CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text].

BACKGROUND:Constrictive pericarditis is a chronic inflammatory process characterized by scarring, fibrosis, and calcification of the pericardium which often progresses to diastolic dysfunction, low cardiac output, and heart failure. CASE SUMMARY:We report a case of a 35-year-old man presenting with dyspnea, orthopnea, and edema for 9 months who was ultimately diagnosed with idiopathic constrictive pericarditis. He underwent successful pericardiectomy with relief of symptoms and volume overload. DISCUSSION:Constrictive pericarditis is a potentially curable form of heart failure with pericardiectomy. Diagnosis is confirmed by echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and invasive hemodynamic evaluation. The clinical diagnosis in this patient was delayed by discordant results from multimodality imaging. This report underscores the clinical challenge of making a diagnosis of a rare disease despite multimodality imaging. TAKE-HOME MESSAGE:In patients presenting with clinical symptoms of heart failure and preserved left ventricular ejection fraction, constrictive pericarditis is one of the potential etiologies.

CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text].

CLINICAL IMPACT RATINGS:GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text].

Ticagrelor is a platelet P2Y 12 receptor inhibitor approved for use in patients with acute coronary syndromes, coronary artery disease, and low‐moderate risk acute ischemic stroke or high‐risk transient ischemic attack. Clinical trials have evaluated the efficacy and safety of ticagrelor on ischemic and bleeding outcomes for different indications and with varying treatment approaches. As a result, there is a large body of clinical evidence demonstrating different degrees of net clinical benefit compared with other platelet inhibitor drugs based on indication, patient characteristics, clinical presentation, treatment duration, and other factors. We provide a review of the major trials of ticagrelor in the context of other randomized trials of clopidogrel and prasugrel to organize the volume of available information, elevate corroborating and conflicting data, and identify potential gaps as areas for further exploration of optimal antiplatelet treatment.

BACKGROUND In the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, the risk of ischemic events was similar in patients with stable coronary artery disease treated with an invasive (INV) strategy of angiography and percutaneous coronary intervention (PCI) or surgical (coronary artery bypass grafting [CABG]) coronary revascularization and a conservative (CON) strategy of initial medical therapy. OBJECTIVES The authors analyzed separately the outcomes of INV patients treated with PCI or CABG. METHODS Patients without preceding primary outcome events were categorized as INV-PCI or INV-CABG from the time of revascularization. The ISCHEMIA primary outcome (composite of cardiovascular death, protocol-defined myocardial infarction or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) was used. RESULTS Among INV-CABG patients, primary outcome events occurred in 84 of 512 (16.4%) at a median follow-up of 2.85 years; 48 events (57.1%) occurred within 30 days after CABG, including 40 procedural MIs. Among INV-PCI patients, primary outcome events occurred in 147 of 1,500 (9.8%) at median follow-up of 2.94 years; 31 of which (21.1%) occurred within 30 days after PCI, including 24 procedural MIs. In comparison, 352 of 2,591 CON patients (13.6%) had primary outcome events at a median follow-up of 3.2 years, 22 of which (6.3%) occurred within 30 days of randomization. The adjusted primary outcome risks were higher after both CABG and PCI within 30 days (HR: 16.25 [95% CI: 11.44-23.07] and HR: 2.99 [95% CI: 1.97-4.53]) and lower thereafter (0.63 [95% CI: 0.44-0.89] and 0.66 [95% CI: 0.53-0.82]). CONCLUSIONS In ISCHEMIA, early revascularization by PCI and CABG was associated with higher early risks and lower long-term risks of cardiovascular events compared with CON. The early risk was greatest after CABG, owing to protocol-defined procedural MIs. (c) 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Source Citation Roubille F, Bouabdallaoui N, Kouz S, et al. Low-dose colchicine in patients with type 2 diabetes and recent myocardial infarction in the COLchicine Cardiovascular Outcomes Trial (COLCOT). Diabetes Care. 2024;47:467-470. 38181203 Clinical Impact Ratings GIM/FP/GP: Cardiology: Endocrinology:

