Cardiovascular Practitioners Research Articles

Empagliflozin: Primus Inter Pares Among Sodium-Glucose Cotransporter-2 Inhibitors?

Sodium/glucose cotransporter-2 (SGLT2) inhibitors are a novel class of antidiabetic medications which have proved capable of providing breakthrough cardiovascular (CV) benefits in a variety of clinical scenarios, including patients with heart failure or obesity, irrespective of diabetic status. Several SGLT2 inhibitors are available, but the most prominent ones are canagliflozin, dapagliflozin, and empagliflozin. Several studies have focused on empagliflozin and its effects on the risk of heart failure incidence and recurrences. Most recently, empagliflozin has been recently tested in patients with recent myocardial infarction in the EMPAgliflozin on Hospitalization for Heart Failure and Mortality in Patients With aCuTe Myocardial Infarction randomized trial, with apparently ambiguous findings. The present viewpoint succinctly illustrates the main features of SGLT2 inhibitors as a pharmacologic class, their ever expanding role as a CV medication, and the comparative effectiveness of different individual SGLT2 inhibitors, explicitly commenting on the recent data on empagliflozin in patients with acute myocardial infarction. The reader will find in this article a poignant perspective on this novel avenue for CV prevention and treatment, which greatly expands the management armamentarium of CV practitioners. Indeed, we make the case that SGLT2 inhibitors have a clearly favorable class effect, with differences between individual agents mainly suitable for personalization of care and minimization of side effects.

ABC as aortic valve, Body Mass Index, COVID, and more: a welcome yet challenging update for cardiovascular practitioners.

ABC as aortic valve, Body Mass Index, COVID, and more: a welcome yet challenging update for cardiovascular practitioners.

Comprehensive bioinformatics analysis reveals the role of cuproptosis-related gene Ube2d3 in myocardial infarction.

Myocardial infarction (MI) caused by severe coronary artery disease has high incidence and mortality rates, making its prevention and treatment a central and challenging aspect of clinical work for cardiovascular practitioners. Recently, researchers have turned their attention to a novel mechanism of cell death caused by Cu2+, cuproptosis. This study integrated data from three MI-related bulk datasets downloaded from the Gene Expression Omnibus (GEO) database, and identified 16 differentially expressed genes (DEGs) related to cuproptosis by taking intersection of the 6378 DEGs obtained by differential analysis with 49 cuproptosis-related genes. Four hub genes, Dbt, Dlat, Ube2d1 and Ube2d3, were screened out through random forest analysis and Lasso analysis. In the disease group, Dbt, Dlat, and Ube2d1 showed low expression, while Ube2d3 exhibited high expression. Focusing on Ube2d3 for subsequent functional studies, we confirmed its high expression in the MI group through qRT-PCR and Western Blot detection after successful construction of a MI mouse model by left anterior descending (LAD) coronary artery ligation, and further clarified the correlation of cuproptosis with MI development by detecting the levels of cuproptosis-related proteins. Moreover, through in vitro experiments, Ube2d3 was confirmed to be highly expressed in oxygen-glucose deprivation (OGD)-treated cardiomyocytes AC16. In order to further clarify the role of Ube2d3, we knocked down Ube2d3 expression in OGD-treated AC16 cells, and confirmed Ube2d3's promoting role in the hypoxia damage of AC16 cells by inducing cuproptosis, as evidenced by the detection of MTT, TUNEL, LDH release and cuproptosis-related proteins. In summary, our findings indicate that Ube2d3 regulates cuproptosis to affect the progression of MI.

Health Care Implications of the COVID-19 Pandemic for the Cardiovascular Practitioner.

There has been substantial excess morbidity and mortality during the COVID-19 pandemic, not all of which was directly attributable to SARS-CoV-2 infection, and many non-COVID-19 deaths were cardiovascular. The indirect effects of the pandemic have been profound, resulting in a substantial increase in the burden of cardiovascular disease and cardiovascular risk factors, both in individuals who survived SARS-CoV-2 infection and in people never infected. In this report, we review the direct effect of SARS-CoV-2 infection on cardiovascular and cardiometabolic disease burden in COVID-19 survivors as well as the indirect effects of the COVID-19 pandemic on the cardiovascular health of people who were never infected with SARS-CoV-2. We also examine the pandemic effects on health care systems and particularly the care deficits caused (or exacerbated) by health care delayed or foregone during the COVID-19 pandemic. We review the consequences of: (1) deferred/delayed acute care for urgent conditions; (2) the shift to virtual provision of outpatient care; (3) shortages of drugs and devices, and reduced access to: (4) diagnostic testing, (5) cardiac rehabilitation, and (6) homecare services. We discuss the broader implications of the COVID-19 pandemic for cardiovascular health and cardiovascular practitioners as we move forward into the next phase of the pandemic.

