The Most Important Articles in Peripheral Arterial Disease (PAD)

The Most Important Articles in Peripheral Arterial Disease Below are what I believe to be the most important articles in peripheral arterial disease in mid-2015.  Each blue trial name is a link to the trial page.  In many cases where the journal article is open access, the link will open the full article.  Otherwise, a Pubmed or Abstract page will open.  Enjoy!   CAPRIE  (clopidogrel vs. aspirin) CHARISMA  (clopidogrel + aspirin) WAVE  (OAC vs. anti-plt) HOPE  (ramipril) VADT  (glucose control, strict vs conservative) ADVANCE  (glucose control) EDIC  (glucose control, DM type I) HPS  (simvastatin) CARP  (coronary revascularization timing vs. vascular surgery) EVAR  (AAA repair, EVAR) DREAM  (EVAR vs. surgical AAA repair)   Guidelines Peripheral Arterial Disease Guidelines   Disclaimer    © 2015 www.markmccauleymd.com.  All rights served.  ...

The Most Important Articles in Heart Failure (HF)

The Most Important Articles in Heart Failure Below are what I believe to be the most important articles in heart failure in mid-2015.  Most of the ICD trials are actually covered in the EP trials section.  Each trial is divided into categories, and each blue trial name is a link to the trial page.  In many cases where the journal article is open access, the link will open the full article.  Otherwise, a Pubmed or Abstract page will open.  Enjoy!   Beta Blockers CAPRICORN  (carvedilol) CIBIS-I, CIBIS-II  (bisoprolol) MERIT-HF  (metoprolol XL) US-CARVEDILOL BEST  (bucindolol) COPERNICUS  (carvedilol) COMET  (carvedilol vs. metoprolol) MOCHA  (carvedilol) SENIORS  (nevibolol) OPTIMIZE-HF  (beta blockers)   ACE Inhibitors HOPE  (ramipril) SOLVD  (enalapril) SAVE  (captopril) ATLAS  (lisinopril dosing) CONSENSUS  (enalapril) OPTIMAAL  (losartan vs. captopril) VALIANT  (valsartan, captopril)   Angiotensin Receptor Blockers CHARM, CHARM-ALTERNATIVE, CHARM-PEF  (candesartan) I-PRESERVE  (irbesartan, HFpEF) PEP-CHF  (perindopril) TOPCAT  (spironolactone, HFpEF) Aldo-DHF  (spironolactone, HFpEF) VALHEFT, A-HEFT ELITE-I, ELITE-II  (losartan)   Other Therapies SCD-HeFT  (amiodarone vs. ICD) ALLHAT  (thiazide diuretics & HTN) DIG  (digoxin) RALES  (spironolactone) EPHESUS  (eplerenone) EMPHASIS-HF  (eplerenone) TREAT  (darbapoietin-alpha) RED-HF  (darbapoietin-alpha) DOSE  (furosemide, bolus vs. continuous) ASCEND-HF  (nesiritide) REMATCH  (LVAD) RELAX WARCEF   Guidelines Heart Failure Guidelines   Disclaimer    © 2015 www.markmccauleymd.com.  All rights served.    ...

The Most Important Articles in Ischemic Heart Disease, Coronary Artery Disease, and Myocardial Infarction

The Most Important Articles in Ischemic Heart Disease, Coronary Artery Disease, and Myocardial Infarction (MI) Below are what I believe to be the most important articles in coronary heart disease in mid-2015.  Each trial is divided into categories, and each blue trial name is a link to the trial page.  In many cases where the journal article is open access, the link will open the full article.  Otherwise, a Pubmed or Abstract page will open.  Enjoy!   Coronary Artery Bypass Grafting (CABG) VA-CABG CASS STICH CARP    PCI COURAGE CARDia TACTICS/TIMI-18 TIMACS OAT APEX-AMI SIRIUS (sirolimus DES) TAXUS-IV (paclitaxel DES) REACT STREAM (rescue PCI) TRANSFER-AMI (rescue PCI) CARESS-IN-AMI BCIS-1 DEFER (FFR) FAME (FFR)   CABG vs. PCI BARI SYNTAX  FREEDOM SHOCK SHOCK-II   Medical/Adjunctive Therapy for Ischemia/Infarct HOPE (ramipril) BARI-2D OASIS-V (enoxaparin vs. fondaparinux) SYNERGY (enoxaparin vs. unfractionated heparin) TIMI-11b (enoxaparin vs. unfractionated heparin in UA/NSTEMI) Antiplatelet Trialists’ Intervention: High Risk  Low Risk CURRENT/OASIS-7 (aspirin & clopidogrel factorial) CURE (clopidogrel) TRITON/TIMI-38 (prasugrel vs. clopidogrel) TRILOGY-ACS (prasugrel vs. clopidogrel) PLATO (ticagrelor vs. clopidogrel) COGENT (clopidogrel/PPI) GRAVITAS (clopidogrel dosing) ACUITY (heparin+GPIIb/IIIa vs. bivalirudin+GPIIb/IIIa vs. bivalirudin) HORIZONS-AMI (bivalirudin) CAPTURE (abciximab) EARLY-ACS (eptifibatide) COMMIT (beta blocker, acute MI) POISE (toprol XL) DECREASE (bisoprolol, perioperative) TRIUMPH (tilarginine, shock) WOEST (clopidogrel without aspirin) CREDO (clopidogrel) GUSTO-1  GUSTO-3  (t-PA, streptokinase) GISSI-1  GISSI-2  (streptokinase, alteplase) ISIS-2 (streptokinase) INTIME-2 (lanoteplase) ASSENT-2 (tenecteplase vs. alteplase)   Cholesterol-Lowering Drugs and Outcome ARIC  / ARIC (rosuvastatin) JUPITER (rosuvastatin) PROVE-IT/TIMI-22 (pravastatin/atorvastatin) A-TO-Z (simvastatin)   Acute Pericarditis ICAP (colchicine) COPE (colchicine)   Scoring Systems in AMI GRACE Scoring System TIMI Risk Score UA/NSTEMI   Guidelines Unstable Angina / NSTEMI STEMI PCI  CABG Surgery Cholesterol     Disclaimer    © 2015 www.markmccauleymd.com.  All rights...

