C-reactive protein, but not low-density lipoprotein cholesterol levels, associate with coronary atheroma regression and cardiovascular events after maximally intensive statin therapy.

Background: Baseline C-reactive protein (CRP) levels predict major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, coronary revascularization, and hospitalization for unstable angina). The association between changes in CRP levels with plaque progression and MACE in the setting of maximally intensive statin therapy is unknown.

Methods And Results: The Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) used serial intravascular ultrasound measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months.

Assessment of prosthetic valve function and para-valvular regurgitation after trans-catheter aortic valve replacement.

Purpose Of Review: To review the current literature on prosthetic valve function and para-valvular regurgitation (PVR) after trans-catheter aortic valve replacement (TAVR). TAVR is a new alternative for the treatment of severe aortic stenosis in patients at high risk for surgical aortic valve replacement and nonsurgical candidates.

Recent Findings: The innovations in three-dimensional trans-esophageal echocardiography have made it an integral part of the TAVR procedure.

The utility of dynamic magnetic resonance venography in the setting of pelvic venous pathology.

The standard initial noninvasive imaging modality for diagnosing May-Thurner syndrome is duplex ultrasound, but this modality provides only indirect measures and is frequently limited, necessitating further imaging to make the diagnosis. Other noninvasive imaging modalities (computed tomographic venography, time of flight, magnetic resonance venography) allow for direct visualization but lack hemodynamic and anatomic information about what is occurring throughout the cardiac cycle. Intravascular ultrasound is the invasive tool of choice in the setting of iliac vein compression syndrome, but quality, noninvasive imaging modalities have yet to be described.

Three-dimensional echocardiography to quantify mitral valve regurgitation.

Purpose Of Review: Current three-dimensional echocardiographic technology, including live three-dimensional transesophageal echocardiography and single-beat three-dimensional color Doppler imaging, are providing valuable new insight into the mechanism and quantification of mitral valve regurgitation.

Recent Findings: We discuss recent applications of three-dimensional volumetric leaflet imaging with emphasis on the distinction between organic and functional mitral regurgitation. We also discuss the added benefit of current and emerging three-dimensional color Doppler methods for the quantification of mitral valve regurgitation severity.

Efficacy and safety of eicosapentaenoic acid ethyl ester (AMR101) therapy in statin-treated patients with persistent high triglycerides (from the ANCHOR study).

AMR101 is an ω-3 fatty acid agent containing ≥96% pure icosapent-ethyl, the ethyl ester of eicosapentaenoic acid. The efficacy and safety of AMR101 were evaluated in this phase 3, multicenter, placebo-controlled, randomized, double-blinded, 12-week clinical trial (ANCHOR) in high-risk statin-treated patients with residually high triglyceride (TG) levels (≥200 and <500 mg/dl) despite low-density lipoprotein (LDL) cholesterol control (≥40 and <100 mg/dl). Patients (n = 702) on a stable diet were randomized to AMR101 4 or 2 g/day or placebo.

Evaluation of meglumine gadoterate-enhanced MR angiography (MRA) compared with time-of-flight MRA in the diagnosis of clinically significant non-coronary arterial disease: a pooled analysis of data from two clinical trials.

Objectives: We analysed pooled data from two clinical trials to assess the diagnostic accuracy and safety of meglumine gadoterate (Gd-DOTA)-enhanced MR angiography (MRA) relative to those of non-enhanced time-of-flight (TOF) MRA for non-coronary arterial disease. Both techniques were compared with X-ray angiography as the gold standard.

Methods: Patients were of both sexes, were aged at least 18 years and had suspected non-coronary arterial disease.

Comparative accuracy of two- and three-dimensional transthoracic and transesophageal echocardiography in identifying mitral valve pathology in patients undergoing mitral valve repair: initial observations.

Background: Identification of mitral regurgitation (MR) mechanism and pathology are crucial for surgical repair. The aim of the present investigation was to evaluate the comparative accuracy of real-time three-dimensional (3D) transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) with two-dimensional (2D) TEE and TTE in diagnosing the mechanism of MR compared with the surgical standard.

Methods: Forty patients referred for surgical mitral valve repair were studied; 2D and 3D echocardiography with both TTE and TEE were performed preoperatively.

The role of echocardiography and other imaging modalities in patients with left ventricular assist devices.

Recent advances in the field of left ventricular device support have led to an increased use of left ventricular assist devices (LVADs) in patients with end stage heart disease. The primary imaging modality to monitor patients with LVADs has been echocardiography. The purpose of this review is to highlight the clinical role of echo and other noninvasive imaging modalities in the assessment of cardiac structure and function in patients with pulsatile and continuous flow LVADs.

