COVID-19 will forever change the landscape of telemedicine
This article discusses novel ways of using telehealth during the current pandemic and measures that would need to be taken to sustain telehealth and teleconsultations. Recent findings Telehealth has expanded to outpatient pediatric cardiology clinics across the globe during the pandemic. Technological advancements in video conferencing and the abundance of readily available wearable devices have allowed cardiologists to establish a preliminary diagnosis and set forth a treatment plan. Additional support by insurance providers and relaxation of mandatory regulations by the government have allowed telehealth to succee...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Culture, teamwork and engagement: 40 years of finding the right ingredients
Purpose of review Changing demands in healthcare, new leadership structures and physician preferences on work-life balance have made culture, teamwork and engagement vitally important for the long-term success of medical practices. With recent emphasis placed on culture, teamwork and engagement, leaders have had to acquire management skills that extend beyond the scope of being a successful clinician, educator and researcher. Recent findings Over the last two decades, experts throughout the business and medical fields have worked to define culture. Furthermore, these authors have shown that success in businesses...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Health anxiety among adults with congenital heart disease
Purpose of review Adults with congenital heart disease (CHD) may experience anxiety specifically related to their medical condition. This review introduces the concepts of health anxiety and heart-focused anxiety, summarizes what is currently known about heart-focused anxiety among adults with CHD and offers suggestions to help adult CHD providers address heart-focused anxiety in their patients. Recent findings Although minimal research has been conducted specific to this outcome, health anxiety may occur at any point across the lifespan of individuals with CHD. A recent study found that children and adolescents...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Improving outcomes collaboratively with families: what works and what doesn’t
Purpose of review As attention begins to shift from short-term surgical outcomes to long-term clinical and quality of life outcomes, patients and families are becoming increasingly responsible for outcomes. For this reason, it is essential to effectively include them in the outcome planning, goal setting, and evaluation processes. Recent findings There are a number of tools and strategies available to maximize patient engagement. These must be employed in direct patient care and system and policy conversations, for meaningful patient partnerships that can lead to improved outcomes. Summary As we move from...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Delivering pediatric cardiac care in sub-Saharan Africa: a model for the developing countries
Purpose of review It is projected that by 2050, around 40% of all births, and about 40% of all children, will be in Africa, up from about 10% in 1950. Consequently, this trend will cause an increase in noncommunicable diseases in children, such as congenital and rheumatic heart diseases. The current state of pediatric cardiac care in sub-Saharan Africa is dire with some countries without cardiac surgical services at all. The purpose of this review is to highlight those components needed to build a sustainable model for a pediatric cardiac care center in sub-Saharan Africa. Recent findings Review of the literatur...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Newer risk assessment strategies in hypertrophic cardiomyopathy
Purpose of review The present article serves to review current risk assessment guidelines for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM) and to discuss how these guidelines can be applied to patients with childhood HCM. New diagnostic techniques that could lead to more accurate risk assessment tools are also discussed. Recent findings Current guidelines for risk assessment in childhood HCM are extrapolated from adult guidelines and lack background research to validate their use. Continuous variables, such as wall thickness, are converted to binary variables, which is particular...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Update on pediatric pulmonary arterial hypertension
Purpose of review Pulmonary arterial hypertension (PAH) causes high morbidity and mortality in children. In this review, we discuss advances in diagnosis and treatment of this disorder. Recent findings Proceedings published from the 2018 World Symposium updated the definition of pulmonary hypertension to include all adults and children with mean pulmonary artery pressure more than 20 mmHg. Targeted PAH therapy is increasingly used off-label, but in 2017, bosentan became the first Food and Drug Administration-targeted PAH therapy approved for use in children. Summary In recent years, advanced imaging and...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Calmodulinopathies: throwing back the veil on the newest life-threatening genetic arrhythmia syndrome
Purpose of review This review provides a basic understanding of the calmodulin gene and its role in calcium homeostasis. We outline the functional effects and clinical expression of CALM mutations and review disease expression and management. Recent findings Calmodulinopathies are rare life-threatening arrhythmia syndromes affecting young individuals. They are caused by mutations in any of the three genes (CALM 1-3) that encode calmodulin (CaM), a ubiquitously expressed Ca2+ signaling protein with multiple targets that in the heart, modulates several ion channels. Patients express varied phenotypes: long QT synd...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

