Myocardial Injury After Noncardiac Surgery: A Systematic Review and Meta-Analysis
Myocardial injury after noncardiac surgery (MINS) is a common postoperative complication associated with adverse cardiovascular outcomes. The purpose of this systematic review was to determine the incidence, clinical features, pathogenesis, management, and outcomes of MINS. We searched PubMed, Embase, Central and Web of Science databases for studies reporting the incidence, clinical features, and prognosis of MINS. Data analysis was performed with a mixed-methods approach, with quantitative analysis of meta-analytic methods for incidence, management, and outcomes, and a qualitative synthesis of the literature to determine ...
Source: Cardiology in Review - October 5, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Long-Acting Basal Insulins: A Review of the More Recently Approved Agents
Long-acting basal insulins are used for the management of both type 1 and type 2 diabetes mellitus. Long-acting basal insulins were developed utilizing recombinant DNA technology and have been available since 2000 with the approval of insulin glargine U-100 followed by insulin detemir in 2005. In recent years, diabetes management has become more complex with the approval of insulin glargine U-300 and insulin degludec U-100 and U-200. Both insulin glargine U-300 and insulin degludec have been compared with insulin glargine U-100 and have demonstrated longer durations of action, as well as lower rates of hypoglycemia. This r...
Source: Cardiology in Review - August 9, 2019 Category: Cardiology Tags: New Therapy Source Type: research
The Preventive Role of Angiotensin Converting Enzyme Inhibitors/Angiotensin-II Receptor Blockers and β-Adrenergic Blockers in Anthracycline- and Trastuzumab-Induced Cardiotoxicity
Anthracycline (doxorubicin) and trastuzumab treatments for cancer patients have been known to cause cardiotoxicity. The current recommendations for prevention of cardiac events from cancer chemotherapies are largely based on opinion. The American Society of Clinical Oncology recommends active screening and prevention of modifiable cardiovascular risk factors. The risk factors are defined as tobacco use, high blood pressure, high cholesterol, alcohol use, obesity, and physical inactivity. Beta-adrenergic blockers and angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) have been the mainstay o...
Source: Cardiology in Review - August 9, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Should Every Patient With Atrial Fibrillation and a CHA2DS2-VASc Score of 1 Be Anticoagulated? A Systematic Review of 37,030 Patients
Patients with atrial fibrillation (AF) are at risk of thromboembolic events. The CHA2DS2-VASc (congestive heart failure, hypertension, age 65–74, diabetes, female sex and vascular disease, which all count for 1 point, and previous transient ischemic stroke/stroke or age ≥ 75 years, which count for two points) score stratifies this risk and consequently indicates whether anticoagulation is required but leaves room for debate regarding patients with a CHA2DS2-VASc score of 1, irrespective of sex. A score of 1, irrespective of sex, is derived from varying risk factors and may represent different risks. We systematically s...
Source: Cardiology in Review - August 9, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Is Anacetrapib Better Than Its CETP Inhibitor Counterparts?
Cholesterol metabolism and transport has been a major focus in cardiovascular disease risk modification over the past several decades. Hydroxymethylglutaryl-CoA reductase inhibitors (statins) have been the most commonly used agents, with the greatest benefit in reducing both the primary and secondary risks of cardiovascular disease. However, heart disease remains the leading cause of death in both men and women in the United States. Further investigation and intervention are required to further reduce the risk for cardiovascular disease and cardiovascular-related deaths. This review will focus on high-density lipoprotein m...
Source: Cardiology in Review - August 9, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Infectious Endocarditis After Transcatheter Aortic Valve Replacement: Epidemiology and Outcomes
With the expansion of the indications of transcatheter aortic valve replacement (TAVR), it is being increasingly performed in older patients with aortic stenosis to improve their quality of life. However, TAVR is not without serious complications. Despite being infrequent, prosthetic valve endocarditis after TAVR is a deadly complication associated with high rates of mortality related to a delayed diagnosis from variable clinical presentations and nonconfirmatory imaging findings. Furthermore, lower intervention rates in these patients, due to their high surgical risk, increases overall mortality. Clinicians should be awar...
Source: Cardiology in Review - August 9, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Cardiotoxicity of Cancer Therapies
Cardiotoxicity is a known complication of many cancer therapies. While the cardiotoxicity of established agents such as anthracyclines, antimetabolites, and alkylating agents is well known, it is important to realize that newer anticancer therapies such as tyrosine kinase inhibitors, angiogenesis inhibitors, and checkpoint inhibitors are also associated with significant adverse cardiovascular effects. Echocardiography, magnetic resonance imaging, and radionuclide imaging have been used to identify these complications early and prevent further consequences. We will discuss the different classes of cancer therapeutic agents ...
