Showing papers in "Current Opinion in Cardiology in 2013"
TL;DR: This updated meta-analysis supports the notion of primary prevention of CVD through engagement in leisure time physical activity, and the role of occupational physical activity in CVD prevention is questionable.
Abstract: Purpose of review Abundant evidence has documented inverse associations of physical activity and the risk of cardiovascular disease (CVD). However, the effects of different types of physical activity (e.g., leisure time and occupational physical activity) are still poorly understood. Recent findings Drawing on recommended and established guidelines for study selection, we identified and included 23 prospective epidemiological studies published during the last 2 years. These studies included a total of more than 790 000 adults at baseline with some 22 000 incident cases occurring during follow-up. Our findings suggest that moderate and high levels of leisure time physical activity are associated with a moderately reduced risk of CVD. In contrast, moderate and high levels of occupational physical activity showed weak positive associations, that is, a slightly increased risk of CVD. Summary This updated meta-analysis supports the notion of primary prevention of CVD through engagement in leisure time physical activity. The role of occupational physical activity in CVD prevention is questionable.
175 citations
TL;DR: Optimizing nutritional intake has been targeted as a key component of the National Pediatric Cardiology Quality Improvement Collaborative and has enabled the development of best practices that have the potential to mitigate poor growth in children with congenital heart defects.
Abstract: Purpose of reviewGrowth failure secondary to feeding problems after complex neonatal cardiac surgery is well documented, but not well understood. The purpose of this review is to describe feeding and growth pattern in children with congenital heart defects.Recent findingsNearly half of the infants w
138 citations
TL;DR: The use of statin therapy was significantly associated with a decreased risk of atrial fibrillation in patients with sinus rhythm and the highest benefit was seen for the prevention of postoperative atrialfibrillation and in secondary prevention of atrian fibrills.
Abstract: Purpose of reviewWhether statins may prevent atrial fibrillation remains a subject of debate. An updated systematic review of randomized controlled trials with statins that collected data on the incidence or recurrence of atrial fibrillation was performed.Recent findingsThirty-two published studies
96 citations
TL;DR: Family history is a risk factor for abdominal aortic aneurysm, suggesting that genetic factors play an important role in AAA development, growth and rupture, and Identification of these factors could improve understanding of the AAA pathogenesis and be useful to identify at risk individuals.
Abstract: Abdominal aortic aneurysm (AAA) is a multifactorial disease with a significant genetic component. Epidemiological studies have identified family history of AAA as a risk factor for both aneurysm development and rupture, making it an important consideration for targeted ultrasound screening of elderly patients and their family members. Ongoing research into the genetics of AAA is focused on identifying risk factor genes for both familial and sporadic aneurysms through the use of linkage analyses and genetic association studies, although no causative mutations have yet been identified. Additionally, micro-array expression profiling and animal models of aneurysms are being used to identify genes and pathways for the design of novel therapeutics. These approaches promise to deliver a better understanding of aneurysms at the molecular level leading to improved screening and treatment.
73 citations
TL;DR: Due to its anatomical and functional proximity to the coronary circulation, epicardial adipose tissue may represent an even more direct CVD risk marker than central adiposity.
Abstract: Purpose of reviewWe comment on the associations between epicardial adiposity and cardiovascular disease (CVD) and associated risk factors. The effects of lifestyle measures and CVD drugs on cardiac adipose tissue are also discussed.Recent findingsEpicardial adipose tissue exerts cardioprotective pro
73 citations
TL;DR: Though avoidance of risk factors in youth is ideal, there is still a window for intervention where long-lasting cardiovascular effects might be avoided and health-enhancing changes in the rates of active and passive smoking, adiposity, increased physical activity, accentuated fitness, modified diet, and socioeconomic position might be important in modifying an individual's trajectory from high risk in youth to low risk in adulthood.
Abstract: PURPOSE OF REVIEW:
To detail recent developments linking modifiable youth risk factors with preclinical markers of cardiovascular disease such as carotid artery intima-media thickness, pulse-wave velocity (PVW) and large artery stiffness, brachial artery flow-mediated dilatation, left ventricular geometry, and coronary artery calcification in adulthood.
