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Expert Review of Cardiovascular Therapy

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https://www.readbyqxmd.com/read/29790365/non-vitamin-k-antagonist-oral-anticoagulants-in-atrial-fibrillation-patients-with-bioprosthetic-valves
#1
Jason G Andrade, Elena Meseguer, Romain Didier, Charles Dussault, Jeffrey I Weitz
The non-vitamin K antagonist oral anticoagulants (NOACs), which include dabigatran, apixaban, edoxaban and rivaroxaban, are preferred over vitamin K antagonists for stoke prevention in most patients with non-valvular atrial fibrillation. The NOACs are contraindicated in atrial fibrillation patients with rheumatic mitral stenosis or mechanical heart valves. There is evidence that bioprosthetic heart valves are less thrombogenic than mechanical heart valves, but it is unknown whether the risk of thromboembolism in atrial fibrillation patients with bioprosthetic valves differs from that in patients without such valves...
May 23, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29757020/recent-advances-in-the-treatment-of-brugada-syndrome
#2
Mariana Argenziano, Charles Antzelevitch
Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome characterized by ST-segment elevation in right precordial ECG leads and associated with sudden cardiac death in young adults. The ECG manifestations of BrS are often concealed but can be unmasked by sodium channel blockers and fever. Areas covered: Implantation of a cardioverter defibrillator (ICD) is first-line therapy for BrS patients presenting with prior cardiac arrest or documented VT. A pharmacological approach to therapy is recommended in cases of electrical storm, as an adjunct to ICD and as preventative therapy...
May 14, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29737886/role-of-proprotein-convertase-subtilisin-kexin-type-9-inhibitors-in-patients-with-coronary-artery-disease-undergoing-percutaneous-coronary-intervention
#3
Eliano P Navarese, Michalina Kołodziejczak, Aniela Petrescu, Bernhard Wernly, Michael Lichtenauer, Alexander Lauten, Antonino Buffon, Wojciech Wanha, Vincenzo Pestrichella, Gennaro Sardella, Gaetano Contegiacomo, Udaya Tantry, Kevin Bliden, Jacek Kubica, Paul A Gurbel
Although novel therapies have improved outcomes in PCI patients, a sizeable number of patients still remain at high cardiovascular risk for recurrent event. There is therefore an unmet need for novel therapies that can improve clinical outcomes, with an associated satisfactory safety profile. Proprotein convertase subtilisin/kexin type 9 (PCSK9) enzyme is a novel lipid-lowering target with a potential to impact high-cardiovascular risk populations including patients with coronary artery disease (CAD), undergoing the percutaneous coronary intervention (PCI)...
May 8, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29734858/current-and-future-applications-of-ct-coronary-calcium-assessment
#4
Christian Tesche, Taylor M Duguay, U Joseph Schoepf, Marly van Assen, Carlo N De Cecco, Moritz H Albrecht, Akos Varga-Szemes, Richard R Bayer, Ullrich Ebersberger, John W Nance, Christian Thilo
Computed tomographic (CT) coronary artery calcium scoring (CAC) has been validated as a well-established screening method for cardiovascular risk stratification and treatment management that is used in addition to traditional risk factors. The purpose of this review is to present an update on current and future applications of CAC. Areas covered: The topic of CAC is summarized from its introduction to current application with focus on the validation and clinical integration including cardiovascular risk prediction and outcome, cost-effectiveness, impact on downstream medical testing, and the technical advances in scanner and software technology that are shaping the future of CAC...
May 8, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29732926/imaging-guided-pre-dilatation-stenting-post-dilatation-ipsp-a-protocolized-approach-highlighting-the-importance-of-intravascular-imaging-for-implantation-of-bioresorbable-scaffolds
#5
Ziad A Ali, Keyvan Karimi Galougahi, Richard Shlofmitz, Akiko Maehara, Gary S Mintz, Alexandre Abizaid, Daniel Chamié, Jonathan Hill, Patrick W Serruys, Yoshinobu Onuma, Gregg W Stone
The advent of the fully bioresorbable vascular scaffold (BVS) is the latest step in a series of advancements in the design of intracoronary stents over the past few decades. The novelty of this technology is in providing temporary vessel scaffolding and local antiproliferative therapy to prevent neointimal hyperplasia after percutaneous coronary intervention followed by gradual resorption of the scaffold to restore the native vessel anatomy and physiology-a process termed vascular reparative therapy. Areas covered: The first generation of BVS has not been able to fully match the high benchmark in safety and efficacy set by contemporary metallic drug-eluting stents...
May 7, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29707966/the-effect-of-exercise-training-in-symptomatic-patients-with-grown-up-congenital-heart-disease-a-review
#6
Jean-Luc Q Hooglugt, Alexandra C van Dissel, Ilja M Blok, Ferdinand H de Haan, Harald T Jørstad, Berto J Bouma, Barbara J M Mulder, Michiel M Winter
The number of grown-up congenital heart disease (GUCH) patients is steadily increasing. Unfortunately, the majority of these patients suffer from late sequelae, with heart failure being the most common cause of death. Exercise training is beneficial and safe in patients with acquired heart failure, as well as in asymptomatic GUCH patients. However, its effect remains unknown in symptomatic GUCH patients. This could cause reticence on positive sports advice, with possible counterproductive effects. Areas covered: A review of current literature was performed to evaluate the effect of exercise training in symptomatic (NYHA≥2) GUCH patients...
