Heart Matters

Therapeutic hypothermia is a relatively new treatment option for patients who suffer cardiac arrest, that can significantly improve neurologic outcomes. What factors determine the success of cooling therapy for cardiac arrest, and what resources does the procedure require? Dr. Michael Mooney, Director of Interventional Cardiology, Minneapolis Cardiology Associates, at Minneapolis Heart Institute / Abbott Northwestern Hospital in Minnesota, explores the indications for therapeutic hypothermia with host Dr. Janet Wright. Might therapeutic hypothermia be approached with a strategy similar to initiatives aimed at reducing door-to-balloon time for ST-elevation MI?

There are many potential options for treating left ventricular dysfunction, from medical to device therapies. Dr. Howard Eisen, Thomas J. Vischer Professor of Medicine and chief of the division of cardiology at Drexel University College of Medicine and Hahnemann University Hospital, in Philadelphia, Pennsylvania, outlines the roles of bypass surgery, percutaneous coronary intervention, cardiac resynchronization, surgical ventricular reconstruction and pharmacologic therapies for treating this condition. Specifically, he describes results of the recent Surgical Treatment for Ischemic Heart Failure, or STITCH, trial, and also tells us about the various ventricular-assist device options currently available. Dr. Alfred Bove hosts.

Fibromuscular dysplasia, most commonly found in the renal or carotid arteries, often goes undiagnosed, even though the condition may affect three- to five-percent of the U.S. patient population. What are symptoms of FMD, and in what patients should physicians screen for FMD, despite the absence of symptom presentation? Dr. Jeffrey Olin, professor of cardiology and director of vascular medicine at Mount Sinai in New York City, offers his insights on FMD, as Dr. Olin has dedicated much of his professional career to spreading awareness about the condition. Dr. Alfred Bove hosts.

Correcting anemia or iron deficiency in patients with heart failure has been shown to improve mortality and quality of life. Among patients with heart failure, how common are anemia and iron deficiency? What type of iron supplementation therapy is most effective? Dr. William Dec, chief of the cardiology division, co-director of the Massachusetts General Hospital Heart Center, and the Roman W. DeSanctis Professor of Medicine at Harvard Medical School, discusses the Ferinject Assessment in Patients with Iron Deficiency and Chronic Heart Failure, or FAIR-HF, trial, and shares his excitement about this new potential pharmacologic therapy for patients with heart failure. Hosted by Dr. Alfred Bove.

Defibrillator and pacemaker leads can be challenging to remove or replace, even when the procedure is performed by an experienced cardiologist. Infection, manufacturer recall and device malfunction are all reasons a lead might require extraction. How can we balance the risks of the procedure with the potential harms of leaving a lead implanted? Dr. Charles Love, professor of clinical medicine in the division of cardiovascular medicine and director of Cardiac Rhythm Device Services at Ohio State University Medical Center, discusses ways to manage the risks of lead extraction with host Dr. Alfred Bove.

Previous trials, including the ENHANCE trial, have raised doubts about the clinical benefits of adding ezetimibe to high-dose statin therapy. The ARBITER 6-HALTS trial added further weight to the results of ENHANCE, wherein the ARBITER trial demonstrated that extended-release niacin was superior to ezetimibe as adjunctive therapy to high-dose statins in slowing atherosclerosis. However, this study was not based on clinical outcomes, but rather on measuring carotid intima-media thickness (CIMT). In addition, the ARBITER trial was relatively small, based on 208 patients completing the trial. Are these data enough to impact clinical use of ezetimibe and niacin, or should we await results of further large-scale trials? Dr. Christopher Cannon, associate professor of medicine at Harvard Medical School and editor-in-chief of the American College of Cardiology's Cardiosource, weighs in on these questions and more regarding adjunctive therapy to high-dose statins, with host Dr. Jack Lewin.

How does an integrated cardiac care model work, and how difficult a process is such a model to implement? What are the various components of the program, and what have the results been? George Halvorson, chairman and chief executive officer of Kaiser Permanente and author of the book Healthcare Will Not Reform Itself, joins host Dr. Jack Lewin to discuss the advantages of a collaborative care model and the importance of efficient data flow. How might such a systematic, coordinated model impact the discussion of health care reform?

Standard troponin assays can be a crucial tool in diagnosing myocardial infarction, but have also been criticized for their low specificity at the time of presentation. Will newer, more sensitive troponin assays improve early detection and diagnostic accuracy for MI? Even with use of the newer assays, Dr. David Morrow, associate professor of medicine at Harvard Medical School, warns that elevated troponin may not necessarily indicate myocardial infarction. What other clinical evidence can physicians use to assess for an acute coronary syndrome? Dr. Janet Wright hosts.

What are the 2009 recommendations for best managing ST-segment-elevation myocardial infarction, or STEMI, and the need for percutaneous coronary intervention, or PCI? Dr. Judith Hochman, the Harold Snyder Family Professor of Cardiology and clinical chief of cardiology at the New York University (NYU)-New York City Health and Hospitals Corporation (HHC) Clinical Translational Science Institute, reviews the most significant components of the focused update on management of STEMI and PCI. Dr. Janet Wright hosts.

Although cardiac resynchronization therapy (CRT) is recommended for patients with moderate to severe heart failure and a prolonged QRS interval, is it ever recommended for patients with mild cardiac symptoms? Can prophylactic resynchronization therapy, delivered by an implantable defibrillator, reduce the risk of heart failure or death in those patients with mild cardiac sympotoms? Tune in to hear Dr. Arthur Moss, professor of medicine and director of the Heart Research Follow-Up Program at the University of Rochester School of Medicine and Dentistry, discuss new findings about whether CRT might play a wider role in the prevention of heart failure. Dr. Janet Wright hosts.