Book on percutaneous treatment in cardiac diseases in women
Summary: In the last two decade, the world of interventional cardiology grew very much in various directions. In the same period , the scientific community has been attempting to shed light on whether the disparity in clinical presentation and response to treatment for many cardiovascular diseases in men and women were due to variations in biological pattern or to social and cultural conventions leading to different attitudes of doctors and patients toward cardiac diseases. Since the first percutaneous interventions in the cardiovascular system, it was observed that women experienced more procedural complications such as arterial dissections, bleedings, spasms etc. This raised the question of whether this is due to late presentation and mismanagement or to a different arterial disease pathophysiology.
It is now well known that compared to their male counterparts, women diagnosed with cardiovascular diseases are older, present more frequently with comorbidities such as diabetes, hypertension, renal insufficiency, inflammatory diseases, have more physical and cardiac dysfunction as well as a lower overall quality of life.
The book does not look within the word of percutaneous cardiovascular interventions to see if and which are the differences in the treatment or/and in the results but rather raise attention on specific points. For example:
- in the percutaneous treatment of Acute Myocardial Infarction, particularly in young women, where more often the disease is due to coronary dissection instead of atherosclerotic plaque rupture, more careful manipulations of guidewires or extensive stenting is needed.
- in carotid stenting, the smaller vessel and the facility to dissect make the procedure more risky and more demanding than in the male population.
- in the use of peri and post procedural antithrombotic therapy, the bleeding risk is higher, particularly when a triple therapy (two antiplatelets and an anticoagulant) is required.
- in transcatheter aortic valve implantation where differences are found both in pathology (higher transvalvular gradients, smaller aortic anulus, smaller LV cavity, more Left ventricular hypertrophy) and in the complications more anular rupture and peripheral vascular complications, less residual aortic regurgitations).
- furthermore there are diseases, which require catheter interventions, which are present much more frequently in women like mitral stenosis or tricuspid regurgitations.
- finally there is a condition unique to women, pregnancy, that, fortunately rarely, can require catheter intervention.
As Prof Serruys said "The development of a highly specialized subspecialty requires an in-depth knowledge of very specific details to efficiently and safely perform these interventions". As such, this book is aimed at providing some of these details in order to help the interventionalists to improve their approach and outcomes in the female population.
Endorsement: This document is endorsed by the European Association of Percutaneous Cardiovascular Interventions
Percutaneous left atrial appendage occlusion
Summary: The increasing interest in left atrial appendage occlusion (LAAO) for ischaemic stroke prevention in atrial fibrillation (AF) fuels the need for more clinical data on the safety and effectiveness of this therapy. Besides an assessment of the effectiveness of the therapy in specific patient groups, comparisons with pharmacological stroke prophylaxis, surgical approaches and other device-based therapies are warranted. This paper documents the consensus reached among clinical experts in relevant disciplines from Europe and North America, European cardiology professional societies and representatives from the medical device industry regarding definitions for parameters and endpoints to be assessed in clinical studies. Adherence to these definitions is proposed in order to achieve a consistent approach across clinical studies on LAAO among the involved stakeholders and various clinical disciplines and thereby facilitate continued evaluation of therapeutic strategies available.
Endorsement: This document is endorsed by the European Association of Percutaneous Cardiovascular Interventions, the European Heart Rhythm Association, the European Cardiac Arrhythmia Society, the Atrial Fibrillation Competence Network,
and the Institut für Herzinfarktforschung Foundation.