Assessment of Cardiac Damage in Aortic Stenosis
Severe aortic stenosis (AS) causes chronic pressure overload of the left ventricle (LV), resulting in the progressive cardiac damage, which extends beyond the LV. Several previous studies have shown a relationship of the cardiac damage to AS, rather than the stenosis severity, with adverse events after aortic valve replacement (AVR) in patients with severe AS. A new staging system for AS patients has important prognostic implications for clinical outcomes after AVR. This review summarizes the importance of assessment of cardiac damage in patients with AS. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Miho Fukui, Philippe G énéreux, João L. Cavalcante Source Type: research
Assessment of Aortic Stenosis Severity
Severe aortic stenosis (AS) is associated with a progressive cardiac remodeling that ultimately leads to heart failure and death if the valve is not replaced. The confirmation of AS severity is therefore crucial to adequately manage patients with AS. Transthoracic echocardiography is the first-line examination to confirm AS severity, but it may be inconclusive in discordant cases. In this setting, AS severity should be confirmed using a multimodality imaging approach. This review gives an overview of how to assess and/or confirm AS severity, especially in case of discordance. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Julien Ternacle, Marie-Annick Clavel Source Type: research
Biomarkers Associated with Aortic Stenosis and Structural Bioprosthesis Dysfunction
This article reviews current blood biomarkers associated with aortic valve stenosis/calcification and bioprosthesis dysfunction. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: C écile Oury, Nancy Côté, Marie-Annick Clavel Source Type: research
Transcatheter Aortic Valve Replacement
This article presents the evolution and current status of TAVR, with respect to the different types of devices and procedures as well as its outcomes. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Erwan Salaun, Philippe Pibarot, Josep Rod és-Cabau Source Type: research
This article reviews current literature regarding impact of aortic stenosis on pregnancy and anesthesia during noncardiac surgery. There are shortcomings in the scientific evidence. Most of the available studies are observational and often retrospective and therefore there is a great deal of bias. This leads to difficulty in drawing conclusions in terms of how to apply the published information to clinical management. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Jordi S. Dahl, Lucia Baris, Rasmus Carter-Storch, Roger Hall Source Type: research
Prevalence and Prognostic Implications of Frailty in Transcatheter Aortic Valve Replacement
Assessment of frailty has become engrained in the preprocedural evaluation of older adults referred for transcatheter aortic valve replacement. Addition of frailty and disability to clinical risk scores results in improved discrimination for short- and midterm mortality and identifies patients less likely to be discharged home and more likely to report worsening quality of life over the ensuing 6 to 12 months. In clinical practice, frailty can be evaluated by a tiered approach starting with a brief screening tool such as the Essential Frailty Toolset. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Palina Piankova, Jonathan Afilalo Source Type: research
Procedures and Outcomes of Surgical Aortic Valve Replacement in Adults
The ideal aortic valve substitute remains elusive. Bioprosthetic valves are the replacement option of choice in elderly patients undergoing aortic valve replacement (AVR). When implanted in young and middle-aged adults, both bioprosthetic and mechanical valves are associated with excess mortality compared with the age- and sex-matched general population. The Ross procedure is the only operation that can restore normal life expectancy in young and middle-aged adults undergoing AVR. In this article, the authors review the various options for surgical AVR and examine their contemporary applications and outcomes. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Amine Mazine, Ismail El-Hamamsy Source Type: research
Planning for Success
Since its inception in 2002, the use of transcatheter aortic valve replacement (TAVR) has rapidly increased over the last 17 years.1,2 Many of the challenges encountered in the early phases of TAVR adoption have been overcome with technological improvements in both the transcatheter valves and delivery systems.3,4 Nonetheless, as TAVR indications broaden to include lower-risk populations,5,6 detailed pre-procedural plan ning is crucial to maintain the safety and efficacy of this therapy. The 2017 American College of Cardiology (ACC) Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement suggeste...
