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Future Cardiology

Noel C Chan, Jeffrey I Weitz
Until recently, heparins and vitamin K antagonists (VKAs) were the cornerstones for prevention and treatment of venous thromboembolism (VTE). This situation changed with the introduction of the direct oral anticoagulants, which are now replacing low-molecular-weight heparin for thromboprophylaxis after elective hip or knee arthroplasty and VKAs for VTE treatment. Rivaroxaban, an oral factor Xa inhibitor, was the first direct oral anticoagulant licensed for VTE prevention and treatment. This paper provides the rationale for factor Xa as a target for anticoagulants, describes the development of rivaroxaban, reviews its pharmacological profile, discusses the clinical trials with rivaroxaban for VTE prevention and treatment and highlights areas of uncertainty...
February 19, 2019: Future Cardiology
Massimiliano Lorenzini, Perry M Elliott
Transthyretin (TTR) related cardiomyopathy is an underdiagnosed cause of heart failure but is increasingly recognized in various settings - from patients admitted with heart failure to symptomatic aortic stenosis - and is rapidly becoming the most frequent form of systemic amyloidosis. Following the recent publication of the landmark ATTR-ACT trial that showed tafamidis to be the first treatment to improve survival in patients with TTR-related cardiac amyloidosis and heart failure, we reviewed the drug's rationale, characteristics and evidence supporting its use in TTR amyloidosis...
February 15, 2019: Future Cardiology
Luca Degli Esposti, Jean-Baptiste Briere, Kevin Bowrin, Sangiorgi Diego, Valentina Perrone, Giuseppe Di Pasquale
AIM: To evaluate antithrombotic treatment patterns in patients in Italy with nonvalvular atrial fibrillation (NVAF) before and after direct oral anticoagulants (DOACs) were approved. METHODS: This analysis included patients with a discharge diagnosis of NVAF in 2010 and 2014, which constituted the pre- and post-DOACs populations, respectively. RESULTS: Approximately 90% of patients were eligible for oral anticoagulant (OAC) therapy. Overall use of OACs increased from 38% in 2010 to 45% in 2014; use of antiplatelet therapy decreased from 36 to 25%...
January 21, 2019: Future Cardiology
Jeffrey C Selan, Takahiro Yoshimura, Samit Bhatheja, Samin K Sharma, Annapoorna S Kini
Coronary bifurcation lesions account for 15-20% of all percutaneous coronary interventions. Percutaneous revascularization of these lesions is technically challenging and results in lower success rates than nonbifurcation lesions. There are unique procedural considerations and techniques that are employed in the percutaneous revascularization of these lesions. Our objective is to define the procedural complexities of treating coronary bifurcation lesions and describe the leading provisional and dedicated two stent techniques used to optimize procedural and clinical results, as described in the BIFURCAID app...
January 15, 2019: Future Cardiology
Paul F Brennan, Mark S Spence
Transcatheter aortic valve implantation (TAVI) is now an established treatment option for both high and intermediate operative risk patients with severe symptomatic aortic stenosis. The number of patients undergoing TAVI has increased over the last decade warranting continued technological improvements in transcatheter heart valve (THV) systems. The novel CENTERA self-expanding THV (Edwards Lifesciences, CA, USA) received CE approval this year. It is deliverable through a 14Fr sheath and has a unique motorized delivery system...
January 9, 2019: Future Cardiology
Maarten P van Wiechen, Nicolas M Van Mieghem
The only curative treatment of aortic stenosis is through surgical or transcatheter aortic valve replacement. Transcatheter aortic valve implantation has evolved from its first in human experience in 2002 and matured to the treatment of first choice of symptomatic severe aortic stenosis in elderly patients with an elevated operative risk. The self-expanding CoreValve® bioprosthesis has been on the forefront of this growing transcatheter aortic valve implantation experience. Over the last decade, various device iterations resulted in the current Evolut PRO® self-expanding valve platform with reduced profile, repositioning/retrievable features and porcine pericardial wrap...
December 19, 2018: Future Cardiology
Benedict M Wiles, Paul R Roberts
Permanent cardiac pacemakers have traditionally comprised a surgically implanted subcutaneous pulse generator affixed to at least one transvenous pacing lead. Despite technological advances, implant-related complications and transvenous-lead failure rates have remained high. The Micra Transcatheter Pacing System is a miniaturized single chamber pacemaker that is implanted directly into the right ventricle, eliminating the subcutaneous pocket and creating a leadless pacemaker system. Registry data show an extremely high implant success rate, significantly lower major complication rates than transvenous pacemakers, stable pacing parameters and reliable battery performance...
December 5, 2018: Future Cardiology
Shabana Shahanavaz, Doff B McElhinney
The introduction of transcatheter therapy for valvular heart disease has changed the spectrum of care of patients with a variety of cardiovascular conditions. Transcatheter valve placement has become established as a method of treating pathologic regurgitation or stenosis of the pulmonary valve, right ventricular outflow tract or a right ventricle to pulmonary artery conduit. In this review, we examine the pathophysiology of and indications for transcatheter pulmonary valve replacement along with procedural complications...
November 30, 2018: Future Cardiology
Eli M Roth
Ischemic heart disease and stroke are the leading causes of death in the world currently. Both of these conditions are primarily caused by atherosclerosis, the underlying pathophysiology of which is the deposition of lipid, specifically low-density lipoprotein cholesterol (LDL-C) within the arterial bed. Proprotein convertase subtilisin kexin type 9 (PCSK9), is a proteolytic enzyme, which indirectly increases LDL-C levels by causing the destruction of LDL receptors, the main way that humans regulate their serum LDL-C levels...
November 30, 2018: Future Cardiology
Mohamed A Ahmed, Mardi Hamra, Thomas J Kiernan
No abstract text is available yet for this article.
