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Volume 15, No 4 - 2014

Volume 15, No 4 - 2014

Table of Contents

Noninvasive Risk Stratification for Sudden Death in Asymptomatic Patients With Wolff-Parkinson-White Syndrome Management Update
Sudden cardiac death (SCD) as the first clinical manifestation of Wolff-Parkinson-White (WPW) syndrome is a well-documented, although rare occurrence. The incidence of SCD in patients with WPW ranges from 0% to 0.39% annually. Controversy exists regarding risk stratification for patients with preexcitation on surface electrocardiogram (ECG), particularly in those who are asymptomatic. This article focuses on the role of risk stratification using exercise and pharmacologic testing in patients with WPW pattern on ECG. [Rev Cardiovasc Med. 2014;15(4):283-289 doi: 10.3909/ricm0717] © 2015 MedReviews®, LLC
The Potential Role of Anti-PCSK9 Monoclonal Antibodies in the Management of Hypercholesterolemia CME-certified Article
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death and disability in developed nations, and it is rising rapidly in other parts of the developing world. Levels of low-density lipoprotein cholesterol (LDL-C) are directly correlated with atherogenic risk, and statin-based therapy is the most common management for these patients. However, many patients exhibit resistance to and/or adverse effects from statin therapy, and there is a need for adjunctive therapies or statin alternatives for these patients. The recently discovered human protein proprotein convertase subtilisin/kexin type 9 (PCSK9) plays an important role in LDL-C metabolism. PCSK9 promotes LDL receptor (LDL-R) degradation with a consequent reduction in LDL-R density and an increase in LDL-C levels. Consequently, PCSK9 inhibition to reduce LDL-C levels has become a primary focus for drug development. Numerous clinical trials focusing on monoclonal antibodies against PCSK9 have demonstrated efficacy equal to or greater than statin therapy for lowering LDL-C levels. Long-term trials are underway to assess safety, tolerability, and ability to reduce ASCVD. [Rev Cardiovasc Med. 2014;15(4):290-309 doi: 10.3909/ricm0773] © 2015 MedReviews®, LLC
Advanced Lipid Testing: When, Why, and In Whom? CME-certified Article
Atherosclerotic cardiovascular disease is a leading cause of morbidity and mortality in developed countries. The management of blood cholesterol with the use of statin drugs in at-risk patients is a pillar of medical therapy for the primary and secondary prevention of cardiovascular disease. Although the standard lipid panel is adequate to accurately assess cardiovascular disease risk in most patients, there are some situations in which conventional cholesterol testing does not fully identify cardiovascular risk or reflect disease progression. A number of advanced lipid tests can assist the clinician when assessing a patient’s cardiovascular disease risk, including measurement of low-density lipoprotein particle number. [Rev Cardiovasc Med. 2014;15(4):310-319 doi: 10.3909/ricm0775] © 2015 MedReviews®, LLC
Why Currently Used Diagnostic Techniques for Heart Failure in Rheumatoid Arthritis Are Not Enough: The Challenge of Cardiovascular Magnetic Resonance Imaging Diagnostic Update
Rheumatoid arthritis (RA) is a multiorgan inflammatory disorder affecting approximately 1% of the population that leads to progressive joint destruction and disability. Patients with RA exhibit a high risk of cardiovascular disease, which results in premature morbidity and mortality and reduced life expectancy, when compared with the general population. Among various guises of myocardial involvement, heart failure (HF) has been recently recognized as an important contributory factor to the excess cardiovascular mortality associated with RA. HF in RA typically presents with occult clinical symptomatology and is mainly associated with structural and functional left ventricular abnormalities leading to diastolic dysfunction, while systolic myocardial performance remains well preserved. As isolated diastolic dysfunction is a predictor of high mortality, the evaluation of patients in early asymptomatic stages, when treatment targeting the heart is more likely to be effective, is of great importance. Although patient history and physical examination remain the cornerstones of HF evaluation, noninvasive imaging of cardiac chambers, coronary arteries, and great vessels may be necessary. Echocardiography, nuclear techniques, and invasive coronary angiography are already established in the routine assessment of HF; however, many aspects of HF pathophysiology in RA remain obscure, due to the limitations of currently used techniques. The capability of cardiovascular magnetic resonance (CMR) to capture early tissue changes allows timely detection of pathophysiologic phenomena of HF in RA, such as myocardial inflammation and myocardial perfusion defects, due to either macrovascular (coronary artery disease) or microvascular (vasculitis) disease. Therefore, CMR may be a useful tool for early, accurate diagnosis and research in patients with RA. [Rev Cardiovasc Med. 2014;15(4):320-331 doi: 10.3909/ricm0724] © 2015 MedReviews®, LLC
Evaluation of Prosthetic Valve Dysfunction With the Use of Echocardiography Diagnostic Update
Prosthetic heart valves (PHVs) are classified as either mechanical or biological. Each valve type has its own risk-to-benefit ratio, unique hemodynamic profile, and Doppler findings, which are also affected by the valve size and the patient’s body surface area. Transthoracic echocardiography, along with two- and three-dimensional transesophageal echocardiography, including color and spectral Doppler, are each important for the comprehensive evaluation of PHVs and to identify the presence and mechanism of valve dysfunction. [Rev Cardiovasc Med. 2014;15(4):332-350 doi: 10.3909/ricm0747] © 2015 MedReviews®, LLC
Renal Denervation: Current Status and Future Applications Treatment Update
Despite the variety of antihypertensive agents that are available, resistant hypertension remains a significant clinical problem and a substantial economic burden. Over the past several years, renal sympathetic denervation has been introduced as a potential therapeutic option for this clinical problem. It is a catheter-based procedure that is showing promising results and appears to be associated with minimal or low risk. Thus far, two completed clinical trials have demonstrated excellent safety and encouraging outcomes. A review of these trials is the focus of this article, in addition to the analysis of ongoing studies, and the possible future applications of this technique. [Rev Cardiovasc Med. 2014;15(4):351-357 doi: 10.3909/ricm0720] © 2015 MedReviews®, LLC
Painful Palpitations: Chest Pain Associated With Postextrasystolic ST Depression
Postextrasystolic T-wave changes have been described as early as 1915. The significance and mechanism of such changes remain controversial. Because postextrasystolic ST changes are rare, much of the ensuing discussion concentrates on the closely related and more commonly reported phenomenon of postextrasystolic T-wave inversion. This report documents the case of a 67-year-old man with a history of coronary artery disease who was admitted to the hospital with chest pain. [Rev Cardiovasc Med. 2014;15(4):358-361 doi: 10.3909/ricm0743] © 2015 MedReviews®, LLC
News and Views From the Literature Coronary Heart Disease
[Rev Cardiovasc Med. 2014;15(4):362-363 doi 10.3909/ricm0756] © 2015 MedReviews®, LLC