Cardiology Question Bank

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1. All of the following long-term outcomes are superior in middleaged patients who undergo isolated AVR with a mechanical vs biological prosthesis, EXCEPT:

Freedom from cerebrovascular events, freedom from structural valve deterioration, and freedom from redo AVR are superior with a mechanical valve in middle-aged patients, but survival is the keyed outcome (not superior/comparable). Hence survival.

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2. Patients with valvular heart disease and rheumatic heart disease should receive prophylaxis for rheumatic fever for at least how long?

Patients with rheumatic heart disease and valvular involvement should receive rheumatic fever prophylaxis for at least 10 years (or until age 40). Hence 10 years.

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3. Which outcome is improved by using TAVR instead of surgical valve replacement in patients with severe aortic stenosis and prior CABG?

TAVR improves (shortens) length of hospital stay compared with surgical valve replacement. Hence length of hospital stay.

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4. TAVR with the SAPIEN 3 valve is inferior to surgical valve replacement for reducing a composite of all-cause death, stroke, and moderate or severe aortic regurgitation in intermediate-risk patients.

The statement that SAPIEN 3 TAVR is inferior to surgery for the composite of death/stroke is false; SAPIEN 3 TAVR is non-inferior or superior. Hence false.

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5. Slower gait speed is associated with higher 30-day mortality after TA

Slower gait speed (a frailty marker) is associated with higher 30-day mortality after TAVR. Hence true.

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6. Which type of antithrombotic therapy should NOT be used in patients with mechanical valve prosthesis?

Oral direct thrombin inhibitors (e.g. dabigatran) should NOT be used in mechanical valve prostheses because of increased thromboembolism and bleeding (RE-ALIGN). Hence oral direct thrombin inhibitor.

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7. A twin with mitral regurgitation (MR) has an elevated mortality risk compared with their unaffected twin.

A twin with mitral regurgitation has an elevated mortality risk compared with their unaffected twin. Hence true.

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8. Mitral annular dimensions are largest in which group of patients undergoing cardiac CT?

Mitral annular dimensions are largest in patients with moderate-to-severe functional (secondary) mitral regurgitation on cardiac CT, reflecting annular dilatation. Hence those with moderate-to-severe (functional MR).

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9. Patients with at least moderate MR at baseline have higher 1- year mortality after transcatheter aortic valve replacement (TAVR)

Patients with at least moderate MR at baseline have higher 1-year mortality after TAVR. Hence true.

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10. Which outcome tends to occur less frequently in elderly patients undergoing aortic valve replacement with a mechanical vs bioprosthetic valve?

Patient-prosthesis mismatch tends to occur less frequently in elderly patients undergoing AVR with a mechanical valve in this comparison. Hence patient-prosthesis mismatch.