Source: Cardiology in Review - August 9, 2019 Category: Cardiology Tags: Review Articles Source Type: research
The Predicament of Gastrointestinal Bleeding in Patients With a Continuous-Flow Left Ventricular Assist Device: Pathophysiology, Evaluation, and Management
Heart failure affects over 5 million Americans, with numbers expected to rise. While heart transplantation is the most effective long-term strategy for end-stage heart failure, there is a limited cardiac donor pool, and these organs are often unavailable at the time of need. Left ventricular assist devices, therefore, continue to be used to bridge this gap. Originally implanted as a bridge to transplant, these devices are now additionally utilized as destination therapy for patients ineligible for transplant. With the widespread applicability of these devices for not just temporary measures, but also for prolonged use, the...
Source: Cardiology in Review - August 9, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Blalock-Taussig Shunt at 75: A Landmark Operation and a Triumph of Diversity Over Prejudice
No abstract available (Source: Cardiology in Review)
Source: Cardiology in Review - August 9, 2019 Category: Cardiology Tags: Editorial Source Type: research
Angiopoietin-Like 3 Protein Inhibition: A New Frontier in Lipid-Lowering Treatment
Angiopoietin-like 3 protein (ANGPTL3) is an inhibitor of both lipoprotein lipase and endothelial lipase in humans. Population studies indicate a relationship between loss of function mutations in ANGPTL3 and favorable reductions in triglycerides and non- high-density lipoprotein cholesterol. In addition, loss of function mutations is associated with a reduced risk of coronary artery disease. Whereas ANGPTL3’s role in human lipid metabolism has yet to be fully clarified, it is unlikely that ANGPTL3 impacts cholesterol uptake via the low-density lipoprotein-receptor, unlike the proprotein convertase subtilisin/kexin9 inhib...
Source: Cardiology in Review - June 11, 2019 Category: Cardiology Tags: New Therapy Source Type: research
Cardiac Applications of Dual-Energy Computed Tomography
Computed tomography is an established tool in the assessment of cardiac anatomy and function. As demonstrated by single photon emission computed tomography, positron emission tomography, and magnetic resonance, the noninvasive evaluation of coronary hemodynamics is an important step in guiding clinical management. Nevertheless, no single modality has been shown to accurately quantify coronary artery stenosis, evaluate an atherosclerotic plaque’s composition for embolic risk stratification, and assess myocardial perfusion. Although not a novel technology, dual-energy computed tomography has undergone significant advanceme...
Source: Cardiology in Review - June 11, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Hearts and Minds: Stress, Anxiety, and Depression: Unsung Risk Factors for Cardiovascular Disease
Anxiety, depression, and stress are exceedingly common in patients with cardiovascular disease (CVD). They increase the risk of cardiac events and are associated with much worse outcomes. A causal relationships exists between anxiety/depression and adverse cardiac events such as acute myocardial infarction and sudden cardiac death. Various treatments, including psychologic therapies and pharmacotherapy, can used to treat patients with these disorders. This review discusses the epidemiology, pathogenesis, and treatment options for patients with CVD who suffer from these conditions and argues that they should be treated as c...
Source: Cardiology in Review - June 11, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Precardiogenic Shock: A New Clinical Entity
The pathogenesis of cardiogenic shock (CS) has evolved from an acute event due to a large myocardial infarction to a semiacute event due to rapid hemodynamic deterioration on a background of preexisting left ventricular systolic dysfunction. Pre-CS refers to the period of rapid hemodynamic deterioration that precedes overt CS with hypotension, inflammatory response, and end-organ failure. Mortality remains extremely high in CS and has not improved over the past decades. Pre-CS offers a unique opportunity to initiate early treatment that may result in better clinical outcomes. The present review addresses the definition, re...
Source: Cardiology in Review - June 11, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Predictors of Adverse Outcomes in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy: A Meta-Analysis of Observational Studies
In conclusion, multiple risk factors have been associated with arrhythmic events in AC patients. However, larger studies are needed to discriminate those patients who will benefit from implantable cardioverter defibrillators. (Source: Cardiology in Review)
Source: Cardiology in Review - June 11, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Parathyroid Hormone and Cardiac Electrophysiology: A Review
Calcium has long been known to be essential to cardiac electrical activity. Parathyroid hormone (PTH) is the main regulator of serum calcium and is central to calcium homeostasis. Although there are significant data linking parathyroid disease states with changes in cardiac electrophysiology, most data have focused on how PTH modulates serum calcium to produce these effects. Close scrutiny of early literature demonstrates that the relationship between PTH and electrocardiographic changes is not straightforward, and numerous studies have linked PTH to arrhythmia. Basic science research has demonstrated that there is a basis...
Source: Cardiology in Review - June 11, 2019 Category: Cardiology Tags: Review Articles Source Type: research
