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Notebook

Antithrombotics in vascular disease and renal dysfunction

Journal of the American College of Cardiology

This analysis evaluated whether the benefits of rivaroxaban 2.5 mg bd plus aspirin, comparedwith aspirin alone, are maintained in vascular patients who also have renal dysfunction.

Notebook

Fracassi F, Crea F, et al.

Volume 73, Issue 18, May 2019

This study examined the prevalence,morphological features, and significance ofhealed plaques at the culprit site in patients withacute coronary syndromes usingoptical coherence tomography.

Notebook

Mavacamten for HOCM- Data from EXPLORER-HCM trial

Hypertrophic cardiomyopathy is as much an anatomical disease as it is a physiological one. The distinction made lately between patients with this condition as either obstructive or non obstructive is solely physiological and not anatomical. This is the aspect of HCM which has been the focus of research as to how & why the muscle physiology is altered & how it can be utilised to engineer specifically directed therapies. Presently employed medications for obstructive hypertrophic cardiomyopathy focus on symptomatic relief with β blockers, non-dihydro¬ pyridine calcium channel blockers, and disopyramide. Whilst they may offer some benefits symptomatically but they fail to generate any meaningful impact on the disease course. The other modality utilised is the surgical/ Invasive septal reduction therapy, including surgical septal myectomy and alcohol septal ablation, which is limited by its invasiveness, its heavy dependance on specialised expertise & also the associated risk in the short & long term. A new agent Mavacamten which is a first- ¬in - ¬class, selective allosteric inhibitor of cardiac myosin ATPase specifically developed to target the underlying pathophysiology of hypertrophic cardiomyopathy by reducing actin–myosin cross¬bridge formation, which in turn reduces contractility and improves myocardial energetics is being explored for clinical use. By targeting the physiologic abnormality involved in the disease process it promises to create a significant impact in the management of HOCM.

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