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Dr David Cohen points out some of physicians' potential "psychological" barriers to more rapid adoption of new antiplatelet agents, even though they may be the best choice for their patients.
Why has the development of less invasive mitral-valve repair therapies lagged so far behind comparable strategies to treat the aortic valve? Experts from FDA, industry, and academic medical centers offered some possible answers in a roundtable discussion.
Now that the FDA has approved a transcatheter aortic valve, cardiac surgeons and cardiologists are working together to put all of their ducks in a row to secure national Medicare coverage for the procedure.
A growing number of centers, especially in Europe, are trying a third route for transcatheter valve implants in select patients. Instead of threading the device from the femoral artery or up through the left ventricular apex, they're deploying it directly through the aorta.
Researchers of the beleaguered antiarrhythmic dronedarone believe the drug may still have a role to play in AF therapy for some patients and are testing it as a low-dose complement to another newer antiarrhythmic drug, ranolazine.
Starting up an atrial fibrillation ablation program takes more than just a couple of skilled electrophysiologists, Dr Rodney Horton explained at the Boston Atrial Fibrillation Symposium.
Overall, the bleeding risk scores were able to identify patients at high risk for bleeding but had limited ability to identify patients at intermediate risk, report investigators.
A special session was scheduled for AHA 2011 for long-awaited hypertension, cholesterol, and obesity guidelines to be unveiled, at least in draft form. But no red carpet was rolled out today.
UPDATED // Apixaban has failed to show a benefit when given as extended prophylaxis for VTE in medically ill patients, compared with a shorter regimen of enoxaparin, the ADOPT results show.
Two early-phase trials of novel drug-eluting stents seeking to move beyond permanent polymer coatings have shown that the Synergy and Cre8 devices seem to match market-approved devices, at least in terms of late loss in simple lesions.
Investigators say the radial-access approach should no longer be considered a valid alternative to the femoral approach but instead should become the recommended access site for STEMI and other ACS. While others agree, they argue that experience is still needed and that unless a clinician is trained and proficient, they shouldn't be doing radial-access PCI in STEMI patients.
The wide geographic variation in the uptake of TAVI was the subject of a session at the recent PCR London Valves Meeting, where attendees learned that Germany is the foremost adopter of this technology. Regulatory hurdles and funding and reimbursement issues, among other things, determine how quickly this new technology is being introduced, speakers explained.
ICE or TEE? That was the debate on imaging during TAVI at last week's PCR London Valves meeting. While most agreed fluoroscopy will always play some role, many advocate transesophageal echo will increasingly be used as the imaging of choice during procedures, whereas others predict intracardiac echo will prevail.
Investigators say implantation of an ILR significantly shortened times to ECG-directed diagnosis and therapy, even when patients were not encouraged to also check in with a syncope clinic.
Canadians who tend to pride themselves on being healthier, generally, than their neighbors south of the border need to take a cold hard look at CVD trends in their own country, according to American cardiologist Dr Clyde Yancy.
Provocative new observational data from the UK show higher in-hospital and three-year mortality with the use of off-pump bypass surgery compared with conventional on-pump CABG. But not all surgeons here at the EACTS meeting agreed with the findings, and the results generated much debate.
Experts discussed tips and tricks for operating under antiplatelet therapy during a special session on the topic at the EACTS meeting earlier this week.
Researchers first observed the obesity epidemic in the 1980s. What do the data on people born since the 1980s predict about the future incidence of obesity?
A new analysis of population cost data confirms that the cost of caring for obese individuals tracks with the number of risk factors, which in turn follows the severity of the obesity.
Over the past few years, patients and physicians have become increasingly aware of the potential hazards of radiation exposure from cardiovascular imaging, especially CCTA. So now many centers have begun implementing comprehensive radiation-reduction programs to reduce the radiation dose from each scan and the cumulative exposure of each patient.
Holistic-medicine authority Deepak Chopra and neurologist Martin A Samuels presented heart-failure specialists with two different but complementary takes on the connection between brain and body.
