Pub Date : 2024-08-01Epub Date: 2024-06-12DOI: 10.1007/s11886-024-02078-7
Arka Chatterjee, Madhan Shanmugasundaram, Kwan S Lee, Toshinobu Kazui, Indranee N Rajapreyar, Deepak Acharya
Purpose of review: Cardiac Allograft vasculopathy (CAV) is a major barrier to improving outcomes after heart transplantation. Coronary angiography has very low sensitivity to detect early CAV and intravascular ultrasound (IVUS) only improves it to some extent. In this article, we detail the current evidence surrounding use of Optical Coherence tomography (OCT) in patients with CAV.
Recent findings: OCT has the ability to recognize CAV at earlier stages with intimal thickness < 150 μm, can characterize CAV in almost pathologic / microscopic detail - plaque characteristics are better visualized and novel early features such as layered fibrotic plaques and microchannels have been identified. Progression of CAV can be monitored also, with promise shown in automated serial measurements also. OCT has significantly advanced our understanding of the pathophysiology-as well as permits precise monitoring and surveillance of the disease. Potential treatment options could also be evaluated using OCT.
{"title":"Optical Coherence Tomography in the Assessment and Management of Cardiac Allograft Vasculopathy.","authors":"Arka Chatterjee, Madhan Shanmugasundaram, Kwan S Lee, Toshinobu Kazui, Indranee N Rajapreyar, Deepak Acharya","doi":"10.1007/s11886-024-02078-7","DOIUrl":"10.1007/s11886-024-02078-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiac Allograft vasculopathy (CAV) is a major barrier to improving outcomes after heart transplantation. Coronary angiography has very low sensitivity to detect early CAV and intravascular ultrasound (IVUS) only improves it to some extent. In this article, we detail the current evidence surrounding use of Optical Coherence tomography (OCT) in patients with CAV.</p><p><strong>Recent findings: </strong>OCT has the ability to recognize CAV at earlier stages with intimal thickness < 150 μm, can characterize CAV in almost pathologic / microscopic detail - plaque characteristics are better visualized and novel early features such as layered fibrotic plaques and microchannels have been identified. Progression of CAV can be monitored also, with promise shown in automated serial measurements also. OCT has significantly advanced our understanding of the pathophysiology-as well as permits precise monitoring and surveillance of the disease. Potential treatment options could also be evaluated using OCT.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305628","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 : 2024-08-01Epub Date: 2024-07-04DOI: 10.1007/s11886-024-02082-x
Bayan Azizi, Danesh Soltani, Amanuel Godana Arero, Asal Sadat Karimi, Akam Ramezani, Ali Vasheghani-Farahani, Haleh Ashraf, Shahin Akhondzadeh, Helin Khosravi, Saeed Nateghi, Tahereh Dadpey
Purpose of review: Marital quality (MQ) is a psychosocial factor that has been neglected in cardiovascular prevention guidelines, although its association with cardiovascular diseases has been identified in several studies. Therefore, we aim to investigate how MQ either in positive or negative dimensions affect different cardiovascular risk factors and diseases.
Recent findings: We systematically searched different databases in September 2023 for longitudinal studies conducted to assess the contribution of MQ to well-established cardiovascular risk factors and diseases. Two independent researchers screened studies and carried out data extraction and quality assessment of included ones. From 12,175 potential studies screened, 40 were included. The presence of significant heterogeneity in methodology, follow-up, and subsequent effect estimates made it unfeasible to do a meta-analysis. Despite the variation, most studies found a significant association of negative MQ measures with physical inactivity (2/2), high levels of smoking (4/5) and alcohol (3/3) use, increased metabolic syndrome risk (3/3), elevated type 2 diabetes mellitus (T2DM) risk and poor T2DM management (3/6), elevated cardiovascular disease risk and progression (9/11), increased body weight and obesity risk (2/3), elevated blood pressure and hypertension risk (7/8). Positive MQ measures were mainly associated with improvement in blood pressure control (2/2), reduced T2DM risk and its good management (1/1), reduced body weight and obesity risk (2/2), and increased survival in cardiovascular diseases (4/4). Based on current evidence, MQ seems to play a crucial role in developing established cardiovascular risk factors and diseases and is worth considering in preventive strategies.
