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Episode #14: Preventive cardiovascular medicine and epidemiology with Drs Philip Greenland and Mauro Montevecchi

Jan 27, 2010 15:45 EST


Dr Mauro Montevecchi joins Dr Philip Greenland for a discussion of novel biomarkers (including CRP) and noninvasive radiological studies (including coronary calcium scoring) and their influence on predictive tests such as the Framingham Risk Score and the C statistic. On a broader level, they also examine the opportunities for fellows in the burgeoning fields of prevention and epidemiology.



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Your comments
Episode #14: Preventive cardiovascular medicine and epidemiology with Drs Philip Greenland and Mauro Montevecchi
# 1 of 1
February 27, 2010 04:53 (EST)
Jan Manolas, MD, PhD, facc

EARLY SCREENING & Secondary Prevention: The Need for a "Pap" Test in Cardiology.

                                         

We are rarely recognizing and even less accept in that we still do not have ANY simple, effective initial screening test that would enable an early detection and secondary prevention in Cardiology…Most of available tools –including biomarkers, coronary calcium scoring etc- have not hitherto contributed  greatly to improve secondary prevention of myocardial disease –mainly CAD. Most of applied diagnostic techniques are more or less expensive or/and need expertise (stress-echo etc) or/and are associated with radiation burden (Stress-SPECT, coronary CT angiography etc) or/and too unspecific (BNP etc). Therefore, their application is (very) limited as initial screening tools for asymptomatic population both in- and above Out-of-hospitals. What we are obviously forgetting is that a great number of pts with CAD, Cardiomyopathies (without LVH or dilatation) in early stages –and even in more advanced stages!- are asymptomatic and as “healthy feeling-and-looking” persons… are not coming to us in hospitals! Therefore, these pts can only are detected by Non-cardiologists and mainly in Outhospital setting. However,  Private Practitioners do not have ANY SENSITIVE-SIMPLE tool in their non-expert hands for daily application in their busy practice! These physicians are confronted with the dilemma of choosing between many sophisticated and expertise needing non-invasive techniques, which cannot be applied in daily practice...  In other words, we still do not have any ..”Cardiologic Pap Test” for private practitioners! Such a tool can be only a stress test for identifying those with latent ischemia or myocardial dysfunction. As we have emphasized in multiple papers, the application of a “Diastolic Handgrip Stress Test using an external pressure transducer” (Presso Test) could solve this great diagnostic leakage..                                                  

Presso Test has been already obtained safely and successfully by both Cardiologists and Non-cardiologists as well as by not “highly trained personnel” in thousands of pts in Europe..An automated evaluation of the result  -based on exact criteria- differentiating “Ischemic” from “Non-ischemic” conditions depending on the LV diastolic behaviour with short (2min) and low level (40% of maximal handgrip) isometric exercise increases the effectiveness in real world. We have suggested the development of a “Pocket Presso”, which would represent the 1st POCKET STRESS TEST device.. for every practitioner and everywhere.. The absolute challenge in next future for the Outhospital Practitioners could be to get 2 screening tools: a pocket echo for evaluating pts with structural cardiac disease (valvular, LVH, dilatation etc) and above a “pocket presso stress test” for every non-cardiologist for detecting only early stage myocardial diseases states, above CAD..   We strongly wish and hope that an early onset of secondary prevention could be realized with the help of Technology for providing both mentioned low-cost, easy to handle pocket devices for including both these diagnostic devices in daily practice resulting in an improved CV care contributing greatly in saving yearly the life of >300.000 US citizen with silent myocardial disease states, who are remaining undiagnosed till their SCD in working places, at home, in the roads....  

 

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About The Fellows' Corner
The Fellows' corner on theheart.org radio offers fellow conducted interviews of thought leaders on a wide range of topics such as training, research, career planning, and the daily dilemmas encountered by the cardiovascular physician. Available for download on theheart.org and through iTunes, our podcasts are anecdotal learning tools and words of wisdom from some of our most valued cardiovascular professionals.

If you are a cardiovascular fellow and would like to participate in our series, contact us at info@theheart.org