Anti-arrhythmic Drugs —a Review and Comment on Relevance in the Current Era: Part 1
AbstractPurpose of reviewThere is apprehension and a general lack of familiarity with regard to using the ionic channel specific anti-arrhythmic agents among internists and even general cardiologists.Recent findingsThis may be related to their relative infrequent use, complicated mechanisms of actions, and real or perceived risks involved with their use. For example, the fact that coronary artery disease is listed as contraindication to the prescription of class IC agents, when so many patients are noted to have presence of non-obstructive disease on increasingly done CT scans, causes confusion and uncertainty about their ...
Source: Current Treatment Options in Cardiovascular Medicine - July 21, 2021 Category: Cardiology Source Type: research

Tricuspid Regurgitation: When and How to Treat
AbstractPurpose of reviewClinically significant tricuspid regurgitation (TR) is increasingly prevalent in the aging population. TR is a progressive disease associated with worse outcomes, and therefore should be treated appropriately and in a timely manner. This review will summarize the indications for treatment of TR, and the invasive modalities currently available or under development for the management of TR.Recent findingsDespite its association with increased morbidity and mortality, surgery for isolated TR is uncommon due to increased operative risk. Various transcatheter tricuspid valve (TV) therapies have been dev...
Source: Current Treatment Options in Cardiovascular Medicine - July 21, 2021 Category: Cardiology Source Type: research

Postpartum Hypertension and the Role of Postpartum Clinics and Digital Health
AbstractPurpose of reviewPostpartum hypertension is common, vastly underrecognized and increases the risk for future cardiovascular events. One of the most common risk factors for the development of postpartum hypertension is preexistent hypertensive disorders of pregnancy (HDP). According to Cirillo and Cohn (2015), HDP complicate 5 –10% of pregnancies worldwide, and their prevalence is increasing. Unfortunately, many clinicians and patients are not aware of the risks associated with HDP, nor are they aware of the importance of monitoring blood pressure in the postpartum period. Telemedicine and digital health may i...
Source: Current Treatment Options in Cardiovascular Medicine - July 21, 2021 Category: Cardiology Source Type: research

Exercise and Sports Participation in Adolescents and Young Adults With Congenital Heart Disease
AbstractPurpose of reviewChildren and adolescents with congenital heart disease (CHD) have historically been restricted from vigorous exercise or competitive sports. With our growing understanding of the benefits of exercise and sports participation, we aim to review current recommendations for safe sports participation in children and adolescents with congenital heart disease.Recent findingsRecently published studies identify obesity to be highly prevalent in patients with CHD, especially as they age. This is more evident if the patients lead a sedentary lifestyle or are restricted from engaging in exercise. Recently publ...
Source: Current Treatment Options in Cardiovascular Medicine - June 26, 2021 Category: Cardiology Source Type: research

The Evidence of Aspirin Use in Prevention of Adverse Pregnancy Outcomes (APOs): Should It Be Continued Long Term After an APO?
AbstractPurpose of reviewAspirin is one of the only proven therapeutic options for the prevention of preeclampsia, an important adverse pregnancy outcome with detrimental short- and long-term consequences to a woman ’s health. The goal of this review is to provide information about the current recommendations for the use of aspirin to prevent preeclampsia and whether there is evidence for postpartum continuation.Recent findingsPreeclampsia is linked to the development of future cardiovascular disease and adverse outcomes in women including stroke, ischemic heart disease, and heart failure. This is likely due to vascu...
Source: Current Treatment Options in Cardiovascular Medicine - June 11, 2021 Category: Cardiology Source Type: research

Post-transplant Management in Heart Transplant Recipients: New Drugs and Prophylactic Strategies
AbstractPurpose of reviewToday, heart transplant offers a 1-year survival of 91% to select patients with end-stage heart failure. Since the implementation of heart allocation system change in Oct 2018, transplantation needs have to be met in critically ill candidates with high waitlist mortality. This brings forth the contemporary challenges of use of more patients bridged from mechanical circulatory support, use of marginal hearts, older donor age, allosensitization, donation after circulatory death, and hepatitis C-positive donors.Recent findingsAdvances in rejection surveillance and diagnosis, immunosuppression, and pro...
Source: Current Treatment Options in Cardiovascular Medicine - June 3, 2021 Category: Cardiology Source Type: research

