Current Opinion in Cardiology最新文献

{"title":"Editorial introductions","authors":"","doi":"10.1097/hco.0000000000001088","DOIUrl":"https://doi.org/10.1097/hco.0000000000001088","url":null,"abstract":"Current Opinion in Cardiology was launched in 1985. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of cardiology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Marc RuelMarc RuelDr Marc Ruel is the Head and Chair of Cardiac Surgery at the University of Ottawa Heart Institute, Canada. Dr Ruel's career theme has been to make cardiac surgery less invasive, more evidence-based, and leading to better patient outcomes. Dr Ruel has pioneered multivessel minimally invasive coronary artery bypass surgery worldwide, as well as several other cardiac surgical techniques. The laboratory research program founded by Dr Ruel (www.beatsresearch.com) has also achieved translational impact. Throughout his 11-year tenure as chair, the Cardiac Surgery Division in Ottawa, Canada has massively grown in surgical volumes and outreach, quality, research and innovation, advanced education, as well as in outside referrals, international reputation, widespread recruitment, and overall impact. Dr Ruel has published 450 scientific papers, 5 books, and has delivered over 350 invited lectures. He leads key clinical trials in cardiac surgery, is a recipient of numerous academic and community awards, and has been featured among the ’Giants of Cardiothoracic Surgery’. Dr Ruel was recently the President of the Canadian Cardiovascular Society, one of the most respected medical societies in the world. Dr Ruel serves as Surgery Editor and Associate Editor for the journal Circulation, Canadian Director for the Society of Thoracic Surgeons, and North American Director for the International Society of Minimally Invasive Cardiothoracic Surgery. Peter StonePeter StonePeter H. Stone, MD, is a Professor of Medicine at Harvard Medical School, USA, Director of the Vascular Profiling Research Group, a Co-Director of the Center for Clinical Investigation, and Senior Physician at Brigham & Women's Hospital, USA. Dr Stone's research interests are in evaluating and managing patients with acute and chronic coronary artery disease. He is using new in-vivo methodologies to identify areas where human coronary disease will progress to determine if pre-emptive therapeutic strategies may avert adverse cardiac events. He received his undergraduate degree from Princeton University, USA, and his Medical Degree from Cornell University, USA. He completed internal medicine training at the University of California, San Francisco, USA, and then did a clinical cardiology fellowship at Pacific Medical Center in San Francisco, USA. He came to the Peter Bent Brigham Hospital as a Cardiology Research Fellow and he has remained at B","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134947933","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}

{"title":"The mitral valve in hypertrophic cardiomyopathy.","authors":"James Malcolmson,&nbsp;Alex Shipolini,&nbsp;Saidi Mohiddin,&nbsp;Konstantinos Savvatis","doi":"10.1097/HCO.0000000000001067","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001067","url":null,"abstract":"<p><strong>Purpose of review: </strong>Whilst abnormally increased left ventricular wall thickness is the hallmark feature of hypertrophic cardiomyopathy (HCM), anomalies of the mitral valve and supporting apparatus are well documented. This review addresses the clinical importance of mitral valve abnormalities in HCM, their mechanistic associations with symptoms, and therapeutic strategies targeting mitral valve and apparatus abnormalities.</p><p><strong>Recent findings: </strong>The normal mitral valve possesses anatomical features facilitating unrestricted blood flow during LV filling, preventing regurgitation during LV systole, and avoiding obstruction of LV ejection. In HCM, a variety of structural and functional abnormalities can conspire to cause deranged mitral valve function, with implications for management strategy. Identification and characterization of these abnormalities is facilitated by multimodality imaging. Alcohol septal ablation (ASA) cannot address primary mitral valve abnormalities, and so is not preferred to surgical intervention if mitral valve abnormalities are present and are judged to make dominant contributions to LV outflow tract obstruction (LVOTO). Two broadly opposing surgical intervention strategies exist, one advocating isolated septal myectomy and the other including adjuvant mitral apparatus modification. Newer, less invasive surgical and transcatheter techniques will expand interventional options.</p><p><strong>Summary: </strong>Mitral valve abnormalities are a central pathological feature of HCM. Multimodality imaging is crucial for their identification and characterization prior to therapeutic intervention.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9937472","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}

