Current Opinion in Cardiology最新文献_第10页

Improving diversity in cardiac surgery clinical trials with ROMA:Women as an exemplar. 以 ROMA:Women 为典范，提高心脏外科临床试验的多样性。

IF 2 4区医学

Current Opinion in Cardiology Pub Date : 2024-09-01 Epub Date: 2024-06-25 DOI: 10.1097/HCO.0000000000001162

Ruth Masterson Creber, Sarah Eslami, Mario Gaudino

{"title":"Improving diversity in cardiac surgery clinical trials with ROMA:Women as an exemplar.","authors":"Ruth Masterson Creber, Sarah Eslami, Mario Gaudino","doi":"10.1097/HCO.0000000000001162","DOIUrl":"10.1097/HCO.0000000000001162","url":null,"abstract":"Purpose of review: To describe methods to improve representation of women in cardiac surgery clinical trials.Recent findings: Cardiovascular disease risk among women is high. Historically, women have been excluded from cardiac surgery trials, in part due to restrictive inclusion criteria. Surgical outcomes, specifically after coronary artery bypass grafting, are consistently worse among female patients, and these outcomes have not improved over the last decade. Addressing treatment effects and clinical benefit among women requires accurate representation in cardiovascular surgery trials. ROMA:Women, is the first cardiac surgery trial to focus solely on women, with the goal of addressing underrepresentation. Through utilizing specific strategies, ROMA:Women is a promising first step in advancing health equity.Summary: Strategies to ensure effective recruitment and representation among women in cardiac surgery clinical trials, such as tailored eligibility criteria and comprehensive strategies to improve communication and increase trust, are two of many potential approaches to address the structural barriers to female representation in cardiac surgery clinical trials. To date, ROMA:Women is an example of a trial that has shown extraordinary preliminary success enrolling women. Designing trials exclusively for women is one strategy to improve the diversity of clinical trial participation.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"426-430"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12071190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Expanding revascularization trials to women and underserved minorities and shifting to patient-centered outcomes: RECHARGE trials program. 将血管重建试验扩大到妇女和服务不足的少数民族，并转向以患者为中心的结果：RECHARGE 试验计划。

IF 2.3 4区医学

Current Opinion in Cardiology Pub Date : 2024-08-20 DOI: 10.1097/hco.0000000000001177

Bjorn Redfors,John A Spertus,Clyde Yancy,Ruth Masterson-Creber,Gregg W Stone,Mario F L Gaudino

{"title":"Expanding revascularization trials to women and underserved minorities and shifting to patient-centered outcomes: RECHARGE trials program.","authors":"Bjorn Redfors,John A Spertus,Clyde Yancy,Ruth Masterson-Creber,Gregg W Stone,Mario F L Gaudino","doi":"10.1097/hco.0000000000001177","DOIUrl":"https://doi.org/10.1097/hco.0000000000001177","url":null,"abstract":"PURPOSE OF REVIEWWe review the limited available evidence informing coronary revascularization decisions in women and minorities, and introduce the RECHARGE trial program, which consists of two separate but integrated parallel multicenter, randomized trials comparing coronary artery bypass grafting (CABG) to percutaneous coronary intervention (PCI), one exclusively enrolling women (RECHARGE:Women) and one exclusively enrolling Black or Hispanic patients (RECHARGE:Minorities).RECENT FINDINGSThe extensive evidence base supporting coronary revascularization suffers from under-representation of women, minorities and minoritized populations, and the use of heterogeneous primary composite outcomes whose components have varying strengths of association with prognosis and quality-of-life (QOL). In RECHARGE, participants will be followed for up to 10 years, with QOL assessments at baseline, 30 days, 3 months, every 6 months for 3 years, and annually thereafter. The primary endpoint is the hierarchical composite of time to all-cause mortality, time-averaged change from baseline in the physical component of the SF-12v2 physical summary score, and time-averaged change from baseline in the mental component of the SF12v2 summary score, evaluated using a win ratio. Independently adjudicated major adverse cardiovascular and noncardiovascular events and disease-specific QoL will be secondary endpoints.SUMMARYThe RECHARGE trials are the first revascularization trials to enroll exclusively women and minority patients and to use patient-centered outcomes as their primary outcome.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"7 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142178809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Robotic mitral surgery: recent advances and outcomes. 机器人二尖瓣手术：最新进展和结果。

