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 Table of Contents  
REVIEW
Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 152-154

Cardiology update: 3rd quarter


Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication11-Jan-2019

Correspondence Address:
Dr. Faraz Ahmed Farooqui
Department of Cardiology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcs.jpcs_66_18

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How to cite this article:
Farooqui FA, Singh S. Cardiology update: 3rd quarter. J Pract Cardiovasc Sci 2018;4:152-4

How to cite this URL:
Farooqui FA, Singh S. Cardiology update: 3rd quarter. J Pract Cardiovasc Sci [serial online] 2018 [cited 2019 Aug 23];4:152-4. Available from: http://www.j-pcs.org/text.asp?2018/4/3/152/249947

In the ASPREE trial,[1] daily use of aspirin was evaluated in elderly individuals without cardiovascular disease dementia and disability. Aspirin did not significantly lower cardiovascular disease as compared to that of placebo. Higher all-cause mortality was observed in individuals receiving daily aspirin (hazard ratio 1.14, confidence interval 1.01–1.29). The higher mortality was mainly driven by excess cancer-related deaths in the aspirin arm. These results are in contrast from previous studies[2] which have demonstrated a protective effect of aspirin on cancer-related death.

In a study of 15,480 patients,[3] aspirin (100 mg) was compared to placebo in patients with type 2 diabetes without cardiovascular disease. There was a significant reduction in serious vascular events in the aspirin group compared to placebo group (8.5% vs. 9.6%). However, major bleeding events occurred more frequently in the aspirin group (4.1% vs. 3.2%). Gastrointestinal bleeding was the most common. There was no significant difference in intracranial bleeding between the two groups.

Rivaroxaban in the dose of 2.5 mg twice a day was evaluated in the COMMANDER HF trial.[4] Study participants included patients with coronary artery disease and chronic heart failure (left ventricular ejection fraction ≤40%). There was no significant difference in the primary efficacy endpoint (a composite of any cause death, myocardial infarction [MI], or stroke). The all-cause mortality was also not significantly different between the two groups.

The VEST investigators evaluated the role of the wearable cardioverter defibrillator in patients with acute MI with an ejection fraction ≤35%.[5] Patients were enrolled within 7 days of hospital discharge. Arrhythmic death was not significantly lower in the device group as compared to that of the control group (1.6% vs. 2.4%, P = 0.18).

The cardiovascular safety of Lorcaserin was evaluated by the CAMELLIA-TIMI 61 investigators.[6] Weight loss of at least 5% occurred significantly higher in individuals receiving Lorcaserin (38.7% vs. 17.4%) compared to that of the placebo group. With regard to the primary safety endpoint of major cardiovascular events, lorcaserin was noninferior to placebo.

Spyropoulos et al. evaluated the role of extended thromboprophylaxis in patients with medical illness after discharge.[7] The MARINER trial compared rivaroxaban with placebo. Rivaroxaban was not associated with a significantly lower risk of symptomatic venous thromboembolism and death due to venous thromboembolism than placebo. The incidence of major bleeding was low.

In the ATTR-ACT study,[8] tafamidis was evaluated in transthyretin amyloid cardiomyopathy. The primary analysis was performed using the Finkelstein–Schoenfeld method. Tafamidis was associated with a significantly lower rate of all-cause mortality compared to placebo (29.5% vs. 42.9%). In addition, tafamidis reduced the decline in functional capacity and quality of life compared to placebo.

The COAPT investigators evaluated the role of transcatheter mitral valve repair in patients with heart failure.[9] Patients with heart failure and moderate-to-severe or severe mitral regurgitation were randomly assigned to transcatheter mitral valve repair plus medical therapy or medical therapy alone. The primary efficacy endpoint of heart failure hospitalizations was significantly lower in the device group (35.8% vs. 67.9%). In addition, any cause mortality was also significantly lower in the device arm (29.1% vs. 46.1%). The rate of freedom from device-related complications exceeded the prespecified safety threshold.

