Challenges in pulmonary hypertension associated with left heart disease.
Authors: Zolty R Abstract INTRODUCTION: Pulmonary hypertension (PH) secondary to left-sided heart disease (Group 2 PH) is a frequent complication of heart failure (HF) and is a heterogeneous phenotypic disorder that worsens exercise capacity, increases risk for hospitalization and survival independent of left ventricular ejection fraction (LVEF) or stage of HF. Areas covered: In this review, an update of the current knowledge and some potential challenges about the pathophysiology and treatments of group 2 PH in patients with HF of either preserved or reduced ejection fraction are provided. Also, this review discus...
Source: Expert Review of Cardiovascular Therapy - May 22, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Medication taking behaviors in patients taking warfarin versus direct oral anticoagulants: A systematic review.
This article aims to compare medication adherence and persistence between warfarin and direct oral anticoagulants (DOACs) and identify reported adherence barriers. As with other chronic illness, medication nonadherence continues to be a problem and appropriate adherence to long-term anticoagulation therapy is needed to improve patient health outcomes and to reduce health expenditure associated with hospitalizations and emergency visits. Areas covered: Warfarin and DOACs such as apixaban, rivaroxaban, edoxaban, and dabigatran have demonstrated effectiveness in the management of atrial fibrillation (AF), deep vein thrombosis...
Source: Expert Review of Cardiovascular Therapy - May 19, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Percutaneous or surgical revascularization for left main stem disease: NOBLE ideas, but do they EXCEL?
This article aims to summarise the key findings of the landmark clinical trials on LMS revascularization and the recently published ESC/EACTS guidelines on myocardial revascularization related to LMS disease. Expert opinion: It is unlikely that there will be a further large randomized trial aimed at addressing the issue of the optimum method of revascularization for LMS disease. Both PCI and CABG are reasonable revascularization options for appropriately selected patients with LMS disease. 'Heart Team' approach is vital to guide the management of patients with LMS disease, when there is obvious clinical equipoise and a man...
Source: Expert Review of Cardiovascular Therapy - May 17, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Proton pump inhibitor-induced hypomagnesemia complicated with serious cardiac arrhythmias.
Authors: Chrysant SG Abstract INTRODUCTION: Magnesium is the 3rd most common intracellular ion after potassium and calcium and is an important element in the functions of the body, since it participates in more than 300 enzyme systems. It also, plays a significant role in the transport of calcium and potassium across the cell membranes and protects against cardiac arrhythmias and is useful for their treatment due to hypomagnesemia induced from the proton pump inhibitors (PPIs). Areas covered: PPIs are used for the treatment of peptic ulcer disease (PUD) and gastroesophageal efflux disease (GERD), but have been asso...
Source: Expert Review of Cardiovascular Therapy - May 17, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Liraglutide for the prevention of major adverse cardiovascular events in diabetic patients.
Authors: Madsbad S Abstract INTRODUCTION: The GLP-1 receptor agonist (GLP-1 RA) liraglutide has a half-life of approximately 13 h and is suitable for subcutaneous administration once daily. The use of liraglutide in people with type 2 diabetes has become popular because of the efficacy and durability in relation to glycemic control in combination with weight loss in most patients. Areas covered: PubMed searches were completed using the terms "GLP-1 receptor agonist", "Liraglutide", "Liraglutide and CVD", "Liraglutide and CVD risk factors". The reference list of articles subse...
Source: Expert Review of Cardiovascular Therapy - May 7, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Pro-inflammatory and pro-resolving mechanisms in the immunopathology of arteriovenous fistula maturation.
Authors: Satish M, Gunasekar P, Agrawal DK Abstract INTRODUCTION: With high rates of arteriovenous fistula (AVF) failure, there is a continued need to predict other factors and mechanisms associated with maturation deficits. Given the central association of inflammation with AVF failure, with neointimal hyperplasia (NIH) as one such mechanism, inflammation must be considered in two endogenous ways, either pro-inflammatory or pro-resolving, resulting in inward or outward vascular remodeling. Areas covered: This review summarizes and critically evaluates the preclinical and interventional data underlying AVF failure ...
