Journal: Prog Cardiovasc Dis

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Abstract

Psychosocial management in cardiac rehabilitation: Current practices, recommendations, and opportunities.

Hughes JW, Serber ER, Kuhn T
Psychosocial management is a core component of outpatient Phase-II cardiac rehabilitation (CR) and includes psychosocial assessment, providing interventions, measuring outcomes, and care coordination. Psychosocial management contributes to the effectiveness of comprehensive CR, but the implementation is not always consistent or clearly described in the literature, in part due to the availability of behavioral health specialists. Patients in CR have many psychosocial needs including anxiety, depression, substance use disorders, sleep problems, psychosocial stress, and cognitive impairment. Behavioral considerations are inherent in many other aspects of CR,such as participation in CR, health behaviors, adherence, and tobacco cessation. Evaluation, or psychosocial assessment, should identify significant issues, record related medications, and incorporate findings in the individual treatment plan. Some patients require further evaluation and treatment by a qualified behavioral health specialist. Psychosocial interventions provided to all patients include patient education, counseling, stress-management, a supportive environment, and exercise. Measuring outcomes entails repeating the psychosocial assessment when patients finish CR and documenting changes. Coordinating care requires understanding available local mental health infrastructure and procedures for making referrals, and may entail identifying additional resources. Interventions provided concurrently with CR to a subset of patients with more extensive needs are typically pharmacotherapy, psychotherapy, or addictions counseling, which are beyond the scope of practice for most CR professionals. The way psychosocial management is implemented suggests clinical and research opportunities. For example, the combined effects of antidepressants and CR on depression and anxiety are not known. A prominent clinical opportunity is to fully implement psychosocial assessment, as required by statute and the core components. This could involve referring patients for whom clinically significant psychosocial concerns are identified during the evaluation for a more thorough assessment by a behavioral health specialist using an appropriate billing model. A research priority is a contemporary description of behavioral health services available to CR programs, including how psychosocial management is implemented. As delivery of CR comes to include more alternative models (e.g., home-based), research is needed on how that affects the delivery of psychosocial management. Increased use of telehealth may broaden clinical opportunities for psychosocial management.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 07 Jan 2022; epub ahead of print
Hughes JW, Serber ER, Kuhn T
Prog Cardiovasc Dis: 07 Jan 2022; epub ahead of print | PMID: 35016916
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Abstract

Cardiac rehabilitation in older adults: Apropos yet significantly underutilized.

Lutz AH, Forman DE
Cardiac Rehabilitation (CR) is a comprehensive disease management program that utilizes exercise training, behavioral modification, education, and psychosocial counseling to optimize outcomes and functionality in patients with cardiovascular disease (CVD)1). While CR was initially designed as an exercise training and fitness program for younger patients, usually men, after debilitating hospitalizations for myocardial infarction or cardiac surgery, evidence has expanded to also include other types of CVD in women as well as men, including heart failure, valvular disease, and peripheral arterial disease2-4). As the population of older adults continues to expand, age-related CVD is endemic and is commonly associated with exercise decline, diminished quality of life, and dependence. CR has the potential to counterbalance these patterns, and therefore stands out as a particularly important consideration for older adults with CVD. Nevertheless, CR remains highly underutilized5,6). Novel approaches to CR including home-based and hybrid CR programs show promise for enhanced outreach to patients who may not otherwise participate. This review summarizes the current data available regarding CR in older adults with CVD with a focus on geriatric-specific complexities, current barriers to utilization, and approaches to enhance participation and effectiveness.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 07 Jan 2022; epub ahead of print
Lutz AH, Forman DE
Prog Cardiovasc Dis: 07 Jan 2022; epub ahead of print | PMID: 35016915
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Abstract

High level physical activity in cardiac rehabilitation: Implications for exercise training and leisure-time pursuits.

