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Expert Review of Cardiovascular Therapy

Pavel Overtchouk, Thomas Modine
Alternative TAVI approaches offer the possibility of valve replacement in patients ineligible to the transfemoral route. Authors provide an updated review of the existing alternative approaches. Areas covered: A systematic review of alternative approaches for TAVI was undertaken. The feasibility, safety, efficacy and technical requirements of the transapical, transaortic, transcarotid, transsubclavian and transcaval approaches have been compared. A multi-slice computed tomography is often necessary for pre-operative planning...
September 20, 2018: Expert Review of Cardiovascular Therapy
Carlos Collet, Takuya Mizukami, Maik J Grundeken
Treatment of coronary bifurcation lesions with contemporary state of the art percutaneous coronary intervention (PCI) is still associated with higher rate of adverse cardiovascular events compared to non-bifurcation lesions. Bench testing and virtual computer modelling have increased our understanding of bifurcation PCI guiding refinement in bifurcation technique. New insights on bifurcation PCI have the potential to further improve clinical outcomes in patients presenting with bifurcation lesions. Areas covered: The present manuscript aims to review the methods for bifurcation lesion assessment and treatment strategy step-by-step supported on bench and clinical evidence...
September 17, 2018: Expert Review of Cardiovascular Therapy
Huazhen Chen, David Power, Gennaro Giustino
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor remains at the cornerstone of treatment to prevent major adverse cardiac events in patients who undergo percutaneous coronary intervention (PCI) with drug-eluting stents (DES). However, the anti-ischemic benefits of DAPT are counterbalanced by an increased risk of hemorrhagic complications, which are known to be associated with increased morbidity and mortality. While the efficacy of DAPT in patients presenting with acute coronary syndromes has been well established, the risk-benefit balance of DAPT in other subsets of patients remain controversial...
September 15, 2018: Expert Review of Cardiovascular Therapy
Alice Clarke, Abdalla Ibrahim, Thomas J Kiernan
Patients with atrial fibrillation taking oral anticoagulation and undergoing percutaneous coronary intervention with stent insertion are recommended to receive antithrombotic therapy with aspirin and P2Y12 receptor antagonist. This combinatory regime encompasses triple therapy (TT). Although TT reduces the risk of ischaemic events such as stroke and stent thrombosis, it is associated with an increased bleeding risk. Areas covered: The efficacy and safety profile of TT is uncertain with undetermined optimal duration and therapeutic combination...
September 14, 2018: Expert Review of Cardiovascular Therapy
Nariman Sepehrvand, Justin A Ezekowitz
No abstract text is available yet for this article.
September 12, 2018: Expert Review of Cardiovascular Therapy
Umair Shafique, Sunita Mathur, Anna Michalski, Rebecca Bunston, Asim N Cheema
No abstract text is available yet for this article.
September 10, 2018: Expert Review of Cardiovascular Therapy
Creuza M Goes, Paola P N F Falcochio, Luciano F Drager
In the last decades, consistent data derived from experimental, epidemiological, and clinical studies pointed obstructive sleep apnea (OSA), the most common sleep disordered breathing worldwide, as a potential risk factor for incidence and recurrence of atrial fibrillation (AF). Areas covered: This review article describes the impact of OSA on AF and discusses potential strategies for managing OSA in the AF scenario. Expert commentary: Untreated OSA seems to be one important predictor of AF treatment failure after chemical or electrical cardioversion as well as after a successful AF ablation...
September 3, 2018: Expert Review of Cardiovascular Therapy
Luca Segreti, Mario Giannotti Santoro, Andrea Di Cori, Giulio Zucchelli, Stefano Viani, Raffaele De Lucia, Veronica Della Tommasina, Valentina Barletta, Luca Paperini, Ezio Soldati, Maria Grazia Bongiorni
Increasing device implantations, patient comorbidities, and longer life expectancy contribute to an increased need for lead extraction. Even if transvenous lead extraction (TLE) is a highly successful procedure, some serious procedural complications are reported. In order to identify those patients who are at higher risk, risk stratification scores were proposed. Areas covered: The major obstacles to lead extractions are represented by the body's response to the foreign implanted material and by the following development of fibrotic reaction between the lead and the vascular system...
August 27, 2018: Expert Review of Cardiovascular Therapy
Raúl Solernó, Pablo Pedroni, Javier Mariani, Ricardo Sarmiento
BACKGROUND: Fractional flow reserve (FFR) has become a useful tool in the assessment of physiological significance of coronary artery stenosis (CAS), and Adenosine (ADE) is associated with a high incidence of transient side effects. Sodium nitroprusside (NPS) has been proposed as an alternative vasodilator agent. A meta-analysis of studies comparing ADE and NPS for FFR assessment in the same coronary lesions was performed. METHODS: Authors searched for articles comparing NPS and ADE for FFR assessment in intermediate coronary lesions published through January 2018...
