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Expert Review of Cardiovascular Therapy

Barbro Kjellström, Clara Hjalmarsson, David Kylhammar, Göran Rådegran
No abstract text is available yet for this article.
November 13, 2018: Expert Review of Cardiovascular Therapy
Alex Asher, Arvind Singhal, George Thornton, Andrew Wragg, Ceri Davies
Non-invasive fractional flow reserve derived from CT coronary angiography (FFRCT ) represents a novel technology to investigate coronary artery disease. The application of computational flow dynamics to anatomical data provides the clinician with a further functional assessment to inform decision-making in patients with coronary artery disease. In the UK FFRCT has received medical technology approval for use since February 2017. Areas covered: This article discusses the mathematical and physiological principles underpinning calculation of non-invasive fractional flow reserve (FFR), as well as discussing the differences between the commercially available technologies...
October 22, 2018: Expert Review of Cardiovascular Therapy
Sahrai Saeed, Eva Gerdts
Hypertension is highly prevalent in aortic valve stenosis (AS) patients as the prevalence of both disorders increases with age. Hypertension and associated stiffening of the large arteries increase afterload and thereby influence both the transvalvular flow and the remodeling of the aortic root and the left ventricle during AS progression. Area covered: The present review gives an overview on complications of hypertension in AS, how these can be diagnosed, and potentially may be managed. Expert commentary: Hypertension-mediated cardiovascular (CV) damage in AS is associated with increased morbidity and a twofold higher mortality even in asymptomatic patients, and also limits the symptomatic and survival benefit from valve replacement...
October 12, 2018: Expert Review of Cardiovascular Therapy
Miguel Haime, Robert R McLean, Katherine E Kurgansky, Maximilian Y Emmert, Nicole Kosik, Constance Nelson, Michael J Gaziano, Kelly Cho, David R Gagnon
BACKGROUND: Saphenous vein grafts (SVGs) remain the most often used conduits for coronary bypass grafting (CABG). Progressive intimal hyperplasia contributes to vein-graft disease and vein-graft failure (VGF). We compared the impact of intraoperative preservation of SVGs in a storage solution (DuraGraft®) versus heparinized saline on VGF-related outcomes after CABG. METHODS: From 1996 to 2004, 2436 patients underwent isolated CABG with ≥ 1 SVG. SVGs were consecutively treated with DuraGraft in 1036 patients (2001-2004) and heparinized saline in 1400 patients (1996-1999)...
October 4, 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 modeling have increased our understanding of bifurcation PCI guiding refinement in bifurcation techniques. 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
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
Umair Shafique, Sunita Mathur, Anna Michalski, Rebecca Bunston, Asim N Cheema
Certain frail patients fail to achieve adequate functional or mortality benefit despite successful transcatheter aortic valve replacement (TAVR). Therefore, frailty assessment methods are becoming an important tool to identify and intervene on this high-risk patient subset for improving clinical outcomes. Areas covered: The authors provide an overview of frailty and frailty assessment tools being used in clinical practice and discuss the impact of frailty on the cardiac patients, particularly among the TAVR population...
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
Kevin Goodwin, Austin Kluis, Tamas Alexy, Ranjit John, Rochus Voeller
Associated with significant morbidity and mortality, neurological complications in adult patients with left ventricular assist devices (LVAD) approaches a prevalence as high as 25%. As the number of individuals using LVAD support grows, it is increasingly important for providers to understand the hematologic and hemodynamic changes associated with LVAD implantation, the risk factors for neurological complications and their mitigation strategies. Areas covered: PubMed searches were completed using the terms 'Left ventricular assist device and stroke' (994 results) then 'Left ventricular assist device and stroke risk factors' (199 results)...
December 2018: Expert Review of Cardiovascular Therapy
Joshua R Niska, Cameron S Thorpe, Sorcha M Allen, Thomas B Daniels, William G Rule, Steven E Schild, Carlos E Vargas, Farouk Mookadam
Recent trials in radiotherapy have associated heart dose and survival, inadequately explained by the existing literature for radiation-related late cardiac effects.  Authors aimed to review the recent literature on cardiac dosimetry and survival/cardiac endpoints. Areas covered: Systematic review of the literature in the past 10 years (2008-2017) was performed to identify manuscripts reporting both cardiac dosimetry and survival/cardiac endpoints.  Authors identified 64 manuscripts for inclusion, covering pediatrics, breast cancer, lung cancer, gastrointestinal diseases (primarily esophageal cancer), and adult lymphoma...
October 26, 2018: Expert Review of Cardiovascular Therapy
Keisuke Narita, Satoshi Hoshide, Kazuomi Kario
Randomized controlled trials and meta-analyses have established the benefits of blood pressure (BP) lowering. The 2017 American Heart Association/American College of Cardiology (AHA/ACC) guidelines for the management of hypertension established 130/80 mmHg as the threshold for the diagnosis- and treatment-target BP level. Area covered: The global trends are thought to be heading toward intensive BP-lowering management. In this paper, authors summarize the evidence on lowering the BP target in hypertensive patients with a focus on the 2017 AHA/ACC guidelines...
