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Evaluation of Coronary Microvascular and Endothelial Function in the Cardiac Catheterization Laboratory
AbstractPurpose of reviewCoronary endothelial and microvascular dysfunction leads to chronic angina (ANOCA) and ischemia (INOCA) in the absence of obstructive epicardial coronary artery disease. These highly prevalent conditions have been associated with increased morbidity and mortality. Comprehensive coronary reactivity testing (CRT) is performed in the cardiac catheterization laboratory to definite diagnosis followed by phenotype-based therapies in this challenging patient population. This document is intended to describe the step-by-step performance of CRT procedure in the cath lab and interpretation of the test result...
Source: Current Treatment Options in Cardiovascular Medicine - June 1, 2023 Category: Cardiology Source Type: research

Intravascular Lithotripsy for Treatment of Calcified Coronary Lesions
AbstractPurpose of reviewIntravascular lithotripsy (IVL) is a novel tool for calcified lesion modification using acoustic pressure waves. In this review, we discuss its use to treat calcified coronary lesions, including technique, mechanism of action, clinical practice, current evidence, advantages and disadvantages, and its role in specific lesion subsets.Recent findingsProspective studies, the “Shockwave Coronary Rx Lithoplasty® Study ” Disrupt CAD I, II, and III have demonstrated that IVL is safe and effective to prepare calcific stenotic lesions for stent deployment.SummaryIVL is a novel, facile technology to modi...
Source: Current Treatment Options in Cardiovascular Medicine - June 1, 2023 Category: Cardiology Source Type: research

Is a History of Seizures an Important Risk Factor for Sudden Cardiac Death in Young Athletes?
AbstractPurpose of ReviewThis review examines the significance of seizures in young athletes and the complex inter-relationship between seizures, epilepsy, and sudden cardiac death.Recent FindingsA history of seizures may reflect a diagnosis of epilepsy, which should be medically optimized for athletic participation. Epilepsy is associated with sudden unexplained cardiac death (sudden unexplained death in epilepsy, SUDEP), with multiple genetic links identified to define some patients as experiencing a “cardiocerebral channelopathy.” It is also important to consider that a history of seizures may reflect a misdiagnosis...
Source: Current Treatment Options in Cardiovascular Medicine - May 20, 2023 Category: Cardiology Source Type: research

Coronary Revascularization in Patients With Cancer
AbstractPurpose of reviewThe treatment of coronary artery disease (CAD) in cancer patients is an evolving landscape. Recent data emphasizes the importance of aggressive management of cardiovascular risk factors and diseases in improving cardiovascular health in this unique group of patients regardless of cancer type or stage.Recent findingsNovel cancer therapeutics such as immune therapies and proteasome inhibitors have been associated with CAD. Recent stent technologies may safely allow for shorter duration (< 6 months) of dual antiplatelet therapy post-percutaneous coronary interventions. Intracoronary imaging may...
Source: Current Treatment Options in Cardiovascular Medicine - May 20, 2023 Category: Cardiology Source Type: research

Revascularization in Left Main Coronary Artery Disease
AbstractPurpose of reviewThe goal of this review is to provide the reader with an up-to-date synopsis of the available literature surrounding the therapeutic options in the revascularization of significant left main (LM) coronary artery disease.Recent findings.Without revascularization, significant LM disease is associated with poor outcomes. Coronary artery bypass grafting (CABG) remains a mainstay of therapy in significant LM disease. More recently, long-term data from several studies suggests that percutaneous coronary intervention (PCI) is a reasonable alternative with comparable clinical outcomes in select patients. R...
Source: Current Treatment Options in Cardiovascular Medicine - May 18, 2023 Category: Cardiology Source Type: research

Is a History of Seizures an Important Risk Factor for Sudden Cardiac Death in Young Athletes?
AbstractPurpose of ReviewThis review examines the significance of seizures in young athletes and the complex inter-relationship between seizures, epilepsy, and sudden cardiac death.Recent FindingsA history of seizures may reflect a diagnosis of epilepsy, which should be medically optimized for athletic participation. Epilepsy is associated with sudden unexplained cardiac death (sudden unexplained death in epilepsy, SUDEP), with multiple genetic links identified to define some patients as experiencing a “cardiocerebral channelopathy.” It is also important to consider that a history of seizures may reflect a misdiagnosis...
Source: Current Treatment Options in Cardiovascular Medicine - April 21, 2023 Category: Cardiology Source Type: research

