Cardiology News / Recent Literature Review / Last Quarter 2016

Abstract

AF Symposium: Orlando, 12-14/1/2017

ACC.17: Washington, DC, 17-19/3/2017

HRS Scientific sessions: Chicago, 10-13/5/2017

EHRA Europace-Cardiostim: Vienna, 18-21/6/2017

ESC Congress: Barcelona, 26-30/8/2017

TOHP Study: Direct Linear Relationship of an Accurate Measure of Usual Sodium Intake to Total Mortality Over a Period of 23-26 Years, With Higher Risk at High Sodium Intake and no Evidence of a U or J Shape

Based on multiple 24-h urine samples collected from pre-hypertensive adults 30 to 54 years of age, among 744 phase I and 2,382 phase II participants randomized to sodium reduction or control, 251 deaths occurred, representing a nonsignificant 15% lower risk in the active intervention (hazard ratio -HR: 0.85; p=NS). Among 2,974 participants not assigned to an active sodium intervention, 272 deaths occurred with a direct linear association between average sodium intake and mortality, with an HR of 0.75, 0.95, and 1.00 (references) and 1.07 (p trend= 0.30) for <2.3, 2.3 to <3.6, 3.6 to <4.8, and ≥4.8 g/24 h, respectively; and with an HR of 1.12 per 1 g/24 h (p = 0.05). There was no evidence of a J-shaped or nonlinear relationship. The HR per unit increase in sodium/ potassium ratio was 1.13 (p = 0.04) (Cook NR et al, J Am Coll Cardiol 2016;68:1609-1617).

FRANCE-2 (FRench Aortic National CoreValve and Edwards) Registry: In High-Risk Patients With Aortic Stenosis Undergoing TAVI, Later Mortality is Due Mainly to Noncardiac Causes / Beyond the First Month After the Procedure, Prosthetic Valve Function Remains Stable, the Incidence of Clinical Events is Low, and Functional Improvement is Usually Sustained

Among 4,201 patients undergoing TAVI, approaches were transfemoral 73%, transapical 18%, subclavian 6%, and transaortic or transcarotid 3% and median follow-up 3.8 years. The 3-year all-cause mortality was 42% and cardiovascular mortality 17.5%. Predictors of 3-year all-cause mortality were male gender (p< 0.001), low body mass index, (p< 0.001), AF (p< 0.001), dialysis (p< 0.001), NYHA class III or IV (p< 0.001), higher logistic EuroSCORE (p<0.001), transapical or subclavian approach (p< 0.001 for both vs transfemoral approach), need for permanent pacemaker implantation (p= 0.02), and post-implant periprosthetic aortic regurgitation grade ≥2 of 4 (p< 0.001). Severe events occurred mainly during the first month and subsequently in <2% of patients/year. Mean gradient, valve area, and residual aortic regurgitation were stable during follow-up (Gilard M et al, J Am Coll Cardiol 2016; 68:1637-1647)... (excerpt)