Cardiovascular risk reduction with icosapent ethyl
Purpose of review Residual risk for atherosclerotic cardiovascular disease (ASCVD) persists even among patients with optimal low-density lipoprotein cholesterol (LDL-C) levels. Randomized trials attempting to modulate other lipids beyond LDL-C have failed to demonstrate significant reductions in ischemic events. Recent findings Mounting evidence suggests that triglyceride elevation is an independent risk factor for ASCVD. Though trials of triglyceride-lowering therapy in the statin era have failed to provide protection from ASCVD events, subgroup analyses have revealed that those with the highest triglycerides at time...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Modulation of cholesterol efflux capacity in patients with myocardial infarction
This article reviews the current data on the ‘cholesterol efflux hypothesis’ and discuss its ability to be modulated has a potential therapeutic target. Recent findings Recent data have demonstrated that impaired serum CEC was associated with increased mortality after a myocardial infarction (MI). Thus, therapeutic intervention aiming to improve CEC and RCT may reduce the risk of recurrent events. Early phase clinical studies targeting CEC showed promising results and a megatrial is ongoing testing the hypothesis that an improved RCT trough a modulation of the CEC can modify patient's prognosis after an acut...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Genetics of early-onset coronary artery disease: from discovery to clinical translation
Purpose of review This review is a comprehensive update on recent discoveries on the genetics of early-onset coronary artery disease (EOCAD), and how those findings can be translated to advance its medical management. Recent findings To date, a total of 266 common variants of modest effect size have been reported to be associated with CAD, but many still warrant functional studies. Rare variants impacting the function of at least 10 genes are now well characterized in Mendelian EOCAD. Estimations of minor allele frequencies in multiple ancestries from large genetic databases have allowed us to estimate the prevalence ...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Vitamin D supplements and prevention of cardiovascular disease
Purpose of review The role of vitamin D supplementation for prevention of cardiovascular disease (CVD) outcomes has been rigorously studied only recently. This review briefly summarizes results from recent randomized controlled trials in the context of prior laboratory and epidemiologic data. Recent findings Randomized trials of vitamin D that included CVD outcomes, as well as two recently published large population-based trials that prespecified CVD as a primary endpoint (The Vitamin D Assessmentand The VITamin D and OmegA-3 TriaL), indicate that vitamin D supplementation does not decrease CVD incidence, when compare...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Sustainability of blood pressure reduction in black barbershops
Purpose of review The prevalence of hypertension (HTN) among non-Hispanic blacks increased from 41 to 55% with the release of the new 2017 ACC/AHA guidelines – the highest among any racial group. Non-Hispanic black men have less physician interaction and lower blood pressure (BP) treatment and control rates when compared with their female counterparts, necessitating community outreach. Here, we review the Los Angeles Barbershop Blood Pressure Study (LABBPS) which demonstrated a community-based approach involving pharmacists, physicians, and barbers could improve BP control rates among black men. Recent findings ...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Review of cardiovascular outcomes trials of sodium–glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists
Purpose of review In recent years, there have been several cardiovascular outcomes trials (CVOT) of two new classes of glucose-lowering medications: sodium–glucose cotransporter-2 inhibitors (SGLT2-i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA). It is important examine their potential for cardiovascular benefit and possible side effects among patients with type 2 diabetes (T2D) mellitus. Recent findings The current article reviews the findings of recent CVOT of SGLT2-i and GLP-1 RA, including their impact on cardiovascular events and relevant side effects. Summary For all T2D patients, with or wi...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Takotsubo syndrome: diagnostic work-up and clues into differential diagnosis
Purpose of review Takotsubo syndrome represents an increasingly recognized clinical entity characterized by a reversible acute myocardial dysfunction, often triggered by an emotional or physical stress, and independent of an underlying epicardial coronary artery disease. The diagnosis is often challenging because of the nonspecific clinical presentation and the inconclusive noninvasive diagnostic imaging. Recent findings The present review provides a brief overview of Takotsubo syndrome clinical presentation and guides the clinician through the diagnostic work-up of Takotsubo syndrome, highlighting clues into differen...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Cardiometabolic risk reduction after metabolic surgery
Purpose of review Metabolic surgery provides the largest and most durable weight loss in persons with obesity. There is abundant randomized evidence to show its superiority over medical treatment alone in achieving improved glycemic control. Recent findings Recent trials have also demonstrated a significant reduction in cardiovascular risk factor burden, whereas data from observational studies suggest an ability to reduce overt cardiovascular events and mortality. Summary In this review, we briefly describe the surgical procedures involved and their indications. We further provide a summary of the effects of metabo...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