The Most Important Articles in Electrophysiology (EP)

The Most Important Articles in Electrophysiology (EP) Below are what I believe to be the most important articles in electrophysiology in mid-2015.  Each trial is divided into categories, and each blue trial name is a link to the trial page.  In many cases where the journal article is open access, the link will open the full article.  Otherwise, a Pubmed or Abstract page will open.  Enjoy!   Atrial Fibrillation AFFIRM RACE RACE-II STOP AF  ASSERT  Crystal AF EURIDIS And ADONIS PALLAS ATHENA AVERROES ARREST-AF CTAF SAFE-T DIONYSOS   Atrial Fibrillation – Stroke Prevention RE-LY  Aristotle  Rocket AF  PROTECT-AF CHADS-VASC ACTIVE-W / ACTIVE-A   Pacing and Implantable Cardioverter/Defibrillators (ICD) MADIT  MADIT-II MADIT-RIT DINAMIT IRIS SCD-HeFT OPTIC CABG-PATCH DAVID AVID CASH CIDS ISSUE-3   Cardiac Resynchronization Therapy (CRT) MADIT-CRT Miracle ICD Miracle ICD II RAFT MUSTIC COMPANION Block-HF RethinQ CARE-HF PROSPECT   EP Study Validation Trials MUSTT REVERSE ICD   Remote Cardiac Monitoring CHAMPION CARISMA TRUST   Heart Failure, Ventricular Tachycardia, and Mortality ANDROMEDA CAST SWORD Diamond-MI ALIVE GEISCA CHF-STAT EMIAT CAMIAT DIG   Syncope VPS-1 VPS-2   Guidelines AF Guidelines SVT Guidelines VT Guidelines Device-Based Therapy Guidelines ICD and CRT Guidelines European Syncope Guidelines   Disclaimer    © 2015 www.markmccauleymd.com.  All rights served.    ...

Aortic Valve Regurgitation (AR)

Aortic Regurgitation (AR) Acute Aortic Regurgitation Acute AR Symptoms: Acute tachycardia Acute dyspnea Acute AR Signs: Tachycardia Severe HF Sx: rales, edema Soft S1 Hypotension Diastolic murmur may be short or inaudible S3/S4 Acute Severe AR Treatment: Urgent surgical replacement (AVR) or repair Nitroprusside IV, Inotropes DO NOT use Intra-Aortic Balloon Pump (IABP) DO NOT use beta blockers or pressors     Chronic Aortic Regurgitation Chronic AR Symptoms: Prolonged asymptomatic stage, then dyspnea Chronic AR Signs: Loud decrescendo diastolic murmur at R upper sternal border (holodiastolic) +/- Austin Flint murmur Wide pulse pressure Bisferiens pulse Head nodding, capillary pulsations, pistol-shot femoral pulses, pulsatile uvula Chronic AR Etiology: Intrinsic valvular:  degenerative, calcification, bicuspid, rheumatic, connective tissue Dz, IE, myxomatous, anorectic drugs Ascending aorta:  degenerative, dissection, Marfan’s, Ehlers-Danlos, inflammatory/aortitis, giant cell arteritis A disease of LV volume and pressure overload Increased preload,  Increased afterload –> often large LV (cor bovinatum) EF is relatively unchanged with corrective surgery Echocardiography in Chronic AR: Signs of severe AR:  PHT < 200 msec, regurg vol > 60 mL,  regurg fraction > 55%, color jet > 60% LVOT Premature MV closure Flow reversal in the proximal descending thoracic aorta Treadmill in Chronic AR:  can do treadmill for estimation of exercise capacity, no need for LVEF changes Catheterization in Chronic AR: Do a cath if echo and Sx are discrepant LV pressure tracing shows gradual rise in diastole Wide pulse pressure Effacement of the dicrotic notch MRI If echo cannot diagnose AR severity, cardiac MRI (CMR) is the next modality Surgical Indications for Severe Chronic AR: Severe AR + any symptoms Severe AR + LVEF < 50%...