Λεωνίδας E. Πουληµένος, FESC Επιµελητής Α Ε.Σ.Υ.
|
|
- Douglas Heath
- 5 years ago
- Views:
Transcription
1 Νεότερη προσέγγιση στη θεραπευτική αντιµετώπιση της Σταθερής Στηθάγχης Από τη Βέλτιστη Φαρµακευτική Αντιµετώπιση στη Βέλτιστη Θεραπευτική Προσέγγιση για τον Εκάστοτε Ασθενή: Μια καινοτόµος Προσέγγιση Λεωνίδας E. Πουληµένος, FESC Επιµελητής Α Ε.Σ.Υ. Καρδιολογικό Τµήµα Γ.Ν. «Ασκληπιείο» Βούλας Διευθ: Καθ. Αθ. Ι. Μανώλης
2 Conflict of Interest (Honoraria and/or Advisory Boards) Astra Zeneca Bayer Menarini MSD Sanofi
3 Stable CAD: Multiple Treatment Options Lifestyle intervention PCI Reduce symptoms Treat underlying disease CABG Medical therapy
4 Repeat revascularization is common post-pci/cabg N = 18,240 who underwent elective PCI or CABG Patients (%) nd revascularization Kempf J et al. Presented at ESC
5 Despite Optimal Medical Therapy, Symptomatic CAD is Here to Stay The Heart and Soul Study: 937 outpatients treated for stable CAD, 3.9 years of follow-up CAD without angina or ischemia Symptomatic CAD Angina alone Ischemia alone (ETT) Angina + ischemia Gehi AK et al. Arch Intern Med. 2008;168(13):
6 Predictors of Physician Under-recognition of Angina in Outpatients with SCHD: APPEAR Study 1257 pts with SCHD Use Seattle Angina Questionnaire 411 reported experiencing angina during the last month 173 (42%) had their angina under recognized by their physician Predictors of under recognition: heart failure OR 3.06 angina OR 1.56 less frequent Arnold SV et al. Circ Cardiovasc Qual Outcomes August 19, 2016
7 Montalescot G, Sechtem U, et al. EHJ 2013;34(38): Medical Management of Patients with SCAD
8 Baseline Results from the STABILITY Study White HD,.Manolis AJ et al. N Engl J Med 2014;370:1702
9 Montalescot G, Sechtem U, et al. EHJ 2013;34(38): Medical Management of Patients with SCAD
10 Montalescot G, Sechtem U, et al. EHJ 2013;34(38): Medical Management of Patients with SCAD
11 Trimetazidine and Cardioprotection: Facts and Perspectives According to the published literature, there is sufficient evidence to support the addition of this agent in the treatment of symptomatic patients with stable angina. Tsioufis K, Manolis AJ Angiology 2014
12 Montalescot G, Sechtem U, et al. EHJ 2013;34(38): Medical Management of Patients with SCAD
13 Ivabradine Improves Exercise Capacity in Patients Already on β-blockers n=889 Change in ETT criteria (s) Ivabradine 7.5mg + atenolol 50mg Placebo + atenolol 50mg p<0.001 p<0.001 p< Total exercise duration Time to angina onset Time to limiting angina Tardif JC, et al. Eur Heart J. 2009; 29 (suppl) 386.
14 Primary Composite End Point Ivabradine n=654 (3.03% PY) Placebo n=611 (2.82% PY) HR = 1.08 [95% CI ] P= Patients with event (%) Ivabradine Placebo , ,5 42 Numbers at risk , ,5 42 Time from randomization (months) Ivabradine Placebo Fox K, Ford I, Steg PG, Tardif JC, Tendera M, Ferrari R. N Eng J Med August 31. DOI: /NEJMoa
15 Components of Primary Composite End Point (angina population: CCS class II, n=12 049) Cardiovascular death Nonfatal myocardial infarction 10 Ivabradine n=245 (1.76% PY) Placebo n=210 (1.51% PY) HR = 1.16 [95% CI ] P= Ivabradine n=235 (1.72% PY) Placebo n=200 (1.47% PY) HR = 1.18 [95% CI ] P= Patients with event (%) , ,5 42 Numbers at risk Time from randomization (months) Ivabradine Placebo Ivabradine , ,5 42 Time from randomization (months) Placebo Fox K, Ford I, Steg PG, Tardif JC, Tendera M, Ferrari R. N Eng J Med August 31. DOI: /NEJMoa
16
17
18 Clinical Development Studies of Ranolazine in Patients with CAD 4 Key Randomized, Placebo-Controlled Trials MARISA = monotherapy (X-over) (n=191) CARISA = combination (parallel) (n=823) ERICA = comb. max dose (parallel) (n=565) MERLIN-TIMI 36 = acute-to-chronic Rx in pts with high-risk NSTE ACS (n=6,550) Pooled data comprise 8,129 patients more extensively studied than any agent in stable CAD
19 Unique Therapeutic and Pharmacology of Ranolazine A. Heart Rate B. Arterial Blood Pressure Beats/min mm Hg Systolic Diastolic 0 Placebo 2.7 ± ± ± Placebo 2.7 ± ± ± 0.4 Ranolazine Concentration (µm) Ranolazine Concentration (µm) Therapeutic concentrations are ~750-4,000 ng/ml (~2 to 8 µm)
20 Clinical Studies of Ranolazine in SCHD MARISA CARISA ERICA
21 Anti-ischaemic and Anti-anginal Effects of Ranolazine: A Comparison with Atenolol Exercise duration Rate-Pressure Product (mmhg min -1 ± SE) 40,000 30,000 20,000 10,000 * * ranolazine placebo atenolol (100mg) * * * * p <0.001 vs placebo p < p = p < Minutes on treadmill Placebo Ranolazine IR 400 mg tid (1741 ± 1026 ng base/ml) Atenolol 100 mg qd Rousseau MF, et al. Am J Cardiol 2005;95(3):311-6 All patients analysis, N = 154.
