSummary: The AHA emphasizes the need for specialized cardio-obstetric anesthesiology care for pregnant patients with cardiovascular disease, involving a multidisciplinary team of obstetricians, cardiologists, anesthesiologists, and other specialists as needed. The approach includes preoperative evaluation, intraoperative management, and postoperative care to maintain maternal hemodynamic stability, optimize oxygen delivery to the fetus, and avoid factors that exacerbate cardiovascular disease. Vaginal delivery with effective neuraxial analgesia is the preferred mode of delivery, with cesarean delivery used for obstetrical indications or high-risk patients. Specific recommendations are also provided for the management of patients with different types of cardiovascular disease, including congenital heart disease, valvular heart disease, pulmonary hypertension, and hypertrophic cardiomyopathy.
Top Things to Know: Statement on the anesthetic care of the pregnant patient with cardiovascular disease – American Heart Association
M-A | Consumption of whole vs. refined grains and risk of cardiovascular disease and all-cause mortality
20 Feb, 2023 | 12:23h | UTCSummary: This systematic review and meta-analysis of prospective cohort studies found that consuming whole grains was associated with a reduced risk of coronary heart disease, cardiovascular disease, and all-cause mortality, while consuming refined grains had no significant influence on these outcomes. Residual confounding can’t be excluded and the association found does not necessarily imply causation.
M-A | Aspirin with or without statin in individuals without atherosclerotic CVD across risk categories
17 Feb, 2023 | 13:22h | UTCSummary: This meta-analysis examined the effects of aspirin in adults without atherosclerotic cardiovascular disease (ASCVD), stratified by statin use across different ASCVD risks. The analysis found that aspirin reduced myocardial infarction but increased major bleeding, and was not associated with total or cardiovascular survival benefits. In adults without ASCVD, concomitant statin appeared to significantly reduce absolute risk reduction for MI associated with aspirin without influencing bleeding risk. The study highlights that the risk-benefit equilibrium may be tilted towards more harm for primary prevention, and that the expected absolute risk of major bleeding exceeds absolute MI benefits by aspirin for every level of ASCVD risk. The findings have implications for the use of aspirin in those already on statin therapy for primary ASCVD prevention.*
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.
Post hoc analysis | Prevalence and significance of bradyarrhythmias in patients screened for atrial fibrillation
17 Feb, 2023 | 13:13h | UTCSummary: This study looked at the prevalence and significance of bradyarrhythmias in people screened for atrial fibrillation using an implantable loop recorder compared to those who did not receive screening. The study found that screening was associated with the incidental diagnosis of bradyarrhythmias in 1 in 5 people and an increase in pacemaker implantations, but it did not reduce the risk of syncope or sudden death. While bradyarrhythmias are common in older people and can be risk markers, actively detecting and treating them in asymptomatic individuals may not improve clinical outcomes.*
Author Interview: Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care – JAMA
Commentary on Twitter
In the randomized LOOP study, AF screening resulted in the coincidental diagnosis of sinus node dysfunction or atrioventricular block in 1 of 5 participants, along with increased pacemaker implantations, but no change in risk of syncope or sudden death. https://t.co/V5JK2iGlQV
— JAMA Cardiology (@JAMACardio) February 15, 2023
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.