Pub Date : 2023-11-01Epub Date: 2023-08-24DOI: 10.1097/HCO.0000000000001081
Alexander C Razavi, Seamus P Whelton, Roger S Blumenthal, Laurence S Sperling, Michael J Blaha, Omar Dzaye
Purpose of review: To provide a summary of the current evidence and highlight future directions regarding coronary artery calcium (CAC) and risk of sudden cardiac death (SCD).
Recent findings: Although up to 80% of all SCD is attributed to coronary heart disease (CHD), the subclinical atherosclerosis markers that help to improve SCD risk prediction are largely unknown. Recent observational data have demonstrated that, after adjustment for traditional risk factors, there is a stepwise higher risk for SCD across increasing CAC burden such that asymptomatic patients without overt atherosclerotic cardiovascular disease (ASCVD) experience a three-fold to five-fold higher SCD risk beginning at CAC at least 100 when compared with CAC = 0. Although the mechanisms underlying increasing CAC and SCD risk have yet to be fully elucidated, risk for myocardial infarction and scar, and/or exercise-induced ischemia may be potential mediators.
Summary: High CAC burden is an important risk factor for SCD in asymptomatic middle-aged adults, suggesting that SCD risk stratification can begin in the early stages of CHD via measurement of calcific plaque on noncontrast computed tomography. Despite the clinical inertia for downstream functional cardiac testing after detecting high CAC, comprehensive ASCVD prevention strategies should be the primary focus for SCD risk reduction.
{"title":"Coronary artery calcium and sudden cardiac death: current evidence and future directions.","authors":"Alexander C Razavi, Seamus P Whelton, Roger S Blumenthal, Laurence S Sperling, Michael J Blaha, Omar Dzaye","doi":"10.1097/HCO.0000000000001081","DOIUrl":"10.1097/HCO.0000000000001081","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide a summary of the current evidence and highlight future directions regarding coronary artery calcium (CAC) and risk of sudden cardiac death (SCD).</p><p><strong>Recent findings: </strong>Although up to 80% of all SCD is attributed to coronary heart disease (CHD), the subclinical atherosclerosis markers that help to improve SCD risk prediction are largely unknown. Recent observational data have demonstrated that, after adjustment for traditional risk factors, there is a stepwise higher risk for SCD across increasing CAC burden such that asymptomatic patients without overt atherosclerotic cardiovascular disease (ASCVD) experience a three-fold to five-fold higher SCD risk beginning at CAC at least 100 when compared with CAC = 0. Although the mechanisms underlying increasing CAC and SCD risk have yet to be fully elucidated, risk for myocardial infarction and scar, and/or exercise-induced ischemia may be potential mediators.</p><p><strong>Summary: </strong>High CAC burden is an important risk factor for SCD in asymptomatic middle-aged adults, suggesting that SCD risk stratification can begin in the early stages of CHD via measurement of calcific plaque on noncontrast computed tomography. Despite the clinical inertia for downstream functional cardiac testing after detecting high CAC, comprehensive ASCVD prevention strategies should be the primary focus for SCD risk reduction.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"509-514"},"PeriodicalIF":2.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10908356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10413331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-09-21DOI: 10.1097/HCO.0000000000001078
Sigrid Sandner, Björn Redfors, Mario Gaudino
Purpose of review: The optimal antiplatelet strategy in patients after coronary artery bypass graft (CABG) surgery is unclear. We review the evidence on the efficacy and safety of DAPT after CABG and discuss potential novel antiplatelet strategies that reduce the risk of bleeding without loss of efficacy.
Recent findings: Adding the potent P2Y12 inhibitor ticagrelor to aspirin for 1 year after CABG is associated with a reduction in the risk of vein graft failure, at the expense of an increased risk of clinically important bleeding. Ticagrelor monotherapy is not associated with better efficacy than aspirin alone, but is not associated with increased bleeding risk.
