Inside This Issue
827 Ricarda Marinigh, Gregory Y. H. Lip, Nicola Fiotti, Carlo Giansante, Deirdre A. Lane (Source: Journal of the American College of Cardiology)...
POSTED 09/02/2010 at 12:22 AM --
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Summaries of Key Journal Articles
(Source: Journal of the American College of Cardiology)...
POSTED 09/02/2010 at 12:22 AM --
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Reply
We presented the information in easy-to-follow language, minimizing technical jargon, to remind busy practicing physicians to ask their patients about the use of herbal products that could potentially increase adverse drug reactions, including catastrophic events, such as major bleeds, transplanted organ rejection, predisposition to life-threatening arrhythmias, or reductions in the efficacy of medications used. The review has been received with great enthusiasm from practicing cardiologists and other health care providers but also has generated criticism, mainly from practitioners and from supporters and manufacturers of herbal products. (Source: Journal of the American College of Cardiology)...
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Herbal Products Review Provides Inaccurate Information on Dietary Supplement Regulations
Tachjian et al. () fail to present a meaningful review of the challenges of herbal supplement use in patients with cardiovascular disease. Instead, they present outdated and incorrect information and make sweeping generalizations about herbal products and dietary supplements in general. As a result, the reader is no better equipped to manage patient care. This is unfortunate, because the potential for drugâherb interactions is a critical topic and is clinically relevant for practicing cardiologists, as 24% of consumers have reported using herbal supplements (), with few patients discussing this supplementation with their health care professionals. Those patients willing to discuss herbal use with their physicians often project distrust of medicine when natural products are too eagerly di......
POSTED 09/02/2010 at 12:22 AM --
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Herbal Products Review: What Do We Really Know?
In the recent paper by Tachjian et al. (), the investigators highlight several important points concerning the use of herbal supplements: 1) their use is widespread, especially among certain important subgroups, such as patients taking prescription medications; 2) disclosure of complementary and alternative medicine use by patients to their physicians remains low; and 3) potentially dangerous herb-drug interactions may be missed. I applaud the investigators for undertaking a topic that is important not only for patients with cardiovascular diseases but also for those with cancer and other chronic diseases. However, a variety of shortcomings in their methods and conclusions detract from the overall importance of their message. (Source: Journal of the American College of Cardiology)...
POSTED 09/02/2010 at 12:22 AM --
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President's Page: The ACC Reconfirms Commitment to Transparent Relationships With Industry
Much has been made over the last few years about conflicts of interest in the medical community's relationships with industry. This includes both relationships with individual physicians as well as those with academic medical centers and professional organizations. (Source: Journal of the American College of Cardiology)...
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Saddle Pulmonary Embolism Visualized by Transthoracic Echocardiography
It is very unusual to visualize a pulmonary artery thrombus on transthoracic echocardiography (TTE). TTE obtained from a 50-year-old man with syncope showed a large thrombus at the main pulmonary trunk (A, arrow, Online Video 1), severe right ventricular enlargement (B, arrow), severely reduced right ventricular systolic function, and severe global hypokinesis of the right ventricle, except the apical segment (McConnell's sign; Online Video 2). Computed tomographic pulmonary angiography showed a large saddle pulmonary embolus involving the main, left, and right pulmonary arteries (C, arrow), which correlated with the TTE findings. Thrombolytic therapy and anticoagulation were initiated. The patient had an uneventful hospital course. (Source: Journal of the American College of Cardiology)...
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Ebstein's Anomaly With Left Ventricular Noncompaction and Bicuspid Aortic Valve
A 59-year-old man with exertional dyspnea was referred for pre-operative evaluation before nephrectomy for a renal mass. Transthoracic echocardiography demonstrated Ebstein's anomaly and marked left ventricular (LV) trabeculation (A and B, Online Videos 1, 2, and 3). Cardiac magnetic resonance imaging confirmed LV dilation with moderately to severely depressed global systolic function. There was extensive LV trabeculation, especially in the mid-ventricle and apex, and a mildly stenotic bicuspid aortic valve (BAV) (C to E, Online Videos 4 and 5). The maximal ratio of noncompacted to compacted myocardium was 2.8, consistent with the diagnosis of LV noncompaction. The displacement of the septal tricuspid leaflet from the mitral valve annulus was 1.9 cm (0.92 cm/m2). (Source: Journal of the Am......
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Arrhythmias in a Contemporary Fontan Cohort: Prevalence and Clinical Associations in a Multicenter Cross-Sectional Study
Conclusions: Overall prevalence of IART was lower in this cohort (7.3%) than previously reported. Lower functional status, an atriopulmonary connection, and paced rhythm were determined to be independently associated with development of IART after Fontan. (Relationship Between Functional Health Status and Ventricular Performance After FontanâPediatric Heart Network; NCT00132782) (Source: Journal of the American College of Cardiology)...
