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  • The NEW-HOPE study and emerging therapies for difficult-to-control and resistant hypertension
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2020-01-08
    Keith C. Ferdinand; Daniel Harrison; Adedoyin Johnson

    Despite the availability of numerous approved antihypertensive drugs, difficult-to-control and resistant hypertension are persistent and are major risk factors for cardiovascular disease. Emerging and investigational treatments that are currently being explored to target hypertension include firibrastat, empagliflozin and interventional procedures, including improved approaches to renal artery denervation and a novel baroreceptor device implantation. Firibrastat is an investigational drug that specifically and selectively inhibits aminopeptidase A leading to decreased formation of angiotensin III in the brain, resulting in decreased blood pressure. Sodium-glucose cotransporter-2 inhibitors, such as empagliflozin used to treat type 2 diabetes, may be beneficial as antihypertensive agents. Empagliflozin in a recent study demonstrated significant reductions in high blood pressure in an African American population. Advances in renal artery denervation and an investigational baroreceptor device implantation also show promise as potential interventions in patients with difficult-to-control and resistant hypertension.

    更新日期:2020-01-08
  • Renal denervation: Alternative treatment options for hypertension?
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-12-27
    Aashish Gupta; Marloe Prince; Tamunoinemi Bob-Manuel; J. Stephen Jenkins
    更新日期:2019-12-27
  • Hypertension in African Americans: Advances in community outreach and public health approaches
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-12-19
    Daphne Ferdinand; Saihariharan Nedunchezhian; Keith C. Ferdinand

    While there have been significant advances made towards controlling cardiovascular disease (CVD) morbidity and mortality in recent decades, African- Americans continue to experience a markedly elevated burden of CVD. Multiple factors have contributed to this major public health crisis, including medication adherence, racial inequities in diagnosis and treatment, lack of culturally competent care, and disparities in healthcare access. Historical approaches to reduce this burden are targeted towards community outreach by recruiting community partners and healthcare providers to disseminate health information on CVD awareness and prevention. Current community-based approaches, such as the barbershop programs and faith-based programs, have built upon previous approaches and incorporated novel ideas to increase community engagement in risk factor and disease reduction. Based on these models, future directions point to an increased usage of community partners, alongside health information technology and healthy behavior patient education, to reduce risk factors and prevalence of CVD in an ethnically vulnerable community.

    更新日期:2019-12-19
  • Resistant hypertension-defining the scope of the problem
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-12-19
    Richard Chia; Ambarish Pandey; Wanpen Vongpatanasin

    The updated scientific statement by the American Heart Association has defined resistant hypertension (HTN;RH) as uncontrolled blood pressure (BP) ≥ 130/80 mmHg, despite concurrent use of 3 anti-HTN drug classes comprising a calcium channel blocker, a blocker of renin-angiotensin system, and a thiazide diuretic, preferably chlorthalidone. Using the updated BP criteria, the prevalence of RH in the United States is found to be modestly increased by approximately 3–4% among treated population. Meta-analysis of observational studies have demonstrated that pseudo-RH from white coat HTN or medication nonadherence is as much common as the truly RH. Thus, screening for pseudo-resistance in the evaluation of all apparent RH is of utmost importance as diagnosis of white-coat HTN requires no treatment, while medication nonadherence would benefit from identifying and targeting barriers to adherence.

    更新日期:2019-12-19
  • Update on hypertension in African-Americans
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-12-09
    Carola Maraboto Gonzalez, Keith C. Ferdinand

    Uncontrolled hypertension (HTN) in the U.S. is particularly prevalent and devastating among black individuals, who disproportionately suffer the consequences of this condition to a greater extent compared with persons in other racial/ethnic groups. Furthermore, African Americans are often underrepresented in cardiovascular clinical trials, limiting the ability to reliably apply the results from many outcome studies in this specific population. In this review, we summarize and analyze the currently available evidence, specifically related to the risk factors, manifestations, complications and management of HTN in this often difficult-to-treat population. The aim of the review is to improve understanding of the underlying pathophysiologic mechanisms and identify the optimal approach to deliver the best care for African American patients.

    更新日期:2019-12-09
  • Renal revascularization in resistant hypertension
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-12-07
    Marloe Prince, Aashish Gupta, Tamunoinemi Bob-Manuel, Jose Tafur

    Renal artery stenosis (RAS) is a common cause of secondary hypertension (HTN) and may lead to resistant (refractory) HTN despite guideline directed medical therapy. Although randomized controlled trials comparing medical therapy to medical therapy and renal artery stenting have shown no benefit with renal artery stenting, according to comparative effectiveness reviews by the Agency for Healthcare Research and Quality, the trials did not enroll patients with the most severe RAS who would be more likely to benefit from renal stenting. Because of limitations of conventional angiography, it is important to assess the hemodynamic severity of moderate (50%–70%) RAS lesions with a hemodynamic measurement. We review techniques to optimize patient selection, to minimize procedural complications, and to facilitate durable patency of renal stenting. We also review the current ACC/AHA Guidelines and SCAI Appropriate Use Criteria as they relate to renal stenting.

    更新日期:2019-12-07
  • Risk stratification for surgery in tricuspid regurgitation
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-12-05
    Evan Rotar, D. Scott Lim, Gorav Ailawadi

    Tricuspid valve (TV) surgery carries high mortality and morbidity, and risk-adjusted mortality has not changed. Patients who can withstand the perioperative period benefit from symptomatic improvement as the right ventricle remodels. Risk stratification for patients undergoing surgical intervention is critically important. The Model for End-Stage Liver Disease (MELD) score is a reliable and accurate mortality risk predictor given the liver and kidney dysfunction that accompany tricuspid regurgitation. Novel clinical risk calculators for isolated TV surgery have also been developed to further guide patients with projected surgical outcomes and reinforce timeliness to intervention.

    更新日期:2019-12-05
  • Systemic hemodynamic atherothrombotic syndrome (SHATS) – Coupling vascular disease and blood pressure variability: Proposed concept from pulse of Asia
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-12-04
    Kazuomi Kario, Julio A. Chirinos, Raymond R. Townsend, Michael A. Weber, Angelo Scuteri, Alberto Avolio, Satoshi Hoshide, Tomoyuki Kabutoya, Hirofumi Tomiyama, Koichi Node, Mitsuru Ohishi, Sadayoshi Ito, Takuya Kishi, Hiromi Rakugi, Yan Li, Chen-Huan Chen, Jeong Bae Park, Ji-Guang Wang

    Hypertension (HTN) is an important risk factor for cardiovascular disease (CVD) but the association between HTN and CVD cannot be explained by average blood pressure (BP) alone. BP variability (BPV) is another important factor, along with the effects of HTN on the vasculature. The concept of systemic hemodynamic atherothrombotic syndrome (SHATS) has been proposed, describing an age-related and synergistic vicious cycle of hemodynamic stress and vascular disease. The importance of SHATS is based on the assumption that the assessment of BPV and arterial disease is likely to provide an effective opportunity to intervene early to reduce progression to HTN in younger patients or to CVD events and organ damage in older patients. In addition to providing an overview of current evidence for the mechanisms and clinical data related to SHATS, this article proposes a new SHATS score for use to diagnose and assess the severity of SHATS. The score includes two components – a BP score and a vascular score – which are multiplied to generate the SHATS score. This reflects the synergistic, rather than additive, effects of BP and vascular disease on target organ damage and CVD events. Although it requires refinement and validation in future studies, early detection of SHATS using tools such as the proposed score, combined with population-based stratification and technology-based anticipation medicine incorporating real-time individual data, has the potential to contribute to meaningful reductions in rates of CVD events and target organ damage.