Coronary Revascularization in Patients With Cancer
AbstractPurpose of reviewThe treatment of coronary artery disease (CAD) in cancer patients is an evolving landscape. Recent data emphasizes the importance of aggressive management of cardiovascular risk factors and diseases in improving cardiovascular health in this unique group of patients regardless of cancer type or stage.Recent findingsNovel cancer therapeutics such as immune therapies and proteasome inhibitors have been associated with CAD. Recent stent technologies may safely allow for shorter duration (< 6 months) of dual antiplatelet therapy post-percutaneous coronary interventions. Intracoronary imaging may...
Source: Current Treatment Options in Cardiovascular Medicine - April 21, 2023 Category: Cardiology Source Type: research

Shortening and De-Escalation of Dual Antiplatelet Therapy After PCI
AbstractPurpose of Review Dual antiplatelet therapy (DAPT) for a period of 6 to 12 months constitutes the standard of care after percutaneous coronary intervention. Post-PCI DAPT leads to a decrease in rates of ischemic events at the expense of increased bleeding risk. This review article is aimed at discussing novel therapeutic strategies proposed to mitigate the bleeding risk associated with DAPT.Recent FindingsAntiplatelet monotherapy after a short-term DAPT post-PCI has been shown to be a feasible and safe alternative. Recent studies have demonstrated that P2Y12 inhibitor monotherapy is associated with improved ou...
Source: Current Treatment Options in Cardiovascular Medicine - April 20, 2023 Category: Cardiology Source Type: research

Novel Strategies to Improve Prescription of Guideline-Directed Medical Therapy in Heart Failure
AbstractPurpose of reviewTo examine the emerging data for novel strategies being studied to improve use and dose titration of guideline-directed medical therapy (GDMT) for patients with heart failure (HF).Recent findingsThere is mounting evidence to employ novel multi-pronged strategies to address HF implementation gaps.SummaryDespite high-level randomized evidence and clear national society recommendations, a large gap persists in use and dose titration of guideline-directed medical therapy (GDMT) in patients with heart failure (HF). Accelerating the safe implementation of GDMT has proven to reduce the morbidity and morta...
Source: Current Treatment Options in Cardiovascular Medicine - April 20, 2023 Category: Cardiology Source Type: research

Mechanical Circulatory Support: When and How to Use It
AbstractPurpose of reviewThe goal of this review is to provide the reader with a summary of the percutaneous mechanical circulatory support (MCS) devices currently used in clinical practice.Recent findingsAlthough there are limited data for MCS including intra-aortic balloon pump (IABP), percutaneous left ventricular (LV) micro-axial pump (Impella), percutaneous left ventricular (LV) centrifugal pump (TandemHeart), VA-extracorporeal membrane oxygenation (VA-ECMO), and right ventricular (RV) support (Impella RP, Protek Duo), these devices are frequently employed in clinical practice.SummaryGuidelines largely support the use...
Source: Current Treatment Options in Cardiovascular Medicine - April 20, 2023 Category: Cardiology Source Type: research

Best Practices for Physiologic Assessment of Coronary Stenosis
AbstractPurpose of ReviewThe goal of this review is to offer an updated and comprehensive summary of the available options for performing both invasive and noninvasive functional assessments of coronary artery disease.Recent FindingsFractional flow reserve (FFR) is an invasive functional coronary assessment of ischemia associated with clinical outcomes. In recent years, alternative pressure wire measurements that do not require hyperemic agents have been developed. Measurements such as instantaneous wave-free ratio (iFR) are non-inferior to FFR, result in shorter procedure times, and eliminate side effects related to the u...
Source: Current Treatment Options in Cardiovascular Medicine - April 18, 2023 Category: Cardiology Source Type: research