TAVR vs Surgical Aortic Valve Replacement Among Low-Risk Patients With Aortic Stenosis

MedicalResearch.com Interview with:

Fausto Biancari, Professor of Surgery, University of Turku, Finland Professor of Cardiothoracic Surgery, University of Oulu, Finland Heart Center, T-Hospital, Hämeentie Turku, Finland

Prof. Biancari

Fausto Biancari, MD, PhD
Professor
University of Turku and University
Oulu, Finland

MedicalResearch.com: What is the background for this study?

Response: Current data is scarce regarding the short- and midterm benefit of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) in low-risk patients with severe aortic valve stenosis.

MedicalResearch.com: What are the main findings?

Response: In this observational study on 2841 low-risk patients with aortic valve stenosis from the Finnish nationwide FinnValve registry, propensity score matching analysis showed similar 30-day and three-year survival after TAVR and SAVR.

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Aspirin for Primary Prevention of Cardiovascular Events

MedicalResearch.com Interview with:

J.L. Mehta, MD, PhD Distinguished Professor of Medicine and Physiology and Biophysics Stebbins Chair in Cardiology University of Arkansas for Medical Sciences Central Arkansas Veterans Healthcare System Little Rock, AR 72205

Dr. Mehta

J.L. Mehta, MD, PhD

Distinguished Professor of Medicine and Physiology and Biophysics

Stebbins Chair in Cardiology

University of Arkansas for Medical Sciences

Central Arkansas Veterans Healthcare System

Little Rock, AR 72205

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Aspirin is commonly used for primary prevention of cardiovascular disease events in a variety of subjects around the world. Recent studies, however, show that routine use of aspirin without assessment of risk for cardiovascular disease events may not be appropriate, and may even be harmful.  Continue reading

Updated Expert Consensus Statement on Platelet Function/Genetic Testing for Guiding P2Y12 Receptor-Inhibitor Treatment in PCI

MedicalResearch.com Interview with:

Prof. Dr. med. Dirk Sibbing, MHBA, FESC Oberarzt, Medizinische Klinik und Poliklinik I Ludwig-Maximilians-Universität (LMU) München Chairperson ESC Working Group on Thrombosis München, Germany

Prof. Sibbing

Prof. Dr. med. Dirk Sibbing, MHBA, FESC
Oberarzt, Medizinische Klinik und Poliklinik I
Ludwig-Maximilians-Universität (LMU) München
Chairperson ESC Working Group on Thrombosis
München, Germany 

MedicalResearch.com: What is the background for this consensus statement? What are the main findings that led to these conclusions?

Response: The availability of different P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor) with varying levels of potency has enabled physicians to contemplate individualized treatment concepts. Such concepts may include escalation or de-escalation of P2Y12 inhibiting therapy.

Alternative DAPT strategies may be chosen according to the clinical setting (stable coronary artery disease vs. acute coronary syndrome), the stage of the disease (early vs. chronic treatment) and patient risk for ischemic and bleeding complications. As always in clinical medicine, guidance by means of biomarkers or risk scores is always helpful and warranted. Here specifically, a tailored DAPT approach may be potentially guided by platelet function (PFT) or genetic testing. Continue reading

Collagen Biomarker Associated With Atrial Fibrillation and Heart Failure Risk

MedicalResearch.com Interview with:
Susana Ravassa PhD

Program of Cardiovascular Diseases, CIMA
University of Navarra, and IdiSNA
Navarra Institute for Health Research
Pamplona, Spain 

MedicalResearch.com: What is the background for this study?

Response: Atrial fibrillation (AF) is an evolving epidemic responsible for substantial morbidity, mortality and health-care expenditure. In particular, when AF and heart failure (HF) occur in combination, clinical evolution is particularly poor. Left atrial (LA) myocardial interstitial fibrosis (MIF) is the main structural lesion in AF and considered as the main factor responsible for the perpetuation of this pathology. In addition, it is known that MIF is associated with a lower effectiveness of the treatment of AF by pulmonary vein isolation with catheter ablation. Therefore, the identification of biomarkers related to MIF, as an affordable and minimally invasive approach, is of great interest to detect patients at risk of AF, as well as to monitor their response to the LA ablation therapy.

