Pocket Mobile Echocardiography: Balance Promise with Prudence

Compared with standard transthoracic echocardiography, a pocket device performed well on some measures, but its role in clinical practice is still evolving.

Registry data show that the rate of late PCI on completely occluded arteries did not decline after the OAT findings prompted guideline recommendations against it.

The 2006 Occluded Artery Trial (OAT) demonstrated no benefit of percutaneous coronary intervention (PCI) to treat completely occluded culprit arteries >24 hours after acute myocardial infarction (MI; JW Cardiol Nov 14 2006).

Consequently, the 2007 American College of Cardiology/American Heart Association guidelines for ST-segment-elevation MI (STEMI), non-STEMI, and PCI include class III recommendations against such treatment. To what extent have the OAT results and the guideline recommendations been incorporated into practice?

Ticagrelor Trumps Clopidogrel in ACS Patients Slated for Noninvasive Management

The results of yet another prespecified subgroup analysis mimic those of the larger trial.

Note: Ticagrelor has now been approved by the FDA for marketing in the U.S. For a discussion of the response to this approval in the cardiology community, see the recent Voices blog on CardioExchange, an online forum for cardiology news and discussion.

Getting the Ejection Fraction Right: Reducing Interobserver Variability

In one echocardiography laboratory, a formal teaching intervention significantly improved an important measure of quality.

An Implantable Device for Resistant Hypertension Performs Well in a Randomized Trial

Baroreflex activation therapy safely lowered systolic blood pressure in patients who had hypertension despite taking an average of five antihypertensive drugs.

In phase I and II trials, a cardiac myosin activator safely improved systolic function without increasing myocardial oxygen consumption.

It seems intuitive that agents that improve cardiac contractility would help patients with systolic dysfunction. Unfortunately, existing agents — including dobutamine (an adrenergic stimulant), milrinone (a phosphodiesterase inhibitor), and levosimendan (a calcium sensitizer unavailable in the U.S.) — are associated with morbidity and mortality that outweigh their benefits. Two manufacturer-sponsored studies now provide early insights into the possible use of omecamtiv mecarbil, a novel selective cardiac myosin activator that, in animal models, increases cardiac contractility without increasing intracellular calcium.

Delays in Treatment for STEMI Increase Risk for Heart Failure

Findings from a population-based observational study suggest that reducing time from EMS call to PCI could improve morbidity as well as mortality.

Time in Therapeutic Range for Warfarin — A European Success Story

A Swedish registry and quality-improvement program resulted in a mean TTR of more than 75%.

Focused Update: ACC/AHA Guidelines on Peripheral Arterial Disease

Revised recommendations emphasize early detection of PAD, prevention of cardiovascular events, and the equivalence of surgical and endovascular revascularization.

Sponsoring Organizations: American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine, Society for Vascular Surgery

Background and Purpose: Changes to recommendations for the management of lower-extremity arterial and abdominal aortic disease reflect clinical-study evidence published since completion of the 2005 guidelines. The 2005 recommendations regarding renal and mesenteric arterial disease remain unchanged in the absence of new pivotal studies of disease in these segments.

Clopidogrel Dosing Based on Genotype: What Difference Does It Make?

In patients heterozygous for the CYP2C19*2 allele, higher doses significantly reduced platelet reactivity, but whether genotype-guided dosing improves outcomes remains unknown.