Heart Newsletter 3, no. 3

News from America's Leading Heart Center
The Cleveland Clinic

Volume Three, Number Three, Winter 2003

Best in America

The Cleveland Clinic Heart Center has been ranked America’s Number One cardiac center in U.S.News & World Report’s annual “America’s Best Hospitals” survey. This is the ninth year in a row the Cleveland Clinic Heart Center has been so honored.

What does this mean to you, the individual patient? If you come to the Cleveland Clinic Heart Center, it means that you can enjoy the comfort of knowing that you are being cared for by America’s most competent and experienced cardiac specialists. It means that you have access to the most advanced treatments and technologies, many unavailable elsewhere. It means you are more likely to have a better outcome, as it has been proved that, in heart care, more experience means better results. These are differences that can mean all the world when it’s your heart and your life that are at stake.

We hope you’ll enjoy this issue of Heart. Every issue of Heart offers the latest news and results from the Cleveland Clinic Heart Center. After reading Heart, we hope that you will consider the Cleveland Clinic Heart Center for your own care, or for that of a loved one, should it ever be necessary.

Guided Imagery for Soothing Surgery

People having heart surgery have many needs beyond their immediate medical condition. There are emotional factors that need to be addressed if a patient is to receive the full benefit of treatment.

When Marye Gail Harrison of Simsbury, Conn., learned she needed surgery to repair the mitral valve in her heart, she was anxious. Fortunately, her doctor had referred her to the Cleveland Clinic Heart Center. Not only does the Cleveland Clinic Heart Center perform more valve procedures, with better outcomes, than any place on earth, it has a Guided Imagery program to soothe and relax patients before and after surgery.

Guided imagery is a technique that has been shown to be effective in reducing anxiety in patients undergoing medical procedures. In this technique, patients listen to specially recorded spoken word and music tapes to help them achieve a calmer, more tranquil state of mind. A 1996 Cleveland Clinic study showed that patients using guided imagery before and after a particular surgery experienced less anxiety and pain and needed 37 percent less pain medication than the control group.

“Guided imagery brought me a lot of comfort,” says Mrs. Harrison, who began using guided imagery a full month ahead of her surgery. Mrs. Harrison was provided with both music and spoken word tapes (along with a tape player) for anxiety reduction and encouragement. “I listened to the guiding words before surgery twice a day,” she says. “After surgery, I wanted the music. It comforted me when I might have felt scared or out of control. Music is a great resource, very calming.”

Mrs. Harrison came to Cleveland with her husband, John Passalacqua — who used the guided imagery tapes to ease his own anxiety about Mrs. Harrison’s surgery. “It filled me with wisdom and struck some notes that meant a lot to me,” he says.

Mrs. Harrison says she believes that “my preparation had a lot to do with my healing. I surrounded myself with good care, love and the best doctors.” Among those doctors was Bruce Lytle, M.D., the surgeon who performed her operation.

“We fell in love with Dr. Lytle,” says Mrs. Harrison. “He spent time with us, explained all the options, answered all my questions. He was personal and professional and very warm… That is greatness.”

Breakthrough Discoveries

New CAD Marker Noted

Researchers from The Cleveland Clinic and Boston University School of Medicine have determined that nitrotyrosine is a powerful marker for assessing risk for coronary artery disease (CAD). Nitrotyrosine is a protein generated during the inflammation associated with atherosclerosis, the plaque buildup that causes blood vessels to narrow and harden. In CAD, atherosclerosis in the heart’s blood vessels can cause heart attacks and heart failure.

The researchers found that compared with commonly used tests for monitoring heart disease risk, such as measuring levels of cholesterol or the inflammation marker C-reactive protein, testing for elevated nitrotyrosine levels in blood did a better job of identifying individuals at increased risk for CAD. The researchers also noted that compared with patients in the study who were not using statin drugs to lower cholesterol, those who did demonstrated lower levels of nitrotyrosine.

“These results suggest that we can use blood levels of nitrotyrosine as a molecular fingerprint to identify a specific type of damage that occurs in vessels during development of atherosclerosis,” said investigator Stanley Hazen, M.D., Ph.D. "Nitrotyrosine appears to be a powerful new diagnostic test for identifying individuals at risk for heart disease and for monitoring how they respond to commonly used therapies.” Researchers are now working on developing a simple, low-cost test to detect and monitor nitrotrosine in the blood

Vitamin E and Your Heart: No Love Match

A new study done at the Cleveland Clinic Heart Center shows that vitamin E supplements, once thought to be a secret weapon against heart disease, are not effective. In fact, they might even be harmful. Patients in the study who were given vitamin E showed no better mortality rates than a control group; patients given beta carotene (a source of vitamin A) experienced slight increases in mortality and cardiac death compared with those in the control group.

“We now have the clinical evidence needed to actively discourage the use of vitamin supplements containing beta-carotene,” said study investigator Marc S. Penn, M.D., Ph.D., the Cleveland Clinic Heart Center cardiologist who led the study. “Further, we discovered that vitamin E did not provide a significant cardiovascular benefit when used as secondary prevention.”

These findings further strengthen the contention that diet supplements are no substitute for good eating habits, exercise, weight loss and smoking cessation as a means of minimizing the risk of heart disease.

