Advances in medical therapy for pulmonary arterial hypertension
Purpose of review The purpose of this review is to demonstrate advances in the medical treatment of pulmonary arterial hypertension (PAH). Reviewed will be the evidence that favors the use of risk assessment in the treatment of PAH. Optimization of combination therapy depending on the risk or worsening will be reviewed. Finally, recent advances in new treatment strategies will be mentioned. Recent findings The use of therapies in sequence or in combination for the treatment of PAH has been shown to decrease morbidity and mortality. Tailoring these treatment strategies to a risk of worsening has been shown to decrease ...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: SPECIAL COMMENTARY Source Type: research

Avoiding physician burnout through physical, emotional, and spiritual energy
Purpose of review The purpose of this review is to update the physician community on current evidence regarding ways individuals can combat the rise in physician burnout. More than half of US physicians are experiencing at least some degree of burnout and the incidence has increased significantly over the past decade. Recent findings Recent findings suggest practicing physical, mental, and emotional self-care are important factors in avoiding physician burnout. Current evidence demonstrates that physical exercise can improve mood, enhance one's ability to deal with stress, and promote high-quality sleep. New research ...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Talent alone is not enough: lessons learned in a decade as chief
Purpose of review In this review, we explore the change in what is required for outstanding and successful clinical practice and the challenges of putting our teams in positions to succeed. Recent findings We review the benefits of sleep in the training of physicians, acknowledge the science and practice of quality, safety, professionalism and communication in clinical practice. Summary The talented physician has more than scientific knowledge and technical expertise; they must incorporate a commitment to patient safety, personal and colleague well being and a culture that is built on values of professional behavio...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Long-lasting benefits of exercise for those living with a Fontan circulation
Purpose of review In recent decades, the physiology and late outcomes of the Fontan circulation have become better characterized and interest has turned to interventions that might improve exercise capacity and clinical sequelae. No therapy has currently been shown to be more effective for improving exercise capacity in the setting of a Fontan circulation than exercise. This review examines the current evidence supporting exercise as therapy for this group. Recent findings People living with a Fontan circulation are at increased risk for reduced skeletal muscle mass and exercise capacity with important implications fo...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

The importance of genetics and genetic counselors in the evaluation of patients with bicuspid aortic valve and aortopathy
This article discusses potential genetic causes of BAV, includes a list of current known and candidate genes associated with BAV, provides a hypothetical case demonstrating the importance of genetic testing and cascade screening, and highlights the value of genetic counselors specializing in cardiovascular genetics. Recent findings Individuals with BAV are at significantly increased risk of progressive aortic valve disease and aortic root aneurysms. There is high heritability associated with BAV, and several specific genes have recently been associated with BAV. There is wide phenotypic variability among BAV malformatio...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Frequent premature ventricular beats in healthy children: when to ignore and when to treat?
Purpose of review Premature ventricular beats (PVCs) are frequently identified in healthy children with structurally normal hearts and generally have a benign clinical course often disappearing spontaneously. However, a small percentage of children may develop a cardiomyopathy. The purpose of this review is to understand which children may be at risk of development of left ventricular (LV) dysfunction with idiopathic PVCs. Recent findings There is increasing evidence that a ventricular ectopic burden more than 24% in adults may lead to LV dysfunction. Most of the pediatric studies to date are retrospective, small case...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Imaging the itis: endocarditis, myocarditis, and pericarditis
Purpose of review Inflammatory and/or infectious conditions affecting the heart and pericardium in children are primarily diagnosed via noninvasive imaging modalities. In addition, the use of multiple imaging modalities (multimodality imaging) is becoming increasingly common to assist in diagnosis, management, and prognosis. This review focuses on the use of noninvasive imaging in endocarditis, myocarditis, and pericarditis, with emphasis placed on the use of echocardiography and cardiac MRI in these conditions. Recent findings Echocardiography remains the most commonly employed imaging modality for all of the above d...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