22 UA/NSTEMI CP < 48h, ST-Dep or +ctn, or DM, or TRS 3 Standard Therapy N = sites 17 Countries Ranolazine IV to PO (1000 mg BID) RANDOMIZE (1:1) Double-blind Placebo Matched IV/PO Holter at enrollment x 7d Duration Event-driven Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST Segment Acute Coronary Syndromes Follow-up Visits: Q4 Months ETT at M8 or Final Final Visit (Median 348 Days) Primary End Point Cardiovascular death, MI or recurrent ischaemia Morrow DA et al. JAMA 2007;297:
23 Results Primary end point CV Death, MI, or Recurrent Ischaemia (% at 12M) Placebo 23.5% (N=3,281) Ranolazine 21.8% (N=3,279) HR 0.92 (95% CI 0.83 to 1.02) P= Days from Randomization Morrow DA et al. JAMA. 2007;297:
24 RESULTS - Primary End Point (CV death, MI or Recurrent Ischemia) Placebo (n = 1,776) Ranolazine (n = 1,789) i.v. 1,000 mg b.i.d. p.o. Percentage (%) P = Among patient with prior angina Wilson S.R. et al.: J Am Coll Cardiol 2009; 53 (17):
25 MERLIN-TIMI 36: Reduction in VT lasting 8 beats % 8 RR 0.65 P < Placebo Incidence (%) 6 4 RR 0.67 P = Ranolazine 5.3% 2 RR 0.63 ( ) P < Hours from randomization Scirica BM et al. Circulation. 2007;116.
26 Pleiotropic Effects and Advantages of Ranolazine Heart Failure with Preserved Ejection Fraction Microcirculation and Women Diabetes Mellitus and Cardiometabolic Risk Factors Arrhythmias Coronary Artery Disease Heart Rate and Blood Pressure
27 Medical treatment of stable angina: A tailored therapeutic approach Manolis AJ, Poulimenos L, Ambrosio G, Kallistratos M, Lopez-Sendon J, Dechend R, Mancia G, Camm J Current ESC guidelines suggest an algorithm for the medical treatment of stable angina categorizing antianginal drugs as first- or second-line therapy, and then providing no further suggestions to guide choice within each step. However, several questions emerge: Is there evidence for such an approach? Is there a true difference between first and second-line drugs in terms of prognosis and symptom relief? Do we have to individualize patients and tailor treatment according to their comorbidities or risk factors? Manolis AJ, Poulimenos L. Ambrosio G, et al. Int J Cardiol 2016;220:
28 First and Second Line Drug Treatment for the Management of SCHD: An Alternative Therapeutic Approach Second line drugs have been introduced much more recently and they have been tested according to much more stringent protocols and we have data on much larger size, with longer follow-up, and safety data. Trial Aspirin Statin Beta blocker RAS blocker Nitrates?????????????????????? SIGNIFY 91.7% 92.3% 83.1% 83% 40.5% MERLIN TIMI-36 95% 83% 89% 79% 40%
29 β-blockers and/or CCB s in SCHD Where is the Evidence?
30 β-blockers Use and Clinical Outcomes in Stable Outpatients with and without CHD Known prior MI: Known CHD, no MI: CHD risk factors: Mean follow-up: 44 mos Bangalore S, et al. JAMA 2012; 308:
31 N =26,793 J Am Coll Cardiol 2014;64(3):247 52
32 Recommended Management of Stable Angina: b-blockers and/or CCB s: Where is the Evidence? ESC Guidelines: b-blockers it has been extrapolated from the post-mi trials that beta-blockers may be cardioprotective also in patients with CHD. However, this has not been proven in a placebo-controlled trial. The beta-blockers trials post-mi were performed before the implementation of other secondary preventive therapy, such as treatment with statins and ACE-I s, which leaves some uncertainty regarding their efficacy on top of a modern treatment strategy. A recent retrospective analysis of the REACH registry suggested that in pts with either CAD RF only, known prior MI, or known CAD without MI, the use of b-blockers was not associated with lower risk of CV events ESC Guidelines: calcium channel blockers heart rate lowering CCB s may improve the prognosis of post-mi patients prognostic documentation in stable CHD has not been available for dihydropyridine CCB s until recently
33 First Step Treatment and Recent Published ESC Guidelines for SCHD Year No of pts Follow up Endpoint Nitrates h ED,ON-AN,ET wks ED, ON-AN days ED B-bl vs CCB s wks Holter ST, ED, LVEF wks ED,ON-AN, ST changes wks ED, ischemia wks EP mos EP wks Symptoms, EP wks Symptoms, EP wks Symptoms, EP wks ST changes
34 First Step Treatment and Recent Published ESC Guidelines for SCHD Trial Year No pts Follow up Treatment Endpoint p APSIS yrs Met vs Ver Death, MI, QOL NS INVEST (HTN and CHD) mos Ver vs Aten Death, MI, Angina NS INVEST mos Ver vs Aten Depression NS
35 Reference on β-blockers in the American Guidelines Review paper n=140; 2 arms of treament; 42 days on treatment; mins on stress test n=92; 2 arms of treatment; 70 days on treatment; mins on stress test n=112; 2 arms of treatment; 56 days on treatment; QoL n=114; 2 arms of treatment; 56 days on treatment; mins on stress test n=173; 2 arms of treatment; 1 years on treatment; QoL n=212; 2 arms of treatment; 84 days on treatment; mins on stress test; Holter n=17; 1 arm of treatment; 56 days on treatment; clinical and haemodynamic response