Echocardiography for the Pregnant Heart
AbstractPurpose of reviewPregnancy is associated with significant hemodynamic changes, making it a potentially high-risk period for women with underlying cardiovascular disease. Echocardiography remains the preferred modality for diagnosis and monitoring of pregnant women with cardiovascular disease as it is widely available and does not require radiation. This paper reviews the role of echocardiography along the continuum of pregnancy in at-risk patients, with a focus on key cardiac disease states in pregnancy.Recent findingsIn the preconception stage, risk stratification scores such as CARPREG II, ZAHARA and the modified...
Source: Current Treatment Options in Cardiovascular Medicine - May 28, 2021 Category: Cardiology Source Type: research

Assisted Reproductive Technologies and Their Association With Adverse Pregnancy Outcomes and Long-Term Cardiovascular Disease: Implications for Counseling Patients
AbstractPurpose of reviewAssisted reproductive technology (ART) has continued to emerge as a treatment option for infertility, a condition that affects a significant proportion of couples of reproductive age. The goal of this review is to provide information on the link between adverse pregnancy outcomes (APOs) and ART and long-term cardiovascular consequences associated with these therapies.Recent findingsIncreasing use and advancing maternal age have raised concerns regarding the short- and long-term use of such technologies. ART and associated hormonal therapies are known to cause potential vascular effects and have an ...
Source: Current Treatment Options in Cardiovascular Medicine - May 25, 2021 Category: Cardiology Source Type: research

Hypertrophic Cardiomyopathy: Updates Through the Lens of Sports Cardiology
AbstractPurpose of reviewThis review will summarize the distinction between hypertrophic cardiomyopathy (HCM) and exercise-induced cardiac remodeling (EICR), describe treatments of particular relevance to athletes with HCM, and highlight the evolution of recommendations for exercise and competitive sport participation relevant to individuals with HCM.Recent findingsWhereas prior guidelines have excluded individuals with HCM from more than mild-intensity exercise, recent data show that moderate-intensity exercise improves functional capacity and indices of cardiac function and continuation of competitive sports may not be a...
Source: Current Treatment Options in Cardiovascular Medicine - May 25, 2021 Category: Cardiology Source Type: research

Novel Myosin-Based Therapies in Hypertrophic Cardiomyopathy
AbstractPurpose of reviewHypertrophic cardiomyopathy is the most common genetic disease of myocardium and is recognized to have substantial clinical impact including sudden cardiac death, arrhythmias, and heart failure. Historically medical therapies have been used in hypertrophic cardiomyopathy (HCM) with limited prospective randomized data to support their effectiveness. In this review, we discuss a novel class of drug that inhibits myosin (myo-blocker) which was developed to precisely target the mechanism of HCM in detail.Recent findingsWe discuss and contextualize the clinical trial results for mavacamten, positioning ...
Source: Current Treatment Options in Cardiovascular Medicine - May 12, 2021 Category: Cardiology Source Type: research

Management Considerations for Lipid Disorders During Pregnancy
AbstractPurpose of reviewDyslipidemias including familial hypercholesterolemia and elevated lipoprotein (a) are not uncommon in young women who may desire pregnancy. In all women, abnormal lipid metabolism has been linked to adverse outcomes during pregnancy, including hypertensive disease of pregnancy, gestational diabetes mellitus, and preterm birth. Optimal management of dyslipidemias in pregnant women remains undefined, as statins are contraindicated in this group.Recent findingsRecent literature questions this traditional avoidance of statins, however, as well as explores their potential benefit in pre-eclampsia speci...
Source: Current Treatment Options in Cardiovascular Medicine - May 12, 2021 Category: Cardiology Source Type: research

Cardiopulmonary Exercise Testing in Athletes: Expect the Unexpected
AbstractPurpose of reviewCardiopulmonary exercise testing (CPET) is a tool designed to assess the integrated function of the cardiac, pulmonary, vascular, and musculoskeletal systems to produce an exercise effort. CPET may be performed for performance purposes as part of optimizing a training program or for clinical purposes in athletes with established cardiovascular disease or in those with symptoms suggestive of cardiopulmonary pathology. Most normative values used for CPET parameters have been derived in the general population, in whom there will be expected differences in exercise physiology as compared to a trained a...
Source: Current Treatment Options in Cardiovascular Medicine - May 12, 2021 Category: Cardiology Source Type: research

