Journal: Prog Cardiovasc Dis

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Abstract

Cancer and atrial fibrillation: Epidemiology, mechanisms, and anticoagulation treatment.

Menichelli D, Vicario T, Ameri P, Toma M, ... Pignatelli P, Pastori D
Cancer patients are at an increased risk of developing atrial fibrillation (AF) and thrombosis. However, the management of anticoagulation in patients with both diseases may be challenging, and data on these patients are lacking. We summarize the current evidence on the incidence and prevalence of cancer in AF and vice versa and provide some practical considerations on the management of oral anticoagulation in specific clinical situations. Low-molecular weight heparins are not approved for thromboprophylaxis in AF, and management of warfarin can be difficult. The use of direct oral anticoagulants may be particularly attractive for their rapid onset/offset action and lower bleeding risk.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 25 Apr 2021; epub ahead of print
Menichelli D, Vicario T, Ameri P, Toma M, ... Pignatelli P, Pastori D
Prog Cardiovasc Dis: 25 Apr 2021; epub ahead of print | PMID: 33915139
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Abstract

Chronic mesenteric ischemia: Diagnosis and management.

Sardar P, White CJ
Chronic mesenteric ischemia (CMI) is an uncommon, potentially underdiagnosed clinical condition. Although there is a high prevalence of mesenteric artery stenoses (MAS), an abundant collateral network in the mesenteric circulation mitigates occurrence of ischemia. The most common etiology of CMI is atherosclerosis. CMI is a clinical diagnosis, based upon typical and atypical symptoms and consistent anatomic findings. Typical symptoms of CMI are postprandial abdominal pain, unintended weight loss and food avoidance. The main modalities to diagnose MAS are duplex ultrasound, CT angiography or MR angiography, although high resolution CTA is preferred. Endovascular therapy with balloon expandable stents has become the preferred treatment for MAS.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 22 Apr 2021; epub ahead of print
Sardar P, White CJ
Prog Cardiovasc Dis: 22 Apr 2021; epub ahead of print | PMID: 33901516
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Abstract

Clinical and translational insights on premature ventricular contractions and PVC-induced cardiomyopathy.

Huizar JF, Tan AY, Kaszala K, Ellenbogen KA
The medical community\'s understanding of the consequences of premature ventricular contractions (PVCs) and PVC-induced cardiomyopathy has been derived mostly from observational and large population-based studies. Due to the difficulty of predicting the development of PVC-cardiomyopathy, the acute and chronic cardiac effects of PVCs and the mechanism of PVC-cardiomyopathy have been derived from pre-clinical studies with large animal models. Recently, these studies have described myocardial substrates that could potentially increase morbidity and mortality in patients with frequent PVCs and PVC-cardiomyopathy. In this paper, we provide an up-to-date comprehensive review of these pre-clinical and clinical studies.

Published by Elsevier Inc.

Prog Cardiovasc Dis: 19 Apr 2021; epub ahead of print
Huizar JF, Tan AY, Kaszala K, Ellenbogen KA
Prog Cardiovasc Dis: 19 Apr 2021; epub ahead of print | PMID: 33857575
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Abstract

Cardiac resynchronization therapy using a pacemaeker or a defibrillator: Patient selection and evidence to support it.

Canterbury A, Saba S
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure (HF), myocardial dysfunction and prolonged ventricular depolarization on surface electrocardiogram. CRT can be delivered by a pacemaker (CRTP) or a combined pacemaker-defibrillator (CRTD). Although these two types of devices are very different in size, function, and cost, current published guidelines do not distinguish between them, leaving the choice of which device to implant to the treating physician and the informed patient. In this paper, we review the published CRT clinical trial literature with focus on the outcomes of HF patients treated with CRT-P versus CRTD. We also attempt to provide guidance as to the appropriate choice of CRT device type, in the absence of randomized prospective trials geared to answer this specific question.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 14 Apr 2021; epub ahead of print
Canterbury A, Saba S
Prog Cardiovasc Dis: 14 Apr 2021; epub ahead of print | PMID: 33865865
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Abstract

Right ventricular lead location and outcomes among patients with cardiac resynchronization therapy: A meta-analysis.