Source: Expert Review of Cardiovascular Therapy - May 7, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Deployment of acute mechanical circulatory support devices via the axillary artery.
Authors: Tayal R, Hirst CS, Garg A, Kapur NK Abstract INTRODUCTION: Use of acute mechanical circulatory support (MCS) devices for high-risk cardiac intervention, cardiogenic shock, and advanced heart failure is growing. Alternate vascular access options for these devices remains a clinical challenge. Building on experience from trans-aortic valve replacement procedures, the axillary artery is becoming a common access route for acute MCS and represents an important advance in the development of acute MCS technologies. Areas covered: Authors review the clinical data and technical aspect of acute MCS deployment via th...
Source: Expert Review of Cardiovascular Therapy - April 24, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Cardiac arrhythmias secondary to hormone therapy in trans women.
Authors: Wamboldt R, Haseeb S, Waddington A, Baranchuk A Abstract INTRODUCTION: With greater social acceptance and the evolution of transgender medicine as a specialty, more trans women are seeking hormone therapy (HT). Several studies have identified an increase in cardiovascular disease in trans women, however no studies have investigated the incidence of arrhythmias. Using two cases from the authors' clinic as examples, we propose that hormone therapy in trans women may increase the risk of cardiac arrhythmias. Areas covered: A literature search of sex hormones and cardiac arrhythmias was conducted. Using sex ho...
Source: Expert Review of Cardiovascular Therapy - April 17, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Spontaneous coronary artery dissection: a review of complications and management strategies.
Authors: Gilhofer TS, Saw J Abstract INTRODUCTION: Spontaneous coronary artery dissection (SCAD) accounts for up to 4% of acute coronary syndromes (ACS) on coronary angiography and predominantly affects women (>90%). SCAD most often occurs in patients with few or no conventional cardiovascular risk factors. This condition remains underdiagnosed due to a lack of awareness among health-care providers and misdiagnosis on coronary angiography. Areas covered: In this review, authors aim to summarize contemporary data on the etiology, morbidity and mortality risks, as well as management strategies in order to raise aw...
Source: Expert Review of Cardiovascular Therapy - April 10, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Transcatheter aortic valve replacement and cardiac conduction.
Authors: Shreenivas S, Schloss E, Choo J, Sarembock I, Lilly S, Kereiakes D Abstract INTRODUCTION: Conduction abnormalities after Transcatheter aortic valve replacement (TAVR) account for a high percentage of post TAVR complications. Areas covered: The etiology of conduction abnormalities is closely tied to cardiac anatomy (length of membranous septum, degree of calcification, location of left bundle within the membranous septum), baseline conduction abnormalities (pre-procedure right bundle branch block), and procedural variables (type of valve, depth of implant). Management of new high-grade AV block and new left...
Source: Expert Review of Cardiovascular Therapy - March 28, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

To test, or not to test: that is the question for the future of lipoprotein(a).
Authors: Ellis KL, Chakraborty A, Moses EK, Watts GF Abstract INTRODUCTION: Lipoprotein(a) [Lp(a)] is a potent, highly heritable and common risk factor for atherosclerotic cardiovascular disease (ASCVD). Evidence for a causal association between elevated Lp(a) and ASCVD has been provided by large epidemiological investigations that have demonstrated a curvilinear association with increased risk, as well as from genetic examinations and cellular and transgenic animal studies. Although there are several therapies available for lowering Lp(a), none are selective for Lp(a) and there is no clinical trial data that has s...
Source: Expert Review of Cardiovascular Therapy - March 28, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Utility of the cold pressor test to predict future cardiovascular events.