Risk Stratification of Acute Pulmonary Embolism
AbstractPurpose of reviewAcute pulmonary embolism (PE) is a heterogeneous disease process whose presentation varies widely between individuals who are asymptomatic, develop cardiogenic shock, or experience acute PE-related mortality. The purpose of this review is to summarize the available tools used to risk stratify patients presenting with acute PE. We will particularly focus on the demographic, clinical, laboratory, imaging, and multifactor tools used to predict mortality, PE-related morbidity, and bleeding complications.Recent findingsEstablished risk assessment strategies incorporate clinical and demographic informati...
Source: Current Treatment Options in Cardiovascular Medicine - May 12, 2021 Category: Cardiology Source Type: research

Contemporary Catheter-Based Treatment Options for Management of Acute Pulmonary Embolism
AbstractIntroductionAcute pulmonary embolism (PE) remains an important cause of cardiovascular mortality and morbidity in the USA and worldwide. Catheter-based therapies are emerging as a new armamentarium for improving outcomes in these patients.Purpose of reviewThe purpose of this review is to familiarize the clinicians with (1) various types of catheter-based modalities available for patients with acute PE, (2) advantages, disadvantages, and appropriate patient selection for the use of these devices, and (3) evidence base and the relevance of such therapies in the COVID-19 pandemic.Recent findingsThere are four main typ...
Source: Current Treatment Options in Cardiovascular Medicine - May 12, 2021 Category: Cardiology Source Type: research

Contemporary Role of Intravascular Lithotripsy in the Management of Peripheral Artery Disease
AbstractPurpose of reviewCalcified peripheral arterial disease (PAD) poses a significant challenge to endovascular treatment. Traditional balloon angioplasty in these restrictive lesions often leads to suboptimal vessel expansion and thereby increased rates of restenosis and complications. Although several calcium-modifying and debulking technologies have been developed to help optimize management of these complex lesions, they have their own limitations. Recently, intravascular lithotripsy (IVL) has been established as an alternative versatile modality for treating a variety of lesions with minimal adverse events. Herein,...
Source: Current Treatment Options in Cardiovascular Medicine - May 12, 2021 Category: Cardiology Source Type: research

Imaging in CABG Patients
AbstractPurpose of the reviewCoronary artery bypass grafting (CABG) is one of the most common major surgical procedures performed. Atherosclerosis however is a progressive condition; it is probably therefore that patients with CABG will represent with ischemic symptoms. The purpose of this review is to provide familiarity with testing in CABG patients to assist clinicians in their decision-making.Recent findingsCT angiography of coronary arteries and grafts (CCTA) has evolved into an alternative approach to diagnose graft disease or occlusion. As such, CCTA may help risk stratify patients post-CABG. CCTA thus joins the arm...
Source: Current Treatment Options in Cardiovascular Medicine - May 12, 2021 Category: Cardiology Source Type: research

Imaging of Spontaneous Coronary Artery Dissection and Counseling Patients of Reproductive Age
AbstractPurpose of reviewThis review highlights issues relevant to women of reproductive age with a history of spontaneous coronary artery dissection (SCAD).Recent findingsCurrent topics regarding the care of SCAD patients include multimodality imaging, pregnancy, lactation, SCAD recurrence, reproductive counseling, migraines, cardiac rehabilitation, and mental health. While no single disease-causing gene for SCAD has been discovered, recent genome-wide association studies show promise for future understanding of underlying mechanisms and risk for SCAD.SummaryPatients with history of SCAD require dedicated, multidisciplina...
Source: Current Treatment Options in Cardiovascular Medicine - May 12, 2021 Category: Cardiology Source Type: research

A Multidisciplinary Approach to Managing Ischemic Wounds and Current Treatment Options
AbstractPurpose of ReviewWe discuss management of arterial wounds pertaining to clinical evaluation, noninvasive diagnostic testing, and relevant classification systems of arterial wounds. In addition, we review recent literature regarding treatment modalities of arterial wounds.Recent FindingsTreatment of arterial wounds is multifactorial and can include the following: local wound care, hyperbaric oxygen therapy, skin grafting, and biologic and regenerative medicine including gene and cellular therapy. This paper is a discussion of the various treatment options for chronic arterial wounds with a review of recent literatur...
Source: Current Treatment Options in Cardiovascular Medicine - May 12, 2021 Category: Cardiology Source Type: research

