Tissue Valve Degeneration and Mechanical Valve Failure
This report offers an overview of the definitions, mechanisms, management, and clinical impact of structural valve degeneration and failure.Recent findingsPublished literature has employed variable definitions and outcome measures, complicating our understanding of bioprosthetic valve behavior and function. The pathophysiology leading to structural valve degeneration is multifactorial and involves mechanical, hematologic, and immunologic elements. Technological advancements have resulted in improved valve performance and new strategies to mitigate the risks of degeneration.SummaryWhile mechanical valves have demonstrated n...
Source: Current Treatment Options in Cardiovascular Medicine - June 14, 2019 Category: Cardiology Source Type: research

Cardiotoxicity of Immune Checkpoint Inhibitors
AbstractPurpose of reviewImmunotherapies, particularly immune checkpoint inhibitors (ICI), are revolutionary cancer therapies being increasingly applied to a broader range of cancers. Our understanding of the mechanism, epidemiology, diagnosis, and treatment of cardiotoxicity related to immunotherapies remains limited. We aim to synthesize the limited current literature on cardiotoxicity of ICIs and to share our opinions on the diagnosis and treatment of this condition.Recent findingsThe incidence of ICI-associated myocarditis ranges from 0.1 to 1%. Patients with ICI-associated myocarditis often have a fulminant course wit...
Source: Current Treatment Options in Cardiovascular Medicine - June 8, 2019 Category: Cardiology Source Type: research

Cardiovascular Complications Associated with Mediastinal Radiation
AbstractPurpose of reviewRadiation-induced heart disease (RIHD) encompasses a broad range of pathologies and is a significant source of morbidity and mortality among cancer survivors. Increased awareness of the early and late consequences of mediastinal radiation has led to the development of strategies for cardiac risk reduction to improve outcomes through active surveillance and early detection of RIHD. This review aims to discuss the current knowledge on the presentation, diagnosis, and management of RIHD.Recent findingsDecades ’ worth of cohort data demonstrates an increased risk of RIHD as cancer survivors age. ...
Source: Current Treatment Options in Cardiovascular Medicine - June 4, 2019 Category: Cardiology Source Type: research

Risk of Cardiomyopathy in Breast Cancer: How Can We Attenuate the Risk of Heart Failure from Anthracyclines and Anti-HER2 Therapies?
AbstractPurpose of reviewTo review cardiotoxicity of and strategies to prevent cardiotoxicity from anthracyclines and anti-HER2 agents used to treat breast cancer.Recent findingsAlthough not common, cardiotoxicity from anthracyclines and anti-HER2 therapies is a major consideration in the use of these agents, especially in the adjuvant setting. Modifications in anthracycline agent, dosing, or schedule or use of Dexrazoxane have been shown to ameliorate the mostly irreversible cardiotoxicity from anthracyclines. Dose delays have been the primary means of addressing the possibly reversible cardiotoxicity from the anti-HER2 a...
Source: Current Treatment Options in Cardiovascular Medicine - May 31, 2019 Category: Cardiology Source Type: research

Connected Health Technology for Cardiovascular Disease Prevention and Management
AbstractPurpose of the reviewAdvances in computing power and wireless technologies have reshaped our approach to patient monitoring. Medical grade sensors and apps that were once restricted to hospitals and specialized clinic are now widely available. Here, we review the current evidence supporting the use of connected health technologies for the prevention and management of cardiovascular disease in an effort to highlight gaps and future opportunities for innovation.Recent findingsInitial studies in connected health for cardiovascular disease prevention and management focused primarily on activity tracking and blood press...
Source: Current Treatment Options in Cardiovascular Medicine - May 18, 2019 Category: Cardiology Source Type: research

The Role of Cardiac Magnetic Resonance Imaging to Detect Cardiac Toxicity From Cancer Therapeutics
AbstractPurpose of reviewThe emerging complexity of cardiac toxicity caused by cancer therapies has created demand for more advanced non-invasive methods to better evaluate cardiac structure, function, and myocardial tissue characteristics. Cardiac magnetic resonance imaging meets these needs without exposure to ionizing radiation, and with superior spatial resolution.Recent findingsSpecial applications of cardiac magnetic resonance (CMR) to assess for cancer therapy –induced cardiac toxicity include the detection of subclinical LV dysfunction through novel methods of measuring myocardial strain, detection of microci...
Source: Current Treatment Options in Cardiovascular Medicine - May 18, 2019 Category: Cardiology Source Type: research