Obstructive Sleep Apnea and Cardiovascular Diseases: Sad Realities and Untold Truths regarding Care of Patients in 2022.

Obstructive sleep apnea (OSA) is one of the most common and serious sleep-related breathing disorders with a high prevalence among patients with cardiovascular (CV) diseases. Despite its widespread presence, OSA remains severely undiagnosed and untreated. CV mortality and morbidity are significantly increased in the presence of OSA as it is associated with an increased risk of resistant hypertension, heart failure, arrhythmias, and coronary artery disease. Evaluation and treatment of OSA should focus on recognizing patients at risk of developing OSA. The use of screening questionnaires should be routine, but a formal polysomnography sleep study is fundamental in establishing and classifying OSA. Recognition of OSA patients will allow for the institution of appropriate therapy that should alleviate OSA-related symptoms with the intent of decreasing adverse CV risk. In this review, we focus on the impact OSA has on CV disease and evaluate contemporary OSA treatments. Our goal is to heighten awareness among CV practitioners.

Breakthrough healthcare technologies in the COVID-19 era: a unique opportunity for cardiovascular practitioners and patients.

The Coronavirus disease 2019 (COVID-19) pandemic, caused by symptomatic severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) infection, has wreaked havoc globally, challenging the healthcare, economical, technological and social status quo of developing but also developed countries. For instance, the COVID-19 scare has reduced timely hospital admissions for ST-elevation myocardial infarction in Europe and the USA, causing unnecessary deaths and disabilities. While the emergency is still ongoing, enough efforts have been put to study and tackle this condition such that a comprehensive perspective and synthesis on the potential role of breakthrough healthcare technologies is possible. Indeed, current state-of-the-art information technologies can provide a unique opportunity to adapt and adjust to the current healthcare needs associated with COVID-19, either directly or indirectly, and in particular those of cardiovascular patients and practitioners. We searched several biomedical databases, websites and social media, including PubMed, Medscape, and Twitter, for smartcare approaches suitable for application in the COVID-19 pandemic. We retrieved details on several promising avenues for present and future healthcare technologies, capable of substantially reduce the mortality, morbidity, and resource use burden of COVID-19 as well as that of cardiovascular disease. In particular, we have found data supporting the importance of data sharing, model sharing, preprint archiving, social media, medical case sharing, distance learning and continuous medical education, smartphone apps, telemedicine, robotics, big data analysis, machine learning, and deep learning, with the ultimate goal of optimization of individual prevention, diagnosis, tracing, risk-stratification, treatment and rehabilitation. We are confident that refinement and command of smartcare technologies will prove extremely beneficial in the short-term, but also dramatically reshape cardiovascular practice and healthcare delivery in the long-term future, for COVID-19 as well as other diseases.

Genetic Testing for Inherited Cardiovascular Diseases: A Scientific Statement From the American Heart Association.

Advances in human genetics are improving the understanding of a variety of inherited cardiovascular diseases, including cardiomyopathies, arrhythmic disorders, vascular disorders, and lipid disorders such as familial hypercholesterolemia. However, not all cardiovascular practitioners are fully aware of the utility and potential pitfalls of incorporating genetic test results into the care of patients and their families. This statement summarizes current best practices with respect to genetic testing and its implications for the management of inherited cardiovascular diseases.