36 Reference on CCB s in the American Guidelines Review Review n=103; 2 arms of treatment; 77 days on treatment. Holter n=41; 2 arms of treatment;? Days on treatment. Holter, QoL Review n=207; 2 arms of treatment; 70 days on treatment. Holter
37 First and Second Line Treatment for SCHD Mortality Symptoms Relief b-blockers DHP s Non-DHP s LAN Ivabradine Ranolazine Nicorandil Trimetazidine No No No No No No No No
38 First and Second Line Treatment for SCHD Mortality Symptoms Relief Symptoms ESC ACC/ b-blockers No Yes IA AHA IB DHP s No Yes IA IB Non-DHP s No Yes IA IIaB LAN No Yes IIaB IB Ivabradine No Yes IIaB - Ranolazine No Yes IIaB IIa Nicorandil No Yes IIaB - Trimetazidine No Yes IIbB -
39
40 Cardiology 2014;129:
41 The J Curve in Hypertension: Fact or Fallacy? INVEST (CAD pts) 30 ONTARGET (high risk pts, mainly with CAD) 3 CV events (%) CV events (%) Adjusted HR >110 to 120 to > to > to > to > >160 On-treatment SBP (mmhg) On-treatment SBP (mmhg) 0 Cardiac events (%) VALUE (High risk pts) < 120 >120 to 130 >130 to 140 >140 to 150 >150 to 160 >160 to 170 >170 to On-treatment SBP (mmhg) CV events (%) TNT (CAD pts) > 100 On-treatment DBP (mmhg) Tsika E, Poulimenos L, Boudoulas KD, Manolis AJ et al. Cardiology 2014;129: Adjusted HR
42 Cardiovascular death, myocardial infarction, or st N= The Lancet 2016
43 Indications and Contraindications Preferred Contraindication/Caution b-blockers Non-DHP s High HR CHF AF (in Rate Control) High HR High BP AF (in Rate Control) DHP s High BP Severe AoS Low BP HOCM Low HR Low BP SSS COPD (non Cardioselective) Asthma MetS (non Vasodilating) Severe PAD (non Vasodilating) AV conduction abnormalities Low HR Low BP CHF AV conduction abnormalities Severe AoS SSS Constipation
44 Indications and Contraindications LA Nitrates Ivabradine Ranolazine Trimetazidine Preferred High BP Possibly in low HR Possibly in HF High HR CHF Low BP Low HR and BP AF Diabetes Mellitus Low HR Low BP NIcorandil Low HR CHF Low BP Contraindication/Caution HOCM PDE-5 Inhibitors AF Low HR Severe Hepatic Disease Patients on Non DHP s Cirrhosis Liver disease Renal impairment Class 1-3 amntiatythmics Parkinson s Disease Severe CKD
45 Preferred Drugs (listed alphabetically) Intolerance to BB / non-dhp CCB Significant AV conduction abnormalities Low HR Low BP AF CHF Microvascular ischemia Diabetes Mellitus COPD DHP s, Ivabradine, LA Nitrates, Nicorandil, Ranolazine, Trimetazidine. DHP s, Ivabradine, LA Nitrates, Nicorandil, Ranolazine, Trimetazidine, DHP s, LA Nitrates, Nicorandil, Ranolazine, Trimetazidine Ivabradine, Ranolazine, Trimetazidine b-blockers (Rate control), Non-DHP s (Rate Control), Ranolazine b-blockers, Ivabradine, Possibly Nitrates b-blocker, DHP, Nicorandil, Ranolazine Ranolazine, Trimetazidine, Vasodilating, b- blockers, b-blockers (cardio-selective), DHP s, Ivabradine, LA Nitrates, Nicorandil, Ranolazine, Trimetazidine
46 Heart Rate >60 bpm 60 bpm BP BP SBP 120 SBP <120 SBP 120 SBP <120 BB or Non-DHP CCB* Ranolazine Ivabradine** DHP Ranolazine DHP Ranolazine Ivabradine** Ranolazine First-line Second-line Third-line LA nitrates Nicorandil Trimetazidine Trimetazidine LA nitrates Nicorandil Trimetazidine Trimetazidine * normal ejection fraction; ** heart rate > 70 bpm BB = beta blocker; CCB = calcium channel blocker; DHP = dihydropyridine; SBP = systolic blood
Treatment of Stable Coronary Artery Disease Pharmacotherapy
Treatment of Stable Coronary Artery Disease Pharmacotherapy José López-Sendón Hospital Universitario La Paz. Madrid. Spain Conflict of interest: I will discuss off label use and/or investigational use
More informationDisclosures. Speaker s bureau: Research grant: Advisory Board: Servier International, Bayer, Merck Serono, Novartis, Boehringer Ingelheim, Lupin
Disclosures Speaker s bureau: Research grant: Advisory Board: Servier International, Bayer, Merck Serono, Novartis, Boehringer Ingelheim, Lupin Servier International, Boehringer Ingelheim Servier International,
More informationTrials Enrolled subjects Findings Fox et al. 2014, SIGNIFY 1
Appendix 5 (as supplied by the authors): Published trials on the effect of ivabradine on outcomes including mortality in patients with different cardiovascular diseases Trials Enrolled subjects Findings
More informationManagement of the coronary patient in Roberto Ferrari
Management of the coronary patient in 2011 Roberto Ferrari What is new in treatment of stable CAD? In the era of interventional cardiology, is chronic stable angina a rare disease? Stable angina pectoris
More informationManejo clínico del paciente con cardiopatía isquémica crónica y comorbilidades asociadas
