PRINT | DIGITAL 2021 NEJM Group Effective January 1, 2021 U.S. Media Kit Revised February 3, 2021 Clinical June | Vol. 23 No. 6 CARDIOLOGY 2014; 63:2438), knowledge has rapidly pro- • Transcatheter aortic valve replacement Oncology GUIDELINE WATCH gressed regarding the natural history of (TAVR) has received a Class I (strong) VHD; new medications have been ap- recommendation along with surgery Focused Update proved, such as the direct-acting oral anti- for patients with severe and symptom- on Management of coagulants (DOACs); and transcatheter atic aortic stenosis (AS) at high risk Valvular Heart Disease therapies have advanced. This progress for surgery and a Class IIa recommen- These guidelines touch upon infective has prompted this focused update. dation for those at intermediate risk. Update endocarditis, treatment of aortic stenosis Treatment decisions depend on indi- from NEJM Group Key Points and of primary and secondary mitral vidual patients’ risks, values, and • The Class IIa (moderate recommenda- regurgitation, and direct-acting oral preferences. tion) guideline that antibiotic prophy- anticoagulants, among other topics. laxis before dental procedures is rea- • For primary or degenerative severe Sponsoring Organizations: American sonable for patients at increased risk mitral regurgitation (MR), surgery is Heart Association and American College for infective endocarditis has now been now considered reasonable (Class IIa) of Cardiology extended to patients with transcatheter in asymptomatic patients even with Target Audience: Primary care providers prosthetic valves. ejection fraction >60% and left ven- tricular end-systolic diameter <40 mm and cardiologists (both general and sub- • DOACs are now considered reasonable if adverse progression on serial imag- specialists) who treat patients with alternatives (Class IIa) to vitamin K ing studies is evident. valvular heart disease (VHD) antagonists (VKAs) for patients • In chronic secondary (functional) Target Population: Adults with VHD with VHD and atrial fibrillation ≥ MR, chordal-sparing mitral valve re- (CHA2DS2-VASc score, 2), although Background and Objective VKAs are specifically preferred for placement is a reasonable alternative Since the 2014 publication of the last patients with mitral stenosis, who to downsized annuloplasty repair comprehensive guideline on VHD (NEJM were excluded from DOAC trials. (Class IIa). JW Cardiol Jun 2014 and J Am Coll Cardiol • The age limit for considering a me- chanical prosthesis is lowered from CONTENTS 60 to 50 (Class IIa), unless anticoagu- lation is not desired, cannot be moni- SUMMARY & COMMENT Nutrition Recommendations for a tored, or is contraindicated. ■ Endoscopic ■ The 2020 ■ Risks and Benefits ■TAVRBrachytherapy in Bicuspid vs. Tricuspid forAortic Stenosis..... 42 Healthier Heart: Getting Patients on Board ...... 45 • New data on leaflet thrombus with Management of Gastrointestinal of Breast Cancer ShouldIntermediate-Risk Non–Infarct-Related Coronary Arteries Coffee, Tea, and the Heart ....................................... 46 Also Be Revascularized After STEMI? .............. 43 Suboptimal Diet Is Associated with Excess surgical and TAVR prostheses have Lynch Syndrome Cancers Screening LargeProstate-Bore Catheters, Cancer Large Bleeding Risks...... 43 Mortality from Cardiometabolic Diseases ........ 47 prompted new anticoagulation guide- Symposium Reduced Leaflet Motion with Bioprosthetic Mixed News on Mortality lines. VKA is reasonable for ≤6 months Aortic Valves: More Details ................................. 43 for Diabetes Patients ............................................. 47 after surgical mitral and aortic valve re- Dual Antithrombotic vs. Dual Antiplatelet Hemodynamic Support After Cardiac Surgery: placement in patients at low bleeding Strategy After ACS ................................................. 44 Levosimendan Strikes Out Again ........................ 48 risk (Class IIa) and ≥3 months after Statin Use, and Possible Statin Intolerance, GUIDELINE WATCH TAVR (Class IIb; weak recommenda- After Acute MI ........................................................ 44 2017 Focused Update on Management Comparison of Two Guidelines on Statins of Valvular Heart Disease ..................................... 41 tion). Initial therapy with VKA is rea- for Primary CVD Prevention ...................................... 45 New Guidelines for the Evaluation of Adults sonable (a new Class IIa guideline) in More Evidence That Excessive Blood Pressure and Children with Suspected Syncope ............. 46 patients with suspected or confirmed Lowering Can Heighten Cardiovascular Risk ... 45 bioprosthetic valve thrombosis who are hemodynamically stable. EDITORIALLY INDEPENDENT LITERATURE SURVEILLANCE FROM NEJM GROUP Trusted. Relevant. Impactful. 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