Aortic stenosis (AS) is the most common valvular heart disease and the main indication for valvular replacement in older women. Correct AS grading is mandatory for an adequate selection of patients for both surgical and transcatheter aortic valve replacement. Women and men have different AS severity grades at the same level of aortic valve calcification. Moreover, besides having smaller cardiac volumes, left ventricular outflow tract and aortic size, women have a specific pattern of left ventricular structural and functional remodelling in response to the AS-related chronic pressure overload. Here, the sex-specific cardiac changes in AS that make AS grading more challenging in women, with consequences for the management and outcome of this group of patients, are reviewed.
{"title":"Grading of Aortic Stenosis: Is it More Complicated in Women?","authors":"Dana Cramariuc, Edda Bahlmann, Eva Gerdts","doi":"10.15420/ecr.2022.13","DOIUrl":"https://doi.org/10.15420/ecr.2022.13","url":null,"abstract":"<p><p>Aortic stenosis (AS) is the most common valvular heart disease and the main indication for valvular replacement in older women. Correct AS grading is mandatory for an adequate selection of patients for both surgical and transcatheter aortic valve replacement. Women and men have different AS severity grades at the same level of aortic valve calcification. Moreover, besides having smaller cardiac volumes, left ventricular outflow tract and aortic size, women have a specific pattern of left ventricular structural and functional remodelling in response to the AS-related chronic pressure overload. Here, the sex-specific cardiac changes in AS that make AS grading more challenging in women, with consequences for the management and outcome of this group of patients, are reviewed.</p>","PeriodicalId":45957,"journal":{"name":"European Cardiology Review","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/84/ecr-17-e21.PMC9820123.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10533513","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}
In this article, three important clinical trials presented at the 2022 European Society of Cardiology Congress have been selected for a brief discussion. These are the SECURE, ADVOR and REVIVED-BCIS2 trials, all of which are investigator-initiated studies whose findings are of interest given their potential to impact clinical practice, ultimately improving current patient care and clinical outcomes.
{"title":"SECURE, ADVOR and REVIVED: Clinical Trials Presented at ESC 2022.","authors":"Guiomar Mendieta","doi":"10.15420/ecr.2022.43","DOIUrl":"https://doi.org/10.15420/ecr.2022.43","url":null,"abstract":"<p><p>In this article, three important clinical trials presented at the 2022 European Society of Cardiology Congress have been selected for a brief discussion. These are the SECURE, ADVOR and REVIVED-BCIS2 trials, all of which are investigator-initiated studies whose findings are of interest given their potential to impact clinical practice, ultimately improving current patient care and clinical outcomes.</p>","PeriodicalId":45957,"journal":{"name":"European Cardiology Review","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b9/99/ecr-17-e28.PMC9947931.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10799436","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}
Coronary slow flow (CSF) phenomenon, also known as cardiac syndrome Y, is defined as the delayed opacification of the coronary vasculature at the distal level. Different hypotheses and theories have been postulated about its substrate and mechanism, such as microvascular and endothelial dysfunction. Several studies have confirmed that CSF is a cause of ischaemia detected by non-invasive testing. Clinically, it can present as angina pectoris, acute coronary syndrome and sudden cardiac death. It has an incidence of 1–5% in patients undergoing coronary angiography and has been most frequently found in young men who are smokers with metabolic syndrome. There are no established treatments for CSF and further studies are still necessary.
{"title":"Slow Coronary Blood Flow: Pathogenesis and Clinical Implications","authors":"A. Aparicio, J. Cuevas, C. Morís, María Martín","doi":"10.15420/ecr.2021.46","DOIUrl":"https://doi.org/10.15420/ecr.2021.46","url":null,"abstract":"Coronary slow flow (CSF) phenomenon, also known as cardiac syndrome Y, is defined as the delayed opacification of the coronary vasculature at the distal level. Different hypotheses and theories have been postulated about its substrate and mechanism, such as microvascular and endothelial dysfunction. Several studies have confirmed that CSF is a cause of ischaemia detected by non-invasive testing. Clinically, it can present as angina pectoris, acute coronary syndrome and sudden cardiac death. It has an incidence of 1–5% in patients undergoing coronary angiography and has been most frequently found in young men who are smokers with metabolic syndrome. There are no established treatments for CSF and further studies are still necessary.","PeriodicalId":45957,"journal":{"name":"European Cardiology Review","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74191539","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}
Lower extremity artery disease (LEAD), a chronic condition with disturbed lower extremity circulation due to narrowing of the arteries, is predominantly caused by atherosclerosis and is associated with the presence of cardiovascular risk factors and an increased risk of cardiovascular events. LEAD is prevalent among older individuals and predicted to rise with the ageing population. In progressive disease, the patient experiences symptoms of ischaemia when walking and, in advanced critical limb-threatening ischaemia, even at rest. However, LEAD is asymptomatic in most patients, delaying diagnosis and treatment. In this setting, circulating biomarkers may facilitate earlier diagnosis in selected individuals. This review provides a broad overview of the circulating biomarkers investigated to date in relation to LEAD and discusses their usefulness in clinical practice.
