Heart International最新文献

Recurrent pericarditis is associated with significant morbidity and adverse impact on quality of life. Contemporary studies have emphasized the key role of autoinflammatory pathways in its pathophysiology, mainly through the activation of inflammasomes and the production of interleukin (IL)-1α and IL-1β. The IL-1 pathway has emerged as a promising target for the treatment of these patients. A novel IL-1 inhibitor, rilonacept, functions as an IL-1 trap binding to the circulating IL-1α and IL-1β mitigating their inflammatory response. Recently, the RHAPSODY phase III clinical trial evaluated the use of rilonacept in patients with recurrent pericarditis, who were refractory to colchicine, or steroid-dependent. Rilonacept significantly reduced symptoms, inflammatory markers and recurrent episodes, and increased successful withdrawal of steroids. The safety profile of the medication is favourable and well tolerated by patients, with local injection site reaction being the most common side effect described. These results have shifted the paradigm of the understanding of the disease and promise to become part of the armamentarium of medications for the standard of care of these patients, with potential use as monotherapy. The changing landscape of therapeutics and pathophysiology warrants increased recognition and understanding from the international cardiology community about this novel drug and its implication in managing these complex patients.The objective of this review is to describe the bio-action of rilonacept in the treatment of recurrent pericarditis.

The current treatment of sustained paroxysmal supraventricular tachycardia (PSVT) often requires attendance at a medical facility. This burden is driven by the lack of an effective self-administered treatment for PSVT. Etripamil (Milestone Pharmaceuticals, Saint-Laurent, QC, Canada) is a novel intra-nasal preparation of a rapidly effective but short-acting calcium-channel blocker, which shows promise in offering out-of-hospital treatment for patients with PSVT. Studies, to date, have demonstrated good tolerability and potential efficacy, with a safety profile that is acceptable for unsupervised self-administration. This article reviews the current epidemiology and international guidelines for the treatment of acute PSVT, the pharmacology and clinical trial evidence behind the novel agent etripamil, and considers its potential role in the management of patients with PSVT.

Sodium-glucose cotransporter (SGLT) 2 inhibitors, or gliflozins, have quickly risen to prominence within the cardiovascular field due to their substantial benefit in the management of heart failure with reduced ejection fraction (HFrEF). SGLT channels are present throughout the body in various isoforms, but SGLT1 and SGLT2 have been the centre of medical investigation due to known genetic mutations. SGLT2 plays a major role in renal re-absorption of glucose, prompting the development of SGLT2 inhibitors to promote glycosuria and aid in diabetes management. The United States Food and Drug Administration requires evaluation of new antidiabetic medications for cardiovascular safety, prompting several randomized controlled trials of SGLT2 inhibitors over the past 5 years. These initial trials demonstrated superiority in cardiovascular outcomes with SGLT2 inhibitor use and suggested particular benefit in heart failure (HF) outcomes, prompting further study of their mechanisms. Subsequent SGLT2 inhibitor studies have demonstrated reductions in HF hospitalizations and cardiovascular mortality in patients with HFrEF, regardless of the presence of diabetes mellitus. In this review, we discuss the mechanism of action and major clinical trial results that have propelled SGLT2 inhibitors into a key role for patients with HFrEF.

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality globally. Despite significant advances in pharmacotherapies and the beneficial effects of statin therapy on ASCVD outcomes and progression of atherosclerosis, residual cardiovascular (CV) risk remains. Extensive evidence has identified the contribution of atherogenic dyslipidaemia, which is particularly characterised by elevated triglycerides (TGL) as a key driver of CV risk, even if low-density lipoprotein cholesterol levels are well controlled. Epidemiologic and genetic/Mendelian randomisation studies have demonstrated that elevated TGL levels serve as an independent marker for an increased risk of ischaemic events, highlighting TGLs as a suitable therapeutic target. Clinical studies have shown that omega 3 fatty acids (OM3FA) are effective in lowering TGLs; however, to date, trials and meta-analyses of combined OM3FA products have not demonstrated any clinical CV outcome benefit in patients receiving statins. However, icosapent ethyl (IPE) - a highly purified, stable ethyl ester of eicosapentaenoic acid (EPA) - has been rigorously demonstrated in multiple studies to be a useful adjunctive therapy to address residual CV risk. EPA is an omega-3 polyunsaturated fatty acid that is incorporated into membrane phospholipid bilayers and is reported to exert multiple beneficial effects along the pathway of coronary atherosclerosis. In this brief review, we will provide an overview of the mode of action of IPE in coronary atherosclerosis, the robust clinical evidence and trial data supporting its use, and expert consensus/recommendations on its use in specific populations, as an adjunct to existing anti-atherosclerotic therapies.

