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Commencing Volume 19, Issue 1, MedReviews has ceased the publication of this journal. Reviews in Cardiovascular Medicine will continue to be published by IMRPress, Ltd. (www.imrpress.org)

Volume 6, No 1 - Winter 2005

Volume 6, No 1 - Winter 2005

Table of Contents

The Deady Triangle of Anemia, Renal Insufficiency, and Cardiovascular Disease: Implications for Prognosis and Treatment
Recently there has been considerable interest in the associations between blood hemoglobin (Hb) level, renal function, and cardiovascular disease. Anemia is a common feature of end-stage renal disease, but it also accompanies lesser degrees of chronic kidney disease (CKD). The degree of anemia roughly approximates the severity of CKD. Anemia seen in diabetes has been linked to diabetic nephropathy; however, diabetes itself affects the hematologic system in several ways. Anemia is associated with left ventricular hypertrophy, cardiovascular morbidity, progressive loss of kidney function, and poor quality of life. Anemia seems to act as a mortality multiplier; that is, at every decrease in Hb below 12 g/dL, mortality increases in patients with CKD, cardiovascular disease, and those with both. Unlike blood transfusion, treatment of anemia with exogenous erythropoietin in patients with cardiorenal disease has shown promise in reducing morbidity and in improving survival and quality of life. Increasing the Hb level from less than 10 g/dL to 12 g/dL has resulted in favorable changes in left ventricular remodeling, improved ejection fraction, improved functional classification, and higher levels of peak oxygen consumption with exercise testing. Clinical trials are underway to test the role of erythropoietin in patients with CKD and in patients with heart failure. [Rev Cardiovasc Med. 2005;6(1):1-10]
The Emerging Role of Percutaneous Intervention in Adults with Congenital Heart Disease
Adults with congenital heart disease (CHD) constitute a patient population that has grown rapidly, due to advances in diagnosis and treatment of children with CHD. Though ideally served by cardiologists with advanced training in congenital conditions, adults with CHD often receive the majority of their care from primary care physicians and general cardiologists. These patients often have unique clinical presentations. An understanding of available therapeutic modalities can assist clinicians in the timing of subspecialty referral. This review focuses on the unique challenges of cardiac catheterization and the role of percutaneous interventions in adults with CHD. [Rev Cardiovasc Med. 2005;6(1):11-22]
Aortic Stenosis: Physics and Physiology - What Do the Numbers Really Mean?
Cardiac catheterization and Doppler echocardiography are two methods used to measure transvalvular gradients and valve area in the assessment of aortic stenosis severity. Although both approaches are based on the same hemodynamic concepts and report data using the same units of measure, each method measures pressure drop or gradient at a different place; hence they produce fundamentally different quantities. Likewise, cardiac catheterization formulas for valve area attempt to obtain the anatomic area whereas the Doppler continuity equation reports the area to which flow is constricted. To use these two methods appropriately, it is necessary to understand the underlying hemodynamic principles and the effects of the methods of measurement on the values obtained. This article examines these variables and shows how they affect the reported gradients and valve areas and how differences can affect clinical application. [Rev Cardiovasc Med. 2005;6(1)23-32]
The Emerging Use of 16- and 64-Slice Computed Tomography Coronary Angiography in Clinical Cardiovascular Practice
Multi-slice computed tomography (MSCT) coronary angiography is an imaging modality that can identify patients with both soft and hard plaque, supplementing the information gleaned from an ordinary coronary calcium scan and classic riskfactor assessment. Clinicians now have the tools to identify the presence of coronary artery disease (CAD) in the presymptomatic phase, as well as those needed to help identify the etiology of pain syndromes in patients presenting with atypical or obscure symptoms and who may be suffering from obstructive CAD, aortic dissection, pulmonary emboli, or other pathologic processes. There is considerable training and practice involved in developing the skills necessary to convert raw information from a CT scanner to optimal diagnostic images; however, MSCT provides important diagnostic information in a faster, less expensive, more patient-friendly, and safer manner than conventional coronary angiography. The following 2 cases describe the use of MSCT coronary angiography in patients with atypical symptoms and exemplify the use of this technology in a clinical setting. [Rev Cardiovasc Med. 2005;6(1):47-53]