Clinical Cardiology Alert – May 1, 2025

Routine Use of Cerebral Embolic Protection Experiences a Resounding Blow in BHF PROTECT-TAVI

In this randomized, multicenter trial involving more than 7,600 patients undergoing transcatheter aortic valve replacement, routine use of a cerebral embolic protection device did not reduce the incidence of early post-procedure stroke.

New Indications for Aortic Valve Replacement in Chronic Aortic Regurgitation

A retrospective observational study of asymptomatic patients with isolated moderate to severe or severe aortic valve regurgitation by echocardiography has shown that left ventricular (LV) ejection fraction (EF) < 60%, LV end systolic volume index > 45 mL/m², or global longitudinal strain less than -15% is associated with all-cause mortality, but mortality is highest when current guideline recommendations are present. This suggests that there is a survival penalty with the sole use of the current guidelines.

Use of Coronary Calcium Score in Familial Coronary Artery Disease

A randomized trial of computed tomography (CT) coronary artery calcium score augmented management vs. usual care of primary prevention patients at moderate risk of a coronary event and with a family history of premature coronary events has shown that, after three years of follow-up, the calcium score group had lower low-density lipoprotein cholesterol levels and smaller total plaque volumes by CT angiography.

Direct Oral Anticoagulants vs. Warfarin for Left Ventricular Thrombus

A small pilot randomized controlled trial, plus a meta-analysis including four other randomized controlled trials, of direct oral anticoagulants compared to warfarin for the treatment of left ventricular thrombus after ST-elevation myocardial infarction has shown that there were no significant differences in the two regimens regarding thrombus resolution and major bleeding events at three-month follow-up.

Systolic Blood Pressure Targets in Octogenarians

An analysis of a U.S. national database of patients 80 years of age or older taking antihypertensive agents was analyzed to determine the optimal systolic blood pressure associated with the lowest cardiovascular mortality and found that the ideal target was < 130 mmHg.