{"title":"Marital Quality-A Neglected Player in the Prevention of Cardiovascular Diseases: A Systematic Review of Longitudinal Studies.","authors":"Bayan Azizi, Danesh Soltani, Amanuel Godana Arero, Asal Sadat Karimi, Akam Ramezani, Ali Vasheghani-Farahani, Haleh Ashraf, Shahin Akhondzadeh, Helin Khosravi, Saeed Nateghi, Tahereh Dadpey","doi":"10.1007/s11886-024-02082-x","DOIUrl":"10.1007/s11886-024-02082-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>Marital quality (MQ) is a psychosocial factor that has been neglected in cardiovascular prevention guidelines, although its association with cardiovascular diseases has been identified in several studies. Therefore, we aim to investigate how MQ either in positive or negative dimensions affect different cardiovascular risk factors and diseases.</p><p><strong>Recent findings: </strong>We systematically searched different databases in September 2023 for longitudinal studies conducted to assess the contribution of MQ to well-established cardiovascular risk factors and diseases. Two independent researchers screened studies and carried out data extraction and quality assessment of included ones. From 12,175 potential studies screened, 40 were included. The presence of significant heterogeneity in methodology, follow-up, and subsequent effect estimates made it unfeasible to do a meta-analysis. Despite the variation, most studies found a significant association of negative MQ measures with physical inactivity (2/2), high levels of smoking (4/5) and alcohol (3/3) use, increased metabolic syndrome risk (3/3), elevated type 2 diabetes mellitus (T2DM) risk and poor T2DM management (3/6), elevated cardiovascular disease risk and progression (9/11), increased body weight and obesity risk (2/3), elevated blood pressure and hypertension risk (7/8). Positive MQ measures were mainly associated with improvement in blood pressure control (2/2), reduced T2DM risk and its good management (1/1), reduced body weight and obesity risk (2/2), and increased survival in cardiovascular diseases (4/4). Based on current evidence, MQ seems to play a crucial role in developing established cardiovascular risk factors and diseases and is worth considering in preventive strategies.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497371","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 : 2024-08-01Epub Date: 2024-06-13DOI: 10.1007/s11886-024-02079-6
Vinícius Martins Rodrigues Oliveira, André Rivera, Izadora Caiado Oliveira, André Maroccolo de Sousa, Maria Elisa Passos Nishikubo, Frans Serpa, Antônio da Silva Menezes Junior
Background: Leadless pacemakers (LPs) are promising alternatives to traditional transvenous pacemakers (TVPs), but their comparative effectiveness and safety in clinical outcomes remain uncertain.
Methods: We systematically searched PubMed, Embase, Scopus, Cochrane, and ClinicalTrials.gov for studies comparing LPs and TVPs. A restricted maximum likelihood random-effects model was used for all outcomes. Heterogeneity was assessed using I2 statistics. We performed a subgroup analysis with studies with multivariate-adjusted data.
Results: We included 21 studies involving 47,229 patients, of whom 12,199 (25.8%) underwent LP implantation. Compared with TVPs, LPs were associated with a significantly lower risk of overall complications (OR 0.61; 95% CI 0.45-0.81; p < 0.01), dislodgement (OR 0.34; 95% CI 0.20-0.56; p < 0.01), and pneumothorax (OR 0.27; 95% CI 0.16-0.46; p < 0.01). No significant difference in all-cause mortality was observed in the overall analysis (OR 1.43; 95% CI 0.65-3.15; p = 0.35) and in studies with multivariate-adjusted data (OR 1.34; 95% CI 0.65-2.78; p = 0.43). However, LPs were associated with a higher risk of pericardial effusion (OR 2.47; 95% CI 1.39-4.38; p < 0.01) and cardiac tamponade (OR 3.75; 95% CI 2.41-5.83; p < 0.01). LPs also demonstrated a lower pacing capture threshold (MD -0.19 V; 95% CI [-0.23 V]-[-0.16 V]; p < 0.01), but no significant difference in impedance (MD 32.63 ohms; 95% CI [-22.50 ohms]-[87.76 ohms]; p = 0.25).
Conclusions: These findings suggest that LPs were associated with lower overall complication rates and similar effectiveness to TVPs. However, randomized controlled trials are warranted to validate these results.
