Contemporary Use of Radial to Peripheral Access for Management of Peripheral Artery Disease
AbstractPurpose of the reviewCompared with femoral access, transradial access for percutaneous vascular intervention has demonstrated several advantages, including lower risks of access site complications, faster patient recovery time, and lower health care costs. This has led to a growing interest in utilization of transradial access as the primary access site for certain peripheral vascular interventions (PVIs). This review outlines the rationale for transradial access for PVI, offers tips on equipment selection and special procedure-specific considerations, discusses challenges and barriers to widespread utilization, an...
Source: Current Treatment Options in Cardiovascular Medicine - February 2, 2021 Category: Cardiology Source Type: research

Practical Approaches to Catheter Ablation of Idiopathic Ventricular Arrhythmias
AbstractPurpose of reviewIn this review, we provide a practical approach to the catheter ablation of idiopathic focal ventricular arrhythmias (VAs) by summarizing the electrocardiographic (ECG) characteristics, mapping strategies, and ablation techniques for each of the major types of idiopathic VAs. We identify special considerations to be taken when treating specific forms of idiopathic VAs with catheter ablation that can increase success rates and reduce complications.Recent findingsInsights on ECG morphologies of VAs have led to novel criteria that can aid in accurate identification and localization of VA sites of orig...
Source: Current Treatment Options in Cardiovascular Medicine - February 2, 2021 Category: Cardiology Source Type: research

Percutaneous Closure of Aortic and Mitral Paravalvular Leaks —Diagnostic and Therapeutic Considerations
AbstractPurpose of reviewParavalvular leak (PVL) represents a suboptimal procedural outcome resulting in an eccentric regurgitant jet following surgical or transcatheter aortic or mitral valve replacements. In this review, the role of integrated imaging modalities, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, for the diagnosis and evaluation of aortic and mitral PVL is comprehensively discussed. Interventional procedures for aortic or mitral PVL using various percutaneous closure devices are reviewed. Clinical outcomes of pe...
Source: Current Treatment Options in Cardiovascular Medicine - February 2, 2021 Category: Cardiology Source Type: research

An Update on Coronary Artery Disease in Pregnancy
AbstractPurpose of reviewWe review recent literature regarding coronary artery disease in pregnant women or women desiring pregnancy. This includes preconception counseling, prenatal care, labor and delivery, management of acute events in pregnancy, and postpartum care.Recent findingsThe pregnancy outcomes for women with coronary artery disease and their babies correlate with the degree of recovery from the initial event, coronary revascularization, and current maternal cardiac status. Preconception care includes assessment of cardiac function and management of cardiac medications. Prenatal care includes monitoring for rec...
Source: Current Treatment Options in Cardiovascular Medicine - February 2, 2021 Category: Cardiology Source Type: research

Complete Revascularization in Patients With STEMI and Multivessel Coronary Artery Disease: Is It Beneficial?
AbstractPurpose of reviewMultivessel coronary artery disease is usually present in up to 50% of patients presenting with ST-elevation myocardial infarction (STEMI). The optimal revascularization approach for non-infarct related lesions has been a topic of recent debate. Various observational studies and clinical trials have been conducted to assess the impact of multivessel revascularization. In this review, we aim to present the currently available evidence behind the different revascularization strategies.Recent findingsEarly observational studies, registry-based analyses, and meta-analyses had suggested a benefit of cul...
Source: Current Treatment Options in Cardiovascular Medicine - January 28, 2021 Category: Cardiology Source Type: research

Role of Inferior Vena Cava Filter Retrieval in Patients on Chronic Anticoagulation Therapy
AbstractPurpose of reviewDescribe the role of inferior vena cava filter (IVCF) retrieval in patients on chronic anticoagulation given the overlap of these treatment options in the management of patients with venous thromboembolic disease.Recent findingsDespite the increase in IVCF retrievals since the Food and Drug Administration safety communications in 2010 and 2014, retrieval rates remain low. Previous studies have shown that longer filter dwell times are associated with greater risk for filter complications and more difficulty with filter retrievals. Recent findings suggest that complications are more frequent in the f...
Source: Current Treatment Options in Cardiovascular Medicine - January 25, 2021 Category: Cardiology Source Type: research

