Current Treatment Options In Cardiovascular Medicine[JOURNAL]
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200 papers
Management of Heart Failure and Cardiogenic Shock in Pregnancy.
Sharma S, Thomas SS
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31820124 · Publisher ↗
PURPOSE OF REVIEW: While the prognosis of peripartum cardiomyopathy (PPCM) is generally more favorable than other cardiomyopathies, PPCM can be associated with cardiogenic shock and significant maternal morbidity in youn...
PURPOSE OF REVIEW: While the prognosis of peripartum cardiomyopathy (PPCM) is generally more favorable than other cardiomyopathies, PPCM can be associated with cardiogenic shock and significant maternal morbidity in young women. The management of a pregnant woman in cardiogenic shock necessitates consideration of harm to the fetus. This review focuses on the management of these women. RECENT FINDINGS: A number of advances have increased the repertoire of therapies available to manage PPCM. Increased understanding of PPCM pathophysiology has led to a number of new and experimental medications. In the current era, mechanical circulatory support has been gaining a stronger presence in critical care and can be used in cardiogenic shock of the pregnant patient refractory to medical therapy. We discuss medical therapies, mechanical circulatory support, arrhythmia management, and a delivery plan in the setting of cardiogenic shock secondary to PPCM.
Cardiovascular Disease Risk in Survivors of Breast Cancer.
Sharma AV, Reddin G, Forrestal B … +1 more , Barac A
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31820123 · Publisher ↗
PURPOSE OF REVIEW: Early detection and improved treatment in breast cancer have resulted in an increased number of survivors. Cardiovascular disease now remains an important cause for morbidity and mortality in this popu...
PURPOSE OF REVIEW: Early detection and improved treatment in breast cancer have resulted in an increased number of survivors. Cardiovascular disease now remains an important cause for morbidity and mortality in this population. There is a growing gap in the knowledge about the optimal long-term cardiovascular management of this population. FINDINGS: Breast cancer and cardiovascular disease share a number of common risk factors. Different breast cancer treatment modalities, including anthracyclines, radiation, and hormonal therapy, can act in synergy with preexisting and/or new cardiovascular risk factors to result in significant cardiovascular disease. We summarize the recent evidence about cardiovascular effects of breast cancer therapy and recommendations for their diagnosis and management during the cancer treatment continuum into survivorship. We also present current research initiatives and how they inform clinical care.
Racial Differences in Atrial Fibrillation Epidemiology, Management, and Outcomes.
Nanda A, Kabra R
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31820122 · Publisher ↗
PURPOSE OF THE REVIEW: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice and is associated with significant morbidity and healthcare cost. Most of the AF studies have predo...
PURPOSE OF THE REVIEW: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice and is associated with significant morbidity and healthcare cost. Most of the AF studies have predominantly included white population, with under-representation of minority population. In this review, we analyze the racial differences in epidemiology, disease awareness, risk factors, genetics, treatments, and outcomes of AF. RECENT FINDINGS: African Americans have a higher prevalence of established AF risk factors but lower incidence and prevalence of AF than non-Hispanic whites. There is also a significant racial and ethnic differences in the prevalence of AF-related symptoms and the detection and awareness of AF. Non-white patients are afforded decreased use of rhythm control treatment strategies and anticoagulation both with warfarin and NOACs for stroke prevention. They are less likely to receive catheter ablation (CA) of AF, compared with non-Hispanic whites. AF in the minority racial and ethnic groups carries increased morbidity and mortality compared with white groups, especially in the black individuals with AF, who have been shown to have a lower QoL compared with their white or Hispanic counterparts. Minorities experience stroke more frequently than the whites which is usually more severe and disabling. There are significant racial differences in AF risk factors, manifestations, management, and outcomes. Recognition of these differences will aid in developing better preventive and treatment strategies for AF to decrease morbidity and mortality. In addition, this knowledge will enhance our understanding regarding the pathophysiology of AF including genetic predisposition.
Antithrombotic Management of Ischemic Stroke.
Sloane KL, Camargo EC
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31792720 · Publisher ↗
PURPOSE OF REVIEW: Ischemic stroke describes a condition in which inadequate blood flow leads to lack of oxygenation to the brain tissue and ensuing neuronal death. There are multiple causes of ischemic stroke, each of w...
