Current Treatment Options In Cardiovascular Medicine[JOURNAL]
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200 papers
Emerging Therapies for Transthyretin Cardiac Amyloidosis.
Alexander KM, Evangelisti A, Witteles RM
Curr Treat Options Cardiovasc Med · 2019 Jul · PMID 31309347 · Publisher ↗
PURPOSE OF REVIEW: Transthyretin cardiac amyloidosis is an underdiagnosed, undertreated disease which is associated with significant morbidity and mortality. This review will discuss the recent advancements in novel ther...
PURPOSE OF REVIEW: Transthyretin cardiac amyloidosis is an underdiagnosed, undertreated disease which is associated with significant morbidity and mortality. This review will discuss the recent advancements in novel therapies for transthyretin amyloidosis. RECENT FINDINGS: In recent phase 3 clinical trials, transthyretin stabilizers (tafamidis) and transthyretin silencers (patisiran and inotersen) have proven to be effective therapies for various forms of transthyretin amyloidosis. Understanding the recent and upcoming clinical trials for transthyretin amyloidosis will be important for improving the management of this challenging disease.
Conceptualizing the Risks of Coronary Heart Disease and Heart Failure Among People Aging with HIV: Sex-Specific Considerations.
Abelman RA, Mugo BM, Zanni MV
Curr Treat Options Cardiovasc Med · 2019 Jul · PMID 31309321 · Publisher ↗
Cardiovascular disease (CVD) is emerging as a major threat to healthy aging among people with HIV (PHIV). PHIV face heightened risks for coronary heart disease (CHD)/myocardial infarction (MI) and heart failure (HF), fue...
Cardiovascular disease (CVD) is emerging as a major threat to healthy aging among people with HIV (PHIV). PHIV face heightened risks for coronary heart disease (CHD)/myocardial infarction (MI) and heart failure (HF), fueled by systemic immune activation and by metabolic dysregulation. Women with HIV (WHIV) evidence unique patterns of vascular and myocardial pathology as compared to men with HIV (MHIV). These patterns include a predilection to microvascular dysfunction and type II MI, as well as a penchant for diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF). Investigations are underway to understand how advanced reproductive aging among WHIV influences systemic immune activation and metabolic dysregulation en route to these CVD phenotypes. A key goal is to identify targeted CVD prevention strategies relevant to WHIV, particularly as efficacious treatment approaches to type II MI and HFpEF are lacking.
Challenges in Implementing Optimal Echocardiographic Screening in Cardio-Oncology.
McDonald JP, MacNamara JP, Zaha VG
Curr Treat Options Cardiovasc Med · 2019 Jul · PMID 31290034 · Publisher ↗
PURPOSE OF REVIEW: Echocardiography is the foundation of noninvasive screening in patients exposed to potentially cardiotoxic chemotherapeutic agents. Guidelines are becoming more consistent in regard to screening and re...
PURPOSE OF REVIEW: Echocardiography is the foundation of noninvasive screening in patients exposed to potentially cardiotoxic chemotherapeutic agents. Guidelines are becoming more consistent in regard to screening and recommend an integrative approach between cardiology and oncology providers as well as optimal non-invasive imaging modalities. Optimal screening with the latest technology will place a significant cost and administrative burden on echocardiographic laboratories and cardiology clinics. RECENT FINDINGS: This review seeks to explore the latest studies regarding quality, cost, patient burden, and value related to implementing wide-spread screening for patients exposed to cardiotoxic chemotherapy. 3D and speckle tracking echocardiography are more reliable and can detect more subtle changes than traditional 2D volumes. Limited studies have revealed an uptake of optimal screening between 30 and 40%. Even fewer studies have evaluated the system-wide cost and value impact of screening in cardio-oncology or have evaluated patient-centered outcomes, such as cost and time burden. Finally, novel approaches, such as the use of point of care ultrasound with artificial intelligence guidance, may help alleviate these challenges. Screening patients at risk for cancer therapeutics-related cardiac dysfunction poses real-world challenges to our healthcare system. While modern echocardiographic techniques improve our ability to detect cardiac dysfunction, further research is needed to understand the challenges of wide-spread implementation.
