Sodium–Glucose Cotransporter-2 Inhibition in Type 2 Diabetes Mellitus: A Review of Large-Scale Cardiovascular Outcome Studies and Possible Mechanisms of Benefit
Cardiovascular (CV) disease remains the leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). However, conventional antihyperglycemic medications seem to have minimal effect on lowering CV risk despite achieving excellent reductions in glycated hemoglobin A1c and associated reductions in microvascular risk. Sodium–glucose cotransporter 2 (SGLT2) inhibitors have emerged as noteworthy antihyperglycemic agents with concomitant CV and renal protection in T2DM patients. In this comprehensive review, we present the key CV findings from major large-scale outcome trials of SGLT2 inhibitors...
Source: Cardiology in Review - October 18, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Acromegalic Cardiomyopathy: An Overview of Risk Factors, Clinical Manifestations, and Therapeutic Options
Acromegaly is a rare endocrine disorder that carries a significant burden of cardiovascular morbidity and mortality. Abnormalities of the growth hormone/insulin-like growth factor-1 axis in acromegaly lead to the characteristic cardiovascular manifestations of this disease. One hallmark feature of the disease is acromegalic cardiomyopathy, a syndrome of progressive cardiac dysfunction characterized by left ventricular hypertrophy, diastolic dysfunction, and combined systolic and diastolic dysfunction in the very advanced stage. In this article, we review the current concepts regarding the pathophysiology of acromegalic car...
Source: Cardiology in Review - October 18, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Risk-Adjusted Overall Mortality as a Quality Measure in the Cardiovascular Intensive Care Unit
Risk-adjusted mortality has been proposed as a quality of care indicator to gauge cardiovascular intensive care Unit (CICU) performance. Mortality is easily measured, readily understandable, and a meaningful outcome for the patient, provider, administrative agencies, and other key stakeholders. Disease-specific risk-adjusted mortality is commonly used in cardiovascular medicine as an indicator of care quality, for external accreditation, and to determine payer reimbursement. However, the evidence base for overall risk-adjusted mortality in the CICU is limited, with most available data coming from the general critical care ...
Source: Cardiology in Review - October 18, 2018 Category: Cardiology Tags: Review Articles Source Type: research
The Physiological Rationale for Incorporating Pulsatility in Continuous-Flow Left Ventricular Assist Devices
Over the past few decades, left ventricular assist device (LVAD) support has extended the lives of many patients with end-stage heart failure. The most common devices are continuous-flow (CF) LVADs. The use of the CF-LVADs has required that clinicians learn the physiological and clinical consequences of long-term continuous blood flow. While this alteration in the normal physiology still offers advantages from mechanical circulatory support, the lack of pulsatility may also increase the likelihood of adverse events. However, it is currently unknown whether newly evolved devices should incorporate pulsatility. In this artic...
Source: Cardiology in Review - October 18, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Overview of Link Between Inflammatory Bowel Disease and Cardiovascular Disease
Inflammation has been shown to play an increasingly important role in the pathogenesis of atherosclerosis and in precipitating thrombotic events. Inflammatory bowel disease (IBD) is a systemic inflammatory disorder with a wide range of extraintestinal manifestations including a clinically significant increase in the risk of venous thromboembolism compared to matched controls in several studies. The data for the association between IBD and ischemic heart disease are less clear; multiple population-based studies have shown both positive and negative associations between the 2 conditions. While the systemic inflammation shoul...
Source: Cardiology in Review - October 18, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Long-Term Outcomes of Drug-Eluting Stents Versus Bare-Metal Stents in End-Stage Renal Disease Patients on Dialysis: A Systematic Review and Meta-Analysis
There are no dedicated data to guide drug-eluting stent (DES) versus bare-metal stent (BMS) selection in patients with end-stage renal disease undergoing dialysis (ESRD-D). It is unclear whether long-term benefits of a specific stent type outweigh risks in this population at high risk for both bleeding and ischemic events. We performed a meta-analysis of nonrandomized studies extracted from PubMed, Scopus, and EMBASE, assessing the safety and effectiveness of DES versus BMS in ESRD-D patients. Odds ratios (OR) and 95% confidence intervals (CI) were computed with the Mantel–Haenszel method. Random-effects model was used f...
Source: Cardiology in Review - October 18, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Acute Coronary Artery Dissection: A Review of the Literature and Current Evidence
Acute coronary artery dissection is a rare, complex disease occurring particularly in young women without traditional cardiovascular risk factors. The pathophysiology and treatment are different from acute coronary syndrome caused by plaque rupture or erosion. Its clinical presentation may vary from unstable angina to sudden cardiac death. Hence, early detection is crucial to manage the dissection and reduce the mortality and morbidity rates. Most coronary dissections will heal spontaneously, and conservative treatment is recommended for uncomplicated cases. In the acute phase, primary percutaneous coronary intervention re...