Franklin BA, Quindry J
Importance
Regular moderate-to-vigorous physical activity and increased levels of cardiorespiratory fitness (CRF) are widely promoted as cardioprotective measures in secondary prevention interventions.
Observations
A low level of CRF increases the risk of cardiovascular disease (CVD) to a greater extent than merely being physically inactive. An exercise capacity <5 metabolic equivalents (METs), generally corresponding to the bottom 20% of the fitness continuum, indicates a higher mortality group. Accordingly, a key objective in early cardiac rehabilitation (CR) is to increase the intensity of training to >3 METs, to empower patients to vacate this \"high risk\" group. Moreover, a \"good\" exercise capacity, expressed as peak METs, identifies individuals with a favorable long-term prognosis, regardless of the underlying extent of coronary disease. On the other hand, vigorous-to-high intensity physical activity, particularly when unaccustomed, and some competitive sports are associated with a greater incidence of acute cardiovascular events. Marathon and triathlon training/competition also have limited applicability and value in CR, are associated with acute cardiac events each year, and do not necessarily provide immunity to the development of or the progression of CVD. Furthermore, extreme endurance exercise regimens are associated with an increased incidence of atrial fibrillation and accelerated coronary artery calcification.

Conclusions:
and relevance
High-intensity training offers a time-saving alternative to moderate intensity continuous training, as well as other potential advantages. Additional long-term studies assessing safety, adherence, and morbidity and mortality are required before high-intensity CR training can be more widely recommended, especially in previously sedentary patients with known or suspected CVD exercising in non-medically supervised settings.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 27 Dec 2021; epub ahead of print
Franklin BA, Quindry J
Prog Cardiovasc Dis: 27 Dec 2021; epub ahead of print | PMID: 34971650
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Abstract

Hybrid cardiac rehabilitation - The state of the science and the way forward.

Heindl B, Ramirez L, Joseph L, Clarkson S, Thomas R, Bittner V
Cardiac rehabilitation (CR) improves exercise capacity and health-related quality of life (HRQoL) in a broad range of patients, including those with coronary artery disease, heart failure (HF), after heart valve surgery, and after heart transplantation. Unfortunately, in traditional center-based CR programs participation and adherence are low. A hybrid model of CR, combining center-based and home-based CR services, has been proposed and is currently being studied as a potential way to help bridge the participation gap, while maintaining the beneficial patient outcomes from CR. However, the ideal composition of a hybrid CR program has not been universally agreed upon. In the present review, we define hybrid CR as any combination of supervised center-based and monitored home-based exercise, where at least two of the core components of CR are addressed. Using this definition, we searched for studies comparing hybrid CR with: (1) traditional center-based CR among CAD patients, (2) usual care among CAD patients, and (3) usual care among HF patients. We found nine studies which fit both our definition and comparison groups. The structure of the hybrid CR programs differed for each study, but typically began with a center-based component lasting 2-11 weeks and transitioned to a home-based component lasting 10-22 weeks, with 3-5 exercise sessions per week composed of either walking (usually with a treadmill) or cycling for 25-35 min at 60-75% maximal heart rate. Patients recorded data from home exercise sessions, via either a digital heart rate monitor or accelerometer, into logbooks which were reviewed by a therapist at specified intervals (often via telephone). Counseling on risk factor management was predominantly provided during the center-based component. In these studies, hybrid CR led to similar short-term outcomes compared to traditional CR in patients with coronary artery disease (CAD), as well as increased adherence and reduced delivery costs. Compared with usual care, in patients with CAD, hybrid CR reduced cardiovascular events, and improved lipid profiles, exercise capacity, and HRQoL. In patients with HF, compared with usual care, hybrid CR improved physical function, exercise capacity, and HRQoL. Ongoing studies may clarify the combination of center-based and home-based CR which produces superior outcomes, and may also better define the role that technology should play in CR interventions.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 23 Dec 2021; epub ahead of print
Heindl B, Ramirez L, Joseph L, Clarkson S, Thomas R, Bittner V
Prog Cardiovasc Dis: 23 Dec 2021; epub ahead of print | PMID: 34958846
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Abstract

Cardiac rehabilitation for heart transplant patients: Considerations for exercise training.

