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Winter 2014 eNewsletter

Choosing between CABG and PCI: What current evidence suggests

Revascularization strategies for patients with multivessel coronary artery disease, left-main disease and /or diabetes may not be so cut-and-dried when comparing coronary artery bypass grafting (CABG) verse percutaneous coronary intervention (PCI).

Exercise stress testing can predict outcome in patients with early hypertrophic cardiomyopathy

Exercise stress testing can be useful in ascertaining the extent of cardiac damage in asymptomatic or minimally symptomatic patients with hypertrophic cardiomyopathy (HCM), which is predictive of long-term outcome.

Case Study: Pulmonary Vein Stenting for Stenosis Following Pulmonary Vein Isolation for Atrial Fibrillation

Severe pulmonary vein stenosis (PVS) is seen in 1-2 percent of patients after PVI and may present with coughing, hemoptysis, and/or dyspnea.

Image of the Issue: Acute Viral Pericarditis

17 year old man with recurrent viral pericarditis; cardiac MRI shows active inflammation in the pericardial sac shown in white on left (yellow arrow) that improves with triple anti-inflammatory therapy (right). MRI is being used to assess the degree of edema and inflammation in the pericardium (figure). Based on these findings, triple anti-inflammatory therapy is often initiated and subsequent slow tapering of the medications is performed with good success.

Resources: CME Calendar

Cleveland Clinic's 17th Diastology and Valve Summit

February 27-March 2, 2014
Eden Roc Hotel
Miami, Florida

The 17th Diastology and Valve Summit will provide a unique opportunity to interact with key opinion leaders and receive updates in heart valve disease, new and emerging imaging technologies, diastology, and multimodality imaging. Designed as an interactive course, you will be fully engaged with faculty during workshops including question and answer sessions.

Register Now

Intensive Vascular Ultrasound Interpretation

Review and Registry Preparation
April 12-13, 2014
Bunts Auditorium, Cleveland Clinic main campus
Cleveland, Ohio

Two days covering a wide spectrum of vascular lab diagnostics including both ultrasound and physiologic testing. Rapid-fire interpretation of vascular studies, mock registrytype exam questions, and vascular physics and technology drills are featured. New topics for 2014: use of ultrasound in planning and follow-up of venous ablation procedures, quality and accreditation in the vascular lab, and Cleveland Clinic’s most unusual vascular ultrasound cases.

Register Now

Pericardial Intervention in Cardiac Electrophysiology

May 6, 2014 | 7-9:30 p.m. (complimentary dinner program)
InterContinental Hotel
San Francisco, California

Dinner symposium at the Heart Rhythm 2014 meeting on benefits, risks and practical considerations in the use of percutaneous procedures for accessing the pericardial space. Featured procedures include ventricular tachycardia ablation, atrial fibrillation ablation and left atrial appendage occlusion.

Register Now

Strategic Management of CIED Infections

May 7, 2014 | 6:15-9:45 p.m. (complimentary dinner program)
InterContinental Hotel
San Francisco, California

Dinner symposium at the Heart Rhythm 2014 meeting exploring the prevention, recognition and management of cardiovascular implantable electronic device (CIED) infections. Features presentations, case studies and panel discussions led by national and international experts in the field.

Register Now

International Fibromuscular Dysplasia Research Network Symposium

May 15-16, 2014
InterContinental Hotel & Bank of America Conference Center
Cleveland, Ohio

Although it’s a nonatherosclerotic disorder, fibromuscular dysplasia (FMD) is associated with major vascular morbidity. This two-day meeting combines a review of the latest knowledge and research activities surrounding FMD with sessions designed to establish a multidisciplinary FMD research network and set an agenda of research priorities. Featuring a faculty of global experts in FMD.

Register Now

15th Annual Intensive Review of Cardiology

Aug. 23-27, 2014
InterContinental Hotel & Bank of America Conference Center
Cleveland, Ohio

Intensive five-day course focused on the needs of practicing cardiologists and those preparing for cardiovascular board certification or recertification. Complex patient management decision-making is emphasized.

Register Now

Preceptorship in Carotid Ultrasound Interpretation

Aug. 25-29 | Oct. 13-17 | Dec. 1-5, 2014
Miller Family Heart & Vascular Institute
Noninvasive Vascular Laboratory
Cleveland, Ohio

Intensive 4½-day training program in interpreting carotid duplex ultrasound examinations. Features lectures, preceptored interpretation sessions with physicians from Cleveland Clinic’s Noninvasive Vascular Laboratory, hands-on screening sessions and extensive review of cases with angiographic correlations. Participants will interpret approximately 125 carotid duplex ultrasound exams. Class size limited to five participants to allow ample direct mentorship from faculty.

