Catheterization and Cardiovascular Interventions, 2003
The present study prospectively evaluated adjunctive antiplatelet therapy in patients without ins... more The present study prospectively evaluated adjunctive antiplatelet therapy in patients without insulin-requiring diabetes during elective coronary stenting. Three hundred patients were randomized to one of three treatment groups: clopidogrel pretreatment, adjunctive abciximab, or control. Stenting was successful in 98% and no deaths occurred. Thirty-day and 1-year major adverse coronary events (MACEs) was similar in all groups. A subgroup of 109 patients undergoing single-vessel stenting of type A/B1 lesions with short guidewire times had no postprocedure myocardial infarction or 30-day MACE. We conclude that patients with these characteristics may safely undergo elective coronary stenting without adjunctive antiplatelet therapy.
A 33-year-old female with no medical history presents for evaluation of mild exertional chest tig... more A 33-year-old female with no medical history presents for evaluation of mild exertional chest tightness and dyspnea. The patient underwent an exercise electrocardiogram stress test that revealed chest tightness and significant dyspnea on stage 2 of the Bruce protocol with frequent exercise-induced premature ventricular contraction. Her transthoracic echocardiogram was normal. Cardiac catheterization showed the right coronary artery arising from the mid-left anterior descending artery (Fig. 1). No substantial stenosis was noted in any coronary arteries. Coronary computed tomography confirmed an anomalous origin of the right coronary artery from the left anterior descending artery at the midlevel, with a prepulmonic course (Fig. 2 and Fig. 3). The patient was started on metoprolol and experienced complete resolution of symptoms.
Integrating Cardiology for Nuclear Medicine Physicians, 2009
Clinical cardiac electrophysiology is a subspecialty of cardiology dealing with the evaluation an... more Clinical cardiac electrophysiology is a subspecialty of cardiology dealing with the evaluation and management of patients with complex rhythm or conduction abnormalities. In the last four decades, clinical cardiac electrophysiology has evolved into an established discipline credited with improving and saving hundreds of thousands of lives. We briefly review the basic electrophysiologic principles, anatomy of the electric system of the
Integrating Cardiology for Nuclear Medicine Physicians, 2009
Myocardial perfusion imaging (MPI) is widely utilized in the non-invasive diagnosis and managemen... more Myocardial perfusion imaging (MPI) is widely utilized in the non-invasive diagnosis and management of coronary artery disease (CAD). Radionuclide MPI has been well studied in the evaluation, risk stratification and identification of patients with CAD who will benefit from revascularization. Myocardial revascularization using percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG) has become a mainstay in the treatment
Integrating Cardiology for Nuclear Medicine Physicians, 2009
In 1953, Dr. Helmut Hertz of Sweden together with Dr. Inge Edler began to use a commercial ultras... more In 1953, Dr. Helmut Hertz of Sweden together with Dr. Inge Edler began to use a commercial ultrasonoscope to examine the heart, thus starting the era of clinical echocardiography [1]. Echocardiography has become an integral part of clinical cardiology. It is used widely in addition to his-tory ...
Integrating Cardiology for Nuclear Medicine Physicians, 2009
The goals of antiarrhythmic drug therapy are to control heart rate, abolish tachyarrhythmias, sup... more The goals of antiarrhythmic drug therapy are to control heart rate, abolish tachyarrhythmias, suppress ectopic beats, and to restore and maintain normal sinus rhythm. The selection of appropriate agents is a match between the common antiarrhythmic drugs, the condition and age of the patient, the urgency of treatment, the potential long-term side effects, and especially the drug’s proven efficacy on the arrhythmia in question [1]. This chapter will discuss the pharmacokinetics and pharmacodynamics of the commonly utilized and marketed antiarrhythmic drugs.
Integrating Cardiology for Nuclear Medicine Physicians, 2009
Cardiovascular diseases (CVD) have reached epidemic proportions in developed countries, and are t... more Cardiovascular diseases (CVD) have reached epidemic proportions in developed countries, and are the leading cause of morbidity and mortality. An estimated 16.7 million–or 29.2% of total global deaths–result from the various forms of CVD, many of which are preventable ...
