Cardiology News

Ursodeoxycholic Acid in Patients With Chronic Heart Failure
Endothelial dysfunction is commonly observed in patients with CHF, and it contributes to the limitation in exercise capacity that accompanies this condition. Bacterial lipopolysaccharide may trigger proinflammatory cytokine release and promote further endothelial dysfunction. UDCA, a bile acid used in the treatment of cholestatic liver disease, has anti-inflammatory and cytoprotective properties and may contribute to the formation of mixed micelles around lipopolysaccharide. These properties may help to improve peripheral blood flow in patients with CHF. This study sought to assess the effects of ursodeoxycholic acid (UDCA) on endothelial function and inflammatory markers in patients with chronic heart failure (CHF) and found that UDCA is well tolerated in patients with CHF and improves peripheral blood flow and is associated with improved markers of liver function. 

Outcomes of Mild Therapeutic Hypothermia After In-Hospital Cardiac Arrest
Although the benefits of mild therapeutic hypothermia (MTH) in selected patients after out-of-hospital cardiac arrest have been consistently demonstrated, no controlled trial of MTH in selected patients after in-hospital cardiac arrest (IHCA) has been published. This article sought to assess the benefit of MTH after IHCA in patients meeting our institutions IHCA MTH inclusion criteria. Overall it found no difference in neurological outcome at discharge was detected in predominantly non-shockable IHCA patients treated with MTH. This finding, if confirmed with further study, may define a population of patients for whom this costly and resource intensive therapy should be withheld.

Treatment of Unexplained Syncope: A Multicenter, Randomized Trial of Cardiac Pacing Guided by Adenosine 5'-Triphosphate Testing
Syncope commonly occurs in the general population, especially in the elderly; its origin remains unexplained in up to 40% of patients. Permanent cardiac pacing represents an effective therapy in patients with syncope of unknown origin that results from neurally mediated cardio-inhibition. The ATP test was introduced in 1986 as a convenient and safe tool to identify patients with syncope of unknown origin with neurally mediated cardiac inhibition. This patient-blinded, multicenter, randomized trial demonstrated that, in patients with syncope of unknown origin and a positive ATP test with no other precluding possible indications, cardiac pacing is an effective therapy, leading to a significant reduction of syncope recurrences. Although only some patients with syncope of unknown origin have a positive ATP test, this quick and safe procedure should be considered part of the armamentarium of syncope diagnosis.

Risk Stratification in Brugada Syndrome
Brugada syndrome is a genetic disease associated with increased risk of sudden cardiac death. Even though its value has been questioned, inducibility of VTs/VF is widely used to select candidates to receive a prophylactic implantable defibrillator, and its accuracy has never been addressed in prospective studies with homogeneous enrolling criteria. The PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) prospective registry was designed to assess the predictive accuracy of sustained ventricular tachycardia/ventricular fibrillation (VTs/VF) inducibility and to identify additional predictors of arrhythmic events in Brugada syndrome patients without history of VT/VF. The data from this study showed that VT/VF inducibility is unable to identify high-risk patients, whereas the presence of a spontaneous type I ECG, history of syncope, ventricular effective refractory period <200 ms, and QRS fragmentation seem useful to identify candidates for prophylactic implantable cardioverter defibrillator.

Left Atrial Volume: Comparison of 2D and 3D Transthoracic Echocardiography with ECG-gated CT Angiography
Left atrial volume (LAV) measurement by conventional two-dimensional (2D) transthoracic echocardiography (TTE) may be limited by the geometric model, by suboptimal definition of left atrial endocardium, or by chamber foreshortening. Three-dimensional (3D) TTE is posited to eliminate chamber foreshortening, and LAV measurement by 3D TTE should be more reflective of true LAV. The aim of this study was to compare conventional 2D TTE and newer 3D TTE for measurements of LAV to multidetector computed tomographic (MDCT) measurements using automated chamber reconstruction (ACR). This study shows that LAV is underestimated by both 2D TTE and 3D TTE relative to coronary computed tomographic angiography. Excellent agreement between the ALM and ACR with MDCT imaging suggests that the geometric model plays a negligible role in the underestimation of LAV. Underestimation of LAV by echocardiography is likely related to suboptimal definition of left atrial contour.