Prenatal Detection of Congenital Heart Disease: the Past, Present, and Future
AbstractPurpose of reviewPrenatal diagnosis of congenital heart disease (CHD) is continuously evolving with each passing decade. Early efforts in fetal cardiology focused on identifying CHD in mid-gestation and understanding of fetal circulation in pathologic conditions. Improving prenatal detection rates for CHD remains an ongoing challenge and increasingly the field of fetal cardiology is moving to not only diagnosing CHD prenatally but also assessing the impact of prenatal diagnosis of CHD outcomes. Future directions include earlier diagnosis of fetal CHD, improved diagnostic rates, widespread sonographer education, and...
Source: Current Treatment Options in Cardiovascular Medicine - January 22, 2021 Category: Cardiology Source Type: research

Updates on the Role of Imaging in Cardiac Amyloidosis
AbstractPurpose of reviewImaging of cardiac amyloidosis has traditionally been hindered by nonspecific findings or diagnosis late in disease. Recent imaging techniques aim to address these gaps.Recent findingsT1 mapping, extracellular volume (ECV) quantification, myocardial strain imaging, positron emission tomography/computed tomography (PET/CT), bone-seeking agents, and cardiac computed tomography angiography (CCTA) are a few of the imaging modalities and techniques used to image cardiac amyloidosis. Many offer the possibility of earlier cardiac amyloidosis detection. PET/CT and bone-seeking agents may allow for quantifi...
Source: Current Treatment Options in Cardiovascular Medicine - January 16, 2021 Category: Cardiology Source Type: research

Outcomes and Procedural Considerations for Women Undergoing PCI
AbstractPurpose of reviewWomen continue to be underrepresented in cardiovascular studies, while heart disease remains a major cause of mortality and morbidity in women as in men. In this review, we explore the differences in presentation, characteristics, and treatment of women presenting for coronary intervention for stable coronary disease or acute coronary syndromes.Recent findingsRecent, large meta-analyses of clinical trials have shown that the sex differences in outcomes after non-ST-elevation acute coronary syndrome are attenuated after thorough adjustment for baseline comorbidities, but worse outcomes and more comp...
Source: Current Treatment Options in Cardiovascular Medicine - January 16, 2021 Category: Cardiology Source Type: research

Digital Health Applications in Heart Failure: a Critical Appraisal of Literature
AbstractPurpose of the reviewDespite advancements in the diagnostic and therapeutic armamentarium, heart failure (HF) remains a major public health concern in the USA and worldwide. Digital health applications hold promise to bridge this gap and improve HF care. This review will provide the reader with a concise overview of the current digital health applications in HF, the main challenges to its use, and discuss the future of digital health for promoting care for HF patients.Recent findingsEmerging evidence continues to support the potential role of digital health across the continuum of HF disease process including prima...
Source: Current Treatment Options in Cardiovascular Medicine - January 16, 2021 Category: Cardiology Source Type: research

The Impact of Depression and Anxiety on Cardiovascular Disease Risk and Outcomes in Women
AbstractPurpose of ReviewDepression and anxiety are known to potentiate cardiovascular disease and result in worse outcomes. These disorders disproportionately affect women. The purpose of this review is to examine the impact of depression and anxiety on cardiovascular outcomes in women.Recent FindingsDepression, anxiety, and psychosocial stressors work through a number of mechanisms to decrease health behavior engagement and increase cardiovascular risk in women. Ultimately, this leads to worsened quality of life, cardiovascular morbidity, and mortality among affected women. Notably, because these conditions are more prev...
Source: Current Treatment Options in Cardiovascular Medicine - January 16, 2021 Category: Cardiology Source Type: research

Preventive Cardio-Oncology: Cardiovascular Disease Prevention in Cancer Patients and Survivors
AbstractPurposeTo review the most common forms of cardiovascular toxicities from anti-cancer drugs, with a focus on their prevention via cardioprotective pharmacologic or lifestyle therapy, risk factors management, screening, monitoring, and surveillance methods.Recent findingsThere are almost 20 million cancer survivors in the USA, and their leading cause of death besides cancer recurrence or a secondary cancer is cardiovascular disease (CVD). CVD is prevalent in this population, with the most common forms being cardiomyopathy, ischemia, atrial fibrillation, and hypertension from cancer drugs or radiation therapy. The fie...
Source: Current Treatment Options in Cardiovascular Medicine - January 4, 2021 Category: Cardiology Source Type: research

