|
Current Cardiology Reviews
ISSN: 1573-403X
Current Cardiology Reviews
Volume 2, Number 1, February 2006
Contents
Atherosclerotic Plaque Detection by Multi-detector
Computed Tomography Pp. 1-9
Javed Butler and Udo Hoffmann
[Abstract]
Management of Acute Coronary Syndromes in Patients
with Renal Insufficiency Pp. 11-16
Giancarlo Marenzi, Emilio Assanelli and Antonio L. Bartorelli
[Abstract]
Real-Time 3D Echocardiography: A New Gold Standard
for Rheumatic Mitral Stenosis Assessment Pp. 17-20
José Zamorano and Leopoldo Pérez
de Isla
[Abstract]
Mitral Balloon Valvuloplasty: State-of-the-Art Paper
Pp. 21-28
Mohamed Eid Fawzy
[Abstract]
Percutaneous Valve Interventions Pp. 29-36
Francesco Maisano, Matteo Montorfano, Andrea
Blasio, Iassen Michev, Giovanni La Canna, Antonio Colombo
and Ottavio Alfieri
[Abstract]
Minimally Invasive and Noninvasive Hemodynamic Monitoring
of the Cardiovascular System: Available Options and Future
Perspectives Pp. 37-39
Salvatore M. Romano, Iacopo Olivotto, Marco Chiostri,
Cristina Giglioli, Massimo Margheri and Gian Franco Gensini
[Abstract]
The Fetal Cardiac Function Pp. 41-53
Ganesh Acharya, Juha Räsänen, Torvid
Kiserud and James C. Huhta
[Abstract]
Modeling Cardiovascular Development: New Approaches
are Making In Vitro En Vogue Pp. 55-63
Richard L. Goodwin, Michael J. Yost and Jay D. Potts
[Abstract]
The Secondary Heart Field: Understanding Conotruncal
Defects from a Developmental Perspective Pp. 65-69
Cary Ward and Margaret Kirby
[Abstract]
Recent Advances in Small Animal Cardiac Magnetic Resonance
Imaging Pp. 71-77
Mathias Nahrendorf and Wolfgang R. Bauer
[Abstract]
Abstracts
[Back to top]
Atherosclerotic Plaque Detection by Multi-detector
Computed Tomography
Javed Butler and Udo Hoffmann
Coronary artery disease (CAD) remains a leading cause of
death worldwide. In order to reduce the mortality from CAD,
early detection and intervention prior to adverse events is
likely to yield the most benefit. This however necessitates
reliable prediction of high-risk patients. The current prediction
schemes that incorporate traditional risk factors like hypertension
and dyslipidemia are not very sensitive and improvements in
risk stratification schemes are urgently needed. Pathophysiologically,
CAD represents a spectrum of abnormalities starting from endothelial
dysfunction to early fatty streaks, progressing to actual
atherosclerotic plaque formation and subsequent stenosis.
Detection of calcified plaques by electron beam computed tomography
has been associated with a higher risk for coronary events.
However, studies have shown that the rupture prone vulnerable
plaques are composed of a thin fibrous cap with a large lipid
pool; many of these plaques are non-calcified. The detection
and characterization of non-calcified plaque is therefore
of especial interest. Coronary multi-detector computed tomography
(MDCT) can detect both calcified and non-calcified plaques
and is emerging as a non-invasive tool that may significantly
impact on how we detect and define high-risk population. MDCT
provides a unique opportunity to study the natural history
and response to therapy of coronary plaques. In this review,
we discuss the use of MDCT to detect coronary plaques and
its potential clinical implications.
[Back to top]
Management of Acute Coronary Syndromes in Patients
with Renal Insufficiency
Giancarlo Marenzi, Emilio Assanelli and Antonio L. Bartorelli
Chronic kidney disease (CKD) is highly prevalent in patients
with acute coronary syndromes (ACS) and is associated with
poor outcomes. The clinical management of patients with CKD
who develop ACS is problematic because of the lack of well-designed
randomized trials assessing therapeutic strategies in such
patients. The almost uniform exclusion of patients with CKD
from randomized studies evaluating new targeted therapies
for ACS, and concern about further deterioration of renal
function and therapy-related toxic effects, may explain the
less frequent use of proven medical therapies in this subgroup
of high-risk patients. This could contribute to their excessive
mortality. The objective of this review is to discuss the
unresolved issues and uncertainties regarding recommended
medical therapies and interventional strategies in CKD patients
who develop an ACS.