Cardio-Oncology Fellowship Training and Education
AbstractPurpose of reviewWith the rapid development of novel cancer therapeutics and the growing number of cancer survivors, there is significant demand for cardio-oncology experts to care for these patients. As such, it has become increasingly necessary to develop formalized training in the field of cardio-oncology. This review will focus on the current state of cardio-oncology education, with recommendations for the development of dedicated cardio-oncology fellowships.Recent findingsCardio-oncology fellowships should be affiliated with high-volume centers that have established cardio-oncology clinical and research progra...
Source: Current Treatment Options in Cardiovascular Medicine - May 18, 2019 Category: Cardiology Source Type: research

Transcatheter Tricuspid Valve Therapy
The objective of this review is to summarize the current progress and future directions in the field of transcatheter TV therapies.Recent findingsTranscatheter TV repair devices are aimed at improving leaflet coaptation either directly by bringing the leaflets together or indirectly by addressing the dilated annulus. Transcatheter TV replacement, on the other hand, can be orthotopic (implantation of prosthetic valve in an anatomically correct position in the tricuspid annulus) or heterotopic (implantation of prosthetic valve in a different anatomic location to counter the hemodynamic and clinical consequences of severe TR)...
Source: Current Treatment Options in Cardiovascular Medicine - May 18, 2019 Category: Cardiology Source Type: research

Artificial Intelligence in Cardiovascular Medicine
AbstractPurpose of reviewThe ripples of artificial intelligence are being felt in various sectors of human life. Machine learning, a subset of artificial intelligence, extracts information from large databases of information and is gaining traction in various fields of cardiology. In this review, we highlight noteworthy examples of machine learning utilization in echocardiography, nuclear cardiology, computed tomography, and magnetic resonance imaging over the past year.Recent findingsIn the past year, machine learning (ML) has expanded its boundaries in cardiology with several positive results. Some studies have integrate...
Source: Current Treatment Options in Cardiovascular Medicine - May 14, 2019 Category: Cardiology Source Type: research

Interventions to Reduce Ethnic and Racial Disparities in Dyslipidemia Management
AbstractPurpose of reviewRace and ethnicity are associated with disparities in risk assessment, screening, patient awareness, treatment, and control of dyslipidemia and can contribute to worsened cardiovascular outcomes. This review summarizes these gaps in care and highlights recent interventions aimed at reducing them.Recent findingsDisparities in dyslipidemia diagnosis and treatment are well documented among certain racial and ethnic minority groups. Less is known about dyslipidemia among Hispanics, Asians, and Native Americans/Pacific Islanders, who have significant heterogeneity in cardiovascular risk and outcomes. Pr...
Source: Current Treatment Options in Cardiovascular Medicine - May 7, 2019 Category: Cardiology Source Type: research

Psychosocial Stress and Cardiovascular Disease
AbstractPurpose of reviewThis manuscript reviews the epidemiological data linking psychosocial stress to cardiovascular disease (CVD), describes recent advances in understanding the biological pathway between them, discusses potential therapies against stress-related CVD, and identifies future research directions.Recent findingsMetabolic activity of the amygdala (a neural center that is critically involved in the response to stress) can be measured on18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) yielding a neurobiological signal that independently predicts subsequent CVD events. F...
Source: Current Treatment Options in Cardiovascular Medicine - April 26, 2019 Category: Cardiology Source Type: research

Radiation-Associated Cardiac Disease: From Molecular Mechanisms to Clinical Management
AbstractPurpose of reviewRadiation-associated cardiac disease (RACD) is an increasingly recognized latent manifestation of chest and mediastinal radiation therapy. The delayed presentation reflects increased survival rates from malignancies successfully treated decades previously. However, individuals are now presenting with multiple coexistent manifestations of RACD and pulmonary disease as a consequence of high-dose radiation administered prior to the routine institution of modern dose-modulating regimens. Increased awareness of RACD is critical for implementation of appropriate screening algorithms and for specific mana...
Source: Current Treatment Options in Cardiovascular Medicine - April 24, 2019 Category: Cardiology Source Type: research

