Sigrid Sandner, Björn Redfors, Mario Gaudino
PURPOSE OF REVIEW: The optimal antiplatelet strategy in patients after coronary artery bypass graft (CABG) surgery is unclear. We review the evidence on the efficacy and safety of DAPT after CABG and discuss potential novel antiplatelet strategies that reduce the risk of bleeding without loss of efficacy. RECENT FINDINGS: Adding the potent P2Y12 inhibitor ticagrelor to aspirin for 1 year after CABG is associated with a reduction in the risk of vein graft failure, at the expense of an increased risk of clinically important bleeding...
November 1, 2023: Current Opinion in Cardiology
Menaka Ponnambalam, Rozen M Alex
PURPOSE OF REVIEW: This review discusses current guidelines and evidence-based care for the preoperative optimization of patients who are undergoing coronary artery bypass grafting (CABG) and for enabling rapid discharge after surgery. RECENT FINDINGS: Since the Enhanced Recovery After Cardiac Surgery Society (ERAS Cardiac) issued guidelines for perioperative care, in 2019, there has been a significant body of research that has added to and provided further guidance regarding preoperative optimization and accelerated recovery after CABG...
November 1, 2023: Current Opinion in Cardiology
Zaid I Almarzooq, Nora M Al-Roub, Scott Kinlay
PURPOSE OF REVIEW: Review the clinical outcomes of different antithrombotic strategies in patients with high bleeding risk (HBR) after percutaneous coronary intervention (PCI). RECENT FINDINGS: Patients with HBR after PCI include those with advanced age (e.g. >75 years of age), a prior history of major bleeding, anemia, chronic kidney disease, and those with indications for long-term anticoagulation. Strategies that successfully decrease bleeding risk in this population include shorter durations of dual antiplatelet therapy (DAPT; of 1-3 months) followed by single antiplatelet therapy with aspirin or a P2Y 12 inhibitor, or de-escalating from a more potent P2Y 12 inhibitor (prasugrel or ticagrelor) to less potent antiplatelet regimens (aspirin with clopidogrel or half-dose ticagrelor or half-dose prasugrel)...
November 1, 2023: Current Opinion in Cardiology
Marvin Louis Roy Lu, David Bowers De Lurgio
PURPOSE OF REVIEW: This review aims to discuss the rationale behind the development of percutaneous LAAC devices as a treatment option for atrial fibrillation patients ineligible for long-term anticoagulation. The evolution of LAAC, from early experiences and challenges to risk mitigation and improved devices and techniques, will be examined. Furthermore, the review will explore our current understanding of the potential and limitations of LAAC in stroke prevention. RECENT FINDINGS: Multiple trials confirm LAAC device safety and efficacy for stroke prevention, but peri-device leak and thrombus remain concerns postimplantation...
October 23, 2023: Current Opinion in Cardiology
Ziad F Issa
PURPOSE OF REVIEW: Safe and effective radiofrequency (RF) myocardial ablation requires real-time monitoring of lesion formation. Here, we review conventional and novel approaches proposed to guide titration of RF energy application. RECENT FINDINGS: Conventional monitoring modalities, such as ablation electrode temperature, generator impedance, and tissue electrophysiological properties have been of limited value in predicting efficacy and safety of ablation. Therefore, several input-driven indices have been proposed to improve the quality and durability of RF ablation lesion while maintaining safety...
October 10, 2023: Current Opinion in Cardiology
Timothy Abrahams, Masashi Fujino, Adam J Nelson, Stephen J Nicholls
PURPOSE OF REVIEW: The aim of this study was to review the impact of combination lipid lowering with statins and proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors on coronary atherosclerosis using serial intravascular imaging. RECENT FINDINGS: Early studies using intravascular ultrasound established the ability of increasingly intensive lipid lowering to both slow progression and ultimately promote regression of coronary disease. More recent clinical trials that have employed serial imaging with optical coherence tomography have permitted the ability to evaluate the impact of intensive lipid lowering on compositional features associated with plaque vulnerability...
