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Current Opinion in Cardiology

Sharon Karr
PURPOSE OF REVIEW: The purpose of this review is to update the physician community on current evidence regarding ways individuals can combat the rise in physician burnout. More than half of US physicians are experiencing at least some degree of burnout and the incidence has increased significantly over the past decade. RECENT FINDINGS: Recent findings suggest practicing physical, mental, and emotional self-care are important factors in avoiding physician burnout...
November 13, 2018: Current Opinion in Cardiology
Mitchell I Cohen
PURPOSE OF REVIEW: Premature ventricular beats (PVCs) are frequently identified in healthy children with structurally normal hearts and generally have a benign clinical course often disappearing spontaneously. However, a small percentage of children may develop a cardiomyopathy. The purpose of this review is to understand which children may be at risk of development of left ventricular (LV) dysfunction with idiopathic PVCs. RECENT FINDINGS: There is increasing evidence that a ventricular ectopic burden more than 24% in adults may lead to LV dysfunction...
November 6, 2018: Current Opinion in Cardiology
Rebecca L Miller, Callie J Diamonstein, Alan Benheim
PURPOSE OF REVIEW: Bicuspid aortic valve (BAV) is a common congenital heart defect, with an estimated frequency of 1-2% in the general population. BAV may occur as an isolated finding or as a feature of certain syndromes. This article discusses potential genetic causes of BAV, includes a list of current known and candidate genes associated with BAV, provides a hypothetical case demonstrating the importance of genetic testing and cascade screening, and highlights the value of genetic counselors specializing in cardiovascular genetics...
November 1, 2018: Current Opinion in Cardiology
Amir H Ashrafi, Victor Y Levy
PURPOSE OF REVIEW: Patent ductus arteriosus (PDA) remains the most common cardiovascular condition afflicting neonates. Despite 5 decades of scientific inquiry pediatric cardiologists and neonatologists still cannot answer the simple question of which PDAs should be treated. RECENT FINDINGS: Although the volume of the shunt is difficult to calculate, echocardiography, biochemical markers, and clinical exam can provide clues to the magnitude and physiologic consequences of the shunt...
November 1, 2018: Current Opinion in Cardiology
Carlos Sisniega, Nayeli Zayas, Tomas Pulido
PURPOSE OF REVIEW: The purpose of this review is to demonstrate advances in the medical treatment of pulmonary arterial hypertension (PAH). Reviewed will be the evidence that favors the use of risk assessment in the treatment of PAH. Optimization of combination therapy depending on the risk or worsening will be reviewed. Finally, recent advances in new treatment strategies will be mentioned. RECENT FINDINGS: The use of therapies in sequence or in combination for the treatment of PAH has been shown to decrease morbidity and mortality...
November 1, 2018: Current Opinion in Cardiology
Susan Payne Etheridge, Sarah Yukiko Asaki, Mary Chun-I Niu
PURPOSE OF REVIEW: Our purpose is to provide an update on the new clinical and genetic aspects of long QT syndrome (LQTS). LQTS is the most common channelopathy and a cause of syncope and sudden death in the young. Although there are 17 types of LQTS, most patients have types 1 or 2 which are due to mutations in KCNQ1 and KCNH2 (encoding for the cardiac potassium channels), and type 3 which is due to a mutation in SCN5A (encoding for the sodium channel). LQTS is characterized by incomplete penetrance and variable expressivity...
November 1, 2018: Current Opinion in Cardiology
Mark J Shen, Bradley P Knight
PURPOSE OF REVIEW: This article uses three commonly encountered clinical scenarios to highlight the value of high-density mapping in the electrophysiology laboratory for the identification of the circuits and substrates during catheter ablation of complex arrhythmias. RECENT FINDINGS: High-density mapping gathered with a multielectrode catheter, with its smaller individual electrode size and closer interelectrode spacing, helps during ablation procedures in a number of ways...
