Genetics, Dyslipidemia, and Cardiovascular Disease: New Insights
AbstractPurpose of ReviewThe cardiovascular (CV) risk related to lipid disorders is well established and is based on a robust body of evidence from well-designed randomized clinical trials, as well as prospective observational studies. In the last two decades, significant advances have been made in understanding the genetic basis of dyslipidemias. The present review is intended as a comprehensive discussion of current knowledge about the genetics and pathophysiology of disorders that predispose to dyslipidemia. We also focus on issues related to statins and the proprotein convertase subtilisin/kexin type 9 (PCSK9) and some...
Source: Current Cardiology Reports - June 21, 2019 Category: Cardiology Source Type: research

New Insights in the Control of Low-Density Lipoprotein Cholesterol to Prevent Cardiovascular Disease
AbstractPurpose of ReviewLow-density lipoprotein cholesterol (LDL-C) is one major cause of cardiovascular disease (CVD). In this review, we discuss current developments in the understanding of LDL-C as lifelong risk factor, treatment targets, and emerging approaches to reduce cardiovascular risk by lowering LDL-C.Recent FindingsRecent evidence underscores the importance of LDL-C lowering in CVD prevention by mechanisms that increase the hepatic clearance of apolipoprotein B-containing lipoproteins from the plasma. Mendelian randomization studies provided evidence on both safety and efficacy of lower LDL-C in the long term....
Source: Current Cardiology Reports - June 21, 2019 Category: Cardiology Source Type: research

Emerging Role of Coronary Computed Tomography Angiography in Lipid-Lowering Therapy: a Bridge to Image-Guided Personalized Medicine
AbstractPurpose of ReviewTo summarize the current status of coronary computed tomography angiography (CTA) in the assessment of coronary plaques and discuss the ability of serial coronary CTA to quantitatively measure changes in the plaque burden in response to lipid-lowering therapy.Recent FindingsRecent advances in coronary CTA have allowed identification of high-risk coronary features in acute coronary syndrome and measurement of changes in the coronary plaque burden with good reproducibility. Statin therapy may delay plaque progression and change some plaque features. However, the clinical relevance of quantitative cha...
Source: Current Cardiology Reports - June 21, 2019 Category: Cardiology Source Type: research

Effect of SGLT2 Inhibitors on the Sympathetic Nervous System and Blood Pressure
AbstractPurpose of the ReviewHyperactivity of sympathetic nervous system (SNS) plays a role in the development of arterial hypertension and heart failure, two co-morbidities frequently associated with type 2 diabetes (T2DM). This review aims at analyzing the effects of sodium-glucose cotransporter type 2 inhibitors (SGLT2is) on blood pressure and more especially on SNS activity in patients with T2DM.Recent FindingsBy enhancing glucosuria, natriuresis, and osmotic diuresis, SGLT2is improve glucose control, promote weight loss, lower arterial blood pressure, and reduce the risk of major cardiovascular events and hospitalizat...
Source: Current Cardiology Reports - June 21, 2019 Category: Cardiology Source Type: research

Pluripotent Stem Cell-Derived Cardiomyocyte Transplantation for Heart Disease Treatment
AbstractPurpose of ReviewCardiovascular disease is the leading cause of mortality worldwide. Pluripotent stem cell-derived cardiomyocytes (PSC-CMs) have great potential to treat heart disease, owing to their capacity of engraftment and remuscularization in the host heart after transplantation. In the current review, we provide an overview of PSC-CMs for clinical transplantation.Recent FindingsStudies have shown that PSC-CMs can survive, engraft, and form gap junctions after transplantation, with functional benefit. Engrafted PSC-CMs matured gradually in host hearts. Only in a large animal model, transient ventricular arrhy...
Source: Current Cardiology Reports - June 21, 2019 Category: Cardiology Source Type: research

Strategies for Minimizing Occupational Radiation Exposure in Cardiac Imaging
AbstractPurpose of ReviewRadiation safety has been at the center of interest of both researchers and healthcare institutions. This review will summarize and shed light on the various techniques adapted to reduce staff exposure to ionizing radiation (IR) in the field of cardiac imaging.Recent FindingsIn the last years, with the advance of awareness and the development of new technologies, there have been several tools and techniques adapted. The breakthrough of several technologies to lower radiation dose and shorten the duration of diagnostic tests associated with IR, the use of protection devices by staff members, and mos...
Source: Current Cardiology Reports - June 21, 2019 Category: Cardiology Source Type: research