The placenta as the window to congenital heart disease
This article reviews the role of the placenta and the potential impact of placental insufficiency on fetuses with congenital heart disease. Recent findings The fetal heart and the placenta are directly linked because they develop concurrently with shared regulatory and signaling pathways. Placental disease is more common in pregnancies carrying a fetus with congenital heart disease and the fetal response to placental insufficiency may lead to the postnatal persistence of cardiac remodeling. The mechanisms underlying this placental–fetal axis of interaction potentially include genetic factors, oxidative stress,...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research

Telemedicine in cardiac procedures: considerations for a remote future
Purpose of review Present a review of relevant literature and suggest a framework for discussion of the considerations affecting the evolution and adoption of Telerobotic Support and Telerobotic Collaboration in the practice of cardiac procedural medicine. Recent findings Recent medical practice has undergone remarkable transformation in the adoption of telemedicine. This evolution has been accelerated by the COVID-19 (SARS-CoV-2) pandemic and has largely been focused on outpatient medicine. Clinical studies and opinion articles have highlighted benefits including reduced costs, increased patient engagement, and...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

The functional medicine approach to atrial fibrillation: can a cure for atrial fibrillation be found in the gut?
Purpose of review The importance of addressing the proximal causes of atrial fibrillation is recognized, yet frustration with the currently applied preventive measures is high. This review describes the functional medicine model (FMM), which identifies the proximal causes of atrial fibrillation at the level of gene-environment interaction. Recent findings The pathological processes leading to atrial fibrillation sustaining disorder have been elucidated in translational studies and are described as ‘nodal points.’ Examples are inflammation, oxidative stress, autoimmune mechanisms, and visceral adiposi...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Percutaneous left atrial appendage occlusion
In conclusion, percutaneous LAAO appears to be a promising option for NVAF patients who are not candidates for long-term OAC in the current era. Further evidence guiding optimal patient selection and periprocedural antithrombotic regimen will help identify the patients who would benefit the most from this procedure. (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Artificial intelligence in cardiovascular medicine
Purpose of review Artificial intelligence is a broad set of sophisticated computer-based statistical tools that have become widely available. Cardiovascular medicine with its large data repositories, need for operational efficiency and growing focus on precision care is set to be transformed by artificial intelligence. Applications range from new pathophysiologic discoveries to decision support for individual patient care to optimization of system-wide logistical processes. Recent findings Machine learning is the dominant form of artificial intelligence wherein complex statistical algorithms ‘learn’ ...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Cryoballoon ablation for extrapulmonary vein targets
Purpose of review Cryoballoon catheter can create large and contiguous lesions with stable contact during ablation. It has proven to be well tolerated and effective in pulmonary vein isolation. But atrial arrhythmias, including atrial fibrillation, atrial tachycardia, and atrial flutter (AFL), also relate to many extrapulmonary vein targets. It is necessary to understand the current evidence for the use of cryoballoon ablation for targets outside of pulmonary veins. Recent findings Studies have shown that the cryoballoon ablation can be used in extrapulmonary vein area, including left atrium roof, left atrial ap...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Focal cryoablation of atrioventricular node reentrant tachycardia: a review and comparison of data
Purpose of review Atrioventricular node reentrant tachycardia (AVNRT) is the most common mechanism of supraventricular tachycardia. Radiofrequency ablation has been the most prevalent method for slow pathway ablation but carries risk of atrioventricular node injury. Focal cryoablation has been utilized as an alternative ablation modality; however, there has been concern about decreased efficacy, resulting in a higher rate of recurrence postablation. We also report outcomes from two international centers using an 8-mm cryocatheter and complete a thorough comparison of existing data on ablation of AVNRT. Recent findin...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Consumer wearable technologies to identify and monitor exercise-related arrhythmias in athletes
Purpose of review The aim of this study was to synthesize the current evidence supporting and against the use of wearable devices to detect underlying heart conditions in athletes and the most significant limitations. Recent findings Although several large studies have been conducted to evaluate the ability of wearables devices to identify atrial fibrillation among the general population, no studies evaluating their ability to detect other exercise-related arrhythmias in athletes are very sparse. Most of the studies or case reports are focused on the wearables’ reliability and accuracy compared with standa...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Pulsed field ablation: a promise that came true
Purpose of review Pulsed field ablation is a nonthermal ablative modality that uses short living, strong electrical field created around catheter to create microscopic pores in cell membranes (electroporation). When adequately dosed/configured it shows a preference for myocardial tissue necrosis. Thus, it holds a promise to become a ‘perfect’ energy source for cardiac ablation to treat arrhythmias. Herein, we present update on platforms in clinical development. Recent findings First in human series using pulsed field ablation for atrial fibrillation ablation have been completed and data published for...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Cybersecurity threats to cardiac implantable devices: room for improvement
Purpose of review For over a decade, vulnerabilities in the healthcare industry have been identified. Medical devices such as cardiovascular implantable electronic devices (CIEDs) are particularly concerning because of direct threats to patient safety and protected health information (PHI). Although these vulnerabilities have been identified and changes have been made, there is significant room for improvement. We identify changes and improvements to be made in the industry, by providers, and by patients. Recent findings Cybersecurity threats in cardiac implantable devices are legitimate concerns for patient saf...
