{"title":"How was myocardial ischemia promoted from disease to syndrome?","authors":"","doi":"10.31887/hm.2020.81/mmarzilli2","DOIUrl":"https://doi.org/10.31887/hm.2020.81/mmarzilli2","url":null,"abstract":"The understanding of myocardial ischemia has dramatically changed in recent years. From a concept entirely focused on coronary atherosclerotic obstructions, we are moving to a complex, dynamic, multifactorial model. The clinical translation of this new model necessitates major changes in diagnostic and therapeutic strategies in order to identify the responsible mechanisms and to tailor therapy.","PeriodicalId":35477,"journal":{"name":"Heart and Metabolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84461196","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":"PCI is a long-lasting solution for abolishing angina. Or maybe not?","authors":"","doi":"10.31887/hm.2020.81/ldeluca","DOIUrl":"https://doi.org/10.31887/hm.2020.81/ldeluca","url":null,"abstract":"We describe a case of a 62-year-old man with no previous history of cardiovascular diseases presenting with typical chest pain. The patient was referred for coronary angiography, which revealed the presence of\u0000single-vessel coronary artery disease. After intracoronary stent implantation, the patient experienced recurrent\u0000episodes of angina followed by further revascularizations that did not clear up his symptoms.","PeriodicalId":35477,"journal":{"name":"Heart and Metabolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87060621","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":"Myocardial Ischemia: From Disease to Syndrome","authors":"","doi":"10.31887/hm.2020.81","DOIUrl":"https://doi.org/10.31887/hm.2020.81","url":null,"abstract":"","PeriodicalId":35477,"journal":{"name":"Heart and Metabolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84182491","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":"Is ischemia a disease or syndrome, the cause of angina, and now even a trial?","authors":"","doi":"10.31887/hm.2020.81/wboden","DOIUrl":"https://doi.org/10.31887/hm.2020.81/wboden","url":null,"abstract":"The clinical manifestations of myocardial ischemia are protean in nature and include a variable combination of typical or atypical angina symptoms, electrocardiographic changes, noninvasive findings of regional\u0000wall motion abnormalities, and reversible scintigraphic perfusion defects—the changes of which, importantly, may\u0000or may not be of epicardial coronary origin. Thus, mounting evidence indicates that the presence or absence of\u0000atherosclerotic coronary artery disease (CAD) should no longer be considered a surrogate marker for myocardial\u0000ischemia, as suggested by the high prevalence of minor or absent coronary obstruction among patients with\u0000proven myocardial ischemia. Whereas the management of CAD has been largely predicated on the plausible\u0000assumption that flow-limiting obstructions of the epicardial coronary arteries are the proximate cause of both\u0000angina and myocardial ischemia, there is scant evidence from many randomized trials and several meta-analyses\u0000that treating epicardial coronary obstructions in patients with stable CAD, particularly with percutaneous coronary\u0000intervention (PCI), reduces mortality and morbidity, as compared with optimal medical therapy (OMT). A crucial\u0000scientific question for which evidence has been lacking is whether more severe and extensive myocardial ischemia\u0000is the driver of adverse cardiovascular outcomes and whether an invasive strategy with myocardial revascularization would be superior to OMT alone in such patients. The results of the recent ISCHEMIA trial (International Study\u0000of Comparative Health Effectiveness with Medical and Invasive Approaches), however, have failed to show—even\u0000in this higher-risk CAD subset—any incremental clinical benefit of revascularization as compared with OMT alone\u0000on cardiac event reduction.","PeriodicalId":35477,"journal":{"name":"Heart and Metabolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86712723","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":"What dictates prognosis in myocardial ischemic syndromes: myocardial ischemia or coronary atherosclerosis?","authors":"","doi":"10.31887/hm.2020.81/rdecaterina","DOIUrl":"https://doi.org/10.31887/hm.2020.81/rdecaterina","url":null,"abstract":"Myocardial ischemic syndromes are the main cause of death worldwide, with a rising incidence in\u0000developing countries. But why and how people with myocardial ischemic syndromes die or suffer major adverse\u0000cardiovascular events, namely myocardial infarction and sudden cardiac death, is still an incompletely resolved\u0000question. The intricacy of the issue arises at least somewhat from the relationship between angina pectoris, coronary atherosclerosis, and transient myocardial ischemia on the one hand and subsequent myocardial infarction,\u0000ischemic heart failure, and death on the other; a cause-effect relationship is not necessarily implied. The question\u0000has important prognostic and therapeutic implications because a proper identification of causes and mechanisms\u0000allows us to optimize the workup of patients and the therapeutic targets. Studies of conditions of myocardial\u0000infarction with normal coronary arteries (MINOCA) and angina with normal coronary arteries can be instrumental\u0000to resolving some of these unknowns. Such analyses convey the concept that coronary atherosclerosis, even\u0000when subclinical and usually considered prognostically irrelevant, has, conversely, important adverse prognostic\u0000implications. They also highlight, however, an important role for myocardial ischemia, which—when appropriately\u0000detected—alters prognosis unfavorably on top of coronary atherosclerosis. L","PeriodicalId":35477,"journal":{"name":"Heart and Metabolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77824148","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":"Clinical detection of myocardial ischemia","authors":"","doi":"10.31887/hm.2020.81/glanza","DOIUrl":"https://doi.org/10.31887/hm.2020.81/glanza","url":null,"abstract":"Myocardial ischemia involves several pathophysiologic mechanisms. To assess suspected myocardial\u0000ischemia in relation to obstructive coronary artery disease (CAD)—the most frequent case—the reference test\u0000would be an electrocardiogram (ECG) exercise