The Use of Statins in the Treatment and Prevention of Atrial Fibrillation
The hydroxy-methyl-glutaryl-CoA reductase inhibitors (statins) are used extensively in the treatment of hyperlipidemia and in the primary and secondary prevention of cardiovascular and cerebrovascular diseases. Statins have also been demonstrated to confer secondary pleiotropic benefits in a variety of other disease processes, including a potential advantage in treating and preventing atrial fibrillation. These effects are primarily due to the up-regulation of endothelial nitric oxide synthase activity and a decrease in nicotinamide adenine dinucleotide phosphate oxidase production, which leads to downstream effects that i...
Source: Cardiology in Review - August 9, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Non-Vitamin K Antagonist Oral Anticoagulants and Antiplatelet Therapy for Stroke Prevention in Patients With Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials
Non-vitamin K antagonist oral anticoagulants (NOACs) are frequently used to prevent stroke in patients with atrial fibrillation. These patients are often also on aspirin or other antiplatelet agents. It is possible that treatment with both NOACs and aspirin or other antiplatelet drug may be effective in decreasing stroke, but data are sparse regarding the efficacy and safety of using both agents for stroke prevention. To address these issues, data were pooled from the 4 recent randomized, controlled trials of NOACs: apixaban, rivaroxaban, dabigatran, and edoxaban, which included 42,411 patients; 14,148 (33.4%) were also on...
Source: Cardiology in Review - August 9, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Role of Antiplatelet Therapy and Anticoagulation in Nonischemic Cardiomyopathy
Heart failure continues to be a leading cause of morbidity and mortality throughout the United States. The pathophysiology of heart failure involves the activation of complex neurohormonal pathways, many of which mediate not only hypertrophy and fibrosis within ventricular myocardium and interstitium, but also activation of platelets and alteration of vascular endothelium. Platelet activation and vascular endothelial dysfunction may contribute to the observed increased risk of thromboembolic events in patients with chronic heart failure. However, current data from clinical trials do not support the routine use of chronic a...
Source: Cardiology in Review - August 9, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Edoxaban: A Novel Factor Xa Inhibitor for the Management of Non-valvular Atrial Fibrillation and Venous Thromboembolism
This article provides an overview of the safety and efficacy along with the advantages and disadvantages of edoxaban. (Source: Cardiology in Review)
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: New Therapy Update Source Type: research

Relaxin for the Treatment of Acute Decompensated Heart Failure: Pharmacology, Mechanisms of Action, and Clinical Evidence
Acute heart failure remains a major cause of morbidity, and its treatment requires an increasing investment of the health care system. Whereas success in treating chronic heart failure has been achieved over the last decades, several pharmacological approaches for acute heart failure have been introduced but have failed to demonstrate any clinical benefit. Serelaxin is a recombinant human relaxin-2 vasoactive peptide that causes systemic and renal vasodilation. Data suggest that the clinical benefits may be attributable to a potential combination of multiple actions of serelaxin, including improving systemic, cardiac, and ...
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: New Therapy Update Source Type: research

