The potential for improving cardio-renal outcomes in chronic kidney disease with the aldosterone synthase inhibitor vicadrostat (BI 690517): a rationale for the EASi-KIDNEY trial.

Patients with chronic kidney disease (CKD) are at risk of progressive loss of kidney function, heart failure, and cardiovascular death despite current proven therapies, including renin-angiotensin system inhibitors (RASi), sodium glucose co-transporter-2 inhibitors (SGLT2i), and statin-based regimens. RASi and SGLT2i reduce risk of CKD progression irrespective of primary cause of kidney disease, suggesting they target final common pathways. Targeting aldosterone overactivity with a nonsteroidal mineralocorticoid receptor antagonist (MRA) also reduces cardiorenal risk in patients with albuminuric diabetic kidney disease already treated with RASi.

Efficacy and safety of aldosterone synthase inhibition with and without empagliflozin for chronic kidney disease: a randomised, controlled, phase 2 trial.

Background: Excess aldosterone accelerates chronic kidney disease progression. This phase 2 clinical trial assessed BI 690517, an aldosterone synthase inhibitor, for efficacy, safety, and dose selection.

Methods: This was a multinational, randomised, controlled, phase 2 trial.

Complete heart block is a significant predictor of mortality in immune checkpoint inhibitor myocarditis.

Background: Immune checkpoint inhibitor (ICI) myocarditis is associated with significant mortality risk. Electrocardiogram (ECG) changes in ICI myocarditis have strong prognostic value. However the impact of complete heart block (CHB) is not well defined.

Rechallenge With Switching Immune Checkpoint Inhibitors Following Autoimmune Myocarditis in a Patient With Lynch Syndrome.

Immune checkpoint inhibitors (ICIs) induce profound benefits in cancer patients with mismatch repair gene mutations or high levels of microsatellite instability. Herein, we present a case of a patient with history of Muir-Torre/Lynch syndrome and metastatic gastric adenocarcinoma in the presence of an MSH2 gene mutation. The patient was initially treated with a PD-1 inhibitor, pembrolizumab, but developed grade 4 myocarditis requiring treatment with infliximab and a prolonged steroid taper.

Warfarin Dosing in Patients With CYP2C9*5 Variant Alleles.

Pharmacogenetic dosing improves the accuracy of warfarin dosing, but current pharmacogenetic dosing algorithms are less accurate in populations of African ancestry. The cytochrome P450 2C9*5 (CYP2C9*5) allele is found almost exclusively in populations of African ancestry, and in vitro studies suggest CYP2C9*5 is associated with reduced clearance of warfarin. The clinical relevance of this single-nucleotide variation (SNV) (formerly SNP) is uncertain.

Peripartum Cardiomyopathy: a Review for the Clinician.

Purpose Of Review: This review summarizes the pathophysiology, diagnosis, and treatment of peripartum cardiomyopathy (PPCM), with a focus on recent discoveries of clinical relevance.

Recent Findings: An increase in oxidative stress and anti-angiogenic activity play key roles in the pathophysiology of peripartum cardiomyopathy. Therapies that target this dysregulation may have a future role in treatment.

The Role of Imaging with Cardiac Computed Tomography in Cardio-Oncology Patients.

Cardiovascular diseases and cancer represent the two most common causes of morbidity and mortality in industrialized countries. With the increase in long-term survival of cancer patients, cardiovascular diseases are the leading cause of mortality for many cancer survivors. In this article, we will review the most common cardiovascular toxicities of cancer therapies and will describe the role of cardiac CT in the detection and monitoring of cardiovascular disease.

Role of Computed Tomography in Assessment of the Thoracic Aorta.

Thoracic aortic disease is increasing in prevalence and can result in serious morbidity and mortality. Computed tomography (CT) angiography is an important imaging modality for assessment of thoracic aortic pathology due to wide availability, rapid acquisition, reproducibility, superior spatial and temporal resolution, and capability for 3D image post-processing. CT is the preferred imaging modality in the acute setting to rapidly identify patients with acute aortic syndromes including dissection, intramural hematoma, and penetrating aortic ulcer.

Myopericarditis in a pregnant woman with acute promyelocytic leukemia.

Acute promyelocytic leukemia (APL) is a form of acute leukemia with a characteristic translocation, t(15;17), and is considered a hematologic emergency, typically treated with all-trans retinoic acid and an anthracycline. We present the case of a young, gravid woman who was diagnosed with APL in the third trimester, initiated typical treatment, and suffered uncommon cardiac complications. < Myopericarditis is not a side effect often encountered in the management of acute promyelocytic leukemia with alpha t-retinoic acid, and its mechanism is incompletely understood but possibly related to the differentiation syndrome.

Cost-effectiveness of dabigatran for stroke prophylaxis in atrial fibrillation.

Background: Recent studies have investigated alternatives to warfarin for stroke prophylaxis in patients with atrial fibrillation (AF), but whether these alternatives are cost-effective is unknown.

Methods And Results: On the basis of the results from Randomized Evaluation of Long Term Anticoagulation Therapy (RE-LY) and other trials, we developed a decision-analysis model to compare the cost and quality-adjusted survival of various antithrombotic therapies. We ran our Markov model in a hypothetical cohort of 70-year-old patients with AF using a cost-effectiveness threshold of $50 000/quality-adjusted life-year.