Current Treatment Options In Cardiovascular Medicine[JOURNAL]
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200 papers
Percutaneous Coronary Intervention for Coronary Bifurcation Lesions: Latest Evidence.
Tan S, Ramzy J, Burgess S … +1 more , Zaman S
Curr Treat Options Cardiovasc Med · 2020 Feb · PMID 32034505 · Publisher ↗
PURPOSE OF REVIEW: This paper provides a synopsis of the best evidence to guide bifurcation percutaneous coronary intervention (PCI), with a focus on recent studies. This is with the aim of guiding the interventional car...
PURPOSE OF REVIEW: This paper provides a synopsis of the best evidence to guide bifurcation percutaneous coronary intervention (PCI), with a focus on recent studies. This is with the aim of guiding the interventional cardiologist in choosing the best, evidence-based technique, to treat commonly encountered coronary bifurcations. RECENT FINDINGS: Current evidence supports the use of provisional stenting for most anatomically suitable bifurcation lesions. Newer techniques for side branch protection in provisional stenting have been developed. When a two-stent strategy is required, use of a double-kissing crush technique is favoured, particularly in left main bifurcations. For bifurcation PCI, as in all complex procedures, intravascular imaging plays a key adjunctive role in improving procedural success. PCI for coronary bifurcation lesions is an ever-growing field with significant advancements in techniques and technology.
Cardiac Imaging in the Athlete: Shrinking the "Gray Zone".
Caruso MR, Garg L, Martinez MW
Curr Treat Options Cardiovasc Med · 2020 Feb · PMID 32016641 · Publisher ↗
PURPOSE OF THE REVIEW: This review will explore frequently encountered diagnostic challenges and summarize the role cardiac imaging plays in defining the boundaries of what constitutes the athlete's heart syndrome versus...
PURPOSE OF THE REVIEW: This review will explore frequently encountered diagnostic challenges and summarize the role cardiac imaging plays in defining the boundaries of what constitutes the athlete's heart syndrome versus pathology. RECENT FINDINGS: Investigations have predominantly focused on differentiating the athlete's heart from potentially lethal pathological conditions that may produce a similar cardiac morphology. Guidelines have identified criteria for identifying definitive pathology, but difficulty arises when individuals fall in the gray zone of expected athletic remodeling and pathology. Transthoracic echo has traditionally been the imaging modality of choice utilizing parameters such as wall thickness, wall:volume ratio, and certain diastolic parameters. Newer echocardiogram techniques such as strain imaging and speckle tracking have potential additive utility but still need further investigation. Cardiac magnetic resonance (CMR) imaging has emerged as an additive technique to help differentiate the phenotypic overlap between these groups. Utilizing gadolinium enhancement and T1 mapping along with its excellent spatial resolution can help distinguish pathology from physiology. Both established and novel cardiac imaging modalities have been used for uncovering the at risk athletes with cardiomyopathies. The issue is of practical importance because athletes are frequently referred to the cardiologist with symptoms of fatigue, palpitations, presyncope, and/or syncope concerned about the safety of their future participation. Imaging is a key component of risk stratification and identifying normal findings of the developed athlete and those "at-risk" athletes.
Mechanical Circulatory Support in Patients with Cardiogenic Shock.
Alkhouli M, Osman M, Elsisy MFA … +2 more , Kawsara A, Berzingi CO
Curr Treat Options Cardiovasc Med · 2020 Jan · PMID 31997019 · Publisher ↗
PURPOSE OF REVIEW: To provide a contemporary concise overview of the currently available mechanical circulatory support (MCS) devices and the emerging concepts in the management of cardiogenic shock (CS). RECENT FINDINGS...
PURPOSE OF REVIEW: To provide a contemporary concise overview of the currently available mechanical circulatory support (MCS) devices and the emerging concepts in the management of cardiogenic shock (CS). RECENT FINDINGS: New classification of CS has emerged and is hoped to allow a unified approach to research and clinical management of CS. A number of MCS devices have also become available for clinical use in the last 2 decades. Those devices have different hemodynamic targets, provide various levels of support, and are associated with specific requirements and potential complications. Data on the utility of MCS in CS remains conflicting with randomized trials showing no benefit of MCS, and observational data suggesting an incremental value for MCS over medical therapy. However, the early use and escalation of MCS in a standardized approach do appear to provide a remarkable improvement in short-term outcomes of patients with CS. MCS devices afforded lifesaving treatment for many patients with CS. However, optimal utilization of such devices requires familiarity with their clinical data, and technical characteristics, and mandates their integration in an algorithmic team-based approach to CS.