Short QT Syndrome in Current Clinical Practice
Short QT syndrome is a rare inherited autosomal dominant cardiac channelopathy associated with malignant ventricular and atrial arrhythmias. A shortened corrected QT interval is a marker for risk of malignant arrhythmias, which are secondary to increased transmural dispersion of repolarization. The underlying gain of function mutations in the potassium channels are most common but genetic testing remains low yield. This review discusses the cellular mechanisms, genetic involvement, clinical presentation, and current recommended management of patients with short QT syndrome relevant to current clinical practice. (Source: Cardiology in Review)
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Antianginal Agents for the Management of Stable Ischemic Heart Disease: A Review
Antianginal medications are an important aspect of optimal medical therapy for the management of angina in patients with stable ischemic heart disease. The lack of a standardized definition of effective antianginal therapy and the lack of clear understanding of the underlying evidence have often been cited as reasons for the large variations in the use of these particular classes of pharmacologic agents in contemporary clinical practice. Hence, we performed a search of the PubMed database and identified published manuscripts examining the effect of common antianginal agents on improving anginal parameters and on important ...
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Antiplatelet and Anticoagulation Treatment in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome: Comparison of the Updated North American and European Guidelines
In 2014, the American Heart Association and the American College of Cardiology (AHA/ACC) published their guideline for the management of patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS), whereas the European Society of Cardiology published their latest guideline for the management of patients with NSTE-ACS in 2011. In this article, we review the main updates in antiplatelet and anticoagulation therapy in the 2014 AHA/ACC guideline and compare them with the 2011 European guidelines. Key recommendations in the AHA/ACC guidelines include the addition of ticagrelor to a broad spectrum of patient...
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Association of Traditional Cardiovascular Risk Factors With Development of Major and Minor Electrocardiographic Abnormalities: A Systematic Review
We examined data analyzing risk factor associations with ECG abnormalities in individuals free of cardiovascular disease. For composite major or minor ECG abnormalities, black race, older age, higher blood pressure, use of antihypertensive medications, higher body mass index, diabetes, smoking, and evidence of left ventricular hypertrophy or higher left ventricular mass are the factors most commonly associated with prevalence and incidence. Risk factor associations differ somewhat according to types of specific ECG abnormalities. Because major and minor ECG abnormalities have important and independent prognostic significan...
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Marijuana Use and Cardiovascular Disease
Marijuana is currently the most used illicit substance in the world. With the current trend of decriminalization and legalization of marijuana in the US, physicians in the US will encounter more patients using marijuana recreationally over a diverse range of ages and health states. Therefore, it is relevant to review marijuana’s effects on human cardiovascular physiology and disease. Compared with placebo, marijuana cigarettes cause increases in heart rate, supine systolic and diastolic blood pressures, and forearm blood flow via increased sympathetic nervous system activity. These actions increase myocardial oxygen ...
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Cryptogenic Stroke: Making the Management Less Cryptic
Cryptogenic stroke (CS) accounts for 20% to 40% of ischemic strokes. CS is defined as a cortical infarct suggestive of an embolic stroke with no identifiable cardiac etiology, large vessel occlusive disease, or small vessel lacunar stroke. The likely etiologies for CS are patent foramen ovale (PFO) and paroxysmal atrial fibrillation, which can be detected by transesophageal echocardiography and long-term cardiac rhythm monitoring. In a busy academic hospital, the stroke service is frequently asked to provide a rational approach to patients with such a presentation. The 2011 American Heart Association/American Stroke Associ...
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: Review Articles Source Type: research

PCSK9 Inhibitors: An Innovative Approach to Treating Hyperlipidemia
Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors are novel agents indicated for the treatment of hyperlipidemia. Inhibition of PCSK9 produces an increase in surface low-density lipoprotein (LDL) receptors and increases removal of LDL from the circulation. Alirocumab (Praluent; Sanofi/Regeneron, Bridgewater, NJ) and evolocumab (Repatha; Amgen, Thousand Oaks, CA) are currently available and approved for use in patients with heterozygous familial hypercholesterolemia, homozygous familial hypercholesterolemia, and clinical atherosclerotic cardiovascular disease. Bococizumab (RN316; Pfizer, New York, NY) is curr...
Source: Cardiology in Review - April 7, 2016 Category: Cardiology Tags: New Therapy Update Source Type: research

Revascularization for Left Anterior Descending Artery Stenosis: A Review of the Evidence That Supports Practice
Disease of the proximal left anterior descending (LAD) artery is a common pathological finding often combined with disease in other coronary arteries. In this article, we review specifically the evidence (and the guidelines arising from the data) for lesions isolated to the proximal LAD only. Critical review of the data reveals limitations with few trials that reflect contemporary practice. Much of the data are observational rather than from randomized trials, and therefore subject to bias. We identified 2 randomized trials of drug-eluting stents versus left internal mammary artery grafting for isolated lesions of the prox...
Source: Cardiology in Review - April 7, 2016 Category: Cardiology Tags: Review Articles Source Type: research

