Getting patients with cardiovascular disease to move more: cardiac rehabilitation and beyond.
Authors: Arena R, Ozemek C PMID: 30509114 [PubMed - as supplied by publisher] (Source: Expert Review of Cardiovascular Therapy)
Source: Expert Review of Cardiovascular Therapy - December 6, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Clinical management in the takotsubo syndrome.
Authors: Jha S, Zeijlon R, Shekka Espinosa A, Alkhoury J, Oras J, Omerovic E, Redfors B Abstract INTRODUCTION: Takotsubo syndrome (TS) is an increasingly recognized acute heart failure syndrome which is self-limiting in most cases but can result in life-threatening complications. TS is difficult to distinguish from acute myocardial infarction (AMI) early in the disease course and currently lacks evidence-based treatment recommendations. Areas covered: Based on the available literature this systematic review discusses the clinical management of patients with TS during (i) the diagnostic workup; (ii) acutely after es...
Source: Expert Review of Cardiovascular Therapy - December 6, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Link between coffee and atrial fibrillation debunked?
Authors: Mattioli AV PMID: 30513013 [PubMed - as supplied by publisher] (Source: Expert Review of Cardiovascular Therapy)
Source: Expert Review of Cardiovascular Therapy - December 6, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Mitral valve prolapse.
This article reviews the pathophysiology, genetics, clinical features, diagnostic imaging, complications, long term outcomes and indications for intervention in mitral valve prolapse. Expert commentary: Several key dilemmas in the management of mitral valve prolapse remain. Factors which influence progression of mitral regurgitation are unclear and therefore we have no therapeutic targets to prevent progression. Evidence-based methods to reduce the risk of sudden death, stroke and endocarditis have not been identified. In symptomatic patients with severe mitral regurgitation valve surgery is recommended. In asymptomatic pa...
Source: Expert Review of Cardiovascular Therapy - November 30, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Exercise as a therapeutic approach to improve blood pressure in patients with peripheral arterial disease: current literature and future directions.
Authors: Ritti-Dias RM, Correia MA, Andrade-Lima A, Cucato GG Abstract INTRODUCTION: Patients with symptomatic peripheral artery disease (PAD) exhibit reduced functional capacity and increased mortality due to cardiovascular disease. Although exercise has been a cornerstone for clinical treatment to improve walking capacity in patients with symptomatic PAD, its effects on cardiovascular parameters have been poorly explored. Areas covered: This review examines the role of exercise in improving blood pressure in patients with symptomatic PAD and summarizes the current evidence on the acute (single bout of exercise) a...
Source: Expert Review of Cardiovascular Therapy - November 29, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Is it safe to stop oral anticoagulation after catheter ablation for atrial fibrillation?
Authors: Romero J, Avendano R, Diaz JC, Taveras J, Lupercio F, Di Biase L Abstract INTRODUCTION: Atrial fibrillation is the most common arrhythmia worldwide. Its increasing prevalence has made the use of oral anticoagulants for stroke prevention routine, however the use of them after the blanking period of catheter ablation remains uncertain. Areas covered: This review outlines the pros and cons of stopping oral anticoagulation after catheter ablation. Major databases such as Pubmed or Embase were used. The most relevant articles published were used along with major recommendations of society guidelines. Authors wi...
Source: Expert Review of Cardiovascular Therapy - November 23, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Current diagnostic strategies for dilated cardiomyopathy: a comparison of imaging techniques.
Authors: Porcari A, De Angelis G, Romani S, Paldino A, Artico J, Cannatà A, Gentile P, Pinamonti B, Merlo M, Sinagra G Abstract INTRODUCTION: Dilated cardiomyopathy (DCM) is generally thought as a final common pathway of several conditions that lead to the same clinical overt phenotype. Multiple imaging modalities play a fundamental role in recognizing the underlying pathological substrate leading to DCM. Areas covered: Echocardiography represents the first reliable and easily accessible diagnostic tool, allowing the identification of associated cardiac abnormalities, such as valve disease and highlighting f...
