Therapeutic Advances In Cardiovascular Disease[JOURNAL]
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200 papers
Corrigendum to gene expression is not regulated by promoter methylation in diabetes-associated cardiac hypertrophy.
Ther Adv Cardiovasc Dis · 2020 · PMID 32951517 · Full text
Abstract loading — click title to view on PubMed.
Safety of day-case endovascular interventions for peripheral arterial disease in a rural, underserved area.
Ansari A, Shah MA, Shah MA … +1 more , Ansari Z
Ther Adv Cardiovasc Dis · 2020 · PMID 32885724 · Full text
BACKGROUND: We aimed to investigate the safety of endovascular procedures undertaken in a single outpatient center located in a rural, underserved area. Endovascular procedures for Peripheral Arterial Disease (PAD) have...
BACKGROUND: We aimed to investigate the safety of endovascular procedures undertaken in a single outpatient center located in a rural, underserved area. Endovascular procedures for Peripheral Arterial Disease (PAD) have become increasingly common in outpatient settings; their safety is yet to be determined in a rural, underserved area with no stand-by vascular surgeon on site. METHODS: We undertook a retrospective case review of endovascular procedures for the investigation and management of lower extremity PAD between December 2012 and August 2015. Patients were classified by Rutherford score, degree of stenosis and length of lesions. Complications were major (requiring hospitalization) or minor, including perforation, distal embolization, hematoma, and allergic reactions, which could be treated immediately in the catheterization laboratory with no sequelae. Patients were monitored in the facility and followed up using clinical, biochemical and radiological parameters at 24 h and 1 month. RESULTS: A total of 692 patients underwent endovascular procedures for the investigation and/or treatment of PAD, of which 608 were interventional. Of these patients, 10.20% experienced procedural complications, of which 0.66% were classified as major, including wire retention and retroperitoneal hemorrhage. In total, 99.34% were discharged safely on the same day as the procedure. No adverse events were reported at follow up. CONCLUSION: Endovascular procedures for PAD can be performed safely in a rural outpatient setting with low complication rates. Most complications are minor and do not require hospitalization. Outpatient procedures for PAD are safe and may widen access to specialist procedures in areas of socio-economic deprivation.
Sodium glucose cotransporter (SGLT)-2 inhibitors alleviate the renal stress responsible for sympathetic activation.
Sano M
Ther Adv Cardiovasc Dis · 2020 · PMID 32715944 · Full text
This review focuses on the pathogenic role of sodium glucose cotransporter (SGLT)-2 in the development of renal dysfunction and heart failure in patients with diabetes, by emphasizing the concept of reno-cardiac syndrome...
This review focuses on the pathogenic role of sodium glucose cotransporter (SGLT)-2 in the development of renal dysfunction and heart failure in patients with diabetes, by emphasizing the concept of reno-cardiac syndrome (kidney injury worsens cardiac condition) and by substantiating the deleterious effect of sympathetic overdrive in this context. Furthermore, the review proposes a mechanistic hypothesis to explain the benefits of SGLT2 inhibitors, specifically that SGLT-2 inhibitors reduce sympathetic activation at the renal level. To illustrate this point, several examples from both animal experiments and clinical observations are introduced. The bidirectional interaction of the heart and kidney were deeply implicated as an exacerbator of heart failure and renal failure without diabetes. Renal cortical ischemia and abnormal glucose metabolism of tubular epithelial cells are likely to exist as common pathologies in nondiabetic heart failure patients. It is no wonder why SGLT-2 inhibitors are specifically being studied even in the absence of diabetes, both for heart failure and also for renal failure.
Flecainide is well-tolerated and effective in patient with atrial fibrillation at 12 months: a retrospective study.
Muzzey M, Tellor KB, Ramaswamy K … +2 more , Schwarze M, Armbruster AL
Ther Adv Cardiovasc Dis · 2020 · PMID 32633682 · Full text
INTRODUCTION: Current atrial fibrillation (AF) guidelines recommend flecainide as a first-line rhythm control option in patients without structural heart disease. While there is proven efficacy in clinical trials and gui...
