August 2020 News Roundup

Cath Lab Dispatch is TCTMD’s monthly roundup of recent news tidbits from journals and medical meetings around the globe.

An article in Structural Heart details the 5-year experience of a nurse-led sedation program in TAVR patients. Compared with anesthesia-led sedation, patients in the nurse-led protocol had similar procedural outcomes, with shorter procedure-room time and lower contrast volume.

In patients with stable CAD and objective evidence of moderate-to-severe ischemia at baseline, PCI added to medical therapy does not reduce all-cause death, CV death, or MI compared with guideline-directed medical therapy alone, according to the results of a meta-analysis published in the American Journal of Cardiology.

Dapagliflozin demonstrated nearly identical CV benefits and safety in patients with HF with reduced ejection fraction (HFrEF) whether they were or were not taking sacubitril/valsartan at baseline, according to results from the DAPA-HF study published in JACC: Heart Failure.

After hospital discharge for an aortic syndrome (ie, aortic dissection, intramural hematoma, or penetrating aortic ulcer), about two-thirds of patients will be readmitted at least once for an aortic- or CV-related event, a study in the Journal of Vascular Surgery concludes. The researchers say the findings “may suggest the need for early follow-up focused on aortic complications while later follow-up should address cardiovascular events.”

For most patients with cardiovascular implantable electronic devices (CIEDs), the use of iPhones and smart watches like Apple Watch are safe, according to a study published in JACC: Clinical Electrophysiology. Among 148 patients, only one instance was identified where an iPhone 6 in close proximity to an implanted device caused documented telemetry interferences. Find TCTMD’s full story here.

From JACC: Cardiovascular Interventions, a state-of-the-art review discusses modalities for functional coronary assessment before, during, and after PCI, as well as what the future may look like when integrating coronary physiology assessments as a means of stratifying patients with a history of angina symptoms.

A large analysis of patients with leukemia undergoing PCI demonstrates increased risk of procedure‐related complications. An accompanying editorial in Catheterization and Cardiovascular Interventions notes that experienced cath lab teams are key to keeping complication rates low for these vulnerable patients.

Preoperative inspiratory muscle weakness is present in approximately 25% of patients undergoing CABG or other elective cardiac surgeries, according to a study published in Heart & Lung. The authors say adequately powered studies are needed to determine whether this muscle weakness is related to increased risk of postoperative pulmonary complications, and to clarify the role that obesity might play in this relationship.

COVID-19

In JACC: Case Reports, operators in France describe performing PCI in the prone position in a COVID-19 patient with acute respiratory distress syndrome and anteroseptal ST-segment elevation with acute systolic dysfunction.

More data from New York City during the peak of the COVID-19 pandemic there suggest a relationship between the virus and emergent large vessel occlusion (ELVO). In a study published in Stroke, researchers found that more than half of patients with ELVO presenting from mid-March to mid-April 2020 tested positive for COVID-19, which they say is significantly higher than the 19.9% infection rate noted in the general population in that area over the same time.

An expert analysis published on ACC.org describes how venovenous or venoarterial extracorporeal membrane oxygenation can be used in patients with cardiopulmonary failure related to COVID-19.

An editorial published in the Journal of Cardiovascular Nursing urges nurses and nurse scientists to mobilize to improve health and ease suffering despite the uncertainty and turbulence affecting both patients and healthcare providers during the pandemic.

The current literature contains very little information on the effects of prolonged quarantine on CV health, or on the efficacy of remotely delivering advice and support to patients with CV disease according to research published in the European Journal of Cardiovascular Nursing. “Urgent research is required during this crisis, and systems must be developed and supported that enable staff to upskill and allow long-term follow-up of people with CVD who have experienced quarantine, social isolation, or social distancing,” the authors write.