The objective of this review is to give an overview of the history and methodology of the CPT, and clinical utility in possibly predicting CV evens in CAD and other atherosclerotic disease. Secondly we will discuss possible future applications of the CPT in clinical care. Expert Opinion: An important issue to address is the fact that the physiology of the CPT is not fully understood at this moment. As pointed out multiple mechanisms might be responsible for contributing to either coronary vasodilatation or coronary vasoconstriction. Regarding the physiological mechanism of the CPT and its effect on the measurements of the ...
Source: Expert Review of Cardiovascular Therapy - March 28, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Developing a disease management program for the improvement of heart failure outcomes: the do's and the don'ts.
Authors: Healy L, Ledwidge M, Gallagher J, Watson C, McDonald K Abstract INTRODUCTION: Heart failure is a highly prevalent condition affecting approximately 2% of people worldwide. Heart failure disease management programmes (DMP) have shown a reduction in mortality and reduced hospitalisation and are an established part of clinical guidelines, however their presence is not widespread. Focusing on application of proven therapies, patient education, diagnosis with work up of cause and easy access for clinical deterioration should be fundamental to the structure of the DMP. Multidisciplinary team care with early and ...
Source: Expert Review of Cardiovascular Therapy - March 28, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Edoxaban for the prevention of stroke in patients with atrial fibrillation.
Authors: Cervantes CE, Merino JL, Barrios V Abstract INTRODUCTION: Edoxaban is the last direct oral anticoagulant marketed for the prevention of stroke among patients with nonvalvular atrial fibrillation (AF). Areas covered: ENGAGE AF-TIMI 48 was the pivotal clinical trial that led to the approval of edoxaban 60 mg once daily. After the publication of this study, a great number of substudies and post hoc analyses have been published, together with some observational studies. The aim of this review was to update the current evidence about the use of edoxaban in AF patients. Expert commentary: In the ENGAGE AF-TIMI 4...
Source: Expert Review of Cardiovascular Therapy - March 24, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Exercise and sports participation in patients with thoracic aortic disease: a review.
Authors: Thijssen CGE, Bons LR, Gökalp AL, van Kimmenade RRJ, Mokhles MM, Pelliccia A, Takkenberg JJM, Roos-Hesselink JW Abstract INTRODUCTION: Current guidelines recommend patients with thoracic aortic disease (TAD) including inherited aortopathies to avoid heavy exercise. However, evidence supporting the negative advice on exercise is scarce. We aimed to provide an up-to-date systematic review of the available evidence on risks and benefits of exercise and sports participation in TAD patients. Areas covered: A systematic search was performed in Medline, Embase and Web of Science: thoracic aortic aneurysm or ...
Source: Expert Review of Cardiovascular Therapy - March 21, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Should all diabetic patients take statin therapy regardless of serum cholesterol level?
Authors: Khalil S, Khayyat S, Al-Khadra Y, Alraies MC PMID: 30856356 [PubMed - as supplied by publisher] (Source: Expert Review of Cardiovascular Therapy)
Source: Expert Review of Cardiovascular Therapy - March 13, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Intracardiac multimorbidity: assessing right ventricular function in left-sided heart failure through cardiopulmonary exercise testing.
Authors: Arena R, Ozemek C PMID: 30786791 [PubMed - as supplied by publisher] (Source: Expert Review of Cardiovascular Therapy)
Source: Expert Review of Cardiovascular Therapy - February 24, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Interaction of obesity and atrial fibrillation: an overview of pathophysiology and clinical management.
Authors: Pouwels S, Topal B, Knook MT, Celik A, Sundbom M, Ribeiro R, Parmar C, Ugale S Abstract INTRODUCTION: Obesity, defined as a Body Mass Index (BMI) of ≥30 kg/m2, is the most common chronic metabolic disease worldwide and its prevalence has been strongly increasing. Obesity is associated with various diseases such as cardiovascular disease, type 2 diabetes and hypertension. Regarding heart rhythm disorders, obesity is associated with an increase in atrial fibrillation (AF), the most common arrhythmia in clinical practice. AF is associated with an increased cardiovascular morbidity and mortality. Obesity, a...
