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A novel ultrasound technique may help prevent stroke after a heart attack. Also this week, homing in on ways to better treat idiopathic pulmonary arterial hypertension.
Echo Shows Unsafe Blood Clots After MI
Echocardiography can differentiate between old and fresh left ventricular thrombi after a myocardial infarction (MI), which may aid in clinical management, according to a pilot study in Circulation: Cardiovascular Imaging.
Using an ultrasound technique called strain rate, which measures tissue pliability in time, Frank Weidemann, MD, from the University of Wuerzburg in Germany, and colleagues, classified 17 thrombi as fresh (5 to 27 days) and 15 as old (4 to 26 months) in 32 MI patients.
After 6 months of treatment with the oral anticoagulant phenprocoumon, all but one of the fresh thrombi disappeared. The one that was left shrank by 50% and showed "old" thrombus strain-rate patterns. Also, 14 of the 15 old thrombi remained unchanged.
Most embolic events after MI occur within the first 4 months and echo is currently used to detect the presence of thrombi. But this new technique may be used to identify thrombus that will positively respond to therapy, researchers concluded.
Targeting the Endothelium in Pulmonary HTN
Obtaining a more localized vasodilator response with the use of acetylcholine and intravascular Doppler ultrasound in children with pulmonary arterial hypertension of unknown origin may be better at predicting future adverse outcomes.
In 43 children and adolescents with a mean age of 10, a cutoff value of less than 1.4 for pulmonary flow reserve was highly predictive of lung transplantation or death up to 5 years after the confirming catheter diagnosis of pulmonary arterial hypertension, reported Christian Apitz, MD, from the University of Giessen in Germany, and colleagues.
Some nonresponders to the more global vasoreactivity tests actually responded to acetylcholine, implying preserved endothelial function, which may have an impact on patient management, they wrote in the Journal of the American College of Cardiology.
Depression Not Linked to Afib
Although depression is associated with a risk of ventricular arrhythmias, it is unrelated to the risk of atrial fibrillation (Afib), a substudy of the Women's Health Study found.
Among more than 30,000 women without a history of cardiovascular disease or Afib, nearly 7% indicated significant global psychological distress, reported William Whang, MD, from Columbia University Medical Center in New York City, and colleagues.
However, the risk of Afib was not associated with psychological distress or depression, they concluded in the study published in the latest issue of the online Journal of the American Heart Association.
Interestingly, a post hoc analysis revealed that women who "felt happy some or a good bit of the time" had a reduced risk of Afib independent of items that measured negative affects.
Early Abuse Puts Middle-Age Heart at Risk
Women who were physically abused as children are at a greater risk of developing metabolic syndrome in mid-life, according to a study published in Health Psychology.
About 34% of the 342 women (113 black, 228 white, mean age 45) in the study reported experiencing some type of physical, emotional, or sexual abuse as a child or adolescent, reported Aimee Midei, MS, from the University of Pittsburgh, and colleagues.
When researchers adjusted for age at baseline, ethnicity, and menopausal status, they found that physical abuse put women at twice the risk of developing metabolic syndrome (HR 2.12, 95% CI 1.15 to 3.91, P=0.02), in particular a high waist circumference and a high fasting glucose. Emotional and sexual abuse were not significantly associated with incident metabolic syndrome, they said.
The link between physical abuse and metabolic syndrome persisted beyond traditional risk factors, suggesting physical abuse is a unique factor in women's cardiovascular health, they concluded.
Approval of Rivaroxaban for DVT, PE Moves Ahead
The FDA has given priority review to the oral anticoagulant rivaroxaban (Xarelto) for the treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), and the long-term prevention of recurrent DVT and PE.
The new drug application, filed by Janssen Research & Development on May 2, comes after the factor Xa inhibitor demonstrated safety and efficacy for these indications in a series of studies in the EINSTEIN program, Janssen said in a statement.
Janssen also announced the withdrawal of its new drug application for the use of rivaroxaban to reduce the risk of stent thrombosis in patients with acute coronary syndrome (ACS). The company did so because this new drug application is contingent on a separate new drug application for rivaroxaban to reduce of the risk of secondary cardiovascular events in patients with ACS, which the FDA last month declined to approve.