Year : 2020 | Volume
: 21 | Issue : 1 | Page : 3--5
Consultant Cardiologist, Department of Cardiology Heart Hospital, Hamad Medical Corporation, Doha, Qatar
Dr. Uma Velupandian
Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha
|How to cite this article:|
Velupandian U. Cardiovascular news.Heart Views 2020;21:3-5
|How to cite this URL:|
Velupandian U. Cardiovascular news. Heart Views [serial online] 2020 [cited 2020 Mar 28 ];21:3-5
Available from: http://www.heartviews.org/text.asp?2020/21/1/3/276530
Announcement: Nobel Prize Winners for 2019 in Physiology and Medicine
On October 7, 2019, the Nobel Assembly at Karolinska Institutet awarded the 2019 Nobel Prize in Physiology or Medicine jointly to William G. Kaelin Jr, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical, Boston, USA, Sir Peter J. Ratcliffe, University of Oxford, Oxford, United Kingdom, and Gregg L. Semenza, Johns Hopkins University, Baltimore, MD, USA, for their pioneering research on “for their discoveries of how cells sense and adapt to oxygen availability.” The Nobel Prize of nine million Swedish krona will be shared equally by the three researchers.
Nobel Media AB 2019
Survival in Out-Of-Hospital Cardiac Arrest After Standard Cardiopulmonary Resuscitation or Chest Compressions Only Before Arrival of Emergency Medical Services, Nationwide Study during Three Guideline Periods
This study, published on April 1, 2019 in Circulation AHA, further reiterates the importance of chest compression only in cardiopulmonary resuscitation (CPR) in the survival of patients with out of hospital cardiac arrest.
In out-of-hospital cardiac arrest, chest compression-only CPR (CO-CPR) has emerged as an alternative to standard CPR (S-CPR), using both chest compressions and rescue breaths. Since 2010, CPR guidelines recommend CO-CPR for both untrained bystanders and trained bystanders unwilling to perform rescue breaths.
The aim of this study was to describe changes in the rate and type of CPR performed before the arrival of emergency medical services (EMS) during three consecutive guideline periods in correlation to 30-day survival.
A total of 30,445 patients were included. For all time periods combined, the adjusted odds ratio for 30-day survival was 2.6 (95% CI: 2.4–2.9) for S-CPR and 2.0 (95% confidence interval [CI]: 1.8–2.3) for CO-CPR, in comparison with NO-CPR. S-CPR was superior to CO-CPR (adjusted odds ratio: 1.2; 95% CI: 1.1–1.4).
The authors concluded that there was an almost a 2-fold higher rate of CPR before EMS arrival and a concomitant 6-fold higher rate of CO-CPR over time. Any type of CPR was associated with doubled survival rates in comparison with NO-CPR. These findings support continuous endorsement of CO-CPR as an option in future CPR guidelines because it is associated with higher CPR rates and overall survival in out-of-hospital cardiac arrest.
A New Era in Transcatheter Aortic Valve Replacement
Transcatheter aortic valve replacement (TAVR) began in 2002 as a treatment for patients with severe aortic stenosis (AS) and prohibitively high surgical risk. Yet multiple randomized trials demonstrated its safety and efficacy comparable to surgery.
Now, two manufacturer-funded comparison trials have published similar results in low-risk patients. The Partner 3 Trial results published in NEJM in May 2019, heralds the new era of TAVR being offered as the default treatment for severe aortic stenosis and is more likely to be a treatment of choice for patients as it is less invasive. This is also an evolving era for cardiothoracic surgery as though the number of patients with native aortic stenosis opting for surgery may decrease; there would still be a relative increase in surgery post valve interventions which may increase the complexity of surgery.
At 71 centers, 1000 patients (mean age 71years; These studies were performed in highly specialised centres with high volume of cases and centre's experience is crucial to success. Also patients with Bicuspid Aortic valve (BAV) were excluded from this study as with all other trials so evidence is lacking in this group. The durability of these prosthesis may be a concern but the 10 year data expected soon will allay anxiety, because so far the 8 year results look promising. Watch the page!
N Engl J Med 2019 Mar 16; [e-pub]
Former NFL Participation Linked to Increased Atrial Fibrillation Prevalence
With the World Cup football 2022, looming over the horizon in the middle east, this is an interesting study published online on July 24, 2019, in the Journal of the American Heart Association.
Philip Aagaard, M. D., Ph. D., from the Cleveland Clinic Foundation, and colleagues conducted a cross-sectional study comparing the prevalence of AF among 460 former national football league (NFL) athletes to the prevalence among 925 population-based controls of similar age and racial composition from the cardiovascular cohort Dallas Heart Study-2. They found that AF was present in 28 individuals, including 23 former NFL athletes (5%) and 5 (0.5%) people in the control group with an odds ratio of 5.7.