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Vivian G. Ng, Rebecca T. Hahn, Tamim M. Nazif Source Type: research
A Decade of Revolutions in Calcific Aortic Stenosis
Calcific aortic stenosis (AS) is the most frequent valvular heart disease in high-income countries and the third most frequent cardiovascular disease after hypertension and coronary artery disease. The prevalence of aortic sclerosis (ie, the preclinical stage of AS) is estimated at 25% in the general population older than 65 years and close to 50% in those older than 80 years.1 The prevalence of AS is less than 1% in the population less than 60 years old,2 but increases exponentially to more than 10% in elderly people older than 75 years. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Marie-Annick Clavel, Philippe Pibarot Tags: Preface Source Type: research
Aortic Valve Disease
CARDIOLOGY CLINICS (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 19, 2019 Category: Cardiology Authors: Marie-Annick Clavel, Philippe Pibarot Source Type: research
Aortic Stenosis with Other Concomitant Valvular Disease
Aortic stenosis presenting as part of a multiple valve disease scenario or as mixed valve disease is frequent. These scenarios induce hemodynamic interactions that may result in diagnostic pitfalls. Echocardiography is the cornerstone technique for diagnosis of valve disorders, but other modalities may be useful. In addition to assessment of each individual lesion, the heart valve team must integrate numerous parameters into the management strategy, including global assessment of clinical and hemodynamic effects, operative risk, life expectancy, natural history of untreated valve disease, valve reparability, and/or suitabi...
Source: Cardiology Clinics - November 1, 2019 Category: Cardiology Authors: Philippe Unger, Christophe Tribouilloy Source Type: research
Current guidelines for management of adults with aortic stenosis recommend aortic valve replacement for patients with clinical consequences due to hemodynamically severe valve obstruction. However, advances in surgical and transcatheter techniques, and improved valve design have led to decreased procedural risk and improved long-term outcomes. Transcatheter aortic valve replacement (TAVR) is recommended for patients with prohibitive surgical risk and is reasonable in intermediate and high-risk patients. Recent trials demonstrated favorable short-term outcomes in patients with low surgical risk undergoing TAVR compared with...
Source: Cardiology Clinics - November 1, 2019 Category: Cardiology Authors: Andrew W. Harris, Philippe Pibarot, Catherine M. Otto Source Type: research
Heart Valve Clinics, Centers, and Networks
There is consensus on important aspects of managing heart valve disease. Despite this, many patients are managed by general physicians or cardiologists without specialist competencies in valve disease, which leads to suboptimal outcomes. Multidisciplinary heart valve clinics bring together cardiologists, surgeons, nurses, and in some countries scientists to deliver expert guidelines and experience-driven optimal care. Patients are referred at the optimal time for interventions at heart valve centers, defined by strict standards of facilities and processes. Valve networks link valve clinic, heart valve center, and the commu...
Source: Cardiology Clinics - November 1, 2019 Category: Cardiology Authors: John B. Chambers, Patrizio Lancellotti Source Type: research
Sex Differences in the Pathophysiology, Diagnosis, and Management of Aortic Stenosis
For years, calcific aortic stenosis (AS) was considered to be similar in men and women, and the underrepresentation of women in research studies prevented any alternate conclusions. With new sex-specific studies and data, the landscape of AS is evolving and recently important sex-disparities were revealed. These sex-specific discrepancies are of utmost importance to stratify and personalize treatment according to sex. It is important and urgent to elucidate the sex-related differences and similarities in the pathophysiology of AS to develop and validate sex-specific approaches for the management and pharmacologic treatment...
Source: Cardiology Clinics - November 1, 2019 Category: Cardiology Authors: Nancy C ôté, Marie-Annick Clavel Source Type: research
Pathophysiology of Aortic Stenosis and Future Perspectives for Medical Therapy
Calcific aortic valve stenosis is the commonest form of heart valve disease in high-income countries and set to become a major health care burden. Currently, there are no medical therapies that have proved to slow down or halt disease progression. The only available treatment is aortic valve replacement, of which the optimal timing is unknown and to which not all patients are suited. This review discusses the pathophysiology of aortic stenosis, how noninvasive imaging techniques have improved our understanding of the underlying biology, and how these emerging insights might translate into potential novel treatments targeti...
