Pub Date : 2024-09-06DOI: 10.1080/14779072.2024.2401876
Benjamin Buck, Mahmoud Houmsse
Introduction: Atrial fibrillation (AF) is the most common arrhythmia with an estimated prevalence of 3.2 million cases in the US. Catheter ablation is a successful rhythm control strategy in paroxysmal AF but it has demonstrated dramatically lower AF-free survival rates in patients with persistent AF. In recent years, myriad novel rhythm control strategies have been developed, each with the promise of improved persistent AF ablation success.
Areas covered: This review discusses multiple novel techniques and approaches to catheter ablation for persistent AF. Authors identified relevant papers by searching PubMed and Google Scholar databases and considered all papers identified, regardless of publication date. It begins by discussing recent advances in electrogram analysis that yielded improved AF-free survival following persistent AF catheter ablation. Next, it discusses several trials revealing the shortcomings of MRI in guiding persistent AF ablation and the limited role it still plays in outcome prognostication. Finally, it discusses one nascent technique (Vein of Marshall ablation) and technology (AI-assisted electrogram analysis) who have shown promise in improving persistent AF ablation.
Expert opinion: In the authors' expert opinions, upcoming persistent AF ablations will utilize a stepwise approach of (1) ensuring PV isolation, (2) Vein of Marshall ablation and (3) AI-assisted ablation to optimize future persistent AF ablation outcomes. This approach systematically addresses arrhythmogenic sources beyond the pulmonary veins, the historical treatment target.
{"title":"Beyond pulmonary vein isolation: approaches to treat patients with persistent atrial fibrillation.","authors":"Benjamin Buck, Mahmoud Houmsse","doi":"10.1080/14779072.2024.2401876","DOIUrl":"https://doi.org/10.1080/14779072.2024.2401876","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial fibrillation (AF) is the most common arrhythmia with an estimated prevalence of 3.2 million cases in the US. Catheter ablation is a successful rhythm control strategy in paroxysmal AF but it has demonstrated dramatically lower AF-free survival rates in patients with persistent AF. In recent years, myriad novel rhythm control strategies have been developed, each with the promise of improved persistent AF ablation success.</p><p><strong>Areas covered: </strong>This review discusses multiple novel techniques and approaches to catheter ablation for persistent AF. Authors identified relevant papers by searching PubMed and Google Scholar databases and considered all papers identified, regardless of publication date. It begins by discussing recent advances in electrogram analysis that yielded improved AF-free survival following persistent AF catheter ablation. Next, it discusses several trials revealing the shortcomings of MRI in guiding persistent AF ablation and the limited role it still plays in outcome prognostication. Finally, it discusses one nascent technique (Vein of Marshall ablation) and technology (AI-assisted electrogram analysis) who have shown promise in improving persistent AF ablation.</p><p><strong>Expert opinion: </strong>In the authors' expert opinions, upcoming persistent AF ablations will utilize a stepwise approach of (1) ensuring PV isolation, (2) Vein of Marshall ablation and (3) AI-assisted ablation to optimize future persistent AF ablation outcomes. This approach systematically addresses arrhythmogenic sources beyond the pulmonary veins, the historical treatment target.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1080/14779072.2024.2398444
Sohum Sheth, Maciej Banach, Peter P Toth
Introduction: Despite decades of research clearly illustrating the direct link between low-density lipoprotein cholesterol (LDL-C) and atherosclerotic cardiovascular disease (ASCVD) risk, LDL-C goal attainment rates are remarkably low in both the primary and secondary prevention settings.
Areas covered: Herein we detail: (1) the low rates of LDL-C goal attainment; (2) despite guidelines clearly outlining indications of use, there is suboptimal initiation, intensification, and persistence of lipid lowering therapy, especially combination therapy; (3) key clinician-related factors contributing to this gap include inconsistent risk assessments, clinical inertia, and barriers to health access; (4) LDL-C reduction is associated with reductions in risk for cardiovascular events. Increasing LDL-C goal attainment rates should be a high public health priority.