Time Is a Precious Commodity: 2018 OPTN Policy Change and the Potential to Lower Heart Transplant Waitlist Time in the Sickest Patients
AbstractPurpose of ReviewHeart transplantation is the gold standard therapy for end-stage heart failure; however, the donor pool is limited, making this a scarce resource that must be allocated to the sickest patients in an efficient, fair, and equitable manner. The allocation policies have been constantly revised over the years to refine the process. We will explore the new heart allocation system, OPTN-Policy 6, as well as, review why these changes were necessary.Recent FindingsOver the past decade, the number of active heart transplant candidates nearly doubled, with a dramatic increase in the number of status 1A and 1B...
Source: Current Cardiology Reports - June 20, 2019 Category: Cardiology Source Type: research

Left Atrial Occlusion Device Implantation: the Role of the Echocardiographer
AbstractPurpose of ReviewAtrial fibrillation is the most common arrhythmia worldwide and is a major risk factor for embolic stroke. For patients with atrial fibrillation who are unable to tolerate systemic anticoagulation, left atrial appendage (LAA) occlusion has been shown to mitigate stroke risk. In this article, we describe the vital role of the echocardiographer in intraprocedural guidance of percutaneous LAA occlusion procedures as well as in the pre- and post-procedure assessment of these patients.Recent FindingsA few percutaneously delivered devices for LAA exclusion from the systemic circulation are available in c...
Source: Current Cardiology Reports - June 10, 2019 Category: Cardiology Source Type: research

Aortic Regurgitation
AbstractPurpose of ReviewAortic regurgitation (AR) is a common form of valvular disease which is characterized by reflux of blood from the aorta into the left ventricle (LV) during diastole. AR results from various etiologies, affecting the aortic valve cusps or the aortic root. The clinical presentation of patients with AR depends on the severity of the regurgitation and differs whether AR develops acutely or if it progresses over a prolonged period, allowing the cardiac chambers to adapt. Echocardiography is the primary method to determine the etiology of AR and to define its severity. We review the current data regardin...
Source: Current Cardiology Reports - June 3, 2019 Category: Cardiology Source Type: research

Specific Anatomic Considerations for Tricuspid Interventions
AbstractPurpose of ReviewThis review discusses the normal anatomy and pathology of the tricuspid valve (TV) and right side of the heart. Emphasis is on those anatomic and pathologic features relevant to interventions intended to restore normal function to the TV in disease states.Recent FindingsTV pathology is less common than aortic and mitral valve pathology, and treatment and outcomes for interventions face considerable hurdles. New innovations and early data showing safety and efficacy in transcatheter interventions have transformed TV interventions into the next frontier in cardiac valve disease treatment. Certain fea...
Source: Current Cardiology Reports - May 30, 2019 Category: Cardiology Source Type: research

Pericardial Cysts: a Contemporary Comprehensive Review
AbstractPurpose of ReviewThis is an in-depth review on the etiology, clinical manifestation, differential diagnosis, diagnostic modalities, complications, and management of pericardial cysts (PCs).Recent FindingsPCs are the third most common type of mediastinal masses and are usually identified incidentally by chest x-ray (CXR) or transthoracic echocardiography (TTE). Although most PCs are asymptomatic, they might lead to serious complications such as cardiac tamponade. Diagnosis is confirmed by cardiac computed tomography or cardiac magnetic resonance. Cysts need to be followed by imaging every 1 to 2  years; however...
Source: Current Cardiology Reports - May 30, 2019 Category: Cardiology Source Type: research

Pulmonary Hypertension Due to Left Heart Disease: an Update
AbstractPurpose of ReviewPulmonary hypertension (PH) frequently complicates heart failure and portends a worse prognosis. This review will summarize and discuss recent updates in the classification and management of patients with PH due to left heart disease.Recent FindingsCareful hemodynamic assessment is critical to the classification of patients with PH and heart failure. Two hemodynamic subgroups of PH in heart failure patients have been described: isolated post-capillary pulmonary hypertension and combined post- and precapillary pulmonary hypertension. The cornerstone in management of PH due to left heart disease is t...
Source: Current Cardiology Reports - May 27, 2019 Category: Cardiology Source Type: research

