The Medical Roundtable Cardiovascular Edition

Expert Discussions, Compelling Topics

The Medical Roundtable – Cardiovascular Edition is peer reviewed medical information published for cardiologists, primary care physicians, and cardiovascular health professionals.

Its mission is to provide expert discussion to synthesize and debate the current state of cardiovascular medicine, while providing physicians with access to the insights of academic and clinical experts in a convenient and easily absorbed roundtable format.

Online First

The Role of Platelet Function Testing  in Improving Clinical Outcomes

Summary
The following Expert Roundtable Discussion was held on November 1, 2017.

The discussion focused primarily on: (1) Factors that contribute toward inadequate antiplatelet drug responsiveness; (2) personalizing antiplatelet therapy to improve clinical outcomes; (3) the limitations of platelet function testing; (4) what is the optimal timing for platelet function testing: at the time of ACS or post-treatment; (5) the role of ROTEM and TEG in addressing clot integrity and platelet function; and (6) the current role for platelet function testing in evaluating patients and outcomes. [Published online ahead of print May 14, 2018.] (Med Roundtable Cardiovasc Ed. 2018 May 14.)
Acute Coronary Syndrome Institutional Protocols
Summary
Dr. Christopher B. Granger, from Duke University Medical Center, Durham, NC moderated the topic “Acute Coronary Syndrome Institutional Protocols” with Dr. Deborah Diercks from UT Southwestern Medical Center, Dallas, TX, Dr. Peter B. Berger from Northwell Health, New Hyde Park, NY, and Dr. Timothy D. Henry from Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA participating.

The discussion focused primarily on:

The lack of systematic institutional protocols for acute coronary syndrome (ACS) treatment;

gaps in the coordination of care among emergency departments, emergency medical services, catheterization labs, and hospital wards;

the distinct issues facing different categories of patients with STEMI, non-STEMI and cardiogenic shock;

first treatment choices at first presentation;

risk stratification in the emergency department;

developing ACS treatment algorithms with guidance on switching therapies; and

considerations surrounding patient adherence and the importance of early patient education.

[Published online ahead of print October 11, 2016.] (Med Roundtable Cardiovasc Ed. 2016 Oct. 11) ©2016 FoxP2Media, LLC
Type II Pulmonary Hypertension in the Setting of Heart Failure with Preserved Ejection Fraction
Summary
Dr. Gary Francis from the University of Minnesota moderated the topic "Type II Pulmonary Hypertension in the Setting of Heart Failure with Preserved Ejection Fraction" with Drs. Michael M. Givertz from Brigham and Women’s Hospital, Gregory D. Lewis from Massachusetts General Hospital, and Marc Pritzker from the University of Minnesota, participating.

The discussion focused primarily on:

The increased prevalence of so-called reactive pulmonary hypertension;

a clinical case of heart failure with preserved ejection fraction (or diastolic heart failure);

variability in the clinical terminology describing this condition;

triggers in echocardiogram reports that may lead to the reporting of additional indices of diastolic function that can be valuable to clinicians;

features other than left-heart disease that may mediate pulmonary hypertension; and

therapies for patients with pulmonary hypertension.

(Med Roundtable Cardiovasc Ed. 2014;4(1):e1–e7) ©2014 FoxP2Media, LLC
The HDL Quandary
Summary
Dr. John LaRosa from SUNY Downstate Medical Center moderated the topic "The HDL Quandary" with Drs. Nathan Wong from the University of California, Irvine, Antonio Gotto from Weill Cornell Medical College, and Daniel J. Rader from the University of Pennsylvania, participating.

The discussion focused primarily on:

The reliability of high-density lipoprotein (HDL) as a biomarker for atherosclerosis risk;

the appropriateness of measuring HDL concentration, HDL particles, or HDL function (eg, cholesterol efflux capacity) as a measure of risk;

clinical trials examining HDL increase as a therapeutic strategy;

beneficial properties of HDL;

new antiatherogenic drugs; and

the relative usefulness of obtaining HDL measurements in clinical practice.

(Med Roundtable Cardiovasc Ed. 2014;4(1):e25–e31) ©2014 FoxP2Media, LLC
State-of-the-Art Management of Heart Failure with Preserved Ejection Fraction
Summary
Dr. Barry Massie from the University of California, San Francisco moderated the topic "State-of-the-Art Management of Heart Failure with Preserved Ejection Fraction" with Drs. Sanjiv J. Shah from Northwestern University Feinberg School of Medicine, and Michael Zile from the Medical University of South Carolina and the RHJ Department of Veterans Affairs Medical Center, participating.

The discussion focused primarily on:

The clinical characteristics of patients with heart failure with preserved ejection fraction (HFpEF);

the diagnostic criteria for and prevalence of HFpEF;

the morbidity and mortality of HFpEF patients;

the epidemiology and pathophysiology of HFpEF;

the different subgroups of HFpEF patients;

the comorbidities implicated as causes of HFpEF and their prevalence;

the findings of clinical trials regarding treatments for HFpEF; and

guidelines for the treatment of HFpEF.

(Med Roundtable Cardiovasc. Ed. 2014;4(1):e32–e44) ©2014 FoxP2Media, LLC
The New Hypertension Guidelines: Hits and Misses
Summary
Dr. Joseph L. Izzo, Jr., from the University at Buffalo/Erie County Medical Center, Buffalo, NY moderated the topic “The New Hypertension Guidelines: Hits and Misses” with Dr. Jan Basile from the Medical University of South Carolina/Ralph H. Johnson VA Medical Center, Charleston, SC, Dr. Marvin Moser from the Yale University School of Medicine, New Haven, CT, and Dr. Alan H. Gradman from the Temple University School of Medicine (Clinical Campus), Pittsburgh, PA participating.

The discussion focused primarily on:

What constitutes a good guideline;

the usefulness of the new recommendations by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure;

the role of combination therapy in managing patients with resistant hypertension;

the use of race as a decision point in selecting drugs for treating hypertension;

specific recommendations for best practices when it comes to managing the hard-to-treat patient; and

the existence and relevance of J-curves.

(Med Roundtable Cardiovasc Ed. 2014;4(1):e54–e63) ©2014 FoxP2Media, LLC
Familial Hypercholesterolemia
Summary
Dr. James Underberg from the New York University School of Medicine moderated the topic "Familial Hypercholesterolemia" with Drs. Eliot Brinton from the Utah Foundation for Biomedical Research, Mary McGowan from the FH Foundation, and Patrick Moriarty from the University of Kansas Medical Center, participating.

The discussion focused primarily on:

General characteristics and incidence of familial hypercholesterolemia (FH);

the importance of identifying patients with FH and beginning treatment early;

the etiology of FH;

criteria used for diagnosing FH;

benefits and drawbacks of genetic testing;

the importance of cascade screening;

resources for patients and clinicians to increase knowledge and awareness of FH;

current pharmacological therapies for FH patients;

accessibility and effectiveness of lipid apheresis therapy;

symptoms of elevated lipoprotein(a); and

new drugs for treating elevated lipoprotein(a) and FH including their mechanisms of action and side effects.

(Med Roundtable Cardiovasc Ed. 2014;4(1):e8–e17) ©2014 FoxP2Media, LLC
Hypertension in Pregnancy
Summary
Dr. Marvin Moser from the Yale School of Medicine moderated the topic "Hypertension in Pregnancy" with Drs. Phyllis August from Cornell Weill Medical College, and Vesna Garovic and Carl Rose from the Mayo Clinic, participating.

The discussion focused primarily on:

The definition of elevated blood pressure in pregnancy;

indications for therapy;

indications for interruption of pregnancy;

timing of treatment of hypertension during pregnancy; and

the drugs of choice for treatment of hypertension in pregnancy.

[Published online ahead of print November 23, 2013.]

(Med Roundtable Cardiovasc Ed. 2013;4(1):e18–e24)

©2013 FoxP2Media, LLC
New Marker of Heart Failure Outcomes: Galectin-3
Summary
Dr. W. Frank Peacock from the Baylor College of Medicine moderated the topic "New Marker of Heart Failure Outcomes: Galectin-3" with Drs. Rudolf de Boer from University Medical Center Groningen, Salvatore Di Somma from San Andrea Hospital, University Sapienza, and Alan Maisel from the University of California—San Diego, participating.

The discussion focused primarily on:

An overview of what is known about the use of galectin-3 as a biomarker in heart failure;

an assessment of how galectin-3 can be applied in clinical practice by emergency department physicians;

implications of galectin-3 levels for cardiological follow-up and heart failure patient management; and

how the use of galectin-3 as a biomarker can be applied to prevent progression of heart failure.

(Med Roundtable Cardiovasc Ed. 2013;4(1):e46–e53)

©2013 FoxP2Media, LLC

Current and Past Issues

Volume 3 / Issue 4

The Medical Roundtable Cardiovascular Edition Vol 3 Iss 4

Drug-Eluting Versus Bare-Metal Stents
Summary
Dr. Gregg Stone from Columbia University Medical Center, New York, NY moderated the topic "Drug-Eluting Versus Bare-Metal Stents" with Drs. Antonio Colombo from San Raffaele Scientific Institute and Columbus Hospital, Milan, Italy, Dean Kereiakes from The Christ Hospital Heart and Vascular Center, Cincinnati, OH, and Ajay Kirtane from Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY.

The discussion focused primarily on:

Advantages, disadvantages, and nuances of drug-eluting and bare-metal stents;

pathophysiology and clinical manifestations of coronary restenosis;

evolution from first-generation, drug-eluting stents to current generation devices;

current dual antiplatelet therapy (DAPT) recommendations (especially with regard to DAPT duration);

the appropriateness of drug-eluting vs bare-metal stents for particular patients; and

the future of stent technology.

(Med Roundtable Cardiovasc Ed. 2014;3(4):208–217)

©2014 FoxP2 Media, LLC
Evaluation of Diastolic Function: How Practical Is It?
Summary
Dr. Philip Liebson from Rush Medical College, Chicago, IL, moderated the topic “Evaluation of Diastolic Function: How Practical Is it?” with Drs. Rami Doukky and Melissa Tracy from Rush Medical College, Chicago, IL.

The discussion focused primarily on:

The interpretation and importance of echocardiogram reports on diastolic function;

the difference between diastolic dysfunction and diastolic heart failure;

the role of diastolic dysfunction and diastolic heart failure in the management of cardiac patients; and

recent advances in the evaluation of diastolic function in echocardiography and other noninvasive measurement of diastolic function.

(Med Roundtable Cardiovasc. Ed. 2014;3(4):218–225)

©2014 FoxP2 Media, LLC
Synthesizing the Current Use of Generics in Cardiovascular Disease
Summary
Dr. Carlos M. Ferrario from the Wake Forest University School of Medicine moderated the topic "Synthesizing the Current Use of Generics in Cardiovascular Disease" with Drs. John M. Flack from Wayne State University and the Detroit Medical Center, Henry Punzi from Punzi Medical Center and Trinity Hypertension Research Institute, Domenic Sica from Virginia Commonwealth University, Richmond, VA; and Daniel Wise from Cardiology Specialists of the Carolinas, Charlotte, NC.

The discussion focused primarily on:

Compliance and control rates for hypertension, dyslipidemia, and diabetes;

adherence to therapy and outcomes in specific patient populations;

effectiveness of lipid management in African Americans and Caucasians; and

the use of generic versus branded drugs in the management of hypertension, dyslipidemia, and the cardiometabolic syndrome.

(Med Roundtable Cardiovasc Ed. 2014;3(4):226–233)

©2014 FoxP2 Media, LLC
Updated ACCF/AHA Guidelines on the Management of UA/NSTEMI: Implications for Antiplatelet Therapy (Part I of II)
Summary
Dr. Keith C. Ferdinand from Tulane University School of Medicine, Tulane Heart and Vascular Institute moderated the topic "Updated ACCF/AHA Guidelines on the Management of UA/NSTEMI: Implications for Antiplatelet Therapy (Part I of II)" with Drs. Carl J. Lavie from the John Ochsner Heart and Vascular Institute, Ochsner Clinical School—The University of Queensland School of Medicine, and the Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University Health System, JoAnne M. Foody from Cardiovascular Wellness Service, Division of Cardiovascular Medicine, Brigham & Women’s Hospital, and Jeffrey S. Berger from the Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY.

The discussion focused primarily on:

The recent changes to the guidelines for unstable angina and non-ST-segment-elevation myocardial infarction, in particular, changes to antiplatelet therapy and the addition of prasugrel and ticagrelor to the therapeutic armamentarium;

the impact of the updated guidelines on antiplatelet therapy in clinical decision making and the use of antiplatelet agents in practice;

the potential application of genetic and/or platelet function testing in antiplatelet therapy; and

compliance issues.

(Med Roundtable Cardiovasc Ed. 2014;3(4):234–241)

©2014 FoxP2 Media, LLC
Updated ACCF/AHA Guidelines on the Management of STEMI: Implications for Antiplatelet Therapy (Part II of II)
Summary
Dr. Keith C. Ferdinand from Tulane University School of Medicine, Tulane Heart and Vascular Institute moderated the topic "Updated ACCF/AHA Guidelines on the Management of STEMI: Implications for Antiplatelet Therapy (Part II of II)" with Drs. Carl J. Lavie from the John Ochsner Heart and Vascular Institute, Ochsner Clinical School—The University of Queensland School of Medicine, and The Department of Preventive Medicine, Pennington Biomedical Research Center, JoAnne M. Foody from Cardiovascular Wellness Service, Division of Cardiovascular Medicine, Brigham & Women’s Hospital, and Jeffrey S. Berger from the Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY.