Squires RW, Bonikowske AR
Heart transplantation (HT) is the treatment of choice for eligible patients with end-stage chronic heart failure (HF). One-year survival world-wide is >85%. Many patients experience a reasonable functional ability post-HT, but episodes of acute rejection, as well as multiple co-morbidities such as hypertension, diabetes, chronic kidney disease and cardiac allograft vasculopathy are common. Immunosuppression with prednisone frequently results in increased body fat and skeletal muscle atrophy. Exercise capacity is below normal for most patients with a mean peak oxygen uptake (VO2) of approximately 60% of expected. HT recipients have abnormal exercise physiology findings related to surgical cardiac denervation, diastolic dysfunction, and the legacy of reduced skeletal muscle oxidative capacity and impaired vasodilatory ability resulting from pre-HT chronic HF. The heart rate response to exercise is blunted. Cardiac reinnervation resulting in partial normalization of the heart rate response to exercise occurs in approximately 40% of HT recipients months to years after HT. Supervised exercise training in cardiac rehabilitation (CR) programs is safe and is recommended by professional societies both before (pre-habilitation) and after HT. Exercise training does not require alteration in immunosuppressants. Exercise training in adults after HT improves peak VO2 and skeletal muscle strength. It has also been demonstrated to reduce the severity of cardiac allograft vasculopathy. In addition, CR exercise training is associated with reduced stroke risk, percutaneous coronary intervention, hospitalization for either acute rejection or HF, and death. There are only limited data for exercise training in the pediatric population.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 19 Dec 2021; epub ahead of print
Squires RW, Bonikowske AR
Prog Cardiovasc Dis: 19 Dec 2021; epub ahead of print | PMID: 34942234
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Abstract

The importance of healthy lifestyle behaviors in the prevention of cardiovascular disease.

Kaminsky LA, German C, Imboden M, Ozemek C, Peterman JE, Brubaker PH
Cardiovascular disease (CVD) is the leading cause of death globally. Advancements in the treatment of CVD have reduced mortality rates, yet the global burden of CVD remains high. Considering that CVD is still largely a preventable disease, prioritizing preventative measures through healthy lifestyle (HL) behaviors is necessary to lessen the burden of CVD. HL behaviors, such as regular exercise, healthy eating habits, adequate sleep, and smoking cessation, can influence a number of traditional CVD risk factors as well as a less commonly measured risk factor, cardiorespiratory fitness (CRF). It is important to note that cardiac rehabilitation programs, which traditionally have focused on secondary prevention, also emphasize the importance of making comprehensive HL behavior changes. This review discusses preventative measures to reduce the burden of CVD through an increased uptake and assessment of HL behaviors. An overview of the importance of CRF as a risk factor is discussed along with how to improve CRF and other risk factors through HL behavior interventions. The role of the clinician for promoting HL behaviors to prevent CVD is also reviewed.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 15 Dec 2021; epub ahead of print
Kaminsky LA, German C, Imboden M, Ozemek C, Peterman JE, Brubaker PH
Prog Cardiovasc Dis: 15 Dec 2021; epub ahead of print | PMID: 34922952
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Abstract

Exercise in patients with left ventricular devices: The interaction between the device and the patient.

Kerrigan DJ, Cowger JA, Keteyian SJ
Advances in the engineering of surgically implanted, durable left ventricular assist devices (LVAD) has led to improvements in the two-year survival of patients on LVAD support, which is now comparable to that of heart transplant (HT) recipients. And with the advent of magnetic levitation technology, both the survival rate and average time on LVAD support are expected to improve even further. However, despite these advances, the functional capacity of patients on LVAD support remains reduced compared to those who received a HT. A few small clinical trials have shown improvement in functional capacity with exercise training. Peak oxygen uptake improves modestly (10%-20%) with exercise training, suggesting a possible celling-effect linked to the ability of the LVAD to increase flow during exercise. This paper reviews both (a) the effect of the LVAD on the cardiorespiratory responses during a single, acute bout of exercise up to maximum and (b) the central and peripheral adaptations that occur among patients with an LVAD who undergo an exercise training regimen. We also address the tenets of the exercise prescription that are unique to patients with a durable LVAD.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 15 Dec 2021; epub ahead of print
Kerrigan DJ, Cowger JA, Keteyian SJ
Prog Cardiovasc Dis: 15 Dec 2021; epub ahead of print | PMID: 34921848
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Abstract

The role of triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention.

