Refocusing on the Primary Prevention of Heart Failure
AbstractPurpose of reviewThe burden of heart failure (HF) is a significant national and global public health problem, with prevalence rates on the rise. Given the significant morbidity, mortality, and healthcare costs attributable to HF, it is of utmost importance to utilize preventive strategies to prevent the development of HF. Therefore, we sought to address how a multi-modal risk assessment approach can be used to stratify patients for HF risk and guide implementation of therapeutic strategies to prevent HF.Recent findingsNew externally validated, multivariate prediction models for incident HF can be applied in the gen...
Source: Current Treatment Options in Cardiovascular Medicine - May 29, 2020 Category: Cardiology Source Type: research

Atrial Fibrillation Management in Heart Failure: Interrupting the Vicious Cycle
AbstractPurpose of reviewIn this review article, we aim to describe the pathophysiology of concomitant atrial fibrillation and both left and right heart failure, as well as pronounce the prognosis of having these two conditions simultaneously. This review also summarizes the current management of atrial fibrillation including stroke and thromboembolism prevention in the presence of systolic and diastolic heart failure.Recent findingsWhile rhythm control strategy is not superior to rate control strategy in atrial fibrillation patients without heart failure, catheter ablation for atrial fibrillation has shown to improve outc...
Source: Current Treatment Options in Cardiovascular Medicine - May 26, 2020 Category: Cardiology Source Type: research

State-of-the-art Review: Interventional Onco-Cardiology
AbstractPurpose of reviewTo discuss invasive cardiovascular procedures as they relate to onco-cardiology, as well as recent additions to anti-cancer therapies and their subsequent effect on cardiovascular toxicity.Recent findingsThe development of immune checkpoint inhibitors and chimeric antigen receptor T cell therapy has been linked to cardiotoxicity and represents an emerging area of concern. Recent advances in transcatheter valve replacement have shown benefits compared with surgical management regardless of malignancy type, stage, or treatment.SummaryWith the increasing use of immunotherapy and increasing recognition...
Source: Current Treatment Options in Cardiovascular Medicine - March 21, 2020 Category: Cardiology Source Type: research

Improving Outcomes With IVUS Guidance During Percutaneous Coronary Interventions
AbstractPurpose of reviewThis review highlights the evidence surrounding the adjunctive diagnostic and therapeutic benefits of intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI).Recent findingsMeta-analyses of randomized trials demonstrate that IVUS has a major impact on PCI-related outcomes with drug-eluting stents by reducing cardiovascular mortality and repeat revascularization. Its application in calcific coronary artery disease has helped identify the benefits and safety of coronary atherectomy, along with playing an important role for primarily guiding PCI while significantly reducing con...
Source: Current Treatment Options in Cardiovascular Medicine - March 16, 2020 Category: Cardiology Source Type: research

Prevention and Management of Radial Access Complications
AbstractPurpose of reviewCoronary angiography and percutaneous coronary interventions via the radial approach are increasing in utilization due to evidence supporting improved outcomes with lower risk of complications, shorter time to ambulation, and improved patient comfort compared with the femoral approach. Radial artery access comes with a unique set of risks and complications compared with the femoral approach. This review discusses the most common of radial access –specific complications and provides guidance regarding prevention and management of these complications.Recent findingsAs radial artery access becom...
Source: Current Treatment Options in Cardiovascular Medicine - March 3, 2020 Category: Cardiology Source Type: research

Clinical Inference From Cardiovascular Imaging: Paradigm Shift Towards Machine-Based Intelligent Platform
AbstractPurpose of reviewDiagnostic imaging plays an indispensable role in the modern management of cardiovascular diseases. Despite significant advances in imaging modalities, the workflow in clinical imaging requires a great deal of human input. With increasing demands in patient care, current workflows in cardiovascular imaging face a number of challenges which include insufficient number of specialists, time constraints, learning curves, and inter-observer variability.Recent findingsAutomated techniques using revolutionary approaches with machine learning can fundamentally alter our interpretation process and produce s...
Source: Current Treatment Options in Cardiovascular Medicine - February 20, 2020 Category: Cardiology Source Type: research

