Generation Of Cardiologists Research Articles

Cardiologist training in Chile and contributions from the Chilean Society of Cardiology and Cardiovascular Surgery

The Chilean Society of Cardiology and Cardiovascular Surgery (SOCHICAR) is a scientific society whose mission is to improve the nation's cardiovascular health. Its primary goals include discussing issues affecting the specialty and engaging in various activities that support its advancement. To achieve these goals, numerous educational initiatives are undertaken for health professionals, including physicians in cardiology training programs. Training specialists in Chile is the responsibility of the universities, which design the curriculum and plan the program according to the graduate profile. SOCHICAR seeks to integrate these new generations of cardiologists, setting up tasks that contribute to their training. It seemed relevant to us to state our position as a Scientific Society in importants aspects related to this process: the graduate profile of the clinical cardiologist, the necessary competencies for their performance nationally, the identification of deficient areas in their training period, and the Society's contributions to this university-dependent process. A total of 15 cardiologists from SOCHICAR, at different stages of professional development, various geographic areas, and areas of performance and functions, were invited to participate in three working groups. This SOCHICAR position statement may be useful and an important source of information to be considered by authorities, accrediting entities, training centers, and the Chilean Society of Cardiology.

Perceptions and Utilization of the U.S. Core Cardiovascular Training Statement

There has been rapid advancement within the field of cardiovascular disease (CVD) with increasing disease complexity and rapidly evolving technologies. These changes present new challenges in training the next generation of cardiologists. In parallel, there has been an evolution in graduate medical

Imágenes cardiovasculares en la valoración del paciente con indicación de implante aórtico transcatéter

Transcatheter aortic implant is one of the most important advances in contemporary cardiology. Its use is widely accepted in those patients with calcified aortic stenosis with a high or prohibitive surgical risk, and has been expanded to the population of intermediate risk. Another approved indication is in patients with bioprosthetic valve degeneration. The success of this technique has largely depended, and will depend, in the advance and appropriate use of multi-imaging techniques. The use of imaging techniques will have to be adapted to the emerging technologies, and will always have a fundamental role in patient selection, support, and direction during the procedure, diagnosis and timely management of complications and long-term follow-up. The training of new generations of cardiologists must include these aspects.

Jeroen Bax: inspiring the next generation of cardiologists

A conversation with the eminent cardiologist Eugene Braunwald fuelled Jeroen Bax's interest in nurturing aspiring cardiologists. “Braunwald told me that what really matters is developing the next generation of researchers and clinicians”, he recalls. By 2018, Bax will have mentored 60 international PhD students in his cardiac imaging research centre at Leiden University Medical Center (LUMC) in the Netherlands. “Jeroen's students have achieved prominent positions at medical institutions throughout the world”, says Anthony DeMaria, Professor of Medicine at the University of California, San Diego. Bax's influence also extends closer to home: his eldest son is a medical student. But he jokes, “this is more likely due to the influence of my wife [an infectious disease expert] than myself”.

The German Chapter of Young Cardiologists (ESC).

Paving the way for future cardiologists The German Chapter of Young Cardiologists (ESC), a section for young cardiologists in—training with a focus on clinical and basic research, was founded in 2011 during the Annual Meeting of the German Cardiac Society (DGK). The initiative was established to enhance national and international networking with regards to scientific collaborations in the cardiovascular field, and to support individual research activities. ![Graphic][1] Professor Michael Bohm, the former president of the DGK, initiated the German Chapter of the Young Cardiologists to provide a platform for the next generation of cardiologists and cardiovascular scientists in Germany. Eligible future members are at an early career stage (under 35 … [1]: /embed/inline-graphic-1.gif

Overview of the Acetylcholine Spasm Provocation Test.

The acetylcholine (ACh) spasm provocation test proposed by Yasue, Okumura et al more than a quarter-century ago has become a popular method for induction of coronary spasm. This test is safe and has a low rate of complications. However, it may be limited in its ability to document attacks in daily life because previously it was the gold-standard method for diagnosing active variant angina. There may be some clinical issues to modify for the next generation of cardiologists. A maximal ACh dose of 50/100 µg in the right coronary artery/left coronary artery is recommended in the Japanese Circulation Society guidelines. We often experienced the usefulness of a maximal ACh dose of 80/200 µg for the induction of coronary spasm in some cases with low or moderate disease activity. It may be necessary to reconsider the maximal ACh dose as a modified method for today's real-world clinical practice. In young patients with rest angina, intracoronary injection of ACh is less sensitive for diagnosis; in these cases, we recommend performing sequential spasm provocation tests. Especially in female patients, to document coronary artery spasm we recommend performing ACh tests first, instead of ergonovine tests, due to the supersensitivity of ACh. We also recommend supplementary use of ACh and ergonovine. This review summarizes our experiences with the ACh spasm provocation test over a period of 24 years. We have found it to be a reliable and useful method for contributing a variety of clinical information and recommend it to the next generation of cardiologists.

