Clinical Cardiology Alert – August 1, 2022

The Value of Stress Testing in Patients with Known Coronary Artery Disease

A comparison of adenosine stress singe photon emission CT, PET, and MRI in stable patients with known coronary artery disease (CAD) showed PET to be more sensitive for detecting invasive fractional flow reserve-identified ischemic lesions. However, the sensitivity was disappointing; thus, patients with known CAD and new symptoms should be referred directly to invasive coronary angiography.

Rivaroxaban Monotherapy for Atrial Fibrillation in Coronary Artery Disease Patients

For patients with atrial fibrillation and stable coronary artery disease, rivaroxaban monotherapy was superior to dual therapy for preventing thrombotic and bleeding events and was associated with a lower mortality.

Reducing the Need for Invasive Coronary Angiography Before TAVR

Among those undergoing evaluation for transcatheter aortic valve replacement, coronary CT angiography and CT-derived fractional flow reserve demonstrated good diagnostic performance, potentially preventing invasive coronary angiography for many patients.

Measure Stroke Risk with Asymptomatic Severe Carotid Artery Stenosis

A community-based, retrospective, observational study of patients with asymptomatic severe carotid artery stenoses showed the crude stroke risk over five years was about 5%. Patients whose stenoses progress to high grade or start at that severity were at the highest risk for stroke.

Echocardiographic Assessment of Right Ventricular Function

A study of a cardiac resynchronization therapy registry demonstrated right ventricular free wall strain by speckle tracking 2D echocardiography is more sensitive for detecting right ventricular dysfunction vs. other echo measures of right ventricular function.