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Volume 13, No 2 & 3 - 2012

Volume 13, No 2 & 3 - 2012

Table of Contents

Biventricular Pacing in Normal Hearts Treatment and Management Update
For more than half a century, pacemakers have proven to be one of the most successful medical interventions. In an effort to approximate normal cardiac physiology, pacemakers have evolved from simple to highly sophisticated devices. There is a growing demand, not only to improve overall mortality and safety in patients with existing devices, but also to improve patient quality of life. With growing evidence of left ventricular dysfunction and desychronization due to prolonged right ventricle apex (RVA) pacing, alternative ways to avoid excessive RVA pacing have been devised. In the pursuit of providing safe long-term pacing, biventricular pacing is emerging as an attractive option. [ Rev Cardiovasc Med. 2012;13(2/3):e53-e61 doi: 10.3909/ricm0601] © 2012 MedReviews®, LLC
Contribution of Right Ventricular Dysfunction to Heart Failure Mortality: A Meta-Analysis Disease State Review: Statistical Update
Right ventricular systolic dysfunction (RVSD) has been related to prognosis in patients with heart failure (HF) and/or left ventricular systolic dysfunction. However, most of the studies addressing this issue are not large enough, have different inclusion criteria, and use different methods to evaluate RV function to draw definite conclusions. We sought to investigate the association between RVSD and outcomes in patients with left ventricular dysfunction. Eleven studies of 40 (27.5%), with 4732 patients, were included in the meta-analysis. RVSD was present in 2234 patients (47.2%). Four of the studies had admission for HF as an endpoint. We found a significant association between RVSD and overall mortality with significant between-studies heterogeneity and presence of publication bias (funnel plot). A significant association was found between RVSD and admission for HF. RVSD is associated with overall mortality and admission for HF during follow-up. Significant between-studies heterogeneity and publication bias must be taken into account when interpreting this information. [ Rev Cardiovasc Med. 2012;13(2/3):e62-e69 doi: 10.3909/ricm0602] © 2012 MedReviews®, LLC
The Biochemical Aspects of a Non–ST-Segment Elevation Acute Coronary Syndrome Management Update
The clinical course of an acute coronary syndrome can vary from relatively benign to potentially fatal. The biomarkers of myocardial necrosis relate to the amount of myocardial damage and are closely linked to a patient’s prognosis. They are measured to help guide management decisions. Recent interest in myocardial neurohumoral mechanisms has identified the natriuretic peptides as strong prognostic biomarkers following an ischemic event. During an acute event they provide information regarding the area of myocardium at risk. The biomarkers of inflammation, such as C-reactive protein, are related to both the development of atherosclerosis and the risk of acute ischemic events. The mechanism characterizing the pathophysiology of the syndrome is represented by these cardiac biomarkers. Assessing combinations of pathobiologically diverse biomarkers may provide a better risk evaluation method and further dictate subsequent therapy. [ Rev Cardiovasc Med. 2012;13(2/3):e70-e76 doi: 10.3909/ricm0607] © 2012 MedReviews®, LLC
Management of Blood Glucose in Patients With Acute Coronary Syndromes Management Update
Hyperglycemia during admission for acute myocardial infarction (MI) is common and associated with poor outcomes. Prior studies employed two distinct approaches to improve outcomes in patients with acute MI—one focused on glucose control, and the other on provision of glucose, insulin, and potassium. However, despite multiple large-scale studies, the benefits of glucose lowering in the setting of acute MI remain unclear. This article reviews data from observational studies and clinical trials and synthesizes this information into practical recommendations based on available evidence. [Rev Cardiovasc Med. 2012;13(2/3):e77-e88 doi: 10.3909/ricm0615] © 2012 MedReviews®, LLC
Infective Endocarditis: A Comprehensive Overview Disease State Review
Infective endocarditis (IE) is an infection of a heart valve or other cardiac structure at a site of endothelial damage. The definition has been also expanded to include infected cardiac devices. A variety of organ systems may be adversely affected in patients with IE. Although advances have improved the diagnostic accuracy for IE, morbidity and mortality remain remarkably high. This article reviews the pathophysiology, complications, diagnosis, and management of IE with recent updates to the literature and the major cardiovascular society guidelines. The increasingly prevalent clinical problem of intracardiac device-related IE is addressed, along with the recent changes to the IE prophylaxis guidelines. [ Rev Cardiovasc Med. 2012;13(2/3): e105-e120 doi: 10.3909/ricm0633] © 2012 MedReviews®, LLC
California ACC Goals
[ Rev Cardiovasc Med. 2012;13(2/3): e121-e123 doi: 10.3909/ricm0662] © 2012 MedReviews®, LLC
Determinants and Functional Significance of Myocardial Perfusion Reserve in Severe Aortic Stenosis Cardiac Magnetic Resonance Imaging
[ Rev Cardiovasc Med. 2012;13(2/3):e137-e138 doi 10.3909/ricm0660] © 2012 MedReviews®, LLC