Manejo clínico del paciente con cardiopatía isquémica crónica y comorbilidades asociadas José López-Sendón Hospital Universitario La Paz Madrid. Spain Starting Point What is the risk of the patient? 1-
More informationHow to successfully manage patients with ischemic heart disease
Cardiology Update 2013 Satellite symposium A. Menarini Davos, February 14, 2013 How to successfully manage patients with ischemic heart disease François Mach Cardiology Department Geneva University Hospital
More informationTRANSPARENCY COMMITTEE OPINION. 4 November 2009
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 4 November 2009 RANEXA 375 mg extended release tablet Pack of 60 (CIP: 394 370-7) RANEXA 500 mg extended release tablet
More informationRANOLAZINE AND IVABRADINE - THEIR CURRENT USE
3 : 35 RANOLAZINE AND IVABRADINE - THEIR CURRENT USE Abstract Chronic stable angina is a debilitating illness affecting millions worldwide. Considerable progress has been made over the last 30 years in
More informationJNC 8 -Controversies. Sagren Naidoo Nephrologist CMJAH
JNC 8 -Controversies Sagren Naidoo Nephrologist CMJAH Joint National Committee (JNC) Panel appointed by the National Heart, Lung, and Blood Institute (NHLBI) First guidelines (JNC-1) published in 1977
More informationBeta-blockers in Patients with Mid-range Left Ventricular Ejection Fraction after AMI Improved Clinical Outcomes
Beta-blockers in Patients with Mid-range Left Ventricular Ejection Fraction after AMI Improved Clinical Outcomes Seung-Jae Joo and other KAMIR-NIH investigators Department of Cardiology, Jeju National
More informationΔιάρκεια διπλής αντιαιμοπεταλιακής αγωγής. Νικόλαος Γ.Πατσουράκος Καρδιολόγος, Επιμελητής Α ΕΣΥ Τζάνειο Γενικό Νοσοκομείο Πειραιά
Διάρκεια διπλής αντιαιμοπεταλιακής αγωγής Νικόλαος Γ.Πατσουράκος Καρδιολόγος, Επιμελητής Α ΕΣΥ Τζάνειο Γενικό Νοσοκομείο Πειραιά International ACS guidelines: Recommendations on duration of dual
More informationScreening for Asymptomatic Coronary Artery Disease: When, How, and Why?
Screening for Asymptomatic Coronary Artery Disease: When, How, and Why? Joseph S. Terlato, MD FACC Clinical Assistant Professor, Brown Medical School Coastal Medical Definition The presence of objective
More informationThe Hearth Rate modulators. How to optimise treatment
The Hearth Rate modulators How to optimise treatment Munich, ESC Congress 2012 Prof. Luigi Tavazzi GVM Care&Research E.S. Health Science Foundation Cotignola, IT Disclosure Cooperation with: Servier, Medtronic,
More informationPatient characteristics Intervention Comparison Length of followup
ISCHAEMIA TESTING CHAPTER TESTING FOR MYCOCARDIAL ISCHAEMIA VERSUS NOT TESTING FOR MYOCARDIAL ISCHAEMIA Ref ID: 4154 Reference Wienbergen H, Kai GA, Schiele R et al. Actual clinical practice exercise ing
More informationLa terapia alla luce delle linee guida: oltre i beta-bloccanti e gli ace-inibitori
Meet the expert: La cardiopatia ischemica cronica nell anziano La terapia alla luce delle linee guida: oltre i beta-bloccanti e gli ace-inibitori Giorgio Basile Ricercatore Geriatria Università di Messina
More informationTreating Hypertension in Individuals with Diabetes
Treating Hypertension in Individuals with Diabetes Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any
More informationHypertension. Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute
Hypertension Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute Hypertension 2017 Classification BP Category Systolic Diastolic Normal 120 and 80 Elevated
More information2/17/2010. Grace Lin, MD Assistant Professor of Medicine University of California, San Francisco
Modern Management of Patients with Stable Coronary Artery Disease Grace Lin, MD Assistant Professor of Medicine University of California, San Francisco Scope of the Problem Prevalence of CAD: 17.6 million
More informationThe ESC Registry on Chronic Ischemic Coronary Disease
EURObservational Research Programme The ESC Registry on Chronic Ischemic Coronary Disease Prof. Fausto J. Pinto, FESC, FACC, FASE, FSCAI Immediate Past-President, ESC University Hospital Sta Maria University
More informationAntihypertensive Trial Design ALLHAT
1 U.S. Department of Health and Human Services Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic National Institutes
More informationShould All Patients Be Treated with Ace-inh /ARB after STEMI with Preserved LV Function?
Should All Patients Be Treated with Ace-inh /ARB after STEMI with Preserved LV Function? Avi Shimony, MD, FESC Cardiology Division Soroka University Medical Center Ben-Gurion University, Beer-Sheva Disclosure
More informationKhai Pham Gia. Vietnam Cardiovascular Organization Cardiovascular Hospital. Hanoi, Vietnam. Declared no potential conflict of interest.