Heart failure (HF) is a highly prevalent and morbid disease in the USA. The chronic, progressive course of HF is defined by periodic exacerbations of symptoms, described as 'worsening heart failure' (WHF). Previously, episodes of WHF have required hospitalization for intravenous diuretics; however, recent innovations in care delivery models for patients with HF have allowed a transition from the acute care setting to the ambulatory setting. The development of remote monitoring strategies, including device-based algorithms and implantable haemodynamic monitoring systems, has facilitated more advanced surveillance of patients, aiming to prevent the clinical deterioration that leads to hospitalization. Additionally, the establishment of multidisciplinary HF clinics has provided the setting and resources for the outpatient treatment of WHF, specifically the administration of intravenous diuretics. Here we review the current state of ambulatory HF management, including mechanisms for patient monitoring and treatment, and outline future opportunities for outpatient management of this patient population.

Complex, high-risk percutaneous coronary intervention (HR-PCI) is increasingly being performed, often with mechanical circulatory support (MCS), though to date, there are limited randomised data on the efficacy of MCS for HR-PCI. The majority of MCS is provided by intra-aortic balloon pumps, but increasingly Impella® (Abiomed, Danvers, MA, USA) heart pumps are being used. While the Impella pumps provide greater increases in cardiac output, these devices require large bore access, which has been associated with an increased risk of bleeding and vascular complications. Decisions regarding the use of Impella are often based on risk-benefit considerations, with Impella-related bleeding risk being a major factor that can impact decisions for planned use. While bleeding risk related to large bore access is a concern, published data on the risk have been quite variable. Thus, the goal of this article is to provide a comprehensive review of reports describing bleeding and vascular complications for Impella-supported HR-PCI.

Transcatheter aortic valve replacement has revolutionised the treatment of aortic valve disease. The Myval™ device (Meril Life Sciences Pvt. Ltd., Gujarat, India) is a CE-marked, next-generation balloon-expandable transcatheter heart valve, designed for the treatment of severe aortic valve stenosis. This review illustrates the salient technical features of this transcatheter valve, pre-clinical studies and evidence from the first-in-human trial. We also provide a brief overview of planned clinical trials and registries.

he management of patients who require percutaneous coronary intervention and are at high risk of bleeding continues to be challenging; balancing thrombotic risk versus bleeding risk to determine the safest duration of dual antiplatelet therapy (DAPT). With recent efforts to determine the safety of 1 month of DAPT after implantation of a drug-eluting stent, drug-coated balloons (DCBs) have also been explored, as both have been shown superior to bare-metal stents, which have historically been used for patients with high bleeding risk. We sought to review the literature surrounding the safety profile and bleeding events with both DCBs and drug-eluting stents, and conclude that while both offer safety of cessation of DAPT after 1 month, DCBs offer lower major adverse cardiovascular events.

Introduction: Bicuspid aortic valve (BAV) is associated with dilation and dissection of the ascending aorta. The high shear forces within the ascending aorta lumen seem to have a pivotal role on the development of such complications. We describe the time-averaged wall shear stress (TAWSS) forces in a patient with normally functioning BAV and significant ostial/mid-shaft left main (LM) stenosis using computational fluid dynamic analysis (CFD).

Case report: A 47-year-old female patient with normally functioning BAV with fusion of right and non-coronary cusps was investigated for unstable angina. CFD and stress mapping of the ascending aorta before LM stenting showed a mean TAWSS of 9.4 Pa and was associated with higher TAWSS values at the site of LM stenosis. The LM lesion was treated by stent implantation of an Orsiro (Biotronik, Berlin, Germany) 4.0 × 12 mm at 18 atm, preceded with a pre-dilation with non-compliant Euphora (Medtronic Inc., Santa Rosa, CA, USA) balloon 3.0 × 12 mm at 16 atm, and followed by an over-dilation with 4.5 × 12 mm non-compliant Euphora balloon at 20 atm. The reconstructed post-procedural model revealed a decrease of the mean ascending aorta TAWSS to 5.6 Pa.

Conclusions: As suggested by our case, stenting of an LM lesion in a patient with BAV has the potential to improve the TAWSS in the ascending aorta, protecting the ascending aorta from the well-known complications of BAV.

The extent of coronary artery disease has been shown to be an important indicator of prognosis. Cardiac computed tomography (CT) has the ability to measure plaque, with both coronary artery calcium scanning and CT angiography (CTA), to give a measure of total atheroma burden. Beyond assessing stenosis and atherosclerosis, CTA can assess high-risk plaque. These plaques are thought to be consistent with plaques that are vulnerable and more likely to rupture and cause acute coronary syndromes. However, the high-risk plaque concept suffers from poor reproducibility and poor positive predictive power. Total coronary atheroma burden has been shown to be a better predictor of coronary events than high-risk plaques or stenosis. This paper reviews the literature in this regard and demonstrates total coronary atheroma burden to be the best predictor of future cardiovascular disease. We searched MEDLINE, EMBASE and the Cochrane library database for studies assessing plaque burden and outcomes by CT. We used text words and related Medical Subject Headings (MeSH) for cardiac, calcification, plaque burden, CT, prognosis, mortality, event, death, survival and myocardial infarction.