Balloon Pulmonary Angioplasty as a Treatment in Chronic Thromboembolic Pulmonary Hypertension: Past, Present, and Future
AbstractPurpose of reviewChronic thromboembolic pulmonary hypertension (CTEPH) is a major cause of precapillary pulmonary hypertension leading to right heart failure and death if left untreated. In addition to pulmonary endarterectomy, which is considered the standard of care, and specific drug therapy that is not however expected to offer relief from the mechanical component of the disease, the therapeutic options for CTEPH have expanded with the development of balloon pulmonary angioplasty (BPA). The purpose of this review is a better understanding and evaluation of BPA as a treatment option in CTEPH patients.Recent find...
Source: Current Treatment Options in Cardiovascular Medicine - February 13, 2020 Category: Cardiology Source Type: research

Percutaneous Coronary Intervention for Coronary Bifurcation Lesions: Latest Evidence
AbstractPurpose of reviewThis paper provides a synopsis of the best evidence to guide bifurcation percutaneous coronary intervention (PCI), with a focus on recent studies. This is with the aim of guiding the interventional cardiologist in choosing the best, evidence-based technique, to treat commonly encountered coronary bifurcations.Recent findingsCurrent evidence supports the use of provisional stenting for most anatomically suitable bifurcation lesions. Newer techniques for side branch protection in provisional stenting have been developed. When a two-stent strategy is required, use of a double-kissing crush technique i...
Source: Current Treatment Options in Cardiovascular Medicine - February 8, 2020 Category: Cardiology Source Type: research

Cardiac Imaging in the Athlete: Shrinking the “Gray Zone”
AbstractPurpose of the reviewThis review will explore frequently encountered diagnostic challenges and summarize the role cardiac imaging plays in defining the boundaries of what constitutes the athlete ’s heart syndrome versus pathology.Recent findingsInvestigations have predominantly focused on differentiating the athlete ’s heart from potentially lethal pathological conditions that may produce a similar cardiac morphology. Guidelines have identified criteria for identifying definitive pathology, but difficulty arises when individuals fall in the gray zone of expected athletic remodeling and pathology. Transt...
Source: Current Treatment Options in Cardiovascular Medicine - February 3, 2020 Category: Cardiology Source Type: research

Mechanical Circulatory Support in Patients with Cardiogenic Shock
AbstractPurpose of reviewTo provide a contemporary concise overview of the currently available mechanical circulatory support (MCS) devices and the emerging concepts in the management of cardiogenic shock (CS).Recent findingsNew classification of CS has emerged and is hoped to allow a unified approach to research and clinical management of CS. A number of MCS devices have also become available for clinical use in the last 2 decades. Those devices have different hemodynamic targets, provide various levels of support, and are associated with specific requirements and potential complications. Data on the utility of MCS in CS ...
Source: Current Treatment Options in Cardiovascular Medicine - January 30, 2020 Category: Cardiology Source Type: research

Creating a Multidisciplinary Pregnancy Heart Team
AbstractPurpose of reviewCardiovascular disease (CVD) is the leading cause of maternal death and cases of cardiovascular death are often associated with failure to provide timely risk-appropriate care. This review outlines considerations for creation of a team focused on the care of women with CVD during pregnancy and beyond.Recent findingsImproved outcomes for women with complex medical or obstetric conditions managed by a multidisciplinary care team inspired national guidelines advising the creation of a Pregnancy Heart Team for women with CVD in pregnancy. The recommendations from the European Society of Cardiology prov...
Source: Current Treatment Options in Cardiovascular Medicine - January 27, 2020 Category: Cardiology Source Type: research

Physiological Assessment of Coronary Lesions in 2020
AbstractPurpose of reviewPhysiological assessment of coronary artery disease (CAD) is an essential component of the interventional cardiology toolbox. However, despite long-term data demonstrating improved outcomes, physiology-guided percutaneous coronary intervention (PCI) remains underutilized in current practice. This review outlines the indications and technical aspects involved in evaluating coronary stenosis physiology, focusing on the latest developments in the field.Recent findingsBeyond fractional flow reserve (FFR), non-hyperemic pressure ratios (NHPR) that assess coronary physiology at rest without hyperemia now...
Source: Current Treatment Options in Cardiovascular Medicine - January 15, 2020 Category: Cardiology Source Type: research

Distal Radial and Ulnar Arteries: the Alternative Forearm Access
AbstractPurpose of reviewRadial artery access for catheter-based procedures has demonstrated improved margins of safety and patient comfort without a loss of efficacy compared with femoral access. Unfortunately, radial access is not always available, so a review of the alternatives such as the ulnar artery and distal radial artery has been completed to understand alternative access sites that may preserve the benefits of distal forearm access without losing the efficacy of traditional transradial access.Recent findingsSeveral different trials have demonstrated the utility of ulnar access as a possible workhorse access poin...
Source: Current Treatment Options in Cardiovascular Medicine - January 15, 2020 Category: Cardiology Source Type: research

