Heart pearls! » Recent cardiology trials

Recent cardiology trials- questions

Dr Jayachandran Thejus MD — Sun, 01 Nov 2009 14:40:19 +0000

The recent study which showed that erythropoietin stimulating agents do not reduce cardiac (or renal) events in diabetic nephropathy patients with anemia-
- TREAT.
The prostacyclin analog which has been recently shown to prevent contrast induced nephropathy in renal insufficiency patients undergoing coronary angiography or intervention-
- Iloprost.
The glucagon-like peptide-1 (GLP-1) which was recently shown to decrease obesity in non-diabetics also-
- Liraglutide.
The recent study which showed that ICDs do not reduce total mortality in early MI with low ejection fraction or other high risk criteria (similar results as in the DINAMIT trial)-
- IRIS.
The recent study which showed that empirical antiarrhythmic drug therapy after ablation therapy for paroxysmal AF reduces clinically significant atrial arrhythmias-
- 5A study.
The selective endothelin-receptor antagonist which was recently shown to be effective in treatment-resistant hypertension-
- Darusentan.
The recent trial which showed endovascular repair of abdominal aortic aneurysms, when compared with surgical repair, has lower perioperative mortality and similar mid-term (2 yr) mortality-
- OVER.

CASPER registry

Dr Jayachandran Thejus MD — Sun, 26 Jul 2009 08:03:51 +0000

Patients resuscitated from sudden cardiac arrest having normal ECG, echo and coronary angiogram.
Further evaluated by cardiac MRI, SAECG, exercise testing and provocative drug testing with adrenaline and procainamide. Selected patients underwent EP study and genetic studies.
Out of 68 patients who were evaluated, in 35 cases (56%) a cause could be found out.
The commonest cause found was LQTS.
Other causes in descending order – CPVT, ARVC, early repolarization, coronary spasm, Brugada syndrome and myocarditis.
The test with maximum yield was provocative drug testing. This led to diagnoses of LQTS, CPVT or ARVC.
Thus further evaluation by these tests can identify the cause of sudden cardiac arrest in around half of cases with normal ECG, echo and CAG.
Circulation 2009;120:278-285.

TRANSCEND trial

Dr Jayachandran Thejus MD — Sat, 25 Jul 2009 11:05:48 +0000

Telmisartan 80 mg daily vs placebo.
Population- ACE inhibitor intolerant patients with either
- Coronary artery, cerebrovascular or peripheral vascular disease or
- Diabetes with end organ damage.
Primary endpoint of cardiovascular death, MI, stroke, or hospitalization for heart failure did not decrease.
Lower incidence of MI + stroke + cardiovascular death (same combination as in HOPE).
Lower incidence of myocardial infarction.
Did not reduce heart failure.
Lancet2008;372:1174-83.

CARDIA study

Dr Jayachandran Thejus MD — Tue, 21 Jul 2009 11:13:50 +0000

Subjects of age 18 to 30 years were followed up for 20 years
Patients who actively commuted to work (walking, cycling) were compared with those who did not.
Those who actively commuted had lower BP, BMI, obesity, triglyceride level and insulin level.
Arch Intern Med 2009;169:1216-1223.

TRANSFER-AMI trial

Dr Jayachandran Thejus MD — Sun, 19 Jul 2009 10:29:41 +0000

STEMI patients given tenecteplase- routine PCI within 6 hours (pharmacoinvasive approach) vs standard therapy (rescue PCI if chest pain, poor ST resolution or hemodynamic instability)
At 30 day follow-up, the primary endpoint of death, heart failure, myocardial infarction, recurrent ischemia or shock occurred in 11% of pharmacoinvasive group vs in 17% of standard therapy group.
Major bleeding was same in both groups.
Suggests that if patient presents to a hospital without facility for PCI, give thrombolytic therapy and shift to a hospital with PCI facility for immediate coronary angiography with intention to do PCI.
N Engl J Med 2009;360:2705-18

STAR trial

Dr Jayachandran Thejus MD — Sun, 19 Jul 2009 09:35:19 +0000

In patients with renal artery stenosis and renal insufficiency- stenting vs medical therapy
2 year follow-up
Stenting was not superior to medical therapy in preserving creatinine clearance
Same results for unilateral and bilateral renal artery stenosis
Similar studies- ASTRAL, CORAL(ongoing)
Ann Intern Med2009;150:840-8.

TIMIC trial

Dr Jayachandran Thejus MD — Sun, 19 Jul 2009 02:08:03 +0000

Tailored Immunosuppression in Inflammatory Cardiomyopathy
Prednisolone and azathioprine given to adults with virus negative inflammatory cardiomyopathy for 6 months
Increased LV ejection fraction
EMB showed marked improvement in inflammation
Minor side effects like weight gain and increased blood glucose in the treatment arm
Eur Heart J 2009;Jun 25:[Epub ahead of print]

FAMOUS trial

Dr Jayachandran Thejus MD — Sun, 19 Jul 2009 01:44:22 +0000

Famotidine 20 mg bid vs placebo in patients taking low dose aspirin
Endoscopy in the beginning and after 12 weeks
Less gastric ulcer, duodenal ulcer and erosive esophagitis in the famotidine group.
Similar trial- ASTERIX trial- omeprazole 20 mg daily reduced peptic ulcers in patients taking aspirin.
Lancet 2009;374:119-25.

ATHEROMA trial

Dr Jayachandran Thejus MD — Thu, 11 Jun 2009 17:30:20 +0000

This trial aimed to find whether higher doses of statins produce additional decrease in inflammatory activity in plaques.

Atorvastatin 10 mg/day VS 80mg/day was studied. The effect on carotid plaques was studied. Macrophage activity in these plaques was studied by USPIO enhanced T2 MRI. (USPIO stands for serial ultra-small super-paramagnetic iron oxide.)

It was found that 80 mg/day atorvastatin decreases macrophage activity in plaques while 10 mg/day does not.

Thus high dose of statin decreases inflammation in plaques while low dose does not.

You can read more in JACC (2009;53:2039-50.)

PHIRST trial

Dr Jayachandran Thejus MD — Wed, 10 Jun 2009 17:51:06 +0000

Sildenafil is useful in pulmonary hypertension. But it has to be given thrice daily. Tadalafil is also a phosphodiesterase 5 inhibitor and it can be given once daily.

This trial meant to find whether tadalafil would be beneficial in pulmonary hypertension. It found that tadalafil reduces pulmonary artery pressure and pulmonary vascular resistance. Also, there is an increase in exercise tolerance. It also decreased the chance of clinical worsening. But there was no decrease in mortality or in subjective dyspnoea scores.

Even in patients on bosentan, these beneficial effects of tadalafil were seen, though to a lesser degree.

The dose of tadalafil used in the study was 40 mg daily.

This trial formed the basis of FDA approval of tadalafil 40 mg daily for pulmonary hypertension.