A personalized approach to long QT syndrome
Purpose of review Our purpose is to provide an update on the new clinical and genetic aspects of long QT syndrome (LQTS). LQTS is the most common channelopathy and a cause of syncope and sudden death in the young. Although there are 17 types of LQTS, most patients have types 1 or 2 which are due to mutations in KCNQ1 and KCNH2 (encoding for the cardiac potassium channels), and type 3 which is due to a mutation in SCN5A (encoding for the sodium channel). LQTS is characterized by incomplete penetrance and variable expressivity. Significant data exist concerning the common types of LQTS and include mutational location, biop...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Management strategies for the preemie ductus
Purpose of review Patent ductus arteriosus (PDA) remains the most common cardiovascular condition afflicting neonates. Despite 5 decades of scientific inquiry pediatric cardiologists and neonatologists still cannot answer the simple question of which PDAs should be treated. Recent findings Although the volume of the shunt is difficult to calculate, echocardiography, biochemical markers, and clinical exam can provide clues to the magnitude and physiologic consequences of the shunt. Epidemiologic data exists showing a positive relationship between a PDA and numerous morbidities. As a result, for most of the 20th and ear...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Advances in fetal echocardiography: myocardial deformation analysis, cardiac MRI and three-dimensional printing
This article will review some of the more recent developments in applying these techniques to the evaluation of fetal cardiac structure and function. Recent findings Myocardial deformation analyses have led to the establishment of normative values for strain and strain rate in the fetal heart and have also been used to evaluate fetal heart function in both fetal disease states and maternal disease states. Technological advances in MRI technology, 3D imaging and 3D printing have opened up new methods of evaluating fetal structural heart disease. Summary A deeper understanding of the subtleties of myocardial dysfunctio...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Catheter ablation in elderly patients: a review of current studies and pending questions
Purpose of review Catheter ablations are established treatment options for cardiac arrhythmias. Despite the fact that they are increasingly performed in elderly patients, publications focusing on procedural safety and success concerning this patient subgroup are sparse. The purpose of this review is to inform about current and upcoming studies regarding catheter ablations in the elderly. Recent findings The overall pattern of available studies is indistinct because of varying age limits and scant patient populations. Most studies do not identify advanced patient age as a promoting factor for peri-procedural complicati...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Cryoballoon ablation beyond paroxysmal atrial fibrillation
Purpose of review Although radiofrequency-based pulmonary vein isolation (PVI) was considered the ‘gold standard’ for the treatment of atrial fibrillation for a long time, the cryoballoon has turned out to be a common alternative tool for atrial fibrillation ablation. Most of the data regarding cryoballoon-based ablation relate to patients with paroxysmal atrial fibrillation (PAF). In this review, we summarize recent knowledge on the usage of cryoballoon ablation for other conditions, especially persistent atrial fibrillation. Recent findings The cryoballoon is an effective ablation tool for PVI. As PVI is...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Ablation of persistent atrial fibrillation and beyond
Purpose of review Percutaneous catheter ablation is an effective treatment for atrial fibrillation. However, catheter ablation for the treatment of persistent atrial fibrillation or long-standing persistent atrial fibrillation is associated with unsatisfying success rates. This review aims to summarize the recent literature on the progress of catheter ablation among patients with persistent atrial fibrillation Recent findings In this review, we outline the potential future therapeutic techniques of catheter ablation of persistent atrial fibrillation. We highlight the innovative techniques (rotor mapping, substrate map...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Value of high-density mapping in the electrophysiology laboratory
This article uses three commonly encountered clinical scenarios to highlight the value of high-density mapping in the electrophysiology laboratory for the identification of the circuits and substrates during catheter ablation of complex arrhythmias. Recent findings High-density mapping gathered with a multielectrode catheter, with its smaller individual electrode size and closer interelectrode spacing, helps during ablation procedures in a number of ways. When high-density mapping is performed during tachycardia, the characterization of macro-reentrant circuits is better. When there is suspicion of a change in tachycard...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Comparing radiofrequency and cryoballoon technology for the ablation of atrial fibrillation
Purpose of review With the growing popularity of the cryoballoon tool for catheter ablation of atrial fibrillation, there has been discussion of whether cryothermal energy is just as or more effective than traditional radiofrequency. This review will compare both thermal energies for the treatment of atrial fibrillation. Recent findings Although the FIRE and ICE trial established that cryoballoon technology is noninferior to radiofrequency ablation for the treatment of atrial fibrillation, both thermal technologies have undergone advancement. This review intends to explore recent changes in technology and catheter abl...
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - December 6, 2018 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

