Coronary Artery Disease: New Approaches without Traditional Revascularization

196 Pages·2012·4.103 MB·English

by  Shahar Lavi, David E. Kandzari, Gregory W. Barsness (auth.), Gregory W. Barsness, David R. Holmes (eds.)

Coronary Artery Disease

Gregory W. Barsness David R. Holmes Jr.
·
Editors
Coronary Artery Disease
New Approaches without Traditional
Revascularization
Editors
Gregory W. Barsness, MD David R. Holmes Jr., MD
Mayo Clinic College of Medicine Mayo Clinic College of Medicine
Rochester, MN Rochester, MN
USA USA
ISBN 978-1-84628-460-1 e-ISBN 978-1-84628-712-1
DOI 10.1007/978-1-84628-712-1
Springer London Dordrecht Heidelberg New York
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For Samuel and Joseph, who have demonstrated patience and
understanding far beyond their years during the completion of this
book.
In addition, we wish to dedicate this book to all of our colleagues
throughout the cardiology community who have continued to
encourage us in this important endeavor.
Most importantly, we want to thank our patients who have brought
these clinical issues to the forefront of our practice and served as the
impetus to bring this project to fruition.

Preface

While the majority of patients with symptomatic coronary artery disease achieve
acceptable angina relief through the standard armamentarium of medical therapy, coro-
nary artery bypass grafting and percutaneous coronary intervention, a growing number
are not candidates for standard revascularization procedures. Standard revasculariza-
tion procedures are largely palliative, and symptom recurrence is relatively common
particularly as patients live longer following revascularization earlier in life in an aging
population. In addition, the rapid worldwide increase in obesity and type 2 diabetes sets
the stage for a potential explosion of patients with severe, diffuse coronary disease. As
these trends continue, the population of patients who fail to achieve adequate symptom-
atic improvement through standard medical and revascularization strategies will cer-
tainly grow exponentially. Because the therapeutic options for patients with
“unrevascularizable” symptomatic coronary artery disease are currently limited, there
is a growing need for development of novel, effective and safe methods of symptom
relief. Experimental and developing strategies have included transmyocardial laser
revascularization (TMR), therapeutic angiogenesis, spinal cord stimulation, external
counterpulsation (ECP), novel medical therapies and complex percutaneous and surgi-
cal revascularization strategies. To date, there is no central repository for data regarding
these developing therapeutic strategies and a resulting lack of direction and focus in
clinical management and research. Patients and clinicians alike are then left with a
sense of helplessness and resignation that “nothing can be done.”
A growing recognition of past failures in the treatment of “untreatable” patients and
expanding awareness of the need for development of safe and effective therapies
makes this an ideal time for the development of a textbook detailing current approaches
and future directions in the management of the unrevascularizable patient. Through a
comprehensive and clinically oriented review of the epidemiology and basic science
foundation for studies in this population, current treatment strategies can be put in the
context of past failures and future directions. As the fi rst textbook of its kind, this book
provides a framework within which the practicing clinician can expand on current
practice, and experienced and young researchers alike can fi nd an insightful resource,
thereby addressing an entirely unmet need. We hope it is met with the enthusiasm with
which it was developed and provides a reliable reference for clinical and basic research-
ers interested in this topic, as well as affected patients and their families.
Rochester, MN, USA Gregory W. Barsness, MD
David R. Holmes Jr., MD

vii

Contents
1 Epidemiology of Cardiovascular Disease
and Refractory Angina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Shahar Lavi, David E. Kandzari, and Gregory W. Barsness
2 Basic Science Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Brendan Doyle and Noel Caplice
3 Coronary Artery Disease: Development and Progression . . . . . . . . . 21
Joerg Herrmann and Amir Lerman
4 Therapeutic Goals in Patients with Refractory Angina. . . . . . . . . . . 29
Mauricio G. Cohen and E. Magnus Ohman
5 Medical Therapy for Chronic Refractory Angina . . . . . . . . . . . . . . . 39
Gregory W. Barsness, Thomas J. Kiernan, and David R. Holmes Jr.
6 EECP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Bradley A. Bart
7 Therapeutic Angiogenesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Timothy D. Henry and Daniel Satran
8 Transmyocardial Laser Revascularization . . . . . . . . . . . . . . . . . . . . . 75
Jignesh S. Shah, Joanna J. Wykrzykowska, and Roger J. Laham
9 Invasive and Device Management of Refractory Angina. . . . . . . . . . 89
E. Marc Jolicoeur, Gregory W. Barsness, and Martial G. Bourassa
10 Cardiac Transplantation for Ischemic Heart Disease . . . . . . . . . . . . 109
Robroy H. Mac Iver, Edwin C. McGee Jr., and Patrick M. McCarthy
11 Alternative Therapies for Chronic Refractory Coronary
Artery Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Brent A. Bauer
12 Nonspecifi c Placebo Effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Piero O. Bonetti
13 Prognostic Implications of Depression in Ischemic Syndromes . . . . 147
Karen E. Joynt and Christopher M. O’Connor
14 Secondary Prevention Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Romero Corral Abel, Lopez Jimenez Francisco, Josef Korinek,
Virend Somers, and Thomas E. Kottke
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
ix