The discussion focused primarily on:

The recent changes to the guidelines for ST-segment-elevation myocardial infarction, in particular, changes to antiplatelet therapy and the addition of prasugrel and ticagrelor to the therapeutic armamentarium;

the impact of the updated guidelines, and evidence from recent clinical trials, on antiplatelet therapy and the use of antiplatelet agents in practice; and

the challenges surrounding implementation and maintenance of evidence-based therapy.

(Med Roundtable Cardiovasc Ed. 2014;3(4):242–250)

©2014 FoxP2 Media, LLC
Secondary Prevention after Acute Coronary Syndrome
Summary
Dr. Paul D. Thompson from the Division of Cardiology, Hartford Hospital, Hartford, CT, moderated the topic “Secondary Prevention after Acute Coronary Syndrome” with Drs. James de Lemos from the Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX; Carl Lavie from the Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA; and Francis Kiernan from the Division of Cardiology, Hartford Hospital, Hartford, CT.

The discussion focused primarily on:

Interventions to start during acute care with an aim toward secondary prevention;

length of treatment with beta blockers;

acute and long-term approaches to angiotensin-converting enzyme inhibitors;

pharmacological approaches for myocardial infarction patients managed by acute angioplasty;

benefits and optimal doses of statins before and after angioplasty;

treatment recommendations for platelet inhibition in patients with drug-eluting and bare-metal stents;

choice of beta blocker and platelet therapy;

long-term use of high-dose statins;

target low-density lipoprotein levels in the long-term;

the importance of cardiac rehabilitation, exercise training, and fitness in secondary prevention;

the need for proactive referral to increase participation and completion of cardiac rehabilitation programs;

benefits of cardiac rehabilitation on psychological stress;

the most appropriate long-term secondary prevention antiplatelet regimen;

risks of combination dual antiplatelet therapy with an oral anticoagulant;

optimal aspirin doses;

bedside and genetic testing of platelet functions; and

use of fibric acid derivatives, niacin, and coenzyme Q10 as statin alternatives.

(Med Roundtable Cardiovasc Ed. 2014;3(4):251–261)

©2014 FoxP2 Media, LLC
New Anticoagulants vs Warfarin: Take Your Choice
Summary
Dr. Annabelle Volgman from the Rush University Medical Center, Chicago IL moderated the topic "New Anticoagulants vs Warfarin: Take Your Choice" with Drs. Peter Kowey from Main Line Health and Jefferson Medical College, Philadelphia, PA, James Reiffel from Columbia University Medical Center, New York, NY, and Albert Waldo from University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH.

The discussion focused primarily on:

How to approach a patient with a Congestive heart failure, Hypertension, Age ≥75, Diabetes mellitus, Stroke (CHADS₂) score of 1;

the lack of efficacy of aspirin as an oral anticoagulant to prevent stroke in atrial fibrillation;

recommendations of various recent guidelines concerning the use of aspirin;

the use of aspirin and clopidogrel in comparison to new anticoagulants as an alternative to warfarin;

clarification of the American College of Chest Physicians guidelines for 2012;

stroke risk prediction with the Congestive heart failure, Hypertension, Age ≥75, Diabetes mellitus, Stroke, Vascular disease, Age 65–74 years, Sex category (CHA₂DS₂-VASc) score;

balancing the risk of stroke against the risk of bleeding risk and falls;

estimation of bleeding risk with Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) scores;

choice of anticoagulant in different patients; and

support for patients with active bleeding on dabigatran or rivaroxaban in comparison to warfarin.

(Med Roundtable Cardiovasc Ed. 2014;3(4):262–270).

©2014 FoxP2 Media, LLC
Health Reforms in an Era of Uncertainty
Summary
Dr. Christopher Pastore from Tampa Cardiac Specialists moderated the topic "Health Reforms in an Era of Uncertainty" with Dr. Jeffrey Rice from Healthcare Blue Book, and Alice G. Gosfield from Alice G. Gosfield and Associates, P.C., Philadelphia, Pennsylvania.

The discussion focused primarily on:

Changes in Medicare and Medicaid with the passage of the Affordable Care Act;

the lack of transparency in pricing for healthcare services and the reasons for it;

the emerging role of accountable care organizations;

changes in the employment of physicians;

the alignment of independent and small group practices with larger organizations and the resulting types of structures; and

the steps that independent practices must take to survive in the new healthcare environment.

(Med Roundtable Cardiovasc Ed. 2014;3(4):271–277)

©2014 FoxP2 Media, LLC
Vasodilators in Acute Heart Failure: Who Needs Them and How Soon?
Summary
Dr. W. Frank Peacock from the Baylor Medical College, Houston, TX, moderated the topic “Vasodilators in Acute Heart Failure: Who Needs Them and How Soon?” with Drs. Alexandre Mebazaa from Paris Diderot University, Paris, France; John Teerlink from University of California—San Francisco, San Francisco, CA; and James Udelson from Tufts Medical Center, Boston, MA.

The discussion focused primarily on:

The role of vasodilation in heart failure (HF);

the ideal patient population for vasodilators;

chronic versus acute HF patients;

hemodynamic models of acute HF;

clinical studies using vasodilators;

the role of blood pressure/hypertension;

novel vasodilators;

guidelines for using vasodilators; and

the use of vasoconstrictors.

(Med Roundtable Cardiovasc Ed. 2014;3(4):278–284)

©2014 FoxP2 Media, LLC

Volume 3 / Issue 3
The Medical Roundtable—  CV Edition Volume 3, Issue 3

The Role of and Selection Process  for the New Anticoagulants in  Nonvalvular Atrial Fibrillation

Summary
Dr. James Reiffel from Columbia University Medical Center, New York, NY moderated the topic "The Role of and Selection Process for the New Anticoagulants in Nonvalvular Atrial Fibrillation" with Drs. Jonathan Halperin from Mount Sinai Medical Center, New York, NY, Peter Kowey from the Lankenau Institute for Medical Research, Jefferson Medical College, Wynnewood, PA, and Gerald Naccarelli from Penn State University College of Medicine, Hershey, PA.

The discussion focused primarily on:

(1) The definition of nonvalvular atrial fibrillation

(2) the advantages and disadvantages of warfarin

(3) the pharmacology of the new anticoagulants

(4) the major clinical trials that led to the approval of the new anticoagulants

(5) determining what anticoagulant to use in patients already on warfarin—“starters” versus “switchers.”

(Med Roundtable Cardiovasc Ed. 2012;3(3):143–151) ©2012 FoxP2  Media, LLC

Coronary Stents:  When Is Enough Enough?

Summary
Dr. Philip Liebson from the Rush University Medical Center, Chicago, IL moderated the topic "Coronary Stents: When Is Enough Enough?" with Drs. Jeffrey Snell and Steve Attanasio, also from the Rush University Medical Center.

The discussion focused primarily on:

(1) The strengths and limitations of coronary stents

(2) how many stents are needed before surgery is considered

(3) considerations for bypass surgery

(4) the determination of flow reserve in the catheterization lab

(5) left main stenting

(6) guidelines for stenting

(7) criteria for bare-metal versus drug-eluting stents

(8) limitations for stenting

(9) the future of stenting.

(Med Roundtable Cardiovasc Ed. 2012;3(3):152–156) ©2012 FoxP2  Media, LLC

Is There A Role for Fibrate Therapy  in the Management of Dyslipidemia?

Summary
Dr. Peter Toth from the CGH Medical Center, Sterling IL moderated the topic "Is There a Role for Fibrate Therapy in the Management of Dyslipidemia?" with Drs. Marshall Elam from the University of Tennessee Health Science Center, Memphis, TN, Sergio Fazio, from the Vanderbilt University Medical Center, Nashville, TN, and Steven Jones from the The Johns Hopkins University, The Johns Hopkins Hospital, Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.

The discussion focused primarily on:

(1) The role of fibrate therapy in the management of dyslipidemia in diabetic patients

(2) triglycerides and coronary heart disease

(3) the role of fibrates in triglyceride and high-density lipoprotein management

(4) the results from the FIELD and ACCORD trials

(5) additional clinical trials using fibrates.

(Med Roundtable Cardiovasc Ed. 2012;3(3):157–163) ©2012 FoxP2  Media, LLC

Heart Failure Treatment: A Focus  on Treatment in Black Patients

Summary
Dr. Keith Ferdinand from the Tulane University School of Medicine, Tulane Heart and Vascular Institute, New Orleans, LA moderated the topic "Heart Failure Treatment: A Focus on Treatment in Black Patients" with Drs. Christopher Leggett from the Cardiovascular Institute of Georgia at East Georgia Regional Medical Center, Statesboro, GA, Ileana Piña from the Montefiore Medical Center, New York, NY, and Frank Smart from the Louisiana State University School of Medicine, New Orleans, LA.

The discussion focused primarily on:

(1) The basic definition of heart failure (HF), systolic-related HF and the risk factors associated with HF

(2) the prevalence of systolic HF and hypertension in self-identified black patients

(3) therapeutic options for patients with systolic HF

(4) the application of these therapeutic options in self-identified black patients

(5) factors that effect patient adherence in this population and the importance of increasing adherence

(6) increasing patient-physician communications and removing barriers for communication

(7) the underrepresentation of minorities, elderly, and women in some HF trials

(8) the African American Heart Failure Trial (A-HeFT) and its application to pharmacologic management in self-identified black patients

(9) current gaps in access to healthcare.

(Med Roundtable Cardiovasc Ed. 2012;3(3):164–172) ©2012 FoxP2Media, LLC

Commentary - The Treatment of Heart Failure  in African Americans

Summary
Clyde W. Yancy, MD, Chief of Division of Cardiology at the Northwestern University Feinberg School of Medicine in Chicago, IL comments on the discussion "Heart Failure Treatment: A Focus on Treatment in Black Patients" by Drs. Ferdinand, Leggett, Piña, and Smart. He asserts that the treatment of those affected with heart failure remains suboptimal, with gaps in care now extensively documented. He also notes that issues regarding race remain in the field of medicine, but that the study of African Americans with heart failure has yielded three important dynamics that should benefit medicine globally going forward: 1) it is likely that impaired nitric oxide bioavailability contributes to cardiovascular disease pathology and is an appropriate target for intervention; 2) hypertension does appear to be clearly related to heart failure with reduced ejection fraction; and 3) the study of African Americans with heart failure has made clearer the depth and extent of disparate care in the United States due to cultural disconnects between patients and providers. Dr. Yancy calls for providers to treat those with heart failure in an optimal evidence-based, guideline-driven manner, to identify and treat accordingly African Americans with heart failure, and to become more aware of their cultural insensitivities and make efforts to understand and adapt to the needs of all patients.

Heart Disease in Women

Summary
Dr. Ezra Amsterdam from the University of California Davis Medical Center, Sacramento, CA moderated the topic "Heart Disease in Women" with Drs. Jeffrey Borer from the Downstate Medical Center, Brooklyn, NY, and L. Kristin Newby from Duke University School of Medicine, Durham, NC.

The discussion focused primarily on:

(1) The underdiagnosis and undertreatment of coronary heart disease in women

(2) gaps in treatment: lower use of evidence based therapies in women

(3) the underrepresentation of women in clinical trials

(4) the differences in coronary heart disease pathophysiology, symptoms and risk factors in women versus men

(5) diagnostic tests for coronary heart disease in women versus men

(6) diastolic dysfunction and the effects of hypertension in women.

(Med Roundtable Cardiovasc Ed. 2012;3(3):175–182) ©2012 FoxP2Media, LLC

Gene Therapy in Heart Failure  and Cell Regenerative Theory

Summary
Drs. Barry Greenberg from the University of California - San Diego, San Diego, CA and Joshua Hare from the University of Miami Miller School of Medicine, Miami, FL discussed the topic "Gene Therapy in Heart Failure."

The discussion focused primarily on:

(1) Shifting paradigms for heart failure therapeutics- hemodynamic to neurohormonal

(2) cell regenerative therapy and gene therapy for heart failure

(3) cell therapy versus drug therapy

(4) the use of gene transfer therapy

(5) neurohormonal activation and effective translational research.

(Med Roundtable Cardiovasc Ed. 2012;3(3):183–188) ©2012 FoxP2Media, LLC

Management of Serum Potassium  in Patients with Heart Failure

Summary
Dr. Bertram Pitt from the University of Michigan School of Medicine, Ann Arbor, MI moderated the topic "Management of Serum Potassium in Patients with Heart Failure" with Drs. George Bakris from the University of Chicago Medicine, Chicago, Il, and Orly Vardeny from the University of Wisconsin, Madison, WI.

The discussion focused primarily on:

(1) The diagnosis of hyperkalemia using potassium levels: biases and laboratory settings

(2) monitoring potassium levels in patients with renal disease and the use of dietary or pharmacologic interventions

(3) risk factors that predispose patients to hyperkalemia

(4) the frequency of hyperkalemia in heart failure and the role of multiple renin-angiotensin system (RAS) inhibitors

(5) recommendations for the frequency of monitoring in patients who take multiple RAS inhibitors

(6) the physicians role in counseling patients on avoiding high-potassium diets

(7) treatment considerations for a patient diagnosed with hyperkalemia

(8) recommended pharmacologic options and the use of dialysis.

(Med Roundtable Cardiovasc Ed. 2012;3(3):190–196) ©2012 FoxP2Media, LLC

What Recent Trials Have Taught Us About the Efficacy of Ezetimibe

Summary
Dr. Robert Rosenson from The Mount Sinai Hospital, New York, NY moderated the topic "What Recent Trials Have Taught Us About the Efficacy of Exetimibe" with Drs. Michael Davidson from the Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, and Robert Hegele from the University of Chicago Pritzker School of Medicine, Chicago, IL.