Register Now

Fall/Winter 2013 eNewsletter

Addressing Device Failures and Problematic Lead Extractions

Cleveland Clinic is taking the lead in addressing the issues with pacemakers or implantable cardioverter-defibrillators potential to fail from infection or lead-related side effects, requiring its removal. Infection alone is a serious concern, occurring in two percent of the three million patients with implanted devices.

Deciding Between Surgical and Catheter-Based Ablation for Elderly Patients

New minimally invasive catheter-based and surgical techniques provide excellent treatment options for elderly patients with atrial fibrillation.

Gut-Flora Metabolite Biomarker for Cardiac Risk

A test for trimethylamine-N-oxide (TMAO), a gut flora-dependent metabolite that contributes to heart disease, was voted one of the top 10 medical innovations of 2014 at Cleveland Clinic’s 10th annual Medical Innovation Summit.

Case Study: Treatment of Necrotizing Pneumonia from Influenza and MRSA

A 28-year-old female presented to a New York hospital with progressive fever, chest pain and sore throat, despite Tamiflu use. She tested positive for H1N1 influenza, was admitted to the intensive care unit and started on antibiotic therapy.

Resources: CME Calendar

17th Cleveland Clinic Diastology and Heart Valve Summit

Available Courses
February 27-March 2, 2014
Eden Roc Hotel
Miami Beach, FL

The 17th Diastology and Valve Summit will provide a unique opportunity to interact with key opinion leaders and receive updates in heart valve disease, new and emerging imaging technologies, diastology, and multimodality imaging.

Register Now

Pericardial Intervention in Cardiac Electrophysiology

Available Courses
May 6, 2014
InterContinental Hotel
San Francisco, CA

This symposium will focus on current approaches to pericardial interventions as they pertain to cardiac electrophysiology. It will use a case-based format to discuss advances in diagnostics and interventional therapeutics that utilize the pericardial space, including catheter-based ablation of ventricular and supraventricular arrhythmias.

Register Now

International Lead Management Collaborative Community Symposium Strategic Management of CIED Infections

Available Courses
May 7, 2014
InterContinental Hotel
San Francisco, CA

Identifying and managing CIED infections can be challenging. This satellite symposium will focus on prevention, recognition and CIED infection management. Didactic presentations, case studies and panel discussions, led by nationally recognized leaders, are designed to provide the best evidence-based recommendations.

Register Now

Fall 2013 eNewsletter

Knowing When to Transfuse: Blood Conservation Strategies Gain Momentum

A recent study published in The Lancet found that a restrictive approach to blood transfusion has emerged nationally as a best practice, supported by clinical guidelines and evidence-based research. However, researchers identified a high degree of variability from institution to institution for certain procedures such as cardiothoracic surgery.

Staged Carotid Stenting Is the Most Effective Treatment for Open Heart Surgery Patients with Severe Coronary and Carotid Disease

When it comes to carotid revascularization in the open heart surgery (OHS) population, the newest and least used alternative — staged carotid artery stenting (CAS) followed by OHS — edged out more widely used approaches beyond the short term.

A Biologic to Treat Dyslipidemia?

Cleveland Clinic studies focus on PCSK9 inhibition

While statin therapy is an effective first-line treatment for patients diagnosed with high cholesterol and with coronary artery disease (CAD), many patients fail to achieve adequate LDL-C reduction despite maximally tolerated statin treatment, and others are intolerant to statins.

Case Study: An 85 Year-Old Male with Hemodynamic Decompensation After an Acute Myocardial Infarction

Hemodynamic instability following an acute myocardial infarction (AMI) is a medical emergency, which must be dealt with immediately. While LV dysfunction is the most common cause of cardiogenic shock, appropriately treated with inotropes, afterload reduction, and IABP, one must be vigilant for mechanical complications of AMI (ruptured papillary muscle, ventricular septal defect, LV pseudoaneurysm and rupture), which need to be treated surgically.

Resources: CME Calendar

9th Annual Pulmonary Hypertension Symposium: Translating Discoveries into Patient Care

Available Courses
November 15-16, 2013
Intercontinental Hotel & Bank of America Conference Center
Cleveland, Ohio

Register Now

2013 Preceptorship in Carotid Ultrasound Interpretation

December 2 – 6, 2013
Cleveland Clinic
Miller Family Heart & Vascular Institute
Noninvasive Vascular Laboratory | Cleveland, Ohio

(class size is limited to six participants)

Register Now

17th Annual Diastology and Valve Summit

February 27 – March 2, 2014
Eden Roc Hotel
Miami Beach, Florida

Register Now

Spring 2013 eNewsletter

Newer Oral Antithrombotics Add Complexity to Bridging Strategies

Dabigatran, rivaroxaban and apixaban are so new that none of the major clinical guidelines address oral anticoagulant bridging recommendations prior to surgery. There is no monitoring test or reversal agent for these oral anticoagulants.