For diabetic patients on aspirin for cardioprotection, twice-daily dosing is better than doubling once-daily doses in those patients who have rapid recovery of platelet COX-1 activity.
The session was entitled "Don't worry, be happy," but the research had a serious side to it, stressing that anger and job stress are linked to higher cardiovascular event rates, while laughter and cognitive behavior therapy can lower the risk.
The first data from telemonitoring in real time show there was more than a doubling of people presenting to the emergency room with subepicardial lesions during the weekend of an earthquake in Chile in February 2010.
For patients at very high risk of cardiovascular disease, the ESC/EAS writing committee states that LDL-cholesterol levels should be lowered to less than 70 mg/dL, a target that is not optional, as it is in the NCEP guidelines. Even moderate-risk patients have a new target, that being less than 115 mg/dL, which is also lower than the NCEP guidelines. The task force believes there is a wealth of evidence supporting the "lower-is-better" LDL theory.
Despite the recent failure of AIM-HIGH, as well as ACCORD-Lipid and FIELD, niacin and fibrates are the drugs of choice for treating patients with high triglycerides and low HDL-cholesterol levels. That said, authors of the new report urge that patients adopt healthier lifestyles, pushing for diet and exercise first to alter the adverse lipid profile.
More and more electrophysiologists are adopting remote monitoring of implantable defibrillators and pacemakers because their patients prefer it over office visits and because it helps them respond to adverse events more efficiently.
In a debate on the best therapy for patients with ventricular tachycardia and preserved left ventricular ejection fraction, the experts agreed that doctors must decide on ablation or an ICD without definitive data to support either option.
The perception that diet soft drinks are a benign alternative to highly sweetened beverages might be dangerously wrong. Overall, consumers of diet soft drinks experienced a 70% greater increase in waist circumference than nonconsumers.
A new analysis of ASCOT has shown that BNP is strongly associated with risk of cardiovascular events in this hypertensive population of patients with no history of prior CVD.
Whether plasma renin predicts cardiovascular outcomes in hypertensive patients is still the subject of debate following conflicting new data from two studies.
A large study of elderly patients with severe aortic stenosis but with preserved LV function who did not undergo surgery identified four echo parameters that predicted mortality.
Better diastolic function might explain part of the reason that some patients with heart failure have preserved exercise capacity; one study found that an E/e' value of less than 10.8 predicted normal exercise tolerance in patients undergoing stress echo.
A home-based approach to the postdischarge care of patients with heart failure didn't improve survival or rehospitalization rates in the trial, compared with care at a specialty outpatient clinic, but maybe that shouldn't be the point of such a trial, according to researchers.
A "debate" had much to teach about the physiology underlying the benefits of contemporary heart-failure therapy and what could be a new twist in managing patients with the disorder.
There was also a small but statistically significant increase in heart rate among patients treated with the highest dose of phentermine/topiramate, but overall reductions in systolic and diastolic blood pressure led to an improvement in rate pulse pressure, according to investigators.
While investigators are not yet recommending relocating large swaths of the hypertensive population to space, data showing zero gravity lowers blood pressure, as well as a not-yet-understood increase in catecholamine levels, open up the possibility that unknown mechanisms might be involved in blood-pressure regulation.
The new document stresses the importance of universal familial-hypercholesterolemia screening by age 20. Children as young as two years old should also be screened if they have a family history of premature cardiovascular disease or elevated cholesterol levels. The consensus group emphasizes the use of statins as first-line therapy during treatment.
A number of studies are attempting to determine why omega-3 fatty acids increase LDL cholesterol. One study suggests that EPA might prevent lipid peroxidation, which would help LDL-cholesterol clearance, while DHA does not. Other analyses confirm the differential effects of EPA and DHA on LDL-cholesterol levels.
Having proved they have more or less attained device and procedural success, TAVI doctors are now peering more closely at the rate of paravalvular aortic regurgitation, and its not-insignificant impact on mortality.