Current Treatment Options in Cardiovascular Medicine Arrhythmia Section From the His Bundle to the Left Bundle: Clinical Applications of Conduction System Pacing
ConclusionCSP seeks to engage the His-Purkinje system either at the His bundle or the proximal fascicular system. Available data support a role for CSP in patients with bradyarrhythmia indications, and with growing experience in CRT applications. Present data best supports HBP, but LBBAP and LVSP may serve as alternative routes for CSP going forward. (Source: Current Treatment Options in Cardiovascular Medicine)
Source: Current Treatment Options in Cardiovascular Medicine - January 4, 2021 Category: Cardiology Source Type: research

Multimodality Imaging in the Evaluation and Treatment of Pulmonary Valve Disorders
AbstractPurpose of reviewTo discuss the epidemiology of pulmonary valve (PV) disorders, anatomy and pathology of the PV, and current treatment strategies for PV disorders with special attention to the patient with congenital heart disease. The focus will be on utilization of multimodality imaging methods including echocardiography, cardiac CT, and MRI in the evaluation and management of PV disorders.Recent findingsThe PV is affected in a myriad of congenital and acquired conditions, leading to stenotic, regurgitant, or mixed lesions. In addition to echocardiography, imaging modalities such as cardiac magnetic resonance ima...
Source: Current Treatment Options in Cardiovascular Medicine - January 2, 2021 Category: Cardiology Source Type: research

Treating Moderate Aortic Stenosis: Too Early or Too Late?
This article will consider treatment strategies for moderate AS, including early surgical and transcatheter aortic valve replacement and medical therapy.Recent findingsThere are few randomized controlled trials dedicated to medical and surgical therapies for moderate AS. Statins, antihypertensive agents and bisphosphonates have not consistently demonstrated an effect on AS progression, timing of aortic valve replacement, or improvement in patient outcomes. Early surgical intervention for patients with concomitant left ventricular dysfunction has been studied in a retrospective manner and appears promising.SummaryAside from...
Source: Current Treatment Options in Cardiovascular Medicine - January 2, 2021 Category: Cardiology Source Type: research

Cardiotoxicity Related to Immune Checkpoint Inhibitors
AbstractPurpose of reviewImmune checkpoint inhibitors (ICI) have modified the management of patients with cancer. Their administration is associated with an increased risk of toxicities that can affect every organ. Cardiovascular toxicities, particularly myocarditis, can occur with a low incidence (
Source: Current Treatment Options in Cardiovascular Medicine - November 26, 2020 Category: Cardiology Source Type: research

Risk Stratification for Subsequent Pregnancy After Prior Peripartum Cardiomyopathy
AbstractPurpose of reviewPeripartum cardiomyopathy (PPCM) is a rare but serious cardiac complication of pregnancy. Patients with PPCM may not have completed their reproductive years and may desire future pregnancies. This review summarizes the epidemiology and pathophysiology of PPCM and gives an overview of the current knowledge of risk factors that can be used to assess the risk of pregnancy after PPCM.Recent findingsAn increasing body of work has been reported on pregnancy outcomes in women with a history of PPCM. The most dominant determinate of poor outcome in subsequent pregnancies (SSP) is left ventricular ejection ...
Source: Current Treatment Options in Cardiovascular Medicine - November 26, 2020 Category: Cardiology Source Type: research

Deep Phenotyping in Cardiovascular Disease
AbstractPurpose of reviewTo review the opportunities and challenges of phenotyping cardiovascular diseases in the modern era.Recent findingsMore recently, the emerging field of precision medicine aims to provide the best available care for each patient based on stratification into new disease subclasses with a common biological basis. The discovery of such subclasses at the correct scale and speed, as well as the translation of this knowledge into clinical care, will depend critically upon digital and computational resources to capture, store, and exchange phenotypic data and upon sophisticated algorithms to integrate thes...
Source: Current Treatment Options in Cardiovascular Medicine - November 26, 2020 Category: Cardiology Source Type: research

The Role of Cardiac Computed Tomography in Valve Disease and Valve Intervention Planning
AbstractPurpose of reviewThis review aims to provide an overview of cardiac CT role in detection of valvular lesions and in transcatheter valve replacement.Recent findingsModern CT scans and protocols allow valve evaluation with high spatial and temporal resolution with reduced radiation dose. Cardiac CT is now mainstay of transcatheter aortic valve replacement (TAVR) planning. It plays a role in sizing of transcatheter aortic valve prosthesis, risk assessment for potential complications, prediction of ideal fluoroscopic angles, and selection of vascular access. Cardiac CT ’s role in transcatheter mitral, pulmonic, a...
Source: Current Treatment Options in Cardiovascular Medicine - November 26, 2020 Category: Cardiology Source Type: research

