Pub Date : 2024-10-01DOI: 10.1007/s11886-024-02138-y
Yasser Jamil, Dana Alameddine, Mahmoud El Iskandarani, Ankit Agrawal, Aro D Arockiam, Elio Haroun, Heba Wassif, Patrick Collier, Tom Kai Ming Wang
Background: Although hyperuricemia is a recognized risk factor for cardiovascular diseases, mixed results have been reported regarding the associations between uric acid-lowering medications and cardiovascular events. This meta-analysis compared the cardiovascular outcomes of different uric acid-lowering medications and placebo.
Methods: Following PRISMA guidelines, we searched OVID Medline, Embase, Web of Science, and Cochrane databases to identify potentially relevant articles until December 2023. Studies must be randomized or observational, report cardiovascular and mortality outcomes, and compare uric acid-lowering medications to placebo or each other. Data was analyzed using Revman (version 5.4) software.
Results: A total of 3,393 studies were searched, after which 47 studies were included, totaling 3,803,509 patients (28 studies comparing xanthine oxidase inhibitors (XOI) versus placebo, 17 studies comparing allopurinol and febuxostat, and 2 studies comparing XOI and uricosuric agents). Overall mean age was 57.3 years, and females comprised 20.8% of all studies. There were no significant differences between XOI and placebo for cardiovascular outcomes (mortality, myocardial infarction, major adverse cardiovascular events, heart failure, or arrhythmia). There was significant heterogeneity in all these pooled analyses. Comparing Allopurinol to Febuxostat, there was a lower risk of heart failure in febuxostat than allopurinol in 3 RCTs (OR 0.66, 95% CI 0.50-0.89, p = 0.006). Other cardiovascular outcomes were not different. Lastly, when comparing XOI and uricosuric agents, no significant differences in MI rates were evident.
Conclusion: XOI was not associated with reduced cardiovascular events compared to placebo. When comparing XOI agents, Febuxostat might reduce the risk of HF, but future studies are required to confirm the findings from the current study.
{"title":"Cardiovascular Outcomes of Uric Acid Lowering Medications: A Meta-Analysis.","authors":"Yasser Jamil, Dana Alameddine, Mahmoud El Iskandarani, Ankit Agrawal, Aro D Arockiam, Elio Haroun, Heba Wassif, Patrick Collier, Tom Kai Ming Wang","doi":"10.1007/s11886-024-02138-y","DOIUrl":"https://doi.org/10.1007/s11886-024-02138-y","url":null,"abstract":"<p><strong>Background: </strong>Although hyperuricemia is a recognized risk factor for cardiovascular diseases, mixed results have been reported regarding the associations between uric acid-lowering medications and cardiovascular events. This meta-analysis compared the cardiovascular outcomes of different uric acid-lowering medications and placebo.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we searched OVID Medline, Embase, Web of Science, and Cochrane databases to identify potentially relevant articles until December 2023. Studies must be randomized or observational, report cardiovascular and mortality outcomes, and compare uric acid-lowering medications to placebo or each other. Data was analyzed using Revman (version 5.4) software.</p><p><strong>Results: </strong>A total of 3,393 studies were searched, after which 47 studies were included, totaling 3,803,509 patients (28 studies comparing xanthine oxidase inhibitors (XOI) versus placebo, 17 studies comparing allopurinol and febuxostat, and 2 studies comparing XOI and uricosuric agents). Overall mean age was 57.3 years, and females comprised 20.8% of all studies. There were no significant differences between XOI and placebo for cardiovascular outcomes (mortality, myocardial infarction, major adverse cardiovascular events, heart failure, or arrhythmia). There was significant heterogeneity in all these pooled analyses. Comparing Allopurinol to Febuxostat, there was a lower risk of heart failure in febuxostat than allopurinol in 3 RCTs (OR 0.66, 95% CI 0.50-0.89, p = 0.006). Other cardiovascular outcomes were not different. Lastly, when comparing XOI and uricosuric agents, no significant differences in MI rates were evident.</p><p><strong>Conclusion: </strong>XOI was not associated with reduced cardiovascular events compared to placebo. When comparing XOI agents, Febuxostat might reduce the risk of HF, but future studies are required to confirm the findings from the current study.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Acute decompensated heart failure (ADHF) patients with symptomatic congestion often require in-hospital admission for intravenous (IV) diuretic, impacting both patient well-being and healthcare expenses. Subcutaneous (SC) furosemide has a potential to facilitate outpatient management of ADHF patients. Thus, this study aims to assess the efficacy and safety of SC furosemide utilization, offering a potential alternative to traditional IV administration.