Fanaroff AC, Lopes RD
Dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel forms the backbone of secondary prevention in patients with acute coronary syndromes (ACS) or who undergo percutaneous coronary intervention (PCI), but in patients with atrial fibrillation (AF), oral anticoagulation (OAC) is superior to antiplatelet therapy for the prevention of stroke and systemic embolism. Patients with AF who undergo PCI or have an ACS event therefore have an indication for both OAC and DAPT, so-called triple antithrombotic therapy. However, observational analyses have shown that the annual rate of major bleeding on triple therapy exceeds 10%. For this reason, five major randomized clinical trials have compared double antithrombotic therapy with OAC and a P2Y12 inhibitor versus triple therapy in patients with AF who underwent PCI or had an ACS event. Each of the trials showed that double antithrombotic therapy reduced the rate of major and clinically relevant non-major bleeding compared with triple therapy and was non-inferior for prevention of ischemic events, including cardiovascular death, myocardial infarction, or stroke. In the one trial that directly compared warfarin with a non-vitamin K antagonist oral anticoagulant (NOAC), apixaban reduced the rate of major or clinically relevant non-major bleeding compared with warfarin and was non-inferior with respect to prevention of ischemic events. As a result of these trials, consensus guidelines recommend that patients with AF who undergo PCI or have an ACS event should be treated with triple antithrombotic therapy (OAC + P2Y12 inhibitor + aspirin) for 7 days or less, followed by double antithrombotic therapy (OAC + P2Y12 inhibitor) for 6 to 12 months.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 05 Dec 2021; epub ahead of print
Fanaroff AC, Lopes RD
Prog Cardiovasc Dis: 05 Dec 2021; epub ahead of print | PMID: 34883097
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Abstract

Left atrial appendage closure - Current status and future directions.

Alfadhel M, Nestelberger T, Samuel R, McAlister C, Saw J
Percutaneous left atrial appendage closure (LAAC) has become an important non-pharmacological intervention for stroke prevention in patients with non-valvular atrial fibrillation (AF). LAAC aims to reduce the risk of thromboembolism without increasing the risk of bleeding, a crucial strategy for patients at high risk for bleeding. Over the last few decades, the safety and long-term efficacy of the procedure in specific populations have grown, and more patients are being treated with these devices. Current and future studies focus on expanding the target population as well as the iteration of current technology. This article reviews recent, present, and future LAAC studies on the two most common devices, the Watchman device (Boston Scientific Corporation) and the Amplatzer cardiac plug (ACP) (St. Jude Medical, Minneapolis, MN), and their subsequent next generations, the Watchman FLX, and the Amulet, respectively.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 26 Nov 2021; epub ahead of print
Alfadhel M, Nestelberger T, Samuel R, McAlister C, Saw J
Prog Cardiovasc Dis: 26 Nov 2021; epub ahead of print | PMID: 34843811
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Abstract

Implantable devices for heart failure monitoring.

Ijaz SH, Shah SP, Majithia A
Heart failure (HF) is associated with considerable morbidity and mortality. The increasing prevalence of HF and inpatient HF hospitalization has a considerable burden on healthcare cost and utilization. The recognition that hemodynamic changes in pulmonary artery pressure (PAP) and left atrial pressure precede the signs and symptoms of HF has led to interest in hemodynamic guided HF therapy as an approach to allow earlier intervention during a heart failure decompensation. Remote patient monitoring (RPM) utilizing telecommunication, cardiac implantable electronic device parameters and implantable hemodynamic monitors (IHM) have largely failed to demonstrate favorable outcomes in multicenter trials. However, one positive randomized clinical trial testing the CardioMEMS device (followed by Food and Drug Administration approval) has generated renewed interest in PAP monitoring in the HF population to decrease hospitalization and improve quality of life. The COVID-19 pandemic has also stirred a resurgence in the utilization of telehealth to which RPM using IHM may be complementary. The cost effectiveness of these monitors continues to be a matter of debate. Future iterations of devices aim to be smaller, less burdensome for the patient, less dependent on patient compliance, and less cumbersome for health care providers with the integration of artificial intelligence coupled with sophisticated data management and interpretation tools. Currently, use of IHM may be considered in advanced heart failure patients with the support of structured programs.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 24 Nov 2021; epub ahead of print
Ijaz SH, Shah SP, Majithia A
Prog Cardiovasc Dis: 24 Nov 2021; epub ahead of print | PMID: 34838788
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Abstract

Update on chronic total occlusion percutaneous coronary intervention.

