EMJ Cardiology最新文献

{"title":"The Bigger Picture in Stroke Prevention and Anticoagulation: Think Beyond Atrial Fibrillation","authors":"J. James","doi":"10.33590/emjcardiol/10313737","DOIUrl":"https://doi.org/10.33590/emjcardiol/10313737","url":null,"abstract":"This symposium brought together experts in cardiology, nephrology, diabetology, and clinical pharmacology to discuss best practice when caring for patients with atrial fibrillation (AF) and comorbidities. They urged delegates to not only consider the issue of AF but also to think about protection in a broader sense, including comorbidities to improve outcomes for patients when it comes to stroke prevention. Dr Ruff spoke of the tremendous opportunity to reduce the burden of stroke by addressing important modifiable risk factors for stroke, focussing on AF and diabetes, and their link to chronic kidney disease (CKD). Dr Bonnemeier and Dr Kreutz discussed patients with AF and renal dysfunction, noting that CKD is a frequent comorbidity associated with increased risk of stroke and bleeding among patients with AF. The associated patient case study inspired debate about the challenges of oral anticoagulant (OAC) therapy in this patient group and highlighted that while decline in renal function is common in AF patients treated with OAC, the extent of decline may depend on which anticoagulant is used. Furthermore, available data from randomised control trials and recent retrospective analyses were shared which showed differences in the progression of CKD associated with vitamin K antagonists (VKA) versus the novel OAC (NOAC), such as rivaroxaban. Dr Patel and Dr Rossing focussed on diabetes and AF, stating that their frequent coexistence is a bad combination associated with substantially increased risks of death and cardiovascular (CV) events. Exploring the link between diabetes and CKD, they demonstrated the significant impact renal dysfunction has on the prognosis of Type 2 diabetes mellitus (T2DM). They additionally presented recent evidence from retrospective analyses comparing renal outcomes in patients with AF and diabetes treated with NOAC or VKA, noting that choice of anticoagulation may impact risk for renal outcomes.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131305950","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}

{"title":"Cardiac Rehabilitation in Heart Failure: Looking Further Ahead","authors":"E. Vilela, R. Ladeiras-Lopes, Marisa Silva, A. João, S. Torres, Lilibeth Campo, F. Miranda, M. Fonseca, D. Caeiro, J. Primo, J. Ribeiro, F. Sampaio, R. Fontes-Carvalho, M. Teixeira, P. Braga","doi":"10.33590/emjcardiol/10311956","DOIUrl":"https://doi.org/10.33590/emjcardiol/10311956","url":null,"abstract":"Heart failure (HF) is associated with significant morbidity and mortality. Despite major advances in the treatment of HF, there are still important unmet needs among this patient population. Cardiac rehabilitation has a central role in cardiovascular prevention and for overall disease management, and can have an important impact among HF patients. The authors present a brief overview on the current role of cardiac rehabilitation among HF patients in a contemporary setting and discuss some areas of future research in the context of this intervention.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124973182","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}

{"title":"Circulating Cardiac Biomarkers in Heart Failure: A Critical Link to Biomarker-Guided Therapy","authors":"A. Berezin","doi":"10.33590/emjcardiol/10310360","DOIUrl":"https://doi.org/10.33590/emjcardiol/10310360","url":null,"abstract":"Current clinical guidelines for the diagnosis, treatment, and prevention of heart failure (HF) are the incorporated measure of biomarkers, predominantly natriuretic peptides (NP), cardiac troponins, soluble ST2 (sST2), and galectin-3, all of which serve as surrogate diagnostic and predictive factors. Whether levels of these biomarkers, measured in a longitudinal manner in HF patients, retain their prognostic power over a course of HF therapy and support continuation of these treatments is not fully understood. The aim of this review is to summarise knowledge regarding the use of single and serial measures of cardiac, biological markers as a surrogate endpoint to predict HF-related clinical events. Cardiac biomarkers, predominantly N-terminal segment of brain natriuretic peptide (NT-proBNP) and sST2, are surrogate biomarkers for numerous clinical studies that have assumed a pivotal role in multiple biomarker strategies preceding HF-related outcomes. It has been suggested that biomarker-guided therapy with serial biomarker measures could be a powerful means to appraise composite risk score and predict HF-related outcomes based on therapeutic adjustment. In the future, large controlled clinical trials should be better designed for justification of an individualised strategy for HF therapy.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116640308","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}