Khai Pham Gia Vietnam Cardiovascular Organization Cardiovascular Hospital Hanoi University of Medicine Hanoi, Vietnam Declared no potential conflict of interest. Hypertension in Patients with Coronary
More informationPolypharmacy - arrhythmic risks in patients with heart failure
Influencing sudden cardiac death by pharmacotherapy Polypharmacy - arrhythmic risks in patients with heart failure Professor Dan Atar Head, Dept. of Cardiology Oslo University Hospital Ullevål Norway 27.8.2012
More informationMetoprolol Succinate SelokenZOC
Metoprolol Succinate SelokenZOC Blood Pressure Control and Far Beyond Mohamed Abdel Ghany World Health Organization - Noncommunicable Diseases (NCD) Country Profiles, 2014. 1 Death Rates From Ischemic
More informationRevascularization in Severe LV Dysfunction: The Role of Inducible Ischemia and Viability Testing
Revascularization in Severe LV Dysfunction: The Role of Inducible Ischemia and Viability Testing Evidence and Uncertainties Robert O. Bonow, MD, MS, MACC Northwestern University Feinberg School of Medicine
More informationBeyond LDL-Cholesterol
Biomarkers for Risk Stratification Beyond LDL-Cholesterol Athanasios J.Manolis Director Cardioilogy Dep, Asklepeion Hospital, Athens, Greece Adj. Professor of Medicine, Emory University Atlanta, USA Adj.
More informationThe Case for PCI as the Preferred Therapy in Most Patients with Chronic Stable Angina
The Case for PCI as the Preferred Therapy in Most Patients with Chronic Stable Angina Ajay J. Kirtane,, MD Columbia University Medical Center The Cardiovascular Research Foundation Conflict of Interest
More informationHypertension Update 2009
Hypertension Update 2009 New Drugs, New Goals, New Approaches, New Lessons from Clinical Trials Timothy C Fagan, MD, FACP Professor Emeritus University of Arizona New Drugs Direct Renin Inhibitors Endothelin
More informationSaudi Arabia February Pr Michel KOMAJDA. Université Pierre et Marie Curie Hospital Pitié Salpétrière
Prevention of Cardiovascular events with Ivabradine: The SHIFT Study Saudi Arabia February 2011 Pr Michel KOMAJDA Université Pierre et Marie Curie Hospital Pitié Salpétrière Paris FRANCE Declaration Of
More informationDECLARATION OF CONFLICT OF INTEREST. None
DECLARATION OF CONFLICT OF INTEREST None How low should we go to avoid harm in hypertensives with comorbidities? CORONARY ARTERY DISEASE Prof. Dr. Maria DOROBANTU, FESC,FACC CARDIOLOGY EMERGENCY HOSPITAL
More information(ClinicalTrials.gov ID: NCT ) Title: The Italian Elderly ACS Study Author: Stefano Savonitto. Date: 29 August 2011 Meeting: ESC congress, Paris
Early aggressive versus initially conservative strategy in elderly patients with non-st- elevation acute coronary syndrome: the Italian randomised trial (ClinicalTrials.gov ID: NCT00510185) Stefano Savonitto,
More informationEnvironmental. Vascular / Tissue. Metabolics
Global Risk Reduction--WINS Picking Mom and Dad-2016 Environmental Vascular / Tissue Metabolics Stop smoking-1b Physical activity-1b Weight control-1b Chelation therapy-3c Influenza vaccination-1b Blood
More informationStress ECG is still Viable in Suleiman M Kharabsheh, MD, FACC Consultant Invasive Cardiologist KFHI KFSHRC-Riyadh
Stress ECG is still Viable in 2016 Suleiman M Kharabsheh, MD, FACC Consultant Invasive Cardiologist KFHI KFSHRC-Riyadh Stress ECG Do we still need stress ECG with all the advances we have in the CV field?
More informationRanolazine: An Update
Ranolazine: An Update J. Dawn Abbott, M.D., F.A.C.C., F.S.C.A.I. Director, Interventional Cardiology Fellowship Associate Professor of Medicine Brown Medical School Cardiovascular Institute Outline Ranolazine
More informationOvercoming the Risk-Treatment Paradox in Non-STE ACS: It s Time! Christopher Granger, MD
Overcoming the Risk-Treatment Paradox in Non-STE ACS: It s Time! Christopher Granger, MD Disclosures Research contracts: AstraZeneca, Bayer, Novartis, GSK, Sanofi-Aventis, BMS, Pfizer, The Medicines Company,
More informationControversies in Cardiac Pharmacology
Controversies in Cardiac Pharmacology Thomas D. Conley, MD FACC FSCAI Disclosures I have no relevant relationships with commercial interests to disclose. 1 Doc, do I really need to take all these medicines?
More informationSBP in range of 120 to 140 :no progression or regression of CAD. Sipahi et al., 2006
Management of Hypertension in Patients with CAD M. Mohsen Ibrahim, MD Cardiology Department- Cairo University 1. What is the optimal BP in patients with hypertension and CAD? 2. What is the minimum safe
More information12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices. Heart Rate as a Cardiovascular Biomarker
12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices Heart Rate as a Cardiovascular Biomarker Inder Anand, MD, FRCP, D Phil (Oxon.) Professor of Medicine,
More informationThe Clinical Unmet need in the patient with Diabetes and ACS
The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge
More informationAntiplatelet Therapy in Primary CVD Prevention and Stable Coronary Artery Disease. Καρακώστας Γεώργιος Διευθυντής Καρδιολογικής Κλινικής, Γ.Ν.
Antiplatelet Therapy in Primary CVD Prevention and Stable Coronary Artery Disease Καρακώστας Γεώργιος Διευθυντής Καρδιολογικής Κλινικής, Γ.Ν.Κιλκίς Primary CVD Prevention A co-ordinated set of actions,
More informationTreatment to reduce cardiovascular risk: multifactorial management
Treatment to reduce cardiovascular risk: multifactorial management Matteo Anselmino, MD PhD Assistant Professor San Giovanni Battista Hospital Division of Cardiology, Department of Internal Medicine University
More informationCVD risk assessment using risk scores in primary and secondary prevention
CVD risk assessment using risk scores in primary and secondary prevention Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Disclosure Honoraria for consulting and speaker activities
More information7 th Munich Vascular Conference
7 th Munich Vascular Conference Secondary prevention of major cardiovascular events in patients with CHD or PAD - What can we learn from EUCLID and COMPASS, evaluating Clopidogrel, Ticagrelor and Univ.-Prof.
