bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosing Heart Failure – Experience and ‘Best Pathways’
Authors: Taylor Clare , Hobbs Richard ,   In-practice Fellow, National Institute for Health Research, Primary Care Clinical Sciences, School of Health and Population Sciences, Primary Care Clinical Sciences Building, University of Birmingham, B15 2TT, UK. E: c.j.taylor.1@bham.ac.uk,   Professor and Head of Primary Care Clinical Sciences, University of Birmingham
Published: August 2014

Heart failure is a clinical syndrome associated with high rates of morbidity and mortality and associated healthcare costs. The burden of heart failure is likely to increase with time, but effective treatments that improve quality of life and survival are available. Accurate and timely diagnosis is crucial to ensure patients receive appropriate treatment and avoid hospital admissions. However, diagnosing heart failure can be difficult as symptoms and signs commonly overlap with other conditions. A chest X-ray can be useful to identify evidence of heart failure or other lung pathology; however, a normal result does not rule out a diagnosis of heart failure. An electrocardiogram (ECG) is often abnormal in patients with heart failure, although up to 10% of patients may have a normal ECG. Natriuretic peptides are a useful biomarker for heart failure and a negative result can rule out the diagnosis. This can be helpful in determining who should be referred for echocardiogram. A new clinical-decision rule (CDR) could help clinicians to achieve a more timely and accurate diagnosis of heart failure.
Risk Stratification in Post-myocardial Infarction Patients
Authors: Wichterle Dan ,   Institute for Clinical and Experimental Medicine, and Faculty of Medicine, Charles University, Videnska 9, 140 21 Prague, Czech Republic. E: wichterle@hotmail.com
Published: August 2014

Despite the implementation of modern therapy for acute myocardial infarction (AMI), the substrate for fatal ventricular tachycardia/fibrillation develops frequently. Primary prevention therapy by implantable cardioverter–defibrillator (ICD) to reduce the risk of sudden cardiac death is recommended in post-MI patients with significant left ventricular (LV) dysfunction. While the benefit of ICD therapy in chronic post-MI patients has been firmly established, the implantation of ICDs in the early post-MI period is not warranted. LV dysfunction has been a major determinant for entry into the primary preventative ICD trials. Currently, numerous risk stratifiers are under investigation in order to improve the efficacy of ICD therapy. More specific selection of patients at risk of preventable cardiac death, based on more than simply ejection fraction, is crucial for the future development of cost-effective prophylactic treatments aimed at closing the gap between scientific evidence and the limited resources of healthcare systems.
The Impact of Angiotensin-II Receptor Blockers on Cardiovascular Events in Hypertensive Patients – Evidence from Real-life Databases
Authors: Petrella Robert J ,   Professor and Ivey Research Chair, University of Western Ontario and the Lawson Health Research Institute, Parkwood Hospital, Room B3002, 801 Commissioners Rd, E London, ON, N6C 5J1, Canada. E: petrella@uwo.ca
Published: August 2014

It is widely recognised that hypertension is a major risk factor for the development of future cardiovascular (CV) events, which in turn are a major cause of morbidity and mortality. Blood pressure (BP) control with antihypertensive drugs has been shown to reduce the risk of CV events. Angiotensin-II receptor blockers (ARBs) are one such class of antihypertensive drugs and randomised controlled trials (RCTs) have shown ARB-based therapies to have effective BP-lowering properties. However, data obtained under these tightly controlled settings do not necessarily reflect actual experience in clinical practice. Real-life databases may offer alternative information that reflects an uncontrolled real-world setting and complements and expands on the findings of clinical trials. Recent analyses of practice-based real-life databases have shown ARB-based therapies to be associated with better persistence and adherence rates and with superior BP control than non-ARB-based therapies. Analyses of real-life databases also suggest that ARB-based therapies may be associated with a lower risk of CV events than other antihypertensive-drug-based therapies.
Automatic Remote Monitoring of Implantable Cardiac Devices in Clinical Practice – The Lumos-T Safely Reduces Routine Office Device Follow-up (TRUST) Trial
Authors: Varma Niraj ,   Consultant Cardiologist, Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio 44195, US. E: varman@ccf.org
Published: August 2014

The use of implantable electronic cardiac devices is increasing. Post-implantation follow-up is important for monitoring both device function and patient condition; however, clinical practice is inconsistent. For example, implantable cardioverter–defibrillator follow-up schedules vary from every three months to yearly according to facility and physician preference and the availability of resources. Importantly, no surveillance occurs between follow-up visits. By contrast, implantable devices with automatic remote monitoring capability provide a means for performing constant surveillance, with the ability to identify salient problems rapidly. The Lumos-T Reduces Routine Office Device Follow-up Study (TRUST) demonstrated that remote home monitoring reduced clinic burden and allowed early detection of patient and/or system problems, enabling efficient monitoring and an opportunity to enhance patient safety. The results of the trial have significant implications for the management of patients receiving all forms of implantable electronic cardiac device.
Evaluation of a Computed Tomography Coronary Angiography Scan – Advantages and Disadvantages of Different Post-processing Techniques
Authors: Stinn Bjoern , Fornaro Juergen , Hibbeln Dennis , Desbiolles Lotus , Wildermuth Simon , Leschka Sebastian ,   Institute of Radiology, General Hospital Saint Gall,   Institute of Radiology, General Hospital Saint Gall,   Institute of Radiology, General Hospital Saint Gall,   Institute of Radiology, General Hospital Saint Gall,   Institute of Radiology, General Hospital Saint Gall,   Institute of Radiology, General Hospital Saint Gall, Rorschacherstrasse 95, 9007 St Gallen, Switzerland. E: sebastian.leschka@kssg.ch
Published: August 2014