Creating a Multidisciplinary Pregnancy Heart Team.
Easter SR, Valente AM, Economy KE
Curr Treat Options Cardiovasc Med · 2020 Jan · PMID 31989331 · Publisher ↗
PURPOSE OF REVIEW: Cardiovascular disease (CVD) is the leading cause of maternal death and cases of cardiovascular death are often associated with failure to provide timely risk-appropriate care. This review outlines con...
PURPOSE OF REVIEW: Cardiovascular disease (CVD) is the leading cause of maternal death and cases of cardiovascular death are often associated with failure to provide timely risk-appropriate care. This review outlines considerations for creation of a team focused on the care of women with CVD during pregnancy and beyond. RECENT FINDINGS: Improved outcomes for women with complex medical or obstetric conditions managed by a multidisciplinary care team inspired national guidelines advising the creation of a Pregnancy Heart Team for women with CVD in pregnancy. The recommendations from the European Society of Cardiology provide general guidance for risk-appropriate care without elaborating on the details of these specialized care teams. A Pregnancy Heart Team led by providers from cardiology, maternal-fetal medicine, obstetrics, obstetric anesthesia, pharmacy, and nursing support a holistic approach to patient care while facilitating opportunities for cross-disciplinary education. This team should focus on frequent antepartum risk stratification, multidisciplinary delivery planning, and comprehensive preconception and postpartum care. Available evidence suggests that a consistent and integrated approach to care for women with CVD in pregnancy has the potential to decrease severe maternal morbidity and mortality. The cost-effectiveness of this approach and the impact of this comprehensive care model on a woman's long-term cardiovascular health warrant future study.
Distal Radial and Ulnar Arteries: the Alternative Forearm Access.
Parikh A, Jia KQ, Lall SK … +2 more , Shah RS, Gilchrist IC
Curr Treat Options Cardiovasc Med · 2020 Jan · PMID 31938936 · Publisher ↗
PURPOSE OF REVIEW: Radial artery access for catheter-based procedures has demonstrated improved margins of safety and patient comfort without a loss of efficacy compared with femoral access. Unfortunately, radial access...
PURPOSE OF REVIEW: Radial artery access for catheter-based procedures has demonstrated improved margins of safety and patient comfort without a loss of efficacy compared with femoral access. Unfortunately, radial access is not always available, so a review of the alternatives such as the ulnar artery and distal radial artery has been completed to understand alternative access sites that may preserve the benefits of distal forearm access without losing the efficacy of traditional transradial access. RECENT FINDINGS: Several different trials have demonstrated the utility of ulnar access as a possible workhorse access point. These suggest efficacy and safety, but inferior ease-of-access and more crossover than traditional radial access exists. Distal (dorsal) radial access has also been shown to have reasonable efficacy and offer some ergonomic advantages, but this comes at the price that 20-30% of all comers may not have a sufficiently large artery to use. Understanding the anatomy and techniques required to access the non-traditional, distal forearm arteries increases the skill set of operators. While neither the ulnar nor distal radial appears to substitute completely for radial access, both have potential applications that should be considered, and their utility should not be ignored.
Physiological Assessment of Coronary Lesions in 2020.
Chowdhury M, Osborn EA
Curr Treat Options Cardiovasc Med · 2020 Jan · PMID 31938934 · Full text
PURPOSE OF REVIEW: Physiological assessment of coronary artery disease (CAD) is an essential component of the interventional cardiology toolbox. However, despite long-term data demonstrating improved outcomes, physiology...