INTRODUCTION: Current atrial fibrillation (AF) guidelines recommend flecainide as a first-line rhythm control option in patients without structural heart disease. While there is proven efficacy in clinical trials and guideline support, it is hypothesized that flecainide may be underutilized due to negative outcomes in the CAST trial and that adverse effects are less common than previously perceived. METHODS: This retrospective chart review evaluated patients ⩾18 years initiated on flecainide for AF from August 2011 to October 2016 by a cardiology provider at the study site. Exclusion criteria included: <5 days of flecainide therapy, AF due to a reversible cause, and inadequate documentation. The primary outcome was efficacy of flecainide at maintaining symptomatic control at 6 and 12 months. Secondary outcomes included characterization of alterations in rhythm control strategies and documented normal sinus rhythm per electrocardiogram at 6 and 12 months. RESULTS: Of the 326 patients identified, 144 patients were included. After 6 and 12 months, 102 patients (70.8%) and 89 patients (61.8%) of the 144 were symptomatically controlled. Atenolol use ( = 0.024), female sex ( = 0.006), hypertension ( = 0.040), and dronedarone failure ( = 0.012) were associated with flecainide discontinuation at 6 months. At 12 months, only previous propafenone failure ( = 0.032) was significant. Of the 144 patients, 16 (11.1%) reported adverse effects with dizziness, hot flashes, bradycardia, and headache (1.4% each) being the most common. CONCLUSION: Flecainide is a well-tolerated medication, even at 12 months, with very minor adverse effects. These results support the utility of flecainide in guideline recommended patient populations.
Ivabradine and endothelium: an update.
Dallapellegrina L, Sciatti E, Vizzardi E
Ther Adv Cardiovasc Dis · 2020 · PMID 32611276 · Full text
Ivabradine is a pure heart-rate lowering drug that is nowadays used, accordingly to the last ESC Guidelines, to reduce mortality and heart failure (HF) hospitalization in patients with HF with reduced ejection fraction a...
Ivabradine is a pure heart-rate lowering drug that is nowadays used, accordingly to the last ESC Guidelines, to reduce mortality and heart failure (HF) hospitalization in patients with HF with reduced ejection fraction and in symptomatic patiens with inappropriate sinus tachycardia. Moreover, interesting effect of ivabradine on endothelial and myocardial function and on oxidative stress and inflamation pathways are progressively emerging. The aim of this paper is to highlight newer evidences about ivabradine effect (and consequently possible future application of the drug) in pathological settings different from guidelines-based clinical practice.
Current status of white coat hypertension: where are we?
Nuredini G, Saunders A, Rajkumar C … +1 more , Okorie M
Ther Adv Cardiovasc Dis · 2020 · PMID 32580646 · Full text
White coat hypertension (WCH) is characterised by an elevated clinic blood pressure (BP) with normal ambulatory or home BP. It is well recognised in clinical practice and occurs in approximately one-third of untreated pa...
White coat hypertension (WCH) is characterised by an elevated clinic blood pressure (BP) with normal ambulatory or home BP. It is well recognised in clinical practice and occurs in approximately one-third of untreated patients with elevated clinic BP. Current evidence suggests that WCH is associated with cardiovascular risk factors, including the development of sustained hypertension and the presence of target organ damage. However, its effects on cardiovascular outcomes remain a matter of debate. There is also insufficient evidence from randomised controlled trials to determine whether WCH warrants treatment. This narrative review aims to provide an update on the current understanding of WCH. It focuses on the clinical characteristics and potential implications of WCH, its relationship to cardiovascular risk and the evidence regarding treatment. Gaps in existing research are also highlighted.
Exercise therapy in routine management of peripheral arterial disease and intermittent claudication: a scoping review.
Abaraogu UO, Abaraogu OD, Dall PM … +4 more , Tew G, Stuart W, Brittenden J, Seenan CA
Ther Adv Cardiovasc Dis · 2020 · PMID 32459138 · Full text
BACKGROUND: Little is known about the extent to which routine care management of peripheral arterial disease (PAD) and intermittent claudication (IC) align with best practice recommendations on exercise therapy. We condu...