This study sought to assess the utility of ultrasound (US) guidance for transradial arterial acce... more This study sought to assess the utility of ultrasound (US) guidance for transradial arterial access. US guidance has been demonstrated to facilitate vascular access, but has not been tested in a multicenter randomized fashion for transradial cardiac catheterization. We conducted a prospective multicenter randomized controlled trial of 698 patients undergoing transradial cardiac catheterization. Patients were randomized to needle insertion with either palpation or real-time US guidance (351 palpation, 347 US). Primary endpoints were the number of forward attempts required for access, first-pass success rate, and time to access. The number of attempts was reduced with US guidance [mean 1.65 ± 1.2 vs. 3.05 ± 3.4, p < 0.0001; median 1 (interquartile range [IQR] 1, 2) vs. 2 (1, 3), p < 0.0001] and the first-pass success rate improved (64.8% vs. 43.9%, p < 0.0001). The time to access was reduced (88 ± 78 vs. 108 ± 112 s, p = 0.006; median 64 [IQR 45, 94] vs. 74 [IQR 49, 120] s, p...
Case history: a 76-year-old African-American female presented to a community hospital with compla... more Case history: a 76-year-old African-American female presented to a community hospital with complaints of chest pain. Her medical history was significant for hypertension, gastroesophageal reflux disease (GERD), hyperlipidemia, and bipolar disorder. On arrival ...
Journal of the American College of Cardiology, 2013
The user has requested enhancement of the downloaded file. major non-CABG related bleeding occurr... more The user has requested enhancement of the downloaded file. major non-CABG related bleeding occurred in one SD patient (GI bleed) and recurrent hospitalization in three patients of SD (6%) vs. one DD patient (2%), p¼0.62. There were no vascular complications. Patient satisfaction scores were equivalent in both groups at all time points. SD was associated with $1,200 savings per patient. Conclusions: Same day discharge after uncomplicated single and multivessel PCI of patients with SA, UA and low risk NSTEMI facilitated by vascular device closure is associated with similar clinical outcomes, patient satisfaction and significant cost savings compared to traditional overnight hospital stay.
Journal of Nuclear Cardiology Cummings, Raza, and Movahed 579 Volume 13, Number 4;576-81 Atrial f... more Journal of Nuclear Cardiology Cummings, Raza, and Movahed 579 Volume 13, Number 4;576-81 Atrial fibrillation during adenosine pharmacologic stress testing
Cardiovascular disease is the leading cause of death in patients aged 65 and above. Although elde... more Cardiovascular disease is the leading cause of death in patients aged 65 and above. Although elderly persons represent only 12.4% of the US population, they account for about a third of drug expenditures. However the appropriate use of cardiovascular medications in these patients has been shown to reduce the rate of cardiovascular morbidity and mortality. The normal aging and the disease process in the elderly result in significant changes at the structural and molecular level in the elderly. The changes that take place in the autonomic nervous system, the kidneys, and the liver in the elderly modify the metabolism and clinical effects of most medications. Elderly patients are also susceptible to side effects and adverse drug reactions. Physicians should have a clear understanding of the normal aging processes, the abnormal changes due to disease process and the changes in the pharmacology of drugs in the elderly to deliver proper care to the elderly patient.
The prevalence of ischemic heart disease (IHD) has been increasing among the women in developed c... more The prevalence of ischemic heart disease (IHD) has been increasing among the women in developed countries. The well recognized IHD excess in men has often obscured the fact that IHD is the leading cause of death in women. Women have atypical symptoms of IHD that lead to a delay in the diagnosis and an overall poor prognosis. Women have a delay in the onset of IHD due to the beneficial effects of their sex hormones. Postmenopausal women lose this beneficial effect of estrogen and undergo significant changes in their lipid profile, arterial pressure, glucose tolerance, and vascular reactivity that increase their risk for development of IHD. Recently there has been considerable interest in the sex hormones and their role in IHD in women. The general belief that hormone replacement therapy (HRT) has an overall beneficial effect on cardiovascular disease (CVD) in women and hence decreases CVD mortality and morbidity has not been shown in the recent multicenter prospective studies. With the availability of various types of estrogen and progestins, physicians prescribing these agents should take into consideration their varying effects on the cardiovascular system. Risk factor modifications should include diet, weight loss, regular exercise, smoking cessation and adequate control of hypertension (HTN), diabetes (DM) and hyperlipidemia. In the appropriate setting, treatment with proven beneficial agents like aspirin, h-blockers, angiotensin converting enzyme (ACE) inhibitors and statins will help decrease the burden of IHD in women. D
Ischemic heart disease is the leading cause of death in the developed countries for those older t... more Ischemic heart disease is the leading cause of death in the developed countries for those older than 65 years of age. In patients suspected to have coronary artery disease a stress test should be performed to identify the vulnerability of the myocardium to ischemia. As a rule of thumb, the evaluation of coronary artery disease is best done by exercise stress test. In patients who are not able to exercise adequately, pharmacological stress agents are used. The commonly used agents are the coronary vasodilators, adenosine and dipyridamole and the catecholamines, dobutamine and arbutamine. These agents are combined with imaging techniques to increase the sensitivity and specificity of the test. These agents have been widely used and have an excellent safety profile. Another advantage in using pharmacological stress agents is that they do not affect the image quality, especially with echocardiography and magnetic resonance imaging. Ongoing developments hold promise for safer and more reliable pharmacological stress agents in the future.