{"title":"Management of Atrial Fibrillation in Europe: Current Care Pathways and the Clinical Impact of Antiarrhythmic Drugs and Catheter Ablation","authors":"M. Velleca, G. Costa, L. Goldstein, M. Bishara, Lee Ming Boo, Qun Sha","doi":"10.33590/emjcardiol/10310415","DOIUrl":"https://doi.org/10.33590/emjcardiol/10310415","url":null,"abstract":"Atrial fibrillation (AF), the most common form of arrhythmia, increases the risk of heart failure, stroke, and death. Management of AF focusses on effectively and safely controlling irregular heart rhythm, improving symptoms, and reducing complications. Early treatment of AF is important as it may improve patient life expectancy and quality of life (QoL). Current European guidelines recommend an integrated approach to AF management that involves shared decision making between patients and multidisciplinary teams of healthcare professionals to improve access to care and patient compliance. Treatment options include the use of anticoagulants, cardioversion, rate control therapies, and rhythm control therapies. Over the long term, rhythm control strategies that include antiarrhythmic drugs (AAD) and catheter ablation are the most common methods for controlling AF. The objective of this review is to highlight current European AF care pathway management recommendations and to examine the clinical, economic, and patient impact of different treatment options, including AAD and catheter ablation. While AAD have been shown to improve QoL and are affordable in the short term, treatment is moderately effective, associated with significant side effects, and can be costly long term. Catheter ablation is a highly effective therapy choice that improves patient wellbeing and is associated with a low rate of ablation-related complications. Compared to drug therapy, catheter ablation provides a significant reduction in AF burden, reduces rates of recurrence, provides a greater improvement in QoL, and facilitates long-term cost savings.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128548943","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}

{"title":"Icosapent Ethyl for the Prevention of Cardiovascular Events","authors":"J. Lloyd","doi":"10.33590/emjcardiol/10311840","DOIUrl":"https://doi.org/10.33590/emjcardiol/10311840","url":null,"abstract":"Prof Nordestgaard said that genetic studies have shown that elevated triglyceride-rich lipoproteins can lead to atherosclerosis and inflammation, which can lead to myocardial infarction (MI). Genetic studies have also shown that lower triglyceride levels are associated with lower cardiovascular risk. Dr Bhatt then said that although low-dose omega-3 fatty acids (1 g/day) are ineffective for preventing heart disease, higher doses (1.8 g/day) have been shown to reduce coronary plaque and the risk of coronary events. He then described the recently published REDUCE-IT trial, which randomised ~8,000 statin-treated patients with elevated triglycerides (1.52–5.63 mmol/L) to icosapent ethyl 4 g/day or placebo. Those randomised to icosapent ethyl had significant reductions in triglyceride levels and cardiovascular events. American and European guidelines have now recognised that omega-3 fatty acids 4 g/day can be beneficial for the management of hypertriglyceridaemia and that icosapent ethyl, in particular, lowers the rate of cardiovascular outcomes. Dr Gitt presented data showing how many patients from DYSIS, a cross-sectional, observational study of lipid goal achievement among statin-treated patients, could benefit from icosapent ethyl. Among >60,000 patients in DYSIS, 72% were at very high cardiovascular risk, and 48% of these had triglycerides >1.52 mmol/L and could therefore potentially benefit from icosapent ethyl. Finally, Dr Konishi presented imaging data showing that eicosapentaenoic acid (EPA), of which icosapent ethyl is a purified ester, is associated with decreased plaque instability. This could help to explain how icosapent ethyl reduces cardiovascular risk.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129122773","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}