Expert opinion: There is an urgent need to rethink dyslipidemia management. Opportunities exist to overcome LDL-C goal attainment barriers, which necessitates a concerted effort from patients, clinicians, health systems, payors, pharmaceutical companies, and public health advocates. LDL-C measurement should be a performance metric for health systems. In addition, upfront use of combination therapy and polypill formulations should be encouraged. Engaging pharmacists to support drug therapy and adherence is crucial. Leveraging telehealth and electronic medical record (EMR) functionalities can enhance these efforts and ensure more effective implementation.
{"title":"Closing the gap between guidelines and clinical practice for managing dyslipidemia: where are we now?","authors":"Sohum Sheth, Maciej Banach, Peter P Toth","doi":"10.1080/14779072.2024.2398444","DOIUrl":"10.1080/14779072.2024.2398444","url":null,"abstract":"<p><strong>Introduction: </strong>Despite decades of research clearly illustrating the direct link between low-density lipoprotein cholesterol (LDL-C) and atherosclerotic cardiovascular disease (ASCVD) risk, LDL-C goal attainment rates are remarkably low in both the primary and secondary prevention settings.</p><p><strong>Areas covered: </strong>Herein we detail: (1) the low rates of LDL-C goal attainment; (2) despite guidelines clearly outlining indications of use, there is suboptimal initiation, intensification, and persistence of lipid lowering therapy, especially combination therapy; (3) key clinician-related factors contributing to this gap include inconsistent risk assessments, clinical inertia, and barriers to health access; (4) LDL-C reduction is associated with reductions in risk for cardiovascular events. Increasing LDL-C goal attainment rates should be a high public health priority.</p><p><strong>Expert opinion: </strong>There is an urgent need to rethink dyslipidemia management. Opportunities exist to overcome LDL-C goal attainment barriers, which necessitates a concerted effort from patients, clinicians, health systems, payors, pharmaceutical companies, and public health advocates. LDL-C measurement should be a performance metric for health systems. In addition, upfront use of combination therapy and polypill formulations should be encouraged. Engaging pharmacists to support drug therapy and adherence is crucial. Leveraging telehealth and electronic medical record (EMR) functionalities can enhance these efforts and ensure more effective implementation.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-02DOI: 10.1080/14779072.2024.2385989
Jawad Basit, Mushood Ahmed, George Kidess, Zaofashan Zaheer, Laveeza Fatima, Hamza Naveed, Mohammad Hamza, Maurish Fatima, Aman Goyal, Pranav Loyalka, Mahboob Alam, M Chadi Alraies
Introduction: Cerebral Embolic Protection Device (CEPD) captures emboli during Transcatheter Aortic Valve Replacement (TAVR). With recently published pivotal trials and multiple cohort studies reporting new data, there is a need to re-calibrate available statistical evidence.
Methods: A systematic literature search was conducted across databases from inception till February 2023. Dichotomous outcomes were pooled using Odds Ratio (OR), while continuous outcomes were pooled using Standardized Mean Difference (SMD) along with 95% corresponding intervals (95% CIs).
Results: Data was included from 17 studies (7 RCTs, 10 cohorts, n = 155,829). Use of CEPD was associated with significantly reduced odds of stroke (OR = 0.60, 95% CI = 0.43-0.85, p = 0.003). There was no significant difference in disabling stroke (p = 0.25), non-disabling stroke (p = 0.72), and 30-day mortality (p = 0.10) between the two groups. There were no significant differences between the two groups for Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) findings, acute kidney injury, risk of pacemaker implantation life-threatening bleed, major bleed, minor bleed, worsening National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and vascular complications (p > 0.05).
Conclusions: The use of CEPD during TAVR reduced the incidence of all-stroke (p = 0.003); however, there were no significant differences in any of the other pooled outcomes (p > 0.05).