PURPOSE OF REVIEW: Physiological assessment of coronary artery disease (CAD) is an essential component of the interventional cardiology toolbox. However, despite long-term data demonstrating improved outcomes, physiology-guided percutaneous coronary intervention (PCI) remains underutilized in current practice. This review outlines the indications and technical aspects involved in evaluating coronary stenosis physiology, focusing on the latest developments in the field. RECENT FINDINGS: Beyond fractional flow reserve (FFR), non-hyperemic pressure ratios (NHPR) that assess coronary physiology at rest without hyperemia now abound. Additional advances in other alternative FFR approaches, including non-invasive coronary CT (FFR), invasive angiography (FFR), and optical coherence tomography (FFR), are being realized. Artificial intelligence algorithms and robust tools that enable detailed pre-procedure "virtual" intervention are also emerging. The benefits of coronary physiological assessment to determine lesion functional significance are well established. In addition to stable CAD, coronary physiology can be especially helpful in clinical scenarios such as left main and multivessel CAD, serial lesions, non-infarct-related arteries in acute coronary syndromes, and residual ischemia post-PCI. Today, coronary physiological assessment remains an indispensable tool in the catheterization laboratory, with an exciting technological future that will further refine clinical practice and improve patient care.
Abnormal ECG Findings in Athletes: Clinical Evaluation and Considerations.
Abela M, Sharma S
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31865466 · Publisher ↗
PURPOSE OF REVIEW: Pre-participation cardiovascular evaluation with electrocardiography is normal practice for most sporting bodies. Awareness about sudden cardiac death in athletes and recognizing how screening can help...
PURPOSE OF REVIEW: Pre-participation cardiovascular evaluation with electrocardiography is normal practice for most sporting bodies. Awareness about sudden cardiac death in athletes and recognizing how screening can help identify vulnerable athletes have empowered different sporting disciplines to invest in the wellbeing of their athletes. RECENT FINDINGS: Discerning physiological electrical alterations due to athletic training from those representing cardiac pathology may be challenging. The mode of investigation of affected athletes is dependent on the electrical anomaly and the disease(s) in question. This review will highlight specific pathological ECG patterns that warrant assessment and surveillance, together with an in-depth review of the recommended algorithm for evaluation.
Primary and Novel Lipid-Lowering Therapies to Reduce Risk in Patients With Peripheral Arterial Disease.
Chionchio A, Galmer A, Hirsh B
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31848747 · Publisher ↗
PURPOSE OF REVIEW: The diagnosis of peripheral arterial disease (PAD) is a high-risk marker for accelerated atherosclerotic cardiovascular disease (ASCVD) and is associated with substantial morbidity and mortality. In ad...
PURPOSE OF REVIEW: The diagnosis of peripheral arterial disease (PAD) is a high-risk marker for accelerated atherosclerotic cardiovascular disease (ASCVD) and is associated with substantial morbidity and mortality. In addition to common, modifiable cardiovascular disease risk factors that contribute to PAD, which include hypertension, diabetes mellitus, and smoking, an elevation in concentrations of serum atherogenic lipoproteins (lipids) is an increasingly recognized contributor to premature atherosclerosis. RECENT FINDINGS: The recognition and inclusion of PAD as a marker of higher-cardiovascular risk demonstrates the need to aggressively reduce elevations in atherogenic lipoproteins, particularly low-density-lipoprotein cholesterol. In addition to diet, lifestyle, and statin therapy, there is evidence that novel, pharmacologic lipid-lowering treatments improve specific outcomes in patients with PAD as primary and adjunctive therapy. In this review, we discuss the efficacy and evolving roles of statin and novel nonstatin therapies on outcomes in patients with PAD.
Management of Hyperlipidemia After Stroke.
Brooks DC, Schindler JL
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31840196 · Publisher ↗
PURPOSE OF REVIEW: Hyperlipidemia is a key therapeutic target for stroke risk modification. The goal of this review is to highlight available treatment options and review their efficacy in the setting of general cardiova...
PURPOSE OF REVIEW: Hyperlipidemia is a key therapeutic target for stroke risk modification. The goal of this review is to highlight available treatment options and review their efficacy in the setting of general cardiovascular disease and after most subtypes of ischemic stroke and hemorrhagic stroke. RECENT FINDINGS: Statins remain first-line in the management of hyperlipidemia to prevent stroke. In recent trials of patients with pre-existing atherosclerotic vascular disease, new agents, most notably PCSK9 inhibitors and ezetimibe, added additional stroke risk reduction when combined with statins. Risk of stroke can be significantly reduced by understanding that hyperlipidemia is a key therapeutic target, particularly in patients with cardiovascular disease, and by identifying patients who may benefit from aggressive LDL-C reduction with statins ± novel agents.