    更新日期:2019-12-04
  • Essential roles for CT and MRI in timing of therapy in tricuspid regurgitation
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-12-02
    Go Hashimoto, Miho Fukui, Paul Sorajja, João L. Cavalcante

    The rapid development of transcatheter tricuspid valve intervention (TTVI) therapies has quickly provided the opportunity to improve patient selection and procedural planning for patients with significant tricuspid regurgitation (TR) considered at high surgical risk. This review focuses on the contributions which both computed tomography angiography and cardiac magnetic resonance can provide in the better understanding of the natural history of TR, in the comprehensive anatomical and functional assessment of right heart involvement and in the timing and planning for TTVI. We also discuss areas of potential importance such as the quantification of response to TTVI, which will be informative for future trials.

    更新日期:2019-12-02
  • Transcatheter therapy for tricuspid regurgitation: The surgical perspective
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-12-02
    Aaron M. Williams, Alexander A. Brescia, Tessa M.F. Watt, Matthew A. Romano, Steven F. Bolling

    Tricuspid regurgitation (TR) remains a complex valve pathology affecting nearly two million people in the United States. Although it can present as a primary valve pathology, TR often presents as a late finding in patients with severe pulmonary disease or end-stage chronic heart failure. Surgical repair of isolated TR or TR from left-sided pathology has been associated with high morbidity and mortality. Furthermore, surgery for patients with TR and advanced cardiac disease has been associated with poor long-term outcomes. In recent years, transcatheter technology has emerged to target high-risk surgical patients with TR. Currently, multiple new transcatheter strategies to treat TR have shown initial benefit. However, further development of this technology is required. The aim of this perspective is to provide an overview of TR pathophysiology and to highlight the successful aspects of surgery for TR that provide insight for further translation of transcatheter strategies for patients with TR. These include replication of successful surgical techniques (ring-based annuloplasty and valve replacement) and the goal of achieving no to minimal residual TR following intervention. Earlier implementation of transcatheter valve repair to minimize TR progression and further development of transcatheter valve replacement strategies are also next steps in the translation of this technology.

    更新日期:2019-12-02
  • Current outcomes of tricuspid valve surgery
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-12-02
    Mohanad Hamandi, Timothy J. George, Robert L. Smith, Michael J. Mack

    Surgical treatment of isolated and concomitant tricuspid disease remains underutilized. The gap between guidelines and clinical practice is reflective in large measure of the historically poor outcomes of tricuspid valve surgery. We reviewed our current surgical outcomes of tricuspid regurgitation to determine whether surgical outcomes have improved in the modern era.

    更新日期:2019-12-02
  • Transcatheter innovations in tricuspid regurgitation: FORMA device
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-12-02
    Guillem Muntané-Carol, David del Val, Elisabeth Bédard, François Philippon, Josep Rodés-Cabau

    Transcatheter tricuspid valve interventions (TTVIs) have arisen in recent years as an alternative treatment of tricuspid regurgitation (TR) in high risk patients. TTVIs can be classified as annuloplasty devices, caval valve implantation (CAVI), tricuspid valve replacement and coaptation devices. The FORMA repair system (Edwards Lifesciences, Irvine, CA, USA) aims to improve the coaptation of tricuspid leaflets by occupying the regurgitant orifice with a balloon spacer, which reduces the regurgitant orifice area. After the first-in-human reported case back in 2015, data from 18 patients treated under compassionate clinical use conditions and from 29 patients under the US early feasibility (EFS) trial have been published. The two studies included very high-risk surgical patients (Euroscore II >8 in both cohorts). Implantation success was achieved in 16 (89%) and 27 (93%) of patients, respectively. In the US EFS trial, results at 30 days showed improvements in New York Heart Association (NYHA) functional class (NYHA class ≥ III in 28% vs 84% at baseline, p = .0002), 6-minute walking test (increase by 21 m, p = .012) and in the Kansas City Cardiomyopathy Questionnaire (increase by 29 points, p < 0001). In addition, the Core Lab evaluation at 30 days showed statistically significant reductions in TR severity grading in the 25 available patients. Regarding the compassionate cohort, 15 patients had available data at 2-year follow-up. NYHA functional class ≥ III was reduced from 93% to 34% (p < .001). However, two-thirds of the patients remained with significant TR at last available follow-up, and there were no significant changes in EROA (0.92 vs. 0.77 cm2; p = .516). In conclusion, this first experience with the FORMA device showed the feasibility of the procedure, albeit with a reasonable rate of device-related complications. Despite the magnitude of TR reduction was moderate at long-term, significant improvements in heart failure symptoms and quality of life were achieved.

    更新日期:2019-12-02
  • Endpoints for tricuspid regurgitation trans-catheter therapy trials
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-12-02
    Rebecca T. Hahn, Ori Ben-Yehuda, Martin B. Leon

    Tricuspid regurgitation (TR), particularly functional or secondary TR, is increasingly recognized in clinical practice and when at least moderate in severity is associated with significant increase in mortality. In recent years multiple new trans-catheter devices have been developed to treat tricuspid regurgitation and are now undergoing clinical trial evaluations. The choice of appropriate endpoints in TR trials is particularly challenging as the disease is complex, often co-exists with left heart disease and pulmonary hypertension, and has not been extensively studied. Endpoints utilized in left heart disease trials have been applied with success to TR trials, and innovative trial designs will allow the initiation of pivotal randomized trials. Ultimately the development of TR specific endpoints may provide for more specific and robust assessment of these novel therapies.

    更新日期:2019-12-02
  • Improving reference equations for cardiorespiratory fitness using multiplicative allometric rather than additive linear models: Data from the Fitness Registry and the Importance of Exercise National Database Registry
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-22
    Alan M. Nevill, Jonathan Myers, Leonard A. Kaminsky, Ross Arena

    New improved reference equations for cardiorespiratory fitness have recently been published, using Data from the Fitness Registry and the Importance of Exercise National Database (FRIEND Registry). The new linear equation for VO2max (ml.kg−1.min−1) was additive, derived using multiple-linear regression. An alternative multiplicative allometric model has also been published recently, thought to improve further the quality of fit. The purpose of the current study was to compare the accuracy and quality/goodness-of-fit of the linear, additive model with the multiplicative allometric model using the FRIEND database. The results identified that the allometric model out performs the linear model based on all model-comparison criteria. The allometric model demonstrates; 1) greater explained variance (R2 = 0.645; R = 0.803) vs. (R2 = 0.62; R = 0.79), 2) residuals that were more normally distributed, 3) residuals that yielded less evidence of curvature, 4) superior goodness-of-fit statistics i.e., greater maximum log-likelihood (MLL) and smaller Akaike Information Criterion (AIC) statistics, 5) less systematic bias together with smaller unexplained standard error of estimates. The Bland and Altman plots also confirmed little or no evidence of curvature with the allometric model, but systematic curvature (lack-of-fit) in the linear model. The multiplicative allometric model to predict VO2max was; VO2max (ml.kg−1.min−1) = M-0.854 · H1.44 · exp. (0.424–0.346 · (sex) -0.011.age), where M = body mass and H = height (R2 = 0.645; R = 0.803) and sex is entered as a [0,1] indicator variable (male = 0 and female = 1). Another new insight obtained from the allometric model (providing construct validity) is that the height-to-body-mass ratio is similar to inverse body mass index or the lean body mass index, both associated with leanness when predicting VO2max. In conclusion adopting allometric models will provide more accurate predictions of VO2max (ml.kg−1.min−1) using more plausible, biologically sound and interpretable models.

