Did the Hospital Readmissions Reduction Program Impact Heart Failure Readmission or Mortality? Comparison of the change in heart failure readmission and mortality rates between hospitals subject to hospital readmission reduction program penalties and critical access hospitals

An article by Sandhu et al. published in the American Heart Journal reported that on using critical access hospitals (CAHs) as a control group, the introduction of financial penalties was only associated with modest reductions in readmissions and an uncertain association with mortality. Continue reading

Long-Term Consequences Post Device Closure of Patent Foramen Ovale in Patients With Cryptogenic Embolism

Recently, Jérôme Wintzer-Wehekind M.D. and his team at Quebec Heart & Lung Institute, Laval University, Quebec, Canada conducted a vast cohort study published in the Journal of American College of Cardiology to look into the long-term outcomes (> 10 years) following PFO closure. Previous randomized trials conducted by various investigators had shown a marvelous reduction in ischemic stroke events for around 2-6 years post PFO closure but not many had gone beyond 10 years. The current study validated that device closure of PFO decreased recurrence of ischemic neurological events and continued to show similar results with the passage of time.  Continue reading

FFRCT Provides Superior Functional Assessment of Coronary Stenosis When Compared With Traditional Functional Imaging Techniques

A study published in JACC reported that fractional flow reserve (FFR) computation from coronary computed tomography angiography (CTA) datasets (FFRCT) had higher diagnostic performance as compared with standard coronary CTA, SPECT, and PET for vessel-specific ischemia, provided coronary CTA images were evaluable by FFRCT, whereas PET had a favorable performance in per-patient and intention-to-diagnose analysis. The investigators also stressed that in patients in whom 3-vessel FFRCT could be analyzed, FFRCT held the clinical potential to provide anatomic and hemodynamic significance of coronary lesions. Continue reading

FDA Issues Cautionary ‘Dear Doctor’ Letter In Response to Study Reporting Increased Deaths with Paclitaxel-Coated Devices in PAD Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality   

The FDA issued a Dear Doctor letter while investigating a potential safety signal with paclitaxel-coated balloons and stents used to treat peripheral artery disease. “This review will focus on the causes of death, the paclitaxel dose delivered, and patient characteristics that may impact clinical outcomes. Additional statistical analyses will be performed to clarify the presence and magnitude of any long-term risks,” the letter stated.  Continue reading

High-Sensitivity Troponin I Can Predict Mortality in Stable Patients Suspected to Have CAD The biomarker was more sensitive compared with other conventional troponin assays and predicted near-term MACE in low-risk patients.

Heightened levels of high sensitivity troponin I (hsTnI) can predict the near-term risk of death, acute myocardial infarction (MI), and hospitalization for unstable angina in stable symptomatic patients suspected to have coronary artery disease (CAD), according to a new study published in the Journal of American College of Cardiology. Continue reading

Higher Dietary Fiber Intake Associated with Reduction in Incidence of Non-Communicable Diseases

A series of systematic reviews and meta-analyses have depicted how findings from prospective studies and clinical trials associated with relatively high intakes of dietary fiber and whole grains were complementary, and striking dose-response evidence indicated that the relationships to several non-communicable diseases could be causal. According to the publication in The Lancet, the implementation of recommendations to increase dietary fiber intake and to replace refined grains with whole grains is expected to benefit human health. Continue reading

Epidemiological Approach Shows Low LDL Levels Do Not Increase the Risk of Sepsis Association Between Low-Density Lipoprotein Cholesterol Levels and Risk for Sepsis Among Patients Admitted to the Hospital With Infection

A fascinating cohort study published in JAMA Network Open conducted by QiPing Feng, Ph.D., and colleagues from Vanderbilt University Medical Center in Nashville, Tennessee, refuted previous studies that showed a significant relationship between low levels of Low-density lipoprotein cholesterol (LDL-C) level and sepsis. Continue reading

Administration of Cangrelor In Addition to Crushed Ticagrelor Bridges Gap of Antiplatelet Inhibition in Patients Undergoing Primary PCI Results from the CANTIC study

According to a new study, Cangrelor could serve to bridge the gap of antiplatelet inhibition in patients undergoing primary percutaneous coronary intervention (P-PCI) for acute coronary syndrome, who were administered crushed ticagrelor. Additionally, no drug-drug interactions (DDI) were reported between the two P2Y12 inhibitors, based on the findings published in Circulation. Continue reading

Identification of a Risk Locus Suggests SCAD May be Genetically Determined Association of the PHACTR1/EDN1 Genetic Locus With Spontaneous Coronary Artery Dissection

In the largest study conducted to date for Spontaneous coronary artery dissection (SCAD), the first genetic risk factor was identified. The findings, published in JACC, suggested that this genetic link could contribute to the clinical overlap between SCAD and fibromuscular dysplasia (FMD). Continue reading

Women in Interventional Cardiology: ‘If You Love it, You Will Make it!’ Study Identifies Factors Dissuading Female Cardiology Fellows From Pursuing Interventional Cardiology

