Cardiovascular Medicine

7 pages, 417 KB

Open AccessReview

Plaque Characterization Using Intracoronary Imaging: Effects of Lipid-Lowering Therapies

by Flavio Giuseppe Biccirè and Lorenz Räber

Cardiovasc. Med. 2024, 27(4), 99; https://doi.org/10.4414/cvm.2024.1379478206 - 14 Aug 2024

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Over the past few years, large observational trials have confirmed the consistent association between vulnerable plaques identified by intracoronary imaging and major cardiovascular events in patients with coronary artery disease. Lipid-lowering therapies have reduced the occurrence of cardiovascular events in these patients; however, [...] Read more.

Over the past few years, large observational trials have confirmed the consistent association between vulnerable plaques identified by intracoronary imaging and major cardiovascular events in patients with coronary artery disease. Lipid-lowering therapies have reduced the occurrence of cardiovascular events in these patients; however, the exact pathophysiological mechanisms behind their clinical benefits have remained underexplored. Intracoronary imaging modalities, including intravascular ultrasonography, near-infrared spectroscopy, and optical coherence tomography have provided fundamental insight into the biological plausibility of these clinical results. Imaging trials employing serial intravascular ultrasonography have suggested that lipid-lowering therapies can either slow disease progression or promote plaque regression, depending on the degree of lipid lowering achieved. More recently, new randomized trials have added significant insights on the additional beneficial effects of achieving very low low-density lipoprotein cholesterol levels on high-risk plaque features, including fibrous cap thickness, lipid accumulation, and inflammatory cell accumulations. This literature review aimed to summarize current evidence on the clinical usefulness of plaque characterization using contemporary intracoronary imaging and the effects of high-intensity lipid-lowering therapies on vulnerable plaque features. Full article

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1 pages, 75 KB

Open AccessEditorial

Evolving Concepts in Plaque Characterization

by Andreas Flammer

Cardiovasc. Med. 2024, 27(4), 97; https://doi.org/10.4414/cvm.2024.1566105391 - 14 Aug 2024

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Abstract

Dear Readers, Once again, a new issue of the journal has been printed. Every time I read the articles in the CVM journal, I am proud of how diverse, contemporary, and fascinating the field of cardiovascular medicine is [...] Full article

2 pages, 102 KB

Open AccessEditorial

Strike Early and Strike Strong After MI: Lowering LDL-C to Target and Below

by Baris Gencer

Cardiovasc. Med. 2024, 27(4), 129; https://doi.org/10.4414/cvm.2024.1547920225 - 14 Aug 2024

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Abstract

Based on the growing clinical evidence on the benefit of very low LDL-C levels in combination with the availability of highly effective lipid-lowering therapy (LLT) options [...] Full article

2 pages, 98 KB

Open AccessCommentary

Perspectives on the Longevity of Cardiac Rhythm Management Devices

by John Fanourgiakis

Cardiovasc. Med. 2024, 27(4), 127; https://doi.org/10.4414/cvm.2024.1443408577 - 14 Aug 2024

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Abstract

Cardiac arrhythmias are a major cause of morbidity and mortality. Cardiac rhythm management devices (CRMDs) are used to diagnose and treat heart rhythm abnormalities. Many prospective randomized trials over the past decade have established the efficacy of CRMD therapy in reducing all-cause mortality [...] Read more.

Cardiac arrhythmias are a major cause of morbidity and mortality. Cardiac rhythm management devices (CRMDs) are used to diagnose and treat heart rhythm abnormalities. Many prospective randomized trials over the past decade have established the efficacy of CRMD therapy in reducing all-cause mortality and improving the quality of life. The manufacturer of every device provides its longevity in its technical characteristics, which are, as studies show, shorter in practice. Patients are concerned about the replacement procedure due to the risk of the procedure and other socioeconomic reasons. The longer the longevity of the devices, the better for the patients, the payers, the doctors and the health care systems. Given the recently redefined term of health technology assessment on a European level, a new regulatory framework has been proposed. Its intention is that, across different healthcare systems, the upfront costs and the reimbursement costs of these devices should be proportional to their longevity. Full article

2 pages, 197 KB

Open AccessInteresting Images

A Patient with Chest Pain and Precordial ST-Segment Elevation

by Andreas Y. Andreou, Elena Leonidou and Andreas Tryfonos

Cardiovasc. Med. 2024, 27(4), 125; https://doi.org/10.4414/cvm.2024.1486643913 - 14 Aug 2024

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Abstract

We present a challenging case of a patient with an isolated right ventricular myocardial infarction (iRVMI) caused by the spontaneous occlusion of a right ventricular branch mimicking an anterior myocardial infarction on the electrocardiogram. A high index of suspicion is required to diagnose [...] Read more.