PURPOSE OF REVIEW: Ischemic stroke describes a condition in which inadequate blood flow leads to lack of oxygenation to the brain tissue and ensuing neuronal death. There are multiple causes of ischemic stroke, each of which may indicate different antithrombotic management strategies. The goal of this review is to provide information about antithrombotic therapies for secondary stroke prevention based on etiology of stroke. RECENT FINDINGS: New studies of existing antiplatelet and antithrombotic therapies have demonstrated varied efficacies of treatments based on the underlying risk factor of ischemic stroke. Understanding the optimal therapies for secondary stroke prevention can enhance care of stroke patients and lower the incidence of recurrent cerebrovascular ischemia.
Cryptogenic Stroke: Diagnostic Workup and Management.
Mac Grory B, Flood SP, Apostolidou E … +1 more , Yaghi S
Curr Treat Options Cardiovasc Med · 2019 Dec · PMID 31792625 · Publisher ↗
PURPOSE OF REVIEW: Cryptogenic stroke describes a subset of ischemic stroke for which no cause can be found despite a structured investigation. There are a number of putative mechanisms of cryptogenic ischemic stroke inc...
PURPOSE OF REVIEW: Cryptogenic stroke describes a subset of ischemic stroke for which no cause can be found despite a structured investigation. There are a number of putative mechanisms of cryptogenic ischemic stroke including a covert structural cardiac lesion, paroxysmal atrial fibrillation, hypercoagulable state or undiagnosed malignancy. Because many of these proposed mechanisms are embolic - and based on studies of thrombus history showing commonalities between thrombus composition between cardioembolic and cryptogenic strokes - the concept of embolic stroke of undetermined source (ESUS) (Hart et al. Lancet Neurol. 13(4):429-38, 2014; Stroke. 48(4):867-72, 2017) has been proposed to describe cryptogenic strokes that may warrant systemic anticoagulation. In this review, we discuss the phenomena of cryptogenic stroke, ESUS and a proposed management pathway. RECENT FINDINGS: 1. The concept of ESUS was proposed in 2014 as a potentially useful therapeutic entity. Two recent trials - NAVIGATE-ESUS (Hart et al. N Engl J Med. 378(23):2191-201, 2018) and RESPECT-ESUS (Diener 2018) were proposed based on this concept. They were negative for their primary endpoint and for the secondary endpoint of ischemic stroke recurrence. Post-hoc analysis of the WARSS trial (Longstreth et al. Stroke. 44(3):714-9, 2013) suggested that people with elevated pro-BNP benefited from systemic anticoagulation whereas those with a normal pro-BNP did not. This led to the hypothesis that a subgroup of patients at higher risk for embolism from the left atrium would benefit from anticoagulation, even if the WARSS trial was negative for the primary endpoint. Thus, the ARCADIA trial (Kamel et al. Int J Stroke. 14(2):207-14, 2019) was proposed - a randomized, active-control, multi-center trial comparing apixaban with aspirin for secondary stroke prevention in patients with ESUS and biomarkers of left atrial cardiopathy. This trial is actively recruiting. 2. Carotid web - an intimal form of fibromuscular dysplasia - has come to increased prominence in the literature as a cause of embolic stroke. It is a non-stenosis, non-atherosclerotic lesion in the posterior wall of the internal carotid artery that leads to pooling with stasis of blood distal to the lesion and, as a consequence, embolic stroke. It is not usually detected by a standard stroke workup as it masquerades as non-calcified atherosclerosis and does not cause hemodynamically significant stenosis. There have been two major recent papers - a meta-analysis in Stroke (Zhang et al. Stroke. 49(12):2872-6, 2018) and narrative review in JAMA Neurology (Kim et al. JAMA Neurol. 2018) - that addressed this topic. Cryptogenic stroke describes a stroke for which no cause has been found. ESUS is a more precisely-defined entity that mandates a specific workup and implicates remote embolism as a cause of stroke. In ESUS, the options for further investigation include long-term cardiac monitoring, transesophageal echocardiography, investigation for occult malignancy or arterial hypercoagulability. Options for management include anti-platelet therapy (the current standard of care), empiric anticoagulation or enrollment in to a clinical trial examining the use of NOACs compared with aspirin for secondary prevention (such as ARCADIA or ATTICUS). In a person less than 60 years old with ESUS and a patent foramen ovale the risk of a recurrent stroke is low but recent trials have suggested that percutaneous device closure reduces this risk further with an acceptable complication rate.