The role of coronary reactivity testing in women with no obstructive coronary artery disease
Purpose of review Two-thirds of women with signs and symptoms of ischemia and no obstructive coronary artery disease (INOCA) have abnormal coronary reactivity. These women are challenging to assess, diagnose and manage because of a lack of evidence-based guidelines. Furthermore, they are considered to be at ‘low risk’ by most physicians, often receive no specific therapy and tend to be dismissed from subspecialty care. Recent findings Coronary reactivity testing (CRT) is considered the reference-standard for evaluation of epicardial and microvascular coronary function in response to various vasoactive agen...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Mechanical circulatory support in the context of coronary artery bypass grafting
Purpose of review With the continuous innovation in mechanical circulatory support as an option for the management of patients in cardiogenic shock from myocardial infarction, it is important to understand the current evidence and recommendations for the use of these devices for patients who require or underwent coronary artery bypass surgery. Recent findings The use of mechanical circulatory support (MCS) in patients with cardiogenic shock who require or underwent coronary artery bypass surgery has not been well studied. Observational studies have shown that the use of intra-aortic balloon pump or percutaneous ventri...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Renal insufficiency and severe coronary artery disease: should coronary artery bypass grafting, off-pump coronary artery bypass grafting or percutaneous coronary intervention be performed?
Purpose of review Chronic kidney disease (CKD) is an important determinant of long-term survival. However, the optimal revascularization strategy for patients with CKD is still controversial. Herein we review the impact of different treatment modalities on the outcomes of patients with CKD. Recent findings CABG could confer better long-term outcomes than PCI in patients with CKD, irrespective of CKD severity. CABG as compared with PCI may be associated with improved long-term survival albeit higher short-term risk. Off-pump as compared with on-pump CABG may be associated with better short-term outcomes but no demonstr...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