The retrospective analysis is based on over 25 374 STEMI patients treated in Sweden between 2005 and 2010. Experts called it "provocative," but not comparable to results from a randomized trial.
Surgeons in the US say they don't want to see transcatheter aortic-valve implants substituted for as many valve-replacement surgeries as they have in Europe, because the PARTNER A neurological events data show that the traditional surgical approach has a lower risk of neurological events and the durability of TAVI is not yet proven.
A large registry analysis shows that high-risk patients have very high mortality rate when transplanted at low-volume centers, but that the center's volume does not matter much in relatively low-risk patients.
Cardiac resynchronization therapy doesn't seem to improve their cardiac function or their survival free of transplant or mechanical circulatory support, an analysis suggests.
The Society for Cardiovascular Angiography and Interventions has released a national quality program, including a Quality Improvement Toolkit for all hospital cath labs.
Trans-fatty acids that occur naturally in ruminant fat and those from industrially produced, partially hydrogenated fish oils both contribute to increased cardiovascular and coronary heart disease mortality, according to a new prospective study.
Couples who attended a preventive cardiology program together, after one partner had suffered a coronary disease event, changed their dietary and exercise habits in tandem, a new analysis from the EUROACTION study shows.
Investigators think that elevated natriuretic peptide levels in brain-dead heart donors could potentially be more powerful than troponins as a predictor of posttransplant outcomes.
A strategy in which everolimus was added to a reduced-dose cyclosporine regimen improved renal function in approximately 50% of patients, Italian investigators report.
Dr Bob Harrington sits down with Drs Alan Bell, Keith Fox, and Jean-François Tanguay for an in-depth discussion on the approach, development, methodology, and implementation of guidelines for antiplatelet therapy in Canada, the US, and Europe.
The radial artery has outperformed the saphenous vein as a conduit for coronary artery bypass grafting in a five-year follow-up of patients with multivessel disease undergoing surgery in a randomized, multicenter Canadian study. These are the first long-term data to address this subject and challenge the notion that has previously existed: that this artery is not much better than a vein, said researchers.
At Cardiovascular Research Technologies 2011, an interventionalist debates a surgeon on whether more left main disease cases will be treated with surgery or percutaneous intervention.
One of the leaders of the Cardiovascular Cell Therapy Research Network updated the encouraging results of a series of trials of stem cells to treat MI at the CRT conference.
Researchers conclude that the net clinical benefit of this investigational agent over aspirin alone is "substantial." Their findings were preliminarily reported last year.
Surgeons and interventionalists are intrigued by the promise of minimally invasive hybrid revascularization procedures, but most surgeons will probably wait to see more clinical data before embracing the concept.
Building a successful ventricular assist device program is harder than it may appear, surgeons experienced with running programs told their colleagues.
Experts warned that it is important to clearly define the link between "venous insufficiency" and MS and that interventionalists and MS experts must answer the remaining unknowns given the high level of public interest in the procedure and the new era of regulation and medical cost containment.
A Food and Drug Administration advisory panel is set to review data and vote on an expanded indication for the RX Acculink Carotid Stent System. The expanded indication would see patients at standard risk for adverse events from endarterectomy become candidates for stenting.
The absolute reduction in VTE risk was 0.76%, meaning that for every 125 patients treated with apixaban instead of enoxaparin, clinicians would prevent one episode of major VTE, report investigators.
Given the advanced age and multiple comorbidities in inoperable aortic-stenosis patients, the finding of a large improvement in quality-of-life end points may be as "equally important" a finding as improved survival.
CORRECTED // The updated recommendations incorporate the new anticoagulant dabigatran, even though the drug is not yet approved in Canada. The purpose of including dabigatran in the 2010 recommendations is to have the guidelines as current as possible, and that includes taking a position on drugs evaluated in clinical trials and expected to soon be in the armamentarium of practicing clinicians.
Investigators showed that less fit runners, assessed by VO2max testing, had signs of inflammation, swelling, and decreased perfusion assessed by MRI three months following the race, while those who were better trained were less likely to experience such damage. The good news is that the damage was temporary and reversible.