SGLT2 inhibitors: practical considerations and recommendations for cardiologists
Purpose of review To address common concerns regarding sodium-glucose cotransporter 2 (SGLT2) inhibitor use for patients with type 2 diabetes mellitus (T2DM) in cardiovascular practice. Recent findings SGLT2 inhibitors provide glycemic control and improve cardiovascular and renal endpoints in T2DM. Cardiovascular outcome trials have demonstrated sustained cardiovascular, heart failure and renal benefits independent of glycemic control, which persist down to an eGFR of 30 ml/min/1.73 m2. SGLT2 inhibitors can be safely administered alongside common diuretics, and routine monitoring of renal function is advised at in...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: Special Commentaries Source Type: research

Glucagon-like peptide-1 receptor agonists and cardiovascular protection in type 2 diabetes: a pathophysiology-based review of clinical implications
Purpose of review Cardiovascular outcome trials (CVOT) with glucagon-like peptide-1 receptor agonists (GLP-1 RA) have had variable results to date: with two CVOTs being positive and two concluding neutrality/safety results for primary cardiovascular outcome. Mechanistic insights delving into the pathophysiologic mechanisms that may link certain GLP-1 RA to cardioprotection may help define the application of this medication class in clinical practice based on the evidence of the CVOT data. We discuss the various mechanisms that have been postulated from animal and preclinical human studies to help explain the benefits obs...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: Special Commentaries Source Type: research

New-onset atrial fibrillation after PCI and CABG for left main disease: insights from the EXCEL trial and additional studies
Purpose of review To provide an up-to-date review of recent trials examining the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) and the impact of postprocedural NOAF compared to nonsurgical atrial fibrillation. Recent findings A recent analysis from the Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial demonstrated that NOAF is much more frequent following surgical compared with percut...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Physical activity and mortality in patients with stable coronary heart disease
Purpose of review To review recent literature on associations between habitual physical activity and mortality in general populations and patients with stable coronary heart disease. Recent findings There are substantial decreases in cardiovascular and all-cause mortality between people who take little or no exercise and those who take regular light or moderate physical activity. The benefits associated with increasing high-intensity exercise are smaller, and an increase in mortality risk is possible. Meta-analyses of trials of exercise-based cardiac rehabilitation suggest a small mortality benefit from supervised exe...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Coronary artery calcification: recent developments in our understanding of its pathologic and clinical significance
Purpose of review Prior investigations have shown the close association between coronary artery calcification (CAC) and total atherosclerotic plaque burden as well as the risk of cardiovascular and all-cause mortality. However, recent pathologic and imaging-based studies suggested that massive dense calcifications are usually associated with stable plaque; whereas, micro calcifications, especially in the thin fibrous cap, are related to vulnerable characteristics. Further, the molecular mechanisms for initiation/progression of vascular calcification are highly complex and still need to be elucidated. In this manuscript, ...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Role of local coronary blood flow patterns and shear stress on the development of microvascular and epicardial endothelial dysfunction and coronary plaque
Purpose of review The natural history of coronary atherosclerosis is complex and atherosclerotic plaques exhibit large morphologic and functional variability within the same individual as well as over time. The purpose of this article is to review the role of blood flow patterns and shear stress on the development of microvascular and epicardial endothelial dysfunction and atherosclerosis progression. Recent findings Recent breakthroughs in cardiovascular imaging have facilitated in-vivo characterization of the anatomic and functional characteristics of atherosclerotic plaques and have highlighted the role of endothel...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Left ventricular function recovery after revascularization: comparative effects of percutaneous coronary intervention and coronary artery bypass grafting
Purpose of review In 2013, heart failure with recovered ejection fraction (HFrecEF) was introduced as a new heart failure phenotype. This review provides an overview of HFrecEF and the comparative effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on left ventricular ejection fraction (LVEF) recovery in patients with ischemic cardiomyopathy. Recent findings There has been emerging data indicating that LV functional recovery is possible and HFrecEF is associated with improved survival and better quality of life. CABG may be associated with larger improvement in LVEF when comp...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Perioperative safety in coronary artery bypass grafting: the role of the anesthesiologist
Purpose of review As our population ages and cardiovascular disease increases in prevalence, a growing number of patients will be candidates for coronary artery bypass grafting (CABG). Outcomes from this common surgery can be improved by a coordinated team approach involving physicians, nurses, and healthcare professionals from multiple specialties. This review will discuss the role cardiovascular anesthesiologists play in the perioperative care of these complex patients. Recent findings Cardiovascular anesthesiologists may play a variety of important roles throughout the entire perioperative period of patients underg...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