A-fib and Stroke Prevention: Innovative Devices Expand Treatment Options

We now know patients with a-fib are five times more likely to suffer a stroke, which means that risk reduction has taken center stage. Newer oral anticoagulants and enhanced surgical techniques have provided more treatment options than ever before - and when it comes to medical devices, a new era is dawning.

Study Confirms Niacin’s Limited Utility in the Era of High-Dose Statin Therapy

HPS2-THRIVE, the largest niacin trial to date, found that in patients with a history of cardiovascular disease whose cholesterol levels are well controlled, niacin really doesn’t add anything and it may even cause harm.

Image of the Issue: TAVR

Amar Krishnaswamy, MD, interventional cardiologist in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, shares images of a successful transcatheter aortic valve replacement.

Case Study: Post-Thrombotic Syndrome

Post-thrombotic syndrome (PTS) occurs in 20 to 50 percent of patients with proximal deep vein thrombosis despite standard anticoagulant therapy.Treating patients with PTS can be discouraging, because treatment options are limited.

Resources: CME Calendar

2013 Preceptorship in Carotid Ultrasound Interpretation

Available Courses
August 26 - 30, 2013 | December 2 - 6, 2013
Cleveland Clinic Heart & Vascular Institute, Noninvasive Vascular Laboratory
Cleveland, Ohio

Register Now

Winter 2013 eNewsletter

Addressing Advanced Heart Failure with LVADs

Left-ventricular assist devices (LVADs) are a viable alternative to transplant for some patients, and today's smaller devices make these an option for more patients with heart failure.

Undercover ICDs

Subcutaneous implantable cardioverter defibrillators (ICDs) are less invasive and don't overreact to arrhythmia, which means reduced risk for the patient.

Image of the Issue

Heather L. Gornik, MD, medical director of the Non-Invasive Vascular Laboratory at Cleveland Clinic, shares this image of classic medial fibroplasia type fibromuscular dysplasia (FMD) of the right renal artery in a patient with difficult to manage hypertension.

Case Study: Occluded Stent Removal for Revascularization in Setting of Infection

Remote endarterectomy is a minimally invasive adaptation of an established revascularization technique that accommodates using a single incision. It also avoids prosthetic graft materials, making it an ideal technique for infected graft cases.

Resources: CME Calendar

2013 Preceptorship in Carotid Ultrasound Interpretation

Available Courses
April 29 - May 3, 2013 | August 26 - 30, 2013 | December 2 - 6, 2013
Cleveland Clinic Heart & Vascular Institute, Noninvasive Vascular Laboratory
Cleveland, Ohio

Register Now
Fall 2012 eNewsletter

Treating Statin-Intolerant Patients

Lowering LDL cholesterol takes a multi-disciplinary approach for statin-intolerant patients

Before you label a patient as statin-intolerant, consider this: many patients have success using a different statin, lower dosing or a combination of prescriptive and over-the-counter therapies that can produce the desired results. Cleveland Clinic ushers patients through the complex process of finding a comfortable, effective regimen that, for many, produces the same positive reductions in low-density lipoprotein (bad) cholesterol, with presumed benefits similar to that seen with traditional statin use.

Could Quality Measures Put Patients at Risk?

Numbers don’t tell all about patient care. A closer look at quality measures reveals that many well-intended processes and standards can result in negative consequences.

Quality measures that are designed to improve patient care actually may cause greater risk and unintended consequences. In other words, what looks good on paper could pose high risk to patients when put into practice. Umesh N. Khot, MD, Chief Quality Officer for Cardiovascular Medicine at Cleveland Clinic, believes that is why careful analysis of quality measures is critical to ensure that newly implemented processes and standards will truly benefit patient outcomes.

Young at Heart

Surgical options for young patients with aortic valve disease.

About 2 percent of people are born with congenital aortic valve disease, and more serious complications can present at any time in their lives. It’s important for patients and surgeons to understand surgical options, so when it’s time to operate, everyone is prepared.

Image of the Issue

This is a giant left renal artery aneurysm seen on a 3D volume rendered image from a CT scan. The image is presented by Cleveland Clinic vascular surgeon Sean Lyden, MD. He chose to address the issue through open surgery involving a kidney autotransplant.