RECENT FINDINGS:
Population-based data from prospective cohort studies beginning in youth with follow-up into adulthood have shown that the modifiable youth risk factors of elevated blood lipids, blood pressure, and adiposity, smoking (active and passive), metabolic disorders, physical inactivity, low cardiorespiratory fitness, and diet associate with preclinical markers of cardiovascular disease in adulthood. The data suggest that, in some instances, those who amend their trajectory by not maintaining these risk factors into adulthood experience reductions in preclinical markers to levels associated with never having had the risk factor.
SUMMARY:
Though avoidance of risk factors in youth is ideal, there is still a window for intervention where long-lasting cardiovascular effects might be avoided. Health-enhancing changes in the rates of active and passive smoking, adiposity, increased physical activity, accentuated fitness, modified diet, and socioeconomic position in the transition from youth to adulthood might be important in modifying an individual's trajectory from high risk in youth to low risk in adulthood.
72 citations
TL;DR: The available clinical data confirm that epinephrine administration during CPR can increase short-term survival (return of pulses), but point towards either no benefit or even harm of this drug for more patient-centred outcomes (long- term survival or functional recovery).
Abstract: Purpose of reviewEpinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest. Epinephrine increases arterial blood pressure and coronary perfusion during CPR via alpha-1-adrenoceptor agonist effects. However, the dose, timing and indications for
70 citations
TL;DR: Measure of right-ventricular function could improve the risk stratification of RVF following LVAD implantation and to develop evidence-guided preventive and therapeutic strategies.
Abstract: PURPOSE OF REVIEW To review recent insights on right-ventricular failure (RVF) following left-ventricular assist device (LVAD) implantation. RECENT FINDINGS Even with the availability of new generation continuous mechanical assist devices, RVF after implantation of LVAD is still associated with high morbidity and mortality. Recent studies have tried to better define the risk of RVF using combined clinical scores and measures of right-ventricular function or strain. Small exploratory studies have also investigated the role of pulmonary vasodilators and phosphodiesterase inhibitors in selected patients receiving LVAD implantation. SUMMARY Measure of right-ventricular function could improve the risk stratification of RVF following LVAD implantation. Future multicenter studies are needed to validate right-ventricular risk scores and to develop evidence-guided preventive and therapeutic strategies.
68 citations
TL;DR: It is suggested that targeting MAPK and Akt/mTOR pathways with potent and specific compounds represents a promising intervention for the treatment of LMNA DCM-CD.
Abstract: Purpose of review LMNA gene encodes the nuclear A-type lamins. LMNA mutations are associated with more than 10 clinical entities and represent one of the first causes of inherited dilated cardiomyopathy. LMNA-dilated cardiomyopathy is associated with conduction disease (DCM-CD) and is a severe and aggressive form of DCM. However, pathogenesis remains largely unknown and no specific treatment is currently available for the patients. In this review, we present recent discoveries that improve the understanding of the cardiac pathophysiological roles of A-type lamins and shed light on potential therapeutic targets. Recent findings In the last decade, many efforts have been made to elucidate how mutations in A-type lamins, ubiquitous proteins, lead to DCM-CD. No clear genotype/phenotype correlations have been found to help in elucidating those mechanisms. Analysis of several mouse models has helped in deciphering critical pathomechanisms. Among those, Mitogen-activated protein kinases (MAPK) and Akt/mTOR appear to be key early-activated signaling pathways in LMNA DCM-CD in both humans and mice. Inhibition of these signaling pathways has shown encouraging beneficial effects upon cardiac evolution of DCM-CD. Summary These recent findings suggest that targeting MAPK and Akt/mTOR pathways with potent and specific compounds represents a promising intervention for the treatment of LMNA DCM-CD.
64 citations
TL;DR: The clinical syndrome of electrical storm has been defined empirically and an outcome-derived definition may better guide clinicians on when and how to treat this emergent problem.
Abstract: Purpose of review With increasing use of implantable cardioverter defibrillators, physicians are increasingly called upon to manage recurrent ventricular tachycardia, sometimes in the form of frequent recurrences known as electrical storm (or ventricular tachycardia storm). Recent findings Standard antiarrhythmic drug therapy may suppress storms, but, when refractory, interventions such as catheter ablation or in some cases surgical cardiac denervation may be helpful. Earlier interventional management may confer better outcomes than persisting with antiarrhythmic pharmacologic therapy. Summary The clinical syndrome of electrical storm has been defined empirically. An outcome-derived definition may better guide clinicians on when and how to treat this emergent problem. When available, an early interventional approach is preferred.
