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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Role of Catheter Ablation as a First-Line Treatment for Atrial Fibrillation
AbstractPurpose of reviewCatheter ablation has emerged as the most effective long-term rhythm controlling strategy in patients with symptomatic atrial fibrillation (AF). Over the last few years, the role of ablation has shifted from a last-resort strategy toward a first-line approach in AF management. The purpose of this review is to highlight the rationale behind an early ablation strategy and to summarize recent data regarding its effectiveness.Recent findingsPulmonary vein isolation (PVI), the cornerstone of catheter ablation of AF, is superior to antiarrhythmic drugs (AADs) in preventing recurrence of AF. PVI is most e...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research

Clinical Implications of Machine Learning, Artificial Intelligence, and Radiomics in Cardiac Imaging
AbstractPurpose of reviewRapid advancements in technology and electronic medical record systems have given rise to massive amounts of cardiac imaging data with the potential to alter medical practices. The rise of machine learning (ML) and radiomics – the concept that images contain invaluable data regarding disease processes beyond what the eyes can see – promises increased precision and accuracy to the current standard of care. Recent advancements in major cardiac imaging modalities, such as echocardiography, cardiac CT and cardiac MRI, h ave uncovered promising diagnostic and prognostic information through t...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research

Severe, Symptomatic Aortic Stenosis: an Update on the Diagnostic and Treatment Tools in Our Arsenal
AbstractPurpose of reviewWe aim to provide the cardiovascular clinician with an update on the classification and diagnosis of severe AS and an evidence-based guide to the treatment options available for severe, symptomatic AS.Recent findingsThe classification of AS is evolving with increasing recognition of hemodynamically distinct AS subtypes and the importance of transvalvular flow in both the diagnosis and management of severe AS. Transcatheter aortic valve replacement (TAVR) has continued to expand its safety and efficacy to include patients with symptomatic, severe AS at low risk for surgical AVR (SAVR). There is emer...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research

Management of Cancer-Associated Thrombosis
AbstractPurpose of reviewLow molecular weight heparin (LMWH) has been the standard of care for patients with cancer-associated thrombosis (CAT) for over 10  years; however, its adoption has been limited. The appearance of direct acting oral anticoagulants (DOACs) revolutionized the treatment of non-cancer venous thromboembolism (VTE) through their attractive fixed dose regimens; however, a lack of dedicated trial experience had relegated their positio n to off-label use in patients with cancer. The goal of this review is to review the evidence that has been generated over the last 3 years for factor Xa inhibitors...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research

Advances in the Diagnosis and Management of Transthyretin Amyloid Cardiomyopathy
AbstractPurpose of reviewTransthyretin amyloid cardiomyopathy (ATTR-CM) is a disease with high morbidity and mortality. This disease is significantly underdiagnosed and is more common than previously appreciated, particularly among older adults and people of African descent. This review discusses recent advances in the diagnosis and treatment for ATTR-CM.Recent findingsHistorically, ATTR-CM was diagnosed via endomyocardial biopsy, a resource-intensive and invasive approach. However, in most cases, ATTR-CM can now be diagnosed non-invasively using bone tracer cardiac scintigraphy, which may facilitate earlier diagnosis. In ...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research

Contemporary Workup and Management of Asymptomatic Patients with Severe Aortic Stenosis
AbstractPurpose of reviewAppropriate management of asymptomatic patients with severe aortic stenosis (AS) is increasingly debated given recent improvements in options for aortic valve replacement (AVR). The goal of this review is to provide an updated approach to evaluation and management of patients with asymptomatic severe AS and to discuss the rationale for early AVR.Recent findingsRegistry data, retrospective studies, and one small randomized controlled clinical trial suggest a mortality benefit to AVR before symptom onset, although larger randomized trials are needed given potential biases of observational data. Other...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research

Targeted Temperature Management for Treatment of Cardiac Arrest
AbstractPurpose of reviewCardiac arrest is a common condition associated with high mortality and a substantial risk of neurological injury among survivors. Targeted temperature management (TTM) is the only strategy shown to reduce the risk of neurologic disability cardiac arrest patients. In this article, we provide a comprehensive review of TTM with an emphasis on recent trials.Recent findingsAfter early studies demonstrating the benefit of TTM in out-of-hospital cardiac arrest due to a shockable rhythm, newer studies have extended the benefit of TTM to patients with a nonshockable rhythm and in-hospital cardiac arrest. A...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research

