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Techno Corner

M. P. Ravindra Nathan
By M. P. Ravindra Nathan, MD, FACP, FACC Director, Hernando Heart Clinic, Brooksville, FL Editor-in-Chief, AAPI Journal


For every practicing cardiologist, there is one convention which is a �must attend� -- the annual Scientific Sessions of the American College of Cardiology (ACC). It is an unprecedented resource for the cardiologists to stay current. This also has become a preeminent global event. Almost every country sends a few delegates (there were many from India) to learn from this premier educational event, present their latest research and exchange ideas with counterparts in USA. It has become a small world for the cardiologists. Hence, the focal theme was �Celebrating the Cardiovascular Community.� New technologies for better diagnosis, new drugs to improve cardiac care, the results of late breaking trials, first-in-man trials, revisiting old ideas � all are neatly packaged, presented and discussed.

I attended the recent three-day 55th ACC convention, which took place in Atlanta, Ga. The 2006 event was perhaps one of the best so far, with live demonstrations of complex procedures as they were performed around the world!

CT scan of coronaries.
This year for the first time, a new concept was employed, to get the practicing cardiologists (�non-invasive�) and the interventional cardiologists (the group who does angioplasties) under one roof. Banners showing �Welcome to Innovation in Intervention: i2 Summit 2006� greeted the attendees from every direction at multiple levels of the huge Georgia World Congress Convention Center. �Obviously, this is one of the most exciting changes at the meeting,� said Dr. Pamela Douglas, president of ACC.

�i2 Summit is a new brand that we are adding to this meeting,� said William O�Neill, MD, chair of the i2 Summit. �We want to provide the latest in technical advances and educational tools to really bring the science and technology of interventional cardiology to the practitioner.�

Douglas opened the session with the plenary address and discussed new opportunities to help the patients. She highlighted the role of cardiovascular imaging in clinical practice. �New diagnostic tools have sparked an exciting evolution in medicine,� she said. Cardiologists have always been after a reliable non-invasive imaging to detect coronary heart disease (CHD) and that test may have finally arrived -- the new 64 slice Cardiac CT and Coronary CTA (CT Angiogram).

CT scan of coronaries.
The latest imaging technology is creating quite a buzz and looks ready for prime time. Imagine that you can actually visualize the arteries in your heart without putting a catheter into your heart at a fraction of the cost and time! �This technology may be quite good at ruling out the presence of CHD,� said Dr. A. Lima, director of CV imaging at Johns Hopkins School of Medicine. In the emergency room, it can quickly tell you if that chest pain you are having is from a blocked artery, with virtually no risk. Which means you can detect the disease in its early stages and hopefully prevent serious heart attacks in future. It is interesting that even our small county � Hernando � has acquired the first such machine recently.

The prestigious Simon Dack lecture was given by Elizabeth G. Nabel, MD, the new director of the National Heart, Lung, and Blood Institute (NHLBI). �The medical care based on knowledge gained from the Human Genome Project and gene based studies represent the future of cardiovascular medicine,� Dr. Nabel said. The greatest biological discovery of the 20th century, the elucidation of the molecular structure of DNA (Ah, the brilliance of Watson and Crick!) is finally coming to the rescue of the man in distress. The way we treat heart diseases is about to change radically as DNA-based therapies are beginning to make an impact and, genomic medicine will provide new ways to predict individual risk for diseases, detect early signs and individualize the treatment.

Discussions on the newer versions of �drug-coated (eluting) stents,� the much-acclaimed treatment for opening the coronary blocks, were quite popular. Newer improved versions are becoming available. �They have significantly reduced the rate of re-occlusion, but they are not altogether without risks,� said Dr. Campbell Rogers, director of Cardiac Catheterization Lab at Brigham and Women�s Hospital, Boston, Mass. Many of you know that acute heart attacks are now commonly treated by quickly opening the blocked artery, a technique known as primary angioplasty.

Findings from several important clinical trials of different therapies for many heart diseases took center stage on the second and third day. �Radiofrequency ablation� � a procedure using a special electrode inserted into your heart to treat certain types of fast heart beats � Atrial Fibrillation � was found to be better than drugs in a study from Milan, Italy.

This procedure is commonly done in Tampa Bay area. The Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA) trial showed that adding the popular drug Plavix to aspirin was not effective in preventing heart attacks, strokes or death from cardiovascular disease in a broad group of high-risk patients. �Our hypothesis that two anti-platelet agents are better than one across a broad population turned out to be incorrect,� said Dr. Deepak Bhatt, a cardiologist from Cleveland Clinic, who presented the study results. This means aspirin alone may suffice for most people. So, check with your doctor in case you are taking both, may be you could get off of one.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.

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