Future Cardiology (Future Cardiol)

Publications in this journal

• Article: Management of the patient with diabetes and coronary artery disease: a contemporary review.

  Timothy Raymond, Russell Raymond, A Michael Lincoff
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  ABSTRACT: Diabetes mellitus is a metabolic disease with microvascular and macrovascular complications, and is well known to increase the risk of coronary atherosclerosis. Despite recent reductions in the prevalence of coronary artery disease and cardiovascular events in the USA, persons with diabetes remain up to four-times as likely to die of cardiovascular disease than the general population. Diabetes is associated with an atherogenic lipid profile, induces a hypercoagulable state, and increases coronary plaque volume, progression and instability. Medicinal and procedural treatments in the patient with diabetes should be multifactorial, targeting and managing the many coexisting risk factors that contribute to atherosclerosis. This type of treatment is complex and should be individualized, and guided by a careful review of recent literature. Here we discuss important clinical data and their impact on up-to-date recommendations for the management of coronary artery disease in the patient with Type 2 diabetes mellitus.
  Future Cardiology 05/2013; 9(3):387-403.
• Article: Highlights of the 6th world congress in paediatric cardiology and cardiac surgery.

  Nicholas Hayes, Henry Chubb, Srinivas Narayan, Shakeel Qureshi
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  ABSTRACT: The 6th World Congress in Paediatric Cardiology and Cardiac Surgery took place in Cape Town, South Africa, in February 2013. The congress is the largest meeting in the field of congenital and paediatric heart disease and attracts a global audience of specialists with the aim of sharing the latest multidisciplinary developments in research and clinical practice. The congress was commended as a huge success and this article aims to give a general flavor of the diverse meeting through detailing a few specific highlights from the various tracks.
  Future Cardiology 05/2013; 9(3):309-12.
• Article: Heart failure and iron deficiency anemia in Italy: results from CARMES-1 registry.

  Carmen Caira, Gerardo Ansalone, Massimo Mancone, Emanuele Canali, Michela Pagliaro, Lara Fratarcangeli, Carlos Alberto Centurion Aznaran, Maria Chiara Gatto, Riccardo Di Pietro, Francesco Fedele
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  ABSTRACT: Aims: To assess the prevalence of anemia and iron deficiency anemia in heart failure (HF) patients, to evaluate the effectiveness of current iron deficiency treatment strategies after discharge, and to analyze hospital readmissions and mortality rates in patients with and without anemia. Patients & methods: A patient registry-based, multicenter, retrospective, observational, cohort study of 418 hospitalized HF patients in Italy, monitored from 1 March 2010 to 30 March 2011. Results: Among patients with HF, 35.9% had anemia at admission; only 51.3% were treated with current iron deficiency treatment strategies during hospitalization and then only 29% of patients who were anemic at discharge were treated with iron at home. After a 4-week follow-up, only 11% of these patients reached the hemoglobin target value (study primary end point). However, current iron deficiency treatment strategies were not significantly associated with reduced risk of rehospitalization, but with a significantly reduced mortality rate after a 6-month follow-up (study secondary end points: 11.7 vs 51.7%; p < 0.0001). Conclusion: In HF patients, there is poor attention paid to anemia, its causes and treatment. Current iron deficiency treatment strategies are mismanaged and CARMES-1 demonstrated that they appear to be insufficient at improving patient outcome in terms of rehospitalization rate reduction, generating high costs, which could be avoided through an optimized treatment strategy. Therefore, more efficacious, efficient and cost-effective treatment strategies are required in Italy for HF patients with iron deficiency anemia to meet this unmet medical need.
  Future Cardiology 05/2013; 9(3):437-44.
• Article: Antiplatelet and anticoagulant strategies in acute coronary syndrome: where we are in 2013.