[Back to top]
Real-Time 3D Echocardiography: A New Gold Standard
for Rheumatic Mitral Stenosis Assessment
José Zamorano and Leopoldo Pérez
de Isla
Real-Time 3D echocardiography allows us to visualize every
cardiac structure in any desired plane orientation, including
the mitral valve. In this article we describe the recent advances
in the assessment of the mitral valvular area and mitral valve
anatomy by means of the use of Real-Time 3D echocardiography.
Real-Time 3D echocardiography has been shown as a useful tool
to evaluate those patients with rheumatic mitral stenosis.
It provides accurate information regarding the mitral valvular
area and mitral valvular score in this kind of patients. Furthermore,
Real-Time 3D echocardiography could replace the classic method
used as the gold standard for the quantification of the mitral
valvular area: the Gorlin’s method. In this work, the
experience of the Cardiovascular Unit of the Hospital Clínico
San Carlos in Madrid, Spain is presented.
[Back to top]
Mitral Balloon Valvuloplasty: State-of-the-Art Paper
Mohamed Eid Fawzy
Percutaneous mitral balloon valvuloplasty (MBV) was introduced
in 1984 by Inoue who developed the procedure as a logical
extension of surgical closed commissurotomy. Since then, MBV
has emerged as the treatment of choice for severe pliable
rheumatic mitral stenosis (MS). With increasing experience
and better selection of patient, the immediate results of
the procedure have improved and the rate of complications
declined. When the reported complications of MBV are viewed
in aggregate, complications occur at approximately the following
rates: mortality (0% to 0.5%), cerebral accident (0.5% to
1%), mitral regurgitation (MR) requiring surgery (2% to 3%).
These complication rates compare favorably to those reported
after surgical commissurotomy. Several randomized trials reported
similar hemodynamic results with MBV and surgical commissurotomy.
Restenosis after MBV range from 4% to 70% depending on the
patient selection, valve morphology and duration of follow
up. Restenosis was encountered in 17.5% of the author’s
series and the 10-year restenosis free survival is 68% and
is higher (78%) in patients with favorable mitral morphology.
The 10-year event free survival is 80% and is higher (86%)
in patients with favorable mitral morphology. The effect of
MBV on severe pulmonary hypertension, concomitant severe tricuspid
regurgitation, left ventricular function, left atrial size
and atrial fibrillation will be addressed in the review. In
addition, the application of MBV in specific clinical situations
such as children, during pregnancy and for restenosis is discussed.
[Back to top]
Percutaneous Valve Interventions
Francesco Maisano, Matteo Montorfano, Andrea
Blasio, Iassen Michev, Giovanni La Canna, Antonio Colombo
and Ottavio Alfieri
Percutaneous valve interventions is a rapidly evolving field
of cardiovascular therapy. New technologies for aortic valve
replacement and mitral valve repair are now developing in
addition to the well established techniques of balloon valvuloplasty
for the treatment of mitral and aortic stenosis. A number
of devices are under development and investigation, and are
going to be used in humans in the next few years to treat
valve disease as an alternative to surgery in selected clinical
conditions. Several clinical benefits are expected to be linked
to the PVI as compared to conventional surgery: less pain
and trauma for patients, shorter length of stay in the intensive
care unit and hospital, and faster recovery from the procedure.
As these techniques are less invasive, they will be potentially
performed in an earlier stage of valve disease, when the clinical
benefits are more probable. However, several demanding issues
are going to challenge the dissemination of PVI in the next
coming years, including: technology development and application,
regulatory issues for new devices and new indications, training
of the operators and development of the clinical applications
for such therapies, evaluation of the results and comparison
with the surgical standards. The present review focuses on
the opportunities as well as on the hurdles of PVI, with the
awareness that the exact role for these techniques has to
be determined yet, and is strictly depending on the results
of the ongoing clinical trials, which will become available
in the next coming years.
[Back to top]
Minimally Invasive and Noninvasive Hemodynamic Monitoring
of the Cardiovascular System: Available Options and Future
Perspectives
Salvatore M. Romano, Iacopo Olivotto, Marco Chiostri,
Cristina Giglioli, Massimo Margheri and Gian Franco Gensini
Monitoring of Cardiac Output (CO) is of paramount importance
in the critical patient. Established methods used to measure
CO, such as oxygen Fick approach and thermodilution, are invasive
and do not allow continuous monitoring. In addition, they
are not reliable in the hemodynamically instable patient and
suffer several technical drawbacks.
Alternative methods are available, such as the Pulse Contour
Method, but are dependent upon external calibration to evaluate
cardiac activity. Recently, the Pressure Recording Analytical
Method (PRAM) has been developed: it allows a more complete
and detailed analysis of pressure morphology and “beat-to-beat”
measurement of the stroke volume (SV) without external calibration.
