Articles of Interest: Cardiovascular Implantable Electronic Devices | Stress CMR with Prior Myocardial Infarction | Recategorization of Anti-inflammatory Drugs

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Abstract image of an artificial neural network creating a heart

Physician Training and Maintenance of Competency for Cardiovascular Implantable Electronic Device (CIED) Therapies

An article published by Yee et al in the Canadian Journal of Cardiology (CJOC) summarized the recent report by the Canadian Heart Rhythm Society (CHRS) Task Force on CIED Implant Training. The task force was established to create a common structure and content specifically for CIED training programs. The CHRS Task Force provided sixteen recommendations for 1) identifying candidates for training, 2) creation of training program curriculum and organization, and 3) ongoing maintenance of competence for CIED-implanting physicians. The intent is that these recommendations will result in improved patient care. If you’re interested in participating in or are currently involved in running a CIED Implantation Training program, you should review the recommendations so that you can better prepare yourself or other physicians for CIED practice. The CHRS Task force has done an excellent job preparing these recommendations to support for the next generation of CIED-implanting physicians.

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Prognostic Value of Vasodilator Stress Perfusion Cardiovascular Magnetic Resonance in Patients with Prior Myocardial Infarction

Cardiovascular MRI (CMR) can provide distinct advantages over other imaging modalities. For example, Pezel et al recently published an article in JACC: Cardiovascular Imaging demonstrating that stress CMR has independent and incremental prognostic value over traditional risk factors in patients with prior myocardial infarction.

Patients without inducible ischemia experienced a lower annual rate of MACE (3.1%) than those with 1–2 (4.9%), 3–5 (21.5%), or ≥6 segments of ischemia (45.7%) (all p < 0.01).

This study is another great example of the value of CMR, in this case, for predicting risk of MACE due to recurrent MI in this patient population.

Advocation for Recategorization of Non-Aspirin Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

This June, Bonnesen and Schmidt published an article in the Canadian Journal of Cardiology in which they advocate for the abandonment of current NSAID terminology, while proposing a new categorization system. To date, NSAIDs have been classified as either traditional NSAIDs or coxibs. Bonnesen and Schmidt suggest that the current classifications do not differentiate NSAIDs based on COX-2 selectivity. Since COX-2 selectivity is correlated with increased cardiovascular risk, the authors advocate to categorize all non-aspirin NSAIDs according to their relative COX-1 and COX-2 selectivity as either COX-1, COX-2, or non-selective inhibitors.

This is a valuable recommendation as the new classification has the potential to help avoid repetition of design flaws in past clinical studies where COX-2 selectivity of NSAIDs was not considered.

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