Source: Current Opinion in Cardiology - December 7, 2020 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 7, 2020 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Ischaemia without obstructive coronary artery disease: the pathophysiology of microvascular dysfunction
Purpose of review Nearly one-third of patients presenting with angina have unobstructed epicardial coronary arteries and evidence of coronary microvascular disease. Up until recently, the pathophysiology of coronary microvascular disease has been poorly understood, resulting in limited effective therapeutic options in these patients. As a result, patients with coronary microvascular disease continue to suffer from a poor quality of life and adverse cardiovascular outcomes. Recent findings Recent mechanistic studies have improved our understanding of the pathophysiology underlying coronary microvascular dysfunction; th...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Preemptive percutaneous coronary intervention for coronary artery disease: identification of the appropriate high-risk lesion
Purpose of review Management of patients with coronary artery disease (CAD) has been based on identification of a coronary obstruction causing ischemia and performing a revascularization procedure to reduce that ischemia, with the goal of thereby preventing subsequent major adverse cardiac events (MACEs) in that vascular territory. Recent investigations demonstrate that preemptive percutaneous coronary intervention (PCI) of nonculprit coronary lesions (NCLs) that may not cause ischemia in patients with ST-segment elevation myocardial infarction (STEMI) reduces MACE. In this review, we focus on preemptive PCI, discuss its...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Thin, very thin, or ultrathin-strut biodegradable or durable polymer-coated drug-eluting stents
Purpose of review The current article will review recently published clinical studies that evaluate very thin or ultrathin-strut drug-eluting stents (DES), focusing on major randomized clinical trials in broad patient populations. Recent findings Multiple randomized trials recently assessed the clinical performance of novel very thin to ultrathin-strut DES. Most randomized trials established noninferiority of the novel device. To date, only one major randomized clinical trial (i.e., BIOFLOW V) showed superiority of an ultrathin-strut biodegradable polymer-coated sirolimus-eluting stent over a very thin-strut durable p...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Mechanisms of myocardial infarction with nonobstructive coronary atherosclerosis: a multifaceted play of different actors with guarded prognosis
Purpose of review Myocardial infarction (MI) with nonobstructive coronary atherosclerosis (MINOCA) on invasive angiography (stenosis severity (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Adverse events beyond 1 year after percutaneous coronary intervention
Purpose of review To provide a summary and critical appraisal of recent literature pertaining to very late adverse events (>1 year) after revascularization with percutaneous coronary intervention (PCI) with coronary stents. Recent findings Recent studies, including an individual patient-level pooled analysis of randomized trials and network meta-analysis have demonstrated that all coronary stents, including contemporary drug-eluting stents (DES), are associated with an ongoing risk of major adverse cardiovascular events related to the stented region beyond the first year after stent implantation, with rates ranging...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Temporal improvements in perioperative stroke rates following coronary artery bypass grafting
Purpose of review Perioperative stroke remains one of the most dreaded complications following coronary artery bypass grafting. In this review, we highlight the significant advances in understanding and preventing stroke in patients undergoing bypass surgery and offer our center's current best-practice recommendations to help avoid this debilitating outcome. Recent findings The incidence of stroke has significantly reduced since the advent of coronary artery bypass graft surgery. Improvements in our understanding of the cause, mechanisms, risk factors, and diagnosis of stroke as well as refinements in medical optimiza...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Hybrid coronary revascularization: are we there yet?
Purpose of review With advances in minimally invasive surgical and percutaneous coronary therapies, hybrid coronary revascularization (HCR) is well positioned to be an ideal strategy for revascularization in selected patients with multivessel coronary artery disease (CAD). The purpose of this review is to highlight recent outcomes and comparative effectiveness studies of HCR. Recent findings Patients undergoing HCR have comparable outcomes compared with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The major benefits compared with CABG appear to be related to short-term morbidity...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Secondary prevention after CABG: do new agents change the paradigm?
Purpose of review Coronary artery bypass graft (CABG) surgery remains the gold-standard treatment for multivessel and left main coronary artery disease. Despite significant improvement in cardiovascular outcomes, patients undergoing CABG remain at risk for recurrent adverse ischemic events and other cardiovascular outcomes (coronary revascularisation, stroke, cardiac death, etc.). The purpose of this review is to summarize the most recent evidence in pharmacological preventive therapies addressing the residual cardiovascular risk in patients who have undergone CABG. Recent findings Novel cardiovascular pharmacological...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Appropriate therapy for patients with stable ischemic heart disease: a review of literature and the implication of the International Study of Comparative Effectiveness with Medical and Invasive Approaches trial
Purpose of review The aim of this review is to review the current literature on the management of stable ischemic heart disease in light of findings from the International Study of Comparative Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial. Recent findings Compared with optimal medical therapy, coronary artery bypass grafting (CABG) has been shown to improve survival and incidence of myocardial infarction in patients with stable ischemic heart disease whereas percutaneous coronary intervention (PCI) has not. The ISCHEMIA trial compared an initial conservative management strategy with optimal medic...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Editorial: Coronary artery surgery
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research

