Progress in cardiovascular diseases
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Prog Cardiovasc Dis · May 2020
Meta AnalysisSafety and efficacy of antiplatelet regimens after percutaneous coronary intervention using drug eluting stents: A network meta-analysis of randomized controlled trials.
We aimed to determine the efficacy and safety of different anti-platelet regimens after percutaneous coronary intervention (PCI) with drug eluting stent (DES) implantation using a network meta-analysis of randomized controlled trials (RCTs). ⋯ Amongst patients undergoing DES implantation, S-DAPT with P2Y12 inhibitor monotherapy reduces bleeding without increased risk of MI or ST compared with L-DAPT. Prospective trials are needed to evaluate if S-DAPT with P2Y12 monotherapy is superior to S-DAPT with ASA monotherapy for ischemic protection.
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Prog Cardiovasc Dis · May 2020
ReviewSpeckle tracking echocardiography as a new diagnostic tool for an assessment of cardiovascular disease in rheumatic patients.
Chronic inflammation represents the cornerstone of the raised cardiovascular (CV) risk in patients with inflammatory rheumatic diseases (IRD). Standardized mortality ratios are increased in these patients compared to the general population, which can be explained by premature mortality associated with early atherosclerotic events. Thus, IRD patients need appropriate CV risk management in view of this CV disease (CVD) burden. ⋯ In recent years, the role of left ventricular ejection fraction (LVEF) as the gold standard parameter for the evaluation of systolic function has been debated, and many efforts have been focused on the clinical validation of new non-invasive tools for the study of myocardial contractility as well as to characterize the subclinical alterations of the myocardial function. Improvement in the accuracy of STE has resulted in a large amount of research showing the ability of STE to overcome LVEF limitations in the majority of primary and secondary heart diseases. This review summarizes the additional value that STE measurement can provide in the setting of IRD, with a focus in the different clinical stages.
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Prog Cardiovasc Dis · May 2020
ReviewApplications of artificial intelligence in multimodality cardiovascular imaging: A state-of-the-art review.
There has been a tidal wave of recent interest in artificial intelligence (AI), machine learning and deep learning approaches in cardiovascular (CV) medicine. In the era of modern medicine, AI and electronic health records hold the promise to improve the understanding of disease conditions and bring a personalized approach to CV care. The field of CV imaging (CVI), incorporating echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and nuclear imaging, with sophisticated imaging techniques and high volumes of imaging data, is primed to be at the forefront of the revolution in precision cardiology. This review provides a contemporary overview of the CVI imaging applications of AI, including a critique of the strengths and potential limitations of deep learning approaches.
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Prog Cardiovasc Dis · Mar 2020
ReviewPrevention of cardiovascular disease for historically marginalized racial and ethnic groups living with HIV: A narrative review of the literature.
Despite developments to improve health in the United States, racial and ethnic disparities persist. These disparities have profound impact on the wellbeing of historically marginalized racial and ethnic groups. This narrative review explores disparities by race in people living with cardiovascular disease (CVD) and the Human Immunodeficiency Virus (HIV). ⋯ Data on racial disparities for persons living with comorbid HIV and CVD are lacking. We found few published articles (n = 7) describing racial disparities for persons living with both comorbid HIV and CVD. Efforts to reduce CVD morbidity in historically marginalized racial and ethnic groups with HIV must address participation in clinical research, social determinants of health and translation of research into clinical practice.
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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. ⋯ Addition of icosapent ethyl to statins has recently been shown to markedly lower risk of ASCVD 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.