Assali M, Buda KG, Megaly M, Hall AB, Burke MN, Brilakis ES
Chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be challenging to perform. The main indication for CTO PCI is to improve symptoms. Several contemporary studies have reported high CTO PCI success rates at experienced centers but success rates in all-comer registries remain low. Several scores can estimate the difficulty and the likelihood of success of CTO PCI. Dual arterial access and use of CTO crossing algorithms can improve the success and safety of CTO PCI. Intracoronary imaging can optimize stent expansion and minimize adverse cardiovascular events. While complications are more common in CTO PCI, careful planning and prompt diagnosis and treatment can prevent them or minimize their adverse consequences. In this article, we review contemporary data on the indications, safety and efficacy of CTO PCI.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 22 Nov 2021; epub ahead of print
Assali M, Buda KG, Megaly M, Hall AB, Burke MN, Brilakis ES
Prog Cardiovasc Dis: 22 Nov 2021; epub ahead of print | PMID: 34826426
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Abstract

Current interventional therapies in acute pulmonary embolism.

Jamil A, Johnston-Cox H, Pugliese S, Nathan AS, ... Giri J, Kobayashi T
Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality. The management of PE is currently evolving given the development of new technologies and team-based approaches. This document will focus on risk stratification of PEs, review of the current interventional therapies, the role of clinical endpoints to assess the effectiveness of different interventional therapies, and the role for mechanical circulatory support in the complex management of this disease.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 21 Nov 2021; epub ahead of print
Jamil A, Johnston-Cox H, Pugliese S, Nathan AS, ... Giri J, Kobayashi T
Prog Cardiovasc Dis: 21 Nov 2021; epub ahead of print | PMID: 34822807
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Abstract

Transcatheter mitral valve interventions.

Resor CD
While there are dozens of novel transcatheter mitral devices in various stages of development, they remain years away from FDA approval. The existing approved transcatheter mitral interventions-transcatheter edge to edge repair for primary and secondary mitral regurgitations and transcatheter mitral valve-in-valve and valve-in-ring procedures for failing surgical prostheses-have seen a marked increase in both use and published data over the past several years. Transcatheter edge to edge repair with MitraClip has revolutionized the management of functional mitral regurgitation in heart failure with demonstrated reductions in mortality and heart failure hospitalization and is an appropriate option for patients with primary mitral regurgitation at high or prohibitive surgical risk. In patients with failing surgical mitral prostheses transcatheter mitral valve-in-valve and valve-in-ring procedures are an appealing alternative to repeat mitral valve surgery. Existing data and relevant concerns for these procedures are discussed herein.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 21 Nov 2021; epub ahead of print
Resor CD
Prog Cardiovasc Dis: 21 Nov 2021; epub ahead of print | PMID: 34822806
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Abstract

Catheter based interventions for lower extremity peripheral artery disease.

Parikh RB, Victor V, Levy MS
The field of peripheral arterial intervention has exploded over the past 20 years. Current knowledge includes a growing evidence base for treatment as well as a myriad of new interventional approaches to complex disease. This review seeks to outline the current state of the art for interventional approaches to lower extremity peripheral arterial disease.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 19 Nov 2021; epub ahead of print
Parikh RB, Victor V, Levy MS
Prog Cardiovasc Dis: 19 Nov 2021; epub ahead of print | PMID: 34813857
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Abstract

Transcatheter tricuspid valve interventions: Current devices and associated evidence.

Mesnier J, Alperi A, Panagides V, Bédard E, ... Philippon F, Rodés-Cabau J
Tricuspid regurgitation (TR) is a common finding in patients with chronic cardiopathy, and often a marker of an advanced disease. Being silent or with symptoms intertwined with the primitive left heart disease, TR has often been neglected, leading to the late referral of patients with advanced right-heart failure. Hence, isolated tricuspid surgery has been associated with high morbidity and mortality rates, the worse of all valve interventions, and medical management has been limited to symptomatic treatment. In this context, percutaneous therapies for severe TR have gained traction, addressing the unmet therapeutic gap for a less invasive disease-modifying management. The aim of this review is to provide an updated overview on transcatheter tricuspid valve interventions, focusing on devices\' characteristics, associated evidence, and future perspectives.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 18 Nov 2021; epub ahead of print
Mesnier J, Alperi A, Panagides V, Bédard E, ... Philippon F, Rodés-Cabau J
Prog Cardiovasc Dis: 18 Nov 2021; epub ahead of print | PMID: 34801577
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Abstract

Temporary mechanical circulatory support in cardiogenic shock.

