IV Nurse Day
January 25, 2016

pure trial cardiology


Richmond, VA. This single-center study demonstrates successful TAVR treatment of pure aortic regurgitation, with LV reverse remodeling consistent with surgical aortic valve surgery results. report a contemporary retrospective single-center observational study of 22 patients with pure aortic regurgitation treated with TAVR using self-expanding prostheses.3 All patients had evidence of heart damage as indicated by increased LV dimensions or LV systolic dysfunction. It appears that leaflet thrombosis, whether clinical or sub-clinical, is the most common thrombotic even after TAVR, and registry data suggest it is not impacted by antiplatelet therapy. A low PURE diet score, Mente said, would typically include low intake of fruits and vegetables, less than one daily serving of nuts and legumes, approximately half a daily serving of dairy and very little red meat and fish — translating to a diet where 69% of energy intake comes from carbohydrates. © 2020 American College of Cardiology Foundation. Similarly, in the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial, patients with stable atherosclerotic disease randomized to receive low-dose rivaroxaban and aspirin demonstrated reduced cardiovascular events with an increased bleeding risk. ‘That meant in the past we were extrapolating from data gathered in a select subset of 10–15% of the world’s population. Vascular. Mark Nicholls, The PURE study implications, European Heart Journal, Volume 39, Issue 48, 21 December 2018, Pages 4227–4229, https://doi.org/10.1093/eurheartj/ehy762, With the PURE study offering a new insight into global dietary trends, Mark Nicholls speaks to the Principal Investigator Professor Salim Yusuf, about its potential impact on heart health. The POPular TAVI (Antiplatelet Therapy for Patients Undergoing Transcatheter Aortic-Valve Implantation) trial was designed to assess the utility of DAPT compared to single therapy in patients undergoing TAVR.

Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation. Dallas, TX. De-escalation of prasugrel after 1 month reduced the risk of bleeding without increasing ischemic events. Ticagrelor was associated with a 17% higher risk of death and a 48% higher risk of bleeding, both statistically significant. Khanal S, Veerman L, Nissen L, Hollingworth S. Res Social Adm Pharm. Most previous data were solely from high income and Western countries, and often in select subsets of the population such as health professions who follow a certain and narrow pattern of diet. We showed that was not true…our data suggest it is because of differences in access to healthcare.’, ‘I think one of the most important findings from PURE is that good healthcare matters at least as much as avoiding risk factors. Given the higher risk for this patient subset, initial intense medical therapy is important. NLM Introduction BAMI: Autologous Cell Therapy for the Treatment of Acute Myocardial Infarction Graziani F, Mencarelli E, Burzotta F, et al. The study showed that treatment with aspirin plus clopidogrel, as opposed to aspirin alone, resulted in a significant increase in bleeding events, with no reduction in thrombotic events such as stroke or MI. Get the latest research from NIH: https://www.nih.gov/coronavirus. Available at. These authors outlined 3 stages of chronic MR: As we continue to strive for a better understanding of the patient-specific features of patients seeing profound benefit from studies such as COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation)10 compared with patients undergoing surgical mitral valve replacement without chordal sparing11 or from the MITRA-FR (Percutaneous Repair With the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation) trial12 who seemingly did not have benefit, this study of the Tendyne valve gives us hope that utilization of CTA and in-depth evaluation of these patients pre- and post-procedure will give us better insights to predict treatment responses. This analysis from the SWEDEHEART Registry is the largest to explore the safety and efficacy of ticagrelor in an all-comer, elderly (>80 years) post-MI patient cohort discharged alive from the hospital.

In terms of impact, Prof. Yusuf believes PURE has fired the debate and discussion, encouraging people to revisit what constitutes a heart-healthy diet via findings that are globally applicable. Prof Andrew Mente discusses PURE, filmed by Radcliffe Cardiology on site in Munich, ESC 2018. ISCHEMIA: Treatment for Patients With Stable Ischemic Heart Disease and Heart Failure BAMI involved 10 countries with 37 centers including 4 cell-processing centers. In a multicultural, multi-ethnic society there are vast differences in nutrient intake between groups as well as changing dietary norms within groups as individual affluence increases. Taken together, it is clear that in the absence of another indication, the addition of clopidogrel to aspirin is not worthwhile in patients undergoing TAVR because it exposes them to unnecessary risk.

Patients with aortic stenosis, who have higher bleeding risk due to the pathophysiology of the disease (a risk that may persist even after TAVR), may not benefit from even aspirin monotherapy.