Source: Cardiology Clinics - November 1, 2019 Category: Cardiology Authors: Kang H. Zheng, Evangelos Tzolos, Marc R. Dweck Source Type: research
Cardiovascular Toxicities in Pediatric Cancer Survivors
This article outlines the current state of knowledge regarding cardiotoxicity in children undergoing cancer therapies, including the impact of specific oncologic therapies, recommendations for cardiovascular screening, the management of established cardiac disease, and the evolving field of pediatric cardio-oncology. (Source: Cardiology Clinics)
Source: Cardiology Clinics - October 4, 2019 Category: Cardiology Authors: Thomas D. Ryan, Rajaram Nagarajan, Justin Godown Source Type: research
Cardiomyopathy Prevention in Cancer Patients
Left ventricular systolic dysfunction (LVSD) and overt heart failure are well known manifestations of chemotherapy-induced cardiotoxicity. The development of LVSD is clinically significant because it can impact the delivery of lifesaving chemotherapy and increase the risk of developing heart failure, compromising quality of life and survival years after cure of the cancer. Cancer treatment –related cardiomyopathy is most commonly associated with anthracyclines and trastuzumab. Several interventions have been identified to prevent cancer-induced cardiomyopathy. Anthracyclines is a major culprit, and prevention strateg...
Source: Cardiology Clinics - October 4, 2019 Category: Cardiology Authors: Tarek Barbar, Syed S. Mahmood, Jennifer E. Liu Source Type: research
Cardiotoxicity Related to Radiation Therapy
With increasing survival from cancer, the incidence of cardiovascular diseases is increasing as a chronic side effect of radiation therapy. Prevention, early recognition, and prompt intervention should be the major focus in the care of these patients. (Source: Cardiology Clinics)
Source: Cardiology Clinics - October 4, 2019 Category: Cardiology Authors: Sana Shoukat, Danyi Zheng, Syed Wamique Yusuf Source Type: research
Arrhythmogenic Anticancer Drugs in Cardio-Oncology
Multiple cancer therapies are associated with cardiac arrhythmias through a variety of pathophysiologic mechanisms. Atrial fibrillation and atrial flutter are common during cancer therapy but should rarely limit continued delivery of therapy. Ventricular arrhythmias are not common during cancer therapy and are more often secondary to other cardiac pathologies. QT interval monitoring is recommended for some agents, although it is often not a reliable predictor of ventricular arrhythmias. Bradyarrhythmias are common and rarely require intervention, but special attention must be paid to heart block in checkpoint inhibitor the...
Source: Cardiology Clinics - October 4, 2019 Category: Cardiology Authors: Isaac Rhea, Paula Hernandez Burgos, Michael G. Fradley Source Type: research
Cardiac Interventional Procedures in Cardio-Oncology Patients
This article presents the specific challenges that interventional cardiologists face when caring for patients with cancer and the modern tools to optimize care. (Source: Cardiology Clinics)
Source: Cardiology Clinics - October 4, 2019 Category: Cardiology Authors: Teodora Donisan, Dinu Valentin Balanescu, Nicolas Palaskas, Juan Lopez-Mattei, Kaveh Karimzad, Peter Kim, Konstantinos Charitakis, Mehmet Cilingiroglu, Konstantinos Marmagkiolis, Cezar Iliescu Source Type: research
Diagnosis and Treatment of Cardiac Amyloidosis Related to Plasma Cell Dyscrasias
Light chain amyloidosis is a deadly disease in which a monoclonal plasma cell dyscrasia produces misfolded immunoglobulin light chains (AL) that aggregate and form rigid amyloid fibrils. The amyloid deposits infiltrate one or more organs, leading to injury and severe dysfunction. The degree of cardiac involvement is a major driver of morbidity and mortality. Early diagnosis and treatment are crucial to prevent irreversible end-organ damage and improve overall survival. Treatment of AL cardiac amyloidosis involves eliminating the underlying plasma cell dyscrasia with chemotherapy and pursuing supportive heart failure manage...