The discussion focused primarily on:

(1) Low-density lipoproteincholesterol lowering and the role of ezetimibe

(2) sitosterolemia and plant sterols

(3) the effect of ezetimibe on lipids, lipoproteins, and remnant lipoproteins

(4) clinical trials using ezetimibe

(5) recommendations regarding the use of plant sterols

(6) recommendations for ezetimibe in clinical practice.

(Med Roundtable Cardiovasc Ed. 2012;3(3):197–203) ©2012 FoxP2Media, LLC
Volume 3 / Issue 2
The Medical Roundtable - CV Edition Vol. 3 Iss. 2

A Critique of the New British Hypertension Recommendations

Summary
Dr. Henry Black from the New York University School of Medicine, New York, NY moderates the topic "A Critique of the New British Hypertension Recommendations" with Drs. Jan Basile and Daniel Lackland from the Medical University of South Carolina, Charleston, SC, and Dr. Marvin Moser from the Yale University School of Medicine, New Haven, CT.

The discussion focused primarily on:

(1) The newly released NICE guidelines for hypertension;

(2) JNC 7 guidelines;

(3) the diagnosis and management of hypertension;

(4) pharmacotherapy for hypertension and evidence from clinical trials; and

(5) expectations from JNC 8.

(Med Roundtable Cardiovasc Ed. 2012;3(2):75-84) ©2012 FoxP2 Media, LLC

Critique of Randomized Controlled Trials Comparing Percutaneous Coronary Intervention with Medical Therapy in Patients with Stable Angina

Summary

Dr. William Frishman from the New York Medical College/Westchester Medical Center, Valhalla, NY moderated the topic "Critique of Randomized Controlled Trials Comparing Percutaneous Coronary Intervention with Medical Therapy in Patients with Stable Angina" with Drs. Jeffrey Borer from the State University of New York Downstate Medical Center, Brooklyn, NY, Joseph Alpert from the University of Arizona in Tucson, Tucson, AZ, and Arthur Fass from the New York Medical College/Westchester Medical Center, Valhalla, NY and New York Medical College/Phelps Memorial Hospital, Sleepy Hollow, NY.

The discussion focused primarily on:

(1) Clinical trials and practical experiences dealing with patients who have stable angina;

(2) the importance of individualizing therapy based on a patient's risk factors;

(3) whether or not the use of invasive and aggressive approaches lead to minimizing sudden death;

(4) the use of diagnostic tests used to evaluate patients with classic anginal symptoms

(5) the use of coronary bypass grafting compared to angioplasty;

(6) the use of ACE inhibitors, aspirin, beta-blockers, calcium channel blockers and nitrates for patients with stable angina;

(7) ruptured plaques and risks;

(8) the treatment of diabetic patients;

(9) the treatment of geriatric angina patients;

(10) healthcare costs and unnecessary angioplasties; and

(11) non-pharmacologic risk reducing interventions.

(Med Roundtable Cardiovasc Ed. 2012;3(2):85-94) ©2012 FoxP2 Media, LLC

A Comparison of Echocardiography, Nuclear Stress Testing, and CT Scanning

Summary
Dr. Mario Garcia from the Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY moderated the topic "A Comparison of Echocardiography, Nuclear Stress Testing, and CT Scanning" with Drs. Daniel Berman from Cedars-Sinai Hospital, Los Angeles, CA, and Mark Travin from the Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.

The discussion focused primarily on:

(1) The diagnostic tests available for testing patients with coronary artery disease;

(2) what type of patient should be tested;

(3) when should testing be done;

(4) cost effective testing options;

(5) the influence of published literature on current testing practices;

(6) screening at risk patients.

(Med Roundtable Cardiovasc Ed. 2012;3(2):95-101) ©2012 FoxP2 Media, LLC

Heart Failure in the Euvolemic Patient

Summary

Dr. Douglas Schocken from Duke University, Durham, NC moderated the topic "Heart Failure in the Euvolemic Patient with Drs. Mark Dunlap from Case Western Reserve University, Cleveland, OH, Paul Sobotka from the University of Minnesota, Minneapolis, MN, and Irving Zucker from the University of Nebraska Medical Center, Omaha, NE.

The discussion focused primarily on:

(1) a case of a woman presenting with decompensated HF caused by possible weight gain and salt and volume overload;

(2) causes that lead to re-hospitalization, including signs for arrhythmias, ischemia, and nonadherence to dietary or pharmacologic recommendations;

(3) what governs the movement of volume into and out of storage areas;

(4) the future development of diagnostic tests and treatments for acute decompensated HF;

(5) prevention of acute translocation of volume into effective arterial circulation.

(Med Roundtable Cardiovasc Ed. 2012;3(1):102-109) ©2012 FoxP2 Media, LLC

Percutaneous Mitral Valve Repair: A Status Report

Summary
Dr. Saibal Kar from the Cedars-Sinai Medical Center, Los Angeles, CA moderated the topic "Percutaneous Mitral Valve Repair: A Status Report" with Drs. Brian Whisenant from Intermountain Heart Institute, Salt Lake City, UT, Samir Kapadia from the Cleveland Clinic, Cleveland, OH, and Scott Lim from the University of Virginia, Charlottesville, VA.

The discussion focused primarily on:

(1) Options in mitral valve repair;

(2) registriessuch as EVEREST and REALISM;

(3) defining the standard of care; and

(4) the use of the MitraClip.

(Med Roundtable Cardiovasc Ed. 2012;3(2):110-116) ©2012 FoxP2 Media, LLC

Future of Percutaneous Devices for Mitral Regurgitation: Edge-to-Edge? Coronary Sinus Devices? Percutaneous Remodeling or Mitral Valve Repair?

Summary
Dr. Michael Borger from the Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany moderated the topic "Future of Percutaneous Devices for Mitral Regurgitation: Edge-to-Edge: Coronary Sinus Devices? Percutaneous Remodeling or Mitral Valve Repair?" with Drs. Volkmar Falk from Universitatsspital Zurich, Zurich, Switzerland, and Francesco Maisano from the Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy.

The discussion focused primarily on:

(1) The role of percutaneous methods of mitral valve repair;

(2) the role of combined procedures;

(3) percutaneous devices;

(4) clinical trials for leaflet based approaches to MR;

(5) Surgical Alfieri solution for MR; and

(6) remodeling surgery for reshaping the left entricle.

(Med Roundtable Cardiovasc Ed. 2012;3(2):117-122) ©2012 FoxP2 Media, LLC

Patient Evaluation and Effective Treatment of Sleep Apnea in Patients with Heart Failure

Summary

Dr. Ana Krieger from the Weill Cornell Center for Sleep Medicine, New York, NY moderated the topic "Patient Evaluation and Effective Treatment of Sleep Apnea in Patients with Heart Failure" with Drs. Francoise Roux and Henry Klar Yaggi from the Yale School of Medicine, New Haven, CT.

The discussion focused primarily on:

(1) The association of HF and sleep apnea;

(2) the adverse effect of sleep apnea on patients with HF;

(3) evaluating HF patients for sleep apnea;

(4) screening tools; and

(5) treatment options.

(Med Roundtable Cardiovasc Ed. 2012;3(2):117-122) ©2012 FoxP2 Media, LLC

VT Ablation: Survival Free from ICD Therapy

Summary
Vivek Reddy from the Mount Sinai Hospital, New York, NY moderated the topic "VT Ablation: Survival Free from ICD Therapy" with Drs. William Stevenson from Brigham and Women's Hospital, Boston, MA, and David Wilber from Loyola University Medical Center, Maywood, IL.

The discussion focused primarily on:

(1) Treating VT using catheter mapping and ablation;

(2) the evolution of ablation therapy to a substrate based approach;

(3) the complications of VT ablation;

(4) the late referral of patients;

(5) additional improvements in catheter ablation; and

(6) treating atients who have VT in the setting of a structurally-normal heart.

(Med Roundtable Cardiovasc Ed. 2012;3(2):130-136) ©2012 FoxP2 Media, LLC
Volume 3 / Issue 1
The Medical Roundtable - CV Edition Vol. 3 Iss. 1

Management of Stable Angina Pectoris

Summary
Dr. Ezra A. Amsterdam from the University of California—Davis moderated the topic "Management of Stable Angina Pectoris" with Drs. William Boden from the University of Buffalo Schools of Medicine and Public Health and Deepak Bhatt from the Harvard Medical School.

The discussion focused primarily on:

(1) the diagnosis of angina in men versus women;

(2) the key factors that influence the diagnosis of angina;

(3) heart disease in women and atypical symptoms;

(4) the use of appropriate tests for diagnosis including stress tests and imaging;

(5) the purposes and goals of treatment;

(6) the use of optimal medical treatment and myocardial revascularization; and

(7) the use of anti-anginals.

(Med Roundtable Cardiovasc Ed. 2012;3(1):8-18) ©2012 FoxP2 Media, LLC

Current and Future Strategies for Overcoming Diuretic Resistance in Acute Heart Failure

Summary
Dr. Tien Ng from the University of Southern California moderated the topic "Current and Future Strategies for Overcoming Diuretic Resistance in Acute Heart Failure," with Drs. Mandeep Mehra from the Brigham and Women's Hospital and Harvard Medical School and Jo Ellen Rodgers from the University of North Carolina.

The discussion focused primarily on:

(1) the role of continuous infusion and high versus low dose loop diuretics to overcome diuretic resistance;

(2) additional agents that augment the diuretic effect while having a loop diuretic sparing effect; and

(3) optimal endpoints, and right-sided failure and its cotribution to the cardiorenal syndrome.

(Med Roundtable Cardiovasc Ed. 2012;3(1):19-25) ©2012 FoxP2 Media, LLC

The Role of HDL-C in the Management of Atherosclerosis

Summary
The following Expert Roundtable Discussion was held on November 13, 2011. Dr. Daniel J. Rader from the University of Pennsylvania moderated the topic "The Role of HDL-C in the Management of Atherosclerosis" with Drs. H. Bryan Brewer from MedStar Research Institute and Atherosclerosis Research, Jean-Claude Tardif from the Research Center of the Montreal Heart Institute, and Peter P. Toth from the University of Illinois.

The discussion focused primarily on:

(1) The epidemiologic association of HDL with coronary disease: causality versus association;

(2) HDL metabolism;

(3) niacin and the results of the AIM-HIGH trial;

(4) additional trials that looked at niacin in raising HDL;

(5) the role of fibrates in the management of low HDL;

(6) new therapies in development for lowering HDL;

(7) lifestyle changes; and

(8) the role of CETP inhibitors and modulators.

(Med Roundtable Cardiovasc Ed. 2012;3(1):27–37) ©2012 FoxP2 Media, LLC

The Role of CETP Modulation and Inhibition in the Progression of Coronary Heart Disease

Summary
Dr. Michael Davidson from the University of Chicago Medical Center moderated the topic "The Role of CETP Modulation and Inhibition in the Progression of Coronary Heart Disease." with Drs. Christie Ballantyne from the Baylor College of Medicine, Stephen Nicholls from the Cleveland Clinic, and Robert S. Rosenson from the Mount Sinai Hospital Medical Center.

The discussion focused primarily on:

(1) how CETP inhibitors/modulators modify HDL cholesterol levels;

(2) the role of CETP inhibitors in dyslipidemia;

(3) CETP modulation compared to inhibition;

(4) HDL particle concentration compared to HDL cholesterol;

(5) why did torcetrapib increase cardiovascular and total mortality;

(6) newer CETP inhibitors in development and how they differ from torcetrapib

(Med Roundtable Cardiovasc Ed. 2012;3(1):38-44) ©2012 FoxP2 Media, LLC

Triggers for Cardiovascular Events

Summary
Dr. Robert A. Kloner from the University of Southern California, and the Heart Institute of Good Samaritan Hospital, Los Angeles moderated the topic "Triggers for Cardiovascular Events" with Drs. Murray Mittleman from Beth Israel Deaconess Medical Center and Harvard Medical School, James Muller from InfraReDx, Inc., and Peter H. Stone from Brigham and Women's Hospital and Harvard Medical School.

The discussion focused primarily on:

(1) acute risk factors as a trigger for heart disease;

(2) short term physiologic factors such as a surge in arterial pressure and/or heart rate, an increase in coagulability, or vasoconstriction;

(3) other triggers such as lack of sleep or overeating;

(4) population stressors such as earthquakes, floods and industrial accidents;

(5) psychological triggers such as anxiety, depression, frustration, anger, and bereavement;

(6) chemical triggers such as cocaine and marijuana;

(7) physical triggers such as moderate physical activity and sexual activity;

(8) environmental exposure such as air pollution and exposure to heavy metals;

(9) the rupture of vulnerable plaques and detection methods; and

(10) pharmacologic approaches as a part of routine prevention

(Med Roundtable Cardiovasc Ed. 2012;3(1):45-54) ©2012 FoxP2 Media, LLC

End Stage Heart Failure: Heart Transplantation, Left Ventricular Assist Device, or Both?

Summary
Dr. James Young from the Cleveland Clinic moderated the topic "End Stage Heart Failure: Heart Transplantation, Left Ventricular Assist Device, or Both?" with Drs. Frank Smart from Louisana State University and Hector Ventura from the Oschner Clinic.

The discussion focused primarily on:

(1) ventricular assist devices used for destination therapy;

(2) a case study: a 71 year old male with dilated cardiomyopathy; and

(3) the use of HeartWare versus HeartMate.

(Med Roundtable Cardiovasc Ed. 2012;3(1):55-60) ©2012 FoxP2 Media, LLC

The Use of ICDs in Post-Infarction Patients

Summary
Dr. John D. Fisher from the Albert Einstein College of Medicine and Montefiore Medical Center moderated the topic "The Use of ICDs in Post-Infarction Patients" with Drs. Charles J. Love from the Ohio State University Medical Center and Bruce L. Wilkoff from the Case Western Reserve University and the Cleveland Clinic.

