April 2022 News Roundup
This month features CAD and insomnia, IABP performed bedside, cardio-obstetrics knowledge gaps, and more.
Every month, Section Editor L.A. McKeown curates a roundup of recent news tidbits from journals and medical meetings around the globe.
Low-risk morbidly obese patients have fewer serious periprocedural complications, but higher rates of new permanent pacemaker and aortic regurgitation with TAVI than SAVR, according to a study published in EuroIntervention. At 2 years, both treatment groups had similar rates of all-cause mortality, CV mortality, and CV readmission. However, all-cause readmissions were higher in the SAVR group.
Insomnia in the months after MI and/or coronary revascularization is associated with increased risk of recurrent MACE, according to a study of 1,082 consecutive patients presented at ESC Preventive Cardiology 2022 and published in SLEEP Advances. Other predictors of MACE were smoking and physical inactivity. The researchers say efforts should be made to assess and effectively manage insomnia in patients with CAD.
A study of hospital-based interpreters who help patients with heart failure (HF) and limited English proficiency found that they often have difficulty adequately explaining clinical terminology and even metaphors used by physicians when talking with patients. Writing in JACC: Heart Failure, the researchers say the findings “highlight the importance of integrating medical interpreters as part of the care team, ensuring [limited English proficiency] HF patients have adequate comprehension of their illness, and improving the discharge process to provide a safe transition plan to the outpatient setting.”
In JACC: Case Reports, physicians explain with photos and videos how they successfully and safely managed a balloon fracture that occurred while performing TAVI with a Sapien (Edwards) valve in an 88-year-old man.
Pulmonary capillary wedge pressure during a passive leg raise—assisted by cath lab staff—is a simple and accurate method for establishing or ruling out occult HF with preserved ejection fraction (HFpEF) during right-heart catheterization. The study, published in Circulation: Heart Failure, concludes that this measure may be especially of value in centers where exercise during a right-heart cath is difficult to perform.
Intra-aortic balloon pump (IABP) insertion can safely be performed at the bedside instead of under fluoroscopic guidance in a cath lab, a single-center experience of 115 patients from Italy suggests. Reporting in Catheterization and Cardiovascular Interventions, the researchers say those who had bedside insertion had similar rates of correct device positioning and device‐related major vascular complications.
Carotid endarterectomy (CEA) to reduce stroke risk in patients with asymptomatic carotid stenosis does not reduce the long-term risk of dementia, according to 20-year results from the randomized ACST-1 trial published online ahead of print in the European Journal of Vascular and Endovascular Surgery.
Large knowledge gaps exist in cardio-obstetrics among cardiologists, cardiovascular team members, and fellows-in-training, a survey shows. “Most respondents (76%) lack access to a dedicated cardio‐obstetrics team, and only 29% of practicing cardiologists received cardio‐obstetrics didactics during training. One third of fellows in training reported seeing pregnant women 0 to 1 time per year, and 12% of fellows in training report formal training in cardio‐obstetrics,” the authors write in the Journal of the American Heart Association.
Having ideal CV health at age 45 is predictive of longer life expectancy for men and women, according to a UK Biobank study of more than 340,000 people followed for a median of 11 years. Even people in the study with cardiometabolic disease had longer life expectancies if they had ideal CV health at middle age, as assessed by the American Heart Association’s Life's Simple 7. The study was published in Lancet eClinical Medicine.
Infolding—or wrinkling along the valve frame—is rare and potentially life-threatening when it occurs in TAVI procedures, and it often leads to prolonged procedure times and enhanced contrast use. A study of 14 cases from two large TAVI centers also found that infolding was associated with more acute kidney injury and new atrioventricular blocks, with greater need for permanent pacemaker. Writing in Structural Heart, researchers emphasize that identifying predictors of infolding can influence implantation strategy and improve safety and clinical outcomes.