Virtual Care 2.0 —a Vision for the Future of Data-Driven Technology-Enabled Healthcare
AbstractA busy community cardiologist finished reading eight echocardiograms over lunch and started clinic at 1  pm. As three patients waited, “Jane,” a 45-year-old graphic designer was seen for “skipped heart beat.” She works about 50 h a week, exercises at the local gym, and enjoys eating a healthy diet. About 4 months ago Jane began experiencing her heart “skipping beats.” She initially attr ibuted the symptoms to long hours in the office and caffeine. But, over the holiday, her brother purchased a smart watch and she began digitally recording her cardiac rhythm. About ...
Source: Current Treatment Options in Cardiovascular Medicine - April 15, 2019 Category: Cardiology Source Type: research

Treatment of Heart Failure With Preserved Ejection Fraction (HFpEF): the Phenotype-Guided Approach
AbstractThe syndrome of heart failure with preserved ejection (HFpEF) continues to rise in prevalence without persuasive evidence of current pharmacologic interventions that can reduce mortality. Clinical trials thus far have generally enrolled “all-comers” with the clinical syndrome of heart failure and objective evidence of a preserved ejection fraction. However, HFpEF is increasingly understood to be a heterogeneous syndrome likely borne from the interplay of genetic predisposition, lifestyle factors, and high burden of associated c omorbidities with each contributing to a variety of incompletely understood ...
Source: Current Treatment Options in Cardiovascular Medicine - April 13, 2019 Category: Cardiology Source Type: research

Mitral Annular Calcification and Calcific Mitral Stenosis: Therapeutic Challenges and Considerations
This article summarizes challenges in the diagnosis and therapy of calcific MS, the indications for valve intervention, procedural concerns, and emerging treatment options.Recent findingsSurgical mitral valve replacement is the procedure of choice in symptomatic patients at acceptable surgical risk, with transcatheter mitral valve replacement (TMVR) being evaluated in clinical trials as an alternative for patients at prohibitive surgical risk. Significant challenges exist with the currently available technology and outcomes have been suboptimal. Optimizing the patient-selection process by using multimodality imaging tools ...
Source: Current Treatment Options in Cardiovascular Medicine - March 30, 2019 Category: Cardiology Source Type: research

Dual Antiplatelet Therapy: How Long Is Long Enough?
AbstractPurpose of reviewThe optimal duration of dual antiplatelet therapy (DAPT) has been a topic of considerable interest in recent years, as the risk of stent thrombosis has decreased with newer generation stents and the impact of significant bleeding events on clinical outcomes is increasingly apparent. The purpose of this review is to highlight the landmark studies examining short-duration (6  months or less) and extended-duration (greater than 12 months) DAPT as well as provide information about prediction tools to help guide individualized patient treatment decisions.Recent findingsShort-duration DAPT is a...
Source: Current Treatment Options in Cardiovascular Medicine - March 30, 2019 Category: Cardiology Source Type: research

Extended Reality in Medical Practice
AbstractPurpose of reviewAdvances in display technology and computing have led to new devices capable of overlaying digital information onto the physical world or incorporating aspects of the physical world into virtual scenes. These combinations of digital and physical environments are referred to as extended realities. Extended reality (XR) devices offer many advantages for medical applications including realistic 3D visualization and touch-free interfaces that can be used in sterile environments. This review introduces extended reality and describes how it can be applied to medical practice.Recent findingsThe 3D display...
Source: Current Treatment Options in Cardiovascular Medicine - March 30, 2019 Category: Cardiology Source Type: research

Diagnosis and Pathophysiological Mechanisms of Group 3 Hypoxia-Induced Pulmonary Hypertension
AbstractPurpose of reviewGroup 3 hypoxia-induced pulmonary hypertension (PH) is an important and increasingly diagnosed condition in both the pediatric and adult population. The majority of pulmonary hypertension studies to date and all three classes of drug therapies were designed to focus on group 1 PH. There is a clear unmet medical need for understanding the molecular mechanisms of group 3 PH and a need for novel non-invasive methods of assessing PH in neonates.Recent findingsSeveral growth factors are expressed in patients and in animal models of group 3 PH and are thought to contribute to the pathophysiology of this ...
Source: Current Treatment Options in Cardiovascular Medicine - March 22, 2019 Category: Cardiology Source Type: research