Corticosteroid administration for patients with coronary artery aneurysms after Kawasaki disease may be associated with impaired regression
Corticosteroid administration in Kawasaki disease (KD) is controversial but accepted as treatment for patients who do not respond to initial treatment. The impact of corticosteroids on evolving coronary artery aneurysms (CAA) and future vascular remodelling is unknown. This study indicated that the use of corticosteroids in the acute phase of KD for patients with evolving CAAs may be associated with worsening involvement and impaired vascular remodelling and warrants further study.

Ablation Stops Paroxysmal Afib
First-line treatment of paroxysmal atrial fibrillation with catheter-based radiofrequency ablation gives patients more long-term relief from the cardiac rhythm disturbances than drug therapy, researchers suggested here. In all, 22 of the 146 patients who underwent ablation experienced any atrial fibrillation, compared with 43 of the 148 patients being treated with drugs (P=0.004), during the two-year period of the Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial, the researchers reported at the American Heart Association meeting.

Simvastatin administration reduces thromboxane production in subjects taking aspirin
Growing evidence indicates that statins may reduce thromboxane A2 synthesis and thrombin generation. We investigated the relationships between thromboxane production, thrombin generation, and oxidative stress in patients receiving aspirin before and after statin administration. This study shows that statins significantly reduce platelet TXA2 formation in patients taking low-dose aspirin and this effect is associated with attenuated thrombin formation in response to vascular injury.

Effect of Two Intensive Statin Regimens on Progression of Coronary Disease
Statins reduce adverse cardiovascular outcomes and slow the progression of coronary atherosclerosis in proportion to their ability to reduce low-density lipoprotein (LDL) cholesterol. However, few studies have either assessed the ability of intensive statin treatments to achieve disease regression or compared alternative approaches to maximal statin administration. The authors of this study performed serial intravascular ultrasonography in 1039 patients with coronary disease, at baseline and after 104 weeks of treatment with either atorvastatin, 80 mg daily, or rosuvastatin, 40 mg daily, to compare the effect of these two intensive statin regimens on the progression of coronary atherosclerosis, as well as to assess their safety and side-effect profiles. They found that Maximal doses of rosuvastatin and atorvastatin resulted in significant regression of coronary atherosclerosis. Despite the lower level of LDL cholesterol and the higher level of HDL cholesterol achieved with rosuvastatin, a similar degree of regression of PAV was observed in the two treatment groups.

Rivaroxaban in Patients with a Recent Acute Coronary Syndrome
Acute coronary syndromes arise from coronary atherosclerosis with superimposed thrombosis. Since factor Xa plays a central role in thrombosis, the inhibition of factor Xa with low-dose rivaroxaban might improve cardiovascular outcomes in patients with a recent acute coronary syndrome. In this double-blind, placebo-controlled trial, the authors randomly assigned 15,526 patients with a recent acute coronary syndrome to receive twice-daily doses of either 2.5 mg or 5 mg of rivaroxaban or placebo for a mean of 13 months and up to 31 months. The primary efficacy end point was a composite of death from cardiovascular causes, myocardial infarction, or stroke. This study found that in patients with a recent acute coronary syndrome, rivaroxaban reduced the risk of the composite end point of death from cardiovascular causes, myocardial infarction, or stroke. Rivaroxaban increased the risk of major bleeding and intracranial hemorrhage but not the risk of fatal bleeding. 

Heart-Attack Stopping Gene Spurs Race to Make New Type of Cholesterol Drug
The world’s biggest drugmakers are racing to market the first medicine to tap into a gene mutation that drops heart-attack risk by as much as 88 percent. Normally, the PCSK9 gene creates a protein that disrupts the ability of liver cells to remove bad cholesterol from blood, enabling it to accumulate. A mutated form of the DNA found in 3 percent of people lowers levels of the protein, allowing more of the artery-clogging hormones to be swept away.

