ABSTRACT
Anticoagulation to reduce thromboembolic stroke risk due to nonvalvular atrial fibrillation in ESKD is associated with increased bleeding. There is an existing debate in ESKD centers around the pros and cons of anticoagulation. We propose percutaneous left atrial appendage occlusion as a third alternative to balance thrombosis and bleeding risks in this high-risk population.
Subject(s)
Atrial Appendage , Atrial Fibrillation , Kidney Diseases , Stroke , Anticoagulants/therapeutic use , Atrial Appendage/surgery , Atrial Fibrillation/complications , Humans , Kidney Diseases/complications , Stroke/etiology , Treatment OutcomeSubject(s)
Atrial Fibrillation , Electric Countershock , Atrial Fibrillation/therapy , Electrodes , Humans , Treatment OutcomeABSTRACT
The presence of non-obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CTA) has been associated with the occurrence of major adverse cardiac events (MACE). However, factors associated with the development of MACE in symptomatic women with non-obstructive CAD on coronary CTA have not been fully elucidated. We sought to examine the influence of risk factors and coronary artery calcification on MACE in symptomatic women with non-obstructive CAD on coronary CTA. Women from PROMISE and SCOT-HEART trials with none or non-obstructive CAD on coronary CTA comprised the study cohort. Baseline characteristics and clinical presentation were assessed. Survival analysis using Kaplan-Meier curves was done to compare outcomes stratified by the atherosclerotic cardiovascular disease (ASCVD) risk score and the Agatston score. The primary endpoint was a composite of all-cause mortality, myocardial infarction, and revascularization. 2597 women had non-obstructive CAD or normal coronary CTA, with a median follow-up of 32 months. Compared to women without MACE, women with MACE had lower high-density lipoprotein cholesterol (HDL-C) levels and higher mean ASCVD risk scores. Further, women with non-obstructive CAD and ASCVD ≥ 7.5% had higher risk of MACE than those with ASCVD < 7.5% [3.2% vs. 1.1%, adjusted HR (aHR) of 3.1 (95% CI 1.32, 7.23), P-value 0.009]. The Agatston calcium score, on the other hand, was not independently associated with MACE among this population of symptomatic women. Symptomatic women with non-obstructive CAD on coronary CTA are at higher risk for MACE, with the ASCVD risk score being independently associated with the occurrence of adverse events.
Subject(s)
Coronary Artery Disease , Computed Tomography Angiography , Coronary Angiography/methods , Coronary Artery Disease/complications , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Female , Humans , Predictive Value of Tests , Prognosis , Risk Assessment , Risk FactorsABSTRACT
BACKGROUND: There are conflicting results regarding the safety and efficacy of direct oral anticoagulants (DOACs) in the management of left ventricular thrombus (LVT) compared with the vitamin K antagonist warfarin. STUDY QUESTION: What is the safety and efficacy of DOACs in the management of LVT compared with warfarin? DATA SOURCE: Randomized clinical trials and cohort studies in the MEDLINE and Cochrane databases from inception till April 4, 2021. STUDY DESIGN: The present analysis is a systematic review and meta-analysis. Desired outcomes were all-cause mortality, complete resolution of LVT, stroke and systemic emboli, and major bleeding. The risk ratio (RR) of the outcomes and 95% confidence intervals (CIs) were calculated using a random-effects modeling approach. RESULTS: Twelve studies with a total of 2322 patients were included. There was no difference between the 2 interventions in the resolution of LVT [RR 0.97 (CI 0.93-1.02)], stroke and systemic embolism [RR 0.95 (CI 0.63-1.45)], bleeding [RR 1.14 (CI 0.81-1.60)], and all-cause mortality [RR 0.99 (CI 0.67, 1.46)]. CONCLUSIONS: DOACs and warfarin have comparable safety and efficacy outcomes in the management of LVT.
Subject(s)
Aminobutyrates/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , Heart Failure/drug therapy , Tetrazoles/therapeutic use , Biphenyl Compounds , Cause of Death , Drug Combinations , Heart Failure/blood , Heart Failure/physiopathology , Hospitalization , Humans , Mortality , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Severity of Illness Index , Stroke Volume , Treatment Outcome , ValsartanABSTRACT
Ventricular arrhythmias (VA) constitute well-known problems in patients with left ventricular assist devices (LVADs), with incidence ranging from 18% to as high as 52%. Catheter ablation has become a common therapeutic intervention to treat drug-refractory VA, particularly with the increase and more widespread use of durable LVADs to bridge patients to transplantation or as destination therapy. In this article, we focus on etiology, mechanisms, periprocedural management, and mapping and ablation techniques in patients with LVADs and VA.
Subject(s)
Arrhythmias, Cardiac , Cardiac Imaging Techniques/methods , Catheter Ablation , Electrocardiography/methods , Heart-Assist Devices , Adult , Aged , Arrhythmias, Cardiac/diagnostic imaging , Arrhythmias, Cardiac/surgery , Electrophysiologic Techniques, Cardiac/methods , Female , Humans , Male , Middle AgedABSTRACT
PURPOSE OF REVIEW: His bundle pacing (HBP) has continued to emerge as a viable alternative to both right ventricular pacing (RVP) and cardiac resynchronization therapy. In recent years, a considerable amount of research has been published with regard to using HBP to treat congestive heart failure (CHF) and this article presents a concise yet comprehensive review of this literature. RECENT FINDINGS: Studies have demonstrated that HBP is useful for CHF patients who are non-responders to biventricular pacing (BiVP) or have a history of previously failed coronary sinus lead placement, right/left bundle branch block cardiomyopathy, or pacing-induced cardiomyopathy. Additionally, HBP is useful in patients with an indication for pacing who are expected to have a RVP burden exceeding 20%. The theoretical benefit of utilizing the native His Purkinje system to excite cardiac tissue is appealing as it can result in true cardiac resynchronization. Limited studies have shown its benefit in reducing heart failure symptoms and improving cardiac function. Larger randomized clinical trials and further investments into developing better technologies are highly desired to make its clinical use sustainable in the long run.
Subject(s)
Bundle of His/physiopathology , Cardiac Resynchronization Therapy/methods , Heart Failure/therapy , Heart Ventricles/physiopathology , Ventricular Function, Left/physiology , Ventricular Function, Right/physiology , Heart Failure/physiopathology , HumansABSTRACT
Subvalvular aortic stenosis (SAS) is one of the common adult congenital heart diseases, with a prevalence of 6.5%. It is usually diagnosed in the first decade of life. Echocardiography is the test of choice to diagnose SAS. Surgical correction is the best treatment modality, and the prognosis is usually excellent. In this review, we describe the pathophysiology, diagnosis, prognosis, and management of SAS with a focus on different pathophysiologic mechanisms, diagnostic approach, and prognosis of the disease by reviewing the current literature.
