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| Current
Cardiology Reviews
ISSN: 1573-403X
Current Cardiology Reviews
Volume 5, Number 4, November 2009
Contents
Roles of Arterial Baroreceptor Reflex During Bezold-Jarisch
Reflex Pp. 263-267
Koji Kashihara
[Abstract] [Full
Text Article]
Peripartum Cardiomyopathy: An Intriguing Challenge. Case Report
with Literature Review Pp. 268-272
Roberto Cemin, Rajesh Janardhanan and Massimo
Daves
[Abstract] [Full
Text Article]
Tombstoning ST-Elevation Myocardial Infarction Pp. 273-278
Bahattin Balci
[Abstract] [Full
Text Article]
Cerebral Collateral Circulation in Carotid Artery Disease
Pp. 279-288
José R. Romero, Aleksandra Pikula, Thanh N.
Nguyen, Yih Lin Nien, Alexander Norbash and Viken
L. Babikian
[Abstract] [Full
Text Article]
Cardiac Innervation and Sudden Cardiac Death Pp. 289-295
Masaki Ieda and Keiichi Fukuda
[Abstract] [Full
Text Article]
Current Approach to the Diagnosis and Treatment of Femoral-Popliteal
Arterial Disease. A Systematic Review Pp. 296-311
Christos Kasapis and Hitinder S. Gurm
[Abstract] [Full
Text Article]
The Use of Exercise Echocardiography in the Evaluation of
Mitral Regurgitation Pp. 312-322
Kibar Yared, Kaitlyn My-Tu Lam and Judy Hung
[Abstract] [Full
Text Article]
Coronary Pressure Measurement Based Decision Making for Percutaneous
Coronary Intervention Pp. 323-333
Kohichiro Iwasaki and Shozo Kusachi
[Abstract] [Full
Text Article]
Outcome of Heart Failure with Preserved Ejection Fraction:
A Multicentre Spanish Registry Pp. 334-342
Juan C. Castillo, Manuel P. Anguital and
Manuel Jiménez
[Abstract] [Full
Text Article]
Surgical Ventricular Restoration: An Operation to Reverse
Remodeling - the Basic Science (Part I) Pp. 343-349
Ganesh Shanmugam and Imtiaz S. Ali
[Abstract] [Full
Text Article]
Surgical Ventricular Restoration: An Operation to Reverse
Remodeling - Clinical Application (Part II) Pp. 350-359
Ganesh Shanmugam and Imtiaz S. Ali
[Abstract] [Full
Text Article]
Abstracts
[Back to top] [Full
Text Article]
Roles of Arterial Baroreceptor Reflex During Bezold-Jarisch
Reflex
Koji Kashihara
Among the many cardiopulmonary reflexes, this review specifically
examines the roles of the arterial baroreflex during the Bezold-Jarisch
reflex (BJR). Activation of cardiopulmonary vagal afferent
C-fibers induces hypotension, bradycardia, and apnea, which
are known collectively as the BJR; myocardial ischemia and
infarction might induce the BJR. Arterial baroreflex has been
established as an important negative feedback system that
stabilizes arterial blood pressure against exogenous pressure
perturbations. Therefore, understanding the functions of the
arterial baroreflex during the BJR is crucial for elucidating
its pathophysiological implications. The main central pathways
of the BJR and the baroreflex are outlined herein, particularly
addressing the common pathway between the reflexes. Furthermore,
the pathophysiological roles of the arterial baroreflex during
the BJR are described along with a brief discussion of pathophysiological
merits and shortcomings of the reflexes.
[Back to top]
[Full
Text Article]
Peripartum Cardiomyopathy: An Intriguing Challenge. Case Report
with Literature Review
Roberto Cemin, Rajesh Janardhanan and Massimo
Daves
Peripartum cardiomyopathy is a relatively rare disease, which
can have devasting consequences and should be promptly identified
and correctly treated. Overall prognosis is good in majority
of the cases, although some patients may progress to irreversible
heart failure. Early diagnosis is important and effective
treatment reduces mortality rates and increases the chance
of complete recovery of ventricular systolic function.
We report of an interesting case with a favourable outcome
and discuss about the clinical presentation, therapy and outcome
of this condition.
[Back to top] [Full
Text Article]
Tombstoning ST-Elevation Myocardial Infarction
Bahattin Balci
Tombstoning ST elevation myocardial infarction can be described
as a STEMI characterized by tombstoning ST-segment elevation.
This myocardial infarction is associated with extensive myocardial
damage, reduced left ventricle function, serious hospital
complications and poor prognosis. Tombstoning ECG pattern
is a notion beyond morphological difference and is associated
with more serious clinical results.