The ROMA trial: why it is needed
Purpose of review We herein summarize the current evidence on the clinical outcome associated with the use of single and multiple arterial grafts for coronary bypass surgery and the role and importance of the Randomized comparison of the clinical Outcome of single versus Multiple Arterial grafts (ROMA) trial. Recent findings Observational evidence suggests that the use of multiple arterial grafts is associated with better clinical outcomes compared to the use of a single arterial graft. Randomized evidence is inconclusive; the 5-year interim analysis of the largest randomized trial on the topic did not show any clinic...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Perioperative use of the intra-aortic balloon pump: where do we stand in 2018?
Purpose of review Intraaortic balloon pump (IABP) has been the most widely used device to help patients recover from circulatory disorder mainly because of cardiogenic shock; however, no evidence-based clinical benefit derived from IABP support has been reported in recent clinical trials. This review provides an overview of the current outcomes and challenges in perioperative IABP use for cardiogenic shock patients. Recent findings Although IABP support yielded no significant difference in mortality for myocardial infarction complicated by cardiogenic shock, perioperative IABP use generated beneficial clinical outcome...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Genetics of coronary artery disease: should they impact the choice of revascularization?
Purpose of review Patients with multivessel coronary artery disease (CAD) may undergo revascularization by either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). This review will discuss the use of polygenic risk scores for risk-stratification of patients with multivessel CAD in order to guide the choice of revascularization. Recent findings A 57-single nucleotide polymorphism (SNP)-polygenic risk score can accurately risk-stratify patients with CAD and identify those who will receive greater benefit from statin therapy. The most recent genomic studies reveal 243 different SNPs...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Ischemic stroke in young adults
Purpose of review Although the clinical approach to the young adult stroke patient is similar to that of an older adult, several important differences exist. The purpose of this article is to concisely review the epidemiology, pathophysiology, risk factors, clinical manifestations, diagnostic methods and current treatment options for the young adult ischemic stroke patient. Recent findings Evidence clearly indicates that the incidence ischemic stroke in young adults is on the rise. A variety of factors are implicated, including an increased burden of classic and emerging vascular risk factors, and improved stroke dete...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan C. Braverman Source Type: research

Novel imaging techniques in pulmonary hypertension
Purpose of review Pulmonary hypertension is a life-shortening condition, which may be idiopathic but is more frequently seen in association with other conditions. Current guidelines recommend cardiac catheterization to confirm the diagnosis of pulmonary hypertension. Evidence suggests an increasing role for noninvasive imaging modalities in the initial diagnostic and prognostic assessment and evaluation of treatment response. Recent findings In this review we examine the evidence for current noninvasive imaging methodologies: echocardiography computed tomography and MRI in the diagnostic and prognostic assessment of s...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan C. Braverman Source Type: research