62 citations
TL;DR: In this paper, the concept of using pulse oximetry as a screening method to detect undiagnosed critical congenital heart defects (CCHD) in asymptomatic newborns was first explored over 10 years ago.
Abstract: Purpose of reviewThe concept of using pulse oximetry as a screening method to detect undiagnosed critical congenital heart defects (CCHD) in asymptomatic newborns was first explored over 10 years ago. A number of studies were subsequently reported, which initially involved relatively small numbers o
TL;DR: The evidence for statins in primary prevention is reviewed and the cardiovascular benefits of statins for primary prevention generally far outweigh the reported harms.
Abstract: Purpose of reviewStatins significantly reduce cardiovascular morbidity and mortality in patients with and without coronary heart disease. Recently, much debate has focused on use of statins for primary prevention following a class-wide safety label change by the US Food and Drug Administration amids
TL;DR: Clinically available genetic tests for heritable cardiac arrhythmia syndromes allow the identification of potentially at-risk family members and contribute to the risk-stratification and selection of therapeutic interventions in affected individuals.
Abstract: Purpose of reviewIn this review, we summarize the basic principles governing rare variant interpretation in the heritable cardiac arrhythmia syndromes, focusing on recent advances that have led to disease-specific approaches to the interpretation of positive genetic testing results.Recent findingsEl
TL;DR: Pharmacological manipulation of HDL-C has not improved the cardiovascular outcomes and several agents have caused harm or unacceptable side-effects and further studies are needed before one can recommend the use of additional lipid-modifying therapies beyond statins.
Abstract: Purpose of review To highlight the recent data evaluating pharmacological manipulation of HDL cholesterol (HDL-C) and examine whether medication-induced changes were associated with improved clinical outcomes and reduced short-term and long-term cardiovascular risks. The review focuses on the studies with niacin and the new cholesteryl ester transfer protein (CETP) inhibitors torcetrapib, dalcetrapib, anacetrapib and evacetrapib. Recent findings Several large randomized clinical trials have evaluated drug therapy on HDL-C and cardiovascular outcomes. Two studies have evaluated the clinical outcomes following HDL-C raising with niacin. Data from the Heart Protection 2 Treatment of HDL to Reduce the Incidence of Vascular Events and The Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health trials both demonstrated no clinical benefit from use of niacin therapy when added to background statin therapy with regard to short-term and long-term cardiovascular risk reduction. Both studies demonstrated excess side-effects from use of niacin. A number of clinical trials have evaluated HDL-C modification from use of a CETP inhibitor. All of the studies have demonstrated significant increases in HDL-C. To date, the outcome data are not favorable. Use of torcetrapib was associated with excess mortality. Use of dalcetrapib had no effect on short-term and long-term cardiovascular events. Two outcome studies with anacetrapib and evacetrapib are ongoing and will report out in a few years' time. Summary Pharmacological manipulation of HDL-C has not improved the cardiovascular outcomes. Several agents have caused harm or unacceptable side-effects. Further studies are needed before one can recommend the use of additional lipid-modifying therapies beyond statins.
TL;DR: Novel methods of fibrosis imaging that utilize properties of extracellular matrix and its biomarkers are introduced that may improve detection and monitoring of disease and improve efficiency and effectiveness of the treatment.
Abstract: Purpose of reviewMyocardial fibrosis is a common feature of many cardiomyopathies, including hypertrophic cardiomyopathy. Myocardial fibrosis has been shown to be reversible and treatable with timely intervention. Although early detection and assessment of fibrosis is crucial, adequate diagnostics a
TL;DR: ociation between biomarkers and noninvasive measures of early atherosclerosis in children continue to emerge and several biomarkers appear to be promising, but there are no explicit data to recommend any of these biomarkers as a routine clinical marker of CVD in children.