IF 2.3 4区医学

Current Opinion in Cardiology Pub Date : 2024-08-20 DOI: 10.1097/hco.0000000000001174

Makoto Hibino,Douglas A Murphy,Michael E Halkos

{"title":"Robotic mitral surgery: recent advances and outcomes.","authors":"Makoto Hibino,Douglas A Murphy,Michael E Halkos","doi":"10.1097/hco.0000000000001174","DOIUrl":"https://doi.org/10.1097/hco.0000000000001174","url":null,"abstract":"PURPOSE OF REVIEWThis review explores recent advancements in robotic cardiac surgery, specifically focusing on its application in diverse mitral valve surgeries. The aim is to provide an overview of current clinical practices and supporting evidence in this evolving field.RECENT FINDINGSA literature review indicates a 30% surge in robotic mitral valve repair from 2015 to 2021, paralleled by a decline in sternotomy-based repair per the STS database. Robotic mitral valve repair consistently shows effective and safe outcomes, with comparable mortality but lower morbidity risks than sternotomy and thoracotomy. The robotic approach exhibits lower conversion to valve replacement, shorter ICU stays, and reduced 30-day readmissions. For experienced programs, robotic techniques prove versatile in various pathologies, including rheumatic heart valve disease, infective endocarditis, ischemic cardiomyopathy, and mitral annular calcification necessitating valve replacement. Literature supports their selective use in high-risk scenarios, including redo surgeries and elderly patients.SUMMARYRecent evidence supports the growing use of robotic approaches in mitral valve surgery, highlighting their efficacy with comparable mortality rates but lower morbidity risks. Robotic techniques consistently yield positive outcomes across various pathologies and patient profiles, signaling a potential paradigm shift in mitral valve interventions.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"5 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142178810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lipoprotein(a) is a highly atherogenic lipoprotein: pathophysiological basis and clinical implications. 脂蛋白（a）是一种高度致动脉粥样硬化的脂蛋白：病理生理学基础和临床意义。

IF 2 4区医学

Current Opinion in Cardiology Pub Date : 2024-08-14 DOI: 10.1097/HCO.0000000000001170

Elias Björnson, Martin Adiels, Jan Borén, Chris J Packard

{"title":"Lipoprotein(a) is a highly atherogenic lipoprotein: pathophysiological basis and clinical implications.","authors":"Elias Björnson, Martin Adiels, Jan Borén, Chris J Packard","doi":"10.1097/HCO.0000000000001170","DOIUrl":"10.1097/HCO.0000000000001170","url":null,"abstract":"Purpose of review: Lipoprotein(a) has been identified as a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis. However, as reviewed here, there is ongoing debate as to the key pathogenic features of Lp(a) particles and the degree of Lp(a) atherogenicity relative to low-density lipoprotein (LDL).Recent findings: Genetic analyses have revealed that Lp(a) on a per-particle basis is markedly (about six-fold) more atherogenic than LDL. Oxidized phospholipids carried on Lp(a) have been found to have substantial pro-inflammatory properties triggering pathways that may contribute to atherogenesis. Whether the strength of association of Lp(a) with ASCVD risk is dependent on inflammatory status is a matter of current debate and is critical to implementing intervention strategies. Contradictory reports continue to appear, but most recent studies in large cohorts indicate that the relationship of Lp(a) to risk is independent of C-reactive protein level.Summary: Lp(a) is a highly atherogenic lipoprotein and a viable target for intervention in a significant proportion of the general population. Better understanding the basis of its enhanced atherogenicity is important for risk assessment and interpreting intervention trials.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is it feasible to treat atrial fibrillation at the time of minimally invasive coronary artery bypass grafting? 在微创冠状动脉旁路移植术时治疗心房颤动是否可行？