{"title":"The Effectiveness and Safety of Leadless Pacemakers: An Updated Meta-Analysis.","authors":"Vinícius Martins Rodrigues Oliveira, André Rivera, Izadora Caiado Oliveira, André Maroccolo de Sousa, Maria Elisa Passos Nishikubo, Frans Serpa, Antônio da Silva Menezes Junior","doi":"10.1007/s11886-024-02079-6","DOIUrl":"10.1007/s11886-024-02079-6","url":null,"abstract":"<p><strong>Background: </strong>Leadless pacemakers (LPs) are promising alternatives to traditional transvenous pacemakers (TVPs), but their comparative effectiveness and safety in clinical outcomes remain uncertain.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Scopus, Cochrane, and ClinicalTrials.gov for studies comparing LPs and TVPs. A restricted maximum likelihood random-effects model was used for all outcomes. Heterogeneity was assessed using I<sup>2</sup> statistics. We performed a subgroup analysis with studies with multivariate-adjusted data.</p><p><strong>Results: </strong>We included 21 studies involving 47,229 patients, of whom 12,199 (25.8%) underwent LP implantation. Compared with TVPs, LPs were associated with a significantly lower risk of overall complications (OR 0.61; 95% CI 0.45-0.81; p < 0.01), dislodgement (OR 0.34; 95% CI 0.20-0.56; p < 0.01), and pneumothorax (OR 0.27; 95% CI 0.16-0.46; p < 0.01). No significant difference in all-cause mortality was observed in the overall analysis (OR 1.43; 95% CI 0.65-3.15; p = 0.35) and in studies with multivariate-adjusted data (OR 1.34; 95% CI 0.65-2.78; p = 0.43). However, LPs were associated with a higher risk of pericardial effusion (OR 2.47; 95% CI 1.39-4.38; p < 0.01) and cardiac tamponade (OR 3.75; 95% CI 2.41-5.83; p < 0.01). LPs also demonstrated a lower pacing capture threshold (MD -0.19 V; 95% CI [-0.23 V]-[-0.16 V]; p < 0.01), but no significant difference in impedance (MD 32.63 ohms; 95% CI [-22.50 ohms]-[87.76 ohms]; p = 0.25).</p><p><strong>Conclusions: </strong>These findings suggest that LPs were associated with lower overall complication rates and similar effectiveness to TVPs. However, randomized controlled trials are warranted to validate these results.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310251","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 : 2024-08-01Epub Date: 2024-07-08DOI: 10.1007/s11886-024-02085-8
S König, S Hilbert, K Bode
Purpose of the review: Cardiac pacing has evolved in recent years currently culminating in the specific stimulation of the cardiac conduction system (conduction system pacing, CSP). This review aims to provide a comprehensive overview of the available literature on CSP, focusing on a critical classification of studies comparing CSP with standard treatment in the two fields of pacing for bradycardia and cardiac resynchronization therapy in patients with heart failure. The article will also elaborate specific benefits and limitations associated with CSP modalities of His bundle pacing (HBP) and left bundle branch area pacing (LBBAP).
Recent findings: Based on a growing number of observational studies for different indications of pacing therapy, both CSP modalities investigated are advantageous over standard treatment in terms of narrowing the paced QRS complex and preserving or improving left ventricular systolic function. Less consistent evidence exists with regard to the improvement of heart failure-related rehospitalization rates or mortality, and effect sizes vary between HBP and LBBAP. LBBAP is superior over HBP in terms of lead measurements and procedural duration. With regard to all reported outcomes, evidence from large scale randomized controlled clinical trials (RCT) is still scarce. CSP has the potential to sustainably improve patient care in cardiac pacing therapy if patients are appropriately selected and limitations are considered. With this review, we offer not only a summary of existing data, but also an outlook on probable future developments in the field, as well as a detailed summary of upcoming RCTs that provide insights into how the journey of CSP continues.
