bluuebunny/crossref_metadata_2025 huggingface dataset:
Histopathological Changes and Clinical Implications in Patients with Hypertrophic Cardiomyopathy
Authors: Almaas Vibeke Marie , Amlie Jan Peder ,   Division of Cardiovascular and Pulmonary Diseases, and Division of Specialised Medicine and Surgery, Oslo University Hospital, Rikshospitalet, University of Oslo,   Division of Cardiovascular and Pulmonary Diseases, and Division of Specialised Medicine and Surgery, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo University Hospital, Rikshospitalet, Postbox 4950, Nydalen, 0424 Oslo, Norway. E: janaml@medisin.uio.no
Published: August 2014

Hypertrophic cardiomyopathy (HCM) is a familial disease with a wide clinical spectrum. Many patients have normal life expectancy, some die suddenly – often as adolescents or young adults – whereas only a few develop end-stage heart failure. In the total HCM population, only 25% develop significant left ventricular outflow tract obstruction. The histopathological hallmarks of HCM are general myocyte hypertrophy, regions of myocyte disarray, different types of fibrosis and small-vessel disease. To better understand the disease development and the aetiology of the electrical instability leading to serious arrhythmias and sudden cardiac death (SCD) in these patients, it is important to explore the relationship between histopathological features and clinical findings and outcome in patients with HCM. This article provides a brief overview of this theme.
The Effects of Plant Stanol Ester in Different Subject Groups
Authors: Gylling Helena , Miettinen Tatu A ,   Department of Clinical Nutrition, University of Eastern Finland, PO Box 1627, 70211 Kuopio, Finland. E: helena.gylling@uef.fi,   Department of Medicine, Division of Internal Medicine, University of Helsinki
Published: August 2014

Different food products enriched with plant stanol esters have proved effective and safe as a dietary hypocholesterolaemic tool in about 60 published clinical studies during 15 years on the market. In addition to lowering low-density lipoprotein (LDL) cholesterol by 10% with a dose of 2g/day, plant stanol effectively reduces serum plant sterols and also, in some studies, serum triglycerides. It has been shown to be an effective dietary hypocholesterolaemic agent in adults and children with primary hypercholesterolaemia, in familial hypercholesterolaemia, in coronary subjects and in type 1 and type 2 diabetes. Plant stanol ester can be combined with statin to obtain more powerful serum total and LDL cholesterol reduction. This combination therapy inhibits both cholesterol synthesis and absorption. Plant stanol ester reduced the C-reactive protein (CRP) level in recent studies and, in contrast to ezetimibe, it does not change the LDL particle size. Plant stanol ester consumption tends to reduce the plant sterol contents of arterial wall, and in some, but not all, studies it improves endothelial function, a surrogate marker of pre-clinical atherosclerosis.
Telehealth – Future Directions in Cardiovascular Care
Authors: Cleland John GF , Barrett David ,   Department of Cardiology, Hull and York Medical School,,   Lecturer in Telehealth, Faculty of Health and Social Care, University of Hull, Cottingham Road, Hull, HU6 7RX, UK. E: d.i.barrett@hull.ac.uk
Published: August 2014

Over recent years, telehealth has increasingly demonstrated its value in supporting the delivery of cardiovascular healthcare. From teletriage services as a portal into healthcare through to telemonitoring of heart failure patients, technology is already increasing the ability of practitioners to provide care remotely, empower patients and improve clinical outcomes. In the future, telehealth services have the potential to have an even greater impact on the provision of cardiovascular care. Embedding telehealth services into mainstream cardiac care, the development of more sophisticated devices and the utilisation of technology in a wider range of clinical contexts will help to accelerate the adoption of telehealth throughout healthcare. This article evaluates the current state of the art in telehealth provision and explores some of the areas for future development in this fast-moving and exciting area of clinical practice.
Remote Navigation for Ablation Procedures – A New Step Forward in the Treatment of Cardiac Arrhythmias
Authors: Nguyen Bich Lien , Merino Jose L , Gang Eli S ,   Electrophysiology Section, Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome,   Arrhythmia-Electrophysiology Research Unit, La Paz University Hospital, Madrid,   Electrophysiology Section, Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, Cardiovascular Research Foundation, 414 North Camden Drive, Beverly Hills, CA 90210, US. E: gang@cvmg.com
Published: August 2014

Catheter ablation has become the curative treatment for various cardiac arrhythmias, including ventricular tachycardia and atrial fibrillation, leading to more challenging procedures, prolonged fluoroscopy exposure and the need for stable and reproducible catheter movement. In the last decade, remotely-controlled catheter ablation has emerged as a novel concept to improve catheter manoeuvrability and stability. This has the potential to increase procedural success, decrease procedure time and minimise catheter-related complications. To date, two remote navigation systems (Niobe from Stereotaxis and Sensei from Hansen Medical) are commercially available based on magnetic and mechanical driven forces, respectively. Both have shown promise but also shortcomings during clinical evaluation. Recently, two new systems, CGCIMaxwell from Magnetecs and Amigo from Catheter Robotics, have shown promising results in animals. They are under clinical evaluation and are also based on magnetic and mechanical driven forces, respectively. This article describes the basic principles of the systems, summarises their respective published experiences during mapping and ablation procedures, their current clinical applications and future directions.
Utilisation of Robotic Navigation Systems in the Treatment of Atrial Fibrillation
Authors: Schilling Richard ,   Consultant Cardiologist, 3rd Floor, St Olaf House, London Bridge Hospital, 27 Tooley Street, London, SE1 2PR, UK. E: cristina.thorne@zen.co.uk
Published: August 2014