stress test; in the event of inconclusive results, an imaging (either\u0000radionuclide or echocardiographic) stress test can be indicated. Pharmacologic stress tests with imaging are\u0000indicated in patients unable to exercise. The same tests can be applied in patients with suspected microvascular\u0000angina; in such patients, a diagnostic clue would be induced angina and ECG changes in the absence of regional\u0000wall motion abnormalities on echocardiographic stress testing. Spasm provocation tests using either acetylcholine\u0000or ergonovine might be necessary to detect myocardial ischemia in patients in whom this is caused by coronary\u0000epicardial, or even microvascular, spasm. ECG Holter monitoring can be helpful to identify and characterize myocardial ischemic episodes that occur during daily life.","PeriodicalId":35477,"journal":{"name":"Heart and Metabolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72616271","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":"Epicardial coronary stenosis severity and myocardial perfusion","authors":"","doi":"10.31887/hm.2020.81/dperera","DOIUrl":"https://doi.org/10.31887/hm.2020.81/dperera","url":null,"abstract":"Patients suspected of having epicardial coronary disease are often investigated with noninvasive\u0000myocardial ischemia tests to establish a diagnosis and guide management. However, the relationship between\u0000myocardial ischemia and coronary stenoses is affected by multiple factors, and there is marked biological variation between patients. The ischemic cascade represents the temporal sequence of pathophysiological events\u0000that occur after interruption of myocardial oxygen delivery. The earliest part of the cascade is examined via perfusion imaging, and fractional flow reserve (FFR) is a corresponding index which is specific to the coronary artery.\u0000Whereas FFR has come to be regarded a clinical reference standard against which other newer invasive and\u0000noninvasive tests are validated, the diagnostic FFR threshold for detecting ischemia was established against a\u0000combination of noninvasive ischemia tests that assessed different stages of the ischemic cascade. Moreover, the\u0000validity of invasive pressure-derived indices of stenosis severity are contingent on the assumption that pressure is\u0000proportional to flow if microvascular resistance is constant, a condition induced by pharmacological intervention\u0000or by examining specific segments of the cardiac cycle. Furthermore, myocardial perfusion reserve depends on\u0000dynamic modulation of microvascular resistance, and dysfunction of the microvasculature can lead to ischemia\u0000even in the absence of epicardial coronary disease.","PeriodicalId":35477,"journal":{"name":"Heart and Metabolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84281471","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":"Avoiding big data pitfalls.","authors":"Pablo Lamata","doi":"10.31887/hm.2020.82/plamata","DOIUrl":"10.31887/hm.2020.82/plamata","url":null,"abstract":"<p><p>Clinical decisions are based on a combination of inductive inference built on experience (ie, statistical models) and on deductions provided by our understanding of the workings of the cardiovascular system (ie, mechanistic models). In a similar way, computers can be used to discover new hidden patterns in the (big) data and to make predictions based on our knowledge of physiology or physics. Surprisingly, unlike humans through history, computers seldom combine inductive and deductive processes. An explosion of expectations surrounds the computer's inductive method, fueled by the \"big data\" and popular trends. This article reviews the risks and potential pitfalls of this computer approach, where the lack of generality, selection or confounding biases, overfitting, or spurious correlations are among the commonplace flaws. Recommendations to reduce these risks include an examination of data through the lens of causality, the careful choice and description of statistical techniques, and an open research culture with transparency. Finally, the synergy between mechanistic and statistical models (ie, the digital twin) is discussed as a promising pathway toward precision cardiology that mimics the human experience.</p>","PeriodicalId":35477,"journal":{"name":"Heart and Metabolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610672/pdf/EMS122730.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38839827","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":"Diabetes and heart failure – a challenging combination","authors":"M. Marzilli","doi":"10.31887/hm.2019.80/dhausenloy","DOIUrl":"https://doi.org/10.31887/hm.2019.80/dhausenloy","url":null,"abstract":"","PeriodicalId":35477,"journal":{"name":"Heart and Metabolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83155790","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":"Mechanisms underlying heart failure in type 2 diabetes mellitus","authors":"J. Gollmer","doi":"10.31887/hm.2019.80/hbugger","DOIUrl":"https://doi.org/10.31887/hm.2019.80/hbugger","url":null,"abstract":"The prevalence of heart failure is markedly increased in individuals with diabetes mellitus. Numerous observational studies suggest that this increased risk for heart failure can be attributed to exacerbated vascular complications and the presence of increased risk factors in diabetic subjects. In addition, experimental studies revealed the presence of a number of distinct molecular alterations in the myocardium that occur independently of vascular disease and hypertension. Many of these molecular alterations are similarly observed in failing hearts of nondiabetic patients and have thus been proposed to contribute to the increased risk for heart failure in diabetes. The interest in understanding the underlying mechanisms of impaired cardio- vascular outcomes in diabetic individuals has much increased since the demonstration of cardioprotective effects of SGLT-2 inhibitors and GLP-1 receptor agonists in recent clinical trials. The current review therefore summarizes the distinct mechanisms that have been proposed to increase the risk for heart failure in diabetes mellitus.","PeriodicalId":35477,"journal":{"name":"Heart and Metabolism","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87306033","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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