Clinical Cardiology Alert – March 1, 2018
March 1, 2018
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CASTLE-AF Supports Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure
Catheter ablation for atrial fibrillation in relatively young men with cardiomyopathy and heart failure is associated with a substantial reduction in arrhythmia burden, improvement in ejection fraction, and reduction in heart failure hospitalizations and mortality compared to medical therapy.
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What’s the Best Technique to Measure Low-flow, Low-gradient Aortic Stenosis?
In patients with low-flow, low-gradient aortic stenosis, current guideline-based criteria for identifying true severe aortic stenosis did not predict aortic stenosis severity or survival. Calculation of the projected aortic valve area at a normal transvalvular flow rate more accurately identifies true severe aortic stenosis and is a stronger predictor of outcomes.
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Accurately Diagnosing Aortic Dissection
A prospective study of patients with suspected acute aortic syndromes showed that a clinical risk score plus D-dimer testing carried a positive predictive value of 99.7% and a 0.3% incidence of false-negative studies. The authors recommended that this approach become the standard method for triage to imaging in patients with suspected acute aortic syndromes.
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Physical Activity and Death in CAD Patients
An observational study of leisure time physical activity (LTPA) assessed at baseline and two years later in stable coronary artery disease patients, who then were followed for about five more years, showed that LTPA at baseline, at two years, and if it went from zero at baseline to some at two years was associated with lower rates of cardiac death compared to inactive patients.
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Stroke Risk in Atrial Fibrillation: A Moving Target?
An investigation of patients in a national database with atrial fibrillation and no comorbidities and not on aspirin or anticoagulants showed that the clinical features that make up the CHA2DS2-VASc score change over time and can increase a patient’s risk for stroke, which could affect therapy decisions.