Source: Expert Review of Cardiovascular Therapy - February 15, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

eHealth to improve patient outcome in rehabilitating myocardial infarction patients.
Authors: Verburg A, Selder JL, Schalij MJ, Schuuring MJ, Treskes RW Abstract INTRODUCTION: Cardiac rehabilitation is aimed at risk factor modification and improving quality of life. eHealth has a couple of potential benefits to improve this aim. The primary purpose of this review is to summarize available literature for eHealth strategies that have been investigated in randomized controlled trials in post-myocardial infarction (MI) patients. The second purpose of this review is to investigate the clinical effectiveness in post-MI patients. Areas covered: The literature was searched using PubMed. Randomized controll...
Source: Expert Review of Cardiovascular Therapy - February 10, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

The link between anemia and adverse outcomes in patients with acute coronary syndrome.
Authors: Guedeney P, Sorrentino S, Claessen B, Mehran R Abstract INTRODUCTION: Anemia is one of the most frequent comorbidities in acute coronary syndrome (ACS) patients and is associated with a significant impact on clinical outcomes. This review summarizes the knowledge and updated management of anemia in the setting of ACS. Areas covered: We provide a review on the prevalence, pathophysiology, prognosis, impact, and updated management of anemia. Expert opinion: Patients with anemia represent a therapeutic challenge in the setting of acute coronary syndrome and require specific acute and chronic management. Despi...
Source: Expert Review of Cardiovascular Therapy - February 5, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Update on Bay ├ęs' syndrome: the association between interatrial block and supraventricular arrhythmias.
Update on Bayés' syndrome: the association between interatrial block and supraventricular arrhythmias. Expert Rev Cardiovasc Ther. 2019 Feb 04;: Authors: Seoane L, Cortés M, Conde D Abstract INTRODUCTION: The past few years have given rise to extensive research on interatrial block and its clinical relevance, mainly its association with supraventricular arrhythmias. In 2015, the authors of this article reviewed the Bayes syndrome for the first time and after three years there has been so much evidence accumulated that it seems reasonable to rewrite an update, based fundamentally on the ne...
Source: Expert Review of Cardiovascular Therapy - February 5, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Diagnosis and treatment of pediatric pulmonary arterial hypertension.
Authors: Farhat N, Lador F, Beghetti M Abstract INTRODUCTION: Paediatric pulmonary arterial hypertension (PAH) remains a rare and severe disease with a poor prognosis. PAH may be idiopathic, heritable or associated to systemic conditions in particular associated with congenital heart disease. Areas covered: A thorough and extensive diagnostic approach is required for a correct diagnosis. Outcome has improved over the last decade with a better diagnostic approach and with the initiation of new targeted therapies. However, there is still significant progress to achieve as there is still no cure for this devastating d...
Source: Expert Review of Cardiovascular Therapy - February 1, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Percutaneous pericardial access for electrophysiological studies in patients with prior cardiac surgery: approach and understanding the risks.
Authors: Killu AM, Asirvatham SJ Abstract INTRODUCTION: The number of procedures for which percutaneous pericardial access is used for has gradually increased since its initial description, and now includes mapping/ablation, atrial appendage ligation and pericardial biopsy. Areas covered: Successful percutaneous pericardial access is predicated on having a thorough understanding of regional anatomy, indications for attempting pericardial puncture and potential complications with appropriate management which are highlighted in this review. In addition, we will discuss the access technique itself, provide tips and pi...
Source: Expert Review of Cardiovascular Therapy - January 4, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Immunopathogenesis and biomarkers of recurrent atrial fibrillation following ablation therapy in patients with preexisting atrial fibrillation.
Authors: Rosenberg JH, Werner JH, Plitt GD, Noble VV, Spring JT, Stephens BA, Siddique A, Merritt-Genore HL, Moulton MJ, Agrawal DK Abstract INTRODUCTION: Recurrent atrial fibrillation (RAF) following ablation therapy occurs in about 50% of patients. The pathogenesis of RAF is unknown, but is believed to be driven by atrial remodeling in the setting of background inflammation. Structural, electrophysiological and mechanical remodeling has been associated with atrial fibrillation (AF). Inflammation and fibrotic remodeling are the major factors perpetuating AF, as mediators released from the atrial tissues and cardio...