Atrial fibrillation (AF) is linked to an increased risk of adverse cardiovascular events. While rhythm control with antiarrhythmic drugs (AADs) is a common strategy for managing patients with AF, catheter ablation may be a more efficacious and safer alternative to AADs for sinus rhythm control. Conventional catheter ablation has been associated with challenges during the arrhythmia mapping and ablation stages; however, the introduction of two remote catheter navigation systems (a robotic and a magnetic navigation system) may potentially overcome these challenges. Initial clinical experience with the robotic navigation system suggests that it offers similar procedural times, efficacy and safety to conventional manual ablation. Furthermore, it has been associated with reduced fluoroscopy exposure to the patient and the operator as well as a shorter fluoroscopy time compared with conventional catheter ablation. In the future, the remote navigation systems may become routinely used for complex catheter ablation procedures.
Implantable Cardioverter–Defibrillators for Primary Prevention of Sudden Cardiac Death
Authors: Gramley Felix , Goette Andreas ,   Department of Cardiology and Vascular Medicine, Mainz University,   Department of Cardiology and Intensive Care Medicine, St Vincenz Hospital, Paderborn, Am Busdorf 2, 33098 Paderborn, Germany. E: andreas.goette@med.ovgu.de
Published: August 2014

Sudden cardiac death (SCD) remains a major cause of death in the industrialised world. Implantable cardioverter–defibrillators (ICDs) have been shown to be an effective therapy option for the primary prevention of SCD in patients at high risk of SCD. This review will discuss adequate risk stratification in various disease states, such as coronary artery disease, ischaemic and non-ischaemic cardiomyopathies (dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy), channelopathies (Brugada syndrome, long- QT syndrome, short-QT syndrome, catecholaminergic polymorphic ventricular tachycardia) and congenital heart diseases, to identify patients at high risk of SCD and selection criteria for ICD therapy. The most important clinical primary prevention trials will be highlighted. Finally, complications of device therapy and quality of life issues will be addressed.
New Drugs for Thromboembolic Prevention in Atrial Fibrillation
Authors: Merino Jose L , López-Sendón Jose ,   Director, Arrhythmia Research Unit, Unidad de Investigación de Arritmias y Electrofisiología, Hospital Universitario La Paz, P Castellana 261, 28046 Madrid, Spain. E: jlmerino@arritmias.net,   Director, Cardiology Department, Hospital Universitario La Paz, IdiPaz, Madrid
Published: August 2014

Atrial fibrillation (AF) is the most frequent sustained arrhythmia and its prevalence is increasing in developed countries. This progressive increase and the negative impact of this arrhythmia on the patient’s prognosis make AF one of the main healthcare problems faced today. This has led to intense research into the main aspects of AF, one of them being thromboembolism prevention. AF patients have a four to five times higher risk of stroke than the general population. Several factors increase thromboembolic risk in patients with AF and the use of risk scores, such as the Congestive Heart Failure, Hypertension, Age Greater than 75, Diabetes, and Prior Stroke or Transient Ischemic Attack (CHADS2), have been used to identify the best candidates for anticoagulation. Antithrombotic drugs are the mainstay of therapy for embolic prevention. The clinical use of these drugs is based on the risk–benefit ratio, where benefit is the reduction of stroke and systemic embolic events and risk is mostly driven by the increase in bleeding events. Generally, antiplatelets are indicated for low-risk patients in light of the fact anticoagulants are the drug of choice for moderate- or high-risk patients. Vitamin K antagonists have been the only option for oral anticoagulation for the last 50 years. However, these drugs have many pharmacodynamic and pharmacokinetic problems. The problems of anticoagulation with vitamin K antagonists have led to the investigation of new drugs that can be administered orally and have a better dose–response relationship, a shorter half-life and, in particular, higher efficacy and safety without the need for frequent anticoagulation controls. The drugs that have been studied most thoroughly in patients with AF are inhibitors of the activated coagulation factor X and inhibitors of coagulation factor II (thrombin), including ximelagatran and dabigatran. In addition, non-pharmacological therapies have been developed to prevent recurrent embolism in certain patient populations.
Telemonitoring in Heart Failure Rehabilitation
Authors: Piotrowicz Ewa , Piotrowicz Ryszard ,   Department of Cardiac Rehabilitation and Non-invasive Electrocardiology, Institute of Cardiology, Alpejska 42 , 04-628 Warsaw, Poland. E: epiotrowicz@ikard.pl,   Department of Cardiac Rehabilitation and Non-invasive Electrocardiology, Institute of Cardiology, Warsaw
Published: August 2014