Registration: The protocol of this meta-analysis was registered with the Open Science framework [https://doi.org/10.17605/OSF.IO/7W564] before data acquisition was started.
{"title":"Cerebral embolic protection for stroke prevention during transcatheter aortic valve replacement.","authors":"Jawad Basit, Mushood Ahmed, George Kidess, Zaofashan Zaheer, Laveeza Fatima, Hamza Naveed, Mohammad Hamza, Maurish Fatima, Aman Goyal, Pranav Loyalka, Mahboob Alam, M Chadi Alraies","doi":"10.1080/14779072.2024.2385989","DOIUrl":"10.1080/14779072.2024.2385989","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral Embolic Protection Device (CEPD) captures emboli during Transcatheter Aortic Valve Replacement (TAVR). With recently published pivotal trials and multiple cohort studies reporting new data, there is a need to re-calibrate available statistical evidence.</p><p><strong>Methods: </strong>A systematic literature search was conducted across databases from inception till February 2023. Dichotomous outcomes were pooled using Odds Ratio (OR), while continuous outcomes were pooled using Standardized Mean Difference (SMD) along with 95% corresponding intervals (95% CIs).</p><p><strong>Results: </strong>Data was included from 17 studies (7 RCTs, 10 cohorts, <i>n</i> = 155,829). Use of CEPD was associated with significantly reduced odds of stroke (OR = 0.60, 95% CI = 0.43-0.85, <i>p</i> = 0.003). There was no significant difference in disabling stroke (<i>p</i> = 0.25), non-disabling stroke (<i>p</i> = 0.72), and 30-day mortality (<i>p</i> = 0.10) between the two groups. There were no significant differences between the two groups for Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) findings, acute kidney injury, risk of pacemaker implantation life-threatening bleed, major bleed, minor bleed, worsening National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and vascular complications (<i>p</i> > 0.05).</p><p><strong>Conclusions: </strong>The use of CEPD during TAVR reduced the incidence of all-stroke (<i>p</i> = 0.003); however, there were no significant differences in any of the other pooled outcomes (<i>p</i> > 0.05).</p><p><strong>Registration: </strong>The protocol of this meta-analysis was registered with the Open Science framework [https://doi.org/10.17605/OSF.IO/7W564] before data acquisition was started.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1080/14779072.2024.2385974
Anne Sorrell, Rebecca Harrell, Elizabeth Jordan, Maeve Sargeant, Rajasekhar Nekkanti, John N Catanzaro, Samuel F Sears
Introduction: The aim of this review is to identify common mood concerns in ICD patients and suggest brief psychological screeners essential for early detection and monitoring in patient care.
Areas covered: Reliable and valid psychological assessment tools are reviewed, including those specifically designed for ICD patient populations.
Expert opinion: Psychological assessment, in combination with cardiologic standard of care, can help overcome many barriers associated with poor implantable cardioverter-defibrillator (ICD) management and related cardiovascular outcomes. Earlier identification and treatment of mood concerns in ICD patients has been shown to improve quality of life (QOL) and patient outcomes. At this time, however, logistical challenges and time restraints, in addition to knowledge of appropriate treatment plans or referral options, remain central barriers to providing integrated, patient-centered care. Ultimately, all cardiology clinics would benefit from a collaborative care team that includes a mental health consultant or in-house psychologists who can provide consultations or referral services. Additionally, all patients that come to the clinics should complete proactive screening measures as routine component of care to assess the presence of mood concerns to improve patient outcomes and aid in treatment planning.