Summary: Dual antiplatelet therapy (DAPT) is recommended after acute coronary syndrome events, but aspirin as single antiplatelet therapy remains the cornerstone of antithrombotic therapy in stable ischemic heart disease because of a lack of solid evidence on the benefit of DAPT on clinical outcomes. Shorter duration DAPT, based on the pathophysiology of vein graft failure, may be a promising strategy that requires testing in adequately powered randomized trials.
{"title":"Antiplatelet therapy around CABG: the latest evidence.","authors":"Sigrid Sandner, Björn Redfors, Mario Gaudino","doi":"10.1097/HCO.0000000000001078","DOIUrl":"10.1097/HCO.0000000000001078","url":null,"abstract":"<p><strong>Purpose of review: </strong>The optimal antiplatelet strategy in patients after coronary artery bypass graft (CABG) surgery is unclear. We review the evidence on the efficacy and safety of DAPT after CABG and discuss potential novel antiplatelet strategies that reduce the risk of bleeding without loss of efficacy.</p><p><strong>Recent findings: </strong>Adding the potent P2Y12 inhibitor ticagrelor to aspirin for 1 year after CABG is associated with a reduction in the risk of vein graft failure, at the expense of an increased risk of clinically important bleeding. Ticagrelor monotherapy is not associated with better efficacy than aspirin alone, but is not associated with increased bleeding risk.</p><p><strong>Summary: </strong>Dual antiplatelet therapy (DAPT) is recommended after acute coronary syndrome events, but aspirin as single antiplatelet therapy remains the cornerstone of antithrombotic therapy in stable ischemic heart disease because of a lack of solid evidence on the benefit of DAPT on clinical outcomes. Shorter duration DAPT, based on the pathophysiology of vein graft failure, may be a promising strategy that requires testing in adequately powered randomized trials.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"38 6","pages":"484-489"},"PeriodicalIF":2.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c0/4d/cocar-38-484.PMC10552805.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41123846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-05DOI: 10.1097/hco.0000000000001088
Current Opinion in Cardiology was launched in 1985. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of cardiology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Marc RuelMarc RuelDr Marc Ruel is the Head and Chair of Cardiac Surgery at the University of Ottawa Heart Institute, Canada. Dr Ruel's career theme has been to make cardiac surgery less invasive, more evidence-based, and leading to better patient outcomes. Dr Ruel has pioneered multivessel minimally invasive coronary artery bypass surgery worldwide, as well as several other cardiac surgical techniques. The laboratory research program founded by Dr Ruel (www.beatsresearch.com) has also achieved translational impact. Throughout his 11-year tenure as chair, the Cardiac Surgery Division in Ottawa, Canada has massively grown in surgical volumes and outreach, quality, research and innovation, advanced education, as well as in outside referrals, international reputation, widespread recruitment, and overall impact. Dr Ruel has published 450 scientific papers, 5 books, and has delivered over 350 invited lectures. He leads key clinical trials in cardiac surgery, is a recipient of numerous academic and community awards, and has been featured among the ’Giants of Cardiothoracic Surgery’. Dr Ruel was recently the President of the Canadian Cardiovascular Society, one of the most respected medical societies in the world. Dr Ruel serves as Surgery Editor and Associate Editor for the journal Circulation, Canadian Director for the Society of Thoracic Surgeons, and North American Director for the International Society of Minimally Invasive Cardiothoracic Surgery. Peter StonePeter StonePeter H. Stone, MD, is a Professor of Medicine at Harvard Medical School, USA, Director of the Vascular Profiling Research Group, a Co-Director of the Center for Clinical Investigation, and Senior Physician at Brigham & Women's Hospital, USA. Dr Stone's research interests are in evaluating and managing patients with acute and chronic coronary artery disease. He is using new in-vivo methodologies to identify areas where human coronary disease will progress to determine if pre-emptive therapeutic strategies may avert adverse cardiac events. He received his undergraduate degree from Princeton University, USA, and his Medical Degree from Cornell University, USA. He completed internal medicine training at the University of California, San Francisco, USA, and then did a clinical cardiology fellowship at Pacific Medical Center in San Francisco, USA. He came to the Peter Bent Brigham Hospital as a Cardiology Research Fellow and he has remained at B