Lifestyle Factors Behind Most Heart Disease

Do our genes doom us to coronary artery disease?Or do we have control over our risk factors? Cleveland Clinic Heart Center researchers believe they have resolved this debate once and for all:

Unhealthy lifestyles cause most heart disease, they say in a recent study published in the Journal of the American Medical Association.

Genes are a contributing factor, but not so much as was previously thought. The study showed that 80 percent to 90 percent of patients with coronary artery disease have at least one of four major risk factors: diabetes, high cholesterol, high blood pressure or cigarette smoking. Prior to this research, it was believed that many of these patients lacked major risk factors.

Dual Therapy Perks Up Hearts

If you have moderate to severe heart failure (a pumping disorder) and arrhythmia (an irregular heartbeat), you may enjoy a better quality of life with a new therapy tested at the Cleveland Clinic Heart Center. The treatment combines cardiac resynchronization therapy (CRT) with implantable cardioverter defibrillators (ICDs).

CRT works through an implantable device that helps resynchronize the lower chambers of the heart when they get out of rhythm with each other. An ICD is a device that can detect a rapid, life-threatening heartbeat and then immediately restore normal heart rhythm by delivering a strong electrical pulse to heart tissue.

“The results of our research show that these two therapies combined can improve a patient’s heart function and exercise capacity,” says James B. Young, M.D., co-principal investigator of the study. Heart failure patients who also suffer arrhythmia should ask their cardiologists if they are candidates for these surgically implanted devices.

CT Scanning Could Replace Angiogram

Cleveland Clinic Heart Center specialists are always looking for new ways of making procedures more effective, less invasive, and more comfortable for the patient.

Among these is spiral CT angiography, which may someday replace conventional coronary angiography as a means of visualizing coronary artery diseases. Angiography involves threading a catheter through the femoral artery and into the heart to inject a special dye. The dye provides the contrast needed to produce images of a patient’s heart vessels. With spiral CT scanning, the patient simply lies on a mobile table, which is slid through a large, square, doughnut-holed scanner. The imaging process produces 3-D images of heart structures and vessels. These images can then be manipulated to produce detailed “cuts” or “slices” of a particular portion of the heart or vessel.

By studying the images, Heart Center radiologists can detect atherosclerosis — the build-up of plaque on artery walls — in its early stages, before the plaque causes the vessel to narrow. Spiral CT images also can reveal potentially unstable “soft plaque,” which is now known to be the primary culprit in sudden coronary artery blockages that result in heart attacks.

This spiral CT image shows a cross-section of the heart from above, with plaque deposits showing up white (indicated with red circle).

The Cleveland Clinic Heart Center welcomes patients from around the country and around the world. We are truly a national heart center. Patients who come to The Cleveland Clinic from outside Ohio have access to special Medical Concierge Services that can assist with transportation, bookings, and all aspects of care during the visit. In addition, the Cleveland Clinic Heart Center also offers medical second opinions through e-Cleveland Clinic, a special internet service. Using a secure Web site, you fill out a condition-specific medical questionnaire and mail pertinent medical information to The Cleveland Clinic for review. The service is available to most people throughout the United States and the world.

For more information, go to e-Cleveland Clinic

Synthetic HDL Reverses Atherosclerosis

New research from the Cleveland Clinic Heart Center provides strong evidence that only five weekly infusions of a synthetic form of the good cholesterol, HDL, can remove significant amounts of plaque from the coronary arteries.

“This is an extraordinary finding,” says Cleveland Clinic Heart Center cardiologist Steven E. Nissen, M.D., who directed the study. “This is the first convincing demonstration that targeting HDL, good cholesterol, can benefit patients with heart disease."(The study is concluded. Synthetic HDL is not yet approved for general use.)

Atherosclerosis, or hardening of the arteries, is the process by which fatty deposits build up on the inner lining of artery walls, creating plaques. These plaques can grow large enough to significantly reduce blood flow. If the plaques rupture, they can cut off blood flow to vital organs, including the heart and brain, causing heart attacks or strokes.

The development of this investigational drug, known as ApoA-I Milano, is an unusual story. There is a town near Milan, in northern Italy, where many of the long-time residents have low HDL (good) cholesterol, which means that they should have a high rate of cardiovascular disease. But they don’t. Paradoxically, they have a very low rate of cardiovascular disease. It was discovered that a certain genetic protein, passed down from generation to generation, protects them from the ill effects of low HDL. Researchers isolated and synthesized this genetic protein and made it into the biopharmaceutical product ApoA-I Milano — a kind of super HDL.

Dr. Nissen cautions that “much more testing needs to be performed to determine whether this form of HDL can be used routinely to treat patients with atherosclerosis.”

For more information, see "Super HDL" Reverses Atherosclerosis

The Home of Heart Care

The Cleveland Clinic Heart Center welcomes patients from all over the world who want their care from America’s number one heart center.

You don’t need a special referral to come to the Cleveland Clinic Heart Center. Call us at 800/545-7718 for information or to make an appointment.

Also, you can visit our Web site at www.clevelandclinic.org/heartcenter.

Click here to learn more about the Heart Center

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