Abnormal ECG Findings in Athletes: Clinical Evaluation and Considerations
AbstractPurpose of reviewPre-participation cardiovascular evaluation with electrocardiography is normal practice for most sporting bodies. Awareness about sudden cardiac death in athletes and recognizing how screening can help identify vulnerable athletes have empowered different sporting disciplines to invest in the wellbeing of their athletes.Recent findingsDiscerning physiological electrical alterations due to athletic training from those representing cardiac pathology may be challenging. The mode of investigation of affected athletes is dependent on the electrical anomaly and the disease(s) in question.SummaryThis revi...
Source: Current Treatment Options in Cardiovascular Medicine - December 21, 2019 Category: Cardiology Source Type: research

Primary and Novel Lipid-Lowering Therapies to Reduce Risk in Patients With Peripheral Arterial Disease
AbstractPurpose of reviewThe diagnosis of peripheral arterial disease (PAD) is a high-risk marker for accelerated atherosclerotic cardiovascular disease (ASCVD) and is associated with substantial morbidity and mortality. In addition to common, modifiable cardiovascular disease risk factors that contribute to PAD, which include hypertension, diabetes mellitus, and smoking, an elevation in concentrations of serum atherogenic lipoproteins (lipids) is an increasingly recognized contributor to premature atherosclerosis.Recent findingsThe recognition and inclusion of PAD as a marker of higher-cardiovascular risk demonstrates the...
Source: Current Treatment Options in Cardiovascular Medicine - December 17, 2019 Category: Cardiology Source Type: research

Management of Hyperlipidemia After Stroke
AbstractPurpose of reviewHyperlipidemia is a key therapeutic target for stroke risk modification. The goal of this review is to highlight available treatment options and review their efficacy in the setting of general cardiovascular disease and after most subtypes of ischemic stroke and hemorrhagic stroke.Recent findingsStatins remain first-line in the management of hyperlipidemia to prevent stroke. In recent trials of patients with pre-existing atherosclerotic vascular disease, new agents, most notably PCSK9 inhibitors and ezetimibe, added additional stroke risk reduction when combined with statins.SummaryRisk of stroke c...
Source: Current Treatment Options in Cardiovascular Medicine - December 16, 2019 Category: Cardiology Source Type: research

Digital Medicine and Evolution of Remote Patient Monitoring in Cardiac Electrophysiology: A State-of-the-Art Perspective
AbstractPurpose of reviewWith the evolution in digital medicine to identify and monitor cardiac electrophysiological (EP) conditions, increased access to cardiac implantable electronic devices (CIEDs), and reimbursements for non-face-to-face care, remote patient monitoring (RPM) is becoming a key part of the EP service line. RPM of cardiac electrophysiological conditions including the use of CIEDs has improved the quality of care and high patient satisfaction and proved to be cost-effective. The focus of this review is literature on RPM in EP, evidence from randomized trials, and observational studies including those of Ap...
Source: Current Treatment Options in Cardiovascular Medicine - December 13, 2019 Category: Cardiology Source Type: research

The Evolving Role of Electrocardiography in Cardiac Resynchronization Therapy
This study aims to summarize the literature on the role of electrocardiography (ECG) in (i) patient selection for cardiac resynchronization therapy (CRT), (ii) predicting clinical response after CRT system is implanted, and (iii) optimizing CRT programming.Recent findingsProgress has been made in interpreting ECG beyond QRS duration and left bundle branch (LBBB) morphology to select patients for CRT. We now understand a higher chance of response to CRT in patients with atypical right bundle branch block and lower response rates in subgroups with atypical LBBB. QRS area has emerged as a novel marker to quantify baseline ele...
Source: Current Treatment Options in Cardiovascular Medicine - December 12, 2019 Category: Cardiology Source Type: research

Endovascular Treatment of Acute Ischemic Stroke
AbstractPurpose of reviewEndovascular thrombectomy (ET), the standard of treatment for emergent large vessel occlusion (ELVO) strokes, has been subject to rigorous efforts to further improve its usage and delivery for optimised patient outcomes. This review aims to provide an outline and discussion about the recently established and emerging recommendations regarding endovascular treatment of stroke.Recent findingsThe indications for ET have expanded continually, with perfusion imaging now enabling selection of patients presenting 6 –24 h after last-known-well, and improved device and operator proficiency allowi...
Source: Current Treatment Options in Cardiovascular Medicine - December 11, 2019 Category: Cardiology Source Type: research