{"title":"Imaging of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.","authors":"Merrill Stewart,&nbsp;Andrew Elagizi,&nbsp;Yvonne E Gilliland","doi":"10.1097/HCO.0000000000001058","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001058","url":null,"abstract":"<p><strong>Purpose of review: </strong>The current article reviews obstructive forms of hypertrophic cardiomyopathy and associated morphologic cardiac abnormalities. It focuses on echocardiographic imaging of the left ventricular (LV) outflow tract obstruction, its evaluation, prognostication, and differentiation from other conditions mimicking obstructive hypertrophic cardiomyopathy.</p><p><strong>Recent findings: </strong>Symptomatic patients with LV outflow tract (LVOT) gradients at least 50 mmHg on maximally tolerated medical therapy are candidates for advanced therapies. Resting echocardiography may only identify 30% of patients with obstructive physiology. Provocative maneuvers are essential for symptomatic patients with hypertrophic cardiomyopathy (HCM). Exercise echocardiography is recommended if they fail to provoke a gradient. Although dynamic LV tract obstruction is seen with obstructive HCM, it is not specific to this condition and exists in other physiologic and pathophysiologic states. Careful clinical evaluation and imaging techniques aid in the differentiation of HCM from these conditions.</p><p><strong>Summary: </strong>Imaging plays an integral role in the diagnosis, prognosis, and risk stratification of HCM patients. Newer imaging technologies, including 3D transthoracic echocardiography, 3D transesophageal, speckle-derived 2D strain, and cardiac MRI, allow for a better hemodynamic understanding of systolic anterior motion and LV tract obstruction. Evolving techniques, that is, artificial intelligence, will undoubtedly further increase diagnostic capabilities. Newer medical therapies are available with the hope that this will lead to better patient management.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10316009","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}

{"title":"Imaging cardiac hypertrophy in hypertrophic cardiomyopathy and its differential diagnosis.","authors":"Lana Rashdan,&nbsp;James Hodovan,&nbsp;Ahmad Masri","doi":"10.1097/HCO.0000000000001070","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001070","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this study was to review imaging of myocardial hypertrophy in hypertrophic cardiomyopathy (HCM) and its phenocopies. The introduction of cardiac myosin inhibitors in HCM has emphasized the need for careful evaluation of the underlying cause of myocardial hypertrophy.</p><p><strong>Recent findings: </strong>Advances in imaging of myocardial hypertrophy have focused on improving precision, diagnosis, and predicting prognosis. From improved assessment of myocardial mass and function, to assessing myocardial fibrosis without the use of gadolinium, imaging continues to be the primary tool in understanding myocardial hypertrophy and its downstream effects. Advances in differentiating athlete's heart from HCM are noted, and the increasing rate of diagnosis in cardiac amyloidosis using noninvasive approaches is especially highlighted due to the implications on treatment approach. Finally, recent data on Fabry disease are shared as well as differentiating other phenocopies from HCM.</p><p><strong>Summary: </strong>Imaging hypertrophy in HCM and ruling out other phenocopies is central to the care of patients with HCM. This space will continue to rapidly evolve, as disease-modifying therapies are under investigation and being advanced to the clinic.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9931407","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}

{"title":"Evaluation and management of drug-eluting stent in-stent restenosis.","authors":"Shane Parfrey,&nbsp;Vincent Siu,&nbsp;John J Graham,&nbsp;Ram Vijayaraghavan,&nbsp;Christopher Li,&nbsp;Jeffrey Pang,&nbsp;Sanjog Kalra,&nbsp;Vladimír Džavík,&nbsp;Harindra C Wijeysundera,&nbsp;Akshay Bagai","doi":"10.1097/HCO.0000000000001073","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001073","url":null,"abstract":"<p><strong>Purpose of review: </strong>In-stent restenosis (ISR) is the most common cause of stent failure. Although the rate of ISR is significantly lower with contemporary drug-eluting stents (DES), it remains a challenging clinical entity to treat.</p><p><strong>Recent findings: </strong>In this review, we focus on a practical approach to management of DES ISR with intravascular imaging at its core, as supported by several recently published articles. This facilitates assessment of the underlying mechanism(s) essential to the successful treatment of ISR allowing for a tailored selection of treatment modalities.</p><p><strong>Summary: </strong>The successful treatment of DES ISR requires identification of the causative mechanism(s). Individualized treatment may include high-pressure balloon angioplasty alone, cutting or scoring balloons, intravascular lithotripsy, atheroablative therapies and a selection of either repeat DES implantation or drug-coated balloon treatment.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9937471","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}

{"title":"Sleep apnea and cardiovascular risk.","authors":"Manu Rajachandran,&nbsp;Nils Nickel,&nbsp;Richard A Lange","doi":"10.1097/HCO.0000000000001065","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001065","url":null,"abstract":"<p><strong>Purpose of review: </strong>Obstructive sleep apnea (OSA) is associated with several cardiovascular risk predictors that have only recently begun to be studied in detail. The strong association between OSA and hypertension, coronary artery disease, congestive heart failure, and sudden cardiac death underscores its significant impact on cardiovascular health. This brief review considers the links between OSA and cardiovascular risk.</p><p><strong>Recent findings: </strong>OSA is an important contributor to endothelial dysfunction and damage, while repetitive hypoxia and hypercarbia contribute to autonomic dysfunction and sympathetic stimulation. In turn, these derangements have deleterious hematologic effects, including hypercoagulability and abnormal platelet aggregability, which are important in the pathogenesis of atherothrombotic disease.</p><p><strong>Summary: </strong>The varied deleterious effects of OSA on cardiovascular health stem from a unique 'perfect storm' of hypoxic oxidative stress, autonomic dysregulation, endothelial damage, and inflammation occurring at the microvascular level. Further research may disentangle these multiple etiologic threads and provide a better understanding of the underlying pathophysiological relationship between OSA and cardiovascular disease.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10316024","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}