Percutaneous Valve Interventions in Heart Failure
AbstractPurpose of reviewHeart failure remains a major cause of morbidity and mortality despite advances in guideline directed medical and electrophysiologic device therapies. Valvular heart disease (VHD) is common in heart failure patients and independently associated with poor outcomes. This review provides an update in the rapidly evolving field of transcatheter heart valve interventions (THVI) in the management of heart failure.Recent findingsAortic stenosis (AS) may cause or worsen heart failure. Functional mitral regurgitation (FMR) and functional tricuspid regurgitation (FTR) occur secondary to heart failure and con...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research

Multimodality Imaging of Pulmonary Hypertension
AbstractPurpose of reviewPulmonary hypertension (PH) is a complex, progressive abnormal physiologic and hemodynamic state seen in many conditions. The purpose of this review is to discuss the updated clinical and hemodynamic classification systems and diagnostic criteria of PH, discuss the role of noninvasive imaging for diagnosing PH, and outline a diagnostic pathway to facilitate targeted therapies.Recent findingsPH is defined as a mean pulmonary arterial pressure (mPAP)>  20 mmHg since the sixth World Symposium on Pulmonary Hypertension (WSPH) in 2018, a lower threshold than the longstanding definition of...
Source: Current Treatment Options in Cardiovascular Medicine - October 10, 2020 Category: Cardiology Source Type: research

Correction to: Techniques to Avoid Complications of Atrial Fibrillation Ablation
In the recently published review “Techniques to Avoid Complications of Atrial Fibrillation Ablation,” the following author name was inadvertently misspelled as Amit Shreshta. (Source: Current Treatment Options in Cardiovascular Medicine)
Source: Current Treatment Options in Cardiovascular Medicine - October 7, 2020 Category: Cardiology Source Type: research

Practical Considerations and Opportunities for SGLT2 Inhibitor Prescription in Heart Failure
AbstractPurpose of reviewAppropriate selection of anti-hyperglycemic agents that are both safe and effective is critical to improve outcomes for individuals with heart failure. Although emerging evidence supports the use of sodium-glucose co-transporter 2 (SGLT2) inhibitors for heart failure patients with or without diabetes, barriers to prescribing these agents still exist. This comprehensive review will focus on evidence supporting SGLT2 inhibitors for patients with heart failure and practical considerations when prescribing these agents in clinical practice.Recent findingsBased on evidence of improved cardiovascular out...
Source: Current Treatment Options in Cardiovascular Medicine - September 21, 2020 Category: Cardiology Source Type: research

Vertebral Artery Stenosis
AbstractPurpose of reviewVertebral artery stenosis is a common condition associated with a very high risk of stroke. The goal of this review is to summarize the pathophysiology and natural history of vertebral artery stenosis and to evaluate the efficacy of medical and endovascular therapies.Recent findingsEarly and aggressive initiation of medical care combined with advancements in antithrombotic and lipid-lowering therapies has substantially reduced the risk of stroke due to vertebral artery stenosis. Endovascular therapy does not appear to be beneficial with extracranial vertebral artery stenosis and appears harmful wit...
Source: Current Treatment Options in Cardiovascular Medicine - September 10, 2020 Category: Cardiology Source Type: research

Multimodality Imaging of Aortic Disease
AbstractPurpose of reviewPatients with aortic disease should have regular imaging surveillance. The goal of this review is to provide an overview of the etiologies of aortic disease as well as provide information on available imaging modalities including ones that are under investigation.Recent findingsAs routine imaging is required for surveillance of aortic disease, many concerns come up including cumulative radiation and contrast exposure, as well as limitations, availability, and cost of imaging modalities. Novel hybrid imaging modalities hold promise for the prediction of complications related to aortic disease.Summar...
Source: Current Treatment Options in Cardiovascular Medicine - September 3, 2020 Category: Cardiology Source Type: research