We present a challenging case of a patient with an isolated right ventricular myocardial infarction (iRVMI) caused by the spontaneous occlusion of a right ventricular branch mimicking an anterior myocardial infarction on the electrocardiogram. A high index of suspicion is required to diagnose an iRVMI because the electrocardiogram may be misleading. Full article

3 pages, 403 KB

Open AccessIntroduction

Atrial Tachycardia Coexisting with Atrioventricular Nodal Reentrant Tachycardia

by Fu Guan, Firat Duru and Urs Eriksson

Cardiovasc. Med. 2024, 27(4), 122; https://doi.org/10.4414/cvm.2024.1416403729 - 14 Aug 2024

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Abstract

The interpretation of the surface electrocardiogram and intracardiac recordings is key for the appropriate diagnosis and interventional treatment of cardiac arrhythmias. This report describes a patient with both a focal atrial tachycardia (AT) and an atypical atrioventricular-nodal reentrant tachycardia that were repeatedly induced [...] Read more.

The interpretation of the surface electrocardiogram and intracardiac recordings is key for the appropriate diagnosis and interventional treatment of cardiac arrhythmias. This report describes a patient with both a focal atrial tachycardia (AT) and an atypical atrioventricular-nodal reentrant tachycardia that were repeatedly induced and terminated by atrial ectopic beats. Radiofrequency ablation of the slow pathway, as well as targeted ablation of the specific AT focus effectively eliminated both tachycardias. Full article

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2 pages, 267 KB

Open AccessCase Report

Recurrent Takotsubo Syndrome with Contemporary Brady- and Tachyarrhythmic Presentation

by Andrea Demarchi, Lorenzo Greco, Francois Regoli, Marcello Di Valentino, Marco Amoruso, Alessandro Felice Chiesa, Silvia Pirroni, Mauro Foletti, Angelo Di Simone, Simone Sarzilla and Andrea Menafoglio

Cardiovasc. Med. 2024, 27(4), 120; https://doi.org/10.4414/cvm.2024.1514199273 - 14 Aug 2024

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Abstract

We present a case of recurrent takotsubo syndrome with contemporary brady- and tachyarrhythmic presentation, a rare clinical pattern for which the correct treatment is still a matter of debate. Full article

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3 pages, 360 KB

Open AccessCase Report

Early Onset Filamin C Cardiomyopathy

by Catarina Ribeiro Carvalho, Marta Catarina Bernardo, Ana Baptista and Ilídio Moreira

Cardiovasc. Med. 2024, 27(4), 117; https://doi.org/10.4414/cvm.2024.1514905178 - 14 Aug 2024

Viewed by 826

Abstract

We present the case of a 27-year-old man who was admitted with new-onset acute heart failure. The echocardiogram revealed biventricular dilatation with a severely reduced systolic function. A genetic study identified a truncated variant of the filamin-C (FLNC) gene. Since the systolic function [...] Read more.

We present the case of a 27-year-old man who was admitted with new-onset acute heart failure. The echocardiogram revealed biventricular dilatation with a severely reduced systolic function. A genetic study identified a truncated variant of the filamin-C (FLNC) gene. Since the systolic function did not improve under heart failure guideline-directed medical therapy, an implantable cardioverter-defibrillator was placed. After two years, the patient is currently being considered for epicardial ventricular tachycardia (VT) ablation due to the failure of appropriate therapies for monomorphic VT despite recovery of the left ventricular (LV) systolic function. Filamin C truncating variants have been recognized as one cause of an overlapping phenotype in dilated and arrhythmogenic cardiomyopathies. These patients typically present with a mildly reduced LV ejection fraction (LVEF), with or without dilatation, and extensive myocardial fibrosis, which heightens the risk of complex ventricular arrhythmias (VAs). Our patient presented a combined phenotype with biventricular dilated cardiomyopathy with a severely reduced LVEF at an unusual young age, as well as an increased incidence of VAs. With this clinical case, we aim to highlight the importance of genetic evaluation in dilated cardiomyopathy, as it can be decisive in its orientation and, consequently, in its prognosis. Full article