BACKGROUND: Little is known about the extent to which routine care management of peripheral arterial disease (PAD) and intermittent claudication (IC) align with best practice recommendations on exercise therapy. We conducted a scoping review to examine the published literature on the availability and workings of exercise therapy in the routine management of patients with PAD and IC, and the attitude and practice of health professionals and patients. METHODS: A systematic search was conducted in February 2018. The Cumulative Index of Nursing and Allied Health Literature, Ovid MEDLINE, Allied and Complementary Medicine Database, ScienceDirect, Web of Science and the Directory of Open Access Repositories were searched. Hand searching of reference lists of identified studies was also performed. Inclusion criteria were based on study aim, and included studies that reported on the perceptions, practices, and workings of routine exercise programs for patients with IC, their availability, access, and perceived barriers. RESULTS: Eight studies met the eligibility criteria and were included in the review. Studies conducted within Europe were included. Findings indicated that vascular surgeons in parts of Europe generally recognize supervised exercise therapy as a best practice treatment for IC, but do not often refer their patients for supervised exercise therapy due to the unavailability of, or lack of access to supervised exercise therapy programs. Available supervised exercise therapy programs do not implement best practice recommendations, and in the majority, patients only undergo one session per week. Some challenges were cited as the cause of the suboptimal program implementation. These included issues related to patients' engagement and adherence as well as resource constraints. CONCLUSION: There is a dearth of published research on exercise therapy in the routine management of PAD and IC. Available data from a few countries within Europe indicated that supervised exercise is underutilized despite health professionals recognizing the benefits. Research is needed to understand how to improve the availability, access, uptake, and adherence to the best exercise recommendations in the routine management of people with PAD and IC.
Antithrombotic and hemostatic stewardship: evaluation of clinical outcomes and adverse events of recombinant factor VIIa (Novoseven) utilization at a large academic medical center.
Marsh K, Green D, Raco V … +2 more , Papadopoulos J, Ahuja T
Ther Adv Cardiovasc Dis · 2020 · PMID 32449469 · Full text
BACKGROUND: Recombinant factor VIIa (rFVIIa) (Novoseven®) is utilized for the reversal of anticoagulation-associated bleeding and refractory bleeding in cardiac surgery. In August 2015, rFVIIa was transferred from the bl...
BACKGROUND: Recombinant factor VIIa (rFVIIa) (Novoseven®) is utilized for the reversal of anticoagulation-associated bleeding and refractory bleeding in cardiac surgery. In August 2015, rFVIIa was transferred from the blood bank to the pharmacy at New York University (NYU) Langone Health. Concordantly, an off-label dosing guideline was developed. The objective of this study was to describe utilization and cost of rFVIIa and assess compliance to our dosing guideline. METHODS: We performed a retrospective, observational review of rFVIIa administrations post-implementation of an off-label dosing guideline. All patients who received rFVIIa between September 2015 and June 2017 were evaluated. For each rFVIIa administration, anticoagulation and laboratory values, indications for use, dosing, ordering and administration times, concomitant blood products, and adverse events were collected. Adverse events included venous thromboembolism, stroke, myocardial infarction, and death due to systemic embolism and mortality. The primary endpoint was the utilization of rFVIIa in accordance with the off-label dosing guideline. Secondary endpoints included hemostatic efficacy of rFVIIa, adverse events, blood products administered, and cost-effectiveness of rFVIIa transition to pharmacy. RESULTS: A total of 63 patients [pediatric ( = 6), adult ( = 57)] received rFVIIa, with the majority of use for refractory bleeding after cardiac surgery. The utilization of rVIIa decreased after development of the off-label dosing guideline and transition from blood bank to pharmacy. The total incidence of thromboembolic events within 30 days was 19.6%; 17.6% arterial and 2% venous; 70% of patients with an adverse event were over 70 years of age. Use of rFVIIa reduced the median number of units of blood products administered. CONCLUSION: Administration of rFVIIa for cardiac surgery appears to be effective for hemostasis. Transitioning rFVIIa from the blood bank to pharmacy and implementation of a dosing guideline appears to have reduced utilization. Patients receiving rFVIIa should be monitored for thromboembolic events. Elderly patients may be at higher risk for thromboembolic events.