The incidence of diabetes has reached epidemic proportions across the world. In patients with dia... more The incidence of diabetes has reached epidemic proportions across the world. In patients with diabetes, there is a two to four times increased risk of developing coronary artery disease (CAD). Diabetes seems to eliminate the protective benefits of hormones in women against CAD. Patients with type II diabetes also have hypertension, dyslipidemia, obesity, endothelial dysfunction and prothrombotic factors, called 'the metabolic syndrome'. Not only the incidence of CAD is higher in diabetes, the mortality of the diabetic patients after a cardiac event is significantly increased as compared to non-diabetics, including sudden death. Although in the past 35 years there has been a decline in the rate of death due to CAD in the general population, this has not been seen among patients with diabetes. Primary prevention can play an important role in decreasing the incidence of CAD in diabetic patients. Aggressive treatment of hyperlipidemia and hypertension is essential. Recent knowledge about the protective effects of aspirin, statins, angiotension converting enzyme inhibitors, and glitazones in the diabetic patients, if used appropriately will go a long way in primary and secondary prevention of CAD in patients with diabetes.
Cardiovascular disease (CVD) in the developed countries continues to grow at an epidemic proporti... more Cardiovascular disease (CVD) in the developed countries continues to grow at an epidemic proportion. There are a significant number of young adults with no clinical evidence of CVD, but who have two or more risk factors that predispose them to CV events and death. Many of these risk factors are modifiable, and by controlling these factors, the CVD burden can be decreased significantly. Recent statistics have shown that, if all major forms of CVD were eliminated, the life expectancy would rise by almost 7 years. Hence it is imperative that primary prevention efforts should be initiated at a young age to avert decades of unattended risk factors. Hyperlipidemia has been linked to CVD almost a century ago. Since then various clinical trials have not only supported this link, but have also shown the CV benefits in aggressively treating patients with hyperlipidemia. In this generation, we have various therapeutic agents that are capable of reducing the elevated lipid levels. With drugs like statins, we are able to reduce the risk of CVD by about 30% and avoid major adverse events. Newer drugs are being researched and introduced in the treatment of hyperlipidemia in humans. These can be used in combination therapy resulting in optimal levels of lipids. The new National Cholesterol Education Program (NCEP)/Adult Treatment Panel III (ATP III) guidelines have come as a wake-up call to clinicians about primary prevention of CVD through strict lipid management and multifaceted risk management approach in the prevention of CVD. D
Cell transplantation is an innovative technology that involves the implantation of a variety of m... more Cell transplantation is an innovative technology that involves the implantation of a variety of myogenic and angiogenic cell types. The transplanted cells proliferate and augment left ventricular performance and therein ameliorate the heart failure symptoms. The concept of cell transplantation has followed the footsteps of angiogenesis starting as bench side research. The latter half of the decade saw the transformation of this potential mechanism to a promising therapy for ischemic heart failure. More than 150 patients have been treated with cellular transplantation worldwide. This novel application has the potential to revolutionize alternative therapeutic approaches to management of heart failure.