Mitral Valve Pathology
AbstractPurpose of ReviewThis review describes numerous pathologic entities that cause structural abnormalities of the mitral valve. Different pathologic entities involve different components of the so-called mitral apparatus: atrial wall, annulus, leaflets, chordae, papillary muscles, and/or left ventricular free wall. These abnormalities can cause valvular stenosis, regurgitation, or both.Recent FindingsCurrently, in addition to open-chest surgery to replace or repair the damaged mitral valve, there are less invasive percutaneous approaches to address mitral valve dysfunction. These include narrowing the orifice, clippin...
Source: Current Cardiology Reports - May 23, 2019 Category: Cardiology Source Type: research

The Cardiorenal Axis: Myocardial Perfusion, Metabolism, and Innervation
AbstractPurpose of the ReviewCardiorenal syndrome (CRS), defined as concomitant heart and kidney disease, has been a focus of attention for nearly a decade. As more patients survive severe acute and chronic heart and kidney diseases, CRS has emerged as an “epidemic” of modern medicine. Significant advances have been made in unraveling the complex mechanisms that underlie CRS based on classification of the condition into five pathophysiologic subtypes. In types 1 and 2, acute or chronic heart disease results in renal dysfunction, while in types 3 and 4, acute or chronic kidney diseases are the inciting factors f...
Source: Current Cardiology Reports - May 20, 2019 Category: Cardiology Source Type: research

Techniques, Timing, and Prognosis of Transcatheter Post Myocardial Infarction Ventricular Septal Defect Repair
AbstractPurpose of ReviewThis review aims to delineate the actual role of percutaneous intervention in the closure of post-myocardial infarction ventricular septal defect (post-MI VSD) and to briefly summarize the main steps of this procedure.Recent FindingsMost of the published studies report experiences using Amplatzer devices for post-MI VSD closure. In the acute phase, morbidity and mortality are quite high up to 70%, with a mean success rate of 90%, with 95% confidence intervals from 60 to 100%, and a 30-day mortality of 40%, with 95% confidence intervals from 0 to 55%. In the chronic phase, that is 14  days afte...
Source: Current Cardiology Reports - May 20, 2019 Category: Cardiology Source Type: research

Masked Hypertension in CKD: Increased Prevalence and Risk for Cardiovascular and Renal Events
AbstractPurpose of ReviewHypertension and chronic kidney disease (CKD) are inextricably linked. The causal nature of the relationship is bidirectional. This relationship holds when blood pressure is assessed in the clinic and outside the clinic with home and ambulatory blood pressure monitoring. Patients with CKD are more likely to have high-risk hypertension phenotypes, such as masked and sustained hypertension, and are at increased risk for cardiovascular disease. The purpose of this review is to describe the increased prevalence of masked hypertension in patients with CKD and then describe the increased risk for target ...
Source: Current Cardiology Reports - May 20, 2019 Category: Cardiology Source Type: research

Secondary Prevention with Antithrombotic Therapies in Stable Ischemic Heart Disease Patients: a Review
In conclusion, the evidence thus far has not been significant enough for the American College of Cardiology to recommend the incorporation of oral anticoagulants in the management of stable ischemic heart disease patients, in contrast to aspirin and clopidogrel. As the antithrombotic and antiischemic properties of these newer agents seem evident, so does their potential for increase in risk of bleeding events. Doctors have to individually tailor antithrombotic medication decisions based on the patient ’s risk-benefit profile. (Source: Current Cardiology Reports)
Source: Current Cardiology Reports - May 18, 2019 Category: Cardiology Source Type: research

Diagnosis and Prognosis of Coronary Artery Disease with SPECT and PET
AbstractPurpose of ReviewRadionuclide myocardial perfusion imaging (MPI) continues to be the most reliable modality for diagnosis of hemodynamically significant coronary artery disease (CAD). The application of radionuclide MPI using single photon emission computed tomography (SEPCT) and positron emission tomography (PET) for CAD is reviewed, with emphasis on diagnosis and risk stratification.Recent FindingsContemporary studies have reported the diagnostic and prognostic value of novel imaging protocols, employing stress-first or stress-only approach. In addition, the superior diagnostic value of PET has been established w...
Source: Current Cardiology Reports - May 18, 2019 Category: Cardiology Source Type: research

