The growing role of diagnostic imaging

Cardiology Review® Online, January 2008, Volume 26, Issue 1

Cardiology Review

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In the Hypertension section in this month's issue of , Turkish author Dr Dogan Erdogan reports on the effects of normal blood pressure, prehypertension, and hypertension on coronary microvascular function. Coronary flow reserve was measured in 160 subjects (none with coronary artery disease) using transthoracic Doppler echocardiography. Not surprisingly, impairment in coronary flow reserve was greatest in the hypertensive subjects, but the presence of even prehypertension indicated evidence of significant dysfunction. Our commentator,Dr Samuel Mann, feels this study "offers an intriguing new approach to identifying patients at risk." In a combined article in the CAD and Diabetes sections, Dr Erland Erdmann from Germany analyzes the effects of an oral antiglycemic agent, pioglitazone, on morbidity and mortality in 2445 patients with type 2 diabetes and a prior myocardial infarction. In general the drug's effects were beneficial, although there was a nonsignificant increase in the incidence of congestive heart failure. Dr Rosemarie Pasmantier comments on this and other studies in which the beneficial effects of this class of diabetic drugs have to be balanced against possible harmful effects. Continuing education credits are available to readers with both the Erdmann and Erdogan articles. Next up is an article looking at both CAD and imaging matters from a group of German authors. Dr Tanja S. Meyer and associates investigated the accuracy of 64-slice computed tomographic (CT) angiography in detecting stenoses in bypass grafts, compared with conventional coronary angiography. The author and her colleagues studied 138 consecutive patients with a history of cardiac surgery who were going to undergo invasive coronary angiography and had the CT procedure 24 hours before cardiac catheterization. They found their technique superior to 4- or-16-slice CT procedures in assessing graft patency and stenosis in an unselected "real-world" patient population. Our cardiac surgical consultant, Dr Harold Lazar, offers his thoughts on the clinical implications of this technique in his commentary. The final contribution in this issue is an original case report documenting a case of community-acquired methicillin-resistant pericarditis. DrAnupama Shivaraju and colleagues from the University of Illinois at Chicago have submitted a report on this rare, but increasingly common pathogen.

—Peter F. Cohn