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Expert Review of Cardiovascular Therapy

Jose M Sanchez, Ghannam Al-Dosari, Sherman Chu, Ramin Beygui, Tobias Deuse, Nitish Badhwar, Randall J Lee
Atrial fibrillation (AF) is the most common cardiac arrhythmia. The incidence of AF increases with age and is associated with increased stroke, heart failure and mortality. Persistent and long standing persistent AF is difficult to treat and often refractory to medical therapy and catheter ablation. Areas covered: This article reviews the historical development of the surgical Cox-MAZE procedure and current hybrid and minimally invasive surgical approaches for the treatment of persistent and long standing persistent AF...
January 12, 2018: Expert Review of Cardiovascular Therapy
Sebastian Nuding, Karl Werdan, Roland Prondzinsky
About 5% of patients with myocardial infarction suffer from cardiogenic shock as a complication, with a mortality of ≥30%. Primary percutaneous coronary intervention as soon as possible is the most successful therapeutic approach. Prognosis depends not only on the extent of infarction, but also - and even more - on organ hypoperfusion with consequent development of multiple organ dysfunction syndrome. Areas covered: This review covers diagnostic, monitoring and treatment concepts relevant for caring patients with cardiogenic shock complicating myocardial infarction...
January 9, 2018: Expert Review of Cardiovascular Therapy
Masakazu Saitoh, Nicole Ebner, Stephan von Haehling, Stefan D Anker, Jochen Springer
Sarcopenia is a common feature, and affects 20-47% of patients with heart failure (HF). Sarcopenia is also an independent predictor of impaired functional capacity, even after adjusting for clinical relevant variables, which is associated with adverse outcome in patients with HF. Areas covered: Several different pathophysiological pathways are involved in sarcopenic processes including altered nutrient intake and absorption, hormonal factor, inflammatory processes, oxidative stress, cellular proteolysis, and unhealthy lifestyle...
January 7, 2018: Expert Review of Cardiovascular Therapy
Shilpa Vijayakumar, Muthiah Vaduganathan, Javed Butler
Type 2 diabetes mellitus (DM) and heart failure (HF) are closely related, with the onset of one serving as an independent risk factor of development or progression of the other. The true impact of their relationship is poorly understood. Since various classes of glucose-lowering therapies have been shown to have differing impact on cardiovascular outcomes, cardiovascular effects of such therapies have been increasingly formally evaluated. Areas Covered: With the increasing prevalence of concomitant HF and type 2 DM, HF outcomes serve as important endpoints in trials of glucose-lowering therapies...
January 3, 2018: Expert Review of Cardiovascular Therapy
Valentina Carubelli, Marco Metra, Lars H Lund
Chronic kidney disease (CKD) is one of the most prevalent comorbidities in HF, and no specific treatment is still available for the so-called cardiorenal syndrome. Areas covered: The aim of this review is to describe the interaction of heart and kidney function and the consequences of cardiorenal syndrome, focusing on the use of available therapeutics. Expert commentary: The presence of CKD has been associated with adverse outcomes in HF regardless of ejection fraction. On the other hand, cardiovascular events are the most common causes of morbidity and mortality among CKD patients, reflecting the close pathophysiological crosstalk between these organs...
January 2, 2018: Expert Review of Cardiovascular Therapy
Karel M Van Praet, Christof Stamm, Christoph T Starck, Simon Sündermann, Alexander Meyer, Matteo Montagner, Timo Z Nazari Shafti, Axel Unbehaun, Stephan Jacobs, Volkmar Falk, Jörg Kempfert
Tricuspid valve regurgitation (TR) is frequently encountered and is most often functional (FTR) in nature. Surgical tricuspid valve (TV) treatment is well established in specialized centers. While transcatheter therapy for other valve disease is well established, interventional treatment of TV disease is still in its early stages. With the increasing adoption of catheter-based treatments, there is a growing interest in and need for interventional treatments for TR. An extensive literature search was methodologically performed aiming for an integrative review paper...