Optimal Non-invasive Strategies to Reduce Recurrent Atherosclerotic Cardiovascular Disease Risk.
Jones-O'Connor M, Natarajan P
Curr Treat Options Cardiovasc Med · 2019 Jun · PMID 31254118 · Full text
PURPOSE OF REVIEW: Cardiovascular disease (CVD) remains the leading cause of death worldwide, with coronary artery disease (CAD) responsible for the vast majority of these deaths. Incidence is increasing in developing co...
PURPOSE OF REVIEW: Cardiovascular disease (CVD) remains the leading cause of death worldwide, with coronary artery disease (CAD) responsible for the vast majority of these deaths. Incidence is increasing in developing countries, and prevalence is increasing globally as populations age. Once CAD is manifest, recurrent event risk remains high. RECENT FINDINGS: Multiple therapeutic avenues have had significant recent developments, including diet, low-density lipoprotein cholesterol management, triglycerides, hypoglycemic agents, antiplatelet agents, and oral anticoagulants. Combined approaches involving specific, tailored lifestyle, and pharmacological interventions will provide the most effective strategy for reducing the risk of recurrent CVD events. Here, we review risk prediction and non-invasive non-pharmacologic and pharmacologic approaches to mitigate residual coronary artery disease risk.
Updates on the Genetic Paradigm in Heart Failure.
Rosenbaum AN, Pereira N
Curr Treat Options Cardiovasc Med · 2019 Jun · PMID 31250202 · Publisher ↗
PURPOSE OF REVIEW: The rapidly evolving field of cardiovascular genetics has already improved the care of patients with heart failure and families. The purpose of the current review is to describe the most and provide th...
PURPOSE OF REVIEW: The rapidly evolving field of cardiovascular genetics has already improved the care of patients with heart failure and families. The purpose of the current review is to describe the most and provide the most pertinent updates in the field of heart failure genetics. RECENT FINDINGS: Recent advanced in heart failure genetics have begun to not only increase the yield of testing through improving technology and use of whole exome or whole genome screening, but also enabled the improving technology and increasing use of whole exome or whole genome screening, but also enabled an enhanced understanding of the implications of results of genetic testing. For instance, new data have described differential responses to heart failure therapies based on genetic testing. Additionally, variant analysis by locus in genetic cardiomyopathies has facilitated a much-improved prognostic understanding of phenotype. Recent years have seen advancements in the understanding of the genetics of rare disorders, including pediatric-onset cardiomyopathies, previously under-investigated; restrictive cardiomyopathies; and non-compaction cardiomyopathy. The last few years have heralded not only a broader understanding of the scope of the genetics of heart failure, but have also provided notable leaps in mechanistic and prognostic understanding, which will serve as the foundation for clinical investigation and future genetic variant assessment.
An Update on Pediatric Cardiomyopathy.
Choudhry S, Puri K, Denfield SW
Curr Treat Options Cardiovasc Med · 2019 Jun · PMID 31236771 · Publisher ↗
PURPOSE OF REVIEW: This review summarizes the clinical characteristics and updated outcomes of primary pediatric cardiomyopathies including dilated (DCM), hypertrophic (HCM), and restrictive cardiomyopathy (RCM), and bri...