《心脏病学最新意见》创刊于1985年。它是一系列成功的评论期刊的一部分,其独特的格式旨在提供许多主要期刊中提出的文献的系统和批判性评估。心脏病学领域分为14个部分,每年审查一次。每个章节都有一个章节编辑,他是该领域的权威,负责确定当时最重要的主题。在这里,我们很高兴地介绍本刊的栏目编辑。Marc Ruel博士是加拿大渥太华大学心脏研究所心脏外科主任和主席。Ruel博士的职业主题一直是使心脏手术的侵入性更小,更有证据,并带来更好的患者结果。Ruel博士在世界范围内率先开展了多血管微创冠状动脉搭桥手术,以及其他几种心脏手术技术。Ruel博士创立的实验室研究项目(www.beatsresearch.com)也取得了转化影响。在他担任主席的11年期间,加拿大渥太华心脏外科部门在手术数量和外展、质量、研究和创新、先进教育以及外部转诊、国际声誉、广泛招聘和整体影响方面都有了大幅增长。Ruel博士发表了450篇科学论文,5本书,并发表了350多次受邀演讲。他领导心脏外科的关键临床试验,是众多学术和社区奖项的获得者,并被评为“心胸外科巨人”之一。Ruel博士最近担任加拿大心血管学会主席,该学会是世界上最受尊敬的医学学会之一。Ruel博士担任《循环》杂志的外科编辑和副编辑,加拿大胸外科学会主任,国际微创心胸外科学会北美主任。Peter H. Stone,医学博士,美国哈佛医学院医学教授,血管谱研究小组主任,临床研究中心联席主任,美国布莱根妇女医院高级医师。Stone博士的研究兴趣是评估和管理急性和慢性冠状动脉疾病患者。他正在使用新的体内方法来确定人类冠状动脉疾病将发展的领域,以确定先发制人的治疗策略是否可以避免不良的心脏事件。他在美国普林斯顿大学获得本科学位,在美国康奈尔大学获得医学学位。他在美国加州大学旧金山分校完成了内科培训,然后在美国旧金山太平洋医学中心做了临床心脏病学研究员。他来到彼得本特布里格姆医院担任心脏病学研究员并一直留在布里格姆妇女医院。他是美国心脏协会波士顿分会的前任主席,国际霍尔特和无创心电图学会的前任主席,也是美国心脏病学会和美国心脏协会的研究员。
{"title":"Editorial introductions","authors":"","doi":"10.1097/hco.0000000000001088","DOIUrl":"https://doi.org/10.1097/hco.0000000000001088","url":null,"abstract":"Current Opinion in Cardiology was launched in 1985. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of cardiology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Marc RuelMarc RuelDr Marc Ruel is the Head and Chair of Cardiac Surgery at the University of Ottawa Heart Institute, Canada. Dr Ruel's career theme has been to make cardiac surgery less invasive, more evidence-based, and leading to better patient outcomes. Dr Ruel has pioneered multivessel minimally invasive coronary artery bypass surgery worldwide, as well as several other cardiac surgical techniques. The laboratory research program founded by Dr Ruel (www.beatsresearch.com) has also achieved translational impact. Throughout his 11-year tenure as chair, the Cardiac Surgery Division in Ottawa, Canada has massively grown in surgical volumes and outreach, quality, research and innovation, advanced education, as well as in outside referrals, international reputation, widespread recruitment, and overall impact. Dr Ruel has published 450 scientific papers, 5 books, and has delivered over 350 invited lectures. He leads key clinical trials in cardiac surgery, is a recipient of numerous academic and community awards, and has been featured among the ’Giants of Cardiothoracic Surgery’. Dr Ruel was recently the President of the Canadian Cardiovascular Society, one of the most respected medical societies in the world. Dr Ruel serves as Surgery Editor and Associate Editor for the journal Circulation, Canadian Director for the Society of Thoracic Surgeons, and North American Director for the International Society of Minimally Invasive Cardiothoracic Surgery. Peter StonePeter StonePeter H. Stone, MD, is a Professor of Medicine at Harvard Medical School, USA, Director of the Vascular Profiling Research Group, a Co-Director of the Center for Clinical Investigation, and Senior Physician at Brigham & Women's Hospital, USA. Dr Stone's research interests are in evaluating and managing patients with acute and chronic coronary artery disease. He is using new in-vivo methodologies to identify areas where human coronary disease will progress to determine if pre-emptive therapeutic strategies may avert adverse cardiac events. He received his undergraduate degree from Princeton University, USA, and his Medical Degree from Cornell University, USA. He completed internal medicine training at the University of California, San Francisco, USA, and then did a clinical cardiology fellowship at Pacific Medical Center in San Francisco, USA. He came to the Peter Bent Brigham Hospital as a Cardiology Research Fellow and he has remained at B","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134947933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/HCO.0000000000001067
