PubMed Health⌕ Search

Biomedical subjects

Norman E Lepor

Publications and source records attributed to Norman E Lepor.

At least 19 recordsLinked to original sources
PubMed2006

Screening CT-coronary angiography: ready for prime time?

Computed tomographic coronary angiography (CTCA) can assist with the diagnosis of a variety of cardiovascular disorders. The rationale for performing screening CTCA is to define the presence, absence, and severity of coronary artery disease, particularly in those patients who are categorized to be at intermediate risk by conventional risk factor assessment for a cardiovascular event. In addition to coronary artery disease, the interventional cardiologist can also use CTCA to evaluate the presence of an anomalous origin of the coronary arteries, the size of the coronary arteries for potential stent placement, the extent of coronary calcium in the obstructive segment and bypass graft patency. With conventional coronary angiography, the combined radiogenic and non-radiogenic mortality is 0.13%, compared to 0.07% with CTCA. Radiation to the clinician is also greatly reduced.

Coronary Angiography↗
PubMed2006

Therapeutic goals for effective platelet inhibition: a consensus document.

Clopidogrel combined with aspirin is the mainstay of antiplatelet therapy for patients who present with acute coronary syndromes as well as following either bare metal or drug-eluting stent placement. Limitations of clopidogrel therapy include the relatively long time course required to achieve maximal inhibition of platelet aggregation, individual variability in response to its effect, the risk of bleeding during its administration, and the irreversible nature of P2Y12 receptor binding, which leads to a prolonged time course for recovery of platelet function following discontinuation of clopidogrel. Several investigational P2Y12 receptor antagonists have pharmacological properties that may overcome some or all of these limitations. These novel agents such as prasugrel, AZD6140, and cangrelor are in advanced stages of clinical development for potential use in patients with coronary artery disease.

Consensus Statements as Topic↗
PubMed2006

Practical guidelines for the use of anticoagulants in the catheterization laboratory.

Optimal treatment of patients during percutaneous coronary interventions (PCIs) is constantly changing as clinical trials provide new and clinically relevant information. Clinicians need to be aware of this information to incorporate these new strategies into clinical practice, leading to improvements in the care of patients. The direct thrombin inhibitor, bivalirudin, will play an increasingly important role as the primary anticoagulant for PCIs because it meets the criteria as a safer, cost-effective, and convenient agent in a spectrum of clinical scenarios. This article will provide practical guidelines to assist the interventional cardiologist to prepare his or her patient for PCI and will focus on some of the more common and more difficult patient cohorts, in particular those patients with chronic kidney disease as well as the elderly, 2 of the fastest growing groups of patients undergoing PCI.

Angioplasty, Balloon, Coronary↗
PubMed2006

Impact of chronic kidney disease and diabetes on percutaneous coronary intervention outcomes.

Abnormalities of glucose metabolism and chronic kidney disease (CKD) complicate treatment and outcomes for patients undergoing percutaneous coronary intervention (PCI). Likely causes of the complicating effects of diabetes include hyperglycemia, abnormalities of microvascular perfusion, and a prothrombotic and proinflammatory state. CKD predisposes to atherosclerosis, adds to the mortality and morbidity risk of cardiovascular disease (CVD), and increases risks for patients undergoing PCI. The complexity of the renal dysmetabolic syndrome and its close association with CVD must be taken into account when developing a therapeutic plan for these patients. Clinical data support the use of abciximab for patients with disturbances of glucose metabolism or with CKD who are undergoing PCI. The use of drug-eluting stents reduces the rate of target vessel revascularization and restenosis.

Abciximab↗
PubMed2005

The deadly triangle of anemia, renal insufficiency, and cardiovascular disease: implications for prognosis and treatment.

Recently there has been considerable interest in the associations between blood hemoglobin (Hb) level, renal function, and cardiovascular disease. Anemia is a common feature of end-stage renal disease, but it also accompanies lesser degrees of chronic kidney disease (CKD). The degree of anemia roughly approximates the severity of CKD. Anemia seen in diabetes has been linked to diabetic nephropathy; however, diabetes itself affects the hematologic system in several ways. Anemia is associated with left ventricular hypertrophy, cardiovascular morbidity, progressive loss of kidney function, and poor quality of life. Anemia seems to act as a mortality multiplier; that is, at every decrease in Hb below 12 g/dL, mortality increases in patients with CKD, cardiovascular disease, and those with both. Unlike blood transfusion, treatment of anemia with exogenous erythropoietin in patients with cardiorenal disease has shown promise in reducing morbidity and in improving survival and quality of life. Increasing the Hb level from less than 10 g/dL to 12 g/dL has resulted in favorable changes in left ventricular remodeling, improved ejection fraction, improved functional classification, and higher levels of peak oxygen consumption with exercise testing. Clinical trials are underway to test the role of erythropoietin in patients with CKD and in patients with heart failure.

Anemia↗
PubMed2005

The emerging use of 16- and 64-slice computed tomography coronary angiography in clinical cardiovascular practice.

Multi-slice computed tomography (MSCT) coronary angiography is an imaging modality that can identify patients with both soft and hard plaque, supplementing the information gleaned from an ordinary coronary calcium scan and classic risk-factor assessment. Clinicians now have the tools to identify the presence of coronary artery disease (CAD) in the presymptomatic phase, as well as those needed to help identify the etiology of pain syndromes in patients presenting with atypical or obscure symptoms and who may be suffering from obstructive CAD, aortic dissection, pulmonary emboli, or other pathologic processes. There is considerable training and practice involved in developing the skills necessary to convert raw information from a CT scanner to optimal diagnostic images; however, MSCT provides important diagnostic information in a faster, less expensive, more patient-friendly, and safer manner than conventional coronary angiography. The following 2 cases describe the use of MSCT coronary angiography in patients with atypical symptoms and exemplify the use of this technology in a clinical setting.

Clinical Competence↗
PubMed2005

Piecing together the evidence on anemia: the link between chronic kidney disease and cardiovascular disease.

Chronic kidney disease (CKD) is now accepted as an independent cardiovascular disease (CVD)-risk state, regardless of its underlying cause. Anemia is a common feature of CKD, particularly in end-stage renal disease. Anemia is also independently associated with poorer outcomes in a wide variety of CVD states, including congestive heart failure and coronary artery disease. Anemia appears to act as an independent mortality multiplier when hemoglobin levels drop below 12 g/dL. With the independent and profound contribution of both CKD and anemia to cardiovascular mortality and morbidity, understanding the pathophysiologic links among these disease states is important. In addition, it is hoped that treatments currently under active investigation and geared specifically to attenuate the cardiovascular risk associated with anemia and CKD, such as erythropoietin therapy, will improve outcomes. This article reviews the evidence for an association among CKD, anemia, and CVD.

Anemia↗