Source: Expert Review of Cardiovascular Therapy - December 26, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Pro-resolving lipid mediators in the resolution of neointimal hyperplasia pathogenesis of in atherosclerotic diseases.
Authors: Satish M, Agrawal DK Abstract INTRODUCTION: Despite advances in drug eluting technologies, neointimal hyperplasia (NIH) and restenosis still plagues endovascular therapy in atherosclerotic diseases. By appreciating atherosclerosis and NIH as complex inflammatory processes, specialized pro-resolving mediators (SPMs) are a superfamily of endogenous unsaturated fatty-acid derived lipids with the potential for inflammatory resolution. Areas covered: Inquiry into SPMs in this context is a novel approach and is the focus of this review, with emphasis on our understanding with NIH. Prior mechanistic understanding...
Source: Expert Review of Cardiovascular Therapy - December 26, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Assessing and managing coronary microcirculation dysfunction in acute ST segment elevation myocardial infarction.
Authors: Armstrong R, De Maria GL, Scarsini R, Banning AP Abstract INTRODUCTION: Microvascular dysfunction in the setting of acute ST segment elevation myocardial infarction (STEMI) is an indicator of poor long-term prognosis. Prompt assessment and pharmacological or procedural therapy (prophylactic or post onset of dysfunction) may improve outcomes in STEMI post primary percutaneous intervention. Areas covered: The aim of this review is to provide a comprehensive analysis of the evidence available about the assessment and management of coronary microcirculatory injury/dysfunction in STEMI. We also aim to elucidate...
Source: Expert Review of Cardiovascular Therapy - December 22, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Gender differences in the clinical features and outcomes of patients with coronary artery disease.
Authors: Wada H, Miyauchi K, Daida H Abstract INTRODUCTION: Women have been at a higher risk for adverse cardiac events following percutaneous coronary intervention (PCI), compared with men. Areas covered: In this review, authors discuss the gender differences that can affect the clinical outcomes after PCI and the important points that can be improved on. Expert commentary: Various factors, such as old age and higher prevalence of comorbidities, have been considered to account for the worse clinical outcomes of PCI in women than in men. In addition, men and women have different presentations of angina or acute cor...
Source: Expert Review of Cardiovascular Therapy - December 22, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Rating of perceived exertion on resistance training in elderly subjects.
Authors: Morishita S, Tsubaki A, Nakamura M, Nashimoto S, Fu JB, Onishi H Abstract INTRODUCTION: The American College of Sports Medicine and American Heart Association recommends resistance training involving 60-70% of 1-repetition maximum (1RM) for 8-12 repetitions on 2 or 3 nonconsecutive days per week for the elderly. The Borg 6-20 scale, Borg category ratio (CR-10) scale, and OMNI scale are used to determine the rating of perceived exertion (RPE) for resistance training. Areas covered: RPE scales for resistance training performed by elderly individuals are described. The RPE has been related to resistance train...
Source: Expert Review of Cardiovascular Therapy - December 22, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Understanding left ventricular hypertrabeculation/noncompaction: pathomorphologic findings and prognostic impact of neuromuscular comorbidities.
Authors: Stöllberger C, Finsterer J Abstract INTRODUCTION: When>3 trabeculations associated with interventricular recesses are found, this is termed "left ventricular hypertrabeculation/noncompaction"(LVHT). Cardiac-imaging methods detect LVHT in all ages, isolated or associated with extracardiac, especially neuromuscular disorders(NMDs). Many issues about LVHT are unclear. The review gives an update about pathomorphologic findings in patients>14 years and the role of NMDs in LVHT. Areas covered: A PubMed-search for the terms "noncompaction" or "non-compaction" or "hype...
Source: Expert Review of Cardiovascular Therapy - December 22, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

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