James Malcolmson, Alex Shipolini, Saidi Mohiddin, Konstantinos Savvatis
Purpose of review: Whilst abnormally increased left ventricular wall thickness is the hallmark feature of hypertrophic cardiomyopathy (HCM), anomalies of the mitral valve and supporting apparatus are well documented. This review addresses the clinical importance of mitral valve abnormalities in HCM, their mechanistic associations with symptoms, and therapeutic strategies targeting mitral valve and apparatus abnormalities.
Recent findings: The normal mitral valve possesses anatomical features facilitating unrestricted blood flow during LV filling, preventing regurgitation during LV systole, and avoiding obstruction of LV ejection. In HCM, a variety of structural and functional abnormalities can conspire to cause deranged mitral valve function, with implications for management strategy. Identification and characterization of these abnormalities is facilitated by multimodality imaging. Alcohol septal ablation (ASA) cannot address primary mitral valve abnormalities, and so is not preferred to surgical intervention if mitral valve abnormalities are present and are judged to make dominant contributions to LV outflow tract obstruction (LVOTO). Two broadly opposing surgical intervention strategies exist, one advocating isolated septal myectomy and the other including adjuvant mitral apparatus modification. Newer, less invasive surgical and transcatheter techniques will expand interventional options.
Summary: Mitral valve abnormalities are a central pathological feature of HCM. Multimodality imaging is crucial for their identification and characterization prior to therapeutic intervention.
{"title":"The mitral valve in hypertrophic cardiomyopathy.","authors":"James Malcolmson, Alex Shipolini, Saidi Mohiddin, Konstantinos Savvatis","doi":"10.1097/HCO.0000000000001067","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001067","url":null,"abstract":"<p><strong>Purpose of review: </strong>Whilst abnormally increased left ventricular wall thickness is the hallmark feature of hypertrophic cardiomyopathy (HCM), anomalies of the mitral valve and supporting apparatus are well documented. This review addresses the clinical importance of mitral valve abnormalities in HCM, their mechanistic associations with symptoms, and therapeutic strategies targeting mitral valve and apparatus abnormalities.</p><p><strong>Recent findings: </strong>The normal mitral valve possesses anatomical features facilitating unrestricted blood flow during LV filling, preventing regurgitation during LV systole, and avoiding obstruction of LV ejection. In HCM, a variety of structural and functional abnormalities can conspire to cause deranged mitral valve function, with implications for management strategy. Identification and characterization of these abnormalities is facilitated by multimodality imaging. Alcohol septal ablation (ASA) cannot address primary mitral valve abnormalities, and so is not preferred to surgical intervention if mitral valve abnormalities are present and are judged to make dominant contributions to LV outflow tract obstruction (LVOTO). Two broadly opposing surgical intervention strategies exist, one advocating isolated septal myectomy and the other including adjuvant mitral apparatus modification. Newer, less invasive surgical and transcatheter techniques will expand interventional options.</p><p><strong>Summary: </strong>Mitral valve abnormalities are a central pathological feature of HCM. Multimodality imaging is crucial for their identification and characterization prior to therapeutic intervention.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"38 5","pages":"415-423"},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9937472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/HCO.0000000000001070
Lana Rashdan, James Hodovan, Ahmad Masri
Purpose of review: The aim of this study was to review imaging of myocardial hypertrophy in hypertrophic cardiomyopathy (HCM) and its phenocopies. The introduction of cardiac myosin inhibitors in HCM has emphasized the need for careful evaluation of the underlying cause of myocardial hypertrophy.