Digital Medicine and Evolution of Remote Patient Monitoring in Cardiac Electrophysiology: A State-of-the-Art Perspective.
Atreja A, Francis S, Kurra S … +1 more , Kabra R
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31832887 · Publisher ↗
PURPOSE OF REVIEW: With the evolution in digital medicine to identify and monitor cardiac electrophysiological (EP) conditions, increased access to cardiac implantable electronic devices (CIEDs), and reimbursements for n...
PURPOSE OF REVIEW: With the evolution in digital medicine to identify and monitor cardiac electrophysiological (EP) conditions, increased access to cardiac implantable electronic devices (CIEDs), and reimbursements for non-face-to-face care, remote patient monitoring (RPM) is becoming a key part of the EP service line. RPM of cardiac electrophysiological conditions including the use of CIEDs has improved the quality of care and high patient satisfaction and proved to be cost-effective. The focus of this review is literature on RPM in EP, evidence from randomized trials, and observational studies including those of Apple Watch and future of CIEDs. RECENT FINDINGS: RPM has progressed to use implantable devices and wearable technologies like sensors embedded in smartphones and apps. American College of Cardiology recently launched a digital transformation network to support digital navigation and RPM across different cardiovascular diseases. The information presented here can inform healthcare providers of the most widely implemented and effective forms of RPM for patients with chronic EP conditions.
The Evolving Role of Electrocardiography in Cardiac Resynchronization Therapy.
Noheria A, Sodhi S, Orme GJ
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31828564 · Publisher ↗
PURPOSE OF REVIEW: This study aims to summarize the literature on the role of electrocardiography (ECG) in (i) patient selection for cardiac resynchronization therapy (CRT), (ii) predicting clinical response after CRT sy...
PURPOSE OF REVIEW: This study aims to summarize the literature on the role of electrocardiography (ECG) in (i) patient selection for cardiac resynchronization therapy (CRT), (ii) predicting clinical response after CRT system is implanted, and (iii) optimizing CRT programming. RECENT FINDINGS: Progress has been made in interpreting ECG beyond QRS duration and left bundle branch (LBBB) morphology to select patients for CRT. We now understand a higher chance of response to CRT in patients with atypical right bundle branch block and lower response rates in subgroups with atypical LBBB. QRS area has emerged as a novel marker to quantify baseline electrical dyssynchrony to improve patient selection. After CRT, the resultant QRS narrowing remains the most validated predictor of long-term favorable outcome. There is increasing awareness of prolonged left ventricular pacing latency hindering the desired response to CRT. There is active interest in using ECG beyond minimizing QRS duration to optimize CRT programming for maximal resynchronization. Novel strategies include fusion of paced and/or conducted wavefronts and minimization of paced QRS area. ECG remains the ubiquitous method for ventricular electrical mapping in context of CRT. The role of ECG in elucidating baseline electrical dyssynchrony to aptly select patients for this treatment continues to evolve, and ECG is increasingly being evaluated as a reliable endpoint for optimal CRT programming.
Endovascular Treatment of Acute Ischemic Stroke.
Maingard J, Foo M, Chandra RV … +1 more , Leslie-Mazwi TM
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31823080 · Publisher ↗
PURPOSE OF REVIEW: Endovascular thrombectomy (ET), the standard of treatment for emergent large vessel occlusion (ELVO) strokes, has been subject to rigorous efforts to further improve its usage and delivery for optimise...
PURPOSE OF REVIEW: Endovascular thrombectomy (ET), the standard of treatment for emergent large vessel occlusion (ELVO) strokes, has been subject to rigorous efforts to further improve its usage and delivery for optimised patient outcomes. This review aims to provide an outline and discussion about the recently established and emerging recommendations regarding endovascular treatment of stroke. RECENT FINDINGS: The indications for ET have expanded continually, with perfusion imaging now enabling selection of patients presenting 6-24 h after last-known-well, and improved device and operator proficiency allowing treatment of M2-MCA occlusions and tandem occlusions. Further inclusion of paediatric patients and patients with larger infarct core or milder stroke symptoms for ET has been proposed; however, this remains unproven. This growing applicability is supported by more efficient systems of care, employing modern techniques such as telemedicine, mobile stroke units and helicopter medical services. Ongoing debate exists regarding thrombolytic agent, thrombectomy technique, anaesthesia method and the role of advanced neuroimaging, with upcoming RCTs expected to provide clarification. The journey to further improving the efficacy of ET has advanced and diversified rapidly over recent years, involving improved patient selection, increased utility of advanced neuroimaging and ongoing device redevelopment, within the setting of more efficient, streamlined systems of care. This dynamic and ongoing influx of evidence-based refinements is key to further optimising outcomes for ELVO patients.