The Clinical Challenge of Clonal Hematopoiesis, a Newly Recognized Cardiovascular Risk Factor

ImportanceDespite current standards of cardiovascular care, a considerable residual burden of risk remains in both primary and secondary prevention. Clonal hematopoiesis of indeterminate potential (CHIP) has recently emerged as a common, potent, age-associated, independent risk factor for myocardial infarction, stroke, heart failure events, and survival following percutaneous aortic valve intervention. The presence of CHIP results from the acquisition of somatic mutations in a small number of leukemia driver genes found in bone marrow stem cells, leading to the expansion of leukocytes clones in peripheral blood. The association between CHIP and cardiovascular disease likely involves activation of the inflammasome pathway. More common DNA sequencing identifies individuals with CHIP who then seek advice regarding management of their cardiovascular risk.ObservationsUsing clinical vignettes based on real encounters, we highlight some of the diverse presentations of CHIP, ranging from incidental identification to that detected during cancer care, that have brought patients to the attention of cardiovascular practitioners. We illustrate how we have applied a consensus-based approach to the evaluation and management of cardiovascular risk in specific patients with CHIP. Since we currently lack evidence to guide the management of these individuals, we must rely on expert opinion while awaiting data to furnish a firmer foundation for our recommendations.Conclusions and RelevanceThese vignettes illustrate that the management of CHIP should involve an individualized plan based on features such as comorbidities, life expectancy, and other traditional cardiovascular risk factors. Because individuals with CHIP will increasingly seek advice from cardiovascular specialists regarding management, these examples provide a template for approaches based on a multidisciplinary perspective. The current need for reliance on expert opinion illustrates a great need for further investigation into the management of this newly recognized contributor to residual cardiovascular risk, both in patients who are apparently well and those with established cardiovascular or malignant disease.

SARS-CoV-2 and COVID-19: facing the pandemic together as citizens and cardiovascular practitioners

SARS-CoV-2 and COVID-19: facing the pandemic together as citizens and cardiovascular practitioners

2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging-Best Practices for Safety and Effectiveness, Part 2: Radiological Equipment Operation, Dose-Sparing Methodologies, Patient and Medical Personnel Protection.

The stimulus to create this document was the recognition that ionizing radiation-guided cardiovascular procedures are being performed with increasing frequency, leading to greater patient radiation exposure and, potentially, to greater exposure to clinical personnel. While the clinical benefit of these procedures is substantial, there is concern about the implications of medical radiation exposure. ACC leadership concluded that it is important to provide practitioners with an educational resource that assembles and interprets the current radiation knowledge base relevant to cardiovascular procedures. By applying this knowledge base, cardiovascular practitioners will be able to select procedures optimally, and minimize radiation exposure to patients and to clinical personnel. "Optimal Use of Ionizing Radiation in Cardiovascular Imaging - Best Practices for Safety and Effectiveness" is a comprehensive overview of ionizing radiation use in cardiovascular procedures and is published online. To provide the most value to our members, we divided the print version of this document into 2 focused parts. "Part I: Radiation Physics and Radiation Biology" addresses radiation physics, dosimetry and detrimental biologic effects. "Part II: Radiologic Equipment Operation, Dose-Sparing Methodologies, Patient and Medical Personnel Protection" covers the basics of operation and radiation delivery for the 3 cardiovascular imaging modalities (x-ray fluoroscopy, x-ray computed tomography, and nuclear scintigraphy). For each modality, it includes the determinants of radiation exposure and techniques to minimize exposure to both patients and to medical personnel.

2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging-Best Practices for Safety and Effectiveness, Part 1: Radiation Physics and Radiation Biology: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways Developed in Collaboration With Mended Hearts.

The stimulus to create this document was the recognition that ionizing radiation-guided cardiovascular procedures are being performed with increasing frequency, leading to greater patient radiation exposure and, potentially, to greater exposure for clinical personnel. Although the clinical benefit of these procedures is substantial, there is concern about the implications of medical radiation exposure. The American College of Cardiology leadership concluded that it is important to provide practitioners with an educational resource that assembles and interprets the current radiation knowledge base relevant to cardiovascular procedures. By applying this knowledge base, cardiovascular practitioners will be able to select procedures optimally, and minimize radiation exposure to patients and to clinical personnel. Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness is a comprehensive overview of ionizing radiation use in cardiovascular procedures and is published online. To provide the most value to our members, we divided the print version of this document into 2 focused parts. Part I: Radiation Physics and Radiation Biology addresses the issue of medical radiation exposure, the basics of radiation physics and dosimetry, and the basics of radiation biology and radiation-induced adverse effects. Part II: Radiological Equipment Operation, Dose-Sparing Methodologies, Patient and Medical Personnel Protection covers the basics of operation and radiation delivery for the 3 cardiovascular imaging modalities (x-ray fluoroscopy, x-ray computed tomography, and nuclear scintigraphy) and will be published in the next issue of the Journal.

