August 2006

Multiple imaging modalities were used to assess left ventricular function in a 64-year-old patient with prior inferior myocardial infarction.

An asymptomatic 65-year-old woman with a 10-year history of well-controlled diabetes mellitus, hyperlipidemia, and hypertension was referred for preoperative cardiac evaluation before noncardiac surgery.

A 37-year-old man was referred for assessment and treatment of syncope by his family doctor.

A 45-year-old man with no significant medical history presents for a new-patient evaluation at your office.

We performed a cost-utility analysis comparing treatment with aspirin, statins, and the combination of aspirin and statins among middle-aged men with no previous history of cardiovascular disease and with different underlying coronary artery disease (CAD) risk levels. Results showed that for men with a 10-year risk of CAD of 7.5% or higher, treatment with aspirin cost less and was more beneficial than no treatment. When the patient's 10-year risk of CAD before treatment was greater than 10%, adding a statin to aspirin treatment was cost effective.

Practicing cardiologists often joke about putting "statins" in the drinking water to stem the epidemic of atherosclerotic cardiovascular disease, but curiously, I don't believe that refers, even in jest, to a cocktail combination of drugs.

We performed cineventriculography, unenhanced echocardiography, contrast-enhanced echocardiography, and magnetic resonance imaging to define the presence of regional left ventricular wall motion abnormalities. Interobserver agreement in the analysis of regional wall motion abnormality was highest for contrast-enhanced echocardiography, followed by cineventriculography and cardiac magnetic resonance imaging; it was lowest for unenhanced echocardiography. Contrast-enhanced echocardiography also showed the highest accuracy in the detection of panel-defined regional wall motion abnormalities.

The lack of a reliable quantitative measurement analysis package for regional left ventricular wall motion is not new.

We assessed how well dobutamine stress echocardiography predicted morbidity and mortality in 2349 patients with diabetes mellitus over a follow-up period of 13.2 years. Results showed that age, failure to achieve the target heart rate, and the percentage of ischemic segments were independent predictors of both mortality and cardiovascular morbidity. Using clinical and stress echocardiographic parameters, a simple model for risk stratification was developed.

Cardiovascular disease is a leading cause of death for persons with diabetes, accounting for almost 80% of mortality in this group in the United States.

In the Prevention of Syncope Trial, we evaluated whether beta-blocker treatment with metoprolol was beneficial for the treatment of patients with vasovagal syncope. Results showed little evidence that metoprolol was effective in reducing the burden of syncopal symptoms. In a substudy analysis, neither age nor response to isoproterenol was useful in selecting which patients might benefit from metoprolol.

Neurocardiogenic syncope (vasovagal syncope) is the most common cause of loss of consciousness, ranging in various studies from 18% to 58% of all syncopal events.