Obradovic D, Freund A, Feistritzer HJ, Sulimov D, ... Desch S, Thiele H
Cardiogenic shock (CS) represents one of the foremost concerns in the field of acute cardiovascular medicine. Despite major advances in treatment, mortality of CS remains high. International societies recommend the development of expert CS centers with standardized protocols for CS diagnosis and treatment. In these terms, devices for temporary mechanical circulatory support (MCS) can be used to support the compromised circulation and could improve clinical outcome in selected patient populations presenting with CS. In the past years, we have witnessed an immense increase in the utilization of MCS devices to improve the clinical problem of low cardiac output. Although some treatment guidelines include the use of temporary MCS up to now no large randomized controlled trial confirmed a reduction in mortality in CS patients after MCS and additional research evidence is necessary to fully comprehend the clinical value of MCS in CS. In this article, we provide an overview of the most important diagnostic and therapeutic modalities in CS with the main focus on contemporary MCS devices, current state of art and scientific evidence for its clinical application and outline directions of future research efforts.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 17 Nov 2021; epub ahead of print
Obradovic D, Freund A, Feistritzer HJ, Sulimov D, ... Desch S, Thiele H
Prog Cardiovasc Dis: 17 Nov 2021; epub ahead of print | PMID: 34801576
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Abstract

Transcatheter aortic valve replacement (TAVR): Recent updates.

Avvedimento M, Tang GHL
Within the last two decades, transcatheter aortic valve replacement (TAVR) has revolutionized the management of symptomatic severe aortic stenosis (AS). Newer generations of transcatheter valve design, optimized imaging planning, growing operator experience, and technical refinements have driven enhancements in safety and reduction of procedural complications over time. These improvements have allowed expansion to lower risk patients, in which TAVR confirmed favorable outcomes compared to surgical aortic valve replacement (SAVR). Based on current evidence, the 2020 AHA/ACC guidelines provided updated recommendations on indications for TAVR, with several clinical indications remain with SAVR. As TAVR expands to younger, low-risk patients with longer life expectancies, different issues of utmost importance have emerged, such as long-term durability, bioprosthetic valve performance, coronary reaccess, prognostic impact of conduction disturbances and paravalvular leak, reintervention after TAVR, and optimal pharmacological management after the procedure. In this review, we provide an update of recent clinical guidelines and available data from clinical trials and registries, and highlight novel strategies to further reduce procedural complications.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 16 Nov 2021; epub ahead of print
Avvedimento M, Tang GHL
Prog Cardiovasc Dis: 16 Nov 2021; epub ahead of print | PMID: 34800439
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Impact:
Abstract

Impact of cardiorespiratory fitness on outcomes in cardiac rehabilitation.

Tutor A, Lavie CJ, Kachur S, Dinshaw H, Milani RV
Cardiovascular rehabilitation (CR) significantly improves outcomes in patients with cardiovascular diseases (CVD), especially coronary heart disease and heart failure (HF). Although CR is often considered as an exercise training (ET) program for patients following CVD events, CR is more than just ET as it involves education, dietary and psychological counseling, as well as a multi-factorial risk factor modification. However, a major component of ET involves efforts to measure and improve levels of cardiorespiratory fitness (CRF). In this state-of-the-art review, we analyze the data, including from our John Ochsner Heart and Vascular Institute, evaluating CRF and its impact on psychological improvements and major outcomes with CR, especially long-term survival.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 11 Nov 2021; epub ahead of print
Tutor A, Lavie CJ, Kachur S, Dinshaw H, Milani RV
Prog Cardiovasc Dis: 11 Nov 2021; epub ahead of print | PMID: 34780726
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Abstract

Cardiac rehabilitation in heart failure: Indications for exercise training based on heart failure phenotype.

