DIALOGUES DIALOGUES IN CARDIOVASCULAR MEDICINE JANUARY 2019 VOLUME 24 #1 Year in Cardiology 2018....

download DIALOGUES DIALOGUES IN CARDIOVASCULAR MEDICINE JANUARY 2019 VOLUME 24 #1 Year in Cardiology 2018. Editors

of 89

  • date post

    22-Jun-2020
  • Category

    Documents

  • view

    0
  • download

    0

Embed Size (px)

Transcript of DIALOGUES DIALOGUES IN CARDIOVASCULAR MEDICINE JANUARY 2019 VOLUME 24 #1 Year in Cardiology 2018....

  • DIALOGUES IN CARDIOVASCULAR MEDICINE JANUARY 2019 VOLUME 24 #1

    www.dialogues-cvm.com

    Year in Cardiology

    2018

  • Editors in Chief Roberto Ferrari, MD, PhD Chair of Cardiology University Hospital of Ferrara, Cona (Ferrara), Italy

    Kim Fox, MD, FRCP National Heart and Lung Institute Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK

    Consulting Editors

    Anand I, MD La Jolla, CA, USA

    Avkiran M, PhD The Rayne Institute St Thomas’ Hospital London, UK

    Bertrand ME, MD Hôpital Cardiologique Lille, France

    Böhm M, MD Saarland University Hospital Homburg/Saar, Germany

    Borer JS, MD University of New York Downstate Medical Center New York, NY, USA

    Erol C, MD Ankara University Ankara, Turkey

    Coats A, MD University of Sydney Sydney, Australia

    Cowie M, MD, PhD National Heart & Lung Institute London, UK

    Danchin N, MD Hôpital Européen Georges- Pompidou Paris, France

    Dargie HJ, MD Western Infirmary Glasgow, UK

    Fox KA, MD University of Edinburgh Edinburgh, UK

    Fuster V, MD, PhD Mount Sinai Medical Center New York, NY, USA

    Gowdak L, MD, PhD Heart institute São Paulo, Brazil

    Hasenfuss G, MD Georg-August Universität Göttingen, Germany

    Heusch G, MD, PhD Institute for Pathophysiology University of Essen Medical School Essen, Germany

    Hu D, MD Heart Institute Intervention Center People Hospital of Pekin University Beijing, China

    Kaski JC, MD St George’s University of London London, UK

    Komajda M, MD Hôpital Pitié-Salpêtrière Paris, France

    Libby P, MD Brigham & Women’s Hospital Boston, MA, USA

    Lopatin Y, MD, PhD Volgograd State Medical University Volgograd, Russian Federation

    Lopez-Sendon JL, MD Hospital University Gregorio Maranon Madrid, Spain

    Lüscher T, MD University Heart Center University Hospital Zürich, Switzerland

    Magaña A, MD Mexican Institute of Social Security Mexico DF, Mexico

    Maggioni AP, MD ANMC Research Center Florence, Italy

    Marber MS, MD, PhD The Rayne Institute St Thomas’ Hospital London, UK

    Marzili M, MD, PhD University of Pisa Pisa, Italy

    Oto A, MD University School of Medicine Ankara, Turkey

    Patrono C, MD University La Sapienza Rome, Italy

    Pepine CJ, MD University of Florida Gainesville, FL, USA

    Pfeffer MA, MD, PhD Brigham and Women’s Hospital Boston, MA, USA

    Pinto F, MD Universidade de Lisboa Lisbon, Portugal

    Rapezzi C, MD University of Bologna Bologna, Italy

    Rosano G, MD, PhD St George’s Hospital Medical School London, UK

    Rosen MR, MD Columbia University College of Physicians & Surgeons New York, NY, USA

    Ryden L, MD, PhD Karolinska University Hospital Solna Stockholm, Sweden

    Seabra-Gomes RJ, MD Instituto do Coracao Hospital Santa Cruz Carnaxide, Portugal

    Shah A, MD James Black Centre British Heart Foundation Centre of Excellence King’s College London London, UK

    Simoons ML, MD Thoraxcenter Erasmus University Medical Center Rotterdam, The Netherlands

    Sipido K, MD, PhD Katholieke Universiteit Leuven Leuven, Belgium

    Steg PG, MD Hôpital Bichat–Claude Bernard Paris, France

    Swedberg K, MD, PhD Sahlgrenska University Hospital Ostra Göteborg, Sweden

    Tardif JC, MD Montreal Heart Institute Québec, Canada

    Tavazzi L, MD Policlinico San Matteo IRCCS Pavia, Italy

    Tendera M, MD Silesian School of Medicine Katowice, Poland

    Widimsky P, MD, PhD Vinohrady Cardiocenter Charles University Hospital Prague, Czech Republic

    Wijns WC, MD OLV Hospital Aalst, Belgium

    Zamorano JL, MD University Francisco de Vitoria Hospital Ramón y Cajal Madrid, Spain

  • 2018 Year in Cardiology

  • editorial Marco Metra 4

    Snapshot in Cardiology Roberto Ferrari, Kim Fox 9

    Prevention, Diagnosis, & Treatment 27

    Managing atrial fibrillation: from screening to treatment selection Bart Mulder, Michiel Rienstra (The Netherlands)