The discussion focused primarily on:

(1) the use of ICDs in post-infarction patients;

(2) how soon after infarction should an ICDs be implanted;

(3) improving survival in post-infarction patients;

(4) the use of revascularization and PCI;

(5) advantages and disadvantages of ICDs;

(6) patient specific considerations; and

(7) guidelines for the use of ICDs.

(Med Roundtable Cardiovasc Ed. 2012;3(1):61-67) ©2011 FoxP2 Media, LLC
Volume 2 / Issue 4
The Medical Roundtable - CV Edition Vol. 2 Iss. 4

A Practical Approach for the Use of Biomarkers in Heart Failure

Summary
Dr. Alan Maisel from the University of San Diego moderated the topic "A Practical Approach for the Use of Biomarkers in Heart Failure" with Drs. W. Frank Peacock from the the Cleveland Clinic and Alan Wu from the University of California, San Francisco participating.

The discussion focused primarily on:

(1) problems with troponins;

(2) emerging biomarkers, including natriuretic peptides;

(3) ST2 and adrenomedullin as unique markers for early detection of high-risk mortality; and

(4) the future of home-testing of biomarkers.

(Med Roundtable Cardiovasc Ed. 2011;2(4):208-214) ©2011 FoxP2 Media, LLC

Evolving Diagnostic and Prognostic Imaging (MR, CT) of the Various Cardiomyopathies: Myocarditis, Dilated, Infiltrative (Amyloid, Sarcoid), Hypertrophic, Noncompaction

Summary
Dr. Javier Sanz from Mount Sinai Hospital in New York moderated the topic "Evolving Diagnostic and Prognostic Imaging (MR, CT) of the Various Cardiomyopathies: Myocarditis, Dilated, Infiltrative (Amyloid, Sarcoid), Hypertrophic, Noncompaction" with Drs. Jeroen Bax from the Leiden University Medical Center in the Netherlands and Raymond Kwong from Brigham and Women's Hospital participating.

The discussion focused primarily on:

(1) the advances in diagnostic and prognostic modalities in myocardial disease. These included magnetic resonance imaging, computed tomography, ultrasonography, and nuclear techniques;

(2)how these modalities go beyond measurement of function, wall thickness, and chamber size, and characterize other abnormalities, such as scarring, edema, infiltration, and even myocardial innervation; and

(3) the future of these novel imaging approaches in the clinical management of patients. (Med Roundtable Cardiovasc Ed.

(Med Roundtable Cardiovasc Ed. 2011;2(4):216-223) ©2011 FoxP2 Media, LLC

Treating Special Populations with Hypertension: Is a Two-Drug or Fixed-Dose Combination Therapy Appropriate Initial Treatment in Hypertension?

Summary
Dr. Jan Basile from the Medical University of South Carolina/Ralph H. Johnson VA Medical Center moderated the topic "Treating Special Populations with Hypertension: Is a Two-Drug or Fixed-Dose Combination Therapy Appropriate Initial Treatment in Hypertension?" with Drs. Alan Gradman from Temple University, Shawna Nesbitt from the University of Texas Southwestern Medical Center, and Dr. Matthew Weir from the University of Maryland Medical Center participating.

The discussion focused primarily on:

(1) when to use monotherapy compared to combination therapy in newly diagnosed hypertensive patients;

(2) the role of baseline blood pressure, age and medical comorbidities as a determinant for monotherapy compared to combination therapy;

(3) the barriers to combination therapy including education, side effects, insurance coverage;

(4) the tolerability of combination therapy;

(5) the use of certain antihypertensives in special populations;

(6) the use of preferred combination therapies;

(7) the use of monotherapy compared to combination therapy in elderly patients;

(8) the use of combination therapy in patients with chronic kidney disease.

(Med Roundtable Cardiovasc Ed. 2011;2(4):225-234) ©2011 FoxP2 Media, LLC

Should Anticoagulation Be Stopped After Successful Ablation for Atrial Fibrillation?

Summary
Dr. David Callans from the University of Pennsylvania moderated the topic "Should Anticoagulation Be Stopped After Successful Ablation for Atrial Fibrillation?" with Drs. Stuart Connolly from McMaster University and Andrea Natale from St. David's Medical Center participating.

The discussion focused primarily on:

(1) the likelihood of atrial fibrillation (AF) in patients after successful ablation;

(2) discontinuation of medication and implementation of monitoring;

(3) the intensity of monitoring and whether it really works; and

(4) the ultimate decision made by both the physician and the patient.

(Med Roundtable Cardiovasc Ed. 2011;2(4):235-240) ©2011 FoxP2 Media, LLC

New Left Ventricular Assist Devices for Bridge to Transplantation and Destination Therapy: Patient Selection and Outcome

Summary
Dr. Andrew Boyle from Aurora St. Luke's Medical Center, Milwaukee moderated the topic "New Left Ventricular Assist Devices for Bridge to Transplantation and Destination Therapy: Patient Selection and Outcome" with Drs. Shashank Desai from Inova Fairfax, Christopher Salerno from The St. Vincent's Heart Center of Indiana, and Jeffrey Teuteberg from the University of Pittsburgh participating.

The discussion focused primarily on:

(1) The historical use of left ventricular assist devices (LVADs) for mechanical circulatory support in end stage heart failure patients;

(2) the advantage of the newer devices;

(3) complications that can arise from LVADs;

(4) patient selection for LVADs;

(5) the use of LVADs as bridge-to-transplant therapy or destination therapy; and

(6) the future of LVADs.

(Med Roundtable Cardiovasc Ed. 2011;2(4):241-248) ©2011 FoxP2 Media, LLC

Clinician Perspective on the Benefits of Niacin Therapy for the Treatment of Dyslipidemia and Strategies to Improve Long-Term Adherence to Therapy

Summary
Dr. Peter H. Jones from the Baylor College of Medicine moderated the topic "Clinician Perspective on the Benefits of Niacin Therapy for the Treatment of Dyslipidemia and Strategies to Improve Long-Term Adherence to Therapy" with Dr. Bradley Bale of the Grace Clinic and Texas Tech Health Science Center and Amy Doneen from the Heart Attack and Stroke Prevention Center, Spokane, WA and Texas Tech Health Science School of Nursing.

The discussion focused primarily on:

(1) when and how to use niacin in clinical practice;

(2) how to manage the expected flushing reaction that may interfere with compliance and adherence;

(3) educating the patient on niacin's benefit and benign effect of flushing; and

(4) a current trial that aims to answer the broader questions about the use of niacin above and beyond what was shown in the AIM-HIGH trial.

(Med Roundtable Cardiovasc Ed. 2011;2(4):249-255) ©2011 FoxP2 Media, LLC

Cardiac Resynchronization Therapy

Summary
Dr. Jonathan Steinberg from Columbia University moderated the topic "Cardiac Resynchronization Therapy" with Drs. Andrew Epstein from the University of Pennsylvania and Angelo Auricchio from the Foundation Cardiocentro participating.

The discussion focused primarily on:

(1) the benefits, risks, and limitations of cardiac resynchronization therapy (CRT);

(2) the challenges of CRT compared with implantable cardioverter-defibrillator/pacemaker therapy;

(3) identification of the best candidates for CRT; and

(4) the incorporation of medical and device management.

(Med Roundtable Cardiovasc Ed. 2011;2(4):256-262) ©2011 FoxP2 Media, LLC

Erectile Dysfunction in Heart Failure Patients

Summary
Dr. Ernst R. Schwarz from the Cedars-Sinai Medical Center moderated the topic "Erectile Dysfunction in Heart Failure Patients" with Drs. Robert Kloner from the Keck School of Medicine at the University of Southern California and Anita Phan from the Heart Institute at Cedars-Sinai Medical Center participating.

The discussion focused primarily on:

(1) whether erectile dysfunction (ED) is caused by underlying disease or an early marker of cardiovascular disease;

(2) optimal medical management of heart failure to reduce morbidity and mortality, with consideration of quality-of-life issues, including ED;

(3) current ED therapy, including medications, devices, and surgery;

(4) sexual dysfunction in women;

(5) barriers to addressing sexual function in patients; and

(6) future treatment options. (Med Roundtable Cardiovasc Ed.

(Med Roundtable Cardiovasc Ed. 2011;2(4):263-268) ©2011 FoxP2 Media, LLC
Volume 2 / Issue 3
The Medical Roundtable - CV Edition Vol. 2 Iss. 3

Selection of Patients for Revascularization for Multivessel Disease and/or Diabetes Based on BARI 2D, COURAGE, SYNTAX, and FREEDOM

Summary
Dr. Spencer King from Saint Joseph's Hospital in Atlanta moderated the topic "Selection of Patients for Revascularization for Multivessel Disease and/or Diabetes Based on BARI 2D, COURAGE, SYNTAX, and FREEDOM" with Drs. David O. Williams from the Brigham and Women's Hospital and Harvard Medical School and William Weintraub from the Christiana Care Health System and Thomas Jefferson University participating.

The discussion focused primarily on:

(1) the history of revascularization techniques;

(2) current use of surgical vs percutaneous revascularization in patients with multivessel disease;

(3) the role of physician bias and pre-judgement in treatment decision-making;

(4) which patients benefit from interventional procedures;

(5) economic considerations in revascularization;

(6) ethics in clinical trial enrollment; and

(7) future directions in the application of interventional and surgical techniques for patients with stable ischemic heart disease.

(Med Roundtable Cardiovasc Ed. 2011;2(3):140-147) ©2011 FoxP2 Media, LLC

Is Cardiac Hypertrophy Compensatory or Harmful?

Summary
Dr. James Scheuer from the Albert Einstein College of Medicine and Montefiore Medical Center moderated the topic "Is Cardiac Hypertrophy Compensatory or Harmful?" with Drs. Richard B. Devereux from the Weill Cornell Medical College and David Kass from Johns Hopkins University School of Medicine participating.

The discussion focused primarily on:

(1) patterns of hypertrophy: concentric versus eccentric;

(2) risks of hypertrophy;

(3) special populations;

(4) sensitivity of echocardiography compared to electrocardiography in detecting left ventricular hypertrophy;

(5) hypertrophy studies in animals;

(6) regression of hypertrophy; and

(7) the use of antihypertensives and direct vasodilators to reduce left ventricular mass.

(Med Roundtable Cardiovasc Ed. 2011;2(3):149-156) ©2011 FoxP2 Media, LLC

Lipids and Guidelines -- "Let Me Be Simple-Minded Doctor!!" LDL-C Less Than 70 mg/dL and Pay Attention to HDL

Summary
Dr. Daniel Rader from the University of Pennsylvania School of Medicine moderated the topic "Lipids and Guidelines - 'Let Me Be Simple Minded Doctor!!' LDL-C Less Than 70 mg/dL and Pay Attention to HDL" with Drs. Roger S. Blumenthal from the Johns Hopkins University School of Medicine and Anne C. Goldberg from Washington University School of Medicine participating.

The discussion focused primarily on:

(1) aggressive targeting of low-density lipoprotein in high-risk patients;

(2) the challenges of moving patients to an LDL cholesterol level <70 mg/dL, even with combination statin therapy;

(3) the effect of results from recent trials such as AIM-HIGH and the recent warning on high-dose simvastatin on clinical practice;

(4) the ideal LDL level in high-risk patients for primary or secondary prevention;

(5) managing cholesterol levels in high-risk patients who cannot tolerate high-dose statins;

(6) the potential impact of generic atorvastatin;

(7) the role of risk scores such as Framingham on LDL goal for primary prevention;

(8) the role of coronary calcium scores, hsCRP, and Lp(a) levels on management approaches;

(9) the importance of non-HDL cholesterol and HDL cholesterol on risk and the implications for treatment; and

(10) the impact of aggressive lifestyle approaches on raising HDL levels.

(Med Roundtable Cardiovasc Ed. 2011;2(3):158-166) ©2011 FoxP2 Media, LLC

Type A Dissections and Ascending Aortic Aneurysms

Summary
Dr. Abe DeAnda from the New York University School of Medicine moderated the topic "Type A Dissections and Ascending Aortic Aneurysms" with Drs. John Ikonomidis from the Medical University of South Carolina and John Elefteriades from the Yale University School of Medicine participating.

The discussion focused primarily on:

(1) aggressive targeting of low-density lipoprotein in high-risk patients;

(2) the challenges of moving patients to an LDL cholesterol level <70 mg/dL, even with combination statin therapy;

(3) the effect of results from recent trials such as AIM-HIGH and the recent warning on high-dose simvastatin on clinical practice;

(4) the ideal LDL level in high-risk patients for primary or secondary prevention;

(5) managing cholesterol levels in high-risk patients who cannot tolerate high-dose statins;

(6) the potential impact of generic atorvastatin;

(7) the role of risk scores such as Framingham on LDL goal for primary prevention;

(8) the role of coronary calcium scores, hsCRP, and Lp(a) levels on management approaches;

(9) the importance of non-HDL cholesterol and HDL cholesterol on risk and the implications for treatment; and

(10) the impact of aggressive lifestyle approaches on raising HDL levels.

(Med Roundtable Cardiovasc Ed. 2011;2(3):167-174) ©2011 FoxP2 Media, LLC

Implantable Cardioverter-Defibrillators in Hypertrophic Cardiomyopathy

Summary
Dr. Barry Maron from the Minneapolis Heart Institute Foundation moderated the topic "Implantable Cardioverter-Defibrillators in Hypertrophic Cardiomyopathy" with Drs. Mark Estes and Martin Maron from the Tufts Medical Center participating.

The discussion focused primarily on:

(1) The efficacy ICDs in hypertrophic cardiomyopathy;

(2) complications related to ICD use;

(3) risk stratification algorithm and selection of patients for primary prevention; and

(4) device selection. (Med Roundtable Cardiovasc Ed.