The frequent use of transesophageal echocardiogram (TEE) has led to the increased recognition of ... more The frequent use of transesophageal echocardiogram (TEE) has led to the increased recognition of aortic atheromas. Retrospective and prospective follow-up studies have reported an association between aortic atheromas and stroke in the high-risk patient population, with complex plaques being more likely to embolize than simple plaques. However, TEE-based studies in the low-risk cohorts have failed to show a similar association. There is growing body of evidence suggesting that aortic atheroma is a marker of generalized atherosclerosis. Although magnetic resonance (MR) imaging and computed tomography (CT) scan are emerging as a powerful noninvasive tool for characterization of aortic atheromas, TEE is the imaging modality of choice. Currently, treatment of aortic atheromas is not well defined, and mixed outcomes have been reported for anticoagulation therapy with warfarin. Statins appear promising based on their plaque stabilization properties. However, there are no randomized control trials to establish the role of both anticoagulation and statins in patients with aortic atheromas, and are warranted in the future. (ECHOCARDIOGRAPHY, Volume 25, February 2008) aortic atheroma, mobile components, stroke, thoracic aorta, transesophageal echocardiogram, vascular imaging Stroke is the third leading cause of death in United States, with approximately 40% of them being cryptogenic in etiology. 1 Since the introduction of transesophageal echocardiogram (TEE), aortic atheromatous plaque, also referred to as aortic atheroma, has been suspected to be a hidden source of embolic stroke. It is unclear whether aortic atheroma is a risk factor for stroke, or a risk marker for generalized atherosclerosis, or an innocent bystander. 2 Due to this uncertainty, clinicians face a dilemma in treating patients with aortic atheromas. This review discusses the classification of aortic theromatous plaques, their epidemiology, and the clinical trials that have studied their embolic risk. It also details current diagnostic imaging tools and treatment options.
Catheterization and Cardiovascular Interventions, 2003
The present study prospectively evaluated adjunctive antiplatelet therapy in patients without ins... more The present study prospectively evaluated adjunctive antiplatelet therapy in patients without insulin-requiring diabetes during elective coronary stenting. Three hundred patients were randomized to one of three treatment groups: clopidogrel pretreatment, adjunctive abciximab, or control. Stenting was successful in 98% and no deaths occurred. Thirty-day and 1-year major adverse coronary events (MACEs) was similar in all groups. A subgroup of 109 patients undergoing single-vessel stenting of type A/B1 lesions with short guidewire times had no postprocedure myocardial infarction or 30-day MACE. We conclude that patients with these characteristics may safely undergo elective coronary stenting without adjunctive antiplatelet therapy. Cathet Cardiovasc Intervent 2003;58:459 -466.
Catheterization and Cardiovascular Interventions, 2003
The present study prospectively evaluated adjunctive antiplatelet therapy in patients without ins... more The present study prospectively evaluated adjunctive antiplatelet therapy in patients without insulin-requiring diabetes during elective coronary stenting. Three hundred patients were randomized to one of three treatment groups: clopidogrel pretreatment, adjunctive abciximab, or control. Stenting was successful in 98% and no deaths occurred. Thirty-day and 1-year major adverse coronary events (MACEs) was similar in all groups. A subgroup of 109 patients undergoing single-vessel stenting of type A/B1 lesions with short guidewire times had no postprocedure myocardial infarction or 30-day MACE. We conclude that patients with these characteristics may safely undergo elective coronary stenting without adjunctive antiplatelet therapy.
A 33-year-old female with no medical history presents for evaluation of mild exertional chest tig... more A 33-year-old female with no medical history presents for evaluation of mild exertional chest tightness and dyspnea. The patient underwent an exercise electrocardiogram stress test that revealed chest tightness and significant dyspnea on stage 2 of the Bruce protocol with frequent exercise-induced premature ventricular contraction. Her transthoracic echocardiogram was normal. Cardiac catheterization showed the right coronary artery arising from the mid-left anterior descending artery (Fig. 1). No substantial stenosis was noted in any coronary arteries. Coronary computed tomography confirmed an anomalous origin of the right coronary artery from the left anterior descending artery at the midlevel, with a prepulmonic course (Fig. 2 and Fig. 3). The patient was started on metoprolol and experienced complete resolution of symptoms.
