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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 5, 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 3, 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 1, 2023 Category: Cardiology Source Type: research

A Review of Current and Evolving Imaging Techniques in Cardiac Amyloidosis
AbstractPurpose of reviewEstablishing an early, efficient diagnosis for cardiac amyloid (CA) is critical to avoiding adverse outcomes. We review current imaging tools that can aid early diagnosis, offer prognostic information, and possibly track treatment response in CA.Recent findingsThere are several current conventional imaging modalities that aid in the diagnosis of CA including electrocardiography, echocardiography, bone scintigraphy, cardiac computed tomography (CT), and cardiac magnetic resonance (CMR) imaging. Advanced imaging techniques including left atrial and right ventricular strain, and CMR T1 and T2 mapping ...
Source: Current Treatment Options in Cardiovascular Medicine - March 4, 2023 Category: Cardiology Source Type: research

Anticoagulation Strategies in Temporary Mechanical Circulatory Support
AbstractPurpose of reviewSystemic therapeutic anticoagulation is uniformly recommended to minimize thromboembolic risk in patients treated with mechanical circulatory support for cardiogenic shock. These patients remain at an elevated bleeding risk as a consequence of both vascular instrumentation and underlying multifactorial hematologic and coagulative derangements. Despite this, there is a void in guidance for appropriate strategies for mitigating thrombotic and bleeding risks.Recent findingsStudies have shown significant variability in the risk of thrombotic and bleeding complications in patients maintained on mechanic...
Source: Current Treatment Options in Cardiovascular Medicine - February 17, 2023 Category: Cardiology Source Type: research

Cardiac Xenotransplantation: a New Frontier for Advanced Heart Failure
AbstractPurpose of reviewCardiac transplantation is a critical treatment for patients with advanced heart failure, offering the ability to markedly improve quality and quantity of life. Unfortunately, this treatment is limited by donor organ availability, despite efforts to increase organ supply and improve donor organ allocation and usage. The transplantation of non-human donor organs (xenotransplantation) offers to readily address many limitations of the current transplantation system; however, scattered attempts to establish this practice have been met with frustration. In this review, we discuss the limitations of the ...
Source: Current Treatment Options in Cardiovascular Medicine - February 8, 2023 Category: Cardiology Source Type: research

Surgical Management of Intracranial Atherosclerotic Disease
We present an update on the latest therapeutic research on this disease and the potential role of surgical interventions.Recent findingsDespite improvements in medical therapy, intracranial atherosclerosis presents one of the highest stroke recurrences even with the best contemporary medical management. Interventions such as direct bypass, angioplasty, and stenting have failed to demonstrate superiority to medical management in well-conducted randomized clinical trials. New avenues of research are focusing on alternative interventions such as submaximal angioplasty and indirect bypass.SummaryPatients with intracranial athe...
Source: Current Treatment Options in Cardiovascular Medicine - January 17, 2023 Category: Cardiology Source Type: research

Intravenous Thrombolytics in the Treatment of Acute Ischemic Stroke
AbstractPurpose of ReviewTo review the current evidence and ongoing clinical trials evaluating the efficacy and safety of tenecteplase (TNK), an alternative tissue plasminogen activator (tPA), in the acute management of arterial ischemic stroke (AIS). To date, alteplase is the only tPA approved by the United States FDA for use in AIS.Recent FindingsThere have been multiple phase two and three trials investigating the safety and efficacy of TNK in AIS. In patients with AIS due to large vessel occlusion, one randomized controlled trial demonstrated superiority of TNK for vessel recanalization rates and long-term functional o...
Source: Current Treatment Options in Cardiovascular Medicine - January 2, 2023 Category: Cardiology Source Type: research

Interatrial Septal Devices for HFpEF: What We Learned from REDUCE LAP-HF
AbstractPurpose of reviewElevated left atrial pressure is a common physiologic perturbation in symptomatic heart failure. A number of interatrial septal devices (IASD) are being studied with a goal of reducing left atrial pressure at rest and during exertion to improve symptoms. Our review discusses historical perspectives, physiologic rationale of IASD therapy, and summarizes recent results and ongoing studies.Recent findingsAlthough preliminary studies showed promising hemodynamic results and improvements in function capacity, the recent sham-controlled, randomized REDUCE LAP-HF II trial failed to meet its primary endpoi...
Source: Current Treatment Options in Cardiovascular Medicine - December 17, 2022 Category: Cardiology Source Type: research