PURPOSE OF REVIEW: This review summarizes the clinical characteristics and updated outcomes of primary pediatric cardiomyopathies including dilated (DCM), hypertrophic (HCM), and restrictive cardiomyopathy (RCM), and briefly discusses left ventricular non-compaction (LVNC) and arrhythmogenic cardiomyopathy (ACM), primarily arrythmogenic right ventricular cardiomyopathy (ARVC). RECENT FINDINGS: Pediatric cardiomyopathies are diseases of the heart muscle with an estimated annual incidence of 1.1-1.5 cases per 100,000. They are progressive in nature and are frequently caused by a genetic mutation causing a structural abnormality in the myocyte. Dilated cardiomyopathy, characterized by left ventricular dilation and systolic dysfunction with normal left ventricular wall thickness, accounts for about 50-60% of all pediatric cardiomyopathy cases. This is followed by hypertrophic cardiomyopathy accounting for about 40%, characterized by abnormally thickened myocardium in the absence of another cause of hypertrophy with non-dilated left ventricle. Left ventricular non-compaction and restrictive cardiomyopathy each account for about 5% of the cases. Genetic mutations play a dominant role in the development of pediatric cardiomyopathies. While treatment for congestive heart failure and arrhythmias alleviates symptoms, it has not been shown to reduce the risk of sudden death. The 5-year transplant-free survival of DCM, HCM, RCM, and LVNC are 50%, 90%, 30%, and 60% respectively. Pediatric cardiomyopathies while not common they are a significant cause of morbidity and mortality in afflicted children. Dilated forms are the most common followed by hypertrophic, left ventricular non-compaction, and restrictive cardiomyopathies. Arrhythmogenic cardiomyopathies tend to be diagnosed later in the teenage years. Treatment typically follows adult recommendations for which there is significantly more data on treatment benefits, although the indications for ICD placement in children remain even less clear, other than for secondary prevention.
Transcatheter Mitral Valve Replacement: An Update on the Current Literature.
El Hajj SC, Eleid MF
Curr Treat Options Cardiovasc Med · 2019 Jun · PMID 31209590 · Publisher ↗
PURPOSE OF REVIEW: The purpose of this review was to evaluate the complexities and challenges associated with transcatheter mitral valve replacement and review the existing data. RECENT FINDINGS: Many patients with mitra...
PURPOSE OF REVIEW: The purpose of this review was to evaluate the complexities and challenges associated with transcatheter mitral valve replacement and review the existing data. RECENT FINDINGS: Many patients with mitral valve disease are not candidates for cardiac surgery and are in need of less invasive transcatheter therapies. The first transcatheter mitral valve replacement (TMVR) in a native valve was performed in 2012. However, the complexities and variability of the mitral valve anatomy and its relationship to neighboring structures have resulted in slower progress with this new therapy compared to the rapid uptake that has occurred with transcatheter aortic valve replacement. TMVR can be applied to degenerated prosthetic valves and annuloplasty rings or to a wide variety of native mitral valve disease. In cases of degenerated bioprosthetic valves, annuloplasty ring, and native valve mitral annular calcification, transcatheter heart valves (THVs) designed for the aortic position can be implanted with high procedural safety and success rates. In the case of native valve mitral regurgitation, the complexities have led to the development of several TMVR systems for native valve disease with different anchoring mechanisms and geometry; all are currently investigational and none are FDA approved at this time. It is clear from the initial experience with TMVR that careful patient selection and pre-procedural planning are necessary to maximize benefit and avoid complications. TMVR is an exciting complex therapy offering promise for patients who cannot be treated with existing techniques. The key to success will be a combination of appropriate patient selection, careful comprehensive pre-procedural planning, rising new technologies, as well as further research to appropriately define and mitigate the risks associated with the procedure.
Cardiotoxicities of Modern Treatments in Breast Cancer.
Dent S, Melloni C, Ivars J … +2 more , Sammons S, Kimmick G
Curr Treat Options Cardiovasc Med · 2019 Jun · PMID 31203459 · Publisher ↗
PURPOSE OF REVIEW: This paper will focus on novel breast cancer therapies used in clinical practice today, as well as review our understanding of standard therapies and their potential impact on cardiovascular health. RE...
PURPOSE OF REVIEW: This paper will focus on novel breast cancer therapies used in clinical practice today, as well as review our understanding of standard therapies and their potential impact on cardiovascular health. RECENT FINDINGS: Established and novel treatments such as anthracyclines, HER2-targeted agents, and immunotherapy have contributed to improvements in breast cancer outcomes; however, these treatments may be associated with an increased risk of cardiovascular injury. The number of available breast cancer treatments continues to expand, as does the need for health care providers to understand the potential impact of these treatments on cardiovascular health. Collaborative approaches in the development of risk stratification, prevention, and surveillance strategies for patients exposed to established and novel breast cancer treatments will facilitate improvements in patient outcomes without compromising their cardiovascular health.
