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Clinical Trials

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zms2187's version from 2017-01-18 18:50

Section

Question Answer
neprilysin inhibitor functionraises levels of bradykinin, natriuretic peptides and adrenomedullin
Function of ARBs/ACE inhibitors blocks formation of angio 2 and thus the stimulation of angio 2 receptors. Only ACEi reduce degradation of kinin
Entresto indicationsneprilysin inhibitor + ARB. 1) for pts w/EF <40%, stable disease, SBP >100, GFR >30 who have tolerated ACE therapy
PARADIGM Trialrandomized dbl blind trial in 8000 HFrEF patients showing that sacubitril/losartan (entresto) reduced CV mortality/hospitalizations compared to ACE alone (enalapril)
DANISH trialassess efficacy of ICD for prevention of mortality in NICM (ef <35%). 1000 pts on optimal medical therapy (ACE/ARB, bb, aldo blocker). ICD group had lower incidence SCD but no diff in all cause mortality except in pts <68yo. Overall results support use in younger pts, but maybe consider risks/benefits in elderly
Indications for ICD in ICM?EF <35% and NYHA Class II or III. OR EF <30% with NYHA Class I. Both cases should be 3 months post revascularization and on good meds
MADIT Ifirst trial to demonstrate ICD role in primary prevention of SCD in high-risk asx pts with hx of prior MI, NSVT on monitoring, EF <35%, inducible sustained VT on EPS also inducible after procaineamide
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NOACs

Question Answer
valvular dz, when to not use noacsmechanical valves, rheumatic heart disease/mitral stenosis, decompensated valvular dz requiring replacement in near future. large NOAC trials excluded these pts
anti-coagulation in pts with mitral stenosis ?don't use noacs (trials didn't include MS pts). Use warfarin for patients with afib (persistent, parox, or perm), hx embolic event, or LA thrombus
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