Computed tomography coronary angiography (CTCA) is increasingly performed worldwide. For the interpretation of the acquired data set, different post-processing techniques are available, such as multiplanar reformation, maximum-intensity projections, direct volume rendering, virtual coronary angioscopy or the angiographic view. Each of these techniques shows certain advantages and disadvantages during application and image interpretation. Thus, a combination of post-processing techniques for the interpretation of CTCA studies should be used. When starting to perform and interpret CTCA, a systematic approach is mandatory for accurate diagnosis. We developed a practical algorithm in our institution for the interpretation of CTCA studies with special emphasis on interpretation steps to avoid a false-negative or false-positive diagnosis. In this article we discuss the strengths and weaknesses of the different post-processing techniques available for evaluation of CTCA and provide a systematic approach for interpreting a CTCA study, with an emphasis on how to avoid false-positive and false-negative classifications.
Svelte™ Acrobat Stent-on-a-Wire Coronary Stent System
Authors: Costa Jr J Ribamar , Abizaid Alexandre ,   Instituto Dante Pazzanese de Cardiologia, São Paulo,   Instituto Dante Pazzanese de Cardiologia, 500. Ibirapuera. São Paulo-SP, l04012-180, Brazil. E: aabizaid@uol.com.br
Published: August 2014

Direct stenting may reduce local vessel trauma, minimise ‘geographical miss’, prevent distal embolisation and save time/money during percutaneous coronary interventions. However, direct stenting is currently performed in ≤50% of most cathether laboratories worldwide. Among the main reasons to pre-dilate, vessels anatomy (tortuosity and amount of calcification) play a central role in the operator’s decision. The recently developed Acrobat Stent-On-A-Wire (SOAW) coronary system combines a very thin (81μ) L605 CoCr stent mounted on a delivery system with a 0.012-inch integrated guidewire tip (distance from the tip of the wire to the stent is 22mm). This is a balloon-expandable stent and the nylon balloon is also directly mounted onto the wire. The Acrobat SOAW may potentially facilitate percutaneous coronary intervention by reducing time/cost and minimising peri-procedural complications and therefore benefit a large number of patients in daily practice who are currently labelled as unfavourable for direct stenting.
Enhanced Imaging Modalities in Atrial Fibrillation
Authors: Wright Matthew ,   Kings College London BHF Centre, Cardiovascular Division, NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, Rayne Institute, Department of Cardiology, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, UK. E: matthew.wright@kcl.ac.uk
Published: August 2014

The wealth of imaging options for the practising electrophysiologist has exploded over the last decade, primarily due to the ability to effectively ablate patients with atrial fibrillation (AF). Currently, an electrophysiologist is able to chose to from pre-procedural computed tomography (CT), magnetic resonance imaging (MRI), procedural fluoroscopy, ultrasound, electroanatomic mapping systems and various combinations of these imaging modalities to help plan and perform the ablation procedure. Increasingly these imaging tools are also being used in follow-up to assess scar formation and help guide repeat procedures when necessary. This article will focus predominantly on the development of fluoroscopic techniques over the past decade.
Electrocardiogram Recognition and Ablation of Atrial Tachycardia
Authors: Feldman Alexander , Kalman Jonathan M ,   Fellow, Cardiac Electrophysiology, Royal Melbourne Hospital, and University of Melbourne, and Division of Cardiology, Ha’Emek Hospital, Afula,   Director, Cardiac Electrophysiology, Royal Melbourne Hospital, and University of Melbourne, Parkville, Victoria 3050, Australia. E: jon.kalman@mh.org.au
Published: August 2014

Focal atrial tachycardia (AT) is a relatively uncommon cause of supraventricular tachycardia, but when present is frequently difficult to treat medically. Atrial tachycardias tend to originate from anatomically determined atrial sites. The P-wave morphology on surface electrocardiogram (ECG) together with more sophisticated contemporary mapping techniques facilitates precise localisation and ablation of these ectopic foci. Catheter ablation of focal AT is associated with high long-term success and may be viewed as a primary treatment strategy in symptomatic patients.
Adjusting Therapy in Pulmonary Arterial Hypertension – The Role of Novel Echocardiographic Techniques
Authors: Coghlan John G , Pellerin Denis ,   Royal Free Campus, Department of Cardiology, Royal Free Hospital, Pond Street, London, NW3 2QG, UK. E: Gerry.Coghlan@royalfree.nhs.uk,   The Heart Hospital, University College London
Published: August 2014