Ali-Ahmed F, Dalgaard F, Allen Lapointe NM, Kosinski AS, ... Sanders GD, Al-Khatib SM
Background
Cardiac resynchronization therapy (CRT) has been demonstrated to improve heart failure (HF) symptoms, reverse LV remodeling, and reduce mortality and HF hospitalization (HFH) in patients with a reduced left ventricular (LV) ejection fraction (LVEF). Prior studies examining outcomes based on right ventricular (RV) lead position among CRT patients have provided mixed results. We performed a systematic review and meta-analysis of randomized controlled trials and prospective observational studies comparing RV apical (RVA) and non-apical (RVNA) lead position in CRT.
Methods
Our meta-analysis was constructed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses. We searched EMBASE and MEDLINE. Eligible studies reported on at least one of the following outcomes of interest: all-cause mortality, the composite endpoint of death and first HFH hospitalization, change in LVEF, New York Heart Association (NYHA) class improvement, and change in LV end systolic volume (LVESV). We performed meta-analysis summaries using a DerSimonian-Laird random-effects model and conservatively used the Knapp-Hartung approach to adjust the standard errors of the estimated model coefficients.
Results
We included nine studies representing a total of 1832 patients. Of those, 1318 (72%) patients had RVA lead placement and 514 (28%) had RVNA lead placement. The mean age of patients was 65.5 ± 4.4 years, and they were predominantly men (69%-97%). There was no statistically significant difference in all-cause mortality by RVA vs. RVNA (OR = 0.77, 95% CI 0.32-1.89; I2 = 16.7%, p = 0.31), or in the combined endpoint of all-cause mortality and first HFH (OR 0.88, 95% CI 0.62-1.25; I2 = 0%, p = 0.84). Also, there was no difference between RVA and RVNA for NYHA class improvement (OR = 1.03, 95% CI 0.9-1.17; I2 = 0%, p = 0.99), change in LVEF (mean difference (MD) = 1.33, 95% CI -1.45 to 4.10; I2 = 47%; p = 0.093), and change in LVESV (MD = -1.11, 95% CI -3.34 to 1.12; I2 = 0%; p = 0.92).
Conclusion
This meta-analysis shows that in CRT pacing, RV lead position does not appear to be associated with clinical outcomes or LV reverse remodeling. Further studies should focus on the relationship of RV lead vis-à-vis LV lead location, and its clinical importance.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 13 Apr 2021; epub ahead of print
Ali-Ahmed F, Dalgaard F, Allen Lapointe NM, Kosinski AS, ... Sanders GD, Al-Khatib SM
Prog Cardiovasc Dis: 13 Apr 2021; epub ahead of print | PMID: 33864874
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Abstract

Current gaps in HFpEF trials: Time to reconsider patients\' selection and to target phenotypes.

Palazzuoli A, Caravita S, Paolillo S, Ghio S, ... Senni M, Italian Society of Cardiology Heart Failure Study Group
Heart Failure with preserved Ejection Fraction (HFpEF) is an increasingly prevalent clinical condition associated with cardiovascular aging, characterized by different pathophysiological mechanisms and poor outcomes. In this manuscript, we analysed the main differences in terms of updated diagnostic criteria and patients\' selection in the most recent HFpEF trials. Recent algorithm purposed for HFpEF diagnosis, does not reflect common criteria adopted in clinical trials. Patients included in the larger studies experienced different characteristics in terms of clinical presentation and echocardiographic features. Current concerns complicate results interpretation and could hypothesize different stages of disease progression, rather than different cardiac phenotypes. Both the lack of diagnostic standardization and the population heterogeneity, might explain why trials investigating the effects of different therapeutic interventions failed to show improved outcomes for patients with HFpEF. Accordingly, we propose to exceed current view mainly based on the morphological adaptations evaluating patients\' characterisation, their cardiovascular risk, associated diseases, and structural features consistent with disease progression. Detailed clinical, imaging and biological characterisation of this population, along with the identification of mechanisms linked with disease progression and prognosis, would allow for tailored treatments and provide important mechanistic insights into the complex HFpEF pathophysiology.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 07 Apr 2021; epub ahead of print
Palazzuoli A, Caravita S, Paolillo S, Ghio S, ... Senni M, Italian Society of Cardiology Heart Failure Study Group
Prog Cardiovasc Dis: 07 Apr 2021; epub ahead of print | PMID: 33839166
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Abstract