Serum uric acid is related to cardiovascular events and correlates with N-terminal pro-B-type natriuretic peptide and albuminuria in patients with diabetes mellitus
Hyperuricemia is a risk factor for cardiovascular events and renal insufficiency. It correlates to intima-media thickness and microalbuminuria. In this study the authors evaluated uric acid as an independent marker for cardiac events in patients with diabetes and found  that serum uric acid is a predictor of cardiac events and correlates to N-terminal pro-B-type natriuretic peptide and albuminuria, underscoring the importance of uric acid as a cardiovascular risk marker in patients with diabetes.

Insomnia and the Risk of Acute Myocardial Infarction
Insomnia, a subjective feeling of having difficulties initiating or maintaining sleep, or having a feeling of nonrestorative sleep, is a highly prevalent condition in the industrialized world. Only a few prospective studies have investigated insomnia in relation to risk for coronary heart disease, and these prior studies have been subjected to several potential methodological limitations. We assessed insomnia symptoms and risk of acute myocardial infarction in a large population-based study, taking into account the established cardiovascular risk factors, psychological distress, and chronic somatic disorders. In our study, insomnia symptoms were associated with a moderate increase in risk for acute myocardial infarction. The results were fairly robust in different multivariable models and sensitivity analyses. Nevertheless, insomnia is a frequent, easily recognizable, and potentially manageable condition. Treatment options include adherence to simple recommendations concerning sleeping habits, often referred to as sleep hygiene, and several nonpharmacological and pharmacological therapies, with the potential to produce reliable and durable changes among persons who have chronic insomnia.

Predictors of Response to Cardiac Resynchronization Therapy
The Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT) trial showed that cardiac resynchronization-defibrillator therapy is associated with a significant reduction in the risk of heart failure or death compared with defibrillator-only therapy. Currently, however, there is limited information on the factors that can be used to distinguish between responders and nonresponders in this population. In the present study, we developed a response score that was based on 7 factors we identified as being associated with favorable reverse remodeling in MADIT-CRT: female sex, a nonischemic origin of cardiomyopathy, left bundle-branch block, QRS greater than 150 milliseconds, prior hospitalization for heart failure, left ventricular end-diastolic volume greater than 125 mL/m2, and left atrial volume less than 40 mL/m2.

Mortality of newly diagnosed heart failure treated with amiodarone
Studies on the safety of amiodarone therapy in heart failure (HF) presented conflicting results. This article evaluated the relationship of commencing treatment with amiodarone (CTA) with the mortality and the morbidity of patients newly diagnosed with HF. Prospective cohort study over 7years on 3734 patients with HF. Main outcomes were all-cause and cardiovascular mortality, hospitalizations and visits. 739 patients who commenced treatment with amiodarone were propensity-matched with another 739 patients. Overall The commencement of treatment with amiodarone is associated with an increased mortality of patients with heart failure, mainly in women and in patients with non-systolic heart failure.  

Study finds cardiac-arrest patients do not benefit from shock delay, device use
A trial of almost 10 000 patients with out-of-hospital cardiac arrest found they were not more likely to survive with good neurological function if they received three minutes of cardiopulmonary resuscitation (CPR) before defibrillation or if they received CPR using an impedance-threshold device (ITD). Thus, there is no need to delay defibrillation in cardiac arrest, but use of the ITD device in CPR requires further research, the investigators say.

Diagnosing Acute Myocardial Infarction in Patients With Left Bundle Branch Block
The author of this article compared the clinical features, laboratory and coronary angiographic findings, treatments, and outcomes among patients with ST-segment elevation myocardial infarction (MI) with and without left bundle branch block (LBBB). According to the protocol, patients with LBBB were eligible only if they had ≥1 mm concordant ST-segment elevation. Obstructive coronary artery disease was present in >87% of the patients with LBBB. Documented MI (elevated biomarkers) with an initially occluded infarct artery was more common in patients with LBBB with concordant ST-segment elevation (71.4%) than in patients without (44.1%; p = 0.027). The use of ST-segment elevation concordance criteria in the presence of LBBB was more often associated with documented MI with an identifiable culprit vessel with an initially occluded infarct-related artery. In conclusion, because a substantial proportion of patients with LBBB have acute MI with a culprit lesion and positive biomarkers, these data support immediate catheterization with the intent for primary percutaneous coronary intervention for all patients presenting with suspected ST-segment elevation myocardial infarction, ischemic symptoms, and presumed new LBBB, particularly if concordant ST-segment elevation is present.