In theory, echocardiography allows an accurate measurement of pulmonary artery pressure, approximate right atrial pressure, cardiac output, right ventricular diastolic function and non-volumetric assessment of systolic function, as well as some insight into the structural alterations of right ventricular architecture. Unfortunately, the vast array of possible measures complicates distillation of the few parameters that provide reproducible prognostically important information. The modest reductions in afterload achieved with current therapies (<5mmHg on average) and the unpredictability of right ventricular response, coupled with the complexity of the populations treated, means that only large-scale survival studies should be considered when determining which parameters inform patient management. Of currently widely used measures, only tricuspid annular plane systolic excursion (TAPSE) and pericardial effusion are recommended when adjusting therapy. Increased use of contrast echo, strain rate imaging, vector velocity imaging and 3D echocardiography appear to hold most hope for the future; however, none as yet has the database to support inclusion into standard clinical practice.
Clinical Benefits of the Cardiac Troponin T-high Sensitive Assay in Acute Coronary Syndrome
Authors:   A satellite symposium report: Held during the European Society of Cardiology Congress, Stockholm
Published: August 2014

On 31 August 2010 Roche Diagnostics hosted a satellite symposium at the European Society of Cardiology Congress in Stockholm entitled ‘Clinical Benefits of the Cardiac Troponin T-high Sensitive Test in Acute Coronary Syndrome.’ The symposium was chaired by Hugo Katus, Medical Director of Cardiology at the Angiology and Pneumology Medical Clinic in Heidelberg and Allan Jaffe, Chair of the Division of Core Clinical Laboratory Services at the Department of Laboratory Medicine and Pathology at the Mayo Clinic in Rochester. The symposium consisted of three talks by leaders in the field of cardiac biomarkers addressing the latest improvements in the diagnosis of acute coronary syndrome.
Pulmonary Embolism – Is There Still a Surgical Treatment Option?
Authors: Moosdorf Rainer ,   Department of Cardiovascular Surgery, University Hospital Giessen and Marburg, Campus Marburg, Baldingerstrasse, 35043 Marburg, Germany. E: moosdorf@med.uni-marburg.de
Published: August 2014

Thanks to improvements in the prophylaxis of deep venous thrombosis, pulmonary embolism has become less common during recent years. Moreover, advanced therapeutic options such as thrombolysis and catheter embolectomy have led to a further decrease in the number of surgical interventions. Looking at recent literature and some recent guidelines, the question arises of whether there is any role left for surgical therapy of pulmonary embolism. This article will deal with this question based on some typical clinical examples and some newer publications.
Outcome of Coronary Artery Bypass Grafting – Strategies for Improvement
Authors: Rastan Ardawan J , Falk Volkmar ,   Department of Cardiac Surgery, Heart Centre, University of Leipzig, Department of Cardiac Surgery, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany. E: rastan@rz.uni-leipzig.de,   Department of Cardiac and Vascular Surgery, University Hospital Zurich
Published: August 2014

During recent years, new conceptual, technical and drug strategies have led to improved early and late outcomes after coronary artery bypass surgery. These new strategies can be divided into the following three groups: optimisation of pre-operative patient selection and indications for and timing of the operation; peri-procedural refinements, including new techniques and instruments to avoid extracorporeal circulation, reduce aortic manipulation and minimise surgical access; and improvements to post-operative care, such as fast-track protocols and long-term drug therapy. In summary, the wide range of the surgical armamentarium available today allows cardiovascular surgeons to adapt the surgical strategy to individual patients and the given clinical scenario. This article aims to describe clinical rationales for the adoption of new concepts, provide an introduction to technical details and discuss clinical study results where appropriate.
Natriuretic Peptides – Addressing the Dilemma of Heart Failure Management
Authors: McDonald Kenneth , Dahlström Ulf ,   Professor and Cardiologist, Director Heart Failure Services, St Vincents University Hospital, Elm Park, Dublin 4, Ireland. E: Kenneth.mcdonald@ucd.ie,   Professor and Cardiologist, Department of Cardiology, Linkoping University Hospital, Linkoping and Department of Medicine and Health, Faculty of Health Sciences, Linkoping University, Linkoping
Published: August 2014

Heart failure (HF) is characterised by non-specific symptoms and unremarkable physical examination; therefore, the need exists for an available objective marker of HF status. Natriuretic peptides (NPs) are a marker that can aid the dilemmas in present-day HF management. More effective screening for clinical deterioration would include changes in brain natriuretic peptide (BNP) levels. Normal values for BNP, <50–100 pg/ml, have excellent negative predictive value (NPV) in excluding HF as a diagnosis. BNP values that are significantly elevated, e.g. >500 pg/ml, make the diagnosis of HF more likely. There are now established and emerging uses for NPs in managing HF in the community. These include the role of NPs at the time of possible new presentation of HF, its role in prognostication and, finally, the increasing interest in using NPs to guide therapy in the outpatient setting.
Acute Myocardial Infarction – The Role of Drug-eluting Stents in Treatment Strategies
Authors: Binder Ronald K , Khattab Ahmed A ,   Cardiology Department, University Hospital Bern,   Cardiology Department, University Hospital Bern, 3010 Bern, Switzerland. E: AhmedAziz.Khattab@insel.ch
Published: August 2014