Case Study: Retrieving an Inferior Vena Cava Filter

Cleveland Clinic’s IVC Filter Retrieval Clinic is focused on removing removable or temporary placed inferior vena cava (IVC) filters to ensure patient safety. In this case, a patient with an imbedded IVC filter avoided open surgery thanks to the Clinic’s expertise and minimally invasive approach.

Summer 2012 eNewsletter

Cardio-Oncology Center: Taking Cancer Treatment to Heart

Cleveland Clinic's Cardio-Oncology Center focuses on early detection and treatment of heart issues caused by cardio-toxic cancer therapies.

Patients with breast cancer, once cured, do not die from recurrence of their cancer according to Juan Carlos Plana, MD, co-director of Cleveland Clinic’s new Cardio-Oncology Center. "They die from heart failure."

The good news is that cancer therapy today is so effective that there are more survivors than ever before. Despite this encouraging trend, cancer patients have another challenge to beat: the chemotherapies used to treat cancer are damaging to the heart.

"In the past, the cardiac complications of cancer treatments were not really a concern," says Dr. Plana. The Center is focused on early detection and treatment of heart issues stemming from cancer treatment. "Today, we are delivering very successful therapies for cancer, and patients are surviving," Dr. Plana says. "And as a result, they live long enough to experience the cardiac complications of cancer therapy."

Alternative Repair for Aortic Aneurysms

Open surgery isn't the only answer for repairing complex aortic aneurysms. Cleveland Clinic’s advanced stent grafting procedures give some patients a less invasive option.

Patients facing open surgery to repair aneurysms and dissections of the ascending aorta and aortic arch could have another alternative at Cleveland Clinic, one of the only medical institutions in the country where complex endovascular stent grafting can be performed. With the introduction of new stent graft devices that can bend to accommodate the aortic arch, it’s now possible to treat more extensive disease, says Matthew Eagleton, MD, a vascular surgeon at Cleveland Clinic.

"Branched devices aren't available everywhere," Dr. Eagleton says. "Because of the research conducted here, we are not limited to only treating patients with conventional aneurysms. We can treat much more complex disease."

Winter 2012 eNewsletter

The Beat Stops Here: Managing AF with Drug Therapy vs. Ablation

Drug therapy has always been the first line of treatment for AF, but recent studies show encouraging outcomes for an ablation-first strategy.

Ablation is currently the second line of therapy for atrial fibrillation (AF), considered only after a medicine has failed to control heart rhythm or drug therapy is not well tolerated by the patient. But recent studies touting better outcomes for an ablation-first strategy could turn this clinical guideline on its head.

Image of the Issue: Seeing Pericardial Inflammation with Multi-modality Imaging

A multi-modality imaging strategy can properly diagnose pericarditis so the disease can be effectively managed.

A patient presenting with pericarditis—inflammation of the lining around the heart—can be mistakenly diagnosed and poorly treated when there is lack of understanding about the disease and its complications. Pericarditis can be confused with nonspecific chest pain, or even heart attack.

Case Study: Ischemic Stroke and Left Ventricular Dysfunction

A 22-year-old woman with Ischemic Stroke and Left Ventricular Dysfunction

Case Presentation: Shikhar Agarwal, MD, MPH, CPH, Cardiology Fellow, Cleveland Clinic
A 22-year-old female was transferred to Cleveland Clinic from an outside hospital for evaluation of acute ischemic stroke. She has presented to an outside hospital two days prior with acute onset numbness and tingling of bilateral upper extremities and mild expressive aphasia.

Fall 2011 eNewsletter

PCI for Left Main Disease: A Viable Option

With the largest randomized clinical trial of left main patients underway, Cleveland Clinic helps lead research to explore interventional alternatives to open heart surgery for patients with complex blockages.

Surgery has always been the go-to treatment for patients with left main disease, which can compromise up to 70 percent of blood flow to the heart. But percutaneous coronary intervention could be an option for well-selected patients with the disease, and neutral outcomes from recent randomized trials where patients received angioplasty and stents further position interventional therapy as a viable option for some patients.

Informing Patients about Clinical Trials

Keep it simple, inform them early. Let patients know about all of their options by including clinical trials when discussing treatment.

Primary care physicians and referring cardiologists play a critical role in getting patients involved in important clinical trials. Patients trust them for information and guidance. And when patients can learn about trials for their condition long before they arrive at Cleveland Clinic for a procedure, they are more likely to consider enrolling.

Imaging Debate: MPI or CT Angiography?

When is it best to use myocardial perfusion imaging (MPI) or CT angiography to evaluate patients with known or suspected coronary artery disease?