The Impact of Premature Menopause on Future Risk of Cardiovascular Disease
AbstractPurpose of ReviewCardiovascular disease remains the leading cause of morbidity and mortality for women in the USA. Recent multi-society guideline updates endorse using a history of premature menopause, defined as occurring before age 40  years, as a risk-enhancing factor for atherosclerotic cardiovascular disease risk assessment in women. Here, we review recent literature on cardiovascular disease risk in women with premature menopause, possible mechanisms linking premature menopause to cardiovascular disease, and the role of meno pausal hormone therapy in postmenopausal women.Recent FindingsLarge cohort studi...
Source: Current Treatment Options in Cardiovascular Medicine - November 20, 2020 Category: Cardiology Source Type: research

Arrhythmias Associated with Inflammatory Cardiomyopathies
AbstractPurpose of reviewTo provide an approach to the diagnosis and treatment of arrhythmias associated with inflammatory cardiomyopathies.Recent findingsInflammatory cardiomyopathies are increasingly recognized as the etiology of both ventricular and supraventricular arrhythmias. There have been recent studies providing novel insights into the pathogenesis of arrhythmias in inflammatory cardiomyopathies and exploring the role of various diagnostic tools and treatment strategies.SummaryPatients with inflammatory cardiomyopathies often present with one or more arrhythmias, including atrioventricular block, atrial and ventr...
Source: Current Treatment Options in Cardiovascular Medicine - November 19, 2020 Category: Cardiology Source Type: research

Disparities in Cardiovascular Care and Outcomes for Women From Racial/Ethnic Minority Backgrounds
AbstractPurpose of reviewRacial, ethnic, and gender disparities in cardiovascular care are well-documented. This review aims to highlight the disparities and impact on a group particularly vulnerable to disparities, women from racial/ethnic minority backgrounds.Recent findingsWomen from racial/ethnic minority backgrounds remain underrepresented in major cardiovascular trials, limiting the generalizability of cardiovascular research to this population. Certain cardiovascular risk factors are more prevalent in women from racial/ethnic minority backgrounds, including traditional risk factors such as hypertension, obesity, and...
Source: Current Treatment Options in Cardiovascular Medicine - November 17, 2020 Category: Cardiology Source Type: research

Vascular Endothelial Growth Factor (VEGF) Inhibitor Cardiotoxicity: What Should We Know?
AbstractPurpose of reviewCancer therapy-induced cardiovascular toxicity is a growing clinical problem with many unanswered questions about the optimal screening, prevention, and management, especially in patients treated with new targeted drugs. Among them, the use of vascular endothelial growth factor inhibitors (VEGFi) has become one of the most promising strategies to successfully approach a wide range of tumors. However, they have been associated with important cardiovascular complications such as systemic hypertension, heart failure, QTc prolongation, and venous and arterial thrombosis. This review addresses a multidi...
Source: Current Treatment Options in Cardiovascular Medicine - November 16, 2020 Category: Cardiology Source Type: research

Sex Differences in HFpEF
AbstractPurpose of reviewHeart failure with preserved ejection fraction (HFpEF) disproportionately affects women. Though no unifying theory exists to explain this phenomenon, the purpose of this review is to explore the many factors that likely contribute to this female predominance.Recent findingsInflammation and microvascular ischemia are increasingly thought to play a role in promoting HFpEF, as is the presence of cardiometabolic traits including hypertension, diabetes, and obesity. All of these factors are more common in women. Female-specific risk factors, including a history of hypertensive disorders of pregnancy and...
Source: Current Treatment Options in Cardiovascular Medicine - November 14, 2020 Category: Cardiology Source Type: research

Cardiovascular Evaluation and Considerations for Women of Advanced Maternal Age Desiring Pregnancy
AbstractPurpose of reviewPregnancy in women of advanced maternal age (AMA) is increasingly common. Women of AMA have higher pregnancy risks, including higher risk of cardiovascular complications such as hypertensive disorders of pregnancy. This review highlights recent data comparing pregnancy risks in both younger women and women of AMA, as well as how these risks are influenced using assisted reproductive therapies (ART). It highlights long-term cardiovascular risks in women of AMA and suggestions on how to perform cardiovascular evaluations both preconception and during pregnancy in this group of women. It also highligh...
Source: Current Treatment Options in Cardiovascular Medicine - November 13, 2020 Category: Cardiology Source Type: research