{"title":"Clinical considerations and pathophysiological associations among obesity, weight loss, heart failure, and hypertension.","authors":"Maria Irene Barillas-Lara,&nbsp;Christian C Faaborg-Andersen,&nbsp;Raymundo A Quintana,&nbsp;Juan Francisco Loro-Ferrer,&nbsp;Stacy A Mandras,&nbsp;Adrian daSilva-deAbreu","doi":"10.1097/HCO.0000000000001069","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001069","url":null,"abstract":"<p><strong>Purpose of review: </strong>To describe the relationship between three pandemics: hypertension, obesity, and heart failure. From pathophysiology to treatment, understanding how these disease entities are linked can lead to breakthroughs in their prevention and treatment. The relevance of this review lies in its discussion of novel pharmacological and surgical treatment strategies for obesity and hypertension, and their role in the prevention and treatment of heart failure.</p><p><strong>Recent findings: </strong>Novel medications such as GLP-1 agonists have demonstrated sustained weight loss in patients with obesity, and concurrent improvements in their cardiometabolic profile, and possibly also reductions in hypertension-related comorbidities including heart failure. Surgical therapies including laparoscopic bariatric surgery represent an important treatment strategy in obese patients, and recent studies describe their use even in patients with advanced heart failure, including those with ventricular assist devices.</p><p><strong>Summary: </strong>These developments have deep implications on our efforts to understand, mitigate, and ultimately prevent the three pandemics, and offer promising improvements to quality of life, survival, and the cost burden of these diseases.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10316047","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}

{"title":"Monitoring treatment with cardiac myosin inhibitors in symptomatic obstructive hypertrophic cardiomyopathy.","authors":"Safia Chatur,&nbsp;Sheila M Hegde","doi":"10.1097/HCO.0000000000001068","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001068","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiac myosin inhibitors (CMIs) represent a major milestone in the treatment of patients with symptomatic obstructive hypertrophic cardiomyopathy. The objective of this review is to discuss the mechanisms of action, clinical trial evidence, safety profile and monitoring of CMIs, which are important to the implementation of these drugs in clinical practice.</p><p><strong>Recent findings: </strong>Mavacamten and aficamten have both been shown to substantially improve left ventricular outflow tract gradients, biomarkers and symptoms in patients with obstructive hypertrophic cardiomyopathy. Both agents are well tolerated with few adverse events in clinical trial follow up. Transient reductions in left ventricular ejection fraction may be associated with both mavacamten and aficamten but respond to dose reduction.</p><p><strong>Summary: </strong>There is now robust clinical trial evidence base to support the use of mavacamten for patients with symptomatic obstructive hypertrophic cardiomyopathy. Generation of long-term safety and efficacy data and exploring applications of CMI to nonobstructive cardiomyopathy and heart failure with preserved ejection fraction represent important next steps.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10316022","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}

{"title":"Editorial introductions.","authors":"","doi":"10.1097/HCO.0000000000001072","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001072","url":null,"abstract":"","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929941","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}

{"title":"Unanswered questions on coronary artery graft patency and clinical outcomes.","authors":"Lamia Harik,&nbsp;Sigrid Sandner,&nbsp;Mario Gaudino","doi":"10.1097/HCO.0000000000001066","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001066","url":null,"abstract":"<p><strong>Purpose of review: </strong>To review current issues related to coronary artery graft patency and outcomes.</p><p><strong>Recent findings: </strong>The association of coronary artery graft patency with clinical outcomes is a traditional concept; however, it has been challenged by the results of numerous studies. Key limitations of the existing evidence include the lack of a universal definition of graft failure, the absence of systematic imaging in contemporary coronary artery bypass grafting trials, the reliance on observational data with inherent selection and survival bias, and high attrition rates for follow-up imaging. Key modulators of graft failure, and of the relationship between graft failure and outcomes, include the type of conduit and myocardial territory grafted, conduit harvesting technique, and postoperative antithrombotic regimen and patient sex.</p><p><strong>Summary: </strong>The relationship between graft failure and clinical events is complex and variable. Overall, the preponderance of current data suggests a possible association between graft failure and nonfatal clinical events.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10316023","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}