Clinical Expert Consensus Document Research Articles

HFSA/SAEM/ISHLT Clinical Expert Consensus Document on the Emergency Management of Patients with Ventricular Assist Devices

Mechanical circulatory support is now widely accepted as a viable long-term treatment option for patients with end-stage heart failure (HF). As the range of indications for the implantation of ventricular assist devices grows, so does the number of patients living in the community with durable support. Because of their underlying disease and comorbidities, in addition to the presence of mechanical support, these patients are at a high risk for medical urgencies and emergencies (Table 1). Thus, it is the responsibility of clinicians to understand the basics of their emergency care. This consensus document represents a collaborative effort by the Heart Failure Society of America, the Society for Academic Emergency Medicine, and the International Society for Heart and Lung Transplantation (ISHLT) to educate practicing clinicians about the emergency management of patients with ventricular assist devices. The target audience includes HF specialists and emergency medicine physicians, as well as general cardiologists and community-based providers.

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.

Intravascular ultrasound assessment of the effect of laser energy on the arterial wall during the treatment of femoro-popliteal lesions: a CliRpath excimer laser system to enlarge lumen openings (CELLO) registry study

The CliRpath Excimer Laser System to Enlarge Lumen Openings (CELLO) registry included patients treated with modified excimer laser catheters for the endovascular treatment of peripheral artery disease affecting the superficial femoral artery (SFA) and proximal popliteal artery. The aim of this study was to assess, via intravascular ultrasound (IVUS) the dissections in the vessel wall following treatment with the laser catheters. IVUS grayscale images from the CELLO registry were systematically reviewed for dissections in the treated vessel segments by two investigators. Images from 33 patients; 66 pullbacks (1867 IVUS frames in 2 phases), were successfully matched frame-to-frame to evaluate identical segments of the treated vessels in the two phases; post-2 mm Turbo-Elite laser pilot channel creation and post Turbo-Booster laser atherectomy. Dissections were categorized as; (1) intimal, (2) medial, (3) intramural hematoma, and (4) adventitial according to the ACC Clinical Expert Consensus Document classification of dissections. An average of 57 frames was evaluated per pullback, giving a total of 3734 frames (1867 matched for pre-ablation (post channel creation) and post-ablation phases). Treatments with the modified Excimer laser catheters resulted in a significant increase in lumen area of 5.5 ± 3.2-mm2 (95% CI 4.3–6.8, p < 0.0001) and reduction in plaque plus media volume of −10.6 ± 36.0 mm3 (95% CI −25.8 to 4.6, p = 0.1619) whilst giving rise to mainly intramural hematoma formations post Turbo-Booster laser treatment in 55% of frames assessed and 24% medial dissections with less than 1% adventitial disruption. The Excimer laser based Turbo-Booster treatment of peripheral artery lesions resulted in significant plaque debulking and increased lumen diameter with negligible degree of adventitial layer injury.

Executive Summary of the SCAI/HFSA Clinical Expert Consensus Document on the Use of Invasive Hemodynamics for the Diagnosis and Management of Cardiovascular Disease

Executive Summary of the SCAI/HFSA Clinical Expert Consensus Document on the Use of Invasive Hemodynamics for the Diagnosis and Management of Cardiovascular Disease

2012 American college of cardiology foundation/society for cardiovascular angiography and interventions expert consensus document on cardiac catheterization laboratory standards update: American college of cardiology foundation task force on expert consensus documents society of thoracic surgeons society for vascular medicine

2012 American college of cardiology foundation/society for cardiovascular angiography and interventions expert consensus document on cardiac catheterization laboratory standards update: American college of cardiology foundation task force on expert consensus documents society of thoracic surgeons society for vascular medicine