Neurovascular Causes of Acute Monocular Visual Loss
AbstractPurpose of reviewAcute monocular visual loss may result from a diverse set of neurovascular and systemic disorders and requires urgent evaluation. The goal of this review is to describe the most current understanding of the clinical features, pathophysiology, diagnosis, and treatment of these disorders.Recent findings1. Acute central retinal artery occlusion (CRAO) should be treated as an equivalent to acute ischemic stroke.2. Several recent clinical trials are evaluating the treatment of non-arteritic anterior ischemic optic neuropathy (NAION).3. Tocilizumab is emerging as a first-line steroid-sparing immunomodula...
Source: Current Treatment Options in Cardiovascular Medicine - September 1, 2020 Category: Cardiology Source Type: research

Left Atrial Electroanatomical Voltage Mapping to Characterize Substrate and Guide Ablation
AbstractPurpose of ReviewDespite enthusiasm for catheter ablation of atrial fibrillation, procedural outcomes are less robust when compared to other atrial arrhythmiasRecent FindingsAdverse atrial remodeling is associated with both the perpetuation of atrial fibrillation as well as decreased responsiveness to restorative therapies. However, characterization of remodeling has historically relied on demographic factors and echocardiographic imaging which provide inadequate insight into the pattern and distribution of atrial fibrosis. Advancements in electroanatomical mapping allow rapid collection of dense three-dimensional ...
Source: Current Treatment Options in Cardiovascular Medicine - September 1, 2020 Category: Cardiology Source Type: research

Current Insights Into Secondary Mitral Regurgitation —Workup and Management
AbstractPurpose of reviewTo outline a comprehensive clinical evaluation of secondary mitral regurgitation (SMR) and to review the state-of-the-art, diagnostic advances, therapeutic challenges, and future developments.Recent findingsSMR is commonly observed in heart failure patients. With an increasing heart failure incidence in an aging population, the prevalence of SMR is expected to rise significantly. SMR is associated with more symptoms, increased hospitalizations for heart failure, and overall worse prognosis. Both diagnostic approach and therapeutic management are challenging, but recent studies provide solutions and...
Source: Current Treatment Options in Cardiovascular Medicine - September 1, 2020 Category: Cardiology Source Type: research

Role of Imaging in Improving Outcomes with Ablation
AbstractPurpose of ReviewThe goal of this review is to provide information about the role that cardiac magnetic resonance imaging (CMR) can play in guiding catheter ablation right from patient selection to creating better lesions to post-ablation follow-up.Recent FindingsCMR can provide very important information of the scar and fibrotic substrate in the cardiac tissue. Cardiac substrate information from CMR plays a critical role in ventricular and atrial arrhythmia management. CMR can demonstrate the extent of acute edema and long-term scar formation from catheter ablation. All this information can lead to optimal targeti...
Source: Current Treatment Options in Cardiovascular Medicine - September 1, 2020 Category: Cardiology Source Type: research

Advances and New Insights in Post-Transplant Care: From Sequencing to Imaging
AbstractPurpose of reviewCardiac imaging and sequencing have greatly improved over the recent years. The goal of this review is to summarize these recent advances in cardiac imaging and sequencing, their application in heart-transplantation, and provide our perspective in how artificial intelligence provides a new paradigm for big data-driven analysis in heart-transplant research.Recent findingsCardiac imaging, particularly parametric mapping by cardiac MRI and global longitudinal strain by echocardiography, has improved our understanding of cardiac allograft rejection and prediction of adverse clinical outcomes. Independe...
Source: Current Treatment Options in Cardiovascular Medicine - September 1, 2020 Category: Cardiology Source Type: research

Atrial Functional Mitral and Tricuspid Regurgitation
AbstractPurpose of reviewFunctional or secondary regurgitation of the atrioventricular valves most commonly presents as a consequence of ventricular heart disease. However, there is increasing recognition that functional mitral and/or tricuspid regurgitation can also relate to isolated atrial pathology in the absence of ventricular disease, as seen in atrial fibrillation (AF) and/or heart failure with preserved ejection fraction (HFpEF). The aim of this review article is to summarize recent data and insights into the mechanisms, diagnosis, and therapeutic options of atrial functional mitral regurgitation (AFMR) and atrial ...
Source: Current Treatment Options in Cardiovascular Medicine - September 1, 2020 Category: Cardiology Source Type: research