Exercise training (ET) is now recommended as an important component of a comprehensive approach to patients with heart failure (HF). Despite the existence of proven benefits of ET, many HF patients remain physically inactive. Introducing telerehabilitation (TR) may eliminate most of the factors that result in the currently low number of patients undergoing outpatient-based rehabilitation programmes and thus increase the percentage of those who will undergo cardiac rehabilitation. Despite the fact that TR is highly applicable and effective, there are few papers dedicated to the study of TR in HF patients. Until recently, only a couple of home rehabilitation-monitoring models have been presented, from the simplest, i.e. heart rate monitoring and transtelephonic electrocardiographic monitoring, through to the more advanced tele-electocardiogram (tele-ECG) monitoring (via a remote device) and realtime electrocardiographic and voice transtelephonic monitoring. It seems the last two are the most useful and reliable. Based on published studies, TR in HF patients could be equally effective as and provide similar improvements in health-related quality of life to standard outpatient cardiac rehabilitation. In addition, adherence to cardiac rehabilitation seems to be better during TR. Due to disease-related limitations, TR seems to be a viable alternative for comprehensive cardiac rehabilitation in HF patients. Further studies are needed to confirm the utility of this type of rehabilitation in routine clinical practice, including its cost-effectiveness. Because of the diversity of technological systems, it is necessary to create a platform to ensure compatibility between the devices used in telemedicine.
Repair Options for Mitral Regurgitation
Authors: Alfieri Ottavio , De Bonis Michele ,   Professor of Cardiac Surgery, and Chief, Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. E: alfieri.ottavio@hsr.it,   Contract Professor of Cardiac Surgery, and Staff Cardiac Surgeon, Department of Cardiac Surgery, San Raffaele University Hospital
Published: August 2014

Mitral valve repair is the treatment of choice for severe degenerative mitral regurgitation providing better freedom from cardiac events, quality of life and long-term survival compared with mitral valve replacement. Increasing numbers of asymptomatic patients are therefore referred for mitral repair. With refinements of the surgical techniques, long-term results have further improved in the last decade. Certainly experience is crucial in determining the likelihood of success and patients with a mitral valve deemed reparable should be referred to centers with high volume and extensive experience in this field. In this article the current role of mitral valve repair in degenerative mitral regurgitation (MR) will be outlined. Moreover some important concepts regarding indication and techniques of mitral repair in the more challenging setting of secondary (functional) mitral regurgitation will be presented and discussed.
Managing Dyslipidaemic Patients – Improving Adherence with Lifestyle Intervention
Authors:   A satellite symposium report: From the European Atherosclerosis Society (EAS) Congress, Gothenburg, 26–29 June 2011
Published: August 2014

On 27 June 2011, during the European Atherosclerosis Society (EAS) Congress 2011, Danone hosted an educational symposium entitled ‖Nutritional Behaviour and Reduction of Cardiovascular Risk: From Basic Science to Clinical Practice‗. The symposium was co-chaired by Professor M John Chapman, EAS President and Director of the Dyslipidaemia and Atherosclerosis Research Unit at the French National Institute of Health and Medical Research (INSERM), Pitié-Salpêtrière Hospital, Paris, and Professor John Deanfield, British Heart Foundation Vandervell Professor of Cardiology, University College Hospital, London, UK. The focus of the four presentations and discussions was whether the incorporation of functional foods in the diet of dyslipidaemic patients might improve adherence to lifestyle changes, and the implications of such an approach.
Percutaneous Revascularisation of Coronary Chronic Total Occlusion – Outcomes and Development of Strategy 2006–2010
Authors: Reifart Nicolaus ,   Chief, Department of Cardiology, Main Taunus Heart Institute, 65812 Bad Soden, Germany. E: n.reifart@reifart-partner.de
Published: August 2014

Percutaneous coronary intervention for chronic total occlusions (CTOs), the most difficult and time-consuming intervention, is evolving rapidly. There has been a well-documented increase in the success rate of procedures in the hands of specifically trained operators from about 60 % to 90 % over the past 10 years; at the same time, the long-term patency with drug-eluting stents is exceeding 90 %. These results are comparable or even superior to surgical revascularisation. Several sophisticated techniques unique to CTO interventions are described in this article, and the need for specific training is emphasised so that a success rate of at least 80 % can be met, as claimed by the European Society of Cardiology guidelines on myocardial revascularisation, and so that patients with CTO who deserve revascularisation are no longer denied appropriate treatment.
Integration Between Computed Tomography and Nuclear Medicine for Non-invasive Assessment of Coronary Anatomy and Myocardial Perfusion
Authors: Acampa Wanda , Petretta Mario , Nappi Carmela , Cuocolo Alberto ,   Institute of Biostructures and Bioimages, National Council of Research,   Department of Clinical Medicine, Cardiovascular and Immunological Sciences,   Department of Biomorphological and Functional Sciences, University of Naples Federico II,   Institute of Biostructures and Bioimages, National Council of Research; Department of Biomorphological and Functional Sciences, University Federico II, Via Pansini 5, 80131 Napoli, Italy. E: cuocolo@unina.it
Published: August 2014