Retrograde type A aortic dissection complicating endovascular therapy of type B aortic dissection and descending thoracic aneurysm disease
Purpose of review Retrograde type A aortic dissection (RTAD) is a fatal complication after endovascular therapy of type B aortic dissection and descending thoracic aneurysm disease. This review aims to elaborate this lethal complication, the potential risks of its incidence, and feasible approaches to lower the occurrence rate. Recent findings Many articles have shown lower incidence of RTAD in patients with thoracic aneurysm than those with aortic dissection. Also, acute aortic dissection seems to be more vulnerable when compared with chronic aortic dissection. Recent studies that focused on the risk of RTAD revealed...
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan C. Braverman Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - October 11, 2018 Category: Cardiology Tags: Editorial Introductions Source Type: research

Amyloidosis cardiomyopathy: update in the diagnosis and treatment of the most common types
Purpose of review The present article provides an update about the recent advances in the diagnosis and management of the most common types of cardiac amyloidosis, including light chain, wild-type transthyretin (ATTRwt), and mutant transthyretin (ATTRm). Recent findings The document reviews the utility of diagnostic tools including innovative echocardiographic indices, magnetic resonance T1 mapping and measurement of extracellular volume, and the role and validation of bone scintigraphy for the noninvasive assessment of ATTR amyloidosis. It summarizes the data about therapies for light chain amyloidosis including bort...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: Special Commentary Source Type: research

Should functional assessment of lesion severity be used to guide coronary bypass?
Purpose of review The purpose of this article is to investigate the potential role of fractional flow reserve (FFR) to guide surgical revascularization. Recent findings Coronary artery bypass is planned and executed primarily based on angiographic coronary anatomy. FFR is the most well-established tool for functional assessment of coronary lesions. Randomized trials have demonstrated the benefit of FFR-guided percutaneous coronary intervention (PCI) to determine the ischemic burden of intermediate lesions. Surgically, FFR is predominantly used to determine the functional severity of intermediate lesions of the left an...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Altered branched chain amino acid metabolism: toward a unifying cardiometabolic hypothesis
Purpose of review Atherosclerotic cardiovascular disease (CVD) and type II diabetes (T2D) share common etiologic pathways that may long precede the development of clinically evident disease. Early identification of risk markers could support efforts to individualize risk prediction and improve the efficacy of primary prevention, as well as uncover novel therapeutic targets. Recent findings Altered metabolism of branched-chain amino acids (BCAAs), and their subsequent accumulation in circulation, may precede the development of insulin resistance and clinically manifest cardiometabolic diseases. BCAAs – the essent...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Diabetes and multivessel disease: coronary artery bypass grafting remains king
Purpose of review Review the recently published scientific evidence to support the decision-making process of revascularization strategy in patients with diabetes mellitus (DM) and multivessel coronary artery disease (MVD). Recent findings Recently published observational analyses have proven the superiority of coronary artery bypass grafting (CABG) in patients presenting with other comorbidities together with DM, such as renal disease or heart failure. Summary Significant challenges and controversies surrounded the choice of the appropriate revascularization method in patients with DM and MVD over the last decades...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Management of patients with end-stage renal disease: coronary artery bypass graft surgery versus percutaneous coronary intervention
Purpose of review Coronary artery disease is common in patients with end-stage renal disease (ESRD) on hemodialysis. ESRD patients are prone to atherosclerosis and are likely to present with advanced CAD requiring coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). Recent findings Individual observational studies and aggregated results comparing PCI to CABG have shown an increased risk of early postoperative mortality in the CABG group followed by a decrease in late mortality and cardiovascular events. Drug eluting stents are preferred to bare metal stents in patients undergoing PC...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