Source: Expert Review of Cardiovascular Therapy - November 22, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

How to evaluate patients with congenital heart disease-related pulmonary arterial hypertension.
Authors: Ntiloudi D, Zanos S, Gatzoulis MA, Karvounis H, Giannakoulas G Abstract INTRODUCTION: Patients with congenital heart disease (CHD), who develop pulmonary arterial hypertension (PAH), live longer and have better quality of life compared to the past due to PAH specific therapy and improved tertiary care. Areas covered: Clinical examination, objective assessment of functional capacity, natriuretic peptide levels, cardiac imaging and haemodynamics all play a pivotal role in the evaluation, general care and management of PAH specific therapy. This review discusses the epidemiology and pathophysiology of PAH-CHD...
Source: Expert Review of Cardiovascular Therapy - November 22, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Determining the best approach to reduce the impact of exercise-induced atrial fibrillation: prevention, screening, or symptom-based treatment?
Authors: San Antonio R, Guasch E, Tolosana JM, Mont L Abstract INTRODUCTION: Regular endurance exercise over the course of many years appears to increase the risk of atrial fibrillation (AF). These data challenge the notion that the benefits of physical activity have no appreciable limits. The incidence of exercise-induced AF is expected to increase as a consequence of the popularity of extreme endurance sports. Actions to reduce its impact are warranted. Areas covered: This review focuses on exercise-induced AF and reviews the existing data regarding the prevention, screening, and treatment of this disease, with t...
Source: Expert Review of Cardiovascular Therapy - November 20, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Organizing stroke systems in the field for patients with suspected large vessel occlusion acute stroke.
Authors: Almekhlafi MA, Holodinsky JK, Hill MD, Kamal N, Goyal M Abstract INTRODUCTION: The dawn of endovascular stroke therapy has reshaped stroke care. Eligible patients need to be rushed to capable centers for intervention. This may entail bypassing closer hospitals that could confirm the diagnosis, administer thrombolytic therapy, then transfer patients for intervention. This has created a set of challenges: identifying endovascular candidates in the field, determining the best transport destination, and getting patients there quickly. Areas covered: This review provides a context for these emerging challenges....
Source: Expert Review of Cardiovascular Therapy - November 20, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Neurological complications associated with left ventricular assist device therapy.
Authors: Goodwin K, Kluis A, Alexy T, John R, Voeller R Abstract INTRODUCTION: Associated with significant morbidity and mortality, neurological complications in adult patients with left ventricular assist devices (LVAD) approaches a prevalence as high as 25%. As the number of individuals using LVAD support grows, it is increasingly important for providers to understand the hematologic and hemodynamic changes associated with LVAD implantation, the risk factors for neurological complications and their mitigation strategies. Areas covered: PubMed searches were completed using the terms 'Left ventricular assist device...
Source: Expert Review of Cardiovascular Therapy - November 15, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Pulmonary arterial hypertension: assessing risk to improve prognosis.
Authors: Kjellström B, Hjalmarsson C, Kylhammar D, Rådegran G PMID: 30422719 [PubMed - as supplied by publisher] (Source: Expert Review of Cardiovascular Therapy)
Source: Expert Review of Cardiovascular Therapy - November 15, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Functional assessment of coronary stenosis: an overview of available techniques. is quantitative flow ratio a step to the future?
Authors: Cesaro A, Gragnano F, Di Girolamo D, Moscarella E, Diana V, Pariggiano I, Alfieri A, Perrotta R, Golino P, Cesaro F, Mercone G, Campo G, Calabrò P Abstract INTRODUCTION: The assessment of coronary lesions severity has always been a relevant topic in the management of the patient undergoing coronary angiography. Fractional flow reserve (FFR) has been introduced as an objective index to determine the significance of a coronary stenosis with a positive impact on clinical outcomes has been demonstrated for FFR-guided coronary interventions. However, several technical drawbacks have been pointed out in c...
Source: Expert Review of Cardiovascular Therapy - October 27, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Pathophysiology of essential hypertension: an update.