Abdominal aortic aneurysms.

Anagnostakos J, Lal BK
Abdominal aortic aneurysms (AAA) are prevalent among older adults and can cause significant morbidity and mortality if not addressed in a timely fashion. Their etiology remains the topic of continued investigation. Known causes include trauma, infection, and inflammatory disorders. Risk factors include cigarette smoking, advanced age, dyslipidemia, hypertension, and coronary artery disease. The pathophysiology of the disease is related to an initial arterial insult causing a cascade of inflammation and extracellular matrix protein breakdown by proteinases leading to arterial wall weakening. When identified early, aneurysms must be monitored for size, growth rate, and other factors which could increase the risk of rupture. Factors predisposing to rupture include size, active smoking, rate of growth, aberrant biomechanical properties of the aneurysmal sac, and female sex. Medical management includes the control of risk factors that may prevent growth, stabilize the aneurysm, and prevent rupture. Surgical management prevents rupture of high risk aneurysms, most commonly predicted by size. Less frequently, surgical management is required when the aneurysm has ruptured. Surgery involves a multidisciplinary approach to evaluate the patient\'s risk profile and to develop an operative plan involving either an endovascular or an open surgical repair. The patient must be carefully monitored post-operatively for complications and, in the case of endovascular repairs, for endoleaks. AAA management has evolved rapidly in recent years. Technical and technological advances have transformed the diagnosis and treatment of this disease.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 04 Apr 2021; epub ahead of print
Anagnostakos J, Lal BK
Prog Cardiovasc Dis: 04 Apr 2021; epub ahead of print | PMID: 33831398
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Abstract

Mitral valve diseases: Pathophysiology and interventions.

Harky A, Botezatu B, Kakar S, Ren M, Shirke MM, Pullan M
Valvular heart disease is common and increasingly prevalent among the elderly. The end result of valvular pathologies is cardiac failure and can lead to sudden death; thus, diagnosis and interventions are very important in the early stages of these diseases. The usual treatment methods of mitral regurgitation include percutaneous mitral valve repair, mitral valve replacement and minimally invasive surgery, whereas the treatment methods of mitral stenosis include percutaneous transluminal mitral commissurotomy and mitral commissurotomy as well as open surgical repair. Nonetheless, ongoing clinical trials are a clear indicator that the management of valve diseases is ever evolving. The focus of this paper is on the various pathologies of the mitral valve, their etiology and clinical management, offering a comprehensive view of mitral valve diseases.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 01 Apr 2021; epub ahead of print
Harky A, Botezatu B, Kakar S, Ren M, Shirke MM, Pullan M
Prog Cardiovasc Dis: 01 Apr 2021; epub ahead of print | PMID: 33812859
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Abstract

Renal artery stenosis.

Safian RD
Renal artery stenosis is the most common secondary cause of hypertension and predominantly caused by atherosclerosis. In suspected patients, a non-invasive diagnosis with ultrasound is preferred. Asymptomatic, incidentally found RAS does not require revascularization. In symptomatic patients requiring revascularization, renal artery stenting is the preferred therapy. Selecting appropriate patients for revascularization requires careful consideration of lesion severity and is optimized with a multidisciplinary team. All patients with atherosclerotic RAS should be treated with guideline-directed medical therapy, including hypertension control, diabetes control, statins, antiplatelet therapy, smoking cessation and encouraging activity.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 17 Mar 2021; epub ahead of print
Safian RD
Prog Cardiovasc Dis: 17 Mar 2021; epub ahead of print | PMID: 33745915
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Abstract

Carotid stenosis, stroke, and carotid artery revascularization.