According to a recent publication in JACC: Cardiovascular Interventions, many factors uniquely dissuade women from pursuing interventional cardiology (IC) compared with men, largely related to the culture of IC as a subspecialty. Targeted resolution of these specific factors may provide the most impact in reducing sex imbalances in the field. Continue reading

New Study Sets the Stage for Determining Optimal Antithrombotic Regimen in TAVR Patients The FRANCE TAVI Registry

According to a study published in JACC: Cardiovascular Interventions, sex, renal failure, and atrial fibrillation affected mortality the most at 3-year follow-up following transcatheter aortic valve replacement (TAVR). In contrast, anticoagulation (mostly given for atrial fibrillation) was found to reduce the risk of bioprosthetic valve dysfunction (BVD) after TAVR. Continue reading

Effects of Maternal Obesity On Cardiac Development An Offspring Study in Human Neonates and Minipigs

The results of a fascinating study conducted by Dr. Patricia Iozzo and her colleagues at the Institute of Clinical Physiology, in Pisa, Italy showed that neonatal changes in cardiac morphology were explained by late-trimester maternal body mass index; myocardial glucose overexposure seen in minipigs could justify early human findings. Moreover, long-term effects in minipigs consisted of myocardial insulin resistance, enzymatic alterations, and hyperdynamic systolic function, according to the publication in JACC: Cardiovascular Imaging. Continue reading

Adjunctive Low Dose Alteplase During Primary PCI Fails to Imrpove Microvascular Obstruction in STEMI Patients Results of the T-Time trial presented at the American Heart Association (AHA) 2018 Scientific Sessions

A multi-center randomized, double blind, placebo-controlled, parallel group clinical trial has shown that among patients with acute ST-elevation myocardial infarction (STEMI) presenting within 6 hours of symptoms, adjunctive low-dose intracoronary alteplase given after reperfusion via primary percutaneous intervention does not reduce microvascular obstruction. Continue reading

Is High Educational Attainment Associated With Higher Cardiovascular Risk and Mortality in Hispanic Individuals? Findings From the Cooper Center Longitudinal Study

Results from a study conducted by investigators at Stanford University School of Medicine did not support the Hispanic paradox in a highly educated Hispanic population. The study demonstrated that Hispanic and non-Hispanic white (NHW) men and women with high educational attainment had similar atherosclerotic cardiovascular disease risk, subclinical coronary atherosclerosis, and mortality during follow-up. The results were published online in the latest issue of JAMA Cardiology. Continue reading

Use of Dynamic Myocardial Imaging in the Evaluation of Heart Failure With Preserved Ejection Fraction Provides Prognostic Value

A study published in JACC: Cardiovascular Imaging has shown that both left ventricular systolic and diastolic reserves contribute to risk prediction in Heart Failure With Preserved Ejection Fraction (HFpEF). Therefore, the inclusion of the exertional assessment of left ventricular function to diagnostic algorithms may improve the prognostication process in this disease condition. Continue reading

Prior Cerebrovascular Disease: A Key Factor In The Assessment for Optimal Left Main Coronary Artery Revascularization Strategy Results From the EXCEL Trial

A study conducted by Dr. Gregg W.Stone and his colleagues from Columbia University Medical Center demonstrated that patients with left main coronary artery disease (LMCAD) and prior cerebrovascular disease (CEVD) compared with those without CEVD have higher rates of stroke and reduced event-free survival after revascularization. In their publication in JACC: Cardiovascular Interventions, they stated that PCI need not be a priori preferred over CABG for LMCAD in patients with known CEVD.  Patients with CEVD should undergo evaluation for both PCI and CABG, with careful consideration of comorbidities, the likelihood of safely achieving complete revascularization, and patient preferences in order to determine the optimal coronary revascularization strategy. Continue reading

Survival Over the First Few Decades Following Tetralogy of Fallot Repair A Study From the Pediatric Cardiac Care Consortium

A study published in JAMA cardiology has shown that long-term survival after simple Tetralogy of Fallot (TOF) repair is excellent. Staged repair and non–valve-sparing operations were negatively associated with survival in the early post repair phase but not the late post repair phase. The study, led by Dr. Clayton A. Smith, Emory University School of Medicine is important for patients with repaired TOF and their caretakers and may guide surgical strategies for optimizing the long-term outcomes of this population. Continue reading

CHIPping Away at the Pathogenesis of Chronic Heart Failure: What is the Clinical Significance of Clonal Hematopoiesis of Indeterminate Potential (CHIP)? Association of Mutations Contributing to Clonal Hematopoiesis With Prognosis in Chronic Ischemic Heart Failure

In a study published in JAMA cardiology, the data suggested that somatic mutations in hematopoietic cells, specifically in the most commonly mutated CHIP driver genes TET2 and DNMT3A, could be significantly associated with the progression and poor prognosis of CHF. The study was led by Dr. Lena Dorsheimer from the Department of Medicine, Goethe University Hospital, Frankfurt, Germany. Continue reading