Expert review of cardiovascular therapy
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Expert Rev Cardiovasc Ther · Nov 2011
ReviewHeart rate recovery: a practical clinical indicator of abnormal cardiac autonomic function.
The autonomic nervous system (ANS) and cardiovascular function are intricately and closely related. One of the most frequently used diagnostic and prognostic tools for evaluating cardiovascular function is the exercise stress test. ⋯ Heart rate recovery after graded exercise is one of the commonly used techniques that reflects autonomic activity and predicts cardiovascular events and mortality, not only in cardiovascular system disorders, but also in various systemic disorders. In this article, the definition, applications and protocols of heart rate recovery and its value in various diseases, in addition to exercise physiology, the ANS and their relationship, will be discussed.
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Expert Rev Cardiovasc Ther · Nov 2011
Should the blood pressure or the blood vessel be the target of therapy?
Measured blood pressure is an insensitive and moderately nonspecific guide to the presence of vascular or cardiac diseases likely to progress to cardiovascular morbid events. Since the goal of the diagnosis and treatment of hypertension is to prevent or forestall such morbid events, blood pressure measurements should be supplemented by studies of the health of the cardiovascular system in defining the syndrome of hypertension and in monitoring its response to therapy.
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Expert Rev Cardiovasc Ther · Nov 2011
Review Comparative StudyAntiplatelet options for secondary prevention in acute coronary syndromes.
Current guidelines recommend dual antiplatelet therapy, a combination of aspirin and a P2Y(12) inhibitor, for 6?12 months after percutaneous coronary intervention with drug-eluting stent implantation in all patients and for 1 year in all patients after an acute coronary syndrome (ACS), irrespective of revascularization strategy. Clopidogrel has a pharmacokinetic and pharmacodynamic profile that results in a delayed and/or subtherapeutic antiplatelet effect, and wide variability in antiplatelet response. New P2Y(12) inhibitors, such as prasugrel and ticagrelor, have favorable pharmacodynamics and clinical efficacy over clopidogrel and offer an alternative antiplatelet treatment strategy in specific patients. ⋯ Ticagrelor also appears to have more rapid and consistent antiplatelet effects than clopidogrel. The higher levels of antiplatelet inhibition provided by prasugrel and ticagrelor compared with standard-dose clopidogrel result in improved ischemic outcomes in patients with ACS. Despite an increase in bleeding risk, prasugrel and ticagrelor appear to have a better net clinical benefit, especially in higher-risk patients with ACS.
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The advent of real-time (RT) 3D transesophageal echocardiography (TEE) in 2007 has enhanced our understanding of the location and extent of the pathology of the native, as well as prosthetic, mitral valve (MV), particularly for MV prolapse and the anatomy of perivalvular dehiscence with prosthetic MV. MV quantification programs provide precise assessment of many quantitative MV parameters allowing 3D echocardiography to determine and quantify the geometry of mitral apparatus, including mitral annulus and periannular region, leaflet volume and anatomy, tethering distances, and tenting volumes. The detailed, accurate and optimal RT spatial visualization of the MV with 3D TEE gives greater confidence to the echocardiographer, interventionalist and the surgeon alike, facilitating medical and surgical treatment decisions. This article highlights recent advances in RT 3D TEE and transthoracic echocardiography echocardiographic imaging of the MV.