Heck D, Jost A
Atherosclerotic disease of the carotid artery places patients at risk of ischemic stroke and consequently is a target of medical, endovascular and open surgical management. Various imaging modalities are used to characterize anatomy/severity of carotid disease and justify intervention, each having advantages and disadvantages. Carotid revascularization techniques including carotid artery stenting, carotid endarterectomy, and transcarotid artery revascularization vary in invasiveness and are not equally suitable for certain subsets of patients. As such, providing quality care for patients with carotid disease requires a multidisciplinary team of experts in clinical diagnosis, image interpretation, medical management, endovascular intervention, and surgical treatment.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 17 Mar 2021; epub ahead of print
Heck D, Jost A
Prog Cardiovasc Dis: 17 Mar 2021; epub ahead of print | PMID: 33744381
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Abstract

Brachiocephalic and subclavian stenosis: Current concepts for cardiovascular specialists.

Patel RAG, White CJ
Brachiocephalic and subclavian artery stenoses are less common manifestations of peripheral arterial disease (PAD) compared to lower extremity PAD. However, even among asymptomatic patients, a diagnosis of PAD portends worse long-term mortality. Symptoms may include subclavian steal syndrome and arm claudication. Among patients with internal mammary coronary bypass grafts, symptoms may include those of myocardial ischemia. Symptomatic subclavian stenosis can be readily treated using endovascular techniques with durable outcomes.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 16 Mar 2021; epub ahead of print
Patel RAG, White CJ
Prog Cardiovasc Dis: 16 Mar 2021; epub ahead of print | PMID: 33744380
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Abstract

Associations of total and aerobic steps with the prevalence and incidence of frailty in older adults with hypertension.

Lefferts EC, Bakker EA, Carbone S, Lavie CJ, Lee DC
Purpose
To examine the associations of total steps/day and faster aerobic steps/day (≥60 steps/min) with the development of frailty in older adults with hypertension (HTN) using a two-phased cross-sectional and prospective approach.
Methods
The sample consisted of 427 older adults with HTN from the Physical Activity and Aging Study (PAAS), aged ≥65 years, with valid step data from an accelerometer-based pedometer. Participants were classified into tertiles of total steps/day (low, mid, high) and three categories of aerobic steps/day (none, low, high). Frailty was defined using a modified Fried score with 5 subdomains including shrinking, weakness, slowness, low physical activity (PA), and exhaustion.
Results
We observed a negative dose-response relationship across categories of total steps/day and aerobic steps/day for the prevalence of frailty and the subdomains of slowness, low PA, and exhaustion (all p for trends <0.05). Greater aerobic steps/day, but not total steps/day, was associated with lower incidence of developing frailty in the 241 participants with a follow-up examination who had no frailty at baseline.
Conclusion
Higher aerobic steps/day were more strongly associated with the lower prevalence and incidence of frailty compared to total steps/day, suggesting that faster aerobic walking may potentially provide greater benefits regarding frailty in older adults with HTN.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 25 Feb 2021; epub ahead of print
Lefferts EC, Bakker EA, Carbone S, Lavie CJ, Lee DC
Prog Cardiovasc Dis: 25 Feb 2021; epub ahead of print | PMID: 33640357
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Abstract

Prognostic value of troponin I in atrial fibrillation.