Tissue Valve Degeneration and Mechanical Valve Failure.
Baldwin ACW, Tolis G
Curr Treat Options Cardiovasc Med · 2019 Jun · PMID 31201568 · Publisher ↗
PURPOSE OF REVIEW: The management of valvular heart disease has been dramatically influenced by recent evolutions in biomedical technology and surgical practice. With an aging population worldwide and accompanying increa...
PURPOSE OF REVIEW: The management of valvular heart disease has been dramatically influenced by recent evolutions in biomedical technology and surgical practice. With an aging population worldwide and accompanying increase in the prevalence of surgical valve disease, an understanding of prosthetic valve behavior and durability is essential for proper patient selection and management. This report offers an overview of the definitions, mechanisms, management, and clinical impact of structural valve degeneration and failure. RECENT FINDINGS: Published literature has employed variable definitions and outcome measures, complicating our understanding of bioprosthetic valve behavior and function. The pathophysiology leading to structural valve degeneration is multifactorial and involves mechanical, hematologic, and immunologic elements. Technological advancements have resulted in improved valve performance and new strategies to mitigate the risks of degeneration. While mechanical valves have demonstrated negligible durability concerns, the benefits of bioprosthetic valves must be weighed against their potential for structural degeneration and subsequent reintervention. Valve selection should involve patient-specific deliberation, and guidelines have been established to help guide risk reduction strategies. Surgical valve replacement remains the standard of care for prosthetic valve failure, but emerging technology offers the potential to slow the development of structural degeneration and transcatheter valve-in-valve options are being increasingly explored.
Cardiotoxicity of Immune Checkpoint Inhibitors.
Zhang L, Jones-O'Connor M, Awadalla M … +6 more , Zlotoff DA, Thavendiranathan P, Groarke JD, Villani AC, Lyon AR, Neilan TG
Curr Treat Options Cardiovasc Med · 2019 Jun · PMID 31175469 · Publisher ↗
PURPOSE OF REVIEW: Immunotherapies, particularly immune checkpoint inhibitors (ICI), are revolutionary cancer therapies being increasingly applied to a broader range of cancers. Our understanding of the mechanism, epidem...
PURPOSE OF REVIEW: Immunotherapies, particularly immune checkpoint inhibitors (ICI), are revolutionary cancer therapies being increasingly applied to a broader range of cancers. Our understanding of the mechanism, epidemiology, diagnosis, and treatment of cardiotoxicity related to immunotherapies remains limited. We aim to synthesize the limited current literature on cardiotoxicity of ICIs and to share our opinions on the diagnosis and treatment of this condition. RECENT FINDINGS: The incidence of ICI-associated myocarditis ranges from 0.1 to 1%. Patients with ICI-associated myocarditis often have a fulminant course with a case fatality rate of 25-50%. The diagnosis of this condition poses many challenges because independently a normal electrocardiogram, biomarkers, or a preserved left ventricular function do not rule out ICI-associated myocarditis. Endomyocardial biopsy should be pursued when clinical suspicion remains despite normal non-invasive tests. Data on optimal screening and surveillance tools are lacking. Cessation of ICIs, combined with high dose corticosteroids and other immunosuppressant approaches are the cornerstones of the treatment of ICI-associated myocarditis. This condition may recur when patients are re-challenged with these agents and the decision to resume ICIs should be made through a multidisciplinary discussion. Immunotherapies have changed the landscape of cancer treatment. Recognizing and managing cardiotoxicity related to ICIs is of critical importance. Our understanding of ICI-cardiotoxicity has improved, but large information gaps remain for further research. Due to the high case fatality rate, any type of cardiac symptoms or signs in a patient who has recently started an ICI should prompt consideration of ICI-cardiotoxicity.
Cardiovascular Complications Associated with Mediastinal Radiation.