What is the state of hybrid coronary revascularization in 2018?
Purpose of review Hybrid coronary revascularization (HCR) combines minimally invasive surgical bypass with percutaneous coronary intervention (PCI) using drug-eluting stents, the goal being to leverage the strengths of each approach. Here we provide an update on HCR from the past 12 months. Recent findings HCR represents a minority of surgical revascularization cases from a small number of highly experienced surgical centers. Most single-center observational series show no differences in major cardiovascular outcomes comparing HCR and coronary artery bypass graft (CABG) or HCR and PCI. The 5-year results of the first ...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

New biomarker strategies to enable precision cardiovascular medicine
Purpose of review Precision medicine is the concept of disease treatment and prevention using an individual's genomic profile in addition to personal and environmental factors. This review outlines examples of new biomarker strategies that enable the practice of precision cardiovascular medicine. Recent findings Although commonly attributed to identifying causative genetic variants, mono-genetic causes of cardiovascular diseases (CVD) are not common and largely focused on lipoprotein analyses. Nevertheless, rare clinical presentations in families with extreme phenotypes can sometimes identify novel pathways that can s...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: PREVENTION: Edited by Andrew Pipe Source Type: research

Genetic stratification for primary prevention of coronary artery disease
Purpose of review To review the literature showing genetic risk variants is a reliable means of stratifying for risk of CAD for primary prevention. Recent findings Over 90 genetic risk variants have been discovered that predispose to CAD. Results of several studies show that these risk variants effectively stratify for risk of CAD in asymptomatic individuals. Summary The total individual genetic risk can be summarized into a single number referred to as the genetic risk score (GRS). The GRS unlike the Framingham Risk Score is not dependent on age and independent of conventional risk factors. As DNA does not change ...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: PREVENTION: Edited by Andrew Pipe Source Type: research

In sickness and in health: relationship quality and cardiovascular risk and management
Purpose of review To review the link between couple relationships and cardiovascular health, the plausible mechanisms by which relationship quality affects heart health, and to provide an overview of couple-based interventions aimed at improving cardiovascular health. Recent findings Marriage and the quality of the couple relationship bond are robust predictors of long-term health outcomes. Chronic relationship conflict and disconnection can be deadly. There are direct and indirect pathways by which couple relationship quality affect cardiovascular health. Direct pathways include effects of relationship quality on car...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: PREVENTION: Edited by Andrew Pipe Source Type: research

Women's heart health: a focus on nurses’ physical activity and sedentary behaviour
Purpose of review This review focuses on recent literature examining and targeting the physical activity and sedentary behaviour of nurses. The role of physical activity and sedentary behaviour in preventing and managing cardiovascular disease (CVD) in women is also discussed. Recent findings Nurses (most of whom are women) represent the largest professional group within the health care workforce and many present with risk factors for CVD (e.g. physical inactivity, sedentary behaviour, overweight/obesity, hypertension, dyslipidemia, diabetes, smoking, depression, anxiety). Several studies have measured the physical ac...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: PREVENTION: Edited by Andrew Pipe Source Type: research

Women's health: making cardiovascular disease real
Purpose of review When patients are seen for persistent chest pain in the absence of obstructive coronary artery disease, the physician must decide if the symptoms are due to myocardial ischemia in order to guide treatment. Recent findings Recent findings indicate that ischemia due to coronary microvascular dysfunction (CMD) is associated with subclinical coronary atherosclerosis and an adverse prognosis. Therapeutic probe trials suggest that antiatherosclerotic and anti-ischemic therapeutic strategies may be useful. A large randomized clinical trial of high-intensity statin, maximally tolerated angiotensin-converting...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: PREVENTION: Edited by Andrew Pipe Source Type: research

Sex-specific risk factors for cardiovascular disease in women-making cardiovascular disease real
Purpose of review Sex-specific differences in pathophysiology, prevalence, and impact of cardiovascular disease (CVD) risk factors may explain the high cardiovascular mortality rates in women. Recent findings We review the sex differences in traditional risk factors (dyslipidemia, hypertension, diabetes, and smoking) and nontraditional risk factors (menopause and hormones, pregnancy, inflammation and autoimmune diseases, anemia, depression, and migraines) and their prognostic and therapeutic implications. Summary Recent research indicates that with respect to traditional risk factors such as dyslipidemia, hypertens...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: PREVENTION: Edited by Andrew Pipe Source Type: research

