Cardiology News / Recent Literature Review / Last Quarter 2015

Abstract

Boston AF Symposium : Orlando, 14-16/1/2016 ACC 65 th Annual Session: Chicago, 2-4/4/2016 HRS 37 th Annual Meeting: San Francisco, 4-7/5/16 CardioStim/Europace : Nice, 8-11/6/2016 Euro PCR : Paris, 17-20/5/2016 ESC Meeting: Rome, 27-31/8/2016 Targeting Ablation to the Distal Segment of the Main Renal Artery and Post-Bifurcation Branches May Optimize Renal Denervation Insufficient procedural efficacy has been proposed to explain nonresponse to renal denervation (RDN). The impact of different patterns of lesion placements on the efficacy and consistency of catheter-based radiofrequency (RF) RDN was examined in pigs. Increasing the number of RF lesions (4, 8, and 12) in the main renal artery was not sufficient, but targeted treatment of the renal artery branches or distal segment of the main renal artery resulted in markedly less variability of response and significantly greater reduction of both norepinephrine (NE) and axon density than conventional treatment of only the main renal artery. Combination treatment (main artery plus branches) produced the greatest change in renal NE and axon density with the least heterogeneity. The changes lasted through 28 days post-treatment (Mahfoud F et al, J Am Coll Cardiol 2015;66:1766-1775). High Levels of Cardiorespiratory Fitness in Midlife Confer Lower Mortality, Use of Health Care Resources, and Health Care Costs Later in Life Among 19,571 healthy individuals who underwent cardiorespiratory fitness assessment at a mean age of 49 years, over 126,388 person-years of follow-up, average annual health care costs were significantly lower for participants aged > 65 years with high than low midlife fitness in both men and women. Average annual health care costs in later life were incrementally lower per MET achieved in midlife in men and women. The authors concluded that higher cardiorespiratory fitness in middle age is strongly associated with lower health care costs at an average of 22 years later in life, independent of cardiovascular risk factors (Bachmann JM et al, J Am Coll Cardiol 2015;66:1876-1885). Very Late Thrombosis of Bioresorbable Coronary Scaffolds Despite Antiplatelet Therapy, Possibly Related to Scaffold Discontinuity and Restenosis, Implies an Extended Period of Vulnerability to Ischemic Events Four patients presented with very late scaffold thrombosis (VLScT) at 44, 19 (2 cases), and 21 months, after implantation of an Absorb Bioresorbable Vascular Scaffold. At the time of VLScT, all patients were taking low-dose aspirin, and 2 patients were also taking prasugrel. Optical coherence tomography (OCT) showed malapposed scaffold struts surrounded by thrombus in 7.1%, 9.0%, and 8.9% of struts in 3 cases. Scaffold discontinuity with struts in the lumen center was the cause of malapposition in 2 cases. Uncovered scaffold struts with superimposed thrombus were the predominant findings in 1 case. OCT percent area stenosis at the time of VLScT was high in 2 cases (71-75%) without evidence of excessive neointimal hyperplasia. Thrombus aspirate analysis showed persistence of intracoronary polymer fragments in 1 case (Raber L et al, J Am Coll Cardiol 2015;66:1901-1914)... (excerpt)