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Abnormalities of myocardial energy metabolism appear as a common background of the two major cardiac disorders: ischemic heart disease (IHD) and heart failure (HF). Myocardial ischemia has been recently conceived as a multifaceted syndrome that can be precipitated by a number of mechanisms including metabolic abnormalities. HF is a progressive disorder characterised by a complex interaction of haemodynamic, neurohormonal and metabolic disturbances. HF may further promote metabolic changes, generating a vicious cycle. Thus, targeting cardiac metabolism in IHD patients may prevent the deterioration of left ventricular function, stopping the progression to HF. For these reasons, several studies have explored the potential benefits of trimetazidine (TMZ), an inhibitor of free fatty acids oxidation that shifts cardiac and muscle metabolism to glucose utilization. Because of its mechanism of action, TMZ has been found to provide a cardioprotective effect in patients with angina, diabetes mellitus, and left ventricular (LV) dysfunction, and those undergoing revascularization procedures, without relevant side effects. In addition, the lack of interference with heart rate, arterial pressure, and most of frequent comorbidities, makes TMZ an attractive option for patients and clinicians as well. The impact of TMZ on long term mortality and morbidity in ischemic syndromes and in heart failure need to be conclusively confirmed in properly designed RCT., (Copyright © 2019. Published by Elsevier B.V.)

Background: Care delivery for the growing population of adults living with congenital heart disease (CHD) has been met with challenges due to a shortage of physicians trained to care for this population. To meet this urgent need, restructuring and standardization of the training programs were implemented in 2015. The consequences of such a system on the graduating fellows have not been examined., Methods: A 25-question electronic survey was distributed to early career physicians who graduated following training in adult CHD (ACHD) care between 2015 and 2017 and are currently practicing in the United States. The survey results were anonymous., Results: Of the 30 physicians who trained in ACHD between 2015 and 2017 in the U.S., 21 (70%) responded to the survey. The majority completed a 2-year ACHD program, practice at an adult hospital, are happy with their current job, spend most of their time in ACHD-related activities, make on average around 250,000 USD for entry level positions, and prioritize supportive leadership and colleagues. Their training was adequate for their job requirements. However, the acquisition of an additional skill, in addition to clinical ACHD care, allowed them to secure a more ideal job. A sizeable number of jobs required program building or expansion with only 9.5% of trainees comfortable doing so immediately after graduation., Conclusions: The new ACHD training curriculum successfully meets most of the needs for ACHD jobs. Integration of specialty tracks, ensuring uniformity in the quality of training between programs, and promoting leadership skills may improve career prospects., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Sleep disordered breathing (SDB) is highly prevalent in patients with atrial fibrillation, heart failure and hypertension and is associated with increased risk of mortality, cardiovascular (CV) events and arrhythmias. Current assessment of the severity of SDB is mainly based on the apnea-hypopnea index (AHI) representing the number of hypopneas and apneas per hour of sleep. However, this event-based parameter alone may not sufficiently reflect the complex pathophysiological mechanisms underlying SDB potentially contributing to CV outcome risk. In this review article, we highlight important limitations and pitfalls of current assessment, quantification and interpretation of SDB-severity in patients with CV disease and will discuss pathophysiological considerations from preclinical and clinical mechanistic studies and possible clinical implications., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Due to the aging population undergoing percutaneous coronary intervention (PCI), interventional cardiologists are confronted daily with treatment of lesions with complex anatomy. Despite improvements in stent devices and PCI techniques, these lesions remain a challenge in terms of procedural success. Guide-extensions (GE) are coaxial "mother and child" catheters employed to facilitate device delivery but they can be used in many different complex scenarios. A comprehensive review of the possible applications of GE and of the GuideLiner™ (GL), the most widely used GE device, is missing. We therefore aim to provide a comprehensive review of all the potential applications of the GL and other GE devices, describe its limitations as well as tips and tricks for successful usage of this GE catheter., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Many hospitals experience a reduction in the number of available physicians on days when national scientific meetings are conducted. This study investigates the relationship between in-hospital mortality in acute myocardial infarction (AMI) patients and admission during national cardiology meeting dates., Methods: Using an administrative database, we analyzed patients with AMI admitted to acute care hospitals in Japan from 2011 to 2013. There were 3 major national cardiology meetings held each year. A hierarchical logistic regression model was used to compare in-hospital mortality and treatment patterns between patients admitted on meeting dates and those admitted on identical days during the week before and after the meeting dates., Results: We identified 6,332 eligible patients, with 1,985 patients admitted during 26 meeting days and 4,347 patients admitted during 52 non-meeting days. No significant differences between meeting and non-meeting dates were observed for in-hospital mortality (7.4% vs. 8.5%, respectively; p=0.151, unadjusted odds ratio: 0.861, 95% confidence interval: 0.704-1.054) and the proportion of percutaneous coronary intervention (PCI) performed on the day of admission (75.9% vs. 76.2%, respectively; p=0.824). We also found that some low-staffed hospitals did not treat AMI patients during meeting dates., Conclusion: Little or no "national meeting effect" was observed on in-hospital mortality in AMI patients, and PCI rates were similar for both meeting and non-meeting dates. Our findings also indicated that during meeting dates, AMI patients may have been consolidated to high-performance and sufficiently staffed hospitals., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