{"title":"PTSD and mood disorders in implantable cardioverter defibrillator patients: is more psychological assessment needed?","authors":"Anne Sorrell, Rebecca Harrell, Elizabeth Jordan, Maeve Sargeant, Rajasekhar Nekkanti, John N Catanzaro, Samuel F Sears","doi":"10.1080/14779072.2024.2385974","DOIUrl":"https://doi.org/10.1080/14779072.2024.2385974","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this review is to identify common mood concerns in ICD patients and suggest brief psychological screeners essential for early detection and monitoring in patient care.</p><p><strong>Areas covered: </strong>Reliable and valid psychological assessment tools are reviewed, including those specifically designed for ICD patient populations.</p><p><strong>Expert opinion: </strong>Psychological assessment, in combination with cardiologic standard of care, can help overcome many barriers associated with poor implantable cardioverter-defibrillator (ICD) management and related cardiovascular outcomes. Earlier identification and treatment of mood concerns in ICD patients has been shown to improve quality of life (QOL) and patient outcomes. At this time, however, logistical challenges and time restraints, in addition to knowledge of appropriate treatment plans or referral options, remain central barriers to providing integrated, patient-centered care. Ultimately, all cardiology clinics would benefit from a collaborative care team that includes a mental health consultant or in-house psychologists who can provide consultations or referral services. Additionally, all patients that come to the clinics should complete proactive screening measures as routine component of care to assess the presence of mood concerns to improve patient outcomes and aid in treatment planning.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-30DOI: 10.1080/14779072.2024.2383648
Walker Boyd, Wesley Young, Mehmet Yildiz, Timothy D Henry, Kari Gorder
Introduction: In-Hospital Cardiac Arrest (IHCA) after ST-segment Elevation Myocardial Infarction (STEMI) is a subset of IHCA with high morbidity. While information on this selected group of patients is limited, closer inspection reveals that this is a challenging patient population with certain risk factors for IHCA following treatment of STEMI.
Areas covered: In this review article, strategies for prevention of IHCA post STEMI are reviewed, as well as best-practices for the care of STEMI patients post-IHCA.
Expert opinion: Early and successful reperfusion is key for the prevention of IHCA and has a significant impact on in-hospital mortality. A number of pharmacological treatments have also been studied that can impact the progression to IHCA. Development of cardiogenic shock post-STEMI increases mortality and raises the risk of cardiac arrest. The treatment of IHCA follows the ACLS algorithm with some notable exceptions.
{"title":"In-hospital cardiac arrest after STEMI: prevention strategies and post-arrest care.","authors":"Walker Boyd, Wesley Young, Mehmet Yildiz, Timothy D Henry, Kari Gorder","doi":"10.1080/14779072.2024.2383648","DOIUrl":"https://doi.org/10.1080/14779072.2024.2383648","url":null,"abstract":"<p><strong>Introduction: </strong>In-Hospital Cardiac Arrest (IHCA) after ST-segment Elevation Myocardial Infarction (STEMI) is a subset of IHCA with high morbidity. While information on this selected group of patients is limited, closer inspection reveals that this is a challenging patient population with certain risk factors for IHCA following treatment of STEMI.</p><p><strong>Areas covered: </strong>In this review article, strategies for prevention of IHCA post STEMI are reviewed, as well as best-practices for the care of STEMI patients post-IHCA.</p><p><strong>Expert opinion: </strong>Early and successful reperfusion is key for the prevention of IHCA and has a significant impact on in-hospital mortality. A number of pharmacological treatments have also been studied that can impact the progression to IHCA. Development of cardiogenic shock post-STEMI increases mortality and raises the risk of cardiac arrest. The treatment of IHCA follows the ACLS algorithm with some notable exceptions.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-30DOI: 10.1080/14779072.2024.2375340
Kotaro Miyashita, Kai Ninomiya, Akihiro Tobe, Shinichiro Masuda, Nozomi Kotoku, Shigetaka Kageyama, Pruthvi C Revaiah, Tsung-Ying Tsai, Bo Wang, Scot Garg, Patrick W Serruys, Yoshinobu Onuma
Introduction: The higher scaffold thrombosis rates observed with the first-generation bioresorbable scaffolds (BRSs) compared to conventional drug-eluting stents were likely due in part to bioresorbable polymers having insufficient radial strength, necessitating larger strut profiles. Meta-analysis of the long-term outcomes from the first-generation Absorb bioresorbable vascular scaffold (BVS) showed that this period of excess risk ended at 3 years. Therefore, current attention has been focused on improving early outcomes by increasing the scaffold's tensile strength and reducing strut thickness.