New Invasive Assessment Measures of Coronary Artery Disease Severity
Ischemic heart disease is the leading cause of mortality worldwide. The assessment and treatment of patients with ischemic heart disease have advanced greatly over the past decade. Particular attention has been given recently to the recognition of lesions that cause ischemia or that are prone to plaque rupture. New invasive measures of coronary artery disease have been developed, including fractional flow reserve, intravascular ultrasound, optical coherence tomography, and most recently, near-infrared spectroscopy. These technologies have helped to guide the assessment of hemodynamically significant lesions and have shown ...
Source: Cardiology in Review - April 7, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Why Does the Bicuspid Aortic Valve Keep Eluding Us?
This article will provide a comprehensive review of (1) the typical clinical course of patients with BAV under contemporary management, (2) new risk-stratifying parameters proposed to make an individualized approach possible, and (3) practical challenges all cardiovascular specialists need to know when implementing and interpreting future BAV-related studies. (Source: Cardiology in Review)
Source: Cardiology in Review - April 7, 2016 Category: Cardiology Tags: Review Articles Source Type: research

MicroRNAs in Cardiovascular Disease: Perspectives and Reality
Since the discovery of the first noncoding RNA decades ago, the transcriptomics evolution has made a great leap reaching to the detection and recognition of microRNAs (miRNAs) in the early 1990s. Thereafter, numerous miRNAs were reported in different species, with a great body of literature focusing on their role in human health and in pathophysiological processes. miRNAs play a significant role in the cardiovascular system, not only in physiology and normal development but also in disease processes and evolution. Further studies on miRNAs have highlighted their participation in several expressions of cardiovascular diseas...
Source: Cardiology in Review - April 7, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Plasma Kallikrein Inhibitors in Cardiovascular Disease: An Innovative Therapeutic Approach
Plasma prekallikrein is the liver-derived precursor of the trypsin-like serine protease plasma kallikrein, and circulates in plasma bound to high molecular weight kininogen. Plasma prekallikrein is activated to plasma kallikrein by activated factor XII or prolylcarboxypeptidase. Plasma kallikrein regulates the activity of multiple proteolytic cascades in the cardiovascular system such as the intrinsic pathway of coagulation, the kallikrein–kinin system, the fibrinolytic system, the renin–angiotensin system, and the complement pathways. As such, plasma kallikrein plays a central role in the pathogenesis of throm...
Source: Cardiology in Review - April 7, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Approaches to Improving Adherence to Secondary Prophylaxis for Rheumatic Fever and Rheumatic Heart Disease: A Literature Review with a Global Perspective
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are autoimmune conditions resulting from infection with group A streptococcus. Current management of these conditions includes secondary antibiotic prevention. This comprises regular 3 to 4 weekly long-acting intramuscular benzathine penicillin injections. Secondary antibiotic prevention aims to protect individuals against reinfection with group A streptococcus, thereby preventing recurrent ARF and the risk of further damage to the heart valves. However, utilization of benzathine penicillin can be poor leaving patients at risk of avoidable and progressive heart ...
Source: Cardiology in Review - February 5, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Abdominal Aortic Aneurysms and Risk Factors for Adverse Events
An abdominal aortic aneurysm (AAA) is a focal full thickness dilatation of the abdominal aorta, greater than 1.5 times its normal diameter. Although some patients with AAA experience back or abdominal pain, most remain asymptomatic until rupture. The prognosis after AAA rupture is poor. Management strategies for patients with asymptomatic AAAs include risk factor reduction, such as smoking cessation, optimizing antihypertensive treatment, and treating dyslipidemia, as well as surveillance by ultrasound. Currently, aneurysm diameter alone is often used to assess risk of rupture. Once the aneurysm diameter reaches 5.5 cm, th...
Source: Cardiology in Review - February 5, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Circulating Biomarkers Predictive of Postoperative Atrial Fibrillation
Postoperative atrial fibrillation (PoAF), a common complication of cardiac surgery, contributes significantly to morbidity, mortality, and increasing healthcare costs. Despite advances in surgical and medical management, the overall incidence of PoAF has not changed significantly, partly because of the limited understanding of mechanisms underlying acute surgery-related factors, such as myocardial injury, inflammation, sympathetic activation, and oxidative stress, which play an important role in the initiation of PoAF, whereas a preexisting atrial substrate appears to be more important in the maintenance of this dysrhythmi...
Source: Cardiology in Review - February 5, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Carotid Intima Media Thickness and Its Utility as a Predictor of Cardiovascular Disease: A Review of Evidence
Cardiovascular (CV) disease is still the leading cause of death in the developed world, despite the considerable progress in CV medical and surgical therapeutics. Many risk factors are associated with the development of future adverse CV events, such as age, hypertension, body mass index, and other comorbidities. Carotid intima media thickness (CIMT) is one method of calculating plaque burden by assessing the level of arterial thickening present. CIMT can be used as a noninvasive marker of atherosclerotic disease with increasing CIMT linked to an increased risk of subsequent CV events. In this review, the association of CI...
Source: Cardiology in Review - February 5, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Strain Imaging: From Physiology to Practical Applications in Daily Practice
Non-Doppler, 2-dimensional strain imaging is a new echocardiographic technique for obtaining strain and strain rate measurements, which serves as a major advancement in understanding myocardial deformation. It analyzes motion in ultrasound imaging by tracking speckles in 2 dimensions. There are a lot of data emerging with multiple applications of strain imaging in the clinical practice of echocardiography. As incorporation of strain imaging in daily practice has been challenging, we intend to systematically highlight the top 10 applications of speckle-tracking echocardiography, which every cardiologist should be aware of: ...
Source: Cardiology in Review - February 5, 2016 Category: Cardiology Tags: Review Articles Source Type: research

