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Volume 16, No 2 - 2015

Volume 16, No 2 - 2015

Table of Contents

Natriuretic Peptides and the Management of Heart Failure Management Update
Natriuretic peptide has been validated as a useful biomarker in the diagnosis of heart failure, although its role in guiding medical management of heart failure is not well established. We endeavored to determine if natriuretic peptide–guided therapy is associated with improved outcomes for heart failure patients. A total of 11 trials (2628 patients) comparing natriuretic peptide–guided therapy with standard therapy for heart failure patients were identified; follow-up times ranged from 3 months to 3 years. Our data indicate that natriuretic peptide levels and all-cause mortality rates do not appear to benefit from natriuretic peptide–guided therapy when compared with standard therapy. However, a decreased rate of cardiovascular events does appear to be associated with natriuretic peptide–guided therapy. [Rev Cardiovasc Med. 2015;16(2):95-104 doi: 10.3909/ricm0736] © 2015 MedReviews®, LLC
Management of Patients With Stable Angina and Type 2 Diabetes
Type 2 diabetes (T2D) is a well-established risk factor for patients with coronary artery disease (CAD). Patients with CAD and comorbid T2D also have a higher risk of cardiovascular complications, such as silent ischemia and stable angina. In treating the symptoms of stable angina in patients with CAD and comorbid T2D, it is vital to utilize therapies that reduce symptoms and improve outcomes. At the same time, there is significant concern about the preservation of glycometabolic parameters, such as glycosylated hemoglobin (HbA1c), particularly because some antianginal therapies, such as α-blockers and calcium channel blockers—although effective at improving the symptoms of stable angina and reducing ischemia—may also worsen glycemic control by increasing HbA1c levels. Available trial data on the efficacy of antianginal agents in patients with stable angina and comorbid T2D are limited. Therefore, in patients with stable angina and T2D, a tailored approach to treatment of stable angina by selecting therapies with a neutral or positive glycometabolic profile may improve outcomes and increase treatment compliance. Additionally, patients with a dual diagnosis may benefit from therapies that have beneficial effects on both stable angina and T2D, thereby reducing polypharmacy. Prospective studies in patients with stable angina and T2D are needed to guide therapy decisions. [Rev Cardiovasc Med. 2015;16(2):105-113 doi: 10.3909/ricm0742] © 2015 MedReviews®, LLC
Renal Denervation: Past, Present, and Future
Hypertension remains a leading cause of cardiovascular morbidity and mortality worldwide. It is estimated that 12.8% of hypertensive adults have resistant hypertension. The sympathetic nervous system is a well-known contributor to the pathophysiology of resistant hypertension. Renal denervation has emerged as an effective procedure to treat resistant hypertension by blocking the sympathetic nervous system. The medical device industry has developed various catheters in an effort to achieve better denervation in the absence of available testing to document adequate denervation. By adding a sham control group to the study design, researchers found that the results of the Renal Denervation in Patients With Uncontrolled Hypertension study (SYMPLICITY HTN-3) showed that renal denervation was not superior to placebo in decreasing systolic blood pressure. Although SYMPLICITY HTN-3 successfully addressed many issues that might have biased the previously published data, incomplete denervation caused by limited operator experience, catheter design, and the radiofrequency ablation technology may have accounted for the discrepancy of the results. This, along with differences in the study design and population, should direct future renal denervation studies. This article reviews the available literature and proposes future directions for renal denervation studies. It also provides a detailed comparison of the available catheters and their respective clinical data. [Rev Cardiovasc Med. 2015;16(2):114-124 doi: 10.3909/ricm0755] © 2015 MedReviews®, LLC
Implementation of the 2013 American College of Cardiology/American Heart Association Blood Cholesterol Guideline Including Data From the Improved Reduction of Outcomes: Vytorin Efficacy International
Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in developed countries. The management of blood cholesterol through use of 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors (statins) in at-risk patients is a pillar of medical therapy for the primary and secondary prevention of cardiovascular disease. The recent 2013 American College of Cardiology/American Heart Association guideline on managing blood cholesterol provides an important framework for the effective implementation of risk-reduction strategies. The guideline identifies four cohorts of patients with proven benefits from statin therapy and streamlines the dosing and monitoring recommendations based on evidence from published, randomized controlled trials. Primary care physicians and cardiologists play key roles in identifying populations at elevated ASCVD risk. In providing a practical management overview of the current blood cholesterol guideline, we facilitate more informed discussions on treatment options between healthcare providers and their patients. [Rev Cardiovasc Med. 2015;16(2):125-130 doi: 10.3909/ricm0762] © 2015 MedReviews®, LLC
