bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers to Implementation of Primary Percutaneous Coronary Intervention in Europe
Authors: Laut Kristina Grønborg , Pedersen Alma Becic , Lash Timothy L , Kristensen Steen Dalby ,   Department of Cardiology, Aarhus University Hospital Skejby, Brendstrupgaardsvej 100, DK-8200 århus N, Denmark. E: kristina@laut.dk,   Department of Clinical Epidemiology, Aarhus University Hospital, Denmark,   Department of Clinical Epidemiology, Aarhus University Hospital, Denmark,   Department of Cardiology, Aarhus University Hospital Skejby, Denmark
Published: August 2014

Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). Despite substantial evidence of its effectiveness, only 40–45% of European STEMI patients are currently treated with PPCI and there are large differences in this proportion between different European countries. Several studies have emphasised that PPCI delivery is complex, with multiple potential barriers to implementation, but there is no comprehensive research estimating the significant characteristics, factors and structures that determine the diffusion of PPCI in Europe. The lack of complete implementation and large national and regional differences arise from the interplay between technology, patients, policy makers, culture and resources. Explanations for the variation in treatment access still remain a puzzle and access to valid data is needed.
Classification of Cardiogenic Stroke – Overcoming the Challenges
Authors: Wolf Marc E , Hennerici Michael G ,   Department of Neurology, Universitäts Medizin Mannheim, University of Heidelberg, Mannheim,   Department of Neurology, Universitäts Medizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany. E: hennerici@neuro.ma.uni-heidelberg.de
Published: August 2014

Precise analysis of stroke subtypes is important for clinical treatment decisions and prognostic evaluation of patients leading to adapted individual patient management. Cardiogenic stroke represents a major part with approximately one-third of all ischaemic strokes, but evaluation is not as simple as could be expected. This is reflected by new classification systems like the Atherosclerosis, Small Vessel Disease, Cardiac Origin and Other Causes (ASCO) score, which permits a more comprehensive evaluation of people who have had a stroke. They allow better presentation of concomitant stroke aetiologies that influence primary management and secondary prophylaxis in cardiogenic stroke patients. Careful analysis of different ischaemic stroke patterns as well as demonstration of either symptomatic or asymptomatic previous ischaemic stroke and/or intracerebral bleedings on magnetic resonance imaging (MRI) is essential for adequate interpretation and best individual choice of antiplatelet/anticoagulation treatment. As a consequence, all people who have had a stroke should undergo a complete stroke work-up, even if a cardioembolic source like atrial fibrillation might be easily detected initially. Future aspects will address the increasing numbers of old people with both neurodegenerative, vascular and cardiac diseases with mutual interference of treatment and prevention regimens.
The Clinical Need for Tele-echocardiography
Authors: Bruining Nico ,   Thoraxcenter, FESC, Erasmus MC, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands. E: n.bruining@erasmusmc.nl
Published: August 2014

Requests for tele-medicine are rapidly growing. We are now used to being constantly connected to the internet via laptops, smartphones and, recently, tablet computers. The next step is to have access to work-related data, such as echocardiographic images. The continuous and rapid growth of echocardiography as the mainstream cardiac imaging modality (40 %), and the use of portable ultrasound devices, are stimulating this request for tele-echocardiography. With the diagnostic quality of the tablet computer screens, the future of tele-echocardiography looks bright.
Neutrophil Gelatinase-associated Lipocalin as a Cardiovascular Biomarker
Authors: Roy Andrew K , Keaney John , Mahon Niall G , Murray Patrick T , Macauley Catherine ,   Cardiology Research Fellow,   Cardiology Research Fellow,   Consultant Cardiologist,   Professor of Pharmacology and Clinical Therapeautics, Department of Cardiology, Mater Misericordiae University Hospital; University College Dublin,   Clinical Research Centre, 54 Nelson St, Dublin 7, Ireland. E: patrick.murray@ucd.ie
Published: August 2014

Neutrophil gelatinase-associated lipocalin (NGAL) is a 25 kDa glycoprotein found in many tissues, and has attracted increasing attention as a biomarker for the early diagnosis of acute kidney injury (AKI). In the kidney, it is produced and released in response to ischaemic insults, and thus may also play a role in diagnostic and prognostic evaluation and management of patients with AKI, including those with acute cardiorenal syndromes. In the cardiovascular system, NGAL has been implicated in endothelial apoptosis and atherosclerosis, as well as in the thrombi associated with abdominal aortic aneurysms. This review explores the novel roles of NGAL in the cardiovascular system, and highlights some of the key research findings in this rapidly evolving field.
Preclinical Diagnosis and Risk Assessment of Atherosclerosis – At Birth? At Event? When is Best?
Authors: Gullace Giuseppe , Khalaf Hassan ,   Director, Heart Center, Istituto Clinico del Policlinico di Monza, Via Petrarca 51, 20050 Verano Brianza, MB, Italy. E: giuseppe.gullace@policlinicodimonza.it,   Director, Education and Training, Prince Sultan Cardiac Center, King Fahad Specialistic Hospital, Buraydah, Al Qassim
Published: August 2014