Despite the presence of a few reports on tombstoning ST elevation,
there is no report which reviews STEMI demonstrating this
electrocardiographic pattern.
[Back to top] [Full
Text Article]
Cerebral Collateral Circulation in Carotid Artery Disease
José R. Romero, Aleksandra Pikula, Thanh N.
Nguyen, Yih Lin Nien, Alexander Norbash and Viken
L. Babikian
Carotid artery disease is common and increases the risk of
stroke. However, there is wide variability on the severity
of clinical manifestations of carotid disease, ranging from
asymptomatic to fatal stroke. The collateral circulation has
been recognized as an important aspect of cerebral circulation
affecting the risk of stroke as well as other features of
stroke presentation, such as stroke patterns in patients with
carotid artery disease. The cerebral circulation attempts
to maintain constant cerebral perfusion despite changes in
systemic conditions, due to its ability to autoregulate blood
flow. In case that one of the major cerebral arteries is compromised
by occlusive disease, the cerebral collateral circulation
plays an important role in preserving cerebral perfusion through
enhanced recruitment of blood flow. With the advent of techniques
that allow rapid evaluation of cerebral perfusion, the collateral
circulation of the brain and its effectiveness may also be
evaluated, allowing for prompt assessment of patients with
acute stroke due to involvement of the carotid artery, and
risk stratification of patients with carotid stenosis in chronic
stages. Understanding the cerebral collateral circulation
provides a basis for the future development of new diagnostic
tools, risk stratification, predictive models and new therapeutic
modalities. In the present review we discuss basic aspects
of the cerebral collateral circulation, diagnostic methods
to assess collateral circulation, and implications in occlusive
carotid artery disease.
[Back to top] [Full
Text Article]
Cardiac Innervation and Sudden Cardiac Death
Masaki Ieda and Keiichi Fukuda
The heart is extensively innervated and its performance is
tightly controlled by the nervous system. Cardiac innervation
density varies in diseased hearts leading to unbalanced neural
activation and lethal arrhythmia. Diabetic sensory neuropathy
causes silent myocardial ischemia, characterized by loss of
pain perception during myocardial ischemia, which is a major
cause of sudden cardiac death in diabetes mellitus (DM). Despite
its clinical importance, the mechanisms underlying the control
and regulation of cardiac innervation remain poorly understood.
We found that cardiac innervation is determined by the balance
between neural chemoattractants and chemorepellents within
the heart. Nerve growth factor (NGF), a potent chemoattractant,
is induced by endothelin-1 upregulation during development
and is highly expressed in cardiomyocytes. By comparison,
Sema3a, a neural chemorepellent, is highly expressed in the
subendocardium of early stage embryos, and is suppressed during
development. The balance of expression between NGF and Seme3a
leads to epicardial-to-endocardial transmural sympathetic
innervation patterning. We also found that downregulation
of cardiac NGF leads to diabetic neuropathy, and that NGF
supplementation rescues silent myocardial ischemia in DM.
Cardiac innervation patterning is disrupted in Sema3a-deficient
and Sema3aoverexpressing mice, leading to sudden death or
lethal arrhythmias. The present review focuses on the regulatory
mechanisms underlying cardiac innervation and the critical
role of these processes in cardiac performance.
[Back to top] [Full
Text Article]
Current Approach to the Diagnosis and Treatment of Femoral-Popliteal
Arterial Disease. A Systematic Review
Christos Kasapis and Hitinder S. Gurm
Peripheral arterial disease (PAD) is a common manifestation
of atherosclerosis affecting 5 million adults in the United
States, with an age-adjusted prevalence of 4% to 15% and increasing
up to 30% with age and the presence of cardiovascular risk
factors. In this article we focus on lower extremity PAD and
specifically on the superficial femoral and proximal popliteal
artery (SFPA), which are the most common anatomic locations
of lower extremity atherosclerosis. We summarize current evidence
and perform a systematic review on the diagnostic evaluation
as well as the medical, endovascular and surgical management
of SFPA disease.
[Back to top]
[Full
Text Article]
The Use of Exercise Echocardiography in the Evaluation of
Mitral Regurgitation
Kibar Yared, Kaitlyn My-Tu Lam and Judy Hung
Mitral regurgitation (MR) is the second most common valvular
disease in western countries after aortic stenosis. Optimal
management of patients with MR depends on the etiology of
the regurgitation and is based predominantly on left ventricular
function and functional status. Recent outcome studies report
high risk subsets of asymptomatic patients with MR, and practice
guidelines underscore the importance of a well-established
estimation of exercise tolerance and recommend exercise testing
to objectively assess functional status and hemodynamic factors.
