Cardiovascular Medicine

2 pages, 259 KB

Open AccessInteresting Images

Chest Pain After Surgical Repair of Bland-Garland-White Syndrome

by André Azul Freitas, Rui Baptista, Valdirene Gonçalves, Nuno Campos and Lino Gonçalves

Cardiovasc. Med. 2022, 25(1), 60; https://doi.org/10.4414/cvm.2022.02191 - 1 Jan 2022

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A 19-year-old female with a past history of a surgical correction of a Bland-Garland-White syndrome was admitted to the emergency department complaining of chest pain precipitated by exercise [...] Full article

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4 pages, 836 KB

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A Wide-Complex Tachycardia in a 90-Year Old Man with a Dual-Chamber Pacemaker

by Agnese Vellaa, Philipp Sutera, Denis Grafb and Hari Vivekananthamb

Cardiovasc. Med. 2022, 25(1), 56; https://doi.org/10.4414/cvm.2022.02192 - 1 Jan 2022

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Abstract

A 90-year-old man with ischaemic heart disease with preserved ejection fraction, paroxysmal atrial flutter and sinus sick syndrome requiring dual-chamber pacemaker implantation 2 years earlier (Sorin KORA 250 DR, atrial lead VEGA R52, ventricular lead VEGA R58; stimulation mode AAIR-DDDR, lower rate limit 60 beats/min, maximum tracking rate 130 beats/min), was brought to the emergency department because of ongoing palpitations for the past 10 days [...] Full article

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9 pages, 12192 KB

Open AccessReview

Von Kräutern zu Pillen, Biologics und Nukleinsäuren

by Thomas F. Lüscher, Arnold von Eckardstein, Jürg Hans Beer, Lorenz Räber, Isabella Sudano, David Nanchen, Christian Mueller, François Mach and Ulf Landmesser

Cardiovasc. Med. 2022, 25(1), 3; https://doi.org/10.4414/cvm.2022.02258 - 1 Jan 2022

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Abstract

Pharmacotherapy has made massive advances: what began with herbs and fungi led to synthetic pills that interfered ever more precisely with receptors and metabolic pathways. Finally, antibodies against specific proteins became part of our therapeutic armamentarium. But none of these measures get to the heart of the matter: the latest revolutionary chapter in pharmacotherapy uses organ-specific nucleotides, short RNA sequences that intervene in pathogenic metabolic pathways even before proteins are formed and sometimes exert a very targeted effect over surprisingly long periods of time. In cardiovascular medicine, this pharmacotherapy of the future is mainly used in the treatment of lipometabolic disorders. RNA interference technology involving the modified small interfering RNA therapeutic inclisiran against the messenger RNA of proprotein convertase subtilisin/kexin type 9 (PCSK9) couples the therapeutic RNA with N-acetylgalactosamine in order to achieve liver-specific silencing of the protein formation of PCSK9 by binding to the asialoglycoprotein receptors on the surface of hepatocytes. Thus, a marked and consistent reduction of PCSK9 and LDL cholesterol levels in plasma can be achieved over more than 6 months. Other developments use antisense oligonucleotides (ASOs) against angiopoietin-like protein 3 (ANGPTL3) or apolipoprotein C-III (apoC-III) to specifically lower triglyceride levels, and the ISIS-APO(a) Rx ASO, massively reduces (>70%) the formation of lipoprotein (a). These new RNA-targeted therapeutics have key advantages, such as a long duration of action, which relates to patient compliance, the specificity of their action in certain cells or organs and metabolic pathways, and they allow for the first time an effective treatment of hypertriglyceridaemia and the mostly genetically determined elevated levels of lipoprotein (a). Large randomised clinical trials testing the effect of these new nucleic acids on cardiovascular events such as myocardial infarction and death are currently underway, including in Switzerland, and will further determine the efficacy and safety of these new drugs. This will certainly herald a new era in the treatment of various cardiovascular diseases. Full article

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3 pages, 418 KB

Open AccessEditorial

Bempedoinsäure—Ein Neuer Lipidsenker als Monotherapie und in Kombination mit Ezetimibe Zusätzlich zu Statinen

by Thomas F. Lüscher, Christian Mueller, Konstantinos C. Koskinas, Isabella Sudano, François Mach and Ulrich Laufs

Cardiovasc. Med. 2022, 25(1), 25; https://doi.org/10.4414/cvm.2022.02183 - 1 Jan 2022