Authors: Saxena T, Ali AO, Saxena M Abstract INTRODUCTION: Hypertension is caused by increased cardiac output and/or increased peripheral resistance. Areas covered: The various mechanisms affecting cardiac output/peripheral resistance involved in development of essential hypertension are covered. These include Genetics, Sympathetic nervous system over activity, Renal mechanisms: Excess sodium intake and pressure natriuresis, Vascular mechanisms: Endothelial cell dysfunction and the Nitric Oxide Pathway, Hormonal Mechanisms: The renin-Angiotensin-Aldosterone system(RAAS), Obesity, Obstructive Sleep Apnea (OSA), Insu...
Source: Expert Review of Cardiovascular Therapy - October 27, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Lowering the systolic blood pressure target in hypertensive patients: current controversies and future outlook.
Authors: Narita K, Hoshide S, Kario K Abstract INTRODUCTION: Randomized controlled trials and meta-analyses have established the benefits of blood pressure (BP) lowering. The 2017 American Heart Association/American College of Cardiology (AHA/ACC) guidelines for the management of hypertension established 130/80 mmHg as the threshold for the diagnosis- and treatment-target BP level. Area covered: The global trends are thought to be heading toward intensive BP-lowering management. In this paper, authors summarize the evidence on lowering the BP target in hypertensive patients with a focus on the 2017 AHA/ACC gui...
Source: Expert Review of Cardiovascular Therapy - October 27, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Radiation and the heart: systematic review of dosimetry and cardiac endpoints.
Authors: Niska JR, Thorpe CS, Allen SM, Daniels TB, Rule WG, Schild SE, Vargas CE, Mookadam F Abstract INTRODUCTION: Recent trials in radiotherapy have associated heart dose and survival, inadequately explained by the existing literature for radiation-related late cardiac effects. Authors aimed to review the recent literature on cardiac dosimetry and survival/cardiac endpoints. Areas covered: A systematic review of the literature in the past 10 years (2008-2017) was performed to identify manuscripts reporting both cardiac dosimetry and survival/cardiac endpoints. Authors identified 64 manuscripts for inclusion, cov...
Source: Expert Review of Cardiovascular Therapy - October 27, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

FFRCT derived from computer tomography angiography: the experience in the UK.
This article discusses the mathematical and physiological principles underpinning calculation of non-invasive fractional flow reserve (FFR), as well as discussing the differences between the commercially available technologies. Diagnostic accuracy, cost effectiveness and safety of non-invasive FFR from the early clinical trials is examined. Further to this the potential implications of the use of non-invasive FFR in clinical practice in the UK are discussed. Expert commentary: Non-invasive FFR represents a promising comprehensive imaging technology providing both anatomical and physiological data to accurately diagnose obs...
Source: Expert Review of Cardiovascular Therapy - October 24, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Targeting sudden death in heart failure with preserved ejection fraction: promise or pipedream?
Authors: Patel RB, Vaduganathan M PMID: 30351178 [PubMed - as supplied by publisher] (Source: Expert Review of Cardiovascular Therapy)
Source: Expert Review of Cardiovascular Therapy - October 24, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Expecting the unexpected: preventing and managing the consequences of coronary perforations.
Authors: Tajti P, Xenogiannis I, Chavez I, Gössl M, Mooney M, Poulose A, Sorajja P, Traverse J, Wang Y, Burke MN, Brilakis ES Abstract INTRODUCTION: Coronary artery perforations are more likely to occur during percutaneous coronary intervention of complex coronary lesions, such as heavily calcified lesions and chronic total occlusions. Areas covered: Authors provide an update on the management of coronary perforations by performing a critical review of the related, recently published literature. Expert commentary: Meticulous attention to guidewire position and to device selection is critical for minimizing the...
Source: Expert Review of Cardiovascular Therapy - October 21, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Assessing and minimizing the risk of percutaneous coronary intervention in patients with chronic kidney disease.