(Med Roundtable Cardiovasc Ed. 2011;2(3):175-180) ©2011 FoxP2 Media, LLC

The Use of Diuretics in the Treatment of Hypertension: Are They Still One of the Preferred Initial Therapies?

Summary
Dr. John Kostis from the UMDNJ-Robert Wood Johnson Medical School moderated the topic "The Use of Diuretics in the Treatment of Hypertension" with Drs. Kenneth Jamerson from the University of Michigan and Marvin Moser from Yale University participating.

The discussion focused primarily on:

(1) The use of diuretics as monotherapy and in combination therapies;

(2) heath-care costs of diuretics compared to other anti-hypertensive therapies;

(3) the use of diuretics compared to other anti-hypertensive drugs;

(4) JNC-7 and diuretics;

(5) the use of diuretics in diabetic patients;

(6) the differences between diuretic compounds; and

(7) the use of diuretics in certain patient subgroups.

(Med Roundtable Cardiovasc Ed. 2011;2(3):191-198) ©2011 FoxP2 Media, LLC

Update on Decision-Making in Degenerative Mitral Valve Disease

Summary
Dr. David Adams from the Mount Sinai Medical Center, New York, NY moderated the topic "Update on Decision-Making in Degenerative Mitral Valve Disease" with Drs. Robert Bonow from Northwestern University, Chicago, IL, Blase Carabello from the Michael E. DeBakey VA Medical Center, Houston, TX, and Randolph Martin from Piedmont Heart Institute, Atlanta, GA.

The discussion focused primarily on:

(1) Guidelines for mitral valve disease management;

(2) mitral valve surgery in patients with mitral regurgitation;

(3) mitral surgery in asymptomatic patients;

(4) the use of imaging and exercise testing in mitral valve disease;

(5) raising awareness for regional reference centers for mitral valve surgery;

(Med Roundtable Cardiovasc Ed. 2011;2(3):181-189) ©2012 FoxP2 Media, LLC
Volume 2 / Issue 2
The Medical Roundtable - CV Edition Vol. 2 Iss. 2

HDL and Triglycerides in the Year 2011: What Might the NCEP ATP IV Guidelines Look Like?

Summary
Dr. Nanette K. Wenger from the Emory University School of Medicine moderated the topic "HDL and Triglycerides in the Year 2011," with Drs. Christie Ballantyne from the Baylor College of Medicine and Michael Davidson from the University of Chicago School of Medicine participating.

The discussion focused primarily on:

(1) speculation as to the recommendations that might be made in the NCEP ATP IV Guidelines, particularly about non-HDL cholesterol

(2) gender specific recommendations with emphasis on the AHA guidelines,

(3) diabetic versus non-diabetic patients with high riglycerides and low HDL levels,

(4) clarifying often misquoted clinical trial data, including ACCORD and VA-HIT,

(5) potential for drugs to raise HDL holesterol by CETP inhibition,

(6) current trials underway evaluating the use of niacin and statin therapy,

(7) Framingham risk evaluation using total holesterol to HDL ratio,

(8) trial data providing insights to metabolic syndrome therapy,

(9) lifestyle modifications for raising HDL,

(10) treatment for women with very high HDL levels, and

(11) whether reducing LDL beyond a floor level provides significant benefits.

(Med Roundtable Cardiovasc Ed. 2011;2(2):72-80) ©2011 FoxP2 Media, LLC

The Role of Older Pharmacological Therapies in Cardiovascular Disease

Summary
Dr. Henry Black from The New York University School of Medicine moderated the topic "The Role of Older Pharmacological Therapies in Cardiovascular Disease," with Drs. William Cushman from the University of Tennessee College of Medicine, William Frishman from the New York Medical College, and Domenic Sica from Virginia Commonwealth University participating.

The discussion focused primarily on:

(1) The comparison of efficacy, cost and side effect profiles of the older cardiovascular drugs versus the newer compounds,

(2) the use of beta blockers, diuretics, calcium channel blockers, anticoagulants, aldosterone receptor antagonists, angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) and anti-anginals in the treatment of cardiovascular disease,

(3) the use of beta blockers in hypertensive patients,

(4) the use of aldosterone receptor antagonists in the treatment of resistant hypertensives,

(5) the use of ACE inhibitors and ARBs in patients taking aldosterone receptor antagonists,

(6) the use of reserpine as an older but effective antihypertensive,

(7) a comparison of the nticoagulants warfarin and dabigatran, and

(8) the use of appropriate diuretic therapy.

(Med Roundtable Cardiovasc Ed. 2011;2(2):82-90) ©2011 FoxP2 Media, LLC

Modern Technology Has Not Replaced the Cardiac Physical Exam

Summary
Dr. Lawrence Cohen from the Yale University School of Medicine moderated the topic "Modern Technology Has Not Replaced the Cardiac Physical Exam," with Drs. Jeffrey S. Borer from the State University of New York Downstate Medical Center, and John Michael Criley from the Geffen School of Medicine at UCLA participating.

The discussion focused primarily on:

(1) the importance of a physical bedside cardiac exam, patient history and clinical evaluation for a cost effective and accurate diagnosis,

(2) the role of modern imaging technologies in supplementing the bedside cardiac exam,

(3) the dearth of effective teaching in medical school of a physical examination for a cardiovascular patient, and

(4) the role simulation labs, virtual patient exams and mannequins in learning cardiac auscultation.

(Med Roundtable Cardiovasc Ed. 2011;2(2):92-98) ©2011 FoxP2 Media, LLC

Cardiovascular Disease and Aging

Summary
Dr. Andrew Duxbury from the University of Alabama at Birmingham moderated the topic "Cardiovascular Disease and Aging" with Drs. Jerome L. Fleg from the National Heart, Lung, and Blood Institute, Marian Limacher from the University of Florida, and Michael W. Rich from Washington University-St. Louis participating.

The discussion focused primarily on:

(1) increase in aging population and the expectation of increased incidence of cardiovascular disease,

(2) worldwide increase in obesity,

(3) the roles of cardiologists and primary care physicians in treating increasing numbers of patients,

(4) forecasting the use of technology in treating the elderly population,

(5) primary prevention of cardiovascular disease including legislative changes in the food industry,

(6) pharmaceutical advances and consideration of polypharmacy incurred by elderly and heart failure patients,

(7) the unabated epidemic of diastolic heart ailure,

(8) guideline modifications for the elderly, including use of ICDs,

(9) some lack of an evidence base for clear treatment of the elderly and the need for trials specifically for the aging population, and

(10) proposed changes to the health care system.

(Med Roundtable Cardiovasc Ed. 2011;2(2):99-106) ©2011 FoxP2 Media, LLC

The Role of Implantable Defibrillators in Cardiac Resynchronization Therapy in Heart Failure Patients

Summary
Dr. Barry Massie from the University of California in San Francisco moderated the topic "The Role of Implantable Defibrillators in Cardiac Resynchronization Therapy in Heart Failure Patients" with Drs. John Cleland from the University of Hull, UK, Mark A. Hlatky from Stanford University, and Lynne Stevenson from Harvard Medical School participating.

The discussion focused primarily on:

(1) the use of implantable defibrillators as therapeutics and preventative devices,

(2) benefits versus cost for patients,

(3) a discussion of which patients which benefit more from these devices,

(4) the inappropriate use of these devices and the adverse consequences that can arise from them,

(5) the controversial role of ICDs (implantable cardiac defibrillators) as primary prevention tools,

(6) the use of ICD in CRT cardiac resynchronization therapy) patients,

(7) the use of beta-blockers in patients with ICDs, and

(8) the US guidelines for the use of cardiac pacemakers and anti arrhythmia devices.

(Med Roundtable Cardiovasc Ed. 2011;2(2):107-116) ©2011 FoxP2 Media, LLC

Present and Future Challenges in Transcatheter Aortic Valve Replacement

Summary
Dr. Josep Rodés-Cabau from Quebec Heart and Lung Institute moderated the topic "Present and Future Challenges in Transcatheter Aortic Valve Replacement," with Drs. Susheel Kodali from the Columbia University Medical Center and Gian Paolo Ussia from the University of Catania participating.

The discussion focused primarily on:

(1) transcatheter aortic valve replacement (TAVR) as an alternative to surgical aortic valve replacement,

(2) the se of the balloon-expandable Edwards valve and the self-expandable CoreValve in TAVR,

(3) patient selection, procedural aspects, complications, results, alve hemodynamics and patient follow up for TAVR,

(4) the transfemoral versus transapical and subclavian approaches for TAVR,

(5) the use of general aesthesia and echo-guidance, and

(6) survival rates for TAVR.

(Med Roundtable Cardiovasc Ed. 2011;2(2):117-124) ©2011 FoxP2 Media, LLC

Exercise to Combat the Cardiovascular Disease Risk of Obesity

Summary
Dr. Gerald Fletcher from Mayo Clinic, Florida moderated the topic "Exercise to Combat the Cardiovascular Disease Risk of Obesity" with Drs. Randal Thomas from Mayo Clinic, Rochester, Hector Ventura from the Ochsner Clinic, and Malissa Wood from the Harvard School of Medicine and Massachusetts General Hospital participating.

The discussion focused primarily on:

(1) the bio-physiological effects of exercise (anti-atherogenic, anti-thrombotic, anti-arrhythmic, anti-ischemic and anti-inflammatory) on cardiovascular disease risk,

(2) the benefits of the anti-thrombotic effects of exercise on the metabolic risks of obesity,

(3) the beneficial effects of exercise on endothelial function and the autonomic nervous system,

(4) additional factors that effect cardiac arrhythmias such as sleep apnea, fat components of the pericardium and the relationship between QTc and BMI,

(5) the relationship between obesity and heart failure,

(6) the besity paradox,

(7) waist circumference and abdominal obesity as significant risk markers, and

(8) recommendations for amount and type of physical activity needed to reduce cardiovascular risk.

(Med Roundtable Cardiovasc Ed. 2011;2(2):125-131) ©2011 FoxP2 Media, LLC
Volume 2 / Issue 1
The Medical Roundtable - CV Edition Vol. 2 Iss. 1

Implications of EMPHASIS-HF for Clinical Practice

Summary
Dr. Marc Pfeffer from Brigham and Women's Hospital of Harvard University moderated the topic "Implications of EMPHASIS-HF for Clinical Practice" with Drs. Bertram Pitt from the University of Michigan and Faiez Zannad from the University of Nancy, France participating.

The discussion focused primarily on:

(1) the RALES trial,

(2) effects of combining spironolactone and ACE inhibtors on renal function,

(3) the CONSENSUS trial,

(4) US physician concern over use of spironolactone and hyperkalemia,

(5) European experience with effective spironolactone therapy,

(6) comparison btween eplerenone and spironolactone, and

(7) the findings of EMPHASIS-HF trial including considerations surrounding ending the trial early.

(Med Roundtable Cardiovasc Ed. 2011;2(1):7-13) ©2011 FoxP2 Media, LLC

Contrast Echocardiography and Carotid Vascular Ultrasound

Summary
Dr. Philip Liebson from the Rush University Medical Center moderated the topic "Contrast Echocardiography and Carotid Vascular Ultrasound" with Drs. Steven B. Feinstein from Rush University Medical Center, and Michael Main from St. Luke's Mid America Heart Institute participating.

The discussion focused primarily on:

(1) the development of various contrast agents,

(2) use of contrast agents for evaluation of shunts,

(3) the Valsalva maneuver,

(4) December 2010 ICAEL standards,

(5) the use of contrast agents to improve technically difficult echocardiograms,

(6) the routine use of contrast agents in post-MI patients,

(7) using contrast agents in stress testing, wall motion and myocardial perfusion,

(8) impact of contrast agents in drug management,

(9) using contrast agents in evaluating carotid arteries, and

(10) contraindications for contrast agents.

(Med Roundtable Cardiovasc Ed. 2011;2(1):15-21) ©2011 FoxP2 Media, LLC

The Role of Heart Rate Modulation for Care of Patients with Coronary Artery Disease and Heart Failure

Summary
Dr. Jeffrey Borer from SUNY Downstate Medical Center, New York, NY moderated the topic "The Role of Heart Rate Modulation for Care of Patients with Coronary Artery Disease and Heart Failure" with Drs. Kim Fox from Royal Brompton Hospital, London, England, and Jean-Claude Tardif from the Montreal Heart Institute, Montreal, Quebec.

The discussion focused primarily on:

(1) effects of heart rate in coronary artery disease and heart failure,

(2) insights regarding the CASS registry,

(3) modalities used for heart rate modulation, including F channel blocker ivabradine, and

(4) results of clinical trial studies with ivabradine and atenolol in angina and heart failure.

(Med Roundtable Cardiovasc Ed. 2011;2(1):23-29) ©2011 FoxP2 Media, LLC

Cardiovascular Effects of NSAIDS

Summary
Dr. William B. White from the University of Connecticut School of Medicine moderated the topic "Cardiovascular effects of NSAIDS" with Drs. Michael E. Farkouh from the University of Toronto and Gary Williams from the Scripps Clinic participating.

The discussion focused primarily on:

(1) the use of NSAIDS in present clinical practice,

(2) an overview of the guideline recommendations from various societies for the treatment of arthritis and osteoarthritis,

(3) the considerations surrounding patients who change their choice of NSAID,

(4) patients having osteoarthritis, rheumatoid arthritis and co-existing cardiovascular disorders,

(5) prevalence of osteoarthritis and obesity in United States population,

(6) effects of NSAIDS on blood pressure and renal function,

(7) effects of NSAIDS on cardiovascular events, and

(8) considerations regarding the choice of NSAID for patients taking aspirin, or other medications.