    更新日期:2019-11-22
  • Left ventricular hypertrophy and hypertension
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-21
    Mehmet Yildiz, Ahmet Afşin Oktay, Merrill H. Stewart, Richard V. Milani, Hector O. Ventura, Carl J. Lavie

    Hypertension (HTN) is a major modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality. The left ventricle (LV) is a primary target for HTN end-organ damage. In addition to being a marker of HTN, LV geometrical changes: concentric remodeling, concentric or eccentric LV hypertrophy (LVH) are major independent risk factors for not only CVD morbidity and mortality but also for all-cause mortality and neurological pathologies. Blood pressure control with lifestyle changes and antihypertensive agents has been demonstrated to prevent and regress LVH. Herein, we provide a comprehensive review of literature on the relationship between HTN and LV geometry abnormalities with a focus on diagnosis, prognosis, pathophysiological mechanisms, and treatment approaches.

    更新日期:2019-11-22
  • Physical activity without weight loss reduces the development of cardiovascular disease risk factors – a prospective cohort study of more than one hundred thousand adults
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-20
    David Martinez-Gomez, Carl J. Lavie, Mark Hamer, Veronica Cabanas-Sanchez, Esther Garcia-Esquinas, Helios Pareja-Galeano, Ellen Struijk, Kabir P. Sadarangani, Francisco B. Ortega, Fernando Rodríguez-Artalejo

    Purpose Whether physical activity (PA) might have certain benefits for cardiovascular disease (CVD) primordial prevention even in the absence of clinically significant weight loss is of public health interest. In this study, we examined the independent and combined associations of simultaneous changes in PA and body weight with the subsequent development of major CVD risk factors in adults. Methods This prospective analysis included 116,134 healthy men and women, aged ≥18 years, with at least 3 medical examinations from the Taiwan MJ Cohort. Two-year changes in PA and body weight between the first and second examination were linked to subsequent development of hypertension, hypercholesterolemia, atherogenic dyslipidemia, metabolic syndrome, type 2 diabetes mellitus (T2DM), and chronic inflammation, which were assessed by physical examinations and laboratory tests. Results During an average follow-up of 5.7 ± 4.1 years after the second examination, 10,840 individuals developed hypertension, 10,888 hypercholesterolemia, 6078 atherogenic dyslipidemia, 13,223 metabolic syndrome, 4816 T2DM, and 2027 inflammation. Weight gain was associated with a subsequent higher risk of all CVD risk factors, with HR (95%CI) ranging from 1.11 (1.00–1.23) for inflammation to 1.74 (1.67–1.82) for metabolic syndrome, compared with participants who lost weight. A stable weight was also associated with a higher risk of all CVD risk factors except with inflammation. In combined analyses, participants who simultaneously gained weight and decreased PA levels had the highest risk compared with those who lost weight and increased PA. Increasing or maintaining PA reduced the increased subsequent risk of some CVD risk factors among participants who maintained a stable weight or gained weight. Among participants who lost weight, decreased PA was not associated with an increased risk. Conclusions Although weight loss is crucial for the prevention of CVD risk factors, increasing or maintaining PA is also important to prevent them among adults who gain or maintain their weight.

    更新日期:2019-11-20
  • Impact of therapeutic lifestyle changes in resistant hypertension
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-20
    Cemal Ozemek, Stephanie C. Tiwari, Ahmad Sabbahi, Salvatore Carbone, Carl J. Lavie

    Hypertensive individuals are at an increased risk of developing heart disease and stroke. Adopting healthy lifestyles, such as being active on ≥4 days per week, weight-loss in the presence of obesity, consuming a diet rich in fruits and vegetables, and sodium below the recommended threshold, avoiding high alcohol consumption and refraining from smoking have been effective lifestyle therapies to prevent or control stage 1 hypertension (HTN). Among the 1 in 3 Americans who have HTN (systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg), 16% are diagnosed with resistant HTN (RHT). Although there are comparatively fewer studies examining the blood pressure lowering effects of therapeutic lifestyle interventions in patients with resistant HTN, the available literature appears promising. This paper reviews key studies that quantify the blood pressure lowering effects of certain therapeutic lifestyles in patients with RHT and highlights areas needing more attention.

    更新日期:2019-11-20
  • Atherosclerotic cardiovascular disease and heart failure: Determinants of risk and outcomes in patients with diabetes
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-07-10
    Adam J. Nelson, Eric D. Peterson, Neha J. Pagidipati

    Cardiovascular disease (CVD) is the most common cause of morbidity and mortality for patients with diabetes mellitus (DM). Although the burden of atherosclerotic CVD (ASCVD) is well documented, heart failure (HF) has been an under-appreciated CVD complication of DM. However, as more patients with DM live longer and survive acute ASCVD events, the distribution of CVD complications has evolved. This review summarizes the epidemiology of DM, the relative risk and prognosis of both ASCVD and HF following a diagnosis of DM, and the likelihood of cause-specific CVD mortality in patients with DM.

    更新日期:2019-11-18
  • Mechanistic insights regarding the role of SGLT2 inhibitors and GLP1 agonist drugs on cardiovascular disease in diabetes
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-08-02
    Vinay Garg, Subodh Verma, Kim Connelly

    The treatment landscape for patients with established or at high risk for cardiovascular disease and type 2 diabetes mellitus has entirely changed over the past decade, with the introduction of several anti-hyperglycemic agents. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists are two anti-hyperglycemic classes which have been of special interest after multiple large cardiovascular disease (CVD) outcomes studies have demonstrated superiority of these agents compared to placebo for major adverse CVD events and in some cases, hospitalization for heart failure. Despite the dramatic results of these trials, only recently have we began to understand the mechanisms underlying these CVD benefits. Here we review the underlying mechanisms which have the greatest plausibility for both of these agents including the impact of ventricular loading conditions, direct effects on cardiac structure and function, myocardial energetics and sodium/hydrogen exchange for SGLT2 inhibitors, and the anti-atherosclerotic, anti-inflammatory, and modulation of endothelial function for GLP-1 agonists.