Antithrombotic Management After Intracranial Hemorrhage.
Cajavilca CE, Hooper D, Imran R … +1 more , Gadhia RR
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31823078 · Publisher ↗
PURPOSE OF REVIEW: Intracranial hemorrhage remains one of the most feared acute neurological emergencies. However, apart from the acute management, secondary risk factor management and prevention of ischemic events remai...
PURPOSE OF REVIEW: Intracranial hemorrhage remains one of the most feared acute neurological emergencies. However, apart from the acute management, secondary risk factor management and prevention of ischemic events remains ambiguous. We present a thorough review of the current data available regarding management of antithrombotics after intracranial hemorrhage. RECENT FINDINGS: The most robust evidence comes from the investigators of the RESTART trial which reassured the safety of resuming antiplatelet therapy after ICH, namely in patients with prior indication and treatment with antithrombotics. We conclude that based on available data, the risk of recurrent ICH is probably too small to exceed the found benefits of antiplatelet therapy in the secondary prevention of ischemic vascular disease.
Coronary Atherosclerosis in Masters Athletes: Mechanisms and Implications for Cardiovascular Disease Risk.
Fernandez AB, Chaudhry W, Thompson PD
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31823073 · Publisher ↗
PURPOSE OF REVIEW: This manuscript reviews the data on the mechanisms and significance of atherosclerotic cardiovascular disease (ASCVD) in masters athletes. It describes recent advances in understanding the biological p...
PURPOSE OF REVIEW: This manuscript reviews the data on the mechanisms and significance of atherosclerotic cardiovascular disease (ASCVD) in masters athletes. It describes recent advances in understanding the biological pathway for the development and progression of ASCVD in athletes. It also reviews salient clinical trials, guidelines on managing ASCVD in masters athletes, and future research directions. RECENT FINDINGS: Recent data have produced controversy as to whether high levels of physical activity and endurance training can promote ASCVD. Longstanding, vigorous endurance exercise may increase the development of calcified and non-calcified coronary plaques. There are no clinical trials to inform clinicians on how to manage masters athletes with occult ASCVD. We provide a review of the data on ASCVD in older athletes, the risks and benefits of exercise in active individuals with ASCVD, and our approach to evaluating and managing these patients. Vigorous physical exertion transiently increases the risk of acute coronary syndrome (ACS) and sudden cardiac death in patients with ASCVD. New research has demonstrated increases in both calcified and non-calcified plaque in athletes, although the dominant plaque type is usually calcific. The mechanisms mediating this possible increase in atherosclerosis in active individuals is uncertain, as is the prognostic implications of the increased atherosclerosis. The predominance of calcified plaque may indicate that coronary plaques in athletes are less prone to rupture and to produce acute coronary events. Some guidelines offer recommendations on the management of non-athletic patients with elevated CAC but data on athletes is scarce. Until additional studies are available, we suggest that athletes with CAC values > 100 Agatston units be managed as if they have preclinical ASCVD. They should be informed of the symptoms of angina and ACS and the importance of prompt medical attention should such symptoms occur. Serum calcium and parathyroid hormones levels should be measured to exclude hyperparathyroidism. Patients should undergo symptom-limited maximal exercise stress testing and aggressive lipid treatment to achieve low-density lipoprotein cholesterol (LDL-C) values < 70 mg/dl.
The Demystification of Secondary Hypertension: Diagnostic Strategies and Treatment Algorithms.
Hirsch JS, Hong S
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31823067 · Publisher ↗
PURPOSE OF REVIEW: Hypertension is one of the most common conditions encountered in the primary care setting, affecting 32-46% of people. While essential or primary hypertension is the most common form of the disease, se...
