Selection of peer-reviewed literature on cardiology
The number of peer-reviewed papers covering the vast field of cardiology is huge, to such an extent that it is frequently difficult for healthcare professionals to keep up with the literature. As a special service to our readers, IHE presents a few key literature abstracts from the clinical and scientific literature chosen by our editorial board as being particularly worthy of attention.
Bleeding in acute coronary syndromes and percutaneous coronary interventions: position paper by the Working Group on Thrombosis of the European Society of Cardiology.
Steg PG et al. Eur Heart J. 2011 Aug;32:1854.
Bleeding has recently emerged as an important outcome in the management of acute coronary syndromes (ACS). Relatively frequent compared to ischaemic outcomes, bleeding has important implications in terms of prognosis, outcomes and costs. In particular, there is evidence that patients experiencing major bleeding in the acute phase are at higher risk of death in the following months, although the causal nature of this relation is still debated. This position paper aims to summarise current knowledge regarding the epidemiology of bleeding in ACS and percutaneous coronary intervention, including measurement and definitions of bleeding, with emphasis on the recent consensus Bleeding Academic Research Consortium (BARC) definitions. It also provides a European perspective on management strategies to minimise the rate, extent and consequences of bleeding. Finally, the research implications of bleeding (measuring and reporting bleeding in trials, the importance of bleeding as an outcome measure, and bleeding as a subject for future research) are also discussed.
The diagnostic value of intracoronary optical coherence tomography.
Regar E et al. Herz 2011 Aug;36 :417
Optical coherence tomography (OCT) is a novel light-based imaging modality that has applications in the analysis of coronary circulation. Compared to conventional intravascular ultrasound, OCT has a ten-fold higher image resolution. This advantage has seen OCT successfully applied in the assessment of atherosclerotic plaque, stent apposition and tissue coverage, heralding a new era in intravascular coronary imaging. This article discusses the diagnostic value of OCT, both in cardiovascular research as well as in potential
clinical applications.
Advances in percutaneous therapy for upper extremity arterial disease.
Capers Q 4th, Phillips J. Cardiol Clin. 2011 Aug;29(3):351-61.
Upper extremity arteries are affected by occlusive diseases from diverse causes, with atherosclerosis being the most common. Although the overriding principle in managing patients with upper extremity arterial occlusive disease should be cardiovascular risk reduction by noninvasive and pharmacologic means, when target organ ischaemia produces symptoms or threatens the patient’s well-being, revascularisation is necessary. Given their minimally invasive nature and successful outcomes, percutaneous catheter-based therapies are preferred to surgical approaches for this. The fact that expertise in these techniques resides in not one but several disciplines (vascular surgery, radiology, cardiology, vascular medicine) makes this an area ripe for multidisciplinary collaboration to the benefit of patients.
Beating heart valve surgery with lung perfusion/ventilation during cardiopulmonary bypass: do we need to break the limits?
Gologorsky E, Macedo FI, Salerno TA.
Expert Rev Cardiovasc Ther. 2011 Jul;9:927.
Myocardial and pulmonary ischemia during cardiopulmonary bypass is associated with cardiac and pulmonary dysfunction that may result in poor outcomes after cardiac surgery. Beating heart valve surgery, utilising continuous coronary perfusion with warm oxygenated blood, together with continuous pulmonary artery perfusion and alveolar ventilation during cardiopulmonary bypass, represents an emerging and exciting novel strategy for myocardial and pulmonary protection. This article presents preliminary clinical results, as well as basic and clinical evidence, indications, contraindications and limitations of these new evolving techniques.