What will surgical coronary revascularization look like in 25 years?
Purpose of review Coronary artery bypass grafting evolved in incremental but significant steps since its introduction. Here, we provide an update on operative techniques, choice of conduits, patient selection/decision-making and primary and secondary prevention measures with potential of influencing the future of coronary artery bypass grafting (CABG) surgery. Recent findings Associated mortality of off-pump CABG (OPCAB) procedures performed in high-volume OPCAB centers (≥164 cases per year) and by experienced surgeons (≥48 cases per year) was reduced compared with on-pump CABG with two or more grafts suggesting...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Multiarterial coronary artery bypass grafting: is the radial artery fulfilling the unkept promise of the right internal thoracic artery?
Purpose of review The debate on the second best conduit for CABG is still intense. In this review, we discuss the role of the radial artery and the right internal thoracic artery (RITA) compared with saphenous vein grafts (SVG). Recent findings The recent RADIAL STUDY has been the first evidence based on randomized trials of a clinical benefit using a second arterial graft in CABG. On the other hand, the definitive 10-year results of the ART trial failed to show a clinical advantage associated with the use of bilateral internal thoracic artery (BITA). A thorough and contextualized analysis of this and other studies, ...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Editorial: Coronary artery surgery: a resurgence and new opportunity to serve our patients better
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Closing the gap between type A and type B aortic dissections
Purpose of review Given its rarity little is known about natural history, surgical indications, and results of acute non-A non-B dissections. With this review, we aim to review the current knowledge of this subject. Recent findings non-A non-B aortic dissections should be differentiated from type B aortic dissections. A strikingly high proportion of these patients have a complicate course requiring treatment and the mortality of patients treated with medical therapy is substantially higher compared to type B dissections. Surgical and endovascular treatment can be accomplished safety, with very good results in terms of...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Carotid artery stenting: an update
Purpose of review To present the latest evidence about carotid artery stenting (CAS) including indications, safety, efficacy, and available equipment. Recent findings The micromesh stent, a new stent design which offers excellent flexibility and embolic protection, has been associated with promising outcomes. Summary CAS has emerged as a minimally invasive treatment method for carotid artery stenosis with comparable outcomes with surgical management. The implementation of new technology combined with operator experience has led to a paradigm shift; however, to date, no robust evidence exists about patient and lesio...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Type A aortic dissection complicated by malperfusion syndrome
Purpose of review Malperfusion is present in up to 40% of acute type A aortic dissections (ATAADs) and results in increased morbidity and mortality. This review presents different management strategies in patients with ATAAD and malperfusion to improve outcomes. Recent findings While the ideal management strategy of ATAAD complicated by malperfusion has yet to be determined, the literature provides evidence for additional techniques to be used in conjunction with central aortic repair to reduce mortality. Summary Recent findings support a role for initial reperfusion and delayed central aortic repair, although opti...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Thrombophilia evaluation in pulmonary embolism
Purpose of review Patients with pulmonary embolism commonly undergo thrombophilia evaluation for a variety of reasons including risk stratification for recurrent venous thromboembolism (VTE) and treatment planning. However, the utility of thrombophilia testing in many clinical scenarios remains unclear. This review evaluates current recommendations for thrombophilia testing described in consensus VTE guidelines, recent literature on the clinical application of these recommendations, novel genetic assessments for hereditary thrombophilias, and studies evaluating use of direct oral anticoagulants (DOACs) in VTE patients wi...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Spontaneous coronary artery dissection: update 2019
Purpose of review Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in women with few or no conventional cardiovascular risk factors. Lack of awareness about this condition among healthcare providers had led to significant underdiagnosis and misdiagnosis in this relatively young patient population. Recent findings The current review summarizes the contemporary data on cause, management strategies and outcomes of SCAD. Summary SCAD is not as rare as previously thought, accounting for up to 4% of all acute coronary syndromes. It is frequently linked with predisposing fa...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Genetic testing for aortopathies: primer for the nongeneticist
Purpose of review Although the majority of thoracic aortic aneurysms and dissections (TAD) in the overall population are mainly related to arterial hypertension and atherosclerosis, Heritable Thoracic Aortic Disease (HTAD) are increasingly recognized, especially in younger individuals. As fatal events in the setting of HTAD are preventable with timely detection and appropriate management, this review aims to provide an overview of the genetic basis of HTAD and practical recommendations for genetic evaluation in this setting. Recent findings Thanks in part to a number of important efforts to set up (inter)national netw...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Predictors of heart failure development in type 2 diabetes: a practical approach
Purpose of review Although type 2 diabetes (T2D) is one of the most important risk factors that leads to the development of de novo heart failure, there are limited data, particularly from a practical/qualitative standpoint, about predictors of heart failure in this population. Recent findings Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been shown to prevent the development of heart failure and the composite of heart failure and cardiovascular death in patients with T2D without known heart failure who have either established atherosclerotic vascular disease or multiple risk factors. The concept of primary ...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

See one, simulate many, do one, teach one: cardiac surgical simulation
Purpose of review To review the cardiac surgical simulation experience with a focus on data supporting its use. Recent findings Simulators have been used to improve trainee performance across multiple surgical domains. Few cardiac surgery residency programs have incorporated the use of simulation individually and Boot Camp programs in the United States and Canada have also introduced surgical simulation early in cardiac surgical training. Simulation curricula have some common elements: component tasks, deliberate practice, progressive operative responsibility, and coaching by an experienced surgeon. Cardiac surgical s...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

Right internal thoracic or radial artery as the second arterial conduit for coronary artery bypass surgery
Purpose of review To summarize the available evidence on the use of the right internal thoracic artery (RITA) and the radial artery as the second arterial graft in coronary artery bypass surgery. Recent findings The current data support the equipoise of the two conduits in terms of clinical and angiographic outcomes. Both RITA and radial artery have better patency than saphenous vein grafts. The use of the RITA carries an increased risk of deep sternal wound infection (DSWI) if the artery is harvested as pedicle. Bilateral internal thoracic artery grafting is more technically demanding than radial artery use and there...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

