Focus on left ventricular hypertrophy

This month, Cardiology Review features an article in the hypertension section by Dr. Khalid Aslam, who has written an overview comparing angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in relation to regression of left ventricular hypertrophy.

Our first continuing medical education (CME) feature is in the lipid section. Drs. Vincent Y. See, Jr. and Robert L. Wilensky evaluate the effect of low-dose atorva-statin on endothelial dysfunction and development of coronary artery disease in 25 transplant patients with normal or mildly elevated cholesterol levels. HMG-CoA reductase inhibitors (statins) appear to improve survival and may decrease rejection and graft atherosclerosis if they are started shortly after cardiac transplantation according to Dr. Harold L. Lazar, our cardiothoracic surgical consultant.

In the diabetes section, our second CME feature, Drs. Zhi You Fang and Thomas H. Marwick from Australia studied 186 patients, with and without diabetes, to determine whether disordered left ventricular function could be detected on echocardiography when overt heart disease was not present. They found that diabetic patients did have such abnormalities and these findings were independent of concomitant left ventricular hypertrophy. In his comments, Dr. Steven Borzak indicates that this is a useful way of describing what is commonly referred to as “diabetic cardiomyopathy.”

In the stroke section, Dr. Peter Bernhardt and colleagues from Germany report on a series of 101 consecutive patients with valvular aortic stenosis who had retrograde cardiac catheterization and a surprisingly high incidence (22%) of silent ischemic brain lesions. Not surprisingly, Dr. William E. Lawson sounds a note of caution concerning the future of this invasive procedure.

The article in the arrhythmias section by Drs. T. Jared Bunch and Roger D. White describes the long-term outcome after out-of-hospital cardiac arrest is successfully treated with early defibrillation. The authors found that long-term survival and quality of life in the 79 survivors were similar to that of a disease-matched control group and the general population, respectively.