Continuing Cardiology Education最新文献

{"title":"Editorial 4TH issue CCE","authors":"V. P. Vassilikos","doi":"10.1002/cce2.30","DOIUrl":"10.1002/cce2.30","url":null,"abstract":"<p>The 4th issue of CCE is dedicated on Arrhythmias. Rhythm disturbances often scare junior and sometimes senior Cardiologists. There has been tremendous progress on the diagnosis, treatment, and follow-up of arrhythmia patients. Old recording techniques, such as the ECG, still remain contemporary and valuable tools for the initial assessment and diagnosis. Novel, sophisticated non-invasive diagnostic techniques and invasive mapping systems have been developed over the last 20 years, allowing further understanding of arrhythmia mechanisms, precise diagnosis, and thus effective and successful treatment. The widespread utilization of radiofrequency ablation and the development of modern cardiac rhythm management devices in the late 80s and 90s are cornerstone treatments for the cure of tachyarrhythmias and the prevention of sudden cardiac death, which in turn exploded Invasive Electrophysiology.</p><p>In the current issue, Dr Katritsis reviews an old, but always important and current issue: The differential diagnosis of supraventricular tachycardias (SVT) from the surface ECG and during electrophysiology study. In the first part of the paper, he refers to the important “tips and tricks” of how to diagnose the type of SVT from the surface 12-lead ECG, i.e., the identification and the chronic relation of retrograde P waves to the QRS. In the second part, he reviews all the important electrophysiologic maneuvers required for the establishment of the diagnosis.</p><p>In the succeeding two papers, Drs Arsenos, Sideris, and Gatzoulis are reviewing the risk-stratification methods for the primary prevention of arrhythmic sudden cardiac death (SCD) in post-infarction patients, a very common clinical issue in everyday practice. Implanted cardioverter defibrillator (ICD) is undoubtfully a life-saving and effective therapy for the prevention of SCD, both for primary and secondary prevention of post-myocardial infarction (MI) patients <span>1</span>. Still in 2016, the most important prognostic marker remains the left ventricular ejection fraction (EF), leaving a big “gray-zone” area of patients, who may not utilize this complicated treatment during their lives. In both papers, they review the pros and cons of the available non-invasive and invasive techniques, and in their second paper they review a “hot” and unanswered issue: the risk stratification of post-MI patients with a preserved EF. The value of a combination of non-invasive risk markers (late potentials, T-wave alternans, heart rate variability and turbulence, deceleration capacity) with invasive ventricular stimulation methods is the subject of the ongoing PRESERVE-EF trial <span>2</span>. The later and similar trials are listed in order to elucidate the magnitude of the problem.</p><p>Atrial fibrillation is the most common supraventricular tachyarrhythmia, affecting more than 5 million in Europe. Pharmacologic treatment with antiarrhythmic drugs is of limited efficacy and is associated with high rec","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 3","pages":"124-125"},"PeriodicalIF":0.0,"publicationDate":"2016-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.30","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74176200","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}

{"title":"New antiarrhythmic drugs for atrial fibrillation","authors":"N. Fragakis,&nbsp;V. P. Vassilikos","doi":"10.1002/cce2.34","DOIUrl":"10.1002/cce2.34","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 \u0000 <p>Atrial fibrillation is a complex arrhythmia that is difficult to treat with conventional antiarrhythmic agents. Novel pharmacological approaches are in progress focused on the development of agents with selective affinity to ion channels predominately involved in the atrium. In parallel, research efforts have been focused on the development of agents targeting to modification of those pathways and molecular mediators which are involved in the propagation and maintenance of atrial fibrillation (AF). In this review, we focus on the basic and clinical pharmacology of new and emerging antiarrhythmic drugs such as vernakalant, dronedarone, and ranolazine, whereas we briefly comment on the future directions of antiarrhythmic therapy in AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/4469486/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 3","pages":"151-157"},"PeriodicalIF":0.0,"publicationDate":"2016-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.34","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84911568","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}

{"title":"Coronary plaques with near-infrared spectroscopy","authors":"B. A. Danek,&nbsp;A. Karatasakis,&nbsp;J. Karacsonyi,&nbsp;A. Alame,&nbsp;P. Kalsaria,&nbsp;E. Resendes,&nbsp;B. V. Rangan,&nbsp;S. Banerjee,&nbsp;E. S. Brilakis","doi":"10.1002/cce2.23","DOIUrl":"10.1002/cce2.23","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Coronary near-infrared spectroscopy (NIRS) is an intravascular imaging modality with high sensitivity and specificity for lipid core plaque detection. A combined modality catheter that coregisters NIRS measurements with intravascular ultrasound (IVUS) is available, providing the operator with both structural and compositional data. NIRS/IVUS can identify plaques at risk for periprocedural myocardial infarction during stenting, allowing implementation of preventive strategies. NIRS/IVUS is currently being studied for identification of vulnerable plaques and vulnerable patients at risk of future cardiovascular events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/4279887/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 2","pages":"89-98"},"PeriodicalIF":0.0,"publicationDate":"2016-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.23","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89086059","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}