Many non-invasive imaging techniques are available for the evaluation of patients with known or suspected coronary heart disease. Among these, computed-tomography-based techniques allow the quantification of coronary atherosclerotic calcium and non-invasive imaging of coronary arteries, whereas nuclear cardiology is the most widely used non-invasive approach for the assessment of myocardial perfusion. The available single-photon-emission computed tomography flow agents are characterised by a cardiac uptake proportional to myocardial blood flow. In addition, different positron emission tomography tracers may be used for the quantitative measurement of myocardial blood flow and coronary flow reserve. Extensive research is being performed in the development of non-invasive coronary angiography and myocardial perfusion imaging using cardiac magnetic resonance. Finally, new multimodality imaging systems have recently been developed bringing together anatomical and functional information. This article provides a description of the available non-invasive imaging techniques in the assessment of coronary anatomy and myocardial perfusion in patients with known or suspected coronary heart disease.
Telmisartan in High Cardiovascular Risk Patients
Authors: Asmar Roland ,   President, Foundation–Medical Research Institutes, Geneva and Professor, Lebanese University of Medicine, Beirut, 11 bis Boulevard Delessert, 75016 Paris, France. E: ra@cmcv.org
Published: August 2014

The worldwide morbidity and mortality burden of cardiovascular disease (CVD) is overwhelming and caused by increasing life expectancy and an epidemic of risk factors, including hypertension. Therapeutic options targeting different areas of the renin–angiotensin–aldosterone system (RAAS) to disrupt pathophysiological processes along the cardiovascular continuum are available. Angiotensin-converting enzyme (ACE) inhibitors are first-line treatments for CVD and angiotensin receptor blockers (ARBs) are suitable alternatives. Both ACE inhibitors and ARBs prevent CVD by lowering blood pressure (BP). Additionally, several studies have demonstrated that RAAS blockade can reduce cardiovascular risk beyond what might be expected from BP lowering alone. However, the ARBs are not all equally effective. Telmisartan is a long-lasting ARB that effectively controls BP over the full 24-hour period. Recently, the Ongoing telmisartan alone and in combination with ramipril global endpoint trial (ONTARGET) study showed that telmisartan reduces cardiovascular events in high cardiovascular risk patients similarly to the gold standard ACE inhibitor ramipril beyond BP lowering alone, but with a better tolerability. Based on the results of the ONTARGET and Telmisartan randomized assessment study in ACE intolerant subjects with cardiovascular disease (TRANSCEND) studies, telmisartan is indicated for the reduction of cardiovascular morbidity. This article aims to review current guidelines for the management of CVD and consider key data from clinical trials and clinical practice evaluating the role of telmisartan in CVD.
Transvenous Phrenic Nerve Stimulation – A Novel Therapy for Central Sleep Apnoea in Heart Failure
Authors: Emani Sitaramesh , Abraham William T ,   Division of Cardiovascular Medicine, The Ohio State University Medical Center, Davis Heart and Lung Research Institute, 473 W. 12th Ave, Suite 200, Columbus, OH, US. E: sitaramesh.emani@osumc.edu,   Division of Cardiovascular Medicine, The Ohio State University Medical Center, Davis Heart and Lung Research Institute, Columbus
Published: August 2014

Central sleep apnoea (CSA) is a prominent co-morbidity in heart failure (HF) resulting from dysregulated neurological responses to abnormal carbon dioxide levels. The presence of CSA in HF has been linked with deleterious physiological changes and is associated with increased mortality, yet treatment options for CSA in HF are currently lacking. This article briefly reviews the mechanisms of CSA in HF as well as the available evidence on present therapies, and describes phrenic nerve stimulation as a potential novel therapeutic approach.
The Use of an Absorbable Microporous Polysaccharide Hemosphere Haemostat (AristaAH®) in Ventricular Assist Device Implant and Cardiac Transplantation Procedures
Authors: Bruckner Brian A , Loebe Matthias ,   The Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, 6550 Fannin Street, Smith Tower Suite 1401, Houston, TX 77030, US. E: babruckner@tmhs.org,   The Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, TX, US
Published: August 2014

Topical haemostatic agents are useful adjuncts for the overall approach to haemostasis during mechanical support and cardiac transplant surgical procedures. Increasing numbers of cardiac surgical patients are presenting with pharmacologically induced impairment of the clotting cascade. Additionally, there continues to be an increase in the numbers of ventricular assist device implantations worldwide and these patients have haemostasis challenges both at the time of implantation and at subsequent transplantation. Patients undergoing assist device placement or cardiac transplantation usually have severe, refractory heart failure and varying degrees of multi-organ dysfunction, which make them susceptible to bleeding during the surgical procedure. Despite routine blood conservation measures and the use of intravenous agents, local surgical field haemostasis still remains a challenge. Topical agents are increasingly used in cardiac surgical procedures, especially in assist device or transplant cases. Herein, we report our institutional approach to topical haemostasis in a high-risk group of patients undergoing assist device or cardiac transplant. AristaAH®, a novel polysaccharide topical haemostat, provides effective and safe control of challenging bleeding situations.
Assessing Acute Decompensated Heart Failure – Strategies and Tools
Authors: Vazir Ali , Cowie Martin R ,   Consultant in Cardiology and Critical Care, Royal Brompton and Harefield NHS Foundation Trust, London and National Heart and Lung Institute, Imperial College London,   Professor of Cardiology, National Heart and Lung Institute, Imperial College London, (Royal Brompton Hospital), Dovehouse Street, London, SW3 6LY, UK. E: m.cowie@imperial.ac.uk
Published: August 2014