Quesada A, López-Valero L, Marcaida-Benito G, Bello JJ, ... Lippi G, Sanchis-Gomar F
Objective
To evaluate whether circulating cardiac troponin I (cTnI) levels are associated with worst outcomes in patients with atrial fibrillation (AF).
Methods
Consecutive patients visiting the emergency room (ER) with a new episode of a previously diagnosed AF or a new diagnosis of AF during ER admission between January 1st, 2010 and December 31st, 2015, were enrolled in the study (n = 2617). After applying exclusion criteria and eliminating repeated episodes, 2013 patients were finally included. Of these, 1080 patients with at least one cTnI measurement in the ER were selected and classified into 4 groups according to cTnI quartiles: Q1 (n = 147) cTnI <10 ng/L (Group 1); Q2 (n = 254): 10-19 ng/L (Group 2); Q3 (n = 409): 20-40 ng/L (Group 3); and Q4 (n = 270): cTnI >40 ng/L (Group 4). The median follow-up period was 47.8 ± 32.8 months. The primary endpoint was all-cause death during the follow-up.
Results
A higher mortality was found in group 4 compared with the other groups (58.9% vs. 28.5%, respectively, p < 0.001), along with, hospitalizations (40.4% vs. 30.7%, p = 0.004), and readmissions due to decompensated heart failure (26.7% vs. 2.5%, p = 0.002). The probability of survival without AF recurrences was lower in the Q4 (p = 0.045). Moreover, cTnI levels >40 ng/L (Q4) were an independent risk factor of death (HR, 2.03; 95% CI, 1.64-2.51; p < 0.001).
Conclusion
The assessment of cTnI at ER admission could be a useful strategy for risk stratification of patients diagnosed with AF by identifying a subgroup with medium-term to long-term increased risk of adverse events and mortality.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 24 Feb 2021; epub ahead of print
Quesada A, López-Valero L, Marcaida-Benito G, Bello JJ, ... Lippi G, Sanchis-Gomar F
Prog Cardiovasc Dis: 24 Feb 2021; epub ahead of print | PMID: 33639172
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Abstract

Aorto-iliac peripheral artery disease.

Javed IN, Hawkins BM
Aorto-iliac disease is a common manifestation of atherosclerosis. Individuals with this condition are at heightened cardiovascular risk, and may have limb symptoms ranging from claudication to limb-threatening ischemia. A regimen of medical therapy, risk factor modification, and exercise is first line therapy. Revascularization is reserved for individuals with lifestyle-limiting claudication despite conservative therapy and in those with chronic limb-threatening ischemia. Multiple endovascular therapies are now available that enable even the most complex aorto-iliac lesions to be approached and treated with safe and durable results.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 21 Feb 2021; epub ahead of print
Javed IN, Hawkins BM
Prog Cardiovasc Dis: 21 Feb 2021; epub ahead of print | PMID: 33631164
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Abstract

Asymptomatic peripheral artery disease: Silent but deadly.

Behroozian AA, Beckman JA
Peripheral Artery Disease (PAD) is a manifestation of atherosclerosis characterized by diminished perfusion of the limb and a state of dysmetabolism. The asymptomatic PAD phenotype is a relatively recent classification. It is unknown how many people currently live with asymptomatic PAD because there are no universal screening recommendations for patients at risk for PAD. Patients with asymptomatic PAD suffer from a similar risk profile of morbidity and mortality as their counterparts with claudication. Despite this increased risk, there is a dearth of clinical investigations into therapies that specifically benefit the asymptomatic PAD population. At present, current pharmacotherapies that have been studied in PAD patient populations do not stratify by symptom status. We believe that further investigation of the impact of existing therapies in this unique population presents an opportunity to reduce morbidity and mortality due to PAD. This can only be achieved in combination with wide-spread adoption of screening for asymptomatic PAD.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 19 Feb 2021; epub ahead of print
Behroozian AA, Beckman JA
Prog Cardiovasc Dis: 19 Feb 2021; epub ahead of print | PMID: 33617896
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Abstract

Effects of statins on myocarditis: A review of underlying molecular mechanisms.

