Rhythmos (E-Journal - First Department of Cardiology / Evagelismos General Hospital of Athens)
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Cardiovascular Complications of the Coronavirus (COVID-19) Infection: COVID-19 and the Heart
No full textApropos with the most recent emergence and disastrous and fulminant course of the new pandemic of the coronavirus (COVID-19) infection, relevant general and cardiovascular issues are herein discussed. Rhythmos 2020;15(2):23-28
Cardiology News / Recent Literature Review / Second Quarter 2020: Cardiology News
No full textCardiology News / Recent Literature Review / Second Quarter 2020
Rhythmos 2020;15(3):55-63.
ESC Meeting/Digital Experience: 29/8-1/9/2020
TCT/ Virtual Event: 14-18/10/2020
HCS/Panhellenic (41st) Congress of Cardiology: Athens, 22-24/10/2020
AHA Meeting 2020: cancelled
ACC Meeting: Atlanta, 20-22/3/2021
EHRA Meeting: Barcelona, 28-30/3/2021
Women Have a Higher Risk of MACE and Ischemia-Driven Target Lesion Revascularization (ID-TLR) Compared With Men at 5 Years Post-PCI
Among 32,877 patients, 9,141 (27.8%) were women who were older and had higher body mass index, more frequent hypertension and diabetes, and less frequent history of surgical or percutaneous revascularization compared with men. Lesions in women had smaller reference vessel diameter and shorter lesion length. At 5 years, women had a higher rate of MACE (18.9% vs 17.7%; p=0.003), all-cause death (10.4% vs 8.7%; p=0.0008), cardiac death (4.9% vs 4.0%; p=0.003) and ID-TLR (10.9% vs 10.2%; p=0.02) compared with men. By multivariable analysis, female sex was an independent predictor of MACE (hazard ratio [HR:]: 1.14; p=0.04) and ID-TLR (HR: 1.23; p=0.009) but not all-cause death (HR: 0.91; p=0.30) or cardiac death (HR: 0.97; p=0.85) (Kosmidou I et al, J Am Coll Cardiol 2020; 75:1631-40).
PARAGON-HF: Baseline and Mean Achieved Systolic Blood Pressure (SBP) of 120-129 mmHg Identified the Lowest Risk Patients With Heart Failure With Preserved Ejection Fraction Treated With Sacubitril/ Valsartan
Among 4,795 trial participants (age 73 ± 8 years, 52% women), multivariable analysis indicated that baseline and mean achieved SBP of 120-129 mmHg demonstrated the lowest risk for all outcomes. Sacubitril/valsartan reduced SBP by 5.2 mmHg compared with valsartan at 4 weeks, which was not modified by baseline SBP. However, sacubitril/valsartan reduced SBP more in women (6.3 mmHg) than men (4 mmHg) (interaction p=0.005). Change in SBP was directly associated with change in NT-proBNP (p<0.001) but not symptom score (p=0.40) (Selvaraj S et al, J Am Coll Cardiol 2020; 75:1644-56)... (excerpt
Novel Angiography-Derived Techniques for Functional Assessment of Coronary Artery Disease: Functional Assessment of Coronary Artery Disease
No full textBackground: The importance of coronary physiology in identifying hemodynamically significant lesions is well established.
Objective: The current review summarizes the most important studies of the novel techniques developed over the last decade that allow the computation of fractional flow reserve (FFR) from either invasive or computed coronary angiography.
Methods: A systematic review of all published research in PubMed and Google Scholar databases, regarding the angiography-derived functional assessment of coronary artery disease (CAD) has been performed. The following terms were used: “functional angiography”, “quantitative flow ratio”, “computed tomography-derived FFR”, “FFR angiography” and “virtual FFR”.
Results: Several multicenter clinical trials have presented the currently available techniques for physiological assessment of coronary artery stenosis, such as quantitative flow ratio (QFR), computed tomography-derived FFR, FFRangio and virtual FFR, their theoretical basis and methodology, as well as their diagnostic performance, using invasive FFR as reference standard.
