Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease, affecting over one million individuals in Europe. Hypertrophic cardiomyopathy patients often require pharmacological intervention for control of symptoms, dynamic left ventricular outflow obstruction, supraventricular and ventricular arrhythmias, and microvascular ischaemia. Current treatment strategies in HCM are predicated on the empirical use of long-standing drugs, such as beta-adrenergic and calcium blockers, although with little evidence supporting their clinical benefit in this disease. In the six decades since the original description of the disease, <50 pharmacological studies enrolling little over 2000 HCM patients have been performed, the majority of which were small, non-randomized cohorts. As our understanding of the genetic basis and pathophysiology of HCM improves, the availability of transgenic and preclinical models uncovers clues to novel and promising treatment modalities. Furthermore, the number of patients identified and followed at international referral centres has grown steadily over the decades. As a result, the opportunity now exists to implement adequately designed pharmacological trials in HCM, using established as well as novel drug therapies, to potentially intervene on the complex pathophysiology of the disease and alter its natural course. Therefore, it is timely to review the available evidence for pharmacological therapy of HCM patients, highlight the most relevant gaps in knowledge, and address some of the most promising areas for future pharmacological research, in an effort to move HCM into the era of evidence-based management.
In patients with systolic heart failure, improvement in functional class and LV function induced by middle-term trimetazidine therapy is paralleled by a reduction in whole body REE. The beneficial cardiac effects of trimetazidine may be also mediated by a peripheral metabolic effect.
BACKGROUND Left main coronary artery (LMCA) disease treatment is traditionally surgical in most cases. Continuous improvement of devices and the emergence of drug-eluting stents (DES) has increased indications of percutaneous treatment in these high-risk lesions. The main objective of this study was to evaluate the efficacy and safety of percutaneous coronary intervention (PCI) with DES on LMCA at a 10 year follow-up.
METHODSWe prospectively included 324 patients (69.53 AE 12.60 years, 73.4% male) with severe LMCA disease undergoing PCI from June 2006 to April 2015. We evaluated major cardiovascular events defined as cardiac death, nonfatal myocardial infarction, target lesion revascularization (RLT) and stent thrombosis after long-term clinical follow-up (median 41.5 months).
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