Shorter Plavix Treatment May Be Equally Effective
Taking the blood thinner Plavix for six months after receiving a stent may be safer and just as effective as two years of treatment, a new study suggests. The standard recommendation is typically at least 12 months of Plavix. But the study found that six months of treatment was enough to prevent rare but deadly complications, says researcher Marco Valgimigli, MD, of the University Hospital of Ferrara, in Italy. The new study, dubbed PRODIGY, involved nearly 2,000 patients who received either a bare-metal stent or a newer drug-coated stent. They were divided into two groups: One got Plavix and aspirin for six months, and the other for two years.The results were presented here at the European Society of Cardiology Congress 2011.

Effects of Beta-Adrenergic Antagonists in Patients With Chronic Kidney Disease
There is an excess burden of cardiovascular disease and death in people with CKD. Despite their potential benefits, the effects of beta-blockers in this population are uncertain. The aim of this systematic review was to study the benefits and risks of beta-adrenergic antagonists (beta-blockers) in patients with chronic kidney disease (CKD). This article found that treatment with beta-blockers improved all-cause mortality in patients with CKD and chronic systolic heart failure. There is insufficient evidence to conclude whether people with CKD who are not known to have heart failure derive benefit from beta-blockers.

Apixaban May Be the Real Thing
The success of apixaban (Eliquis), a novel oral direct factor Xa inhibitor, in a head-to-head comparison with warfarin for prevention of stroke in patients with atrial fibrillation, continues to generate buzz at the European Society of Cardiology meeting, and in an exclusive MedPage TodayInFocus video report, Elliott Antman, MD, of Harvard Medical School, explains why. Antman, a spokesperson for the American Heart Association and a researcher with the TIMI investigators at Brigham and Women's Hospital, tells Peggy Peck, MedPage Todayexecutive editor, that he thinks much of the enthusiasm is warranted, but the enthusiasm is a long way from clinical utility -- especially since apixaban is not yet FDA approved.

Dual-Chamber Implantable Cardioverter-Defibrillator Selection Is Associated With Increased Complication Rates and Mortality 
 The majority of patients enrolled in ICD efficacy trials received single-chamber devices. Although dual-chamber ICDs offer theoretical advantages over single-chamber defibrillators, the clinicalsuperiority of dual-chamber models has not been conclusively proven, and they may increase complications. The aim of this study was to compare single- versus dual-chamber implantable cardioverter-defibrillator (ICD) implantation and complication rates in a large, real-world population. In this large, multicenter cohort of patients, dual-chamber ICD use was common. Dual-chamber device implantation was associated with increases in periprocedural complications and in-hospital mortality compared with single-chamber defibrillator selection.

Increased risk of coronary heart disease among women smokers compared with men
A large meta-analysis suggests that the harmful effects of tobacco smoking affect men and women differently [1]. In a study of more than two million people, researchers showed that the pooled adjusted female-to-male relative risk of coronary heart disease in smokers vs nonsmokers is 25% higher in women. The results of the study are published online August 11, 2011 in the Lancet.

Rivaroxaban Contests Warfarin for Stroke Prevention in AF
A once-daily, oral, fixed dose of the Factor Xa inhibitor rivaroxaban was noninferior to warfarin for the prevention of stroke in patients with atrial fibrillation in a randomized, double-blind trial. Moreover, although rates of bleeding were similar between the two groups of patients, "bleeding that proved fatal or involved a critical anatomical site occurred less frequently in the rivaroxaban group," Dr. Manesh R. Patel of Duke University, Durham, N.C., and his coauthors wrote online Aug. 10 in the New England Journal of Medicine.

Serum gamma-glutamyltransferase is associated with arterial stiffness in healthy individuals
Gamma-glutamyltransferase (GGT) has been reported to be useful in predicting cardiovascular disease. Arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) is not only a marker of vascular damage but a significant predictor of cardiovascular events. Gender difference has been reported in the association between GGT and baPWV. This article assessed the association between GGT and baPWV in a large population and determined whether there was gender difference and the results suggest that GGT is independently associated with the increased level of arterial stiffness both in men and in women and the association between them appears to be stronger in men compared to women.