Update in the Evaluation and Management of Perioperative Stroke.
Jayaraman DK, Mehla S, Joshi S … +2 more , Rajasekaran D, Goddeau RP
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31773401 · Publisher ↗
PURPOSE OF REVIEW: This review will review the current knowledge and gaps in the literature on the relationship between surgery and ischemic stroke. FINDINGS: Surgery and ischemic stroke are interrelated phenomena as sur...
PURPOSE OF REVIEW: This review will review the current knowledge and gaps in the literature on the relationship between surgery and ischemic stroke. FINDINGS: Surgery and ischemic stroke are interrelated phenomena as surgery is an independent risk factor for stroke and perioperative stroke increases morbidity and mortality leading to poor outcomes after surgery. This relationship and the risk of adverse outcome apply not only the clinically apparent stroke in the perioperative period but also clinically silent brain infarction detected only on radiological studies. The risk of perioperative stroke depends on several factors including (i) patient-related factors (age, history of prior stroke, and other comorbidities), (ii) procedure-related factors (type of surgery/procedure, use of cardiopulmonary bypass, antiplatelet/antithrombotic interruption, and metabolic derangement), and (iii) perioperative atrial fibrillation. With observation and retrospective data, the literature is limited to prevention and management of perioperative stroke.
Advances in MRI Applications to Diagnose and Manage Cardiomyopathies.
Vajapey R, Eck B, Tang W … +1 more , Kwon DH
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31773390 · Publisher ↗
PURPOSE OF REVIEW: The prevalence of heart failure continues to rise, and imaging characterization of the cardiomyopathic process is important for identifying myocardial disease, initiating appropriate treatment, and imp...
PURPOSE OF REVIEW: The prevalence of heart failure continues to rise, and imaging characterization of the cardiomyopathic process is important for identifying myocardial disease, initiating appropriate treatment, and improving outcomes. We aimed to summarize recent advances in cardiac magnetic resonance imaging (CMR) applications for the diagnosis, characterization, and implications on management of various cardiomyopathies. RECENT FINDINGS: Parametric mapping by CMR has emerged as an important advancement in quantification of myocardial fibrosis, increased extracellular space, and myocardial edema. In addition, improved assessment of myocardial function with myocardial strain assessment may provide early identification of patients at risk and determining responsiveness to therapeutic interventions. Novel MRI techniques and the advent of artificial intelligence may help to uncover important mechanistic insights into the cardiomyopathic process. Innovative CMR techniques continue to evolve, and it will be of interest to determine how these advances can be incorporated into clinical practice to improve diagnosis, treatment, and management of patients with cardiomyopathies.
Ventricular Arrhythmias in Patients With Left Ventricular Assist Device (LVAD).
Ahmed A, Amin M, Boilson BA … +2 more , Killu AM, Madhavan M
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31773322 · Publisher ↗
PURPOSE OF REVIEW: Left ventricular assist device (LVAD) implantation is a well-known treatment option for patients with advanced heart failure refractory to medical therapy and is recognized both as bridge to transplant...
PURPOSE OF REVIEW: Left ventricular assist device (LVAD) implantation is a well-known treatment option for patients with advanced heart failure refractory to medical therapy and is recognized both as bridge to transplant and a destination therapy. The risk of ventricular arrhythmias (VAs) is common after LVAD implantation. We review the pathophysiology and recent advances in the management of VA in LVAD patients. RECENT FINDINGS: VAs are most likely to occur in the early post-operative periods after LVAD implantation and a prior history of VA is the most important risk factor. Post-LVAD VAs are usually well tolerated with less morbidity and decreased risk of sudden cardiac death. However, risk of right heart failure in the setting of persistent VAs is being increasingly recognized. The mechanisms of post-LVAD VAs may vary depending on the time from LVAD implantation. Electrical remodeling may play an important role in the immediate post-implant phase. Preexisting myocardial scar and to a lesser extent mechanical irritation from the LVAD cannula are important in the later phases. Most LVAD patients have a previously placed implantable cardioverter-defibrillator (ICD). The benefit of implanting a new ICD in LVAD patients is unknown and should be individualized. For ICD programming, a conservative strategy with higher detection zones and prolonged time to detection is usually recommended aiming to minimize ICD shocks. More aggressive programming is appropriate if the VA results in hemodynamic instability. Antiarrhythmic drugs including amiodarone, mexiletine, and beta blockers are usually the first-line therapy for VAs. Catheter ablation has been shown to be safe and effective in LVAD recipients with recurrent VAs not responsive to antiarrhythmic drugs. LVAD-related VA is most frequently reentrant secondary to myocardial scar and usually well tolerated. Management options include antiarrhythmic drugs and catheter ablation.