December 28, 2017: Expert Review of Cardiovascular Therapy
Niki Katsiki, Costas Tsioufis, George Hahalis, Vasilios G Athyros
No abstract text is available yet for this article.
December 27, 2017: Expert Review of Cardiovascular Therapy
Alexis T Wilson, Sadanand Dey, James W Evans, Mohamed Najm, Wu Qiu, Bijoy K Menon
The Alberta Stroke Program Early CT Score on non-contrast CT is a key component in prognostication and treatment selection in acute stroke care. Previous findings show that the reliability of this scale must be improved to maximize its clinical utility. Areas covered: This review discusses technical, patient-level, and reader-level sources of variability in ASPECTS reading; relevant concepts in the psychology of medical image perception; and potential interventions likely to improve inter- and intra-rater reliability...
December 21, 2017: Expert Review of Cardiovascular Therapy
Nick Curzen, Mark Mariathas, Bartosz Olechowski, Michael Mahmoudi
Troponin is considered to be the gold standard biomarker for ruling out MI. There has been a drive to improve the diagnostic speed, and as such the high sensitivity cardiac troponin (Hs-cTn) assays have been introduced into clinical practice and are now part of international guidelines. Their novel value in clinical practice more generally is becoming apparent. Areas covered: In this review we will evaluate the evidence for the use of Hs-cTn assays in clinical practice, the issues with the assay and how the Hs-cTn can be utilized in the future as a biomarker of cardiovascular risk...
December 20, 2017: Expert Review of Cardiovascular Therapy
Sathya D Unudurthi, Amara Greer-Short, Nehal Patel, Drew Nassal, Thomas J Hund
In the heart, pathways that transduce extracellular environmental cues (e.g. mechanical force, inflammatory stress) into electrical and/or chemical signals at the cellular level are critical for the organ-level response to chronic biomechanical/neurohumoral stress. Specifically, a diverse array of membrane-bound receptors and stretch-activated proteins converge on a network of intracellular signaling cascades that control gene expression, protein translation, degradation and/or regulation. These cellular reprogramming events ultimately lead to changes in cell excitability, growth, proliferation, and/or survival...
December 19, 2017: Expert Review of Cardiovascular Therapy
Ariela R Orkaby, Daniel E Forman
The benefits of physical activity have long been recognized as powerful preventive opportunities for both prevention of cardiovascular disease and aging-related morbidity. However, physical activity remains under-prescribed and under-utilized. Areas covered: In this narrative review, the authors focus on physical activity as a modifiable lifestyle factor that can modify aging processes as well as cardiovascular pathophysiology that is often exacerbated by aging. Specific recommendations are provided for physical activity over the range of typical older individuals, spanning from those who are sedentary and frail to those who are active and robust...
December 19, 2017: Expert Review of Cardiovascular Therapy
J J Coughlan, Aidan Daly, Samer Arnous, Tom J Kiernan
Patent foramen ovale (PFO) is a common anatomical variant in the adult circulation. It is a channel allowing communication between the left and right atria and is a remnant of the foetal circulation. In approximately 25% of the population, this channel persists into adulthood. PFO has been proposed as a potential pathophysiological mechanism for cryptogenic stroke. Areas covered: This review will examine the contemporary evidence for both the association between cryptogenic stroke and PFO and the management of this condition...
December 19, 2017: Expert Review of Cardiovascular Therapy
Altan Onat, Aysem Kaya, Evin Ademoglu
Lipoproteins and the apolipoproteins (apo) that they carry are major determinants of cardiovascular diseases (CVD) as well as metabolic, renal and inflammatory chronic disorders either directly or through mediation of risk factors. The notion that elevated low-density lipoprotein cholesterol (LDL-C) and apoB levels are related to the acquisition of CVD and, high-density lipoprotein cholesterol (HDL-C) and apoA-I indicate protection against CVD has been challenged in the past decade. Advanced age, adiposity, ethnicity or impaired glucose intolerance rendered autoimmune activation in an environment of pro-inflammatory state/oxidative stress and may disrupt the linear risk association between lipoproteins...