October 15, 2018: Current Opinion in Cardiology
Ioanna Kosmidou, Gregg W Stone
PURPOSE OF REVIEW: To provide an up-to-date review of recent trials examining the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) and the impact of postprocedural NOAF compared to nonsurgical atrial fibrillation. RECENT FINDINGS: A recent analysis from the Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial demonstrated that NOAF is much more frequent following surgical compared with percutaneous revascularization for LMCAD, and is strongly associated with an increased 3-year risk of mortality and stroke...
November 2018: Current Opinion in Cardiology
Atsushi Sakamoto, Renu Virmani, Aloke V Finn
PURPOSE OF REVIEW: Prior investigations have shown the close association between coronary artery calcification (CAC) and total atherosclerotic plaque burden as well as the risk of cardiovascular and all-cause mortality. However, recent pathologic and imaging-based studies suggested that massive dense calcifications are usually associated with stable plaque; whereas, micro calcifications, especially in the thin fibrous cap, are related to vulnerable characteristics. Further, the molecular mechanisms for initiation/progression of vascular calcification are highly complex and still need to be elucidated...
November 2018: Current Opinion in Cardiology
Gerasimos Siasos, Vasiliki Tsigkou, Marina Zaromytidou, Jaskanwal D Sara, Anubodh Varshney, Ahmet Umit Coskun, Amir Lerman, Peter H Stone
PURPOSE OF REVIEW: The natural history of coronary atherosclerosis is complex and atherosclerotic plaques exhibit large morphologic and functional variability within the same individual as well as over time. The purpose of this article is to review the role of blood flow patterns and shear stress on the development of microvascular and epicardial endothelial dysfunction and atherosclerosis progression. RECENT FINDINGS: Recent breakthroughs in cardiovascular imaging have facilitated in-vivo characterization of the anatomic and functional characteristics of atherosclerotic plaques and have highlighted the role of endothelial shear stress and epicardial and microvascular endothelial dysfunction in the natural history of coronary atherosclerosis...
November 2018: Current Opinion in Cardiology
Josh Zimmerman, Linda Shore-Lesserson
PURPOSE OF REVIEW: As our population ages and cardiovascular disease increases in prevalence, a growing number of patients will be candidates for coronary artery bypass grafting (CABG). Outcomes from this common surgery can be improved by a coordinated team approach involving physicians, nurses, and healthcare professionals from multiple specialties. This review will discuss the role cardiovascular anesthesiologists play in the perioperative care of these complex patients. RECENT FINDINGS: Cardiovascular anesthesiologists may play a variety of important roles throughout the entire perioperative period of patients undergoing CABG...
November 2018: Current Opinion in Cardiology
Kay Maeda, Shuichiro Takanashi, Yoshikatsu Saiki
PURPOSE OF REVIEW: Intraaortic balloon pump (IABP) has been the most widely used device to help patients recover from circulatory disorder mainly because of cardiogenic shock; however, no evidence-based clinical benefit derived from IABP support has been reported in recent clinical trials. This review provides an overview of the current outcomes and challenges in perioperative IABP use for cardiogenic shock patients. RECENT FINDINGS: Although IABP support yielded no significant difference in mortality for myocardial infarction complicated by cardiogenic shock, perioperative IABP use generated beneficial clinical outcomes for high-risk patients undergoing coronary revascularization...
November 2018: Current Opinion in Cardiology
Christopher A Stack, John W Cole
PURPOSE OF REVIEW: Although the clinical approach to the young adult stroke patient is similar to that of an older adult, several important differences exist. The purpose of this article is to concisely review the epidemiology, pathophysiology, risk factors, clinical manifestations, diagnostic methods and current treatment options for the young adult ischemic stroke patient. RECENT FINDINGS: Evidence clearly indicates that the incidence ischemic stroke in young adults is on the rise...