Lee Chuy K, Nahhas O, Dominic P … +5 more , Lopez C, Tonorezos E, Sidlow R, Straus D, Gupta D
Curr Treat Options Cardiovasc Med · 2019 Jun · PMID 31161453 · Publisher ↗
PURPOSE OF REVIEW: Radiation-induced heart disease (RIHD) encompasses a broad range of pathologies and is a significant source of morbidity and mortality among cancer survivors. Increased awareness of the early and late...
PURPOSE OF REVIEW: Radiation-induced heart disease (RIHD) encompasses a broad range of pathologies and is a significant source of morbidity and mortality among cancer survivors. Increased awareness of the early and late consequences of mediastinal radiation has led to the development of strategies for cardiac risk reduction to improve outcomes through active surveillance and early detection of RIHD. This review aims to discuss the current knowledge on the presentation, diagnosis, and management of RIHD. RECENT FINDINGS: Decades' worth of cohort data demonstrates an increased risk of RIHD as cancer survivors age. Additionally, interventional/surgical management of irradiated patients poses unique considerations and can be technically challenging. Used in conjunction with echocardiography, multimodality imaging for morphologic and functional assessment adds complementary value in screening, surveillance, and targeted symptom investigation in patients at risk for RIHD. Furthermore, sensitive imaging parameters and biomarkers have shown potential in detecting subclinical RIHD. Despite the development of techniques which minimize cardiac exposure to ionizing radiation, their effects on the long-term development of RIHD remain to be seen. Due to the morbidity and mortality associated with RIHD, both patients and clinicians should be aware of the lifelong cardiovascular risks of mediastinal radiation exposure. RIHD surveillance should be a consideration throughout the survivorship period. Studies to evaluate the clinical consequences of contemporary radiation therapy strategies aimed at minimizing cardiac doses and the value of novel, more sensitive metrics for the early detection or prognostication of RIHD are ongoing.
Risk of Cardiomyopathy in Breast Cancer: How Can We Attenuate the Risk of Heart Failure from Anthracyclines and Anti-HER2 Therapies?
Kimmick G, Dent S, Klem I
Curr Treat Options Cardiovasc Med · 2019 May · PMID 31152324 · Publisher ↗
PURPOSE OF REVIEW: To review cardiotoxicity of and strategies to prevent cardiotoxicity from anthracyclines and anti-HER2 agents used to treat breast cancer. RECENT FINDINGS: Although not common, cardiotoxicity from anth...
PURPOSE OF REVIEW: To review cardiotoxicity of and strategies to prevent cardiotoxicity from anthracyclines and anti-HER2 agents used to treat breast cancer. RECENT FINDINGS: Although not common, cardiotoxicity from anthracyclines and anti-HER2 therapies is a major consideration in the use of these agents, especially in the adjuvant setting. Modifications in anthracycline agent, dosing, or schedule or use of Dexrazoxane have been shown to ameliorate the mostly irreversible cardiotoxicity from anthracyclines. Dose delays have been the primary means of addressing the possibly reversible cardiotoxicity from the anti-HER2 agent, trastuzumab, whereas the other anti-HER2 therapies, pertuzumab, lapatinib, and neratinib, are relatively nontoxic to the myocardium. Data from recent randomized clinical trials suggest that the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), and beta blockers may prevent subclinical cardiotoxicity, as measured by decline in the left ventricular ejection fraction, associated with these agents. Longer-term follow-up will be needed to confirm their role in prevention of symptomatic cardiomyopathy and subsequent cardiovascular disease in women with breast cancer. Preliminary evidence suggests that the use of ACEi, ARB, and beta blockers during treatment with anthracyclines and trastuzumab may prevent subsequent cardiomyopathy. Larger trials with meaningful clinical endpoints are needed.
Cardio-Oncology Fellowship Training and Education.
Fradley MG
Curr Treat Options Cardiovasc Med · 2019 May · PMID 31104193 · Publisher ↗
PURPOSE OF REVIEW: With the rapid development of novel cancer therapeutics and the growing number of cancer survivors, there is significant demand for cardio-oncology experts to care for these patients. As such, it has b...
