Immune checkpoint inhibitor myocarditis
Purpose of review The purpose of this study is to summarize and highlight the recent literature regarding immune checkpoint inhibitor myocarditis. Recent findings The use of immune checkpoint inhibitors, a promising form of immunotherapy, is rapidly increasing in oncology. These drugs have been recently found to cause a fulminant myocarditis associated with a high-case fatality rate. Most patients present early in the course of treatment with positive cardiac biomarkers. Endomyocardial biopsy findings resemble high-grade cardiac transplant rejection. Treatment requires cessation of immunotherapy, aggressive immunosupp...
Source: Current Opinion in Cardiology - April 11, 2019 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Treatment of chemotherapy-associated cardiomyopathy
Purpose of review The number of cancer survivors is increasing, and cardiovascular events are a significant cause of morbidity and mortality in these patients. Preexisting cardiovascular conditions as well as the development of cancer therapeutics-related cardiac dysfunction (CTRCD), in particular left ventricular dysfunction and heart failure, limit the options for cancer therapies for these patients and contribute to reduced cancer survival. Recent findings Recent guidelines and position statements from various cardiology and oncology societies provide an outline for the practicing physician for the management of CT...
Source: Current Opinion in Cardiology - April 11, 2019 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Adriamycin-associated cardiomyopathy: where are we now? updates in pathophysiology, dose recommendations, prognosis, and outcomes
Purpose of review Advances in cancer treatments have resulted in significant improvements in survival. Anthracycline chemotherapeutics play a major role in the treatment of hematologic malignancies and solid tumors; however, there is a risk of anthracycline cardiomyopathy in survivors. This focused review will provide a historical context on anthracycline cardiomyopathy and will also review pathophysiologic mechanisms of cardiotoxicity, dosage recommendations, prognosis, and outcomes. Recent findings Anthracycline inhibition of topoisomerase 2β in cardiomyocytes is believed to be the dominant mechanism of anthrac...
Source: Current Opinion in Cardiology - April 11, 2019 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Risk factors for chemotherapy-related cardiac toxicity
Purpose of review The purpose of this review is to discuss the clinical and treatment-related factors that increase the risk of cardiotoxicity with anthracyclines and human epidermal growth factor 2 receptor inhibitors. Recent findings Age and preexisting left ventricular dysfunction have been identified most consistently as being associated with the development of clinical heart failure or a worsening of left ventricular function with chemotherapy. Other cardiovascular conditions, including hypertension, diabetes, and coronary artery disease, are also associated with the risk of cardiotoxicity. There is growing evide...
Source: Current Opinion in Cardiology - April 11, 2019 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Editorial: Highlights from the emerging field of cardio-oncology
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - April 11, 2019 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Genetics of atrial cardiomyopathy
Purpose of review Atrial cardiomyopathy is a frequently encountered but underappreciated clinical entity that is characterized by altered atrial size and function. Although traditionally considered a primary atrial disorder, atrial cardiomyopathy was recently redefined to include secondary atrial remodelling. This conceptual shift has implications for the scope of etiological factors and intervention strategies. Our aim was to evaluate the potential contribution of genetics to atrial cardiomyopathy. Recent findings Although the genetics of atrial cardiomyopathy is relatively unexplored, extensive efforts have been mad...
Source: Current Opinion in Cardiology - April 11, 2019 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Telomere length and cardiovascular disease risk