Correction

HomeCirculationVol. 124, No. 5Correction Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection Originally published2 Aug 2011https://doi.org/10.1161/CIR.0b013e31822c95c8Circulation. 2011;124:e175This article corrects the followingACCF/AHA 2011 Expert Consensus Document on Hypertension in the ElderlyIn the article by Aronow et al, “ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents,” which published ahead of print April 25, 2011, and appeared in the May 31, 2011, issue of the journal (Circulation. 2011;123:2434–2506), a correction was needed.On page 2472, the legend to Figure 10, the abbreviation that begins on line 5 read “ARB, aldosterone receptor blocker.” It has been changed to read, “ARB, angiotensin receptor blocker.”This correction has been made to the current online version of the article, which is available at http://circ.ahajournals.org/cgi/content/full/123/21/2434. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesACCF/AHA 2011 Expert Consensus Document on Hypertension in the ElderlyWilbert S. Aronow, et al. Circulation. 2011;123:2434-2506 August 2, 2011Vol 124, Issue 5 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/CIR.0b013e31822c95c8 Originally publishedAugust 2, 2011 PDF download Advertisement

Correction

HomeCirculationVol. 123, No. 21Correction Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection Originally published31 May 2011https://doi.org/10.1161/CIR.0b013e318222d03fCirculation. 2011;123:e616This article corrects the followingACCF/AHA 2011 Expert Consensus Document on Hypertension in the ElderlyIn the article by Aronow et al, “ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents,” which published ahead of print April 25, 2011, and appeared in the May 31, 2011, issue of the journal (Circulation. 2011;123:2434–2506) several corrections were needed.1. On page 2446, Figure 2 has been replaced in its entirety. The original figure appeared as:Download figureDownload PowerPointThe correct figure, as shown below, appears in the print and the current online version of the article.Download figureDownload PowerPoint2. On page 2480, in the right column, the sentence that begins on line 12 of the second paragraph read, “Thiazides can be selected if the eGFR is >30 mL/min/1.73 m2; if hypoalbuminemia or hyperkalemia is not present.” It has been changed to read, “Thiazides can be selected if the eGFR is >30 mL/min/1.73 m2; if hypoalbuminemia or hypokalemia is not present.”These corrections have been made to the print version and to the current online version of the article, which is available at http://circ.ahajournals.org/cgi/content/full/123/21/2434. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesACCF/AHA 2011 Expert Consensus Document on Hypertension in the ElderlyWilbert S. Aronow, et al. Circulation. 2011;123:2434-2506 May 31, 2011Vol 123, Issue 21 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/CIR.0b013e318222d03f Originally publishedMay 31, 2011 PDF download Advertisement SubjectsStatements and Guidelines

ACCF/ACG/AHA 2010 Expert Consensus Document on the Concomitant Use of Proton Pump Inhibitors and Thienopyridines: A Focused Update of the ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

This expert consensus document was developed by the American College of Cardiology Foundation (ACCF), the American College of Gastroenterology (ACG), and the American Heart Association (AHA). Expert consensus documents inform practitioners, payers, and other interested parties of the opinion of ACCF and document cosponsors concerning evolving areas of clinical practice or medical technologies. Expert consensus documents cover topics for which the evidence base, experience with technology, or clinical practice is not considered sufficiently well developed to be evaluated by the formal ACCF/AHA Practice Guidelines process. Often, the topic is the subject of considerable ongoing investigation. Thus, the reader should view the expert consensus document as the best attempt of the ACCF and document cosponsors to inform clinical practice in areas where rigorous evidence may not yet be available. To avoid actual, potential, or perceived conflicts of interest that may arise as a result of industry relationships or personal interests among the writing committee, all members of the writing committee, as well as peer reviewers of the document, are asked to disclose all current healthcare-related relationships and those existing 12 months before initiation of the writing effort. The ACCF Task Force on Clinical Expert Consensus Documents (CECD) reviews these disclosures to determine which companies make products (on market or in development) that pertain to the document under development. Based on this information, a writing committee is formed to include a majority of members with no relevant relationships with industry (RWI), led by a chair with no relevant RWI. Authors with relevant RWI are not permitted to draft or vote on text or recommendations pertaining to their RWI. RWI are reviewed on all conference calls and updated as changes occur. Author and peer reviewer RWI pertinent to this document are disclosed in Appendixes 1 and 2, respectively. Additionally, to ensure complete transparency, …

ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography

This document was developed by the American College of Cardiology Foundation (ACCF) Task Force on Clinical Expert Consensus Documents (ECDs) and cosponsored by the American College of Radiology (ACR), American Heart Association (AHA), American Society of Nuclear Cardiology (ASNC), North American

Clinical features and outcomes of carotid artery stenting by clinical expert consensus criteria: A report from the CARE registry

In 2007, a multispecialty society task force published a clinical expert consensus document (CECD) on carotid stenting (CAS), containing recommendations for appropriate patient selection and quality of care. The CECD also inspired creation of a large, national registry of carotid revascularization, the Carotid Artery Revascularization and Endarterectomy (CARE) registry. Our goal here was to investigate whether initial CAS procedures submitted to CARE conformed to CECD recommendations, and examine their clinical outcomes. We analyzed CAS procedures for the period January 1, 2005 through December 31, 2008. These were grouped into those that conformed to CECD recommendations [CECD(+), n = 4,636, 79.8%] and those that did not [CECD(-), n = 1,168, 20.2%]. The CECD(+) patients were older than CECD(-) patients (71.5 +/- 10.3 vs. 67.6 +/- 10.3 years, P = 0.001, respectively), and more frequently had chronic kidney disease (46.9% vs. 17.8%, P = 0.001), chronic lung disease (33.0% vs. 12.4%, P = 0.001), ejection fraction <or= 0.30 (13.5% vs. 5.5%, P = 0.001) and contralateral carotid artery occlusion (12.7% vs. 4.6%, P = 0.001). Clinical outcomes at 30 days were similar, including death (1.24% vs. 0.76%, P = 0.184), stroke (5.32% vs. 5.34%, P = 0.954), and death, stroke, or MI (7.04% vs. 6.95%, P = 0.944). Most CAS procedures submitted to CARE conformed to CECD recommendations for patient selection. For reported data, clinical outcomes at 30 days were similar for procedures meeting and those not meeting recommendations, and were similar to outcomes reported by other large registries. These findings suggest that acceptable patient selection criteria for CAS are employed as it expands beyond investigators into more widespread clinical practice.

The SHAPE Paradigm

Atherosclerosis is a chronic immunoinflammatory disease trigerred by lipoprotein retention in the subendothelium and produces its most serious manifestations by triggering arterial thrombosis when the plaque ruptures or erodes.1 Atherothrombotic cardiovascular disease remains the leading cause of death in the West and is achieving similar dubious distinction in developing countries.2 Atherosclerosis begins at a young age, but it remains clinically silent for a long time and the majority of clinical manifestations occur later in life. Despite considerable progress, regrettably 50% of life-threatening acute cardiovascular events occur in previously asymptomatic individuals. Identifying individuals at risk for future cardiovascular events affords an opportunity for risk reduction and thus remains a major imperative for healthcare professionals. In 2006 the SHAPE (Society for Heart Attack Prevention and Education) Task Force introduced an algorithm incorporating noninvasive screening for subclinical atherosclerosis to augment risk factor–based risk stratification in asymptomatic subjects between the ages of 45 to 75 in men and 55 to 75 in women, excluding those at very low risk or at high risk.3 In June 2009, the Texas Governor Rick Perry signed off on the Texas Heart Attack Prevention Bill introduced by Rep Rene Oliveira, mandating health-benefit plans to cover noninvasive screening for subclinical atherosclerosis. This bill grew out of the 2006 SHAPE Task Force guidelines and became effective September 1, 2009; an earlier version of the bill had been rejected in 2007. This generated a mixed reaction from healthcare professionals and others, much of which played out in the media. The critics argued that such an action is inappropriate because: (1) the SHAPE guidelines were created by an ad hoc group and had not been explicitly endorsed by the American College of Cardiology (ACC) or the American Heart Association (AHA), and (2) SHAPE guidelines are not based on randomized clinical …