November 28, 2018: Future Cardiology
Luca Baldetti, Alessandro Beneduce, Mario Gramegna, Antonio Colombo, Francesco Giannini
The COMBO stent is a new, sirolimus-eluting bioresorbable polymer, bioengineered stent. This technology combines the advantages of second-generation drug-eluting stents with the endothelial progenitor cell capture technology mediated by the anti-CD34 antibody coating on the COMBO luminal surface. This dual technology should improve vessel endothelium regeneration and may lay the biological basis for a short dual antiplatelet therapy course. As new evidence is adding on the safety and efficacy of this stent compared with first- and second-generation drug-eluting stents and across a variety of patient populations, aim of this review is to summarize available clinical experience and future perspective with this device...
November 27, 2018: Future Cardiology
Maurizio Taramasso, Mizuki Miura, Mara Gavazzoni, Martin Andreas, Matteo Saccocci, Gökhan Gülmez, Rishi Puri, Francesco Maisano
The Portico TAVI system (Abbott Vascular, Santa Clara, CA, USA) has been specifically designed to mitigate some of the complications associated with first-generation valves. Most of the data generated from randomized studies comparing transcatheter aortic valve implantation with surgery stem from reported experiences with first generation transcatheter heart valve devices. The aim of this review is to describe the repositionable and retrievable Portico system and its implantation technique, coupled with our single-center experience and to provide a review of the clinical results reported so far in the literature...
November 27, 2018: Future Cardiology
Dario Buccheri
No abstract text is available yet for this article.
November 22, 2018: Future Cardiology
Mohammad H Namazi, Morteza Safi, Amir Momenizadeh, Isa Khaheshi, Mehdi Memaryan, Mohammad R Movahed
We found a coexistence of Mahaim fibers, coarctation of aorta and bicuspid valve in a young patient presenting with palpitations and subraventricular tachycardia. This rare combination of these three congenital cardiac abnormalities occurring in the same patient has not been reported previously. Detailed cardiac studies unmasked the patient's cardiac abnormalities. Furthermore, successful percutaneous intervention in treating coarctation and catheter-based ablation of Mahaim fibers were performed with resolution of symptoms...
November 13, 2018: Future Cardiology
Robert J Henning
The global prevalence of diabetes has risen in adults from 4.7% in 1980 to 8.5% in 2014. 90-95% of adults with diabetes have Type 2 diabetes (T2D). This paper focuses on the diagnosis and treatment of T2D patients who have or are at risk for cardiovascular disease. Hyperglycemia, insulin resistance and excess fatty acids increase oxidative stress, disrupt protein kinase C signaling and increase advanced glycation end-products that result in vascular inflammation, vasoconstriction, thrombosis and atherogenesis...
November 9, 2018: Future Cardiology
Vinai C Bhagirath, John W Eikelboom, Sonia S Anand
The cardiovascular outcomes for people using anticoagulation strategies (NCT01776424) trial randomized 27,395 patients with stable coronary artery disease or peripheral artery disease (PAD) to receive rivaroxaban 5 mg twice-daily alone, the combination of rivaroxaban 2.5 mg twice-daily and aspirin 100 mg daily, or aspirin 100 mg daily alone. The combination arm resulted in a 24% reduction in the primary end point of cardiovascular death, stroke or myocardial infarction, and an 18% reduction in mortality...
November 2018: Future Cardiology
Robert M Stoekenbroek, David Kallend, Peter Lj Wijngaard, John Jp Kastelein
Inclisiran is a novel drug that inhibits PCSK9 synthesis specifically in the liver, harnessing the natural mechanism of RNAi. Phase I and II data show that inclisiran lowers low-density lipoprotein cholesterol levels on average by >50% with a duration of effect that enables twice-yearly dosing. Phases I, II and emerging Phase III data support inclisiran's safety, tolerability and risk-benefit profile. The ongoing ORION program includes Phase III trials that will provide robust evidence of inclisiran's safety and efficacy in individuals at high risk of atherosclerotic cardiovascular disease (ASCVD), including established ASCVD and familial hypercholesterolemia...
October 30, 2018: Future Cardiology
Katelyn W Sylvester, Jean M Connors
Despite significant advances in strategies and compliance with venous thromboembolism (VTE) prophylaxis, hospital-acquired VTE remains a leading cause of preventable deaths in acute medically ill patients. A majority of venous thromboembolic events occur post-hospital discharge when risk factors persist and pharmacoprophylactic regimens have been completed. Until recently, there has been an unmet need for safe and effective extended-duration VTE prevention. Three major trials evaluated this concept, but excess bleeding outweighed the benefit of reduced thromboembolic events...
October 24, 2018: Future Cardiology
Sofian Johar, Nazar Luqman
AIM: The Micra™ Transcatheter Pacing System is a leadless pacemaker that has been introduced recently. We share our experience in a low volume center and the use of right ventricular angiography (RVA) during implantation. MATERIALS & METHODS: Patients underwent Micra implantation and RVA was performed to predetermine the implant site. RESULTS: Nine patients underwent Micra implantation. The most common indication was atrial fibrillation with bradycardia...
September 25, 2018: Future Cardiology
Rajesh Reddy, Maulik Majmudar, Neil Dhopeshwarkar, Victoria Vacaro, Eric Isselbacher, Ami B Bhatt
AIM: To determine if patients in cardiology practices would be interested in or willing to use mobile health technologies. METHODS: Patients seen at an ambulatory cardiology clinic for any indication were included. A paper survey was administered during pre-intake that assessed frequency of use, familiarity with and interest in mobile health applications. Data were analyzed using an exploratory logistic regression analysis to determine demographic predictors for technology utilization...
September 2018: Future Cardiology
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