Purpose of review Telomere length has been hypothesized as a putative biomarker for cardiovascular disease. However, the findings are mixed and shared confounding factors may explain these associations. The current review aims to summarize the recent literature on the role of telomere length in cardiovascular disease and give directions for future potential as a predictive biomarker. Recent findings In this review, we outline the biology of telomeres as a biomarker of aging through its shortening capacity across the life course. Recent epidemiological evidence for its associations with cardiovascular risk factors and ...
Source: Current Opinion in Cardiology - April 11, 2019 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Epigenetics in dilated cardiomyopathy
We present some of the recent progress in the field of epigenetics in DCM by focusing on the four major epigenetic modifications, that is, DNA methylation, histone modification, chromatin remodeling as well as the noncoding RNAs. The major players involved in these DCM-related epigenetic reprogramming will be highlighted. Finally, the diagnostic and the therapeutic implications for DCM based on new knowledge of epigenetic regulation will also be discussed. Summary As a rapidly expanding field, epigenetic studies in DCM have the promise to yield both novel mechanistic insights as well as potential new avenues for more ef...
Source: Current Opinion in Cardiology - April 11, 2019 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Sex differences in hypertrophic cardiomyopathy: new insights
Purpose of review Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy, diagnosed by left ventricular hypertrophy of at least 15 mm maximal wall thickness (MWT). Recent studies reported a sex difference in clinical presentation, progression and outcome of HCM. This review provides an overview of recent studies into sex differences in HCM. Recent findings A higher number of men (55–65% of total HCM patient group) with manifest HCM has been observed, whereas female patients are older at first evaluation and diagnosis, present more frequently with symptoms, and have worse survival. Addition...
Source: Current Opinion in Cardiology - April 11, 2019 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Multiomic approaches to delineate the pathogenesis of cardiac disease
Purpose of review Comprehensive analyses of the genome, transcriptome, proteome and metabolome are instrumental in identifying biomarkers of disease, to gain insight into mechanisms underlying the development of cardiovascular disease, and show promise for better stratifying patients according to disease subtypes. This review highlights recent ‘omics’ studies, including integration of multiple ‘omics’ that have advanced mechanistic understanding and diagnosis in humans and animal models. Recent findings Transcriptome-based discovery continues to be a primary method to obtain data for hypothesis...
Source: Current Opinion in Cardiology - April 11, 2019 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Noncoding RNAs in cardiovascular diseases
Purpose of review Human genome is pervasively transcribed, producing coding and noncoding RNAs. Recent studies have revealed the roles of a class of noncoding RNAs, the long noncoding RNAs (lncRNAs), in heart failure and other cardiovascular diseases. This review provides a brief summary of recent findings on lncRNA function. Recent findings Recent studies have documented the roles of lncRNAs in cardiac regeneration, conduction, hypertrophy/dysfunction, and endothelial function. LncRNAs perform these functions through acting as competing RNA (by binding and sequestering MicroRNAs) or acting as guides to protein target...
Source: Current Opinion in Cardiology - April 11, 2019 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - April 11, 2019 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Cardiovascular complications following pneumonia: focus on pneumococcus and heart failure
Purpose of review Pneumonia, an inflammatory disease, is the single largest infectious cause of death. Pneumonia has recently been established as an important contributing factor to major adverse cardiovascular events including heart failure. Developing an intermechanistic understanding of pneumonia and cardiovascular disease is crucial for successful future drug therapy and reducing healthcare expenditure. Recent findings Up to 30% of patients admitted with pneumonia develop cardiovascular complications such as heart failure within 10 years of hospital discharge. Recent mechanistic studies have identified inflammatio...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