Although primary percutaneous coronary intervention (PCI) has become the cornerstone in the treatment of ST-segment elevation acute myocardial infarction (AMI), systemic fribrinolysis may still be considered for patients in areas where PCI is not accessible. The downside of initial plain balloon angioplasty, mainly coronary artery dissection and vessel re-occlusion, was effectively solved by the application of coronary stents. The incidence of target vessel failure, witnessed after bare metal stent (BMS) implantation, was dramatically reduced by the introduction of drug-eluting stents (DES), which significantly and effectively alleviate restenosis in the overall population. A minute incidence of late and very late DES thrombosis led to some safety concerns, which were soon rebutted, particularly by the development of newer generation DES. DES have consequently outplayed BMS among almost all anatomical and clinical subgroups of coronary artery disease patients. However, AMI remains one of the last contested territories. Today there is a growing body of evidence to support the use of DES as a safe and effective treatment of AMI.
A Guide to the Use of Left Ventricular Analysis with 3D Echo in Dyssynchrony
Authors: Passaretti Bruno , Sganzerla Paolo , Lucca Elena , Borrelli Alessio , Bakthadze Nikoloz , Belvito Chiara , Mascioli Giosuè ,   Department of Cardiology, Humanitas Gavazzeni, Cliniche Humanitas Gavazzeni, Via Gavazzeni, 21, 24125 Bergamo, Italy. E: bruno.passaretti@gavazzeni.it,   Department of Cardiology, Humanitas Gavazzeni, Bergamo,   Department of Arrhythmology, Humanitas Gavazzeni, Bergamo,   Department of Arrhythmology, Humanitas Gavazzeni, Bergamo,   Department of Arrhythmology, Humanitas Gavazzeni, Bergamo,   Department of Arrhythmology, Humanitas Gavazzeni, Bergamo,   Department of Arrhythmology, Humanitas Gavazzeni, Bergamo
Published: August 2014

Data from single-centre studies suggest that echocardiographic parameters of mechanical dyssynchrony may improve patient selection for cardiac resynchronisation therapy (CRT). To our knowledge, the only published multicentre trial that compared 12 echocardiographic methods, the Predictors of response to cardiac resynchronization therapy (PROSPECT) trial, stated that none of the echocardiographic measurements of ventricular dyssynchrony applied in the study were able to distinguish responders from non-responders. Realtime 3D echocardiography is able to measure left ventricular (LV) size, function and dyssynchrony to identify the presence and extension of scar tissue and to evaluate where the site of latest mechanical activation is. After CRT device implantation, it also allows physicians to detect where the first mechanical activation secondary to LV pacing is located. Indeed, it can be useful in interventricular (VV) delay optimisation of the device after the implantation and, in single-centre studies, it was able to predict response to CRT and to identify responders from non-responders. Care must be taken to optimise temporal resolution, but now volume rates of 70–80vps can be easily obtained in the majority of cases. VV optimisation using realtime 3D echocardiography is feasible and intuitive, but time-consuming compared with traditional methods based on Doppler or algorithms. In this article we illustrate our approach to LV analysis with realtime 3D echocardiography in the study of dyssynchrony.
Baroreflex Sensitivity Assessment – Latest Advances and Strategies
Authors: La Rovere Maria Teresa , Maestri Roberto , Pinna Gian Domenico ,   Department of Cardiology, Fondazione “Salvatore Maugeri”, IRCCS, Istituto Scientifico di Montescano, 27040 Montescano (PV), Italy E: mariateresa.larovere@fsm.it,   Biomedical Engineering, S. Maugeri Foundation-IRCCS, Scientific Institute of Montescano,   Biomedical Engineering, S. Maugeri Foundation-IRCCS, Scientific Institute of Montescano
Published: August 2014

The baroreflex mechanism has been recognised as a key part of cardiovascular regulation. Alterations in the baroreceptor-heart rate reflex (baroreflex sensitivity [BRS]) contribute to sympathetic–parasympathetic imbalance, playing a major role in the development and progression of many cardiovascular disorders. Therefore, the measurement of the baroreflex is a source of valuable information in the clinical management of cardiac disease patients. This article reviews the most relevant advances for the measurement of BRS and their clinical and prognostic implications. Novel therapeutic strategies, exploring the use of electrical stimulation of the carotid sinus, have been evaluated recently in experimental and preliminary clinical studies to lower blood pressure and to reduce the level of baroreflex-mediated sympathoexcitation in heart failure. A recent study has also shown that the implementation of an artificial baroreflex system to regulate sympathetic vasomotor tone automatically is feasible.
Non-pharmacological Interventions for Patients with Resistant Hypertension
Authors: Abe Naomi , Bisognano John D ,   Department of Internal Medicine, Division of Cardiology, University of Rochester Medical Center,   Department of Internal Medicine, Division of Cardiology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York, US. E: John_Bisognano@urmc.rochester.edu
Published: August 2014