Acute heart failure – the rapid onset of, or change in, signs and/or symptoms of heart failure requiring urgent treatment – is a serious clinical syndrome, associated with high mortality and healthcare costs. History, physical examination and early 2D and Doppler echocardiography are crucial to the proper assessment of patients, and will help determine the appropriate monitoring and management strategy. Most patients are elderly and have considerable co-morbidity. Clinical assessment is key to monitoring progress, but a number of clinical techniques – including simple Doppler and echocardiographic tools, pulse contour analysis and impedance cardiography – can help assess the response to therapy. A pulmonary artery catheter is not a routine monitoring tool, but can be very useful in patients with complex physiology, in those who fail to respond to therapy as would be anticipated, or in those being considered for mechanical intervention. As yet, the serial measurement of plasma natriuretic peptides is of limited value, but it does have a role in diagnosis and prognostication. Increasingly, the remote monitoring of physiological variables by completely implanted devices is possible, but the place of such technology in clinical practice is yet to be clearly established.
Remote Monitoring of Patients with Implanted Cardiac Devices – A Review
Authors: Afolabi Bosede A , Kusumoto Fred M ,   Division of Cardiology, Department of Medicine, University of Florida and Shands, Jacksonville, Florida, US,   Electrophysiology and Pacing Service, Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 4500 San Pablo Ave, Jacksonville, FL 32224, US. E: Kusumoto.fred@mayo.edu
Published: August 2014

There has been a rapid growth in the number of patients with cardiovascular implantable electronic devices (CIEDs), due to the consistent good results from large randomised trials and changing worldwide demographics with progressive ageing in all developed countries. Early generations of CIEDs provided only basic operations and stored only rudimentary data, but the evolution of all types of CIEDs (pacemakers, defibrillators, cardiac resynchronisation devices, implantable monitors) has led to their increased complexity and the development of a myriad of specialised features. As an outgrowth of this increased sophistication, once implanted, CIEDs can provide significant amounts of important clinical information, allowing to identify the presence of significant arrhythmias, assess drug efficacy, evaluate heart failure status and continuously monitor device function. With the advent of new methods of remote monitoring, the information recorded by these devices can be accessible in real time and thus lead to more timely clinical decision-making. This article summarises the impact of remote monitoring on clinical practice today and how the use of remote monitoring may evolve to affect the practice of medicine in the future.
Remote Management of Pacemakers and Implantable Defibrillators – Role and Long-term Viability
Authors: Burri Haran ,   Associate Professor, Cardiology Service, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland. E: haran.burri@hcuge.ch
Published: August 2014

Modern pacemakers and implantable defibrillators from all major device companies have wireless capabilities that allow them to automatically communicate data to a transmitter unit installed at the patient’s home, which then relays the data to a secure database. The data are available for consultation by the physician, who can thereby remotely follow-up and monitor both the patient and the device. There is solid evidence showing that remote device follow-up can safely reduce the number of clinic visits. The strategy is well accepted by patients (with advantages such as a reduction in travel and waiting time) and physicians. The remote monitoring of parameters tracking heart failure, arrhythmias or technical issues has the potential to improve patient safety and outcomes. Secondary endpoints of randomised trials indicate that remote device monitoring may reduce the duration of hospital stays and the number of adverse events such as strokes and inappropriate shocks. Reimbursement of remote device monitoring became available in the US in 2006 and more recently in a few European countries. However, to make remote device management viable in the long term, the issue of reimbursement still needs to be addressed by the healthcare authorities of many countries.
Landscape of Combination Therapy – Which Way Forward? Proceedings of the Satellite Symposium Held at the ESH European Meeting on Hypertension and Cardiovascular Protection, 27 April 2012, London
Authors: Fonseca Patricia , Dominiczak Anna F , Harrap Stephen ,   Medical Writer, Touch Briefings, Saffron House, 6–10 Kirby street, London, EC1N 8TS, UK. E: patricia.fonseca@touchbriefings.com,   Professor, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK,   Professor, Department of Physiology, University of Melbourne, Victoria, Australia
Published: August 2014

Early combination therapy is more effective for hypertension control in high-risk patients than monotherapy, and current guidelines recommend the use of either an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) for first-line therapy in patients younger than 55 years. Recent evidence shows that ACEIs reduce mortality, whereas ARBs show no apparent benefit despite their blood pressure lowering action. However, it is important to consider which blood pressure parameters should be targeted given that different drugs have distinct effects on key parameters. Remarkably, a high percentage of hypertensive patients whose treatment has brought these parameters within target ranges still remain at high risk of cardiovascular disease due to additional risk factors. Combination therapy with synergistic effects on blood pressure and metabolic control should thus be considered for the long-term treatment of hypertensive patients with co-morbid conditions.
When to Start a Prostanoid in Pulmonary Arterial Hypertension Patients
Authors: Goncalvesova Eva ,   Associate Professor, Heart Failure and Transplant Department, National Institute of Cardiovascular Disease, Bratislava, Slovakia. E: eva.goncalvesova@nusch.sk
Published: August 2014