This article contains updated knowledge and management of patients with CKD undergoing PCI. Areas covered: In this article, the pathophysiological mechanisms behind the association of CKD, complex CAD lesions, and complications of PCI are reviewed and the different risk scores available to assess the occurrence of CI-AKI are detailed. Furthermore, various strategies developed to prevent or reduce the impact of complications of PCI are described. Expert commentary: Patients with CKD have remained a challenge in the field of PCI. Several strategies have been evaluated in the last 20 years, with uneven results. Intravascular ...
Source: Expert Review of Cardiovascular Therapy - October 17, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Managing complications of hypertension in aortic valve stenosis patients.
Authors: Saeed S, Gerdts E Abstract INTRODUCTION: Hypertension is highly prevalent in aortic stenosis (AS) patients as the prevalence of both disorders increases with age. Hypertension and associated stiffening of the large arteries increase afterload and thereby influence both the transvalvular flow and the remodelling of the aortic root and the left ventricle during AS progression. Area covered: The present review gives an overview on complications of hypertension in AS, how these can be diagnosed, and potentially may be managed. Expert commentary: Hypertension-mediated cardiovascular damage in AS is associated w...
Source: Expert Review of Cardiovascular Therapy - October 14, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Associations between socioeconomic status, atrial fibrillation and outcomes: A systematic review.
CONCLUSION: Low SES was associated with poorer outcomes when AF was present. These findings may imply that healthcare professionals and policy interventions should focus on the promotion of AF-education and management among patients with AF and low SES. PMID: 30293472 [PubMed - as supplied by publisher] (Source: Expert Review of Cardiovascular Therapy)
Source: Expert Review of Cardiovascular Therapy - October 10, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Relationship between P-wave duration and the risk of atrial fibrillation.
Authors: Hari KJ, Nguyen TP, Soliman EZ Abstract INTRODUCTION: P-wave duration (PWD) is an electrocardiographic (ECG) marker reflecting atrial conduction, and studies have shown that its prolongation is associated with atrial fibrillation. Areas covered: This review addresses the relationship between PWD and atrial fibrillation, how anatomic and physiologic changes in the atria potentiate the risk for atrial fibrillation, and how these atrial anatomic and physiologic changes relate to PWD. Other P-wave related entities, such as P-wave terminal force in V1, PR interval and P wave axis are also addressed. Expert comm...
Source: Expert Review of Cardiovascular Therapy - October 10, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Left ventricular reverse remodeling prediction in non-ischemic cardiomyopathy: present and perspectives.
Authors: Masè M, Merlo M, Vitrella G, Stolfo D, Sinagra G PMID: 30295546 [PubMed - as supplied by publisher] (Source: Expert Review of Cardiovascular Therapy)
Source: Expert Review of Cardiovascular Therapy - October 10, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Optimal medical treatment of hypertension in patients with coronary artery disease.
Authors: Mahtta D, Elgendy IY, Pepine CJ Abstract INTRODUCTION: Coronary artery disease (CAD) remains the leading cause of mortality and morbidity worldwide, and hypertension is its most prevalent modifiable risk factor. Patients with CAD and concomitant hypertension are a special population with distinct physiologic and structural alterations. Optimal blood pressure (BP) control in this population has been linked with reduction in adverse outcomes, however, excessive lowering of BP could jeopardize myocardial and cerebral perfusion. Areas covered: Authors highlight the prevalence of the CAD and hypertension dyad, ...
Source: Expert Review of Cardiovascular Therapy - October 10, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Betrixaban for first-line venous thromboembolism prevention in acute medically ill patients with risk factors for venous thromboembolism.
This article describes the role of betrixaban in the prevention of venous thromboembolism (VTE) in acutely ill medical patients. This article provides a consolidated summary of the primary APEX study findings as well as pre-specified and exploratory substudies. This article also provides a review of the results of studies in which other direct Factor Xa inhibitors have been evaluated in an extended duration regimen in this patient population. Expert commentary: While previous agents have demonstrated that extended duration VTE prophylaxis can be efficacious, betrixaban is the first agent to demonstrate efficacy without an ...