[Back to top]
[Full
Text Article]
Coronary Pressure Measurement Based Decision Making for Percutaneous
Coronary Intervention
Kohichiro Iwasaki and Shozo Kusachi
The fractional flow reserve (FFR) is a simple, reliable,
and reproducible physiologic index of lesion severity. In
patients with intermediate stenosis, FFR≥0.75
can be used to safely defer percutaneous coronary intervention
(PCI), and patients with FFR≥0.75
have a very low cardiac event rate. Coronary pressure measurement
can determine which lesion should be treated with PCI in patients
with tandem lesions, and PCI on the basis of FFR has been
demonstrated to result in an acceptably low repeat PCI rate.
FFR can identify patients with equivocal left main coronary
artery disease who benefit from coronary bypass surgery. Coronary
pressure measurement distinguishes patients with an abrupt
pressure drop pattern from those with a gradual pressure drop
pattern, and the former group of patients benefit from PCI.
Coronary pressure measurement is clinically useful in evaluating
sufficient recruitable coronary collateral blood flow for
prevention of ischemia, which affects future cardiac events.
FFR is useful for the prediction of restenosis after PCI.
As an end-point of PCI, FFR ≥0.95
and ≥0.90
would be appropriate for coronary stenting and coronary angioplasty,
respectively. In summary, if you encounter a coronary stenosis
in doubt you should measure pressure rather than dilate it.
[Back to top]
[Full
Text Article]
Outcome of Heart Failure with Preserved Ejection Fraction:
A Multicentre Spanish Registry
Juan C. Castillo, Manuel P. Anguital and
Manuel Jiménez
Background: Studies on clinical features, treatment
and prognosis of patients with congestive heart failure (CHF)
and preserved left ventricular ejection fraction (LVEF) are
few and their results frequently conflicting.
Aims: To investigate the characteristics and long
term prognosis of patients with CHF and preserved (≥
45%) LVEF.
Methods and Results: We conducted a prospective multicentre
study with 4720 patients attended in 62 heart failure clinics
from 1999 to 2003 in Spain (BADAPIC registry). LVEF was preserved
in 30% patients. Age, female gender, prevalence of atrial
fibrillation, hypertension and non-ischaemic cardiopathy were
all significantly greater in patients with preserved LVEF.
Mean follow-up was 40±12
months. Mortality and other cardiovascular complication rates
during follow up were similar in both groups. On multivariate
analysis ejection fraction was not an independent predictor
for mortality. Survival at one and five years was similar
in both groups (79% and 59% for patients with preserved LVEF
and 78% and 57% for those with reduced LVEF, respectively).
Conclusions: In the BADAPIC registry, a high percentage
of heart failure patients had preserved LVEF. Although clinical
differences were seen between groups, morbidity and mortality
were similar in both groups.
[Back to top]
[Full
Text Article]
Surgical Ventricular Restoration: An Operation to Reverse
Remodeling - the Basic Science (Part I)
Ganesh Shanmugam and Imtiaz S. Ali
Congestive heart failure as a consequence of ischemic heart
disease is an increasing medical problem. Notwithstanding
the huge advances in the medical and conventional surgical
management of heart failure, eventual outcomes remain suboptimal.
This 2 part article outlines the magnitude of the problem,
the limitations of conventional therapies as they exist, and
the use of newer procedures that directly address the restoration
of ventricular pump function.
The first part of the article deals with the pathology of
different facets of the remodeling process, and the unique
anatomy, geometry and flow dynamics as they pertain to ventricular
function in the normal as well as the failing heart. It then
details the limitations of conventional therapy, thereby laying
the basis for the need and evolution of newer surgical procedures
and ends with the selection of patients for ventricular restoration
procedures and the pitfalls in the choice of patients for
such newer techniques.
[Back to top]
[Full
Text Article]
Surgical Ventricular Restoration: An Operation to Reverse
Remodeling - Clinical Application (Part II)
Ganesh Shanmugam and Imtiaz S. Ali
The first part of the article dealt with the basic science
behind the evolution of ventricular restoration procedures
and the rationale for the use of novel surgical techniques.
The second part describes the preoperative workup of patients
in advanced heart failure, the core information required to
determine the surgical approach and the essential principles
and techniques of ventricular restoration. It then examines
the effects of ventricular restorative procedures on pump
function and clinical outcomes, the results of the worldwide
experience with ventricular restoration and concludes with
more recent advances in this field. |