More informationCosa c è di nuovo nelle LLGG e nella gestione del paziente con scompenso cardiaco. Maurizio Volterrani IRCCS San Raffaele Rome Capri, 24 April 2015
Cosa c è di nuovo nelle LLGG e nella gestione del paziente con scompenso cardiaco Maurizio Volterrani IRCCS San Raffaele Rome Capri, 24 April 2015 Treatment options for patients with chronic symptomatic
More informationClinical Case. Management of ACS Based on ACC/AHA & ESC Guidelines. Clinical Case 4/22/12. UA/NSTEMI: Definition
Clinical Case Management of ACS Based on ACC/AHA & ESC Guidelines Dr Badri Paudel Mr M 75M Poorly controlled diabetic Smoker Presented on Sat 7pm Intense burning in the retrosternal area Clinical Case
More informationJoo-Yong Hahn, MD/PhD
Sungkyunkwan University School of Medicine Joo-Yong Hahn, MD/PhD Heart Vascular Stork Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Grant support Korean Society of Interventional
More informationBlood Pressure Targets in Diabetes
Stockholm, 29 th August 2010 ESC Meeting Blood Pressure Targets in Diabetes Peter M Nilsson, MD, PhD Department of Clinical Sciences University Hospital, Malmö Sweden Studies on BP in DM2 ADVANCE RCT (Lancet
More informationEffects of heart rate reduction with ivabradine on left ventricular remodeling and function:
Systolic Heart failure treatment with the If inhibitor ivabradine Trial Effects of heart rate reduction with ivabradine on left ventricular remodeling and function: results of the SHIFT echocardiography
More informationCardiac evaluation for the noncardiac. Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology
Cardiac evaluation for the noncardiac patient Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology Objectives! Review ACC / AHA guidelines as updated for 2009! Discuss new recommendations
More informationRole of Clopidogrel in Acute Coronary Syndromes. Hossam Kandil,, MD. Professor of Cardiology Cairo University
Role of Clopidogrel in Acute Coronary Syndromes Hossam Kandil,, MD Professor of Cardiology Cairo University ACS Treatment Strategies Reperfusion/Revascularization Therapy Thrombolysis PCI (with/ without
More informationHeart rate lowering treatment in chronic heart failure
Heart rate lowering treatment in chronic heart failure Jaromir Hradec 3rd Dept. Med., Charles Univ., Prague Czech Republic Things we knew, things we did Things we have learnt, things we should do What
More informationManagement of stable CAD FFR guided therapy: the new gold standard
Management of stable CAD FFR guided therapy: the new gold standard Suleiman Kharabsheh, MD Director; CCU, Telemetry and CHU Associate professor of Cardiology, Alfaisal Univ. KFHI - KFSHRC Should patients
More informationNew Agents for Heart Failure: Ivabradine Jeffrey S. Borer, MD
New Agents for Heart Failure: Ivabradine Jeffrey S. Borer, MD Professor of Medicine, Cell Biology, Radiology and Surgery Director, The Howard Gilman Institute for Heart Valve Disease and the Schiavone
More informationClinical Controversies in Perioperative Medicine
Clinical Controversies in Perioperative Medicine Hugo Quinny Cheng, MD Division of Hospital Medicine University of California, San Francisco Cardiac Evaluation: New Guidelines A 70-y.o. man with progressive
More informationESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES
ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES Pr. Michel KOMAJDA Institute of Cardiology - IHU ICAN Pitie Salpetriere Hospital - University Pierre and Marie Curie, Paris (France) DEFINITION A
More informationDual Antiplatelet duration in ACS: too long or too short?
Dual Antiplatelet duration in ACS: too long or too short? Leonardo Bolognese, MD, FESC, FACC Cardiovascular Department, Arezzo, Italy Paradigm Shift the ideal duration of DAPT: a moving target Early (stent-related)
More informationOutcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension
Outcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension Prof. Massimo Volpe, MD, FAHA, FESC, Chair of Cardiology, Department of Clinical and Molecular Medicine
More informationDavid A. Orsinelli, MD, FACC, FASE Professor, Internal Medicine The Ohio State University Division of Cardiovascular Medicine Columbus, Ohio
1 STABLE ISCHEMIC HEART DISEASE: A NON-INVASIVE CARDIOLOGIST S PERSECTIVE 2018 Cardiovascular Course for Trainees and Early Career Physicians APRIL 20, 2018 David A. Orsinelli, MD, FACC, FASE Professor,
More informationManaging HTN in the Elderly: How Low to Go
Managing HTN in the Elderly: How Low to Go Laxmi S. Mehta, MD, FACC The Ohio State University Medical Center Assistant Professor of Clinical Internal Medicine Clinical Director of the Women s Cardiovascular
More informationIs there enough evidence for DAPT after endovascular intervention for PAOD?
Is there enough evidence for DAPT after endovascular intervention for PAOD? Prof. I. Baumgartner Head Clinical & Interventional Angiology University Hospital Bern Disclosure Speaker name:...i. Baumgartner...
More informationHFpEF, Mito or Realidad?
HFpEF, Mito or Realidad? Ileana L. Piña, MD, MPH Professor of Medicine and Epidemiology/Population Health Associate Chief for Academic Affairs -- Cardiology Montefiore-Einstein Medical Center Bronx, NY
More informationHow clinically important are the results of the large trials in hypertension?