{"title":"Circulating Biomarkers in Lower Extremity Artery Disease","authors":"L. Ziegler, U. Hedin, A. Gottsäter","doi":"10.15420/ecr.2021.58","DOIUrl":"https://doi.org/10.15420/ecr.2021.58","url":null,"abstract":"Lower extremity artery disease (LEAD), a chronic condition with disturbed lower extremity circulation due to narrowing of the arteries, is predominantly caused by atherosclerosis and is associated with the presence of cardiovascular risk factors and an increased risk of cardiovascular events. LEAD is prevalent among older individuals and predicted to rise with the ageing population. In progressive disease, the patient experiences symptoms of ischaemia when walking and, in advanced critical limb-threatening ischaemia, even at rest. However, LEAD is asymptomatic in most patients, delaying diagnosis and treatment. In this setting, circulating biomarkers may facilitate earlier diagnosis in selected individuals. This review provides a broad overview of the circulating biomarkers investigated to date in relation to LEAD and discusses their usefulness in clinical practice.","PeriodicalId":45957,"journal":{"name":"European Cardiology Review","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79903091","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}
Troponin has been the cornerstone of the definition of MI since its introduction to clinical practice. High-sensitivity troponin has allowed clinicians to detect degrees of myocardial damage at orders of magnitude smaller than previously and is challenging the definitions of MI, with implications for patient management and prognosis. Detection and diagnosis are no doubt enhanced by the greater sensitivity afforded by these markers, but perhaps at the expense of specificity and clarity. This review focuses on the definitions, pathophysiology, prognosis, prevention and management of type 2 MI and myocardial injury. The five types of MI were first defined in 2007 and were recently updated in 2018 in the fourth universal definition of MI. The authors explore how this pathophysiological classification is used in clinical practice, and discuss some of the unanswered questions in this era of availability of high-sensitivity troponin.
{"title":"Type 2 MI and Myocardial Injury in the Era of High-sensitivity Troponin","authors":"R. Rafiudeen, P. Barlis, H. White, W. van Gaal","doi":"10.15420/ecr.2021.42","DOIUrl":"https://doi.org/10.15420/ecr.2021.42","url":null,"abstract":"Troponin has been the cornerstone of the definition of MI since its introduction to clinical practice. High-sensitivity troponin has allowed clinicians to detect degrees of myocardial damage at orders of magnitude smaller than previously and is challenging the definitions of MI, with implications for patient management and prognosis. Detection and diagnosis are no doubt enhanced by the greater sensitivity afforded by these markers, but perhaps at the expense of specificity and clarity. This review focuses on the definitions, pathophysiology, prognosis, prevention and management of type 2 MI and myocardial injury. The five types of MI were first defined in 2007 and were recently updated in 2018 in the fourth universal definition of MI. The authors explore how this pathophysiological classification is used in clinical practice, and discuss some of the unanswered questions in this era of availability of high-sensitivity troponin.","PeriodicalId":45957,"journal":{"name":"European Cardiology Review","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78734074","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}
Colchicine: ECLA PHRI COLCOVID Trial The anti-inflammatory effect of colchicine on the cytokine storm made it a promising candidate for the treatment of COVID-19, and the drug is known to be safe and well tolerated. Randomised controlled trials (RCTs) in hospitalised patients have reported limited clinical benefits of colchicine, such as increased time to clinical deterioration (mean [SD] event-free survival time was 18.6 [0.83] days in the control group versus 20.7 [0.31] in the colchicine group; log-rank p=0.03) and reduced duration of oxygen supplementation therapy and hospitalisation.3,4