Percutaneous coronary intervention for the management of stable ischemic heart disease
Purpose of review The purpose of this review is to summarize landmark studies and recent evidence in support for and against benefits of routine percutaneous coronary intervention (PCI) in the management of patients with stable ischemic heart disease (SIHD). Recent findings Randomized controlled trials have raised uncertainty regarding the prognostic benefits of routine PCI in patients with SIHD. The benefits of PCI to improve symptoms and quality of life (QOL), thought to be more established, was brought into question recently by the ORBITA trial. Two hundred participants with single vessel SIHD optimized first on an...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

Total arterial off-pump coronary revascularization: The Holy Grail?
Purpose of review Coronary artery bypass grafting (CABG) remains the standard of care for patients with complex multivessel coronary artery disease. However, conventional CABG utilizing left internal mammary artery and supplemental vein grafts performed on cardiopulmonary bypass is marred by questionable long-term patency of vein grafts and risk of neurological injury. Total arterial off-pump CABG is a strategy associated with avoidance of neurological injury and vein graft failure. The aim of this review is to summarize recent evidence on safety and effectiveness of total arterial off-pump CABG. Recent findings Two k...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

Anomalous origins of the coronary arteries: current knowledge and future perspectives
Purpose of review The purpose of this review is to survey the contemporary literature surrounding congenital anomalies of origin of the coronary arteries and to identify remaining gaps in knowledge. Recent findings In recent years, lineage tracing analyses and mechanistic studies in model organisms have enhanced our understanding of the normal embryologic development of the coronary arteries, and how disruption of this intricate process can lead to congenital coronary anomalies. The true incidence of these anomalies remains unknown. Although a majority of cases are believed to be clinically silent, clinical presentati...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

Revascularization in left ventricular dysfunction: an update
Purpose of review The purpose of this article is to provide an overview of revascularization in patients with coronary artery disease (CAD) and left ventricular dysfunction (LVD). Recent findings Patients with significant CAD and LVD are a high-risk patient population. They make up a minority of the cases from the largest, prospective coronary revascularization trials. The Surgical Treatment for Ischemic Heart Failure (STICH) Trial and its substudies are the most important and well cited in this field. The 10-year data from STICH showed that surgical revascularization was associated with lower all-cause mortality comp...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

Role of stress management for cardiovascular disease prevention
Purpose of review Despite the significant decline in cardiovascular disease (CVD) rates owing to recognition of risk factors, timely and appropriate therapy for acute events, and improved medical therapy, it remains the leading cause of death globally. Novel risk factors and modifications must be considered in the development and progression of CVD. The purpose of this review is to delineate the association between psychological and mental stress and CVD. Recent findings Stress has been implicated as a significant risk factor in both the acceleration of atherosclerosis and a trigger for acute CVD events. In the last d...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: PREVENTION: Edited by Ron Blankstein Source Type: research

Screening and management of familial hypercholesterolemia
Purpose of review To discuss recent findings related to epidemiology, diagnosis, natural history, atherosclerotic cardiovascular disease (ASCVD) risk heterogeneity and stratification, and treatment of familial hypercholesterolemia. Recent findings Familial hypercholesterolemia persists subdiagnosed, inadequately treated and social disparities aggravate this scenario. Molecular diagnosis is recommended but still not widely available and reimbursed, also recent reclassification of genetic variants associated with familial hypercholesterolemia limits its routine use. New familial hypercholesterolemia clinical diagnostic ...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: PREVENTION: Edited by Ron Blankstein Source Type: research

Future role of proprotein convertase subtilisin/kexin type 9 inhibitors in preventive cardiology
Purpose of review The use of therapeutic monoclonal antibodies to target proprotein convertase subtilisin/kexin type 9 (PCSK9) represents a novel approach to the management of hypercholesteremia and prevention of atherosclerotic cardiovascular disease. We review the most recent literature relevant to PCSK9 inhibition with emphasis on how recent results and ongoing trials have and will continue to shape the use of this new therapeutic class in preventive cardiology. Recent findings PCSK9 inhibitors reduce plasma lipoprotein(a) concentrations but a mechanistic understanding remains elusive. Evaluation of evolocumab for ...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: PREVENTION: Edited by Ron Blankstein Source Type: research