November 2018: Current Opinion in Cardiology
Mario F L Gaudino, David P Taggart, Stephen E Fremes
PURPOSE OF REVIEW: We herein summarize the current evidence on the clinical outcome associated with the use of single and multiple arterial grafts for coronary bypass surgery and the role and importance of the Randomized comparison of the clinical Outcome of single versus Multiple Arterial grafts (ROMA) trial. RECENT FINDINGS: Observational evidence suggests that the use of multiple arterial grafts is associated with better clinical outcomes compared to the use of a single arterial graft...
November 2018: Current Opinion in Cardiology
Sonya K Hui, Emma Lindale, Louise Sun, Marc Ruel
PURPOSE OF REVIEW: Patients with multivessel coronary artery disease (CAD) may undergo revascularization by either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). This review will discuss the use of polygenic risk scores for risk-stratification of patients with multivessel CAD in order to guide the choice of revascularization. RECENT FINDINGS: A 57-single nucleotide polymorphism (SNP)-polygenic risk score can accurately risk-stratify patients with CAD and identify those who will receive greater benefit from statin therapy...
November 2018: Current Opinion in Cardiology
Simeng Zhang, Yanqing Chen, Qingsheng Lu
PURPOSE OF REVIEW: Retrograde type A aortic dissection (RTAD) is a fatal complication after endovascular therapy of type B aortic dissection and descending thoracic aneurysm disease. This review aims to elaborate this lethal complication, the potential risks of its incidence, and feasible approaches to lower the occurrence rate. RECENT FINDINGS: Many articles have shown lower incidence of RTAD in patients with thoracic aneurysm than those with aortic dissection...
November 2018: Current Opinion in Cardiology
Janet M C Ngu, Marc Ruel, Louise Y Sun
PURPOSE OF REVIEW: In 2013, heart failure with recovered ejection fraction (HFrecEF) was introduced as a new heart failure phenotype. This review provides an overview of HFrecEF and the comparative effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on left ventricular ejection fraction (LVEF) recovery in patients with ischemic cardiomyopathy. RECENT FINDINGS: There has been emerging data indicating that LV functional recovery is possible and HFrecEF is associated with improved survival and better quality of life...
November 2018: Current Opinion in Cardiology
Erika Opingari, Arun C R Partridge, Subodh Verma, Harpreet S Bajaj
PURPOSE OF REVIEW: To address common concerns regarding sodium-glucose cotransporter 2 (SGLT2) inhibitor use for patients with type 2 diabetes mellitus (T2DM) in cardiovascular practice. RECENT FINDINGS: SGLT2 inhibitors provide glycemic control and improve cardiovascular and renal endpoints in T2DM. Cardiovascular outcome trials have demonstrated sustained cardiovascular, heart failure and renal benefits independent of glycemic control, which persist down to an eGFR of 30 ml/min/1...
November 2018: Current Opinion in Cardiology
Harpreet S Bajaj, Badr Al-Jabri, Subodh Verma
PURPOSE OF REVIEW: Cardiovascular outcome trials (CVOT) with glucagon-like peptide-1 receptor agonists (GLP-1 RA) have had variable results to date: with two CVOTs being positive and two concluding neutrality/safety results for primary cardiovascular outcome. Mechanistic insights delving into the pathophysiologic mechanisms that may link certain GLP-1 RA to cardioprotection may help define the application of this medication class in clinical practice based on the evidence of the CVOT data...
November 2018: Current Opinion in Cardiology
Chethan R Kasargod Prabhakar, Ralph Stewart
PURPOSE OF REVIEW: To review recent literature on associations between habitual physical activity and mortality in general populations and patients with stable coronary heart disease. RECENT FINDINGS: There are substantial decreases in cardiovascular and all-cause mortality between people who take little or no exercise and those who take regular light or moderate physical activity. The benefits associated with increasing high-intensity exercise are smaller, and an increase in mortality risk is possible...
November 2018: Current Opinion in Cardiology
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