Cardiology News /Recent Literature Review / Last Quarter 2014

Abstract

20^th Annual Boston AF Symposium: Orlando, 8-10/1/15

HCS Working Groups Seminar: Ioannina, 2/2015

ACC: San Diego, 14-16/3/15

HRS: Boston, 13-16/5/15

EuroPCR: Paris, 19-22/5/15

Europace: Milan, 21-24/6/15

ESC: London, 29/8-2/9/15

AFFORD study: n-3 Polyunsaturated Fatty Acids (Fish Oil) do not Reduce Atrial Fibrillation Recurrences

In a double-blind, randomized, placebo-controlled trial of fish oil (4 g/day, docosahexaenoic acid - DHA: eicosapentaenoic acid - EPA 1:2) vs safflower oil placebo in 337 patients with symptomatic paroxysmal or persistent AF followed for 9 ± 4 months, the primary endpoint (time to first symptomatic or asymptomatic AF recurrence lasting >30 s) occurred in 64% of patients in the fish oil arm and 63% of patients in the placebo arm (hazard ratio: 1.10; p= NS). hs-CRP and myeloperoxidase - MPO were normal at baseline and decreased to a similar degree at 6 months. The authors concluded that high-dose fish oil does not reduce AF recurrence in patients with a history of AF not receiving AA therapy, and does not reduce inflammation or oxidative stress markers in this population (Nigam A et al, J Am Coll Cardiol 2014;64:1441-1448).  

N.B.: Another randomized study (VITAL - VITamin D and OmegA-3 TriaL) is currently examining the effect of 1 g/d of n-3 PUFAs on AF in a much larger population (N=25,875) without cardiac disease over 5 years.

RELAX-AHF: Serelaxin Reduces Mainly Cardiova-scular & Sudden Deaths, Rather than HF Deaths

The RELAX-AHF study showed that IV serelaxin (recombinant human relaxin-2) compared with placebo reduced mortality at 6 months among 1,161 patients with acute heart failure (HF). In this group there were 107 deaths (9.3%): 37 (35%) from HF, 25 (23%) from sudden death, 15 (14%) from other cardiovascular (CV) causes, 19 (18%) from non-CV causes, and 11 (10%) classified as unknown. The treatment effect of serelaxin was most pronounced on other CV deaths (hazard ratio - HR: 0.29; p= 0.005) and sudden death (HR: 0.46; p= 0.065), with no effect of serelaxin treatment on HF or non-CV deaths. The authors concluded that the effects of serelaxin on mortality were mainly due to reduced CV causes and sudden death, without apparent effect on HF deaths (Feleker GM et al, J Am Coll Cardiol 2014;64:1591-1598). N.B.: an ongoing large phase III outcome trial (NCT01870778) will further examine serelaxin’s effect on mortality.

ARISTOTLE: Anticoagulation Quality was Lower in Warfarin-Treated Patients who Received Amiodarone, and Amiodarone was Associated with Significantly Higher Risk of Thrombo-embolism, while Apixaban had a Benefit over Warfarin in Both Groups

In the ARISTOTLE trial, 2,051 (11.4%) patients received amiodarone. Time in the therapeutic range (TTR) in patients on warfarin and amiodarone was lower than patients not on amiodarone (56.5% vs 63%; p<0.0001). More patients on amiodarone had thromboembolism (stroke or systemic embolism) (1.58%/year vs 1.19%/year; hazard ratio -HR: 1.47; p= 0.0322). Mortality and major bleeding rates were higher, albeit not significantly different, in the amiodarone vs the non-amiodarone group. Apixaban, compared with warfarin, decreased systemic embolism, death, and major bleeding in both groups. The authors concluded that amiodarone was associated with significantly increased stroke and systemic embolism risk and a lower TTR when used with warfarin. Apixaban consistently reduced the rate of stroke and systemic embolism, death, and major bleeding compared with warfarin in both (amiodarone and non-amiodarone) groups (Flaker G et al, J Am Coll Cardiol 2014;64:1541-1550)... (excerpt)