Despite the improved safety and efficacy profile of non-Vitamin K Antagonist Oral Anticoagulants (NOACAs), the current guidelines still limit their use to stroke prevention in non-valvular atrial ...fibrillation (AF) patients and venous thromboembolism prophylaxis and treatment.
In this report, the authors discussed the published data related to NOACs use in prosthetic valves highlighting the proposed mechanisms of NOACs failure and other controversial data regarding their efficacy and safety in prosthetic valves.
Although NOACs have proven to be even safer and more effective alternatives to vitamin K antagonists (VKAs) in several indications for anticoagulation, the data regarding their safety and efficacy in prosthetic heart valves is still debatable. The controversial data regarding NOACs use in prosthetic valves renders it difficult to define specific guideline-recommendation for safe and efficient use in this population. The available evidence suggesting that NOACs are as safe and as efficient as VKA regarding thromboembolic prophylaxis and risk of bleeding was primarily based on patients who had undergone bioprosthetic valve and concomitant atrial fibrillation. Further research is warranted to establish if NOACs can be a safer and more efficient alternative to VKAs in patients with prosthetic valves either metallic or bioprosthetic.
Coronary angiography was performed revealing proximal significant eccentric lesions in both left anterior descending (LAD) and left circumflex arteries with a diseased right coronary artery without ...significant lesions (video 3), After a heart team assessment, he was counselled to have a left internal mammary artery graft to LAD, ventricular aneurysmectomy and VSR closure. Advances in reperfusion strategies have lowered the incidence of mechanical complications of acute myocardial infarction (AMI).1 VSR is a rarely seen complication in the setting of AMI, which usually results in cardiogenic shock, right ventricular dysfunction with a high incidence of mortality even with immediate surgical repair. Clinical presentations are heart failure, angina, ventricular arrhythmia, systemic embolisation or ventricular rupture.2 While ventricular pseudoaneurysm formation occurs when cardiac rupture is contained by adherent pericardium or scar tissue.3 TTE is the first step in the diagnosis of mechanical complications following AMI, and CMR is the diagnostic modality of choice to confirm the diagnosis and plan for further interventions.
...several studies exclusively used rivaroxaban7–9 or reported its outcomes separately.10–12 We conducted this meta-analysis to evaluate the role of rivaroxaban in comparison with VKAs. ...there was ...no difference in stroke, bleeding, and mortality between both groups.8 In another retrospective study that included 64 patients with ST-segment elevation myocardial infarction complicated by LVT, thrombus resolution in the rivaroxaban arm was similar to the VKA arm (p = 0.096). ...rivaroxaban showed a signal for higher thrombus resolution.Disclosures The authors have no conflicts of interest to declare.
Heart Failure (HF) is among the major causes of global morbidity as well as mortality. Increased prevalence, frequent and prolonged hospitalization, rehospitalization, long-term consumption of ...healthcare resources, absenteeism, and death upsurge the economic burden linked to HF. For decades, Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Blockers (ARBs), Beta-Blockers (BBs), and mineralocorticoid receptor antagonists (MRA), have remained the mainstay of the standard of care for HF management. Despite their proven efficacy and cost-effectiveness, HF remains a global pandemic and is still increasing in prevalence. Sacubitril/ Valsartan (SAC/VAL) is an Angiotensin Receptor/Neprilysin Inhibitor (ARNI) that proved out to be a game-changer drug in HF treatment. Recent data indicated that SAC/VAL is more efficient and can improve the overall quality of life of HF patients with reduced ejection fraction (HFrEF) with fewer side effects. It is now incorporated in the guidelines as an alternative to ACEIs or ARBs to lower morbidity in addition to mortality in HFrEF patients. This review article will discuss the current guidelines-approved indications and highlight the potential emerging indications, in addition to the currently ongoing clinical trials that will expand the use of SAC/VAL.
Low high-density lipoprotein-cholesterol (HDL-C) concentration is among the strongest independent risk factors for cardiovascular disease, however, studies to assess the cardioprotective effect of ...normal or high HDL-C level are lacking.
To determine the prognostic impact of initial serum HDL-C level on in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) and the one-year all-cause mortality in patients presenting with ST-elevation myocardial infarction (STEMI) we performed a retrospective analysis of the data from 1,415 patients presenting with STEMI in a tertiary-care centre equipped with a 24-hour-ready catheterisation laboratory. The period from June 2014 to June 2017 was reviewed with a follow-up as regards one-year all-cause mortality. Patients were divided into two groups according to HDL-C level. HDL-C <40 mg/dL (2.22 mmol/L) was considered low, while HDL-C ≥40 mg/dL was considered normal.
There were 1,109 patients with low HDL-C, while 306 had normal HDL-C levels, which was statistically significant (p<0.001). Total MACCE and all-cause mortality were significantly lower in patients with normal HDL-C (p=0.03 and p=0.01, respectively).
In conclusion, this retrospective study to assess the prognostic effect of HDL-C in patients presenting with STEMI, found normal HDL-C level was associated with lower in-hospital MACCE and all-cause mortality at one-year follow-up.
On examination his blood pressure (BP) was 220/110 mm Hg, and his heart rate was 120 beats per min. In his medical history, it was noted that he had experienced recurrent episodes of hypertension and ...tachycardia, intractable epilepsy, psychiatric problems—specifically depression and anorexia nervosa—and episodic abdominal pain for the past 10 years; he was reportedly pain free during the time between relapses. A CT of the patient's brain was normal, but an MRI showed bilateral asymmetric vasogenic oedema within both occipital and parietal regions—a picture typical of so-called posterior reversible encephalopathy syndrome (figure).