The Demystification of Secondary Hypertension: Diagnostic Strategies and Treatment Algorithms
AbstractPurpose of reviewHypertension is one of the most common conditions encountered in the primary care setting, affecting 32 –46% of people. While essential or primary hypertension is the most common form of the disease, secondary hypertension is quite prevalent, occurring in 10–20% of patients with hypertension. Accurately diagnosing secondary hypertension is a challenging and often time-consuming process that requir es considerable expertise and effort. However, once the secondary etiology is identified, the patient benefits profoundly from a potentially curative treatment that may lead to significant imp...
Source: Current Treatment Options in Cardiovascular Medicine - December 11, 2019 Category: Cardiology Source Type: research

Antithrombotic Management After Intracranial Hemorrhage
We present a thorough review of the current data available regarding management of antithrombotics after intracranial hemorrhage.Recent findingsThe most robust evidence comes from the investigators of the RESTART trial which reassured the safety of resuming antiplatelet therapy after ICH, namely in patients with prior indication and treatment with antithrombotics.SummaryWe conclude that based on available data, the risk of recurrent ICH is probably too small to exceed the found benefits of antiplatelet therapy in the secondary prevention of ischemic vascular disease. (Source: Current Treatment Options in Cardiovascular Medicine)
Source: Current Treatment Options in Cardiovascular Medicine - December 10, 2019 Category: Cardiology Source Type: research

Racial Differences in Atrial Fibrillation Epidemiology, Management, and Outcomes
AbstractPurpose of the reviewAtrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice and is associated with significant morbidity and healthcare cost. Most of the AF studies have predominantly included white population, with under-representation of minority population. In this review, we analyze the racial differences in epidemiology, disease awareness, risk factors, genetics, treatments, and outcomes of AF.Recent findingsAfrican Americans have a higher prevalence of established AF risk factors but lower incidence and prevalence of AF than non-Hispanic whites. There is also a signi...
Source: Current Treatment Options in Cardiovascular Medicine - December 10, 2019 Category: Cardiology Source Type: research

Coronary Atherosclerosis in Masters Athletes: Mechanisms and Implications for Cardiovascular Disease Risk
AbstractPurpose of reviewThis manuscript reviews the data on the mechanisms and significance of atherosclerotic cardiovascular disease (ASCVD) in masters athletes. It describes recent advances in understanding the biological pathway for the development and progression of ASCVD in athletes. It also reviews salient clinical trials, guidelines on managing ASCVD in masters athletes, and future research directions.Recent findingsRecent data have produced controversy as to whether high levels of physical activity and endurance training can promote ASCVD. Longstanding, vigorous endurance exercise may increase the development of c...
Source: Current Treatment Options in Cardiovascular Medicine - December 10, 2019 Category: Cardiology Source Type: research

Importance of the Cardio-Obstetrics Team
ConclusionsWe have solid evidence supporting a multidisciplinary approach to the care of patients with cardiac conditions in pregnancy. This approach is optimal because it facilitates a consistent and clear message to the patient (and those caring for each patient) regarding management and risks associated with pregnancy, as well as subsequent risk and postpartum follow-up. We support the extension of clinical collaboration between obstetricians and cardiologists to the research realm and know that working together to investigate the outcomes of moms with heart conditions and their babies will provide clinically meaningful...
Source: Current Treatment Options in Cardiovascular Medicine - December 10, 2019 Category: Cardiology Source Type: research

Managing Mitral Regurgitation in Heart Failure —Perspectives After COAPT
AbstractPurpose of reviewFunctional mitral regurgitation (MR) in setting of cardiomyopathy causes significant morbidity and worsened survival. Surgical therapies have failed to demonstrate significant overall benefit for functional MR. More recently, major trials utilizing transcatheter therapies for functional MR have been completed and offer new avenues for intervention. This review evaluates and compares 2 major recent trials designed to test the benefit of edge-to-edge repair using the MitraClip system for severe functional MR.Recent findingsThe Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy f...
Source: Current Treatment Options in Cardiovascular Medicine - December 10, 2019 Category: Cardiology Source Type: research