2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness.

2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness.

Primarna mitralna regurgitacija - ehokardiografska procena

In developed countries aortic stenosis (AS) is the most common acquired valvular heart disease in elder population. A 75 years old patient has been admitted to our institution due to symptomatic severe AS. Preoperative transthoracic echocardiography confirmed severe, calcified AS with a gradients of 95/49 mmHg, AVA 0.5 cm2 and moderate aortic regurgitation. Left ventricular ejection fraction was preserved. Preoperative coronary angiography and Duplex scan of carotid arteries excluded significant stenosis. Surgical risk assessed with EuroScore II was increased 5.9%. In the presence of restricted mobility, significant frailty and other circumstances that may affect the rehabilitation, TAVI as an intervention mode would have been more suitable. Since this was not available, our patient underwent successful surgical aortic valve replacement. The first postoperative echocardiogram revealed normal function of the bileaflet mechanical valve 29/14mmHg with mild transvalvular regurgitation. Without any prior psychiatric disorders, patient after the operation experienced complete lack of energy and willingness to cooperate or to perform any daily activity so she remained immobile. The antidepressives were ineffective. The rehabilitation process was complicated with decubitus and Acinetobacter and Proteus mirrabilis in wound culture. After antibiotic treatment we had the appearance of diarrhea, severe hypoalbuminaemia and the global edemas progressed to anasarca This three months long and costly struggle of all cardiovascular practitioners and family unfortunately was unsuccessful. This case is one more confirmation that we need objective frailty assessment, as one of major risk factors in elderly with AS, before making definitive decision of interventional, either surgical or transcatheter treatment.

Use of novel oral anticoagulant agents in venous thromboembolism.

New oral anticoagulants (NOAC) serve as alternatives for patients currently using warfarin for the prevention and treatment of venous thromboembolic (VTE) disease. This article provides a brief summary of the clinical use of these drugs as well as a review of the landmark clinical trials which evaluated described their safety and efficacy. As more data becomes available, a fundamental understanding of these medications will be vital to cardiovascular practitioners managing patients with VTE.

Improving Genomic Literacy Among Cardiovascular Practitioners via a Flipped-Classroom Workshop at a National Meeting.

The enormous progress in the field of human genetics since the completion of the Human Genome Project—most notably the identification of both rare and common variants associated with a plethora of clinical traits and diseases through novel methodologies, such as the genome-wide association study and next-generation DNA sequencing—has revolutionized our understanding of human health. At the same time, this progress threatens to outstrip the ability to apply these discoveries to clinical care for the benefit of patients. One significant barrier is a lack of genomic literacy among clinical practitioners,1–4 not surprising given that many advances in genetics and genomics have emerged recently, well after the completion of formal training by most practitioners. Published examples of attempts to enhance the teaching of clinical genomics to medical learners have largely been lecture based. For example, the Stanford University’s Department of Pathology created a Genomic Medicine course for their residents and fellows that comprised a series of 10 lectures that were also made available online.5 In another example, the Tufts University School of Medicine’s medical school curriculum added a lecture on the science and technology of genomic testing and incorporated a homework assignment in which students analyzed the results of genome testing of anonymous patients.6 Neither of these educational innovations address the considerable need to educate active practitioners about genetics and genomics in a way that does not rely on traditional lecture-based classroom learning—an impracticality for busy professionals—but rather draws from best practices in adult education, including the growing recognition of the superiority of active-learning approaches in science, technology, engineering, and mathematics education, such as the so-called flipped classroom.7 In 2010, through the Program Directors Section of the Association of Pathology Chairs, the Training Residents in Genomics (TRIG) working group (WG) was formed to create teaching tools …

