Contents
Asad Ghafoor (Source: Cardiology Clinics)
Source: Cardiology Clinics - September 23, 2023 Category: Cardiology Source Type: research
Forthcoming Issues
Coronary Physiology in Contemporary Clinical Practice (Source: Cardiology Clinics)
Source: Cardiology Clinics - September 23, 2023 Category: Cardiology Source Type: research
Coronary Physiology to Optimize Percutaneous Coronary Intervention
Since the original description by Pijls and colleagues in 1993, Fractional Flow Reserve (FFR) has established itself as the key diagnostic tool to determine lesion severity during coronary angiography and the deciding factor whether a percutaneous coronary intervention (PCI) is indicated and necessary. Since the original publication of the “Physiology” issue in Interventional Cardiology Clinics in 2015, the routine use of physiology during PCI in the United States has more than doubled to ∼25%. Importantly, the clinical applications of coronary physiology measurements have also increased substantially over the past f...
Source: Cardiology Clinics - August 30, 2023 Category: Cardiology Authors: Allen Jeremias Tags: Preface Source Type: research
Secondary Mitral Regurgitation and Transcatheter Mitral Valve Therapies
Transcatheter mitral valve repair should be considered for patients with severe secondary mitral regurgitation with symptomatic heart failure with reduced ejection fraction for symptom improvement and survival benefit. Patients with a higher severity of secondary mitral regurgitation relative to the degree of left ventricular dilation are more likely to benefit from transcatheter mitral valve repair. A multidisciplinary Heart Team should participate in patient selection for transcatheter mitral valve therapy. (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 28, 2023 Category: Cardiology Authors: Michael J. Pienta, Matthew A. Romano Source Type: research
When all Else Fails, Try This
Heart failure (HF) is a progressive disease. It is estimated that more than 250,000 patients suffer from advanced HF with reduced ejection fraction refractory to medical therapy. With limited donor pool for heart transplant, continue flow left ventricle assist device (LVAD) is a lifesaving treatment option for patients with advanced HF. This review will provide an update on indications, contraindications, and associated adverse events for LVAD support with a summary of the current outcomes data. (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 27, 2023 Category: Cardiology Authors: Abbas Bitar, Keith Aaronson Source Type: research
The Economic Burden of Heart Failure with Reduced Ejection Fraction
Treatment of heart failure with reduced ejection fraction (HFrEF) has benefitted from a proliferation of new medications and devices. These treatments carry important clinical benefits, but also come with costs relevant to payers, providers, and patients. Patient out-of-pocket costs have been implicated in the avoidance of medical care, nonadherence to medications, and the exacerbation of health care disparities. In the absence of major health care policy and payment redesign, high-quality HFrEF care delivery requires transparent integration of cost considerations into system design, patient-clinician interactions, and med...
Source: Cardiology Clinics - July 24, 2023 Category: Cardiology Authors: Larry A. Allen, Emily Fryman Lowe, Dan D. Matlock Source Type: research
The Uncertain Benefit from Implantable Cardioverter-Defibrillators in Nonischemic Cardiomyopathy
Life-threatening dysrhythmias remain a significant cause of mortality in patients with nonischemic cardiomyopathy (NICM). Implantable cardioverter-defibrillators (ICD) effectively reduce mortality in patients who have survived a life-threatening arrhythmic event. The evidence for survival benefit of primary prevention ICD for patients with high-risk NICM on guideline-directed medical therapy is not as robust, with efficacy questioned by recent studies. In this review, we summarize the data on the risk of life-threatening arrhythmias in NICM, the recommendations, and the evidence supporting the efficacy of primary preventio...
Source: Cardiology Clinics - July 24, 2023 Category: Cardiology Authors: Mohsin Khan, Arshad Jahangir Source Type: research
Obesity in Heart Failure with Reduced Ejection Fraction
Obesity has been long recognized as a risk factor for the development of heart failure, but recent evidence suggests obesity is more typically associated with heart failure with preserved ejection fraction as opposed to heart failure with reduced ejection fraction (HFrEF). Nevertheless, numerous studies have found that obesity modulates the presentation and progression of HFrEF and may contribute to the development of HFrEF in some patients. Although obesity has definite negative effects in HFrEF patients, the effects of intentional weight loss in HFrEF patients with obesity have been poorly studied. (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 24, 2023 Category: Cardiology Authors: Matthew B. Amdahl, Varun Sundaram, Yogesh N.V. Reddy Source Type: research
Guide to Temporary Mechanical Support in Cardiogenic Shock
Cardiogenic shock is a multisystem pathology that carries a high mortality rate, and initial pharmacotherapies include the use of vasopressors and inotropes. These agents can increase myocardial oxygen consumption and decrease tissue perfusion that can oftentimes result in a state of refractory cardiogenic shock for which temporary mechanical circulatory support can be considered. Numerous support devices are available, each with its own hemodynamic blueprint. Defining a patient ’s hemodynamic profile and understanding the phenotype of cardiogenic shock is important in device selection. Careful patient selection incorpor...