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3 pages, 349 KB

Open AccessCase Report

Delayed Intervention’s Impact on Transcatheter Mitral Valve Implantation Strategy

by Ion Vasiloi, Thomas Nestelberger, Beat A. Kaufmann, Fabien Praz and Oliver T. Reuthebuch

Cardiovasc. Med. 2024, 27(4), 114; https://doi.org/10.4414/cvm.2024.1514206641 - 14 Aug 2024

Viewed by 232

Abstract

Transcatheter mitral valve implantation (TMVI) is used for treating severe mitral valve regurgitation in patients deemed unsuitable for open-heart surgery. However, delays between preoperative workup and therapy can lead to changes in the clinical condition and structural valve findings, necessitating a meticulous reevaluation [...] Read more.

Transcatheter mitral valve implantation (TMVI) is used for treating severe mitral valve regurgitation in patients deemed unsuitable for open-heart surgery. However, delays between preoperative workup and therapy can lead to changes in the clinical condition and structural valve findings, necessitating a meticulous reevaluation of diagnostic and therapeutic options. Case Presentation: A 77-year-old woman with severe mitral valve regurgitation and severe comorbidities was referred to our Heart Team and was deemed suitable for TMVI based on the initial evaluation. The echocardiographic finding showed a severe degenerative mitral valve regurgitation with prolapse of the A3 and P3 segments and an eccentric jet directed posteriorly to the atrial roof but without the complete picture of Barlow’s disease. Due to delayed approval by the patient, the therapeutic procedure was postponed. Subsequent echocardiographic reevaluation six months later revealed a hypermobile anterior mitral leaflet resulting from chordal elongation in conjunction with a septal bulge, raising the risk for postoperative left ventricular outflow tract (LVOT) obstruction. To mitigate this risk, TMVI combined with the Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction (LAMPOON) was performed. Post-implantation echocardiography revealed a well-functioning mitral valve prosthesis without para- and transvalvular leak, a mean gradient of 3 mm Hg, and no LVOT obstruction. Conclusions: The diagnostic and therapeutic evaluation of TMVI remains intricate and time-consuming, necessitating thorough planning. Prompt performance of the procedure is crucial to prevent unforeseen structural changes that could jeopardize the patient’s outcome. The combination of TMVI with the LAMPOON technique for preventing LVOT obstruction appears feasible and suitable for selected patients. Full article

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6 pages, 463 KB

Open AccessReview

Contemporary Antithrombotic Drug Removal via Hemoadsorption in Cardiac Surgery

by Daniel Wendt, Efthymios Deliargyris and Stephan Geidel

Cardiovasc. Med. 2024, 27(4), 108; https://doi.org/10.4414/cvm.2024.1387770349 - 14 Aug 2024

Viewed by 797

Abstract

The incidence of severe bleeding in patients treated with dual antiplatelet therapy, including the new P2Y12 inhibitors or new direct oral anticoagulants, who are undergoing urgent cardiac surgery is very high. Novel strategies, including the removal of antithrombotics via intraoperative hemoadsorption, have shown [...] Read more.

The incidence of severe bleeding in patients treated with dual antiplatelet therapy, including the new P2Y12 inhibitors or new direct oral anticoagulants, who are undergoing urgent cardiac surgery is very high. Novel strategies, including the removal of antithrombotics via intraoperative hemoadsorption, have shown promising results, which are summarized in this holistic review. Overall, current evidence supports antithrombotic removal via hemoadsorption as a potential new therapy in the management of perioperative bleeding risk in patients on antithrombotic medications undergoing cardiopulmonary bypass-assisted cardiac surgery. Full article

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Cardiovasc. Med., Volume 27, Issue 4 (08 2024) – 10 articles

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