Management of Cervico-Cranial Arterial Dissections
AbstractPurpose of reviewCervico-cranial arterial dissections are a distinct etiology of both ischemic and hemorrhagic neurovascular events. These dissections can involve the extracranial carotid or vertebral arteries, classified collectively as cervical artery dissections, or can be intracranial arterial dissections, and complications and management of each differ. The most recent evidence is reviewed in this publication.Recent findingsSignificant heterogeneity regarding treatments of dissections exists among providers and with recent advances in endovascular approaches to neurovascular care, appreciating the latest evide...
Source: Current Treatment Options in Cardiovascular Medicine - November 13, 2020 Category: Cardiology Source Type: research

Swimming: What the Sports Cardiologist Should Know
AbstractPurpose of reviewTo inform the reader on the current knowledge of the cardiovascular effects of swimming and review the characteristics and treatments of unique cardiac conditions affecting the swimmer including swimming-induced pulmonary edema, long QT syndrome, troponin elevation, and sudden cardiac arrest/death.Recent findingsNew research has characterized swimming-induced cardiac remodeling as eccentric remodeling notable for greater left ventricular chamber dilation relative to wall thickening suggesting that swimming primarily challenges the heart with a volume load. Additionally, recent data from triathlons ...
Source: Current Treatment Options in Cardiovascular Medicine - November 12, 2020 Category: Cardiology Source Type: research

Cardiovascular Complications of Prostate Cancer Therapy
AbstractPurpose of reviewWith treatment advances, the most common cause of death in prostate cancer patients is cardiovascular disease. Discerning the contribution of prostate cancer treatment on cardiovascular complications versus the natural progression of cardiovascular disease remains an ongoing area of investigation. Evaluating the research and identifying opportunities for further investigation is critical for optimal care of this prostate cancer patient population.Recent findingsThe degree that hormone therapy contributes to cardiovascular morbidity and mortality remains uncertain with conflicting results from large...
Source: Current Treatment Options in Cardiovascular Medicine - November 12, 2020 Category: Cardiology Source Type: research

Contraception for the Cardiac Patient: a Cardiologist ’s Primer
AbstractPurpose of reviewCardiovascular disease (CVD) is the number one cause of maternal mortality in the USA. There are many cardiac conditions which pose significant risk to maternal health, and these women should be offered options to avoid unwanted pregnancies. Individualized contraceptive counseling focusing on woman ’s desire for future pregnancy, comorbid conditions, and desire for hormone or non-hormonal (contraceptive) options is paramount to avoid adverse or unwanted side effects. The purpose of this review is to give general guidance on prescribing both hormonal and non-hormonal contraceptives for provid ...
Source: Current Treatment Options in Cardiovascular Medicine - November 9, 2020 Category: Cardiology Source Type: research

A Hidden Threat: Anomalous Aortic Origins of the Coronary Arteries in Athletes
AbstractPurpose of reviewAnomalous aortic origins of the coronary arteries (AAOCA) are a primary cause of sudden cardiac death in athletes. This review will detail the epidemiology, pathophysiology, and risk stratification of AAOCA, while also highlighting return-to-play considerations for athletes.Recent findingsSport pre-participation cardiovascular screening methods lack sensitivity and specificity in the identification of AAOCA. For the symptomatic athlete, clinicians must maintain a heightened clinical suspicion for AAOCA in order to proceed with appropriate cardiac imaging and functional assessments. Anomalous origin...
Source: Current Treatment Options in Cardiovascular Medicine - November 7, 2020 Category: Cardiology Source Type: research

“Hyperacute” Stroke Rehabilitation Care: Common Issues and Considerations
AbstractPurpose of reviewWe provide a comprehensive review of current issues and treatment guidelines for stroke rehabilitation in the acute care setting.Recent findingsNeuroplasticity and stroke recovery have been found to start at the onset of injury. As a result, neurorehabilitation beginning in the acute care setting has emerged as a promising management strategy to improve patient outcomes and quality of life. Specific treatment and rehabilitation protocols in the acute recovery phase include those that target motor recovery, spasticity, cognitive processes, nutrition, communication, and family dynamics.SummaryStroke ...
Source: Current Treatment Options in Cardiovascular Medicine - November 5, 2020 Category: Cardiology Source Type: research