Atherosclerosis is a multifactorial disease of polygenic inheritance and the interrelation with environmental and social factors adds to complexity of the disease. Atherosclerosis starts during childhood but manifests later during life. Early diagnosis is possible but the value of knowing is that you can take action. Different modalities of preclinical diagnosis of atherosclerosis include genotyping, non-invasive imaging techniques and traditional risk factors. This article highlights the value and limitation of each modality and elaborates on how to progress without being confronted by a patient having an unexpected heart attack when this can be anticipated and prevented.
New Anticoagulants as an Alternative to Aspirin in Atrial Fibrillation – Implications of the Apixaban versus Acetylsalicylic Acid to Prevent Strokes (AVERROES) Trial
Authors: De Caterina Raffaele ,   Professor of Cardiology, Institute of Cardiology and Centre of Excellence on Ageing, G d’Annunzio University, Chieti and G Monasterio Foundation, Pisa, c/o Ospedale SS Annunziata, Via dei Vestini, 66013 Chieti, Italy. E: rdecater@unich.it
Published: August 2014

Atrial fibrillation (AF) is an extremely common arrhythmia, substantially increasing the risk of stroke and thromboembolism. Prevention of stroke and thromboembolism is, therefore, an important part of AF management. Guidelines until now have recommended that patients with AF receive some form of antithrombotic therapy, either as a vitamin K antagonist or aspirin, with a preference for anticoagulants in most cases. However, such current treatments are suboptimal, and despite recommendations, many patients do not receive adequate thromboprophylaxis because they are considered, for various reasons, ‘unsuitable’ to receive a vitamin K antagonists. In this patient population, apixaban, a new oral anticoagulant inhibiting activated coagulation factor X (FXa), administered in fixed doses and without anticoagulation monitoring, has undergone testing against aspirin in the recently published Apixaban versus acetylsalicylic acid to prevent strokes (AVERROES) trial. This short review will briefly address the strengths and limitations of this trial and the practical relevance of this new clinical information.
Controversies in Implantable Cardioverter-defibrillator Therapy
Authors: Marinelli Alessandro , Luzi Mario , Capucci Alessandro ,   Medical Doctor, Università Politecnica delle Marche, Azienda Ospedaliero Universitaria Ospedali Riuniti, Clinica di Cardiologia, Via Conca 71, Località Torrette, 60126 (AN), Italy. E: marinelli.doc@gmail.com,   Medical Doctor,   Medical Doctor; Director of Cardiology Clinic and Professor of Cardiology, Università Politecnica delle Marche, Clinica di Cardiologia, Ospedali Riuniti di Ancona
Published: August 2014

Implantable cardioverter-defibrillator (ICD) therapy is a mainstay in sudden cardiac death (SCD) prevention. Its efficacy has been proven in several conditions such as heart failure and reduced left ventricular ejection fraction (LVEF) and in familial SCD syndromes. In contrast to the fairly clear role of ICD therapy for secondary prevention, its role and indications for primary prevention of SCD has been more difficult to define. Many questions remain unresolved in this setting, such as the choice of the optimal time for implantation after a myocardial infarction and the degree of LVEF reduction that is able to predict future events and to justify the risks of ICD implant. The choice of ICD therapy may also be challenging in patients with different demographic features and comorbidities from that enrolled in clinical trials. Finally, the relative rarity of familial SCD syndromes seriously limits the data upon which recommendations are based and therefore many questions concerning the risk-benefit of ICD implantation remain unresolved.
Platelet Function Testing in Clinical Practice – Experience and Views from Europe and the US
Authors: Bergmeijer Thomas O , van Werkum Jochem Wouter , Tantry Udaya S , Gurbel Paul A , ten Berg Jurrien M ,   St Antonius Centre for Platelet Function Research, St Antonius Hospital, Nieuwegein,   St Antonius Centre for Platelet Function Research, St Antonius Hospital, Nieuwegein; Department of Cardiology, St Antonius Hospital, Nieuwegein,   Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore,   Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore,   St Antonius Centre for Platelet Function Research, St Antonius Hospital, Nieuwegein; Department of Cardiology, St Antonius Hospital, PO Box 2500, 3435 CM Nieuwegein, The Netherlands. E: jurtenberg@gmail.com
Published: August 2014

A 68-year-old male is admitted to our hospital because of a 50-minute episode of chest pain occurring during the night. On admission he is symptom-free. His electrocardiogram shows new negative T waves in the leads V1–V3. Troponin T, measured twice, with a six-hour interval, is negative. His previous history mentions diabetes mellitus type II, hypercholesterolaemia and obesity (110 kg/176 cm/body mass index 35). He is treated with aspirin (300 mg loading dose, then 80 mg/day), clopidogrel (600 mg loading dose, then 75 mg/day), fondaparinux (2.5 mg subcutaneously/day) and metoprolol (100 mg/day). He is scheduled to undergo coronary angiography the next day. The question is: should we measure platelet function and/or genetics in this patient?
New Antiplatelet Drugs in Perspective
Authors: Penela Diego , Diaz-Ricart Maríbel , Heras Magda ,   Cardiologist, Department of Cardiology, Thorax Institute,   Haematologist, Department of Hemotherapy-Hemostasis,   Senior Consultant, Hospital Clínic, University of Barcelona, IDIBAPS, Department of Cardiology, Villarroel, 170, 08036 Barcelona, Spain. E: mheras@clinic.ub.es
Published: August 2014