Endovascular approach for acute limb ischemia without thrombolytic therapy.
Fukuda K, Yokoi Y
Ther Adv Cardiovasc Dis · 2020 · PMID 32438865 · Full text
BACKGROUND: Endovascular therapy for acute lower limb ischemia (ALLI) has developed and demonstrated safety and efficacy. The purpose of this study was to assess clinical outcomes in patients treated for ALLI with conven...
BACKGROUND: Endovascular therapy for acute lower limb ischemia (ALLI) has developed and demonstrated safety and efficacy. The purpose of this study was to assess clinical outcomes in patients treated for ALLI with conventional endovascular or surgical revascularization. METHOD: This study was a retrospective single-center review. Consecutive patients with ALLI treated with conventional endovascular revascularization (ER) without thrombolytic agent or surgical revascularization (SR) between 2008 and 2014 were investigated. The 1 year and 3 year amputation rate and mortality rate were assessed by time-to-event methods, including Kaplan-Meier estimation. RESULT: A total of 64 limbs in 62 patients with ALLI due to thromboembolism or thrombosis of a native artery, bypass graft, or previous stented vessel were included. The majority of limbs (90.9%) presented with Rutherford clinical categories 1 to 2 ischemia. Technical success rate was 95.5% in ER and 92.9% in SR group ( = 0.547). Overall amputation rates were 9.1% in ER 9.5% in SR after 1 year ( = 0.971) and 9.1% in ER 11.9% in SR after 3 year ( = 0.742). Overall mortality rates were 15% in ER 7.1% in SR after 1 year ( = 0.491) and 15% in ER 11.2% in SR after 3 year ( = 0.878). CONCLUSION: Endovascular or surgical revascularization of ALLI resulted in comparable outcomes in limb salvage and mortality rate at 1 year and 3 year. Conventional endovascular therapy without thrombolytic agent such as stenting, balloon angioplasty, or catheter-directed thrombosuction may be considered as a treatment option for ALLI.
Inter-observer variation of Syntax score among cardiac surgeons, clinical and interventional cardiologists.
de Araujo GN, Leiria TLL, Furtado MV … +7 more , Matte BDS, Machado GP, Krepsky AM, Bergoli LCC, Goncalves SC, Wainstein MV, Polanczyk CA
Ther Adv Cardiovasc Dis · 2020 · PMID 32438849 · Full text
BACKGROUND: Despite the complexity of SYNTAX score (SS), guidelines recommend this tool to help choosing between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with left m...
BACKGROUND: Despite the complexity of SYNTAX score (SS), guidelines recommend this tool to help choosing between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with left main of three-vessel coronary artery disease. The aim of this study was to compare the inter-observer variation in SS performed by clinical cardiologists (CC), interventional cardiologists (IC), and cardiac surgeons (CS). METHODS: Seven coronary angiographies from patients with left main and/or three-vessel disease chosen by a heart team were analyzed by 10 CC, 10 IC and 10 CS. SS was calculated SYNTAX website. RESULTS: Kappa concordance was very low between CC and CS (k = 0.176), moderate between CS and IC (k = 0.563), and moderate between CC and IC (0.553). There was a statistically significant difference between CC, who classified more cases as low complexity (70%), and CS, who classified more cases as moderate complexity (80%) ( = 0.041). CONCLUSION: Concordance between SS analyzed by CC, CS and IC is low. The usefulness of SS in decision-making of revascularization strategy is undeniable and evidence supports its use. However, this study highlights the importance of well-trained professionals on calculating the SS. It could avoid misclassification of borderline cases.
Multicap to improve adherence after acute coronary syndromes: results of a randomized controlled clinical trial.
Mariani J, Rosende A, De Abreu M … +6 more , Gonzalez Villa Monte G, D'Imperio H, Antonietti L, Lemonnier G, de Bonis A, Tajer C
Ther Adv Cardiovasc Dis · 2020 · PMID 32186246 · Full text
BACKGROUND: Adherence to treatment after a myocardial infarction (MI) is poor, even in the early postinfarction period. Combining evidence-based drugs into a multicap could improve adherence in this population. No previo...