Evidence-Based Approach to Out-of-Hospital Cardiac Arrest
AbstractPurpose of reviewOut-of-hospital cardiac arrest (OHCA) is a leading cause of death. Despite improvements in the cardiac disease management, OHCA outcomes remain poor. The purpose of this review is to provide information on the management of OHCA survivors, evidence-based treatments, and current gaps in the knowledge.Recent findingsMost common cause of death from OHCA is neurological injury followed by shock and multiorgan failure. Prognostication tools are available to help with the clinical decision-making. Taking measures to improve EMS response time, encouraging bystander CPR, early defibrillation, and targeted ...
Source: Current Treatment Options in Cardiovascular Medicine - May 10, 2021 Category: Cardiology Source Type: research

Current Perspective on Menopause Hormone Therapy and Cardiovascular Risk
AbstractPurpose of reviewIn past decades, there has a been a paradigm shift concerning menopause, hormone therapy (HT), and cardiovascular disease (CVD). While initial observational studies suggested hormone replacement to provide a cardioprotective benefit for all menopausal women, subsequent large randomized trials have not confirmed these benefits and furthermore brought to light the risks of HT with regard to CVD, venous thrombosis, and stroke. The goal of this review is to summarize current recommendations regarding HT as it pertains to cardiovascular risk.Recent FindingsMenopause HT remains the most effective treatme...
Source: Current Treatment Options in Cardiovascular Medicine - May 5, 2021 Category: Cardiology Source Type: research

Chronic Total Occlusion PCI Techniques in 2020
AbstractPurpose of reviewChronic total occlusions (CTO) represent a frequently encountered subset of coronary lesions, where percutaneous coronary intervention is considered particularly challenging. Recent advances in equipment dedicated for CTO have resulted in improved outcomes and have inspired the discovery of several novel techniques.Recent findingsThe most significant advancement in the field of CTO interventions is the incorporation of the available techniques in integrated algorithms. These algorithms are tailored to lesion characteristics and allow for prompt and seamless transition across the available treatment...
Source: Current Treatment Options in Cardiovascular Medicine - May 5, 2021 Category: Cardiology Source Type: research

Acute Thoracic Complications of Minimally Invasive Cardiac Procedures
AbstractPurpose of reviewComplications of minimally invasive cardiac procedures range from self-limiting to life-threatening. This review article will highlight the incidence, risk factors, and imaging features of acute thoracic complications of three of the most common minimally invasive cardiac procedures encountered in practice: transcatheter aortic valve replacement, cardiac implantable electronic devices, and pulmonary vein isolation.Recent findingsMost minimally invasive cardiac procedures have a relatively low risk profile. Acute thoracic complications are usually detected during the procedure; however, delayed pres...
Source: Current Treatment Options in Cardiovascular Medicine - May 5, 2021 Category: Cardiology Source Type: research

The New Role of Cardiac Imaging Following the ISCHEMIA Trial
AbstractPurpose of reviewThis review is aimed at summarizing the recently published ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) and how its findings may impact cardiac imaging for stable ischemic heart disease (SIHD) moving forward.Recent findingsThe ISCHEMIA trial compared an initial invasive management strategy with goal of complete coronary revascularization versus an initial medical therapy strategy among stable patients with newly diagnosed moderate to severe myocardial ischemia on non-invasive testing. The trial results showed that an early invasive st...
Source: Current Treatment Options in Cardiovascular Medicine - May 5, 2021 Category: Cardiology Source Type: research

Imaging the Coronary Venous System: Current Trends and Risk Stratification
AbstractPurpose of reviewThe coronary venous system has been a rather unique source of investigation over the last 20  years in regard to cardiac imaging, with primary focus/attention on variant anatomy, pre-ablative planning imaging, as well as congenital heart evaluation. Progressive advances in fast imaging using both MDCT and CMR have made the techniques shared below become more widely available. This review h ighlights the advances in coronary venous imaging over the last 10 years with emphasis on the most up to date clinical treatment options given the advancements in the various imaging modalities. These p...
Source: Current Treatment Options in Cardiovascular Medicine - May 5, 2021 Category: Cardiology Source Type: research