Source: Cardiology Clinics - October 4, 2019 Category: Cardiology Authors: Kevin M. Alexander, Alessandro Evangelisti, Ronald M. Witteles Source Type: research
Carcinoid Heart Disease
Carcinoid heart disease is the collective term for all cardiac manifestations that develop in patients with carcinoid. The cardiac manifestations of carcinoid tumors are attributed to the paraneoplastic effects of vasoactive substances released by the malignant cells. The clinical manifestations of carcinoid heart disease include valvular destruction leading to valvular regurgitation and stenosis, right-sided heart failure, and metastatic carcinoid disease. A combination of biomarkers and cardiac imaging is used in screening and diagnosis of carcinoid heart disease in patients with carcinoid syndrome. The management of car...
Source: Cardiology Clinics - October 4, 2019 Category: Cardiology Authors: Daniel Perry, Salim S. Hayek Source Type: research
Role of Cardiovascular Biomarkers in the Risk Stratification, Monitoring, and Management of Patients with Cancer
Cardiovascular effects of cancer therapies are of concern. Prediction, diagnosis, and management of cardiotoxicity is a challenge. Cardiovascular biomarkers are being studied in relationship to cancer therapy, showing promise in detection and prevention of cardiotoxicity. We summarize the use of biomarkers in cardio-oncology and presents recommendations for their use. Troponins and natriuretic peptides are the most commonly used biomarkers. High-quality evidence supporting their use is lacking. Biomarkers can be incorporated into a detection strategy for cardiotoxicity. Large, well-powered studies are needed to delineate c...
Source: Cardiology Clinics - October 4, 2019 Category: Cardiology Authors: Christopher W. Hoeger, Salim S. Hayek Source Type: research
Implementing a Cardio-oncology Center of Excellence
This article serves as a template decide if a cardio-oncology program should be started and expanded as a center of excellence for the discipline as well as to help in implementing and financially sustaining a program. (Source: Cardiology Clinics)
Source: Cardiology Clinics - October 4, 2019 Category: Cardiology Authors: Anita M. Arnold, Cathleen Biga Source Type: research
This article reviews anthracycline cardiotoxicity in terms of historical significance, epidemiology, current detection strategies, prevention strategies, and patient care after anthracycline-based chemotherapy. (Source: Cardiology Clinics)
Source: Cardiology Clinics - October 4, 2019 Category: Cardiology Authors: Jose Alvarez-Cardona, Daniel J. Lenihan Source Type: research
MRI of Cardiotoxicity
Cardiovascular magnetic resonance (CMR) imaging is useful to identify systolic dysfunction, particularly when echocardiographic imaging is not acceptable because of poor acoustic windows or when left ventricular ejection fraction (LVEF) is inconclusive by other modalities and an accurate LVEF measurement is needed. Of particular advantage in cardio-oncology is CMR ’s capability to perform tissue characterization to noninvasively identify changes in pathologic conditions related to cancer therapy or to discriminate causes of disease that may confound presentation in cardio-oncology patients. For these reasons, there i...
Source: Cardiology Clinics - August 31, 2019 Category: Cardiology Authors: Jennifer Hawthorne Jordan, William Gregory Hundley Source Type: research
Approach to Surgery for Cardiac Tumors
This article offers the authors ’ approach to simple and complex primary and secondary cardiac tumors. Symptoms of primary cardiac tumors are primarily determined by tumor size and anatomic location. Most simple primary tumors and some complex primary tumors are best managed by surgical resection. Secondary tumors are 30 times m ore frequent than primary cardiac tumors. Surgical resection of secondary tumors is rational in a few highly selected patients. For complex primary and secondary tumors, the authors recommend referral to an experienced multidisciplinary cardiac tumor team. (Source: Cardiology Clinics)
Source: Cardiology Clinics - August 27, 2019 Category: Cardiology Authors: Bobby Yanagawa, Edward Y. Chan, Robert J. Cusimano, Michael J. Reardon Source Type: research
This article summarizes the role of trastuzumab in cancer treatment, the mechanisms of trastuzumab-induced cardiotoxicity, recent clinical investigations, and current controversies. (Source: Cardiology Clinics)
Source: Cardiology Clinics - August 27, 2019 Category: Cardiology Authors: Rachel Barish, Emily Gates, Ana Barac Source Type: research
Echocardiography Imaging of Cardiotoxicity
Heart disease is the most important cause of non-cancer death for patients with cancer. Addressing the cardiotoxic effects of anticancer therapies to prevent increased cardiovascular risk in this population is crucial. Echocardiography plays a big role in monitoring cardiotoxicity induced by cancer treatment. Many emerging modalities, including tissue Doppler imaging measures, speckle tracking imaging, and three-dimensional echocardiography, may provide improved sensitivity and specificity to detect cancer treatment-induced cardiotoxicity. Additional research is critical to define the value of both conventional and novel i...
