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Volume 12, No 1 - 2011

Volume 12, No 1 - 2011

Table of Contents

The Influence of CYP2C19 Polymorphisms on the Pharmacokinetics, Pharmacodynamics, and Clinical Effectiveness of P2Y12 Inhibitors Management Update
P2Y12 antagonists, in combination with aspirin, significantly reduce thrombotic and ischemic events in patients presenting with an acute coronary syndrome and in patients undergoing percutaneous coronary intervention. The thienopyridine clopidogrel is a prodrug that requires bioactivation by the cytochrome P450 (CYP) system in order to exert its antiplatelet effect. Common genetic polymorphisms that reduce the catalytic activity of the CYP2C19 isoenzyme decrease circulating levels of active metabolite, reduce levels of platelet inhibition, and increase the risk of ischemic events in clopidogrel-treated patients. Herein, we review the impact of the CYP2C19 genotype on the pharmacokinetics and pharmacodynamics of clopidogrel, the association between CYP2C19 genotype and clinical outcome, and present the rationale for the implementation of CYP2C19 genotyping to individualize antiplatelet therapy in clinical practice. [Rev Cardiovasc Med. 2011;12(1):1-12 doi: 10.3909/ricm0590]
Dialysis-Induced Myocardial Stunning: The Other Side of the Cardiorenal Syndrome Treatment Update
Cardiorenal syndrome is an umbrella term describing the range of interactions between the heart and kidneys. Commonly, this focuses on the potential for reduced renal function as a consequence of heart disease and the impact of reduced renal functional reserve on the heart. Importantly, these interactions include both consequences of the disease state and those arising from therapeutic interventions directed at the cardiorenal axis. This article focuses on the potential impact of dialysis treatment, which generates intermittent circulatory stress and results in both acute and chronic adverse cardiovascular effects. This largely unappreciated dimension of the cardiorenal interaction in patients with end-stage renal failure is common, associated with a significant increase in mortality, and may be amenable to a variety of therapeutic approaches in this population characterized by particularly significant clinical management challenges. [Rev Cardiovasc Med. 2011;12(1):13-20 doi: 10.3909/ricm0585]
The Role of Oxidative Stress in the Metabolic Syndrome Disease State Review
Loss of reduction-oxidation (redox) homeostasis and generation of excess free oxygen radicals play an important role in the pathogenesis of diabetes, hypertension, and consequent cardiovascular disease. Reactive oxygen species are integral in routine in physiologic mechanisms. However, loss of redox homeostasis contributes to proinflammatory and profibrotic pathways that promote impairments in insulin metabolic signaling, reduced endothelial-mediated vasorelaxation, and associated cardiovascular and renal structural and functional abnormalities. Redox control of metabolic function is a dynamic process with reversible pro- and anti-free radical processes. Labile iron is necessary for the catalysis of superoxide anion, hydrogen peroxide, and the generation of the damaging hydroxyl radical. Acute hypoxia and cellular damage in cardiovascular tissue liberate larger amounts of cytosolic and extracellular iron that is poorly liganded; thus, large increases in the generation of oxygen free radicals are possible, causing tissue damage. The understanding of iron and the imbalance of redox homeostasis within the vasculature is integral in hypertension and progression of metabolic dysregulation that contributes to insulin resistance, endothelial dysfunction, and cardiovascular and kidney disease. [Rev Cardiovasc Med. 2011;12(1):21-29 doi: 10.3909/ricm0555]
Statin Therapy in the Perioperative Period Treatment Update
Statins are frequently used as chronic therapy for reducing cardiovascular mortality and morbidity, but there has been less emphasis on the role of statins in the perioperative period. This review evaluates data regarding statin use in vascular and noncardiac surgery, the use of statins in combination with _-blockers in the perioperative period, perioperative statin use in patients already treated with statins, and the safety of statin therapy in the perioperative period. Current recommendations state that patients who are prescribed statins as chronic therapy should continue treatment in the perioperative period, but data suggest that there may be benefit from the use of perioperative statins in a wider population. [Rev Cardiovasc Med. 2011;12(1):30-37 doi: 10.3909/ricm0552]
Heart House: Report From the ACC Leadership Forum and Board of Governors Meeting CA ACC News
[Rev Cardiovasc Med. 2011;12(1):38 doi: 10.3909/ricm0591a]
Heart Failure Readmission Rates CA ACC News
[Rev Cardiovasc Med. 2011;12(1):40-41 doi: 10.3909/ricm0591c]
Insights Into Endovascular Revascularization in Limb Salvage Procedures: "Antegrade-Retrograde" Technique in Chronic Total Occlusion Case Review
Significant occlusions of the peripheral arterial circulation, responsible for chronic limb ischemia (CLI), are a serious cause of morbidity, mortality, and poor quality of life. The currently available treatment options for patients with severely symptomatic CLI include bypass surgery and arterial revascularization. Percutaneous transluminal angioplasty for CLI is shown to be as effective as bypass surgery at high-volume centers, and it also offers a less invasive alternative, leading to quicker patient recovery times and lower short-term costs. This case report reviews the current techniques available and discusses an ?antegrade-retrograde? angioplasty approach to successfully recanalize such challenging obstructions. [Rev Cardiovasc Med. 2011;12(1):42-47 doi: 10.3909/ricm0553]
Left Ventricular Outflow Tract Obstruction After Bioprosthetic Mitral Valve Replacement With Preservation of the Anterior Leaflet Case Review
A 79-year-old woman with a history of bioprosthetic aortic and mitral valve replacement with coronary artery bypass graft surgery presented with pulmonary edema 4 years after surgery. Transthoracic echocardiography and transesophageal echocardiography revealed an obstruction of the left ventricular outflow tract caused by the bioprosthetic mitral valve. We present this case, accompanied by a review of the literature. [Rev Cardiovasc Med. 2011;12(1):48-51 doi: 10.3909/ricm0556]
Cardiac Magnetic Resonance Imaging News and Views From the Literature
[Rev Cardiovasc Med. 2011;12(1):52-54 doi: 10.3909/ricm0569]