Cardiology News / Recent Literature Review / Last Quarter 2018

Abstract

Rhythmos 2019;14(1):13-21.

ACC.19 Meeting: New Orleans, LA, USA, 16-18/3/2019 

EHRA Congress: Lisbon, 17-19/3/2019

HRS Meeting: San Francisco, CA, USA, 8-11/5/2019

EuroPCR: Paris, 21-24/5/2019

ESC Meeting: Paris, 31/8-4/9/2019

TOTAL Trial: Although High Thrombus Burden Was an Important Predictor of Outcome in STEMI, Routine Thrombus Aspiration Did Not Improve Outcomes at 1 Year and Was Associated With an Increased Rate of Stroke

Among 10,732 patients with STEMI randomized to routine manual thrombectomy versus PCI alone, the primary outcome of cardiovascular (CV) death, MI, cardiogenic shock, or heart failure at 1 year was similar with thrombus aspiration in patients with high (8.1% vs. 8.3% thrombus aspiration; hazard ratio - HR: 0.97) or low thrombus burden (% vs. 5% thrombus aspiration; HR: 1.22; interaction p=0.41). However, among patients with high thrombus burden, stroke at 1 month was more frequent with thrombus aspiration (31 / 0.7% thrombus aspiration vs 16 / 0.4% PCI alone, HR: 1.90). In the high thrombus burden group, thrombus aspiration did not improve 1-month (HR: 0.78; p=0.06) and 1-year CV mortality (HR: 0.88; p=0.25). Irrespective of treatment assignment, high thrombus burden was an independent predictor of death (HR: 1.78) (Jolly SS et al, J Am Coll Cardiol 2018;72: 1589–96).

Meta-Analysis: Catheter Ablation of Atrial Fibrillation (AF) in Patients with Heart Failure (HF) was Superior to Conventional Drug Therapy in Improving All-Cause Mortality, HF Hospitalizations, LVEF, 6-Minute Walk Test Distance, VO2max, and Quality of Life, With an Increase, Albeit Non-Significant, in Adverse Events

Meta-analysis of 6 RCTs involving 775 patients indicated that compared with drug therapy, AF ablation reduced all-cause mortality (9% vs 17.6%; risk ratio -RR, 0.52) and HF hospitalizations (16.4% vs 27.6%; RR, 0.60). Ablation improved left ventricular ejection fraction (LVEF) (mean difference, 6.95%), 6-minute walk test distance (mean difference, 20.93 m), peak oxygen consumption (Vo₂max) (mean difference, 3.17 mL/kg per minute), and quality of life (mean difference in Minnesota Living with Heart Failure Questionnaire score, −9.02 points). Serious adverse events were more common in the ablation groups (7.2% vs 3.8%; RR, 1.68) (Turagam MK et al, Ann Int Med 2018, Dec 25).

 The Mitral Annulus Disjunction (MAD) Arrhythmic Syndrome

Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral valve leaflet hinge point. MAD has been associated with mitral valve prolapse (MVP) and sudden cardiac death. Among 116 patients with MAD (age 49 ± 15 years; 60% female), palpitations were the most common symptom (71%), while severe arrhythmic events occurred in 14 (12%) patients. Patients with severe arrhythmic events were younger (age 37 ± 13 years vs 51 ± 14 years; p=0.001), had lower ejection fraction (51 ± 5% vs 57 ± 7%; p=0.002) and had more frequently papillary muscle fibrosis (4 or 36% vs 6 or 9%; p=0.03). MVP was evident in 90 (78%) patients and was not associated with ventricular arrhythmia (Dejgaard LA et al, J Am Coll Cardiol 2018;72:1600-9)... (excerpt)