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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.com)

Volume 9  No 4 - Fall 2008

Volume 9 No 4 - Fall 2008

Table of Contents

Optimizing Outcomes in Coronary CT Imaging Diagnostic Update
Cardiac computed tomographic angiography (CCTA) is revolutionizing our approach to the identification and management of coronary artery atherosclerosis. CCTA has the unique ability to assess extracoronary cardiac findings within the standard field of view, including the anatomy of cardiac structures—the atria, ventricles, valves, pericardium, great vessels, and venous anatomy—and any related abnormalities. Appropriate clinical applications include evaluation of intermediate-risk patients with acute chest pain and those with suspected coronary anomalies, uninterpretable or equivocal stress test results, or suspected cardiac morphologic abnormalities. Optimization of this diagnostic examination requires close attention to details such as minimizing motion and attaining sufficient contrast opacification. Iso-osmolar contrast can help achieve maximum patient comfort with the smallest elevation of heart rate and variability, as well as minimize the risk of acute kidney injury. Newer scanning equipment and protocols have improved image quality in difficult cases, including obese patients and those with heavy coronary calcification or metal artifacts. Current imaging protocols have reduced exposure to ionizing radiation and continue to improve safety. [Rev Cardiovasc Med. 2008;9(4):215-224]
Assessment of Myocardial Viability: Review of the Clinical Significance Diagnostic Update
The identification of myocardial viability in patients with coronary artery disease and left ventricular dysfunction (LVD) has important clinical and prognostic implications. Two terms commonly used to define clinical conditions of potentially reversible contractile dysfunction are stunned myocardium and hibernating myocardium. Stunned myocardium refers to transient depression of contractile function secondary to an acute ischemic insult. Hibernating myocardium is a form of contractile dysfunction of living myocytes in the setting of chronic ischemia or chronically reduced flow reserve. Numerous observational studies have shown improved clinical outcomes after revascularization of patients with LVD and evidence of myocardial viability, although patients with nonviable myocardium have not been shown to have the same benefits. The use of noninvasive techniques to determine myocardial viability provides important information to guide clinicians in deciding which patients with LVD are likely to receive benefit from a revascularization procedure. Positron emission tomography, single-photon emission computed tomography, dobutamine echocardiography, and cardiac magnetic resonance imaging each have advantages and limitations. [Rev Cardiovasc Med. 2008;9(4):225-231]
Magnetic Resonance Imaging in Patients With Implantable Cardiac Devices Diagnostic Update
The use of magnetic resonance imaging (MRI) in patients with implantable cardiac devices, such as pacemakers, cardioverter defibrillators, and loop recorders, has been contraindicated based on concerns regarding the powerful magnetic field generated by MRI. Due to the widespread application and powerful diagnostic capability of MRI, there are instances in which denying a patient with an implantable cardiac device an MRI evaluation may influence the quality of health care received. There are data to suggest that MRI might be considered a relative contraindication instead of an absolute contraindication in device patients when precautions are taken by experienced physicians to lower the risk of adverse events. Despite the potential concerns, several hundred non–pacemaker-dependent patients and several pacemaker-dependent patients have undergone MRI without complications while being monitored under a number of different safety protocols. Various strategies have been used to minimize the risk of performing MRI procedures in device patients. Patient selection must be rigorous and made on a case-by-case basis. [Rev Cardiovasc Med. 2008;9(4):232-238]
The Importance of Recognizing and Treating Low Levels of High-Density Lipoprotein Cholesterol: A New Era in Atherosclerosis Management Management Update
Low levels of high-density lipoprotein cholesterol (HDL-C) represent a major cardiovascular risk factor, with a stronger relationship to coronary heart disease than that seen with elevated levels of low-density lipoprotein cholesterol (LDL-C). HDL-C has important antiatherogenic effects, including reverse cholesterol transport, inhibition of LDL-C oxidation, and antiplatelet and anti-inflammatory actions. Patients with low HDL-C are also at an amplified risk of coronary heart disease due to the common coexistence of other risk factors, including excess adiposity, metabolic syndrome, type 2 diabetes mellitus, hypertriglyceridemia, and the atherogenic dyslipidemia characterized by small dense LDL-C. First-line therapy of low HDL-C generally consists of nonpharmacologic measures such as improved fitness and weight loss. Current pharmaceutical options include statins, fibrates, and nicotinic acid. A host of novel approaches involving HDL-C and reverse cholesterol transport hold the promise of fundamentally changing the natural history of atherosclerosis, the most common and important chronic disease in humans. [Rev Cardiovasc Med. 2008;9(4):239-258]
The Athlete’s Heart: Prevention of Sudden Cardiac Death CA ACC Review
[Rev Cardiovasc Med. 2008;9(4):259-260]
Best of the ESC Congress 2008 Meeting Review
Highlights From the European Society of Cardiology Congress, August 30-September 3, 2008, Munich, Germany [Rev Cardiovasc Med. 2008;9(4):261-268]
TCT 2008: New Data Lead to New Directions in Treating Cardiovascular Disease Meeting Review
Highlights From the 20th Annual Transcatheter Cardiovascular Therapeutics Symposium, October 12-17, 2008, Washington, DC [Rev Cardiovasc Med. 2008;9(4):269-274]
Symptomatic Metastatic Right Atrial Lymphoma in a Patient With AIDS Presenting With Pulmonary Embolization Case Review
Tumors involving the heart are rare, and the majority of them are benign. Secondary lymphoma with localization to the heart is the third most common malignant heart tumor and is more common, by far, than primary cardiac lymphomas. In patients with human immunodeficiency virus, the risk of development of systemic lymphoma is 60 to 200 times higher than in the general population. Symptoms usually consist of chest pain and dyspnea. Patients can also present with obstructive symptoms, based on the location and size of the tumor, and signs such as elevated jugular venous pressure, peripheral edema, ascites, and hepatomegaly. Transthoracic echocardiography is the initial modality of choice for diagnosis of cardiac lymphomas because it is readily available and helps localize the tumor, but transesophageal echocardiography and magnetic resonance imaging remain the best tests for evaluation. Treatment consists primarily of chemotherapy, and anticoagulation can be used in certain cases where embolization of the tumor is likely. This case review describes a 37-year-old man with past medical history significant for herpes zoster and stage 1 syphilis who presented with complaints of weight loss, intermittent fevers, and vague chest pains of 1-month duration. [Rev Cardiovasc Med. 2008;9(4):275-279]
Percutaneous Coronary Intervention Reviewing the Literature
[Rev Cardiovasc Med. 2008;9(4):280-282]