Methods: A systematic search was conducted until April 14 2024 across scientific databases. This review included studies comparing SC furosemide with oral and IV formulations in adult HF patients.
Results: This study analyzed 687 patients from 20 studies. The results demonstrate that SC furosemide can effectively manage symptomatic congestion in HF patients and results in significant cost reductions, symptom relief, and improved quality of life. Although further investigation into mortality rates is needed, SC furosemide demonstrates efficacy comparable to IV furosemide in diuresis and weight loss, with similar bioavailability and natriuretic effects. Adverse events are generally minor, predominantly related to skin irritation. Innovative strategies, such as developing isotonic alkaline solutions and improved infusion devices, are being explored to address these challenges.
Conclusion: SC furosemide offers a promising alternative for managing ADHF, particularly in symptomatic HF patients with volume overload. The integration of SC furosemide into routine clinical practice and future guidelines, could optimize the management of HF, reducing hospital admission and improving patient outcomes.
{"title":"The Role of Subcutaneous Furosemide in Heart Failure Management: A Systematic Review.","authors":"Wynne Widiarti, Pandit Bagus Tri Saputra, Melissa Valentina Ariyanto, Cornelia Ghea Savitri, Chaq El Chaq Zamzam Multazam, Johanes Nugroho Eko Putranto, Firas Farisi Alkaff","doi":"10.1007/s11886-024-02124-4","DOIUrl":"https://doi.org/10.1007/s11886-024-02124-4","url":null,"abstract":"<p><strong>Background: </strong>Acute decompensated heart failure (ADHF) patients with symptomatic congestion often require in-hospital admission for intravenous (IV) diuretic, impacting both patient well-being and healthcare expenses. Subcutaneous (SC) furosemide has a potential to facilitate outpatient management of ADHF patients. Thus, this study aims to assess the efficacy and safety of SC furosemide utilization, offering a potential alternative to traditional IV administration.</p><p><strong>Methods: </strong>A systematic search was conducted until April 14 2024 across scientific databases. This review included studies comparing SC furosemide with oral and IV formulations in adult HF patients.</p><p><strong>Results: </strong>This study analyzed 687 patients from 20 studies. The results demonstrate that SC furosemide can effectively manage symptomatic congestion in HF patients and results in significant cost reductions, symptom relief, and improved quality of life. Although further investigation into mortality rates is needed, SC furosemide demonstrates efficacy comparable to IV furosemide in diuresis and weight loss, with similar bioavailability and natriuretic effects. Adverse events are generally minor, predominantly related to skin irritation. Innovative strategies, such as developing isotonic alkaline solutions and improved infusion devices, are being explored to address these challenges.</p><p><strong>Conclusion: </strong>SC furosemide offers a promising alternative for managing ADHF, particularly in symptomatic HF patients with volume overload. The integration of SC furosemide into routine clinical practice and future guidelines, could optimize the management of HF, reducing hospital admission and improving patient outcomes.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-28DOI: 10.1007/s11886-024-02122-6
Matthew Alonzo, Javier Contreras, Jakob Bering, Ming-Tao Zhao
Purpose of review: Hypoplastic left heart syndrome (HLHS) is a critical congenital heart defect characterized by the underdevelopment of left-sided heart structures, leading to significant circulatory challenges, and necessitating multiple surgeries for survival. Despite advancements in surgical interventions, long-term outcomes often involve heart failure, highlighting the need for a deeper understanding of HLHS pathogenesis. Current in vivo and in vitro models aim to recapitulate HLHS anatomy and physiology, yet they face limitations in accuracy and complexity.
Recent findings: In vivo models, including those in chick, lamb, and mouse, provide insights into hemodynamic and genetic factors influencing HLHS. In vitro models using human induced pluripotent stem cells offer valuable platforms for studying genetic mutations and cellular mechanisms. This review evaluates these models' utility and limitations, and proposes future directions for developing more sophisticated models to enhance our understanding and treatment of HLHS.