A Case for Inclusion of Genetic Counselors in Cardiac Care
We present a series of cases collected from a nationwide query of genetics professionals regarding issues related to cost and utilization of genetic testing. Three themes emerged across cases: (1) choosing the most appropriate genetic test, (2) choosing the best person to test, and (3) interpreting results accurately. These cases demonstrate that involvement of a genetic counselor throughout the evaluation, diagnosis, and continuing management of individuals and families with inherited cardiovascular conditions helps to promote the efficient use of healthcare dollars. (Source: Cardiology in Review)
Source: Cardiology in Review - February 5, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Sacubitril/Valsartan: A Novel Cardiovascular Combination Agent
Sacubitril/valsartan [LCZ696 (Entresto), Novartis Pharmaceuticals Corp.] is the first in a new class of drugs that combines neprilysin inhibition with angiotensin II receptor antagonism, the combination of which acts to increase endogenous natriuretic peptides while inhibiting the renin–angiotensin–aldosterone system. Sacubitril/valsartan has been studied in the treatment of hypertension, heart failure with reduced ejection fraction (HFrEF), and heart failure with preserved ejection fraction (HFpEF) and has demonstrated clinical efficacy in blood pressure reduction in hypertensive patients with and without HFpE...
Source: Cardiology in Review - December 5, 2015 Category: Cardiology Tags: New Therapy Update Source Type: research

Hypertension in Sub-Saharan Africa: A Contextual View of Patterns of Disease, Best Management, and Systems Issues
Sub-Saharan Africa (SSA) bears the highest burden of both communicable and noncommunicable disease and has the weakest health systems. Much attention is directed toward a rising burden of chronic disease in the setting of epidemiologic transition and urbanization. Indeed, the highest prevalence of hypertension globally is in the World Health Organization’s African region at 46% of adults aged 25 and above. And while hypertension in SSA is common, its prevalence varies significantly between urban and rural settings. Although there is evidence for epidemiologic transition in urban areas, there is also evidence of stati...
Source: Cardiology in Review - December 5, 2015 Category: Cardiology Tags: Other Invited Review Article Source Type: research

