US cardiology最新文献

Heart failure (HF) is a global health issue, contributing significantly to morbidity and mortality, particularly in North America. The management of HF is complex, requiring diligent monitoring to prevent decompensation and clinical progression. While there have been improvements in treating HF, it still leads to significant negative health outcomes and heavily contributes to the use of healthcare services. Outpatient management for HF lacks consistent application of proven therapies and the early identification and management of worsening conditions. Remote monitoring (RM) offers a solution to these challenges and there has been growing attention from HF healthcare providers and medical systems. This review explores the evolution and role of RM in the ambulatory care of HF patients, particularly emphasizing the impact of RM on clinical outcomes amid the COVID-19 pandemic.

Cardiopulmonary exercise testing (CPET) is a crucial tool for assessing cardiorespiratory function, providing invaluable insights into individual physiological capacities. This review explores the clinical indications of CPET, its contraindications, as well as a comprehensive protocol for its execution. Additionally, it highlights key parameters measured during CPET and their interpretation, as well as the role of CPET in the prescription of aerobic training in cardiac rehabilitation. This review aims to provide a comprehensive, up-to-date synthesis of advances in the field of CPET and their clinical implications.

The etiology of cardiac tumors has a broad differential diagnosis. The use of a multidisciplinary team along with appropriate workup with multimodality imaging is critical for patient management. A 41-year-old man with a history of heavy tobacco use presented with abdominal distension, edema, and dyspnea for the past month. Prior to this presentation, he had experienced two episodes of right upper extremity and left lower extremity paresthesias that resolved spontaneously. A chest computed tomography (CT scan revealed an 8.5 cm mass that obliterated the left atrium and protruded across the mitral valve. Multimodal imaging (transthoracic echocardiography and cardiac MRI) confirmed a diagnosis of myxoma. Highlighting the severity of the presentation, hemodynamics revealed severe pulmonary hypertension. The patient underwent surgical resection with complete resolution of symptoms. Atrial myxomas are rare, but are among the most common type of benign cardiac tumors. Prompt optimization and definitive surgical management are critical.

The absence of a Food and Drug Administration-approved percutaneous valve technology for the treatment of severe aortic regurgitation (AR) presents a challenge for high-risk patients. In this report, we describe the successful treatment of an 84-year-old male patient suffering from severe symptomatic AR and concomitant cardiorenal syndrome with renal failure using a 34 mm Evolut R (Medtronic) self-expanding transcatheter aortic valve replacement. This intervention resulted in the resolution of AR, cardiorenal syndrome, and congestive heart failure symptoms.

Incorporating sexual orientation, gender identity, and expression (SOGIE) data into cardiovascular research design is necessary to reduce cardiovascular healthcare disparities among sexual and gender minority (SGM) people. To achieve this, researchers should not only understand appropriate terminology, but also implement inclusive survey tools that respect privacy and cultural nuances, as the benefit of obtaining SOGIE information is critical to tailoring cardiovascular interventions and ensuring equitable healthcare outcomes. In order to address potential concerns related to disclosing SOGIE information, we must prioritize sensitivity training for healthcare professionals to foster an inclusive environment for data collection, ethical considerations, and confidentiality safeguards. This review aims to develop and inform critical thinking about sex and gender and to identify strategic mechanisms to include SOGIE data in cardiovascular research, thus improving cardiovascular health outcomes for SGM individuals. By embracing a more comprehensive and inclusive approach to data collection, cardiovascular research can contribute significantly to advancing personalized and inclusive healthcare practices and medical education, and ultimately promote better health outcomes for all SGM individuals.

Hypertrophic cardiomyopathy (HCM) is a complex and heterogeneous cardiac disorder characterized by cardiac hypertrophy disproportionate to loading stimuli (e.g. hypertension or aortic stenosis). Diagnosing HCM requires a thorough examination of clinical symptoms, with echocardiography as the key initial imaging tool. Multimodality imaging further supports diagnosis, helps assess left ventricular outflow obstruction, and aids in risk stratification for sudden cardiac death. The cornerstone of HCM management remains pharmacological therapy with β-blockers and calcium channel blockers serving as first-line agents to alleviate symptoms and reduce left ventricular outflow tract obstruction. More recently, cardiac myosin inhibitors have revolutionized the treatment paradigm for obstructive HCM. Procedural interventions such as septal reduction therapy are reserved for refractory cases. Genetic testing and risk stratification for sudden cardiac death play a critical role in treatment decisions, guiding further testing in first-degree relatives and ICD implantation in high-risk individuals. Exercise recommendations have evolved based on recent data, challenging traditional restrictions and emphasizing individualized plans.

Transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic valve disease. However, its success has brought attention to concurrent tricuspid valve disease and the inadequacy of treatments. This review explores the emerging field of transcatheter tricuspid valve interventions (TTVI) after TAVR. We address the pathophysiology and prevalence of post-TAVR tricuspid valve disease and TTVI strategies, including repair, replacement, annuloplasty, and edge-to-edge repair. We also discuss clinical studies assessing TTVI safety and efficacy, including for patients with previous TAVR. Collaboration among clinical disciplines remains crucial for advancing this emerging field to establish best practices regarding patient selection and procedural complexities.

Patients and clinicians in the cardiac intensive care unit (CICU) are often tasked with making high-stakes decisions about aggressive or life- sustaining therapies. Shared decision-making (SDM), a collaborative process where patients and clinicians work together to make medical decisions that are aligned with a patient's goals and values, is therefore highly relevant in the CICU, especially in the context of palliative or end-of-life decisions. Despite its importance, there are barriers to optimal integration and implementation of SDM. This review describes the fundamentals and models of SDM, the role of SDM in the CICU, and evidence-based strategies to promote SDM in the CICU.