  Matthew Lumley, Divaka Perera
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  ABSTRACT: Multiple antiplatelet and anticoagulant therapies are available for the treatment of acute coronary syndromes. The combination of agents should be tailored to the individual patient carefully considering the balance between ischemic and bleeding risk, as well as the planned revascularization strategy. Despite multiple large-scale, rigorously designed and conducted randomized controlled trials, it can be difficult to select the correct pharmacotherapy for each patient and many unanswered questions remain, such as the safety and optimal doses of differing combinations of antiplatelet/anticoagulant therapy, as well as the timing and duration of therapies. In addition, the headline results of many trials report improved efficacy outcomes at the cost of increased bleeding risk; however, very few show a clear mortality benefit. It is therefore difficult to weigh up the risk-benefit profile of emerging therapies.
  Future Cardiology 05/2013; 9(3):371-85.
• Article: A novel patch for heart rhythm monitoring: is the Holter monitor obsolete?

  Steven L Higgins
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  ABSTRACT: A number of substantial improvements to the 60-year-old concept of the Holter monitor have recently been developed. One promising advance is the Zio(®) Patch (iRhythm Technologies, Inc., CA, USA), a small 2 × 5-inch patch, which can continuously record up to 14 days of a single ECG channel of cardiac rhythm without the need for removal during exercise, sleeping or bathing. Its ease-of-use, which enables optimal long-term monitoring, has been established in the ambulatory setting, although some insurance carriers have been reluctant to reimburse appropriately for this advance, an issue characteristic of other heart monitors, treated as 'loss-leaders.' In this article, in addition to discussing possible reasons for this reluctance, a novel model for direct-to-consumer marketing of heart monitoring, outside of the traditional health insurance reimbursement model, is also presented. Additional current and future advances in heart rhythm recording are also discussed. Such potentially revolutionary opportunities have only recently become possible as a result of technologic advances.
  Future Cardiology 05/2013; 9(3):325-33.
• Article: The benefits of ivabradine are independent of resting heart rate.

  Graziano Riccioni
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  ABSTRACT: Evaluation of: Tardif JC, Ponikowski P, Kahan T; on behalf of the ASSOCIATE investigators. Effects of ivabradine in patients with stable angina receiving beta-blockers according to baseline heart rate: an analysis of the ASSOCIATE study. Int. J. Cardiol. pii:S0167-5273(12)01385-X (2012). Chronic stable angina pectoris is the most common manifestation of coronary artery disease. A large body of evidence points to high resting heart rate (HR) as a risk factor for mortality in various populations, including patients with cardiovascular disease. Elevated HR is an important pathophysiological variable that increases myocardial oxygen demand and also limits tissue perfusion by reducing the duration of diastole, during which most myocardial perfusion occurs. Large epidemiological trials have established that elevated resting HR is a prognostic factor for cardiovascular events and mortality in healthy individuals and in patients with myocardial infarction, stable coronary artery disease and heart failure. The classical treatments for HR reduction show such negative aspects. β-blocker therapy exerts negative effects on regional myocardial blood flow and function when HR reduction is eliminated by atrial pacing. Calcium channel antagonists functionally antagonize coronary vasoconstriction mediated through α-adrenoreceptors and are thus devoid of this undesired effect, but the compounds are nevertheless negative inotrope. Ivabradine (IVA), a pure HR-lowering drug, reduces the myocardial oxygen demand of exercise and contributes to the restoration of oxygen balance, which has demonstrated a benefit in chronic cardiovascular disease. No relevant negative effects are evidenced on cardiac conduction, contractility, relaxation or repolarization, or blood pressure. In this post-hoc analysis, the authors show that IVA treatment, compared with the placebo group, had no significant impact on systolic or diastolic blood pressure at rest or during exercise and reduces HR in all stages of physical exercise and during the treatment period. These benefits are independent of baseline HR, both at rest and during physical exercise, confirming that HR reduction with IVA is beneficial in all patients, even with β-blocker therapy, if their resting HR is above 60 bpm.
  Future Cardiology 05/2013; 9(3):313-5.
• Article: Changes in BNP and QTc for prediction of sudden death in heart failure.