{"title":"In Vivo and In Vitro Approaches to Modeling Hypoplastic Left Heart Syndrome.","authors":"Matthew Alonzo, Javier Contreras, Jakob Bering, Ming-Tao Zhao","doi":"10.1007/s11886-024-02122-6","DOIUrl":"https://doi.org/10.1007/s11886-024-02122-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>Hypoplastic left heart syndrome (HLHS) is a critical congenital heart defect characterized by the underdevelopment of left-sided heart structures, leading to significant circulatory challenges, and necessitating multiple surgeries for survival. Despite advancements in surgical interventions, long-term outcomes often involve heart failure, highlighting the need for a deeper understanding of HLHS pathogenesis. Current in vivo and in vitro models aim to recapitulate HLHS anatomy and physiology, yet they face limitations in accuracy and complexity.</p><p><strong>Recent findings: </strong>In vivo models, including those in chick, lamb, and mouse, provide insights into hemodynamic and genetic factors influencing HLHS. In vitro models using human induced pluripotent stem cells offer valuable platforms for studying genetic mutations and cellular mechanisms. This review evaluates these models' utility and limitations, and proposes future directions for developing more sophisticated models to enhance our understanding and treatment of HLHS.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1007/s11886-024-02126-2
Mary Rodriguez Ziccardi, Joan E Briller
Purpose of review: Cardiovascular disease (CVD) continues to be a leading contributor to maternal mortality and morbidity. Echocardiography is an essential tool for patients with suspected and known CVD to establish symptom etiology, treatment strategy, and prognosis. We summarize the current status of conventional and novel techniques for assessment of CVD during pregnancy.
Recent findings: Conventional techniques are still useful for evaluation of known or suspected CVD. Advanced technology using speckle tracking continues to evolve and is increasingly applied for diagnosis of subclinical disease including hypertensive disorders of pregnancy and left ventricular (LV) dysfunction. Precise recommendations on how frequently echocardiography should be performed and for whom remain in flux. However, a recently published consensus statement and new screening tool for pregnancy assessment of patients with valvular heart disease provide additional advice on using this modality. Echocardiography remains the diagnostic modality of choice for evaluation and risk stratification in pregnancy.
{"title":"Echocardiography for Management of Cardiovascular Disease in Pregnancy.","authors":"Mary Rodriguez Ziccardi, Joan E Briller","doi":"10.1007/s11886-024-02126-2","DOIUrl":"https://doi.org/10.1007/s11886-024-02126-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiovascular disease (CVD) continues to be a leading contributor to maternal mortality and morbidity. Echocardiography is an essential tool for patients with suspected and known CVD to establish symptom etiology, treatment strategy, and prognosis. We summarize the current status of conventional and novel techniques for assessment of CVD during pregnancy.</p><p><strong>Recent findings: </strong>Conventional techniques are still useful for evaluation of known or suspected CVD. Advanced technology using speckle tracking continues to evolve and is increasingly applied for diagnosis of subclinical disease including hypertensive disorders of pregnancy and left ventricular (LV) dysfunction. Precise recommendations on how frequently echocardiography should be performed and for whom remain in flux. However, a recently published consensus statement and new screening tool for pregnancy assessment of patients with valvular heart disease provide additional advice on using this modality. Echocardiography remains the diagnostic modality of choice for evaluation and risk stratification in pregnancy.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1007/s11886-024-02108-4
Saraschandra Vallabhajosyula, Shashank S Sinha, Ajar Kochar, Mohit Pahuja, Frank J Amico, Navin K Kapur
Purpose of review: Cardiogenic shock (CS) is associated with high in-hospital and long-term mortality and morbidity that results in significant socio-economic impact. Due to the high costs associated with CS care, it is important to define the short- and long-term burden of this disease state on resources and review strategies to mitigate these.
Recent findings: In recent times, the focus on CS continues to be on improving short-term outcomes, but there has been increasing emphasis on the long-term morbidity. In this review we discuss the long-term outcomes of CS and the role of hospital-level and system-level disparities in perpetuating this. We discuss mitigation strategies including developing evidence-based protocols and systems of care, improvement in risk stratification and evaluation of futility of care, all of which address the economic burden of CS. CS continues to remain the pre-eminent challenge in acute cardiovascular care, and a combination of multi-pronged strategies are needed to improve outcomes in this population.