Abstract: Purpose of review The magnitude of lifetime risk of cardiovascular disease (CVD) has radically increased along with the high prevalence of obesity in children. The spotlight is now on dysfunctional adiposity as a precursor for the development of premature CVD. As full-blown CVD is not present in childhood, there is a critical need for surrogate markers to best assess, predict, and treat the children who are vulnerable to developing CVD. Recent findings Accumulation of excess fat mass can be conceived as a derangement in the balance between energy intake and expenditure. This appears to provoke various structural and metabolic alterations leading to adipocyte dysfunction, with important cardiovascular health consequences. Subclinical inflammation, insulin resistance, oxidative stress, and endothelial dysfunction appear to play important roles early in the clinical course of obesity. Summary Associations between biomarkers and noninvasive measures of early atherosclerosis in children continue to emerge and several biomarkers appear to be promising. At present, there are no explicit data to recommend any of these biomarkers as a routine clinical marker of CVD in children. More work is needed to validate these biomarkers and to improve understanding of their role in CVD risk prediction in the pediatric population.
TL;DR: To fully realize the benefits of clinical genetic testing in cardiovascular medicine, clinicians must implement several components including judicious genetic testing, pretest and posttest genetic counseling, interpretation and application of genetic test results, and cascade family genetic testing and clinical screening.
Abstract: The number of clinically available genetic tests for heritable cardiovascular diseases has recently increased because of novel gene discoveries and advancements in DNA sequencing technologies. The purpose of this review is to provide up-to-date genetic testing information and guidance on how to incorporate genetic testing into cardiovascular medicine.
Heritable cardiovascular conditions display vast genetic heterogeneity, genetic overlap between phenotypes, incomplete penetrance and variable expressivity, and are associated with risk for sudden cardiac death, making the practice of cardiovascular genetic medicine a great responsibility. Multigene testing panels now exist for many cardiovascular conditions, and test utility has recently been augmented by population-based genomic sequence datasets. Large amounts of DNA sequence data necessitate rigorous interpretation of this probabilistic information. Timely practice guidelines and expert statements have been published.
To fully realize the benefits of clinical genetic testing in cardiovascular medicine, clinicians must implement several components including judicious genetic testing, pretest and posttest genetic counseling, interpretation and application of genetic test results, and cascade family genetic testing and clinical screening. Components important to the proper integration of cardiovascular genetic medicine are offered.
TL;DR: Greater physician education and research are needed to improve the preparticipation examination in athletes to avoid high false-positive rates.
Abstract: Purpose of reviewTo review the recent literature and recommendations for cardiovascular screening in young athletes.Recent findingsThe primary purpose of the preparticipation examination is to detect the cardiovascular disorders known to cause sudden cardiac arrest in the athlete. Studies demonstrat
TL;DR: Cardiac amyloidosis, an infiltrative restrictive cardiomyopathy once thought to be universally fatal, is now increasingly recognized as less rare than previously thought, and recent advances in diagnosis and treatment are associated with improved prognosis.
Abstract: Purpose of reviewCardiac amyloidosis, an infiltrative restrictive cardiomyopathy once thought to be universally fatal, is now increasingly recognized as less rare than previously thought. This update is intended to provide a review of newer aspects of the presentation, diagnosis and treatment of car
TL;DR: Despite the prevalence of depression in heart failure, the current levels of research and awareness remain abysmal in detecting, diagnosing and treating depression, which remains an independent predictor of mortality.
Abstract: Purpose of reviewThis review aims to provide a general overview of the recent advances in understanding of depression as it pertains to heart failure. The focus is to impart an up to date knowledge in this field.Recent findingsThe mortality associated with heart failure remains high despite recent p
TL;DR: Interstage home monitoring programs are a model of collaborative care that improves outcomes and may serve as a template for the care of other populations of medically complex infants.
Abstract: Purpose of reviewPatients with single-ventricle, shunt-dependent physiology are at increased risk for interstage death due to the inherent instability of parallel circulation. Enhanced surveillance and early identification of deteriorating physiology via interstage home monitoring result in signific
TL;DR: The recent advances in our understanding of Alzheimer's disease pathophysiology and the renin angiotensin system pathways suggest that angioensin receptor blockers (ARBs) are ideal drugs to explore for Alzheimer disease therapy as discussed by the authors.
Abstract: Purpose of reviewThe recent advances in our understanding of Alzheimer's disease pathophysiology and the renin angiotensin system pathways suggest that angiotensin receptor blockers (ARBs) are ideal drugs to explore for Alzheimer's disease therapy.Recent findingsNew evidence suggests that the brain
TL;DR: Reduction in chronic inflammation associated with less visceral fat after surgery may contribute to the reduction in CVD, which may promote improvement of endothelial dysfunction and insulin resistance.
