Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Feb 2019
Meta AnalysisLeft Ventricular Unloading During Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a widely used form of mechanical circulatory support in patients with refractory cardiogenic shock. A common drawback of this modality is a resultant increase in left ventricular afterload. ⋯ In observational studies, left ventricular unloading was associated with decreased mortality in adult patients with cardiogenic shock treated with VA-ECMO. In the absence of prospective randomized data, left ventricular unloading may be considered for appropriately selected patients undergoing VA-ECMO support.
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J. Am. Coll. Cardiol. · Feb 2019
ReviewAtrial Fibrillation and Cognitive Function: JACC Review Topic of the Week.
Numerous vascular risk factors and vascular diseases contribute to cognitive impairment and dementia. Many studies and registries show an association of atrial fibrillation (AF) with cognitive impairment, cognitive decline, and dementia. This is true for vascular dementia and Alzheimer's disease. ⋯ A number of retrospective observational and prospective studies support that anticoagulation in patients with AF may reduce the risk of cognitive decline and dementia. This holds for both vitamin K antagonists (e.g., warfarin) and direct oral anticoagulants. However, it still remains unproven if anticoagulation reduces cognitive decline and dementia in AF patients based on randomized trials.
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J. Am. Coll. Cardiol. · Feb 2019
Randomized Controlled TrialDurability of Transcatheter and Surgical Bioprosthetic Aortic Valves in Patients at Lower Surgical Risk.
Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis and intermediate or high surgical risk. ⋯ In the NOTION trial through 6 years, SVD was significantly greater for SAVR than TAVR, whereas BVF was low and similar for both groups. Longer-term follow-up of randomized clinical trials will be necessary to confirm these findings. (Nordic Aortic Valve Intervention Trial; NCT01057173).
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J. Am. Coll. Cardiol. · Feb 2019
Meta Analysis Comparative StudyImpact of Chronic Kidney Disease on Outcomes of Myocardial Revascularization in Patients With Diabetes.
The optimal coronary revascularization strategy in patients with stable ischemic heart disease (SIHD) who have type 2 diabetes (T2DM) and chronic kidney disease (CKD) remains unclear. ⋯ Among SIHD patients with T2DM and no CKD, CABG + OMT significantly reduced MACCE compared with PCI + OMT. In subjects with CKD, there was a nonsignificant trend toward a better MACCE outcome with CABG and a significant reduction in subsequent revascularization.