Management of Asymptomatic Carotid Artery Stenosis
AbstractPurpose of reviewThe goal of this paper is to provide the reader with a review of the evidence supporting the surgical and medical management of patients with asymptomatic internal carotid artery (ICA) stenosis.Recent findingsBased on the results of earlier clinical trials, surgical intervention with carotid endarterectomy (CEA) has long been the preferred method of management for patients with asymptomatic severe carotid stenosis. Carotid artery stenting (CAS) is another less invasive surgical option that has similar outcomes over the long-term. However, more recent improvements in medical management have reduced ...
Source: Current Treatment Options in Cardiovascular Medicine - December 9, 2019 Category: Cardiology Source Type: research

Cardiovascular Disease Risk in Survivors of Breast Cancer
AbstractPurpose of reviewEarly detection and improved treatment in breast cancer have resulted in an increased number of survivors. Cardiovascular disease now remains an important cause for morbidity and mortality in this population. There is a growing gap in the knowledge about the optimal long-term cardiovascular management of this population.FindingsBreast cancer and cardiovascular disease share a number of common risk factors. Different breast cancer treatment modalities, including anthracyclines, radiation, and hormonal therapy, can act in synergy with preexisting and/or new cardiovascular risk factors to result in si...
Source: Current Treatment Options in Cardiovascular Medicine - December 9, 2019 Category: Cardiology Source Type: research

Exercise Recommendations for the Athlete With Coronary Artery Disease
AbstractPurpose of the reviewWe provide a framework for formulating exercise prescriptions for those with CAD in order to achieve the “optimal” dose of exercise for each individual.Recent findingsMultiple epidemiological studies demonstrate that exercise is inversely associated with atherosclerotic coronary artery disease (CAD), yet the risk of an acute coronary event is transiently elevated during vigorous exercise. In turn, CAD is the most common cause of exercise-related sudden cardiac death (SCD) in older athletes. When prescribing exercise recommendations for athletes with CAD, we should maintain equipoise...
Source: Current Treatment Options in Cardiovascular Medicine - December 9, 2019 Category: Cardiology Source Type: research

Role of Imaging for Suspected Cardiac Thrombus
AbstractPurpose of reviewCardiac thrombus formation is a frequent complication of a variety of prevalent diseases. Embolism of cardiac thrombus has the potential to result in significant morbidity and mortality from cerebrovascular and peripheral vascular events.Recent findingsEchocardiography is the most commonly used imaging modality for diagnosing intracardiac thrombus. However, technological advances in computed tomography and magnetic resonance imaging have allowed newer noninvasive modalities to evolve into robust tools for the clinical evaluation of patients suspected of disease.SummaryComplimentary use of these ima...
Source: Current Treatment Options in Cardiovascular Medicine - December 9, 2019 Category: Cardiology Source Type: research

Management of Heart Failure and Cardiogenic Shock in Pregnancy
AbstractPurpose of reviewWhile the prognosis of peripartum cardiomyopathy (PPCM) is generally more favorable than other cardiomyopathies, PPCM can be associated with cardiogenic shock and significant maternal morbidity in young women. The management of a pregnant woman in cardiogenic shock necessitates consideration of harm to the fetus. This review focuses on the management of these women.Recent findingsA number of advances have increased the repertoire of therapies available to manage PPCM. Increased understanding of PPCM pathophysiology has led to a number of new and experimental medications. In the current era, mechani...
Source: Current Treatment Options in Cardiovascular Medicine - December 9, 2019 Category: Cardiology Source Type: research

Cryptogenic Stroke: Diagnostic Workup and Management
AbstractPurpose of reviewCryptogenic stroke describes a subset of ischemic stroke for which no cause can be found despite a structured investigation. There are a number of putative mechanisms of cryptogenic ischemic stroke including a covert structural cardiac lesion, paroxysmal atrial fibrillation, hypercoagulable state or undiagnosed malignancy. Because many of these proposed mechanisms are embolic – and based on studies of thrombus history showing commonalities between thrombus composition between cardioembolic and cryptogenic strokes – the concept of embolic stroke of undetermined source (ESUS) (Hart et al....
Source: Current Treatment Options in Cardiovascular Medicine - December 3, 2019 Category: Cardiology Source Type: research