December 15, 2017: Expert Review of Cardiovascular Therapy
Nandini Nair, Enrique Gongora
Implantation of left ventricular assist devices (LVADS) in older patients appears to be an attractive option in the wake of donor shortage and increasing incidence and prevalence of end stage heart failure. Since the inception of the artificial heart program half a century ago tremendous progress in research and development has led to utilization of more sophisticated devices. VADs have therefore emerged as a successful therapy for extending life with meaningful quality. Areas covered: This review will address the use of LVADS as a bridge to transplantation, destination therapy and comparison of LVAD therapy with alternate list heart transplantation in the elderly population...
December 13, 2017: Expert Review of Cardiovascular Therapy
Luis F Hidalgo, Srihari S Naidu, Wilbert S Aronow
Hypertrophic obstructive cardiomyopathy has been rising in prevalence, due to increased awareness and advanced imaging. For the symptomatic patient, pharmacological management remains an effective approach to the majority of patients with obstructive hypertrophic cardiomyopathy. However, a significant subset fails to improve sufficiently with medical therapy initially, or progressively becomes more symptomatic despite augmented medications over time. Most of the advances in the treatment of obstructive hypertrophic cardiomyopathy have therefore been made in the area of non-pharmacologic management, particularly septal reduction therapy...
December 12, 2017: Expert Review of Cardiovascular Therapy
Bogusław Okopień, Lukasz Buldak, Aleksandra Bołdys
Significant advancements in the treatment of hypercholesterolemia have recently been achieved. However, a considerable level of residual cardiovascular risk still affects patients' outcomes. Atherogenic dyslipidemia is one of the major constituents of residual risk. Fibrates, PPAR alpha agonists, which modify lipid profile and have numerous pleiotropic effects, seem to be drugs of choice in patients with atherogenic dyslipidemia. These drugs are effective both in monotherapy and combined therapy with statins...
November 28, 2017: Expert Review of Cardiovascular Therapy
Victoria Jacobs, Kevin G Graves, Thomas J Bunch
Atrial fibrillation (AF) is strongly associated with dementia, including idiopathic dementias such as Alzheimer's disease. The relative risk of dementia is highest in AF patients 70 years and younger, and the burden of exposure to arrhythmia appears to underlie part of the risk. Areas covered: Anticoagulation choices and approach influence dementia risk. In warfarin patients, inadequate time spent in therapeutic range is highly associated with the increased dementia risk long-term. This risk is further accentuated with frequent over anticoagulation in patients also receiving aspirin...
November 28, 2017: Expert Review of Cardiovascular Therapy
Michael Farnier
Alirocumab is a fully human immunoglobulin G1 monoclonal antibody directed against proprotein convertase subtilisin/kexin type 9 (PCSK9) approved for the treatment of hypercholesterolemia in high-risk patients. The objective is to provide an updated review of the recent data published for alirocumab. Areas covered: The efficacy and safety of alirocumab has been initially evaluated in a comprehensive phase 3 program conducted in more than 6 000 patients with primary non-familial and heterozygous familial hypercholesterolemia: alirocumab reduced LDL-cholesterol up to 62% in phase 3 with every 2-week dosing compared with placebo, and up to 36% compared with ezetimibe, with an excellent safety and tolerability profile...
November 24, 2017: Expert Review of Cardiovascular Therapy
M Chadi Alraies, Sheila Sahni
No abstract text is available yet for this article.
November 22, 2017: Expert Review of Cardiovascular Therapy
Francesca Salghetti, Juan Sieira, Gian-Battista Chierchia, Antonio Curnis, Carlo de Asmundis
The transseptal puncture (TSP) enables access to the left heart, through the fossa ovalis (FO), both in electrophysiology and in cardiac interventional procedures. TSP is usually safe in experienced hands. Sometimes TSP can be technically demanding and carries the risk of severe complications in approximately 1%. While performing a TSP, every effort should be taken in order to avoid complications. In the event of complications, prompt recognition and reaction are essential and a combined "heart-team" management may be the most effective approach...
November 22, 2017: Expert Review of Cardiovascular Therapy
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