Vasopressin for cardiac arrest: Meta-analysis of randomized controlled trials
Prior meta-analyses-reported results of randomised controlled trials (RCTs) published between 1997 and 2004 failed to show any vasopressin-related benefit in cardiac arrest. Based on new RCT-data and a hypothesis of a potentially increased vasoconstricting efficacy of vasopressin, we sought to determine whether the cumulative, current evidence supports or refutes an overall and/or selective benefit for vasopressin regarding sustained restoration of spontaneous circulation (ROSC), long-term survival, and neurological outcome. This article found that Vasopressin use in the resuscitation of cardiac arrest patients is not associated with any overall benefit or harm. However, vasopressin may improve the long-term survival of asystolic patients, especially when average DRUG is <20min.

Prevalence and Characteristics of Early Repolarization
Early repolarization has been implicated in a syndrome of polymorphic ventricular tachycardia and fibrillation in patients without organic heart disease. The of this article authors evaluated the prevalence and characteristics of early repolarization in patients in CASPER (Cardiac Arrest Survivors With Preserved Ejection Fraction Registry). One hundred patients with apparently unexplained cardiac arrest and preserved ejection fraction underwent extensive clinical and genetic testing to unmask subclinical electrical or structural disease. A blinded independent analysis of the 12-lead electrocardiogram (ECG) was performed. Early repolarization was defined as 0.1 mV QRS-ST junction (J-point) elevation with terminal QRS slurring or notching in at least 2 contiguous inferior and/or lateral leads. Overall early repolarization is present in a significant proportion of causally diagnosed and idiopathic VF. It is often intermittent and more pronounced in IVF patients.

Low-molecular-weight heparin beats unfractionated in STEMI
A new meta-analysis has found that low-molecular-weight heparins (LMWHs) are associated with a reduction in mortality and major bleeding rates in STEMI patients treated with primary PCI as compared with unfractionated heparin (UFH) [1]. And patients at greatest risk seem to derive the most benefit from LMWHs, report Dr Eliano Pio Navarese (Nicolaus Copernicus University, Bydgoszcz, Poland) and colleagues in their paper published online July 20, 2011 in the Journal of Thrombosis and Haemostasis.

Impact of Renin-Angiotensin System Blockade Therapy on Outcome in Aortic Stenosis
The purpose of this study was to investigate the impact of renin-angiotensin system blockade therapy on outcomes in aortic stenosis (AS). Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are perceived to be relatively contraindicated in AS. However, inhibitors of the renin-angiotensin system maybe beneficial in AS through their cardioprotective and beneficial effects on left ventricular remodeling. Overall This large observational study suggests that ACEI/ARB therapy is associated with an improved survival and a lower risk of CV events in patients with AS.

Effect of Spironolactone on Patients With Atrial Fibrillation and Structural Heart Disease
Several studies have shown that the modulation of fibrotic scar in cardiac diseases has beneficial effects on cardiac arrhythmias. In addition, recent reports suggest a potential role of mineralocorticoid receptor upregulation in atrial fibrillation (AF). The role of spironolactone, a mineralocorticoid receptor blocker and a potent antifibrotic agent, in AF is as yet unexplored. The aim of this study was to determine if spironolactone, a mineralocorticoid receptor blocker with potent antifibrotic properties, has beneficial effects on AF. This was a comprehensive retrospective analysis was performed on 83 patients with AF, including 23 who were treated with spironolactone for ≥3 months. The combined primary outcome of hospitalization for AF or direct current cardioversion (DCCV) was compared between patients treated with spironolactone in addition to the usual care for AF and those receiving conventional medical therapy alone. It was found that patients receiving spironolactone had significantly fewer primary outcome events (AF-related hospitalizations or DCCV) (22% vs 53%), showing that Spironolactone therapy is associated with a reduction in the burden of AF, as reflected by a combination of hospitalizations for AF and DCCV. 