Pulmonary arterial hypertension (PAH) is a progressive and debilitating disease with poor prognosis and limited therapeutic options. While currently available PAH treatments can provide substantial clinical benefits, they are not curative. The efficacy of prostanoid treatment in PAH is well-established in clinical trials, open-label and long-term observational studies, and prostanoid therapy is considered the most effective treatment for moderate to severe PAH. However, a growing body of data demonstrates that the majority of PAH patients are not treated with a prostanoid, even at the time of their death. The logistics of parenteral administration have limited prostanoid use in clinical practice in some centres; the lure of using a simple oral therapy can be compelling for both the physician and the patient. However, deterioration on oral therapies appears inevitable and therefore, there is a need to initiate early prostanoid therapy in eligible patients and to overcome barriers to their use. Oral treatment delays patient referral to specialist PAH centres, significantly affecting the prognosis. Recent studies have demonstrated that an aggressive early approach to treatment, utilising prostanoids as first-line therapy, either as monotherapy or in combination with oral therapies, results in excellent long-term survival.
A New Fixed-wire, ‘Stent-on-a-wire’, Very-low-profile Stent Delivery System – Rationale, Design and Update
Authors: Fischell Tim A ,   Professor of Medicine, Michigan State University, and Director, Cardiovascular Research, Borgess Medical Center, 1521 Gull Road, Kalamazoo, MI 49048, US. E: tafisc@gmail.com
Published: August 2014

Coronary artery stenting has evolved substantially since the first use of coronary stenting as an adjunct to balloon angioplasty in the early 1990s. The performance (and particularly the deliverability) of coronary stents has improved such that coronary stenting is now the primary mode of revascularisation for percutaneous coronary interventions (PCIs) in more than 95% of cases. The new Svelte™ stent-on-a-wire (SOAW) delivery system represents one of the first substantive innovations in stent delivery systems (SDS) in more than a decade. This SDS uses a shapeable ‘fixed wire’ as an integral part of the SDS. This allows a significant reduction in SDS profile (~0.029 inches) compared with conventional monorail or over-the-wire SDS. This SOAW SDS is intended to facilitate direct stenting. It has the potential to provide substantial procedural cost savings by eliminating the need for a coronary guidewire and balloon pre-dilatation and/or post-dilatation, and by reducing contrast use and the time required to complete the procedure. The SOAW system is compatible with 5Fr guiding catheters, and may reduce the need for closure devices, facilitate stenting via the radial approach and (potentially) reduce bleeding risks. In conclusion, the Svelte SOAW SDS represents a new very-low-profile balloon-expandable SDS that should promote direct stenting in PCIs. The efficiency and small profile of this SDS may allow procedural cost savings, a reduction in procedure time and a reduced risk of bleeding complications. These theoretical advantages will need to be demonstrated in clinical trials.
Differential Drug-eluting Stent Effects in Patients with Diabetes – Bench-to-bedside Evidence for Neointimal Suppression and Restenosis Reduction
Authors: Banning Adrian P , Hood Kristin L , Finn Aloke V , Patterson Cam , Abizaid Alexandre , Eppihimer Michael J , Dawkins Keith D , Baim Donald S ,   John Radcliffe Hospital, Room 2557, Cardiology Department, Level 2, Headley Way, Headington, Oxford, OX3 9DU, UK. E: adrian.banning@orh.nhs.uk,   Boston Scientific Corporation, Natick,   Emory University School of Medicine, Atlanta,   The University of North Carolina at Chapel Hill,   Institute Dante Pazzanese of Cardiology, São Paulo,   Boston Scientific Corporation, Natick,   Boston Scientific Corporation, Natick,   Boston Scientific Corporation, Natick
Published: August 2014

Patients with diabetes are particularly prone to coronary atherosclerosis, and the presence of diabetes increases the annual mortality risk in patients with proven coronary artery disease. Patients with diabetes also have an increased risk of restenosis following both balloon angioplasty and bare-metal stent (BMS) placement, due to differences in cellular proliferative signalling and a consequent accentuated neointimal response compared with that seen in patients without diabetes. Drug-eluting stents (DES) generally moderate this neointimal response and reduce restenosis in patients both with and without diabetes, without increasing the safety risk compared with BMS. However, it is unknown whether the different antiproliferative agents used in DES influence their comparative safety and efficacy. This article summarises recent peer-reviewed data from a range of molecular, cellular, imaging and clinical studies to provide an integrated bench-to-bedside perspective on the relative effects of commercially available DES in patients with diabetes versus patients without diabetes.
Pre-clinical and Clinical Study Results for the Coracto™ Rapamycin-eluting Stent – A New-generation Drug-eluting Stent
Authors: Reifart Nicolaus , Gyöngyösi Mariann , Karl-Eugen Hauptmann , Rabe Alexander , Enayat Darius , Giokoglu Kiriakos , Kolodgie Frank D , Vorpahl Marc , Yazdani Saami K , Hemetsberger Rayyan , Samaha Eslam , Pavo Imre J , Virmani Renu ,   Main Taunus Kliniken, Bad Soden,   Medical University of Vienna, Austria. E: mariann.gyongyosi@meduniwien.ac.at,   Krankenhaus Barmherzige Brüder,   Main Taunus Kliniken, Bad Soden,   Main Taunus Kliniken, Bad Soden,   Main Taunus Kliniken, Bad Soden,   CVPath Institute, Inc.,   CVPath Institute, Inc.,   CVPath Institute, Inc.,   Medical University of Vienna,   Medical University of Vienna,   Medical University of Vienna,   CVPath Institute, Inc.
Published: August 2014

