Case Western Reserve University School of Medicine & UH Case Medical Center
First multi-PI combined training program between CWRU and Cleveland Clinic headed by Fabio Cominelli
Dr. Marco Costa found a second blocked artery in Mack Bailey’s heart — and demonstrated to a Good Morning America audience the first vascular-imaging technology based on optical coherence tomography (OCT) — at the same time Thursday.
Costa is an interventional cardiologist and director of the cardiovascular research institute at University Hospitals Case Medical Center in Cleveland, Ohio. Bailey is a 60-year-old Clevelander with had a heart attack and is being treated by Costa.
Both agreed to be filmed and interviewed by the NBC morning news show because University Hospitals is the first — and so far only — hospital to use the C7-XR Imaging System and accompanying C7 Dragonfly Imaging Catheter made by LightLab Imaging Inc. during patient heart procedures.
While using the technology to place a stent in one of Bailey’s heart arteries, Costa found a second blocked artery that had not shown up on images of Bailey’s heart. Costa ended up placing two stents, that day.
“If he had gone home this weekend without having this procedure today, he would have gone home with a very nice, well-placed stent in the vessel that did not cause the heart attack,” Costa said during the Good Morning America segment.
The LightLab system uses near-infrared light to produce high-resolution, real-time images that are better and faster than images produced by competing ultrasound technology. The system recently was approved for sale by the Food and Drug Administration. UH Case Medical Center was the core laboratory on the FDA approval study and analyzed the study’s results, according to the Case Western Reserve University School of Medicine blog.
Reuters Report ::
Men with heart disease who also have erectile dysfunction die sooner than men who do not seek treatment for impotence, researchers reported on Monday.
They found that men who had both conditions were twice as likely to die from any cause and twice as likely to have a heart attack than men with heart disease alone.
The researchers expressed concern that using drugs such as Pfizer’s Viagra or Eli Lilly’s Cialis to treat erectile dysfunction could mask the symptoms that point to widespread heart and artery disease and said men complaining of impotence should be checked by a cardiologist.
“Erectile dysfunction is something that regularly should be addressed in the medical history of patients; it might be a symptom of early atherosclerosis,” Dr. Michael Bohm of the University of Saarland in Germany, who led the study, said in a statement.
His team studied 1,519 men in 13 countries taking part in some larger studies of various heart disease treatments. As part of the study the men were also asked about erectile dysfunction.
More than half of them, 55 percent, did, Bohm’s team said in a report published in the journal Circulation and also presented at a meeting of the American College of Cardiology.
During the two years of the study, 11.3 percent of the patients who reported erectile dysfunction died, compared to 5.6 percent of those with mild or no impotence problems.
“It has long been known that erectile dysfunction is a marker for cardiovascular disease,” said Dr. Sahil Parikh at University Hospitals Case Medical Center in Cleveland, Ohio, who was not involved in the study.
The first impotence drug, Pfizer’s Viagra, known generically as sildenafil, was at first developed to lower blood pressure, he said.
“They realized it had this other effect, which patients quite enjoyed,” Parikh said in a telephone interview.
Viagra and rival drugs such as Eli Lilly’s Cialis and Bayer AG’s BAYG.DE Levitra all work by increasing blood flow.
“In order to have proper erectile function, you have to have adequate blood flow to the genitals. If you have atherosclerosis, whether in the arteries on the neck, which can cause stroke, or the arteries of the heart, which can cause heart attack … it is the same disease.”
But while the erectile dysfunction drugs help blood flow all over the body, they do not treat the underlying hardening and narrowing in the arteries that is causing the problem.
“If patients have erectile dysfunction, we have to be very aggressive about screening and treating them for heart disease,” Parikh said.
When Viagra came onto the market, many health experts welcomed it as a way to get men who might otherwise neglect their health to go to a doctor. But Bohm and Parikh both agreed that patients — and their doctors — need to look hard at the hearts of men with erectile dysfunction.
“Men with ED going to a general practitioner or a urologist need to be referred for a cardiology workup to determine existing cardiovascular disease and proper treatment,” Bohm said.
“The medication works and the patient doesn’t show up any more,” he added. “These men are being treated for the ED, but not the underlying cardiovascular disease.”
The drugs are wildly popular. Viagra alone had sales of nearly $2 billion in 2009.
Half of Americans are in control of their blood pressure. But the number of new cases has gone up according to a new study out published in the Journal of American Medical Association which finds that one out of every three people had their hypertension under control 20 years ago compared to 50% of patients now. However, the number of people diagnosed with the condition has continued to go up.
Dr. Donald Hricik of CWRUmedicine Division of Nephrology and Hypertension at University Hospitals Case Medical Center is interviewed for the story. Watch the video.