PURPOSE OF REVIEW: With the rapid development of novel cancer therapeutics and the growing number of cancer survivors, there is significant demand for cardio-oncology experts to care for these patients. As such, it has become increasingly necessary to develop formalized training in the field of cardio-oncology. This review will focus on the current state of cardio-oncology education, with recommendations for the development of dedicated cardio-oncology fellowships. RECENT FINDINGS: Cardio-oncology fellowships should be affiliated with high-volume centers that have established cardio-oncology clinical and research programs with dedicated cardio-oncology faculty. Several recent publications have proposed recommendations to develop uniform cardio-oncology training standards, core curricula, and evaluation metrics. With the rapid evolution of the field and the support of various profession organizations, the number and quality of dedicated cardio-oncology fellowship programs is expected to increase significantly. The adoption of defined training requirements and evaluation standards to measure competency will be essential to ensure the legitimacy and success of the field.
The Role of Cardiac Magnetic Resonance Imaging to Detect Cardiac Toxicity From Cancer Therapeutics.
Soufer A, Baldassarre LA
Curr Treat Options Cardiovasc Med · 2019 May · PMID 31104180 · Publisher ↗
PURPOSE OF REVIEW: The emerging complexity of cardiac toxicity caused by cancer therapies has created demand for more advanced non-invasive methods to better evaluate cardiac structure, function, and myocardial tissue ch...
PURPOSE OF REVIEW: The emerging complexity of cardiac toxicity caused by cancer therapies has created demand for more advanced non-invasive methods to better evaluate cardiac structure, function, and myocardial tissue characteristics. Cardiac magnetic resonance imaging meets these needs without exposure to ionizing radiation, and with superior spatial resolution. RECENT FINDINGS: Special applications of cardiac magnetic resonance (CMR) to assess for cancer therapy-induced cardiac toxicity include the detection of subclinical LV dysfunction through novel methods of measuring myocardial strain, detection of microcirculatory dysfunction, identification of LV and LA fibrosis, and more sensitive detection of inflammation caused by immune checkpoint inhibitors. CMR plays a significant role in the non-invasive workup of cardiac toxicity from cancer therapies, with recent advancements in the field that have opened avenues for further research and development.
Connected Health Technology for Cardiovascular Disease Prevention and Management.
Wongvibulsin S, Martin SS, Steinhubl SR … +1 more , Muse ED
Curr Treat Options Cardiovasc Med · 2019 May · PMID 31104157 · Full text
PURPOSE OF THE REVIEW: Advances in computing power and wireless technologies have reshaped our approach to patient monitoring. Medical grade sensors and apps that were once restricted to hospitals and specialized clinic...
PURPOSE OF THE REVIEW: Advances in computing power and wireless technologies have reshaped our approach to patient monitoring. Medical grade sensors and apps that were once restricted to hospitals and specialized clinic are now widely available. Here, we review the current evidence supporting the use of connected health technologies for the prevention and management of cardiovascular disease in an effort to highlight gaps and future opportunities for innovation. RECENT FINDINGS: Initial studies in connected health for cardiovascular disease prevention and management focused primarily on activity tracking and blood pressure monitoring but have since expanded to include a full panoply of novel sensors and pioneering smartphone apps with targeted interventions in diet, lipid management and risk assessment, smoking cessation, cardiac rehabilitation, heart failure, and arrhythmias. While outfitting patients with sensors and devices alone is infrequently a lasting solution, monitoring programs that include personalized insights based on patient-level data are more likely to lead to improved outcomes. Advances in this space have been driven by patients and researchers while healthcare systems remain slow to fully integrate and adequately adapt these new technologies into their workflows. Cardiovascular disease prevention and management continue to be key focus areas for clinicians and researchers in the connected health space. Exciting progress has been made though studies continue to suffer from small sample size and limited follow-up. Efforts that combine home patient monitoring, engagement, and personalized feedback are the most promising. Ultimately, combining patient-level ambulatory sensor data, electronic health records, and genomics using machine learning analytics will bring precision medicine closer to reality.