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Abstract

The fact that cholesterol, and especially low-density lipoprotein (LDL-C), is one of the most important causes of myocardial infarction, some ischaemic strokes and cardiac death has been convincingly documented by countless epidemiological, genetic and pharmacological studies. In fact, individuals with a PCSK9 missense mutation have extremely low LDL-C levels and are virtually completely protected from heart attacks and cardiac death. Intravas-cular ultrasound studies have also shown that a reduction in arteriosclerotic plaques in the coronary arteries is only achieved with an LDL-C < 1.4 mmol/L. Based on these data and recent randomised studies, the 2019 ESC/EAS guidelines on the management of dyslipidaemias have recommended new, significantly lower LDL-C target values for various risk groups. These target values can be achieved with statins alone in only a few high-risk patients. Accordingly, there is a need for new lipid lowering agents. Bempedoic acid is a prodrug that is metabolised in the liver by the enzyme acyl-coenzyme A synthetase very long chain-1 (ACSVL1) into the active substance bempe-doyl-coenzyme A (ETC-1002-coenzyme A). This active metabolite inhibits the enzyme ATP citrate lyase, which starts the biosynthesis of cholesterol above HMG coenzyme A reductase, where statins act. Since the enzyme ACSVL1 is not expressed in skeletal muscle cells, there is no conversion of the prodrug in muscle. Therefore, the drug is also being tested in particular in people with muscle problems when taking a statin. The LDL-C lowering of bempe-doic acid is about 15–22% in statin-naïve patients and about 18% in addition to statins. When combined with ezetimibe, bempedoic acid lowers LDL-C by 45% in statin-naïve patients and about 36% in addition to statins.Bempedoic acid is usually very well tolerated. However, there may be a reversible in-crease in uric acid and, in certain patients, a slight decrease in haemoglobin and an increase in platelets, reversible after discontinuation. Accordingly, after 4 weeks, not only the changes in the lipid values should be checked, but also haematological parameters and uric acid. The increase in uric acid must be taken into account especially in patients with a history of gout who are not treated with allopurinol and in patients on loop diuretics, as this or a pre-disposition to hyperuricaemia can lead to an attack. Bempedoic acid is there-fore a new lipid-lowering drug that, in addition to a statin alone or in combi-nation with ezetimibe, is particularly suitable for high-risk patients to achieve the LDL-C target values and, especially in combination with ezetimibe, is also a valuable alternative for patients with statin intolerance. Full article

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3 pages, 1955 KB

Open AccessArticle

Reliability of an ECG-Algorithm for Identification of the Infarct-Related Artery in Inferior Myocardial Infarction in Clinical Practice

by Beate Buchmann, Tim Rönz and Piero O. Bonetti

Cardiovasc. Med. 2022, 25(1), 18; https://doi.org/10.4414/cvm.2022.02190 - 1 Jan 2022

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Abstract

BACKGROUND: The presence of ST-segment elevation in lead III exceeding that in lead II when combined with ST-segment depression in leads I, aVL or both, was proposed as a powerful predictor of occlusion of the right coronary artery with sensitivity/specificity values of 90%/71% in patients with acute inferior ST-segment elevation myocardial infarction (STEMI). The present study was performed to investigate the reliability of this ECG algorithm in clinical practice. METHODS: ECGs of all consecutive patients who presented to our hospital with acute inferior STEMI and underwent emergency coronary angiography / primary percutaneous coronary intervention between January 2006 and December 2013 were analysed retrospectively by two independent cardiologists according to the criteria mentioned above. The results were then compared with the angiographic findings and 28-day mortality data were collected. RESULT S: A total of 356 patients with acute inferior STEMI were included in the present study. The right coronary artery was the infarct-related artery in 272 (76.4%) patients and the left circumflex coronary artery in 76 (21.4%) patients, whereas inferior STEMI was caused by distal occlusion of a large left anterior descending coronary artery in 4 (1.1%) and of the Ramus intermedius in 4 (1.1%) patients. In our population the sensitivity/specificity values of the proposed ECG algorithm to correctly identify the right coronary artery were 78%/49%. There was a non-significant trend towards a higher 28-day mortality in patients with a positive ECG algorithm (3.5% vs 1.0%, p = 0.186). CONCLUSIONS: In the present study we could not reproduce the excellent diagnostic accuracy of an ECG algorithm for predicting the infarct-related artery in acute inferior STEMI reported in the literature. Thus, given its suboptimal diagnostic reliability and the lack of therapeutic consequences in patients with acute inferior STEMI and a clear indication for immediate reperfusion therapy, the clinical relevance of the proposed ECG algorithm is questionable. Full article

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Cardiovasc. Med., Volume 25, Issue 1 (01 2022) – 5 articles

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