How clinically important are the results of the large trials in hypertension? Stéphane LAURENT, MD, PhD, FESC Pharmacology Department and PARCC / INSERM U970 Hôpital Européen Georges Pompidou, Université
More informationCongestive Heart Failure: Outpatient Management
The Chattanooga Heart Institute Cardiovascular Symposium Congestive Heart Failure: Outpatient Management E. Philip Lehman MD, MPP Disclosure No financial disclosures. Objectives Evidence-based therapy
More informationHypertension Update Clinical Controversies Regarding Age and Race
Hypertension Update Clinical Controversies Regarding Age and Race Allison Helmer, PharmD, BCACP Assistant Clinical Professor Auburn University Harrison School of Pharmacy July 22, 2017 DISCLOSURE/CONFLICT
More informationPharmacological Treatment for Chronic Heart Failure. Dr Elaine Chau HK Sanatorium & Hospital, Hong Kong 3 August 2014
Pharmacological Treatment for Chronic Heart Failure Dr Elaine Chau HK Sanatorium & Hospital, Hong Kong 3 August 2014 1 ACC/AHA 2005 guideline update for Diagnosis & management of CHF in the Adult -SA Hunt
More informationPreoperative Cardiac Evaluation:
Preoperative Cardiac Evaluation: The New Guidelines Hugo Quinny Cheng, MD Division of Hospital Medicine University of California, San Francisco Disclosures No financial relationships with pharmaceutical
More informationALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic
1 U.S. Department of Health and Human Services National Institutes of Health Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker
More informationManagement of Stable Ischemic Heart Disease. Vinay Madan MD February 10, 2018
Management of Stable Ischemic Heart Disease Vinay Madan MD February 10, 2018 1 Disclosure No financial disclosure. 2 Overview of SIHD Diagnosis Outline of talk Functional vs. Anatomic assessment Management
More informationPROCORALAN MAKING A STRONG ENTRY TO THE NEW ESC GUIDELINES FOR THE MANAGEMENT OF HEART FAILURE
Press Release Issued on behalf of Servier Date: June 6, 2012 PROCORALAN MAKING A STRONG ENTRY TO THE NEW ESC GUIDELINES FOR THE MANAGEMENT OF HEART FAILURE The new ESC guidelines for the diagnosis and
More informationLearning Objectives. Epidemiology of Acute Coronary Syndrome
Cardiovascular Update: Antiplatelet therapy in acute coronary syndromes PHILLIP WEEKS, PHARM.D., BCPS-AQ CARDIOLOGY Learning Objectives Interpret guidelines as they relate to constructing an antiplatelet
More informationImaging ischemic heart disease: role of SPECT and PET. Focus on Patients with Known CAD
Imaging ischemic heart disease: role of SPECT and PET. Focus on Patients with Known CAD Hein J. Verberne Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands International Conference
More informationSlide notes: References:
1 2 3 Cut-off values for the definition of hypertension are systolic blood pressure (SBP) 135 and/or diastolic blood pressure (DBP) 85 mmhg for home blood pressure monitoring (HBPM) and daytime ambulatory
More informationPractical Office Management of Stable Angina
Practical Office Management of Stable Angina All you need to know about it in 30 minutes Andy Ignaszewski MD FRCPC Head, Division of Cardiology PHC Physician Director, PHC Heart Centre Clinical Professor,
More informationHYPERTENSION GUIDELINES WHERE ARE WE IN 2014
HYPERTENSION GUIDELINES WHERE ARE WE IN 2014 Donald J. DiPette MD FACP Special Assistant to the Provost for Health Affairs Distinguished Health Sciences Professor University of South Carolina University
More informationBlood Pressure Treatment Goals
Blood Pressure Treatment Goals Kenneth Izuora, MD, MBA, FACE Associate Professor UNLV School of Medicine November 18, 2017 Learning Objectives Discuss the recent studies on treating hypertension Review
More informationHeart Rate in Patients with Coronary Artery Disease - the Lower the Better? An Analysis from the Treating to New Targets (TNT) trial
Heart Rate in Patients with Coronary Artery Disease - the Lower the Better? An Analysis from the Treating to New Targets (TNT) trial Sripal Bangalore, MD, MHA, Chuan-Chuan Wun, PhD, David A DeMicco, PharmD,
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Is there a mortality risk associated with aspirin use in heart failure? Results from a large community based cohort Margaret Bermingham, Mary-Kate Shanahan, Saki Miwa,
More informationPerioperative Cardiology Consultations for Noncardiac Surgery Ischemic Heart Disease
2012 대한춘계심장학회 Perioperative Cardiology Consultations for Noncardiac Surgery Ischemic Heart Disease 울산의대울산대학병원심장내과이상곤 ECG CLASS IIb 1. Preoperative resting 12-lead ECG may be reasonable in patients with
More informationRate Control versus Rhythm Control in NSTEMI
Rate Control versus Rhythm Control in NSTEMI Gulmira Kudaiberdieva, MD, FESC Adana, Turkey Conflict of interest: None to declare Istanbul - 2012 OUTLINE Significance of AF in ACS Prognostic value of AF
More informationClinical Seminar. Which Diabetic Patient is a Candidate for Percutaneous Coronary Intervention - European Perspective
Clinical Seminar Which Diabetic Patient is a Candidate for Percutaneous Coronary Intervention - European Perspective Stephan Windecker Department of Cardiology Swiss Cardiovascular Center and Clinical
More informationSuffolk PCT Drug & Therapeutics Committee New Medicine Report (Adopted by the CCG until review and further notice)
Suffolk PCT Drug & Therapeutics Committee New Medicine Report (Adopted by the CCG until review and further notice) This drug has been reviewed because it is a product that may be prescribed in primary
More informationManagement of ST-elevation myocardial infarction Update 2009 Late comers: which options?
