July 2006

A 62-year-old white man weighing 78 kg was referred to our cardiac catheterization laboratory for evaluation and percutaneous treatment of suspected ischemic coronary artery disease.

A 61-year-old man was admitted to the hospital for increasing shortness of breath, weight gain, and orthopnea.

We compared the use of early, minimally invasive ultrafiltration with usual care in patients with acute decompensated heart failure in a randomized controlled trial. Ultrafiltration therapy resulted in greater fluid removal than standard therapy and was shown to be a safe and effective alternative to loop diuretics for sodium and fluid homeostasis in patients with heart failure. More research is needed to identify those patients most likely to benefit from this approach.

The literature is replete with studies of treatments for chronic heart failure that have shown morbidity and mortality benefits.

We evaluated the performance of the 64-slice spiral computed tomography coronary angiography scanner in 52 symptomatic patients with stable sinus rhythm and found that it was highly reliable in ruling out the presence of a significant coronary stenosis. This technique may be regarded as a suitable alternative to invasive coronary angiography.

Despite advances in cardiac testing, noninvasive methodologies remain limited in their accuracy to (1) determine the etiology of chest pain; (2) detect preclinical coronary artery disease; and (3) track the progression of atherosclerotic lesions in native and revascularized coronary vessels.

Up to 100 sudden deaths occur among high school and college athletes each year in the United States, most commonly resulting from hypertrophic cardiomyopathy and other cardiac disorders. Studies have shown that preparticipation screening examinations that include a 12-lead electrocardiogram, which is not currently required in the United States, can identify asymptomatic athletes with hypertrophic cardiomyopathy. The current dilemma is how the United States, with its large population and emphasis on reducing health care costs, can realistically implement an effective prescreening process to identify these athletes.

When Hank Gathers collapsedon court during a college basketball game against Portland State on March 4, 1990, and later died, the event both jolted the national consciousness and set into motion changes in the athletic preparticipation screening process. Although another collapse had occurred just 4 months before, and an irregular heartbeat was detected at that time, Gathers was not compliant with the prescribed beta blocker and continued to play. An autopsy revealed that the 23-year-old Gathers suffered from cardiomyopathy.

An asymptomatic 66-year-old man with a history of nonobstructing carotid artery plaque and sleep apnea was referred for cardiac computed tomography (CT) scanning for risk stratification. He exercised on a regular basis with no symptoms and had normal results on at least 2 nuclear stress tests, the last test being performed only 12 months earlier.

In this issue, Schubert and Helenowski present a very dramatic instance of an increasingly common application of computed tomography (CT) coronary angiography—detection of an anomalous origin of the coronaries (page 40).