{"title":"Identifying the progression of coronary artery disease: prediction of cardiac events","authors":"M. I. Papafaklis,&nbsp;M. C. Mavrogiannis,&nbsp;P. H. Stone","doi":"10.1002/cce2.25","DOIUrl":"10.1002/cce2.25","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Coronary artery disease (CAD) remains as a principal cause of morbidity and mortality worldwide. Despite the advancements in medical therapy and interventional procedures during the past years, the rate of major adverse cardiac events remains high both in individuals without previous history of heart disease and in patients with known CAD. Improved strategies of risk stratification for identifying subclinical atherosclerosis and asymptomatic individuals at high risk for cardiac events may help in intensifying treatment at targeted population groups, thereby providing enhanced primary prevention. Latest technological progress has made available new methodologies (e.g., fractional flow reserve and virtual surrogates) for assessing coronary anatomy and obstructive lesions precipitating acute cardiac events. Coronary imaging using either invasive (e.g., intravascular ultrasound, optical coherence tomography) or noninvasive (e.g., multislice computed tomography) modalities has enabled the detailed identification of atherosclerotic plaque features and inflammatory processes, thereby providing a “histology-like” quantification of the disease burden within coronary arteries. Additionally, the local hemodynamic environment, in particular endothelial shear stress, is considered as a primary stimulus for plaque development and progression. In vivo assessment of endothelial shear stress in humans has been made possible using three-dimensional coronary imaging and computational fluid dynamics techniques, and could potentially provide a more comprehensive evaluation of the risk for disease progression. Combined assessment of cardiovascular burden focusing on the functional significance of obstructive CAD, the anatomic features of plaque vulnerability, and the local hemodynamic milieu could yield an increased predictive capacity for prognostication, and thus enable preemptive strategies that could avert cardiac events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer Questions and Earn CME</b>: https://wileyhealthlearning.com/Activity2/4279913/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 2","pages":"105-114"},"PeriodicalIF":0.0,"publicationDate":"2016-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.25","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82431370","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}

{"title":"Pathologic correlates in stable coronary plaques. Traditional and novel insights from pathology","authors":"C. Lutter,&nbsp;M. Joner","doi":"10.1002/cce2.29","DOIUrl":"10.1002/cce2.29","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Coronary artery disease (CAD) remains the most common cause of death overall and is the leading cause of cardiovascular mortality worldwide <span>1</span>. Although huge advances in medical therapy have been made within the last decades, the number of worldwide deaths due to CAD will further increase according to current forecasts <span>2</span>. Based on the knowledge and understanding of CAD which cardiovascular research has provided over the last decades, patient care has made substantial progress in daily clinical practice. Although the implementation and further refinement of invasive treatment techniques have paved the way for revolutionary concepts especially in the setting of acute coronary syndromes, a true mortality benefit after percutaneous coronary intervention (PCI) of stable lesions has not been shown to date, which may partly be explained by incomplete understanding of atherosclerotic lesion progression underlying the symptomatic presentation of patients with CAD. Therefore, the following review focuses on traditional knowledge and novel concepts of stable atherosclerotic coronary plaque progression from a pathological point of view, to provide a foundation for future technological refinements and novel therapeutic approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/4279927/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 2","pages":"56-65"},"PeriodicalIF":0.0,"publicationDate":"2016-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.29","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91533654","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}

{"title":"Basic interpretation of intracoronary ultrasound and optical coherence tomography images: examples","authors":"M. I. Papafaklis","doi":"10.1002/cce2.26","DOIUrl":"10.1002/cce2.26","url":null,"abstract":"<p>Latest advancements in intracoronary imaging have enabled the insertion of miniaturized catheters with imaging probes in coronary arteries in order to provide detailed imaging information in a cross-sectional image format after an automated pullback. Cross-sectional images can then be also used for longitudinal reconstructions for the vessel segment imaged. There are two main broadly available intracoronary imaging modalities, namely intravascular ultrasound (IVUS) and optical coherence tomography (OCT), which provide information on (1) the lumen and wall morphology as well as the anatomic and tissue characteristics of atherosclerotic plaques, and (2) endovascular implants <span>1, 2</span>. The main imaging features that are visualized during IVUS or OCT imaging in everyday clinical practice in the catheterization laboratory will be presented using intravascular images from routine cases.</p><p>Dr. Papafaklis has nothing to disclose.</p>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 2","pages":"115-121"},"PeriodicalIF":0.0,"publicationDate":"2016-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.26","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73744336","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}