The SCOT-HEART investigators assessed the diagnostic utility of coronary computed tomography angiography (CTA) in patients with stable chest pain.[10] The addition of CTA to standard care was evaluated in 4146 patients. The primary endpoint of death from coronary heart disease or nonfatal MI at 5 years was significantly lower in the CTA arm (2.3% vs. 3.9%). The use of CTA did not result in a significantly higher rate of coronary angiography or coronary revascularization.

In a randomized controlled trial of 400 patients, Iversen et al. compared oral and intravenous antibiotic therapy in patients with culture positive, left-sided infective endocarditis.[11] All patients received initial antibiotic therapy for 10 days. The primary outcome was a composite of all-cause mortality, unplanned cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen, from the time of randomization until 6 months after antibiotic treatment was completed. It was demonstrated that changing to oral antibiotic therapy was noninferior to continued intravenous antibiotic therapy.

In the MITRA-FR trial, patients with severe secondary mitral regurgitation were randomized to percutaneous mitral valve repair in addition to medical therapy or medical therapy alone.[12] The primary efficacy endpoint was a composite of death from any cause or unplanned hospitalization for heart failure at 12 months. There was no significant difference in the primary endpoint between the two groups (51.3% vs. 54.6%, P = 0.53).

The TALENT trial was a noninferiority trial that compared the supraflex sirolimus eluting stent and the xience everolimus-eluting stent.[13] The rate of device-oriented composite endpoint of cardiac death, target-vessel MI, and clinically indicated target lesion revascularization at 12 months was 4.9% with supraflex and 5.3% with xience, a difference that met criteria for noninferiority.

In a phase I/II trial of noninvasive cardiac radioablation, 19 adults with treatment-refractory episodes of ventricular tachycardia (VT) or cardiomyopathy related to premature ventricular complexes, arrhythmogenic scar regions were targeted by combining noninvasive anatomic and electric cardiac imaging with a standard stereotactic body radiation therapy workflow followed by delivery of a single fraction of 25 Gy to the target. There was a reduction of VT episodes from 119 (range: 4–292) to 3 (range, 0–31), along with reduction for both implantable cardioverter-defibrillator shocks and anti-tachycardia pacing. Overall survival was 72% at 12 months.[14]

REDUCE-IT evaluated icosapent ethyl, a highly purified ethyl ester of eicosapentaenoic acid, enrolling over 8000 patients with elevated triglycerides at increased cardiovascular risk and followed them for 5 years. REDUCE-IT studied patients with triglycerides of 135–499 mg/dL. There was a statistically significant 25% reduction in the primary endpoint of cardiovascular death, MI, stroke, coronary revascularization, or hospitalization for unstable angina and 20% reduction in death due to cardiovascular causes, as well as 31% reduction in MI and 28% reduction in stroke.[15] Icosapent ethyl is already approved for use in patients with triglycerides 500 mg/dL or greater.

A cohort of 66 children with early-onset childhood cardiomyopathy underwent genetic analysis using next-generation sequencing. A pathogenic variant was detected in 39% of children. This was a de novo variant in 46% of cases, whereas 34% were recessively inherited and 20% were dominantly inherited. In some cases, the genetic diagnosis had implications for management. For example, calmodulin-1 was associated with life-threatening arrhythmias, whereas TAZ was associated with good outcomes.[16],[17] New phenotypic cardiomyopathic presentations were seen for known mutations in PPA2, NEK8, TBX20, TAB2, JPH 2, and CALM1. The improvement was observed in patients with TAZ, MRPL44, and DNAJC19 mutations.

A systematic review explored the diagnostic accuracy of various cardiovascular magnetic resonance index tests for the diagnosis of acute myocarditis in adult patients.