If statins are metabolized in the small intestine, will they retain their efficacy after gastric bypass? That's a question Norwegian investigators set out to answer.
An open-label, two-year extension study of the phase 2 trial finds that early weight loss is sustained in patients taking 2.4 mg and 3.0 mg doses of liraglutide, which is approved as a second-line diabetes drug. Blood-pressure levels also dropped after liraglutide treatment.
The Moxy drug-coated angioplasty balloon shows promise in short-term results from the LEVANT I trial and will have a chance to prove itself on a bigger stage in LEVANT II.
ADDITION, a large, randomized, primary-care-based trial, has failed to show a significant impact of intensive treatment of type 2 diabetes on cardiovascular events compared with routine care in those newly diagnosed with diabetes. But the trial, which was much applauded, shows the feasibility of screening patients for undiagnosed diabetes and demonstrates that early intervention does reduce events, say the investigators.
Two relatively new agents for type 2 diabetes have a role to play in the treatment of this disorder because they have been shown to induce weight loss as well as improve glycemia. And these drugs have enabled insulin to be withdrawn in some insulin-dependent patients, says one expert.
The findings could help explain the "quite modest" but significant clinical benefits of omega-3 polyunsaturated fatty acids, typically given as fish-oil capsules, that have been observed in heart failure.
Surveillance for allograft rejection is generally no less costly using the AlloMap test, but patients prefer the test, with only provisional biopsy, because—most likely—they have to suffer fewer of the invasive procedures. So should the test have a role in patients at low risk for rejection?
Preliminary data from a new registry of more than 10 000 patients with AF, the largest ever, spanning 26 countries, shows that that much remains to be done in this field. AF is frequently not controlled, and even when it is, patients are often symptomatic. In addition, physicians need better guidance on how to treat AF, and better drug and devices are required, say experts.
Investigators with the trial gave reporters at the ADA 2010 Scientific Sessions a cursory preview of a post hoc analysis to be reported in more detail later in the meeting: the controversial drug apparently wasn't associated with an excess risk of MI or other cardiovascular events in the BARI 2D trial. The finding, with all its limitations, adds to an already-contentious debate about the drug's safety.
A potential new treatment option for patients with resistant hypertension involving a catheter-based procedure to ablate the renal sympathetic nerves has led to a decent blood-pressure reduction that lasted two years in a small number of patients. It is expected that the results of a controlled trial with the therapy in more than 100 patients will be reported at the AHA meeting in November.
UPDATED // In a surprising turn of events, Spanish doctors have discovered that some hypertension patients taking ACE inhibitors or ARBs long term developed albuminuria or that existing albuminuria progressed. The findings suggest that RAS suppression with these agents "doesn't last forever," says the senior researcher.
AstraZeneca and Cleveland Clinic are sponsoring the SATURN trial to compare the efficacy of high-dose statins in a representative population of coronary disease patients with modifiable risk factors.
The clinical usefulness of a multiple biomarker index, one that includes markers of inflammation, depends on atherosclerotic disease burden, according to the results of a new study. The increased risk of events for asymptomatic patients with a biomarker score above the median occurs mainly in those with a mild amount of atherosclerosis disease, report researchers.
Ten risk factors are associated with 90% of the risk of stroke; of these modifiable risk factors, hypertension is the most important for all stroke subtypes and is a particularly dangerous risk factor for intracerebral hemorrhage.
Experts discussed the hurdles and opportunities for the development of echocardiography in a series of mock debates on its role in cardiac imaging and how it stacks up against other modalities.
The CABG alone won't help dyssynchrony, so patients with heart failure who have indications for both CABG and cardiac resynchronization therapy will benefit from getting both at the same procedure; delaying CRT pending the outcomes of CABG can mean that the patient could lose a lot, according to a small randomized study.
Medical therapy directed by direct pulmonary-artery-pressure readings from the tiny device led to a 30% drop in six-month risk of heart-failure hospitalization for the trial's patients with NYHA class 3 disease.