{"title":"The Price We Pay for Progression in Shock Care: Economic Burden, Accessibility, and Adoption of Shock-Teams and Mechanical Circulatory Support Devices.","authors":"Saraschandra Vallabhajosyula, Shashank S Sinha, Ajar Kochar, Mohit Pahuja, Frank J Amico, Navin K Kapur","doi":"10.1007/s11886-024-02108-4","DOIUrl":"https://doi.org/10.1007/s11886-024-02108-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiogenic shock (CS) is associated with high in-hospital and long-term mortality and morbidity that results in significant socio-economic impact. Due to the high costs associated with CS care, it is important to define the short- and long-term burden of this disease state on resources and review strategies to mitigate these.</p><p><strong>Recent findings: </strong>In recent times, the focus on CS continues to be on improving short-term outcomes, but there has been increasing emphasis on the long-term morbidity. In this review we discuss the long-term outcomes of CS and the role of hospital-level and system-level disparities in perpetuating this. We discuss mitigation strategies including developing evidence-based protocols and systems of care, improvement in risk stratification and evaluation of futility of care, all of which address the economic burden of CS. CS continues to remain the pre-eminent challenge in acute cardiovascular care, and a combination of multi-pronged strategies are needed to improve outcomes in this population.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1007/s11886-024-02137-z
Siddharth J Trivedi, Jamieson M Bourque
Purpose of review: 18F-Fluorodeoxyglucose positron emission tomography (PET) combined with computed tomography (CT), referred to as 18F-FDG PET/CT, plays a significant role in the diagnosis and management of patients with systemic infectious and inflammatory conditions. This review provides an overview of 18F-FDG PET/CT in systemic infectious and inflammatory conditions, including infective endocarditis (IE), cardiac implantable electrical device (CIED)/left ventricular assist device (LVAD) infection, sarcoidosis, and large-vessel vasculitis (LVV).
Recent findings: This review highlights the past and present literature in the increasing role of 18F-FDG PET/CT in cardiovascular inflammation and infection, including diagnostic and prognostic findings. They key aspects of this paper are to highlight the importance of 18F-FDG PET/CT in cardiovascular infection and inflammation, and to provide illustrations of how it can contribute to patient diagnosis and management.
{"title":"Innovations in Imaging: <sup>18</sup>F-Fluorodeoxyglucose PET/CT for Assessment of Cardiovascular Infection and Inflammation.","authors":"Siddharth J Trivedi, Jamieson M Bourque","doi":"10.1007/s11886-024-02137-z","DOIUrl":"https://doi.org/10.1007/s11886-024-02137-z","url":null,"abstract":"<p><strong>Purpose of review: </strong><sup>18</sup>F-Fluorodeoxyglucose positron emission tomography (PET) combined with computed tomography (CT), referred to as <sup>18</sup>F-FDG PET/CT, plays a significant role in the diagnosis and management of patients with systemic infectious and inflammatory conditions. This review provides an overview of <sup>18</sup>F-FDG PET/CT in systemic infectious and inflammatory conditions, including infective endocarditis (IE), cardiac implantable electrical device (CIED)/left ventricular assist device (LVAD) infection, sarcoidosis, and large-vessel vasculitis (LVV).</p><p><strong>Recent findings: </strong>This review highlights the past and present literature in the increasing role of <sup>18</sup>F-FDG PET/CT in cardiovascular inflammation and infection, including diagnostic and prognostic findings. They key aspects of this paper are to highlight the importance of <sup>18</sup>F-FDG PET/CT in cardiovascular infection and inflammation, and to provide illustrations of how it can contribute to patient diagnosis and management.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1007/s11886-024-02139-x
Roopesh Sai Jakulla, Brett W Sperry
Purpose of review: This article summarizes findings seen in various cardiomyopathies on myocardial perfusion imaging (MPI) with positron emission tomography (PET).
Recent findings: MPI is the cornerstone for evaluation of coronary ischemia, and technological advancements have yielded improved imaging quality and reduction in radiation exposure, particularly with PET. Multi-specialty guidelines and appropriate use criteria provide guidance on utilization of PET MPI in various scenarios related to evaluation of chest pain, new onset cardiomyopathy, and other scenarios where coronary ischemia should be assessed. Various non-ischemic cardiomyopathies such as septal and apical hypertrophic cardiomyopathy, amyloidosis, sarcoidosis, takotsubo, and dilated cardiomyopathy have typical imaging findings on PET MPI and can be identified if these patterns are understood. It is essential to recognize specific imaging patterns in non-ischemic cardiomyopathies which may aide in diagnosis. Ultimately, multimodality imaging, including echocardiography and cardiac magnetic resonance, complement PET MPI in diagnosing and guiding treatment options for these conditions.