Management and Treatment of Myocarditis in Athletes
AbstractPurpose of reviewMyocarditis is an inflammation of the myocardium that can often be associated with cardiac dysfunction and arrhythmias, and is even one of the leading causes for sudden cardiac death (SCD) in athletes. This review aims to summarize the current evidence and treatment guidelines for the management of myocarditis in the active population.Recent findingsPhysical exertion is likely a trigger for dangerous arrythmias and further propagates myocardial damage in athletes with myocarditis. For this reason, abstinence from sports is a critical facet of management in the initial inflammatory period. The use o...
Source: Current Treatment Options in Cardiovascular Medicine - November 4, 2020 Category: Cardiology Source Type: research

Differential Outcomes for African-American Women with Cardiovascular Complications of Pregnancy
AbstractPurpose of reviewMaternal mortality is rising in the USA, and cardiovascular disease is the leading cause of death. Black women are 3 times more likely to die than White women as a result of pregnancy-related causes. In this review, we describe the differential outcomes of Black women with cardiovascular conditions related to pregnancy.Recent findingsBlack women have a higher risk of developing peripartum cardiomyopathy (PPCM) and preeclampsia compared to White women. Black women with PPCM present with more severe disease and are less likely to experience myocardial recovery. Black women with preeclampsia are at hi...
Source: Current Treatment Options in Cardiovascular Medicine - November 3, 2020 Category: Cardiology Source Type: research

Cardiotoxicity of Contemporary Anticancer Immunotherapy
AbstractPurpose of reviewContemporary anticancer immunotherapy, particularly immune checkpoint inhibitors (ICI) and chimeric antigen receptor (CAR) T cell therapy, has changed the landscape of treatment for patients with a variety of malignancies who historically had a poor prognosis. However, both immune checkpoint inhibitors and CAR T cell therapy are associated with serious cardiovascular adverse effects. As immunotherapy evolves to include high-risk patients with preexisting cardiovascular risk factors and disease, the risk and relevance of its associated cardiotoxicity will be even higher.Recent findingsICI can cause ...
Source: Current Treatment Options in Cardiovascular Medicine - November 3, 2020 Category: Cardiology Source Type: research

Sex Differences in Young Adults Who Experience Myocardial Infarction
AbstractPurpose of reviewThe purpose of this review is to highlight sex differences in presentation, underlying mechanisms, treatment, and outcomes in young adults with myocardial infarction (MI).Recent findingsIn addition to traditional plaque rupture and plaque erosion, MI in young women can be caused by spontaneous coronary artery dissection (SCAD), MI with nonobstructive coronary arteries (MINOCA), and type 2 MI. MINOCA is more common in young women compared with young men, has a different epidemiology, and is associated with non-traditional cardiovascular risk factors. Additionally,  pregnancy-associated conditio...
Source: Current Treatment Options in Cardiovascular Medicine - November 3, 2020 Category: Cardiology Source Type: research

The Association of Adverse Pregnancy Outcomes and Cardiovascular Disease: Current Knowledge and Future Directions
AbstractPurpose of reviewAdverse pregnancy outcomes are associated with increased risk for future cardiovascular disease. The goal of this review is to share what is currently known about the increased risk and to identify areas for future research.Recent findingsSevere studies have identified a strong association between adverse pregnancy outcomes and cardiovascular disease such as heart failure, valvular disease, ischemic heart disease, stroke, hypertension, and metabolic syndrome. The recognition of this increased risk is reflected in recent changes in prevention guidelines. The guidelines now recognize sex-specific ris...
Source: Current Treatment Options in Cardiovascular Medicine - October 31, 2020 Category: Cardiology Source Type: research

Workup and Management of Primary Mitral Regurgitation
AbstractPurpose of reviewWe summarize the current concepts and methods for diagnosis and management of primary mitral regurgitation due to leaflet prolapse or flail.Recent findingsCurrent practice guidelines emphasize accurate diagnosis of chronic primary severe MR, differentiating between symptomatic and asymptomatic states, and assessing both hemodynamic and functional impact, thereby ensuring timely surgical or transcatheter intervention for those who stand to benefit from it. No effective medical therapy for chronic severe mitral regurgitation has been found to date. Surgical repair has significant advantages over valv...
Source: Current Treatment Options in Cardiovascular Medicine - October 30, 2020 Category: Cardiology Source Type: research