    更新日期:2019-11-18
  • Diabetic cardiomyopathy - A comprehensive updated review
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-03-25
    Ghulam Murtaza, Hafeez Ul Hassan Virk, Muhammad Khalid, Carl J. Lavie, Hector Ventura, Debabrata Mukherjee, Vijay Ramu, Sukhdeep Bhogal, Gautam Kumar, Madhan Shanmugasundaram, Timir K. Paul

    Diabetes causes cardiomyopathy and increases the risk of heart failure independent of hypertension and coronary heart disease. This condition called “Diabetic Cardiomyopathy” (DCM) is becoming a well- known clinical entity. Recently, there has been substantial research exploring its molecular mechanisms, structural and functional changes, and possible development of therapeutic approaches for the prevention and treatment of DCM. This review summarizes the recent advancements to better understand fundamental molecular abnormalities that promote this cardiomyopathy and novel therapies for future research. Additionally, different diagnostic modalities, up to date screening tests to guide clinicians with early diagnosis and available current treatment options has been outlined.

    更新日期:2019-11-18
  • The 2018 AHA/ACC/Multi-Society Cholesterol guidelines: Looking at past, present and future
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-13
    Neil J. Stone, Scott M. Grundy

    The authors review more than three decades of progress in providing clinicians and patients with guidance on risk assessment, patient evaluation and cholesterol management. Beginning with the National Cholesterol Education Program's Initial Adult Treatment Panel report, the cholesterol guidelines increasingly reflect the progress made in understanding the benefits of improved lifestyle and nutrition to improve lipid profiles, major risk factors and reduce ASCVD risk. Moreover, they now provide qualitative and quantitative assessment tools to guide appropriate risk reduction LDL-C lowering therapy. Use of the Pooled Cohort Equations to determine Low, Borderline, Intermediate and High 10-year ASCVD risk is now joined by recognition of conditions and biomarkers that enhance ASCVD risk. This personalizes the risk discussion for the patient. An important addition is the selective use of coronary artery calcium (CAC) scoring to reclassify risk in patients at borderline or intermediate risk, but for whom a risk decision regarding statin therapy is uncertain. In secondary prevention, current guidelines provide criteria for determining a “very high” risk group in whom risk is especially high and in whom aggressive LDL-C lowering can be shown to provide increased absolute benefit. Current guidelines provide a comprehensive look at children and adolescents, young adults, elderly, women and issues specific to women through the life course. They provide guidance for those adults at risk due to severe hypercholesterolemia, persistent hypertriglyceridemia after secondary causes have been addressed, those with inflammatory disorders and HIV, those adults with chronic kidney disease, and those affected by issues of race/ethnicity. They conclude with a brief summary of recommendations emphasizing important concepts for providing safety with LDL-C lowering therapy. This combination of best external evidence and clinical expertise from the expert panel should provide a solid foundation for lipid management of patients at risk for or with clinical ASCVD.

    更新日期:2019-11-18
  • Impact of fitness and changes in fitness on lipids and survival
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-09
    Carl J. Lavie, Sergey Kachur, Xuemei Sui

    In the past five decades, cardiorespiratory fitness (CRF) has become fairly established as an important risk factor or marker for cardiovascular disease (CVD), as well as CVD - and all-cause mortality. Substantial evidence supports a strong inverse association between baseline levels of CRF and the risk of developing CVD risk factors, including dyslipidemia. Additionally, accumulating evidence also supports that maintaining or improving a certain level of CRF over time leads to a lower rate of developing CVD risk factors, such as dyslipidemia, and also improves survival. Recent evidence also supports the role of resistance exercise and muscular strength to reduce the development of metabolic syndrome and hypercholesterolemia and potentially reduce development of diabetes as well, in addition to improving survival. Therefore, great efforts are needed to increase both CRF and muscle strength with aerobic exercise and resistance exercise in the primary and secondary prevention of CVD.

    更新日期:2019-11-11
  • Coronary artery calcium scoring for individualized cardiovascular risk estimation in important patient subpopulations after the 2019 AHA/ACC primary prevention guidelines
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-09
    Omar Dzaye, Ramzi Dudum, Cara Reiter-Brennan, Sina Kianoush, Rajesh Tota-Maharaj, Miguel Cainzos-Achirica, Michael J. Blaha

    The 2018 and 2019 American Heart Association and American College of Cardiology (AHA/ACC) guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend consideration of so-called “risk-enhancing factors” in borderline to intermediate risk individuals. These include high-risk race/ethnicity (e.g. South Asian origin), chronic kidney disease, a family history of premature ASCVD, the metabolic syndrome, chronic inflammatory disorders (e.g. rheumatoid arthritis [RA], psoriasis, or chronic human immunodeficiency virus [HIV]), and conditions specific to women, among others. Studies suggest, however, that risk may be highly heterogeneous within these subgroups. The AHA/ACC guidelines also recommend consideration of coronary artery calcium (CAC) scoring for further risk assessment in borderline to intermediate risk individuals in whom management is uncertain. Although the combination of risk enhancing factors and CAC burden (together with Pooled Cohort estimates) may lead to more accurate ASCVD risk assessment, few publications have closely examined the interplay between risk enhancing factors and CAC scoring for personalized risk estimation. Our aim is to review the relevant literature in this area. Although further research is clearly needed, CAC assessment seems a highly valuable option to inform individualized ASCVD risk management in these important, often highly heterogeneous patient subgroups.

    更新日期:2019-11-11
  • Implications for REDUCE IT in clinical practice
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-09
    Vera Bittner

    Statin therapy is effective in primary and secondary prevention, but substantial residual risk remains on statin treatment, especially among high risk and very high risk patients. Add-on therapy with ezetimibe and proprotein convertase subtilisin /kexin type 9 (PCSK9) inhibitors provides additional risk reduction through further reduction in low density lipoprotein cholesterol. Elevated triglycerides/triglyceride rich lipoproteins contribute to atherogenesis and to the residual risk on statin therapy. Addition of icosapent ethyl to statins has recently been shown to markedly lower risk of cardiovascular disease (CVD) events in patients with established atherosclerotic CVD (ASCVD) and high risk patients with type II diabetes mellitus. These data are discussed in the context of current guidelines and synthesized in a decision pathway to guide combination lipid-lowering therapy in patients at high ASCVD risk.

    更新日期:2019-11-11
  • Tricuspid regurgitation is a public health crisis
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-09
    Maurice Enriquez-Sarano, David Messika-Zeitoun, Yan Topilsky, Christophe Tribouilloy, Giovanni Benfari, Hector Michelena

    Tricuspid regurgitation (TR) has long been a forgotten valve disease of benign reputation. However, TR deserves higher attention and represents a growing public health crisis. Indeed, recent epidemiological data suggest that 1.6 million US residents are affected by moderate or severe TR. Furthermore, large recent cohorts demonstrate that higher degrees of TR are associated with considerable excess mortality, independent of all background clinical and hemodynamic contexts. Finally, analysis of recent cohorts also shows that >90% of patients with moderate or severe TR are never offered surgical treatment and remain untreated. Therefore, TR is frequent, severely impacts outcomes, and is rarely treated, justifying the development of new strategies and methods for its treatment.

    更新日期:2019-11-11
  • Transcatheter innovations in tricuspid regurgitation: Navigate
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-07
    Haytham Elgharably, Serge C. Harb, Samir Kapadia, Lars G. Svensson, Jose L. Navia

    Patients with isolated functional or recurrent tricuspid regurgitation are often considered high risk and denied surgery. There has been growing experience for transcatheter tricuspid valve implantation through valve-in-valve or valve-in-ring, and recently, but to a lesser extent, in native annulus. The NaviGate is a novel self-expanding valved-stent designed with unique features to treat tricuspid regurgitation, particularly, in the settings of severely dilated tricuspid annulus. Herein, we present the innovation facets and clinical application of the NaviGate system.