Cardiovascular Evaluation of Children With Malignancies
AbstractPurpose of reviewThe anthracycline (AC) group of drugs is widely used for cancer chemotherapy and has improved outcomes in many childhood malignancies. However, cardiovascular complications are major causes of morbidity and mortality in AC recipients, with the greatest risk factor being a higher cumulative dosage. The purpose of this review is to describe the etio-pathogenesis and risk factors of AC induced cardiotoxicity, with emphasis on currently available and emerging modalities of non-invasive imaging in its surveillance, and to review guidelines on its prevention and treatment.Recent findingsPresently, ejecti...
Source: Current Treatment Options in Cardiovascular Medicine - March 11, 2019 Category: Cardiology Source Type: research

Advances in Management of Stable Coronary Artery Disease: the Role of Revascularization?
AbstractPurpose of reviewCoronary artery disease remains the most common cause of death worldwide. In patients with biomarker-positive acute coronary syndrome, the combination of guideline-directed medical therapy with routine revascularization is associated with improved outcomes. However, the role of routine revascularization in stable ischemic heart disease, in addition to medical therapy, remains a matter of debate. In this review, we aimed to describe the role of revascularization in stable ischemic heart disease.Recent findingsRevascularization is indicated in patients with stable ischemic heart disease and progressi...
Source: Current Treatment Options in Cardiovascular Medicine - March 11, 2019 Category: Cardiology Source Type: research

Atherectomy and Specialty Balloons in Percutaneous Coronary Intervention
AbstractPurpose of reviewInterventional cardiologists are increasingly being called upon to perform complex revascularization in patients who are deemed not to be candidates for surgical revascularization and, until recently, many of these patients would have only been offered medical management. Further, changing demographics have resulted in an increasingly elderly and frail population with diabetes and chronic kidney disease being referred for revascularization. Owing to the increasing prevalence of coronary artery calcification and the importance of achieving complete revascularization, advanced tools and techniques ar...
Source: Current Treatment Options in Cardiovascular Medicine - March 4, 2019 Category: Cardiology Source Type: research

Management of Saphenous Vein Graft Disease in Patients with Prior Coronary Artery Bypass Surgery
AbstractPurpose of reviewIn this review, we summarize the pathogenesis of saphenous venous graft (SVG) failure in patients following coronary artery bypass graft (CABG) surgery. We also provide an update on various aspects of prevention and management of SVG failure.Recent findingsApplication of perioperative measures and medical therapies to promote SVG patency is crucial to optimize clinical outcomes in patients following CABG. Percutaneous coronary intervention (PCI) of SVG disease is fraught with complications, with the highest risk being no-reflow and periprocedural myocardial infarction due to distal embolization of ...
Source: Current Treatment Options in Cardiovascular Medicine - February 28, 2019 Category: Cardiology Source Type: research

Evaluation and Monitoring of Pulmonary Hypertension in Neonates With Congenital Diaphragmatic Hernia
AbstractPurpose of reviewThis review aims to describe the assessment of pulmonary hypertension and ventricular function in neonates with congenital diaphragmatic hernia and the long-term follow-up of their pulmonary vascular disease.Recent findingsIn 2015, the pediatric pulmonary hypertension guidelines from the American Heart Association and American Thoracic Society suggested class I level of evidence B guidelines for routine evaluation of patients with congenital diaphragmatic hernia, including longitudinal care in an interdisciplinary pulmonary hypertension program and following the recommendations offered for all chil...
Source: Current Treatment Options in Cardiovascular Medicine - February 15, 2019 Category: Cardiology Source Type: research