The gut microbiome and heart failure
Purpose of review The human gut is populated by a complex community of microbiota that coexists with the host to maintain homeostasis. Accumulating evidence shows that changes in the composition and diversity of gut microbiota, known as dysbiosis, is associated with cardiovascular diseases, such as atherosclerosis, hypertension, and heart failure. Recent findings Although recent advances in biochemical and molecular analyses have contributed to the detection, identification, and characterization of a variety of gut microbiota genomes and their associated metabolites, the exact mechanisms of action remain unclear. As t...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

Biomarker developments in heart failure: 2016 and beyond
Purpose of review Biomarkers play a fundamental role in the management of heart failure. Both new and old biomarkers are evaluated every year with new information gained for their use in heart failure. Major advancements have been made in the past 2 years in key biomarkers that will surely become part of standard clinical management of heart failure. This review will focus on major developments since 2016. Recent findings Soluble suppression of tumorigenicity 2 has had multiple breakthrough studies solidifying its prognostic use in both acute and chronic heart failure and with multiple studies showing a strong benefit...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

Right ventricular failure management
Purpose of review Review recent advances in the diagnosis and management of right ventricular (RV) failure. Recent findings Temporary and durable device-based management of RV failure has emerging applications. Summary Research advances and clinical management in RV failure have been limited by a lack of consensus on a universal definition. Echocardiographic and cardiac MRI-based predictors of RV failure are imperfect. Combinations of hemodynamic and imaging variables may have better predictive value. Loading conditions and ventriculo-arterial coupling play important roles in RV function. The current treatment appr...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

Treatment of diabetes and heart failure: a paradigm shift for cardiologists?
Purpose of review Diabetes is a well-recognized risk factor for the development of cardiovascular disease. In recent years, several new glucose-lowering drugs (GLD) have shown improvements in cardiovascular outcomes, renewing interest of cardiovascular specialists in diabetes management. Recent findings Individual studies in the last 5 years have demonstrated the cardiovascular safety of certain dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 agonists, and sodium glucose cotransporter 2 inhibitors. Recent meta-analyses have attempted to demonstrate class effects of these medications, but remain driven by se...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

Update on the diagnosis and management of acute heart failure
Purpose of review To highlight the advances in the diagnosis and management of acute heart failure (AHF) from recent clinical trials and observational studies. Recent findings We highlight date from recent studies examining the use of novel biomarkers (micro RNAs, osteopontin, insulin-like growth-factor binding protein-7) for the diagnosis of AHF. In addition, we summarize the evidence for novel pharmacological therapies including: serelaxin, ularitide, clevidipine, urocortins, BMS-986231, TRB027, vericiguat, omecamtiv, and torsemide. Finally, we explore the evidence behind the use of novel management algorithms. Sum...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

Mechanical circulatory support in the heart failure population
Purpose of review Use of durable left ventricular assist devices (LVADs) has increased considerably in recent years because of the insufficient supply of donor hearts for cardiac transplantation and improvement in outcomes from refinements in technology. This review examines clinical utility of these devices and summarizes the most recent evidence supporting the use of LVAD therapy. Recent findings There continues to be significant advancements made in LVAD technology, which has resulted in improvements in the rates of adverse events and overall patient quality of life. Specifically, less invasive and improved surgica...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

Secondary mitral regurgitation: percutaneous edge-to-edge repair on the cutting edge?
Purpose of review Secondary mitral regurgitation commonly complicates heart failure. Although the evidence for its management is most robust for treating the underlying cardiomyopathy, treatment aimed at additionally reducing the severity of mitral regurgitation with a percutaneous edge-to-edge device, MitraClip, has recently emerged. Recent findings Despite the use of contemporary evidence-based heart failure therapies, patients with secondary mitral regurgitation and heart failure continue to remain at high risk for adverse clinical events; in both the MITRA-FR and COAPT trials, an extremely high event rate was evid...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

COMPASS for Vascular Surgeons: Practical Considerations
Purpose of review To suggest a practical approach for the application of data from the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial in patients with peripheral artery disease (PAD). Recent findings The COMPASS trial showed that low-dose rivaroxaban 2.5 mg twice daily plus daily aspirin was superior to aspirin alone in reducing major adverse cardiovascular and cerebrovascular events, and major adverse limb events among patients with stable atherosclerotic vascular disease, including those with PAD. The risk for major bleeding, however, was higher with rivaroxaban plus aspirin. C...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Early failure of aortic bioprostheses: what are the mechanisms?
Purpose of review The purpose of this study is to review the contemporary evidence surrounding aortic bioprosthetic valve deterioration, with a focus on early failure of surgically implanted valves. Recent findings Structural valve deterioration (SVD) remains the most frequent cause of premature bioprosthetic aortic valve failure. However, recent evidence suggests that SVD represents a spectrum, and that clinically silent hemodynamic valve deterioration frequently precedes and predisposes to overt SVD. Hemodynamic valve deterioration is defined as an increase in mean transprosthetic gradient and/or worsening transpros...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Transcatheter tricuspid valve intervention: a practical algorithm for patient selection
Purpose of review Worldwide experience in transcatheter tricuspid valve intervention is increasing as more options become available for the treatment of severe tricuspid regurgitation. These devices can be categorized by their primary mechanism of action, including edge-to-edge leaflet devices, space occupying devices, annuloplasty devices, complete valve replacement and caval valve implantation. This review summarizes the current technologies in use, early clinical results and factors that may affect procedural success. Recent findings Almost all transcatheter devices for tricuspid regurgitation are investigational w...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Late deaths after Fontan procedure: the next frontier
Purpose of review It has been more than 4 decades since the development of Fontan operation. With the contemporary surgical strategies to treat the patients with a single ventricle physiology, the medium-term survival of the patients following Fontan operation is excellent. Nonetheless, the Fontan circulation with a pumpless pulmonary circulation has fundamental physiologic limitations, which are associated with late Fontan failure and deaths. There has been an exponential growth of adolescence and adults living with a Fontan circulation, which poses significant challenges in future. Recent findings In this review, we...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Clinical application of echocardiographic-derived myocardial strain imaging in subclinical disease: a primer for cardiologists
Propose of review To highlight the evidence to support the measurement of left ventricular (LV) global longitudinal strain (GLS) in the risk assessment and management of patients with valvular heart disease. Recent findings Subclinical myocardial dysfunction that is characterized by impaired LV GLS is often present in patients with valvular disease. The addition of GLS to the LV systolic function assessment refines disease classification and improves both prognosis and management of valvular disease. Summary The measurement of global systolic function is essential in risk assessment and management of all patients w...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