Use of Extracorporeal Membrane Oxygenation in Refractory Cardiogenic Shock
Cardiogenic shock is a condition marked by low cardiac output and end-organ hypoperfusion frequently requiring hemodynamic support, and it carries a high mortality. Extracorporeal membrane oxygenation (ECMO) is an effective tool in providing mechanical circulatory support in patients with cardiogenic shock refractory to conventional medical therapies. ECMO can be an essential bridge to recovery, ventricular assist device implantation or transplant. A multidisciplinary team approach is needed in managing such patients and intensive monitoring is required to avoid complications from ECMO. Nevertheless, randomized clinic tria...
Source: Cardiology in Review - December 5, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Treatment Options in Massive and Submassive Pulmonary Embolism
Pulmonary embolism (PE) is a common cardiovascular condition that represents a spectrum of disorders with a gradient of increased risk of adverse outcomes. The U.S. Surgeon General estimated that approximately 100,000 to 180,000 PE-related deaths occur in the United States annually, and that PE is the most preventable cause of death among hospitalized patients. Risk stratification is critical to identify the patients who may benefit from advanced therapy. This review will provide an overview of PE pathophysiology, evidence-based risk stratification strategies for patients with acute PE, a summary of traditional and novel o...
Source: Cardiology in Review - December 5, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Native and Prosthetic Valve Emergencies
This article addresses the etiologies, presentation, and diagnosis of these conditions and presents the relevant data that bears on which therapy may be most appropriate for which condition. (Source: Cardiology in Review)
Source: Cardiology in Review - December 5, 2015 Category: Cardiology Tags: Review Articles Source Type: research

The Pulmonary Artery Catheter in 2015: The Swan and the Phoenix
This article systematically reviews the evolution of PACs, the results of nonrandomized and randomized studies in various clinical conditions, the reasons for its decline, and current indications of PAC. (Source: Cardiology in Review)
Source: Cardiology in Review - December 5, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Usefulness of Platelet Function Tests to Predict Bleeding With Antithrombotic Medications
The pharmacological inhibition of platelets has always been regarded as a double-edged sword: the challenge of balancing the antithrombotic effect against the bleeding risk. Potent antiplatelet agents and novel oral anticoagulants, sometimes in combination, are increasingly used in the treatment of cardiovascular disease and for thromboprophylaxis in atrial fibrillation. Although such treatment has reduced the risk of thrombotic events, the potential for major bleeding has increased, and a technique to identify those at increased bleeding risk is greatly needed. Platelet function tests (PFTs), most frequently VerifyNow and...
Source: Cardiology in Review - October 7, 2015 Category: Cardiology Tags: Review Articles Source Type: research

The Cardiovascular Effects of Colchicine: A Comprehensive Review
This article serves as a focused and updated discussion on the cardiovascular effects of colchicine and emphasizes the importance of randomized, placebo-controlled trials to further our clinical and pharmacological understanding of these findings. (Source: Cardiology in Review)
Source: Cardiology in Review - October 7, 2015 Category: Cardiology Tags: Review Articles Source Type: research