Resistant hypertension is defined as the failure to reach a target blood pressure (BP) despite adherence to a regimen of the maximum tolerated doses of three antihypertensive medications, one of which is a diuretic. It is estimated that 20–30% of patients with hypertension have resistant hypertension. Age and obesity are strong risk factors and the incidence and prevalence of resistant hypertension may be rising as the population ages and the number of people who are overweight increases. The specific prognostic implications of resistant hypertension have not been analysed. Several studies point to the poor outcome associated with elevated BP; the outcome of resistant hypertension is likely impaired relative to hypertension that can be controlled with medication. Here, we give an overview of three novel, non-pharmacological therapies available for patients with resistant hypertension, including an implantable carotid stimulator (Rheos®), a paced breathing assistive device (RESPeRATE®) and a device designed to guide users through effective isometric handgrip exercise (Zona Plus™ and others). These unique approaches have so far demonstrated promising efficacy and safety and are likely to benefit patients who fail antihypertensive medical therapy. The exact process by which these devices lower BP remains elusive. However, studies in which this process is investigated have shed light on the possible mechanisms regulating long-term BP. Further investigation is necessary to establish the optimal role of these devices in relation to conventional antihypertensive pharmacotherapy. Some of these approaches may prove to be a relatively inexpensive and safe adjunctive, or even an alternative method to lowering BP.
Tackling Childhood Obesity as a Strategy in Cardiovascular Risk Reduction
Authors: Banerjee Rajarshi , Leeson Paul ,   British Heart Foundation, Clinical Research Fellow and Honorary Specialist Registrar in Cardiology, Cardiovascular Clinical Research Facility, Level 1, John Radcliffe Hospital, Oxford, OX3 9DU, UK. E: Rajarshi.banerjee@cardiov.ox.ac.uk,   British Heart Foundation, Senior Clinical Research Fellow and Honorary Consultant Cardiologist, John Radcliffe Hospital, Oxford
Published: August 2014

The current obesity epidemic has already led to a prominent increase in the prevalence of young adults with components of the metabolic syndrome which markedly increases their risk of cardiovascular disease. This review outlines the current epidemiology of childhood obesity and summarises recent studies into potential interventions in childhood that may ameliorate the future burden of weight-related disease.
Sustainability of Cardiac Imaging
Authors: Picano Eugenio ,   Director, Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1, 56124 Pisa, Italy. E: picano@ifc.cnr.it
Published: August 2014

Medical imaging is the largest controllable source of radiation exposure in the population of industrialised countries – totalling around 150 chest X-rays per head per year. Of these exposures, one half comes from cardiovascular testing (cardio-computed tomography [CT], nuclear cardiology and interventional cardiology). The high level of radiation exposure provides immense benefits when appropriate, but may result in an increased incidence of radiation-induced cancer in the not-too-distant future. Current estimates suggest that about five to 10 % of all cancers may be due to medical radiation exposure. Of every three examinations, one is inappropriately prescribed (lack of justification) and another is performed with inappropriately high radiation doses (lack of optimisation). Cardiologists are often unaware of the radiological dose of the examination they prescribe or practice, but they should make every effort so that “each patient should get the right imaging exam, at the right time, with the right radiation dose”, as suggested by US Food and Drug Administration (FDA) in the 2010 initiative to reduce unnecessary radiation exposure from medical imaging. This is best obtained through a systematic implementation of the ‘3A’s strategy’ proposed by the International Atomic Energy Agency in 2011: audit (of true delivered dose); appropriateness (since at least one-third of examinations are inappropriate); awareness (since the knowledge of doses and risks is largely suboptimal in doctors and patients). A good cardiologist cannot be scared of radiation, but must always remain aware of the risks.
Stress-induced Myocardial Ischaemia – Perfusion Contrast Echocardiography to Evaluate Presence and Severity of Coronary Artery Disease
Authors: Shah Benoy Nalin , Senior Roxy ,   Clinical Research Fellow in Echocardiology, Royal Brompton Hospital,   Professor of Clinical Cardiology and Director of Echocardiography, National Heart and Lung Institute, Imperial College, Royal Brompton Hospital and Northwick Park Hospital, Department of Echocardiography, Sydney Street, London, SW6 6NP, UK. E: R.Senior@rbht.nhs.uk
Published: August 2014

The development of stable transpulmonary ultrasound contrast agents (UCAs) has allowed the echocardiographic assessment of myocardial perfusion, a technique known as myocardial contrast echocardiography (MCE). MCE exploits the ultrasonic properties of UCAs, which consist of acoustically active gas-filled microspheres. These are intravascular agents that have a rheology similar to red blood cells and thus allow analysis of myocardial blood flow both at rest and after stress. The combined assessment of wall motion and myocardial perfusion provides significant diagnostic and prognostic information during stress echocardiography. Functional imaging tests, such as myocardial perfusion scintigraphy and stress cardiac magnetic resonance imaging, are also used for non-invasive assessment of coronary disease. The principal advantages of MCE are that it does not expose the patient to ionising radiation or radioactive pharmaceuticals, is not contraindicated in patients with an implanted metallic device or who suffer from claustrophobia and it can be performed at the bedside. The purpose of this article is to outline the physiological principles underpinning ischaemia testing with MCE before proceeding to review the evidence base for MCE in patients with known or suspected coronary artery disease.
The Percutaneous Mitral Valve Repair Procedure – The Role of Echocardiographic Guidance
Authors: Swaans Martin , van den Branden Ben , Post Marco , van der Heyden Jan ,   Department of Cardiology, St Antonius Hospital, Koekoekslaan 1 3435 CM Nieuwegein, The Netherlands. E: m.swaans@antoniusziekenhuis.nl,   Department of Cardiology, St Antonius Hospital, Nieuwegein,   Department of Cardiology, St Antonius Hospital, Nieuwegein,   Department of Cardiology, St Antonius Hospital, Nieuwegein
Published: August 2014