Current and future role of lipoprotein(a) in preventive cardiology
Purpose of review The purpose of this review is to highlight our emerging understanding of lipoprotein(a) [Lp(a)]'s role in atherosclerotic cardiovascular disease (ASCVD), its structure–function relationship, and promising developments within the therapeutic pipeline. Recent findings Elevated levels of Lp(a) are strongly associated with an increased risk of coronary heart disease, calcific aortic valve stenosis, and ischemic stroke. With circulating levels almost exclusively genetically mediated, increased levels of Lp(a) contribute significantly to the residual cardiovascular disease risk in individuals with ot...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: PREVENTION: Edited by Ron Blankstein Source Type: research

Aspirin for primary prevention of cardiovascular disease: is it time to move on?
Purpose of review Aspirin has been used for decades for the primary prevention of cardiovascular disease. However, several recent trials evaluating the benefits and risks of aspirin for primary prevention have been published, creating the need to reevaluate this important topic. Recent findings Three large randomized trials studying aspirin in various primary prevention populations including individuals with diabetes, an elderly population, and middle-aged adults at high cardiovascular risk have recently been completed. These trials found a small benefit for individuals with diabetes and no benefit in the elderly and ...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: PREVENTION: Edited by Ron Blankstein Source Type: research

Assessment of myocardial viability by cardiac MRI
Purpose of review Left ventricular systolic dysfunction because of coronary artery disease is common, and ascertaining which patients will benefit from revascularization can be challenging. Viability testing is an accepted means by which to base this decision, with multiple noninvasive imaging modalities available for this purpose. This review aims to highlight the key role of cardiac magnetic resonance in myocardial viability assessment, with a focus on its unique strengths over other imaging modalities. Recent findings Transmural extent of hyperenhancement with late gadolinium imaging has been shown to be greater ac...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN Edited by Sherif Nagueh Source Type: research

Assessment of myocardial viability by myocardial contrast echocardiography: current perspectives
Purpose of review The current guidelines recommend the use of myocardial contrast echocardiography (MCE) to assess myocardial viability. There are two clinical scenarios where detection of myocardial viability has clinical significance: in ischemic cardiomyopathy and following acute myocardial infarction with significant left ventricular dysfunction. Myocardial contrast echocardiography (MCE), which utilizes microbubbles can assess the integrity of the microvasculature, which sustains myocardial viability in real time and can hence rapidly provide information on myocardial viability at the bedside without ionizing radiat...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN Edited by Sherif Nagueh Source Type: research

Imaging and heart failure: myocardial strain
Purpose of review To summarize literature on the application of myocardial strain in patients with heart failure published since 2018. Recent findings Left ventricular (LV) and right ventricular strain provides important prognostic information in patients with acute and chronic heart failure and new insights in disease mechanisms in amyloidosis. The addition of left atrial strain to current societal diastolic dysfunction criteria may improve detection of clinically relevant diastolic dysfunction. The recently developed method for noninvasive estimation of myocardial work incorporates loading conditions into the evalua...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN Edited by Sherif Nagueh Source Type: research

Dobutamine echocardiography for assessment of viability in the current era
Purpose of review Studies from the 1990s and early 2000s documented the utility of dobutamine echocardiography for the prediction of functional recovery and prognosis with revascularization. The results of The Surgical Treatment of Ischemic Heart Failure (STICH) trial called into question the value of viability assessment using dobutamine echocardiography. The purpose of this review is to re-examine the literature on dobutamine echocardiography, put into context the STICH results, and provide insight into the current role of dobutamine echocardiography viability testing. Recent findings In contrast to the results of p...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN Edited by Sherif Nagueh Source Type: research