Recent findings: Advances in imaging of myocardial hypertrophy have focused on improving precision, diagnosis, and predicting prognosis. From improved assessment of myocardial mass and function, to assessing myocardial fibrosis without the use of gadolinium, imaging continues to be the primary tool in understanding myocardial hypertrophy and its downstream effects. Advances in differentiating athlete's heart from HCM are noted, and the increasing rate of diagnosis in cardiac amyloidosis using noninvasive approaches is especially highlighted due to the implications on treatment approach. Finally, recent data on Fabry disease are shared as well as differentiating other phenocopies from HCM.
Summary: Imaging hypertrophy in HCM and ruling out other phenocopies is central to the care of patients with HCM. This space will continue to rapidly evolve, as disease-modifying therapies are under investigation and being advanced to the clinic.
{"title":"Imaging cardiac hypertrophy in hypertrophic cardiomyopathy and its differential diagnosis.","authors":"Lana Rashdan, James Hodovan, Ahmad Masri","doi":"10.1097/HCO.0000000000001070","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001070","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this study was to review imaging of myocardial hypertrophy in hypertrophic cardiomyopathy (HCM) and its phenocopies. The introduction of cardiac myosin inhibitors in HCM has emphasized the need for careful evaluation of the underlying cause of myocardial hypertrophy.</p><p><strong>Recent findings: </strong>Advances in imaging of myocardial hypertrophy have focused on improving precision, diagnosis, and predicting prognosis. From improved assessment of myocardial mass and function, to assessing myocardial fibrosis without the use of gadolinium, imaging continues to be the primary tool in understanding myocardial hypertrophy and its downstream effects. Advances in differentiating athlete's heart from HCM are noted, and the increasing rate of diagnosis in cardiac amyloidosis using noninvasive approaches is especially highlighted due to the implications on treatment approach. Finally, recent data on Fabry disease are shared as well as differentiating other phenocopies from HCM.</p><p><strong>Summary: </strong>Imaging hypertrophy in HCM and ruling out other phenocopies is central to the care of patients with HCM. This space will continue to rapidly evolve, as disease-modifying therapies are under investigation and being advanced to the clinic.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"38 5","pages":"397-404"},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9931407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/HCO.0000000000001058
Merrill Stewart, Andrew Elagizi, Yvonne E Gilliland
Purpose of review: The current article reviews obstructive forms of hypertrophic cardiomyopathy and associated morphologic cardiac abnormalities. It focuses on echocardiographic imaging of the left ventricular (LV) outflow tract obstruction, its evaluation, prognostication, and differentiation from other conditions mimicking obstructive hypertrophic cardiomyopathy.
Recent findings: Symptomatic patients with LV outflow tract (LVOT) gradients at least 50 mmHg on maximally tolerated medical therapy are candidates for advanced therapies. Resting echocardiography may only identify 30% of patients with obstructive physiology. Provocative maneuvers are essential for symptomatic patients with hypertrophic cardiomyopathy (HCM). Exercise echocardiography is recommended if they fail to provoke a gradient. Although dynamic LV tract obstruction is seen with obstructive HCM, it is not specific to this condition and exists in other physiologic and pathophysiologic states. Careful clinical evaluation and imaging techniques aid in the differentiation of HCM from these conditions.