European Society of Cardiology Annual Session 2009 Management of ST-elevation myocardial infarction Update 2009 Late comers: which options? Antonio Abbate, MD Assistant Professor of Medicine Virginia Commonwealth
More informationJ-curve Revisited. An Analysis of Blood Pressure and Cardiovascular Events in the Treating to New Targets (TNT) Trial
J-curve Revisited An Analysis of Blood Pressure and Cardiovascular Events in the Treating to New Targets (TNT) Trial Sripal Bangalore, MD, MHA, Franz H Messerli, MD, Chuan-Chuan Wun, PhD, Andrea L. Zuckerman,
More informationJames M. Kirshenbaum, MD, FACC
James M. Kirshenbaum, MD, FACC Associate Professor of Medicine Harvard Medical School Co-Director, Clinical Cardiology Director, Acute Interventional Cardiology Brigham and Women s Hospital Boston, MA
More informationThe ACC Heart Failure Guidelines
The ACC Heart Failure Guidelines Fakhr Alayoubi, Msc,R Ph President of SCCP Cardiology Clinical Pharmacist Assistant Professor At King Saud University King Khalid University Hospital Riyadh-KSA 2017 ACC/AHA/HFSA
More informationThe Diabetes Link to Heart Disease
The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM
More informationABSTRACT ORIGINAL RESEARCH. Stefan Perings. Georg Stöckl. Malte Kelm. On behalf of the RESPONSIfVE study investigators
Adv Ther (2016) 33:1550 1564 DOI 10.1007/s12325-016-0377-7 ORIGINAL RESEARCH Effectiveness and Tolerability of Ivabradine with or Without Concomitant Beta-Blocker Therapy in Patients with Chronic Stable
More informationΦαρμακευτική θεραπεία της μετεμφραγματικής καρδιακής ανεπάρκειας. Α. Καραβίδας Υπεύθυνος ιατρείου καρδιακής ανεπάρκειας Γ.Ν.Α Γ.
Φαρμακευτική θεραπεία της μετεμφραγματικής καρδιακής ανεπάρκειας Α. Καραβίδας Υπεύθυνος ιατρείου καρδιακής ανεπάρκειας Γ.Ν.Α Γ.Γεννηματάς Clinical Trials on Fibrinolysis N = 61.41 AMI pts, ( GUSTO I, GUSTOIIb,
More informationSemilogarithmic relation between rest heart rate and life expectancy
The importance of heart rate in heart failure Karl Swedberg Professor of Medicine Department t of emergency and cardiovascular medicine i Sahlgrenska Academy University of Gothenburg, Sweden karl.swedberg@gu.se
More informationCauses of death in Diabetes
Rates of CV events in Diabetes patients Respiratory4.2 Cancer 7.6 Diabetes 1.3 CV disease 17.3 Causes of death in Diabetes 250 200 150 100 50 0 per 10,000 person-years 97 151 243 Framingham 5 X increase
More informationClinical and Economic Value of Rivaroxaban in Coronary Artery Disease
CHRISTOPHER B. GRANGER, MD Professor of Medicine Division of Cardiology, Department of Medicine; Director, Cardiac Care Unit Duke University Medical Center, Durham, NC Clinical and Economic Value of Rivaroxaban
More informationRisk Stratification for CAD for the Primary Care Provider
Risk Stratification for CAD for the Primary Care Provider Shimoli Shah MD Assistant Professor of Medicine Directory, Ambulatory Cardiology Clinic Knight Cardiovascular Institute Oregon Health & Sciences
More informationThe life after myocardial infarction: a long quiet river?
The life after myocardial infarction: a long quiet river? Cardiac rehabilitation: for whom and how? Dr. Barnabas GELLEN MD, PhD, FESC Poitiers JESFC 2018 - Paris Conflicts of interest Speaker honoraria
More informationEffects of heart rate reduction with ivabradine on left ventricular remodeling and function:
Systolic Heart failure treatment with the If inhibitor ivabradine Trial Effects of heart rate reduction with ivabradine on left ventricular remodeling and function: results of the SHIFT echocardiography
More informationPrevention of Atrial Fibrillation and Heart Failure in the Hypertensive Patient
Prevention of Atrial Fibrillation and Heart Failure in the Hypertensive Patient The Issue of Primary Prevention of A.Fib. (and Heart Failure) and not the Prevention of Recurrent A.Fib. after Electroconversion
More information» A new drug s trial
» A new drug s trial A placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause
More informationHFpEF. April 26, 2018
HFpEF April 26, 2018 (J Am Coll Cardiol 2017;70:2476 86) HFpEF 50% or more (40-71%) of patients with CHF have preserved LV systolic function. HFpEF is an increasingly frequent hospital discharge. Outcomes
More informationNew evidences in heart failure: the GISSI-HF trial. Aldo P Maggioni, MD ANMCO Research Center Firenze, Italy
New evidences in heart failure: the GISSI-HF trial Aldo P Maggioni, MD ANMCO Research Center Firenze, Italy % Improving survival in chronic HF and LV systolic dysfunction: 1 year all-cause mortality 20
More informationΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ. Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH
ΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH Hypertension Co-Morbidities HTN Commonly Clusters with Other Risk
More informationMANAGEMENT OF HYPERTENSION: TREATMENT THRESHOLDS AND MEDICATION SELECTION
Management of Hypertension: Treatment Thresholds and Medication Selection Robert B. Baron, MD MS Professor and Associate Dean Declaration of full disclosure: No conflict of interest Presentation Goals
More information