Extensive cardiac lipoma with aneurysmal right ventricle.

A 56-year-old female with history of mitral valve replacement and automated implantable cardioverter-defibrillator placement presented with dyspnea on exertion for two years and recurrent ascites. Imaging studies, including transthoracic and transesophageal echocardiograms as well as 64-slice computed tomography (CT) angiogram revealed a large mass encasing the entire heart consistent with lipoma. In addition, a right ventricular free wall aneurysm was found.

Feasibility of dual Doppler velocity measurements to estimate volume pulsations of an arterial segment.

If volume flow was measured at each end of an arterial segment with no branches, any instantaneous differences would indicate that volume was increasing or decreasing transiently within the segment. This concept could provide an alternative method to assess the mechanical properties or distensibility of an artery noninvasively using ultrasound. The goal of this study was to determine the feasibility of using Doppler measurements of pulsatile velocity (opposed to flow) at two sites to estimate the volume pulsations of the intervening arterial segment.

Platelet activation patterns in platelet size sub-populations: differential responses to aspirin in vitro.

Circulating platelets are heterogeneous in size and structure. Whether this translates into differences in platelet function and efficacy of antiplatelet therapy is unclear. Hence, we decided to investigate the activation patterns among different platelet populations differentiated by size, and to compare the inhibitory effects of aspirin in these populations.

Efficacy and safety of angiotensin receptor blockade are not modified by aspirin in patients with chronic heart failure: a cohort study from the Candesartan in Heart failure--Assessment of Reduction in Mortality and morbidity (CHARM) programme.

Aims: It is unknown whether there is an interaction between aspirin and angiotensin receptor blockers on outcomes in patients with heart failure (HF).

Methods And Results: The efficacy and safety of candesartan vs. placebo was assessed in 7599 patients with symptomatic HF and reduced or preserved left ventricular ejection fraction enrolled in the CHARM programme according to baseline aspirin use.

Three-dimensional color Doppler echocardiography for direct measurement of vena contracta area in mitral regurgitation: in vitro validation and clinical experience.

Objectives: Our goal was to prospectively compare the accuracy of real-time three-dimensional (3D) color Doppler vena contracta (VC) area and two-dimensional (2D) VC diameter in an in vitro model and in the clinical assessment of mitral regurgitation (MR) severity.

Background: Real-time 3D color Doppler allows direct measurement of VC area and may be more accurate for assessment of MR than the conventional VC diameter measurement by 2D color Doppler.

Methods: Using a circulatory loop with an incorporated imaging chamber, various pulsatile flow rates of MR were driven through 4 differently sized orifices.

Impact of contrast echocardiography on evaluation of ventricular function and clinical management in a large prospective cohort.

Objectives: The aim of this study was to evaluate the impact of echocardiographic contrast utilization on patient diagnosis and management.

Background: Contrast echocardiography (CE) has improved visualization of endocardial borders. However, its impact on patient management has not been evaluated previously.

Safety of contrast administration for endocardial enhancement during stress echocardiography compared with noncontrast stress.

The aim was to evaluate the safety of stress echocardiography using contrast (CE) for endocardial enhancement compared with a noncontrast (NCE) cohort in a large nonselect population. The recent Food and Drug Administration warning cited lack of data for safety regarding the use of contrast in conjunction with stress echocardiography. A detailed record review was performed for 5,069 consecutive patients who underwent stress echocardiography (58% pharmacologic, 42% exercise) during an 8-year period.

Statin therapy alters the relationship between apolipoprotein B and low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol targets in high-risk patients: the MERCURY II (Measuring Effective Reductions in Cholesterol Using Rosuvastatin) trial.

Objectives: The purpose of this analysis was to compare concentrations of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (HDL-C), and apolipoprotein B (apoB) before and during statin therapy.

Background: Reducing LDL-C to a pre-determined goal may still leave an excess of atherogenic lipoproteins, as reflected in apoB levels.

Methods: The MERCURY II (Measuring Effective Reductions in Cholesterol Using Rosuvastatin therapY II) trial examined the effects of statin treatment in patients with high coronary heart disease (CHD) risk, LDL-C > or =130 and <250 mg/dl, and triglycerides <400 mg/dl.

Peripheral venous hypertension of the hand: a complication of a proximal radial artery arteriovenous fistula.

Venous hypertension due to dialysis access is usually secondary to outflow obstruction. The bidirectional proximal radial artery arteriovenous fistula (PRAVF) has been proposed as a procedure to increase autogenous fistula utilization and is rarely reported to cause peripheral venous hypertension. We report here a case of peripheral venous hypertension from a PRAVF, the first report to our knowledge caused by a peripheral outflow obstruction.