{"title":"A Review of the Burden of Atrial Fibrillation: Understanding the Impact of the New Millennium Epidemic across Europe","authors":"M. Velleca, G. Costa, L. Goldstein, M. Bishara, Lee Ming Boo","doi":"10.33590/emjcardiol/10310292","DOIUrl":"https://doi.org/10.33590/emjcardiol/10310292","url":null,"abstract":"Atrial fibrillation (AF), the most common form of arrhythmia, is fast becoming one of the world’s most significant health issues. It is well established that AF increases the risk of mortality, and is associated with significant morbidity, including an increased risk of stroke. AF also worsens quality of life for patients, which can also be a burden for caregivers. As a result of Europe’s ageing population, the prevalence of AF is expected to rise substantially in the future. With more patients expected to be affected by AF, rates for AF-related strokes, hospitalisations, and doctor visits are also expected to rise, ultimately raising healthcare system costs across Europe. It is estimated that up to 2.6% of total annual healthcare expenditure is associated with AF in European countries. The high cost of AF is largely attributable to hospitalisations and complications such as stroke, i.e., in 2015, stroke was estimated to cost €45 billion a year in the European Union (EU). The purpose of this review is to highlight the current scale and growing burden of this new millennium epidemic in Europe. This review aims to foster a greater awareness and understanding of the magnitude of the clinical, patient, and economic burden of AF. An understanding of the burden of AF is imperative for directing care pathway management and healthcare policies that can help alleviate the burden of AF experienced by patients, caregivers, and healthcare systems in Europe.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130285458","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}

{"title":"Chemokines: A Potential Therapeutic Target for the Stabilisation of Vulnerable Plaque","authors":"B. Tucker, S. Patel","doi":"10.33590/emjcardiol/10311650","DOIUrl":"https://doi.org/10.33590/emjcardiol/10311650","url":null,"abstract":"The introduction of lipid lowering medications was initially thought to provide a solution to the growing burden of coronary heart disease. However, 30 years later, the rates of acute coronary syndrome remain unacceptably high. This realisation forced cardiovascular scientists to look beyond lipids and led to the now widely accepted understanding of atherosclerosis pathobiology: immune-facilitated lipid retention with focal and generalised chronic inflammation. A fundamental component of this inflammatory process is chemokines: a class of cytokines characterised by their ability to facilitate cell recruitment, although it is now known that their function extends beyond chemotaxis. Mounting evidence suggests that chemokines are essential for the destabilisation and subsequent rupture of atherosclerotic plaque. Therefore, chemokine pathways provide a novel therapeutic target for plaque stabilisation. This review addresses the role of chemokines in regulating plaque vulnerability and discusses therapeutic approaches targeted at manipulating chemokine pathways.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126627273","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}

{"title":"A Clinical Review of Ventricular Arrhythmias in Patients with Congestive Heart Failure","authors":"N. Boyle","doi":"10.33590/emjcardiol/18-00058r1","DOIUrl":"https://doi.org/10.33590/emjcardiol/18-00058r1","url":null,"abstract":"Heart failure is an increasingly prevalent condition, which is associated with ventricular arrhythmias. The reduction in cardiac pumping efficiency leads to the activation of several compensatory mechanisms. These mechanisms eventually lead to cardiac remodelling and a decline in haemodynamic status, contributing to the formation of a substrate conducive to arrhythmias, including increased automaticity, triggered activity, and, most commonly, re-entry circuits. In turn, ventricular arrhythmias can lead to the worsening of heart failure. A diagnosis of heart failure and ventricular arrhythmias is obtained using the patient’s history, examination findings, and investigation results. A key tool in this is echocardiogram imaging, which visualises the cardiac chambers, determines ventricular ejection fraction, and identifies structural abnormalities. A reduction in ejection fraction is a significant risk factor for the development of ventricular arrhythmias. Arrhythmias are diagnosed by ECG, Holter monitoring, and telemetry or event monitoring, and should initially be treated by optimising the medical management of heart failure. Anti-arrhythmic drugs, including beta-blockers, are usually the first-line therapy. Sudden cardiac death is a significant cause of mortality in heart failure patients, and implantable cardioverter defibrillator devices are used in both primary and secondary prevention. Anti-arrhythmic drugs and catheter ablation are important adjunctives for minimising shock therapy. In addition, autonomic modulation may offer a novel method of controlling ventricular arrhythmias. The objective of this review is to provide a practical overview of this rapidly developing field in relation to current evidence regarding the underlying pathophysiology, burden of disease, and management strategies available.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124012078","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}