{"title":"Conduction System Pacing: Hope, Challenges, and the Journey Forward.","authors":"S König, S Hilbert, K Bode","doi":"10.1007/s11886-024-02085-8","DOIUrl":"10.1007/s11886-024-02085-8","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Cardiac pacing has evolved in recent years currently culminating in the specific stimulation of the cardiac conduction system (conduction system pacing, CSP). This review aims to provide a comprehensive overview of the available literature on CSP, focusing on a critical classification of studies comparing CSP with standard treatment in the two fields of pacing for bradycardia and cardiac resynchronization therapy in patients with heart failure. The article will also elaborate specific benefits and limitations associated with CSP modalities of His bundle pacing (HBP) and left bundle branch area pacing (LBBAP).</p><p><strong>Recent findings: </strong>Based on a growing number of observational studies for different indications of pacing therapy, both CSP modalities investigated are advantageous over standard treatment in terms of narrowing the paced QRS complex and preserving or improving left ventricular systolic function. Less consistent evidence exists with regard to the improvement of heart failure-related rehospitalization rates or mortality, and effect sizes vary between HBP and LBBAP. LBBAP is superior over HBP in terms of lead measurements and procedural duration. With regard to all reported outcomes, evidence from large scale randomized controlled clinical trials (RCT) is still scarce. CSP has the potential to sustainably improve patient care in cardiac pacing therapy if patients are appropriately selected and limitations are considered. With this review, we offer not only a summary of existing data, but also an outlook on probable future developments in the field, as well as a detailed summary of upcoming RCTs that provide insights into how the journey of CSP continues.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554375","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 : 2024-07-30DOI: 10.1007/s11886-024-02107-5
Eitan Frankel, Reginald Ho
Purpose of review: Ventricular arrhythmias (VAs) affect many patients with heart failure and underlying structural heart disease and are associated with significant morbidity and mortality. Antiarrhythmic drugs are often the initial treatment, but medication alone often fails to sufficiently suppress VAs. While catheter ablation (CA) remains the gold standard for treatment of VAs, CA is an invasive procedure and can be associated with periprocedural complications including acute clinical decompensation. Thus, there is an important need for alternative therapies.
Recent findings: Recent advances in risk stratification and the development of new ablation technologies may reduce some of the periprocedural complications and limitations of CA. In addition, less invasive therapies for VAs may provide an alternative treatment strategy for patients in both the acute and chronic setting. For patients acutely admitted with ventricular tachycardia electrical storm (VT-ES) or recurrent VT and cardiogenic shock, risk stratification tools have been developed to identify patients at high risk of acute hemodynamic decompensation during CA. These patients require a multidisciplinary approach and might need mechanical circulatory support (MCS) if CA is selected as the treatment strategy. Alternatively, less invasive therapies targeting the autonomic nervous system may be reasonable. In the chronic setting, developments in medical therapy have reduced the risk of sudden cardiac death in heart failure patients and stereotactic whole-body radiation (SBRT) has evolved as a potential, non-invasive therapy. Further research is needed to personalize VA therapy for individual patients.
审查目的:室性心律失常(VAs)影响着许多患有心力衰竭和潜在结构性心脏病的患者,并与严重的发病率和死亡率相关。抗心律失常药物通常是最初的治疗方法,但单靠药物往往无法充分抑制室性心律失常。虽然导管消融术(CA)仍是治疗 VAs 的黄金标准,但 CA 是一种侵入性手术,可能会引起围手术期并发症,包括急性临床失代偿。因此,我们亟需替代疗法:最近的研究结果:风险分层方面的最新进展以及新型消融技术的开发可能会减少 CA 的一些围手术期并发症和局限性。此外,针对室颤的微创疗法可为急性和慢性患者提供另一种治疗策略。对于因室性心动过速电风暴(VT-ES)或复发性室性心动过速和心源性休克而急诊入院的患者,已开发出风险分层工具来识别 CA 期间急性血流动力学失代偿的高风险患者。这些患者需要多学科治疗,如果选择 CA 作为治疗策略,可能需要机械循环支持(MCS)。另外,针对自律神经系统的微创疗法也可能是合理的选择。在慢性病方面,医学疗法的发展降低了心衰患者发生心脏性猝死的风险,立体定向全身放射(SBRT)已发展成为一种潜在的非侵入性疗法。针对不同患者的个性化 VA 治疗还需要进一步的研究。