Does ischemia burden in stable coronary artery disease effectively identify revascularization candidates? Ischemia burden in stable coronary artery disease effectively identifies revascularization candidates.

Given the enormous economic and human consequences of ischemic heart disease (IHD), it is not unanticipated that IHD has been the central clinical focus of the cardiology community for many years. The primary question that generations of cardiologists have faced, and we continue to face, is how do we optimally manage these patients? Fundamentally, it is a strategy of revascularization with adjunct medical therapy superior to medical therapy alone for optimal survival in patients with IHD? Addressing this question has been an iterative process as pharmacotherapy and interventions have evolved over time. The importance of the answer, however, seems to increase as issues of healthcare costs face us today. See Response by Reynolds et al Given the spectrum of IHD, an important component of this question is defining patient subgroups, in which different treatment strategies may be advantageous. In large part, physicians have defined these subgroups the way they have defined IHD, by using anatomic criteria—1 vessel, 2 vessel, multivessel, etc. Alternatively, patients with IHD can also be considered on the basis of whether their obstructive disease is flow limiting, as would be determined by direct assessment of the flow reserve of the individual lesions, or by assessment of the amount of ischemic myocardium by noninvasive myocardial perfusion imaging (MPI) using single photon emission computed tomography (SPECT) or positron emission computed tomography (PET) techniques. As we will see, the perceived therapeutic benefit of a treatment strategy can differ on the basis of how IHD is defined and which criteria are used for patient selection. The early, original randomized clinical trials (RCT; pre-1990) comparing strategies of medical therapy versus revascularization with medical therapy were interpreted as suggesting a survival advantage for a revascularization strategy in the setting of more advanced, higher risk, IHD (left main, 3-vessel coronary artery disease [CAD]) but …

Management of Medical Radiation: Perspectives from Cardiology

Cardiac imaging with ionizing radiation provides immense diagnostic and therapeutic benefits, and also determines a corresponding increase in long-term cancer risk that should be included in the tailored, individualized benefit-risk balance. Cardiologists have a particular responsibility to avoid inappropriate and non-optimized use of radiation, since they are responsible for about 40 % of overall exposure from medical radiation, but they sometimes show suboptimal radiological awareness. The radiological dose of common radiological examinations can range from the equivalent of 1–60 milliSievert (mSv), with a reference dose average of 15 mSv (corresponding to 750 chest x-rays) for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multidetector coronary angiography, or a myocardial perfusion imaging scintigraphy. The tendency of the previous generation of cardiologists to ignore radiological doses, neglect risks and forget long-term consequences is no longer conscionable considering medical and ethical reasons, but also medicolegal. Institutions, scientific societies and political governance of health care should implement policies to reduce the unacceptablly high rate of inappropriate examinations, not infrequently performed on the wrong patient, with the wrong dose, at the wrong moment. Appropriateness and optimization are a difficult, moving, and elusive target, and there are so many clinical nuances in patient presentation and factors of variability regarding dose determination that it is not easy to have a sharp cut-off between appropriate and optimized vs inappropriate and nonoptimized examinations, but the wrong indication and dose is certainly one that is not audited and remains undisclosed. The 2014 European Society of Cardiology position paper on the use of medical radiation in cardiology provides a simple roadmap for clinical cardiologists to achieve the challenging yet fundamental goal of making our cardiology wards, imaging laboratories, and catheterization suites a safer place for doctors and patients.

William A. Zoghbi, M.D., lends expertise on special imaging issue of The Methodist Debakey Cardiovascular Journal.