Abstract 4537: Relationship Between Procedure Indications and Outcomes of Carotid Artery Stenting: Preliminary Results from the CARE Registry

Background: In 2007 a consortium of specialty societies developed and published a clinical expert consensus document (CECD) on carotid artery stenting (CAS). This CECD listed suggested indications for CAS based on the presence of symptoms, stenosis severity, and the presence of features that increase the surgical risk of carotid endarterectomy. The National Cardiovascular Data Registry, in conjunction with multiple specialty societies, established the CARE (Carotid Artery Revascularization and Endarterectomy) Registry to provide a comprehensive national database characterizing both forms of carotid revascularization. Methods: CARE employs written definitions, a data dictionary, standardized data collection tools, and quality control checks. We constructed an algorithm that categorized each procedure as conforming to a Recommended Indication (RECC) if it met the indications criteria in the CECD, or as not recommended (NOTRECC) if it didn’t. Patient characteristics and outcomes of these 2 groups were compared. Results: There were 3118 CAS procedures submitted from 107 participating centers for the period 01/2007 through 03/2008. Of these, 2397 (77%) were RECC, while 721 (23%) were NOTRECC. Clinical profiles in the NOTRECC group were more favorable, but overall outcomes were similar. (See Table ) Conclusions: CAS procedures categorized as NOTRECC by CECD criteria accounted for approximately one-fourth of submissions to the CARE Registry. Clinical profiles were different. Outcomes were similar.

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

This document has been developed by the American College of Cardiology Foundation (ACCF) Task Force on Clinical Expert Consensus Documents, the American College of Gastroenterology (ACG), and the American Heart Association (AHA). Expert consensus documents (ECDs) are intended to inform practitioners, payers, and other interested parties of the opinion of the ACCF and document cosponsors concerning evolving areas of clinical practice and/or technologies that are widely available or new to the practice community. Topics chosen for coverage by ECDs are so designed because the evidence base, the experience with technology, and/or the clinical practice are not considered sufficiently well developed to be evaluated by the formal American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines process. Often the topic is the subject of ongoing investigation. Thus, the reader should view ECDs as the best attempt of the ACCF and other cosponsors to inform and guide clinical practice in areas where rigorous evidence may not be available or the evidence to date is not widely accepted. When feasible, ECDs include indications or contraindications. Topics covered by ECDs may be addressed subsequently by the ACC/AHA Practice Guidelines Committee as new evidence evolves and is evaluated. The Task Force on ECDs makes every …

ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting

2007;49;126-170 J. Am. Coll. Cardiol. H. Stein, Cynthia M. Tracy, Robert A. Vogel, and Deborah J. Wesley Lindner, Gerald M. Pohost, Richard S. Schofield, Samuel J. Shubrooks, JR, James Eisenberg, Cindy L. Grines, Mark A. Hlatky, Robert C. Lichtenberg, Jonathan R. Harrington, Jonathan Abrams, Jeffrey L. Anderson, Eric R. Bates, Mark J. Rundback, Robert D. Safian, Michael A. Sloan, Christopher J. White, Robert A. William A. Gray, Kenneth Ouriel, Eric D. Peterson, Kenneth Rosenfield, John H. Donald E. Casey, Jr, Christopher U. Cates, Gary R. Duckwiler, Ted E. Feldman, Biology, Society of Interventional Radiology, Eric R. Bates, Joseph D. Babb, Cardiovascular Angiography and Interventions, Society for Vascular Medicine and American Society of Interventional & Therapeutic Neuroradiology, Society for Committee on Carotid Stenting) (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Task Force on Clinical Expert Consensus Documents Carotid Stenting: A Report of the American College of Cardiology Foundation ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on This information is current as of January 4, 2011 http://content.onlinejacc.org/cgi/content/full/49/1/126 located on the World Wide Web at: The online version of this article, along with updated information and services, is

ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring by Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain

ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring by Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy is a fascinating disease entity in which hypertrophy of the myocardium occurs, primarily as a result of mutations of genes encoding the cardiac sarcomere.1–3 Our knowledge of patients with this unique disease of the heart muscle has advanced significantly. Once thought to be a rare malignant disease with a high risk of sudden death, population studies have revealed hypertrophic cardiomyopathy to be a more common disease with a benign outlook in the majority of affected patients.4 Hypertrophic cardiomyopathy is now recognized to comprise a wide spectrum of disease processes, with varying genetics, anatomy, clinical presentation, and prognosis. The dynamic left ventricular outflow tract obstruction that was initially the hallmark of hypertrophic cardiomyopathy continues to be a source of controversy. Article p 2232 The pathophysiology of hypertrophic cardiomyopathy is complex and still not completely understood. The first description of hypertrophic cardiomyopathy came in 1957 when Sir Russell Brock5 found a functional subvalvular obstruction in patients undergoing aortic valvotomy for clinically suspected valvular aortic stenosis. In 1958, Teare6 described the cardiac anatomy of 8 young patients who died suddenly with severe asymmetric left ventricular hypertrophy with bizarre muscle bundle orientation. In the 1960s, Braunwald et al7 defined a specific disease process in which asymmetric septal hypertrophy, myofibril disarray, and dynamic outflow tract obstruction were found. Thus, the early focus of hypertrophic cardiomyopathy was on this dynamic obstruction; the response of the obstruction to changes in preload, afterload, and contractility formed the basis for diagnosis. With the advent of echocardiography, which allowed direct visualization of the hypertrophied myocardium, it became apparent that obstruction was not necessary for the diagnosis of hypertrophic cardiomyopathy. The entire relationship of obstruction to hypertrophic cardiomyopathy was subsequently questioned. Some thought that hypertrophic cardiomyopathy was primarily a disease of diastole, with obstruction …

Intravascular Ultrasound in Cardiovascular Medicine

Case presentation: A 38-year-old man underwent angiography 2 weeks after a non–ST-segment myocardial infarction. He was overweight and prehypertensive, with a blood pressure of 134/86 mm Hg. His biochemical parameters included low-density lipoprotein cholesterol (LDL-C) 127 mg/dL, high-density lipoprotein cholesterol (HDL-C) 38 mg/dL, and C-reactive protein (CRP) 3.2 mg/L. Angiography revealed mild disease throughout the coronary arteries and a hazy appearance that involved the proximal left anterior descending coronary artery. Intravascular ultrasound (IVUS) imaging revealed diffuse and extensive atherosclerosis with evidence of plaque rupture at multiple sites (Figure 1). In the presence of no significant luminal stenoses, the patient was treated medically with aspirin and low-dose statin therapy. Figure 1. Illustrative example of coronary angiography of the left anterior descending artery that appears to be free of irregularities, apart from a hazy appearance in the proximal segment. A representative cross-sectional tomographic image obtained by IVUS examination (top right) within the proximal segment (white arrow on angiogram) revealed substantial atheroma within the arterial wall. The bottom right segment illustrates a tomographic image of atheroma containing significant ulceration (5 o’clock) at the site of the gold arrow on the angiogram. The application of IVUS in this case highlights a number of important points with regard to the natural history of atherosclerosis and its modification by use of established medical therapies. The ability to image the entire arterial wall represents a significant advantage over coronary angiography. In the presence of minimal luminal stenoses, IVUS imaging in patients with coronary symptoms typically reveals extensive and diffuse atherosclerosis.1 Application of serial IVUS imaging in prospective clinical trials has enabled a greater understanding of the impact of antiatherosclerotic interventions on patients with established coronary artery disease (CAD). Ultrasonic coronary imaging has revealed essential details about the natural history of atherosclerosis. Atheroma formation begins at a …

Left ventricular assist devices: bridges to transplantation, recovery, and destination for whom?