Treatment with antiplatelet therapy is mandatory in acute coronary syndrome. The effectiveness of aspirin and clopidogrel both in the acute phase and in secondary prevention has been clearly demonstrated, although some problems have also arisen, such as variability of platelet inhibition with clopidogrel or increased bleeding in patients undergoing urgent surgery. New antiplatelet drugs have been tested and are currently incorporated into the therapeutic armamentarium. Their different pharmacokinetic and pharmacodynamic properties are a good addition to the classic antiplatelet therapy, overcoming some of its limitations. In this context, the choice of appropriate antiplatelet therapy requires an individualised approach. The aim of this article is to summarise existing evidence and highlight the main features of the new antiplatelet drugs, as well as offering a vision of some challenges in the use of this therapy.
Troponin in Non-ischaemic Dilated Cardiomyopathy
Authors: Barison Andrea , Pastormerlo Luigi Emilio , Giannoni Alberto ,   Scuola Superiore Sant’Anna and Fondazione G Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy.; Division of Cardiovascular Medicine, Fondazione G Monasterio CNR-Regione Toscana, Pisa, Via Giuseppe Moruzzi 1, 56124, Italy. E: barison@sssup.it,   Scuola Superiore Sant’Anna, Pisa; Division of Cardiovascular Medicine, Fondazione G Monasterio CNR-Regione Toscana, Pisa,   Scuola Superiore Sant’Anna, Pisa; Division of Cardiovascular Medicine, Fondazione G Monasterio CNR-Regione Toscana, Pisa
Published: August 2014

Non-ischaemic dilated cardiomyopathy (DCM) is a disease characterised by progressive left ventricular remodelling and dysfunction. DCM represents a major cause of morbidity and mortality. Cardiac troponins are sensitive biohumoral markers of myocyte injury that are used for diagnostic purposes in acute coronary syndromes but that are also detected in DCM. Several pathophysiological factors (wall stress, neurohormonal activation, inflammation, metabolic dysfunction, microvascular ischaemia) have been advocated to explain subtle ongoing necrosis in DCM. In particular, new ultrasensitive assays expand the detection range toward physiological cardiac troponin levels, allowing accurate biohumoral characterisation of myocardial remodelling from the early stages of DCM. Moreover, several clinical studies have demonstrated that increased cardiac troponin plasma levels are associated with worse prognosis and that further increases in cardiac troponin over time contribute to additional risk. Serial plasma cardiac troponin evaluation represents an accurate marker of disease evolution and risk stratification in DCM, identifying high-risk patients who need strict follow-up and enhanced therapeutic effort.
Diagnosis and Management of Cardiomyopathies – A Focus on Genetics, Cardiac Magnetic Resonance and Clinical Features
Authors: Sinagra Gianfranco , Moretti Michele , Vitrella Giancarlo , Merlo Marco , Bussani Rossana , Brun Francesca , Perkan Andrea ,   Department of Cardiology, University Hospital of Trieste,   Department of Cardiology, University Hospital of Trieste, Azienda Ospedaliero-Universitaria ‘Ospedali Riuniti’, Via P. Valdoni 1, 34100 Trieste, Italy. E: michele.moretti@gmail.com,   Department of Cardiology, University Hospital of Trieste,   Department of Cardiology, University Hospital of Trieste,   Department of Cardiovascular Pathology and Morbid Anatomy, University of Trieste,   Department of Cardiology, University Hospital of Trieste,   Department of Cardiology, University Hospital of Trieste
Published: August 2014

In recent years, outstanding progress has been made in the diagnosis and treatment of cardiomyopathies. Genetics is emerging as a primary point in the diagnosis and management of these diseases. However, molecular genetic analyses are not yet included in routine clinical practice, mainly because of their elevated costs and execution time. A patient-based and patient-oriented clinical approach, coupled with new imaging techniques such as cardiac magnetic resonance, can be of great help in selecting patients for molecular genetic analysis and is crucial for a better characterisation of these diseases. This article will specifically address clinical, magnetic resonance and genetic aspects of the diagnosis and management of cardiomyopathies.
Application of CD271+ Human Bone Marrow-derived Stem Cells for Ischaemic Heart Disease Therapy
Authors: Ghodsizad Ali , Farag Mina , Loebe Matthias , Lumsden Eric , Phiechaczek Christoph , Karck Matthias , Ruhparwar Arjang ,   The Surgical Stem Cell Therapy and Tissue Engineering Group, Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany. E: aghodsi@gmx.org,   The Surgical Stem Cell Therapy and Tissue Engineering Group, University of Heidelberg,   The Methodist Hospital, Houston,   The Methodist Hospital, Houston,   The Surgical Stem Cell Therapy and Tissue Engineering Group, University of Heidelberg,   The Surgical Stem Cell Therapy and Tissue Engineering Group, University of Heidelberg,   The Surgical Stem Cell Therapy and Tissue Engineering Group, University of Heidelberg
Published: August 2014