{"title":"Management of Ventricular Arrhythmias in Heart Failure: Can Less Be More?","authors":"Eitan Frankel, Reginald Ho","doi":"10.1007/s11886-024-02107-5","DOIUrl":"https://doi.org/10.1007/s11886-024-02107-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>Ventricular arrhythmias (VAs) affect many patients with heart failure and underlying structural heart disease and are associated with significant morbidity and mortality. Antiarrhythmic drugs are often the initial treatment, but medication alone often fails to sufficiently suppress VAs. While catheter ablation (CA) remains the gold standard for treatment of VAs, CA is an invasive procedure and can be associated with periprocedural complications including acute clinical decompensation. Thus, there is an important need for alternative therapies.</p><p><strong>Recent findings: </strong>Recent advances in risk stratification and the development of new ablation technologies may reduce some of the periprocedural complications and limitations of CA. In addition, less invasive therapies for VAs may provide an alternative treatment strategy for patients in both the acute and chronic setting. For patients acutely admitted with ventricular tachycardia electrical storm (VT-ES) or recurrent VT and cardiogenic shock, risk stratification tools have been developed to identify patients at high risk of acute hemodynamic decompensation during CA. These patients require a multidisciplinary approach and might need mechanical circulatory support (MCS) if CA is selected as the treatment strategy. Alternatively, less invasive therapies targeting the autonomic nervous system may be reasonable. In the chronic setting, developments in medical therapy have reduced the risk of sudden cardiac death in heart failure patients and stereotactic whole-body radiation (SBRT) has evolved as a potential, non-invasive therapy. Further research is needed to personalize VA therapy for individual patients.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855063","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 : 2024-07-29DOI: 10.1007/s11886-024-02106-6
Eman Mubarak, Jacob Cleman, Gaëlle Romain, Carlos Mena-Hurtado, Kim G Smolderen
Purpose of review: Peripheral artery disease (PAD) is a growing global epidemic. Women with PAD are at elevated risk of experiencing psychosocial stressors that influence the diagnosis, management, and course of their illness due to unique sex- and gender-based factors.
Recent findings: We review existing evidence for increased psychosocial risk in women with PAD with a focus on mood disorders, chronic stress, pain experiences, substance use disorders, health behaviors and illness perceptions, and healthcare access. We discuss how these factors exacerbate PAD symptomatology and lead to adverse outcomes. Existing gaps in women's vascular care are reviewed and potential solutions to bridge these gaps through psychosocial care integration are proposed. Current care paradigms for women's vascular care do not adequately screen for and address psychosocial comorbidities. Clinician education, integration of evidence-based psychological care strategies, implementation of workflows for the management of individuals with PAD and mental health comorbidities, reform to reimbursement structures, and further advocacy are needed in this space. This review provides a construct for integrated behavioral health care for women with PAD and advocates for further integration of care.
审查目的:外周动脉疾病(PAD)是一种日益严重的全球性流行病。由于独特的性和性别因素,患有 PAD 的女性承受社会心理压力的风险较高,这些压力会影响她们的诊断、管理和病程:我们回顾了有关女性 PAD 患者心理社会风险增加的现有证据,重点关注情绪障碍、慢性压力、疼痛体验、药物使用障碍、健康行为和疾病认知以及医疗服务的获取。我们将讨论这些因素是如何加剧 PAD 症状并导致不良后果的。我们回顾了女性血管护理方面的现有差距,并提出了通过整合社会心理护理来弥补这些差距的潜在解决方案。目前的女性血管护理模式不能充分筛查和解决社会心理并发症。在这一领域需要开展临床医生教育、整合循证心理护理策略、实施工作流程以管理患有 PAD 和心理健康合并症的患者、改革报销结构以及进一步宣传。本综述为患有 PAD 的女性提供了综合行为健康护理的构架,并倡导进一步整合护理。
{"title":"Addressing Psychosocial Care Needs in Women with Peripheral Artery Disease.","authors":"Eman Mubarak, Jacob Cleman, Gaëlle Romain, Carlos Mena-Hurtado, Kim G Smolderen","doi":"10.1007/s11886-024-02106-6","DOIUrl":"https://doi.org/10.1007/s11886-024-02106-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>Peripheral artery disease (PAD) is a growing global epidemic. Women with PAD are at elevated risk of experiencing psychosocial stressors that influence the diagnosis, management, and course of their illness due to unique sex- and gender-based factors.