Dual antiplatelet therapy (DAPT) combines two antiplatelet agents to decrease the risk of thrombotic complications associated with atherosclerotic cardiovascular diseases. Emerging data about the duration of DAPT is being published continuously. New approaches are trying to balance the time, benefits, and risks for patients taking DAPT for established cardiovascular diseases. Short-term dual DAPT of 3–6 months, or even 1 month in high-bleeding risk patients, is equivalent in terms of efficacy and effectiveness compared to long-term DAPT for patients who experienced percutaneous coronary intervention in an acute coronary syndrome setting. Prolonged DAPT beyond 12 months reduces stent thrombosis, major adverse cardiovascular events, and myocardial infarction rates but increases bleeding risk. Extended DAPT does not significantly benefit stable coronary artery disease patients in reducing stroke, myocardial infarction, or cardiovascular death. Ticagrelor and aspirin reduce cardiovascular events in stable coronary artery disease with diabetes but carry a higher bleeding risk. Antiplatelet therapy duration in atrial fibrillation patients after percutaneous coronary intervention depends on individual characteristics and bleeding risk. Antiplatelet therapy is crucial for post-coronary artery bypass graft and transcatheter aortic valve implantation; Aspirin (ASA) monotherapy is preferred. Antiplatelet therapy duration in peripheral artery disease depends on the scenario. Adding vorapaxar and cilostazol may benefit secondary prevention and claudication, respectively. Carotid artery disease patients with transient ischemic attack or stroke benefit from antiplatelet therapy and combining ASA and clopidogrel is more effective than ASA alone. The optimal duration of DAPT after carotid artery stenting is uncertain. Resistance to ASA and clopidogrel poses an incremental risk of deleterious cardiovascular events and stroke. The selection and duration of antiplatelet therapy in patients with cardiovascular disease requires careful consideration of both efficacy and safety outcomes. The use of combination therapies may provide added benefits but should be weighed against the risk of bleeding. Further research and clinical trials are needed to optimize antiplatelet treatment in different patient populations and clinical scenarios.

Source Citation Gragnano F, Mehran R, Branca M; Single Versus Dual Antiplatelet Therapy (Sidney-2) Collaboration. P2Y12 inhibitor monotherapy or dual antiplatelet therapy after complex percutaneous coronary interventions. J Am Coll Cardiol. 2023;81:537-552. 36754514

As a result of increasing adoption of imaging screening, the number of adult patients with a diagnosis of anomalous aortic origin of the coronary arteries (AAOCA) has grown in recent years. Existing guidelines provide a framework for management and treatment, but patients with AAOCA present with a wide range of anomalies and symptoms that make general recommendations of limited applicability. In particular, a large spectrum of interventions can be used for treatment, and there is no consensus on the optimal approach to be used. In this paper, a multidisciplinary group of clinical and interventional cardiologists and cardiac surgeons performed a systematic review and critical evaluation of the available evidence on the interventional treatment of AAOCA in adult patients. Using a structured Delphi process, the group agreed on expert recommendations that are intended to complement existing clinical practice guidelines.

Question: In patients with chronic heart failure (HF) and preserved ejection fraction (pEF), does adding empagliflozin to usual therapy improve major HF outcomes? Design: Randomized placebo-controlled trial (EMPEROR-Preserved [Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction]). Blinding: Treatment allocation concealed; blinded (patients, investigators, other staff involved in trial conduct and analysis, and clinical event adjudication committee).* Setting: 622 centers in 23 countries. Patients: 5988 patients aged >= 18 years (mean age, 72 y; 55% men; 33% with left ventricular EF [LVEF] >= 60%; 49% with diabetes; mean estimated glomerular filtration rate, 61 mL/min/1.73 m(2)) who had chronic HF (New York Heart Association class II to IV), LVEF >40%, and N-terminal pro-Btype natriuretic peptide level >300 pg/mL (>900 pg/mL in patients with atrial fibrillation). Key exclusions: conditions that could affect patient safety or independently affect clinical course. Interventions: Empagliflozin, 10 mg/d (n = 2997), or placebo (n = 2991), added to usual therapy.

João Pedro Ferreira, MD, PhD; Faiez Zannad, MD, PhD; Javed Butler, MD, MPH; Gerasimos Filippatos, MD, PhD; Stuart J. Pocock, PhD; Martina Brueckmann, MD; Dominik Steubl, MD; Elke Schueler, MSc, Dipl-Math; Stefan D. Anker, MD, PhD; Milton Packer, MD