September 26, 2023: Current Opinion in Cardiology
Gabriele M Iacona, Jules J Bakhos, Michael Z Tong, Faisal G Bakaeen
PURPOSE OF REVIEW: The surgical management of patients undergoing coronary artery bypass grafting (CABG) with low ejection fraction presents unique challenges that require meticulous attention to details and good surgical technique and judgement. This review details the latest evidence and best practices in the care of such patients. RECENT FINDINGS: CABG in patients with low ejection fraction carries a significant risk of perioperative mortality and morbidity related to the development of postcardiotomy shock...
September 19, 2023: Current Opinion in Cardiology
Songnan Wen, Yu Liao, Tejas S Khurana, Rong Bai
PURPOSE OF REVIEW: Early recurrence of atrial tachyarrhythmia (ERAT) during blanking period (BP) is not uncommon after catheter ablation of AF. Current guidelines and consensus statements recommend conservative treatment of ERAT. This review summarized recent studies, underlying mechanism and clinical managements of ERAT, and proposed a reconsideration of the definition and clinical significance of BP. RECENT FINDINGS: Recent studies have shown that the entity of ERAT in the very early phase of BP (i...
September 19, 2023: Current Opinion in Cardiology
Daniel R Feldman, Emily P Zeitler
PURPOSE OF REVIEW: Cognitive dysfunction is a complex condition that is becoming increasingly more prevalent. There has been growing acknowledgement that individuals with atrial fibrillation are at an increased risk of cognitive dysfunction beyond the association of age with both disorders. The purpose of this review is to explore the potential underlying mechanisms connecting atrial fibrillation and cognitive dysfunction and to examine the existing evidence for potential treatment options...
September 8, 2023: Current Opinion in Cardiology
Maria Irene Barillas-Lara, Christian C Faaborg-Andersen, Raymundo A Quintana, Juan Francisco Loro-Ferrer, Stacy A Mandras, Adrian daSilva-deAbreu
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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...
September 1, 2023: Current Opinion in Cardiology
James Malcolmson, Alex Shipolini, Saidi Mohiddin, Konstantinos Savvatis
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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...
September 1, 2023: Current Opinion in Cardiology
Manu Rajachandran, Nils Nickel, Richard A Lange
PURPOSE OF REVIEW: 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. RECENT FINDINGS: OSA is an important contributor to endothelial dysfunction and damage, while repetitive hypoxia and hypercarbia contribute to autonomic dysfunction and sympathetic stimulation...
September 1, 2023: Current Opinion in Cardiology
Ehab Bakbak, Aishwarya Krishnaraj, Brady Park, Subodh Verma, David A Hess
PURPOSE OF REVIEW: This review will provide an overview of the recent literature linking the pathophysiology of cardiometabolic disease with the depletion and dysfunction of circulating vascular regenerative (VR) cell content. Moreover, we provide rationale for the use of VR cells as a biomarker for cardiovascular risk and the use of pharmacological agents to improve VR cell content. RECENT FINDINGS: Recent studies demonstrate the potential of VR cells as a biomarker of cardiovascular risk and as a therapeutic target...
August 31, 2023: Current Opinion in Cardiology
Aish Sinha, Haseeb Rahman, Divaka Perera
PURPOSE OF REVIEW: Heart failure with preserved ejection fraction (HFpEF) accounts for half of all heart failure presentations and is associated with a dismal prognosis. HFpEF is an umbrella term that constitutes several distinct pathophysiological entities. Coronary microvascular dysfunction (CMD), defined as the inability of the coronary vasculature to augment blood flow adequately in the absence of epicardial coronary artery disease, is highly prevalent amongst the HFpEF population and likely represents one distinct HFpEF endotype, the CMD-HFpEF endotype...