Integrating Cardiology for Nuclear Medicine Physicians, 2009
Clinical cardiac electrophysiology is a subspecialty of cardiology dealing with the evaluation an... more Clinical cardiac electrophysiology is a subspecialty of cardiology dealing with the evaluation and management of patients with complex rhythm or conduction abnormalities. In the last four decades, clinical cardiac electrophysiology has evolved into an established discipline credited with improving and saving hundreds of thousands of lives. We briefly review the basic electrophysiologic principles, anatomy of the electric system of the
Integrating Cardiology for Nuclear Medicine Physicians, 2009
Myocardial perfusion imaging (MPI) is widely utilized in the non-invasive diagnosis and managemen... more Myocardial perfusion imaging (MPI) is widely utilized in the non-invasive diagnosis and management of coronary artery disease (CAD). Radionuclide MPI has been well studied in the evaluation, risk stratification and identification of patients with CAD who will benefit from revascularization. Myocardial revascularization using percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG) has become a mainstay in the treatment
Integrating Cardiology for Nuclear Medicine Physicians, 2009
In 1953, Dr. Helmut Hertz of Sweden together with Dr. Inge Edler began to use a commercial ultras... more In 1953, Dr. Helmut Hertz of Sweden together with Dr. Inge Edler began to use a commercial ultrasonoscope to examine the heart, thus starting the era of clinical echocardiography [1]. Echocardiography has become an integral part of clinical cardiology. It is used widely in addition to his-tory ...
Integrating Cardiology for Nuclear Medicine Physicians, 2009
The goals of antiarrhythmic drug therapy are to control heart rate, abolish tachyarrhythmias, sup... more The goals of antiarrhythmic drug therapy are to control heart rate, abolish tachyarrhythmias, suppress ectopic beats, and to restore and maintain normal sinus rhythm. The selection of appropriate agents is a match between the common antiarrhythmic drugs, the condition and age of the patient, the urgency of treatment, the potential long-term side effects, and especially the drug’s proven efficacy on the arrhythmia in question [1]. This chapter will discuss the pharmacokinetics and pharmacodynamics of the commonly utilized and marketed antiarrhythmic drugs.
Integrating Cardiology for Nuclear Medicine Physicians, 2009
Cardiovascular diseases (CVD) have reached epidemic proportions in developed countries, and are t... more Cardiovascular diseases (CVD) have reached epidemic proportions in developed countries, and are the leading cause of morbidity and mortality. An estimated 16.7 million–or 29.2% of total global deaths–result from the various forms of CVD, many of which are preventable ...
This study sought to assess the utility of ultrasound (US) guidance for transradial arterial acce... more This study sought to assess the utility of ultrasound (US) guidance for transradial arterial access. US guidance has been demonstrated to facilitate vascular access, but has not been tested in a multicenter randomized fashion for transradial cardiac catheterization. We conducted a prospective multicenter randomized controlled trial of 698 patients undergoing transradial cardiac catheterization. Patients were randomized to needle insertion with either palpation or real-time US guidance (351 palpation, 347 US). Primary endpoints were the number of forward attempts required for access, first-pass success rate, and time to access. The number of attempts was reduced with US guidance [mean 1.65 ± 1.2 vs. 3.05 ± 3.4, p < 0.0001; median 1 (interquartile range [IQR] 1, 2) vs. 2 (1, 3), p < 0.0001] and the first-pass success rate improved (64.8% vs. 43.9%, p < 0.0001). The time to access was reduced (88 ± 78 vs. 108 ± 112 s, p = 0.006; median 64 [IQR 45, 94] vs. 74 [IQR 49, 120] s, p...
Case history: a 76-year-old African-American female presented to a community hospital with compla... more Case history: a 76-year-old African-American female presented to a community hospital with complaints of chest pain. Her medical history was significant for hypertension, gastroesophageal reflux disease (GERD), hyperlipidemia, and bipolar disorder. On arrival ...
Journal of the American College of Cardiology, 2013
The user has requested enhancement of the downloaded file. major non-CABG related bleeding occurr... more The user has requested enhancement of the downloaded file. major non-CABG related bleeding occurred in one SD patient (GI bleed) and recurrent hospitalization in three patients of SD (6%) vs. one DD patient (2%), p¼0.62. There were no vascular complications. Patient satisfaction scores were equivalent in both groups at all time points. SD was associated with $1,200 savings per patient. Conclusions: Same day discharge after uncomplicated single and multivessel PCI of patients with SA, UA and low risk NSTEMI facilitated by vascular device closure is associated with similar clinical outcomes, patient satisfaction and significant cost savings compared to traditional overnight hospital stay.