Cell transplantation for myocardial regeneration has been shown to have beneficial effects on cardiac function after myocardial infarction. Here, we discuss the application of CD 271+ bone marrow-derived stem cells (BMCs) as novel markers for the enrichment of mesenchymal somatic stem cells. Injection of BMCs into ischaemic myocardium during surgery has been shown to be both feasible and safe. This novel approach might hold promise as an alternative to medical management in patients with severe ischaemic heart failure who are ineligible for conventional revascularisation.
Novel Oral Antiplatelet Agents
Authors: Baron Suzanne J , Giugliano Robert P ,   Department of Cardiology, Massachusetts General Hospital,   Cardiovascular Division, Brigham and Women‗s Hospital, 75 Francis Street, Boston, MA 02115, US. E: rgiugliano@partners.org
Published: August 2014

One of the mainstays of the treatment of acute coronary syndromes is the interference of thrombus formation. Over the past few years, much research has been dedicated to understanding the cellular mechanisms involved in the development of thrombus. This research has resulted in the identification of new pharmacological targets for drug advancement as well as the development of more sophisticated versions of previously existing medications. In this article, we review the literature on the newest advances in oral antiplatelet therapies.
Myocardial Metabolic Imaging in the Clinical Setting
Authors: Tamaki Nagara , Kuge Yuji , Yoshinaga Keiichiro ,   Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, North 15, West 17, Sapporo, 060–8638, Japan. E: natamaki@med.hokudai.ac.jp,   Radioisotope Center, Hokkaido University, Sapporo,   Department of Molecular Imaging, Hokkaido University Graduate School of Medicine, Sapporo
Published: August 2014

Glucose and free fatty acids are a major energy source in the myocardium. Metabolic imaging with single photon emission tomography (SPECT) and positron emission tomography (PET) have been widely used for the evaluation of the pathophysiology of coronary artery disease (CAD) and heart failure. 18F fluorodeoxyglucose (FDG) is a glucose analogue that is used to measure myocardial glucose utilisation. The myocardial uptake of a modified branched fatty acid, 15-(p-[iodine-123] iodophenyl)-3-(R,S) methylpentadecanoic acid (BMIPP), reflects the activation of fatty-acid metabolism by co-enzyme A (CoA) and indirectly reflects cellular adenosine triphosphate (ATP) production. The turnover rate of the tricarboxylic acid (TCA) cycle reflects the rate of overall myocardial oxidative metabolism. 11C acetate is readily metabolised to CO2 almost exclusively through the TCA cycle. These three major agents have been most commonly used for probing myocardial energy metabolism in vivo. Such metabolic imaging has been used for assessing myocardial viability on the basis of persistent glucose utilisation in ischaemic but viable myocardium. BMIPP and FDG have been identified for locating a recent history of myocardial ischaemia. Furthermore, metabolic imaging is promising for the assessment of the pathophysiology of heart failure and the treatment effect of various drugs, as well as mechanical treatments. In this article we will provide an overview of the application of myocardial metabolic imaging in a clinical setting.
Cardiac Magnetic Resonance Imaging – Role and Applications
Authors: Rajiah Prabhakar , Desai Milind Y ,   Clinical Fellow, Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic,   Clinical Fellow, Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic; Associate Professor of Medicine, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, US. E: desaim2@ccf.org
Published: August 2014

Magnetic resonance imaging (MRI) has become an important imaging modality in the non-invasive evaluation of cardiovascular diseases because of technological advances that facilitate the rapid acquisition of high-quality images. MRI is considered the gold standard in the evaluation of myocardial function. The good spatio-temporal resolution, wide field-of-view and multiplanar reconstruction capabilities of MRI make it ideal for the evaluation of the anatomy of the heart and great vessels. In this article, we discuss the current role and applications of cardiovascular MRI.
The Role of Stent Design and Polymers in Safety Outcomes – A Review
Authors: Zivelonghi Carlo , Geremia Giulia , Pighi Michele , Ribichini Flavio ,   Division of Cardiology,   Division of Cardiology,   Division of Cardiology,   Director, Cardiovascular Interventions Unit, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy. E: flavio.ribichini@univr.it
Published: August 2014

Each component of a drug-eluting stent (DES) contributes to the safety of the device. Continuous efforts are being dedicated to the search of the optimal compromise between facility of use, safety and long-term efficacy. Shorter balloons reduce the vascular trauma beyond the stent struts; the metallic composition of the stent platform and the platform itself interact with the vascular wall in a long-lasting equilibrium between radial force, vessel patency and reparative cellular regrowth. The modality of drug elution is largely regulated by the chosen drug carrier, rather than by the chemical properties of the drug itself. Drug elution can be accomplished by permanent polymers that remain in the vessel wall forever, by biodegradable polymers that leave the naked metallic structure behind after their complete absorption, or even by direct release of the drug from stent reservoirs. The clinical performance of DESs has been exhaustively assessed in a large number of studies that have showed rapid and continuous improvements, from the first-generation DESs to the latest devices, based on substantial changes in stent design and polymer composition.
Deformation Measurements by Echocardiography versus Late Enhancement Magnetic Resonance Imaging in Patients with Coronary Artery Disease
Authors: Amundsen Brage H , Thorstensen Anders , Støylen Asbjørn ,   Resident and Researcher, ISB, Pb 8905, MTFS, 7491 Trondheim, Norway. E: brage.h.amundsen@ntnu.no,   Consultant,   Associate Professor and Consultant, MI Lab, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology and Department of Cardiology, St Olavs University Hospital, Trondheim, Norway
Published: August 2014