BACKGROUND: Adherence to treatment after a myocardial infarction (MI) is poor, even in the early postinfarction period. Combining evidence-based drugs into a multicap could improve adherence in this population. No previous randomized trial assessing fixed-dose combination therapy has included patients early after a MI. We aimed to assess if a multicap containing four secondary prevention drugs increases adherence to treatment at 6 months after MI hospitalization. The study was designed as a randomized, parallel, open-label, controlled trial. METHODS: Patients were randomized within 7 days of a MI to either multicap or control group. The multicap group received a capsule containing aspirin, atenolol, ramipril, and simvastatin. The control group received each drug in separate pills. The primary outcome was adherence at 6 months. We also measured blood pressure, heart rate, serum cholesterol levels, C-reactive protein, and platelet aggregation. RESULTS: The study was stopped prematurely when 100 patients were included for futility. At 6 months, 92 (95.8%) patients were adherent to medical treatment: 98.0% in the multicap group and 93.5% in the control group [relative risk (RR) 1.05; 95% confidence interval (CI) 0.96-1.14; = 0.347]. There were no differences between groups in systolic blood pressure ( = 0.662), diastolic blood pressure ( = 0.784), heart rate ( = 0.533), total cholesterol ( = 0.760), LDL-c ( = 0.979), C-reactive protein ( = 0.399), or in the proportion of patients with adequate platelet aggregation inhibition ( = 0.600). CONCLUSIONS: The study did not find any improvement in the adherence at 6 months after a MI with a multicap-based strategy (Multicap for Increase Adherence After Acute Myocardial Infarction; [ ClinicalTrials.gov identifier: NCT02271178]).
Endpoint selection for noninferiority percutaneous coronary intervention trials: a methodological description.
Waliszewski M, Rosenberg M, Rittger H … +2 more , Breul V, Krackhardt F
Ther Adv Cardiovasc Dis · 2020 · PMID 32168991 · Full text
BACKGROUND: The objective of this review is to provide a practical update on endpoint selection for noninferiority (NI) studies in percutaneous coronary intervention studies. METHODS: A PubMed search was conducted for pr...
BACKGROUND: The objective of this review is to provide a practical update on endpoint selection for noninferiority (NI) studies in percutaneous coronary intervention studies. METHODS: A PubMed search was conducted for predefined terms to explore the use of NI designs and intrapatient comparisons to determine their current importance. Sample size calculations for the most frequently used endpoints with NI hypotheses were done to increase statistical awareness. RESULTS: Reported NI trials, with the most frequently chosen clinical endpoint of major adverse cardiac events (MACE), had NI margins ranging from 1.66% to 5.00%, resulting in patient populations of 400-1500 per treatment group. Clinical study endpoints comprising of MACE complemented with rates of bleeding complications and stent thrombosis (ST) are suggested to conduct a statistically and clinically meaningful NI trial. Study designs with surrogate endpoints amenable to intrapatient randomizations, are a very attractive option to reduce the number of necessary patients by about half. Comparative clinical endpoint studies with MACE and ST/bleeding rates to study a shortened dual antiplatelet therapy (DAPT) in coronary stent trials are feasible, whereas ST as the sole primary endpoint is not useful. CONCLUSIONS: Expanded composite clinical endpoints (MACE complemented by ST and bleeding rates and intrapatient randomization for selected surrogate endpoints) may be suitable tools to meet future needs in device approval, recertification and reimbursement.
Acute right heart failure: future perspective with the PERKAT RV pulsatile right ventricular support device.
Ferrari MW, Schulze PC, Kretzschmar D
Ther Adv Cardiovasc Dis · 2020 · PMID 31918629 · Full text
Acute right heart failure is associated with impaired prognosis in cardiogenic shock. Since most pharmacological therapies are not evaluated for the failing right ventricle, or even contraindicated, there is a need for r...
Acute right heart failure is associated with impaired prognosis in cardiogenic shock. Since most pharmacological therapies are not evaluated for the failing right ventricle, or even contraindicated, there is a need for rapid minimal invasive circulatory right heart support. The PERKAT RV is such a device for acute therapy in congestive heart failure. It reduces the central venous pooling by pumping blood from the inferior vena cava into the pulmonary artery with flow rates of up to 4 litres/min. The device was evaluated in an animal model of acute pulmonary embolism after careful tests. PERKAT RV increased cardiac output by 59% in sheep suffering from acute right heart failure. We await the first human implantation in the near future. Based on the PERKAT concept, future devolvement will also focus on left heart support.