Dietary Fats and Chronic Noncommunicable Diseases. Morgantown, WV. Cardiocentre, Charles University and University Hospital Kralovske Vinohrady Thus, individualized therapeutic decisions regarding treatment strategies focused on the most effective elimination of ischemia seem warranted in these patients to achieve optimum results while awaiting future study results. To conduct the study, the association between diet quality, cardiovascular disease (CVD), and death was first examined in 138 527 people aged 35–70 without CVD from the PURE study. By Subhash Banerjee, MD, FACC Mente A. ‘If we can follow these 300 000 people for at least another decade and even more, we will inform not only CVD but conditions of ageing including dementia, disability, frailty and cancers, lung disease, and kidney disease’. This is perhaps best demonstrated by the lack of an interaction between age and treatment assignment in the PLATO (Platelet Inhibition and Patient Outcomes) randomized clinical trial. Pallazola VA, Davis DM, Whelton SP, Cardoso R, Latina JM, Michos ED, Sarkar S, Blumenthal RS, Arnett DK, Stone NJ, Welty FK. There is ongoing debate about whether to address coronary disease before or after TAVR. The study, originally designed to assess the superiority of prasugrel, was terminated prematurely due to futility. Gebremariam LW, Aoyama A, Kahsay AB, Hirakawa Y, Chiang C, Yatsuya H, Matsuyama A. Nagoya J Med Sci. Cardiology. Dietary Composition and Cardiovascular Risk: A Mediator or a Bystander. Considering the findings from POPular TAVI and GALILEO, one has to conclude that any use of anticoagulation or antiplatelet medication in TAVR patients should be undertaken only with a clear indication and not solely because the patient has had TAVR. By Rani K. Hasan, MD, MHS, FACC

Further studies are needed to assess the overall cardiovascular benefit versus bleeding risk in patients with PAD with or without CAD stratified into low and high bleeding risk per Valve Academic Research Consortium definitions. This could make the guideline more consonant with real-world practice where downstream use remains prevalent. There are still questions to be answered.
Nutrients. The study found that the specific placement location of this pad contributed to the variability of the response, with optimal reverse remodeling evident when the device was placed at the distal apical compared to the mid-apical area. Patients randomized to rivaroxaban 2.5 mg BID and aspirin had a significant reduction in major adverse limb events and cardiovascular events compared to those receiving placebo and aspirin. That is putting the importance of healthcare at least on an equal footing with controlling risk factors in the population.’. While acknowledging that conventional thinking remains focused on lowering to very low levels of intake of fats, and saturated fats in particular, the study’s senior author Prof. Salim Yusuf believes PURE challenges that specific view.

But the incidence of ISTH (International Society on Thrombosis and Haemostasis) bleeding was higher in the rivaroxaban and aspirin group. Interventions and Structural Heart Disease, International Study of Comparative Health Effectiveness With Medical and Invasive Approaches, Autologous Bone Marrow Cell Therapy in Acute Myocardial Infarction Trial, Downstream versus Upstream administration of P2Y12 receptor Blockers In non-ST elevated acUte coronary Syndromes with initial invasive indication, Ticagrelor and Clopidogrel in Elderly ACS Patients: SWEDEHEART Registry, Efficacy and Safety of Trimetazidine in Patients Having Been Treated by Percutaneous Coronary Intervention. That, says Prof. Yusuf, is a simple fact of funding and logistics, with the enormous challenge of conducting studies in several countries. Healio.com. Low-Carbohydrate Diets in the Management of Obesity and Type 2 Diabetes: A Review from Clinicians Using the Approach in Practice. The ATPCI (Efficacy and Safety of Trimetazidine in Patients Having Been Treated by Percutaneous Coronary Intervention) trial is a well-designed and conducted trial that was presented at ESC Congress 2020 and simultaneously published in The Lancet. Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation.
After adjusting for factors that could influence the relationship, compared with the poorest quality diet, the highest quality diet was associated with significantly lower risks of major cardiovascular events and deaths. The 4-year cumulative primary outcome occurred more often in the HF/LVEF 35-45% group compared to those without HF/LVEF 35-45% (22.7% vs. 13.8%; p = 0.004), with similar, significant differences for cardiovascular death or MI (19.7% vs. 12.3%) and all-cause death or HF (15.0% vs. 6.9%). Graziani et al. The researchers found elevated carbohydrate intake was associated with adverse outcomes, three or four servings per day of fruits and vegetables was associated with positive outcomes and elevated fat intake was associated with reduced mortality risk. Coll. More importantly than relying on an arbitrary age criterion for senior citizens, this study in my view calls for a more individualized and nuanced approach to the selection of P2Y12 inhibitors in elderly post-MI patients.

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