The aim of this article is to discuss the present and future potential of deformation imaging by echocardiography and scar visualisation by magnetic resonance imaging (MRI) in patients with coronary artery disease (CAD). The two methods are clearly different: one is concerned with function, the other with morphology. Echocardiography, with its versatility of methods and high applicability, will continue to be the workhorse in cardiac imaging of patients with CAD. Important additional information can be extracted from deformation imaging methods, especially due to the high temporal resolution in tissue Doppler. Deformation measurements in 3D images are still limited by their lower resolution compared with 2D but will continue to improve. The standardisation of image analysis and the collaboration within the echocardiographic community to conduct larger studies will be important tasks in the attempt to establish evidence for the new methods. Late enhancement MRI is a method with unique properties and will continue to be an important alternative in selected patients and settings, as well as an invaluable research tool.
Transcatheter Aortic Valve Implantation in High-risk Patients with Severe Aortic Stenosis
Authors: Fonseca Patricia , Rosenhek Raphael , Bapat Vinayak , Lins Markus ,   Medical Writer, Touch Medical Communications, Touch Briefings, Saffron House, 6–10 Kirby Street, London, EC1N 8TS, UK. E: patricia.fonseca@touchbriefings.com,   Associate Professor and Director, Clinic for Valvular Heart Disease, Department of Cardiology, Medical University of Vienna, Austria,   Consultant Cardiac Surgeon, Department of Cardiothoracic Surgery, Guy’s and St Thomas’ Hospital, London, UK,   Professor of Cardiology, Department of Cardiology, University Clinic Schleswig-Holstein, Kiel, Germany at a satellite symposium held on 9 December 2011 during EUROECHO 2011, 7–10 December 2011, Budapest, Hungary
Published: August 2014

Aortic stenosis (AS) has become an increasingly prevalent condition in ageing Western populations. Symptomatic AS is associated with significant morbidity, high hospitalisation rates and reduction in quality of life and life-expectancy. A large number of patients with severe AS are not currently receiving proper treatment, with subsequent increased mortality. While surgical aortic valve replacement continues to be an effective treatment for these patients, transcatheter aortic valve implantation is a new alternative for those at high risk from surgery. Overall, valve replacement and implantation procedures have a significant impact on prognosis and quality of life in AS patients. Referring a patient to a centre that has a multidisciplinary heart team will ensure that all treatment options are fully explored and the best clinical outcomes are reached.
Risk Stratification in Asymptomatic Aortic Stenosis
Authors: Dulgheru Raluca , Hana Weisz Sara , Magne Julien , Lancellotti Patrizio ,   Heart Valve Clinic, University of Liege, Department of Cardiology, University Hospital Sart Tilman, Liege, Belgium University of Medicine and Pharmacy ‘Carol Davila’, Bucharest, Romania,   Heart Valve Clinic, University of Liege, Department of Cardiology, University Hospital Sart Tilman, Liege, Belgium; Second University of Naples, Department of Cardiology, Naples, Italy,   Heart Valve Clinic, University of Liege, Department of Cardiology, University Hospital Sart Tilman, Liege, Belgium,   Heart Valve Clinic, University of Liege, University Hospital Sart Tilman, 4000 Liege, Belgium. E: plancellotti@chu.ulg.ac.be
Published: August 2014

Aortic stenosis is now the most frequent valvular heart disease in developed countries with a steadily increase in prevalence. The necessity of surgery in symptomatic patients is well established. However, the need for surgery in asymptomatic patients remains controversial. The identification of several factors (predictors of outcome) that may help selection of patients who are most likely to benefit from early elective surgery is challenging and of clinical importance.
Developments in Implantable Cardioverter Defibrillator Therapy
Authors: Foster William , Sopher Mark ,   Fellow,   Consultant, Cardiology Department, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK. E: Mark.Sopher@rbch.nhs.uk
Published: August 2014

Since the first implantable cardioverter defibrillator (ICD) implant in 1980, advances in the design of the devices, leads, detection algorithms and programming have led to major advances in device implantation, arrhythmia detection, recording and termination. Shocks from ICDs can be life-saving but increase morbidity, particularly when they are unnecessary or inappropriate. Recent evidence-based advances in programming have allowed reliable arrhythmia termination, in many cases without the need for shocks. The development of the subcutaneous ICD has allowed implantation in patients for whom vascular access may be difficult or best avoided. Remote monitoring of ICD patients allows some follow-up visits to be done in the patient’s home and increases the diagnostic data available to the ICD centre.
Clinical Implications from Recent Trials and New Guidelines for Stroke Prevention in Atrial Fibrillation
Authors: Müssigbrodt Andreas , Hindricks Gerhard ,   Physicians, Department of Electrophysiology, Leipzig University, Heart Center, Department of Electrophysiology, Strümpellstrasse 39, 04289 Leipzig, Germany. E: andreas.muessigbrodt@gmail.com,   Physicians, Department of Electrophysiology, Heart Center, Leipzig University, Leipzig, Germany
Published: August 2014