IF 2 4区医学

Current Opinion in Cardiology Pub Date : 2024-08-14 DOI: 10.1097/HCO.0000000000001173

Stephen D Waterford, Niv Ad

{"title":"Is it feasible to treat atrial fibrillation at the time of minimally invasive coronary artery bypass grafting?","authors":"Stephen D Waterford, Niv Ad","doi":"10.1097/HCO.0000000000001173","DOIUrl":"10.1097/HCO.0000000000001173","url":null,"abstract":"Purpose of review: Coronary artery bypass grafting remains the most common operation performed by cardiac surgeons. As a result, a cardiac surgeon with a typical practice will most commonly encounter atrial fibrillation when performing coronary artery bypass grafting. In this review, we first emphasize the importance of treating atrial fibrillation in patients undergoing coronary bypass grafting. We review benefits of concomitant surgical ablation and its importance relative to complete coronary revascularization. We then discuss options to treat atrial fibrillation in a more minimally invasive manner in these patients, while still preserving treatment efficacy.Recent findings: Surgical ablation at the time of coronary artery bypass grafting surgery could be as important as complete revascularization. Bi-atrial ablation provides superior rhythm control compared to left-sided ablation only.Summary: We highlight various options for surgical ablation at the time of coronary artery bypass grafting surgery, and provide an algorithm for ablation in individual patients.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

High reliability pediatric heart centers: Always working toward getting better. 高度可靠的儿科心脏中心：不断进步

IF 2 4区医学

Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-03-26 DOI: 10.1097/HCO.0000000000001143

Andrea Torzone, Alexandra Birely

{"title":"High reliability pediatric heart centers: Always working toward getting better.","authors":"Andrea Torzone, Alexandra Birely","doi":"10.1097/HCO.0000000000001143","DOIUrl":"10.1097/HCO.0000000000001143","url":null,"abstract":"Purpose of review: The purpose of this review is to examine high reliability through the lens of a contemporary pediatric heart center, noting that continuous improvement, rather than perfection, should be embraced. Aiming to elevate topics with lesser attention, this review elaborates on key concepts and proposed considerations for maintaining a high reliability heart center.Recent findings: As provision of care reaches a new complexity, programs are called upon to evaluate how they can bring their teams into the future of pediatric cardiac care. Although much has been written about high reliability in healthcare, it has not been explored within pediatric heart centers. Practical application of high reliability enables a shared mental model and aligns teams toward eliminating patient harm. Suggested facilitators of high reliability within heart center teams include interprofessional collaboration, recognition of nursing expertise, psychological safety, and structural empowerment void of hierarchy.Summary: As the pediatric cardiac population evolves, care becomes more complex with a narrow margin of error. High reliability can guide continuous improvement. Acknowledging culture as the underpinning of all structure and processes allows teams to rebound from failure and supports the mission of rising to exceptional patient challenges.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"356-363"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hypertrophic cardiomyopathy and competitive sports: let 'em play? 肥厚型心肌病与竞技体育：让他们玩吗？

IF 2 4区医学

Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-05-10 DOI: 10.1097/HCO.0000000000001148

Mats Steffi Jennifer Masilamani, Bryan Cannon

{"title":"Hypertrophic cardiomyopathy and competitive sports: let 'em play?","authors":"Mats Steffi Jennifer Masilamani, Bryan Cannon","doi":"10.1097/HCO.0000000000001148","DOIUrl":"10.1097/HCO.0000000000001148","url":null,"abstract":"Purpose of review: Hypertrophic cardiomyopathy (HCM) is one of the most common cardiovascular genetic conditions. Although most patients with HCM typically do well clinically, there is a small but real incidence of sudden cardiac death. A diagnosis of HCM was previously a reason for complete exclusion in sports, particularly competitive sports.However, many of these recommendations are based on expert consensus, and much data has been published in the last decade furthering the scientific knowledge in this area, and allowing athletes who may have been previously excluded the potential to participate in strenuous activities and competitive sports.Recent findings: With recent publications on participation in sports with HCM, as well as an emphasis on shared decision-making, more athletes with HCM are participating in competitive sports, even at a professional level. Even contact sports in the presence of an implantable cardioverter-defibrillator are no longer mutually exclusive in the current era.Summary: Previous guidelines were likely overly restrictive for patients with HCM. Although there is a risk of sudden death that cannot be ignored, the potential for shared decision making as well as medical guidance are entering a new era in all aspects of medicine, particularly in sports participation.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"308-314"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Double outlet right ventricle - the 50% rule has always been about the conus. 双出口右心室--50% 规则一直与锥体有关。