The term "onco-cardiology" has been used in reference to cardiotoxicity in the treatment of malignant disease. In actual clinical situations, however, cardiovascular disease (CVD) associated with malignant disease and the concurrence of atherosclerotic disease with malignant disease are commonly observed, complicating the course of treatment. Patients with malignant disease associated with coronary artery disease often die from the cardiovascular disease, so it is essential to classify these disease states. Additionally, the prevalence of these classifications makes it easy to manage patients with malignant disease and coronary artery disease. We divided the broad field of onco-cardiology into 4 classifications based on clinical scenarios (CSs): CS1 represents the so-called paraneoplastic syndrome. CS2 represents cardiotoxicity during treatment of malignant diseases. CS3 represents the concurrence of atherosclerotic disease with malignant disease, and CS4 represents cardiovascular disease with benign tumors. This classification facilitates the management of patients with malignant disease and coronary artery disease by promoting not only the primary but also the secondary prevention of CVD., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Abstract presentations at scientific congresses are a preparation for publication in peer reviewed journals. The present study aimed to investigate the prediction of abstract acceptance of peer reviewed publications focusing on the difference between male and female first authors., Methods: We evaluated 8411 abstracts submitted to the German Cardiac Society by 2090 females and 6321 male scientists. Abstract grading (3 to 9 reviewers, blinded on a 5-point scale) separated those accepted and rejected followed by a bibliometric analysis of Medline publications from 2006 to 2012., Results: While rating of abstracts was not different between males and females (p=0.475), publication rate of females was lower compared to males (17.5% vs 24.4 ≥%, p<0.001). Female authors achieved a higher impact factor in their publications (5.1 ± 0.2 vs 4.4 ± 0.1, p=0.0003) and were more often listed on papers in highly ranked journals (impact factor ≥ 5) than males. Although, more accepted abstracts than rejected ones were published in high rank journals, a considerable number of papers were generated from rejected abstracts (22%)., Conclusions: Female cardiologists had a better publication success than males concerning high rank peer reviewed publications. Acceptance in blinded abstract evaluation often detects work published later, while rejected contributions still might represent high quality work suitable for publication in peer reviewed journals., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: China has become the world's second-largest economy after the United States since 2010. The cardiovascular diseases in have deteriorated significantly in resent 20 years. There is few published report about collaboration in Chinese Cardiology and Cardiovasology (C&C) field so far. The current study reveals the status of the collaboration activities in Chinese C&C field., Methods: Articles published in 5 journals related to C&C from 2000 to 2010 were retrieved from China National Knowledge Infrastructure (CNKI) and VIP Journal Integration Platform(VJIP). Methods such as co-authorship, co-word analysis, centrality, k-core, m-slice were used in this study., Results: Although the percentage of co-authored papers and the average number of authors per paper in Chinese C&C field were generally increasing, the geographic distribution of the research collaboration activities was extremely uneven. There were 87 authors and 5 institutions ranking in top 1% of all the three centralities but 92.8% authors belonged to 10-Core and below. 90.93% authors are among 1-slice, 2-slice and 3-slice. We found 63 cohesive research groups in the focuses of research collaboration for Coronary artery disease and myocardial infarction, etc., Conclusion: The government should provide important role in supporting or encouraging the research collaboration among different regional areas. Based on the author ranking in the centralities, we will be able to select academic leaders more easily. The research studies in the field of collaboration network will provide important role to assist researchers to master the forefront research subjects, and to help research scientists to apply for scientific project funding., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: Improved processes of referral from Primary Care are an important part of a strategy to reduce the population burden of cardiovascular disease. A unique service of rapid access clinics, where primary care practitioners can refer patients to a daily secondary care cardiology service without appointment has been established at Charing Cross Hospital in West London. Previous data have shown the effectiveness of this service in diagnosing and risk stratifying patients with suspected cardiac disease. We evaluated Primary Care and Patient views on this service., Methods: A patient survey of a cohort of 1223 patients recruited to a follow up study of individuals seen over 1 year in the service and qualitative in-depth interviews of a randomised sample of 10 out of 82 referring Primary Care Practitioners was performed., Results: Less than 2% of patients had a negative experience of the service. Most patients did not have to revisit the Primary Care Practitioner for the same symptom. Primary Care Practitioners were overwhelmingly positive about the ease of access. They viewed positively the ability to obtain prompt diagnosis or reassurance. The heart failure service was used least but this was the most challenging condition to diagnose. There were concerns about nurse specialist based services and restriction to 'first presentations'. Communication about the service could be improved., Conclusions: A 'no appointment', one stop, rapid access service for the diagnosis and risk stratification of suspected new cardiac disease is viewed very positively by patients and Primary Care Practitioners.