Wheat HL, Fedson S, Bozkurt B, Josephson RA
Exercise intolerance with dyspnea and fatigue is pervasive amongst individuals with heart failure (HF) due to both central and peripheral mechanisms. Cardiac rehabilitation (CR) is a cornerstone therapy for numerous cardiovascular disease (CVD) processes, and it\'s use in HF with reduced ejection fraction (HFrEF) has shown significant benefit in improved mortality and quality of life (QoL). Less is known about the benefit of CR in the setting of HF with preserved ejection fraction (HFpEF), and optimal exercise therapy (ET) may vary based on underlying disease phenotype. Here we offer review of existing data for ET in both HFrEF and HFpEF with proposed exercise treatment modalities based on underlying comorbidities and variable phenotypes.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 28 Oct 2021; epub ahead of print
Wheat HL, Fedson S, Bozkurt B, Josephson RA
Prog Cardiovasc Dis: 28 Oct 2021; epub ahead of print | PMID: 34756951
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Abstract

Inspiratory muscle weakness in cardiovascular diseases: Implications for cardiac rehabilitation.

Smith JR, Taylor BJ
Exercise limitation is a cardinal manifestation of many cardiovascular diseases (CVD) and is associated with poor prognosis. It is increasingly well understood that exercise-based cardiac rehabilitation (CR) is an intervention that portends favorable clinical outcomes, including improvements in exercise capacity. The etiology of exercise limitation in CVD is multifactorial but is typically governed by terminal sensations of pain, fatigue, and/or breathlessness. A known but perhaps underestimated complication of CVD that contributes to breathlessness and exercise intolerance in such patients is inspiratory muscle dysfunction. For example, inspiratory muscle dysfunction, which encompasses a loss in muscle mass and/or pressure generating capacity, occurs in up to ~40% of patients with chronic heart failure and is associated with breathlessness, exertional intolerance, and worse survival in this patient population. In this review, we define inspiratory muscle weakness, detail its prevalence in a range of CVDs, and discuss how inspiratory weakness impacts physiological function and clinical outcomes in patients with CVD often referred to CR. We also evaluate the available evidence addressing the effects of exercise-based CR with and without concurrent specific inspiratory muscle training (IMT) on inspiratory muscle function, general physiological function, and clinical outcomes in patients with CVD. Finally, we consider whether the assessment of global respiratory muscle function should become standard as part of the patient intake assessment for phase II CR programs, giving practical guidance on the implementation of such measures as well as IMT as part of phase II CR.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 21 Oct 2021; epub ahead of print
Smith JR, Taylor BJ
Prog Cardiovasc Dis: 21 Oct 2021; epub ahead of print | PMID: 34688670
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Impact:
Abstract

Transcatheter valve-in-valve implantation in degenerated surgical aortic and mitral bioprosthesis: Current state and future perspectives.

Alperi A, Garcia S, Rodés-Cabau J
The use of bioprosthetic valves for treating patients with severe valve disease has increased over the last 2 decades, and, as a consequence, a growing number of patients with failing surgical bioprosthesis is expected in the near future. In this setting, valve-in-valve (ViV) transcatheter aortic/mitral valve replacement (TAVR and TMVR) has emerged as an alternative to redo surgery. Despite the increasing experience in ViV procedures, the development of these techniques faces several specific challenges, mainly related to the unique anatomical and physiological characteristics of ViV-TAVR/TMVR. Subsequently, various approaches have been proposed to overcome ViV-related complications and pitfalls. A growing body of evidence is currently available concerning early- and long-term clinical outcomes of patients undergoing ViV-TAVR/TMVR. These data should be comprehensively evaluated by the Heart Team in the decision-making process involving patients with failing surgical bioprostheses. In this review, we aimed to delineate the technical challenges and risks associated with ViV-TAVR and ViV-TMVR, provide an updated overview of the main clinical results, and summarize the future perspectives of this evolving field.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 20 Oct 2021; epub ahead of print
Alperi A, Garcia S, Rodés-Cabau J
Prog Cardiovasc Dis: 20 Oct 2021; epub ahead of print | PMID: 34688669
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Impact:

This program is still in alpha version.