Cardiology Journal 2013, tom 20, nr 4

Sponsored by the National Heart, Lung, and Blood Institute, the Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) trial enrolled patients with diabetes mellitus (DM) and multivessel coronary artery disease (CAD) in a treatment with a coronary artery bypass grafting (CABG) surgery or a percutaneous coronary intervention (PCI) with sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES)...

Atrial fi brillation (AF) is twice as prevalent among patients with chronic kidney disease (CKD) and over 10 times more prevalent in patients on dialysis than in the general population [1, 2]. In the Chronic Renal Insuffi ciency Cohort of 3,267 adult participants, nearly 1 in 5 participants had evidence of AF; age, female gender, and a history of cardiovascular disease were the major predictors of AF in the study. Also, among 956 outpatients with coronary artery disease in the Heart and Soul Study, kidney dysfunction was independently associated with prevalent AF [3]...

Rising pacing threshold after implantation is a well-known phenomenon in endocardial pacing, caused by formation of a fi brotic capsule at the lead-tissue interface due to infl ammatory reactions [1]. Use of anti-inflammatory drugs like dexamethasone has been established for many years to suppress acute and chronic cellular infl ammation and release of infl ammatory mediators, resulting in lower pacing threshold and pacing energy [1, 2]...

Coronary artery disease, the leading cause of mortality and morbidity in the industrialised world, has traditionally been associated with poorer outcomes in patients undergoing aortic valve replacement (AVR) [1–4] for aortic stenosis. Improvements in surgical technique, myocardial preservation, perioperative management and earlier referral allows concomitant coronary artery bypass grafting (CABG) to be performed in selected patients undergoing AVR, resulting in satisfactory rates of operative mortality and a signifi cant improvement in quality of life compared to medical therapy [1, 5–7]...

Atherosclerotic renal artery stenosis (RAS) is one of the common reasons for secondary hypertension [1–3] and increased risk of cardiovascular mortality [4, 5]. Despite excellent outcomes of renal artery stenting, clinical benefi t from revascularization remains controversial [6]. Large randomized controlled trials comparing percutaneous angioplasty and optimal medical therapy did not prove revascularization advantages [7–12]...

Cardiac resynchronization therapy (CRT) is an important therapeutic option for patients with advanced heart failure (when optimal pharmacotherapy is insuffi cient) [1]. The essence of CRT is to increase cardiac output (CO), reducing interventricular (VV) conduction delay caused by left bundle branch block [2]. CRT reduces clinical symptoms of heart failure, decreasing incidence of hospitalization, and also signifi cantly decreasing mortality in these patients [3, 4]...

Tricuspid valve (TV) dysfunction is one of more important complications in patients with cardiac implantable electronic devices due to the endocardial lead. The frequency of this complication is underestimated and its impact on the clinical symptoms is attributed to other illnesses. How ever, further increase in complications related to lead crossing the TV is expected with the increasing number of implanted pacemakers (PM), cardioverter-defi brillators (ICD) and cardiac resynchronization therapy devices [1]...

Risk algorithms, mostly based on the analysis of the chronological age (CA) and classic cardiovascular (CV) risk factors, have limitations in the precise CV risk assessment of an individual and may cause underestimation of subjects, in whom aggressive modifi cation of CV disease risk factors should be introduced [1, 2]. Therefore, the concept of evaluating the “vascular age” (VA) — that would refl ect the real atherosclerotic damage — has recently drawn a growing attention in the fi eld of the CV risk assessment [3–6]...

Coronary computed tomography (CT) angiography is an established noninvasive method for coronary arteries imaging in patients with symptoms suggestive of coronary artery disease, both for diagnostic and prognostic purposes [1, 2]. In a case of the retrospective scanning, a multi-detector CT (MDCT) examination permits the measurement of volumes, and assessment of cardiac function [3]. Apart from diagnostic information, the left ventricular (LV) function evaluation adds incremental prognostic value over coronary artery evaluation [4]...

Percutaneous coronary intervention (PCI) has revolutionized the management and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) [1]. Primary PCI, according to the European Society of Cardiology (ESC) 2008 guidelines, is the treatment of choice in patients with STEMI within 12 h of chest pain onset [2]. However, the time delay associated with transportation to a hospital with a catheterization laboratory is a major drawback of primary PCI and may have an adverse effect on outcomes [3]...