Heart International最新文献

{"title":"The Evolving Role of Omega 3 Fatty Acids in Cardiovascular Disease: Is Icosapent Ethyl the Answer?","authors":"Suvasini Lakshmanan, Matthew J Budoff","doi":"10.17925/HI.2021.15.1.7","DOIUrl":"10.17925/HI.2021.15.1.7","url":null,"abstract":"<p><p>Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality globally. Despite significant advances in pharmacotherapies and the beneficial effects of statin therapy on ASCVD outcomes and progression of atherosclerosis, residual cardiovascular (CV) risk remains. Extensive evidence has identified the contribution of atherogenic dyslipidaemia, which is particularly characterised by elevated triglycerides (TGL) as a key driver of CV risk, even if low-density lipoprotein cholesterol levels are well controlled. Epidemiologic and genetic/Mendelian randomisation studies have demonstrated that elevated TGL levels serve as an independent marker for an increased risk of ischaemic events, highlighting TGLs as a suitable therapeutic target. Clinical studies have shown that omega 3 fatty acids (OM3FA) are effective in lowering TGLs; however, to date, trials and meta-analyses of combined OM3FA products have not demonstrated any clinical CV outcome benefit in patients receiving statins. However, icosapent ethyl (IPE) - a highly purified, stable ethyl ester of eicosapentaenoic acid (EPA) - has been rigorously demonstrated in multiple studies to be a useful adjunctive therapy to address residual CV risk. EPA is an omega-3 polyunsaturated fatty acid that is incorporated into membrane phospholipid bilayers and is reported to exert multiple beneficial effects along the pathway of coronary atherosclerosis. In this brief review, we will provide an overview of the mode of action of IPE in coronary atherosclerosis, the robust clinical evidence and trial data supporting its use, and expert consensus/recommendations on its use in specific populations, as an adjunct to existing anti-atherosclerotic therapies.</p>","PeriodicalId":12836,"journal":{"name":"Heart International","volume":"15 1","pages":"7-13"},"PeriodicalIF":1.9,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524612/pdf/heart-int-15-07.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40568365","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":"Ambulatory Management of Worsening Heart Failure: Current Strategies and Future Directions.","authors":"Alison L Wand,&nbsp;Stuart D Russell,&nbsp;Nisha A Gilotra","doi":"10.17925/HI.2021.15.1.49","DOIUrl":"https://doi.org/10.17925/HI.2021.15.1.49","url":null,"abstract":"<p><p>Heart failure (HF) is a highly prevalent and morbid disease in the USA. The chronic, progressive course of HF is defined by periodic exacerbations of symptoms, described as 'worsening heart failure' (WHF). Previously, episodes of WHF have required hospitalization for intravenous diuretics; however, recent innovations in care delivery models for patients with HF have allowed a transition from the acute care setting to the ambulatory setting. The development of remote monitoring strategies, including device-based algorithms and implantable haemodynamic monitoring systems, has facilitated more advanced surveillance of patients, aiming to prevent the clinical deterioration that leads to hospitalization. Additionally, the establishment of multidisciplinary HF clinics has provided the setting and resources for the outpatient treatment of WHF, specifically the administration of intravenous diuretics. Here we review the current state of ambulatory HF management, including mechanisms for patient monitoring and treatment, and outline future opportunities for outpatient management of this patient population.</p>","PeriodicalId":12836,"journal":{"name":"Heart International","volume":"15 1","pages":"49-53"},"PeriodicalIF":0.2,"publicationDate":"2021-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524605/pdf/heart-int-15-49.