{"title":"European Society of Cardiology Highlights: Late-breaking Trials – COVID-19","authors":"Maki Komiyama, K. Hasegawa","doi":"10.15420/ecr.2022.03","DOIUrl":"https://doi.org/10.15420/ecr.2022.03","url":null,"abstract":"Colchicine: ECLA PHRI COLCOVID Trial The anti-inflammatory effect of colchicine on the cytokine storm made it a promising candidate for the treatment of COVID-19, and the drug is known to be safe and well tolerated. Randomised controlled trials (RCTs) in hospitalised patients have reported limited clinical benefits of colchicine, such as increased time to clinical deterioration (mean [SD] event-free survival time was 18.6 [0.83] days in the control group versus 20.7 [0.31] in the colchicine group; log-rank p=0.03) and reduced duration of oxygen supplementation therapy and hospitalisation.3,4","PeriodicalId":45957,"journal":{"name":"European Cardiology Review","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82640472","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}
AF is the most common cardiac arrhythmia. There is growing evidence that inflammatory mechanisms play an important role in its pathogenesis; inflammasome activation contributes to the onset and progression of AF. An increase in NOD-like-receptor-pyrin domain-containing-3 (NLRP3) inflammasome activation releases proinflammatory cytokines that activate nuclear factor (NF)-κB, which regulates the production of immunoglobulin free light chains (FLCs). Serum FLC levels are increased in patients with AF, and FLCs are biomarkers of inflammation. Inflammasomes and NF-κB may be targets for anti-inflammatory strategies to prevent and treat AF when FLC levels are elevated. This review discusses the role of inflammation in the pathogenesis of AF, as well as FLCs as novel inflammatory biomarkers for the management of AF.
{"title":"Management of Atrial Fibrillation Using Immunoglobulin Free Light Chains, Novel Biomarkers of Inflammation.","authors":"Akira Matsumori","doi":"10.15420/ecr.2022.30","DOIUrl":"https://doi.org/10.15420/ecr.2022.30","url":null,"abstract":"<p><p>AF is the most common cardiac arrhythmia. There is growing evidence that inflammatory mechanisms play an important role in its pathogenesis; inflammasome activation contributes to the onset and progression of AF. An increase in NOD-like-receptor-pyrin domain-containing-3 (NLRP3) inflammasome activation releases proinflammatory cytokines that activate nuclear factor (NF)-κB, which regulates the production of immunoglobulin free light chains (FLCs). Serum FLC levels are increased in patients with AF, and FLCs are biomarkers of inflammation. Inflammasomes and NF-κB may be targets for anti-inflammatory strategies to prevent and treat AF when FLC levels are elevated. This review discusses the role of inflammation in the pathogenesis of AF, as well as FLCs as novel inflammatory biomarkers for the management of AF.</p>","PeriodicalId":45957,"journal":{"name":"European Cardiology Review","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/88/74/ecr-17-e22.PMC9820057.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10533509","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}
Numerous prediction scores have been developed to better inform clinical decision-making following out-of-hospital cardiac arrest (OHCA), however, there is no consensus among clinicians over which score to use. The aim of this review was to identify and compare scoring systems to predict survival and neurological recovery in patients with OHCA. A structured literature search of the MEDLINE database was carried out from inception to December 2021. Studies developing or validating scoring systems to predict outcome following OHCA were selected. Relevant data were extracted and synthesised for narrative review. In total, 16 scoring systems were identified: one predicting the probability of return of spontaneous circulation, six predicting survival to hospital discharge and nine predicting neurological outcome. NULL-PLEASE and CAST are recommended as the best scores to predict mortality and neurological outcome, respectively, due to the extent of external validation, ease of use and high predictive value of the variables. Whether use of these scores can lead to more cost-effective service delivery remains unclear.