Abstract: PURPOSE OF REVIEW Obesity is an independent risk factor for cardiovascular disease (CVD) and promotes CVD risk factors. Bariatric surgery has gained much favor because it ameliorates CVD. This review examines the current evidence for the mechanism behind this, which is currently thought to occur in part by reduction of adiposopathy, or dysfunctional adipose tissue, through modulation of adipokine secretion. RECENT FINDINGS Increased visceral fat in obesity leads to adiposopathy, due to the chronic inflammation present in this tissue. Bariatric surgery causes weight loss as well as reduction in insulin resistance, hypertension, dyslipidemia, cardiac hypertrophy, and mortality. It also causes changes in the adipokines adiponectin, leptin, and C-reactive protein, but not in tumor necrosis factor-α. These changes contribute to improved CVD risk, possibly through decrease of chronic inflammation. SUMMARY The modulations in adipokine secretion that occur after bariatric surgery are involved with reduction in CVD risk factors, CVD, and CV mortality. On the basis of the known anti-inflammatory effects of adiponectin and the pro-inflammatory effects of leptin and CRP, reduction in chronic inflammation associated with less visceral fat after surgery may contribute to the reduction in CVD. This may promote improvement of endothelial dysfunction and insulin resistance. Further work is necessary to explore these relationships.
TL;DR: The burden of RSV disease will decline, once a vaccine is available, and immunoprophylaxis with palivizumab is a useful tool for high-risk patients to reduce comorbidity and fatal outcome.
Abstract: Purpose of reviewLower respiratory tract infections multiply morbidity and mortality within patients with significant congenital heart disease (CHD). For respiratory syncytial virus (RSV), one of the most important pathogens, immunoprophylaxis with palivizumab has successfully been introduced. The q
TL;DR: The latest research replicates and extends the existing knowledge regarding epidemiology and familial evaluation of SADS, whilst genetic studies support a role for the molecular autopsy.
Abstract: Purpose of review Unexplained sudden death and the sudden arrhythmic death syndrome (SADS) affect a small but significant proportion of young and apparently healthy individuals. This review revisits the causes underlying such deaths and the investigational strategies that identify surviving family who may be at risk. Recent findings Recent epidemiological data is available from case series or government records. The yield from familial cardiological evaluation for inherited conditions has been supported by additional small series. The greatest advance has come with molecular autopsy studies, which have utilized various methodologies and candidate genes to investigate SADS cases and their families. Summary The latest research replicates and extends the existing knowledge regarding epidemiology and familial evaluation of SADS, whilst genetic studies support a role for the molecular autopsy.
TL;DR: The recent finding that postprandial serum triglyceride levels are even better than fasting serum triglycerides levels as predictors of vascular disease indicate that it is better to measure an index of triglyceride-rich lipoproteins in the postpr andial period than in thePostabsorptive fasting state.
Abstract: Purpose of reviewIn this review we discuss the postprandial pathophysiological mechanisms that promote vascular disease, the evidence for a role of postprandial lipaemia (PPL) in vascular disease and the effect of modifiable and nonmodifiable factors in PPL.Recent findingsPPL refers to the dynamic c
TL;DR: Sutureless aortic valve replacement has been shown to be well tolerated, to provide excellent haemodynamic performance and to be particularly suitable in minimally invasive procedures or in patients with extensive calcified aorta root or with the need of short ACC and CPB times for marked comorbidities.