Areas covered: This review summaries the lessons learned from the first-generation BRS. It updates the long-term clinical outcomes of trials evaluating the ABSORB BVS and metallic alloy-based BRS. In addition, it reviews the next-generation BRSs manufactured in Asia.
Expert opinion: Critical areas to improve the performance and safety of biodegradable scaffolds include further development in material science, surface modification, delivery systems, and long-term follow-up studies.
{"title":"Long-term outcomes following bioresorbable vascular scaffolds.","authors":"Kotaro Miyashita, Kai Ninomiya, Akihiro Tobe, Shinichiro Masuda, Nozomi Kotoku, Shigetaka Kageyama, Pruthvi C Revaiah, Tsung-Ying Tsai, Bo Wang, Scot Garg, Patrick W Serruys, Yoshinobu Onuma","doi":"10.1080/14779072.2024.2375340","DOIUrl":"10.1080/14779072.2024.2375340","url":null,"abstract":"<p><strong>Introduction: </strong>The higher scaffold thrombosis rates observed with the first-generation bioresorbable scaffolds (BRSs) compared to conventional drug-eluting stents were likely due in part to bioresorbable polymers having insufficient radial strength, necessitating larger strut profiles. Meta-analysis of the long-term outcomes from the first-generation Absorb bioresorbable vascular scaffold (BVS) showed that this period of excess risk ended at 3 years. Therefore, current attention has been focused on improving early outcomes by increasing the scaffold's tensile strength and reducing strut thickness.</p><p><strong>Areas covered: </strong>This review summaries the lessons learned from the first-generation BRS. It updates the long-term clinical outcomes of trials evaluating the ABSORB BVS and metallic alloy-based BRS. In addition, it reviews the next-generation BRSs manufactured in Asia.</p><p><strong>Expert opinion: </strong>Critical areas to improve the performance and safety of biodegradable scaffolds include further development in material science, surface modification, delivery systems, and long-term follow-up studies.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.1080/14779072.2024.2379836
Abraham Samuel Babu, Vibha Bhat, Prinu Jose, Sebastian Padickaparambil, Ramachandran Padmakumar, Panniyammakal Jeemon
Background: Cardiac rehabilitation (CR) remains greatly underutilized, especially in low- and middle-income countries (LMIC). It is therefore important to explore factors that contribute to this, as perceived by health-care professionals (HCPs).
Research design and methods: This was a qualitative study using in-depth interviews that enrolled 18 HCPs (i.e. six each of physicians, physiotherapists, and nurses; mean experience in CR: 17.9 ± 11.8 yrs) working in cardiovascular care, and CR across private and government hospitals (both teaching and non-teaching) in India.
Results: The main challenges were related to lack of referrals, perceived lack of benefit from CR, poor infrastructure within hospitals and health systems, and differences in practice. The perceived inadequacies were lack of competencies in CR, limited task sharing strategies, and ineffective utilization of existing human resources. Devising strategies to improve awareness and competencies, facilitating task sharing, and remodeling holistic care with an active CR component may be beneficial to facilitate greater implementation of CR in India.
Conclusions: Challenges, inadequacies, and solutions to implementing CR have been explored by involving various HCPs commonly involved in delivering CR across different health systems in a LMIC.
Trial registration: www.ctri.nic.in with identifier CTRI/2020/07/026807.