First- and second-generation drug-eluting stents (DES) have successfully decreased the rate of restenosis compared with bare-metal stents (BMS); however, the incidence of late stent thrombosis, which mostly occurs after the implantation of DES, and chronic restenosis are still important medical problems. A new generation of DES, the Coracto™ rapamycin-eluting stent (RES), has the potential to reduce late stent thrombosis and the risk of chronic restenosis due to the totally biodegradable polymer providing a controlled drug release. In brief, the results of the two pre-clinical studies proved the safety and efficacy of the Coracto RES. In addition, in a clinical study comparing the Coracto RES and the Constant BMS, patients receiving the Coracto RES with chronic total occlusion (CTO) had a 71% decrease in the relative risk of restenosis after six months and an 82% reduction in target vessel revascularisation (TVR) after 24 months. The late stent thrombosis of the Coracto RES was 0% at 24-month follow-up. This article provides an overview of the data obtained from pre-clinical animal experiments using a porcine and rabbit model of stenting and a recently conducted clinical study demonstrating the safety and efficacy of the Coracto RES.
Endovascular Aortic Aneurysm Repair in ‘Non-ideal’ Patients – Techniques and Outcomes
Authors: Etezadi Vahid , Katzen Barry T ,   BCVI Cook Research Scholar, Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, 8900 North Kendall Drive, Miami, FL 33176, US. E: vetezadi@hotmail.com,   Founder, and Medical Director, Baptist Cardiac and Vascular Institute, and Clinical Professor of Radiology, University of South Florida College of Medicine and the University of Miami, Miller School of Medicine
Published: August 2014

After almost 20 years of clinical experience, endovascular aortic aneurysm repair (EVAR) has become a well approved and established treatment with a rising prevalence and popularity among vascular specialists. Its initial favourable outcomes have been sufficiently maintained through long-term follow-ups in appropriately selected patients. Improvements to the EVAR technique with the introduction of newer-generation devices as well as enhancements in imaging systems and follow-up modalities have significantly expanded the scope of this treatment. However, there are still many patients with anatomies that preclude them from candidacy or result in sub-optimal outcome, such as an unfavourable neck, tortuosity or difficult access. This article briefly discusses the major known issues affecting EVAR candidacy and outcome and highlights some of the techniques that have been described to overcome these obstacles.
Percutaneous Coronary Intervention During Cardiac Arrest and Ongoing Chest Compressions
Authors: Olivecrona Göran K , Noc Marko ,   Chairman, Working Group on PCI, Swedish Society of Cardiology, Department of Cardiology, Skane University Hospital–Lund, 221 85 Lund, Sweden. E: goran.olivecrona@med.lu.se,   Centre for Intensive Internal Medicine, University Medical Centre, Slovenia
Published: August 2014

Prolonged cardiac arrest in the cath lab is associated with very high mortality rates. Use of manual chest compressions have, until recently, been the only rapid response available to circulate the patient in such scenarios. The recent introduction of mechanical chest compression devices offers a new alternative that may perform better than manual chest compressions, especially during a continued interventional procedure.
New Transcatheter Mitral Valve Treatment
Authors: del Valle-Fernández Raquel , Ruiz Carlos E ,   Interventional Cardiology Department, Hospital Central de Asturias, Oviedo,   Director, Structural Heart Disease Department, Lenox Hill Heart and Vascular Institutes of New York, 130 East 77th Street, 9th Floor Blackhall, New York, NY 10076, US. E: cruiz@lenoxhill.net
Published: August 2014

Percutaneous treatment of severe mitral regurgitation is a very interesting therapeutic option for those patients considered not to be suitable candidates for surgery. Different technologies have already demonstrated proof-of-concept, and one of these devices (the Mitraclip device) has already obtained the Conformité Europeéne mark. However, demonstrating safety and efficacy for most of these technologies is being harder than anticipated. Recently, research and development has become more compromised due to the financial crisis. This paper reviews the venues that are currently under evaluation.
Diagnosis and Management of Post-myocardial Infarction Ventricular Septal Defects
Authors: Glenie Timothy , Ruygrok Peter ,   Interventional Fellow,   Interventional Cardiologist, Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Grafton, Auckland 1030, New Zealand. E: pruygrok@adhb.govt.nz
Published: August 2014