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40583008","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":"A Review of Bleeding Risk with Impella-supported High-risk Percutaneous Coronary Intervention.","authors":"George W Vetrovec,&nbsp;Amir Kaki,&nbsp;Thom G Dahle","doi":"10.17925/HI.2020.14.2.92","DOIUrl":"https://doi.org/10.17925/HI.2020.14.2.92","url":null,"abstract":"<p><p>Complex, high-risk percutaneous coronary intervention (HR-PCI) is increasingly being performed, often with mechanical circulatory support (MCS), though to date, there are limited randomised data on the efficacy of MCS for HR-PCI. The majority of MCS is provided by intra-aortic balloon pumps, but increasingly Impella® (Abiomed, Danvers, MA, USA) heart pumps are being used. While the Impella pumps provide greater increases in cardiac output, these devices require large bore access, which has been associated with an increased risk of bleeding and vascular complications. Decisions regarding the use of Impella are often based on risk-benefit considerations, with Impella-related bleeding risk being a major factor that can impact decisions for planned use. While bleeding risk related to large bore access is a concern, published data on the risk have been quite variable. Thus, the goal of this article is to provide a comprehensive review of reports describing bleeding and vascular complications for Impella-supported HR-PCI.</p>","PeriodicalId":12836,"journal":{"name":"Heart International","volume":"14 2","pages":"92-99"},"PeriodicalIF":0.2,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524743/pdf/heart-int-14-92.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40565408","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":"The Myval Transcatheter Heart Valve System for the Treatment of Severe Aortic Stenosis - Current Evidence and Future Directions.","authors":"Gunasekaran Sengottuvelu,&nbsp;Vijay Kumar,&nbsp;Ashok Seth","doi":"10.17925/HI.2020.14.2.86","DOIUrl":"https://doi.org/10.17925/HI.2020.14.2.86","url":null,"abstract":"<p><p>Transcatheter aortic valve replacement has revolutionised the treatment of aortic valve disease. The Myval™ device (Meril Life Sciences Pvt. Ltd., Gujarat, India) is a CE-marked, next-generation balloon-expandable transcatheter heart valve, designed for the treatment of severe aortic valve stenosis. This review illustrates the salient technical features of this transcatheter valve, pre-clinical studies and evidence from the first-in-human trial. We also provide a brief overview of planned clinical trials and registries.</p>","PeriodicalId":12836,"journal":{"name":"Heart International","volume":"14 2","pages":"86-91"},"PeriodicalIF":0.2,"publicationDate":"2020-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524723/pdf/heart-int-14-86.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40567832","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":"Drug-coated Balloons or Drug-eluting Stents - Determining an Optimum Strategy for Patients with High Bleeding Risk.","authors":"Natasha H Corballis, Tha H Nyi, Vassilios S Vassiliou, Simon C Eccleshall","doi":"10.17925/HI.2020.14.2.100","DOIUrl":"10.17925/HI.2020.14.2.100","url":null,"abstract":"<p><p>he management of patients who require percutaneous coronary intervention and are at high risk of bleeding continues to be challenging; balancing thrombotic risk versus bleeding risk to determine the safest duration of dual antiplatelet therapy (DAPT). With recent efforts to determine the safety of 1 month of DAPT after implantation of a drug-eluting stent, drug-coated balloons (DCBs) have also been explored, as both have been shown superior to bare-metal stents, which have historically been used for patients with high bleeding risk. We sought to review the literature surrounding the safety profile and bleeding events with both DCBs and drug-eluting stents, and conclude that while both offer safety of cessation of DAPT after 1 month, DCBs offer lower major adverse cardiovascular events.</p>","PeriodicalId":12836,"journal":{"name":"Heart International","volume":"14 2","pages":"100-104"},"PeriodicalIF":1.9,"publicationDate":"2020-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524755/pdf/heart-int-14-100.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40565407","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":"Left Main Stenosis Stenting Normalises Wall Shear Stress of Ascending Aorta in Bicuspid Aortic Valve.","authors":"Gianluca Rigatelli,&nbsp;Marco Zuin","doi":"10.17925/HI.2020.14.2.121","DOIUrl":"https://doi.org/10.17925/HI.2020.14.2.121","url":null,"abstract":"<p><strong>Introduction: </strong>Bicuspid aortic valve (BAV) is associated with dilation and dissection of the ascending aorta. The high shear forces within the ascending aorta lumen seem to have a pivotal role on the development of such complications. We describe the time-averaged wall shear stress (TAWSS) forces in a patient with normally functioning BAV and significant ostial/mid-shaft left main (LM) stenosis using computational fluid dynamic analysis (CFD).