Transcatheter Tricuspid Valve Therapy.
Kolte D, Elmariah S
Curr Treat Options Cardiovasc Med · 2019 May · PMID 31104153 · Publisher ↗
PURPOSE OF REVIEW: Despite the increasing prevalence of tricuspid regurgitation (TR) and its association with poor survival, isolated tricuspid valve (TV) surgery remains infrequent. To address this unmet clinical need,...
PURPOSE OF REVIEW: Despite the increasing prevalence of tricuspid regurgitation (TR) and its association with poor survival, isolated tricuspid valve (TV) surgery remains infrequent. To address this unmet clinical need, several less invasive transcatheter TV therapies have emerged as an alternative to surgery in high-risk patients with severe functional TR. The objective of this review is to summarize the current progress and future directions in the field of transcatheter TV therapies. RECENT FINDINGS: Transcatheter TV repair devices are aimed at improving leaflet coaptation either directly by bringing the leaflets together or indirectly by addressing the dilated annulus. Transcatheter TV replacement, on the other hand, can be orthotopic (implantation of prosthetic valve in an anatomically correct position in the tricuspid annulus) or heterotopic (implantation of prosthetic valve in a different anatomic location to counter the hemodynamic and clinical consequences of severe TR). Data from first-in-man and phase 1/2 clinical studies on the safety and efficacy of various transcatheter TV therapies appear promising. Technological advancement and increased experience are anticipated to improve outcomes of transcatheter TV therapy in the coming years. Ongoing and future studies should focus on careful patient selection, optimal timing of intervention, and long-term clinical outcomes and device durability.
Artificial Intelligence in Cardiovascular Medicine.
Seetharam K, Shrestha S, Sengupta PP
Curr Treat Options Cardiovasc Med · 2019 May · PMID 31089906 · Full text
PURPOSE OF REVIEW: The ripples of artificial intelligence are being felt in various sectors of human life. Machine learning, a subset of artificial intelligence, extracts information from large databases of information a...
PURPOSE OF REVIEW: The ripples of artificial intelligence are being felt in various sectors of human life. Machine learning, a subset of artificial intelligence, extracts information from large databases of information and is gaining traction in various fields of cardiology. In this review, we highlight noteworthy examples of machine learning utilization in echocardiography, nuclear cardiology, computed tomography, and magnetic resonance imaging over the past year. RECENT FINDINGS: In the past year, machine learning (ML) has expanded its boundaries in cardiology with several positive results. Some studies have integrated clinical and imaging information to further augment the accuracy of these ML algorithms. All the studies mentioned in this review have clearly demonstrated superior results of ML in relation to conventional approaches for identifying obstructions or predicting major adverse events in reference to conventional approaches. As the influx of data arriving from gradually evolving technologies in health care and wearable devices continues to be more complex, ML may serve as the bridge to transcend the gap between health care and patients in the future. In order to facilitate a seamless transition between both, a few issues must be resolved for a successful implementation of ML in health care.
Interventions to Reduce Ethnic and Racial Disparities in Dyslipidemia Management.
Chang AY, Abou-Arraj NE, Rodriguez F
Curr Treat Options Cardiovasc Med · 2019 May · PMID 31065884 · Publisher ↗
PURPOSE OF REVIEW: Race and ethnicity are associated with disparities in risk assessment, screening, patient awareness, treatment, and control of dyslipidemia and can contribute to worsened cardiovascular outcomes. This...