{"title":"Identifying stable coronary plaques with OCT technology","authors":"E. Regar,&nbsp;N. van Ditzhuijzen,&nbsp;J. van der Sijde,&nbsp;J. Ligthart,&nbsp;K. Witberg,&nbsp;G. van Soest,&nbsp;A. Karanasos","doi":"10.1002/cce2.27","DOIUrl":"10.1002/cce2.27","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>This article discusses the current value of optical coherence tomography (OCT) for the assessment of stable coronary lesions. OCT generates intracoronary images with unprecedented image resolution, namely a 10-fold higher image resolution compared to conventional intravascular ultrasound. OCT is able to visualize a variety of atherosclerotic plaques features that have been associated with rapid lesion progression and clinical events. There is broad agreement that the detailed, easy accessible, and interpretable information of OCT on the presence of atherosclerosis, its extent, lumen narrowing, as well as on the result of any interventional measure can be of clinical value, at least in individual patients and in specific clinical scenarios. Preliminary data indicate that OCT can change the operator's intention-to-treat and modify the overall revascularization strategy, potentially avoiding unnecessary interventional procedures. OCT might be efficient in complex interventions including treatment of long lesions, diffuse disease, bifurcations, as well as in all cases of angiographically ambiguous lesions. As such, OCT might emerge, next to its undisputed position in research, as tool of choice in all clinical scenarios where angiography is limited by its nature as two-dimensional luminogram.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/4279893/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 2","pages":"77-88"},"PeriodicalIF":0.0,"publicationDate":"2016-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.27","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82157682","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}

{"title":"Stable coronary artery disease. Is it really stable? Lesion morphology interpretation by Grayscale and VH-IVUS in patients with coronary artery disease","authors":"S. Brugaletta,&nbsp;G. Giacchi,&nbsp;L. Ortega-Paz,&nbsp;H. M. Garcia-Garcia,&nbsp;M. Sabaté","doi":"10.1002/cce2.24","DOIUrl":"10.1002/cce2.24","url":null,"abstract":"Despite the wide knowledge on the pathological features of an unstable plaque, it is hard to differentiate in vivo a stable from an unstable plaque. The possibility to differentiate these plaques is mainly based on coronary angiography, which depicts artery as a planar silhouette of the contrast‐filled lumen without any information on the vessel wall. Conversely, intracoronary imaging techniques, such as IVUS and IVUS virtual histology, are the established gold standard for in vivo qualitatively (e.g. visually) identification of plaque morphology and coronary plaque tissue components, helping understanding of plaque stability degree. We herein describe these imaging technologies and its clinical and research applications.","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 2","pages":"66-76"},"PeriodicalIF":0.0,"publicationDate":"2016-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.24","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84406449","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}

{"title":"Characterizing stable coronary plaques with MSCT angiography","authors":"C. Van Mieghem","doi":"10.1002/cce2.28","DOIUrl":"10.1002/cce2.28","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Noninvasive access to coronary anatomy has long been anticipated and eventually became available with the emergence of multislice computed tomography angiography (MSCTA). MSCTA offers the possibility to identify coronary artery disease already in its preclinical phase. This unprecedented information proves to be useful in clinical practice as it allows the appropriate allocation of preventive therapies such as statin and aspirin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/4279884/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 2","pages":"99-104"},"PeriodicalIF":0.0,"publicationDate":"2016-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.28","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76213618","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}

{"title":"Echocardiography in interventional cardiology","authors":"M. Y. Henein","doi":"10.1002/cce2.22","DOIUrl":"10.1002/cce2.22","url":null,"abstract":"<div>\u0000 \u0000 <p>Over the last two decades, cardiology practice has experienced fast development of new interventional diagnostic and treatment procedures. While most procedures are cath lab based, the use of echocardiography as an imaging technique has become an integral part. In addition to the important use of transesophageal echocardiography in aortic and mitral valve surgery, it has now become an essential imaging technique for transcatheter aortic valve replacement and MitraClip procedures. Likewise, atrial septal procedures—whether hall closure or puncture for mitral valvuloplasty—are both performed under transesophageal echo guidance. Even ventricular procedures, for example alcohol septal reduction and pericardiocentesis, are performed under direct echo imaging. Thus, Doppler echocardiography has become an integral component of most cardiac procedures where operators need to have optimum skills as what to look for at different stages of the procedure.</p>\u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/4193230/Activity.aspx</p>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 1","pages":"6-12"},"PeriodicalIF":0.0,"publicationDate":"2016-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.22","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88614640","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}