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Expert Review of Cardiovascular Therapy

Baldeep S Sidhu, Justin Gould, Benjamin J Sieniewicz, Bradley Porter, Christopher A Rinaldi
A significant number of patients undergo upgrade to cardiac resynchronisation therapy (CRT). These patients tend to differ from individuals undergoing de novo CRT implantations both in terms of their baseline demographics and the aetiology underlying their heart failure. Areas covered: There are several factors that need to be considered when upgrading patients to CRT, such as, venous patency. Potentially, these conditions can cause issues which may result in procedures being more difficult than de novo implantations...
July 9, 2018: Expert Review of Cardiovascular Therapy
Gerald Fitzgerald, Tom Kiernan
PCSK9 inhibitors are monoclonal antibodies to proprotein convertase-subtilisin/kexin type 9 which significantly reduce LDL cholesterol concentration in vivo by inhibiting degradation of the LDL receptor in hepatocytes. The introduction of PCSK9 inhibitors heralded a new era of intensive LDL-C reduction with LDL-C concentrations lowered below levels ever thought possible with conventional treatments such as statins. With their introduction considerations regarding cost, clinical outcomes and long-term safety are paramount...
July 6, 2018: Expert Review of Cardiovascular Therapy
Steven G Chrysant, George S Chrysant
Hyperhomocysteinemia has been considered as a risk factor for systemic atherosclerosis, cardiovascular disease (CVD) and stroke and many epidemiologic and case-controlled studies have demonstrated its association with these complications. In addition, treatment of hyperhomocysteinemia with folic acid ± B vitamins prevents the development of atherosclerosis, CVD and strokes. However, subsequent prospective, randomized, placebo- controlled trials have not shown an association of high homocysteine levels or their lowering with treatment with the incidence of atherosclerosis, CVD or strokes, due possibly, to the fortification of flower with folic acid...
July 6, 2018: Expert Review of Cardiovascular Therapy
Gilman D Plitt, Jordan T Spring, Michael J Moulton, Devendra K Agrawal
Heart failure with preserved ejection fraction (HFpEF) continues to be a major challenge for clinicians. Many crucial aspects of the syndrome remain unclear, including the exact pathophysiology, early diagnosis, and treatment. Patients with HFpEF are often asymptomatic late into the disease process, and treatment with medications commonly used in heart failure with reduced ejection fraction (HFrEF) has not been proven to be beneficial. In addition, the confusion of similar terms with HFpEF, such as diastolic heart failure (DHF), and diastolic dysfunction (DD), has led to a misunderstanding of the true scope of HFpEF...
July 5, 2018: Expert Review of Cardiovascular Therapy
Giuseppe Lippi, Fabian Sanchis-Gomar
No abstract text is available yet for this article.
July 5, 2018: Expert Review of Cardiovascular Therapy
Allie E Goins, Robert Rayson, Michael Yeung, George A Stouffer
Challenges remain in predicting mortality and severe myocardial dysfunction in patients undergoing primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI). Areas covered: Cardiogenic shock is associated with a high mortality rate. Less well characterized are patients who are not in cardiogenic shock but will die from pump failure as a result of a STEMI. There is a long history of using hemodynamics to risk stratify patients with acute MI with the Killip class being shown to provide prognostic information in the pre-reperfusion, thrombolytic and PPCI eras...
July 5, 2018: Expert Review of Cardiovascular Therapy
Roopinder K Sandhu, Jeff S Healey
Atrial fibrillation (AF) is a condition of global importance and it is associated with significant morbidity, mortality and healthcare costs. A considerable proportion of patients with AF are asymptomatic and stroke may be the first clinical manifestation of their AF diagnosis. AF screening provides an opportunity to identify patients with undetected AF prior to suffering a devastating complication. Areas covered: This review will provide a rationale for AF screening; summarize AF screening methods, studies and economic analyses; evaluate AF as a condition meeting criteria for population screening and discuss potential drawbacks...
July 2, 2018: Expert Review of Cardiovascular Therapy
Abdul-Rahman R Abdel-Karim, Barry F Uretsky
Stenting has advanced the treatment of coronary artery disease, with angiography being historically the gold standard to assure adequate stent deployment. However, intravascular imaging modalities including intravascular ultrasound and optical coherence tomography have shown high rates of inadequate stent deployment in angiographically optimized stents. The association of malapposition with adverse clinical outcomes remains controversial. Areas covered: The definition, types and risk factors for metallic stent malapposition, the natural history and significance of stent strut malapposition and its correlation with short- and long-term outcomes were reviewed...
June 28, 2018: Expert Review of Cardiovascular Therapy
Fabio Mangiacapra, Edoardo Bressi, Alessandro Sticchi, Carmine Morisco, Emanuele Barbato
The presence and extent of myocardial ischemia are the major determinants of prognosis in patients with coronary artery disease (CAD). Unlike coronary angiography alone, fractional flow reserve (FFR) has enabled interventional cardiologists to accurately determine whether coronary atherosclerotic plaques are responsible for myocardial ischemia, and therefore deserve to be revascularized. Areas covered: An overview on the role of FFR in the diagnosis and treatment of coronary artery disease, as well as the potential related controversies is provided...