Conclusion: A variety of novel angiography-derived techniques for physiological assessment of CAD exist, showing high diagnostic performance and are expected to increase the use of coronary physiology in the guidance of clinical decision making upon revascularization strategy. Rhythmos 2020;15(4):73-77
Ventricular Ectopy in the Normal Heart. An Elusive Menace or a Harmless Variant? Ventricular Ectopy in the Normal Heart
No full textPremature ventricular complexes (PVCs) are a common feature specially at increasing age. In the normal heart they are usually benign, but in some cases, they may be associated with sudden cardiac death or risk of heart failure. Although the pathophysiological mechanisms of these effects are not yet fully clarified, PVCs’ potential to cause a form of cardiomyopathy is now widely accepted. In this brief review we present the main evidence regarding ventricular ectopy and its consequences, in individuals without pre-existing heart disease. Rhythmos 2020;15(3): 47-51
Cardiology News / Recent Literature Review / Last Quarter 2019
Get PDFHCS 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
Childhood Secondhand Smoke Exposure Predicts Increased Risk for Adulthood Atrial Fibrillation (AF) After Adjustment for AF Risk Factors
A study analyzed Framingham Offspring cohort participants with parents in the Original cohort with known smoking status during the offspring’s childhood, evaluated every 2-8 years and being under routine surveillance for incident AF. Of 2,816 Offspring cohort participants with at least 1 parent in the Original cohort, 82% were exposed to parental smoking. For every pack/day increase in parental smoking, there was an 18% increase in offspring AF incidence (adjusted hazard ratio - HR: 1.18; p=0.04). Additionally, parental smoking was a risk factor for offspring smoking (adjusted odds ratio - OR: 1.34; p<0.001). Offspring smoking mediated 17% of the relationship between parental smoking and offspring AF (Groh CA et al, J Am Coll Cardiol 2019; 74:1658-64).
When Left Untreated, Severe Aortic Stenosis (AS) is Associated With Poor Long-Term Survival / But Also Moderate AS Confers Poor Survival Rates
Among 16,129 (6.7%), 3,315 (1.4%), and 6,383 (2.6%) patients had mild, moderate, and severe AS, respectively, on an adjusted basis (vs. no AS; 5-year mortality 19%), patients with mild to severe AS had an increasing risk of long-term mortality (adjusted hazard ratio: 1.44-2.09; p<0.001 for all comparisons). The 5-year mortality was 56% and 67%, respectively, in those with moderate AS (mean gradient 20.0-39.0 mmHg/peak velocity 3.0-3.9 m/s) and severe AS (≥40 mmHg, ≥4 m/s, or AV area<1 cm2 in low-flow, low-gradient severe AS). A markedly increased risk of death from all causes (5-year mortality >50%) and CV disease was evident from a mean AV gradient >20 mmHg (moderate AS) after adjusting for age, sex, LV systolic or diastolic dysfunction, and aortic regurgitation (Strange G et al, J Am Coll Cardiol 2019; 74:1851-63).
Premature (Age≤45 Years) Acute or Stable Obstructive Coronary Artery Disease (CAD) is an Aggressive Disease Despite the Currently Recommended Prevention Measures, With High Rates of Recurrent Events and Mortality
Among 880 patients with premature CAD, aged 40.1 ± 5.7 years, mainly men, smokers, with a family history of CAD or hypercholesterolemia, at baseline presentation, 91% underwent coronary revascularization, predominantly for acute MI (79%). Over 20 years, one-third (n = 264) of patients presented with a total of 399 ischemic events, and 36% had at least a second recurrent event. MI was the most frequent first recurrent event (n=131 of 264), mostly related to new coronary lesions (17% vs 8%; p=0.01; hazard ratio - HR: 1.45 for new vs initial culprit lesion). All-cause death (n=55; 6.3%) occurred at 8.4 years (median time). Ethnic origin (sub-Saharan African vs. Caucasian, adjusted HR - adjHR: 1.95; p=0.02), inflammatory disease (adjHR: 1.58; p=0.03), and persistent smoking (adjHR: 2.32; p<0.01) were the strongest correlates of a first recurrent event. When considering all recurrent events, the same factors and Asian ethnicity predicted poor outcome, but persistent smoking had the greatest impact on prognosis (Collet J-P et al, J Am Coll Cardiol 2019; 74:1868-78)... (excerpt
Successful Electrical Cardioversion of Long-Standing Persistent Atrial Fibrillation: Tips and Tricks: Electrical Cardioversion of Long-Standing Persistent Atrial Fibrillation
No full textA case of electrical cardioversion of long-standing persistent atrial fibrillation (AF) is presented along with tips and tricks for a successful strategy to restore and maintain sinus rhythm. Rhythmos 2020; 15(3):52-54
Left Bundle Branch Block (LBBB) Induced Angina / Painful LBBB Syndrome: Painful LBBB syndrome
No full textA case of painful left bundle branch block (LBBB) syndrome is presented where anginal symptoms developed during periods of rate-dependent LBBB associated with stress or exertion. Rhythmos 2020; 15(4):78-79
Cardiology News / Recent Literature Review / Third Quarter 2020: Cardiology News
No full textRhythmos 2020;15(4):80-87.