Importance of sodium-glucose cotransporter 2 inhibitor use in diabetic patients with acute heart failure.
Kambara T, Shibata R, Osanai H … +4 more , Nakashima Y, Asano H, Murohara T, Ajioka M
Ther Adv Cardiovasc Dis · 2019 · PMID 31854243 · Full text
BACKGROUND: It is known that once heart failure occurs in older patients with diabetes, the overall prognosis is extremely poor. We investigated whether early initiation of SGLT2 inhibitor therapy after admission was ben...
BACKGROUND: It is known that once heart failure occurs in older patients with diabetes, the overall prognosis is extremely poor. We investigated whether early initiation of SGLT2 inhibitor therapy after admission was beneficial for diabetic patients requiring inpatient treatment for acute heart failure. METHODS: We retrospectively assessed consecutive patients with comorbid diabetes who were admitted to the Department of Cardiology in Tosei General Hospital for treatment of acute heart failure. Patients were divided into two groups: those who initiated SGLT2 inhibitor therapy (SGLT2 inhibitor group; mean age: 73 ± 9 years) and those who did not receive the inhibitors during hospitalization (conventional treatment group; mean age: 75 ± 10 years). RESULTS: No intergroup differences were observed in the distribution of either the severity or classes of heart failure on admission. Glycosylated hemoglobin levels were significantly higher in the SGLT2 inhibitor group (HbA1c: 8.1% ± 0.8%) than in the conventional treatment group (HbA1c: 7.1% ± 0.8%) ( = 0.003). After admission, patients in both groups recovered equally well, and in almost the same period of time, before discharge. The rate of diuretics use at the time of discharge in the SGLT2 inhibitor group ( = 8, 67%) was significantly lower than that in the conventional treatment group ( = 19, 100%) ( = 0.016). In particular, the dose of loop diuretics in the conventional treatment group was 34 ± 4 mg/day while that in the SGLT2 inhibitor group was significantly lower at 13 ± 5 mg/day ( = 0.008). During hospitalization, the incidence of acute kidney injury was significantly higher in the conventional treatment group ( = 11, 58%) than in the SGLT2 inhibitor group ( = 2, 16%) ( = 0.031). CONCLUSIONS: For the treatment and management of heart failure in patients with diabetes, early initiation of SGLT2 inhibitor therapy appears to be effective.
Intravenous antiplatelet therapies (glycoprotein IIb/IIIa receptor inhibitors and cangrelor) in percutaneous coronary intervention: from pharmacology to indications for clinical use.
Capodanno D, Milluzzo RP, Angiolillo DJ
Ther Adv Cardiovasc Dis · 2019 · PMID 31823688 · Full text
Oral antiplatelet drugs are crucially important for patients with acute coronary syndrome or stable coronary artery disease undergoing percutaneous coronary intervention (PCI). In recent decades, several clinical trials...
Oral antiplatelet drugs are crucially important for patients with acute coronary syndrome or stable coronary artery disease undergoing percutaneous coronary intervention (PCI). In recent decades, several clinical trials have focused on reducing periprocedural ischemic events in patients undergoing PCI by means of more rapid platelet inhibition with the use of intravenous antiplatelet drugs. Glycoprotein IIb/IIIa receptor inhibitors (GPIs) block the final common pathway of platelet aggregation and enable potent inhibition in the peri-PCI period. In recent years, however, the use of GPIs has decreased due to bleeding concerns and the availability of more potent oral P2Y inhibitors. Cangrelor is an intravenous P2Y receptor antagonist. In a large-scale regulatory trial, cangrelor administration during PCI allowed for rapid, potent and rapidly reversible inhibition of platelet aggregation, with an anti-ischemic benefit and no increase in major bleeding. This article aims to provide an overview of general pharmacology, supporting evidence and current status of intravenous antiplatelet therapies (GPIs and cangrelor), with a focus on contemporary indications for their clinical use.