Tricuspid and Pulmonic Valve Pathology
AbstractPurpose of ReviewThis review describes the normal structure and pathologic changes that affect the right-sided cardiac valves and chambers.Recent FindingsThe anatomy and pathology described have been known for many years. Knowledge of these findings has gained relevance. The pattern of endocarditis is changing. New diagnostic techniques have allowed better characterization of lesions responsible for cardiac dysfunction. Novel, less invasive interventions have made recognition of abnormalities more clinically relevant.SummaryThere are many different pathologic entities that can affect the right-sided cardiac valves....
Source: Current Cardiology Reports - May 18, 2019 Category: Cardiology Source Type: research

Novel Myocardial PET/CT Receptor Imaging and Potential Therapeutic Targets
AbstractPurpose of the ReviewActivation of myocardial cannabinoid type 1 receptors (CB1-R) and/or angiotensin II type 1 receptors (AT1-R) likely plays an important mechanistic role in determining the left-ventricular remodeling process in systolic heart failure. We provide an overview on novel radiotracer probes and positron emission tomography (PET)/computed tomography (CT) imaging to noninvasively probe the expression of myocardial CB1-R and/or AT1-R.Recent FindingsRecent translational investigations have demonstrated the feasibility of11C-OMAR or11C-KR31173 and PET/CT to image and quantify myocardial CB1-R and/or AT1-R ...
Source: Current Cardiology Reports - May 18, 2019 Category: Cardiology Source Type: research

Use of Cardiac Imaging to Evaluate Cardiac Function and Pulmonary Hemodynamics in Patients with Heart Failure
AbstractPurpose of ReviewNoninvasive hemodynamic assessments in patients with heart failure (HF) are essential for appropriate diagnosis and establishment of the best treatment strategies. Recently, the impact of pulmonary circulation and right ventricular function on prognosis in HF patients has drawn increasing attention. In this article, we explore the usefulness of cardiac imaging for hemodynamic assessments, mainly focusing on echocardiographic evaluation.Recent FindingsThe reliability of Doppler echocardiography as a noninvasive alternative to Swan-Ganz catheterization has been well investigated with higher than 80% ...
Source: Current Cardiology Reports - May 10, 2019 Category: Cardiology Source Type: research

Transseptal Puncture: Devices, Techniques, and Considerations for Specific Interventions
AbstractPurpose of ReviewTransseptal puncture is a routinely performed interventional cardiology procedure for an array of cardiac diseases. We aimed to review the current status of available devices and techniques of transseptal puncture with consideration to specific interventions.Recent FindingsExcept for a few modifications, devices for transseptal puncture technique has not changed much compared to when it was first described almost 60  years ago. For difficult transseptal puncture, a few newer techniques such as radio frequency needle puncture system have been used but there is lack of robust clinical study. Adv...
Source: Current Cardiology Reports - May 7, 2019 Category: Cardiology Source Type: research

Is There a Need to Revise Goals in the Management of Dyslipidemias?
AbstractPurpose of ReviewCurrent guidelines on the management of patients with dyslipidemias recommend specific risk-dependent low-density lipoprotein cholesterol (LDL-C) treatment goals. Recently, several randomized clinical trials have investigated further lowering of LDL-C in addition to statin therapy using novel therapeutic approaches and examined their effects on cardiovascular (CV) risk. This review summarizes newly available data on efficacy and safety of lowering LDL-C beyond statin therapy and below current treatment targets.Recent FindingsIn patients at very high risk for CV events, a significant residual risk r...
Source: Current Cardiology Reports - April 30, 2019 Category: Cardiology Source Type: research

Psychosocial Factors and Recovery After Acute Myocardial Infarction in Younger Women
AbstractPurpose of ReviewTo explain sex and gender approaches to studying acute myocardial infarction (AMI) risk and outcomes in younger women (18 –55 years). More specifically, by looking at the AMI care pathway—from AMI risk to receiving acute and follow-up outpatient care to longer term AMI outcomes—we will examine where potential psychosocial factors may be associated with inequalities in AMI care and outcomes in younger women.Recent FindingsDespite recent declines in AMI incidence, morbidity, and mortality rates, younger women stand out as a group whose incidence has risen and who face worse out...
Source: Current Cardiology Reports - April 24, 2019 Category: Cardiology Source Type: research

Refractory Angina: the Current State of Mechanical Therapies
AbstractPurpose of ReviewRefractory angina (RA), which is characterized by tissue ischemia along with neurological, mitochondrial, and psychogenic dysfunction, is becoming a major cause of morbidity in patients with advanced coronary artery disease. In this review, we discuss in detail the invasive mechanical non-cell therapy –based options, the evidence behind these therapies, and future trends.Recent FindingsThere is extensive ongoing research in the areas of spinal-cord stimulation, transmyocardial laser revascularization, sympathectomy, angiogenesis, and other non-cell-based therapies to explore the best therapy ...
Source: Current Cardiology Reports - April 22, 2019 Category: Cardiology Source Type: research

