Benralizumab improves outcomes in severe eosinophilic asthma patients regardless of smoking history, with former smokers achieving similar benefits in exacerbation reduction, oral corticosteroid sparing, asthma control and lung function to never-smokers https://bit.ly/4grFy7e.
BACKGROUND:Device-detected subclinical atrial fibrillation (DDAF) is a significant risk factor for major cardiovascular events, especially in implantable cardioverter-defibrillator (ICD) recipients. The DX ICD, which utilizes a single ventricular lead with a floating atrial dipole, has demonstrated superior performance in diagnosing DDAF compared to conventional single-lead ICDs. However, comparisons between DX and dual-chamber (DDD) ICDs for atrial monitoring are limited. OBJECTIVE:To compare the incidence of newly detected DDAF in patients without an indication for atrial pacing who received either a DX or a standard DDD ICD. METHODS:Remote transmissions from the Italian Home Monitoring Expert Alliance dataset were analyzed. DDAF incidence for different burden cutoffs ( ≥ 15 min, ≥ 6 h, and ≥ 24 h) was compared between groups using propensity score (PS) matching to adjust for baseline characteristics. RESULTS:In a cohort of 1329 patients (527 with DX ICD and 802 with DDD ICD), 30.7% experienced DDAF lasting ≥ 15 min, 22.3% ≥ 6 h, and 14.0% ≥ 24 h during a median follow-up of 4.5 years. DDAF incidence was lower in the DX ICD group for all burden cutoffs (p < 0.0001). However, after PS matching, DDAF rates were similar between groups, with no significant differences (p ≥ 0.36). Multivariate analysis identified age and 1-month right ventricular pacing percentage as predictors of DDAF across all burden cutoffs, with no effect based on device type or programmed basic rate. CONCLUSION:In patients without atrial pacing indication or history of clinical atrial fibrillation at implantation, the DX ICD demonstrated DDAF detection capabilities comparable to DDD ICDs in a real-world setting.
As transcatheter aortic valve replacement (TAVR) is now performed in patients with longer life expectancy, the need for coronary access (CA) after TAVR is expected to rise. The aim of this study was to evaluate the feasibility of CA after TAVR with 4 different types of transcatheter heart valves (THVs). In the multicenter, prospective CAvEAT (Coronary Access After TAVI; NCT04647864) registry, coronary angiography was performed immediately following transfemoral TAVR using short-frame SAPIEN 3 or SAPIEN 3 Ultra (SAPIEN 3/Ultra) and tall-frame ACURATE neo or ACURATE neo2 (ACURATE neo/neo2), Portico or Navitor, and Evolut Pro or Evolut Pro+ (Evolut Pro/Pro+) THVs. The primary endpoint was defined as selective CA of both coronary arteries. In total, 632 patients were enrolled (mean age 82 years, 59% women). Selective CA of both coronary arteries was achieved in 89% of SAPIEN 3/Ultra, 63% of ACURATE neo/neo2, 62% of Portico or Navitor, and 45% of Evolut Pro/Pro+ THVs (P < 0.001). Unfeasible CA of at least 1 coronary artery occurred in 2%, 6%, 6%, and 9% of cases, respectively (P = 0.06). In pairwise comparisons, the incidence of the primary endpoint was significantly higher for the SAPIEN 3/Ultra compared with all tall-frame THVs (P < 0.001). Among tall-frame devices, no significant difference was observed between the ACURATE neo/neo2 and the Portico or Navitor (P = 0.9), but both devices demonstrated higher rates of the primary endpoint than the Evolut Pro/Pro+ (P = 0.005 and P = 0.002, respectively). Multivariate analysis identified implantation depth, moderate or severe commissural misalignment, and use of a tall-frame THV as independent predictors of unfeasible or nonselective CA. The short-frame SAPIEN 3/Ultra THV demonstrated the highest rate of selective CA following TAVR. Among tall-frame THVs, the large-cell designs of the Portico or Navitor and ACURATE neo/neo2 outperformed the closed-cell Evolut Pro/Pro+ in terms of selective CA.