Parsamanesh N, Karami-Zarandi M, Banach M, Penson PE, Sahebkar A
Myocarditis refers to the clinical and histological characteristics of a diverse range of inflammatory cellular pathophysiological conditions which result in cardiac dysfunction. Myocarditis is a major cause of mortality in individuals less than 40 years of age and accounts for approximately 20% of cardiovascular disease (CVD) events. Myocarditis contributes to dilated cardiomyopathy in 30% of patients and can progress to cardiac arrest, which has a poor prognosis of <40% survival over 10 years. Myocarditis has also been documented after infection with SARS-CoV-2. The most commonly used lipid-lowering therapies, HMG-CoA reductase inhibitors (statins), decrease CVD-related morbidity and mortality. In addition to their lipid-lowering effects, increasing evidence supports the existence of several additional beneficial, \'pleiotropic\' effects of statins. Recently, several studies have indicated that statins may attenuate myocarditis. Statins modify the lipid oxidation, inflammation, immunomodulation, and endothelial activity of the pathophysiology and have been recommended as adjuvant treatment. In this review, we focus on the mechanisms of action of statins and their effects on myocarditis, SARS-CoV-2 and CVD.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 19 Feb 2021; epub ahead of print
Parsamanesh N, Karami-Zarandi M, Banach M, Penson PE, Sahebkar A
Prog Cardiovasc Dis: 19 Feb 2021; epub ahead of print | PMID: 33621589
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Abstract

Vertebral artery stenosis.

Madonis SM, Jenkins JS
Symptomatic vertebral artery stenosis is associated with high risk of early recurrent stroke. Vertebral artery stenosis can be treated with angioplasty and stenting with good technical results. In this review we outline the framework for the diagnosis and management of vertebral artery disease with focus on the emerging benefits of angiography and endovascular interventions.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 13 Feb 2021; epub ahead of print
Madonis SM, Jenkins JS
Prog Cardiovasc Dis: 13 Feb 2021; epub ahead of print | PMID: 33592207
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Abstract

The current status of drug-coated devices in lower extremity peripheral artery disease interventions.

Amlani V, Falkenberg M, Nordanstig J
Lower limb peripheral artery disease is a leading cause of cardiovascular disease morbidity and mortality. Endovascular revascularization is often indicated to improve walking function and to prevent limb loss but restenosis in the treated vessel segment remains a concern that limits the overall effectiveness of the treatment. The most promising technique to prevent restenosis is the use of drug-coated devices, and the most common drug used to coat lower limb balloon angioplasty balloons and stents is paclitaxel. A systematic review and meta-analysis in 2018 reported a possible increase in late mortality attributable to paclitaxel-coated devices. Since then, their use has been brought into question. Here, we present an update of data focusing on the efficacy and safety of paclitaxel-coated devices in lower limb treatment applications. While paclitaxel-coated devices appear to reduce restenosis rates it is still unclear how these surrogate marker improvements translate to direct patient benefits and uncertainty remains as to whether paclitaxel-coated devices confer an increased risk of long-term mortality. Available randomized clinical data is hampered by trial heterogeneity, insufficient power, potential attrition bias and the lack of a plausible mechanistic explanation. An important step forward is that the ongoing trials that were temporarily halted due to the Katsanos et al. report have now both commenced recruitment and may ultimately resolve this clinical dilemma by virtue of their larger sample sizes. Other possible ways forward are the ongoing investigation of alternative anti-proliferative coating agents and use of new sophisticated vascular imaging techniques to more clearly identify patients at risk of restenosis already in the preoperative setting.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 12 Feb 2021; epub ahead of print
Amlani V, Falkenberg M, Nordanstig J
Prog Cardiovasc Dis: 12 Feb 2021; epub ahead of print | PMID: 33587964
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Abstract

The current status of renal denervation for the treatment of arterial hypertension.