    更新日期:2019-11-07
  • Coconut oil intake and its effects on the cardiometabolic profile – A structured literature review
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-07
    Heitor O. Santos, Scott Howell, Conrad P. Earnest, Filipe J. Teixeira

    In recent years, health professionals and laypersons have disseminated misinformation regarding the consumption of coconut oil. Those encouraging the supplementation of coconut oil argue that it provides health benefits and protective cardiovascular effects. Our article examines the effects of coconut oil intake on the cardiometabolic profile by exploring various lipid indices, as well as potential non-lipid effects, such as weight loss. The majority of randomized controlled trials show that coconut oil intake or its supplementation increases low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDLC), and total cholesterol when compared with other vegetable oils. Lauric acid, a medium-chain fatty acid and the main constituent of coconut oil, increases LDL-C and HDL-C concentrations, since it plays a main role as a substrate for apolipoprotein (apo)A1 and apoB synthesis, which are the key molecules in HDL-C and LDL-C particles, respectively. Despite some findings demonstrating an increase in HDLC, definitive long-term clinical trials are imperative to ascertain whether this effect is clinically relevant given that the consumption of saturated fatty acids (SFA), independent of coconut oil, may also increase HDL-C concentrations. Despite the promotion in the mainstream media, coconut oil intake has failed as a weight loss strategy and should not be considered as a supplementation strategy to increase satiety and/or thermogenesis. If one desires to include coconut oil in the diet, then we suggest that it should be limited and encompassed within the current recommendations of SFA intake, which are up to 10% of total caloric intake.

    更新日期:2019-11-07
  • 更新日期:2019-11-01
  • Preventing preventable chronic disease: An essential goal.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-08-20
    Henry Greenberg,F Xavier Pi-Sunyer

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Tricuspid annuloplasty with the Millipede ring.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-15
    Jason H Rogers,Walter D Boyd,Steven F Bolling

    更新日期:2019-11-01
  • Cardiovascular magnetic resonance imaging in myocarditis.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2011-10-22
    Helene Childs,Matthias G Friedrich

    Cardiovascular magnetic resonance imaging (CMR) has become the leading modality in noninvasive imaging of myocarditis. Consensus on the use of 3 CMR criteria for myocarditis, referred to as edema, early, and late enhancement, has standardized CMR protocol for assessing myocarditis. Although definite diagnosis of myocarditis remains challenging, the outcome of this disease necessitates further investigation with the objective of providing robust noninvasive tests. Moreover, relative to current tools such as endomyocardial biopsy, CMR is a promising technique in the setting of this insidious and complex disease.

    更新日期:2019-11-01
  • Lipid update 2020 - Introduction and foreword.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2019-11-13
    Jennifer G Robinson

    更新日期:2019-11-01
  • Cardiovascular, inflammatory, and metabolic consequences of sleep deprivation.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2008-12-27
    Janet M Mullington,Monika Haack,Maria Toth,Jorge M Serrador,Hans K Meier-Ewert

    That insufficient sleep is associated with poor attention and performance deficits is becoming widely recognized. Fewer people are aware that chronic sleep complaints in epidemiologic studies have also been associated with an increase in overall mortality and morbidity. This article summarizes findings of known effects of insufficient sleep on cardiovascular risk factors including blood pressure, glucose metabolism, hormonal regulation, and inflammation with particular emphasis on experimental sleep loss, using models of total and partial sleep deprivation, in healthy individuals who normally sleep in the range of 7 to 8 hours and have no sleep disorders. These studies show that insufficient sleep alters established cardiovascular risk factors in a direction that is known to increase the risk of cardiac morbidity.

    更新日期:2019-11-01
  • The uncertain significance of low vitamin D levels in African descent populations: a review of the bone and cardiometabolic literature.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2013-11-26
    Michelle Y O'Connor,Caroline K Thoreson,Natalie L M Ramsey,Madia Ricks,Anne E Sumner

    Vitamin D levels in people of African descent are often described as inadequate or deficient. Whether low vitamin D levels in people of African descent lead to compromised bone or cardiometabolic health is unknown. Clarity on this issue is essential because if clinically significant vitamin D deficiency is present, vitamin D supplementation is necessary. However, if vitamin D is metabolically sufficient, vitamin D supplementation could be wasteful of scarce resources and even harmful. In this review vitamin D physiology is described with a focus on issues specific to populations of African descent such as the influence of melanin on endogenous vitamin D production and lactose intolerance on the willingness of people to ingest vitamin D fortified foods. Then data on the relationship of vitamin D to bone and cardiometabolic health in people of African descent are evaluated.

    更新日期:2019-11-01
  • Genetic epidemiology of type 2 diabetes and cardiovascular diseases in Africa.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2013-11-26
    Fasil Tekola-Ayele,Adebowale A Adeyemo,Charles N Rotimi

    The burdens of type 2 diabetes (T2D) and cardiovascular diseases (CVD) are increasing in Africa. T2D and CVD are the result of the complex interaction between inherited characteristics, lifestyle, and environmental factors. The epidemic of obesity is largely behind the exploding global incidence of T2D. However, not all obese individuals develop diabetes and positive family history is a powerful risk factor for diabetes and CVD. Recent implementations of high throughput genotyping and sequencing approaches have advanced our understanding of the genetic basis of diabetes and CVD by identifying several genomic loci that were not previously linked to the pathobiology of these diseases. However, African populations have not been adequately represented in these global genomic efforts. Here, we summarize the state of knowledge of the genetic epidemiology of T2D and CVD in Africa and highlight new genomic initiatives that promise to inform disease etiology, public health and clinical medicine in Africa.

    更新日期:2019-11-01
  • The role of cardiovascular magnetic resonance in adults with congenital heart disease.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2011-10-22
    Philip J Kilner

    The comprehensive coverage and versatility of cardiovascular magnetic resonance (CMR), providing functional as well as anatomical information, make it an important facility in a center specializing in the care of adults with congenital heart disease. Imaging specialists using CMR to investigate acquired heart disease should also be able to recognize and evaluate previously unsuspected congenital malformations. Conditions that may present or be picked up during imaging in adulthood include atrial septal defect, anomalously connected pulmonary veins, double-chambered right ventricle, congenitally corrected transposition of the great arteries, aortic coarctation, and patent arterial duct. To realize its full potential and to avoid pitfalls, CMR of adults with congenital heart disease requires specific training and experience. Appropriate pathophysiological understanding is needed to evaluate cardiovascular function after surgery for tetralogy of Fallot, after transposition of the great arteries, and after Fontan operations. For these and other more complex cases, CMR should ideally be undertaken by specialists committed to long-term collaboration with the clinicians and surgeons managing the patients in a tertiary referral center.