Increased Risk for Heart Valve Disease Associated With Antiphospholipid Antibodies in Patients With Systemic Lupus Erythematosus
Antiphospholipid antibodies are associated with arterial and venous thrombosis and obstetric manifestations. These antibodies are frequent in patients with systemic lupus erythematosus (up to 40% of patients). In such patients, the prevalence of valvular heart disease is increased. It has been suggested that valvular disease, in particular Libman-Sacks endocarditis, is associated with antiphospholipid antibodies. However, conflicting data have been reported, and the possible relationship is still debated. In this systematic review and meta-analysis of 23 studies including 1656 patients, we clearly demonstrate that in lupus patients with antiphospholipid antibodies compared with lupus patients without these antibodies, the risk for valvular disease, including Libman-Sacks endocarditis, is increased 3-fold. Furthermore, we show that some antibody profiles (lupus anticoagulant, IgG, or high anticardiolipin antibody titers) are associated with an even higher risk for valvular disease. These studies did not evaluate the risk for valvular disease directed against an important target antigen of antiphospholipid antibodies, β2-glycoprotein I. Therefore, additional studies are warranted. However, our meta-analysis greatly improves the current understanding of the contribution of antiphospholipid antibodies to valvular disease. These results have already had an impact on management strategies of patients with systemic lupus: In clinical practice, an echocardiogram should be performed in patients with antiphospholipid antibodies to detect, monitor, and implement treatment strategies for valvular disease. Conversely, in lupus patients with heart valve disease, in particular when surgery is indicated, the presence of antiphospholipid antibodies should be determined because they indicate a high risk of perioperative thrombotic complications.

Dronedarone Permanent AF Study Stopped Due to CV Event Imbalance
A significant increase in cardiovascular events in patients with permanent atrial fibrillation who are taking dronedarone in the PALLAS trial has led the drug’s manufacturer to suspend the phase IIIb study. Dronedarone (Multaq), a benzofuran derivative that is a an analogue of amiodarone, is approved in the United States and the European Union for a different population of patients with AF, not those with permanent AF, and "the benefit-risk of Multaq remains unchanged in its approved indication in nonpermanent AF," the company said in a press release issued on July 7.

Sudden Cardiac Death Gene Trigger Found
For the first time in a community setting, researchers have identified a genomic hot spot that doubles the risk of sudden cardiac arrest. The meta-analysis of five genome-wide association studies, which included 1,283 sudden cardiac death cases and more than 20,000 controls, led researchers to the BAZ2B locus, Dan E. Arking, PhD, from Johns Hopkins University School of Medicine in Baltimore, and colleagues reported. The BAZ2B area contains three genes not previously known to play a role in cardiac biology, according to the study published online in PLoS Genetics.

Association of Serum Phosphate Levels With Aortic Valve Sclerosis and Annular Calcification
Mineral metabolism disturbances are common among older people and may contribute to cardiac valvular calcification. Associations of serum mineral metabolism markers with cardiac valvular calcification have not been evaluated in a well-characterized general population of older adults. This study was conducted to evaluate mineral metabolism markers as potential risk factors for calcific aortic valve disease.This study found that higher serum phosphate levels within the normal range were associated with valvular and annular calcification in a community-based cohort of older adults. Phosphate may be a novel risk factor for calcific aortic valve disease and warrants further study.

Cardiovascular benefits of salt restriction remain unproven 
The cardiovascular benefits of salt restriction remain unproven on the basis of currently available evidence, authors of a systematic review concluded.The accumulation of clinical-trial data on 6,500 participants failed to produce a statistically significant outcome for hypertensive or normotensive individuals with respect to overall mortality or cardiovascular morbidity. Moreover, salt restriction was associated with an increased mortality risk in patients with congestive heart failure (CHF), according to a report in the Cochrane Database of Systematic Reviews.