Percutaneous mitral valve repair is a sophisticated procedure which requires a unique collaboration between the interventionalist and echocardiographer since it is mainly driven by real-time transoesophageal echocardiography (TEE). Fluoroscopy plays a lesser role. We will review the role of echocardiography during the different procedural steps and the additional value of three-dimensional (3D TEE).
Off-pump Transapical Mitral Valve Repair with Implantation of Neo-chordae
Authors: Hoebartner Michael , Kiefer Philipp , Borger Michael Andrew , Mohr Friedrich Wilhelm , Seeburger Joerg ,   Department of Cardiac Surgery, Leipzig Heart Centre,   Department of Cardiac Surgery, Leipzig Heart Centre,   Department of Cardiac Surgery, Leipzig Heart Centre,   Department of Cardiac Surgery, Leipzig Heart Centre,   Department of Cardiac Surgery, Leipzig Heart Centre, Heart Centre, Leipzig University, Struempelstrasse 39, 04289 Leipzig, Germany. E: seej@med.uni-leipzig.de
Published: August 2014

The authors present a case report of a mitral valve repair procedure featuring beating-heart, sternal-sparing implantation of neo-chordae. The 73-year-old female patient had severe mitral regurgitation (MR) pre-operatively, but no MR post-operatively and at 30-day follow-up. The patient was enrolled in the Transapical artificial chordae tendineae (TACT) trial sponsored by NeoChord Inc.
Stroke Prevention in Atrial Fibrillation – The Unmet Need and Morbidity Burden
Authors: Camm A John ,   British Heart Foundation Professor of Clinical Cardiology, St George’s University of London, Cranmer Terrace, London, SW17 0RE, UK. E: jcamm@sgul.ac.uk
Published: August 2014

Atrial fibrillation (AF) occurs in epidemic proportion and is now recognised to occur in about 2 % of the general population. Its prevalence is age-related – about 10 % of 80-year-olds have this arrhythmia with hypertension, valvular disease and heart failure being the most frequent underlying conditions. Up to 10 % of cases of AF may be idiopathic, although genetic, autonomic, inflammatory, infective and toxic causes may account for many of these. AF is associated with serious consequences of which death, sudden death, stroke, heart failure, pulmonary disease and hospitalisation are the most serious. Thromboembolic stroke occurs in about 5 % of AF patients each year, which is approximately five-fold the stroke rate in age and gender-matched patients without AF. AF-related thromboembolic stroke accounts for 15–20 % of all strokes. Risk factors for thromboembolic stroke include clinical factors (such as age, female gender, diabetes, heart failure, hypertension, renal failure and arterial disease), elevated levels of biomarkers (such as troponin, B-type natriuretic peptide, C-reactive protein and micro-albuminuria) and echocardiographic features (such as left ventricular systolic dysfunction, increased left atrial size, left atrial ‘smoke’ and thrombus). There are several clinical risk stratification schemes used to identify AF patients at high risk of thromboembolic stroke. The CHADS2 scheme is popular, but tends to group a high proportion of patients in low and intermediate risk categories. The recently introduced CHA2DS2-VASc scheme identifies truly low-risk patients and avoids placing more than a small proportion in a low or intermediate risk category where there is a guideline mandated choice between anticoagulant, antiplatelet or no therapy. This scheme, which is well validated, has been recommended by the European Society of Cardiology in anticipation of the introduction of new and safer oral anticoagulants. Although warfarin is an effective therapy for the prevention of thromboembolic complications of AF it is inadequately used because of fear of haemorrhagic complications and the difficulties associated with monitoring and maintenance of the correct level of anticoagulation. At present, as few as 20 % of patients who should be anticoagulated are effectively treated. New anticoagulant therapies, which are much easier to use, coupled with more attention to the indications for anticoagulation, should result in more effective anticoagulation and a major reduction in the thromboembolic complications associated with AF.
The Future of Echocardiographic Left Ventricular Quantification – Towards Automated Assessment of Global and Regional Function in Four Dimensions
Authors: Kleijn Sebastiaan A , Aly Mohamed FA , Kamp Otto ,   Research Fellow Cardiology, Department of Cardiology 5F 003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. E: s.kleijn@vumc.nl,   Research Fellow Cardiology, VU University Medical Center Amsterdam,   Cardiologist and Director of the Echocardiography Laboratory, VU University Medical Center Amsterdam
Published: August 2014

Quantification of global and regional left ventricular (LV) function using echocardiography has significantly improved with evolving technology and development of more robust techniques. By building on the strengths and solving some of the limitations of techniques such as 2D speckle tracking imaging and 3D echocardiography, newly developed 3D speckle tracking offers a comprehensive quantitative evaluation of global and regional LV function, including assessment of dyssynchrony. Not only chamber indices such as LV volumes and ejection fraction, but also parameters directly assessing global and regional myocardial function such as strain and torsion can now be visualised and quantified in one fast analysis. Data on the validation and application of these parameters are quickly accumulating, demonstrating great promise for their clinical use – for example, for identification of regional wall motion abnormalities, assessment of dyssynchrony and prediction of response to cardiac resynchronisation therapy. In this regard, 3D speckle tracking echocardiography serves as a major stepping stone towards a robust fully automated assessment of global and regional LV function in the near future.
Cardiac Transplantation – Status in 2011
Authors: Khush Kiran K , Hunt Sharon A ,   Division of Cardiovascular Medicine, Stanford University, 300 Pasteur Drive, Falk CVRC, Palo Alto, CA 94305, US. E: kiran@stanford.edu,   Division of Cardiovascular Medicine, Stanford University
Published: August 2014