Dyslipidemia Profiles in Patients with Peripheral Artery Disease
AbstractPurpose of ReviewThis review of the literature aims to discuss the evidence linking different lipid and apolipoprotein measures to peripheral artery disease.Recent FindingsMeasures of atherogenic dyslipidemia, including elevations in total cholesterol and total cholesterol/high-density lipoprotein cholesterol as well as low levels of high-density lipoprotein cholesterol, are strongly associated with future risk of peripheral artery disease. Compared to coronary artery disease, there are fewer data showing an association between low-density lipoprotein cholesterol and future risk of peripheral artery disease. Novel ...
Source: Current Cardiology Reports - April 22, 2019 Category: Cardiology Source Type: research

Lifestyle Interventions to Prevent Cardiovascular Events After Stroke and Transient Ischemic Attack
AbstractPurpose of ReviewTo summarize lifestyle interventions including pharmacological and non-pharmacological methods targeting modifiable risk factors and their impact on the future cardiovascular events in patients who have suffered transient ischemic attack (TIA) and/or ischemic stroke (IS).Recent FindingsThe latest research indicates that secondary prevention measures can decrease the risk of recurrent stroke, cardiovascular events, and even death. Modifiable risk factors also require behavioral change which can be challenging.SummaryThere is limited data demonstrating the impact of lifestyle interventions, alone or ...
Source: Current Cardiology Reports - April 22, 2019 Category: Cardiology Source Type: research

Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes
AbstractPurpose of ReviewThe aims of this review are to summarize recent data on mortality and cardiovascular disease (CVD) in type 1 and type 2 diabetes and to determine the interventions that could have contributed to a reduction in mortality.Recent FindingsRecent studies found a downward trend in mortality and CVD among both diabetics and non-diabetics worldwide over the last few decades. The decline among diabetics is steeper than that among non-diabetics. Despite a parallel trend of decline, an approximately twofold difference in mortality and CVD between the two populations remains.SummaryA greater emphasis on glycem...
Source: Current Cardiology Reports - April 22, 2019 Category: Cardiology Source Type: research

Treatment Challenges in Patients with Acute Heart Failure and Severe Aortic Valve Stenosis
AbstractPurpose of ReviewThe goal of this paper is to describe the treatment challenges in patients with aortic stenosis in combination with a reduced left ventricular function.Recent FindingsSince the risk of mortality is increased in this patient population, transcatheter aortic valve implantation emerged as an important treatment option. Concomitant factors such as mitral regurgitation or coronary artery disease are important co-factors that need to be evaluated and taken into account for treatment decision.SummaryTreatment of the severe aortic stenosis is key in this complex setting. Since several co-factors may exist ...
Source: Current Cardiology Reports - April 22, 2019 Category: Cardiology Source Type: research

Device Closure of Patent Foramen Ovale for Cryptogenic Stroke: Patient Selection and Outcomes According to New Randomized Trials
AbstractPurpose of ReviewThis review summarizes the most recent randomized clinical trials that studied the role of device-mediated patent foramen ovale (PFO) closure in patients after an ischemic stroke presumed to have been caused by a paradoxical embolism.Recent FindingsThree major randomized trials published in 2017 studied the strategy of using PFO closure for secondary prevention in patients between the ages of 18 and 60 who presented with an index stroke having characteristics of an embolic mechanism. All patients had a PFO that potentially could have enabled paradoxical embolism and other causes of stroke were excl...
Source: Current Cardiology Reports - April 22, 2019 Category: Cardiology Source Type: research

Polygenic Hypercholesterolemia and Cardiovascular Disease Risk
AbstractPurpose of the ReviewIdentification of loci and common single-nucleotide polymorphisms (SNPs) that have modest effects on plasma lipids have been used to confirm or refute the causal role of lipid traits in the development of coronary heart disease (CHD), and as tools to identify individuals with polygenic hypercholesterolemia.Recent FindingsSeveral groups have reported on the use of SNP scores in distinguishing individuals with a clinical diagnosis of familial hypercholesterolemia (FH) with a monogenic or polygenic etiology. We review evidence that those with monogenic FH have worse prognosis and discuss the possi...
Source: Current Cardiology Reports - April 22, 2019 Category: Cardiology Source Type: research