Abstract: PURPOSE OF REVIEW The sutureless aortic bioprosthesis has been recently introduced in clinical practice for aortic valve replacement (SU-AVR) and appears to provide enhanced implantability and favourable haemodynamics, particularly advisable in minimally invasive surgery, in difficult anatomical situations or elderly patients. Implants of sutureless bioprosthesis are increasingly performed, and the first meaningful findings have been released and herewith analysed. RECENT FINDINGS A two-centre experience in 208 patients has shown safety, ease of implantation, excellent haemodynamic performance and limited aortic cross-clamp (ACC) and cardiopulmonary (cardiopulmonary bypass, CPB) times, also in the case of associated coronary artery bypass grafting. Another multicentre experience with a third sutureless, albeit stented, valve implanted in 146 patients has been also presented with early favourable results. The sutureless aortic valve has been reported to be competitive also in relation to the transcatheter aortic valve implantation (TAVI) procedure in high-risk patients, as demonstrated by a propensity score based comparative analysis in a multicentre study, with reduced paravalvular leak rate but with increased atrial fibrillation occurrence in SU-AVR cases. Other single-centre series have been published with satisfactory results in terms of excellent haemodynamic performances or of enhanced implantability in high-risk patients or during minimally invasive procedures. SUMMARY Sutureless aortic valve replacement has been shown to be well tolerated, to provide excellent haemodynamic performance and to be particularly suitable in minimally invasive procedures or in patients with extensive calcified aortic root or with the need of short ACC and CPB times for marked comorbidities. Further evaluations are, however, still necessary to conclusively show the actual advantages of SU-AVR, also as an alternative to TAVI procedures in operable high-risk patients.
TL;DR: The available literature supports the use of transcatheter MVIV implantation in selected high-risk patients with favorable results, and the early and mid-term outcomes are excellent with no evidence of structural valve deterioration in the available follow-up period.
Abstract: Purpose of reviewTranscatheter mitral valve-in-valve (MVIV) implantation is an emerging technique for reoperative mitral valve replacement in high-risk patients. Clear guidelines on the use of transcatheter MVIV implantation are yet to be determined. In this review, we report our own experience as w
TL;DR: As the application of long-term VAD support continues to grow, it will be increasingly important to clarify and target the mechanisms contributing to ventricular arrhythmias in this population.
Abstract: Purpose of review To summarize the available evidence concerning the occurrence and treatment of ventricular arrhythmias in patients supported with long-term ventricular assist devices (VADs). Recent findings Approximately one-third of left ventricular assist device-supported patients experience significant ventricular arrhythmias, with higher rates in certain patient subsets. Ventricular arrhythmias are associated with both increased mortality and morbidity in VAD-supported patients. Mechanical factors, myocardial fibrosis and alterations in cardiac myocyte physiology because of myocardial unloading are contributors to ventricular arrhythmias in this population. In the absence of definitive trials, current evidence supports implanted cardioverter defibrillators (ICDs) in long-term VAD patients to mitigate the risks associated with ventricular arrhythmias. Though antiarrhythmic therapies have limited efficacy, amelioration of inflow cannula contact with the endocardium and suction events or ablation of specific anatomic origins of ventricular arrhythmias, when present, are also efficacious in VAD-supported hearts. Summary As the application of long-term VAD support continues to grow, it will be increasingly important to clarify and target the mechanisms contributing to ventricular arrhythmias in this population. Prospective trials assessing the benefits of de-novo ICD placement, ablative strategies and other prophylactic and therapeutic interventions will be increasingly important to further improve the survival and quality of life among VAD-supported patients.
TL;DR: There is evidence to support the view that HDL functionality and the mechanism by which a therapeutic agent raises HDL-C are more important than plasma cholesterol levels, rather than simply raising the cholesterol cargo.
Abstract: Purpose of review Cardiovascular disease (CVD) is the leading cause of morbidity and premature mortality in Europe and the United States, and is increasingly common in developing countries. High-density lipoprotein cholesterol (HDL-C) is an independent risk factor for CVD and is superior to low-density lipoprotein cholesterol (LDL-C) as a predictor of cardiovascular events. The residual risk conferred by low HDL-C in patients with a satisfactory LDL-C was recently highlighted by the European Atherosclerosis Society. Despite the lack of randomized controlled trials, it has been suggested that raising the level of HDL-C should be considered as a therapeutic strategy in high-risk patients because of the strong epidemiological evidence, compelling biological plausibility, and both experimental and clinical research supporting its cardioprotective effects. Recent findings Three recent large randomized clinical trials investigating the effect of HDL-C raising with niacin and dalcetrapib in statin-treated patients failed to demonstrate an improvement in cardiovascular outcomes. Summary There is evidence to support the view that HDL functionality and the mechanism by which a therapeutic agent raises HDL-C are more important than plasma HDL-C levels. Future therapeutic agents will be required to improve this functionality rather than simply raising the cholesterol cargo.