Cardiology
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Is Sex Still an Important Variable in Stroke Risk with Atrial Fibrillation?
An analysis of a very large database of patients with recent-onset atrial fibrillation has shown that whether sex was included in the formulas to predict thromboembolic risk and guide the use of oral anticoagulants probably is not as important as it was decades ago.
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New Injectable Cholesterol-Lowering Drug Trial
A comparison of inclisiran therapy to placebo and ezetimibe therapy over six months in primary prevention patients at low risk of atherosclerotic cardiovascular disease and not taking lipid-lowering therapy has shown that inclisiran subcutaneously every six months reduces low-density lipoprotein cholesterol more than ezetimibe and is comparable to the reported results of high-dose statins taken daily.
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CT Coronary Artery Calcium Progression After an Initial Score of Zero
A large Korean study of asymptomatic subjects undergoing more than one computed tomography (CT) coronary calcium scoring scan as part of an employment-based health screening has shown that most had scores of 0, and that during a maximum follow-up of 12 years, the majority stayed at 0 on a repeat scan. Also, in those with a coronary artery calcium score of 0 initially, clinically significant scores (> 100) were only found in 4% of scans at 10-year follow-up.
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Shortened DAPT Followed by Reduced-Dose Prasugrel Monotherapy Notches a Win in ACS Patients
In this study of acute coronary syndrome (ACS) patients, one month of dual antiplatelet therapy (DAPT) followed by reduced-dose prasugrel monotherapy led to a reduction in major bleeding events compared to 12 months of DAPT, without a corresponding increase in ischemic events.
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Artificial Intelligence ECG Analysis to Rule Out Acute Myocardial Infarction
A large Korean study of an artificial intelligence electrocardiogram (ECG) interpretation algorithm for identifying patients with acute myocardial infarction showed a high degree of accuracy for diagnosing acute myocardial infarction and identifying patients at risk for 30-day major adverse cardiac events in an emergency department setting, which was similar or superior to standard risk stratification methods.
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What Kind of Block?
The electrocardiogram in the figure was obtained from an older adult who presented for evaluation of syncope. What kind of atrioventricular (AV) block is present? Or is the rhythm something other than an AV block?
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Looking Beyond LDL in Cardiovascular Risk Screening for Women
In a 30-year prospective study of nearly 28,000 initially healthy U.S. women, baseline levels of high-sensitivity C-reactive protein, low-density lipoprotein cholesterol or lipoprotein(a) independently and additively predicted major cardiovascular events.
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Does Thoracentesis Speed Recovery from Heart Failure?
An unblinded, multicentered, randomized trial of patients with acute heart failure hospital admissions and significant pleural effusions showed that early thoracentesis, in addition to recommended medical therapy, did not reduce mortality or length of stay, or increase days alive out of the hospital for 90 days. However, it was relatively safe and could be employed in selected persistently symptomatic patients with very large effusions.
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Echocardiography vs. CMR for Quantitating Aortic Regurgitation
A small study of echocardiography compared to cardiac magnetic resonance (CMR) imaging in patients with chronic aortic regurgitation of variable severity has shown that the simple use of the color Doppler regurgitant jet vena contracta width and the end-diastolic left ventricular volume index by two-dimensional echocardiographic imaging can accurately predict who has clinically significant regurgitation.
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Stroke Risk in Patients with New AF During Hospitalization for Other Reasons
In a Canadian administrative database study of patients who developed atrial fibrillation during a hospitalization for other reasons, researchers followed the patients for one year to ascertain the risk of subsequent stroke. The incidence of stroke in those not anticoagulated generally was below the 2% per year threshold recommended for treatment with anticoagulants. However, in those with a CHA2DS2-VA score ≥ 5 (sex not included based on new data) and in those admitted for cardiac medical problems, the 95% confidence intervals of stroke risk did cross 2%. Thus, selected patients may be candidates for anticoagulation.