April 2015

Click here to review the Cardiology Review editorial advisory board.

UnitedHealth, the nation's largest health insurance company, recently announced a partnership with 3 telemedicine companies to cover video-based doctor visits in the same way it covers in-person visits.

More than 13,000 physicians and cardiovascular team members attended the ACC 2015 meeting in San Diego on March 14-16, 2015. In this issue of Cardiology Review, we focus on 6 important studies presented at ACC 2015: LEGACY, OSLER, PEGASUS, EMBRACE-STEMI, MATRIX, and CoreValve.

Mortality in patients with type 1 diabetes mellitus (T1DM) is higher than in the general population, and whether mortality improves or alters with glycemic control is unknown.

The recent FDA approvals of ivabradine and the WATCHMAN Left Atrial Appendage Closure Device, study results on EHRs and quality of medical care, and more are covered in this installment.

The presence of chronic kidney disease (CKD) in patients with atrial fibrillation increases the risk of stroke and thromboembolism (TE) as well as the risk of bleeding, thus complicating their treatment. In this context, it has been suggested that CKD should be included in the CHA2DS2-VASc (Congestive heart failure; Hypertension; Age ≥75 years; Diabetes mellitus; previous Stroke, transient ischemic attack, or thromboembolism; Vascular disease; Age 65 to 74 years; Sex category) score.

Click here to review the CME questions for this month's issue.

After a brutal winter, particularly for those in the Midwest and on the East Coast, spring is finally in the air. I hope everyone had a nice spring break with their families and is eager to read some insightful material on cardiology.

The addition of a mitral valve repair to patients undergoing coronary artery bypass graft (CABG) surgery with moderate ischemic mitral regurgitation is still a source of controversy. Recent guidelines state that concomitant mitral valve repair at the time of CABG may be beneficial, but the evidence is inconclusive.

Refractory angina is a loosely defined term generally referring to the persistence of life-impacting angina despite maximal antianginal medications and, when possible, coronary revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]). Numerous novel pharmacotherapies and mechanical interventions have been proposed, and studies conducted, to treat patients with refractory angina.

Atrial fibrillation (AF) and heart failure (HF) often coexist. The use of beta-blockers in HF patients has a class 1A recommendation in both the European and American guidelines. In current guidelines for heart failure therapy, the recommendation for beta-blockers is not restricted to patients with sinus rhythm, and includes all HF patients.

In the era of progressive technology, the diagnostic modalities for stable coronary artery disease are various. The original cardiac stress test has been used in the past for many purposes, including diagnosis of obstructive coronary artery disease in a patient with chest pain as well as risk stratification for ischemia. More recently, coronary computed tomographic angiography (CCTA) has emerged as a great tool to diagnose anatomically obstructive coronary lesions. However, for the past few years, obtaining functional and physiologic data such as comparative fractional flow reserve (FFR) has become the gold standard for evidence of ischemia on CCTA similar to invasive angiography.

The primary objectives of treating acute ischemic stroke are to prevent death and limit functional disability. Similar to acute myocardial infarction (AMI), timely reperfusion using systemic thrombolysis has been shown to improve outcome of acute stroke, namely functional neurologic recovery, but not mortality. But unlike AMI, the role of intra-arterial or endovascular therapy in acute stroke has not been clearly established.

Click here to read the statement of need, learning objectives, instructions on how to obtain CME credit, faculty list and disclosures, and other information for this activity.