May 4, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29595355/irreversible-electroporation-for-the-treatment-of-cardiac-arrhythmias
#7
Alan Sugrue, Elad Maor, Antoni Ivorra, Vaibhav Vaidya, Chance Witt, Suraj Kapa, Samuel Asirvatham
Cardiac ablation is an established treatment modality for the management of patients with cardiac arrhythmias. Current approaches to cardiac ablation employ thermal based energy to achieve lesions (damage) within the heart. There are many shortcomings and limitations of thermal based approaches. Electroporation (DC energy) is a non-thermal alternative approach to ablation has shown significant promise in animal studies. Areas covered: An extensive review of the literature on the application of electroporation for ablation (both cardiac and collateral cardiac tissue) was undertaken...
March 29, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29589974/coronary-chronic-total-occlusion-intervention-utility-or-futility
#8
Patrick Marechal, Laurent Davin, Olivier Gach, Christophe Martinez, Mathieu Lempereur, Nicolas Lhoest, Patrizio Lancellotti
Despite an incidence of about 18-52% of the patients undergoing coronary angiography, chronic total occlusions (CTO) are rarely revascularised by percutaneous angioplasty (PCI). Nevertheless, current evidence suggests that successful CTO angioplasty improves symptoms, quality of life and long-term survival. During the last decade, the improvement of specific tools and techniques for these complex procedures, and the increasing experience of operators, have led to the achievement of success and complication rates almost equivalent to non-CTO angioplasty...
March 28, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29589775/role-of-cyp2c19-genotype-testing-in-clinical-use-of-clopidogrel-is-it-really-useful
#9
Irfan Zeb, Nassim Krim, Jonathan Bella
P2Y12 inhibitors, including clopidogrel have become an integral part of treatment for patients receiving coronary stent placement as a result of stable coronary artery disease or acute coronary syndromes (ACS) and also for medically managed ACS patients. Areas covered: Clopidogrel efficacy can be significantly modified by polymorphism of CYP2C19 genotype (more than 25 allelic variants) involved in its metabolism that can adversely affect its anti-platelet activity. As a result, a substantial number of patients (20-30%) with ACS show an inadequate response to clopidogrel despite a standardized dosing regimen...
March 28, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29575965/atrial-fibrillation-in-the-middle-east-unmapped-underdiagnosed-undertreated
#10
Warkaa Al-Shamkhani, Harold Ayetey, Gregory Y H Lip
Atrial fibrillation (AF) is the commonest persistent cardiac arrhythmia with an estimated incidence rate of between 1.5-2% and an important cause of strokes. Few epidemiological studies and clinical trials on the management of AF have been conducted outside Europe and North America. These gaps in our understanding of AF likely lead to sub-optimal management of patients with AF in the rest of the world. Areas covered: We discuss the epidemiology, treatment and clinical outcomes for AF in the Middle East after a systematic review of published work for AF from the Middle East...
March 26, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29745734/primary-prevention-of-post-pericardiotomy-syndrome-using-corticosteroids-a-systematic-review
#11
Rachel Wamboldt, Gianluigi Bisleri, Benedict Glover, Sohaib Haseeb, Gary Tse, Tong Liu, Adrian Baranchuk
Post-pericardiotomy syndrome is a well-recognized inflammatory phenomenon that commonly occurs in patients following cardiac surgery. Due to the increased morbidity and resource utilization associated with this condition, research has recently focused on ways of preventing its prevention this condition; primarily using colchicine, NSAIDs and corticosteroids. Areas covered: This systematic review summarizes the three clinical studies that have used corticosteroids for PPS primary prevention in the perioperative period...
June 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29564922/recognition-and-management-of-idiopathic-systemic-capillary-leak-syndrome-an-evidence-based-review
#12
Noor Ul-Ain Baloch, Marvi Bikak, Abdul Rehman, Omar Rahman
INTRODUCTION: Idiopathic systemic capillary leak syndrome (SCLS) is a unique disorder characterized by episodes of massive systemic leak of intravascular fluid leading to volume depletion and shock. A typical attack of SCLS consists of prodromal, leak and post-leak phases. Complications, such as compartment syndrome and pulmonary edema, usually develop during the leak and post-leak phases respectively. Judicious intravenous hydration and early use of vasopressors is the cornerstone of management in such cases...
May 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29561176/adenosine-triphosphate-adenosine-guided-pulmonary-vein-isolation-does-not-improve-the-outcomes-of-ablation-a-meta-analysis-of-randomized-controlled-trials
#13
Muhammad R Afzal, Omar Kahaly, Raul Weiss, Mahmoud Houmsse, Emile G Daoud, John D Hummel
BACKGROUND: Successful pulmonary vein isolation (PVI) is the most reliable predictor of success after ablation in patients with atrial fibrillation (AF). Adenosine triphosphate (ATP) unmasks the dormant conduction and can be used to improve the effectiveness of PVI. The impact of ATP guided PVI on clinical outcomes is discordant in various randomized controlled trials (RCTs). OBJECTIVES: To delineate the incremental benefit of ATP during PVI in patients with AF through a meta-analysis...