Preclinical diastolic dysfunction with normal LVEF ups mortality in study
Nearly two-thirds of outpatients with a normal LVEF when referred for echocardiography also had LV diastolic dysfunction, and moderate or severe diastolic dysfunction independently predicted mortality over the next several years, in a retrospective single-center study [1]. In far and away most cases, those with diastolic dysfunction had no symptoms and no history of clinical heart failure. Archives of Internal Medicine

Impact of QRS Duration on Clinical Event Reduction With Cardiac Resynchronization Therapy
Cardiac resynchronization therapy (CRT) does not reduce adverse cardiac events in heart failure (HF) patients with moderately prolonged QRS intervals as previously thought, a study indicates. Research led by Ilke Sipahi (Case Western Reserve University, Cleveland, Ohio, USA) revealed that although CRT was effective in reducing adverse clinical events in systolic HF patients with severely prolonged baseline QRS duration (≥150 ms), it did not reduce such events in patients with moderately prolonged QRS duration (120-143 ms).

Normal Stress Echocardiogram Is Highly Predictive Of Lack Of Cardiac Events In Obese Patients
A normal stress echocardiogram is highly predictive of a lack of cardiac events over the next year in obese and normal-weight patients alike who have chest pain," according to research presented at the American Society of Echocardiography meeting. Investigators found that, "of 366 obese patients and 142 normal-weight patients who had a negative stress echocardiogram after presenting with chest pain, none had a major adverse cardiac event through one year."

Angiotensin-Converting Enzyme Inhibitors added to Beta Blockers May Decrease the Development of New-Onset Diabetes Mellitus in Patients With Stable Coronary Artery Disease
We used data from patients with stable coronary artery disease (CAD) to assess the risk of new-onset diabetes mellitus (NOD) with β blockers and to determine whether angiotensin-converting enzyme (ACE) inhibition would modify this risk. The Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) trial randomized 8,290 patients with stable CAD to trandolapril or placebo. Presence of NOD was assessed at each study visit over a median follow-up time of 4.8 years. Participants taking β blockers assigned to the placebo group were at increased risk for NOD adjusting for baseline covariates, and this risk was attenuated in those assigned to trandolapri. β blocker use was associated with increased risk for NOD in patients with stable CAD, and this risk was decreased in patients treated concurrently with an ACE inhibitor. In conclusion, these data suggest that ACE inhibition may attenuate the risk for glucose abnormalities observed in patients taking β blockers.

Removal of Tonsils, Appendix Linked to Early MI
People who had their tonsils, appendix, or both removed before the age of 20 had a higher risk of acute myocardial infarction before age 40, according to a Swedish population study.
When compared with controls and adjusted for parental occupation and parental history of acute myocardial infarction, these patients had a hazard ratio for MI of 1.33 (95% CI 1.05 to 1.70) with appendectomy and 1.44 (95% CI 1.04 to 2.01) with tonsillectomy, Imre Janszky, MD, from the Karolinska Institute in Stockholm, and colleagues found.

Risk of Bleeding With 2 Doses of Dabigatran Compared With Warfarin in Older and Younger Patients With Atrial Fibrillation
The Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial in patients with atrial fibrillation and at least 1 additional risk factor for stroke demonstrated that dabigatran 110 mg twice a day compared with warfarin was associated with a similar risk of stroke or systemic embolism and a lower risk of major bleeding, and that dabigatran 150 mg twice a day compared with warfarin was associated with a lower risk of stroke or systemic embolism and a similar risk of major bleeding. The effects of dabigatran compared with warfarin on stroke or systemic embolism were consistent in all subgroups examined, but there was a significant treatment-by-age interaction for major bleeding such that dabigatran 110 mg twice a day compared with warfarin was associated with a lower risk of major bleeding in patients aged <75 years and a similar risk in those aged >75 years, whereas dabigatran 150 mg twice a day compared with warfarin was associated with a lower risk of major bleeding in those aged <75 years and a trend toward higher risk of major bleeding in those aged >75 years. The interaction between treatment and age was evident for extracranial bleeding but not for intracranial bleeding, which was consistently reduced with dabigatran compared with warfarin irrespective of age. These results suggest that in patients with atrial fibrillation and at least 1 additional risk factor for stroke who are aged <75 years, the higher dabigatran dose might be preferable, whereas in older patients, the lower dabigatran dose might be considered a means to reduce the risk of bleeding. For More Cardiology News Visit Our Cardiology Archives