</p><p><strong>Recent findings: </strong>We review existing evidence for increased psychosocial risk in women with PAD with a focus on mood disorders, chronic stress, pain experiences, substance use disorders, health behaviors and illness perceptions, and healthcare access. We discuss how these factors exacerbate PAD symptomatology and lead to adverse outcomes. Existing gaps in women's vascular care are reviewed and potential solutions to bridge these gaps through psychosocial care integration are proposed. Current care paradigms for women's vascular care do not adequately screen for and address psychosocial comorbidities. Clinician education, integration of evidence-based psychological care strategies, implementation of workflows for the management of individuals with PAD and mental health comorbidities, reform to reimbursement structures, and further advocacy are needed in this space. This review provides a construct for integrated behavioral health care for women with PAD and advocates for further integration of care.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787465","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 : 2024-07-29DOI: 10.1007/s11886-024-02109-3
Andrew Chiou, Melody Hermel, Zohar Chai, Ariana Eiseman, Sheila Jeschke, Sandeep Mehta, Unab Khan, Zahra Hoodbhoy, Nilofer Safdar, Adeel Khoja, Vashma Junaid, Elizabeth Vaughan, Anwar T Merchant, Junaid Iqbal, Aysha Almas, Salim S Virani, Sana Sheikh
Purpose of review: While primary prevention strategies target individuals who are at high risk of cardiovascular disease, there is rising interest towards primordial prevention that focuses on preventing the development of risk factors upstream of disease detection. Therefore, we review the advantages of primordial prevention interventions on minimizing future cardiovascular events.
Recent findings: Primordial prevention of atherosclerotic cardiovascular disease involves behavioral, genetic, and environmental strategies, starting from fetal/infant health and continuing throughout childhood and young adulthood. Early interventions focusing on modifiable risk factors such as physical inactivity, non-ideal body weight, smoking, and environmental pollutants are important towards preventing the initial occurrence of risk factors such as hypertension, dyslipidemia, and diabetes to ultimately reduce cardiovascular disease. Implementing primordial prevention strategies early on in life can minimize cardiovascular events and lead to healthy aging in the population. Future studies can further evaluate the effectiveness of various primordial prevention strategies.
{"title":"Going from Primary to Primordial Prevention: Is the Juice Worth the Squeeze?","authors":"Andrew Chiou, Melody Hermel, Zohar Chai, Ariana Eiseman, Sheila Jeschke, Sandeep Mehta, Unab Khan, Zahra Hoodbhoy, Nilofer Safdar, Adeel Khoja, Vashma Junaid, Elizabeth Vaughan, Anwar T Merchant, Junaid Iqbal, Aysha Almas, Salim S Virani, Sana Sheikh","doi":"10.1007/s11886-024-02109-3","DOIUrl":"https://doi.org/10.1007/s11886-024-02109-3","url":null,"abstract":"<p><strong>Purpose of review: </strong>While primary prevention strategies target individuals who are at high risk of cardiovascular disease, there is rising interest towards primordial prevention that focuses on preventing the development of risk factors upstream of disease detection. Therefore, we review the advantages of primordial prevention interventions on minimizing future cardiovascular events.</p><p><strong>Recent findings: </strong>Primordial prevention of atherosclerotic cardiovascular disease involves behavioral, genetic, and environmental strategies, starting from fetal/infant health and continuing throughout childhood and young adulthood. Early interventions focusing on modifiable risk factors such as physical inactivity, non-ideal body weight, smoking, and environmental pollutants are important towards preventing the initial occurrence of risk factors such as hypertension, dyslipidemia, and diabetes to ultimately reduce cardiovascular disease. Implementing primordial prevention strategies early on in life can minimize cardiovascular events and lead to healthy aging in the population. Future studies can further evaluate the effectiveness of various primordial prevention strategies.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787466","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 : 2024-07-27DOI: 10.1007/s11886-024-02104-8
Polydoros N. Kampaktsis, Carolyn Hennecken, Mrinali Shetty, Laura McLaughlin, Georgios Rampidis, Athanasios Samaras, Dimitrios Avgerinos, Nikolaos Spilias, Toshiki Kuno, Alexandros Briasoulis, Andrew J. Einstein
Purpose of Review
To summarize the current use of cardiac computed tomography (CT) technologies as well as their pertinent evidence in regards to prevention of coronary artery disease (CAD).