Pharmacologic therapy for pulmonary artery hypertension
This article aims to review pharmacotherapeutics for PAH. Recent findings PAH-specific therapies have evolved over the last three decades and have expanded from one therapy in the 1990s to 14 FDA-approved medications. Current therapies are directed at restoring the imbalance of vasoactive mediators that include nitric oxide, endothelin and prostacyclin. Although these agents are effective as monotherapy, recent trials have promulgated the strategy of upfront combination therapy. The availability of oral prostacyclin agonists has also allowed for expanded treatment options. Risk assessment is vital in guiding therapy for...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

The aberrant subclavian artery: approach to management
Purpose of review Aberrant subclavian artery (ASCA) represents one of the most common congenital vascular anomalies of the aortic arch. The majority of ASCAs are associated with an aneurysm which occurs at their origin from the descending thoracic aorta, namely, the Kommerell's diverticulum. In this review, we discuss recent data with regards to indications of treatment and surgical management of these anatomical variants. Recent findings Various surgical methods have been described for the repair of ASCA and Kommerell's diverticulum. Traditionally, treatment included open surgery; however, recent studies describe a s...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Management of renovascular hypertension
Purpose of review Renovascular occlusive disease remains a common cause of resistant and rapidly progressive hypertension. The present review summarizes current practice regarding management of renovascular hypertension (RVH). Recent findings Current data using blood oxygen level dependent MR emphasize the tolerance of the kidney to moderate reductions in blood flow and the efficacy of antihypertensive drug therapy for many individuals. Prospective trials have failed to identify benefits of revascularization for moderate disease, either regarding blood pressure or renal function. Antihypertensive drug therapy includin...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Penetrating atherosclerotic ulcer
Purpose of review Penetrating aortic ulcer (PAU) is defined as ulceration of an aortic atherosclerotic plaque penetrating through the internal elastic lamina into the media. With the advances in imaging techniques, the differential diagnosis between PAU and other aortic ulcers remains a challenge. This review aims to summarize the latest insight into PAU, based on clinical context and the newest imaging characteristics, to aid treatment decision-making. Recent findings Most PAUs are asymptomatic and do not require urgent invasive treatment. Nevertheless, when PAU leads to an acute aortic syndrome, emergency invasive t...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Pulmonary hypertension associated with left-sided heart failure
Purpose of review Pulmonary hypertension is a common phenomenon in heart failure patients that is highly relevant for morbidity and outcome. Although postcapillary in nature, the pathophysiology of pulmonary hypertension in patients with heart failure with reduced or preserved ejection fraction is complex, and decisions about management strategies remain challenging. Recent findings Recently, the hemodynamic definitions and subclassification of postcapillary pulmonary hypertension have been revisited. The distinction between isolated postcapillary pulmonary hypertension (IpcPH) and combined post and precapillary pulmo...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research