Summary: Imaging plays an integral role in the diagnosis, prognosis, and risk stratification of HCM patients. Newer imaging technologies, including 3D transthoracic echocardiography, 3D transesophageal, speckle-derived 2D strain, and cardiac MRI, allow for a better hemodynamic understanding of systolic anterior motion and LV tract obstruction. Evolving techniques, that is, artificial intelligence, will undoubtedly further increase diagnostic capabilities. Newer medical therapies are available with the hope that this will lead to better patient management.
{"title":"Imaging of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.","authors":"Merrill Stewart, Andrew Elagizi, Yvonne E Gilliland","doi":"10.1097/HCO.0000000000001058","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001058","url":null,"abstract":"<p><strong>Purpose of review: </strong>The current article reviews obstructive forms of hypertrophic cardiomyopathy and associated morphologic cardiac abnormalities. It focuses on echocardiographic imaging of the left ventricular (LV) outflow tract obstruction, its evaluation, prognostication, and differentiation from other conditions mimicking obstructive hypertrophic cardiomyopathy.</p><p><strong>Recent findings: </strong>Symptomatic patients with LV outflow tract (LVOT) gradients at least 50 mmHg on maximally tolerated medical therapy are candidates for advanced therapies. Resting echocardiography may only identify 30% of patients with obstructive physiology. Provocative maneuvers are essential for symptomatic patients with hypertrophic cardiomyopathy (HCM). Exercise echocardiography is recommended if they fail to provoke a gradient. Although dynamic LV tract obstruction is seen with obstructive HCM, it is not specific to this condition and exists in other physiologic and pathophysiologic states. Careful clinical evaluation and imaging techniques aid in the differentiation of HCM from these conditions.</p><p><strong>Summary: </strong>Imaging plays an integral role in the diagnosis, prognosis, and risk stratification of HCM patients. Newer imaging technologies, including 3D transthoracic echocardiography, 3D transesophageal, speckle-derived 2D strain, and cardiac MRI, allow for a better hemodynamic understanding of systolic anterior motion and LV tract obstruction. Evolving techniques, that is, artificial intelligence, will undoubtedly further increase diagnostic capabilities. Newer medical therapies are available with the hope that this will lead to better patient management.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"38 5","pages":"405-414"},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10316009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/HCO.0000000000001073
Shane Parfrey, Vincent Siu, John J Graham, Ram Vijayaraghavan, Christopher Li, Jeffrey Pang, Sanjog Kalra, Vladimír Džavík, Harindra C Wijeysundera, Akshay Bagai
Purpose of review: In-stent restenosis (ISR) is the most common cause of stent failure. Although the rate of ISR is significantly lower with contemporary drug-eluting stents (DES), it remains a challenging clinical entity to treat.
Recent findings: In this review, we focus on a practical approach to management of DES ISR with intravascular imaging at its core, as supported by several recently published articles. This facilitates assessment of the underlying mechanism(s) essential to the successful treatment of ISR allowing for a tailored selection of treatment modalities.
Summary: The successful treatment of DES ISR requires identification of the causative mechanism(s). Individualized treatment may include high-pressure balloon angioplasty alone, cutting or scoring balloons, intravascular lithotripsy, atheroablative therapies and a selection of either repeat DES implantation or drug-coated balloon treatment.
{"title":"Evaluation and management of drug-eluting stent in-stent restenosis.","authors":"Shane Parfrey, Vincent Siu, John J Graham, Ram Vijayaraghavan, Christopher Li, Jeffrey Pang, Sanjog Kalra, Vladimír Džavík, Harindra C Wijeysundera, Akshay Bagai","doi":"10.1097/HCO.0000000000001073","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001073","url":null,"abstract":"<p><strong>Purpose of review: </strong>In-stent restenosis (ISR) is the most common cause of stent failure. Although the rate of ISR is significantly lower with contemporary drug-eluting stents (DES), it remains a challenging clinical entity to treat.</p><p><strong>Recent findings: </strong>In this review, we focus on a practical approach to management of DES ISR with intravascular imaging at its core, as supported by several recently published articles. This facilitates assessment of the underlying mechanism(s) essential to the successful treatment of ISR allowing for a tailored selection of treatment modalities.</p><p><strong>Summary: </strong>The successful treatment of DES ISR requires identification of the causative mechanism(s). Individualized treatment may include high-pressure balloon angioplasty alone, cutting or scoring balloons, intravascular lithotripsy, atheroablative therapies and a selection of either repeat DES implantation or drug-coated balloon treatment.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"38 5","pages":"433-440"},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9937471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/HCO.0000000000001065
Manu Rajachandran, Nils Nickel, Richard A Lange
Purpose of review: Obstructive sleep apnea (OSA) is associated with several cardiovascular risk predictors that have only recently begun to be studied in detail. The strong association between OSA and hypertension, coronary artery disease, congestive heart failure, and sudden cardiac death underscores its significant impact on cardiovascular health. This brief review considers the links between OSA and cardiovascular risk.