    更新日期:2019-11-01
  • Prolonged QTc interval in cancer therapeutic drug development: defining arrhythmic risk in malignancy.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2010-08-24
    Joanna M Brell

    Anticancer therapy drug development is an arduous task, taking 10 to 15 years to complete, requiring approximately 1 billion dollars, and rarely leads to Food and Drug Administration approval. Methods to predict unacceptable drug-induced toxicity, such as a prolonged QTc interval/risk of torsade de pointes, should be highly informative to quickly and accurately determine if further resources should be allocated in the continued development of an agent. Expert consensus has established guidelines to ascertain the ability of a new drug to prolong the QTc interval. Although QTc measurement is the best way to assess arrhythmic risk, it is imprecise for a variety of reasons. In addition, oncology patients have multiple risk factors for QTc prolongation at baseline. Competing interests involved in assessing arrhythmic risk of a new oncology agent include inability to precisely follow published guidelines for QTc assessment, patients' concomitant medical problems interfering with drug assessment and therefore clinical trial enrollment, patient safety concerns, general public safety concerns regarding toxicity assessment, need for discovery of more curative drug therapies, and individual patient perception of therapeutic risk vs benefit. Oncology patients are concerned about access to experimental agents, as well as early abandonment of a potentially beneficial agent because of a low estimated risk of toxicity, even if the event is catastrophic. We review the issues involved in evaluating the QTc interval-prolonging risk in new anticancer agents.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Assessment of diastolic function.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-07-09
    Miguel A Quiñones

    更新日期:2019-11-01
  • Prognosis in diastolic heart failure.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-07-09
    Kristen M Franklin,Gerard P Aurigemma

    Diastolic dysfunction and the clinical syndrome of diastolic heart failure have become well recognized as contributors to the overall burden of congestive heart failure. This increasing awareness has led to several recent investigations into the impact of diastolic abnormalities on morbidity and mortality. This article reviews the current state of knowledge regarding the prognosis of patient populations with diastolic dysfunction and diastolic heart failure.

    更新日期:2019-11-01
  • Epidemiology of diastolic heart failure.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-07-09
    Theophilius E Owan,Margaret M Redfield

    Heart failure (HF) is a major public health problem. Clinical studies suggest that a significant proportion of patients with HF have preserved ejection fraction, a clinical syndrome commonly referred to as diastolic HF (DHF). One of the purposes of epidemiological studies is to identify unmet public health needs in a population and to quantify the magnitude of the problem in a manner that is free from the referral bias inherent in clinical studies. We review current epidemiological data estimating the prevalence of DHF, highlight the challenges posed by existing data, and suggest focus for future studies on the epidemiology of DHF. We limited the review to studies that met our definition of population-based studies (eg, studies drawing participants from a defined community or all consecutive referrals to a health facility that is the sole provider to a defined community). Studies relevant to the epidemiology of each stage of DHF (American College of Cardiology/American Heart Association stages A-D) were reviewed. These epidemiological studies clearly define the magnitude of this health care problem and underscore the urgent need for studies elucidating the natural history, pathophysiology, and optimal diagnostic and management strategy for this extremely common clinical syndrome.

    更新日期:2019-11-01
  • Diagnostic criteria for diastolic heart failure.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-07-09
    R Frederick Yturralde,William H Gaasch

    A diagnosis of diastolic heart failure can be made if the patient exhibits clinical evidence of heart failure and has a normal left ventricular ejection fraction. The diagnosis is confirmed if there is evidence of ventricular hyperthrophy and/or concentric remodeling, left atrial enlargement, or laboratory evidence of diastolic dysfunction.

    更新日期:2019-11-01
  • Diastolic heart failure: definitions and terminology.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-07-09
    Michael R Zile,Catalin F Baicu,David D Bonnema

    Patients with chronic heart failure can be divided into 2 broad categories: systolic heart failure and diastolic heart failure. There are significant differences in demographics, prognosis, left ventricular structure, as well as systolic and diastolic function between these 2 groups of patients. The purpose of this presentation is to define the terminology used to describe these 2 broad categories of heart failure and to characterize the functional measurements that constitute their pathophysiological mechanisms.

    更新日期:2019-11-01
  • Exercise test-induced arrhythmias.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-07-02
    James Beckerman,Teresa Wu,Sarah Jones,Victor F Froelicher

    Exercise testing commonly used by clinicians to characterize cardiovascular risk by detecting myocardial ischemia and assessing response to exercise. However, a consensus has not previously existed regarding the significance of exercise test-induced arrhythmias due to conflicting results from the available studies. Recent studies with longer follow-up and improved technology have therefore stimulated this current review of the topic. Despite the continued debate in the literature regarding the prognosis of ETIA in a general population, there is sufficient evidence to suggest that clinicians should closely evaluate and follow those patients with arrhythmias during exercise testing and aggressively modify risk factors for coronary artery disease.

    更新日期:2019-11-01
  • Matrix, cytoskeleton, or myofilaments: which one to blame for diastolic left ventricular dysfunction?
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-07-02
    Jean G F Bronzwaer,Walter J Paulus

    During cardiac filling, the relative contribution of distension of interstitial collagen, of distension of cytoskeletal proteins, and of low-grade diastolic cross-bridge cycling in the generation of diastolic left ventricular (LV) pressure remains unclear. In failing myocardium, interstitial collagen deposition and cross-linking are augmented. This increase in collagen deposition is accompanied by expression of a stiffer isoform of titin in the cardiomyocytes. Higher diastolic stiffness of failing myocardium is therefore not necessarily related to increased interstitial collagen content. Moreover, phosporylation of titin by protein kinase A and G, and inhibition of titin-actin interaction by cytosolic calcium allow for dynamic modulation of its diastolic tension generation and could account for acute shifts of myocardial distensibility. Acute shifts of myocardial distensibility, as occur in hypertrophy or in demand ischemia, have usually been attributed to a diastolic resurgence of cross-bridge interaction. In hypertrophied and failing myocardium, the recent demonstrations of diastolic calcium release from the ryanodine receptor, of deficient diastolic calcium removal from the cytosol, and of enhanced myofilamentary calcium sensitivity support residual diastolic cross-bridge interaction. In demand ischemia, the role of calcium overload in the reduction of diastolic LV distensibility is less clear because of correction of the reduced diastolic LV distensibility by quick stretches but not by a calcium desensitizer. Simultaneous imposition in animal models of multiple molecular changes involving interstitial, cytoskeletal, and myofilamentary proteins could elucidate their relative importance for myocardial stiffness and lead to selective correction of diastolic LV dysfunction as a novel mode of heart-failure therapy.

    更新日期:2019-11-01
  • Postmortem studies of the intertruncal plexus and cardiac conduction system from patients with Chagas disease who died suddenly.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-07-02
    Thomas N James,Marcos A Rossi,Shoji Yamamoto

    Throughout the cardiac conduction system of each heart there were numerous destructive lesions including focal inflammatory infiltration with lymphocytes and in neighboring regions extensive focal fibrotic degeneration. These lesions involved myocytes, nerves and blood vessels. They were adequate explanation for the familiar disturbances in cardiac rhythm and conduction typical of Chagasic cardiomyopathy. In one heart there was a left ventricular apical aneurysm, which is often considered typical of Chagasic cardiomyopathy. To our surprise, virtually every myocyte in the region of the aneurysm was undergoing extensive dehiscence, thus severing all intercellular junctions of the involved myocytes. Therefore, we suggest that the left ventricular apical aneurysms represent a form of disuse atrophy produced by the sympathetic denervation caused by neuropathology in the intertruncal plexus of each heart. Sympathetic innervation of virtually the entire left ventricle is derived from nerves supplied through ganglia in the intertruncal plexus. The random nature of the neuropathology in the intertruncal plexus is the probable explanation of why some Chagasic hearts exhibit generalized Chagasic cardiomyopathy, while others have a more restricted denervation ending in left ventricular apical aneurysms. Perhaps the most intriguing finding in our study was the abundance of flagellated trypanosoma cruzi within the intertruncal plexus of each heart. The trypanosomes were often in clusters, sometimes encysted by a thin fibrous membrane, but more often in loose aggregates without a surrounding membrane. Some trypanosomes were seen boring into intertruncal nerves while others formed dense clusters of trypanosomes attached to the outer surface of an intertruncal vein. We believe that these observations have seldom, if ever, been described before, and they represent interesting opportunities in future diagnosis and treatment of cardiac disease caused by trypanosoma cruzi.