The Role of Biomarkers and Imaging to Predict Preeclampsia and Subsequent Cardiovascular Dysfunction
AbstractPurpose of reviewPreeclampsia is a major cause of maternal morbidity and mortality worldwide. Despite decades of research, the ability of clinicians to accurately predict the onset of preeclampsia prior to the manifestation of symptoms has not significantly improved. In this review, we will examine the pathophysiology underlying preeclampsia and discuss the role of potential biomarkers for early prediction and diagnosis. In addition, we will explore imaging modalities in the detection of early myocardial and vascular endothelial dysfunction associated with preeclampsia.Recent findingsCirculating angiogenic and anti...
Source: Current Treatment Options in Cardiovascular Medicine - May 5, 2021 Category: Cardiology Source Type: research

New Advances and Ongoing Challenges in the Use of Biologic Agents in Cardiac Sarcoidosis and Other Inflammatory Cardiomyopathies
AbstractPurpose of reviewInflammatory cardiomyopathies encompass several different conditions revolving around inflammation. Experts, supported primarily by experience, have utilized immunosuppression as a treatment option to halt the inflammation and prevent the common end result of dilated cardiomyopathy. Very limited evidence exists to support a uniformed approach.Recent findingsStandard immunosuppression protocols are typically used to treat inflammatory cardiomyopathies associated with systemic inflammatory diseases. However, specific features such as eosinophilic infiltration or fulminant course merit a more aggressi...
Source: Current Treatment Options in Cardiovascular Medicine - May 5, 2021 Category: Cardiology Source Type: research

Counseling Women With Peripartum Cardiomyopathy About Subsequent Pregnancies
AbstractPurpose of reviewPeripartum cardiomyopathy (PPCM) is a potentially catastrophic form of heart failure caused by left ventricular systolic dysfunction that develops during pregnancy or in the early postpartum period. After the initial diagnosis and treatment, many women desire another pregnancy; however, risks of a subsequent pregnancy need to be considered, as PPCM may lead to significant adverse outcomes for both mother and fetus. The goal of this review is to provide information about risk stratification prior to subsequent pregnancy, strategies to mitigate the risk of subsequent pregnancy, and long-term maternal...
Source: Current Treatment Options in Cardiovascular Medicine - May 5, 2021 Category: Cardiology Source Type: research

Machine Learning Applications in Heart Failure Disease Management: Hype or Hope?
AbstractPurpose of the reviewMachine learning (ML) approaches have emerged as powerful tools in medicine. This review focuses on the use ML to assess risk of events in patients with heart failure (HF). It provides an overview of the ML process, challenges in developing risk scores, and strategies to mitigate problems.Recent findingsRisk scores developed using standard statistical methods have limited accuracy, particularly when they are applied to populations other than the one in which they were developed. Computerized ML algorithms which identify correlations between descriptive variables in complex, non-linear, multi-di...
Source: Current Treatment Options in Cardiovascular Medicine - May 5, 2021 Category: Cardiology Source Type: research

Novel Therapies in Heart Failure with Reduced Ejection Fraction: from Soluble Guanylyl Cyclase Stimulators to Cardiac Myosin Activators
AbstractPurpose of reviewIn this review, our goal was to provide a brief background on the evolution of therapeutic targets for heart failure with reduced ejection fraction (HFrEF), summarize the results of recent clinical trials with diverse pharmacological targets, discuss potential limitations of these findings, and provide future perspectives.Recent findingsDespite advances in pharmacological and device therapy, HFrEF still carries a considerably high morbidity and mortality. For the past four decades, the neurohormonal model has been pivotal in the development of efficacious pharmacotherapies for HFrEF. However, recen...
Source: Current Treatment Options in Cardiovascular Medicine - March 26, 2021 Category: Cardiology Source Type: research

Invasive Hemodynamic and Metabolic Evaluation of HFpEF
AbstractPurpose of reviewHeart failure with preserved ejection fraction (HFpEF) is a complex and heterogeneous condition of multiple causes, characterized by a clinical syndrome resulting from elevated left ventricular filling pressures, with an apparently unimpaired left ventricular systolic function. Although HFpEF has been long recognized as a distinct entity with significant morbidity for patients, its diagnosis remains challenging to this day. In recent years, few diagnostic algorithms have been postulated to aid in the identification of this condition. Invasive hemodynamic and metabolic evaluation is often warranted ...
Source: Current Treatment Options in Cardiovascular Medicine - March 26, 2021 Category: Cardiology Source Type: research