Cardiovascular disease prevention: challenges remain; opportunities grow
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: PREVENTION: Edited by Andrew Pipe Source Type: research

Applications of left ventricular strain measurements to patients undergoing chemotherapy
Purpose of review We aim to summarize the utility of strain in monitoring the effects of cancer therapy-related cardiotoxicity (CTRC) on the development of left ventricular (LV) dysfunction. Recent findings Serial assessment of cardiac function at baseline and during treatment is recommended in patients undergoing cancer treatment. Historically, the use of left ventricular ejection fraction (LVEF) has been used to monitor for cardiac toxicity from cancer therapies but myocardial mechanic parameters, in particular global longitudinal strain (GLS), have emerged as powerful adjunctive tools. On the basis of longitudinal ...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN: Edited by Sherif Nagueh Source Type: research

Right ventricular strain: measurement and clinical application
Purpose of review Right ventricular (RV) assessment has long been challenging and technically difficult using echocardiography. This is mainly the result of the asymmetrical shape of the RV making it difficult to visualize on one-or-two dedicated views, thus requiring multiple integrated views and subjective assessment. Measurement of tricuspid annular systolic plane excursion and RV tissue Doppler velocity have become relied-upon methods of objective assessments; however, have limitations for characterizing true RV physiology. Recent findings Studies suggest that two-dimensional RV free wall longitudinal systolic str...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN: Edited by Sherif Nagueh Source Type: research

Left atrial strain: measurement and clinical application
Purpose of review To summarize recent literature on the use of left atrial strain in the diagnosis and management of patients with heart failure. Recent findings Left atrial dysfunction is a hallmark of diastolic dysfunction and heart failure, in particular, heart failure with preserved ejection fraction (HFpEF). Recently, myocardial deformation analysis via strain and strain rate measurements have been applied to the left atrium. These measurements have been shown to aid in the diagnosis of heart failure and be accurate predictors of cardiac pressures, diastolic dysfunction, exercise performance, and clinical outcome...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN: Edited by Sherif Nagueh Source Type: research

Application of left ventricular strain in patients with aortic and mitral valve disease
Purpose of review Left ventricular (LV) global longitudinal strain (GLS) is widely recognized as a more sensitive measure of LV systolic function compared with LV ejection fraction (LVEF). In addition, the measurement of LVGLS is more reproducible than two-dimensional LVEF. Current guidelines for diagnosis and treatment of valvular heart disease include LVEF as one of the parameters to take into consideration in the clinical decision-making. However, a large body of evidence is showing that LVGLS may be a better prognosticator than LVEF in various valvular heart diseases. In this timely state-of-the-art review, the evide...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN: Edited by Sherif Nagueh Source Type: research

Application of left ventricular strain to patients with coronary artery disease
The objective of this article was to review the potential application of two-dimensional (2D) and three-dimensional (3D) strains in patients with coronary artery disease. Recent findings Reports on the diagnostic accuracy of myocardial deformation analysis using 2D and 3D speckle-tracking analyses to detect significant coronary stenosis at rest or during stress and to evaluate myocardial viability are limited. A newer 2D strain approach that uses layer-specific strain analysis might be sensitive in the detection of subtle regional myocardial dysfunction induced by myocardial ischemia. However, its potential accuracy is ...
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN: Edited by Sherif Nagueh Source Type: research

An introduction to left ventricular strain
This article reviews the definition of left ventricular strain, outlines the types of strain and reviews how strain is acquired and measured. In addition, the advantages of strain analysis over LVEF as well as the incremental prognostic value of strain are examined. We further review the challenges associated with strain imaging as well as outline the future of strain imaging. (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - August 9, 2018 Category: Cardiology Tags: IMAGING AND HEART FAILURE: MYOCARDIAL STRAIN: Edited by Sherif Nagueh Source Type: research