Ethics and Bias in Clinical Trial Enrollment in Stroke
AbstractPurpose of ReviewTo familiarize the reader with ethical concerns and potential scientific bias in management and conduction of clinical stroke trials.Recent FindingsThe goal of clinical trials in stroke is to find effective interventions for stroke prevention, acute treatment, and rehabilitation and recovery. Acute trials must be designed in the context of the time-sensitivity of revascularization therapies. Standard ethical constraints apply. However, informed consent is hindered by tight time windows for reperfusion therapy and frequent cognitive impairment in patients. These might be mitigated by using visual de...
Source: Current Cardiology Reports - April 22, 2019 Category: Cardiology Source Type: research

Multimodality Imaging for the Assessment of Pericardial Diseases
AbstractPurpose of ReviewThe diagnosis of pericardial syndromes, while occasionally straightforward, includes a wide range of pathologies and is often a well-recognized clinical challenge. The aim of this review is to highlight the key role of the various imaging modalities for the diagnosis and management of the spectrum of pericardial diseases.Recent FindingsCardiac imaging has become an integral part of the diagnostic process often beginning with echocardiography and supported by advanced imaging modalities including computed tomography, magnetic resonance imaging, and positive emission tomography. These modalities go b...
Source: Current Cardiology Reports - April 16, 2019 Category: Cardiology Source Type: research

Correction to: Cardiotoxicity of Targeted Cancer Drugs: Concerns, “The Cart Before the Horse,” and Lessons from Trastuzumab
In the original publication, there were two errors in Fig.  2. “Anhracyline” should be “Anthracycline” and “targetd” should be “targeted.” The original article has been corrected. (Source: Current Cardiology Reports)
Source: Current Cardiology Reports - April 15, 2019 Category: Cardiology Source Type: research

Revascularization Strategies for Non-ST-Elevation Myocardial Infarction
AbstractPurpose of ReviewNon-ST-elevation myocardial infarction (NSTEMI) is an urgent medical condition that requires prompt application of simultaneous pharmacologic and non-pharmacologic therapies. The variation in patient clinical characteristics coupled with the multitude of treatment modalities makes optimal and timely management challenging. This review summarizes risk stratification of patients, the role and timing of revascularization, and highlights important considerations in the revascularization approach with attention to individual patient characteristics.Recent FindingsThe early invasive management of NSTEMI ...
Source: Current Cardiology Reports - April 10, 2019 Category: Cardiology Source Type: research

Nutrigenetics of Blood Cholesterol Concentrations: Towards Personalized Nutrition
AbstractPurpose of the ReviewTo summarize achievements made in the field of nutrigenetics to personalized nutrition. Moreover, the limitations and challenges observed to enable clinical utilization are discussed.Recent FindingsCurrently, with the availability of low-cost genetic testing and new bioinformatics tools, significant developments have occurred to allow issues inherent to the highly complex nature of genetic data to be tackled. Moreover, new statistical methods have uncovered combinatory patterns of SNPs that collectively explain the high interindividual variability in response to dietary interventions. Yet, the ...
Source: Current Cardiology Reports - March 29, 2019 Category: Cardiology Source Type: research

Transcatheter Tricuspid Valve Interventions: An Emerging Field
AbstractPurpose of ReviewThis review aims to provide an updated overview and a clinical perspective on novel transcatheter tricuspid valve interventions (TTVI), highlighting potential challenges and future directions.Recent FindingsSevere tricuspid regurgitation (TR) is a predictor of mortality. However, a sizeable number of patients remain untreated until the end –stage when cardiac surgery presents a prohibitive risk. The emergent need in finding a treatment for patients with TR, deemed for surgery options, has encouraged the development of TTVI. These procedures mimic classical surgery techniques and are mainly di...
Source: Current Cardiology Reports - March 28, 2019 Category: Cardiology Source Type: research

Radial Artery Versus Saphenous Vein Grafts in Coronary Artery Bypass Surgery: a Literature Review
AbstractPurpose of ReviewCoronary artery bypass grafting is a preferred strategy for complete coronary revascularization in patients who have multi-vessel coronary artery disease, left ventricular dysfunction, and/or diabetes. Both arterial (internal thoracic artery/radial artery) and venous grafts are utilized to bypass the obstruction in native vessels. Despite having radial arterial grafts as a preferred second conduit for bypass, venous grafts are more commonly used.Recent FindingsWe review the existing literature and report the preferred conduit based on a recently published meta-analysis of 6 randomized controlled tr...
Source: Current Cardiology Reports - March 22, 2019 Category: Cardiology Source Type: research