August 29, 2023: Current Opinion in Cardiology
Marc Ruel
PURPOSE OF REVIEW: This article discusses current shortcomings in coronary artery bypass surgery and ways to overcome them. RECENT FINDINGS: Minimally invasive coronary bypass surgery, robotic coronary bypass, and hybrid approaches aim to avoid sternotomy, employ arterial grafts, and minimize the use of cardiopulmonary bypass. Other considerations such as bypass graft validation, the optimization of guideline-directed medical therapy, and the development of coronary surgery specialists are also crucial to further the benefits of coronary artery bypass grafting on future patients...
August 25, 2023: Current Opinion in Cardiology
Sundeep Chaudhry, Naresh Kumar, Ross Arena, Subodh Verma
PURPOSE OF REVIEW: Cardiopulmonary exercise testing (CPET) is the gold standard for directly assessing cardiorespiratory fitness (CRF) and has a relatively new and evolving role in evaluating atherosclerotic heart disease, particularly in detecting cardiac dysfunction caused by ischemic heart disease. The purpose of this review is to assess the current literature on the link between cardiovascular (CV) risk factors, cardiac dysfunction and CRF assessed by CPET. RECENT FINDINGS: We summarize the basics of exercise physiology and the key determinants of CRF...
August 22, 2023: Current Opinion in Cardiology
Nikhil Mistry, Helen Jiang, Kyle Chin, Gregory M T Hare, Subodh Verma, C David Mazer
PURPOSE OF REVIEW: Anemia is prevalent in patients with acute coronary syndromes. In this setting, there is uncertainty and controversy surrounding the optimal transfusion strategy for managing anemia. The goal of this review is to summarize the current clinical evidence, guidelines, and future directions for managing transfusion in acute coronary syndromes. RECENT FINDINGS: There is limited evidence from randomized trials evaluating restrictive versus liberal transfusion in patients hospitalized with and/or for acute coronary syndromes...
August 18, 2023: Current Opinion in Cardiology
Alexander C Razavi, Seamus P Whelton, Roger S Blumenthal, Laurence S Sperling, Michael J Blaha, Omar Dzaye
PURPOSE OF REVIEW: To provide a summary of the current evidence and highlight future directions regarding coronary artery calcium (CAC) and risk of sudden cardiac death (SCD). RECENT FINDINGS: Although up to 80% of all SCD is attributed to coronary heart disease (CHD), the subclinical atherosclerosis markers that help to improve SCD risk prediction are largely unknown. Recent observational data have demonstrated that, after adjustment for traditional risk factors, there is a stepwise higher risk for SCD across increasing CAC burden such that asymptomatic patients without overt atherosclerotic cardiovascular disease (ASCVD) experience a three-fold to five-fold higher SCD risk beginning at CAC at least 100 when compared with CAC = 0...
August 15, 2023: Current Opinion in Cardiology
Gry Dahle
PURPOSE OF REVIEW: Coronary artery disease is the third leading cause of mortality worldwide. Coronary artery surgery is an important treatment option. Certain groups such as people of color, those from lower socioeconomic backgrounds and women tend to have lower rates of receiving the surgery they need (Fig. 1). RECENT FINDINGS: Still there are disparities in treatment options for coronary artery disease among different groups, due to geographic location, economical situation, institutional tradition and sex...
August 10, 2023: Current Opinion in Cardiology
Ahmed A Mohamed, Kausik K Ray
PURPOSE OF REVIEW: This review aims to offer an up-to-date evaluation of Inclisiran's (a small interfering RNA treatment) ability to decrease low-density lipoprotein cholesterol (LDL-C), as well as its safety and potential effects on decreasing cardiovascular risk. RECENT FINDINGS: Inclisiran significantly lowers LDL-C levels, as shown by phase III studies, by inhibiting hepatic synthesis of proprotein convertase subtilisin kexin 9 (PCSK-9), a protein implicated in the degradation of LDL receptors...
July 27, 2023: Current Opinion in Cardiology
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