Lauder L, Böhm M, Mahfoud F
Despite the availability of safe and effective antihypertensive drugs, blood pressure (BP) control to guideline-recommended target values is poor. Several device-based therapies have been introduced to lower BP. The most extensively investigated approach is catheter-based renal sympathetic denervation (RDN), which aims to interrupt the activity of afferent and efferent renal sympathetic nerves by applying radiofrequency energy, ultrasound energy, or injection of alcohol in the perivascular space. The second generation of placebo-controlled trials have provided solid evidence for the BP-lowering efficacy of radiofrequency- and ultrasound-based RDN in patients with and without concomitant pharmacological therapy. In addition, the safety profile of RDN appears to be excellent in all registries and clinical trials. However, there remain unsolved issues to be addressed. This review summarizes the rationale as well as the current evidence and discusses open questions and possible future indications of catheter-based RDN.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 12 Feb 2021; epub ahead of print
Lauder L, Böhm M, Mahfoud F
Prog Cardiovasc Dis: 12 Feb 2021; epub ahead of print | PMID: 33587963
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Abstract

Dialysis access intervention: Techniques for the interventional cardiologist.

Bittl JA
Interventional cardiologists who treat malfunctioning hemodialysis accesses play an important role in the life of patients with end-stage kidney disease (ESKD). By collaborating with interventional nephrologists who currently perform the bulk of routine access angiographic procedures, interventional cardiologists can fill an important gap in the care of ESKD patients by performing urgent or emergent procedures that fall outside the schedule of an outpatient interventional nephrology laboratory to ensure that hemodialysis patients will not miss a hemodialysis session or get a temporary catheter. This paper reviews the pathophysiology of dialysis access failure and illustrates the catheter-based approaches used by interventional cardiologists to treat malfunctioning dialysis accesses.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 12 Feb 2021; epub ahead of print
Bittl JA
Prog Cardiovasc Dis: 12 Feb 2021; epub ahead of print | PMID: 33587962
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Abstract

Femoral-popliteal peripheral artery disease: From symptom presentation to management and treatment controversies.

Krawisz AK, Raja A, Secemsky EA
Peripheral artery disease (PAD) is a common condition with increasing prevalence domestically and worldwide. Patients with PAD have a poor prognosis, as PAD is associated with high rates of myocardial infarction, ischemic stroke, and cardiovascular disease death. The primary symptom of PAD, claudication, significantly reduces quality of life and functional status and is associated with depression. In addition to several advances in medications for PAD over the last decade, endovascular device therapy has seen a significant breakthrough in the form of paclitaxel-coated devices (PCDs), which significantly reduce rates of restenosis relative to non-PCDs, a finding which has been demonstrated in numerous randomized clinical trials. After their introduction to the market in 2012 (paclitaxel-eluting stents) and 2014 (paclitaxel-coated balloons) their use surged as they replaced non-PCDs and were designated the first-line endovascular therapy by society guidelines. This trend was abruptly reversed, however, after a meta-analysis of summary-level data was published in December of 2018 that reported an elevated mortality associated with PCDs compared with non-PCDs 2-5 years after treatment. This meta-analysis has been criticized for considerable methodological flaws. The Food and Drug Administration conducted a review and concluded that insufficient data existed to make a definitive statement regarding the safety of PCDs. They called for restriction of the use of PCDs to the highest-risk patient populations. At the same time, the FDA deemed pursuing new RCTs to better evaluate PCDs unfeasible due to the high numbers of patients and long follow-up time that would be required. In this setting, real-world data emerged as a powerful source of information for the evaluation of PCDs. Real-world data offers advantages over randomized-controlled trials including expeditious access to and analysis of data and the availability of large numbers of patients. Several retrospective observational studies demonstrate no difference in long-term all-cause mortality in patients treated with PCDs relative to those treated with non-PCDs. This paclitaxel controversy has illustrated the critical role that real-world data is assuming in long-term safety monitoring of medical devices.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 12 Feb 2021; epub ahead of print
Krawisz AK, Raja A, Secemsky EA
Prog Cardiovasc Dis: 12 Feb 2021; epub ahead of print | PMID: 33592208
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Abstract

Navigating between the science and art of acute limb ischemia treatment.

