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Hot Trials from the European Society of Cardiology Annual Congress

Below are some highlights from four key studies presented in Barcelona, Spain, between Aug. 26 and Aug. 29, 2022, along with Dr. Crawford’s personal commentary on each.

Appropriate Management of Thoracic Aortic Aneurysms

Among patients with arch and descending thoracic aorta aneurysms followed over a mean of 20 months, aneurysm-related mortality was predicted by the size and growth rate of the aneurysms, along with age and sex.

Predicting the Tolerability of Sacubitril/Valsartan in Advanced Heart Failure

An analysis of the sacubitril/valsartan run-in period for chronic, advanced heart failure patients showed 18% could not tolerate the lowest dose, usually because of hypotension or renal dysfunction. Investigators identified six predictors of non-tolerance, which may help clinicians choose the best candidates.

Those Anterior T Waves

The ECG in the figure was obtained from a man in his 60s who was seen in the field for new chest pain. How might one interpret this tracing?

Are SGLT2 Inhibitors Effective for HFpEF Patients Without Diabetes?

After comparing empagliflozin to placebo for patients with heart failure and preserved left ventricular ejection fraction, researchers found no differences in the significant reduction of the primary outcome of cardiovascular death or heart failure hospitalization over 36 months based on whether patients were diabetic.

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 rate.

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

A comparison of adenosine stress single-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. Patients with known CAD and new symptoms should be referred directly to invasive coronary angiography.

Appropriate Management of Thoracic Aortic Aneurysms

Among patients with arch and descending thoracic aorta aneurysms followed over a mean 20 months, aneurysm-related mortality was predicted by the size and growth rate of the aneurysms, along with age and sex.

Clinical Significance of Mitral Annular Calcification

Researchers found mitral annular calcification to be uncommon, and few experience associated moderate to severe mitral stenosis or regurgitation. However, the latter group recorded a high mortality rate over three years follow-up, which was significantly lower in those who underwent valve interventions, even when corrected for younger age, fewer comorbidities.

Provocative Testing with Intracoronary Acetylcholine as Part of Cardiac Catheterization Evaluation

In this systematic review and meta-analysis of invasive coronary provocation testing, intracoronary acetylcholine was found to be a safe procedure, with low rates of major complications.