Native T1 mapping had superior diagnostic accuracy across all index tests. The area under the curve (AUC) of T2 mapping was greater than the AUC of increased T2 ratio/signal and early gadolinium enhancement, whereas extracellular volume showed no superiority compared with other index tests.[18]

 
  References Top

1.
McNeil JJ, Wolfe R, Woods RL, Tonkin AM, Donnan GA, Nelson MR, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med 2018;379:1509-18.  Back to cited text no. 1
    
2.
Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW, et al. Effect of daily aspirin on long-term risk of death due to cancer: Analysis of individual patient data from randomised trials. Lancet 2011;377:31-41.  Back to cited text no. 2
    
3.
Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, Barton J, et al. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. New England Journal of Medicine. 2018;379:1529-39.  Back to cited text no. 3
    
4.
Zannad F, Anker SD, Byra WM, Cleland JG, Fu M, Gheorghiade M, et al. Rivaroxaban in patients with heart failure, sinus rhythm, and coronary disease. N Engl J Med 2018;379:1332-42.  Back to cited text no. 4
    
5.
Olgin JE, Pletcher MJ, Vittinghoff E, Wranicz J, Malik R, Morin DP, et al. Wearable cardioverter–defibrillator after myocardial infarction. N Engl J Med 2018;379:1205-15.  Back to cited text no. 5
    
6.
Bohula EA, Wiviott SD, McGuire DK, Inzucchi SE, Kuder J, Im K, et al. Cardiovascular safety of lorcaserin in overweight or obese patients. N Engl J Med 2018;379:1107-17.  Back to cited text no. 6
    
7.
Spyropoulos AC, Ageno W, Albers GW, Elliott CG, Halperin JL, Hiatt WR, et al. Rivaroxaban for thromboprophylaxis after hospitalization for medical illness. N Engl J Med 2018;379:1118-27.  Back to cited text no. 7
    
8.
Maurer MS, Schwartz JH, Gundapaneni B, Elliott PM, Merlini G, Waddington-Cruz M, et al. Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med 2018;379:1007-16.  Back to cited text no. 8
    
9.
Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med 2018;379:2307-18.  Back to cited text no. 9
    
10.
SCOT-HEART Investigators, Newby DE, Adamson PD, Berry C, Boon NA, Dweck MR, et al. Coronary CT angiography and 5-year risk of myocardial infarction. N Engl J Med 2018;379:924-33.  Back to cited text no. 10
    
11.
Iversen K, Ihlemann N, Gill SU, Madsen T, Elming H, Jensen KT, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med 2018. Doi: 10.1056/NEJMoa1808312. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30152252. [Last accessed on 2018 Dec 28].  Back to cited text no. 11
    
12.
Obadia JF, Zeitoun DM, Leurent G, Lung B, Bonnet G, Piriou N, et al. Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation. N Engl J Med 2018;379:2297-306.  Back to cited text no. 12
    
13.
Modolo R, Chichareon P, Kogame N, Asano T, Chang CC, de Winter RJ, et al. A prospective multicenter randomized all-comers trial to assess the safety and effectiveness of the thin-strut sirolimus-eluting coronary stent SUPRAFLEX: Rationale and design of the TALENT trial. EuroIntervention 2018. pii: EIJ-D-18-00499.  Back to cited text no. 13
    
14.
Robinson CG, Samson PP, Moore KM, Hugo GD, Knutson N, Mutic S, et al. Phase I/II trial of electrophysiology-guided noninvasive cardiac radioablation for ventricular Tachycardia. Circulation 2018;138. Available from: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.118.038261. [Last accessed on 2018 Dec 28].  Back to cited text no. 14
    
15.
Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med 2018. Doi: 10.1056/NEJMoa1812792.  Back to cited text no. 15
    
16.
Lipshultz SE, Sleeper LA, Towbin JA, Lowe AM, Orav EJ, Cox GF, et al. The incidence of pediatric cardiomyopathy in two regions of the United States. N Engl J Med 2003;348:1647-55.  Back to cited text no. 16
    
17.
Cox GF, Sleeper LA, Lowe AM, Towbin JA, Colan SD, Orav EJ, et al. Factors associated with establishing a causal diagnosis for children with cardiomyopathy. Pediatrics 2006;118:1519-31.  Back to cited text no. 17
    
18.
Kotanidis CP, Bazmpani MA, Haidich AB, Karvounis C, Antoniades C, Karamitsos TD, et al. Diagnostic accuracy of cardiovascular magnetic resonance in acute myocarditis: A systematic review and meta-analysis. JACC Cardiovasc Imaging 2018;11:1583-90.  Back to cited text no. 18
    




 

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