Cardiology

Can any physician consider using intermittent inotropic therapy in patients with congestive heart failure?

Cardiac resynchronization treatment (CRT) has moved into the mainstream of patient care after several randomized studies have demonstrated improved quality of life, reversed remodeling, and decreased heart failure hospitalizations. More recently, 2 large studies have demonstrated a mortality benefit of CRT independent of implantable cardioverter defibrillator

The vital cell stress protein, heat shock protein (Hsp)60, has recently been found in the circulation of healthy subjects over an extremely large concentration range. We performed an analysis of subjects with diabetes to determine whether Hsp60 is associated with biochemical markers of cardiovascular disease. Results showed that high circulating levels of Hsp60 are associated with clinically manifest cardiovascular disease. Hsp60 has cytokine-like actions, which may be responsible for this association.

Circulating biomarkers have been used in cardiovascular medicine as predictors of incident or prevalent disease.

We assessed whether duration of nonischemic cardiomyopathy was related to the degree of benefit from implantable cardioverter-defibrillator (ICD) insertion. Subjects who had a recent diagnosis of nonischemic cardiomyopathy had at least a similar benefit from ICD insertion as did those with a remote diagnosis. These results indicate that ICD therapy should be considered in such patients as soon as they are diagnosed and once reversible causes of left ventricular dysfunction have been excluded.

This review presents a substudy analysis of the Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) trial, which examined the role of prophylactic implantable cardioverter defibrillator (ICD) implantation in patients with nonischemic cardiomyopathy.

We assessed whether C-reactive protein (CRP) concentrations predicted future risk of hypertension in a cohort of young adults. Results showed that CRP levels do not independently predict risk of incident hypertension after accounting for body mass index. Further research is needed in the area of inflammation and hypertension, with a special focus on the effect of obesity and age-related changes on this process.

Is hypertension an inflammatory disease?

This study evaluated whether exogenous insulin use to control blood glucose in patients with type 2 diabetes was associated with the development of hypertension by analyzing data obtained from a large national sample in Taiwan. Exogenous insulin use was shown to be a significant risk factor for hypertension development.

Insulin resistance has been linked to an increased risk of hypertension, type 2 diabetes mellitus, and cardiovascular disease.

We assessed the histologic features of 526 carotid plaques from consecutive patients undergoing endarterectomy for symptomatic carotid stenosis and found a high prevalence of coronary-type plaque instability, with strong correlations between macrophage infiltration and both cap rupture and time since stroke. Temporal trends were much weaker after a transient ischemic attack than after a stroke, with a tendency for plaque features to persist for a longer period, suggesting heterogeneity in the underlying pathological mechanisms.

This is the largest study of excised carotid plaques to date. All patients were symptomatic. Although not all plaques could be analyzed for each category (which excluded 94 plaques from cap analysis), this remains the largest histological study of its kind.

Diabetic cardiomyopathy is a clinical condition characterized by altered myocardial function in the absence of coronary artery disease, hypertension, and valvular or congenital heart disease. Patients with this condition exhibit changes in cardiac structure that may be attributed to the direct effect of diabetes mellitus. The author discusses the mechanisms, risk factors, screening, diagnosis, prevention, and treatment of cardiomyopathy in patients with diabetes.

The increasing prevalence of atrial fibrillation in the elderly, especially compared with younger age groups, is striking (8% in persons > 80 years compared with 1% in those < 60 years).

After an acute coronary syndrome (ACS) event, elderly patients are at greater risk of death and nonfatal coronary events compared with younger patients. Despite this, elderly patients continue to receive less evidence-based therapy. Lipidlowering therapy with statins is now routine practice for the secondary prevention of coronary heart disease. Achieving the optional National Cholesterol Expert Panel goal of a low-density lipoprotein cholesterol level of < 70 mg/dL for ACS patients over 70 years of age could prevent nearly 80 deaths or nonfatal coronary events for every 1000 patients treated for 2 years with a number needed to treat of approximately 12.

Elderly patients with a history of an acute coronary syndrome (ACS) are at higher risk for subsequent cardiovascular events than younger patients.

Over a period of 14 years, we followed 282 patients aged 70 years or older who were hospitalized with heart failure. Median survival was 2.5 years, but 25% of patients died within 1 year, and 25% survived for at least 5 years following hospital discharge. A simple 7-item risk score based on data readily available at the time of hospitalization effectively stratified patients into low-, intermediate-, and high-risk categories for subsequent mortality.

Congestive heart failure does not necessarily "go away" in the elderly.

We assessed the association between the incidence of coronary heart disease and alcohol consumption among hypertensive men enrolled in the Health "Professionals" Follow-Up Study. Moderate alcohol consumption (1 to 2 drinks per day) was associated with a lower risk of myocardial infarction, as in the general population, but was not associated with the risks of stroke, total mortality, or mortality from cardiovascular causes. These results show that men with hypertension who drink moderately may not need to change their drinking habits.

Features of hypertrophic obstructive cardiomyopathy (HOCM) include obstruction at the left ventricular outflow tract (caused by a markedly thickened proximal interventricular septum) and systolic anterior motion of the mitral valve. The case discussed here illustrates several classic features of this disease including clinical presentation, diagnostic workup, and noninvasive and invasive management.

A significant reduction in the age-adjusted incidence of stroke in men and women and 30-day mortality in men was shown in a community-based cohort study with biennial assessment of vascular risk factors and active surveillance for incident stroke over the past 50 years. Lifetime risk, severity of stroke, and 30-day mortality in women were stable. Increased life expectancy results in an increase in lifetime risk. This increased longevity is balanced by improvements in risk factor management, yielding no significant change.