December 2018: Expert Review of Cardiovascular Therapy
Tarun Saxena, Azeema Ozefa Ali, Manjari Saxena
Hypertension is caused by increased cardiac output and/or increased peripheral resistance. Areas covered: The various mechanisms affecting cardiac output/peripheral resistance involved in the development of essential hypertension are covered. These include genetics; sympathetic nervous system overactivity; renal mechanisms: excess sodium intake and pressure natriuresis; vascular mechanisms: endothelial cell dysfunction and the nitric oxide pathway; hormonal mechanisms: the renin-angiotensin-aldosterone system (RAAS); obesity, obstructive sleep apnea (OSA); insulin resistance and metabolic syndrome; uric acid; vitamin D; gender differences; racial, ethnic, and environmental factors; increased left ventricular ejection force and hypertension and its association with increased basal sympathetic activity - cortical connections...
December 2018: Expert Review of Cardiovascular Therapy
Arturo Cesaro, Felice Gragnano, Domenico Di Girolamo, Elisabetta Moscarella, Vincenzo Diana, Ivana Pariggiano, Alfonso Alfieri, Rocco Perrotta, Pasquale Golino, Francesco Cesaro, Giuseppe Mercone, Gianluca Campo, Paolo Calabrò
The assessment of coronary lesions severity has always been a relevant topic in the management of the patient undergoing coronary angiography. Fractional flow reserve (FFR) has been introduced as an objective index to determine the significance of a coronary stenosis with a positive impact on clinical outcomes has been demonstrated for FFR-guided coronary interventions. However, several technical drawbacks have been pointed out in clinical practice limiting the diffusion of FFR worldwide. To exceed these limits, other indices and the quantitative flow ratio (QFR) have been recently developed and tested in clinical studies...
December 2018: Expert Review of Cardiovascular Therapy
Ravi B Patel, Muthiah Vaduganathan
No abstract text is available yet for this article.
December 2018: Expert Review of Cardiovascular Therapy
Peter Tajti, Iosif Xenogiannis, Ivan Chavez, Mario Gössl, Michael Mooney, Anil Poulose, Paul Sorajja, Jay Traverse, Yale Wang, M Nicholas Burke, Emmanouil S Brilakis
Coronary artery perforations are more likely to occur during percutaneous coronary intervention of complex coronary lesions, such as heavily calcified lesions and chronic total occlusions. Areas covered: Authors provide an update on the management of coronary perforations by performing a critical review of the related, recently published literature. Expert commentary: Meticulous attention to guidewire position and to device selection is critical for minimizing the risk for coronary perforation. If a perforation occurs, following a structured, algorithmic approach can maximize the likelihood of a successful outcome...
November 2018: Expert Review of Cardiovascular Therapy
Paul Guedeney, Sabato Sorrentino, Birgit Vogel, Usman Baber, Bimmer E Claessen, Roxana Mehran
Chronic kidney disease (CKD) is commonly present in patients undergoing percutaneous coronary intervention (PCI). These patients frequently present with more complex coronary artery disease (CAD) and higher risk of peri-procedural and post-procedural adverse events, including bleeding, thrombotic events, and contrast-induced acute kidney injury (CI-AKI). This article contains updated knowledge and management of patients with CKD undergoing PCI. Areas covered: In this article, the pathophysiological mechanisms behind the association of CKD, complex CAD lesions, and complications of PCI are reviewed and the different risk scores available to assess the occurrence of CI-AKI are detailed...
November 2018: Expert Review of Cardiovascular Therapy
Tarek Nafee, C Michael Gibson, Megan K Yee, Fahad Alkhalfan, Gerald Chi, Ryan Travis, Mahshid Mir, Arzu Kalayci, Mehrian Jafarizade, Aditya Ganti, Syed Hassan Kazmi, Eiman Ghaffarpasand, Anmol Pitliya, Sudarshana Datta, Sadaf Sharfaei, Mahda Alihashemi, Ahmed Elsaiey, Iqra Qamar, Mohamadmostafa Jahansouz, Usama Talib, Farima Kahe, Shaghayegh Habibi, Mohammed Abdelwahed, Feham Tariq, Manpreet Kaur, Ahmed Younes, Sargun S Walia, Amandeep Singh, Syed Muhammad Dildar, M Khurram Afzal, Mathieu Kerneis
Compared to other direct oral anticoagulants, betrixaban has a longer half-life, smaller peak-trough variance, minimal renal clearance, and minimal hepatic Cytochrome P (CYP) metabolism. The Acute Medically Ill VTE Prevention with Extended Duration Betrixaban (APEX) trial evaluated the efficacy and safety of extended duration betrixaban compared to standard duration enoxaparin in acutely ill hospitalized patients. Areas covered: This article describes the role of betrixaban in the prevention of venous thromboembolism (VTE) in acutely ill medical patients...
November 2018: Expert Review of Cardiovascular Therapy
Dhruv Mahtta, Islam Y Elgendy, Carl J Pepine
Coronary artery disease (CAD) remains the leading cause of mortality and morbidity worldwide, and hypertension is its most prevalent modifiable risk factor. Patients with CAD and concomitant hypertension are a special population with distinct physiologic and structural alterations. Optimal blood pressure (BP) control in this population has been linked with reduction in adverse outcomes, however, excessive lowering of BP could jeopardize myocardial and cerebral perfusion. Areas covered: Authors highlight the prevalence of the CAD and hypertension dyad, as well as the implications of various structural and physiological changes in this population...
November 2018: Expert Review of Cardiovascular Therapy
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