Clinical Cardiology Alert – April 1, 2023

When the Aortic Annulus Is Small, Does TAVR Valve Type Matter?

In this propensity-matched analysis of transcatheter aortic valve replacement (TAVR) registry patients with small aortic annuli, the hemodynamic advantage of self-expanding TAVR valves was not associated with better clinical outcomes compared with balloon-expandable valves up to five years.

Does One Negative Troponin Measurement Rule Out Acute Coronary Syndrome?

Using a common clinical chest pain algorithm plus a point-of-care troponin measurement for low-risk patients, researchers reported significantly lower healthcare costs. Also, this approach did not seem to result in more major adverse cardiovascular events.

The Role of Influenza Vaccination in Cardiovascular Event Prevention

Researchers studied English patients with an acute cardiovascular event who received an influenza vaccine in the same 12-month period and compared that to the 120-day period after vaccination and the rest of the year. They observed those vaccinated were less likely to experience an acute cardiovascular event for 120 days after vaccine vs. the rest of the year.

Bleeding Risk with Combination Amiodarone and Direct-Acting Oral Anticoagulants

Among patients with atrial fibrillation who were taking a direct-acting oral anticoagulant, there was a significant association between major bleeding and amiodarone use within 60 days, but no association with amiodarone use longer than 60 days before the bleed.

Unexpected Low Voltage on an ECG

A registry study of hypertrophic cardiomyopathy (HCM) patients and elite athletes in Italy revealed low voltage on ECG is not uncommon in HCM and may be a marker for more left ventricular scarring on cardiac imaging — and a poor prognosis.