Comprehensive Evaluation of Right Heart Performance and Pulmonary Hemodynamics in Neonatal Pulmonary Hypertension
AbstractPurpose of reviewPulmonary hypertension is characterized by an elevation of pulmonary artery pressures and prolonged exposure of the right ventricle to high afterload that collectively contribute to morbidity and mortality in both the term and preterm infants. This review summarizes the pathogenesis, etiologies, and hemodynamic profiles of the conditions that result in pulmonary hypertension in neonates. We explore the application of echocardiographic techniques for the assessment of right ventricular performance and pulmonary hemodynamics that enhance and guide the diagnosis and management strategies in neonates.R...
Source: Current Treatment Options in Cardiovascular Medicine - February 15, 2019 Category: Cardiology Source Type: research

Prelude to “Pediatric and Congenital Heart Disease”
(Source: Current Treatment Options in Cardiovascular Medicine)
Source: Current Treatment Options in Cardiovascular Medicine - February 15, 2019 Category: Cardiology Source Type: research

Renal Artery Denervation for Hypertension
AbstractPurpose of reviewHypertension (HTN) has a growing impact, already affecting over 1 billion people. An estimated 2 –16% of those with HTN have resistant HTN. The sympathetic nervous system (SNS) is a recognized contributor to the pathophysiology of resistant HTN. Current hypertensive pharmacotherapy has not fully targeted the SNS; therefore, the SNS has become a prominent research therapeutic target. This revi ew summarizes the evidence and rationale behind renal denervation (RDN) therapy and the technology available.Recent findingsPrior to the SYMPLICITY HTN-3 clinical trial, trials found RDN to be an effecti...
Source: Current Treatment Options in Cardiovascular Medicine - February 14, 2019 Category: Cardiology Source Type: research

Preterm Birth Is a Novel, Independent Risk Factor for Altered Cardiac Remodeling and Early Heart Failure: Is it Time for a New Cardiomyopathy?
AbstractPurpose of reviewAround 10% of the global population is born preterm (
Source: Current Treatment Options in Cardiovascular Medicine - February 14, 2019 Category: Cardiology Source Type: research

Comprehensive Noninvasive Evaluation of Right Ventricle-Pulmonary Circulation Axis in Pediatric Patients with Pulmonary Hypertension
AbstractPurpose of reviewThe purpose of this review is to detail the advanced echocardiographic studies that evaluated outcomes in pediatric PH using these advanced imaging techniques: (1) right heart size and function (using 2D and 3D echocardiography), (2) myocardial mechanics, and (3) right ventricular (RV) to pulmonary arterial coupling.Recent findingsAdvanced echocardiographic imaging tools in pediatric PH include RV/left ventricular ratio, 3D echocardiographic assessment of RV volumes and ejection fraction, right atrial and RV strain, and RV-pulmonary arterial coupling ratio that allow for evaluation of clinical outc...
Source: Current Treatment Options in Cardiovascular Medicine - February 9, 2019 Category: Cardiology Source Type: research

Coronary Revascularization in High-Risk Stable Patients With Significant Comorbidities: Challenges in Decision-Making
AbstractPurpose of reviewThere is a growing cohort of complex high-risk patients with stable ischemic heart disease (SIHD) who present for coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). These patients are older, have complex coronary disease, and a substantial comorbidity burden including frailty. The procedural risks and outcomes of CABG and PCI in these patients are more difficult to assess based on the available literature, which has generally studied a younger population with a lower comorbidity burden.Recent findingsThere have been initiatives to recalibrate and expand risk m...
Source: Current Treatment Options in Cardiovascular Medicine - February 9, 2019 Category: Cardiology Source Type: research

Revascularization in Cardiogenic Shock and Advanced Heart Failure
AbstractPurpose of reviewIschemic heart disease is the most common cause of heart failure with systolic dysfunction. The progressive course of heart failure characterized by increasing levels of care and worsening quality of life often indicates an advanced stage. Similarly, cardiogenic shock remains a major clinical problem with prohibitively high mortality rates despite major advances in clinical care. Here, we review the current treatment options and available data for revascularization in patients with ischemic cardiomyopathy, advanced heart failure, and cardiogenic shock. We also explore the emerging role of Intervent...
Source: Current Treatment Options in Cardiovascular Medicine - February 7, 2019 Category: Cardiology Source Type: research