</p><p><strong>Case report: </strong>A 47-year-old female patient with normally functioning BAV with fusion of right and non-coronary cusps was investigated for unstable angina. CFD and stress mapping of the ascending aorta before LM stenting showed a mean TAWSS of 9.4 Pa and was associated with higher TAWSS values at the site of LM stenosis. The LM lesion was treated by stent implantation of an Orsiro (Biotronik, Berlin, Germany) 4.0 × 12 mm at 18 atm, preceded with a pre-dilation with non-compliant Euphora (Medtronic Inc., Santa Rosa, CA, USA) balloon 3.0 × 12 mm at 16 atm, and followed by an over-dilation with 4.5 × 12 mm non-compliant Euphora balloon at 20 atm. The reconstructed post-procedural model revealed a decrease of the mean ascending aorta TAWSS to 5.6 Pa.</p><p><strong>Conclusions: </strong>As suggested by our case, stenting of an LM lesion in a patient with BAV has the potential to improve the TAWSS in the ascending aorta, protecting the ascending aorta from the well-known complications of BAV.</p>","PeriodicalId":12836,"journal":{"name":"Heart International","volume":"14 2","pages":"121-122"},"PeriodicalIF":0.2,"publicationDate":"2020-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524745/pdf/heart-int-14-121.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40567834","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":"The Quantification of Total Coronary Atheroma Burden - A Major Step Forward.","authors":"Jean-Marc Foult,&nbsp;Shruthi Pranesh,&nbsp;Matthew J Budoff","doi":"10.17925/HI.2020.14.2.73","DOIUrl":"https://doi.org/10.17925/HI.2020.14.2.73","url":null,"abstract":"<p><p>The extent of coronary artery disease has been shown to be an important indicator of prognosis. Cardiac computed tomography (CT) has the ability to measure plaque, with both coronary artery calcium scanning and CT angiography (CTA), to give a measure of total atheroma burden. Beyond assessing stenosis and atherosclerosis, CTA can assess high-risk plaque. These plaques are thought to be consistent with plaques that are vulnerable and more likely to rupture and cause acute coronary syndromes. However, the high-risk plaque concept suffers from poor reproducibility and poor positive predictive power. Total coronary atheroma burden has been shown to be a better predictor of coronary events than high-risk plaques or stenosis. This paper reviews the literature in this regard and demonstrates total coronary atheroma burden to be the best predictor of future cardiovascular disease. We searched MEDLINE, EMBASE and the Cochrane library database for studies assessing plaque burden and outcomes by CT. We used text words and related Medical Subject Headings (MeSH) for cardiac, calcification, plaque burden, CT, prognosis, mortality, event, death, survival and myocardial infarction.</p>","PeriodicalId":12836,"journal":{"name":"Heart International","volume":"14 2","pages":"73-75"},"PeriodicalIF":0.2,"publicationDate":"2020-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524610/pdf/heart-int-14-73.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40567833","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":"ST-elevation Myocardial Infarction and Multivessel Coronary Artery Disease - A Critical Review of Current Practice, Evidence and Meta-analyses.","authors":"Filippo Figini,&nbsp;Shao Liang Chen,&nbsp;Imad Sheiban","doi":"10.17925/HI.2020.14.2.80","DOIUrl":"https://doi.org/10.17925/HI.2020.14.2.80","url":null,"abstract":"<p><p>In recent years, practice and guidelines for patients with ST-elevation myocardial infarction (STEMI) have evolved from a 'culprit-only approach' to complete revascularisation; however, several issues remain, particularly regarding assessment of non-culprit lesions and timing of their revascularisation. Complete revascularisation should be performed in patients presenting with STEMI; however, available studies often present contradictory results regarding the optimal timing of non-culprit lesion percutaneous coronary intervention (PCI). The aim of this review is to provide a practical approach for the assessment of patients presenting with STEMI and multivessel coronary artery disease by analysing randomised trials, meta-analyses and our clinical experience. We recommend multivessel revascularisation at the time of primary PCI for simple cases, while we suggest deferring treatment of complex lesions; the optimal timing of staged PCI should be individualised according to clinical judgement.</p>","PeriodicalId":12836,"journal":{"name":"Heart International","volume":"14 2","pages":"80-85"},"PeriodicalIF":0.2,"publicationDate":"2020-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9562769/pdf/heart-int-14-80.