{"title":"Challenges and solutions to implementing cardiac rehabilitation in a low- and middle-income country.","authors":"Abraham Samuel Babu, Vibha Bhat, Prinu Jose, Sebastian Padickaparambil, Ramachandran Padmakumar, Panniyammakal Jeemon","doi":"10.1080/14779072.2024.2379836","DOIUrl":"10.1080/14779072.2024.2379836","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) remains greatly underutilized, especially in low- and middle-income countries (LMIC). It is therefore important to explore factors that contribute to this, as perceived by health-care professionals (HCPs).</p><p><strong>Research design and methods: </strong>This was a qualitative study using in-depth interviews that enrolled 18 HCPs (i.e. six each of physicians, physiotherapists, and nurses; mean experience in CR: 17.9 ± 11.8 yrs) working in cardiovascular care, and CR across private and government hospitals (both teaching and non-teaching) in India.</p><p><strong>Results: </strong>The main challenges were related to lack of referrals, perceived lack of benefit from CR, poor infrastructure within hospitals and health systems, and differences in practice. The perceived inadequacies were lack of competencies in CR, limited task sharing strategies, and ineffective utilization of existing human resources. Devising strategies to improve awareness and competencies, facilitating task sharing, and remodeling holistic care with an active CR component may be beneficial to facilitate greater implementation of CR in India.</p><p><strong>Conclusions: </strong>Challenges, inadequacies, and solutions to implementing CR have been explored by involving various HCPs commonly involved in delivering CR across different health systems in a LMIC.</p><p><strong>Trial registration: </strong>www.ctri.nic.in with identifier CTRI/2020/07/026807.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.1080/14779072.2024.2380764
Robert J H Miller, Piotr J Slomka
Introduction: Myocardial perfusion imaging (MPI) is one of the most commonly ordered cardiac imaging tests. Accurate motion correction, image registration, and reconstruction are critical for high-quality imaging, but this can be technically challenging and has traditionally relied on expert manual processing. With accurate processing, there is a rich variety of clinical, stress, functional, and anatomic data that can be integrated to guide patient management.
Areas covered: PubMed and Google Scholar were reviewed for articles related to artificial intelligence in nuclear cardiology published between 2020 and 2024. We will outline the prominent roles for artificial intelligence (AI) solutions to provide motion correction, image registration, and reconstruction. We will review the role for AI in extracting anatomic data for hybrid MPI which is otherwise neglected. Lastly, we will discuss AI methods to integrate the wealth of data to improve disease diagnosis or risk stratification.
Expert opinion: There is growing evidence that AI will transform the performance of MPI by automating and improving on aspects of image acquisition and reconstruction. Physicians and researchers will need to understand the potential strengths of AI in order to benefit from the full clinical utility of MPI.
{"title":"Current status and future directions in artificial intelligence for nuclear cardiology.","authors":"Robert J H Miller, Piotr J Slomka","doi":"10.1080/14779072.2024.2380764","DOIUrl":"10.1080/14779072.2024.2380764","url":null,"abstract":"<p><strong>Introduction: </strong>Myocardial perfusion imaging (MPI) is one of the most commonly ordered cardiac imaging tests. Accurate motion correction, image registration, and reconstruction are critical for high-quality imaging, but this can be technically challenging and has traditionally relied on expert manual processing. With accurate processing, there is a rich variety of clinical, stress, functional, and anatomic data that can be integrated to guide patient management.</p><p><strong>Areas covered: </strong>PubMed and Google Scholar were reviewed for articles related to artificial intelligence in nuclear cardiology published between 2020 and 2024. We will outline the prominent roles for artificial intelligence (AI) solutions to provide motion correction, image registration, and reconstruction. We will review the role for AI in extracting anatomic data for hybrid MPI which is otherwise neglected. Lastly, we will discuss AI methods to integrate the wealth of data to improve disease diagnosis or risk stratification.</p><p><strong>Expert opinion: </strong>There is growing evidence that AI will transform the performance of MPI by automating and improving on aspects of image acquisition and reconstruction. Physicians and researchers will need to understand the potential strengths of AI in order to benefit from the full clinical utility of MPI.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141598956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1080/14779072.2024.2371968
John Stone, Manish Kumar, Ariela R Orkaby
Introduction: Cardiovascular disease (CVD) is associated with significant morbidity, functional decline, and mortality in older adults. The role of statins for primary CVD prevention in older adults remains unclear, largely due to systematic exclusion of these individuals in trials that inform current practice guidelines, leading to conflicting national and international practice recommendations for statin use for primary prevention of CVD in adults aged 75 and older.