Antithrombotic Strategies in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention
AbstractPurpose of reviewThe choice of appropriate antithrombotic therapy in patients with atrial fibrillation (AF) undergoing percutaneous coronary interventions (PCI) should be approached prudently. Careful consideration is necessary, balancing the ischemic and bleeding risk. Traditionally, triple antithrombotic therapy comprising of aspirin, a P2Y12 inhibitor, and an oral anticoagulant is associated with high bleeding rates.Recent findingsRecent trials have evaluated the safety and effectiveness of dual antithrombotic therapy in AF patients undergoing PCI. These studies have shown a significant reduction in bleeding wit...
Source: Current Treatment Options in Cardiovascular Medicine - February 7, 2019 Category: Cardiology Source Type: research

Radial Percutaneous Coronary Intervention in Complex Arm and Chest Vasculature: Tips and Tricks
This article also discusses the difficulties faced during transradial approach in patients with prior coronary artery bypass grafting (CABG).SummaryNumerous large randomized trials have demonstrated the value of the transradial approach over the transfemoral approach during cardiac catheterization. However, this technique is routinely avoided or aborted due to anatomical variations in the upper arm and chest. These obstacles have delayed adoption of transradial access by operators despite the apparent benefits. This article reviews some of the available tips and tricks described in the literature to overcome anatomical obs...
Source: Current Treatment Options in Cardiovascular Medicine - January 26, 2019 Category: Cardiology Source Type: research

Contemporary Approach to Chronic Total Occlusion Interventions
AbstractPurpose of reviewChronic total occlusion (CTO) poses one of the greatest technical challenges to interventional cardiologists. Despite recent advancements in techniques and clinical trials showing significant benefits of CTO percutaneous coronary interventions (PCI), the proportion of patients with untreated CTOs remains high. We therefore aim to perform a comprehensive review of the various techniques available, recent advancements, benefits, and complications associated with CTO PCI.Recent findingsThree randomized clinical trials examining the benefits of CTO PCI have recently been presented. Scoring systems have...
Source: Current Treatment Options in Cardiovascular Medicine - January 18, 2019 Category: Cardiology Source Type: research

Interpreting the Athlete ’s ECG: Current State and Future Perspectives
AbstractSudden cardiac death (SCD) is the leading cause of death in athletes. A large proportion of these deaths are associated with undiagnosed cardiovascular disease. Screening for high-risk individuals enables early detection of pathology, as well as permitting lifestyle modification or therapeutic intervention.ECG changes in athletes occur as a result of electrical and structural adaptations secondary to repeated bouts of exercise. Such changes are common and may overlap with patterns suggestive of underlying cardiovascular disease. Correct interpretation is therefore essential, in order to differentiate physiology fro...
Source: Current Treatment Options in Cardiovascular Medicine - November 19, 2018 Category: Cardiology Source Type: research

Vascular Genetics: Presentations, Testing, and Prognostics
AbstractPurpose of reviewNumerous studies have begun to unravel the genetic basis of not only aortic disease but also other forms of commonly encountered vascular diseases. The goal of this review is to provide clinicians a reference to help identify and diagnose different types of vascular disease with a genetic underpinning.Recent findingsOngoing studies have identified numerous genes involved in the TGF- β signaling pathway that are also associated with thoracic aortic aneurysm and dissection, and it is possible to test for pathogenic variants in these genes in the clinical setting using commercially available gene...
Source: Current Treatment Options in Cardiovascular Medicine - November 13, 2018 Category: Cardiology Source Type: research

State of the Art Management of Mechanical Heart Valves During Pregnancy
AbstractPurpose of the reviewTo review the management of women with mechanical heart valves during pregnancy, from preconception counseling through delivery with a summary of the latest guidelines.Recent findingsThe hypercoagulability of pregnancy combined with the imperfect choices of anticoagulant agents contribute to a high risk of complications in pregnant women with mechanical heart valves. Valve thrombosis remains a major concern, much of which occurs during the first trimester transition to heparin-based products. The safest method of anticoagulation, with the best balance of maternal and fetal risk, is use of low-d...
Source: Current Treatment Options in Cardiovascular Medicine - November 12, 2018 Category: Cardiology Source Type: research

