Distinct pathological mechanisms distinguish acute coronary syndrome caused by plaque erosion from plaque rupture
Purpose of review
The current systematic review aims to provide novel insights into the distinct pathological features of acute coronary syndrome (ACS) with intact fibrous cap, also known as ‘plaque erosion’. A more detailed understanding of its underlying pathomechanisms provides the basis for future personalized therapeutic approaches to ACS.
Recent findings
In the past years, a mounting proportion of evidence point towards the concept of plaque erosion being responsible for more than one-third of all cases of ACS and representing an autonomous ACS-causing entity driven by biomechanical forces, immunologic...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research
Coronary plaque features on CTA can identify patients at increased risk of cardiovascular events
Purpose of review
Multicenter studies showed that the characterization of coronary atherosclerosis by coronary computed tomography (CT) angiography (CCTA) provides independent and incremental prognostic value above and beyond traditional measures of coronary artery disease (CAD) and is able to identify patients at risk of future event. Aim of the present review is to expound the major imaging plaque features associated with increased risk of coronary event and to review the data supporting the usefulness of CCTA as tool for plaque assessment and for monitoring the changes in atherosclerotic burden.
Recent findings
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Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research
Persistent inflammatory residual risk despite aggressive cholesterol-lowering therapy: what is next?
Purpose of review
To briefly summarize recently published evidence on the possible therapeutic modulation of inflammatory processes in atherosclerotic cardiovascular disease (ASCVD), focusing on the rationale for an additional randomized clinical trial, targeting both persistently elevated cholesterol and inflammatory residual risk and critically discuss still open issues and future perspectives with regard to treatment allocation.
Recent findings
Several large-scale clinical trials over the past few years have advanced our understanding of the role of inflammation in atherosclerosis, demonstrating that targetin...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research
Evaluation of coronary stenosis versus plaque burden for atherosclerotic cardiovascular disease risk assessment and management
Purpose of review
To provide a summary of recent literature on the relative impact of luminal stenosis versus atherosclerotic plaque burden in atherosclerotic cardiovascular disease (ASCVD) risk stratification and management.
Recent findings
Recent results from both randomized controlled clinical trials as well as observational cohort studies have demonstrated that ASCVD risk is mediated mainly by the extent of atherosclerotic disease burden rather than by the presence of coronary stenosis or inducible ischemia. Although patients with obstructive CAD are generally at higher risk for ASCVD events than patients wi...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research
The pleiotropic cardiovascular effects of sodium-glucose cotransporter-2 inhibitors
Purpose of review
Throughout the history of medicine, scientists and clinicians have observed unanticipated drug effects leading at times to an entirely new use for a drug class, and other times eliminating them from practice. The sodium-glucose cotransporter-2 (SGLT2) inhibitors are one such class of drugs. These agents were initially studied as diabetic agents and their unanticipated and significant cardiovascular benefit has now created a new class of drugs for an entirely new population. Here we review the pleiotropic cardiovascular effects of SGLT2 inhibitors, the potential mechanisms of action, side effect profil...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research
Ischemic mitral regurgitation: when should one intervene?
Purpose of review
Optimal timing of intervention for ischemic mitral regurgitation remains to be elucidated. This review summarizes the data on the management of ischemic mitral regurgitation, and their implications on current practice and future research.
Recent findings
Mechanistically, ischemic mitral regurgitation can present as Type I, Type IIIb or mixed Type I and IIIb disease. Severity of mitral regurgitation is typically quantified with echocardiography, either transthoracic or transesophageal echocardiography, but may also be assessed via cardiac MRI. In patients with moderate ischemic mitral regurgitat...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research
What does complete revascularization mean in 2021? – Definitions, implications, and biases
Purpose of review
Coronary revascularization is known to be an excellent treatment for coronary artery disease. However, whether incomplete myocardial revascularization compromises long-term outcomes, as compared to complete revascularization (CR), remains contentious. Herein, we review the concept of and evidence on CR/incomplete revascularization (ICR) and discuss future perspectives.
Recent findings
When possible, achieving CR in coronary artery bypass grafting is desirable; nonetheless, ICR is also a reasonable option to balance the therapeutic benefits against the risks.