After the release of the 2010 guidelines of the European Society of Cardiology (ESC) and the 2011 update of the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC), new evidence has emerged that requires adaption of current clinical practice in the treatment of atrial fibrillation (AF). In 2011, results were published from two central AF trials concerning prevention of stroke in patients with AF: the Rivaroxaban Once daily oral direct factor Xa inhibition Compared with vitamin K antagonist for prevention of stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) and the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study. Other important aspects that have emerged since 2010 include findings of stroke risk in paroxysmal AF patients, prediction for AF-associated stroke and haemorrhage, risk–benefit considerations concerning oral anticoagulation in patients with chronic kidney disease and risk–benefit considerations with use of antiplatelet agents, alone, combined, or in combination with oral anticoagulants in AF patients. Canadian AF guidelines were updated earlier this year, incorporating the new evidence. Also, in 2012, the American College of Chest Physicians released guidelines for the antithrombotic therapy of AF. Similar updates of the ESC and the AHA/ACC guidelines are expected, which will include new findings from the cardiovascular congresses over the upcoming months. Additionally, also in 2012, the Heart Rhythm Society, the European Heart Rhythm Association and the European Cardiac Arrhythmia Society (HRS/EHRA/ECAS) released a consensus statement on the interventional treatment of AF. The following short review summarises these new data and furthermore highlights our current clinical practice.
Comparison of Standard and Derived 12-Lead Electrocardiograms Registrated by a Simplified 3-Lead Setting with Four Electrodes for Diagnosis of Coronary Angioplasty-induced Myocardial Ischaemia
Authors: Bonaventura Klaus , Wellnhofer Ernst , Fleck Eckart ,   Doctor, Department of Cardiology, Angiology, Heart, Thorax and Vascular Centre, Klinikum Ernst von Bergmann and University Outpatient Clinic Potsdam, Sports Medicine and Sports Orthopaedics, University of Potsdam, Charlottenstraße 72, 14467 Potsdam, Germany. E: kbonaventura@klinikumevb.de,   Doctor, Department of Cardiology, German Heart Institute Berlin, Berlin, Germany,   Doctor, Department of Cardiology, German Heart Institute Berlin, Berlin, Germany
Published: August 2014

Electrocardiograms (ECGs), myocardial infarction, patient monitoring, EASI lead ECG, percutaneous transluminal coronary angioplasty, four electrodes set 12-lead ECG, 12-lead ECG, cardiovascular patients
High-sensitivity Troponins – Difficult Friends in Acute Coronary Syndromes
Authors: Klingenberg Roland , Matter Christian M , Wyss Christophe , Hof Danielle , von Eckardstein Arnold , Lüscher Thomas F ,   Clinical Fellow, Department of Cardiology/Cardiovascular Research, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland. E: roland.klingenberg@usz.ch,   Attending Physician, Department of Cardiology/Cardiovascular Research, University Hospital Zurich and Zurich Centre of Integrated Human Physiology, University of Zurich,   Attending Physician, Department of Cardiology/Cardiovascular Research, University Hospital Zurich,   Clinical Fellow, Department of Clinical Chemistry, University Hospital Zurich,   Professor, Department of Clinical Chemistry, University Hospital Zurich and Zurich Centre of Integrated Human Physiology, University of Zurich,   Professor, Department of Cardiology/Cardiovascular Research, University Hospital Zurich and Zurich Centre of Integrated Human Physiology, University of Zurich, Zurich, Switzerland
Published: August 2014

The introduction of novel high-sensitivity cardiac troponin (hs-cTn) assays has made it possible to measure cardiac troponin levels that are up to 10-fold lower than those detectable by conventional cardiac troponin (cTn) assays. With such novel assays, an elevated risk of major adverse cardiovascular events was noted across the continuum of cTn levels, with an incremental risk of increasing levels even in healthy individuals, but also in patients with stable coronary artery disease, congestive heart failure or acute coronary syndrome (ACS). The rapid triage of patients presenting to the accident and emergency department with chest pain is critical to ensure optimal management, and the novel hs-cTn assays provide a valuable tool for a more rapid exclusion of acute myocardial infarction (AMI), with a higher sensitivity, negative predictive value and diagnostic accuracy compared with conventional cTn assays. The associated decrease in specificity and positive predictive value for the diagnosis of AMI can be overcome by serial measurements to assess the absolute and relative increases in cTn levels. This article provides a contemporary overview of the role of hs-cTn in the detection of individuals with subclinical disease, diagnosis of ACS, risk stratification and clinical management. Furthermore, aspects of uncertainty, such as cut-offs, and the role of hs-cTn for clinical decision-making are addressed.
Therapeutic Strategies in Pulmonary Arterial Hypertension
Authors: Vizza Carmine Dario , Badagliacca Roberto , Poscia Roberto , Mezzapesa Mario , Nocioni Martina , Fedele Francesco ,   Department of Cardiovascular and Respiratory Science, School of Medicine, University of Rome “Sapienza”, Policlinico Umberto, Viale del Policlinico 155 - 00161 Rome, Italy. E: dario.vizza@uniroma1.it,   Department of Cardiovascular and Respiratory Science, School of Medicine, University of Rome “Sapienza”, Rome, Italy,   Department of Cardiovascular and Respiratory Science, School of Medicine, University of Rome “Sapienza”, Rome, Italy,   Department of Cardiovascular and Respiratory Science, School of Medicine, University of Rome “Sapienza”, Rome, Italy,   Department of Cardiovascular and Respiratory Science, School of Medicine, University of Rome “Sapienza”, Rome, Italy,   Department of Cardiovascular and Respiratory Science, School of Medicine, University of Rome “Sapienza”, Rome, Italy
Published: August 2014