We had previously demonstrated that the deleterious impact of MIF in the heart is due to alterations in both the quality (i.e., extent of cross-linking among collagen fibrils and type of collagen fibers that determine their rigidity and resistance to degradation [collagen cross-linking or CCL]) and the quantity (i.e., extent of collagen fibers that occupy the myocardial tissue [collagen deposition or CD]) of fibrotic tissue. We have shown that certain circulating biomarkers related to collagen type I metabolism are associated with CCL and CD. On the one hand, the serum carboxy-terminal propeptide of procollagen type I (PICP), released during the conversion of procollagen type I into fibril-forming mature collagen type I, is directly correlated with myocardial CD.

On the other hand, the ratio of serum carboxy-terminal telopeptide of collagen type I to serum matrix metalloproteinase-1 (serum CITP:MMP-1 ratio) is inversely correlated with myocardial CCL, as the higher is the cross-linking among collagen type I fibrils the lower will be the cleavage of CITP by MMP-1 during the process of degradation of the fiber. Interestingly, we have previously reported that the combination of these biomarkers identifies patients with heart failure presenting with a complex pattern of MIF characterized by both increased CCL and CD (CCL+CD+) showing a higher risk of adverse clinical evolution as compared with heart failure  patients without this combination of biomarkers. As both increased CCL and CD have been found in the left atrial myocardium in patients with AF, we designed this investigation to explore whether the CCL+CD+ combination of biomarkers is associated with AF. Continue reading

TAVRcathAID Mobile App Facilitates Coronary Access Education After TAVR

MedicalResearch.com Interview with:

Annapoorna Kini, MDZena and Michael A Wiener Professor of MedicineDirector of the Cardiac Catheterization LaboratoryMount Sinai Heart at Mount Sinai Hospital

Dr. Kini

Annapoorna Kini, MD
Zena and Michael A Wiener Professor of Medicine
Director of the Cardiac Catheterization Laboratory
Mount Sinai Heart at Mount Sinai Hospital

MedicalResearch.com: What is the background for this study?  

  • Expanding indication and use of Transcatheter aortic valve replacement (TAVR) poses a unique problem of coronary access after valve implantation.
  • Troubleshooting tools and techniques have been published but are not available at the fingertips of the user at all the times.
  • We tried to address this unique problem with an innovative educational mobile application (app) called “TAVRcathAID”.

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Opioid Crisis Linked To Rapid Increase in Chronically Infected Heart Valves

MedicalResearch.com Interview with:

Serena Day, MDOhio State University.

Dr. Serena Day

Serena Day, MD
Ohio State University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The idea for this research came from my own observations of patients that I was caring for in the hospital first as an Internal Medicine Resident and now as a senior Cardiology Fellow. I did my residency here at Ohio State and noticed a marked increase in the number of patients with endocarditis that we were caring for just in my short time here as a trainee.

Over 5 years, we saw an increase of 436% in intravenous drug use related endocarditis. How this disease is treated as changed as well. It used to be that if a patient was a good surgical candidate, we would offer a replacement valve. Now, we see that these patient’s have such a high rate of recurrent intravenous drug use and reinfection of their heart valves that we now treat with antibiotics only rather than surgery. In many cases, the infection never goes away because we can’t offer definitive therapy with surgery due to their high relapse and reinfection rates of nearly 50%.
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Less Than Six Hours of Sleep May Raise Risk of Heart Disease

MedicalResearch.com Interview with:

José M. Ordovás, PhD Director Nutrition and Genomics Professor Nutrition and Genetics            JM-USDA-HNRCA at Tufts University Boston, MA 02111

Dr. Ordovás

José M. Ordovás, PhD
Director Nutrition and Genomics
Professor Nutrition and Genetics
JM-USDA-HNRCA at Tufts University
Boston, MA 02111

MedicalResearch.com: What is the background for this study?