The Female Athlete ’s Heart: Facts and Fallacies
AbstractPurpose of the reviewFor many years, competitive sport has been dominated by men. Recent times have witnessed a significant increase in women participating in elite sports. As most studies investigated male athletes, with few reports on female counterparts, it is crucial to have a better understanding on physiological cardiac adaptation to exercise in female athletes, to distinguish normal phenotypes from potentially fatal cardiac diseases. This review reports on cardiac adaptation to exercise in females.Recent findingsRecent studies show that electrical, structural, and functional cardiac changes due to physiologi...
Source: Current Treatment Options in Cardiovascular Medicine - November 3, 2018 Category: Cardiology Source Type: research

Left Ventricular Trabeculations in Athletes: Epiphenomenon or Phenotype of Disease?
AbstractPurpose of reviewExcessive trabeculation attracting a diagnosis of left ventricular noncompaction cardiomyopathy (LVNC) has been reported in ostensibly healthy athletes. This review aims to explain why this occurs and whether this represents a spectrum of athletic physiological remodelling or unmasking of occult cardiomyopathy.Recent findingsGenetic studies have yet to identify a dominant mutation associated with the LVNC phenotype and reported gene mutations overlap with many distinct cardiomyopathies and ion channel disorders, implying that the phenotype is shared across different genetic conditions. Large contem...
Source: Current Treatment Options in Cardiovascular Medicine - October 26, 2018 Category: Cardiology Source Type: research

Transcatheter Mitral Valve Planning and the Neo-LVOT: Utilization of Virtual Simulation Models and 3D Printing
AbstractPurpose of reviewTranscatheter mitral valve replacement (TMVR) is an emerging alternative for patients with severe mitral valve regurgitation who are considered at high risk for conventional surgical options. The early clinical experience with TMVR has shown that pre-procedural planning with computed tomography (CT) is needed to mitigate the risk of potentially lethal procedural complications such as left ventricular outflow tract (LVOT) obstruction. The goal of this review is to provide an overview of key concepts relating to TMVR pre-procedural planning, with particular emphasis on imaging-based methods for predi...
Source: Current Treatment Options in Cardiovascular Medicine - October 26, 2018 Category: Cardiology Source Type: research

Visceral Artery Aneurysms: Diagnosis, Surveillance, and Treatment
AbstractVisceral artery aneurysms (VAAs) are a rare, but serious clinical entity as rupture confers a high rate of mortality. Data regarding the prevalence, treatment, and prognosis of VAAs is largely from case series, as true randomized trials are lacking. The incidence of VAAs has risen over the decades with advances in imaging technology, availability, and utilization. Even in the presence of symptoms, the prompt diagnosis of VAAs may be challenging as symptoms are often nonspecific and varied. Although there are no definitive treatment guidelines, asymptomatic VAAs require treatment in the following scenarios: when the...
Source: Current Treatment Options in Cardiovascular Medicine - October 26, 2018 Category: Cardiology Source Type: research

Atrial Fibrillation (AF) in Endurance Athletes: a Complicated Affair
AbstractPurpose of reviewA complex relationship exists between exercise and atrial fibrillation (AF). Moderate exercise reduces AF risk whereas intense strenuous exercise has been shown to increase AF burden. It remains unclear at which point exercise may become detrimental. Overall, endurance athletes remain at lower cardiovascular risk and experience fewer strokes. The questions that arise therefore are whether AF is an acceptable byproduct of strenuous exercise, whether athletes who experience AF should be told to reduce exercise volume and how should they be managed. This review aims to critically review the literature...
Source: Current Treatment Options in Cardiovascular Medicine - October 26, 2018 Category: Cardiology Source Type: research

Left Ventricular Hypertrophy in Athletes: Differentiating Physiology From Pathology
AbstractPurpose of reviewThe changes that occur in athlete ’s heart are influenced by a number of factors including age, gender, ethnicity and the type of cardiovascular training. It is therefore important that the clinician is able to integrate all of these factors when assessing athletes to be able to guide investigations appropriately and to distinguis h pathology from physiology. This review discusses the potential diagnostic conundrums when trying to differentiate physiological left ventricular hypertrophy from pathological hypertrophic cardiomyopathy in athletes. The mechanism of physiological and pathological ...
Source: Current Treatment Options in Cardiovascular Medicine - October 26, 2018 Category: Cardiology Source Type: research

