EMJ CardiologyPub Date : 2017-10-12DOI: 10.33590/emjcardiol/10311110
S. Goel, Shiv Raj, Abhishek Sharma, U. Gidwani, R. Frankel, J. Shani
{"title":"Bioresorbable Coronary Scaffolds: Current State of Evidence","authors":"S. Goel, Shiv Raj, Abhishek Sharma, U. Gidwani, R. Frankel, J. Shani","doi":"10.33590/emjcardiol/10311110","DOIUrl":"https://doi.org/10.33590/emjcardiol/10311110","url":null,"abstract":"Second-generation drug-eluting stents are currently considered the standard of care in patients undergoing treatment for coronary artery disease with percutaneous coronary intervention. Despite significant improvements in stenting technology and stent material over the past three decades, the concern that a permanent metallic prosthesis within the coronary vasculature can serve as a trigger for stent-related adverse events, mainly stent thrombosis and in-stent restenosis, still persists. In order to overcome the disadvantages of drug-eluting stents there has been a robust development in the field of bioresorbable coronary scaffolds (BRS). These devices aim to provide temporary scaffolding to restore vessel patency and, after serving its purpose, fully degrade and thus allow restoration of vasomotion along with luminal enlargement. The initial experience with bioresorbable scaffolds in low-risk patients presenting with simple lesions was satisfying and generated optimism among interventional cardiologists by promising better patient outcomes. However, the unrestricted use of these devices in patients presenting with a higher baseline risk and more complex lesions came at the cost of alarmingly high rates of adverse cardiac events, especially the late device thrombosis. Although its non-inferiority compared to metallic everolimus-eluting stents was formally met in the clinical trials, there was a clear trend towards an increased occurrence of myocardial infarction and device thrombosis during the first year after device implantation, which persisted even at long-term follow-up raising concern on the future of BRS. This review article discusses the development, design, clinical data, and future directions in the field of BRS.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130185773","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}
EMJ CardiologyPub Date : 2017-10-12DOI: 10.33590/emjcardiol/10313817
K. Luyten, Matthias Schoenberger
{"title":"Molecular Imaging of Cardiac Metabolism, Innervation, and Conduction","authors":"K. Luyten, Matthias Schoenberger","doi":"10.33590/emjcardiol/10313817","DOIUrl":"https://doi.org/10.33590/emjcardiol/10313817","url":null,"abstract":"Cardiac diseases have complex molecular origins. However, current clinical diagnostic tools are often inadequate to uncover specific molecular components of cardiac pathologies. Thus, we are still lacking a detailed understanding of disease progression, and both patient diagnosis and treatment are often inaccurate. Molecular imaging could play a leading role in translating basic research to both preclinical and clinical cardiac research, ultimately improving our understanding and management of human disease. In this review, we highlight the diversity of current molecular imaging tools that have been used in clinical research or have reached the stage of clinical translation. Facilitated by the steadily increasing infrastructure of clinical positron emission tomography and positron emission tomography-magnetic resonance imaging cameras and advancing gating analysis, these tools allow the implementation of clinical cardiac molecular imaging trials to deepen our knowledge of human disease and improve patient care.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"105 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132934121","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}
EMJ CardiologyPub Date : 2017-10-12DOI: 10.33590/emjcardiol/10314768
Héctor O. Rodríguez
{"title":"Arrhythmogenic Cardiomyopathy: Genetic Pathology, Inflammatory Syndrome, or both?","authors":"Héctor O. Rodríguez","doi":"10.33590/emjcardiol/10314768","DOIUrl":"https://doi.org/10.33590/emjcardiol/10314768","url":null,"abstract":"Arrhythmogenic cardiomyopathy (ACM) affects mainly young athletes <35 years old and has a potential risk of malignant arrhythmias and sudden death. Different post-mortem and clinical studies have been conducted in North America, Asia, and Europe, with sharp differences in incidence and sex-associated pattern. Alterations in desmosome proteins, such as desmoglein, plakophilin, ion channels, or intracellular calcium handling proteins, have been highlighted as the principal cause of ACM, but the pathology has shown more complexity than initially described. This short review summarises the principal and more recent findings about ACM, mainly those related to inflammatory phenomena reported in the literature. Viral infections, especially enterovirus, have been associated with ACM and may be implicated in myocardial apoptosis, structural cardiac changes, and sudden death. Bartonella henselae and Sarcocystis infection have additionally been reported in ACM patients. Information regarding the role of proinflammatory cytokine or T cell infiltration and their possible role in sudden death is scarce, with increasing evidence of proinflammatory infiltrate associated with fibro-fatty ventricular patches related to biventricular affectation and worse outcomes. Nevertheless, findings taken from other sudden death-causing cardiomyopathies, such as viral myocarditis and Chagas disease, allow us to propose proinflammatory cytokines, such as tumour necrosis factor and interleukins 17 and 2, as possible serological markers of sudden death and/or ventricular dysfunction in order to conduct further research and identify diagnosis/prognosis markers for ACM.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127978950","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}