Response: The current knowledge supports the notion that poor sleep is associated with cardiovascular risk factors such as obesity, hypertension, and diabetes. Besides, there is some proof that poor sleep might be related to the development of atherosclerosis; however, this evidence has been provided by studies including few participants and, in general, with sleep disorders, such as sleep apnea. Our research has used state-of-the-art imaging technology to measure plaque buildup in the arteries, and objective measures of sleep quantity and quality in about 4000 participants of the PESA CNIC- Santander Study. Moreover, this is the first study to look at the multiterritory development of plaques versus other studies that looked exclusively at the coronary arteries. Therefore, this combination provides stronger evidence than previous studies about the risk of poor sleep on the development of atherosclerosis.

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Maternal Obesity Raises Risk of Congenital Heart Defects

MedicalResearch.com Interview with:

Martina Persson, M.D, PhD Karolinska Institutet

Dr. Persson

Martina Persson, M.D, PhD
Karolinska Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is well known that maternal obesity increases risks of adverse fetal outcomes, including congenital malformations of the heart. However, it is unclear if maternal overweight and obesity associate with risks of specific and more complex congenital heart defects. We conducted a population-based cohort study in Sweden using data from several health registries. The study included more than 2 million live, singletons born between 1992-2012. Risks (prevalence rate ratios) of complex heart defects (Tetralogy of Fallot, transposition of the great arteries (TGA), atrial septal defects (ASD), aortic arch defects, and single ventricle heart) and several specific heart defects were estimated in infants to mothers with overweight and increasing degree of obesity.

We found that risks of aortic arch defects, ASD and patent ductus arteriosus (in term infants) increased with maternal obesity severity. On the other hand, we found no clear associations between maternal BMI and risks of several other complex and specific heart defects.  Continue reading

Staged vs One-Time Multivessel Revascularization in Multivessel CAD

MedicalResearch.com Interview with:
Peter Hu MD Cleveland ClinicPeter T. Hu MD
Department of Cardiology
Cleveland Clinic

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Among patients with blockages in multiple coronary vessels, we studied predictors and outcomes of having a staged versus one-time multivessel percutaneous coronary intervention. By “staged” we mean performing coronary intervention only on one vessel, letting the patient recover, and fixing the other blockages at a later date. We know that multivessel coronary artery disease is very common – present in up to 2/3 of patients who require coronary interventions. Previous studies in patients with STEMI (ST-elevation myocardial infarction) suggested that staged multivessel PCI was associated with lower risk of death compared with one-time multivessel revascularization. Outside of STEMI patients, very little data exist in a broader group of patients who undergo coronary interventions to multiple vessels.

In our study, we found an association between doing a staged PCI and lower long-term mortality benefit compared with fixing multiple blockages at once. What was surprising was there seemed to be a correlation with the degree of benefit from staged PCI based on the symptoms and signs the patient presented with.

The association with improved outcomes was strongest in patients with STEMI, followed by those with NSTEMI, unstable angina, and stable angina, respectively. We also found that the decision to perform staged PCI was driven by patient and procedural characteristics, as well as other unmeasured site variation.  Continue reading

More Than Moderate Alcohol Not Good For The Heart

MedicalResearch.com Interview with:

Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS Director of Clinical Research Division of Cardiology Endowed Professor of Atrial Fibrillation Research University of California, San Francisco

Dr. Gregory M Marcus

Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS
Director of Clinical Research
Division of Cardiology
Endowed Professor of Atrial Fibrillation Research
University of California, San Francisco

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Moderate alcohol consumption has previously been associated with a decreased risk of heart attack. However, as we have previously shown that individuals who believe alcohol to be good for the heart tend to drink more, there is a concern that these previous data might appear to justify excessive alcohol consumption.

In addition, previous research on the topic of alcohol consumption and heart disease has relied almost entirely on participant self-report, which is known to be particularly unreliable among heavy drinkers. Finally, previous research has sought to study relationships between alcohol and various types of heart disease, but there has not been an emphasis on individual-level characteristics that might influence these relationships.
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