The more you look, the more you find: atrial fibrillation – nowhere to hide
Purpose of review We provide an updated review on the incidence of postoperative atrial fibrillation (POAF) after cardiac surgery as determined by enhanced cardiac rhythm monitoring technology and provide a rationale for why a more aggressive detection approach for POAF may be clinically useful. Recent findings Most of the published literature had focused on the in-hospital incidence of POAF after cardiac surgery. However, recent studies using continuous cardiac rhythm technologies revealed that the incidence of POAF during the postdischarge, subacute ( (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Biomarkers of aortic bioprosthetic valve structural degeneration
Purpose of review Bioprosthetic valves are now used for the majority of surgical aortic valve replacements and for all transcatheter aortic valve replacements. However, bioprostheses are subject to structural valve deterioration (SVD) and have, therefore limited durability. Recent findings Clinical, imaging, and circulating biomarkers may help to predict or indicate the presence of bioprosthetic valve SVD. The most important biomarkers of SVD includes: patient-related clinical biomarkers, such as diabetes and renal failure; valve-related biomarkers, such as absence of antimineralization process and severe prosthesis-p...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Utilizing wall shear stress as a clinical biomarker for bicuspid valve-associated aortopathy
Purpose of review Bicuspid aortic valve (BAV) results from fusion of two adjacent aortic valve cusps, and is associated with dilatation of the aorta, known as BAV-associated aortopathy, or bicuspid aortopathy. Bicuspid aortopathy is progressive, increasing the risk of life-threatening clinical events, such as aortic dissection. Regular monitoring and timely intervention with prophylactic surgical resection of the proximal aorta is recommended. Recent findings Aortopathy is heterogeneous among patients. Studies have shown that different flow patterns lead to specific phenotypes of aortopathy. Although not uniform, BAV ...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Predicting the future of TAVR: an obituary to open aortic valve replacement?
Purpose of review Transcatheter aortic valve replacement (TAVR) has become the cornerstone for aortic valve intervention since the first implantation in 2002. Recent advances with novel devices and introduction into lower risk cohorts have been successful. In this review, we discuss the ongoing limitations to transcatheter aortic valve therapy and whether it will replace surgical aortic valve replacement in the foreseeable future. Recent findings A better understanding of valve durability, high-grade heart block, and stroke post TAVR has led to practice changes that improve patient outcome. Summary Although there h...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

PALMD as a novel target for calcific aortic valve stenosis
Purpose of review Novel medical treatments are urgently needed to stem the escalating socioeconomic burden of calcific aortic valve stenosis (CAVS). Herein, we describe the discovery of PALMD as a disease-causing gene for CAVS and discuss its implications for the understanding of disease pathogenesis and the development of new treatment options. Recent findings Large-scale genomic approaches are finally starting to yield genetic loci robustly associated with CAVS. PALMD was discovered using a transcriptome-wide association study, whereby the results of a genome-wide association study were integrated with the first exp...
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - February 6, 2019 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

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