Journal of Nuclear Cardiology Cummings, Raza, and Movahed 579 Volume 13, Number 4;576-81 Atrial f... more Journal of Nuclear Cardiology Cummings, Raza, and Movahed 579 Volume 13, Number 4;576-81 Atrial fibrillation during adenosine pharmacologic stress testing
Cardiovascular disease is the leading cause of death in patients aged 65 and above. Although elde... more Cardiovascular disease is the leading cause of death in patients aged 65 and above. Although elderly persons represent only 12.4% of the US population, they account for about a third of drug expenditures. However the appropriate use of cardiovascular medications in these patients has been shown to reduce the rate of cardiovascular morbidity and mortality. The normal aging and the disease process in the elderly result in significant changes at the structural and molecular level in the elderly. The changes that take place in the autonomic nervous system, the kidneys, and the liver in the elderly modify the metabolism and clinical effects of most medications. Elderly patients are also susceptible to side effects and adverse drug reactions. Physicians should have a clear understanding of the normal aging processes, the abnormal changes due to disease process and the changes in the pharmacology of drugs in the elderly to deliver proper care to the elderly patient.
The prevalence of ischemic heart disease (IHD) has been increasing among the women in developed c... more The prevalence of ischemic heart disease (IHD) has been increasing among the women in developed countries. The well recognized IHD excess in men has often obscured the fact that IHD is the leading cause of death in women. Women have atypical symptoms of IHD that lead to a delay in the diagnosis and an overall poor prognosis. Women have a delay in the onset of IHD due to the beneficial effects of their sex hormones. Postmenopausal women lose this beneficial effect of estrogen and undergo significant changes in their lipid profile, arterial pressure, glucose tolerance, and vascular reactivity that increase their risk for development of IHD. Recently there has been considerable interest in the sex hormones and their role in IHD in women. The general belief that hormone replacement therapy (HRT) has an overall beneficial effect on cardiovascular disease (CVD) in women and hence decreases CVD mortality and morbidity has not been shown in the recent multicenter prospective studies. With the availability of various types of estrogen and progestins, physicians prescribing these agents should take into consideration their varying effects on the cardiovascular system. Risk factor modifications should include diet, weight loss, regular exercise, smoking cessation and adequate control of hypertension (HTN), diabetes (DM) and hyperlipidemia. In the appropriate setting, treatment with proven beneficial agents like aspirin, h-blockers, angiotensin converting enzyme (ACE) inhibitors and statins will help decrease the burden of IHD in women. D
Ischemic heart disease is the leading cause of death in the developed countries for those older t... more Ischemic heart disease is the leading cause of death in the developed countries for those older than 65 years of age. In patients suspected to have coronary artery disease a stress test should be performed to identify the vulnerability of the myocardium to ischemia. As a rule of thumb, the evaluation of coronary artery disease is best done by exercise stress test. In patients who are not able to exercise adequately, pharmacological stress agents are used. The commonly used agents are the coronary vasodilators, adenosine and dipyridamole and the catecholamines, dobutamine and arbutamine. These agents are combined with imaging techniques to increase the sensitivity and specificity of the test. These agents have been widely used and have an excellent safety profile. Another advantage in using pharmacological stress agents is that they do not affect the image quality, especially with echocardiography and magnetic resonance imaging. Ongoing developments hold promise for safer and more reliable pharmacological stress agents in the future.
The incidence of diabetes has reached epidemic proportions across the world. In patients with dia... more The incidence of diabetes has reached epidemic proportions across the world. In patients with diabetes, there is a two to four times increased risk of developing coronary artery disease (CAD). Diabetes seems to eliminate the protective benefits of hormones in women against CAD. Patients with type II diabetes also have hypertension, dyslipidemia, obesity, endothelial dysfunction and prothrombotic factors, called 'the metabolic syndrome'. Not only the incidence of CAD is higher in diabetes, the mortality of the diabetic patients after a cardiac event is significantly increased as compared to non-diabetics, including sudden death. Although in the past 35 years there has been a decline in the rate of death due to CAD in the general population, this has not been seen among patients with diabetes. Primary prevention can play an important role in decreasing the incidence of CAD in diabetic patients. Aggressive treatment of hyperlipidemia and hypertension is essential. Recent knowledge about the protective effects of aspirin, statins, angiotension converting enzyme inhibitors, and glitazones in the diabetic patients, if used appropriately will go a long way in primary and secondary prevention of CAD in patients with diabetes.