Areas covered: In this narrative review, we performed a literature review utilizing PubMed, and ultimately focus on seven major national and international guidelines of lipid lowering therapy. Through the lens of two clinical cases, we review physiologic changes in lipid metabolism with aging, discuss the relationship between cholesterol and cardiovascular events in older adults, examine the national and international guidelines and the available evidence informing these guidelines for statin use in primary prevention of CVD in older adults. Finally we review practical clinical considerations for drug monitoring and deprescribing in this population.
Expert opinion: Guidelines for the use of statins for primary CVD prevention in older adults is conflicting. Collectively, evidence to date suggests statin therapy may be beneficial for primary CVD prevention in older adults free of life-limiting comorbidities. Randomized controlled trials are currently underway to address current evidence gaps.
{"title":"The role of statin therapy in older adults: best practices and unmet challenges.","authors":"John Stone, Manish Kumar, Ariela R Orkaby","doi":"10.1080/14779072.2024.2371968","DOIUrl":"10.1080/14779072.2024.2371968","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular disease (CVD) is associated with significant morbidity, functional decline, and mortality in older adults. The role of statins for primary CVD prevention in older adults remains unclear, largely due to systematic exclusion of these individuals in trials that inform current practice guidelines, leading to conflicting national and international practice recommendations for statin use for primary prevention of CVD in adults aged 75 and older.</p><p><strong>Areas covered: </strong>In this narrative review, we performed a literature review utilizing PubMed, and ultimately focus on seven major national and international guidelines of lipid lowering therapy. Through the lens of two clinical cases, we review physiologic changes in lipid metabolism with aging, discuss the relationship between cholesterol and cardiovascular events in older adults, examine the national and international guidelines and the available evidence informing these guidelines for statin use in primary prevention of CVD in older adults. Finally we review practical clinical considerations for drug monitoring and deprescribing in this population.</p><p><strong>Expert opinion: </strong>Guidelines for the use of statins for primary CVD prevention in older adults is conflicting. Collectively, evidence to date suggests statin therapy may be beneficial for primary CVD prevention in older adults free of life-limiting comorbidities. Randomized controlled trials are currently underway to address current evidence gaps.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1080/14779072.2024.2374366
Mark A Sammut, Dwayne Conway, Javaid Iqbal, Arvindra Krishnamurthy, Kenneth P Morgan, Paul D Morris, James D Richardson, Alexander M K Rothman, Julian P Gunn, Robert F Storey
Background: Triple antithrombotic therapy (TAT) with aspirin, a P2Y12 inhibitor, and oral anticoagulation in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) raises concerns about increased bleeding. Regimens incorporating more potent P2Y12 inhibitors over clopidogrel have not been investigated adequately.
Research design and methods: A retrospective observational study was performed on 387 patients with AF receiving TAT for 1 month (n = 236) or ≤1 week (n = 151) after PCI. Major and clinically relevant non-major bleeding and major adverse cardiac and cerebrovascular events (MACCE) were assessed up to 30 days post-procedure.
Results: Bleeding was less frequent with ≤1 week versus 1 month of TAT (3.3 vs 9.3%; p = 0.025) while MACCE were similar (4.6 vs 4.7%; p = 0.998). No differences in bleeding or MACCE were observed between ticagrelor/prasugrel and clopidogrel regimens. For patients receiving ≤1 week of TAT, no excess of MACCE was seen in the subgroup given no further aspirin post-PCI compared with those given aspirin for up to 1 week (3.6 vs 5.2%).