Source: Expert Review of Cardiovascular Therapy - October 10, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Stress echocardiography in valvular heart disease.
This article examines the role of stress echocardiography for assessment of patients with low flow, low gradient aortic stenosis, asymptomatic severe valve disease and patients where symptoms are discordant to the resting severity of valve disease. Expert commentary: Stress echocardiography helps clinicians determine the true severity of valve disease and may identify the cause of symptoms in patients with only mild/moderate disease. The data provided by stress echocardiography will help determine the appropriate management strategy and the correct timing of intervention. PMID: 30286667 [PubMed - as supplied by publish...
Source: Expert Review of Cardiovascular Therapy - October 7, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Management of advance heart failure: a review.
Authors: Kalmonovich E, Audurier Y, Akodad M, Mourad M, Battistella P, Agullo A, Gaudard P, Colson P, Rouviere P, Albat B, Ricci JE, Roubille F Abstract INTRODUCTION: Heart failure (HF) has become a global pandemic. Despite recent developments in both medical and device treatments, HF incidences continues to increase. The current definition of HF restricts itself to stages at which clinical symptoms are apparent. In advanced heart failure (AdHF), it is universally accepted that all patients are refractory to traditional therapies. As the number of HF patients increase, so does the need for additional treatments, wi...
Source: Expert Review of Cardiovascular Therapy - October 6, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Relationship between intra-operative vein graft treatment with DuraGraft ® or saline and clinical outcomes after coronary artery bypass grafting.
Relationship between intra-operative vein graft treatment with DuraGraft® or saline and clinical outcomes after coronary artery bypass grafting. Expert Rev Cardiovasc Ther. 2018 Oct 04;: Authors: Haime M, McLean RR, Kurgansky KE, Emmert MY, Kosik N, Nelson C, Gaziano MJ, Cho K, Gagnon DR Abstract BACKGROUND: Saphenous vein grafts (SVGs) remain the most often used conduits for coronary bypass grafting (CABG). Progressive intimal hyperplasia contributes to vein-graft disease and vein-graft failure (VGF). We compared the impact of intra-operative preservation of SVGs in a storage solution (DuraGraft&r...
Source: Expert Review of Cardiovascular Therapy - October 6, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

A comparison of alternative access routes for transcatheter aortic valve implantation.
Authors: Overtchouk P, Modine T Abstract INTRODUCTION: Alternative TAVI approaches offer the possibility of valve replacement in patients ineligible to the transfemoral route. Authors provide an updated review of the existing alternative approaches. Areas covered: A systematic review of alternative approaches for TAVI was undertaken. The feasibility, safety, efficacy and technical requirements of the transapical, transaortic, transcarotid, transsubclavian and transcaval approaches have been compared. A multi-slice computed tomography is often necessary for pre-operative planning. Although the first developed, the t...
Source: Expert Review of Cardiovascular Therapy - September 21, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Optimal duration of dual antiplatelet therapy after PCI: integrating procedural complexity and the acuteness of clinical presentation.
Authors: Chen H, Power D, Giustino G Abstract INTRODUCTION: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor remains at the cornerstone of treatment to prevent major adverse cardiac events in patients who undergo percutaneous coronary intervention (PCI) with drug-eluting stents (DES). However, the anti-ischemic benefits of DAPT are counterbalanced by an increased risk of hemorrhagic complications, which are known to be associated with increased morbidity and mortality. While the efficacy of DAPT in patients presenting with acute coronary syndromes has been well established, the risk-bene...
Source: Expert Review of Cardiovascular Therapy - September 18, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Contemporary techniques in percutaneous coronary intervention for bifurcation lesions.
Authors: Collet C, Mizukami T, Grundeken MJ Abstract INTRODUCTION: Treatment of coronary bifurcation lesions with contemporary state of the art percutaneous coronary intervention (PCI) is still associated with higher rate of adverse cardiovascular events compared to non-bifurcation lesions. Bench testing and virtual computer modelling have increased our understanding of bifurcation PCI guiding refinement in bifurcation technique. New insights on bifurcation PCI have the potential to further improve clinical outcomes in patients presenting with bifurcation lesions. Areas covered: The present manuscript aims to revie...