The Heartbreak of Psoriasis: A Review of Cardiovascular Risk in Patients With Psoriasis
Psoriasis is a common, chronic, autoimmune condition characterized by excessive growth and differentiation of keratinocytes that affects approximately 1% to 3% of the general population in the United States. Mounting evidence has led to an increasing awareness that psoriasis as a disease is more than “skin deep” and that it shares systemic manifestations with other chronic inflammatory diseases such as Crohn’s and diabetes mellitus. Recent studies have not only shown an increased prevalence of cardiovascular risk factors in psoriasis but have also identified psoriasis as an independent risk factor for dev...
Source: Cardiology in Review - October 7, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Current Strategies in the Evaluation and Management of Cocaine-Induced Chest Pain
With each successive year, the number of Emergency Department (ED) visits related to illicit drug abuse has progressively increased. Cocaine is the most common illegal drug to cause a visit to the ED. Cocaine use results in a variety of pathophysiological changes with regards to the cardiovascular system, such as constriction of coronary vessels, dysfunction of vascular endothelium, decreased aortic elasticity, hemodynamic disruptions, a hypercoagulable state, and direct toxicity to myocardial and vascular tissue. The clinical course of patients with cocaine-induced chest pain (CCP) is often challenging, and electrocardiog...
Source: Cardiology in Review - October 7, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Feasibility and Significance of Preclinical Diagnosis in Hypertrophic Cardiomyopathy
Preclinical diagnosis in hypertrophic cardiomyopathy (HCM) refers to the detection of functional or histopathological abnormalities in subjects who carry any HCM-causing gene mutation, before or even without the development of left ventricular hypertrophy [genotype(+)/phenotype(-)subjects]. The concept that HCM pathology may exist in the absence of left ventricular hypertrophy is quite old but the ability to recognize the presence of early myocardial changes is quite new. Lessons from animal models have shown that in experimental human HCM, myocardial cell mechanical dysfunction precedes histopathological changes, such as ...
Source: Cardiology in Review - October 7, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Transcatheter Mitral Valve Replacement: Design Implications, Potential Pitfalls and Outcomes Assessment
Transcatheter mitral valve replacement (TMVR) is an emerging new treatment option in patients with advanced mitral valve disease deemed a high or prohibitive risk for surgery. Designing an ideal TMVR device requires a detailed understanding of different mitral valve pathologies and the complex, dynamic anatomy and physiology of the mitral apparatus. This review aims to critically evaluate design implications in TMVR in the context of mitral valve disease, imaging prerequisites, procedural approaches, potential complications, and outcomes assessment. (Source: Cardiology in Review)
Source: Cardiology in Review - October 7, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Highly Sensitive Cardiac Troponin Assays: A Comprehensive Review of Their Clinical Utility
Cardiovascular disease is a major source of morbidity and remains the leading cause of death in the United States. To evaluate patients with suspected cardiovascular disease, several laboratory markers of cardiac injury are available including creatinine kinase, creatinine kinase isoenzyme MB, myoglobin, and cardiac troponins (cTn) I and T. cTns have become the preferred marker of cardiac damage because they are highly sensitive and are almost completely cardiac specific. Recently, highly sensitive cTn (hs-cTn) assays were developed and have been used across the world to more quickly and accurately diagnose myocardial infa...
Source: Cardiology in Review - October 7, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Epigenetic Regulation in Heart Failure: Part II DNA and Chromatin
Epigenetic regulatory mechanisms play key roles in cardiac development, differentiation, homeostasis, response to stress and injury, and disease. Human heart failure (HF) epigenetic regulatory mechanisms have not been deciphered to date. This 2-part review distills the rapidly evolving research focused on human HF epigenetic regulatory mechanisms. Part I, which was published in the September/October issue, focused on epigenetic regulatory mechanisms involving RNA, specifically the role of short, intermediate, and long noncoding RNAs (lncRNAs) and endogenous competing RNA regulatory networks. Part II, now in the November/De...
Source: Cardiology in Review - October 7, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Vorapaxar: A Protease-Activated Receptor Antagonist for the Prevention of Thrombotic Events
In this study, vorapaxar was discontinued in patients with a history of stroke due to excessive risk for intracranial hemorrhage after 2 years of therapy. As an adjunctive therapy to standard regimens, vorapaxar provides a greater net clinical benefit in MI patients who are at a lower risk for bleeding. In patients with PAD, it reduces the rates of recurrent acute limb ischemia with rehospitalization or peripheral revascularization. The most concerning adverse effect is bleeding. Vorapaxar should not be used in patients with a history of stroke, transient ischemic attack, intracranial hemorrhage, or active pathological ble...
Source: Cardiology in Review - August 6, 2015 Category: Cardiology Tags: New Therapy Update Source Type: research