Pulmonary arterial hypertension (PAH) is a serious and life-threatening condition for which the prognosis remains poor. Treatment options include endothelial receptor antagonists, phosphodiesterase (PDE5) inhibitors and prostanoids. Despite all demonstrating good short-term efficacy, none of the currently available drug therapies are curative. Treatment with prostanoids is complex and requires careful monitoring and management through a specialist centre. Furthermore, clinical efficacy is dependent on adequate up-titration of the drug. Treatment should be individualised and modified according to clinical response, with the addition of other therapies if required. The importance of monitoring and modifying therapeutic regimes is discussed. There appears to be reluctance among patients and physicians to employ prostanoid therapy, though an aggressive first-line therapy may be appropriate in advanced cases.
Left Main Stenosis – Where Do We Stand?
Authors: Bertog Stefan Christian , Steinberg Daniel Howard , Wunderlich Nina , Franke Jennifer , Sievert Horst ,   CardioVascular Centre, Frankfurt,   CardioVascular Centre, Frankfurt,   CardioVascular Centre, Frankfurt,   CardioVascular Centre, Frankfurt,   CardioVascular Centre Frankfurt, Seckbacher Landstrasse 65, 60389 Frankfurt, Germany. E: info@CVCFrankfurt.de
Published: August 2014

The presence of significant left main coronary disease is associated with increased mortality. Limited data examining the role of surgery in patients with a left main stenosis suggest a significant improvement in longevity. With the advent of coronary stenting, particularly the use of drug-eluting stents and improvements in percutaneous technology, left main coronary intervention has become more commonplace. However, despite important advances in the understanding of left main disease, management can be challenging. Many aspects, including the assessment of significance and the need for and choice of intervention (surgical or percutaneous revascularisation), remain unclear. This article serves to facilitate the management of patients with left main coronary disease with a focus on the assessment of lesion significance and the role of percutaneous intervention.
The Role of Revascularisation in Patients Undergoing Non-cardiac Surgery
Authors: Menees Daniel S , Bates Eric R ,   Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan,   Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, CVC Cardiovascular Medicine, 1500 E Medical Center Drive SPC 5869, Ann Arbor, MI 48109-5869, US. E: ebates@umich.edu
Published: August 2014

Coronary artery disease (CAD) affects millions of US citizens. As the population ages, an increasing number of people with CAD are undergoing non-cardiac surgery and face significant peri-operative cardiac morbidity and mortality. Risk-prediction models can be used to help identify those patients at increased risk of peri-operative cardiovascular complications. Risk-reduction strategies utilising pharmacotherapy with beta blockade and statins have shown the most promise. Importantly, the benefit of prophylactic coronary revascularisation has not been demonstrated. The weight of evidence suggests reserving either percutaneous or surgical revascularisation in the pre-operative setting for those patients who would otherwise meet independent revascularisation criteria.
Devices for Transcatheter Haemodynamic Support for Left Heart Failure
Authors: Ali Aman , Sanborn Timothy A ,   Internal Medicine Hospitalist, NorthShore University HealthSystem,   Head, Division of Cardiology, NorthShore University HealthSystem, and Clinical Professor, Pritzker School of Medicine, University of Chicago, 2650 Ridge Ave, Walgreen Building, Third Floor, Evanston, IL 60201, US. E: tsanborn@northshore.org
Published: August 2014

Among patients with acute myocardial infarction (AMI), those in cardiogenic shock have the highest mortality rate. Early revascularisation with primary percutaneous intervention or coronary artery bypass surgery has decreased the mortality rate of patients in cardiogenic shock, but it remains high. The conventional treatment of haemodynamic instability has been the use of the intra-aortic balloon pump (IABP); however, the IABP may not give adequate support to patients with severe left ventricular dysfunction. Recent advances in percutaneous left ventricular assist devices, specifically the TandemHeart and Impella LP 2.5, have shown improved haemodynamic support compared with the IABP. This article provides an overview of the use of percutaneous left ventricular assist devices to treat patients presenting with cardiogenic shock after acute MI.
Aortic Valve Implantation – Developments and Challenges
Authors: Buellesfeld Lutz , Gerckens Ulrich ,   Division of Interventional Cardiology, Department of Cardiology, Bern University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland. E: Lutz.Buellesfeld@insel.ch,   HELIOS Heart Centre, Siegburg
Published: August 2014

Surgical aortic valve replacement is the reference standard for patients with symptomatic severe aortic valve stenosis, but it is associated with a high surgical risk in numerous patient subgroups who present with co-morbidities such as reduced ejection fraction, prior surgery or advanced age. Transcatheter aortic valve implantation utilising stent-based prostheses has emerged as a promising new option in recent years and has been used by a number of operators in different centres, with incremental success in line with procedural experience. This has sparked the evolution of more sophisticated techniques, ranging from the initial anterograde approach to the currently used retrograde approach utilising arterial access or a transapical approach. The technology has also significantly improved over the years, with the development of delivery catheters with smaller profiles and better prostheses with various size options. These developments in the field of transcatheter aortic valve implantation and future perspectives will be discussed in this article.
Drug-eluting Balloon Analysis
Authors: Ruebben Alexander , Boeing Juergen , Weiss Norbert ,   Aachen Resonance GmbH, Pauwelsstrasse 19, 52074 Aachen, Germany. E: ruebben@gmx.net,   Aachen Resonance GmbH,   Aachen Resonance GmbH
Published: August 2014