{"title":"Guidelines, Clinical Evidence, and Real-Life Practice: How to Find Your Way in Managing Hypercholesterolaemia","authors":"J. Fricker","doi":"10.33590/emjcardiol/10314733","DOIUrl":"https://doi.org/10.33590/emjcardiol/10314733","url":null,"abstract":"Prof Masana presented evidence that low-density lipoprotein (LDL) cholesterol is a causal factor for atherosclerosis and that cardiovascular disease (CVD)-relative risk (RR) is reduced proportionally to LDL reductions, regardless of the type of monotherapy used. Combination therapy offers the advantage of increased lipid-lowering efficacy and a reduction in the side effects associated with high-intensity statins. The rationale thus exists for replacing high-intensity statin therapy with high-intensity cholesterol-lowering therapy.\u0000\u0000Prof Farnier gave an in-depth description of the results of the IMPROVE-IT, FOURIER, and ODYSSEY-Outcomes trials, demonstrating that the magnitude of clinical benefit is independent of whether it is achieved by statins, ezetimibe, or PCSK9 inhibitors. The IMPROVE-IT study also showed that the magnitude of benefit is proportionate to the absolute decrease in LDL cholesterol. This is consistent with the conclusions of a meta-analysis of randomised controlled statin trials, showing that patients achieving very low LDL cholesterol levels have a reduced risk of major cardiovascular (CV) events compared with those achieving moderately low levels. The greatest benefits for reductions in major adverse CV events from lowering LDL cholesterol occur in patients with diabetes.\u0000\u0000The above studies have led the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) taskforce on PCSK9 inhibitors to outline a strategy for additional treatment, with patients on maximally-tolerated statin doses failing to achieve LDL cholesterol goals at 4 weeks being considered for ezetimibe treatment, and those failing to achieve goals after a further 4 weeks being considered for PCSK9 inhibitors.\u0000\u0000Votes from the audience, collected at the start and end of each presentation, showed that the speakers convinced delegates that the lower the LDL cholesterol level achieved the better the outcome for patients would be, that combination therapy is as effective as single dose high-intensity statins, and that statins plus ezetimibe should be considered as standard treatment in high-risk patients, particularly in Type II diabetes mellitus (T2DM) patients.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121422971","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}

{"title":"Contemporary Use of Intracoronary Imaging in Percutaneous Coronary Intervention","authors":"M. E. Li Kam Wa, R. Gerber","doi":"10.33590/emjcardiol/10313845","DOIUrl":"https://doi.org/10.33590/emjcardiol/10313845","url":null,"abstract":"Since the first balloon angioplasty in 1977, remarkable advances in catheter-based technology have been achieved with the use of stents and intracoronary devices. However, despite these developments, visual assessment of a 2-dimensional lumenogram of the coronary vessels remains the predominant method of assessing coronary disease and guiding angioplasty worldwide. It is an enigma that there is still such a low uptake in the use of intravascular imaging, whether in the form of intravascular ultrasound (IVUS) or optical coherence tomography (OCT), with both techniques providing cross-sectional imaging of the coronary vessels with a resolution at the microscopic scale. The intracoronary imaging community tends to focus on the academic aspects of IVUS and OCT, often highlighting the evidence-based benefits in lesion subsets, such as left main stem or bifurcation percutaneous coronary intervention. However, this does not impart crucial practical-related aspects pertaining to IVUS or OCT, which can improve outcomes and achieve optimal results for operators and patients. Here, the authors present a case-based approach to IVUS and OCT use in contemporary clinical practice, with the hope of providing useful, practical insights for the busy interventionalist and prompting the consideration of intracoronary imaging catheters as an essential part of their percutaneous coronary intervention toolbox.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132681359","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}