Management of In-laboratory Cardiopulmonary Arrest
AbstractPurpose of reviewThe purpose of this review is to update the reader on the risk factors, causes, and mechanisms for cardiac arrest in the cardiac catheterization laboratory. In addition, the review provides a summary of recently published data specifically pertaining to the management of in-lab cardiac arrest.Recent findingsThe incidence of cardiac arrest in unselected patients undergoing cardiac catheterization is approximately 0.5%. ST elevation myocardial infarction and cardiogenic shock account for the majority of cases. Pulseless electrical activity is the most common initial rhythm. Mechanical chest compressi...
Source: Current Treatment Options in Cardiovascular Medicine - March 23, 2021 Category: Cardiology Source Type: research

New Approaches to Donor Selection and Preparation in Heart Transplantation
AbstractPurpose of reviewWith increasing survival of patients with stage D heart failure, the demand for heart transplantation has increased. The supply of donor hearts remains relatively limited. Strategies have been investigated and new technologies have been developed to expand the current donor pool. These new approaches will be discussed herein.Recent findingsDonor hearts are often considered “marginal” due to risk factors such as older age, size mismatch with the intended recipient, prolonged ischemic time, presence of left ventricular hypertrophy, and hepatitis B/C infection. We reviewed recent data rega...
Source: Current Treatment Options in Cardiovascular Medicine - March 23, 2021 Category: Cardiology Source Type: research

A Critical Review of Hemodynamically Guided Therapy for Cardiogenic Shock: Old Habits Die Hard
AbstractPurpose of reviewHere, we review the importance of using hemodynamic data to guide therapy and risk stratification in cardiogenic shock as well as the various definitions of this syndrome that have been used in prior studies. Furthermore, we provide perspective regarding the controversy surrounding pulmonary artery (PA) catheter use as well as current society guidelines and scientific statements. Lastly, we review the technical aspects for accurate interpretation of data of cardiogenic shock.Recent findingsMore recent studies specifically evaluating cardiogenic shock patients have shown higher mortality when PA cat...
Source: Current Treatment Options in Cardiovascular Medicine - March 23, 2021 Category: Cardiology Source Type: research

Cardiac Testing in Search for Occult Atrial Fibrillation after Ischemic Stroke
AbstractPurpose of reviewDetermining the etiology of ischemic stroke is critical to administering targeted therapy to prevent recurrent stroke and further neurologic deterioration. Ischemic strokes of cardioembolic and cryptogenic etiologies are frequent and are often ultimately attributed to atrial fibrillation (AF). However, the paroxysmal nature of AF presents challenges for accurate and timely detection to prevent a recurrent stroke. The purpose of this review is to evaluate serologic, electrographic, echocardiographic, and radiologic markers of AF after an ischemic stroke.Recent findingsInnovative applications of biot...
Source: Current Treatment Options in Cardiovascular Medicine - March 23, 2021 Category: Cardiology Source Type: research

Case Selection During the COVID-19 Pandemic: Who Should Go to the Cardiac Catheterization Laboratory?
AbstractPurpose of reviewTo summarize the best available evidence and recommendations regarding case selection for cardiac catheterization laboratory (CCL) during the coronavirus disease 2019 (COVID-19) pandemic with emphasis on ST segment elevation myocardial infarction (STEMI) management.Recent findingsThe restructuring of cardiovascular services to preserve hospital beds and personal protective equipment during the COVID-19 pandemic had a profound effect on healthcare delivery around the world with unintended consequences. In the United States, a significant 38% reduction in CCL activations for STEMI was noted in the ea...
Source: Current Treatment Options in Cardiovascular Medicine - March 18, 2021 Category: Cardiology Source Type: research

Contemporary Cardiovascular Imaging Advancements and Social Media
AbstractPurpose of reviewSocial media (SoMe) as a means of knowledge dissemination has grown significantly in cardiovascular imaging in recent years. This media platform allows for a free exchange of ideas, the development of new communities, and the ability to disseminate advancements rapidly. While the social media platforms offer limitless potential, their public domain necessitates several important suggestions around best practices.Recent findingsIn cardiovascular imaging, specific hashtags have emerged to encompass the major modalities to include #EchoFirst, #YesCCT, #WhyCMR, and #CVNuc. Cardiovascular imaging journa...
Source: Current Treatment Options in Cardiovascular Medicine - March 15, 2021 Category: Cardiology Source Type: research

