CDU

Traditional cardiac pacemakers are continuing to improve, particularly in regard to new applications. We have already seen pacemakers with memories from Biotronik (Berlin, Germany) and other companies that can be downloaded by telephone to provide historic information enabling the cardiologist to monitor at a distance. According to Science et Vie, a French medical journal, the next step will be for the cardiologist to adjust the pacemaker settings at distance. Another development envisioned is for the pacemaker to automatically contact emergency services in case of malfunction.

A concept arising from a group of cardiologists at the Paris-Cochin and Saint-Cloud hospitals in Paris and the Centres hospitaliers in Tours and Rouen is pacemaker implantation to prevent problems of cardiac arrythmia. They have shown that precautionary implantation reduces the risk of death from arrythmia problems by 30%.

In their project, 49 patients suffering from Steinert's myotonic dystrophy were studied. This is a degenerative neuromuscular disease of genetic origin that develops in adolescents or young people and affects one Frenchman in 8,000. At present, the illness is treated by implantation of a pacemaker, but only after cardiac problems have been diagnosed.

The researchers have shown in their project that preventive implantation of at-risk patients can prevent the appearance of serious symptoms and thus reduce mortality.

Siemens CT scanner IDs high-risk patients

Using a simple eight-factor quiz and a computed tomography (CT) scan, researchers from the University of Munster (Munster, Germany) studied statistics from 30,000 men and women in the Ruhrgebiet (lower Rhine area) region of Germany. Factors measured using the Prospective Cardiovascular Munster calculator (PROCAM) developed by Gerd Assmann of the University of Munster included low-density lipoprotein (LDL), high-density lipoprotein (HDL), fasting triglyceride level, systolic blood pressure, smoking, diabetes and having a first-degree relative who had a heart attack before the age of 60.

Men in the top fifth of the scoring had a CT scan using the Somatom Sensation 16 from Siemens Medical Solutions (Erlangen, Germany) and no less than 82% showed lesions in their blood vessels, while men in the bottom fifth were free of such lesions.

"CT scanning for quantification of hard and soft coronary lesions in individuals at risk, as determined by the PROCAM score, is a valuable and non-invasive means of finding those patients who urgently require medical or even surgical treatment to prevent imminent heart attack," Assmann said. "Combining this score with Siemens' CT technology creates a powerful tool for identifying high-risk patients before heart attacks occur."

Separately, Christopher Becker from the Grosshadern Clinic (Munich, Germany) has reported the use of the Somatom Sensation to produce 16-slice CT images which can differentiate and visualize coronary lesions in early, possibly preclinical stages.

"Based on the performance of this new technology, cardiac CT has the potential to become a complementary tool to invasive coronary catheterization and may allow for effective control of pharmaceutical treatments such as lipid-lowering agents," Becker said. Speaking at the recent Global Risk of Coronary Heart Disease and Stroke symposium in Florence, Italy, he demonstrated that even small coronary arteries with less than one mm diameter could be assessed with the Siemens Sensation.

Because more images are gathered in one rotation of the CT gantry and because real-time reconstruction is possible, cardiologists are now able to gather more information in a shorter period of time, and so make decisions faster, Siemens said.

Molecular imaging in plaque detection

Philips Medical Systems (Best, the Netherlands) and Kereos (St. Louis, Missouri) are collaborating on the development of imaging techniques for use in ultrasound, magnetic resonance and nuclear medicine focusing on the molecular causes of disease.

The project will combine Kereos' targeted nanoparticle technology with Philips' engineering and software development, with the aim of developing molecular imaging agents for vulnerable plaque in arteries, a major cause of heart disease.

Project leader is Dr. Samuel Wickline, professor of medicine, biomedical engineering and physics at Washington University (also St. Louis). "Our team is very excited about this agreement," Wickline said. "We are certain that it will quickly lead to major breakthroughs in advancing contrast agent and scanner technologies for molecular imaging and targeted therapeutics."

Real-time 3-D beating-heart images

The Live 3-D Echo ultrasound system from Philips Medical Systems (Best, Netherlands) has the potential to provide better visualization of complex features, better assessment of valvular function, better catheter guidance in 3-D space, better assessment of regional/global function and better productivity due to decreased examination times, the company said.

The new system was made possible by combining breakthroughs in transducer technology, supercomputer signal processing and built-in intelligence according to Heinrich Beckermann, marketing manager of cardiology at Philips Medical. "We believe real-time ultrasound has the potential to advance echocardiography from the diagnostic realm into clinical treatment," he said.

Out-of-hospital defibrillators disappoint

Scottish researchers predict that public-access defibrillators will only increase the existing survival rate for cardiac arrest from 5% to 6.3%. In a recent review in the British Medical Journal, the researchers reviewed records of out-of-hospital cardiac arrests in Scotland from 1991 to 1998. They estimated that of 15,189 cases of cardiac arrest, 79% occurred in sites unsuitable for the location of public-access defibrillators. Only 3% occurred in possibly suitable sites such as buses and multi-story parking garages, while 18% occurred in suitable sites such as shops, offices and sports centers. A second study covering 7,185 heart attacks over a five-year period showed that only 16% took place in public locations.

ECG developments

Remco Italia (Milan, Italy) has added the Elan 12-channel ECG system to its Cardioline range. It is designed to be connected to ECG networks and hospital information systems with communication through LAN or telephone line. ECG networks can be created using a Cardioline client-server solution or through integration with existing information systems.

Cardio Control (Rijswijk, the Netherlands) has launched the new lightweight 24-hour Perfect Holter recorder, which also incorporates pacemaker-detection capabilities. Using flash-card technology, the instrument can record up to 72 hours on a single removable card. Basic software provides on-screen review of a 24-hour signal with color-coded abnormalities, whereas the Enhanced version includes arrhythmia detection with beat-to-beat editing, ST-segment and pacemaker detection.

Novartis, Torrent to develop AGE-breaker

Novartis (Basel, Switzerland) and Torrent Pharmaceuticals (Ahmedabad, India) are collaborating in the development and marketing of a so-called AGE -breaker that can rupture the interaction between glucose and proteins. AGE (advanced glycosylation end-product) reactions have been associated with age-related hardening of the artery walls and an increased risk of cardiovascular disease.