Devices for Autonomic Regulation Therapy in Heart Failure With Reduced Ejection Fraction
Heart failure (HF) is associated with significant morbidity and mortality and an increasing economic burden. The persistence of HF’s risk factors, coupled with an aging population, also leads to an increase in its incidence and prevalence. It is well established that sympathetic hyperactivity and parasympathetic withdrawal are instrumental in the development and worsening of HF. Therefore, restoring autonomic balance to the cardiovascular system is an attractive therapeutic approach. The following is a review of current clinical trials of device-based autonomic regulation therapy in the management of HF with a reduced ej...
Source: Cardiology in Review - December 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Milrinone Dosing and a Culture of Caution in Clinical Practice
Milrinone is an invaluable agent in the treatment of end-stage heart failure patients who are refractory to optimal medical therapy. In addition to its use in acute decompensated heart failure, milrinone can also be employed as a home infusion therapy or a bridge to cardiac transplant. Concerns about its adverse effects, such as an increased risk of arrhythmias and hypotension, often limit the doses of milrinone used in clinical practice. In addition, milrinone is infrequently used or avoided entirely in patients with acute renal failure or end-stage renal disease because the drug is primarily cleared by renal excretion. D...
Source: Cardiology in Review - December 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Ability of Nonstrain Diastolic Parameters to Predict Doxorubicin-Induced Cardiomyopathy: A Systematic Review With Meta-Analysis
Doxorubicin is an important cause of chemotherapy-induced cardiomyopathy. Prior studies have found conflicting results of whether nonstrain diastolic parameters can predict doxorubicin-induced cardiotoxicity. We performed a systematic review of English written publications using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following inclusion criteria were applied: cancer subjects, echo-derived nonstrain diastolic profile, and patients compared before and after treatment to predict systolic dysfunction. The following exclusion criteria were applied: other cardiotoxic agents, n...
Source: Cardiology in Review - December 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Mitral Valve and Subvalvular Repair for Secondary Mitral Regurgitation: Rationale and Clinical Outcomes of the Papillary Muscle Sling
We present a comprehensive review of the pathophysiology of secondary MR, and the rationale and clinical outcomes of MV repair with papillary muscle sling placement for the treatment of secondary MR. (Source: Cardiology in Review)
Source: Cardiology in Review - December 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Cardiosphere-Derived Cells and Ischemic Heart Failure
After a myocardial infarction, heart tissue becomes irreversibly damaged, leading to scar formation and inevitably ischemic heart failure. Of the many available interventions after a myocardial infarction, such as percutaneous intervention or pharmacological optimization, none can reverse the ischemic insult on the heart and restore cardiac function. Thus, the only available cure for patients with scarred myocardium is allogeneic heart transplantation, which comes with extensive costs, risks, and complications. However, multiple studies have shown that the heart is, in fact, not an end-stage organ and that there are endoge...
Source: Cardiology in Review - December 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Five Presidents and a Secretary
No abstract available (Source: Cardiology in Review)
Source: Cardiology in Review - December 7, 2017 Category: Cardiology Tags: Editorial Source Type: research
Early Coronary Angiography for Survivors of Out-of-Hospital Cardiac Arrests Without ST Elevation
There are over 300,000 out-of-hospital cardiac arrests (OOHCA) in the United States each year, and the long-term survival rate is less than 10%. Despite improvements in postarrest management, the greatest drop-off in survival occurs during hospitalization, mostly due to myocardial dysfunction and neurological injury. Coronary artery disease is common in postcardiac arrest patients, with an incidence of approximately 60–80%. In patients with a chest pain syndrome and an ST-segment–elevation myocardial infarction pattern evident on the presenting electrocardiogram, immediate revascularization is recommended by cardiovasc...
Source: Cardiology in Review - October 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Pregnancy in Patients With Congenital Heart Disease: A Contemporary Challenge
The majority of female patients with congenital heart disease (CHD) survives into childbearing age and require evidence-based counseling regarding pregnancy options. Even though most of them will have an uneventful pregnancy, they may be at high risk of cardiac, obstetric, and fetal complications. Predictive factors for these complications have been previously identified in numerous studies and with the use of specific scores [CARdiac disease in PREGnancy, Zwangerschap bij Aangeboren HARtAfwijkingen, and World Health Organization (WHO) risk stratification.] Importantly, the subtype of CHD is of vital importance for the pre...