Management of Maternal Stroke and Mitigating Risk.
Kozberg MG, Camargo EC
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31754878 · Publisher ↗
PURPOSE OF REVIEW: Pregnancy places women at a higher risk for hemorrhagic and ischemic strokes. This review discusses the pathophysiological mechanisms underlying this increased risk, management considerations for pregn...
PURPOSE OF REVIEW: Pregnancy places women at a higher risk for hemorrhagic and ischemic strokes. This review discusses the pathophysiological mechanisms underlying this increased risk, management considerations for pregnant patients, and ways to decrease the risk of stroke in this patient population. RECENT FINDINGS: Rates of ischemic and hemorrhagic pregnancy-associated stroke have increased over the past 20 years, particularly events associated with hypertensive disorders of pregnancy. There is a growing body of evidence supporting the use of acute reperfusion therapies in ischemic pregnancy-associated stroke including tissue plasminogen activator (tPA) and endovascular thrombectomy. While the unique physiology of pregnancy places women at a higher risk of stroke, acute ischemic stroke management in pregnant patients should closely mirror the management of non-pregnant patients. Secondary stroke prevention agents should be selected with consideration of the pregnancy.
Management of the Cardiovascular Complications of Substance Use Disorders During Pregnancy.
Edelson PK, Bernstein SN
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31754867 · Publisher ↗
PURPOSE OF REVIEW: Substance use disorder in pregnancy and subsequent cardiovascular complications are on the rise in the USA. The care of pregnant women with substance use disorder is complex, and requires a thorough un...
PURPOSE OF REVIEW: Substance use disorder in pregnancy and subsequent cardiovascular complications are on the rise in the USA. The care of pregnant women with substance use disorder is complex, and requires a thorough understanding of mechanisms of action, pathophysiology, and cardiovascular response during pregnancy. The goal of this review is to provide information about the most common drugs of abuse in pregnancy and to recommend management guidelines. RECENT FINDINGS: Pregnant women with substance use disorder are at increased risk of significant cardiovascular complications, both as a direct effect of acute intoxication as well as the secondary risk from infection and cardiotoxicity associated with chronic use. This risk must be considered in the antepartum management, delivery, and postpartum periods. Understanding the increased cardiovascular risk of pregnant women with substance use disorder, as well as specific drug interactions, anesthesia considerations, best practices, and management considerations, is important for all clinicians caring for this population.
The Use of Echocardiography and Advanced Cardiac Ultrasonography During Pregnancy.
O'Kelly AC, Sharma G, Vaught AJ … +1 more , Zakaria S
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31754837 · Full text
PURPOSE OF REVIEW: Pregnancy is a time of significant cardiovascular change. Echocardiography is the primary imaging modality used to assess cardiovascular anatomy and physiology during pregnancy. Both two-dimensional (2...
PURPOSE OF REVIEW: Pregnancy is a time of significant cardiovascular change. Echocardiography is the primary imaging modality used to assess cardiovascular anatomy and physiology during pregnancy. Both two-dimensional (2D) echocardiography and advanced cardiac ultrasound modalities play pivotal roles in identifying and monitoring these changes, especially in women with preexisting or new cardiac disease. This paper reviews the role of echocardiography and advanced cardiac ultrasound during normal pregnancy and pregnancy complicated by hypertensive disorders, valvular disorders, and cardiomyopathy. It also examines the role of echocardiography in guiding decisions about delivery. RECENT FINDINGS: The data establishing normal echo parameters during pregnancy are inconsistent. In addition, there is limited research exploring the role of advanced cardiac ultrasound modalities, such as tissue Doppler imaging or speckle tracking echocardiography, in assessing cardiac function during pregnancy. What data there are suggest that these advanced modalities can be used to identify subclinical changes before traditional echocardiography can, and thus have clear utility in identifying early abnormal cardiac responses to pregnancy. Echocardiography is the modality of choice for imaging the heart in pregnant women. Advanced ultrasound modalities increasingly play a role in identifying abnormal adaptations to pregnancy and detecting subclinical changes. This, in turn, can help promote a healthy pregnancy for both mother and fetus.