IF 2 4区医学

Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-02-23 DOI: 10.1097/HCO.0000000000001131

Rebecca Josowitz, Lindsay S Rogers

{"title":"Double outlet right ventricle - the 50% rule has always been about the conus.","authors":"Rebecca Josowitz, Lindsay S Rogers","doi":"10.1097/HCO.0000000000001131","DOIUrl":"10.1097/HCO.0000000000001131","url":null,"abstract":"Purpose of review: There has been much variability in the definition of double outlet right ventricle (DORV) spanning the last century. Historically, emphasis has been placed on the assignment of the great arteries to the right ventricle as a definition of DORV. In this review, we aim to underscore the importance of conal muscle, rather than rules surrounding assignment of great arteries to ventricles. We will be outlining the variability in patient anatomy that results from variations in conal muscle development in DORV, which may not fit perfectly into predefined constructs. This anatomic variability directly determines physiology and surgical repair options.Recent findings: There is a growing appreciation of the utility of cross-sectional imaging in complex DORV, and the generation of patient-specific 3D models with virtual reality simulations for surgical planning. These models improve the prediction of candidacy for biventricular repair and allow the mapping of complex baffle pathways preoperatively.Summary: DORV is not a disease entity in itself, but rather a vast spectrum of disorders associated with maldevelopment of conal muscle and often abnormal expansion of one the great vessels. Patient-specific 3D models will be crucial for improved surgical planning and patient outcomes.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"348-355"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effects of bempedoic acid on markers of inflammation and Lp(a). 鱼贝多酸对炎症指标和脂蛋白（a）的影响

IF 2 4区医学

Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-03-04 DOI: 10.1097/HCO.0000000000001137

Sukhila Reddy, Abhizith Deoker

{"title":"Effects of bempedoic acid on markers of inflammation and Lp(a).","authors":"Sukhila Reddy, Abhizith Deoker","doi":"10.1097/HCO.0000000000001137","DOIUrl":"10.1097/HCO.0000000000001137","url":null,"abstract":"Purpose of review: To study the effect of bempedoic acid on markers of inflammation and lipoprotein (a) to help determine if the drug would be useful to treat patients with elevated cardiovascular risks and residual cardiovascular risk despite optimal low-density lipoprotein cholesterol (LDL-C) levels.Recent findings: Bempedoic acid is found to cause significant reduction in LDL-C and high-sensitivity C-reactive protein (hs-CRP) in various randomized clinical trials. Multiple meta-analyses have also found that bempedoic acid therapy leads to reduction in non-high-density lipoprotein cholesterol (non-HDL-C), total cholesterol (TC) and apolipoprotein B (ApoB) levels. However, it has minimal effect on lipoprotein (a) (Lp(a)) level.Summary: Bempedoic acid is a new lipid-lowering agent that inhibits enzyme ATP-citrate lyase in the cholesterol biosynthesis pathway. Major risk of cardiovascular events and its associated morbidity and mortality are proportional to LDL-C and inflammatory markers levels. It was found that bempedoic acid significantly lowers LDL-C, hs-CRP and other inflammatory markers levels. This drug could potentially be used in patients with elevated cardiovascular risk, in patients with residual cardiovascular risk despite attaining LDL-C goal and in statin intolerant patients.","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"280-285"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Leaders need to look in the mirror. 领导者需要照照镜子。

IF 2 4区医学

Current Opinion in Cardiology Pub Date : 2024-07-01 Epub Date: 2024-03-11 DOI: 10.1097/HCO.0000000000001138

Josh Koch

引用次数: 0