Circulation Editors’ Picks

<i>Circulation</i> Editors’ Picks

Impact Through Discovery: A Global Challenge

> “He who has health has hope; and he who has hope has everything.” > > —Arabic proverb Good afternoon; on behalf of the American Heart Association and American Stroke Association, welcome, colleagues and friends from around the globe, to Scientific Sessions 2011. Whether you are in clinical care, research, or education, I thank you for joining us. It is truly an honor to be in the company of those engaged in the noblest of endeavors, the improvement of human health. I would like to take a moment to personally thank those of you joining us from around the world. Approximately 100 nations are represented at Sessions this year. That is only fitting because global prevention of cardiovascular disease and stroke is a major focus of our meeting. To succeed in global prevention, we must all be part of a united front. I am going to discuss how our research world reaches far beyond the laboratory and the clinical setting. We will explore the crucial differences it makes in human health, in addition to how vital biomedical research is to economies and societies around the world. And we will discover some of the perils we will face globally if we do not find ways to fund more research. The community of cardiovascular practitioners and researchers has much to be proud of. The trends in mortality from cardiovascular disease and stroke having increased over the first half of the past century have significantly declined since the 1960s. Much of the decline is in the reduction in mortality from coronary heart disease. The decline is attributed to dramatic advances in the acute and chronic treatment of atherosclerotic coronary artery disease. The recognition of the importance of control of risk factors such as …

Abstract P195: Cardiovascular Practitioner's Perspectives on Guilt as a Motivational Tool

Objective: Encouraging lifestyle change is a key facet of cardiovascular care, but health professionals report frustration and frequently feel ineffective in efforts to engage patients in behavior modification. In this study, we sought to define cardiovascular practitioners' perspectives on using guilt as a motivational tool. Methods: We conducted and audio recorded semi-structured interviews with 24 cardiovascular practitioners. Subjects were given a definition of guilt, asked to comment on how often they encountered patients who felt guilty, describe how they responded to those patients, and describe how guilt as a motivational tool might or might not promote lifestyle changes. Interviews were transcribed and coded to identify major themes. Results: Most (n=23/24) practitioners reported encountering patients who felt guilty for not taking better care of themselves. There was no consistent response to guilt: 3 practitioners used fear, 6 induced further guilt, 8 provided education, 5 reassured, and 9 used a ‘starting over’ approach. Practitioners did not agree on whether guilt was an effective motivator; some believed it was (‘My thing is ‘do you want to see your kids grow up, do you want to walk your daughter down the aisle?’ that's guilt, that's healthy guilt and I do use it. And it hits them right in the best spot.'), others did not (“I do think it's harmful because it lowers the self-esteem.”). Several practitioners (n= 8) referenced their own personal experiences or background; only one subject referenced literature on behavior change. Conclusions: Most cardiovascular practitioners encountered guilt in patients over lifetyle. There was no standard approach to the use of guilt in motivation, suggesting the need for more research and training on how to address guilt in cardiovascular patients.

Towards a new order in cardiovascular medicine: re-engineering through global collaboration

The financial ‘meltdown’ that began in 2008 dramatically underscores the need for significant global changes in our fundamental institutions and interactions, and the field of medicine is no exception. Global ‘flattening’ encompassed by modern information and communication networks has increased our awareness of major health disparities at almost every level. At the same time, however, we have unprecedented access to knowledge that allows people to live longer and healthier lives. The field of cardiovascular medicine is particularly illustrative of this paradox. Despite decades of unprecedented improvements in prevention, treatment, and outcomes, cardiovascular medicine now faces a major global upswing in disease impact, driven by global demographic and cultural trends. Moreover, given the discipline's emphasis on technological and pharmacological treatments, it accounts for a major portion of healthcare costs. Outstanding emerging examples of local, national, and global collaboration among cardiovascular practitioners, however, suggest rapidly growing awareness of these challenges, as well as new opportunities for addressing them.1 In this article, we argue that leaders in the field of cardiovascular medicine have a fundamental responsibility to create, develop, and implement a global knowledge network that exemplifies the learning health system of the future. Numerous studies document the effects of cardiovascular disease (CVD), as well as the impact of its treatment and prevention, on rates of death and disability among the world's population. As life expectancies increase globally, the prevalence of ischaemic heart disease and heart failure will continue to grow even as age-specific risk drops due to application of existing measures for treatment and prevention.2,3 New and striking increases in obesity and diabetes mellitus threaten to compound the effects of age, creating a dramatic surge in CVD prevalence and potentially offsetting gains achieved through reductions in smoking and by the use of effective treatments aimed at lowering lipid …

Introduction to the Supplement: Controversies and Challenges of Tetralogy Of Fallot and Other Challenges Facing Paediatric Cardiovascular Practitioners and Their Patients

Introduction to the Supplement: Controversies and Challenges of Tetralogy Of Fallot and Other Challenges Facing Paediatric Cardiovascular Practitioners and Their Patients