The editors of the Methodist DeBakey Cardiovascular Journal extend a heartfelt thanks to William A. Zoghbi, M.D., for serving as guest editor of this special issue on multimodality cardiac imaging. A leader in cardiology and cardiovascular imaging, Dr. Zoghbi is the William L. Winters Endowed Chair of Cardiovascular Imaging at the Houston Methodist DeBakey Heart & Vascular Center in Houston Methodist Hospital and is director of the hospital’s Cardiovascular Imaging Institute, which he founded in 2005. Dr. Zoghbi completed his internal medicine and cardiology training at Baylor College of Medicine in Houston, where he joined the faculty in 1985 and became the John S. Dunn Professor of Medicine and director of the echocardiography laboratory. Dr. Zoghbi has developed novel techniques to evaluate valvular disorders and cardiac function, improving the noninvasive evaluation and management of heart disease. He is also known for his research on myocardial hibernation and his development of 3-dimensional techniques to evaluate valvular dynamics and measure valvular regurgitation. Dr. Zoghbi has authored more than 250 original publications and has been invited to lecture on his work at every major cardiology conference around the globe. He also has trained more than 100 cardiology fellows in advanced cardiovascular imaging, many of whom now hold positions of leadership in academic medicine. A recipient of the Richard Popp Excellence in Teaching Award from the American Society of Echocardiography (ASE), Dr. Zoghbi chaired the development of national and international guidelines for evaluating native and artificial heart valves with cardiac ultrasound, and he co-chaired the American College of Cardiology (ACC) committee that wrote a monograph on how best to train the new generation of cardiologists in multimodality cardiovascular imaging. Dr. Zoghbi has been actively involved with the ACC, the American Heart Association, and the ASE for more than 25 years, serving as president of both the ASE and ACC and on the ACC’s board of trustees since 2001. He is currently a board member of the World Heart Federation, co-chairing its Global Task Force for Cardiovascular Disease, and recently represented the ACC at the United Nations and World Health Organization. R E C O G N I T I O N S

Defining Success in Heart Failure

In 1986, the landmark vasodilator trial, the Vasodilator–Heart Failure Trial (V-HeFT-1), ushered in a modern therapeutic regimen that provided hope, for the first time, to millions of patients suffering from and dying of heart failure.1 Entry criteria for the trial were simple and confined to men with “impaired cardiac function and reduced exercise tolerance.” The primary end point was all-cause mortality. Most clinicians did not quibble about the borderline statistical significance of the overall study, recognizing that a new era of heart failure therapy and clinical trials had begun. The Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS)2 and Studies of Left Ventricular Dysfunction (SOLVD)3 were published subsequently, in 1987 and 1991, respectively, further refining patient selection while molding a new generation of cardiologists, many of whom became heart failure specialists. Article see p 1985 Since those heady times, the evolution of therapy for heart failure has become increasingly complex. The managing clinician must integrate a number of factors about the individual heart failure patient before adding treatments to the pharmacological foundation of renin-angiotensin and β-adrenergic inhibition. Crucial historical or phenotypic variables may include left ventricular ejection fraction (LVEF), functional classification and/or exercise tolerance, history and timing of previous arrhythmias or myocardial infarction, QRS duration and current rhythm, duration of heart failure symptoms, adequacy of or intolerance to optimization of medical therapy, gender, race, cause of the cardiomyopathy, valvular competence, and renal function. Important patient characteristics currently determine eligibility for additional medications, electric devices, surgical procedures, cardiac transplantation, ventricular assist devices, endomyocardial biopsy, cardiac rehabilitation, hospitalization, or hospice. This process of exacting classification of disease has served other disciplines well; imagine outcome trials for the wide range of thrombolytic or antiplatelet agents without the concomitant and careful descriptors of the manifestations of the acute coronary syndrome.4 Likewise, …

Challenges posed by adults with repaired congenital heart disease.

“Pediatric Congenital Cardiac Becomes a Postoperative Adult: The Changing Population of Congenital Heart Disease,” which was written in 1973,1 was the first publication devoted to what was destined to become a new field of special cardiovascular interest. Subsequent decades witnessed the maturity of this new subspecialty, which was formally recognized at the 22nd Bethesda Conference in 1990.2 It is altogether fitting for Circulation to include the present article in “Clinical Cardiology: New Frontiers.” The present article can be considered a sequel to the 1973 article, which dealt with the types of surgical interventions, the effects of those interventions on survival patterns, the desirability of primary anatomic repair in infancy, and the importance of postoperative residua and sequelae.1 The 1973 article opened by stating: “It is now possible to perform palliative or corrective surgery on almost all congenital cardiac anomalies, even the most complex … Survival patterns are affected, often profoundly. We are therefore confronted with a changing population of congenital cardiacs … However, we are obliged to look beyond the present and define our ultimate goal. What do we seek to accomplish? The answer is clear. Our efforts should focus on the quality of long-term survival.”1 Long-term survival is chiefly concerned with the growing number of postoperative patients who require continuing medical surveillance.3 What is needed is a new generation of cardiologists with a career interest in adult congenital heart disease; these highly trained specialists function best within tertiary care facilities designed for the comprehensive care of adult patients. With few exceptions, such facilities are part of major university hospital systems. Major facilities draw patients regionally, nationally, and internationally. The geographic distribution of tertiary care centers will best be determined by the quality of the facility and the services offered rather than by external constraints …