综述目的:本文总结了正电子发射断层扫描(PET)心肌灌注成像(MPI)在各种心肌病中的发现:MPI 是评估冠状动脉缺血的基石,技术的进步提高了成像质量,减少了辐射暴露,尤其是 PET。多专科指南和适当使用标准为 PET MPI 在评估胸痛、新发心肌病和其他需要评估冠状动脉缺血的各种情况下的使用提供了指导。各种非缺血性心肌病,如室间隔和心尖肥厚型心肌病、淀粉样变性、肉样瘤病、拓扑型心肌病和扩张型心肌病在 PET MPI 上都有典型的成像结果,如果了解这些模式,就可以进行识别。识别非缺血性心肌病的特殊成像模式至关重要,这有助于诊断。最终,包括超声心动图和心脏磁共振在内的多模态成像可辅助 PET MPI 诊断这些疾病并指导治疗方案。
{"title":"Diagnosing Non-Ischemic Cardiomyopathies on Myocardial Perfusion Imaging with Positron Emission Tomography.","authors":"Roopesh Sai Jakulla, Brett W Sperry","doi":"10.1007/s11886-024-02139-x","DOIUrl":"https://doi.org/10.1007/s11886-024-02139-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>This article summarizes findings seen in various cardiomyopathies on myocardial perfusion imaging (MPI) with positron emission tomography (PET).</p><p><strong>Recent findings: </strong>MPI is the cornerstone for evaluation of coronary ischemia, and technological advancements have yielded improved imaging quality and reduction in radiation exposure, particularly with PET. Multi-specialty guidelines and appropriate use criteria provide guidance on utilization of PET MPI in various scenarios related to evaluation of chest pain, new onset cardiomyopathy, and other scenarios where coronary ischemia should be assessed. Various non-ischemic cardiomyopathies such as septal and apical hypertrophic cardiomyopathy, amyloidosis, sarcoidosis, takotsubo, and dilated cardiomyopathy have typical imaging findings on PET MPI and can be identified if these patterns are understood. It is essential to recognize specific imaging patterns in non-ischemic cardiomyopathies which may aide in diagnosis. Ultimately, multimodality imaging, including echocardiography and cardiac magnetic resonance, complement PET MPI in diagnosing and guiding treatment options for these conditions.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1007/s11886-024-02141-3
Rishi Rikhi, Michael D Shapiro
Purpose of review: The present review aims to summarize current evidence, explore underlying mechanisms, and help guide clinicians regarding statin therapy and diabetes risk in primary prevention.
Recent findings: The observational and genetic epidemiology, as well as evidence from randomized controlled trials and meta-analyses, illustrate a modest, dose-dependent increase in risk of diabetes from statin therapy. Risk of new onset diabetes from statins appears to be greatest in those near the diagnostic threshold for diabetes or with diabetes risk factors prior to statin initiation. The risk of incident diabetes is vastly offset by the cardiovascular protection offered from statin therapy and should not deter guideline recommended statin initiation in primary prevention.
{"title":"Impact of Statin Therapy on Diabetes Incidence: Implications for Primary Prevention.","authors":"Rishi Rikhi, Michael D Shapiro","doi":"10.1007/s11886-024-02141-3","DOIUrl":"https://doi.org/10.1007/s11886-024-02141-3","url":null,"abstract":"<p><strong>Purpose of review: </strong>The present review aims to summarize current evidence, explore underlying mechanisms, and help guide clinicians regarding statin therapy and diabetes risk in primary prevention.</p><p><strong>Recent findings: </strong>The observational and genetic epidemiology, as well as evidence from randomized controlled trials and meta-analyses, illustrate a modest, dose-dependent increase in risk of diabetes from statin therapy. Risk of new onset diabetes from statins appears to be greatest in those near the diagnostic threshold for diabetes or with diabetes risk factors prior to statin initiation. The risk of incident diabetes is vastly offset by the cardiovascular protection offered from statin therapy and should not deter guideline recommended statin initiation in primary prevention.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1007/s11886-024-02133-3
Harsha Sanaka, Elio Haroun, Aro Daniela Arockiam, Tiffany Dong, Allan Klein, Tom Kai Ming Wang
Purpose of review: To outline recent advances in imaging and treatment for recurrent pericarditis (RP).
Recent findings: Greater understanding of NLRP3 inflammasome activation in the pathogenesis of RP has led to the development of several anti-interleukin (IL-1) agents, and technological advancements have increased the utility of multimodality imaging in RP. Multimodality imaging plays a crucial role in the assessment of RP, with echocardiography serving as the initial imaging modality; cardiac magnetic resonance (CMR) as a pivotal test for diagnosis, grading severity, and surveillance; and cardiac computed tomography (CT) providing complimentary information and assisting operative assessment. Anti-IL-1 agents are now well-established as second line therapy for RP, with recent clinical trials demonstrating their efficacy.