Traditional cardiac risk factors, such as smoking, hypertension and obesity, are widely accepted contributors to the onset and progression of cardiovascular disease (CVD), one of the foremost causes of morbidity and mortality worldwide. Largely overlooked, however, is the impact of mental health on cardiac disease. From extensive MEDLINE and PsycINFO searches, we have reviewed the association between specific psychiatric disorders and CVD-related morbidity and mortality, the efficacy and safety of their treatments, and plausible behavioral and biological mechanism through which these associations may occur. The preponderance of evidence suggests that depression, anxiety disorders, bipolar disorder and schizophrenia are all important cardiac risk factors, and patients with these disorders are at significantly higher risk for cardiac morbidity and mortality than are their counterparts in the general population. Antidepressants, antipsychotics, mood stabilizers and benzodiazepines are effective therapeutic interventions, and many are safe to use in cardiac populations. Some, such as selective serotonin reuptake inhibitors and atypical antipsychotics, may even improve cardiac outcomes in healthy individuals and patients with CVD, although more work is needed to confirm this hypothesis. A combination of behavioral and biological mechanisms underlies the association between cardiac disease and mental illness, many of which are shared across disorders. With further research, it may be learned that psychiatric treatments definitively reverse the detrimental effects of mental illness on cardiac health. Currently, however, the challenge lies in raising awareness of mental health issues in cardiac patients, so that basic but critical treatments may be initiated in this population.

Medical practice is moving fast towards non-invasive and non-surgical disease management. While significant progress has been made with coronary artery disease prevention, MDCT stands as an ideal non-invasive tool for its progression. It accurately assesses both arterial lumen and wall disease. Although the main concern of current cardiology practice is the coronary stenotic disease, arterial wall calcification itself may significantly contribute to patients' symptoms. Thus, in addition to the beneficial use of MDCT in patients with mild to moderate risk for coronary disease, the unique information it provides on wall disease may assist the management of symptomatic patients with no flow-limiting lesions.

Latest advances in the diagnostic management of arrhythmogenic right ventricular dysplasia-cardiomyopathy (ARVD/C) confirm that ARVD/C is not a rare disease (one affected in 1000-1250 inhabitants) and is of familial origin in 50-80% of cases. Diagnostic criteria defined in 1994 lead to low rates in the diagnosis of ARVD/C. Progress was made in the definition of diagnostic markers. New criteria of localised right precordial QRS prolongation could be identified. The detection of epsilon potentials could be enhanced by highly amplified and modified recording techniques. Vectorcardiography, signal averaging per lead and electroanatomic voltage mapping might become more important in the future. Cardiac MRI does not represent the single diagnostic test to make the diagnosis of ARVD/C. It remains a promising noninvasive imaging technique with advantages in the evaluation of the right ventricle. After the characterisation of mutations in the plakophilin-2 gene, molecular genetics is going to become an important diagnostic tool. Up to now, unsolved problems exist in the differentiation of ARVD/C and other conditions with ventricular arrhythmias evolving from the right ventricle such as Brugada syndrome and right ventricular outflow tract tachycardia. These problems can be overcome by distinct ECG analysis and the use of imaging techniques. With the help of corrected and modified diagnostic criteria it seems to be possible to identify symptomatic and asymptomatic affected by ARVD/C with predominantly major criteria and only in a minority of cases minor criteria.

The numbers of papers on the Medline database concerning seven innovations in cardiology in the last 20 years were ascertained by year from the time of their discovery until the present. They were further divided into three geographical regions. The proliferation of papers in medical journals regarding new discoveries is initially exponential, with a plateau phase which is unrelated in magnitude to the constants in the model for the exponential phase. The magnitude of the plateau phase in the case of drugs is related to the number of indications for use of the drug. The proliferation of papers on a particular subject in English journals lags behind journals from the United States of America and the rest of the world. Eventually there are a larger number of papers published per year, per head of the population or per doctor in England than in the U.S.A. Current computer databases are not satisfactory for research audit. The department within an institution and an assessment of the quality of the research should be available.