Neuromodulation Approaches for Cardiac Arrhythmias: Recent Advances
AbstractPurpose of ReviewThis review aims to describe the latest advances in autonomic neuromodulation approaches to treating cardiac arrhythmias, with a focus on ventricular arrhythmias.Recent FindingsThe increasing understanding of neuronal remodeling in cardiac diseases has led to the development and improvement of novel neuromodulation therapies targeting multiple levels of the autonomic nervous system. Thoracic epidural anesthesia, spinal cord stimulation, stellate ganglion modulatory therapies, vagal stimulation, renal denervation, and interventions on the intracardiac nervous system have all been studied in preclini...
Source: Current Cardiology Reports - March 18, 2019 Category: Cardiology Source Type: research

PET/CT for Diagnosis and Management of Large-Vessel Vasculitis
AbstractPurpose of ReviewThis review aims to discuss the use of fluorodeoxyglucose (FDG) positron emission tomography (PET/CT) for diagnosis and management of patients with large-vessel vasculitis (LVV).Recent FindingsIncidence of LVV is likely underestimated, in part due to its non-specific symptoms. Nevertheless, early diagnosis of LVV is essential to initiate timely therapy in order to prevent vascular complications, such as stenoses and aneurysms. FDG PET/CT imaging has the ability to detect LVV during the acute phase, prior to edema and other vascular structural changes, with its high sensitivity for inflammatory acti...
Source: Current Cardiology Reports - March 18, 2019 Category: Cardiology Source Type: research

Cardiotoxicity of Targeted Cancer Drugs: Concerns, “The Cart Before the Horse,” and Lessons from Trastuzumab
We describe the biologic foundations and clinical evidence for such controversy. We show that trastuzumab cardiotoxicity is probably overrated, leading some experts to raise unjustified overconcerns about the cardiotox icity of trastuzumab as a single agent or in combination with anthracyclines or other old and new drugs. We analyze the biases that caused trastuzumab cardiotoxicity to be overrated.SummaryTrastuzumab is a life-saving agent showing a moderate and clinically manageable cardiac dysfunction, and yet, it is portrayed as cardiotoxic. We take the trastuzumab lesson to reaffirm that cardio-oncologists should provid...
Source: Current Cardiology Reports - March 18, 2019 Category: Cardiology Source Type: research

The Importance and Role of Multiple Risk Factor Control in Type 2 Diabetes
AbstractPurpose of ReviewThe importance of composite risk factor control for reducing CVD risk in type 2 diabetes (T2DM) has gained increased attention and here we review the latest findings in the field.Recent FindingsThe Steno-2 study was the first to show that early intensive risk factor control could improve risk factor status and halve the CVD risk in patients with diabetes with lasting impact. A range of observational studies have added further insight to the importance of multiple risk factor control showing an incremental association between number of risk factors controlled and reduction in CVD risk. Noteworthy, a...
Source: Current Cardiology Reports - March 18, 2019 Category: Cardiology Source Type: research

Ultrasound Molecular Imaging: Principles and Applications in Cardiovascular Medicine
AbstractPurpose of ReviewNon-invasive molecular imaging is currently used as a research technique to better understand disease pathophysiology. There are also many potential clinical applications where molecular imaging may provide unique information that allows either earlier or more definitive diagnosis, or can guide precision medicine-based decisions on therapy. Contrast-enhanced ultrasound (CEU) with targeted microbubble contrast agents is one such technique that has been developed that has the unique properties of providing rapid information and revealing information only on events that occur within the vascular space...
Source: Current Cardiology Reports - March 18, 2019 Category: Cardiology Source Type: research

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left Main Stenosis
This article reviews the latest data on unprotected left main (ULM) percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery, with a focus on the NOBLE and EXCEL trials.Recent FindingsIn EXCEL trial, the primary endpoint at 3  years was 15.4% in the PCI group and 14.7% in the CABG group (p = 0.02 for non-inferiority of PCI versus CABG). In NOBLE, the primary endpoint at 5 years was 28% and 18% for PCI and CABG, respectively (HR 1.51, CI 1.13–2.0, which did not meet the criteria for non-inferiority of PCI to CABG;p for superiority of CABG was 0.0044). Higher rep...
Source: Current Cardiology Reports - March 18, 2019 Category: Cardiology Source Type: research