As the treatment of acute myocardial infarction has evolved from conservative management to thrombolysis and, in more recent times, primary angioplasty, the incidence of ventricular rupture, in particular post-infarction ventricular septal defect (VSD), appears to have fallen. In this article we discuss the clinical presentation and investigation of post-infarction VSD, the natural history as well as surgical and percutaneous interventional management and outcomes. Very limited published information is available from small series reports with the inherent limitation of selection bias. Survival is clearly enhanced by surgical or percutaneous intervention. Overall outcomes remain suboptimal but do appear to be significantly better in the absence of cardiogenic shock and if the procedure can be deferred, factors which are clearly related. Further research is required in this difficult field.
Femoral Vascular Access – Approaches and Available Devices
Authors: Holland Benjamin H , Applegate Robert J ,   Section of Cardiology, Wake Forest School of Medicine, North Carolina, US,   Section of Cardiology, Wake Forest School of Medicine, Medical Centre Boulevard, Winston-Salem, NC 27157-1045, US. E: bapplega@wfubmc.edu
Published: August 2014

Femoral access remains a vital route for many cardiac and non-cardiac procedures, including those involving the use of large delivery systems. In the common femoral artery access is extremely important to minimise complications and optimise use of closure devices. Dissatisfaction with haemostasis achieved by manual compression stimulated development of VCDs that provide quick and effective haemostasis after sheath removal. Despite shortening time to haemostasis and ambulation, a debate still rages regarding their overall contribution to reducing complications and healthcare costs.
Invasive Imaging of Bioresorbable Coronary Scaffolds – A Review
Authors: van Ditzhuijzen Nienke S , Ligthart Jurgen MR , Bruining Nico , Regar Evelyn , van Beusekom Heleen MM ,   Department of Cardiology, Division of Experimental Cardiology; Cardiovascular Research School COEUR, Erasmus University Medical Centre, Rotterdam, The Netherlands,   Department of Cardiology, Division of Experimental Cardiology,   Department of Cardiology, Division of Experimental Cardiology,   Department of Cardiology, Division of Experimental Cardiology,   Department of Cardiology, Division of Experimental Cardiology, Ee2355a Erasmus University Medical Centre, Dr. Molewaterplein 50-60, 3015 GE Rotterdam, The Netherlands. E: h.vanbeusekom@erasmusmc.nl
Published: August 2014

Various fully bioresorbable stents (BRS) have been recently developed, allowing for temporary scaffolding of the vessel wall. The potentially unique advantage of BRS to temporary scaffold the vessel could reduce the risk of adverse clinical outcomes caused by acute vessel geometry changes, late malapposition, jailed side branches or inflexibility of permanent stents. The design of BRS is, however, not similar for all stents, resulting in differences in degradation and behaviour. To assess the performance of BRS, the effect of degradation and behaviour on the vessel wall should be accurately evaluated. Intracoronary imaging techniques such as intravascular ultrasound (IVUS), optical coherence tomography (OCT) and near-infrared spectroscopy (NIRS) allow for detailed longitudinal evaluation of the stent and the vessel wall and might therefore aid in improving design and behaviour of BRS.
Double Chronic Total Occlusion Recanalisation with Antegrade and Retrograde Techniques and the Use of a Novel Drug-eluting Stent with Biodegradable Polymer
Authors: Konstantinidis Nikolaos V , Sianos Georgios ,   1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece,   1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, 54636, Thessaloniki, Greece. E: gsianos@auth.gr
Published: August 2014

Percutaneous recanalisation of coronary chronic total occlusions (CTOs) has proved an efficient and safe treatment option with steadily ascending success rates, especially since the advent and constant refinement of the retrograde approach. Uptake remains low, even though experienced operators have in the last five years reached an unprecedented maturity level, producing success rates in the range of 90 %, clearly comparable to non-occlusive coronary artery disease treatment. Antegrade and retrograde techniques are currently considered complementary components of a CTO procedure, rather than discrete treatment strategies. We report on the case of a successful CTO recanalisation procedure on a young patient with two chronically occluded coronary arteries and a large ischaemic burden. Both CTOs were addressed in the same session employing a range of dedicated CTO recanalisation techniques, without compromising on safety issues related to contrast dye consumption and radiation exposure. A novel drug-eluting stent (DES) with biodegradable polymer was used to treat the lesions.
The Role of the Transradial Approach for Complex Coronary Interventions in Patients with Acute Coronary Syndrome
Authors: Kedev Sasko ,   Professor of Medicine, University Clinic of Cardiology, Medical Faculty, University of St Cyril and Methodius, Vodnjanska 17, 1000 Skopje, Macedonia. E: skedev@gmail.com
Published: August 2014

Despite advances in antithrombotic and antiplatelet therapy, bleeding complications remain an important cause of morbidity and mortality in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). A significant proportion of such bleedings are related to the access site, and adoption of transradial access (TRA) may reduce these complications. In patients with ST-segment elevation myocardial infarction (STEMI), TRA reduced cardiac mortality in comparison with the femoral approach (TFA). High-risk patients such as women, obese patients and elderly subjects who are at increased risk for vascular complications and bleeding, might particularly benefit from the TRA. However, specific radial expertise providing procedural time and a success rate comparable to those with the TFA are strongly recommended before using this technique in the emergency setting.