The CREST trial, first reported in February, showed similar net outcomes for carotid stenting vs endarterectomy, but editorialists say they are sticking with surgery for symptomatic disease.
A new analysis of SITS registry data since release of studies showing benefit from thrombolysis out to 4.5 hours finds increased use of tPA in all time frames, with no indication that doctors are taking additional time deciding whether to treat.
A new study testing NSTE-ACS patients for both the clopidogrel-poor-metabolizer mutation and for platelet reactivity suggests that giving up to four additional 600-mg loading doses of the drug to patients who have high platelet reactivity may be the best way to handle the uncertainty over nonresponsiveness. Outcome data are still needed.
A next-generation zotarolimus-coated Driver stent, with a rejiggered polymer to better control drug eluting, has proved itself seemingly identical to the Xience, although a higher rate of stent thrombosis in the newer device has raised some eyebrows.
By programming certain variables, including faster VT/VF thresholds and longer detection durations, among others, overall shock reduction was reduced between 17% and 28%, according to investigators.
The recycled pacemakers and ICDs, obtained from US patients who were getting an upgrade or needed replacements for other reasons, "performed just like brand-new devices" in the recipients, according to researchers who followed them for at least five years.
At 30 days, the MACCE rate with the proximal cerebral-protection system was 2.7%. Overall, even older and symptomatic patients treated with the cerebral-protection device did as well as the overall cohort.
Swedish researchers report that a new anthropometric measure—waist-to-hip-to-height—is better than other body-mass measures widely in use, at least for predicting all-cause mortality. But just how feasible would such a tool be in general practice?
A new study shows one in 10 apparently healthy Americans have both prehypertension and prediabetes, significantly raising their risk of a cardiovascular event. Such individuals should be flagged to receive counseling about lifestyle changes, say researchers.
A late-breaking clinical trial on the Rheos system—a pacemakerlike device surgically implanted in the carotid—was pulled from its slot here at the ASH meeting this morning.
In an analysis admittedly with some big limitations, recipients of hearts that had been judged good for transplantation but were from donors who had been heavy drinkers were about as likely to survive the first postoperative month as those getting hearts from light drinkers or abstainers.
The ACCORD BP study shows that there is no benefit to be gained from intensively lowering systolic blood pressure to less than 120 mm Hg in type 2 diabetics; for now, a goal of <140 mm Hg seems reasonable in this population, say the authors.
UPDATED // The standard heart-rate target of <80 bpm doesn't lead to better clinical outcomes and is harder to achieve than a target of <110 bpm, a prospective randomized trial found.
A variety of experts at the CRT conference discuss what it will take to bring minimally invasive transcatheter-valve implants to patients beyond those ineligible for open-heart surgery.
A subanalysis shows that dabigatran is at least as efficacious and may be even safer than warfarin in this higher-risk subgroup. A trend toward increased MI in the overall study with dabigatran was not seen in patients with prior stroke or TIA.
Researchers say the incremental benefit of vigorous activity over moderate physical activity is small and that as long as individuals are burning a certain number of calories per week they lower their risk of cardiovascular disease.
Individuals living within 100 m of major roadway were more than three times as likely to have coronary atherosclerosis detected by angiography as those who lived farther away.
Researchers have successfully "linked" the Society of Thoracic Surgeons' national surgery database to CMS records to facilitate the study of long-term outcomes of cardiothoracic surgery.
In a study of 4586 patients with severe degenerative mitral regurgitation, even mild heart-failure symptoms are associated with decline in cardiac function, suggesting that early valve surgery will yield better long-term outcomes than surgery after symptoms become manifest.
The radiation dose from coronary CT angiography can be almost cut in half without reducing the diagnostic value of the images, researchers in Innsbruck have shown.
Results from one of the first registries to evaluate contemporary use of both the Edwards Sapien transcatheter valve and the CoreValve bioprosthesis show that complication rates are low and similar, following a short training period, and that mortality, at least out to six months, is "acceptable" for both types of devices.
