Multimodality imaging in transcatheter aortic valve replacement.

Transcatheter aortic valve replacement is a major advance that has dramatically changed our approach to elderly patients with severe aortic stenosis. This advance has been made possible by innovative device and delivery improvements, coupled with rapid developments in multimodality imaging. Multimodality imaging draws from multiple imaging fields and is central to patient evaluation and treatment.

California ACC goals.

MISSION: To advocate for accessible, highest quality, cost-effective cardiovascular care for Californians. The purpose of the Chapter shall be to contribute to the prevention of cardiovascular diseases, to ensure optimal quality care for the individuals with such diseases, and to foster the highest professional ethical standards.

Current and future alternatives to warfarin for the prevention of stroke in atrial fibrillation.

Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice and is associated with a nearly 5-fold increase in the risk of stroke. Warfarin has been the cornerstone of treatment to reduce stroke risk in AF patients for decades. Although effective in preventing thrombosis, warfarin is difficult to manage and is associated with a 1% to 7% yearly risk of major hemorrhage.

Obesity and physical fitness in California school children.

Background: Obesity rates have reached epidemic proportions in the United States and California. Thus, the California Department of Education began a series of steps to address the increase in obesity and decline in fitness in the 6.3 million public school children in California.

Use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy to reduce cardiovascular events in high-risk patients: part 2.

As presented previously in Part 1 of this 2-part article, many long-term clinical trials provide overwhelming evidence of the benefits of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) across the cardiovascular continuum. Trials also indicate additive or synergistic effects of combination therapy in renal disease and heart failure. Part 2, which is presented here, discusses the extensive interaction of the renin-angiotensin system (RAS) with the cellular and molecular pathophysiology of cardiovascular disease and the cross-continuum effects of ARBs and ACE inhibitors, which raises the possibility that RAS inhibition can offer protection in high-risk patients who do not have symptoms.

Effect of percutaneous mitral repair with the MitraClip device on mitral valve area and gradient.

Aims: Percutaneous repair of mitral regurgitation (MR) by leaflet apposition using a clip deployed via transseptal catheterisation is undergoing evaluation.

Methods And Results: In order to detect the potential for clinically significant left ventricular inflow obstruction after percutaneous repair, we measured mitral valve area (MVA) and mean transmitral gradient (MVG) echocardiographically in 96 patients implanted with a clip followed for up to 24 months. By planimetry, the mean MVA decreased from 6.

Use of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker therapy to reduce cardiovascular events in high-risk patients: Part 1.

Cardiovascular disease is understood as a continuum; risk factors induce a pathophysiologic cascade that culminates in end-organ failure. The renin-angiotensin system (RAS) influences multiple aspects of the pathophysiology via hemodynamic and nonhemodynamic effects. Many long-term clinical trials provide overwhelming evidence of benefits of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) across the cardiovascular continuum, including benefits regarding hypertension, myocardial infarction, stroke, renal disease, and heart failure.

Dobutamine stress echocardiography in preoperative and long-term postoperative risk assessment of elderly patients.

The authors reviewed all negative preoperative dobutamine stress echocardiograms (DSEs) performed over a 3-year period to determine the value of negative DSE for preoperative risk assessment in elderly patients. All patients with negative DSE performed for preoperative evaluation were followed. Cardiac event rates during and after the operative procedure were determined for hard end points (nonfatal myocardial infarction, cardiac death) and soft end points (emergency room visits, hospitalization for unstable angina, congestive heart failure, coronary angioplasty, coronary artery bypass graft surgery).