  Micha T Maeder, Peter Ammann
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  ABSTRACT: Evaluation of: Vrtovec B, Knezevic I, Poglajen G, Sebesjen M, Okrajsek R, Haddad F. Relation of B-type natriuretic peptide level in heart failure to sudden cardiac death in patients with and without QT interval prolongation. Am. J. Cardiol. 111(6), 886-890 (2013). Guidelines recommend an implantable cardioverter defibrillator (ICD) for patients with chronic heart failure (HF) and left ventricular ejection fraction (LVEF) <35%, and New York Heart Association (NYHA) class II/III, despite optimal medical treatment. However, by this mode of patient selection, many patients receive an ICD but never use it. Therefore, additional clinical and laboratory parameters, including estimated glomerular filtration rate and B-type natriuretic petide (BNP), and ECG parameters such as the corrected QT-interval (QTc), have been suggested for a more refined assessment of the risk of sudden cardiac death (SCD). However, changes in these parameters over time may be even more informative for SCD prediction than single measures, but this had not been investigated so far. In the present paper, the authors assessed the association between changes in BNP and QTc during a 3-month period in 398 patients with advanced chronic HF (NYHA III/IV) and LVEF <40%. After a follow-up of 1 year, 20 patients had suffered SCD. Patients with a significant (≥10%) increase in BNP were more likely to have a significant (≥10%) increase in QTc and had a longer QTc at 3 months than those without. The risk of SCD did not differ between patients with and without a significant increase in BNP, but was higher in patients with a significant increase in QTc compared with those without. Among patients with an increase in BNP of ≥10%, those with an increase in QTc of ≥10% were several-fold more likely to experience SCD compared with those without, whereas there was no such association between the change in QTc and SCD among patients without an increase in BNP of ≥10%. Thus, this study showed that changes in QTc better predicted SCD than changes in BNP, and that a strategy using both a marker of heart failure severity and a marker of the propensity of the left ventricle for arrhythmia better predicted SCD than a single-marker strategy. Further studies are required to evaluate whether novel markers besides LVEF and NYHA class alone (e.g., biomarkers and cardiac MRI) will allow a more accurate selection of patients with chronic HF who need an ICD.
  Future Cardiology 05/2013; 9(3):317-20.
• Article: Menopausal hormone therapy: examining cardiovascular and clinical impacts of treatment.

  Christine L Chiu, Joanne M Lind
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  ABSTRACT: Postmenopausal women have reduced levels of female sex hormones and this may play a significant role in the onset of cardiovascular disease. Menopausal hormone therapy (MHT), which is primarily prescribed for the treatment of perimenopausal symptoms, has been associated with risk of coronary heart disease, hypertension and stroke in women. This review will summarize the outcomes of observational studies and randomized clinical trials that have investigated the influence of MHT use on the cardiovascular system. In addition, it will explore how the timing of MHT prescription relative to menopause, dosage and route of administration may alter the impact of MHT on cardiovascular health.
  Future Cardiology 05/2013; 9(3):427-35.
• Article: Premature birth: implications for cardiovascular health.

  Mikael Norman
  Future Cardiology 05/2013; 9(3):293-5.
• Article: Plasmonic photothermal therapy for atheroregression below Glagov threshold.

  Alexander N Kharlamov
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  ABSTRACT: The advent of nanomedicine allowed for the development and design of tools that enhance detailed diagnosis and target treatment of atherosclerosis. Given the rapid progress in nanoagent synthesis and utility, clinical application of these technologies can be anticipated in the near future. This review article focuses on the development of these technologies in interventional cardiology, with the main goal of achieving atheroregression below a Glagov threshold of 40%. Special attention is given to plasmonic photothermal therapy. Vascular remodeling maintains the lumen dimension as long as the external elastic membrane can accommodate an increase in plaque burden that does not surpass a certain threshold. We propose that this threshold becomes the target for the development of strategies that reverse atherosclerosis, especially for the generation of devices and tools of nanomedicine.
  Future Cardiology 05/2013; 9(3):405-25.
• Article: Cardiac MRI of acute coronary syndrome.