Source: Cardiology in Review - October 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Is Swimming Safe in Heart Failure? A Systematic Review
It is not clear whether swimming is safe in patients with chronic heart failure. Ten studies examining the hemodynamic effects of acute water immersion (WI) (155 patients; average age 60 years; 86% male; mean left ventricular ejection fraction (LVEF) 29%) and 6 randomized controlled trials of rehabilitation comparing swimming with either medical treatment only (n = 3) or cycling (n = 1) or aerobic exercise (n = 2), (136 patients, average age 59 years; 84% male, mean LVEF 31%) were considered. In 7 studies of warm WI (30–35°C): heart rate (HR) fell (2% to −15%), and both cardiac output (CO) (7–37%) and stroke volume ...
Source: Cardiology in Review - October 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Neprilysin Inhibition and the Treatment of Heart Failure: Recent Steps in the Right Direction
This article will review the history of the natriuretic peptide system and the investigations into it as a target for heart failure treatment, culminating in the positive results of the PARADIGM-HF trial, as well as planned and potential future directions for research. (Source: Cardiology in Review)
Source: Cardiology in Review - October 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Echocardiography in the Evaluation of Pulmonary Embolism
Pulmonary embolism is a major cause of mortality. Acute pulmonary embolism also encompasses a wide clinical spectrum of severity, ranging from asymptomatic silent disease to hemodynamic instability and shock. Echocardiography is a useful modality to improve treatment strategies for pulmonary embolus. Echocardiography plays a role in risk stratification at the time of diagnosis. The evaluation of the right ventricle (RV) has evolved over time. RV variables evaluated by echocardiography include RV size, RV/left ventricular ratio, RV fractional area of change, tricuspid annular plane systolic excursion, RV systolic pressure, ...
Source: Cardiology in Review - October 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Vitamins for Cardiovascular Diseases: Is the Expense Justified?
Despite the knowledge that a well-balanced diet provides most of the nutritional requirements, the use of supplemental vitamins is widespread among adults in the United States. Evidence from large randomized controlled trials over the last 2 decades does not support vitamin supplementation for the reduction of cardiovascular risk factors or clinical outcomes. Many of the vitamins used in common practice likely are safe when consumed in small doses, but long-term consumption of megadoses is not only expensive but has the potential to cause adverse effects. Therefore, a need exists to revisit this issue, reminding the public...
Source: Cardiology in Review - October 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Contemporary Diagnosis and Management of Atrial Flutter: A Continuum of Atrial Fibrillation and Vice Versa?
Atrial flutter (AFlu) is usually a fast (>240 bpm) and regular right atrial macroreentrant tachycardia, with a constrained critical region of the reentry circuit located at the cavotricuspid isthmus (CTI; typical CTI-dependent AFlu). However, a variety of right and left atrial tachycardias, resulting from different mechanisms, can also present as AFlu (atypical non-CTI-dependent AFlu). The electrocardiogram can provide clues to its origin and location; however, additional entrainment and more sophisticated electroanatomical mapping techniques may be required to identify its mechanism, location, and target area for a succes...
Source: Cardiology in Review - October 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Brain-Heart Interactions in Traumatic Brain Injury
The cardiovascular manifestations associated with nontraumatic head disorders are commonly known. Similar manifestations have been reported in patients with traumatic brain injury (TBI); however, the underlying mechanisms and impact on the patient’s clinical outcomes are not well explored. The neurocardiac axis theory and neurogenic stunned myocardium phenomenon could partly explain the brain-heart link and interactions and can thus pave the way to a better understanding and management of TBI. Several observational retrospective studies have shown a promising role for beta-adrenergic blockers in patients with TBI in redu...
Source: Cardiology in Review - October 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
Ascending Aortic Aneurysm Is an Inherited Disease: A Contemporary Literature Review Based on Hill’s Criteria of Specificity, Strength of Association, and Biological Coherence
There is growing evidence of a differential etiological basis for thoracic aortic aneurysms (TAA), with ascending (As) TAAs being genetically mediated and descending (Des) TAAs more strongly related to acquired pathologies. A comprehensive literature review of this hypothesis has not been carried out. We carried out a systematic literature review based on the latest guidelines on TAA endorsed by the American Heart Association. The etiologies were classified as genetic and inherited, the studies were tabulated accordingly, and Hill’s epidemiological criteria of causality were applied. We found 38 studies addressing the et...
Source: Cardiology in Review - October 7, 2017 Category: Cardiology Tags: Review Articles Source Type: research