Prevention and Treatment of Cancer-Associated Venous Thromboembolism: a Review.
Sanfilippo KM, Wang TF
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31748926 · Publisher ↗
PURPOSE OF REVIEW: Patients with cancer have an increased risk of venous thromboembolism (VTE). Cancer-associated VTE is associated with an increased risk of morbidity and mortality. Treatment of VTE in cancer is associa...
PURPOSE OF REVIEW: Patients with cancer have an increased risk of venous thromboembolism (VTE). Cancer-associated VTE is associated with an increased risk of morbidity and mortality. Treatment of VTE in cancer is associated with higher rates of recurrent thrombosis as well as major bleeding compared with the general population. The goal of this review is to provide a summary of current evidence for the prevention and treatment of cancer-associated VTE. RECENT FINDINGS: Validated risk prediction models are available to aide clinicians in identifying patients with cancer with the highest risk of VTE. Those patients with intermediate to high risk of VTE may benefit from primary prophylaxis with apixaban or rivaroxaban. Low-molecular-weight heparin is superior to vitamin K antagonists for the treatment of cancer-associated VTE. There is mounting evidence to support use of the direct oral anticoagulants for VTE in patients with cancer. Decisions on type and duration of anticoagulation in patients with cancer, either for primary or secondary prevention, should be made on a case-by-case basis with taking into account the individual patient bleeding and thrombotic risk.
Cardiac MRI Evaluation of Myocarditis.
Hahn L, Kligerman S
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31732820 · Publisher ↗
PURPOSE OF REVIEW: Cardiac MRI (CMR) is the non-invasive test of choice for the assessment of myocarditis. In 2009, the Lake Louise Criteria for the diagnosis of myocarditis using CMR were first released. The decade sinc...
PURPOSE OF REVIEW: Cardiac MRI (CMR) is the non-invasive test of choice for the assessment of myocarditis. In 2009, the Lake Louise Criteria for the diagnosis of myocarditis using CMR were first released. The decade since that time has vastly improved our understanding of CMR's strengths and limitations. Traditional CMR methods including T2-weighted imaging and late gadolinium enhancement have proven their diagnostic value, but diagnostic performance is dependent on patient presentation. RECENT FINDINGS: Newer parametric mapping techniques have begun to be more comprehensively studied and may improve diagnostic accuracy of CMR in an expanded set of clinical scenarios. Additionally, the prognostic value of CMR has begun to solidify. These advances culminated in an update to the Lake Louise Criteria at the end of 2018. In this review, we discuss the evolution of the diagnostic criteria for CMR in the assessment of myocarditis. We also discuss the pathophysiologic premises behind the use of specific MRI sequences and an up-to-date summary of their individual utility.
Idiopathic Non-atherosclerotic Carotid Artery Disease.
Harriott A
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31728831 · Publisher ↗
PURPOSE OF REVIEW: The purpose of this review is to provide an overview of idiopathic non-atherosclerotic causes of carotid artery disease and its manifestations. RECENT FINDINGS: Four major causes of non-atherosclerotic...
PURPOSE OF REVIEW: The purpose of this review is to provide an overview of idiopathic non-atherosclerotic causes of carotid artery disease and its manifestations. RECENT FINDINGS: Four major causes of non-atherosclerotic carotid artery disease including dissection, fibromuscular dysplasia, moyamoya disease, and inflammatory large vessel vasculitis are discussed. While there is a dearth of clinical trials involving some of the rarer conditions, recent data from clinical trials supporting antiplatelet over anticoagulation treatment of cervical artery dissection, recent consensus statements on the management of fibromuscular dysplasia, and guideline approaches to diagnosis and treatment of large vessel vasculitis are summarized. Idiopathic non-atherosclerotic causes of carotid artery disease are under appreciated and may lead to significant morbidity and mortality. While less common compared with atherosclerotic disease, non-atherosclerotic disease may affect younger patient populations and result in non-cerebrovascular arterial involvement and systemic organ damage. Therefore, prompt recognition of these disorders is key to their management.