综述的目的:概述复发性心包炎(RP)成像和治疗的最新进展:随着对NLRP3炎性体激活在RP发病机制中的作用的进一步了解,开发出了多种抗白细胞介素(IL-1)药物,而技术的进步也提高了多模态成像在RP中的应用。多模态成像在 RP 的评估中起着至关重要的作用,其中超声心动图是初始成像模式;心脏磁共振(CMR)是诊断、严重程度分级和监测的关键检查;心脏计算机断层扫描(CT)提供补充信息并协助手术评估。抗IL-1药物作为RP的二线疗法现已得到广泛认可,最近的临床试验也证明了其疗效。
{"title":"Advances in the Multimodality Imaging and Management of Recurrent Pericarditis: A Contemporary Review.","authors":"Harsha Sanaka, Elio Haroun, Aro Daniela Arockiam, Tiffany Dong, Allan Klein, Tom Kai Ming Wang","doi":"10.1007/s11886-024-02133-3","DOIUrl":"https://doi.org/10.1007/s11886-024-02133-3","url":null,"abstract":"<p><strong>Purpose of review: </strong>To outline recent advances in imaging and treatment for recurrent pericarditis (RP).</p><p><strong>Recent findings: </strong>Greater understanding of NLRP3 inflammasome activation in the pathogenesis of RP has led to the development of several anti-interleukin (IL-1) agents, and technological advancements have increased the utility of multimodality imaging in RP. Multimodality imaging plays a crucial role in the assessment of RP, with echocardiography serving as the initial imaging modality; cardiac magnetic resonance (CMR) as a pivotal test for diagnosis, grading severity, and surveillance; and cardiac computed tomography (CT) providing complimentary information and assisting operative assessment. Anti-IL-1 agents are now well-established as second line therapy for RP, with recent clinical trials demonstrating their efficacy.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1007/s11886-024-02136-0
Matthew J Magoon, Babak Nazer, Nazem Akoum, Patrick M Boyle
Purpose of review: Technology drives the field of cardiac electrophysiology. Recent computational advances will bring exciting changes. To stay ahead of the curve, we recommend electrophysiologists develop a robust appreciation for novel computational techniques, including deterministic, statistical, and hybrid models.
Recent findings: In clinical applications, deterministic models use biophysically detailed simulations to offer patient-specific insights. Statistical techniques like machine learning and artificial intelligence recognize patterns in data. Emerging clinical tools are exploring avenues to combine all the above methodologies. We review three ways that computational medicine will aid electrophysiologists by: (1) improving personalized risk assessments, (2) weighing treatment options, and (3) guiding ablation procedures. Leveraging clinical data that are often readily available, computational models will offer valuable insights to improve arrhythmia patient care. As emerging tools promote personalized medicine, physicians must continue to critically evaluate technology-driven tools they consider using to ensure their appropriate implementation.
{"title":"Computational Medicine: What Electrophysiologists Should Know to Stay Ahead of the Curve.","authors":"Matthew J Magoon, Babak Nazer, Nazem Akoum, Patrick M Boyle","doi":"10.1007/s11886-024-02136-0","DOIUrl":"https://doi.org/10.1007/s11886-024-02136-0","url":null,"abstract":"<p><strong>Purpose of review: </strong>Technology drives the field of cardiac electrophysiology. Recent computational advances will bring exciting changes. To stay ahead of the curve, we recommend electrophysiologists develop a robust appreciation for novel computational techniques, including deterministic, statistical, and hybrid models.</p><p><strong>Recent findings: </strong>In clinical applications, deterministic models use biophysically detailed simulations to offer patient-specific insights. Statistical techniques like machine learning and artificial intelligence recognize patterns in data. Emerging clinical tools are exploring avenues to combine all the above methodologies. We review three ways that computational medicine will aid electrophysiologists by: (1) improving personalized risk assessments, (2) weighing treatment options, and (3) guiding ablation procedures. Leveraging clinical data that are often readily available, computational models will offer valuable insights to improve arrhythmia patient care. As emerging tools promote personalized medicine, physicians must continue to critically evaluate technology-driven tools they consider using to ensure their appropriate implementation.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}