  Shamruz Akarem Khan, Eric E Williamson, Thomas A Foley, Ethany L Cullen, Phillip M Young, Philip A Araoz
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  ABSTRACT: Acute coronary syndrome (ACS) is a major cause of morbidity and mortality worldwide. New serological biomarkers, such as troponins, have improved the diagnosis of ACS; however, the diagnosis of ACS can still be difficult as there is marked heterogeneity in its presentation and significant overlap with other disorders presenting with chest pain. Evidence is accumulating that cardiac MRI provides information that can aid the detection and differential diagnosis of ACS, guide clinical decision-making and improve risk-stratification after an event. In this review, we present the relevant cardiac MRI techniques that can be used to detect ACS accurately, provide differential diagnosis, identify the sequelae of ACS, and determine prognostication after ACS.
  Future Cardiology 05/2013; 9(3):351-70.
• Article: Million Hearts™: preventing a million heart attacks and strokes through public-private collaboration.

  Janet S Wright
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  ABSTRACT: Janet S Wright speaks to Caroline Telfer, Assistant Commissioning Editor. Janet S Wright is the Executive Director of Million Hearts™, a US Department of Health and Human Services initiative with the explicit goal of preventing a million heart attacks and strokes by 2017. From May 2008-September 2011, Dr Wright served as Senior Vice President for Science and Quality at the American College of Cardiology (ACC). The division she led at the ACC encompasses the clinical guidelines, performance measures, health policy statements and appropriate-use criteria; quality improvement projects such as Door-to-Balloon and Hospital-to-Home; and the National Cardiovascular Data Registry, a suite of databases containing over 12 million patient records in both inpatient and outpatient care settings. Prior to joining the ACC, Dr Wright spent many years in practice in Chico, CA, USA. Dr Wright served on the ACC's Board of Trustees and chaired the Task Force on Performance Assessment, Recognition, Reinforcement, Reward and Reporting. She was a member of National Committee for Quality Assurance's Clinical Programs Committee and of the Quality Alliance Steering Committee. She served on the board of the Center for Information Therapy, a nonprofit organization committed to the provision of personalized health information during each healthcare encounter. From 2003 until moving to Washington (USA), Dr Wright served as a founding member of the Independent Citizens' Oversight Committee, the 29-person board charged with administering the California Institute for Regenerative Medicine. Her primary interests are the design and implementation of systems of care to achieve optimal outcomes for patients and the full deployment of hooks, tricks and cues that help people get and stay healthy.
  Future Cardiology 05/2013; 9(3):305-7.
• Article: The potential role of natriuretic peptides in acute coronary syndrome stratification.

  Matteo Beltrami, Ranuccio Nuti, Marilyn Gilleman, Alberto Palazzuoli
  Future Cardiology 05/2013; 9(3):297-300.
• Article: Can dabigatran improve blood pressure control?

  Vivencio Barrios, Carlos Escobar
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  ABSTRACT: Hypertension is the most frequent condition associated with atrial fibrillation (AF) and stroke, the most terrible complication of AF. Achieving blood pressure (BP) goals as well as an adequate antithrombotic treatment are critical to reduce the incidence of stroke. But are interactions between anticoagulants and antihypertensive agents relevant for achieving BP targets? We present the case of a patient with hypertension and AF in which the interaction between losartan and acenocoumarol was associated with an irregular systolic BP control, but after switching to dabigatran, BP control improved. In this report, the possible mechanisms that may explain this change are discussed.
  Future Cardiology 05/2013; 9(3):321-3.
• Article: Pharmacologic treatments for pulmonary hypertension: exploring pharmacogenomics.