August 24, 2018: Expert Review of Cardiovascular Therapy
Alessandro Galluzzo, Massimo Imazio
Medical therapy of pericardial diseases is moving forward to the road of evidence-based medicine and has improved in the last years because of the first randomized clinical trials in the area as well as new therapeutic options for recurrent pericarditis. Areas covered: The present review will focus on more recent advances with a special emphasis on the treatment of pericarditis, the area with more significant improvements in the last years. Medline/Pubmed Library were systematically screened with two specific key searches: 'pericarditis AND therapy' and 'pericardial effusion AND therapy'...
September 2018: Expert Review of Cardiovascular Therapy
Katie Walsh, Francis Marchlinski
Atrial fibrillation (AF) is the most common cardiac arrhythmia. Ablation is an excellent treatment option for appropriately selected patients. Catheter ablation tools and techniques have evolved since AF ablation was first introduced, but pulmonary vein isolation remains the cornerstone of the procedure. Outcomes from ablation have improved dramatically over the last 20 years, but remain less than optimal for certain patient groups. Areas covered: This review outlines the process of patient selection for AF ablation in contemporary practice, from diagnosis and AF classification to procedural risk assessment...
September 2018: Expert Review of Cardiovascular Therapy
J Alberto Neder, Alcides Rocha, Maria Clara N Alencar, Flavio Arbex, Danilo C Berton, Mayron F Oliveira, Priscila A Sperandio, Luiz E Nery, Denis E O'Donnell
Heart failure (HF) with reduced ejection fraction and chronic obstructive pulmonary disease (COPD) frequently coexist, particularly in the elderly. Given their rising prevalence and the contemporary trend to longer life expectancy, overlapping HF-COPD will become a major cause of morbidity and mortality in the next decade. Areas covered: Drawing on current clinical and physiological constructs, the consequences of negative cardiopulmonary interactions on the interpretation of pulmonary function and cardiopulmonary exercise tests in HF-COPD are discussed...
September 2018: Expert Review of Cardiovascular Therapy
Giulia Rastrelli, Mauro Dicuio, Yacov Reismann, Alessandra Sforza, Mario Maggi, Giovanni Corona
Since 2010 some evidence supporting the possible increased cardiovascular (CV) risk related to testosterone treatment (TTh) has created much debate in the scientific community. Based on these results, the US Food and Drug Administration agency has questioned TTh for aging men recognizing its value only for classical hypogonadism due to genetic or organic causes. To better clarify this topic, we scrutinized and summarized, also by using meta-analytic methods, the data generated during the last 7 years, as derived from the analysis of randomized controlled trials (RCTs) on TTh and CV risk...
September 2018: Expert Review of Cardiovascular Therapy
Shaojie Chen, Felix K Weise, K R Julian Chun, Boris Schmidt
Interventional left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation (OAC) therapy for the prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF). Areas covered: Antithrombotic therapy following interventional LAAO is critical in balancing the risk of thromboembolism and bleeding during the endothelialization of the implanted devices. In this article, the most recent clinical trials are reviewed and the current real-world antithrombotic strategies following LAAO device implantation are discussed...
September 2018: Expert Review of Cardiovascular Therapy
Kannayiram Alagiakrishnan, Darren Mah, Gabor Gyenes
Cardiac rehabilitation program is an evidence-based intervention and established model of exercise delivery following myocardial infarction and heart failure. Although it forms an important part of recovery and helps to prevent future events and complications, there has been little focus on its potential cognitive benefits. Areas covered: Coronary artery disease and heart failure are common heart problems associated with significant morbidity and mortality, and cognitive decline is commonly seen in affected individuals...
September 2018: Expert Review of Cardiovascular Therapy
Dirkjan Kauw, M A C Koole, Jolien R van Dorth, Igor I Tulevski, G Aernout Somsen, Marlies P Schijven, Daan A J Dohmen, Berto J Bouma, Barbara J M Mulder, Mark J Schuuring, Michiel M Winter
Mobile health (mHealth), an advanced form of eHealth is expected to drastically change the field of traditional healthcare in the near future as wearables and mobile applications are rapidly increasing in number. The majority of patients with congenital heart disease (CHD) now reach adulthood and this relative young patient population seems particularly suited for mHealth, as they require lifelong follow-up, experience high morbidity burden, and were raised in this digital era. In patients with acquired heart disease the potential of eHealth has been demonstrated, yet data are still inconclusive...
September 2018: 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 resynchronization therapy (CRT). These patients tend to differ from individuals undergoing de novo CRT implantations both in terms of their baseline demographics and the etiology 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...
August 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...
August 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...
August 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, and diastolic dysfunction (DD), has led to a misunderstanding of the true scope of HFpEF...
August 2018: Expert Review of Cardiovascular Therapy
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