Updates in the Definition, Diagnostic Work Up, and Therapeutic Strategies for MINOCA
AbstractPurpose of reviewMyocardial infarction with non-obstructive coronary arteries (MINOCA) is found in up to 6% of patients presenting with acute coronary syndrome. These patients represent a group with unique pathophysiology and treatment needs. This review summarizes recent advancement in the understanding of the causes and diagnostic work up of patients presenting with MINOCA.Recent findingsHistorically the importance of MINOCA has been under-recognized, and the condition was considered a more benign form of acute coronary syndrome. More recently consensus documents from major cardiac societies have highlighted the ...
Source: Current Treatment Options in Cardiovascular Medicine - October 28, 2020 Category: Cardiology Source Type: research

The Impact of Exercise and Athletic Training on Vascular Structure and Function
AbstractPurpose of reviewMyocardial adaptation to athletics and exercise training is a well-described process that has garnered much interest over the past decades. By contrast, our understanding of how the vascular system adapts in the trained athlete remains limited. The goal of this review is to provide a comprehensive overview of the impact of exercise on structure and function of the extra-cardiac vascular system.Recent findingsWhile structural changes in the size of the aorta are rare in young athletes, emerging data suggest that long-term athletic participation may be a risk factor for aortic dilation in middle-age ...
Source: Current Treatment Options in Cardiovascular Medicine - October 28, 2020 Category: Cardiology Source Type: research

Sex Differences in Cardiovascular Disease and Unique Pregnancy-Associated Risk Factors in Women
AbstractPurpose of reviewCardiovascular disease is the leading cause of mortality in women. Beyond conventional cardiovascular risk factors, women additionally face sex-specific cardiovascular disease risk factors, which include a history of adverse pregnancy outcomes. Adverse pregnancy outcomes include the hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm delivery,  and small-for-gestational age delivery. Here, we review sex differences in cardiovascular disease with an emphasis on pregnancy-associated risk factors and discuss implications for the prevention and treatment of cardiovascu...
Source: Current Treatment Options in Cardiovascular Medicine - October 28, 2020 Category: Cardiology Source Type: research

Updates to a Modern Dilemma: a Practical Approach to the Workup and Management of Low-Gradient Severe Aortic Stenosis Using Transvalvular Flow Rate
AbstractPurpose of reviewTo provide a new and practical approach for clinicians assessing and managing patients with low-gradient severe aortic stenosis (AS) using recent data highlighting the importance of transvalvular flow rate in AS assessment.Recent findingsRecent data have highlighted the unifying underpinning of low-gradient severe AS to be low transvalvular flow rate, and shown the impact that flow rate has on diagnostic and prognostic utility in AS. Additional developments in echocardiographic measurement technique and non-echocardiographic modalities have also been made which can help tackle this clinical conundr...
Source: Current Treatment Options in Cardiovascular Medicine - October 28, 2020 Category: Cardiology Source Type: research

Pregnancy After Spontaneous Coronary Artery Dissection (SCAD): a 2020 Update
AbstractPurpose of reviewSpontaneous coronary artery dissection (SCAD) is a disease which affects a predominantly female and relatively young population, some of whom have not yet completed their reproductive lives. SCAD has traditionally been considered a contraindication to future pregnancy due to concerns about the risk of recurrence and the high-risk phenotype associated with pregnancy-associated SCAD (P-SCAD). This review summarizes recent advancements in the understanding of pregnancy and reproductive health after SCAD.Recent findingsAlthough traditionally under-recognized and underdiagnosed, the importance of SCAD a...
Source: Current Treatment Options in Cardiovascular Medicine - October 28, 2020 Category: Cardiology Source Type: research

Systematic Review: Does Balloon Pulmonary Angioplasty (BPA) Improve Right Ventricular Function in CTEPH Patients? Evaluation Based on Imaging Findings
AbstractPurpose of reviewChronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening disease with many complications, such as right heart failure. Therefore, a direct and efficient therapy is imperative. This review aims to determine the effectiveness of balloon pulmonary angioplasty (BPA) on right ventricular (RV) function among CTEPH patients, using imaging methods.Recent findingsFrom April 2019 to August 2019, PubMed database was searched for randomized control trials and cohort studies conducted until August 2019, evaluating the impact of BPA on RV function as assessed by non-invasive modalities. Data w...
Source: Current Treatment Options in Cardiovascular Medicine - October 21, 2020 Category: Cardiology Source Type: research