Conclusions: TAT post-PCI for ≤1 week was associated with less bleeding despite greater use of ticagrelor/prasugrel but similar MACCE versus 1-month TAT. These findings support further studies on safety and efficacy of dual therapy with ticagrelor/prasugrel immediately after PCI.
背景:接受经皮冠状动脉介入治疗(PCI)的心房颤动(AF)患者使用阿司匹林、P2Y12 抑制剂和口服抗凝药进行三联抗血栓治疗(TAT)会引起出血增加的担忧。与氯吡格雷相比,更强效的 P2Y12 抑制剂的治疗方案尚未得到充分研究:对 387 名房颤患者进行了回顾性观察研究,这些患者在 PCI 后接受了 1 个月(236 人)或≤1 周(151 人)的 TAT 治疗。结果显示,PCI术后1个月(236人)或≤1周(151人)接受TAT治疗的房颤患者出血较少,而PCI术后≤1周接受TAT治疗的房颤患者出血较多:结果:TAT≤1周与1个月相比,出血发生率较低(3.3% vs 9.3%;p = 0.025),而MACCE相似(4.6% vs 4.7%;p = 0.998)。ticagrelor/prasugrel方案与氯吡格雷方案在出血或MACCE方面没有差异。在接受≤1周TAT治疗的患者中,PCI后不再服用阿司匹林的亚组与服用阿司匹林最多1周的亚组相比,未发现MACCE过多的情况(3.6% vs 5.2%):结论:尽管使用更多的替卡格雷/普拉格雷,但PCI后≤1周的TAT与更少的出血相关,但与1个月的TAT相比,MACCE相似。这些发现支持进一步研究PCI术后立即使用替卡格雷/普拉格雷双重疗法的安全性和有效性。
{"title":"Duration of triple antithrombotic therapy and clinical outcomes after percutaneous coronary intervention in atrial fibrillation.","authors":"Mark A Sammut, Dwayne Conway, Javaid Iqbal, Arvindra Krishnamurthy, Kenneth P Morgan, Paul D Morris, James D Richardson, Alexander M K Rothman, Julian P Gunn, Robert F Storey","doi":"10.1080/14779072.2024.2374366","DOIUrl":"10.1080/14779072.2024.2374366","url":null,"abstract":"<p><strong>Background: </strong>Triple antithrombotic therapy (TAT) with aspirin, a P2Y<sub>12</sub> inhibitor, and oral anticoagulation in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) raises concerns about increased bleeding. Regimens incorporating more potent P2Y<sub>12</sub> inhibitors over clopidogrel have not been investigated adequately.</p><p><strong>Research design and methods: </strong>A retrospective observational study was performed on 387 patients with AF receiving TAT for 1 month (<i>n</i> = 236) or ≤1 week (<i>n</i> = 151) after PCI. Major and clinically relevant non-major bleeding and major adverse cardiac and cerebrovascular events (MACCE) were assessed up to 30 days post-procedure.</p><p><strong>Results: </strong>Bleeding was less frequent with ≤1 week versus 1 month of TAT (3.3 vs 9.3%; <i>p</i> = 0.025) while MACCE were similar (4.6 vs 4.7%; <i>p</i> = 0.998). No differences in bleeding or MACCE were observed between ticagrelor/prasugrel and clopidogrel regimens. For patients receiving ≤1 week of TAT, no excess of MACCE was seen in the subgroup given no further aspirin post-PCI compared with those given aspirin for up to 1 week (3.6 vs 5.2%).</p><p><strong>Conclusions: </strong>TAT post-PCI for ≤1 week was associated with less bleeding despite greater use of ticagrelor/prasugrel but similar MACCE versus 1-month TAT. These findings support further studies on safety and efficacy of dual therapy with ticagrelor/prasugrel immediately after PCI.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11262428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}