SMOKING IS A STRONG INDEPENDENT PREDICTOR FOR FUNCTIONAL SIGNIFICANCE OF INTERMEDIATE CORONARY LESIONS

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Carcinoid heart disease: current understanding and future directions.

Carcinoid tumors are rare and aggressive malignancies. A multitude of vasoactive agents are central to the systemic effects of these tumors. The additional burden of cardiac dysfunction heralds a steep decline in quality of life and survival. Unfortunately, by the time carcinoid syndrome surfaces clinically, the likelihood of cardiac involvement is 50%. Although medical therapies such as somatostatin analogues may provide some symptom relief, they offer no mortality benefit. On the other hand, referral to surgery following early detection has shown increased survival. The prompt recognition of this disease is therefore of the utmost importance

The impact of proprotein convertase subtilisin-kexin type 9 serine protease inhibitors on lipid levels and outcomes in patients with primary hypercholesterolaemia. A network meta-analysis

AIMS: We performed a network meta-analysis of randomized controlled trials (RCTs) in patients with primary hypercholesterolaemia to compare the impact of proprotein convertase subtilisin-kexin type 9 serine protease (PCSK9) inhibitors with placebo and ezetimibe on lipid levels and outcomes. METHODS AND RESULTS: MEDLINE/PubMed, Cochrane CENTRAL, and ClinicalTrials.gov were searched for RCTs assessing PCSK9 inhibitors vs. other therapies in patients with primary hypercholesterolaemia. Network meta-analysis with both a frequentist approach and a Bayesian framework was performed to directly and indirectly compare PCSK9 inhibition on lipid levels with ezetimibe and placebo. Odds ratios with 95% confidence intervals (OR [95% CIs]) were generated with random-effects models to compare outcomes. Our meta-analysis included 17 RCTs with 13 083 patients that were randomized to PCSK9 inhibitors (n = 8250), placebo (n = 3957), ezetimibe (n = 846), or PCSK9 inhibitors and ezetimibe (n = 30). The mean age was 59 ± 10, 52% were male, 34% had coronary artery disease, 51% had hypertension, 19% had diabetes mellitus, baseline LDL of 122 ± 36 mg/dL, total cholesterol of 199 ± 39 mg/dL, and HDL of 51 ± 14 mg/dL. inhibitors significantly reduced LDL cholesterol by 57% relative to placebo (P < 0.001) and 36.1% relative to ezetimibe (P < 0.001). Proprotein convertase subtilisin-kexin type 9 serine protease inhibitors reduced the incidence of all-cause mortality [OR 0.43 (95% CI 0.22-0.82), P = 0.01] but was associated with an increased incidence of neurocognitive adverse events [OR 2.34 (95% CI 1.11-4.93), I(2) = 4%, P = 0.02] when compared with placebo. CONCLUSION: Proprotein convertase subtilisin-kexin type 9 serine protease inhibition significantly improved lipid profiles and reduced the incidence of all-cause mortality compared with placebo but had a higher rate of neurocognitive adverse events. Thus, PCSK9 inhibitor therapy may serve as an alternative for patients with statin intolerance and for those who do not respond to other lipid reduction therapy

The impact of diabetes mellitus on outcome of patients undergoing transcatheter aortic valve replacement

Background: The outcomes of patients with diabetes mellitus (DM) who are referred to surgical aortic valve replacement are poor in comparison to non-diabetic (ND) patients. However, the outcome of diabetic patients referred to transcatheter aortic valve replacement (TAVR) is less established. Further, DM and AS are both associated with left ventricular hypertrophy. It is not clear if alleviation of AS results in greater degree of reverse remodeling in DM patients in comparison to ND. We aim to evaluate if diabetes mellitus has an impact on TAVR outcome and remodeling patterns. Methods: All consecutive patients who underwent TAVR (2007–2012) were included in this analysis. A comparison of baseline, procedural, post-procedural outcomes and echocardiographic left-ventricle mass indices was performed between DM and ND patients. Results: DM was prevalent in 165 of 499 (33.0%) consecutive patients who underwent TAVR. DM patients were younger, weighed more, had higher rates of renal insufficiency and larger caliber peripheral vessels. Other than that, no disparities were noted in baseline characteristics. Procedural aspects were mostly similar between the groups but ND patients had higher rates of both vascular complications and bleeding. This did not translate into statistically significant differences in mortality both at 30 days and at 1 year (DM 6.7% vs. ND 10.5%; p = 0.16 and DM 22.4% vs. 25.7%; p = 0.48, respectively). Incidences of reverse remodeling patterns were similar between the two groups. Conclusion: TAVR outcome is probably driven by baseline characteristics and post-operative complications while diabetes itself is not associated with poor outcome after TAVR