Cardiovascular disease (CVD) in the developed countries continues to grow at an epidemic proporti... more Cardiovascular disease (CVD) in the developed countries continues to grow at an epidemic proportion. There are a significant number of young adults with no clinical evidence of CVD, but who have two or more risk factors that predispose them to CV events and death. Many of these risk factors are modifiable, and by controlling these factors, the CVD burden can be decreased significantly. Recent statistics have shown that, if all major forms of CVD were eliminated, the life expectancy would rise by almost 7 years. Hence it is imperative that primary prevention efforts should be initiated at a young age to avert decades of unattended risk factors. Hyperlipidemia has been linked to CVD almost a century ago. Since then various clinical trials have not only supported this link, but have also shown the CV benefits in aggressively treating patients with hyperlipidemia. In this generation, we have various therapeutic agents that are capable of reducing the elevated lipid levels. With drugs like statins, we are able to reduce the risk of CVD by about 30% and avoid major adverse events. Newer drugs are being researched and introduced in the treatment of hyperlipidemia in humans. These can be used in combination therapy resulting in optimal levels of lipids. The new National Cholesterol Education Program (NCEP)/Adult Treatment Panel III (ATP III) guidelines have come as a wake-up call to clinicians about primary prevention of CVD through strict lipid management and multifaceted risk management approach in the prevention of CVD. D
Cell transplantation is an innovative technology that involves the implantation of a variety of m... more Cell transplantation is an innovative technology that involves the implantation of a variety of myogenic and angiogenic cell types. The transplanted cells proliferate and augment left ventricular performance and therein ameliorate the heart failure symptoms. The concept of cell transplantation has followed the footsteps of angiogenesis starting as bench side research. The latter half of the decade saw the transformation of this potential mechanism to a promising therapy for ischemic heart failure. More than 150 patients have been treated with cellular transplantation worldwide. This novel application has the potential to revolutionize alternative therapeutic approaches to management of heart failure.
The frequent use of transesophageal echocardiogram (TEE) has led to the increased recognition of ... more The frequent use of transesophageal echocardiogram (TEE) has led to the increased recognition of aortic atheromas. Retrospective and prospective follow-up studies have reported an association between aortic atheromas and stroke in the high-risk patient population, with complex plaques being more likely to embolize than simple plaques. However, TEE-based studies in the low-risk cohorts have failed to show a similar association. There is growing body of evidence suggesting that aortic atheroma is a marker of generalized atherosclerosis. Although magnetic resonance (MR) imaging and computed tomography (CT) scan are emerging as a powerful noninvasive tool for characterization of aortic atheromas, TEE is the imaging modality of choice. Currently, treatment of aortic atheromas is not well defined, and mixed outcomes have been reported for anticoagulation therapy with warfarin. Statins appear promising based on their plaque stabilization properties. However, there are no randomized control trials to establish the role of both anticoagulation and statins in patients with aortic atheromas, and are warranted in the future. (ECHOCARDIOGRAPHY, Volume 25, February 2008) aortic atheroma, mobile components, stroke, thoracic aorta, transesophageal echocardiogram, vascular imaging Stroke is the third leading cause of death in United States, with approximately 40% of them being cryptogenic in etiology. 1 Since the introduction of transesophageal echocardiogram (TEE), aortic atheromatous plaque, also referred to as aortic atheroma, has been suspected to be a hidden source of embolic stroke. It is unclear whether aortic atheroma is a risk factor for stroke, or a risk marker for generalized atherosclerosis, or an innocent bystander. 2 Due to this uncertainty, clinicians face a dilemma in treating patients with aortic atheromas. This review discusses the classification of aortic theromatous plaques, their epidemiology, and the clinical trials that have studied their embolic risk. It also details current diagnostic imaging tools and treatment options.
Catheterization and Cardiovascular Interventions, 2003
The present study prospectively evaluated adjunctive antiplatelet therapy in patients without ins... more The present study prospectively evaluated adjunctive antiplatelet therapy in patients without insulin-requiring diabetes during elective coronary stenting. Three hundred patients were randomized to one of three treatment groups: clopidogrel pretreatment, adjunctive abciximab, or control. Stenting was successful in 98% and no deaths occurred. Thirty-day and 1-year major adverse coronary events (MACEs) was similar in all groups. A subgroup of 109 patients undergoing single-vessel stenting of type A/B1 lesions with short guidewire times had no postprocedure myocardial infarction or 30-day MACE. We conclude that patients with these characteristics may safely undergo elective coronary stenting without adjunctive antiplatelet therapy. Cathet Cardiovasc Intervent 2003;58:459 -466.
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