Current management of the vascular subtype of Ehlers–Danlos syndrome
Purpose of review Vascular Ehlers–Danlos syndrome (vEDS) is the most severe form of EDS, affecting the synthesis of type III collagen. It is notable for decreased life expectancy and morbidity, including spontaneous vessel rupture. The present review summarizes recent findings that have improved the ability to manage and delineate the natural history of vEDS. Recent findings Recent EDS consortium guidelines for the diagnosis of vEDS have emerged and outlined clinical features and molecular diagnostic tools to help facilitate rapid diagnosis. Although medical interventions to help halt the disease progression rem...
Source: Current Opinion in Cardiology - October 11, 2020 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 11, 2020 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Sodium–glucose cotransporter 2 inhibitors at the intersection of cardiovascular, renal and metabolic care: an integrated and multidisciplinary approach to patient-centered care
Purpose of review The management of individuals who live with type 2 diabetes requires an integrated and multifaceted approach. Recent findings Sodium–glucose cotransporter 2 inhibitors effectively prevent and treat cardiorenal complications in the presence of type 2 diabetes. They also reduce death and disease progression in those with established heart failure (with reduced ejection fraction) in the absence of diabetes. Summary Close collaborations between primary care physicians, cardiovascular specialists, endocrinologists and nephrologists are necessary to optimize cardiovascular, renal and metabolic ris...
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

The COMPASS trial: practical considerations for application after coronary artery bypass surgery
Purpose of review We review the cardiovascular outcomes for people using anticoagulation strategies (COMPASS) trial with particular emphasis on patients with a history of remote coronary artery bypass grafting (CABG) and those who were enrolled 4–14 days after CABG. We provide practical guidance for selecting patients with the greatest potential to benefit who have acceptable bleeding risk. In particular, we address concerns about postoperative bleeding and discuss the relative merits of rivaroxaban and aspirin versus P2Y12 inhibition and aspirin. Recent findings The COMPASS trial demonstrated that rivaroxaban a...
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

Percutaneous management of coronary bifurcation lesions: current perspective
Purpose of review Coronary artery disease affecting bifurcations poses a challenge for percutaneous intervention. Several techniques and strategies for percutaneous management of bifurcation lesions have been described in the literature with variable data available for outcomes. In this review, we provide an overview of the strategies and techniques used for percutaneous intervention of bifurcation lesions with an update of recent technical developments and clinical evidence. Recent findings The coronary bifurcation lesions of both left main and other coronary segments are best treated with a provisional stenting stra...
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

Stress cardiac MRI in stable coronary artery disease
Purpose of review Non-invasive testing is often the first step in the evaluation of stable coronary artery disease (CAD). Stress cardiac magnetic resonance imaging (CMR) is an established modality with high diagnostic accuracy and prognostic value. This review will focus on the recent advances in understanding how stress CMR can help guide patient care. Recent findings Diagnostic accuracy of stress CMR has been validated against coronary angiography with fractional flow reserve (FFR) in patients with stable CAD. Large registry data have shown stress CMR to have important prognostic importance and that its cost-effecti...
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

A comparison of surgical, total percutaneous, and hybrid approaches to treatment of combined coronary artery and valvular heart disease
Purpose of review The purpose of this review is to compare outcomes of surgical valve replacement (SVR) and coronary artery bypass grafting (CABG), minimally invasive cardiac surgery (MICS) SVR and percutaneous coronary intervention (PCI), and transcatheter aortic valve replacement and PCI for the treatment of combined coronary artery disease (CAD) and valvular heart disease (VHD). Recent findings Several studies have attempted to identify key differences in outcomes with hybrid MICS SVR and PCI approaches to combined CAD and VHD. Recent studies have demonstrated that MICS SVR and PCI, when compared with conventional ...
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

Revascularization strategies for left main coronary artery disease: current perspectives
Purpose of review Left main coronary artery disease (LMCAD) represents a high-risk subset of coronary artery disease with significant morbidity and mortality if not treated in a timely manner. In this review, we survey the contemporary evidence on the management of LMCAD, highlight advances, and provide in-depth review of data comparing surgical and percutaneous approaches. Recent findings LMCAD represents a heterogeneous condition and management should be guided by key clinical and anatomic factors. In recent years, there has been a wealth of published prospective data including results of the EXCEL and NOBLE trials....
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