Three-Dimensional Angle Assessment and Plaque Distribution Classification in Left Main Disease: Impact of Geometry on Outcome Classification Update
Bifurcation geometry and plaque distribution in a diseased left main artery (LM) have the potential to drive operators’ decisions regarding treatment strategies, techniques, and material selection. The three-dimensional (3D) geometry of the LM bifurcation typically results in specific patterns of plaque distribution. Plaque distribution may, in turn, significantly affect the procedural and long-term clinical and angiographic outcomes of LM percutaneous coronary intervention. Each LM bifurcation must be treated according to its unique anatomic and pathologic characteristics. Novel classification schemes of plaque distribution and 3D assessment may be valuable aids to obtaining a working picture of the bifurcation geometry. [Rev Cardiovasc Med. 2015;16(2):131-139 doi: 10.3909/ricm0763] © 2015 MedReviews®, LLC
Novel Agents for the Prevention and Management of Hyperkalemia Management Update
Hyperkalemia is defined as serum potassium concentrations elevated above the upper limit of normal (> 5.0 mEq/L). It has become more common in cardiovascular practice due to the growing population of patients with chronic kidney disease and the broad application of drugs that modulate renal elimination of potassium by reducing production of angiotensin II (angiotensin-converting enzyme inhibitors, direct renin inhibitors, b-adrenergic receptor antagonists), blocking angiotensin II receptors (angiotensin receptor blockers), or antagonizing the action of aldosterone on mineralocorticoid receptors (mineralocorticoid receptor antagonists). The risk of hyperkalemia is a major limiting factor for the use of these disease-modifying drugs in both acute and chronic cardiorenal syndromes. Thus, agents to control the plasma concentration of potassium are needed in the multidrug treatment of cardiorenal disease, including chronic kidney disease, heart failure, and acute kidney injury. Novel oral therapies in development for both acute and extended use in the management of hyperkalemia include patiromer sorbitex calcium and sodium zirconium cyclosilicate. Important biochemical differences between these compounds result in unique product profiles and electrolyte outcomes in patients treated for hyperkalemia. This review highlights the major mechanisms of hyperkalemia and key results from randomized trials in a range of clinical scenarios in patients with, and at risk for, hyperkalemia. [Rev Cardiovasc Med. 2015;16(2):140-155 doi: 10.3909/ricm0782] © 2015 MedReviews®, LLC
Home Telemedicine in Heart Failure: A Pilot Study of Integrated Telemonitoring and Virtual Provider Appointments
Congestive heart failure is a significant cause of hospitalization, rehospitalization, and death. Reducing hospital readmission rates is a national priority. Various telemonitoring devices and programs have been developed to help meet this goal. The Health Connect system incorporates monitoring of physiologic data with regular virtual provider appointments. The Health Connect system integrates traditional telemedicine with virtual provider appointments. Virtual appointments empower patients to advocate for their own health by providing numerous opportunities for education and feedback. In addition to early identification of impending decompensation, virtual appointments allow providers to address noncompliance, which is a major factor driving poor outcomes. Further research is required to confirm the benefit of the Health Connect system. [Rev Cardiovasc Med. 2015;16(2):156-162 doi: 10.3909/ricm0760] © 2015 MedReviews®, LLC
Update From the California Chapter of The American College of Cardiology
[Rev Cardiovasc Med. 2015;16(2):163-164 doi: 10.3909/ricm16-2CAACC] © 2015 MedReviews®, LLC
Silk Suture Embolization for Sealing Distal Coronary Artery Perforation: Report of Two Cases
Coronary artery perforation (CAP) is an infrequent yet potentially life-threatening complication of percutaneous coronary intervention. We report, for the first time, two cases of successful closure of guidewire-induced distal CAP with silk suture embolization using a microcatheter. This technique appears to be safe, simple, and effective for the treatment of distal guidewire perforations, even in refractory cases. [Rev Cardiovasc Med. 2015;16(2):165-169 doi: 10.3909/ricm0768] © 2015 MedReviews®, LLC