Low M, Gray BH
The diagnosis and treatment of acute limb ischemia (ALI) has long been a fierce adversary that has evolved over the last several decades with scientific advancements in endovascular therapy. History and physical examination remain the mainstay of diagnosis enhanced by detailed imaging to guide therapy. Many endovascular tools are available for prompt restoration of flow that compliment traditional surgical options. These devices incorporate the mechanical removal of thrombus and the chemical dissolution of thrombus . Medical decision-making for ALI patients must take into account the patient characteristics, anatomic variables, mechanism of ischemia, degree of ischemia, and operator skill to employ the right strategy for the right patient. This moving target challenges scientific study, making the therapeutic bedside decision making an artform. We present an overview of the field, supportive data, and a treatment algorithm that hopefully captures this delicate balance.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 11 Feb 2021; epub ahead of print
Low M, Gray BH
Prog Cardiovasc Dis: 11 Feb 2021; epub ahead of print | PMID: 33587961
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Abstract

Prioritizing movement to address the frailty phenotype in heart failure.

Laddu DR, Ozemek C, Sabbahi A, Severin R, Phillips SA, Arena R
Frailty is a highly prevalent multisystem syndrome in older adults with heart failure (HF) and is associated with poor clinical prognosis and increased complexity of care. While frailty is neither disease nor age specific, it is a clinical manifestation of aging-related processes that reflects a reduced physiological ability to tolerate and recover from stress associated with aging, disease, or therapy. Within this context, physical frailty, which is distinctly oriented to physical functional domains (e.g., muscle weakness, slowness, and low activity), has been recognized as a critical vital sign in older persons with HF. Identification and routine assessment of physical frailty, using objective physical performance measures, may guide the course of patient-centered treatment plans that maximize the likelihood of improving clinical outcomes in older HF patients. Exercise-based rehabilitation is a primary therapy to improve cardiovascular health in patients with HF; however, the limited evidence supporting the effectiveness of exercise tailored to older and frail HF patients underscores the current gaps in management of their care. Interdisciplinary exercise interventions designed with consideration of physical frailty as a therapeutic target may be an important strategy to counteract functional deficits characteristic of frailty and HF, and to improve patient-centered outcomes in this population. The purpose of this current review is to provide a better understanding of physical frailty and its relation to management of care in older patients with HF. Implications of movement-based interventions, including exercise and physical rehabilitation, to prevent or reverse physical frailty and improve clinical outcomes will further be discussed.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 05 Feb 2021; epub ahead of print
Laddu DR, Ozemek C, Sabbahi A, Severin R, Phillips SA, Arena R
Prog Cardiovasc Dis: 05 Feb 2021; epub ahead of print | PMID: 33556427
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Abstract

The need for exercise sciences and an integrated response to COVID-19: A position statement from the international HL-PIVOT network.

Faghy MA, Arena R, Stoner L, Haraf RH, ... Ashton REM, HL-PIVOT Network
COVID-19 is one of the biggest health crises that the world has seen. Whilst measures to abate transmission and infection are ongoing, there continues to be growing numbers of patients requiring chronic support, which is already putting a strain on health care systems around the world and which may do so for years to come. A legacy of COVID-19 will be a long-term requirement to support patients with dedicated rehabilitation and support services. With many clinical settings characterized by a lack of funding and resources, the need to provide these additional services could overwhelm clinical capacity. This position statement from the Healthy Living for Pandemic Event Protection (HL-PIVOT) Network provides a collaborative blueprint focused on leading research and developing clinical guidelines, bringing together professionals with expertise in clinical services and the exercise sciences to develop the evidence base needed to improve outcomes for patients infected by COVID-19.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 03 Feb 2021; epub ahead of print
Faghy MA, Arena R, Stoner L, Haraf RH, ... Ashton REM, HL-PIVOT Network
Prog Cardiovasc Dis: 03 Feb 2021; epub ahead of print | PMID: 33549590
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This program is still in alpha version.