Assessment and management of coronary artery disease in patients undergoing transcatheter aortic valve replacement
Purpose of review Coronary artery disease (CAD) is commonly observed in patients undergoing transcatheter aortic valve replacement (TAVR). Significant variability exists across institutions for strategies used for CAD diagnosis and its management. The heart team often relies upon traditional practice patterns and the decision for revascularization by percutaneous coronary intervention (PCI) is influenced by patient, angiographic, operator, and system-related factors. Recent findings Contemporary coronary tomography angiography (CTA) shows significant promise for detection of clinically important CAD and preliminary da...
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

Editorial: Coronary surgery: is there a need for a subspecialty?
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh Verma Source Type: research

Opportunities for improved cardiovascular disease prevention in oncology patients
Purpose of review Cancer patients often have cardiovascular risk factors at the time of cancer diagnosis, which are known to increase the risk of cardiotoxicity. Cancer survivors have significantly higher cardiovascular risk. Current cardiovascular disease prevention guidelines are based on studies that largely excluded these patients. We reviewed recent data regarding cardiovascular disease prevention in this population. Recent findings Nonpharmacologic therapies aiming to reduce ‘lifestyle toxicity’ produced by cancer treatments have demonstrated potential to decrease the incidence of adverse outcomes. E...
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: PREVENTION: Edited by Ron Blankstein Source Type: research

Recent trends in acute myocardial infarction among the young
Purpose of review In recent decades, the incidence of myocardial infarction (MI) has declined among the general population. However, MI rates in the young have not decreased as much as has been observed among older individuals. This review will focus on recent trends of MI in young patients, factors that may account for these trends, and implications for future prevention. Recent findings MI rates in young patients, particularly in women, have not decreased in the same fashion as they have for their older counterparts, with some studies reporting an increase. The reasons for these findings include underestimation of c...
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: PREVENTION: Edited by Ron Blankstein Source Type: research

Targeting multiple domains of residual cardiovascular disease risk in patients with diabetes
Purpose of review There has been a recent resurgence of diabetes-related cardiovascular complications after years of steady improvement. This review highlights established and emerging contemporary secondary prevention approaches that lower the risk of atherosclerotic and nonatherosclerotic cardiovascular disease events among patients with diabetes. Recent findings Secondary prevention therapies modify residual risk targets, including cardiometabolic pathways, lipoproteins, thrombosis, and inflammation. Large-scale clinical trials of sodium-glucose cotransporter-2 inhibitors have demonstrated significant reductions in...
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: PREVENTION: Edited by Ron Blankstein Source Type: research

Nutrition and physical activity recommendations from the United States and European cardiovascular guidelines: a comparative review
Purpose of review A healthy lifestyle throughout one's lifespan is the core foundation for both primary and secondary prevention of cardiovascular disease (CVD). Risk-based decisions for pharmacological therapy is added on-top of lifestyle management. Thus, understanding lifestyle-based recommendations is central to CVD prevention. Recent findings In 2018 and 2019, the American Heart Association (AHA) and American College of Cardiology (ACC) published new guidelines for lipid management and primary prevention of cardiovascular disease (CVD), respectively. The European Society of Cardiology (ESC) and European Atheroscl...
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: PREVENTION: Edited by Ron Blankstein Source Type: research

The evolving role of coronary artery calcium in preventive cardiology 30 years after the Agatston score
Purpose of review On the brink of the 30th anniversary of the Agatston score we summarize the epidemiological data that shaped the recommendations relevant to coronary artery calcium (CAC) included in the 2018/2019 US and European guidelines for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). We also discuss the implications of novel CAC research conducted in asymptomatic populations within the past 2 years. Recent findings Based on a wealth of observational evidence, CAC has emerged as a mainstay in personalized risk assessment and is now endorsed as a class IIa tool in both US and European ...
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: PREVENTION: Edited by Ron Blankstein Source Type: research

Surgical treatment of mitral regurgitation
Purpose of review Mitral repair is the best treatment for degenerative mitral regurgitation. Many patients are referred too late for optimal outcomes. The US repair vs. replacement rate is only 60–80%, at a time when the inferiority of replacement has been established. Therefore, widely used traditional techniques of repair are being reappraised. Recent findings Identification of risk factors predictive of poor early and late outcome have improved timing for surgical referral. Composite risk scores have been developed. Novel echocardiographic, cardiac MRI, and molecular level risk factors could improve timing. A...
Source: Current Opinion in Cardiology - August 13, 2020 Category: Cardiology Tags: IMAGING AND MITRAL REGURGITATION: Edited by Sherif Nagueh Source Type: research