Manufacturing Better Outcomes in Cardiovascular Intervention: 3D Printing in Clinical Practice Today
AbstractPurpose of reviewDescribe and evaluate the integration of 3D printing-related innovations into current cardiovascular treatment paradigms and examine the state of regulatory and reimbursement hurdles ahead.Recent findingsMounting years of clinical experience have established the utility of printed models of patient anatomy in numerous treatment and teaching scenarios, most notably as pre- and intra-procedural planning tools guiding decision-making for congenital heart disease and catheter-based interventions. In part due to a continued lack of reimbursement and under-defined (and slow to evolve) regulatory status, ...
Source: Current Treatment Options in Cardiovascular Medicine - October 25, 2018 Category: Cardiology Source Type: research

Intracranial Aneurysm: Diagnostic Monitoring, Current Interventional Practices, and Advances
AbstractPurpose of reviewCerebral aneurysms are commonly diagnosed incidentally with non-invasive neuro-imaging modalities (i.e., brain MRA and/or head CTA). The first decision to be made in the management of patients with unruptured cerebral aneurysms is to determine if the aneurysm should undergo treatment as any intervention carries a risk of morbidity and mortality.Recent findingsThe multiple risk factors that are associated with increased risk of aneurysm rupture should be evaluated (size, shape, and location of aneurysm; history of hypertension and cigarette smoking and family history of cerebral aneurysms). With the...
Source: Current Treatment Options in Cardiovascular Medicine - October 24, 2018 Category: Cardiology Source Type: research

Incidental Non-cardiac Findings in Cardiovascular Imaging
AbstractImprovements in imaging techniques have led to an expansion in the number of cross-sectional cardiac studies being performed. This means that incidental non-cardiac findings (INCF) identified on cardiac imaging have become an important clinical concern. The majority of INCF are not clinically significant. However, some INCF will require follow-up or changes in management. Differentiating clinically significant from non-significant INCF can be challenging, particularly given the breadth of potential findings and the range of organ systems involved. Following up INCF also has economic implications. Recent changes to ...
Source: Current Treatment Options in Cardiovascular Medicine - October 23, 2018 Category: Cardiology Source Type: research

Correction to: Coronary Artery Calcium: Recommendations for Risk Assessment in Cardiovascular Prevention Guidelines
In the recently published review “Coronary Artery Calcium: Recommendations for Risk Assessment in Cardiovascular Prevention Guidelines,” the following author name was inadvertently misspelled as Alison Peng. The correct spelling of the author’s name is: Allison Peng as shown above. (Source: Current Treatment Options in Cardiovascular Medicine)
Source: Current Treatment Options in Cardiovascular Medicine - October 18, 2018 Category: Cardiology Source Type: research

Peripartum Cardiomyopathy: a Review for the Clinician
AbstractPurpose of reviewThis review summarizes the pathophysiology, diagnosis, and treatment of peripartum cardiomyopathy (PPCM), with a focus on recent discoveries of clinical relevance.Recent findingsAn increase in oxidative stress and anti-angiogenic activity play key roles in the pathophysiology of peripartum cardiomyopathy. Therapies that target this dysregulation may have a future role in treatment. Suppression of prolactin release using bromocriptine, a dopamine-receptor antagonist, has been associated with more favorable outcomes in small studies but more research is needed. Similarly, VEGF agonists may prove to b...
Source: Current Treatment Options in Cardiovascular Medicine - September 29, 2018 Category: Cardiology Source Type: research

Imaging and Management of Heart Failure and Preserved Ejection Fraction
AbstractPurpose of reviewThe prevalence of heart failure with preserved ejection fraction (HFpEF) is rising and in some places, it is already the most prevalent form of heart failure. The usual treatments of HF do not improve mortality or outcomes in HFpEF, suggesting a distinct pathophysiology that remains poorly characterized. The neutrality of clinical trial results is also attributable to the heterogeneity of patient profiles, and by poor characterization offered by classical echocardiography parameters. Emerging imaging modalities may overcome this problem. We therefore aimed to summarize recent advances offered by ca...
Source: Current Treatment Options in Cardiovascular Medicine - September 27, 2018 Category: Cardiology Source Type: research