Source: Cardiology in Review - August 21, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Interatrial Shunting, a Novel Device-Based Therapy for Patients With Heart Failure
Heart failure (HF) patients with either reduced ejection fraction or preserved ejection fraction experience a high mortality rate. The most recent pharmacologic advance for treating patients with HF with reduced ejection fraction has been with sacubitril/valsartan. Along with pharmaceutical research, there has been interest in device-based therapies as another treatment approach. One novel interventional device therapy that has shown promise in early tests and trials is the interatrial shunt device developed by Corvia Medical Inc. and the V-Wave device by V-Wave Ltd. Inserted between the atria in the atrial septum, both de...
Source: Cardiology in Review - August 21, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Predictors of Outcomes in Myocardial Infarction and Cardiogenic Shock
This article reviews the existing literature on short- and long-term predictors and risk stratification in MI complicated by CS. (Source: Cardiology in Review)
Source: Cardiology in Review - August 21, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Periprocedural Management of Direct Oral Anticoagulants Surrounding Cardioversion and Invasive Electrophysiological Procedures
As direct oral anticoagulants (DOACs) have demonstrated favorable efficacy and safety outcomes compared with vitamin K antagonists for the treatment and prevention of venous thromboembolism and the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, their role in the management of anticoagulation during electrophysiological procedures continues to evolve. At present, guidelines are limited regarding specific recommendations for the use of DOACs in these clinical settings. Here, we review available data regarding the risks and benefits associated with various periprocedural anticoagu...
Source: Cardiology in Review - August 21, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Novel Pharmacotherapy in Hypertrophic Cardiomyopathy
This article reviews the currently recommended and frequently used medications (beta-blockers, nondihydropyridine calcium channel blockers, and disopyramide) and emerging pharmacological treatment options in the management of HCM. The mechanism of action and latest clinical trials of the novel agents are discussed in greater detail. (Source: Cardiology in Review)
Source: Cardiology in Review - August 21, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Functional Mitral Regurgitation: An Interventional Cardiologist’s Perspective
Functional mitral regurgitation (FMR) is common in patients with heart failure and portends a poor prognosis. The etiology is secondary to nonischemic or ischemic (postmyocardial infarction) adverse remodeling. Treatment includes guideline-directed medical therapy, cardiac resynchronization therapy, and in some cases, surgical repair or replacement. Transcatheter mitral valve (MV) repair with the MitraClip device is approved in patients with degenerative MR and is currently under investigation for use in FMR, as are several transcatheter MV replacement devices. This review discusses the basis of FMR pathophysiology, classi...
Source: Cardiology in Review - August 21, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Left Main Disease: What Is the Correct Approach to Revascularization?
Percutaneous coronary intervention of the left main coronary artery has evolved through registries and meta analyses, supported by results from the EXCEL [Everolimus-Eluting Stents (EES) or Bypass Surgery for Left Main Coronary Artery Disease] and NOBLE (Percutaneous Coronary Angioplasty versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left Main Stenosis) trials as an acceptable alternative to coronary artery bypass grafting in patients with low and intermediate Syntax scores. Advances in stenting strategies and the availability of larger diameter drug-eluting stents improve patient safety and optimize pr...
Source: Cardiology in Review - August 21, 2018 Category: Cardiology Tags: Review Articles Source Type: research
A Nonsurgical Approach to Mesenteric Vascular Disease: Erratum
No abstract available (Source: Cardiology in Review)
Source: Cardiology in Review - June 5, 2018 Category: Cardiology Tags: Erratum Source Type: research
Are Shorter Durations of Dual Antiplatelet Therapy Acceptable Following Percutaneous Coronary Intervention?
Much debate has centered on whether or not the standard 12-month duration of dual antiplatelet therapy (DAPT) is still necessary postpercutaneous coronary intervention, given recent improvements in stent technology. The benefits of shorter (3–6 months) durations of DAPT include a potential lower risk for bleeding and less patient drug cost and pill burden. Although randomized clinical trials have shown noninferiority for shorter versus longer DAPT regimens in many regards, some endpoints (e.g., myocardial infarction) may still occur less frequently with longer DAPT regimens, particularly in higher risk populations (e.g.,...
Source: Cardiology in Review - June 5, 2018 Category: Cardiology Tags: Feature Curbside Consult Source Type: research