Recent findings: OSA is an important contributor to endothelial dysfunction and damage, while repetitive hypoxia and hypercarbia contribute to autonomic dysfunction and sympathetic stimulation. In turn, these derangements have deleterious hematologic effects, including hypercoagulability and abnormal platelet aggregability, which are important in the pathogenesis of atherothrombotic disease.
Summary: The varied deleterious effects of OSA on cardiovascular health stem from a unique 'perfect storm' of hypoxic oxidative stress, autonomic dysregulation, endothelial damage, and inflammation occurring at the microvascular level. Further research may disentangle these multiple etiologic threads and provide a better understanding of the underlying pathophysiological relationship between OSA and cardiovascular disease.
{"title":"Sleep apnea and cardiovascular risk.","authors":"Manu Rajachandran, Nils Nickel, Richard A Lange","doi":"10.1097/HCO.0000000000001065","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001065","url":null,"abstract":"<p><strong>Purpose of review: </strong>Obstructive sleep apnea (OSA) is associated with several cardiovascular risk predictors that have only recently begun to be studied in detail. The strong association between OSA and hypertension, coronary artery disease, congestive heart failure, and sudden cardiac death underscores its significant impact on cardiovascular health. This brief review considers the links between OSA and cardiovascular risk.</p><p><strong>Recent findings: </strong>OSA is an important contributor to endothelial dysfunction and damage, while repetitive hypoxia and hypercarbia contribute to autonomic dysfunction and sympathetic stimulation. In turn, these derangements have deleterious hematologic effects, including hypercoagulability and abnormal platelet aggregability, which are important in the pathogenesis of atherothrombotic disease.</p><p><strong>Summary: </strong>The varied deleterious effects of OSA on cardiovascular health stem from a unique 'perfect storm' of hypoxic oxidative stress, autonomic dysregulation, endothelial damage, and inflammation occurring at the microvascular level. Further research may disentangle these multiple etiologic threads and provide a better understanding of the underlying pathophysiological relationship between OSA and cardiovascular disease.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"38 5","pages":"456-461"},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10316024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/HCO.0000000000001069
Maria Irene Barillas-Lara, Christian C Faaborg-Andersen, Raymundo A Quintana, Juan Francisco Loro-Ferrer, Stacy A Mandras, Adrian daSilva-deAbreu
Purpose of review: To describe the relationship between three pandemics: hypertension, obesity, and heart failure. From pathophysiology to treatment, understanding how these disease entities are linked can lead to breakthroughs in their prevention and treatment. The relevance of this review lies in its discussion of novel pharmacological and surgical treatment strategies for obesity and hypertension, and their role in the prevention and treatment of heart failure.
Recent findings: Novel medications such as GLP-1 agonists have demonstrated sustained weight loss in patients with obesity, and concurrent improvements in their cardiometabolic profile, and possibly also reductions in hypertension-related comorbidities including heart failure. Surgical therapies including laparoscopic bariatric surgery represent an important treatment strategy in obese patients, and recent studies describe their use even in patients with advanced heart failure, including those with ventricular assist devices.