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40565402","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":"Computed Tomography-based Patient-specific Biomechanical and Fluid Dynamic Study of Anomalous Coronary Arteries with Origin from the Opposite Sinus and Intramural Course.","authors":"Gianluca Rigatelli,&nbsp;Marco Zuin","doi":"10.17925/HI.2020.14.2.105","DOIUrl":"https://doi.org/10.17925/HI.2020.14.2.105","url":null,"abstract":"<p><strong>Background: </strong>The anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) constitutes one of the most clinically relevant coronary artery anomalies in adults. Exact pathophysiology and the impact of intramural (IM) course segment stenting in ACAOS with IM course (ACAOS-IM) has not been clarified. We aimed to elucidate the pathophysiology and impact of stenting applying biomechanical and computational fluid dynamics to computed tomography (CT) in patient-specific coronary vessel reconstruction.</p><p><strong>Methods: </strong>We separated coronary artery (left or L-, right or R-) ACAOS-IM into segments (proximal, mid and distal), based on coronary angiography and coronary CT angiography features, in a series of patients at Rovigo General Hospital, Italy, between 1 January 2003 and 1 January 2018. Blood pressure gradient across the coronary circulation, calculated blood flow, vorticity magnitude, wall shear stress (WSS) and IM segment deformation were analysed by simulating exercise, before and after virtual stent implantation.</p><p><strong>Results: </strong>In 21 symptomatic patients (13 males, mean age 46.1 ± 8.1 years, L-ACAOS-IM in 9 and R-ACAOS-IM in 12 patients), computational fluid dynamic analysis in both L- and R-ACAOS demonstrated higher basal WSS values in the IM course (9.5 ± 0.2 and 8.6 ± 0.2 Pa for R- and L-ACAOS, respectively), than in the rest of the vessels. These values decreased after stenting. Vorticity magnitude significantly decreased after stenting as well, compared with baseline. Biomechanical deformation analysis revealed not only compression, but also a twisting of the IM segment with a mean distal pressure drop of 32% and 35% in R- and L-ACAOS, respectively, which was corrected by stent implantation.</p><p><strong>Conclusions: </strong>In both L- and R-ACAOS subtypes, the IM segment appeared to be phasically compressed and deformed with a degree of twisting that causes resting and exercise cross-sectional deformation and a drop in distal pressure. Stenting of the IM segment results in normalisation of the flow profile, correction of the IM segment deformation and reverses the drop in pressure, for both variants of ACAOS.</p>","PeriodicalId":12836,"journal":{"name":"Heart International","volume":"14 2","pages":"105-111"},"PeriodicalIF":0.2,"publicationDate":"2020-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524708/pdf/heart-int-14-105.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40676051","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":"Spontaneously Recanalised Coronary Thrombus in the Left Anterior Descending Artery Presenting as Ventricular Tachycardia.","authors":"Jie Man Low,&nbsp;Noah Kimit,&nbsp;Rizwan Rashid,&nbsp;Magdi El-Omar","doi":"10.17925/HI.2020.14.2.123","DOIUrl":"https://doi.org/10.17925/HI.2020.14.2.123","url":null,"abstract":"<p><p>Spontaneously recanalized coronary thrombus (SRCT), also known as honeycomb, lotus root or Swiss-cheese lesion, is an increasingly recognised finding in patients undergoing coronary angiography. It is thought to arise from partial resorption of an initially occlusive thrombus. Most patients present with angina or exertional breathlessness. We describe a case of a 69-year-old patient who presented with ventricular tachycardia and was found to have SRCT in the left anterior descending artery on coronary angiography. Echocardiography and left ventricular (LV) angiography showed an akinetic, aneurysmal, thin-walled LV apex, diagnostic of an old anterior infarct. We highlight the role of optical coherence tomography in making the diagnosis and discuss the available management options of this condition.</p>","PeriodicalId":12836,"journal":{"name":"Heart International","volume":"14 2","pages":"123-128"},"PeriodicalIF":0.2,"publicationDate":"2020-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524615/pdf/heart-int-14-123.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40565404","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}