Familial aggregation of esophageal adenocarcinomas, esophagogastric junction adenocarcinomas, and their precursor Barrett’s esophagus (BE) has been termed familial BE (FBE). Numerous studies documenting increased familial risk for these diseases raise the hypothesis that there may be an inherited susceptibility to the development of BE and its associated cancers. I
n this study, using segregation analysis for a binary trait as implemented in S.A.G.E. 6.0.1, we analyzed data on 881 singly ascertained pedigrees to determine whether FBE is caused by a common environmental or genetic agent and, if genetic, to identify the mode of inheritance of FBE. The inheritance models were compared by likelihood ratio tests and Akaike’s A Information Criterion. Results indicated that random environmental and/or multifactorial components were insufficient to fully explain the familial nature of FBE, but rather, there is segregation of a major type transmitted from one generation to the next (P < 10(-10)). An incompletely dominant inheritance model together with a polygenic component fits the data best.
For this dominant model, the estimated penetrance of the dominant allele is 0.1005 [95% confidence interval (95% CI), 0.0587-0.1667] and the sporadic rate is 0.0012 (95% CI, 0.0004-0.0042), corresponding to a relative risk of 82.53 (95% CI, 28.70-237.35) or odds ratio of 91.63 (95% CI, 32.01-262.29). This segregation analysis provides epidemiologic evidence in support of one or more rare autosomally inherited dominant susceptibility allele(s) in FBE families and, hence, motivates linkage analyses.
Read the full article on CWRUmedicine.org
An alternative one-on-one, patient-oriented approach to heart disease and heart failure
According to James C. Fang, MD, Medical Director, Advanced Heart Failure & Transplant Center and Professor, Case Western Reserve University Department of Medicine, “The mission of the Advanced Heart Failure & Transplant Center is to provide the latest and most effective therapies to patients in Northeast Ohio and surrounding regions in a personalized one-on-one, patient-centered approach.”
With a high level of expertise in treating heart failure, performing heart transplants, and implanting VADs (also known as heart pumps), the Center offers another sophisticated site in Ohio for patients to consider for their heart and vascular health. One of the most important services provided by the physicians at the Center is their ability to review a patient’s current medical and device therapies and then to provide other treatment options to improve their prognosis and quality of life. “At University Hospitals Case Medical Center, we offer many options and a very personalized approach. We are proud of the fact that we offer very individualized care,” says Dr. Fang. “Many patients don’t recognize that they are suffering needlessly.”
The VAD Option
Patients seen at the Center have refractory congestive heart failure and continue to be short of breath despite medications, device therapy (such as biventricular pacemakers) and heart surgery. These patients find that even doing simple activities like taking a shower or sitting in a chair are difficult. In addition, they cannot stay out of the hospital for very long – they are often regularly admitted for shortness of breath and fluid buildup in the legs. Such patients may be candidates for heart transplantation or a VAD.
VADs are sophisticated, miniaturized pumps that help the heart to provide sufficient blood flow throughout the patient’s body. “VADs are the newest form of a mechanical heart,” says Dr. Fang. A healthy heart can normally pump about 5 L of blood per minute around the body at rest. If, for example, a patient’s heart can pump only 1 L of blood per minute, the VAD will pump an additional 4 L, for a total of 5 L of blood per minute. “The heart pump helps,” notes Dr. Fang, “without entirely taking over the function of the heart.”
Typically, heart pumps are used temporarily while a patient awaits a heart transplant. Current first generation VADs, such as the Thoratec Heartmate XVE, are also used as a “destination” therapy – a permanent solution for heart failure. These devices can function for 12 to 18 months before they must be replaced. It is anticipated that a new, second generation of heart pumps, now undergoing investigational study, will increase the duration of ventricular assistance to two to four years. Nationwide about 2,500 heart transplant operations are performed annually and the Advanced Heart Failure & Transplant Center’s heart surgeons have collectively performed hundreds of heart transplants.
Learn more about VADs at CWRUmedicine.org
Friday and Saturday April 9 & 10, 2010
The Ritz-Carlton, Cleveland, OH
About the Symposium | This symposium updates the stateof-the-art on management of rheumatologic diseases and will be of interest not only to rheumatologists, but also to primary care physicians. Allied health professionals will also benefit from this symposium.
Learning Objectives | At the conclusion of this symposium, participants will be able to:
- Develop strategies for managing patients with rheumatoid arthritis and related arthritis at every stage of the disease.
- Identify selected treatment modalities for rheumatic diseases and enumerate how these new advances may impact the practice of rheumatology.
- Identify patients who are at the stage of their disease where stem cell transplant may be beneficial.
Continuing Education | The Case Western Reserve University School of Medicine designates this educational activity for a maximum of 11 AMA PRA Category 1 CreditsTM.
Learn more at CWRUmedicine.org