PURPOSE OF REVIEW: Race and ethnicity are associated with disparities in risk assessment, screening, patient awareness, treatment, and control of dyslipidemia and can contribute to worsened cardiovascular outcomes. This review summarizes these gaps in care and highlights recent interventions aimed at reducing them. RECENT FINDINGS: Disparities in dyslipidemia diagnosis and treatment are well documented among certain racial and ethnic minority groups. Less is known about dyslipidemia among Hispanics, Asians, and Native Americans/Pacific Islanders, who have significant heterogeneity in cardiovascular risk and outcomes. Programs to reduce inequalities have focused on targeted risk assessment, improved screening practices, statin adherence-enhancing policies, culturally inclusive risk factor modification campaigns, and multidisciplinary treatment teams, with variable success. Interventions to reduce racial/ethnic disparities in dyslipidemia are important at all phases of care. Nevertheless, initiatives concentrating on single elements of the lipid treatment cascade were generally less effective at improving clinical endpoints than those that comprehensively addressed multiple phases. Moreover, there was a disproportionately greater number of published studies analyzing patient-facing lifestyle-based risk factor modifications than other types of interventions. Future investigations should focus on understudied populations such as disaggregated Hispanic, Asian, and Native American populations. Additionally, innovative strategies utilizing information technology and provider-facing programs are needed.
Psychosocial Stress and Cardiovascular Disease.
Dar T, Radfar A, Abohashem S … +3 more , Pitman RK, Tawakol A, Osborne MT
Curr Treat Options Cardiovasc Med · 2019 Apr · PMID 31028483 · Full text
PURPOSE OF REVIEW: This manuscript reviews the epidemiological data linking psychosocial stress to cardiovascular disease (CVD), describes recent advances in understanding the biological pathway between them, discusses p...
PURPOSE OF REVIEW: This manuscript reviews the epidemiological data linking psychosocial stress to cardiovascular disease (CVD), describes recent advances in understanding the biological pathway between them, discusses potential therapies against stress-related CVD, and identifies future research directions. RECENT FINDINGS: Metabolic activity of the amygdala (a neural center that is critically involved in the response to stress) can be measured on F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG-PET/CT) yielding a neurobiological signal that independently predicts subsequent CVD events. Furthermore, a serial pathway from ↑amygdalar activity → ↑hematopoietic tissue activity → ↑arterial inflammation → ↑CVD events has been elucidated, providing new insights into the mechanism linking stress to CVD. Psychosocial stress and stress conditions are independently associated with CVD in a manner that depends on the degree and duration of stress as well as the individual response to a stressor. Nevertheless, the fundamental biology remains incompletely defined, and stress is often confounded by adverse health behaviors. Thus, most clinical guidelines do not yet recognize psychosocial stress as an independent CVD risk factor or advocate for its treatment in CVD prevention. Clarification of this neurobiological pathway provides a better understanding of the underlying pathophysiology and suggests opportunities to develop novel preventive strategies and therapies.
Radiation-Associated Cardiac Disease: From Molecular Mechanisms to Clinical Management.
Donnellan E, Jellis CL, Griffin BP
Curr Treat Options Cardiovasc Med · 2019 Apr · PMID 31020465 · Publisher ↗
PURPOSE OF REVIEW: Radiation-associated cardiac disease (RACD) is an increasingly recognized latent manifestation of chest and mediastinal radiation therapy. The delayed presentation reflects increased survival rates fro...
PURPOSE OF REVIEW: Radiation-associated cardiac disease (RACD) is an increasingly recognized latent manifestation of chest and mediastinal radiation therapy. The delayed presentation reflects increased survival rates from malignancies successfully treated decades previously. However, individuals are now presenting with multiple coexistent manifestations of RACD and pulmonary disease as a consequence of high-dose radiation administered prior to the routine institution of modern dose-modulating regimens. Increased awareness of RACD is critical for implementation of appropriate screening algorithms and for specific management strategies involving the timing and strategies of intervention in these patients. RECENT FINDINGS: Recent advances in multimodality cardiac imaging have demonstrated pathognomonic findings of RACD, which can predict outcomes including mortality. Accurate diagnosis of these typically concurrent manifestations is critical and should prompt referral to a center experienced in managing RACD as surgical risk is significantly increased for this patient cohort, particularly for those undergoing redo operation. The latent effect of RACD and its unique combination of manifestations means that these patients will increasingly present with challenging management issues, resulting in increased rates of morbidity and mortality. Timing of treatment intervention must be carefully considered, although percutaneous options may provide alternative future strategies for this higher risk cohort.
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