June 20, 2018: Expert Review of Cardiovascular Therapy
Jean-Baptiste Gourraud, Paul Khairy, Sylvia Abadir, Rafik Tadros, Julia Cadrin-Tourigny, Laurent Macle, Katia Dyrda, Blandine Mondesert, Marc Dubuc, Peter G Guerra, Bernard Thibault, Denis Roy, Mario Talajic, Lena Rivard
Atrial fibrillation (AF) is the most frequent arrhythmia worldwide. While mostly seen in elderly, it can also affect young adults (≤45 years of age), older adolescent and children. Areas covered: The aim of this review is to provide an overview of the current management of AF in young patients. Specific issues arise over diagnostic workup as well as antiarrhythmic and anticoagulation therapies. The future management and diagnostic strategies are also discussed. Expert commentary: Management of AF in the young adult is largely extrapolated from adult studies and guidelines...
June 18, 2018: Expert Review of Cardiovascular Therapy
Arif Albulushi, Andreas Giannopoulos, Nikolaos Kafkas, Stylianos Dragasis, Gregory Pavlides, Yiannis S Chatzizisis
Acute right ventricle myocardial infarction (RVMI) is observed in 30-50% of patients presenting with inferior wall myocardial infarction and, occasionally, with anterior wall myocardial infarction. The clinical consequences vary from no hemodynamic compromise to severe hypotension and cardiogenic shock depending on the extent of RV ischemia. Areas covered: The pathophysiological mechanisms, diagnostic steps and novel therapeutic approaches of acute RVMI are described. Expert commentary: Diagnosis of acute RVMI is based on physical examination, cardiac biomarkers, electrocardiography and coronary angiography, whereas non-invasive imaging modalities (echocardiography, cardiac magnetic resonance imaging) play a complementary role...
June 14, 2018: Expert Review of Cardiovascular Therapy
Marcello Arca, Andrew Hsieh, Handrean Soran, Paul Rosenblit, Louis O'Dea, Michael Stevenson
BACKGROUND: Volanesorsen, an investigational inhibitor of apoC-III synthesis, significantly reduced triglyceride levels in clinical trials in patients with familial chylomicronemia syndrome (FCS), a rare genetic disorder characterized by marked chylomicronemia leading to a spectrum of symptoms, including recurrent abdominal pain and episodes of potentially fatal acute pancreatitis (AP). OBJECTIVE: To determine the effect of volanesorsen on burden of disease on patients with FCS Methods: ReFOCUS was a retrospective global web-based survey open to patients with FCS who received volanesorsen for ≥3 months in an open-label extension study...
June 11, 2018: Expert Review of Cardiovascular Therapy
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
Sheryl L Chow, Robert L Page, Christophe Depre
This review summarizes the current management of heart failure (HF) in patients with reduced ejection fraction and the potential role of heart rate lowering agents in select populations, as recommended in the updated guidelines. Areas covered: PubMed was searched for studies that evaluated the role of heart rate lowering or ivabradine in HF management. Expert commentary: Targeting heart rate may offer benefit when added to renin-angiotensin aldosterone antagonists, and beta-blockers. Ivabradine is a heart rate lowering agent that acts on the funny current (If ) in the sinoatrial node, thereby reducing heart rate without directly affecting cardiac contraction and relaxation...
July 2018: Expert Review of Cardiovascular Therapy
Rohit K Kharbanda, Eusebio Garcia-Izquierdo, Ad J J C Bogers, Natasja M S De Groot
High-resolution atrial mapping studies have provided novel insights in the pathophysiology of atrial fibrillation (AF) in the last few years. Increasing attention is being drawn to the so-called focal activation patterns (FAPs); however, there is no consensus on criteria to identify and characterize these patterns. Areas covered: In this expert review, an overview of definitions and criteria used to examine FAPs obtained from atrial mapping studies is provided and studies reporting on the underlying mechanisms are discussed...
July 2018: Expert Review of Cardiovascular Therapy
Leonardo Seoane, Marcia Cortés, María Esther Aris Cancela, Juan Furmento, Adrián Baranchuk, Diego Conde
Until recently, vitamin K antagonists (VKA) were the only drugs available for long-term anticoagulation. The use of these drugs is laborious due to their variable pharmacokinetics and pharmacodynamics. The advent of direct oral anticoagulants has produced a paradigm shift due to their low incidence of drug interactions, their stable plasma levels, and their lack of monitoring. Rivaroxaban, a factor Xa inhibitor, has been tested in different clinical scenarios and has proved to be effective and safe, even increasing the scope of the old VKA...
July 2018: Expert Review of Cardiovascular Therapy
Chandana Shekar, Matthew Budoff
Coronary artery calcification (CAC) is reflective of atherosclerotic disease and incrementally predictive of future cardiovascular events (CVE), independent of traditional risk factors. Extra coronary calcium such as aortic valve calcification, which can be identified and quantified by computed tomography (CT) imaging, has shown to predict future CVE in both asymptomatic and symptomatic (i.e. stable angina and acute coronary syndrome [ACS]) settings. It has hence been a vital tool in studies involving new therapies for cardiovascular disease...
July 2018: Expert Review of Cardiovascular Therapy
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...
June 2018: Expert Review of Cardiovascular Therapy
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
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)...
June 2018: Expert Review of Cardiovascular Therapy
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