Review on Short Term Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention with Drug Eluting Stent.

The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) have been a debatable topic for several decades. With the newer generation drug eluting stents, risk of major adverse cardiovascular events (MACE) has significantly reduced and hence, shorter duration of DAPT (one to three months) is now recommended especially in patients with high bleeding risk. Our review highlights the current guidelines and the recommendations from the recent trials.

COVID-19 and Cardiovascular Disease: A Comprehensive Review.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic that impacted the lives of billions of people worldwide. Angiotensin-converting enzyme 2 (ACE2) receptor act as a gate for viral cell entry through binding to virus S-protein. Cardiovascular patients are thought to be more susceptible to severe COVID-19 infection due to overexpression of ACE2 receptors in these patients. There is a growing body of evidence suggesting worse outcomes and increased mortality among COVID-19 patients with preexisting cardiovascular diseases. SARS-CoV-2 is capable of causing a wide range of cardiovascular diseases including myocarditis, heart failure, arrhythmia, myocardial ischemia and venous thromboembolism. Drug-disease interaction in COVID-19 patients with preexisting cardiovascular conditions has become a major concern. In this review, we discuss different aspects of the relationship between COVID-19 and the cardiovascular system along with a brief pharmacological overview.

Heart Failure with Preserved Ejection Fraction: Concise Review.

Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent disease, causing a significant burden to the elderly population. Due to the inconsistencies in the standard definition and criteria for diagnosis, HFpEF is often underdiagnosed and left untreated. Although diastolic dysfunction is one of the key driving factors of the disease process, other factors like systolic limitations, endothelial dysfunction, arterial stiffness, and poor ventricular-arterial coupling are also contributing factors. While various treatment modalities have been investigated, the management continues to remain supportive. This review highlights the various American College of Cardiology/American Heart Association and European Society of Cardiology definitions, pathophysiology, and current treatment modalities available for HFpEF.

Percutaneous Closure of a Cribriform Secundum Atrial Septal Defect and Patent Foramen Ovale.

Atrial septal defects (ASDs) and patent foramen ovale (PFO) are common congenital cardiac malformations that portend a higher risk of ischemic stroke. Percutaneous closure of ASDs using septal occluder devices has proven to be a safe and effective alternative to surgery. We present a case of symptomatic cribriform secundum ASD and PFO who underwent successful percutaneous closure using two Amplatzer occluder devices using a novel "sandwich technique."

Proprotein Convertase Subtilism/Kexin 9 (PCSK9) Inhibitors: Adding to the Armamentarium of the Primary Care Physician.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality worldwide, and its prevalence is expected to further increase in the next decade. It imparts a substantial burden on the healthcare system. Dyslipidemia, defined as low-density lipoprotein (LDL), total cholesterol, triglycerides, or lipoprotein levels more than 90th percentile, or an HDL level less than the 10th percentile, is significant risk factor for ASCVD and offers a therapeutic target to reduce the morbidity and mortality associated with ASCVD. While statins remain first-line therapy for the primary and secondary prevention of ASCVD, many patients may not be able to tolerate statins. Furthermore, in many patients, statin therapy alone may not be sufficient in decreasing LDL cholesterol levels. Within the past decade, several new classes of cholesterol lowering agents have been developed and studied as potential adjunctive therapy for patients who are unable to meet target LDL levels with traditional therapy alone. While many of these therapies (fibrates, bile acid sequestrants, and niacin) have demonstrated limited utility in dyslipidemia therapy, the newer proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors have proven to be some of the most potent lipid-lowering therapies available. Recent studies have demonstrated promise for these agents in the role of future management of dyslipidemia. In this review article, we aim to provide a review of recent literature of the PCSK9 inhibitors. These targets may provide additional benefit and alternative options in the treatment of dyslipidemia in the future.

Ultra-Low Contrast Volume Technique for Coronary Angiography - Successful Application in Clinical Setting.

Iodinated contrast media used during cardiac catheterization predispose patients to develop contrast-induced nephropathy. Reducing contrast volumes without impairing the quality of angiographic imaging appears to be a viable solution. We present three cases of patients with chronic kidney disease in which we used an ultra-low contrast volume technique to help minimize contrast exposure risk. This technique uses an automated contrast injection system that can be used during diagnostic or coronary interventional cases and reduces the risk of iatrogenic kidney disease without compromising imaging quality.

The State of the Absorb Bioresorbable Scaffold: Consensus From an Expert Panel.

Significant progress has been made in the percutaneous coronary intervention technique from the days of balloon angioplasty to modern-day metallic drug-eluting stents (DES). Although metallic stents solve a temporary problem of acute recoil following balloon angioplasty, they leave behind a permanent problem implicated in very late events (in addition to neoatherosclerosis). BRS were developed as a potential solution to this permanent problem, but the promise of these devices has been tempered by clinical trials showing increased risk of safety outcomes, both early and late. This is not too dissimilar to the challenges seen with first-generation DES in which refinement of deployment technique, prolongation of dual antiplatelet therapy, and technical iteration mitigated excess risk of very late stent thrombosis, making DES the treatment of choice for coronary artery disease. This white paper discusses the factors potentially implicated in the excess risks, including the scaffold consideration and deployment technique, and outlines patient and lesion selection, implantation technique, and dual antiplatelet therapy considerations to potentially mitigate this excess risk with the first-generation thick strut Absorb scaffold (Abbott Vascular, Abbott Park, Illinois). It remains to be seen whether these considerations together with technical iterations will ultimately close the gap between scaffolds and metal stents for short-term events while at the same time preserving options for future revascularization once the scaffold bioresorbs.

Cardiovascular disease and bridging the diagnostic gap.

Cardiovascular disease (CVD) is now the leading cause of death worldwide. It continues to be on the rise and has become a true pandemic that has no respect to borders.' Coronary artery disease (CAD) is the most common type of CVD. It continues to be the leading cause of mortality both in men and women in the U.S.' Approximately every 25 seconds, an American will suffer an acute coronary syndrome, and approximately every minute someone will die of one. Risk stratification and early disease detection continue to be the bedrock of most preventative strategies. Risk assessment tools like Framingham Heart Score (FHS used in the U.S.), prospective cardiovascular monster (PROCAM used in Germany), or systemic coronary risk evaluation (SCORE used in Europe) are among the common and widely available estimators of a multi-factorial absolute risk of developing CVD.6 Recently, coronary artery calcium (CAC) has emerged as a non-invasive modality that might improve prediction of future cardiovascular events. We have conducted a comprehensive review of CVD risk factors, risk assessment and screening tools being applied to aid in early detection of CVD. As we work on bridging the diagnostic gap of the leading cause of mortality across the globe, utility of accurate and sensitive risk assessment and screening tools for early CVD detection is vital. This will aid in our goal of early detection, modifying risk factors and prevention of CVD incidence.