(Med Roundtable Cardiovasc Ed. 2011;2(1):30-40) ©2011 FoxP2 Media, LLC

Which is More Important: Plaque Quantity or Plaque Rupture?

Summary
Dr. William C. Roberts from the Baylor Heart and Vascular Institute moderated the topic "Which is More Important: Plaque Quantity or Plaque Rupture?" with Drs. James de Lemos from University of Texas Southwestern Medical Center and Peter Libby from the Brigham and Women's Hospital participating.

The discussion focused primarily on:

(1) vulnerable plaque focus over plaque quantity,

(2) defining characteristics of vulnerable plaque,

(3) techniques for diagnosing vulnerable plaque,

(4) the frequency of significant thrombus detection and clinical events,

(5) biomarkers and imaging technology for detecting vulnerable plaques,

(6) therapy for patients with atherosclerotic plaque or vulnerable plaques,

(7) the effects of lipid levels on therapy choices, and

(8) effect of heparin on ruptured plaque.

(Med Roundtable Cardiovasc Ed. 2011;2(1):41-47) ©2011 FoxP2 Media, LLC

What Is the Role of Cholesterol Absorption Inhibitors in Current Lipid Management?

Summary
Paul Thompson from Hartford Hospital moderated the topic "What Is the Role of Cholesterol Absorption Inhibitors in Current Lipid Management?" with Drs. Robert S. Rosenson from the Mount Sinai School of Medicine and Allen Taylor from the Washington Hospital Center and MedStar Health Research Institute participating.

The discussion focused primarily on:

(1) current practice guidelines and the role of ezetimibe,

(2) alternative therapies for lowering LDL cholesterol,

(3) the ARBITER 6 and SHARP studies,

(4) treatment therapy for patients not at goal on a statin,

(5) the use of resins and niacin in lowering LDL colesterol,

(6) the niche situations where ezetimibe could be effective, and

(7) debate over various alternative agents, including tertiary effects, price and effectiveness.

(Med Roundtable Cardiovasc Ed. 2011;2(1):49-56) ©2011 FoxP2 Media, LLC

Managing Atrial Fibrillation (New Antiarrhythmics and New Anticoagulants): Do They Represent Improvements over Previously Available Therapy?

Summary
Dr. James Reiffel from Columbia University moderated the topic "Managing Atrial Fibrillation (New Antiarrhythmics and New Anticoagulants): Do They Represent Improvements over Previously Available Therapy?" with Drs. Peter Kowey from Jefferson Medical College, and Gerald Naccarelli from the Penn State University College of Medicine participating.

The discussion focused primarily on:

(1) the rhythm control approach,

(2) American and European guidelines,

(3) details of the ATHENA trial,

(4) cardioversion with "pill in a pocket" therapy,

(5) the ACT and AVRO trials in Europe studying vernakalant,

(6) preclinical data showing efficacy of dronedarone and ranolazine combination therapy,

(7) ablation therapy,

(8) anti-coagulation therapy, including the ROCKET-AF study, and new drug therapies, and

(9) side effects of drug therapy.

(Med Roundtable Cardiovasc Ed. 2011;2(1):57-64) ©2011 FoxP2 Media, LLC
Volume 1 / Issue 4
The Medical Roundtable - CV Edition Vol. 1 Iss. 4

Percutaneous Aortic Valve Implantation

Summary
Dr. William Roberts from the Baylor Cardiovascular Institute at Baylor University moderated the topic "Percutaneous Aortic Valve Implantation" with Drs. Robert Bonow from the Feinberg School of Medicine at Northwestern University and Paul Grayburn from Baylor University participating.

The discussion focused primarily on:

(1) identifying patient candidates for operative aortic valve replacement or percutaneous transcatheter valve implantation,

(2) the use of MRI and echocardiography to distinguish valve types,

(3) surgical techniques including mini-sternotomy,

(4) the experience of interventional cardiologists and surgeons at large centers, and

(5) the use of the transapical approach.

(Med Roundtable Cardiovasc Ed. 2010;1(4):215-219) ©2010 FoxP2 Media, LLC

When is Ablation, Defibrillation or Medical Treatment Indicated in Atrial Fibrillation?

Summary
Dr. Hugh Calkins from Johns Hopkins School of Medicine moderated the topic "When is Ablation, Defibrillation or Medical Treatment Indicated in Atrial Fibrillation?" with Drs. David Callans from the University of Pennsylvania, and John Hummel from Ohio State University participating.

The discussion focused primarily on:

(1) efficacy of catheter ablation of atrial fibrillation, including success and complication rates, and techniques,

(2) complicated candidates for AF ablation and different treatment strategies,

(3) recommendations regarding first or second line approaches for ablation vs. antiarrhythmic drugs,

(4) antiarrhythmic drug therapy, and

(5) cardioversion.

(Med Roundtable Cardiovasc Ed. 2010;1(4):221-226) ©2010 FoxP2 Media, LLC

Transitions of Care: Heart Failure

Summary
Dr. Ileana Piña from Case Western Reserve University moderated the topic "Transitions of Care: Heart Failure" with Drs. John Rumsfeld from the Denver VA Medical Center, Rebecca Boxer from the University Hospitals Case Medical Center, Mary Norine Walsh from St. Vincent Heart Center of Indiana, and Sarah Goodlin from Patient-Centered Education and Research and the Portland Oregon VA Medical Center participating.

The discussion focused primarily on:

(1) safe and appropriate transition of the in patient to the outpatient setting, including skilled nursing facilities,

(2) cost impact on Medicare of re-hospitalizations,

(3) rehospitalization rate as a metric,

(4) the American College of Cardiology's H2H quality initiative and its three basic cores,

(5) methods to decrease rehospitalization, including patient education and post-discharge follow-up,

(6) end-of-life measures, including educating hospice nurses and management of devices,

(7) systems used in integrated healthcare systems, and

(8) patient-centered medical home model of care.

(Med Roundtable Cardiovasc Ed. 2010;1(4):221-226) ©2010 FoxP2 Media, LLC

Novel Risk Factors for Coronary Artery Disease Prevention: Fact or Fiction?

Summary
Dr. Philip Liebson from Rush Medical College moderated the topic "Novel Risk Factors for Coronary Artery Disease Prevention: Fact or Fiction?" with Drs. Ezra Amsterdam from the University of California, Davis and JoAnne Foody from Harvard Medical School participating.

The discussion focused primarily on:

(1) classic cardiovascular risk factors and Framingham risk score,

(2) definition of risk factors vs. risk markers,

(3) novel risk markers such as hs-CRP, coronary calcium scores, Lp(a), Carotid IMT, Ankle Brachial Index, Nuclear Magnetic Resonance Spectroscopy, Computed Tomography Coronary Angiography and PAI-1,

(4) explaining the C statistic,

(5) the incremental value of the tests compared to the costs,

(6) the Reynolds Risk Score,

(7) obesity as a risk factor.

(Med Roundtable Cardiovasc Ed. 2010;1(4):236-242) ©2010 FoxP2 Media, LLC

The Role of Cardiopulmonary Exercise Testing (CPX) in Research of Chronic Heart Failure and in Treatment Decisions

Summary
Dr. William Kraus from the Duke University Medical Center moderated the topic "The Role of Cardiopulmonary Exercise Testing (CPX) in Research of Chronic Heart Failure and in Treatment Decisions," with Drs. David Whellan from the Jefferson Coordinating Center for Clinical Research, and Jonathan Myers from the Palo Alto VA Hospital.

The discussion focused primarily on:

(1) standards of care for heart failure patients, including surgery, mechanical support and prescriptions,

(2) the use of VO₂ as a parameter of measurement,

(3) expert use of and training for the testing systems and variability of results,

(4) creation of a testing facility and the American Heart Association Scientific Statement "A Clinicians' Guide to CPX Testing",

(5) detecting primary cause of cardiomyopathy,

(6) the complementary use of pulmonary function testing,

(7) examination of the CPX test results and its various parameters,

(8) the role of CPX testing in clinical trials.

(Med Roundtable Cardiovasc Ed. 2010;1(4):243-249) ©2010 FoxP2 Media, LLC

Emergency Department Risk Stratification of Suspected Acute Heart Failure

Summary
Dr. W. Frank Peacock from the Cleveland Clinic moderated the topic "Emergency Department Risk Stratification of Suspected Acute Heart Failure" with Drs. Deborah Diercks from the University of California Davis Medical Center, J. Douglas Kirk from the University of California Davis Medical Center, Phillip Levy from Wayne State University, Peter S. Pang from the Northwestern University Feinberg School of Medicine, and Alan Storrow from Vanderbilt University participating.

The discussion focused primarily on:

(1) risk stratification on presentation to the emergency department for patient care and disposition

(2) new tools including biomarkers, physiologic responses and better descriptions of the initial presentation,

(3) the complexities of using blood pressures as an approach for risk stratification,

(4) the use of naturietic peptides in the risk stratification process,

(5) the role of troponin elevation and disposition of the ED patient,

(6) issues surrounding the patient with cardio-renal problems, including neutrophil gelatinase associated lipocalin (NGAL) as a biomarker for renal injury,

(7) using procalcitonin to diagnose heart failure and pneumonia,

(8) research regarding the potential for novel biomarkers, including MR-proADM and copeptin,

(9) the use of lactate as a surrogate for identifying sepsis patients and

(10) the evolving use of echocardiography in the ED.

(Med Roundtable Cardiovasc Ed. 2010;1(4):220-259) ©2010 FoxP2 Media, LLC

Out-of-Office Blood Pressure Monitoring

Summary
Dr. William B. White from the University of Connecticut School of Medicine moderated the topic "Out-of-Office Blood Pressure Monitoring" with Drs. Aldo Peixoto from the Yale School of Medicine, and Robert A. Phillips from the UMass Memorial Medical Center participating.

The discussion focused primarily on:

(1) ambulatory blood pressure monitoring,

(2) normal decline of blood pressure or "dippers"

(3) white-coat effect versus white-coat hypertension

(4) treatment of the white-coat hypertensive patient,

(5) out-of-office blood pressure monitoring techniques,

(6) monitoring the "masked" hypertensive patient,

(7) monitoring the resistant hypertensive patient,

(8) monitoring the high risk patient with hypertension and hyperaldosteronism, renal artery stenosis or chronic kidney disease,

(9) management and monitoring nocturnal hypertension,and

(10) morning surge blood pressure.

(Med Roundtable Cardiovasc Ed. 2010;1(4):260-266) ©2010 FoxP2 Media, LLC

The JNC 8---What Might Be Expected?

Summary
Dr. Marvin Moser from the Yale School of Medicine moderated the topic "The JNC 8 - What Might Be Expected?" with Drs. Jan Basile from the Medical University of South Carolina, Norman Kaplan from UT Southwestern Medical School at Dallas, and Ronald Victor from Cedars-Sinai Medical Center, Los Angeles participating.

The discussion focused primarily on:

(1) Joint National Committee (JNC) reports prior to the forthcoming JNC 8,

(2) progress in controlling hypertension, including special populations

(3) blood pressure goals,

(4) diagnostic evaluation of the hypertensive patient,

(5) lifestyle changes that impact blood pressure,

(6) initial therapy, including the use of beta-blockers and direct renin inhibitors, including eldery and obese populations,

(7) combination therapy,

(8) safety of ARBs and cancer, and

(9) predictions on the recommendations that might be included in the forthcoming JNC 8 report.

(Med Roundtable Cardiovasc Ed. 2010;1(4):267-275) ©2010 FoxP2 Media, LLC

Letter to the Editor
Volume 1 / Issue 3
The Medical Roundtable - CV Edition Vol. 1 Iss. 3

Are Alternative Medical Therapies of Any Benefit in Patients with Heart Disease?

Summary
Dr. James Dalen from the University of Arizona moderated the topic "Are Alternative Medical Therapies of Any Benefit in Patients with Heart Disease?" with Drs. Stephen Devries from Northwestern University, Michael Davidson from the University of Chicago and Gulshan Sethi from University of Arizona participating.

The discussion focused primarily on:

(1) integrative approaches to heart failure therapy,

(2) physician-patient discussion regarding supplements, nutrition, and physical activity

(3) use of plant based stanols and sterols,

(4) alternative therapies for patients undergoing cardiac surgery, including, guided imagery, massage, meditation and yoga,

(5) oxidative stress and the effectiveness of antioxidant supplements,

(6) laughter therapy,

(7) the potential harm of folic acid, and

(8) considerations for preoperative preparations.

(Med Roundtable Cardiovasc Ed. 2010;1(1):145-151) ©2010 FoxP2 Media, LLC

Do Thiazide Diuretics Cause Diabetes? If So, Is It of Clinical Significance?

Summary
Dr. Barry Carter from the University of Iowa moderated the topic "Do Thiazide Diuretics Cause Diabetes? If So, Is It of Clinical Significance?" with Drs. Jan Basile from the Medical University of South Carolina and the Ralph H. Johnson VA Medical Center, William Cushman from the University of Tennessee College of Medicine and the Memphis VA Medical Center, and Domenic Sica from the Virginia Commonwealth University participating.

The discussion focused primarily on:

(1) the potential for new onset diabetes following initiation of thiazide diuretics,

(2) the relationship of other drugs used in the treatment of hypertension,

(3) review of clinical trial data,

(4) review clinical practice guidelines,

(5) the risks associated with thiazide diuretics, including hypokalemia,

(6) dosing strategies to mitigate risks in this class of drugs,

(7) thiazide treatment in combination with other therapeutic options,

(8) strategies for reducing the need for additional antihypertensive agents,

(9) promoting lifestyle modifications that can overcome adverse metabolic effects of the thiazide diuretics.