Source: Cardiology Clinics - July 21, 2023 Category: Cardiology Authors: David Snipelisky, Jerry D. Estep Source Type: research
Frailty and Its Implications in Heart Failure with Reduced Ejection Fraction
Frailty affects half of all patients with heart failure with reduced ejection fraction (HFrEF) and carries a ∼2-fold increased risk of mortality. The relationship between frailty and HFrEF is bidirectional, with one condition exacerbating the other. Paradoxical to their higher clinical risk, frail patients with HFrEF are more often under-treated due to concerns over medication-related adverse clinical ev ents. However, current evidence suggests consistent safety of HF medical therapies among older frail patients with HFrEF. A multidisciplinary effort is necessary for the appropriate management of these high-risk patients...
Source: Cardiology Clinics - July 14, 2023 Category: Cardiology Authors: Khawaja M. Talha, Stephen J. Greene, Javed Butler, Muhammad Shahzeb Khan Source Type: research
The War Against Heart Failure Hospitalizations
Successful remote patient monitoring depends on bidirectional interaction between patients and multidisciplinary clinical teams. Invasive pulmonary artery pressure monitoring has been shown to reduce heart failure (HF) hospitalizations, facilitate guideline-directed medical therapy optimization, and improve quality of life. Cardiac implantable electronic device-based multiparameter monitoring has shown encouraging results in predicting future HF-related events. Potential expanded indications for remote monitoring include guideline-directed medical therapy optimization, application to specific populations, and subclinical d...
Source: Cardiology Clinics - July 7, 2023 Category: Cardiology Authors: Ioannis Mastoris, Kashvi Gupta, Andrew J. Sauer Source Type: research
Heart Failure with Reduced Ejection Fraction and COVID-19, when the Sick Get Sicker
Minoritized racial and ethnic groups have the highest incidence, prevalence, and hospitalization rate for heart failure. Despite improvement in medical therapies and overall survival, the morbidity and mortality of these groups remain elevated. The reasons for this disparity are multifactorial, including social determinant of health (SDOH) such as access to care, bias, and structural racism. These same factors contributed to higher rates of COVID-19 infection among minoritized racial and ethnic groups. In this review, we aim to explore the lessons learned from the COVID-19 pandemic and its interconnection between heart fai...
Source: Cardiology Clinics - June 15, 2023 Category: Cardiology Authors: Johanna Contreras, Elizabeth O. Tinuoye, Alejandro Folch, Jose Aguilar, Kendall Free, Onyedika Ilonze, Sula Mazimba, Roopa Rao, Khadijah Breathett Source Type: research
Heart Failure with Reduced Ejection Fraction And COVID-19, When The Sick Get Sicker: Unmasking Racial and Ethnic Inequities During A Pandemic
Minoritized racial and ethnic groups have the highest incidence, prevalence, and hospitalization rate for heart failure. Despite improvement in medical therapies and overall survival, the morbidity and mortality of these groups remain elevated. The reasons for this disparity are multifactorial, including social determinant of health (SDOH) such as access to care, bias and structural racism. These same factors contributed to higher rates of COVID-19 infection among minoritized racial and ethnic groups. In this review, we aim to explore the lessons learned from the COVID 19 pandemic and its interconnection between heart fail...
Source: Cardiology Clinics - June 15, 2023 Category: Cardiology Authors: Johanna Contreras, Elizabeth O. Tinuoye, Alejandro Folch, Jose Aguilar, Kendall Free, Onyedika Ilonze, Sula Mazimba, Roopa Rao, Khadijah Breathett Source Type: research
Congenital Heart Block
Congenital complete heart block (CCHB) defines atrioventricular conduction abnormalities diagnosed in utero or within the first 27 days of life. Maternal autoimmune disease and congenital heart defects are most commonly responsible. Recent genetic discoveries have highlighted our understanding of the underlying mechanism. Hydroxychloroquine shows promise in preventing autoimmune CCHB. Patients may develop symptomatic bradycardia and cardiomyopathy. The presence of these and other specific findings warrants placement of a permanent pacemaker to relieve symptoms and prevent catastrophic events. The mechanisms, natural histor...
Source: Cardiology Clinics - June 14, 2023 Category: Cardiology Authors: Leonard Steinberg Source Type: research
Left Bundle Branch Block
Left bundle branch block (LBBB) is not just a simple electrocardiogram alteration. The intricacies of this general terminology go beyond simple conduction block. This review puts together current knowledge on the historical concept of LBBB, clinical significance, and recent insights into the pathophysiology of human LBBB. LBBB is an entity that affects patient diagnosis (primary conduction disease, secondary to underlying pathology or iatrogenic), treatment (cardiac resynchronization therapy or conduction system pacing for heart failure), and prognosis. Recruiting the left bundle branch with conduction system pacing depend...
Source: Cardiology Clinics - June 14, 2023 Category: Cardiology Authors: Margarida Pujol-L ópez, José M. Tolosana, Gaurav A. Upadhyay, Lluís Mont, Roderick Tung Source Type: research