Application of mechanical cardiac support now requires consideration of a wider range of goals beyond bridging to transplantation to include destination therapy and perhaps bridging to recovery.1,2 Responsible dissemination of the technology requires identification of patient populations from which to select candidates most likely to benefit. At this early stage, benefit is most apparent against a high background mortality from end-stage heart failure. Heart failure affects an estimated 5 million patients in the United States. Of those, ≈60% have heart failure with left ventricular dilation and reduced ejection fraction. Trials demonstrating benefit of therapies for heart failure have focused primarily on mild–moderate heart failure with reduced ejection fraction, generally with annual mortality in the range of 8% to 18%.3 Advanced heart failure has been defined as symptoms limiting daily activity (New York Heart Association class III and IV) despite attempted therapy with angiotensin-converting enzyme inhibitors, β-blockers, digoxin, and diuretics,4 a description that applies to ≈300 000 to 800 000 patients in the United States. Although often labeled as “refractory,” many patients enjoy improved quality of life and decreased hospitalizations after referral to experienced heart failure centers, where aggressive medical strategies focus on relief of congestion. Surgical approaches include complex revascularization, valvular repair/replacement, or ventricular reconstruction. When technically successful, biventricular pacing can improve functional status for many of the 25% to 40% of patients with marked ventricular asynchrony.5 If early stabilization allows institution of β-adrenergic–blocking agents, prognosis is further improved.6 Dedicated heart failure management programs that facilitate patient education, compliance, and fluid balance have been integral to benefits observed with these therapies. The highest-risk heart failure populations are best identified after optimization of current therapies. Low left ventricular ejection fraction is not sufficient description of either function or prognosis once heart failure has become advanced. Neither …

Impact of the acute results on the long-term outcome after the treatment of in-stent restenosis: a serial intravascular ultrasound study.

The current study used serial (postintervention and follow-up) intravascular ultrasound (IVUS) to assess the impact of acute results on long-term follow-up of patients with in-stent restenosis (ISR). All patients (n = 180) with serial IVUS studies of ISR lesions from the following gamma-irradiation brachytherapy trials were included: Washington Radiation for In-Stent Restenosis Trial (WRIST), Gamma-1, and Angiorad Radiation Technology for In-Stent Restenosis Trial in Native Coronaries (ARTISTIC). There were 106 irradiated and 74 placebo patients. Quantitative analysis was performed according to the American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of IVUS. Images were acquired using motorized transducer pullback, cross-sectional analysis was performed every 1 mm, and volumetric and mean planar dimensions were calculated. The independent predictors for the absolute follow-up minimum lumen area (MLA) were the postintervention MLA, the postintervention minimum stent area, and the use of brachytherapy. Placebo patients lost 45% of the postintervention MLA while irradiated patients lost only 17% of the MLA. The independent predictors of the follow-up percent intimal hyperplasia (intimal hyperplasia volume divided by stent volume) and the independent predictors of the absolute increase in intimal hyperplasia were the postintervention percent intimal hyperplasia and the use of brachytherapy. Serial IVUS analysis shows that the follow-up MLA and percent intimal hyperplasia are dependent on the results obtained during the treatment of ISR lesions.

American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines.

This document has been developed as a Clinical Expert Consensus Document (CECD), combining the resources of the American College of Cardiology Foundation (ACCF) and the European Society of Cardiology (ESC). It is intended to provide a perspective on the current state of management of patients with hypertrophic cardiomyopathy. Clinical Expert Consensus Documents are intended to inform practitioners, payers, and other interested parties of the opinion of the ACCF and the ESC concerning evolving areas of clinical practice and/or technologies that are widely available or new to the practice community. Topics chosen for coverage by expert consensus documents are so designed because the evidence base, the experience with technology, and/or the clinical practice are not considered sufficiently well developed to be evaluated by the formal American College of Cardiology/American Heart Association (ACC/AHA) Practice Guidelines process. Often the topic is the subject of considerable ongoing investigation. Thus, the reader should view the CECD as the best attempt of the ACC and the ESC to inform and guide clinical practice in areas where rigorous evidence may not yet be available or the evidence to date is not widely accepted. When feasible, CECDs include indications or contraindications. Some topics covered by CECDs will be addressed subsequently by the ACC/AHA Practice Guidelines Committee. The Task Force on Clinical …