Evolving paradigms in antithrombotic therapy for anticoagulated patients undergoing coronary stenting.
Buccheri S, Angiolillo DJ, Capodanno D
Ther Adv Cardiovasc Dis · 2019 · PMID 31814532 · Full text
A sizable proportion of coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) with stent implantation have an indication for treatment with oral anticoagulant therapy (OAC). The coexi...
A sizable proportion of coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) with stent implantation have an indication for treatment with oral anticoagulant therapy (OAC). The coexistence of atrial fibrillation (AF) and the need for PCI expose patients to a higher risk of developing thrombotic complications, and a multitargeted antithrombotic treatment strategy, addressing both platelet- and coagulation-mediated triggering mechanisms of thrombosis, is necessary for ensuring full protection from ischemic hazards. The increased bleeding risk identified with triple antithrombotic therapy has driven the search for alternative treatment modalities and pharmacological combination strategies aimed at achieving an optimal balance between safety and efficacy in this complex clinical scenario. Over a short time period, the paradigms surrounding the management of patients undergoing PCI who require OAC have substantially evolved. In this review, we summarize and critically evaluate the results of recent randomized clinical trials investigating the pharmacological management of patients who, in addition to antiplatelet therapy, have an indication for OAC treatment before or at the time of a PCI procedure.
Influence of rurality on the awareness of myocardial infarction symptoms in the US.
Tran P, Tran L
Ther Adv Cardiovasc Dis · 2019 · PMID 31797738 · Full text
BACKGROUND: Myocardial infarctions (MIs) are the leading cause of death in the United States (US). Differences in MI mortality rates exist between rural and urban areas in the US. Early recognition of MI symptoms can lea...
BACKGROUND: Myocardial infarctions (MIs) are the leading cause of death in the United States (US). Differences in MI mortality rates exist between rural and urban areas in the US. Early recognition of MI symptoms can lead to receiving prompt lifesaving treatment. In this study, we identified the influence of living in a rural area, rurality, on disparities in MI symptom awareness across the US. METHODS: We examined 2007 and 2009 Behavioral Risk Factor Surveillances System survey data using logistic regressions to model the impact of rurality on MI symptom awareness while controlling for sociodemographic and MI clinical factors. From the results of these models, we created a type of marginal probability, known as average adjusted predictions (AAPs) and the difference in AAPs, called average marginal effects (AMEs), to determine patterns of awareness for each MI symptom between rural, suburban, and urban areas. RESULTS: We found that there were similar odds and probabilities of being aware of all five MI symptoms between rural, suburban, and urban areas, although rural residents consistently had a slightly higher odds and probability of being aware of all five MI symptoms compared with suburban and urban residents. Rural, suburban, and urban residents had the highest probability of being aware of chest pain/discomfort (95.5-96.1%) and the lowest probability of being aware of jaw/back/neck pain (68.6-72.0%). After adjustment, more than 25% of rural, suburban, and urban residents were found to be unaware that jaw/back/neck pain and feeling weak/light-headed/faint were symptoms of MI. AMEs were greatest for all areas for jaw/back/neck pain (-3.5% to -3.2%) and smallest for chest pain/discomfort (-0.6% to -0.2%). CONCLUSIONS: The study's results highlight the need to increase awareness of the MI symptoms of jaw/back/neck pain and feeling weak/light-headed/faint to shorten hospital delay and time to treatment, especially for rural areas where cardiovascular disease mortality is high.
AHA/ACC/Multisociety Cholesterol Guidelines: highlights.
Jialal I, Devaraj S
Ther Adv Cardiovasc Dis · 2019 · PMID 31590600 · Full text
Abstract loading — click title to view on PubMed.
Serum visfatin level is associated with complexity of coronary artery disease in patients with stable angina pectoris.
Duman H, Özyıldız AG, Bahçeci İ … +3 more , Duman H, Uslu A, Ergül E
Ther Adv Cardiovasc Dis · 2019 · PMID 31588856 · Full text
BACKGROUND: Visfatin is an adipokine that plays a role in the inflammatory process of atherosclerosis. This study aimed to investigate whether adipokine is associated with the extent of stable coronary artery disease (CA...