Summary: These developments have deep implications on our efforts to understand, mitigate, and ultimately prevent the three pandemics, and offer promising improvements to quality of life, survival, and the cost burden of these diseases.
{"title":"Clinical considerations and pathophysiological associations among obesity, weight loss, heart failure, and hypertension.","authors":"Maria Irene Barillas-Lara, Christian C Faaborg-Andersen, Raymundo A Quintana, Juan Francisco Loro-Ferrer, Stacy A Mandras, Adrian daSilva-deAbreu","doi":"10.1097/HCO.0000000000001069","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001069","url":null,"abstract":"<p><strong>Purpose of review: </strong>To describe the relationship between three pandemics: hypertension, obesity, and heart failure. From pathophysiology to treatment, understanding how these disease entities are linked can lead to breakthroughs in their prevention and treatment. The relevance of this review lies in its discussion of novel pharmacological and surgical treatment strategies for obesity and hypertension, and their role in the prevention and treatment of heart failure.</p><p><strong>Recent findings: </strong>Novel medications such as GLP-1 agonists have demonstrated sustained weight loss in patients with obesity, and concurrent improvements in their cardiometabolic profile, and possibly also reductions in hypertension-related comorbidities including heart failure. Surgical therapies including laparoscopic bariatric surgery represent an important treatment strategy in obese patients, and recent studies describe their use even in patients with advanced heart failure, including those with ventricular assist devices.</p><p><strong>Summary: </strong>These developments have deep implications on our efforts to understand, mitigate, and ultimately prevent the three pandemics, and offer promising improvements to quality of life, survival, and the cost burden of these diseases.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"38 5","pages":"447-455"},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10316047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1097/HCO.0000000000001068
Safia Chatur, Sheila M Hegde
Purpose of review: Cardiac myosin inhibitors (CMIs) represent a major milestone in the treatment of patients with symptomatic obstructive hypertrophic cardiomyopathy. The objective of this review is to discuss the mechanisms of action, clinical trial evidence, safety profile and monitoring of CMIs, which are important to the implementation of these drugs in clinical practice.
Recent findings: Mavacamten and aficamten have both been shown to substantially improve left ventricular outflow tract gradients, biomarkers and symptoms in patients with obstructive hypertrophic cardiomyopathy. Both agents are well tolerated with few adverse events in clinical trial follow up. Transient reductions in left ventricular ejection fraction may be associated with both mavacamten and aficamten but respond to dose reduction.
Summary: There is now robust clinical trial evidence base to support the use of mavacamten for patients with symptomatic obstructive hypertrophic cardiomyopathy. Generation of long-term safety and efficacy data and exploring applications of CMI to nonobstructive cardiomyopathy and heart failure with preserved ejection fraction represent important next steps.
{"title":"Monitoring treatment with cardiac myosin inhibitors in symptomatic obstructive hypertrophic cardiomyopathy.","authors":"Safia Chatur, Sheila M Hegde","doi":"10.1097/HCO.0000000000001068","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001068","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiac myosin inhibitors (CMIs) represent a major milestone in the treatment of patients with symptomatic obstructive hypertrophic cardiomyopathy. The objective of this review is to discuss the mechanisms of action, clinical trial evidence, safety profile and monitoring of CMIs, which are important to the implementation of these drugs in clinical practice.</p><p><strong>Recent findings: </strong>Mavacamten and aficamten have both been shown to substantially improve left ventricular outflow tract gradients, biomarkers and symptoms in patients with obstructive hypertrophic cardiomyopathy. Both agents are well tolerated with few adverse events in clinical trial follow up. Transient reductions in left ventricular ejection fraction may be associated with both mavacamten and aficamten but respond to dose reduction.</p><p><strong>Summary: </strong>There is now robust clinical trial evidence base to support the use of mavacamten for patients with symptomatic obstructive hypertrophic cardiomyopathy. Generation of long-term safety and efficacy data and exploring applications of CMI to nonobstructive cardiomyopathy and heart failure with preserved ejection fraction represent important next steps.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"38 5","pages":"424-432"},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10316022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}