(Med Roundtable Cardiovasc Ed. 2010;1(3):152-159) ©2010 FoxP2 Media, LLC

Should an Aldosterone Blocker Be Added to an ACE Inhibitor and Beta Blocker in Heart Failure?

Summary
Dr. Prakash Deedwania from the VA Central California Healthcare System and USCF school of medicine San Francisco, CA moderated the topic "Should an Aldosterone Blocker Be Added to an ACE Inhibitor and Beta Blocker in Heart Failure?"with Drs. Bertram Pitt from the University of Michigan Division of Cardiology and Faiez Zannad from the University of Nancy in France participating.

The discussion focused primarily on:

(1) aldosterone receptor blockade and effects on mortality and arrythmias,

(2) mechanisms affected by aldosterone, including, fibrosis, collagen, nervous system and potassium

(3) collagen as a biomarker,

(4) cardiac remodeling,

(5) protecting against hyperkalemia, hypokalemia, and hypomagnesemia,

(6) pleiotropic effects of anti-aldosterone therapy,

(7) the impact of renal insufficiency on treatment considerations,

(8) treatment therapy and adverse effects,

(9) European guidelines,

(10) role of aldosterone blockade in diastolic heart failure, and

(11) prevention of fibrosis through early intervention.

(Med Roundtable Cardiovasc Ed. 2011;1(3):160-166) ©2010 FoxP2 Media, LLC

Cardioprotective Benefits of Vigorous Physical Activity: The Risk Benefit Issue

Summary
Dr. Barry Franklin from the William Beaumont Hospital moderated the topic "Cardioprotective Benefits of Vigorous Physical Activity: The Risk Benefit Issue" with Drs. I-Min Lee from Harvard Medical School, David Swain from Old Dominion University and Paul Williams from the Ernest Orlando Lawrence Berkeley National Laboratory participating.

The discussion focused primarily on:

(1) current recommendations for physical activity, including minimum levels and intensity,

(2) threshold intensity for improving aerobic activity,

(3) potential for additional risk reduction for heart disease,

(4) physiologic mechanisms and increase in aerobic capacity,

(5) potential for glucose control,

(6) the National Runners' Health Study and benefits of exceeding activity from current guidelines,

(7) modification of current guidelines for optimization of cardioprotective benefits,

(8) potential risks of vigorous physical activity,

(9) obesity prevention, and

(10) recommendations regarding commencement of moderate- or vigorous activity.

(Med Roundtable Cardiovasc Ed. 2010;1(3):167-175) ©2010 FoxP2 Media, LLC

The Role of Digoxin in Heart Failure

Summary
Dr. Ali Ahmed from the University of Alabama at Birmingham moderated the topic "The Role of Digoxin in Heart Failure" with Drs. Mihai Gheorghiade from the Northwestern University, William Wehrmacher from Rush University and Michel White from the Montreal Heart Institute participating.

The discussion focused primarily on:

(1) the role of digoxin in patients receiving ACE inhibitor or beta blocker therapy,

(2) clinical trial data and digoxin toxicity,

(3) use of digoxin in patients with advanced heart failure,

(4) the rarity of continuing education on use of digoxin,

(5) an historical perspective of the evolution of the use of digoxin,

(6) changes in treatment of HF patients which may allow for use of digoxin,

(7) use of digoxin in women,

(8) use of digoxin with end stage renal disease, and

(9) contraindications of the use of digoxin.

(Med Roundtable Cardiovasc Ed. 2010;1(3):176-181) ©2010 FoxP2 Media, LLC

Pharmacological Therapy for Regurgitant Valve Lesions: Does It Really Work?

Summary
Dr. Jeffrey Borer from the SUNY Downstate Medical Center moderated the topic "Medical Therapy for Regurgitant Valve Lesions: Do They Really Work?" with Drs. Blase Carabello from the Michael E. DeBakey VA Medical Center and Dr. Mark Starling from Banner Heart Hospital participating.

The discussion focused primarily on:

(1) potential effects of pharmacological unloading therapy in aortic and mitral regurgitation,

(2) the differences in potential effects in these two diseases,

(3) clinical trial data available to support conclusions,

(4) potential utility of vasodilating and other heart failure therapy prior to planned surgery for patients with regurgitant valve disease and heart failure,

(5) potential importance of adverse actions of specific vasodilators that could compromise theoretical benefits,

(6) potential roles of drug therapies for problems other than volume overload that may be associated with regurgitant valve diseases, including prophylaxis for infective endocarditis, among others.

(Med Roundtable Cardiovasc Ed. 2010;1(3):182-189) ©2010 FoxP2 Media, LLC

*Dr. Starling was unable to attend the live discussion and subsequently inserted his commentaries.

Use of Statins in Prevention of Heart Disease, but Beware Statin Myopathy

Summary
Dr. Paul Thompson from Hartford Hospital moderated the topic "Use of Statins in Prevention of Heart Disease, But Beware Statin Myopathy" with Drs. Robert Rosenson from Mount Sinai School of Medicine, and Peter Toth from Sterling-Rock Falls Clinic participating.

The discussion focused primarily on:

(1) symptoms of statin myopathy,

(2) size of patient populations,

(3) statin use may unmask underlying conditions, such as McArdle Disease,

(4) mechanisms for statin myopathic complaints,

(5) therapy, including assessment of secondary disorders,

(6) considerations surrounding use of muscle biopsies,

(7) impact of CoQ10 and Vitamin D deficiencies,

(8) proper dosing strategies, combination and alternative therapies,

(9) prevalence of fibromyalgia and rhabdomyolysis,

(10) use of creatine kinase levels and ethnicity variants, and

(11) PCSK9 inhibitor research.

(Med Roundtable Cardiovasc Ed. 2010;1(3):190-199) ©2010 FoxP2 Media, LLC

Resistant Hypertension: Truly Resistant or Just Difficult to Control?

Summary
Dr. Marvin Moser from Yale University and Dr. Norman Kaplan from the University of Texas Southwestern Medical Center at Dallas participated in this discussion focusing on the topic "Resistant Hypertension: Truly Resistant or Just Difficult to Control?"

The discussion focused primarily on:

(1) treatment of resistant hypertentsion,

(2) differentiation between truly resistant patients and patients who are difficult to treat,

(3) white coat hypertension as a factor,

(4) blood pressure monitoring,

(5) renal vascular disease and aldosteronism,

(6) surgical and pharmaceutical therapy,

(7) intensity of medication to illicit response and patient condition,

(8) treatment of older patient populations,

(9) the impact of lifestyle changes on blood pressure reduction,

(10) treatment of middle-aged patient populations, and

(11) impact of NSAIDs on therapy.

(Med Roundtable Cardiovasc Ed. 2010;1(3):200-206) ©2010 FoxP2 Media, LLC
Volume 1 / Issue 2
The Medical Roundtable - CV Edition Vol. 1 Iss. 2

Statins: Do They Have Beneficial Effects Over and Above Their Actions on Lipids?

Summary
Dr. Antonio Gotto from Weill Cornell Medical College moderated the topic "Statins: Do they have beneficial effects over and above their actions on lipids?" with Drs. John LaRosa from State University of New York-Downstate Medical Center, and James Reiffel from Columbia University Medical Center participating.

The discussion focused primarily on:

(1) possible additional benefits, or pleiotropic effects, of statins beyond statin monotherapy's primary effect to reduce LDL cholesterol,

(2) the results of the clinical trial JUPITER and the use of statins for prevention,

(3) the use of CRP as a cardiovascular risk factor,

(4) the increased risk of diabetes balanced against cardiovascular benefits,

(5) the impact of statins on atrial fibrillation,

(6) the effectiveness in acute coronary syndrome,

(7) the antioxidant effects of statins, and

(8) the use of omega-3 fish oils.

(Med Roundtable Cardiovasc Ed. 2010;1(2):73-78) ©2010 FoxP2 Media, LLC

Mitral Valve Surgery and Mitral Prolapse

Summary
Dr. John Elefteriades from Yale University moderated the topic "Mitral Valve Surgery and Mitral Prolapse" with Drs. David Adams from Mt. Sinai Medical Center, Sabet Hashim from Yale University, and Maurice Sarano from the Mayo Clinic participating.

The discussion focused primarily on:

(1) diagnosis and assessment of different aspects of mitral insufficiency, including echocardiolography techniques, clinical assessment and cardiac remodeling,

(2) the use of the PISA method of measurement,

(3) regurgitant volume markers,

(4) evolution of mitral valve repair surgical techniques, including the Carpentier techniques,

(5) response of the left ventricle to mitral repairs vs. replacements,

(6) the relationship between cardiologist and surgeon,

(7) the role of the robot in mitral regurgitation, and

(8) transformative developments that will dramatically change the field.

(Med Roundtable Cardiovasc Ed. 2010;1(1):79-85) ©2010 FoxP2 Media, LLC

Practice Guidelines in Cardiovascular Disease: How Defining the Evidence Can Impact the Guidelines

Summary
Dr. Daniel Lackland from the Medical University of South Carolina moderated the topic "Practice Guidelines in Cardiovascular Disease: How Defining the Evidence Can Impact the Guidelines" with Drs. William Cushman from the University of Tennessee College of Medicine, and Stanley S. Franklin from the University of California, Irvine, participating.

The discussion focused primarily on:

(1) global risk assessment for cardiovascular disease,

(2) limitations on global risk assessment

(3) the role of observational data in extrapolating from clinical trials and treatment decisions,

(4) the role of clinical trial evidence and application to specific patient populations,

(5) evidence and clinical feelings that may justify treating prehypertensive patients,

(6) risk assessment data for initiating aspirin therapy, and

(7) shortcomings of randomized controlled trials.

(Med Roundtable Cardiovasc Ed. 2010;1(1):86-94) ©2010 FoxP2 Media, LLC

Identification and Management of Low Risk Patients Presenting to the Emergency Department with Chest Pain

Summary
Dr. Ezra Amsterdam from the University of California (Davis) School of Medicine moderated the topic "Identification and Management of Low Risk Patients Presenting to the Emergency Department with Chest Pain" with Drs. Allan Jaffe from the Mayo Clinic and Michael Farkouh from Mount Sinai Medical Center participating.

The discussion focused primarily on:

(1) immediate recognition of low risk patients on presentation,

(2) further risk stratification by selected testing methods,

(3) chest pain units and accelerated diagnostic protocols, and

(4) decision to discharge directly from the emergency department with outpatient follow-up.

(Med Roundtable Cardiovasc Ed. 2010;1(1):95-102) ©2010 FoxP2 Media, LLC

Status of ICDs for Primary and Secondary Prevention of Sudden Death

Summary
Dr. Philip Liebson from the Rush University Medical Center moderated the topic "Status of ICDs for Primary and Secondary Prevention of Sudden Death" with Drs. Robert Hauser from the Minneapolis Heart Institute and Richard Trohman from the Rush University Medical Center participating.

The discussion focused primarily on:

(1) indications for ICDs,

(2) the role of supplementary antiarrhythmic agents,

(3) evaluation of prognosis,

(4) choice of ICD type,

(5) subsidiary roles of biventricular pacemakers,

(6) complications such as unnecessary shocks, device malfunction, manufacturer recalls, and possible proarrhythmias,

(7) cost effectiveness of ICDs and

(8) patient issues in regard to quality of life.

(Med Roundtable Cardiovasc Ed. 2010;1(1):103-110) ©2010 FoxP2 Media, LLC

What Do the Newer Trials Tell Us About the Management of Heart Failure? A Discussion of Three Thought-Provoking Papers

Summary
Dr. Douglas Schocken from the Duke Heart Center moderated the topic "What Do the Newer Trials Tell Us About the Management of Heart Failure? A Discussion of Three Thought-Provoking Papers" with Drs. Stephen S. Gottlieb from the University of Maryland School of Medicine, Lynne Warner Stevenson from the Brigham and Women's Hospital and James Young from the Cleveland Clinic participating.

The discussion focused primarily on:

Management of chronic heart failure by reviewing the findings of three papers published in 2009 on the use of intravenous iron, BNP biomarkers and ventricular assist devices:

(1) Dr. Anker et al. addressed a novel medical approach to the problem by using intravenous ferric carboxymaltose,

(2) Dr. Pfisterer et al. examined the way in which physicians assess medical management and thereby modify therapies , and

(3) Dr. Slaughter et al. considered a fresh look at a newer type of mechanical ventricular assist device for failing hearts.

(Med Roundtable Cardiovasc Ed. 2010;1(1):111-119) ©2010 FoxP2 Media, LLC

GPP2: Good Publication Practices for Sponsored Medical Research: Elevating the Integrity of Scientific Communications

Summary
Dr. Marvin Moser from Yale University School of Medicine moderated the topic "GPP2: Good Publication Practices for Sponsored Medical Research: Elevating the Integrity of Scientific Communications" with Bryce McMurray from Wolters Kluwer, Carol Sanes-Miller, MS, CMPP, from AstraZeneca, LP, and Yvonne Yarker, PhD, CMPP from Scientific Connexions, and Treasurer of ISMPP participating.

The discussion focused primarily on:

organized efforts to elevate the perception of collaborative medical publishing of industry sponsored research,

transparency of authorship of medical journal articles, ghost writing and scientific writing assistance,

duplicate publication of clinical trial results,

integrity of journal articles sponsored by the pharmaceutical industry,

omission of relevant data which might indicate bias, and

appropriate disclosure of conflicts of interest.

(Med Roundtable Cardiovasc Ed. 2010;1(1):120-127) ©2010 FoxP2 Media, LLC

Alcohol Ablation or Ventricular Septal Myotomy/Myectomy for Severe Obstructive Hypertrophic Cardiomyopathy?