Source: Expert Review of Cardiovascular Therapy - September 18, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Triple antithrombotic therapy in patients with atrial fibrillation undergoing PCI: Current evidence and practice.
Authors: Clarke A, Ibrahim A, Kiernan TJ Abstract INTRODUCTION: Patients with atrial fibrillation taking oral anticoagulation and undergoing percutaneous coronary intervention with stent insertion are recommended to receive antithrombotic therapy with aspirin and P2Y12 receptor antagonist. This combinatory regime encompasses triple therapy (TT). Although TT reduces the risk of ischaemic events such as stroke and stent thrombosis, it is associated with an increased bleeding risk. Areas covered: The efficacy and safety profile of TT is uncertain with undetermined optimal duration and therapeutic combination. This rev...
Source: Expert Review of Cardiovascular Therapy - September 16, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Oxygen therapy in acute myocardial infarctions: do we need to re-evaluate its necessity?
Authors: Sepehrvand N, Ezekowitz JA PMID: 30207191 [PubMed - as supplied by publisher] (Source: Expert Review of Cardiovascular Therapy)
Source: Expert Review of Cardiovascular Therapy - September 14, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Frailty assessment and impact of frailty on outcomes after transcatheter aortic valve replacement.
Authors: Shafique U, Mathur S, Michalski A, Bunston R, Cheema AN PMID: 30199270 [PubMed - as supplied by publisher] (Source: Expert Review of Cardiovascular Therapy)
Source: Expert Review of Cardiovascular Therapy - September 11, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Strategies to manage obstructive sleep apnea to decrease the burden of atrial fibrillation.
Authors: Goes CM, Pretti P, Drager LF Abstract INTRODUCTION: In the last decades, consistent data derived from experimental, epidemiological and clinical studies pointed Obstructive Sleep Apnea (OSA), the most common sleep disordered breathing worldwide, as a potential risk factor for incidence and recurrence of atrial fibrillation (AF). Areas covered: This review article describes the impact of OSA on AF and discusses potential strategies for managing OSA in the AF scenario. Expert commentary: Untreated OSA seems to be one important predictor of AF treatment failure after chemical or electrical cardioversion as we...
Source: Expert Review of Cardiovascular Therapy - August 25, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Comparison of sodium nitroprusside and adenosine for fractional flow reserve assessment: a systematic review and meta-analysis.
Authors: Solernó R, Pedroni P, Mariani J, Sarmiento R Abstract BACKGROUND: Fractional flow reserve (FFR) has become a useful tool in the assessment of physiological significance of coronary artery stenosis (CAS), and Adenosine (ADE) is associated with a high incidence of transient side effects. Sodium nitroprusside (NPS) has been proposed as an alternative vasodilator agent. A meta-analysis of studies comparing ADE and NPS for FFR assessment in the same coronary lesions was performed. METHODS: Authors searched for articles comparing NPS and ADE for FFR assessment in intermediate coronary lesions publishe...
Source: Expert Review of Cardiovascular Therapy - August 21, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Utility of risk scores to predict adverse events in cardiac lead extraction.
Authors: Segreti L, Giannotti Santoro M, Di Cori A, Zucchelli G, Viani S, De Lucia R, Della Tommasina V, Barletta V, Paperini L, Soldati E, Bongiorni MG Abstract INTRODUCTION: Increasing device implantations, patient comorbidities and longer life expectancy contribute to an increased need for lead extraction. Even if transvenous lead extraction are highly successful procedures, some serious procedural complications are reported. In order to identify those patients who are at higher risk, risk stratification scores were proposed. Areas covered: The major obstacles to lead extractions are represented by the body's re...
Source: Expert Review of Cardiovascular Therapy - August 18, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Cardiovascular impact of testosterone therapy for hypogonadism.