TCT/ Virtual Event: 14-18/10/2020
HCS/Panhellenic (41st) Congress of Cardiology: Athens, 22-24/10/2020
AHA Meeting 2020: cancelled
ACC Meeting: Atlanta, 20-22/3/2021
EHRA Meeting: Barcelona, 28-30/3/2021
COMPASS Trial: Rivaroxaban 2.5 mg bid Plus ASA vs ASA Alone Resulted in Fewer Events (Stroke and Cardiovascular Mortality), Particularly in High-Risk Subgroups and Those With Multiple Risk Characteristics With Less Frequent Severe Bleedings and Less Clinical Impact
Rivaroxaban 2.5 mg bid plus aspirin 100 mg reduced the risk of cardiovascular (CV) events as compared with ASA monotherapy in the COMPASS trial but increased the risk of major bleedings. The current prespecified analysis was performed to assess the net clinical benefit (NCB) of adding rivaroxaban 2.5 mg bid to ASA monotherapy in patients with chronic vascular disease in the COMPASS study cohort with a specific focus on high-risk subgroups. A lower number of NCB adverse outcomes was observed with rivaroxaban 2.5 mg bid plus ASA vs ASA alone (hazard ratio, 0.80, P=0.0005), which became increasingly favorable with longer treatment duration. In selected high-risk subgroups, a larger absolute risk reduction for experiencing a NCB event was observed (Steffel J et al, Circulation 2020; 142:40-48).
COVID-19: The Prevalence of DVT is High, Associated With Adverse Outcomes in Hospitalized Patients With COVID-19 / Prophylaxis for DVT May be Protective in Patients With a Padua Protection Score ≥4 After Admission
Of the 143 patients hospitalized with COVID-19 (age 63±14 years, 51.7% men), 66 patients developed lower extremity DVT (46.1%). Compared with patients who did not have DVT, patients with DVT were older and had a lower oxygenation index, a higher rate of cardiac injury, and worse prognosis, including an increased rate of deaths (34.8% vs 9 11.7%; P=0.001) and a decreased proportion of patients discharged (48.5% vs 77.9%; P<0.001). In the subgroup of patients with a Padua prediction score ≥4 and whose ultrasound scans were performed >72 h after admission, DVT was present in 34% patients in the subgroup receiving thromboprophylaxis vs 66% patients in the nonprophylaxis group (P=0.010) (Zhang L et al, Circulation 2020; 142:114–128).
Meta-Analysis: Prasugrel and Ticagrelor Reduced Ischemic Events and Increased Bleeding Compared With Clopidogrel in Patients with ACS / A Significant Mortality Reduction Was Observed With Ticagrelor Only /There was no Efficacy and Safety Difference Between Prasugrel and Ticagrelor
According to a network meta-analysis of 12 RCTs including 52 816 patients with acute coronary syndrome (ACS), in comparison with clopidogrel, ticagrelor significantly reduced cardiovascular mortality (hazard ratio-HR, 0.82) and all-cause mortality (HR, 0.83), with no significant mortality reduction with prasugrel (HR, 0.90 and HR, 0.92, respectively). In comparison with each other, there were no significant differences in mortality. In comparison with clopidogrel, prasugrel reduced myocardial infarction (HR, 0.81), whereas ticagrelor showed no risk reduction (HR, 0.97). Differences between prasugrel and ticagrelor were not significant. Stent thrombosis risk was significantly reduced by both ticagrelor and prasugrel versus clopidogrel (28%–50% range of reduction). In comparison with clopidogrel, both prasugrel (HR, 1.26) and ticagrelor (HR, 1.27) significantly increased major bleeding. There were no significant differences between prasugrel and ticagrelor for all outcomes explored (Navarese EP et al, Circulation. 2020;142:150–160)... (excerpt
An Undersized Stent Does Not Forgive
Get PDFStent thrombosis is a rare complication of percutaneous coronary intervention (PCI) with potential devastating results. Stent undersizing and malapposition are major risk factors of stent thrombosis and have been strongly associated with early stent thrombosis. However, despite the continuous progress of interventional cardiology, there is no consensus regarding optimal management of this medical emergency. Herein, we present a case of subacute stent thrombosis that manifested as a severe inferior ST-elevation myocardial infarction four days after an initial PCI of the right coronary artery. A stepwise treatment approach was followed aiming initially to achieve flow TIMI III without stenting during primary PCI. During a revision procedure, stent undersizing and malapposition were identified as underlying mechanisms of stent thrombosis using intravascular imaging guidance and treated successfully with corrective PCI. Further evidence is needed to refine the optimal treatment strategy in the setting of stent thrombosis. Rhythmos 2019;14(2):31-34.
Management of Venous Thromboembolism and Atrial Fibrillation in Patients with Cancer. The Role of Direct Oral Anticoagulants
Get PDFCancer is accompanied by an increase of both thrombotic and hemorrhagic complications. Thus, the management of venous thromboembolism (VTE) or atrial fibrillation (AF) presents certain difficulties in oncologic patients. So far, low molecular weight heparins (LMWHs) have been proved the most effective and safe agents for long-term use in the VTE setting. However the novel oral anticoagulants (Direct Oral Anti Coagulants-DOACs), which are more friendly to use and begin to displace conventional anticoagulation in non-cancer patients, emerge as an attractive alternative. We present the latest data from randomized trials, meta-analyses of DOACs in oncologic populations and recent recommendation papers, as these agents claim their role in the management of cancer patients. Rhythmos 2019;14(1):5-9