Antithrombotic Management of Ischemic Stroke
AbstractPurpose of reviewIschemic stroke describes a condition in which inadequate blood flow leads to lack of oxygenation to the brain tissue and ensuing neuronal death. There are multiple causes of ischemic stroke, each of which may indicate different antithrombotic management strategies. The goal of this review is to provide information about antithrombotic therapies for secondary stroke prevention based on etiology of stroke.Recent findingsNew studies of existing antiplatelet and antithrombotic therapies have demonstrated varied efficacies of treatments based on the underlying risk factor of ischemic stroke.SummaryUnde...
Source: Current Treatment Options in Cardiovascular Medicine - December 3, 2019 Category: Cardiology Source Type: research

Update in the Evaluation and Management of Perioperative Stroke
AbstractPurpose of reviewThis review will review the current knowledge and gaps in the literature on the relationship between surgery and ischemic stroke.FindingsSurgery and ischemic stroke are interrelated phenomena as surgery is an independent risk factor for stroke and perioperative stroke increases morbidity and mortality leading to poor outcomes after surgery. This relationship and the risk of adverse outcome apply not only the clinically apparent stroke in the perioperative period but also clinically silent brain infarction detected only on radiological studies. The risk of perioperative stroke depends on several fac...
Source: Current Treatment Options in Cardiovascular Medicine - November 27, 2019 Category: Cardiology Source Type: research

Advances in MRI Applications to Diagnose and Manage Cardiomyopathies
AbstractPurpose of reviewThe prevalence of heart failure continues to rise, and imaging characterization of the cardiomyopathic process is important for identifying myocardial disease, initiating appropriate treatment, and improving outcomes. We aimed to summarize recent advances in cardiac magnetic resonance imaging (CMR) applications for the diagnosis, characterization, and implications on management of various cardiomyopathies.Recent findingsParametric mapping by CMR has emerged as an important advancement in quantification of myocardial fibrosis, increased extracellular space, and myocardial edema. In addition, improve...
Source: Current Treatment Options in Cardiovascular Medicine - November 27, 2019 Category: Cardiology Source Type: research

Ventricular Arrhythmias in Patients With Left Ventricular Assist Device (LVAD)
AbstractPurpose of reviewLeft ventricular assist device (LVAD) implantation is a well-known treatment option for patients with advanced heart failure refractory to medical therapy and is recognized both as bridge to transplant and a destination therapy. The risk of ventricular arrhythmias (VAs) is common after LVAD implantation. We review the pathophysiology and recent advances in the management of VA in LVAD patients.Recent findingsVAs are most likely to occur in the early post-operative periods after LVAD implantation and a prior history of VA is the most important risk factor. Post-LVAD VAs are usually well tolerated wi...
Source: Current Treatment Options in Cardiovascular Medicine - November 27, 2019 Category: Cardiology Source Type: research

Management of the Cardiovascular Complications of Substance Use Disorders During Pregnancy
AbstractPurpose of reviewSubstance use disorder in pregnancy and subsequent cardiovascular complications are on the rise in the USA. The care of pregnant women with substance use disorder is complex, and requires a thorough understanding of mechanisms of action, pathophysiology, and cardiovascular response during pregnancy. The goal of this review is to provide information about the most common drugs of abuse in pregnancy and to recommend management guidelines.Recent findingsPregnant women with substance use disorder are at increased risk of significant cardiovascular complications, both as a direct effect of acute intoxic...
Source: Current Treatment Options in Cardiovascular Medicine - November 22, 2019 Category: Cardiology Source Type: research

Management of Maternal Stroke and Mitigating Risk
AbstractPurpose of reviewPregnancy places women at a higher risk for hemorrhagic and ischemic strokes. This review discusses the pathophysiological mechanisms underlying this increased risk, management considerations for pregnant patients, and ways to decrease the risk of stroke in this patient population.Recent findingsRates of ischemic and hemorrhagic pregnancy-associated stroke have increased over the past 20  years, particularly events associated with hypertensive disorders of pregnancy. There is a growing body of evidence supporting the use of acute reperfusion therapies in ischemic pregnancy-associated stroke in...
Source: Current Treatment Options in Cardiovascular Medicine - November 21, 2019 Category: Cardiology Source Type: research

The Use of Echocardiography and Advanced Cardiac Ultrasonography During Pregnancy
AbstractPurpose of reviewPregnancy is a time of significant cardiovascular change. Echocardiography is the primary imaging modality used to assess cardiovascular anatomy and physiology during pregnancy. Both two-dimensional (2D) echocardiography and advanced cardiac ultrasound modalities play pivotal roles in identifying and monitoring these changes, especially in women with preexisting or new cardiac disease. This paper reviews the role of echocardiography and advanced cardiac ultrasound during normal pregnancy and pregnancy complicated by hypertensive disorders, valvular disorders, and cardiomyopathy. It also examines th...
Source: Current Treatment Options in Cardiovascular Medicine - November 21, 2019 Category: Cardiology Source Type: research