    更新日期:2019-11-01
  • Chlamydia pneumoniae and atherosclerosis: from Koch postulates to clinical trials.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-07-02
    Catherine Liu,David D Waters

    Atherosclerosis is increasingly viewed as an inflammatory process. A number of infectious agents have been implicated in the pathogenesis of coronary artery disease. Chlamydia pneumoniae has been the most popular and well-studied of these pathogens. It is difficult to prove a causal relationship which requires the fulfillment of Koch's postulates, first developed in the late 1800s, to establish an infectious agent as the cause of a disease process. This paper reviews the evidence for and against Chlamydia pneumoniae infection as a contributing factor to atherosclerosis disease. It examines seroepidemiologic and histopathologic studies as well as animal models using Koch's postulates and then provides an analysis of current clinical trial data.

    更新日期:2019-11-01
  • Predicting perioperative cardiac risk.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-07-02
    Miklos D Kertai,Jan Klein,Jeroen J Bax,Don Poldermans

    Cardiovascular complications are the major cause of perioperative morbidity and mortality of patients undergoing major vascular surgery. This is related to the frequent presence of an underlying coronary artery disease. This paper reviews the pathology of perioperative cardiac complications and cardiac risk assessment and risk reduction strategies. Guidelines of the American College of Cardiology and American Heart Association for the evaluation of cardiac risk for noncardiac surgery may provide the necessary framework for the assessment and management of patients undergoing major vascular surgery. Based on the American College of Cardiology and American Heart Association guidelines and data from contemporary studies, patients without risk factors are considered to be at low risk and do not require additional evaluations for coronary artery disease. Patients with 1 or 2 cardiac risk factors represent an intermediate-risk group for perioperative cardiac complications. If beta-blockers are prescribed, the probability of cardiac complications is low and there is no need for further noninvasive testing. Patients with 3 or more risk factors are at high risk for cardiac complications and the use of noninvasive testing may help further refine cardiac risk based on the presence and absence of test-induced myocardial ischemia. beta-Blockers should be prescribed to all patients, and coronary revascularization should be reserved for high-risk patients who have a clearly defined need for revascularization independent of the need for major vascular surgery.

    更新日期:2019-11-01
  • Brucella endocarditis: the importance of surgical timing after medical treatment (five cases).
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-07-02
    Ibrahim Ozsöyler,Levent Yilik,Sahin Bozok,Sibel El,Bilgin Emrecan,Serdar Biçeroğlu,Ali Gürbüz

    INTRODUCTION Brucella endocarditis is a disease that is hard to treat medically and has a high mortality. Immediate surgery after medical treatment is very important because delaying surgery may lead to that are difficult to repair. METHODS Five patients who were admitted to our institution with a diagnosis of Brucella endocarditis were medically treated with doxycycline (200 mg/d), rifampin (600 mg/d), and ceftriaxone (2 g/d). Preoperative mean medical treatment time was 5.2 weeks (range, 4-6 weeks). The patients were taken for operation when their general status improved. We report in this study the results of these patients. RESULTS Three patients had aortic valve replacement whereas 2 had both aortic and mitral valve replacements. No mortality or morbidity was encountered in the patients. Mean postoperative hospitalization time was 15 days (range, 12-19 days). The patients were discharged with doxycycline (200 mg/d) and rifampin (600 mg/d) but without antipyretic medication. Postoperative antibiotherapy was continued up to a mean of 3.6 months (range, 2-6 months). Mean postoperative follow-up time was 15.8 months. None of the patients needed hospitalization in their follow-up time. CONCLUSION Adequate preoperative antibiotherapy, immediate surgery, and continuation of postoperative antibiotherapy according to clinical progress seem to be a convenient treatment strategy for Brucella endocarditis.

    更新日期:2019-11-01
  • Cardiovascular effects of ephedra alkaloids: a comprehensive review.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-07-02
    Richard Andraws,Preety Chawla,David L Brown

    The Ephedra alkaloids have received much press lately secondary to reported adverse events in those using whole extracts as "dietary supplements" for weight loss or athletic performance enhancement. These reports are troubling given the increasing use of these supplements by the general public. We reviewed the available literature as well as online material on these compounds, including information on their pharmacology, regulation, effects on weight loss and athletic performance, and adverse events. Extracts of Ephedra shrubs contain highly active alpha- and beta-adrenergic agonists that have profound effects on the heart and vasculature. Evidence for their effectiveness is limited. Adverse cardiovascular and cerebrovascular effects, including stroke, myocardial infarction, and sudden death, temporally related to their use are well described. The recent Food and Drug Administration ban on these compounds is not broad enough. Ephedra supplements contain a highly bioactive class of compounds that pose a significant risk to the public under the current regulatory framework. More stringent oversight by regulatory authorities is required to minimize the incidence of adverse events.

    更新日期:2019-11-01
  • Developing the next generation of cardiac markers: disease-induced modifications of troponin I.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-03-02
    Jason L McDonough,Jennifer E Van Eyk

    Troponin I (TnI) and Troponin T (TnT) have evolved into arguably the two most important diagnostic markers for acute myocardial injury. Part of their diagnostic utility lies in the uniquely important roles that both TnI and TnT play in the calcium-dependent regulation of cardiac muscle contraction. Both proteins undergo extensive physiologic regulation, principally through phosphorylation, as well as specific disease-induced pathologic modifications, including phosphorylation, oxidation, and proteolysis. Many, if not all, of these protein modifications in some way modulate contractility, and when detected in serum may therefore provide important information about both the disease state and functional status of the heart. However, the complexity of the TnI (and TnT) forms in the serum is large, which leads to difficulty in detecting all of the Tn subunits in serum, and hence interpreting the biologic significance of each modified product. But, as diagnostic tools and modalities improve, our ability to monitor and detect specific disease-induced modified forms of proteins will inevitably lead to better and more specific diagnoses and therapies.