Summary
Although angiography-...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research
Coronary artery bypass grafting in low ejection fraction: state of the art
Purpose of review
As the number of patients with reduced ejection fraction secondary to ischemic cardiomyopathy (ICM) increases, coronary artery bypass grafting is being used with increasing frequency. In this review, we summarize the different operative considerations in this vulnerable patient population.
Recent findings
Preoperative optimization with mechanical circulatory support devices, especially in the setting of hemodynamic instability, can reduce perioperative morbidity and mortality. The advantage of advanced techniques, such as off-pump CABG and multiple arterial grafting remains unclear. Concomitant...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research
Less invasive multivessel coronary artery bypass grafting: now is the time
Purpose of review
Less invasive multivessel coronary artery bypass grafting techniques have seen a progressive evolution over the last two decades. In their current state, they are easily reproduced and applicable to most patients requiring multivessel revascularization. The purpose of this review is to highlight their importance among a spectrum of evolving therapies and the accruing evidence in their favour.
Recent findings
The first large dual center experience with minimally invasive coronary artery bypass grafting (MICS CABG) demonstrated the feasibility of performing multivessel surgical revascularization ...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research
Building new cardiac vasculature and myocardium: where are we at?
Purpose of review
This review describes the latest advances in cell therapy, biomaterials and 3D bioprinting for the treatment of cardiovascular disease.
Recent findings
Cell therapies offer the greatest benefit for patients suffering from chronic ischemic and nonischemic cardiomyopathy. Rather than replacing lost cardiomyocytes, the effects of most cell therapies are mediated by paracrine signalling, mainly through the induction of angiogenesis and immunomodulation. Cell preconditioning, or genetic modifications are being studied to improve the outcomes. Biomaterials offer stand-alone benefits such as bioactive...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research
Editorial: Current opinion on controversial issues in coronary artery bypass surgery
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research
Review new concepts in pharmacotherapy for peripheral arterial disease
Purpose of review
To provide an overview of new concepts in the pharmacotherapy of patients with peripheral artery disease (PAD).
Recent findings
Modern therapeutic strategies for patients with PAD include specific symptom management and multidisciplinary prevention of cardiovascular events. Low-dose rivaroxaban in combination with aspirin improves outcomes compared with aspirin monotherapy among patients with PAD. Other novel concepts include the use of bosentan, vorapaxar or sildenafil among symptomatic patients with PAD. Likewise, lipid-lowering therapy reduces the risk of major cardiovascular and limb events...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research
Chronic thromboembolic pulmonary hypertension anno 2021
Purpose of review
In the past decades, the diagnostic and therapeutic management of chronic thromboembolic pulmonary hypertension (CTEPH) has been revolutionized.
Recent findings
Advances in epidemiological knowledge and follow-up studies of pulmonary embolism patients have provided more insight in the incidence and prevalence. Improved diagnostic imaging techniques allow accurate assessment of the location and extend of the thromboembolic burden in the pulmonary artery tree, which is important for the determination of the optimal treatment strategy. Next to the pulmonary endarterectomy, the newly introduced tec...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research
Catheter-based therapies in acute and chronic pulmonary embolism
Purpose of review
The aim of this study is to summarize currently available catheter-based therapies in acute and chronic pulmonary embolic disease.
Recent findings
Catheter-based therapies to treat acute pulmonary embolism and its sequelae such as chronic thromboembolic pulmonary hypertension (CTEPH) are emerging as the next frontier within interventional cardiology. However, the true benefit of these catheter-based therapies in intermediate-risk and high-risk pulmonary embolism and CTEPH remains unclear. The current evidence supporting such interventions comes primarily from small single-arm studies in acute p...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research
Artificial intelligence and machine learning in aortic disease
Purpose of review
Discuss foundational concepts for artificial intelligence (AI) and review recent literature on its application to aortic disease.
Recent findings
Machine learning (ML) techniques are rapidly evolving for the evaluation of aortic disease – broadly categorized as algorithms for aortic segmentation, detection of pathology, and risk stratification. Advances in deep learning, particularly U-Net architectures, have revolutionized segmentation of the aorta and show potential for monitoring the size of aortic aneurysm and characterizing aortic dissection. These algorithms also facilitate application ...
Source: Current Opinion in Cardiology - October 21, 2021 Category: Cardiology Tags: DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan Braverman Source Type: research