PURPOSE OF REVIEW: Hypertension is one of the most common conditions encountered in the primary care setting, affecting 32-46% of people. While essential or primary hypertension is the most common form of the disease, secondary hypertension is quite prevalent, occurring in 10-20% of patients with hypertension. Accurately diagnosing secondary hypertension is a challenging and often time-consuming process that requires considerable expertise and effort. However, once the secondary etiology is identified, the patient benefits profoundly from a potentially curative treatment that may lead to significant improvements in quality of life, morbidity, and mortality. RECENT FINDINGS: Common causes of secondary hypertension include medication-induced hypertension, renal parenchymal disease, renovascular hypertension, obstructive sleep apnea, and primary aldosteronism. Other rarer forms include mineralocorticoid-driven hypertension or its mimics, as well as hypercortisolism and pheochromocytoma. Although complex, standard protocols have emerged for investigation, diagnosis, and treatment of these conditions. The current review aims to elucidate the many causes of secondary hypertension and describe their respective prevalence, clinical presentation, screening, diagnosis, treatment, and follow-up. By demystifying secondary hypertension, it is hoped that this disease will be more easily identified and treated so that the associated cardiovascular morbidity and end-organ damage may be mitigated.
Importance of the Cardio-Obstetrics Team.
Grodzinsky A, Florio K, Spertus JA … +11 more , Daming T, Lee J, Rader V, Nelson L, Gray R, White D, Swearingen K, Thomas M, Singh A, Magalski A, Schmidt L
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31820201 · Publisher ↗
PURPOSE: In the USA, maternal mortality has been rising since the 1980s. Cardiovascular disease is recognized as the leading cause of this worrisome trend, and a multidisciplinary approach to the care of patients with ca...
PURPOSE: In the USA, maternal mortality has been rising since the 1980s. Cardiovascular disease is recognized as the leading cause of this worrisome trend, and a multidisciplinary approach to the care of patients with cardiovascular conditions during pregnancy is becoming increasingly important. We outline the literature supporting this multidisciplinary approach, highlight our center's experience in building and expanding an integrated cardio-obstetrics practice, and provide guidance regarding patient selection and management within a combined practice. Antenatal management patterns and delivery planning for patients with cardiovascular disease during pregnancy vary substantially among cardiovascular and obstetric and maternal fetal medicine practices in the USA. The need for multidisciplinary care between cardiologists and obstetricians is evident and has been supported by best practice statements from the American Heart Association, the American College of Obstetrics and Gynecology, and the Cardiac Disease in Pregnancy Study (CARPREG) investigators, whose CARPREG II risk score included "late first antenatal visit" as a predictor of adverse outcomes of pregnancy. CONCLUSIONS: We have solid evidence supporting a multidisciplinary approach to the care of patients with cardiac conditions in pregnancy. This approach is optimal because it facilitates a consistent and clear message to the patient (and those caring for each patient) regarding management and risks associated with pregnancy, as well as subsequent risk and postpartum follow-up. We support the extension of clinical collaboration between obstetricians and cardiologists to the research realm and know that working together to investigate the outcomes of moms with heart conditions and their babies will provide clinically meaningful information to support the care of these unique patients.
Exercise Recommendations for the Athlete With Coronary Artery Disease.
Rao P, Shipon D
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31820188 · Publisher ↗
PURPOSE OF THE REVIEW: We provide a framework for formulating exercise prescriptions for those with CAD in order to achieve the "optimal" dose of exercise for each individual. RECENT FINDINGS: Multiple epidemiological st...
PURPOSE OF THE REVIEW: We provide a framework for formulating exercise prescriptions for those with CAD in order to achieve the "optimal" dose of exercise for each individual. RECENT FINDINGS: Multiple epidemiological studies demonstrate that exercise is inversely associated with atherosclerotic coronary artery disease (CAD), yet the risk of an acute coronary event is transiently elevated during vigorous exercise. In turn, CAD is the most common cause of exercise-related sudden cardiac death (SCD) in older athletes. When prescribing exercise recommendations for athletes with CAD, we should maintain equipoise between the benefits derived from sports participation and the risk of an adverse cardiac event. Athletes are not immune from atherosclerotic CAD, and we should perform risk assessments regardless of physical and athletic prowess. Cardiopulmonary exercise testing may be a useful tool to develop individualized exercise regimens for athletes with CAD.