Although different drug-eluting balloons appear similar in the underlying concept, the technical differences are important. This article takes a closer look at the coating technique and applications of the different products in the market and why different techniques have been used. The main points covered are loading dose, excipient used and homogenous or partial drug coverage of the balloon used.
Developments in Transcatheter Heart Valves for Patients with Severe Aortic Stenosis
Authors: Eggebrecht Holger , Kahlert Philipp , Patsalis Polykarpos , Wendt Daniel , Thielmann Matthias , Erbel Raimund ,   Department of Cardiology, Cardioangiological Center Bethanien (CCB), Im Prüfling 23, 60389 Frankfurt, Germany. E: h.eggebrecht@ccb.de,   Department of Cardiology,   Department of Cardiology,   Department of Cardiothoracic Surgery, West-German Heart Center Essen, University of Duisburg-Essen,   Department of Cardiothoracic Surgery, West-German Heart Center Essen, University of Duisburg-Essen,   Department of Cardiology
Published: August 2014

Transcatheter aortic valve implantation (TAVI) has become a viable treatment option for elderly patients with symptomatic severe aortic stenosis who are highly likely to require conventional surgery. Current developments in TAVI essentially focus on three issues: miniaturisation of catheter devices and sheaths for facilitated transfemoral vascular access; development of retrievable and repositionable valve systems; and the prevention of peri-procedural embolic stroke. This article will provide a review of current developments in the field of TAVI.
Current Status of Carotid Stenting
Authors: Shabaneh Bahaeddin , Strickman Neil , Krajcer Zvonimir ,   Department of Cardiology, Texas Heart Institute at St Luke’s Episcopal Hospital,   Department of Cardiology, Texas Heart Institute at St Luke’s Episcopal Hospital,   Department of Cardiology, Texas Heart Institute at St Luke’s Episcopal Hospital, 6624 Fannin St., Suite 2780, Houston, TX 77030, US. E: ZvonkoMD@aol.com
Published: August 2014

Carotid stenting has significantly evolved over the last decade as techniques and equipment have continued to improve. Several phases of waxing and waning enthusiasm have occurred that have started to settle in favour of carotid stenting in select patients. Carotid stenting is being performed more frequently in community hospitals with reasonable results, as seen in multiple registries. The most recent randomised trials that have compared carotid stenting versus carotid endarterectomy have shed considerable light on the safety and efficacy of stenting, but also have created controversy over the methods and design of many of these trials. The results of the most recent trial, Carotid revascularization endarterectomy versus stenting (CREST) and other registry studies have lifted considerable fog from the scene and confirmed the safety and efficacy of stenting. We are optimistic that future trials will involve better methods and equipment and will help to establish carotid stenting as a standard therapy for carotid artery stenosis.
Renal Revascularisation Therapy in 2011 – In Perspective
Authors: Colyer William R , Cooper Christopher J ,   Assistant Professor of Medicine, Cardiovascular Division, University of Toledo, 3000 Arlington Ave., MS 1118, Toledo, OH 43614, US. E: william.colyer@utoledo.edu,   University of Toledo
Published: August 2014

The management of renal artery stenosis (RAS) remains controversial. There is a large body of evidence from registries and cohort studies suggesting that revascularisation with stenting is beneficial in RAS; however, randomised trials of revascularisation versus medical therapy have failed to demonstrate that revascularisation improves outcome. Owing to significant methodological limitations, recent randomised trials have increased the controversy instead of resolving it, yet these trials cannot be disregarded. Currently, there appears to be a role for stenting in RAS, particularly among patients with at least moderate chronic kidney disease who seem to derive the greatest benefit from stenting. Additionally, there is probably some degree of blood pressure improvement; however, in most cases, stenting does not provide a cure. Thus, it is important that a physician evaluates each patient with RAS carefully and considers multiple issues to determine whether stenting would be beneficial.
Optimum Therapies for ST-Elevation Myocardial Infarction Managed with Primary Percutaneous Coronary Intervention
Authors: Brodie Bruce R ,   Clinical Professor of Medicine, University of North Carolina Teaching Services, Moses Cone Hospital, LeBauer Cardiovascular Research Foundation, 313 Meadowbrook Terrace, Greensboro, NC 27408, US. E: bbrodie89@gmail.com
Published: August 2014

This article reviews optimum therapies for the management of ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI). Optimum anti-thrombotic therapy includes aspirin, bivalirudin and the new anti-platelet agents prasugrel or ticagrelor. Stent thrombosis (ST) has been a major concern but can be reduced by achieving optimal stent deployment, use of prasugrel or ticagrelor, selective use of drug-eluting stents (DES) and use of new generation DES. Large thrombus burden is often associated poor outcomes. Patients with moderate to large thrombus should be managed with aspiration thrombectomy and patients with giant thrombus should be treated with glycoprotein IIb/IIIa inhibitors and may require rheolytic thrombectomy. The great majority of STEMI patients presenting at non-PCI hospitals can best be managed with transfer for primary PCI even with substantial delays. A small group of patients who present very early, who are at high clinical risk and have long delays to PCI, may best be treated with a pharmaco-invasive strategy.