The basic principle of PRAM algorithm is the ability of detecting
interactions between the cardiac and circulatory system, and
therefore of calculating a new parameter, describing the work
expenditure of cardiovascular system strictly correlated to
SV, the Cardiac Cycle Efficiency (CCE). PRAM is becoming a
promising alternative to traditional techniques, and may expand
the potential applications of hemodynamic monitoring in clinical
practice.
[Back to top]
The Fetal Cardiac Function
Ganesh Acharya, Juha Räsänen, Torvid
Kiserud and James C. Huhta
Despite significant progress in the prenatal diagnosis of
congenital heart disease and the postnatal management, the
prenatal evaluation of fetal heart function remains difficult.
The unique characteristics of the fetal circulation have a
significant impact on its cardiac function. Commonly used
physiological concepts about the function of the heart can
be misleading when applied to the intrauterine situation.
Most noninvasive parameters of cardiac function are not validated
in the fetus. In addition, unlike structural defects that
can be easily confirmed after delivery, functional hemodynamic
abnormalities diagnosed in utero cannot be verified postnatally
with certainty as the neonatal circulation defers considerably
from the fetal circulation. This review attempts to describe
commonly used methods of assessment of fetal cardiac function,
their physiological basis and, their utility in clinical practice.
[Back to top]
Modeling Cardiovascular Development: New Approaches
are Making In Vitro En Vogue
Richard L. Goodwin, Michael J. Yost and Jay D. Potts
In vitro models have proven themselves to be powerful
allies with in vivo models for the dissection of
the molecular mechanisms of cardiovascular development. The
purpose of this manuscript is to review the advances that
have enabled the creation of a new generation of in vitro
models. These advances include the advent of new biomaterials
and cell scaffolds that have provided the opportunity to design
niches where developmental processes can occur under controlled,
in vitro conditions. The engineering of biomaterials,
along with new imaging capabilities, are being applied to
important developmental questions. These interdisciplinary
approaches promise to accelerate the identification of the
molecular processes that regulate the cell-cell and cell-extracellular
matrix (ECM) interactions that occur during the development
of cardiac tissues. These new models not only offer the opportunity
to test molecular mechanisms but also provide morphogenetic
assays where the development of functional cardiovascular
tissues can be achieved. The advent of these technologies
is far reaching: from the ability to engineer functional cardiovascular
tissues to the rational implantation of cell therapies for
cardiovascular disease.
[Back to top]
The Secondary Heart Field: Understanding Conotruncal
Defects from a Developmental Perspective
Cary Ward and Margaret Kirby
The development of a septated outflow is complicated, and
insight into this process has been limited. However, our lab
and others have recently described a secondary source of myocardium
that adds to the lengthening outflow tract at later stages
of development. Without the addition of this secondary heart
field (SHF), the outflow is shortened and can not undergo
the rotation necessary to make appropriate ventriculoarterial
connections. Defects of outflow alignment such as tetralogy
of Fallot and double outlet right ventricle may therefore
be the result of problems with the addition of the secondary
heart field. Moreover, the SHF adds a smooth muscle component
to the outflow above the semilunar valves which may be necessary
for proper insertion of the coronary stems into the aorta.
This review will use the newly discovered SHF as well as other
recent advances in the understanding of outflow development
to shed light on the developmental pathology behind conotruncal
defects.
[Back to top]
Recent Advances in Small Animal Cardiac Magnetic Resonance
Imaging
Mathias Nahrendorf and Wolfgang R. Bauer
Small animal models of heart failure have added invaluable
information to advance diagnosis, pathophysiology and treatment
of patients with heart failure, a growing epidemic in the
western world. During the last decade, advances in small animal
magnetic resonance imaging have contributed to this accumulating
body of knowledge.
In the review we give an overview about imaging techniques,
their application to heart failure models in rats and mice,
with focusing on providing practical information which will
aid readers to acknowledge the opportunities offered by small
animal MRI. We aim to provide this information as a useful
guidance for developing imaging strategies and experimental
protocols. In addition, theoretical background with respect
to physics of imaging and pathophysiology of disease will
be discussed. Techniques like cine, spin labeling perfusion,
determination of regional blood volume by usage of intravascular
contrast agents, myocardial motion encoding by phase mapping,
coronary angiography, spectroscopic imaging, assessment of
viability by late enhancement techniques will be described
with specific applications in mind, such as phenotyping of
the creatine kinase knock out mouse and assessment of myocardial
mechanics and perfusion during remodeling after myocardial
infarction.
|