Summary
Dr. William Roberts from the Baylor Heart and Vasclar Institute moderated the topic "Alcohol Ablation or Ventricular Septal Myotomy/Myectomy for Severe Obstructive Hypertrophic Cardiomyopathy?" with Drs. Joseph Dearani from the Mayo Clinic and Barry Maron from the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute participating.

The discussion focused primarily on:

(1) hypertrophic cardiomyopathy (HC) and prevalence of left ventricular outflow obstruction,

(2) therapeutic plan for patients with HC, including beta blocker therapy, alcohol ablation and surgical myectomy,

(3) gradients for determining suitability for surgery,

(4) technique of performing surgical myectomy,

(5) post-surgical follow-up patient care,

(6) effectiveness of myectomy surgery on patient quality of life,

(7) considerations for using alcohol septal ablation, and

(8) probability of installing an ICD post surgery.

(Med Roundtable Cardiovasc Ed. 2010;1(1):128-133) ©2010 FoxP2 Media, LLC

Pulmonary Arterial Hypertension: The Role of Right Ventricular Failure--Diagnosis and Therapy

Summary
The following Expert Roundtable Discussion was held on March 30, 2010. Dr. Mandeep Mehra from the University of Maryland School of Medicine moderated the topic "Pulmonary Arterial Hypertension: The Role of Right Ventricular Heart Failure-Diagnosis and Therapy" with Drs. Patricia Uber and Myung Park both from University of Maryland School of Medicine participating.

The discussion focused primarily on:

(1) defining the diagnostic algorithm and indicators for pulmonary arterial hypertension,

(2) pharmacologic treatment options,

(3) acute vasoreactivity testing and its implications in therapeutic treatment, and

(4) risk stratification of patients to select therapy.

(Med Roundtable Cardiovasc Ed. 2010;1(2):134-139) ©2010 FoxP2 Media, LLC
Volume 1 / Issue 1
The Medical Roundtable-CV Edition

Summary
I am pleased to assume the Editor-in-Chief role of a new journal, which will be published quarterly commencing in January 2010. As a complement to traditional journals, The Medical Roundtable - CV Edition (TMR) will not include original or review articles but will include 7-8 roundtable discussions by experts dealing with controversial issues in cardiology. TMR is a contemporary format for healthcare professional education. By providing the busy physician with a window into the everyday conversations held among expert researchers, clinicians and academicians, TMR is providing access to the experience of colleagues and peers on the forefront of cardiovascular medicine.

Our Preview Issue includes four moderated discussions held throughout the past several months. The first panel, on aortic valve disease in the elderly, was led by Dr. Jeffrey Borer, Professor of Medicine and Chairman of the Department of Medicine and Cardiology at the SUNY Downstate Medical Center. Drs. Joseph Alpert of the University of Arizona and Dr. Blase Caraballo at the Michael De Bakey VA Center in Houston, Texas, participated in this discussion.

Letter From the Publisher

The Medical Roundtable - CV Edition

Lower Blood Pressure Targets: How Low Is Too Low?

Summary
The following Expert Roundtable Discussion was held on August 8, 2009. Dr. Clive Rosendorff from Mount Sinai School of Medicine moderated the topic "Lower Blood Pressure Targets: How Low Is Too Low?" with Drs. Franz Messerli from Columbia University College of Physicians and Surgeons and Steven Nissen from the Cleveland Clinic participating.

The medical community has known for a long time that lowering an elevated blood pressure decreases cardiovascular risk. Over the past two decades or so, published guidelines for hypertension management have proposed lower and lower blood pressure goals. The Expert Panel Discussion address the question: "Can blood pressure be reduced too much, perhaps to undesireable levels?" The theoretical limit to blood pressure lowering depends on the notion that the diastolic blood pressure is also the coronary perfusion pressure, and thus very low. Very low diastolic blood pressures may result in myocardial ischemia, particularly if there is LV hypertrophy or occlusive coronary disease. This situation would result in a slight increase in the cardiovascular risk at very low diastolic blood pressures which can be represented by a J-curve relationship. The experts' discussion focuses on answering the question of whether aggressively lowering blood pressure in hypertensive patients with coronary artery disease can be dangerous. The discussion addresses the evidence for this statement and whether this is actually a problem for patients. In addition, the experts venture opinions as to potential lower limits of acceptable diastolic blood pressure that the medical community could consider for their patients. (Med Roundtable Cardiovasc Ed. 2010;1(1):6–11) ©2010 FoxP2 Media, LLC

Aortic Valve Disease in the Elderly: When is Surgery Indicated? What Can be Expected in a Follow Up?

Summary
Dr. Jeffrey Borer moderated the topic "Aortic Valve Disease in the Elderly" with Drs. Blase Carabello, Chief of Medical Services at the Michael E. Debakey VA Medical Center, Houston, TX and Joseph Alpert, Professor of Medicine at the University of Arizona College of Medicine participating.*

The discussion focused primarily on:

(1) aortic valve disease (AVD) in the elderly,

(2) patient selection and when AVD surgery could be indicated,

(3) risks of particular concern to the elderly patient population,

(4) reasonable contraindications to surgery, and

(5) discusses answers to the issue regarding patients' expectations for recovery. As part of the discussion, the participants engage each other regarding the definition of "elderly", the desire of the patient to have the surgery and undergo rehabilitation, whether drugs, primarily vasodilators, can provide an alternative to surgery, the role of technology in patient selection, and the challenges of rehabilitation for elderly patients including payor limitations.

(Med Roundtable Cardiovasc Ed. 2010;1(1):12-17) ©2010 FoxP2 Media, LLC

*Dr. Alpert was unable to attend the live discussion and inserted his commentary subsequently.

CT Scans for Coronary Artery Disease: Are They Useful or Overused?

Summary
Dr. Marian Limacher moderated the topic "CT Scans for Coronary Artery Disease: Are They Useful or Overused?" with Drs. Matthew Allison, Associate Professor at the University of California, San Diego, and Allen Taylor, Co-Director of Non-Invasive Imaging at the Cardiology Division of Washington Hospital Center in Washington, D.C. participating.

The panelists engage in a discussion centered on the value to the physician and patient of using cardiac computed tomography scans in the assessment of coronary artery disease. The different technologies are defined and differentiated, including availability of newer equipment and the continued use of older scanning methods. The experts address:

(1) the usefulness of CT scans to provide additional information for more accurate patient risk stratification

(2) safety and risk of CT scan radiation exposure

(3) the use of CT scans for patient adherence to medication guidelines

(4) the cost of CT scans and insurance coverage

(5) application of CT scan technology in symptomatic versus asymptomatic patients

(6) alternative testing uses

(7) ongoing research including MESA and studies regarding CT angiography.

(Med Roundtable Cardiovasc Ed. 2010;1(1):18-24) ©2010 FoxP2 Media, LLC

What Is the Role of Beta Blocker Therapy in the Treatment of Hypertension?

Summary
Dr. Jan Basile from the Medical University of South Carolina in Charleston moderated the topic "What Is the Role of Beta Blocker Therapy in the Treatment of Hypertension?" with Drs. John Cockroft, from The Wales Heart Research Institute and Alan Gradman, from Temple University participating.

The discussion focused primarily on:

(1) classification of different types of beta blockers,

(2) beta blockers as initial and secondary therapy,

(3) use of beta blockers in patients with compelling indications, such as coronary heart disease and heart failure,

(4) the AB/CD rule,

(5) therapy for the patient with resting tachycardia,

(6) beta blockers' effectiveness in younger and older patients,

(7) the benefits associated with vasodilatory beta blockers, including new onset diabetes,

(8) the use of central pressure measurements rather than brachial pressure,

(9) side effects such as erectile dysfunction,

(10) the impact of beta blockers on diastolic dysfunction and

(11) the frequency of postural hypotension and impact of additional nitric oxide release.

(Med Roundtable Cardiovasc Ed. 2010;1(2):25-31) ©2010 FoxP2 Media, LLC

What Do the Newer Trials Tell Us About the Treatment of Coronary Heart Disease?

Summary
Dr. Peter Libby from Boston's Brigham and Women's Hospital moderated the topic "What Do the Newer Trials Tell Us About the Treatment of Coronary Heart Disease?" with Drs. Spencer King from St. Joseph's Heart and Vascular Institute and Carl Pepine from University of Florida participating.

The discussion focused primarily on:

(1) late-breaking trial data challenging the notion that invasive revascularization reduces cardiovascular events and improves outcomes,

(2) management of stable and acute forms of CHD,

(3) interventional and pharmacologic approaches, including interpretations of trial results and limitations,

(4) the need for new biomarkers and the measurement of ischemia as predictor of ACS,

(5) percutaneous intervention,

(6) emergency response systems to reduce "door to balloon" time,

(7) practical considerations concerning therapeutic treatment in the emergency room,

(8) medical non-interventional approaches as initial therapy.

(Med Roundtable Cardiovasc Ed. 2010;1(1):32-40) ©2010 FoxP2 Media, LLC

Evolving Concepts in Diabetes and the Metabolic Syndrome

Summary
Dr. Thomas Giles from Tulane University School of Medicine moderated the topic "Evolving Concepts in Diabetes and the Metabolic Syndrome" with Drs. Brent Egan from the Medical University of South Carolina, Bonita Falkner from Thomas Jefferson University and Willa Hsueh from Methodist Hospital, participating.

The discussion focused primarily on:

(1) the increase in childhood Type II diabetes, management and treatment,

(2) the increase in detection of polycystic ovary syndrome (PCOS),

(3) pharmacologic treatment of diabetic and hypertensive patients, including DBB4 inhibitors,

(4) American Diabetes Association recommendations on hemoglobin A1c levels,

(5) the increasing awareness of nonalcoholic steatohepatitis (NASH) as a complication of diabetes,

(6) the recommendations for using lipid lowering agents, and

(7) the emergence of pre-diabetes as a disease state.

(Med Roundtable Cardiovasc Ed. 2010;1(1):41-46) ©2010 FoxP2 Media, LLC

Low Level Troponin Interpretation In The Era Of High Sensitivity Troponins

Summary
Dr. W. Frank Peacock from the Cleveland Clinic moderated the topic "Low Level Troponin Interpretation In The Era Of High Sensitivity Troponins" with Drs. Allan Jaffe, Mayo Clinic and Alan Wu, University of California - San Francisco participating.

The discussion focused primarily on:

(1) chemical markers of myocardial damage,

(2) educating physicians on the impact of more positive troponin results due to high sensitivity assays,

(3) value of a cardiologist consult,

(4) troponin levels as a standard for determining myocardial infarction and myocardial ischemia,

(5) clarification of terminology, cutoffs and standardization of assays,

(6) development of ultra-high sensitivity assays and impact on interpretation and therapeutic response,

(7) usefulness of alternative biomarkers such as B-type natriuretic peptide, CK-MB, myoglobin and others, including a "multimarker panel", and

(8) triage of patients in the emergency department.

(Med Roundtable Cardiovasc Ed. 2010;1(1):47-53) ©2010 FoxP2 Media, LLC

What Do the New Trials Tell Us About the Management of Hypertension?

Summary
Dr. Marvin Moser moderated the topic "What do the new trials tell us about the management of hypertension?" with Drs. Jan Basile, Professor of Medicine, Medical University of South Carolina, Charleston, SC, William Cushman, Professor of Preventive Medicine and Medicine, University of Tennessee College of Medicine, Memphis, TN and Norman Kaplan, Professor of Medicine, UT Southwestern Medical Center, Dallas, TX participating.

Over the past three or four years, numerous hypertension treatment trials have been undertaken. Some of these were designed to determine (1) whether or not practicing physicians should be treating adolescent or very elderly hypertensive patients, (2) at what level should treatment be started, and (3) what are goal BP levels. Other trials have been designed to establish whether or not 130/80 should now be the goal for treatment instead of 140/90, especially in diabetic patients or patients with renal disease. Finally, there have been many comparative trials to determine whether there is a difference between the effectiveness of one drug combination compared to others. There is an ongoing debate about whether or not practicing physicians should treat an adolescent who has even transient systolic BP elevations of 145 or 150. There have also been debates for years regarding levels of BP to treat in the elderly. This roundtable addresses such questions as: (a) Do physicians ignore elevated BP at age 75, or at 80? (b) Do physicians ignore an 85-year-old person with systolic BP of 160 - 175? (c) Do physicians have any new data that help the practicing physicians resolve these issues? (Med Roundtable Cardiovasc Ed. 2010;1(1):54-60) ©2010 FoxP2 Media, LLC

Cardiovascular Workups: When and How Much of a Workup to Assess the Ability to Participate in Sports?

Summary
Dr. Paul Thompson, Director of Cardiology, Hartford Hospital, Hartford, CT moderated the topic "Cardiovascular Workups: When and How Much of a Workup to Assess the Ability to Participate in Sports?" with Drs. Mark Estes, Professor of Medicine, Tufts University, Boston, MA, Rachel Lampert, Associate Professor, Yale University, New Haven, CT and Ben Levine, UT Southwestern Medical Center, Dallas, TX.

The screening of athletes has become an area of hot debate as well as an area of intense public health interest. While the medical community is well aware of the benefits of exercise, exercise also has been shown paradoxically and specifically in young athletes, to increase the risk of sudden cardiac death. The roundtable experts discuss recommendations as to how to screen these athletes and in addition, they address what physicians may do before a patient who is not an athlete, and perhaps also middle-aged, wants to start an exercise program. The American College of Cardiology has suggested that diabetics, men over the age of 45 and women over the age of 55 need exercise stress tests. This recommendation has never been examined very carefully and is labelled as "Level of Evidence 2B," essentially meaning that there is some support for this recommendation, but no randomized control trial data. The roundtable experts discuss these topics. (Med Roundtable Cardiovasc Ed. 2010;1(1):61-68) ©2010 FoxP2 Media, LLC