EMJ CardiologyPub Date : 2016-11-08DOI: 10.33590/emjcardiol/10314431
Katherine Sutherland
{"title":"Blood Pressure Control: A Marathon or a Sprint?","authors":"Katherine Sutherland","doi":"10.33590/emjcardiol/10314431","DOIUrl":"https://doi.org/10.33590/emjcardiol/10314431","url":null,"abstract":"This symposium discussed several recent initiatives used around the world to improve the management of hypertensive patients and achieve better blood pressure (BP) control. The key objectives of the symposium were to review the current position with regards to BP control in Europe, to discuss the initiatives used in Italy, France, and Canada to improve hypertension management and their outcomes, and to assess how single-pill fixed-dose combinations of antihypertensive drugs have improved adherence. Some of the key barriers to BP control were discussed and measures to overcome these presented, so that further improvements in hypertension management can be achieved going forward.\u0000\u0000Prof Anthony Heagerty opened the meeting by discussing the key causes of suboptimal BP control and the results of the SPRINT study. Prof Massimo Volpe presented the initiative to achieve 70% BP control and assessed its success to date in Italy. Prof Jean-Jacques Mourad discussed the results of the PAssAGE 2014 study and French League Against Hypertension Survey (FLAHS) in 2015, following the initiative to achieve 70% BP control in France by the end of 2015. Prof Raj Padwal presented the Canadian hypertension Education Program (CHEP) and the improvements in the management of hypertensive patients in Canada. Finally, Dr Julian Segura bought the meeting to a close by discussing how fixed-dose combinations have improved adherence in clinical practice.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129426798","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}
EMJ CardiologyPub Date : 2016-10-13DOI: 10.33590/emjcardiol/10312401
Ozan M. Demir, J. Hudson, W. Wallis
{"title":"Current Concepts in Coronary Artery Spasm","authors":"Ozan M. Demir, J. Hudson, W. Wallis","doi":"10.33590/emjcardiol/10312401","DOIUrl":"https://doi.org/10.33590/emjcardiol/10312401","url":null,"abstract":"Coronary artery spasm is an abnormality of coronary vascular smooth muscle contraction that is associated with significant morbidity and mortality. The underlying pathophysiological process has remained unclear since Myron Prinzmetal described it in 1959. This article reviews current literature of the pathogenesis and outlines clinical features, diagnosis, and treatment options.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115117794","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}
EMJ CardiologyPub Date : 2016-10-13DOI: 10.33590/emjcardiol/10314225
G. Sathananthan, B. Lowe, T. Hornung
{"title":"The Fontan Circulation","authors":"G. Sathananthan, B. Lowe, T. Hornung","doi":"10.33590/emjcardiol/10314225","DOIUrl":"https://doi.org/10.33590/emjcardiol/10314225","url":null,"abstract":"The original Fontan procedure was first introduced in the 1970s. The concept behind this surgical technique was revolutionary. It has subsequently transformed the lives of children born with complex congenital heart disease which was once thought to be inoperable and resulted in early death. The procedure itself has had several modifications over the decades, with subsequent improvements in long-term outcomes for these patients. Fontan patients are now surviving well into adulthood and the majority are able to live wholesome fulfilling lives. There are, however, a small proportion who are faced with the negative long-term physiological effects of this unconventional circulation. Early detection and management of these patients is the key to their long-term survival.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130826768","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}
EMJ CardiologyPub Date : 2016-10-13DOI: 10.33590/emjcardiol/10314127
Udaya Prashant Ponangi
{"title":"Recurrent Coronary Perforations in an Aneurysmal Coronary Artery Treated with Covered Stent","authors":"Udaya Prashant Ponangi","doi":"10.33590/emjcardiol/10314127","DOIUrl":"https://doi.org/10.33590/emjcardiol/10314127","url":null,"abstract":"An elderly hypertensive lady presented to us with acute coronary syndrome; an angiogram revealed total thrombotic occlusion of large left circumflex artery. After thrombosuction, there was proximal tight stenosis followed by an aneurysmal segment of the culprit vessel that was stented successfully. Subsequent post-dilatation at the site of aneurysm produced a large perforation, which was sealed off immediately with a covered stent. Unfortunately, the patient had sudden cardiac tamponade and arrest later in the intensive cardiac care unit due to repeat perforation, and could not be resuscitated from this complication. Aneurysmal and ectatic arteries have fragile walls and aggressive post-dilatation for achieving optimal stent apposition should be avoided.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128824151","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}