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Culprit Mechanism(s) for Exercise Intolerance in Heart Failure With Normal Ejection Fractionâ
Heart failure with normal ejection fraction (HFNEF) currently accounts for >50% of all heart failure patients, and its prevalence relative to heart failure with reduced ejection fraction (HFrEF) is rising at a rate of 1% per year. Despite this worrisome epidemiological trend, pathophysiological mechanisms underlying HFNEF and diagnostic or treatment strategies for HFNEF remain the subject of controversy (). That also holds for the cause of exercise intolerance in HFNEF, as evident from this issue of the Journal, which features 2 papers on this subject () and from a series of recent studies addressing left ventricular (LV) filling mechanics in stressed HFNEF patients (). In these studies, various mechanisms were proposed, which either alone or in concert could account for low exercise toler......
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Hemodynamic Basis of Exercise Limitation in Patients With Heart Failure and Normal Ejection Fraction
Conclusions: The HFNEF patients achieved a similar peak exercise PCWP to that of asymptomatic controls, at a much lower workload. This occurs at a lower SVI and in the setting of higher SVRI. The E/eâ² does not reflect the hemodynamic changes during exercise in HFNEF patients. (Source: Journal of the American College of Cardiology)...
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Global Cardiovascular Reserve Dysfunction in Heart Failure With Preserved Ejection Fraction
Conclusions: HFpEF is characterized by depressed reserve capacity involving multiple domains of cardiovascular function, which contribute in an integrated fashion to produce exercise limitation. Appreciation of the global nature of reserve dysfunction in HFpEF will better inform optimal design for future diagnostic and therapeutic strategies. (Source: Journal of the American College of Cardiology)...
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Age as a Risk Factor for Stroke in Atrial Fibrillation Patients: Implications for Thromboprophylaxis
The prevalence of atrial fibrillation (AF) is related to age and is projected to rise exponentially as the population ages and the prevalence of cardiovascular risk factors increases. The risk of ischemic stroke is significantly increased in AF patients, and there is evidence of a graded increased risk of stroke associated with advancing age. Oral anticoagulation (OAC) is far more effective than antiplatelet agents at reducing stroke risk in patients with AF. Therefore, increasing numbers of elderly patients are candidates for, and could benefit from, the use of anticoagulants. However, elderly people with AF are less likely to receive OAC therapy. This is mainly due to concerns about a higher risk of OAC-associated hemorrhage in the elderly population. Until recently, older patients were ......
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ESC: Pre-Procedure Statins May Cut MI Risk (CME/CE)
STOCKHOLM (MedPage Today) -- Statins delivered before invasive procedures appear to reduce the occurrence of cardiovascular events, a meta-analysis showed. (Source: MedPage Today Cardiovascular)...
POSTED 09/01/2010 at 10:13 PM --
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CURRENT-OASIS 7 published: Double-dose clopidogrel in PCI debated
Although there was no benefit of doubling the clopidogrel dose in the overall ACS population studied, benefits were suggested in the PCI subgroup. But are these robust enough?
For complete story visit theheart.org. (Source: theHeart.org)...
POSTED 09/01/2010 at 04:00 PM --
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Tight BP Control Flops for Most CKD Patients (CME/CE, with audio)
(MedPage Today) -- Intensive blood pressure control doesn't slow progression of chronic kidney disease (CKD) in hypertensive patients overall but may help those with baseline proteinuria, according to a randomized trial. (Source: MedPage Today Cardiovascular)...
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HHS awards $17M for patient-centered outcomes research
U.S. Department of Health and Human Services Secretary Kathleen Sebelius has announced three sets of grants and cooperative agreements, totaling nearly $17 million for patient-centered outcomes research. (Source: Cardiovascular Business News)...
POSTED 09/01/2010 at 03:51 PM --
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AMIA launches international health informatics partnership
The American Medical Informatics Association (AMIA) has launched a non-profit, wholly owned subsidiary organization, called the Global Health Informatics Partnership, to serve as an international center for collaborative initiatives on healthcare informatics. (Source: Cardiovascular Business News)...
POSTED 09/01/2010 at 03:22 PM --
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Report: Radiology among least common diagnostic errors
While diagnostic errors are encountered in every specialty and are generally lowest (less than five percent) for certain specialties that rely on visual pattern recognition and interpretation (e.g., radiology, pathology, dermatology), error rates in specialties that rely more on data gathering and the combination of different elements for a conclusive diagnosis are higher (10 to 15 percent), according to an article published in September Pennsylvania Patient Safety Advisory. (Source: Cardiovascular Business News)...
POSTED 09/01/2010 at 01:49 PM --
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ESC guidelines give top recommendation to CRT for mild heart failure
It's been in the wind on both sides of the Atlantic; now it's official in Europe: a class I A recommendation for cardiac resynchronization therapy for patients in sinus rhythm with NYHA class 2...
For complete story visit theheart.org. (Source: theHeart.org)...
POSTED 09/01/2010 at 01:15 PM --
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