Doxorubicin Cardiotoxicity: Pathophysiology Updates
AbstractPurpose of reviewDoxorubicin has long been known to cause cardiotoxicity, yet our understanding of its pathophysiologic mechanisms remains incomplete. This review aims to update readers on the most recent evidence supporting candidate mechanisms and proposed treatments for doxorubicin cardiotoxicity.Recent findingsDoxorubicin causes cardiotoxicity via traditional mechanisms, such as oxidative stress, DNA and mitochondrial damage, and iron overload, as well as through novel pathways such as autophagy and CYP1 induction. The relative importance of each pathway and how these pathways interact with each other is not we...
Source: Current Treatment Options in Cardiovascular Medicine - October 14, 2020 Category: Cardiology Source Type: research

Current Treatment Options of Fontan Arrhythmias: Etiology, Incidence, and Diagnosis
AbstractPurpose of the reviewPatients who undergo single ventricle palliation with a Fontan are at a high risk for developing arrhythmias. This review will address our understanding of pathophysiology, incidence, presentation, and type of arrhythmia, focusing on recent developments.Recent findingsPatients with the initially described atriopulmonary connection type of Fontan have a high incidence of arrhythmias, with severe consequences. Arrhythmias are less of a problem with the two currently used surgical techniques, the lateral tunnel and the extracardiac conduit Fontan, with the extracardiac Fontan being potentially les...
Source: Current Treatment Options in Cardiovascular Medicine - October 14, 2020 Category: Cardiology Source Type: research

Update on Bicuspid Aortic Valve Syndrome: Patient Selection and Therapies in 2020
This article highlights our current understanding of bicuspid aortic valve (BAV) syndrome and how genetics, pathology, imaging features, and clinical symptoms direct the clinical management, surveillance, and intervention of those with BAV.Recent findingsWhile randomized data and guidelines are lacking, transcatheter therapies are routinely used for BAV stenosis in medical centers throughout the world. Guidelines suggest that younger patients age less than 50  years undergo surgical aortic valve replacement (AVR) with a mechanical valve and the elderly>  70 years of age receive a bioprosthetic valve. Fo...
Source: Current Treatment Options in Cardiovascular Medicine - October 12, 2020 Category: Cardiology Source Type: research

Imaging and Management of Coronary Artery Anomalies
AbstractPurpose of reviewTo highlight imaging features of coronary artery anomalies, especially those that may require surgical intervention, and review various management options.Recent findingsThe clinical presentation of coronary artery anomalies ranges from clinically silent lesions to those leading to sudden cardiac death. With the evolution and increasing use of advanced imaging techniques such as computed tomography, more cases are being identified on scans either done specifically for this purpose or discovered incidentally. Management decisions can be complex and often require a multidisciplinary approach.SummaryI...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research

Current Treatment Options of Fontan Arrhythmias: Management
AbstractPurpose of the reviewArrhythmias are a common complication of patients with single ventricle anatomy who undergo the Fontan operation. This review will address current management strategies for acute and chronic arrhythmias.Recent findingsAlterations to surgical techniques, newer antiarrhythmic medications, and improvements in catheter ablation procedures have improved the management of patients with arrhythmias following Fontan palliation.SummaryArrhythmias predict poor prognosis for Fontan patients. Early and aggressive management of arrhythmias improve patient outcomes. For bradyarrhythmias, management strategie...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research

Cardiac Contractility Modulation in Heart Failure: Mechanisms and Clinical Evidence
AbstractPurpose of reviewDevice-based therapy utilizing cardiac contractility modulation (CCM ™) was approved by the FDA in March 2019 for patients with moderately to severely symptomatic heart failure with reduced ejection fraction between 25 and 45% on optimal guideline-directed medical therapy in normal sinus rhythm and not a candidate for cardiac resynchronization therapy. This review explores the mechanism of action behind CCM, the most recent clinical trials, and the expansion of therapy to additional patient populations.Recent findingsThe most recent trial on CCM explored a two-lead system, which was as equall...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research

Atrial Fibrillation in Rheumatic Heart Disease
AbstractPurpose of reviewAtrial fibrillation is the commonest sustained arrhythmia in rheumatic heart disease and is associated with significant morbidity and mortality. In this review, we discuss its epidemiology, natural course and management with special emphasis on recent developments in understanding and treatment of atrial fibrillation in rheumatic heart disease.Recent findingsUse of direct oral anticoagulants appears promising, especially in developing countries where regular coagulation monitoring is a challenge. Also, restoration and maintenance of sinus rhythm in rheumatic atrial fibrillation appear feasible and ...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research