The Creation of an Interatrial Right-To-Left Shunt in Patients with Severe, Irreversible Pulmonary Hypertension: Rationale, Devices, Outcomes
AbstractPurpose of the ReviewTargeted pharmacotherapies did improve survival rates, exercise capacity, and quality of life (QoL) of PAH patients. However, these pharmacological interventions are expensive and not always accessible. In addition, not all patients do respond similarly to these medications and many will continue to deteriorate. This review aims to discuss the beneficial role of an artificial right-to-left shunt and highlights current interventional devices and outcomes.Recent FindingsSince patients with preexisting atrial shunts or patients with Eisenmenger ’s disease show better survival rates, improved...
Source: Current Cardiology Reports - March 18, 2019 Category: Cardiology Source Type: research

Relationship Between Outpatient Clinic and Ambulatory Blood Pressure Measurements and Mortality
AbstractPurpose of ReviewThis review aims to summarize and discuss the relationship between outpatient clinic and ambulatory blood pressure (BP) measurements and cardiovascular morbidity and mortality.Recent FindingsContemporary clinical practice guidelines worldwide recommend ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. Recent epidemiological studies and systematic reviews showed ABPM predicts cardiovascular events and mortality independent of clinic BP. Ambulatory BP appears to be prognostically superior to clinic BP.SummaryABPM characterizes BP phenotypes that would not have othe...
Source: Current Cardiology Reports - March 18, 2019 Category: Cardiology Source Type: research

The Adult with Post-operative Congenital Heart Disease: a Systematic Echocardiographic Approach
This article attempts to review some of the commonly seen repaired congenital heart defects in the adult population (ACHD), with a focus on important echocardiographic findings that may assist a practitioner in recognizing and managing this group of patients.Recent FindingsThe prevalence of ACHD population is increasing, and currently, there are over 1 million adults with congenital heart disease. At the current time, the total number of ACHD patients exceeds the total number of pediatric patients with CHD. The recently released 2018 American College of Cardiology/American Heart Association guidelines for the management of...
Source: Current Cardiology Reports - March 18, 2019 Category: Cardiology Source Type: research

Most Promising Therapies in Interventional Cardiology
This article will review the most promising up and coming interventional cardiovascular therapies, with a primary focus on the treatment of coronary artery disease.Recent FindingsFrom the first stent, to the first transcatheter aortic valve implantation (TAVI), and the left appendage closure technique, percutaneous interventions revolutionized the treatment of multiple diseases and dramatically improved the prognosis of many patients. While these advances have decreased the risk of mortality in some patients (such as ST-elevation myocardial infarction), 15% of acute coronary syndrome (ACS) patients still experience recurre...
Source: Current Cardiology Reports - March 13, 2019 Category: Cardiology Source Type: research

Physiology-Guided Management of Serial/Diffuse Coronary Artery Disease
AbstractPurpose of ReviewJust over four decades ago, the management of coronary artery disease (CAD) witnessed a major breakthrough with the advent of minimally invasive treatment modalities like angioplasty followed by coronary stenting. Dr. Andreas Gruentzig pioneered this field in 1977 by adding a balloon to the Dotter catheter. From its inception, he was cognizant of the need for measuring pressures before and after balloon inflation in the treated coronary artery, device placement in the treated coronary artery. However, for decades subsequently, emphasis was placed primarily on preprocedural non-invasive tests and an...
Source: Current Cardiology Reports - March 7, 2019 Category: Cardiology Source Type: research

Intensive Cardiac Rehabilitation: an Underutilized Resource
AbstractPurpose of ReviewTo review evidence-based lifestyle modification strategies for secondary prevention and explore how they are incorporated in traditional cardiac rehabilitation (CR) and intensive cardiac rehabilitation (ICR) programs.Recent FindingsWhile physical activity is an important element of cardiac rehabilitation, more recent studies support a variety of methods, including stress management and plant-based diets, to reduce cardiovascular risk factors. Patients who participate in traditional CR programs demonstrate clinical improvement, which are significantly greater in intensive CR (ICR). Yet, there is sti...
Source: Current Cardiology Reports - March 4, 2019 Category: Cardiology Source Type: research