Prevention and Treatment of Cancer-Associated Venous Thromboembolism: a Review
AbstractPurpose of reviewPatients with cancer have an increased risk of venous thromboembolism (VTE). Cancer-associated VTE is associated with an increased risk of morbidity and mortality. Treatment of VTE in cancer is associated with higher rates of recurrent thrombosis as well as major bleeding compared with the general population. The goal of this review is to provide a summary of current evidence for the prevention and treatment of cancer-associated VTE.Recent findingsValidated risk prediction models are available to aide clinicians in identifying patients with cancer with the highest risk of VTE. Those patients with i...
Source: Current Treatment Options in Cardiovascular Medicine - November 20, 2019 Category: Cardiology Source Type: research

Cardiac MRI Evaluation of Myocarditis
AbstractPurpose of reviewCardiac MRI (CMR) is the non-invasive test of choice for the assessment of myocarditis. In 2009, the Lake Louise Criteria for the diagnosis of myocarditis using CMR were first released. The decade since that time has vastly improved our understanding of CMR ’s strengths and limitations. Traditional CMR methods including T2-weighted imaging and late gadolinium enhancement have proven their diagnostic value, but diagnostic performance is dependent on patient presentation.Recent findingsNewer parametric mapping techniques have begun to be more comprehensively studied and may improve diagnostic a...
Source: Current Treatment Options in Cardiovascular Medicine - November 16, 2019 Category: Cardiology Source Type: research

Role of PFO Closure in Ischemic Stroke Prevention
AbstractPurpose of reviewTo highlight recent advancements in the management of acute ischemic stroke patients with patent foramen ovale (PFO).Recent findingsOne significant recent development was publication of long-term follow-up data from the RESPECT trial demonstrating evidence in favor of PFO closure over medical management. This data subsequently led to FDA approval for AMPLATZER ™ septal occluder in the treatment of patients aged 18 to 60 years with both PFO and no other determined etiology for ischemic stroke, otherwise referred to as embolic stroke of undetermined source. Several subsequent closure trial...
Source: Current Treatment Options in Cardiovascular Medicine - November 14, 2019 Category: Cardiology Source Type: research

Paravalvular Leaks —From Diagnosis to Management
AbstractPurpose of reviewAs the number of surgical and transcatheter valve replacements continue to increase in the aging population, so does the incidence of paravalvular leak (PVL). Given its impact on morbidity and mortality, this article will focus on the epidemiology, clinical presentation, diagnostic assessment, and available treatments for PVL.Recent findingsDespite being performed on inoperable and typically higher risk patients, short-term complication rates of transcatheter PVL closure appear relatively low (
Source: Current Treatment Options in Cardiovascular Medicine - November 14, 2019 Category: Cardiology Source Type: research

Peripheral Vascular Disease in Women: Therapeutic Options in 2019
This article reviews the different management strategies ranging from pharmacotherapy, revascularization, and rehabilitation with an emphasis on the response of women to these therapies.Recent findingsOverall, the representation of women in the majority of the published data in this arena remains poor. Studies examining medical therapy and endovascular and surgical revascularization were not designed to address sex disparities. Nevertheless, we dissect these therapies and their relevant randomized trials.SummaryThe paucity of data investigating the response of women to the different management options makes it difficult to...
Source: Current Treatment Options in Cardiovascular Medicine - November 14, 2019 Category: Cardiology Source Type: research

Vessel Wall Imaging of Cerebrovascular Disorders
AbstractPurpose of reviewHigh-resolution magnetic resonance vessel wall imaging (VWI) permits direct visualization of intracranial arterial wall pathology, providing diagnostic and prognostic information that is complementary to conventional imaging techniques. We highlight the most recent studies that have advanced the clinical application of VWI.Recent findingsVWI aids in distinguishing and diagnosing intracranial atherosclerotic disease (ICAD), intracranial dissections, central nervous system vasculitis, reversible cerebral vasoconstriction syndrome, and moyamoya disease. VWI may help predict recurrent stroke in ICAD, t...
Source: Current Treatment Options in Cardiovascular Medicine - November 14, 2019 Category: Cardiology Source Type: research

