Innovative Solutions to Cardiovascular Dilemmas: From Diagnosis to Therapy

Dear Colleagues,

For the care of cardiovascular (CV) patients, there have been many guidelines, issued by the American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), Heart Failure Society (HFS) and Heart Rhythm Society (HRS), etc. From these guideline-directed medical therapies (GDMTs), physicians at the bedside or in the clinic can select the most suitable diagnostic strategy, a choice of time-proven prevention tactics or evidence-based management protocols. However, in many instances, even after applying the gold-standard GDMTs, physicians encounter clinical failures, which are highlighted below.

In the prevention of coronary artery disease (CAD), why do patients still develop this condition even after all risk factors are controlled (blood pressure <120 mmHg, low-density lipoprotein (LDL) <50 mg, no smoking)? Of the CAD patients with moderate (50%) stenotic lesion, which could undergo medical treatment without developing acute coronary syndrome (ACS)? What is the pathophysiological mechanism of the benefits for these patients on medications? For CAD patients who undergo percutaneous coronary interventions (PCIs) (balloon angioplasty or stenting), what are the flow dynamic features that the PCI rectifies so that no new lesion will develop? In patients with new dilated cardiomyopathy and a reduced ejection fraction (EF), which test could identify the patients whose EF returns to a normal level with GDMT? Many patients with aortic stenosis (AS), dilated cardiomyopathy, and anomalous origin of coronary artery from the opposite aortic sinus of Valsalva (ACAOS) have patent coronary arteries. Why do they all present with chest pain (CP) and sudden death (SCD)? What is the common pathophysiological mechanism of CP and SCD in these patients?  

As physicians at the front line, could we offer any new breakthrough solutions in the diagnosis and management of the patients who fail GDMT? Could any new clinical, imaging, laboratory methodology, computational fluid dynamic or big data analysis, artificial intelligence (AI) or machine learning (ML) algorithms identify the root cause of these failures? To solve these problems, the best management strategy is to rectify or to reverse the disease mechanism. If so, what is the most cost- and time-effective treatment plan?

This Special Issue focuses on the new, innovative, breakthrough strategies and tactics in the diagnosis, prevention, and management of common CV problems seen by clinicians, such as stable CAD, ACS, dilated cardiomyopathy, heart failure, valvular disease, atrial fibrillation, ventricular arrythmia, sudden cardiac death, etc. The common denominator of these patients is that they all fail GDMT. This Special Issue covers topics including risk stratification tools, diagnostic modalities, and personalized short- and long-term preventive and therapeutic strategies. By highlighting the mechanism of disease and its reversal as a management tactic, this Special Issue will enable clinicians at the frontline to present their new, innovative clinical decision-making processes and cutting-edge treatment modalities for CV patients beyond GDMT

Dr. Thach N. Nguyen
Dr. C Michael Gibson
Guest Editors

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