Therapeutic Role of Innovative Anti-Inflammatory Medications in the Prevention of Acute Coronary Syndrome
An improved understanding of the pathogenesis of acute coronary syndromes and its relationship to atherosclerotic plaque rupture and thrombosis has contributed to the investigation of novel therapies for prevention and treatment. New data ascribe an increasingly important role of active inflammation in contributing to thinning of the atherosclerotic fibrous cap and plaque instability. Despite this understanding, there are currently no therapeutic approaches to specifically target the unstable plaque. Multiple randomized trials investigating treatment strategies have recently been completed or are currently being conducted,...
Source: Cardiology in Review - August 6, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Atrial Fibrillation in Athletes
Atrial fibrillation is the most common arrhythmia in athletes and may be associated with endurance sport practice. Atrial ectopic beats, chronic systemic inflammation, autonomic system alterations, anatomic adaptation, myocardial injury and illicit drugs seem to be implicated in the increased prevalence of atrial fibrillation in athletes, but clear evidence is lacking. Treatment of the arrhythmia is a challenging issue, as atrial fibrillation may impair athletic performances and deteriorate athletes’ quality of life. This review focuses on the epidemiology, possible pathophysiological mechanisms, and management of at...
Source: Cardiology in Review - August 6, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Novel Biomarkers of Acute Kidney Injury After Contrast Coronary Angiography
Acute kidney injury (AKI), defined as a rise in serum creatinine of greater than 25% from baseline measured at 48 hours after renal insult, may follow iodinated contrast coronary angiography. Termed contrast-induced nephropathy, it can result in considerable morbidity and mortality. Measurement of serum creatinine as a functional biomarker of glomerular filtration rate is widely used for detection of AKI, but it lacks sensitivity for the early diagnosis of AKI (typically rising 24 hours after functional loss) and, as a solely functional marker of glomerular filtration rate, is unable to differentiate among the various caus...
Source: Cardiology in Review - August 6, 2015 Category: Cardiology Tags: Review Articles Source Type: research

The Current Status of Tissue-Engineered Vascular Grafts
This article aims to review the current status of research into the production and use of tissue-engineered grafts. TEVGs have a number of theoretical advantages over synthetic grafts. The results of animal and human studies have been promising, but more work must be done before TEVGs can replace traditional grafts. (Source: Cardiology in Review)
Source: Cardiology in Review - August 6, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Iron Oxide Nanoparticles as Contrast Agents in Molecular Magnetic Resonance Imaging: Do They Open New Perspectives in Cardiovascular Imaging?
Molecular magnetic resonance imaging has recently emerged as a powerful tool for the detection and assessment of cardiovascular diseases. Contrast agents have an important role in this novel modality because molecular imaging requires highly sensitive, specific, and efficient imaging agents. Iron oxide nanoparticles (IONs) are a new class of contrast agents with unique properties that provide special opportunities in cardiovascular molecular imaging. IONs are captured by macrophages and can be successfully used in the detection and evaluation of atherosclerotic plaques, abdominal aortic aneurysms, and inflammations related...
Source: Cardiology in Review - August 6, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Epigenetic Regulation in Heart Failure: Part I RNA
Epigenetic regulatory mechanisms play key roles in cardiac development, differentiation, homeostasis, response to stress and injury and disease. Human heart failure epigenetic regulatory mechanisms have not been deciphered to date. This 2-part review distills the rapidly evolving research focused on human heart failure epigenetic regulatory mechanisms. Part I focuses on epigenetic regulatory mechanisms involving RNA, specifically the role of short, intermediate and long noncoding RNAs and endogenous competing RNA regulatory networks. Part II focuses on the epigenetic regulatory mechanisms involving DNA, including DNA methy...
Source: Cardiology in Review - August 6, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Ivabradine: A Unique and Intriguing Medication for Treating Cardiovascular Disease
There has been much research linking elevated resting heart rate to cardiovascular morbidity and mortality. Based on these findings, a lower resting heart rate would be of theoretical benefit in patients with cardiovascular disease. From a pathophysiologic perspective, a lower resting heart rate would be of particular benefit in patients with ischemic heart disease and/or heart failure. Although β-blockers and nondihydropyridine calcium channel blockers are effective at lowering heart rate, they have many other pharmacologic effects that may not be desirable in some patients, such as negative inotropy. Ivabradine is a...
Source: Cardiology in Review - June 8, 2015 Category: Cardiology Tags: New Therapy Update Source Type: research