UPDATED WITH COMMENTARY // Thoratec's HeartMate II continuous-flow VAD keeps about half of patients alive and stroke- or reintervention-free after two years in pivotal destination therapy trial.
Results showing that people eat less when they know how many calories are in that Big Mac are mixed, but experts say that menu labeling provides only upside, with no public-health cost, and that over time results will show the information to have a positive effect on obesity rates in the US.
Intensive lifestyle intervention in the management of diabetes produces sustained weight loss and improvements in fitness, as well as improvements in glycemic control, systolic blood pressure, and HDL-cholesterol levels.
Researchers in Ottawa find that the longevity of porcine replacement heart valves may depend partly on whether the blood type of the patient matches the blood type of the valve's "original owner."
Women and men have the same rates of chest pain and other classic symptoms during ACS, although women are more likely to experience some other symptoms such as jaw and neck pain.
Researchers using different international databases report that the Framingham and UKPDS risk equations overestimate the probability of CV events in diabetic patients.
Individuals with schizophrenia and diabetes—as opposed to diabetes only—have a greater risk of CAD but a smaller likelihood of receiving CABG or PCI, a large cohort study suggests.
Doctors from across the specialties of cardiology, diabetes, and psychiatry are being urged to collaborate to improve care for the mentally ill, who are more likely to die from cardiovascular disease than any other cause.
A single-nucleotide polymorphism associated with chronically raised natriuretic-peptide levels is common enough to potentially influence interpretation of BNP and NT-proBNP assays under some circumstances, researchers say; there is increasing evidence that the gene variant may enhance survival in some patient groups.
A pilot analysis suggests the cell therapy can improve functional capacity, but amiodarone may be needed to prevent ventricular arrhythmias; its investigators say they plan to switch gears on the remainder of the study.
The past few cardiology meetings have included data on the FAME study, and TCT 2009 was no exception. Investigators showed that the one-year and 18-month results were durable out to two years, although some researchers would like to see the study replicated to conclusively prove the added value of fractional flow reserve testing.
TCT 2009 kicked off with a discussion on revascularization strategies for left main PCI. Interventionalist Dr Paul Teirstein argues the data are sufficient for left main PCI to be a class IIa indication, upgrading it from the current class III recommendation, but surgeon Dr David Taggart says that CABG is still the preferred revascularization option in the majority of left main patients.
Results of a new survey showed that a surprising 15% of textbooks had one or more drug or device sponsors and, in two cases, those sponsors had tried to influence the content of the textbooks.
French researchers who systematically quantified the prevalence of spin across 72 negative randomized controlled trials say half of the studies put a positive spin on the negative findings in the conclusion sections of the papers.
Despite showing an impressive 45% reduction in stroke with valsartan add-on therapy compared with non-ARB add-on treatment in high-risk hypertensive patients in Japan, the findings of the KYOTO HEART study are not strong enough to support ARB use as first-line therapy in Western populations, say expert observers.
A phase 3 study with darusentan in patients with resistant hypertension was encouraging, but the data are still "very, very early," said the researcher who presented the late-breaking trial at the European Hypertension meeting this weekend.
A new, low-cost, solar-powered blood-pressure-monitoring device has been shown to be accurate and easy to use and was well accepted by healthcare professionals and patients in a field trial in Africa. This could be a "critical tool" in tackling the global problem of hypertension, said one expert.
The investigational glucagonlike peptide-1 receptor agonist exenatide lowers hemoglobin A1C levels to a greater extent; more patients with type 2 diabetes reached A1C targets.
The investigational glucagonlike peptide-1 (GLP-1) analog is also associated with more weight loss and better tolerability than the already-on-the-market GLP-1 receptor blocker exenatide.
The findings should help quell fears of a late catch-up phenomenon with a stent some have referred to as "DES-lite" and dispel concerns raised in meeting presentations last year about increased adverse events with this device.
Longer-term results from these two relatively small randomized trials are reassuring but not sufficient to provide a full rationale for using DES in AMI, experts say.