Source: Cardiology Clinics - August 27, 2019 Category: Cardiology Authors: Yu Kang, Marielle Scherrer-Crosbie Source Type: research
Cardiotoxicity of Immune Therapy
This article reviews cardiotoxicity associated with contemporary immunotherapy and discusses potential management strategies. (Source: Cardiology Clinics)
Source: Cardiology Clinics - August 27, 2019 Category: Cardiology Authors: Sarju Ganatra, Rohan Parikh, Tomas G. Neilan Source Type: research
Common Vascular Toxicities of Cancer Therapies
This article provides an overview of the most common presentations and their management strategies. (Source: Cardiology Clinics)
Source: Cardiology Clinics - August 26, 2019 Category: Cardiology Authors: Joerg Herrmann Source Type: research
Fluoropyrimidines are chemotherapeutic agents that confer great benefit to many patients with solid tumors, but their use is often limited by cardiotoxicity. The incidence and precise mechanisms of cardiotoxicity remain uncertain. Clinical presentations of fluoropyrimidine toxicity are varied and include chest pain, myocardial infarction, acute cardiomyopathy, arrhythmia, cardiogenic shock, and sudden cardiac death. Proposed mechanisms include coronary vasospasm, coronary endothelial dysfunction, direct myocardial toxicity, myocarditis, and Takotsubo cardiomyopathy. Therapeutic and prophylactic interventions primarily targ...
Source: Cardiology Clinics - August 26, 2019 Category: Cardiology Authors: Jaya Kanduri, Luis Alberto More, Anuradha Godishala, Aarti Asnani Source Type: research
CARDIOLOGY CLINICS (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 4, 2019 Category: Cardiology Authors: Silvi Shah, Charuhas V. Thakar Source Type: research
This article discusses the various mechanisms involved in the pathophysiology of the cardiorenal syndrome. (Source: Cardiology Clinics)
Source: Cardiology Clinics - May 21, 2019 Category: Cardiology Authors: Ujjala Kumar, Nicholas Wettersten, Pranav S. Garimella Source Type: research
Treatment of Cardiorenal Syndrome
The treatment of cardiorenal syndrome is as complex as the various mechanisms underlying its pathophysiology. Randomized controlled data typically focus on the treatment of heart failure with cardiac specific endpoints and a lack of worsening renal function used as a surrogate for efficacy. When heart failure is considered the inciting event, the acute state is managed with vasodilators, inotropic support, and decongestion; whereas neurohormonal axis inhibition is more commonly applied to chronic state. A recent shift in thought process regarding the interplay of cardiac and renal dysfunction suggests that renal congestion...
Source: Cardiology Clinics - May 15, 2019 Category: Cardiology Authors: Jack Rubinstein, Darek Sanford Source Type: research
Sudden Cardiac Death in End-Stage Renal Disease
This article details the many possible etiologies and presents a brief overview of more recent research that may in the future prove of great benefit in improving the mortality of our patients with end-stage renal disease. (Source: Cardiology Clinics)
Source: Cardiology Clinics - May 15, 2019 Category: Cardiology Authors: Page V. Salenger Source Type: research
Cardiovascular disease is the leading cause of morbidity and mortality in patients with kidney disease in the United States. The risk of cardiovascular events increases with progression of kidney disease, and significant resources are spent in health care in treating kidney and cardiovascular disease disorders. The current issue of Cardiology Clinics aims to bridge the gap between the 2 specialties of nephrology and cardiology. Each article comprehensively summarizes various important concepts of heart and kidney connection, including pathophysiology and management of cardiorenal syndrome, contrast-induced nephropathy, the...
Source: Cardiology Clinics - May 15, 2019 Category: Cardiology Authors: Silvi Shah, Charuhas V. Thakar Tags: Preface Source Type: research