Cardiology News / Recent Literature Review / First Quarter 2020
Virtual HRS Meeting: (San Diego) 6-9/5/2020
Virtual EuroPCR: (Paris) 19-22/5/2020
?ESC Meeting: Amsterdam, 29/8-2/9/2020
?TCT: Miami Beach, FL, USA, 23-27/9/20
?HCS/Panhellenic (41st) Congress of Cardiology: Athens, 22-24/10/20
Persistent Proarrhythmic Neural Remodeling (Characterized by Extracardiac Sympathetic Hyperinnervation and Sympathetic Neural Hyper-activity) Despite Recovery from Premature Ventricular Contraction-Induced Cardiomyopathy (PVC-CM)
In 12 canines, with pacing-applied PVC-CM, after 12 weeks of PVCs, LVEF and dP/dT decreased significantly. Resting sympathetic nerve activity (SNA) and vagal nerve activity (VNA), exercise SNA, SNA response to evoked PVCs, heart rate (HR) at rest, and exercise increased, whereas HR variability (HRV) decreased. There was increased spontaneous atrial and ventricular arrhythmias in PVC-CM. Increased SNA preceded both atrial and ventricular arrhythmia onset. Clonidine suppressed SNA and abolished all arrhythmias. After stopping PVC for 4 weeks, LVEF, dP/dT, and resting VNA recovered to baseline levels. However, SNA, resting HR, HRV, and atrial and ventricular proarrhythmia persisted. Sympathetic hyperinnervation was found in stellate ganglia but not ventricles of PVC-CM and recovered animals versus sham controls. The authors concluded that neural remodeling in PVC-CM is characterized by extracardiac sympathetic hyperinnervation and sympathetic neural hyperactivity that persists despite normalization of LVEF, constituting an important trigger and substrate for atrial and ventricular proarrhythmia (Tan AY et al, J Am Coll Cardiol 2020; 75:1-13).
PARAGON-HF: The Benefits of Sacubitril/Valsartan in HFpEF are Present When Initiated in the High-Risk Window Within 180 Days of a Recent Hospitalization
Among 4,796 randomized patients in PARAGON-HF, over a median follow-up of 35 months, risk of total HF hospitalizations and cardiovascular death was inversely and nonlinearly associated with timing from prior HF hospitalization (p<0.001). Compared with valsartan, absolute risk reductions with sacubitril/valsartan were more prominent in patients enrolled early after hospitalization: 6.4% (≤1 month), 4.6% (1-3 months), and 3.4% (3-6 months), whereas no risk reduction was observed in patients screened >6 months or who were never hospitalized (trend in absolute risk reduction: pinteraction=0.050) (Vaduganathan M et al, J Am Coll Cardiol 2020; 75:245-54).
Oral Anticoagulation (OAC) for Patients With Atrial Fibrillation (AF) on Long-Term Dialysis: Not Associated With a Reduced Risk of Thromboembolism / Warfarin, Dabigatran, and Rivaroxaban Were Associated With Higher Bleeding Risk Compared With Apixaban and no Anticoagulant
Of 16 observational studies (N=71,877) regarding patients on long-term dialysis who had AF, only 2 studies investigated direct OACs. Outcomes for dabigatran and rivaroxaban were limited to major bleeding events. Compared with no anticoagulants, apixaban and warfarin were not associated with a significant decrease in stroke and/or systemic thromboembolism (apixaban 5 mg, hazard ratio -HR: 0.59; apixaban 2.5 mg, HR: 1.00; warfarin, HR: 0.91). Apixaban 5 mg was associated with a significantly lower risk of mortality (vs. warfarin, HR: 0.65; vs. apixaban 2.5 mg, HR: 0.62; vs. no anticoagulant, HR: 0.61). Warfarin was associated with a significantly higher risk of major bleeding than apixaban 5 mg/2.5 mg and no anticoagulant (vs. apixaban 5 mg, HR: 1.41; vs. apixaban 2.5 mg, HR: 1.40; vs. no anticoagulant, HR: 1.31). Dabigatran and rivaroxaban were also associated with significantly higher risk of major bleeding than apixaban and no anticoagulant (Kuno T et al, J Am Coll Cardiol 2019; 75:273-85)... (excerpt)
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