Cardiology News / Recent Literature Review / Third Quarter 2019

Cardiology News

Abstract

Rhythmos 2019;14(4):80-86.

HCS 40^th Cardiology Congress: Ioannina, 17-19/10/2019

AHA Meeting: Philadelphia, PA, USA, 16-18/11/2019

HCS Working Groups: Thessaloniki, 20-22/2/2020

ACC Meeting: Chicago, IL, USA, 28-30/3/2020

EHRA Meeting: Vienna, 29-31/3/2020

HRS Meeting: San Diego, 6-9/5/2020

EuroPCR: Paris, 19-22/5/2020

ESC Meeting: Amsterdam, 29/8-2/9/2020

Carpal Tunnel Syndrome (CTS) is Associated With Amyloidosis, Heart Failure (HF), and Adverse Cardiovascular (CV) Outcomes

Among 56,032 patients from the Danish registries who underwent surgical treatment for CTS, compared with a sex- and age-matched cohort, CTS was associated with a future diagnosis of amyloidosis (hazard ratio-HR: 12.12), and a higher incidence of HF, (HR 1.54). Risk of other adverse outcomes was also associated with CTS (p<0.0001 for AF, AV block, and pacemaker implantation) (Fosbel EL et al, J Am Coll Cardiol 2019; 74:15-23).

MI Risk Stratification with Single Measurement of High-Sensitivity Cardiac Troponin: an optimized threshold of <5 ng/l safely identified almost one-half of all patients as low risk at presentation, with hs-cTnI >120 ng/l identifying high-risk patients

Among 2,212 patients admitted for chest pain, acute MI occurred in 12%. Two assays of high-sensitivity cTnI had excellent sensitivities (98.6-99.6%) and negative predictive values (NPVs) (range 99.5-99.8%) for acute MI or death at 30 days across both assays. An optimized threshold of <5 ng/l identified almost one-half of all patients as low risk, with sensitivities of 98.6% and NPVs of 99.6% for acute MI or death at 30 days across both assays. For high-risk patients, hs-cTnI ≥120 ng/l resulted in positive predictive values for acute MI of ≥70% (Sandoval Y et al, J Am Coll Cardiol 2019; 74:271-82).

AG10, a Selective Transthyretin (TTR) Stabilizer, Appears a Safe and Effective Treatment for Patients With Amyloid TTR Cardiomyopathy (ATTR-CM)

Patients (n=49) with ATTR-CM (NYHA class II-III) were randomized 1:1:1 to AG10 400 mg, AG10 800 mg, or placebo bid for 28 days. AG10 is a selective, oral TTR stabilizer under development for ATTR-CM that mimics a protective TTR mutation. AG10 treatment was well-tolerated, achieved target plasma concentrations and achieved near-complete stabilization of TTR. TTR stabilization was more complete and less variable at the higher dose. Average serum TTR increased by 36 ± 21% and 51 ± 38% at 400 and 800 mg, respectively (both p<0.0001 vs placebo). Baseline serum TTR in treated subjects was below normal in 80% of mutant and 33% of wild-type subjects. AG10 treatment restored serum TTR to the normal range in all patients (Judge DP et al, J Am Coll Cardiol 2019; 74:285-95).

IMPULSE/PEFCAT: Pulsed Field Ablation (PFA) is a New Promising Mode Allowing Ultra-Rapid PV Isolation

During PFA, subsecond electric fields creating microscopic pores in cell membranes (electroporation) are particularly applicable to cardiomyocytes which have among the lowest thresholds to these fields, potentially permitting preferential myocardial ablation. Safety and effectiveness of catheter-PFA was assessed in 2 first-in-human trials in 81 patients with paroxysmal atrial fibrillation (AF). All PVs were acutely isolated by monophasic (n=15) or biphasic (n=66) PFA with ≤3 min elapsed delivery/patient, skin-to-skin procedure time of 92.2 ± 27.4 min, and fluoroscopy time of 13.1 ± 7.6 min. With successive waveform refinement, durability at 3 months improved from 18% to 100% of patients with all PVs isolated. There was only 1 procedure-related pericardial tamponade, with no additional adverse events over the 120-day median follow-up. The 12-month Kaplan-Meier estimate of freedom from arrhythmia was 87.4 ± 5.6% (Reddy VY et al, J Am Coll Cardiol 2019;74: 315-26)... (excerpt)