{"title":"Scoring Systems to Predict Survival or Neurological Recovery after Out-of-hospital Cardiac Arrest.","authors":"Rishi Naik, Indrajeet Mandal, Diana A Gorog","doi":"10.15420/ecr.2022.05","DOIUrl":"https://doi.org/10.15420/ecr.2022.05","url":null,"abstract":"<p><p>Numerous prediction scores have been developed to better inform clinical decision-making following out-of-hospital cardiac arrest (OHCA), however, there is no consensus among clinicians over which score to use. The aim of this review was to identify and compare scoring systems to predict survival and neurological recovery in patients with OHCA. A structured literature search of the MEDLINE database was carried out from inception to December 2021. Studies developing or validating scoring systems to predict outcome following OHCA were selected. Relevant data were extracted and synthesised for narrative review. In total, 16 scoring systems were identified: one predicting the probability of return of spontaneous circulation, six predicting survival to hospital discharge and nine predicting neurological outcome. NULL-PLEASE and CAST are recommended as the best scores to predict mortality and neurological outcome, respectively, due to the extent of external validation, ease of use and high predictive value of the variables. Whether use of these scores can lead to more cost-effective service delivery remains unclear.</p>","PeriodicalId":45957,"journal":{"name":"European Cardiology Review","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/a8/ecr-17-e20.PMC9820201.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10533511","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}
Hypertension is one of the most prevalent cardiovascular risk factors and blood pressure control remains a clinical challenge, especially for patients with established cardiovascular disease. Late-breaking clinical trials and other evidence in hypertension have evolved to assess the most accurate ways to measure blood pressure, the use of combination therapies, considerations in special populations and evaluation of new techniques. Recent evidence supports the superiority of ambulatory or 24-hour blood pressure measurements, rather than office blood pressure measurements, for the assessment of cardiovascular risk. The use of fixed-dose combinations and polypills has been demonstrated to be valid and to provide clinical benefits beyond blood pressure control. There have also been advances in new approaches such as telemedicine, devices and the use of algorithms. Clinical trials have provided valuable data on blood pressure control in primary prevention, during pregnancy and in the elderly. The role of renal denervation remains unsolved but innovative techniques using ultrasound or alcohol injections are being explored. Current evidence and results of latest trials are summarised in this review.
{"title":"Most Recent Trials and Advances in Hypertension.","authors":"Elías Martínez Rey-Rañal, Alberto Cordero","doi":"10.15420/ecr.2022.27","DOIUrl":"https://doi.org/10.15420/ecr.2022.27","url":null,"abstract":"<p><p>Hypertension is one of the most prevalent cardiovascular risk factors and blood pressure control remains a clinical challenge, especially for patients with established cardiovascular disease. Late-breaking clinical trials and other evidence in hypertension have evolved to assess the most accurate ways to measure blood pressure, the use of combination therapies, considerations in special populations and evaluation of new techniques. Recent evidence supports the superiority of ambulatory or 24-hour blood pressure measurements, rather than office blood pressure measurements, for the assessment of cardiovascular risk. The use of fixed-dose combinations and polypills has been demonstrated to be valid and to provide clinical benefits beyond blood pressure control. There have also been advances in new approaches such as telemedicine, devices and the use of algorithms. Clinical trials have provided valuable data on blood pressure control in primary prevention, during pregnancy and in the elderly. The role of renal denervation remains unsolved but innovative techniques using ultrasound or alcohol injections are being explored. Current evidence and results of latest trials are summarised in this review.</p>","PeriodicalId":45957,"journal":{"name":"European Cardiology Review","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/04/fe/ecr-17-e24.PMC9947933.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10850771","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}
EMPEROR-Preserved Trial and EMPEROR-Pooled Analysis For the first time, the EMPEROR-Preserved trial proved the efficacy of a pharmacological product in patients with HF with preserved ejection fraction (HFpEF).1 In this study, 5,988 patients with symptomatic HF, ejection fraction (EF) >40% and high levels of natriuretic peptides were randomised to the sodium–glucose cotransporter-2 inhibitor (SGLT2i) empagliflozin (10 mg once daily) or a placebo.
{"title":"New Trial Evidence on Heart Failure: Highlights from the European Society of Cardiology Congress 2021","authors":"G. Ferrannini, G. Savarese","doi":"10.15420/ecr.2022.06","DOIUrl":"https://doi.org/10.15420/ecr.2022.06","url":null,"abstract":"EMPEROR-Preserved Trial and EMPEROR-Pooled Analysis For the first time, the EMPEROR-Preserved trial proved the efficacy of a pharmacological product in patients with HF with preserved ejection fraction (HFpEF).1 In this study, 5,988 patients with symptomatic HF, ejection fraction (EF) >40% and high levels of natriuretic peptides were randomised to the sodium–glucose cotransporter-2 inhibitor (SGLT2i) empagliflozin (10 mg once daily) or a placebo.","PeriodicalId":45957,"journal":{"name":"European Cardiology Review","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76068042","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}