Authors: Rastrelli G, Dicuio M, Reismann Y, Sforza A, Maggi M, Corona G Abstract INTRODUCTION: Since 2010 some evidence supporting the possible increased cardiovascular (CV) risk related to testosterone treatment (TTh) has created much debate in the scientific community. Based on these results, the US Food and Drug Administration agency has questioned TTh for aging men recognizing its value only for classical hypogonadism due to genetic or organic causes. To better clarify this topic, we scrutinized and summarized, also by using meta-analytic methods, the data generated during the last seven years, as derived from ...
Source: Expert Review of Cardiovascular Therapy - August 15, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Current challenges in managing comorbid heart failure and COPD.
Authors: Neder JA, Rocha A, Alencar MCN, Arbex F, Berton DC, Faria M, Sperandio PA, Nery LE, O'Donnell DE Abstract INTRODUCTION: Heart failure with reduced ejection fraction (HF) and chronic obstructive pulmonary disease (COPD) frequently coexist, particularly in the elderly. Given their rising prevalence and the contemporary trend to longer life expectancy, overlapping HF-COPD will become a major cause of morbidity and mortality in the next decade. Areas covered: Drawing on current clinical and physiological constructs, the consequences of negative cardiopulmonary interactions on the interpretation of pulmonary fu...
Source: Expert Review of Cardiovascular Therapy - August 15, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Catheter ablation for atrial fibrillation: current patient selection and outcomes.
Authors: Walsh K, Marchlinski F Abstract INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Ablation is an excellent treatment option for appropriately selected patients. Catheter ablation tools and techniques have evolved since AF ablation was first introduced, but pulmonary vein isolation remains the cornerstone of the procedure. Outcomes from ablation have improved dramatically over the last twenty years, but remain less than optimal for certain patient groups. Areas covered: This review outlines the process of patient selection for AF ablation in contemporary practice, from diagnosis ...
Source: Expert Review of Cardiovascular Therapy - August 15, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Advances in medical therapy for pericardial diseases.
Authors: Galluzzo A, Imazio M Abstract INTRODUCTION: Medical therapy of pericardial diseases is moving forward to the road of evidence-based medicine and has improved in the last years because of the first randomized clinical trials in the area as well as new therapeutic options for recurrent pericarditis. Areas covered: The present review will focus on more recent advances with a special emphasis on the treatment of pericarditis, the area with more significant improvements in the last years. Medline/Pubmed Library were systematically screened with two specific key searches: "pericarditis AND therapy" and...
Source: Expert Review of Cardiovascular Therapy - August 15, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Cardiac rehabilitation and its effects on cognition in patients with coronary artery disease and heart failure.
Authors: Alagiakrishnan K, Mah D, Gyenes G Abstract INTRODUCTION: Cardiac rehabilitation program is an evidence-based intervention and established model of exercise delivery following myocardial infarction and heart failure. Although it forms an important part of recovery and helps to prevent future events and complications, there has been little focus on its potential cognitive benefits. Areas covered: Coronary artery disease and heart failure are common heart problems associated with significant morbidity and mortality, and cognitive decline is commonly seen in affected individuals. Cognitive impairment may influ...
Source: Expert Review of Cardiovascular Therapy - August 11, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Antithrombotic strategies after interventional left atrial appendage closure: an update.
Authors: Chen S, Weise FK, Chun KJ, Schmidt B Abstract INTRODUCTION: Interventional left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation (OAC) therapy for the prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF). Areas covered: Antithrombotic therapy following interventional LAAO is critical in balancing the risk of thromboembolism and bleeding during the endothelialization of the implanted devices. In this article, the most recent clinical trials are reviewed and the current real-world antithrombotic strategies follo...
Source: Expert Review of Cardiovascular Therapy - August 11, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

eHealth in patients with congenital heart disease: a review.