May 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29557686/t1-and-t2-mapping-in-myocarditis-seeing-beyond-the-horizon-of-lake-louise-criteria-and-histopathology
#14
Valentina O Puntmann, Andreas M Zeiher, Eike Nagel
Myocarditis and its sequelae remain an unconquered clinical problem, disproportionately affecting the young. Several hurdles beset myocarditis, including non-specific symptoms, heterogeneous clinical presentation, dynamic disease stages, underscored by an absence of an easy diagnostic test or a specific treatment. Areas covered: The current diagnostic means are poorly equipped to counter the challenge; the gold standard by invasive endomyocardial biopsy relies on availability of expert procedural and reading skill...
May 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29521112/evaluation-of-the-right-ventricle-by-echocardiography-particularities-and-major-challenges
#15
Michael Dandel, Roland Hetzer
Compared with the left ventricle (LV), the right ventricle (RV) is less suited for evaluation by echocardiography (ECHO). Nevertheless, RV ECHO-assessment has currently emerged as an important diagnostic tool with meaningful prognostic value and essential contribution to therapeutic decisions. Although significant progress has been made, including generation of higher-quality normative data, validation of several two-dimensional measurements and improvements in three-dimensional ECHO-techniques, many challenges in RV ECHO-assessment still persist...
April 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29509034/myocardial-healing-using-cardiac-fat
#16
Santiago Roura, Carolina Gálvez-Montón, Antoni Bayes-Genis
Chronic diseases, including myocardial scar healing and heart failure remission, impose huge social and economic burdens, and novel approaches are needed. Several therapeutic modalities are currently being evaluated, including cell therapy, stem cell conditioning, and cardiac tissue engineering. Areas covered: This review discusses the restoration of cardiac function after myocardial infarction using a vascularized flap of autologous cardiac adipose tissue over an akinetic scar. It addresses the risks and benefits of using cardiac adipose progenitors and the adipose graft transposition procedure (AGTP) to ameliorate cardiac dysfunction in preclinical and clinical trials...
April 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29508624/optimization-and-simplification-of-transcatheter-aortic-valve-implantation-therapy
#17
Marco Barbanti, Simona Gulino, Giuliano Costa, Corrado Tamburino
Transcatheter aortic valve implantation (TAVI) is now a widely adopted therapy for the treatment of elderly patients with severe aortic stenosis. Improved pre-procedural screening, increased operators' experience and technology advancement have made this technique highly reliable and standardized. Areas covered: The purpose of this review article is to provide an overview of the strategies that can be adopted to optimize the TAVI procedure (pre-interventional work-up and procedural simplification and early discharge)...
April 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29478345/cardiovascular-magnetic-resonance-imaging-in-heart-failure
#18
Kihei Yoneyama, Yuki Kitanaka, Osamu Tanaka, Yoshihiro J Akashi
Heart failure is a complex clinical syndrome resulting from heart structural remodeling and impaired function in ejecting blood; its incidence is increasing markedly worldwide. The observed variations in the structure and function of the heart are attributable to differences in etiology of heart failure. Cardiac magnetic resonance imaging (CMR) can characterize myocardial tissue, assess myocardial viability, and help diagnose specific cardiomyopathies. The emergence of T1 mapping techniques further improves our knowledge and the clinical assessment of myocardial diffuse fibrosis...
April 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29471698/gender-differences-in-acute-coronary-syndromes-focus-on-the-women-with-acs-without-an-obstructing-culprit-lesion
#19
Jane S Titterington, Olivia Y Hung, Anita P Saraf, Nanette K Wenger
The etiologies of acute coronary syndromes (ACS) in women expand beyond the traditional paradigm of obstructive epicardial atherosclerotic disease and plaque rupture. Fundamental differences in pathobiology and presentation can partially explain the gender disparity in ACS diagnosis and management, but there is also much we do not know about the spectrum of coronary artery disease in women. Areas covered: This review seeks to explain some key differences between men and women in terms of risk factors, pathophysiology, and clinical presentations, as well as identify areas where more data are needed, focusing on women presenting with ACS but without a culprit lesion to explain their presentation...
April 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29463140/premature-ventricular-beats-in-the-athlete-management-considerations
#20
Tamanna K Singh, Aaron L Baggish
Premature ventricular beats (PVBs) in competitive athletes are incidentally found during pre-participation ECG screening. Their clinical significance remains debatable with several studies suggesting they are a benign reflection of athlete's heart, and others proposing they may indicate underlying structural heart disease and heightened risk for sudden cardiac death (SCD). Areas covered: Effective management of athletes with PVBs may best be accomplished using an algorithmic approach for risk stratification with a goal of differentiating benign PVBs from those reflective of underlying cardiomyopathies...
April 2018: Expert Review of Cardiovascular Therapy
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