Idiopathic Non-atherosclerotic Carotid Artery Disease
AbstractPurpose of reviewThe purpose of this review is to provide an overview of idiopathic non-atherosclerotic causes of carotid artery disease and its manifestations.Recent findingsFour major causes of non-atherosclerotic carotid artery disease including dissection, fibromuscular dysplasia, moyamoya disease, and inflammatory large vessel vasculitis are discussed. While there is a dearth of clinical trials involving some of the rarer conditions, recent data from clinical trials supporting antiplatelet over anticoagulation treatment of cervical artery dissection, recent consensus statements on the management of fibromuscul...
Source: Current Treatment Options in Cardiovascular Medicine - November 14, 2019 Category: Cardiology Source Type: research

Sport Participation in Patients with Implantable Cardioverter-Defibrillators
AbstractPurpose of reviewAthletes diagnosed with cardiovascular disease may receive implantable cardioverter defibrillators (ICDs). Until recently, there were no data describing the safety of return to play for athletes receiving an ICD, and consensus recommendations restricted ICD patients to competitive sports no more vigorous than bowling or golf.Recent findingsThe ICD Sports Registry prospectively followed 440 athletes who continued sports participation after receiving an ICD, for up to 4  years. While many received shocks, both appropriate and inappropriate, during competition or practice, as well as during other...
Source: Current Treatment Options in Cardiovascular Medicine - November 14, 2019 Category: Cardiology Source Type: research

Coronary Computed Tomography Angiography: Enhancing Risk Stratification and Diagnosis of Cardiovascular Disease in Women
AbstractPurpose of reviewThere are numerous gender- and sex-based differences that contribute to the increased morbidity and mortality related to atherosclerotic cardiovascular disease (ASCVD) in women. Early detection of risk and targeted management of atherosclerotic disease is fundamental to reduce ASCVD risk and improve outcomes in women. In this review, we examine the utility of cardiac computed tomography (CT) and coronary CT angiography (CTA) in three ASCVD scenarios including coronary artery calcium scoring for risk stratification in asymptomatic women, and coronary CTA for diagnosis and prognosis of stable ischemi...
Source: Current Treatment Options in Cardiovascular Medicine - October 4, 2019 Category: Cardiology Source Type: research

Pre and Post Procedure Imaging of the Watchman ® Device with Cardiac Computed Tomography Angiography
AbstractPurpose of reviewLeft atrial appendage occlusion with the Watchman ® device requires pre and post procedure imaging. Currently, transesophageal echocardiography is the recommended modality, though cardiac computed tomography angiography may be an acceptable alternative.Recent findingsCardiac computed tomography angiography can be used to safely and accurately predict Watchman ® device sizing. It can also be used to detect post procedure complications similar to, or better than, transesophageal echocardiography.SummaryCardiac computed tomography angiography is a viable alternative imaging modality for pre an...
Source: Current Treatment Options in Cardiovascular Medicine - September 14, 2019 Category: Cardiology Source Type: research

The Impact of Pharmacist-Based Services Across the Spectrum of Outpatient Heart Failure Therapy
AbstractPurpose of reviewA multidisciplinary approach is vital to reduce mortality and hospitalizations in patients with heart failure. As members of the multidisciplinary team, pharmacists are uniquely positioned to care for patients across the spectrum of heart failure. This comprehensive review explores the different facets in which pharmacists can be utilized to impact the care for patients with heart failure, including those with cardiac transplant and left ventricular assist devices (LVADs), in the outpatient setting.Recent findingsPharmacists can see heart failure patients in a variety of settings to reduce drug the...
Source: Current Treatment Options in Cardiovascular Medicine - September 10, 2019 Category: Cardiology Source Type: research

Clinical Applications of MRA 4D-Flow
AbstractPurpose of reviewFour-dimensional (4D)-Flow cardiovascular magnetic resonance (CMR) is three-dimensional, time-resolved, three-directional velocity-encoded magnetic resonance that provides flow velocity data within a volumetric region across the cardiac cycle (CC). The goals of this paper are to review the current clinical applications of this technique; provide an overview of the general physics; discuss key points from the expert consensus document; and present recent advances in the field. The advantages and disadvantages of 4D-Flow CMR in comparison with the standard and gold standard methods are summarized.Rec...
Source: Current Treatment Options in Cardiovascular Medicine - September 10, 2019 Category: Cardiology Source Type: research