EMJ CardiologyPub Date : 2016-10-13DOI: 10.33590/emjcardiol/10312462
Hack‐Lyoung Kim
{"title":"Arterial Stiffness and Coronary Artery Disease","authors":"Hack‐Lyoung Kim","doi":"10.33590/emjcardiol/10312462","DOIUrl":"https://doi.org/10.33590/emjcardiol/10312462","url":null,"abstract":"Although there have been marked improvements in both diagnostic and therapeutic interventions over several decades, coronary artery disease (CAD) remains the leading cause of death worldwide. Intensive modification of classic risk factors such as hypertension, diabetes mellitus, dyslipidaemia, and cigarette smoking has significantly reduced the development of CAD. The high prevalence of residual cardiovascular events does however require improvements in identification and risk stratification strategies. In this context, arterial stiffness, which reflects arterial ageing, damage, and arteriosclerosis has emerged as an important risk factor for cardiovascular disease. The measurements of arterial stiffness are easy to make using several non-invasive methods such as pulse wave velocity. The clinical utility of the measures has been validated in many prior studies. Recent evidence has suggested that the measures of arterial stiffness are correlated with the presence and extent of CAD. More importantly, increased arterial stiffness is an independent predictor of CAD-related morbidity and mortality beyond classic risk factors. Considering its non-invasiveness, simplicity, and reliability, arterial stiffness could serve as a useful marker of CAD and help identify high-risk patients who may benefit from more aggressive management.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116044460","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}
EMJ CardiologyPub Date : 2016-10-13DOI: 10.33590/emjcardiol/10313053
R. Casalino, Leonardo Jorge Cordeiro de Paula, Eduardo Bello Martins, F. Tarasoutch
{"title":"Valvular Heart Disease and Risk Score Systems in Clinical Practice","authors":"R. Casalino, Leonardo Jorge Cordeiro de Paula, Eduardo Bello Martins, F. Tarasoutch","doi":"10.33590/emjcardiol/10313053","DOIUrl":"https://doi.org/10.33590/emjcardiol/10313053","url":null,"abstract":"Heart valve disease is a very common medical condition; the most frequent aetiology is degenerative valve disease, mainly represented by calcific aortic stenosis in the elderly. In developing countries, valvular heart disease triggered by rheumatic fever is the most important aetiology and can lead to a heterogeneous heart valve disease, mainly represented by mitral stenosis in young female patients. The need for heart valve surgery is common in this context and preoperative risk stratification is essential in making surgical decisions. To evaluate the preoperative risk of these valve heart disease patients, risk scores have been created to assess the surgical morbidity and mortality.\u0000\u0000In this article, we aim to discuss the current risk score systems, and the applicability and effectiveness of these systems in specific populations of heart valve disease taking into account the epidemiological characteristics of the studied populations.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"18 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131637821","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}
EMJ CardiologyPub Date : 2016-10-13DOI: 10.33590/emjcardiol/10312254
T. Mughal
{"title":"Interpreting Findings with Non-Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation: Collective Views on Data from Seminal Studies to Present in Clinical Practice","authors":"T. Mughal","doi":"10.33590/emjcardiol/10312254","DOIUrl":"https://doi.org/10.33590/emjcardiol/10312254","url":null,"abstract":"Clinical trials show that non-vitamin K antagonist oral anticoagulants (NOACs) have good efficacy-safety profiles relative to warfarin across a broad spectrum of patients with non-valvular atrial fibrillation (NVAF). These findings are currently being confirmed for rivaroxaban through real-world evidence, with results from these studies consistent with results from Phase III randomised controlled trials (RCTs). Of all the NOACs, rivaroxaban currently has the most extensive real-world experience across different data sources (prospective and retrospective registries, database analyses, and prospective studies). Anticoagulant-related bleeding is still a concern amongst clinicians, however awareness of patient characteristics and other factors that can increase bleeding risk can assist in the proactive and effective management of bleeding episodes. Particularly, in atrial fibrillation (AF) patients with renal impairment who have an incrementally higher risk of bleeding and stroke, administration of NOACs versus vitamin K antagonists (VKAs) is beneficial. When dosed appropriately, NOACs such as rivaroxaban are effective in patients with renal impairment and offer an alternative to warfarin, with increased efficacy and decreased risk of critical bleeding events.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129699185","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}
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