Assessment of myocardial viability using single-photon emission computed tomography myocardial perfusion imaging
Purpose of review The assessment of myocardial viability continues to be a pressing and sometimes challenging clinical question. Among other imaging modalities proven to be useful in the assessment of myocardial viability, single-photon emission computed tomography (SPECT) instrumentation and expertise continue to be the most widely available to the practicing physicians. Understanding the utility of SPECT myocardial perfusion imaging in this domain is an enduring need. Recent findings A wealth of basic science and clinical data established the value of a variety of Tl-201 and Tc-99m SPECT protocols in the assessment ...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN Edited by Sherif Nagueh Source Type: research

Assessment of myocardial viability by PET
In conclusion, imaging myocardial viability by PET provides assessment of both physiological perfusion and myocardial tissue's metabolic activity to differentiate hibernating from scarred myocardium. (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN Edited by Sherif Nagueh Source Type: research

Myocardial viability: heart failure perspective
Purpose of review This review highlights the different imaging modalities available to assess myocardial viability in patients with heart failure and coronary artery disease (CAD) being considered for revascularization. Recent findings Myocardial viability can be determined by a variety of cardiac imaging modalities. Recent studies have confirmed the use of cardiovascular magnetic resonance imaging (CMR) in patients with heart failure and CAD, suggesting that those who undergo revascularization but have evidence of residual viable or ‘jeopardized’ myocardium have increased mortality compared with those who...
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN Edited by Sherif Nagueh Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - August 8, 2019 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Cardiotoxicity of HER2-targeted therapies
Purpose of review Cardiotoxicity is a well recognized adverse effect of human epidermal growth factor receptor 2 (HER2)-targeted therapies. The goal of this review is to highlight recent studies that have advanced our knowledge of the diagnosis, prevention, and management of cardiotoxicity associated with HER2-targeted agents. Recent findings Several clinical risk factors for cardiotoxicity associated with HER2-targeted therapies have been identified including age, low-baseline left ventricular ejection fraction, and treatment with anthracyclines; however, these remain insufficient to identify all patients at risk for...
Source: Current Opinion in Cardiology - June 8, 2019 Category: Cardiology Tags: SPECIAL COMMENTARIES Source Type: research

Cardiac toxicities of anticancer treatments: chemotherapy, targeted therapy and immunotherapy
Purpose of review Current oncologic treatments have shown improvement in overall survival in cancer patients. However, the cardiac toxicities of cancer therapeutics, particularly chemotherapy, targeted therapy and immunotherapy can have life-threatening side effects. Recent findings A MEDLINE search for cardiovascular toxicities associated with Federal Drug Administration (FDA)-approved cancer treatments including chemotherapy, targeted therapy and immunotherapy was performed. We included comprehensive articles and research articles establishing the incidence, diagnosis, monitoring and management of cardiovascular tox...
Source: Current Opinion in Cardiology - June 8, 2019 Category: Cardiology Tags: SPECIAL COMMENTARIES Source Type: research

Polygenic risk scores in coronary artery disease
Purpose of review Large genome-wide association studies (GWAS) have identified variants accounting for a substantial portion of the heritable risk for coronary artery disease (CAD). These studies have catalyzed drug discovery and generated the possibility of improved risk prediction and stratification. Here, we review the current state-of-the art in polygenic risk scores (PRSs) and look to the future, as these scores move towards clinical application. Recent findings Over the last decade, multilocus PRSs for CAD have expanded to include millions of variants and demonstrated strong association with CAD outcomes, even w...
Source: Current Opinion in Cardiology - June 8, 2019 Category: Cardiology Tags: SPECIAL COMMENTARIES Source Type: research

The role of lipoprotein (a) in primary and secondary cardiovascular disease prevention: a systematic review of epidemiological studies
Purpose of review Lipoprotein (a) [Lp(a)] is highly suggested as an emerging risk factor in cardiovascular disease (CVD) prevention. However, there remains controversy regarding the shape of Lp(a) risk curve and the extent to which Lp(a) confers risk for CVD, independently of conventional lipid markers. This systematic review outlines the current state of knowledge regarding the role of Lp(a) in primary and secondary CVD prevention. Recent findings Searches resulted in the selection of n = 19 studies. In the context of primary CVD prevention, n = 9 cohorts, n = 2 case-cohorts, and n = 2 retrospective s...
Source: Current Opinion in Cardiology - June 8, 2019 Category: Cardiology Tags: LIPIDS AND EMERGING RISK FACTORS: Edited by Dimitri P. Mikhailidis and Anthony S. Wierzbicki Source Type: research