Multiple regression analysis after accounting for cardiovascular risk factors showed independent association with older age, high body mass index, non-Afro-Caribbean race, and no correlation with hypertension and diabetes. In 15 out of 23 NFL players with AF, this was an incidental finding at the time of study and 80% of them had as Chads-VASc 2 score of >1. They were asymptomatic and rate controlled. Interestingly, the former NFL players also had an 8-fold higher prevalence of paced cardiac rhythms when compared with controls (2% vs. 0.25%).
The authors concluded that “former participation in the NFL was associated with an increased prevalence of AF and slowed cardiac conduction compared with a population-based control group.”
Journal of the American Heart Association. 2019;8:e010401
Sex Differences in De Novo Heart Failure After Stemi
This study reported in the Journal of American College of Cardiology on November 5, 2019, from the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries), a large observational and multinational registry from 41 centers in 12 European countries, evaluated the 30-day all-cause mortality (primary outcome) and heart failure Killip class II and above (secondary outcome) at admission in patients with ST elevation myocardial infarction.
Of 10,443 patients with STEMI, 3112 were women. The incidence of de novo heart failure (after adjustment and matching for age, cardiovascular risk factors, comorbidities, disease severity, and delay to hospital presentation) was higher for women than men (25.1% vs. 20.0%; odds ratio [OR]: 1.34; 95% CI: 1.21–1.48). Women with de novo heart failure had higher mortality (25.1% vs. 20.6%; OR: 1.29; 95% CI: 1.05–1.58), and this remained the case even among patients with de novo heart failure undergoing reperfusion therapy (21.3% vs. 15.7%; OR: 1.45; 95% CI: 1.07–1.96).
The authors Cenko et al. concluded that women are at higher risk for de novo heart failure after STEMI and women with de novo heart failure have worse survival.
J Am Coll Cardiol; 2019;74:2379-2389
Good News Dog Owners!-You Will Have Longer Life Expectancy After Coronary Events
Previous research has shown that dog owners have lower blood pressure and better cholesterol values, implying better heart health. However, it was unclear if dog ownership is associated with improved survival.
In a meta-analysis, published October 8, 2019, researchers in Canada analyzed 10 studies with a follow-up of 1–22 years, most of them from Scandinavia and England. The analysis was based on data from more than 3.8 million patients from 10 prospective studies. Nine of them compared all-cause mortality of dog owners and nonowners, and four studies compared cardiovascular outcomes. The results showed that dog ownership was associated with:
24% reduction in overall all-cause mortality65% reduction in all-cause mortality in individuals who had prior coronary events31% reduction in cardiovascular mortality.
Confounding factors such as physical fitness, psychological benefit of companionship, and healthier lifestyle were unaccounted for.
The authors however concluded that “dog ownership is associated with lower risk of death over the long term, which is possibly driven by a reduction in cardiovascular mortality.”
Circulation: Cardiovascular Quality and Outcomes. 2019;12:e005554
Food and Drug Administration Alert!
UPDATE: The Food and Drug Administration (FDA) warns that biotin may interfere with laboratory tests: FDA Safety Communication November 5, 2019.
The U. S. FDA is updating the 2017 safety communication to remind the public, health-care providers, laboratory personnel, and laboratory test developers that biotin, often found in dietary supplements, can significantly interfere with certain laboratory tests and cause incorrect results that may go undetected. Biotin in patient samples can cause falsely high or falsely low results, and depending on the type of test, the FDA is particularly concerned about biotin interference, causing a falsely low result for troponin and its implications in failed detection of myocardial infarction.
While some laboratory test developers have been successfully addressed the issue of biotin interference of their assays, many others have not. The FDA has posted a webpage on biotin interference with troponin laboratory tests, Assays Subject to Biotin Interference, to notify the public about troponin assays where the risk of biotin interference has not yet been addressed.
Recommendations for health care providers:
Talk to your patients about any biotin supplements or multivitamin supplements they are taking that may contain biotin, including supplements marketed for hair, skin, and nail growthKnow that biotin is found in multivitamins, including prenatal multivitamins, biotin supplements, and dietary supplements for hair, skin, and nail growth in levels that may interfere with laboratory testsBe aware that many laboratory tests, including but not limited to cardiovascular diagnostic tests and hormone tests, that use biotin technology are potentially affected, and incorrect test results may be generated if there is biotin in the patient's specimenCommunicate to the laboratory conducting the testing if your patient is taking biotinIf a laboratory test result does not match the clinical presentation of your patient, consider biotin interference as a possible source of errorReport to the laboratory test manufacturer and the FDA if you become aware of a patient experiencing an adverse event following potentially incorrect laboratory test results due to biotin interference.
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Conflicts of interest
There are no conflicts of interest.