Recent Findings
Cardiac CTA has now become a main non-invasive method for the evaluation of symptomatic CAD. In addition to coronary calcium score, other CT technologies such as atherosclerotic plaque analysis, fractional flow reserve estimation by CT, pericoronary fat attenuation, and endothelial wall shear stress have emerged. Whether the use of CT modalities can enhance risk prediction and prevention in CAD has not been fully answered.
Summary
We discuss the evidence for coronary artery calcium scoring and coronary CT angiography in primary prevention and the current barriers to their use. We attempt to delineate what can be done to expand use and what studies are needed to broaden adoption in the future. We also examine the potential roles of emerging CT technologies. Finally, we describe potential clinical approaches to prevention that would incorporate cardiac CT technologies.
{"title":"Current and Emerging Approaches for Primary Prevention of Coronary Artery Disease Using Cardiac Computed Tomography","authors":"Polydoros N. Kampaktsis, Carolyn Hennecken, Mrinali Shetty, Laura McLaughlin, Georgios Rampidis, Athanasios Samaras, Dimitrios Avgerinos, Nikolaos Spilias, Toshiki Kuno, Alexandros Briasoulis, Andrew J. Einstein","doi":"10.1007/s11886-024-02104-8","DOIUrl":"https://doi.org/10.1007/s11886-024-02104-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>To summarize the current use of cardiac computed tomography (CT) technologies as well as their pertinent evidence in regards to prevention of coronary artery disease (CAD).</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Cardiac CTA has now become a main non-invasive method for the evaluation of symptomatic CAD. In addition to coronary calcium score, other CT technologies such as atherosclerotic plaque analysis, fractional flow reserve estimation by CT, pericoronary fat attenuation, and endothelial wall shear stress have emerged. Whether the use of CT modalities can enhance risk prediction and prevention in CAD has not been fully answered.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>We discuss the evidence for coronary artery calcium scoring and coronary CT angiography in primary prevention and the current barriers to their use. We attempt to delineate what can be done to expand use and what studies are needed to broaden adoption in the future. We also examine the potential roles of emerging CT technologies. Finally, we describe potential clinical approaches to prevention that would incorporate cardiac CT technologies.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141770060","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 : 2024-07-20DOI: 10.1007/s11886-024-02105-7
Ahmad M Osailan
Purpose of review: Cardiovascular diseases (CVDs) are the leading cause of mortality in Saudi Arabia. Cardiac rehabilitation (CR) is one of the well-known interventions to control and minimize the burden of CVDs. Despite recommendations, CR utilization remains suboptimal in Saudi Arabia due to many reasons, including limited awareness, logistical barriers, shortage of specialized facilities and trained professionals, and perceptions about CVDs illness. This review is to evaluate the current status, effectiveness, accessibility, and challenges of CR utilization in Saudi Arabia, and to explore potential future directions for improving these services. The review addresses key questions regarding the incidence of CVDs, the characteristics of existing CR programs, barriers to CR access, and stakeholder perspectives.
Recent findings: Recent studies demonstrate that the effectiveness of CR, particularly exercise training, in improving outcomes for post-coronary artery bypass grafting (CABG) patients is well-documented, though data on its impact on other cardiac conditions is limited. There are significant barriers to CR utilization in Saudi Arabia, including limited awareness, logistical challenges, a shortage of specialized facilities and trained professionals, and cultural perceptions about CVD. Stakeholder perspectives highlight the necessity for culturally sensitive and inclusive approaches, particularly in addressing gender-specific needs and enhancing patient-provider communication. The Saudi Vision 2030 presents opportunities to expand and enhance CR services in alignment with international standards. This review found that while CR is a crucial intervention for managing CVDs, its utilization in Saudi Arabia is suboptimal due to various barriers. To improve CR access and effectiveness, future strategies should focus on increasing public and professional awareness, developing infrastructure, training healthcare professionals, and fostering public-private partnerships. These measures are essential to making CR more accessible and tailored to the diverse needs of the Saudi population, ultimately enhancing the quality of cardiovascular care and patient outcomes in the region.