    News on cardiac rehabilitation in 2018 - Massimo F. Piepoli (Italy)

    Groundbreaking advances in cardiovascular research Edoardo Bertero, Christoph Maack (Germany)

    Changing the face of heart failure treatment: results from three pivotal studies - Jeffrey S. Borer (USA)

    Optimize heart failure care around the world - Yuri Lopatin (Russian Federation)

    Percutaneous coronary intervention and optimal medical therapy at the crossroads in stable CAD management - William E. Boden (USA)

    Guidelines, Registries, & Trials 61

    First-line anti-ischemic agents for stable coronary artery disease: insights from CLARIFY - Emmanuel Sorbets (France)

    A lower blood pressure target in hypertensive patients: update on the recent hypertension guidelines - Emmanuelle Vidal-Petiot (France)

    Big data: bridging the gap between real-world and trial evidence Gianluigi Savarese (Sweden)

    Where are we with the EurObservational Research Programme in 2018? Aldo P. Maggioni (Italy)

    Abbreviations & Acronyms 81

    instructions for Authors 86

  • YEAR IN CARDIOLOGY 2018 | 5 4 | YEAR IN CARDIOLOGY 2018

    EDITORIAL I graduated in 1981. Thus, it is difficult not to feel a little bit sad when thinking about the extraordinary steps forward that cardiology witnessed in the previous decades. Current treatments of all major cardiovascular diseases still seem to be founded on those great achievements. However, cardiology is still moving forward and major changes have occurred, including in this last year, which may, in fact, be more than in the years before. Without any pretense of being comprehensive, I will just take this occasion to briefly present some of these impressive advances.

    Prevention Dyslipidemia. Major advances occurred in the treatment of dyslipidemia and di- abetes. The REDUCE-IT trial showed that administration of a high-dose highly purified eicosapentaenoic acid ethyl ester to patients with established cardio- vascular disease or diabetes, high triglycerides, and low LDL cholesterol levels reduced plasma triglycerides and, more importantly, major adverse cardiovascu- lar events (MACE), cardiovascular death, stroke, or myocardial infarction (MI) by 25%. These results are in marked contrast with the neutral results of trials with n-3 fatty acids that had no effect on MACE in the ASCEND and VITAL trials in 2018, and they might be explained by the drug’s anti-inflammatory and antiplatelet actions and by lowering triglyceride levels.

    Hypercholesterolemia. In 2018, the second major trial of PCSK-9 inhibition with a human monoclonal antibody, the ODISSEY trial, was concluded. The adminis- tration of alirocumab led to a 1.6% reduction in the rate of MACE in patients with a previous acute coronary syndrome and with LDL cholesterol levels ≥70 mg/dL, non–HDL cholesterol levels ≥100 mg/dL, or apolipoprotein B levels ≥80 mg/dL de- spite high-dose statin therapy. Practical recommendations for the use of PCSK-9 inhibitors were also published.

    Diabetes. In 2018, confirmation of the favorable effects of SGLT2 inhibitors on car- diovascular outcomes was obtained. In previous trials in diabetic patients at high cardiovascular risk, both empagliflozin and canagliflozin reduced cardiovascular death and heart failure (HF) hospitalizations. These beneficial effects were con- firmed this year with dapagliflozin in the DECLARE-TIMI 58 trial. SGLT2 inhibitors have neutral effects on nonfatal stroke or MI and their favorable effects are spe- cific for cardiovascular death and, namely, HF events. There is the potential for favorable effects in patients with HF, independently of concomitant diabetes; this hypothesis is being tested in ongoing trials.

    Antithrombotic strategies. When used in primary prevention, aspirin did not re- duce cardiovascular events and increased the hemorrhagic risk, even in subjects at high risk, such as those with diabetes (ASCEND trial) or the elderly (ASPREE

  • YEAR IN CARDIOLOGY 2018 | 5 4 | YEAR IN CARDIOLOGY 2018

    trial). New avenues for antithrombotic treatment in secondary prevention were opened by the COMPASS trial, where the combination of low-dose rivaroxaban and aspirin led to a reduction in MACE (primary end point) and deaths, compared with aspirin alone, in patients with chronic atherosclerotic vascular disease.

    Imaging Major progress occurred with all imaging modalities, including (i) echocardiogra- phy, where global longitudinal strain established its role as an early measurement of left ventricular (LV) systolic dysfunction; (ii) cardiac magnetic resonance (CMR), with major studies about tissue characterization, T1 mapping, and extracellular volume assessment; (iii) coronary computed tomography (CT); (iv) nuclear imaging with quantitative coronary flow measurement and perfusion imaging with posi- tron emission tomography (PET); and (v) fusion imaging with CMR/PET and CT/ PET showing the relation between anatomical and functional abnormalities. In 2018, the results of the SCOT-HEART trial were presented and published, show- ing that patients who were referred to outpatient clinics for stable angina and received standard treatment, mainly based on exercise electrocardiography, plus coronary CT had a reduction in the primary end point of death or MI, mainly driven by a reduction in nonfatal MI, during a 5-year follow-up vs patients who received standard therapy alone. Interestingly, no differe