Multimodality Imaging of Cardiac Trauma
AbstractPurpose of reviewThe purpose of this article is to review the imaging findings of blunt and penetrating traumatic cardiac injury.Recent findingsDue to its speed of acquisition and ready availability, multidetector CT has become the gold standard for imaging of both blunt and penetrating cardiac trauma. Echocardiography is the first-line modality for evaluation of the valves. While magnetic resonance imaging provides the most comprehensive examination, it should only be utilized for problem solving or follow-up.SummaryCardiac traumatic injury is a rare entity that may result in significant adverse clinical outcomes....
Source: Current Treatment Options in Cardiovascular Medicine - March 15, 2021 Category: Cardiology Source Type: research

Evaluation and Management of Pulmonic Valve Disease
AbstractPurpose of reviewThe goal of this review is to provide information about the causes, consequences, exam, echocardiographic findings, and guideline-based treatment options for pulmonic valve lesions.Recent findingsBalloon pulmonic valvuloplasty and surgical valve replacement are the primary treatment options for hemodynamically significant stenosis and regurgitation, respectively. Transcatheter pulmonic valve replacement has emerged as a treatment option for select native valve lesions or dysfunctional surgical conduits.SummarySymptoms of pulmonic valve disease can be overlooked, and long-term effects on right ventr...
Source: Current Treatment Options in Cardiovascular Medicine - March 15, 2021 Category: Cardiology Source Type: research

Advances in Mapping and Ablation of Ventricular Fibrillation
AbstractPurpose of reviewCatheter ablation of ventricular fibrillation (VF) is challenging due to the difficulty in interpreting fibrillatory electrograms and the complete hemodynamic collapse with VF precluding detailed mapping. Successful ablation can be performed by eliminating triggers of VF. We review the contemporary advances in VF ablation, especially targeting the substrate for VF.Recent findingsStrategies to map and eliminate the substrate for VF can be applied generally, even in the absence of a reliable trigger. VF substrate can be mapped during sinus rhythm with signature low-voltage, fractionated, and late ele...
Source: Current Treatment Options in Cardiovascular Medicine - March 12, 2021 Category: Cardiology Source Type: research

New Hemodynamic Insights in Pulmonary Vascular Disease and Heart Failure with Preserved Ejection Fraction
AbstractPurpose of reviewPatients often present with a mixed phenotype of pulmonary vascular disease and heart failure with preserved ejection fraction (HFpEF). Identifying the exact hemodynamic culprits in such cases has important therapeutic implications. This review discusses the hemodynamic characterization and treatment options in patients with pulmonary vascular disease, HFpEF, and their combination.Recent findingsThe threshold for pulmonary hypertension (PH) has been lowered toward a mean pulmonary arterial pressure (mPAP)> 20  mmHg at rest.Exercise-induced PH is defined as mPAP> 30  mmHg during exer...
Source: Current Treatment Options in Cardiovascular Medicine - February 22, 2021 Category: Cardiology Source Type: research

Structural Transcatheter Cardiac Interventions in the Cardio-Oncology Population
AbstractPurpose of reviewModern cancer therapies have resulted in prolonged survival and decreased mortality for many types of cancer. Consequently, cancer patients with concomitant cardiovascular disease (CVD) present prior to diagnosis of cancer, resulting from various forms of cancer therapy, or developing after cancer remission are at higher risk for development of cardiovascular-associated morbidity and mortality. Management of CVD, particularly structural heart disease, in this patient population is challenging and associated with elevated surgical risk. Minimally invasive transcatheter procedures have emerged as low...
Source: Current Treatment Options in Cardiovascular Medicine - February 22, 2021 Category: Cardiology Source Type: research

Sustainable Resumption of Cardiac Catheterization Laboratory Procedures, and the Importance of Testing, During Endemic COVID-19
ConclusionOur patients are at definite risk from their cardiovascular disease, and a return to suspension of proven prognostic interventional treatments on an elective  basis – the default for the first wave – must be avoided at all costs. (Source: Current Treatment Options in Cardiovascular Medicine)
Source: Current Treatment Options in Cardiovascular Medicine - February 22, 2021 Category: Cardiology Source Type: research

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