Sport Participation in Patients with Implantable Cardioverter-Defibrillators.
Lampert R
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31728782 · Publisher ↗
PURPOSE OF REVIEW: Athletes diagnosed with cardiovascular disease may receive implantable cardioverter defibrillators (ICDs). Until recently, there were no data describing the safety of return to play for athletes receiv...
PURPOSE OF REVIEW: Athletes diagnosed with cardiovascular disease may receive implantable cardioverter defibrillators (ICDs). Until recently, there were no data describing the safety of return to play for athletes receiving an ICD, and consensus recommendations restricted ICD patients to competitive sports no more vigorous than bowling or golf. RECENT FINDINGS: The ICD Sports Registry prospectively followed 440 athletes who continued sports participation after receiving an ICD, for up to 4 years. While many received shocks, both appropriate and inappropriate, during competition or practice, as well as during other physical activity or rest, there were no failures to defibrillate and no injuries related to arrhythmia or shock during sports. Recent subanalyses as described below have focused on how best to program the ICD, and on the younger subgroup including interscholastic athletes. Based on these data, the most recent consensus statement from the AHA/ACC on athletic eligibility now describes sports participation with an ICD as a IIB recommendation, "may be considered".
Peripheral Vascular Disease in Women: Therapeutic Options in 2019.
Saati A, AlHajri N, Ya'qoub L … +2 more , Ahmed W, Alasnag M
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31728774 · Publisher ↗
PURPOSE OF REVIEW: In recent years, there have been advances in the prevention, management, and control of peripheral vascular disease (PVD). There is a trend towards aggressive risk factor modification, noninvasive scre...
PURPOSE OF REVIEW: In recent years, there have been advances in the prevention, management, and control of peripheral vascular disease (PVD). There is a trend towards aggressive risk factor modification, noninvasive screening, and endovascular revascularization with surgical approaches reserved only for select cases. This article reviews the different management strategies ranging from pharmacotherapy, revascularization, and rehabilitation with an emphasis on the response of women to these therapies. RECENT FINDINGS: Overall, the representation of women in the majority of the published data in this arena remains poor. Studies examining medical therapy and endovascular and surgical revascularization were not designed to address sex disparities. Nevertheless, we dissect these therapies and their relevant randomized trials. The paucity of data investigating the response of women to the different management options makes it difficult to make any evidence-based recommendations. This not only applies to the type of intervention, but also the appropriate timing and risks entailed.
Paravalvular Leaks-From Diagnosis to Management.
Bernard S, Yucel E
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31728667 · Publisher ↗
PURPOSE OF REVIEW: As the number of surgical and transcatheter valve replacements continue to increase in the aging population, so does the incidence of paravalvular leak (PVL). Given its impact on morbidity and mortalit...
PURPOSE OF REVIEW: As the number of surgical and transcatheter valve replacements continue to increase in the aging population, so does the incidence of paravalvular leak (PVL). Given its impact on morbidity and mortality, this article will focus on the epidemiology, clinical presentation, diagnostic assessment, and available treatments for PVL. RECENT FINDINGS: Despite being performed on inoperable and typically higher risk patients, short-term complication rates of transcatheter PVL closure appear relatively low (< 10%). When indirectly compared with surgical PVL closure, long-term mortality, reoperation rates and degree of symptom improvement are similar. Nonetheless, current transcatheter closure devices are off-label and repurposed from other indications. Further development of percutaneous closure devices is an essential next step in order to improve and optimize outcomes. In patients with surgical and especially transcatheter-replaced heart valves, clinicians need to maintain vigilance for the presence of PVL, particularly in those with new-onset heart failure or hemolysis. Multimodality imaging is essential to detect and quantify PVL. Echocardiography (both transthoracic and transesophageal) is the backbone of diagnosis and quantification, and cardiac computed tomography and cardiac magnetic resonance imaging play an important role in defect characterization and in periprocedural planning. For those patients who are unable to undergo surgery, transcatheter PVL closure is an appropriate next step in management as it has similar outcomes to surgical intervention when performed in a center of expertise.
Vessel Wall Imaging of Cerebrovascular Disorders.