BACKGROUND: Visfatin is an adipokine that plays a role in the inflammatory process of atherosclerosis. This study aimed to investigate whether adipokine is associated with the extent of stable coronary artery disease (CAD). METHODS: The study population included 110 patients who underwent elective coronary angiography (CAG) due to stable angina pectoris. The severity of CAD was assessed by the 'Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX)' score. We evaluated patients in two groups: group 1 with a SYNTAX score <22 (low) and group 2 with a SYNTAX score ⩾22 (intermediate to high). RESULTS: Serum visfatin (8.6 ± 4.2 ng/ml 13.4 ± 5.2 ng/ml, < 0.001) and serum C-reactive protein (CRP) levels [0.46 (0.25-0.77) mg/dl 0.71 (0.32-1.10) mg/dl, < 0.001] were lower in group 1. A positive significant correlation was found between serum visfatin level and SYNTAX score ( = 0.559, < 0.001). In a multivariate logistic regression analysis, visfatin [odds ratio (OR) 1.22, 95% confidence interval (CI) 1.10-1.36; < 0.001], CRP (OR 6.22, 95% CI 1.70-22.7; = 0.006), and diabetes mellitus (OR 3.83, 95% CI 1.10-13.2; = 0.034) were found to be independent predictors of SYNTAX score. CONCLUSIONS: Serum visfatin level was positively correlated with CAD severity in patients with high SYNTAX score. Serum visfatin level can be a useful biomarker for predicting high SYNTAX scores in patients with angina pectoris undergoing CAG.
Hemodynamic differences among hypertensive patients with and without heart failure using impedance cardiography.
Silva Lopes B, Craveiro N, Firmino-Machado J … +2 more , Ribeiro P, Castelo-Branco M
Ther Adv Cardiovasc Dis · 2019 · PMID 31554488 · Full text
BACKGROUND: Impedance cardiography is a reliable, well-tolerated, and non-invasive method used to obtain hemodynamic measurements and could potentially be useful in heart failure (HF) diagnosis, hemodynamic monitoring of...
BACKGROUND: Impedance cardiography is a reliable, well-tolerated, and non-invasive method used to obtain hemodynamic measurements and could potentially be useful in heart failure (HF) diagnosis, hemodynamic monitoring of critically ill patients, and help in the choice of antihypertensive therapy. The objective of this study was to determine the differences between hemodynamic parameters in a study population of hypertensive patients with and without HF, using impedance cardiography. METHODS: A case-control study was designed and named the TARGET study. Participants were enrolled in two study groups: control group C, hypertensive patients without HF and the HF group, hypertensive patients with HF. A descriptive analysis was carried out to characterize the sample and differences in continuous variables were tested for statistical significance by independent sample test. RESULTS: The study included 102 hypertensive outpatients. The control group consisted of 77 individuals (58.4% males; mean age 63.9 ± 12.5 years old) and the HF group consisted of 25 individuals (44.0% males; mean age 74.2 ± 8.7 years old). The mean Cardiac Index (CI) was 2.70 ± 1.02 L.min.m (2.89 ± 1.04 2.12 ± 0.70; < 0.001), mean Stroke Index (SI) was 35.5 ± 14.7 mL.m (37.7 ± 15.2 28.5 ± 10.8; = 0.006), mean Ejection Phase Contractility Index (EPCI) was 33.7 ± 12.7 1000 s (35.8 ± 13.1 27.2 ± 9.2; = 0.003), mean Inotropic State Index (ISI) was 74.3 ± 28.2 100 s (78.8 ± 28.9 60.6 ± 20.7; = 0.005), and mean Left Stroke Work Index (LSWI) was 51.3 ± 23.1 g.min.m (55.4 ± 23.5 38.9 ± 16.6; = 0.002). CONCLUSIONS: In this study, hypertensive patients with HF had significantly lower values of blood flow parameters, contractility, and left work indices compared with hypertensive patients without HF. These differences reflected the incorrect hemodynamic pattern (mostly hypodynamic) of these patients. Impedance cardiography (ICG) seems to be an adequate method to reflect these differences.
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