The wide availability of CT coronary angiography for assessing coronary artery disease (CAD) introduces an interesting question concerning cardiovascular imaging. What is the best way to manage patients: stress myocardial perfusion imaging (MPI) to assess physiologic criteria; or CT coronary angiography to identify anatomic criteria?

Diagnose This

A case study from our Fall Physician eNewsletter

Sheila* is a 22-year old mother of two children who was living an otherwise healthy life until one day she experienced a sudden numbness and tingling in her upper extremities. She could not communicate, though she was aware of what was going on around her. The next day, she became feverish and her blood pressure dropped to the 60s.

*Not her real name.

CME Calendar

Healthcare professionals are invited to attend the following upcoming symposia.

Cardiovascular CT Training Program 2011

September 16-23, 2011
Location: Cleveland Clinic, Cleveland, OH

Shaping the Future of Cardiovascular Care: Progress and Controversies

October 5-7, 2011
InterContinental Hotel and Bank of America Conference Center, Cleveland, Ohio

HVI Referrals

To refer patients to a Cleveland Clinic Heart & Vascular specialist, please call:

  • Cardiovascular Medicine - 216.444.6697
  • Thoracic and Cardiovascular Surgery - 877.843.2781
  • Vascular Surgery - 216.444.4508

Same day appointments are available.

Spring 2011 eNewsletter

Monitoring Patients with Heart Failure

Remote monitoring devices present significant potential for Cleveland Clinic patients who are at risk for worsening heart failure and the physicians who treat them.

Remote monitoring is an under-tapped technology that can be utilized to identify patient vulnerabilities for worsening heart failure and to potentially avert costly hospital visits. Cleveland Clinic researchers are currently conducting one of the largest multi-center national studies focused on understanding how device-based remote monitoring can be used to manage patients with heart failure. The technology has potential to intercept patients before they need to seek hospital care. But the challenge for medical institutions is how to manage the vast streams of data and how to best act on newfound information.

Robotic Mitral Valve Repair: Settling the Controversy

A Cleveland Clinic study shows that robotic MV repair is safe, effective and cost-competitive, making it a great success story in modern surgery.

Robotic mitral valve (MV) repair is as safe and effective as conventional approaches, and it’s less invasive and requires shorter hospital stays. Cleveland Clinic’s large registry of cardiovascular surgery cases enabled a comprehensive data review.

Choosing Ablation to Treat AF

Studies show better long-term results for ablation vs. drug therapy in treating patients with atrial fibrillation.

Studies show that for many patients ablation is a superior method of treating atrial fibrillation (AF) compared to drug therapy, and today the threshold for turning to ablation has decreased. Some savvy patients are asking for this procedure rather than medications. Meanwhile, results from multi-center trials are supporting ablation as an effective long-term therapy for managing AF.

Image of the Issue

With a non-contrast Computed Tomography (CT) scan, physicians can get a clearer picture of whether a patient’s risk factors such as high blood pressure, elevated cholesterol levels or high body mass index should be treated more aggressively with a non-contrast Computed Tomography (CT) scan.

Diagnose This

A case study from our Spring Physician eNewsletter

Dan* is 48 and happily married. Until two years ago, he was sexually active without any limitations. Then, he presented with left leg claudication symptoms and erectile dysfunction, despite treatments with Sildenafil (Viagra) up to 100 mg. Dan has a history of smoking, hypertension, hyperlipidemia, coronary artery and peripheral arterial disease. What could be the cause of Dan’s erectile dysfunction?

*Not his real name

CME Calendar

Healthcare professionals are invited to attend the following upcoming symposia.

Cleveland Clinic Health Care Quality Innovation Summit

May 11-13, 2011
Cleveland Clinic Main Campus, Cleveland, Ohio

Shaping the Future of Cardiovascular Care: Progress and Controversies

October 5-7, 2011
InterContinental Hotel and Bank of America Conference Center, Cleveland, Ohio

Cardiovascular CT Training Program 2011

June 3-10, 2011
Cleveland Clinic Main Campus, Cleveland, Ohio

HVI Referrals

To refer patients to a Cleveland Clinic heart and vascular specialist please call:

  • Cardiovascular Medicine - 216.444.6697
  • Thoracic and Cardiovascular Surgery - 877.843.2781
  • Vascular Surgery - 216.444.4508

Same day appointments are available.

Reviewed: 01/14

Talk to a Nurse: Mon. - Fri., 8:30 a.m. - 4 p.m. (ET)

Call a Heart & Vascular Nurse locally 216.445.9288 or toll-free 866.289.6911.

Schedule an Appointment

Toll-free 800.659.7822

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

© Copyright 2014 Cleveland Clinic. All rights reserved.

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