Heart transplantation finally became a reality in 1967 and it continues to evolve, with changes in donor availability, recipient characteristics, waiting list times and post-transplant outcomes. Improvements in donor management, surgical techniques and post-operative care, development of potent immunosuppressive drugs and advances in the management of long-term complications have improved the quality of life and survival of heart transplant recipients. The introduction of mechanical circulatory support devices is providing an increasingly safe and effective alternative treatment for patients who are awaiting transplantation or those who are not transplant candidates. In this article, we review the current status of heart transplantation in 2011, with an eye towards future directions.
Real-life Bifurcation – Challenges and Potential Complications
Authors: Narbute Inga , Jegere Sanda , Kumsars Indulis , Juhnevica Dace , Knipse Agnese , Erglis Andrejs ,   Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga,   Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga,   Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga,   Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga,   Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga,   Chief, Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Pilsoni Str. 13 LV1002, Riga, Latvia. E: a.a.erglis@stradini.lv
Published: August 2014

Together with calcified lesions, saphenous vein grafts, chronic total occlusions and unprotected left main lesions, bifurcation lesions are complex lesions that remain among the outstanding challenges of treatment with percutaneous coronary intervention. Bifurcation lesions are associated with increased rates of procedural complications, restenosis and adverse events than lesions in the body of the vessel. The introduction of drug-eluting stents for the treatment of bifurcation lesions has dramatically decreased restenosis rates, especially in patients suffering from diabetes. However, abrupt side branch closure, side branch ostial restenosis and stent thrombosis remain areas where further improvement is needed. Although a provisional T-stent strategy is most often used when side branch stenting is required, there are true bifurcation lesions where the selected use of more complex bifurcation approaches (such as the crush technique, T-stenting or the culotte technique) seem appropriate, particularly when the main branch and side branch are larger vessels with more diffuse side branch disease. The major challenge with any technique is to ensure that the side branch is protected and there is a satisfactory final result. Many technical questions rise in trying to ensure this outcome and lower the risk of intra- and post-procedural complications such as side branch closure and restenosis, stent thrombosis, dissection and fracture of a jailed wire: how can difficult side branch access be solved? How can unfavourable side branch anatomy be re-wired after main vessel stent placement? How can fracture of a jailed wire be avoided? Is side-strut dilation beneficial?
Congenital Anomalies of the Coronary Arteries
Authors: Jamshidi Peiman , Erne Paul ,   Division of Cardiology, Luzerner Kantonsspital Luzern, Lucerne,   Head of Cardiology, Luzerner Kontonsspital Luzern, CH-6000 Luzern 16, Switzerland. E: paul.erne@ksl.ch
Published: August 2014

Multiple variations of congenital anomalies of the coronary arteries exist that may occur in isolation or in association with other congenital anomalies. They can cause myocardial ischaemia. A rare but potentially lethal condition is the anomalous origin of the left coronary artery from the pulmonary artery. The most common haemodynamically significant coronary abnormalities are coronary artery fistulae. A left-toright shunt exists in more than 90% of cases. The origin of the left coronary artery from the proximal right coronary artery (RCA) or the right aortic sinus with subsequent passage between the aorta and the right ventricular outflow tract has been associated with sudden death during or shortly after exercise in young persons. High anterior origin of the RCA is commonly encountered but is of no haemodynamic significance. It is difficult to engage the ostium of the RCA selectively using conventional catheter manipulation. In this article we will discuss various types of congenital coronary anomaly, providing examples.
Haemodynamic Support Devices for Complex and High-risk Percutaneous Coronary Intervention
Authors: Ho Kay Woon , Džavík Vladimír ,   Peter Munk Cardiac Centre, University Health Network, Toronto,   Peter Munk Cardiac Centre, Interventional Cardiology Program, Peter Munk Cardiac Centre, University Health Network, 6–246 EN Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada, M5G 2C4. E: vlad.dzavik@uhn.on.ca
Published: August 2014

Patients at high risk, such as those with marked left ventricular dysfunction, acute coronary syndromes with unstable haemodynamics and arrhythmias, as well as single target vessels that supply a large area of myocardium, are undergoing percutaneous coronary intervention (PCI) with increasing frequency. Percutaneous haemodynamic support devices, including intra-aortic balloon counterpulsation pumps, percutaneous cardiopulmonary support and left ventricular assist devices, have been developed as adjunctive therapies during these complex procedures. Improvements in haemodynamic profiles with the use of these devices enhance procedural safety, allowing successful PCI to be performed in a more stable environment. Nevertheless, the use of these devices is associated with potentially serious complications and solid evidence for their routine use in high-risk PCI is lacking. Ongoing improvements in device designs and deployment techniques may eventually allow earlier, prophylactic use of support devices. Until then, the use of haemodynamic support devices should be individualised after careful consideration of the potential benefits and risks involved.
Treatment of Bifurcation Coronary Artery Disease with the Dedicated Cappella Sideguard® Stent
Authors: Mamas Mamas A , Fath-Ordoubadi Farzin ,   Manchester Heart Centre, Manchester Royal Infirmary; Manchester Academic Health Science Centre, University of Manchester,   Manchester Heart Centre, Manchester Royal Infirmary, Manchester Royal Infirmary, Manchester, M13 9PT, UK. E: Farzin.fath-ordoubadi@cmft.nhs.uk
Published: August 2014