Kern KC, Liebeskind DS
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31728661 · Publisher ↗
PURPOSE OF REVIEW: High-resolution magnetic resonance vessel wall imaging (VWI) permits direct visualization of intracranial arterial wall pathology, providing diagnostic and prognostic information that is complementary...
PURPOSE OF REVIEW: High-resolution magnetic resonance vessel wall imaging (VWI) permits direct visualization of intracranial arterial wall pathology, providing diagnostic and prognostic information that is complementary to conventional imaging techniques. We highlight the most recent studies that have advanced the clinical application of VWI. RECENT FINDINGS: VWI aids in distinguishing and diagnosing intracranial atherosclerotic disease (ICAD), intracranial dissections, central nervous system vasculitis, reversible cerebral vasoconstriction syndrome, and moyamoya disease. VWI may help predict recurrent stroke in ICAD, treatment effects in vasculitis, and disease progression in moyamoya. VWI also identifies ruptured intracranial aneurysms and may predict stability of unruptured aneurysms. Implementing VWI as an adjunctive imaging technique may permit earlier and noninvasive discrimination of rare vasculopathies. However the prognostic utility of VWI for more common cerebrovascular pathologies requires further validation.
Role of PFO Closure in Ischemic Stroke Prevention.
Osteraas ND, Vargas A, Cherian L … +1 more , Song S
Curr Treat Options Cardiovasc Med · 2019 Nov · PMID 31724077 · Publisher ↗
PURPOSE OF REVIEW: To highlight recent advancements in the management of acute ischemic stroke patients with patent foramen ovale (PFO). RECENT FINDINGS: One significant recent development was publication of long-term fo...
PURPOSE OF REVIEW: To highlight recent advancements in the management of acute ischemic stroke patients with patent foramen ovale (PFO). RECENT FINDINGS: One significant recent development was publication of long-term follow-up data from the RESPECT trial demonstrating evidence in favor of PFO closure over medical management. This data subsequently led to FDA approval for AMPLATZER™ septal occluder in the treatment of patients aged 18 to 60 years with both PFO and no other determined etiology for ischemic stroke, otherwise referred to as embolic stroke of undetermined source. Several subsequent closure trial results have recently been published, which also demonstrated benefit of PFO closure over medical management for ischemic stroke risk reduction in select patients. Based on the results of the more recently published REDUCE trial, the FDA granted approval for the GORE™ septal occluder. There is current, well-established evidence that PFO closure for secondary stroke prevention is effective in select cases.
Coronary Computed Tomography Angiography: Enhancing Risk Stratification and Diagnosis of Cardiovascular Disease in Women.
Karnib S, Chinnaiyan KM
Curr Treat Options Cardiovasc Med · 2019 Oct · PMID 31584125 · Publisher ↗
PURPOSE OF REVIEW: There are numerous gender- and sex-based differences that contribute to the increased morbidity and mortality related to atherosclerotic cardiovascular disease (ASCVD) in women. Early detection of risk...
PURPOSE OF REVIEW: There are numerous gender- and sex-based differences that contribute to the increased morbidity and mortality related to atherosclerotic cardiovascular disease (ASCVD) in women. Early detection of risk and targeted management of atherosclerotic disease is fundamental to reduce ASCVD risk and improve outcomes in women. In this review, we examine the utility of cardiac computed tomography (CT) and coronary CT angiography (CTA) in three ASCVD scenarios including coronary artery calcium scoring for risk stratification in asymptomatic women, and coronary CTA for diagnosis and prognosis of stable ischemic heart disease and acute chest pain. The risks of radiation exposure and the potential applications of novel technologies in women are explored. RECENT FINDINGS: CTA provides the capabilities of early recognition and management of nonobstructive coronary artery disease (CAD). Recent advancements in plaque composition and morphology further enhance the prognostic yield from coronary CTA. Innovations in stress perfusion and computational fluid dynamics allow for evaluation of physiological measures of ischemia. In addition, developments in artificial intelligence (AI) may also help unlock a deeper understanding of atherosclerosis and risk in women. Coronary CTA is an accurate and useful modality for early detection and management of ASCVD in women. Novel technologies hold great promise for furthering our understanding of sex-specific pathophysiology and potential improvement in clinical management and outcomes.
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