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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.

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.

Are SGLT2 Inhibitors Effective for HFpEF Patients Without Diabetes?

After comparing empagliflozin vs. 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.

Researchers Suggest Checking Blood Pressure in Both Arms

After taking two readings, use the higher measurement for diagnosis. Guidelines recommend this practice, but data were lacking.

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.

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.

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.

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.

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.