    更新日期:2019-11-01
  • Cardiac troponins in renal insufficiency and other non-ischemic cardiac conditions.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-03-02
    Gary S Francis,W H Wilson Tang

    The emergence of cardiac troponins has been an interesting step in the diagnosis of ACS. It has clearly helped us to better triage patients toward a more aggressive posture in performing early cardiac catheterization, and in some cases, early use of adjunctive Gp IIb/IIIa antagonists and percutaneous or surgical myocardial revascularization. However, with this step forward has come uncertainty and many cardiology consults regarding positive cardiac troponins in patients without ACS or myocardial infarction. In general, increased cardiac troponins imply a worse prognosis. This is clearly true of patients with ESRD and advanced heart failure. It is also true of patients with severe, noncardiac illnesses. In other situations, such as acute pericarditis and cardiac surgery, slightly elevated cardiac troponins do not seem to predict a worse prognosis, and can probably be disregarded. The elevation of cardiac troponins after successful percutaneous coronary interventions is not unexpected, and the level of cardiac troponin release seems to predict problems, but lively controversy persists. Last, monitoring cardiac troponins in cardiac transplant recipients and those receiving certain cardiotoxic chemotherapies may be of some diagnostic value, but clearly more experience and clinical research are needed.

    更新日期:2019-11-01
  • Analytical issues for cardiac troponin.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-03-02
    Fred S Apple

    更新日期:2019-11-01
  • Troponins in acute coronary syndromes.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-03-02
    Benjamin M Scirica,David A Morrow

    Cardiac troponins have replaced creatine kinase-MB as the preferred biomarker for establishing the diagnosis of myocardial infarction (MI). Expert recommendations set the diagnostic decision-limit for each assay at the 99th percentile of troponin levels in an apparently healthy reference population, which due to a lack of standardization, will vary depending upon the manufacturer. Among patients presenting with an acute coronary syndrome (ACS), even low-level elevations of cardiac troponin T or I correlate with higher risk of death and recurrent ischemic events compared to patients with levels of troponin below the decision limit. Renal failure does not appear to diminish the prognostic value of troponins among patients with a high clinical probability of ACS. Moreover, patients with elevated levels of troponin derive the most benefit from more intense medical therapy with antithrombin and antiplatelet medications, as well as an early invasive management strategy. Whereas cardiac troponins are extremely specific for myocardial necrosis, they do not discriminate between ischemic and non-ischemic etiologies of myocardial injury. Clinicians must, therefore, determine whether a patient's presenting symptoms are consistent with ACS. Combining troponin with other cardiac biomarkers may offer complimentary information on the underlying pathobiology and prognosis in an individual patient. Future generations of troponin assays may detect specific posttranslational modifications of troponins that may increase the analytic sensitivity for myocardial damage and offer insight into the timing and mechanism of myocardial injury.

    更新日期:2019-11-01
  • Biology of the troponin complex in cardiac myocytes.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2005-03-02
    Michael S Parmacek,R John Solaro

    Troponin is the regulatory complex of the myofibrillar thin filament that plays a critical role in regulating excitation-contraction coupling in the heart. Troponin is composed of three distinct gene products: troponin C (cTnC), the 18-kD Ca(2+)-binding subunit; troponin I (cTnI), the approximately 23-kD inhibitory subunit that prevents contraction in the absence of Ca2+ binding to cTnC; and troponin T (cTnT), the approximately 35-kD subunit that attaches troponin to tropomyosin (Tm) and to the myofibrillar thin filament. Over the past 45 years, extensive biochemical, biophysical, and structural studies have helped to elucidate the molecular basis of troponin function and thin filament activation in the heart. At the onset of systole, Ca2+ binds to the N-terminal Ca2+ binding site of cTnC initiating a conformational change in cTnC, which catalyzes protein-protein associations activating the myofibrillar thin filament. Thin filament activation in turn facilitates crossbridge cycling, myofibrillar activation, and contraction of the heart. The intrinsic length-tension properties of cardiac myocytes as well as the Frank-Starling properties of the intact heart are mediated primarily through Ca(2+)-responsive thin filament activation. cTnC, cTnI, and cTnT are encoded by distinct single-copy genes in the human genome, each of which is expressed in a unique cardiac-restricted developmentally regulated fashion. Elucidation of the transcriptional programs that regulate troponin transcription and gene expression has provided insights into the molecular mechanisms that regulate and coordinate cardiac myocyte differentiation and provided unanticipated insights into the pathogenesis of cardiac hypertrophy. Autosomal dominant mutations in cTnI and cTnT have been identified and are associated with familial hypertrophic and restrictive cardiomyopathies.

    更新日期:2019-11-01
  • Reperfusion treatment of ST-elevation acute myocardial infarction.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2004-12-09
    Flavio Ribichini,Valeria Ferrero,William Wijns

    Reperfusion treatment of ST-segment elevation myocardial infarction (STEMI) is one of the medical interventions with the largest potential for saving human lives, independently of age and gender. An attempt to reopen an acutely occluded coronary artery can be done within a wide array of possibilities, from the simple administration of aspirin to the combination of drugs and complex coronary artery interventions. Fibrinolytic drugs and aspirin represent the easiest way to attempt reperfusion and together offer an acceptable compromise between opportunity for treatment and efficacy. Other drugs and the use of invasive revascularization alternatives yield further advantages, and in some high-risk subgroups may be the most rational treatment approach. Beyond investigator's bias and dedication to either form of reperfusion treatment, interventions and/or drugs should be used as needed (and as possible) to increase the overall impact of reperfusion treatment in the community, taking advantage of the best potential of each approach. Most resources have been directed toward the improvement of reperfusion rates with the combination of fibrinolytic and antiplatelet drugs or with angioplasty. These efforts have certainly raised costs, but have not decisively improved clinical outcome nor have they broadened the impact of reperfusion treatment in the community. Indeed, the main shortcoming of reperfusion therapy is that the cohort of untreated patients is still larger than the cohort of treated patients. At a time when mortality of patients with STEMI reaching the hospital and receiving treatment has decreased significantly, the prehospital diagnosis and treatment of STEMI with the objective of enlarging the treated population and shortening the pretreatment delays is likely the best strategy to further reduce mortality. The need for a population approach to treatment of STEMI is even more obvious when considering the expanding patient load that continuously worsens its clinical risk profile, together with the increasing incidence of diabetes, obesity, hypertension, and smoking habits. The target for improving reperfusion treatment of STEMI in the future, and thereby saving more lives, seems now to involve a cultural change and fulfillment of an organizational mission more than an incremental improvement in the current pharmacologic or interventional approach. These epidemiologic and social aspects of contemporary medicine deserve full attention at a time when researchers, clinicians, and health care providers tend to focus primarily on technological advances.

    更新日期:2019-11-01
  • The clinical use of angiotensin-converting enzyme inhibitors.
    Prog. Cardiovasc. Dis. (IF 6.162) Pub Date : 2004-12-09
    Joseph Wong,Rajiv A Patel,Peter R Kowey

    Through an integrative understanding of cardiovascular pathophysiologic characteristics at the multiorgan level, significant achievements in cardiovascular therapeutics have been achieved and enabled the rationale design and development of drugs such as the angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). In this article, we present a detailed review of the physiologic features of the renin-angiotensin-aldosterone system (RAAS), ACE inhibitors and ARB clinical pharmacologic characteristics, and specific diseases in which they are considered to be the standard of the care as supported by important clinical trial data. It is envisioned that an updated and detailed understanding of ACE inhibitors and ARBs will facilitate their successful use in the treatment of heart failure, myocardial infarction, hypertension, renal failure, and diabetic nephropathy.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
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