{"title":"Cardiac Rehabilitation in Saudi Arabia: Current Status and Future Directions.","authors":"Ahmad M Osailan","doi":"10.1007/s11886-024-02105-7","DOIUrl":"https://doi.org/10.1007/s11886-024-02105-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiovascular diseases (CVDs) are the leading cause of mortality in Saudi Arabia. Cardiac rehabilitation (CR) is one of the well-known interventions to control and minimize the burden of CVDs. Despite recommendations, CR utilization remains suboptimal in Saudi Arabia due to many reasons, including limited awareness, logistical barriers, shortage of specialized facilities and trained professionals, and perceptions about CVDs illness. This review is to evaluate the current status, effectiveness, accessibility, and challenges of CR utilization in Saudi Arabia, and to explore potential future directions for improving these services. The review addresses key questions regarding the incidence of CVDs, the characteristics of existing CR programs, barriers to CR access, and stakeholder perspectives.</p><p><strong>Recent findings: </strong>Recent studies demonstrate that the effectiveness of CR, particularly exercise training, in improving outcomes for post-coronary artery bypass grafting (CABG) patients is well-documented, though data on its impact on other cardiac conditions is limited. There are significant barriers to CR utilization in Saudi Arabia, including limited awareness, logistical challenges, a shortage of specialized facilities and trained professionals, and cultural perceptions about CVD. Stakeholder perspectives highlight the necessity for culturally sensitive and inclusive approaches, particularly in addressing gender-specific needs and enhancing patient-provider communication. The Saudi Vision 2030 presents opportunities to expand and enhance CR services in alignment with international standards. This review found that while CR is a crucial intervention for managing CVDs, its utilization in Saudi Arabia is suboptimal due to various barriers. To improve CR access and effectiveness, future strategies should focus on increasing public and professional awareness, developing infrastructure, training healthcare professionals, and fostering public-private partnerships. These measures are essential to making CR more accessible and tailored to the diverse needs of the Saudi population, ultimately enhancing the quality of cardiovascular care and patient outcomes in the region.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731096","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 : 2024-07-01Epub Date: 2024-05-15DOI: 10.1007/s11886-024-02069-8
Amr Darwish, Akila Bersali, Mujtaba Saeed, Aneesh Dhore, Dimitrios Maragiannis, K Carlos El-Tallawi, Dipan J Shah
Purpose of review: This review offers an evidence-based analysis of established and emerging cardiovascular magnetic resonance (CMR) techniques used to assess the severity of primary mitral regurgitation (MR), identify adverse cardiac remodeling and its prognostic effect. The aim is to provide different insights regarding clinical decision-making and enhance the clinical outcomes of patients with MR.
Recent findings: Cardiac remodeling and myocardial replacement fibrosis are observed frequently in the presence of substantial LV volume overload, particularly in cases with severe primary MR. CMR serves as a useful diagnostic imaging modality in assessing mitral regurgitation severity, early detection of cardiac remodeling, myocardial dysfunction, and myocardial fibrosis, enabling timely intervention before irreversible damage ensues. Incorporating myocardial remodeling in terms of left ventricular (LV) dilatation and myocardial fibrosis with quantitative MR severity assessment by CMR may assist in defining optimal timing of intervention.
{"title":"Assessing Regurgitation Severity, Adverse Remodeling, and Fibrosis with CMR in Primary Mitral Regurgitation.","authors":"Amr Darwish, Akila Bersali, Mujtaba Saeed, Aneesh Dhore, Dimitrios Maragiannis, K Carlos El-Tallawi, Dipan J Shah","doi":"10.1007/s11886-024-02069-8","DOIUrl":"10.1007/s11886-024-02069-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review offers an evidence-based analysis of established and emerging cardiovascular magnetic resonance (CMR) techniques used to assess the severity of primary mitral regurgitation (MR), identify adverse cardiac remodeling and its prognostic effect. The aim is to provide different insights regarding clinical decision-making and enhance the clinical outcomes of patients with MR.</p><p><strong>Recent findings: </strong>Cardiac remodeling and myocardial replacement fibrosis are observed frequently in the presence of substantial LV volume overload, particularly in cases with severe primary MR. CMR serves as a useful diagnostic imaging modality in assessing mitral regurgitation severity, early detection of cardiac remodeling, myocardial dysfunction, and myocardial fibrosis, enabling timely intervention before irreversible damage ensues. Incorporating myocardial remodeling in terms of left ventricular (LV) dilatation and myocardial fibrosis with quantitative MR severity assessment by CMR may assist in defining optimal timing of intervention.</p>","PeriodicalId":10829,"journal":{"name":"Current Cardiology Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140921762","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}