Management of Asymptomatic Carotid Artery Stenosis.
Silverman S
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31820138 · Publisher ↗
PURPOSE OF REVIEW: The goal of this paper is to provide the reader with a review of the evidence supporting the surgical and medical management of patients with asymptomatic internal carotid artery (ICA) stenosis. RECENT...
PURPOSE OF REVIEW: The goal of this paper is to provide the reader with a review of the evidence supporting the surgical and medical management of patients with asymptomatic internal carotid artery (ICA) stenosis. RECENT FINDINGS: Based on the results of earlier clinical trials, surgical intervention with carotid endarterectomy (CEA) has long been the preferred method of management for patients with asymptomatic severe carotid stenosis. Carotid artery stenting (CAS) is another less invasive surgical option that has similar outcomes over the long-term. However, more recent improvements in medical management have reduced the risk of stroke in this population to comparable rates seen with CEA. As a result, medical management alone is advocated as well for patients with asymptomatic carotid stenosis. In addition to stenosis severity, there are a number of features of plaque morphology associated with vulnerable plaque that predict future stroke risk. Rates of stroke in patients with asymptomatic severe carotid stenosis with modern surgical techniques, CEA and CAS, are similar to modern medical therapy alone. Both surgery and medical therapy are good treatment options but it is not known which treatment is superior. The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2), an NIH-sponsored, multicenter, randomized trial that aims to answer this important management decision.
Role of Imaging for Suspected Cardiac Thrombus.
Whalen H, Dako F, Patel P … +4 more , Sahbaz J, Hong-Zohlman S, White CS, Jeudy J
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31820132 · Publisher ↗
PURPOSE OF REVIEW: Cardiac thrombus formation is a frequent complication of a variety of prevalent diseases. Embolism of cardiac thrombus has the potential to result in significant morbidity and mortality from cerebrovas...
PURPOSE OF REVIEW: Cardiac thrombus formation is a frequent complication of a variety of prevalent diseases. Embolism of cardiac thrombus has the potential to result in significant morbidity and mortality from cerebrovascular and peripheral vascular events. RECENT FINDINGS: Echocardiography is the most commonly used imaging modality for diagnosing intracardiac thrombus. However, technological advances in computed tomography and magnetic resonance imaging have allowed newer noninvasive modalities to evolve into robust tools for the clinical evaluation of patients suspected of disease. Complimentary use of these imaging techniques is crucial in the diagnosis of cardiac thrombus and initiation of anticoagulation therapy.
Managing Mitral Regurgitation in Heart Failure-Perspectives After COAPT.
Betz J, Lilly SM, Abraham WT
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31820126 · Publisher ↗
PURPOSE OF REVIEW: Functional mitral regurgitation (MR) in setting of cardiomyopathy causes significant morbidity and worsened survival. Surgical therapies have failed to demonstrate significant overall benefit for funct...
PURPOSE OF REVIEW: Functional mitral regurgitation (MR) in setting of cardiomyopathy causes significant morbidity and worsened survival. Surgical therapies have failed to demonstrate significant overall benefit for functional MR. More recently, major trials utilizing transcatheter therapies for functional MR have been completed and offer new avenues for intervention. This review evaluates and compares 2 major recent trials designed to test the benefit of edge-to-edge repair using the MitraClip system for severe functional MR. RECENT FINDINGS: The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) and Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation (MITRA-FR) trials were simultaneous trials evaluating the treatment of effect of MitraClip in the setting of severe functional mitral regurgitation. Results of the trials were quite different with COAPT demonstrating substantial clinical benefit including significantly improved survival compared with MITRA-FR in which no clinical benefit was derived. Key differences in the patient population between the COAPT and MITRA-FR trials help to explain the contrasting results between the 2 trials designed to test the same hypothesis. Patients in COAPT had higher severity of MR with less dilated ventricles compared with MITRA-FR. These results will help shape patient selection for who will most benefit from MitraClip therapy. Further transcather mitral valve therapies continue to evolve and will likely offer alternative therapies for MR as technology improves.
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