  Julio D Duarte, Rebekah L Hanson, Roberto F Machado
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  ABSTRACT: Pulmonary hypertension (PH) is a disease with multiple etiologies and is categorized into five broad groups. Of these groups, pulmonary arterial hypertension (PAH) is the most studied and, therefore, all of the currently available drug classes (prostacyclin analogs, endothelin receptor antagonists and phosphodiesterase type 5 inhibitors) were developed to treat PAH. Thus, limited treatment data exist for the less-studied non-PAH forms of PH. Pharmacogenomics can be a tool to better understand the pathways involved in PH, as well as to improve personalization of therapy. However, little pharmacogenomic research has been carried out on this disease. New treatments for PH are on the horizon, deriving from both repurposed currently available drugs and novel therapeutics.
  Future Cardiology 05/2013; 9(3):335-49.
• Article: The ‘napkin-ring’ sign on coronary computed tomography angiography can identify advanced atherosclerotic lesions.

  Caroline Telfer
  Future Cardiology 03/2013; 9(2):161-2.
• Article: Tolvaptan for the treatment of hyponatremia and hypervolemia in patients with congestive heart failure.

  Masatsugu Hori
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  ABSTRACT: Patients with heart failure often show increased arginine vasopressin secretion and enhanced sympathetic and renin-angiotensin-aldosterone activation, which accelerate renal water reabsorption, causing water retention and volume overload. Tolvaptan is an orally active antagonist of arginine vasopressin type 2 receptors in the collecting duct of the kidney that inhibits water reabsorption without substantially affecting the electrolyte balance. Tolvaptan in combination with conventional diuretics improves fluid retention and congestive symptoms in patients with heart failure and volume overload, with minimal effects on hemodynamics and serum potassium. Tolvaptan slightly increases serum sodium concentrations, generally within the normal range. Although it does not seem to affect long-term mortality, tolvaptan does improve short-term water retention and congestive symptoms in heart failure patients with volume overload despite the use of conventional diuretics, and is approved for this indication in Japan.
  Future Cardiology 03/2013; 9(2):163-76.
• Article: Choice of cell-delivery route for successful cell transplantation therapy for the heart.

  Satsuki Fukushima, Yoshiki Sawa, Ken Suzuki
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  ABSTRACT: The cell-delivery route is one of the major factors influencing the therapeutic effect and complications of cell transplantation therapy for cardiac diseases. There are four major clinically practical routes, with each method having its own advantages and disadvantages. First, intramyocardial injection allows targeted cell delivery into the areas of interest, although this induces mechanical injury, inflammation and islet-like donor cell clusters, leading to limited donor cell survival and arrhythmogenicity. Second, intracoronary injection is less likely to induce inflammation, whereas poor initial cell retention in the heart is a concern. Third, intravenous injection is easy and economical, but cell recruitment into the heart is not frequent. Finally, epicardial placement of 'cell sheets' enables higher efficiency of cell engraftment, but poor integration into the myocardium may be an issue. This review summarizes up-to-date clinical and preclinical knowledge regarding these cell-delivery methods. We further discuss the ways to refine these methods towards optimizing cell transplantation therapy for the heart.
  Future Cardiology 03/2013; 9(2):215-27.
• Article: A holistic approach to managing a patient with heart failure.

  Alison Duncan, Colin Cunnington
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  ABSTRACT: Despite varied and complex therapeutic strategies for managing patients with heart failure, the prognosis may remain poor in certain groups. Recognition that patients with heart failure frequently require input from many care groups formed the basis of The British Society of Heart Failure Annual Autumn Meeting in London (UK), in November 2012, entitled: 'Heart failure: a multidisciplinary approach'. Experts in cardiology, cardiac surgery, general practice, care of the elderly, palliative care and cardiac imaging shared their knowledge and expertise. The 2-day symposium was attended by over 500 participants from the UK, Europe and North America, and hosted physicians, nurses, scientists, trainees and representatives from the industry, as well as patient and community groups. The symposium, accredited by the Royal College of Physicians and the Royal College of Nursing, focused on the multidisciplinary approach to heart failure, in particular, current therapeutic advances, cardiac remodeling, palliative care, atrial fibrillation, heart rate-lowering therapies, management of acute heart failure and the management of patients with mitral regurgitation and heart failure.
  Future Cardiology 03/2013; 9(2):189-92.