Bifurcation coronary lesions represent a significant proportion of percutaneous coronary intervention (PCI) procedures and are often technically challenging with both lower procedural success rates and higher adverse event rates than those observed in non-bifurcation lesions. Conventional techniques used to treat bifurcation lesions, including provisional stenting and various two-stent approaches, have several shortcomings. Dedicated bifurcation stents such as the Cappella Sideguard® have been developed to overcome the problems associated with the current available techniques. This review focuses on the utility of the nitinol Sideguard stent in the treatment of bifurcation lesions and discusses the benefits of its trumpet-shaped design, self-expanding properties and low-profile delivery system. Treatment of bifurcation lesions using the Sideguard stent is straightforward and not subject to some of the limitations associated with conventional PCI techniques. Several trials are currently on the way to assess the safety and clinical efficacy of this very promising stent platform.
Using Natriuretic Peptides to ‘Guide’ Therapy in Heart Failure
Authors: van Kimmenade Roland RJ , Januzzi Jr James L ,   Department of Cardiology, Maastricht University Medical Centre,   Cardiology Division, Massachusetts General Hospital, Yawkey 5984, 55 Fruit Street, Boston, MA 02114, US. E: jjanuzzi@partners.org
Published: August 2014

Assays for B-type natriuretic peptide (BNP) and its cleavage equivalent amino terminal proB-type natriuretic peptide (NT-proBNP) have quickly progressed from being biochemical novelties to representing valuable diagnostic tools for the physician confronted with patients suffering from suspected or proven heart failure. Besides being useful adjuncts for the diagnostic evaluation of heart failure, these biomarkers have shown to be superior predictors of prognosis in patients so affected. An intriguing synergy between BNP and NT-proBNP with respect to therapy response has been observed, which has led to the intriguing concept of their use to unlock a personalised, optimal strategy for heart failure management. In this paper, we aim to review the current available data on natriuretic peptide guided therapy and provide some insights on the implementation of this approach in clinical practice.
Wall Motion Tracking and Activation Imaging – Latest Developments and Applications for Patients with Heart Failure
Authors: Nesser Hans Joachim ,   Director, 2nd Department of Medicine, Elisabethinen Teaching Hospital, Linz, University of Graz and Innsbruck, A-4020 Linz, Fadingerstrasse 1, Austria. E: hans-joachim.nesser@elisabethinen.or.at
Published: August 2014

Wall motion tracking is a relatively new tool to define regional and global wall motion, ventricular volumes and ejection fraction. Speckle-tracking echocardiography (STE) allows the calculation of a variety of myocardial function indices – including longitudinal, radial, transverse and circumferential strain, strain rate, displacement, velocity and rotation (twist and torsion) – not only as a 2D application, but also in 3D. In patients with heart failure and cardiac dyssynchrony, there remains a lack of optimal management regarding decisions to implant a cardiac resynchronisation therapy device. Many decisions are made based on data from electrocardiography. Whereas conventional echocardiographic techniques are of limited value in defining mechanical dyssynchrony, newer developments, such as 2D and 3D speckle tracking, have been shown to have significant potential to define the latest site of mechanical activation. Recent 3D STE innovations, including activation imaging, 3D strain and area tracking, open new doors to the definition of segmental delay of mechanical deformation related to time. There is considerable optimism that 3D techniques will improve the present understanding and treatment of patients with cardiac dyssynchrony.
Drug-eluting Balloons in Coronary Artery Disease – Current and Future Perspectives
Authors: Belkacemi Anouar , Agostoni Pierfrancesco , Voskuil Michiel , Doevendans Pieter , Stella Pieter ,   Department of Interventional Cardiology, University Medical Centre Utrecht,   Department of Interventional Cardiology, University Medical Centre Utrecht,   Department of Interventional Cardiology, University Medical Centre Utrecht,   Department of Interventional Cardiology, University Medical Centre Utrecht,   Department of Interventional Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Room E.01.207, 3584 CX, Utrecht, The Netherlands. E: P.Stella@umcutrecht.nl
Published: August 2014

Percutaneous treatment of complex coronary lesions, such as small-vessel disease, diabetes and long diffuse disease, remain hampered by suboptimal results, even with the use of drug-eluting stents (DES). The paclitaxel drug-eluting balloon (DEB) is an interesting emerging device that optimises clinical outcomes in these specific lesions. The DEB may become a viable alternative treatment option for the inhibition of coronary restenosis and subsequent revascularisation, as it allows local release of a high-concentration antirestenotic drug, paclitaxel, into the coronary vessel without using a metal scaffold or durable polymers. Several studies have already shown promising and consistent results in the treatment of in-stent restenosis. The DEB has demonstrated its added value compared with certain DES. Inspired by these results, an increasing number of studies have been started in different coronary lesion subsets to explore the value of the DEB in a broader range of lesions. It will be interesting to see whether the DEB will find more indications beyond in-stent restenosis treatment. Moreover, will all DEBs offer the same added value, or will there be differences in efficacy among the DEBs produced by the various manufacturers? As was the case in the development of DES, now the puzzle pieces have to be put together for DEB.