A Novel Class of Human Cardiac Stem Cells
Following the recognition that hematopoietic stem cells improve the outcome of myocardial infarction in animal models, bone marrow mononuclear cells, CD34-positive cells, and mesenchymal stromal cells have been introduced clinically. The intracoronary or intramyocardial injection of these cell classes has been shown to be safe and to produce a modest but significant enhancement in systolic function. However, the identification of resident cardiac stem cells in the human heart (hCSCs) has created great expectation concerning the potential implementation of this category of autologous cells for the management of the human di...
Source: Cardiology in Review - June 8, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Cardiac Transplantation in the New Era
The prevalence of heart failure continues to rise due to the aging population and longer survival of people with conditions that lead to heart failure, eg, hypertension, diabetes, and coronary artery disease. Although medical therapy has had an important impact on survival of patients and improving quality of life, heart transplantation remains the definitive therapy for patients that eventually deteriorate. Since the first successful heart transplantation in 1967, significant improvements have been made regarding donor and recipient selection, surgical techniques, and postoperative care. However, the number of potential o...
Source: Cardiology in Review - June 8, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Reverse Remodeling in Systolic Heart Failure
Left ventricular (LV) remodeling is the most common term used to describe the functional, structural, myocellular, and interstitial changes that occur in response to myocardial injury and/or chronic changes in myocardial loading conditions. Progression of LV remodeling over time in response to neurohormonal activation, increased wall stress, and inflammatory signaling pathways is associated with an increased risk of major morbidity and mortality. LV reverse remodeling describes the process by which an injured LV with a dilated spherical phenotype may return toward a normalization of ventricular structure and function, eith...
Source: Cardiology in Review - June 8, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Frequent Premature Ventricular Contractions: An Electrical Link to Cardiomyopathy
Heart failure is common and is associated with significant morbidity and mortality. Identifying potentially modifiable risk factors for the development of ventricular dysfunction is important in both the prevention and the treatment of this condition. Arrhythmia disorders are increasingly recognized as contributory to the development of ventricular failure. Poorly controlled supraventricular tachyarrhythmias, altered left ventricular activation due to left bundle branch block or right ventricular pacing, and frequent premature ventricular contractions (PVCs) constitute the main subtypes of arrhythmia disorders that are ass...
Source: Cardiology in Review - June 8, 2015 Category: Cardiology Tags: Review Articles Source Type: research

Heart Failure With Preserved Ejection Fraction: What Is in a Name?
Evidence-based management of heart failure (HF) with preserved left ventricular ejection fraction (LVEF; HFpEF) remains a major gap in the care of patients with HF. Clinical trials directed toward the population with HFpEF have been disappointing, although renin–angiotensin–aldosterone system blockade appears to prevent HF in populations predisposed to HFpEF. This paradox may partly be because of inhomogeneity within the HF populations studied. Although the term HFpEF is often used to imply a specific diagnosis, in fact this constellation may be due to a large variety of disease states with different underlying...
Source: Cardiology in Review - June 8, 2015 Category: Cardiology Tags: Review Articles Source Type: research