Authors: Kauw D, Koole M, van Dorth JR, Tulevski II, Somsen GA, Schijven MP, Dohmen DAJ, Bouma BJ, Mulder BJM, Schuuring MJ, Winter MM Abstract INTRODUCTION: Mobile health (mHealth), an advanced form of eHealth is expected to drastically change the field of traditional healthcare in the near future as wearables and mobile applications are rapidly increasing in number. The majority of patients with congenital heart disease (CHD) now reach adulthood and this relative young patient population seems particularly suited for mHealth, as they require lifelong follow-up, experience high morbidity burden and were raised in ...
Source: Expert Review of Cardiovascular Therapy - August 10, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Complications associated with cardiac resynchronisation therapy upgrades versus de novo implantations.
This article discusses these issues and compares the rates of procedural-related complications for CRT upgrades and de novo implantations. It discusses the proportion of patients that are likely to respond to CRT with each intervention. Expert commentary: Understanding the relative risks of CRT upgrades versus de novo implantations is important to help operators select the correct initial device and counsel patients accordingly. Growing experience with image guided implantations and endocardial pacing may prove to be particularly relevant to patients undergoing CRT upgrades. PMID: 29985076 [PubMed - as supplied by publ...
Source: Expert Review of Cardiovascular Therapy - July 11, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Mechanisms, diagnosis, and treatment of heart failure with preserved ejection fraction and diastolic dysfunction.
Authors: Plitt GD, Spring JT, Moulton MJ, Agrawal DK Abstract INTRODUCTION: Heart failure with preserved ejection fraction (HFpEF) continues to be a major challenge for clinicians. Many crucial aspects of the syndrome remain unclear, including the exact pathophysiology, early diagnosis, and treatment. Patients with HFpEF are often asymptomatic late into the disease process, and treatment with medications commonly used in heart failure with reduced ejection fraction (HFrEF) has not been proven to be beneficial. In addition, the confusion of similar terms with HFpEF, such as diastolic heart failure (DHF), and diastol...
Source: Expert Review of Cardiovascular Therapy - July 8, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

The current status of homocysteine as a risk factor for cardiovascular disease: a mini review.
Authors: Chrysant SG, Chrysant GS Abstract INTRODUCTION: Hyperhomocysteinemia has been considered as a risk factor for systemic atherosclerosis, cardiovascular disease (CVD) and stroke and many epidemiologic and case-controlled studies have demonstrated its association with these complications. In addition, treatment of hyperhomocysteinemia with folic acid ± B vitamins prevents the development of atherosclerosis, CVD and strokes. However, subsequent prospective, randomized, placebo- controlled trials have not shown an association of high homocysteine levels or their lowering with treatment with the incidence...
Source: Expert Review of Cardiovascular Therapy - July 8, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

PCSK9 inhibitors and LDL reduction: pharmacology, clinical implications and future perspectives.
Authors: Fitzgerald G, Kiernan T Abstract INTRODUCTION: PCSK9 inhibitors are monoclonal antibodies to proprotein convertase-subtilisin/kexin type 9 which significantly reduce LDL cholesterol concentration in vivo by inhibiting degradation of the LDL receptor in hepatocytes. The introduction of PCSK9 inhibitors heralded a new era of intensive LDL-C reduction with LDL-C concentrations lowered below levels ever thought possible with conventional treatments such as statins. With their introduction considerations regarding cost, clinical outcomes and long-term safety are paramount. Areas covered: This review examines th...
Source: Expert Review of Cardiovascular Therapy - July 8, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

The use of hemodynamics to predict mortality in patients undergoing primary PCI for ST-elevation myocardial infarction.
Authors: Goins AE, Rayson R, Yeung M, Stouffer GA Abstract INTRODUCTION: Challenges remain in predicting mortality and severe myocardial dysfunction in patients undergoing primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI). Areas covered: Cardiogenic shock is associated with a high mortality rate. Less well characterized are patients who are not in cardiogenic shock but will die from pump failure as a result of a STEMI. There is a long history of using hemodynamics to risk stratify patients with acute MI with the Killip class being shown to provide prognostic informatio...
Source: Expert Review of Cardiovascular Therapy - July 6, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research