New evidence on the role of inflammation in CVD risk
Purpose of review Based on compelling data from animal and human studies, over the past few decades, the viewpoint of atherosclerosis as an exclusively lipid-driven disease, has been gradually replaced by the concept of a chronic low-grade inflammatory process of the arterial wall. This review presents a brief description on the role of inflammation in atherosclerosis, and examines selected anti-inflammatory interventions that have been tested in clinical trials designed to prevent adverse cardiovascular disease (CVD) events and excess CVD risk. Recent findings The Canakinumab Anti-inflammatory Thrombosis Outcomes Stu...
Source: Current Opinion in Cardiology - June 8, 2019 Category: Cardiology Tags: LIPIDS AND EMERGING RISK FACTORS: Edited by Dimitri P. Mikhailidis and Anthony S. Wierzbicki Source Type: research

Biomarker variability and cardiovascular disease residual risk
Purpose of review A number of cohorts and clinical trials have reported observing associations between intraindividual variation of biomarkers and manifestations of cardiovascular disease (CVD). Recent findings Intraindividual (or ‘visit-to-visit’) variability of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and triglyceride have all been found to associate with CVD outcomes, independent of their mean absolute levels, independent of each other, and independent of other traditional risk factors. These findings ...
Source: Current Opinion in Cardiology - June 8, 2019 Category: Cardiology Tags: LIPIDS AND EMERGING RISK FACTORS: Edited by Dimitri P. Mikhailidis and Anthony S. Wierzbicki Source Type: research

Genetic risk scores in lipid disorders
Purpose of review Extensive work has gone into understanding the genetics of cardiovascular disease (CVD) and implicating genes involved in hyperlipidaemia. Translation into routine practise involves using genetic risk scores (GRS) to identify high-risk individuals in the general population. Some of these risk scores are beginning to disentangle the complex nature of CVD and inherited dyslipidaemias. Recent findings GRS of varying complexity have been used to identify high-risk groups of patients with polygenic CVD including some individuals with risk equivalent to monogenic disease. In phenotypic familial hypercholes...
Source: Current Opinion in Cardiology - June 8, 2019 Category: Cardiology Tags: LIPIDS AND EMERGING RISK FACTORS: Edited by Dimitri P. Mikhailidis and Anthony S. Wierzbicki Source Type: research

Hyperuricaemia and vascular risk: the debate continues
Purpose of review To update the evidence about the role of elevated levels of uric acid as a risk factor for cardiovascular disease. The review includes the most recent epidemiological evidence as well as the possible mechanisms supporting the interaction between uric acid and cardiovascular, metabolic and renal disease. Recent findings The confirmed role of uric acid as involved in the onset and progression of cardiovascular and metabolic diseases. In particular, the review will focus on the possible mechanism of action of uric acid and the level of involvement of xanthine-oxidase as a mechanism responsible for both ...
Source: Current Opinion in Cardiology - June 8, 2019 Category: Cardiology Tags: LIPIDS AND EMERGING RISK FACTORS: Edited by Dimitri P. Mikhailidis and Anthony S. Wierzbicki Source Type: research

Mean platelet volume and coronary artery disease
Purpose of review To critically review the literature describing links between mean platelet volume (MPV) and cardiovascular disease (CVD). We will focus on coronary artery disease (CAD). The MPV is measured routinely as part of a routine blood count. Recent findings There is accumulating evidence showing that the MPV may predict CVD, as well as outcomes in patients with CAD. There is also evidence linking MPV and comorbidities (e.g. diabetes mellitus and impaired glycaemic control) that are expected in patients with CAD. The effect on MPV of drugs commonly used to treat CAD has not been clarified, but there is some e...
Source: Current Opinion in Cardiology - June 8, 2019 Category: Cardiology Tags: LIPIDS AND EMERGING RISK FACTORS: Edited by Dimitri P. Mikhailidis and Anthony S. Wierzbicki Source Type: research