Summaries of Key Journal Articles
(Source: Journal of the American College of Cardiology)...
POSTED 07/01/2009 at 10:09 AM --
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Serendipity
During this time of political change, we have been reading numerous editorials outlining current ideas about how medicine should be reorganized. This letter was stimulated by some of those recently published. (Source: Journal of the American College of Cardiology)...
POSTED 07/01/2009 at 10:09 AM --
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Chronobiological Patterns of Onset of Tako-Tsubo Cardiomyopathy: A Multicenter Italian Study
To the Editor: Several cardiovascular events, including acute myocardial infarction (AMI), show well-defined temporal patterns in their occurrence throughout the year and the day (). Tako-Tsubo cardiomyopathy (TTC), also called “stress cardiomyopathy” or “transient left ventricular apical ballooning syndrome,” is an acquired cardiomyopathy prevalent in elderly women presenting with a history of emotional or physical stress that mimics the clinical scenario of an AMI (). The aim of this study was to verify whether TTC could exhibit significant chronobiological patterns of onset. We analyzed data from 90 consecutive patients with TTC admitted between January 2002 and December 2007 to the coronary care unit of 7 Italian referral cardiac centers. All patients were enrolled according to......
POSTED 07/01/2009 at 10:09 AM --
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President's Page: Relations With Industry: Thoughts on Claims of a Broken System
In April 2009, an article written by a number of well-respected physicians appeared in the Journal of the American Medical Association (). In the article, the authors recommended sweeping changes in how professional medical associations (PMAs), such as the American College of Cardiology (ACC), should interact with pharmaceutical and medical device industries. (Source: Journal of the American College of Cardiology)...
POSTED 07/01/2009 at 10:09 AM --
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Why Are (Only) Some Infarcted Hearts Arrhythmogenic?⁎
In this issue of the Journal, Haqqani et al. () provide valuable insight as to why some patients who survive a large myocardial infarction (MI) are prone to ventricular tachycardia (VT), yet other survivors of a similar infarct are seemingly immune. They compare 17 patients presenting with recurrent, sustained monomorphic ventricular tachycardia (SMVT) with 17 post-MI patients undergoing prophylactic implantable cardioverter-defibrillator (ICD) insertion, who had so far been free from clinical episodes of SMVT. Notably, the SMVT and prophylactic ICD groups appeared nearly identical with regard to clinical characteristics (Table 1 in Haqqani et al. []), both being almost exclusively male, with equally depressed ejection fractions (0.28 and 0.26, respectively) and equally dilated ventricles.......
POSTED 07/01/2009 at 10:09 AM --
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Fundamental Differences in Electrophysiologic and Electroanatomic Substrate Between Ischemic Cardiomyopathy Patients With and Without Clinical Ventricular Tachycardia
Objectives: The aim of this study was to compare the electrophysiologic substrate in ischemic cardiomyopathy (ICM) patients with and without sustained monomorphic ventricular tachycardia (SMVT).Background: Despite the universal presence of potentially arrhythmogenic left ventricular (LV) scarring, it is not clear why the majority of ICM patients never develop SMVT.Methods: Detailed electroanatomic mapping of the LV endocardium was performed in 17 stable control ICM patients (16 males) without clinical SMVT. They were compared with 17 ICM patients (15 males) with spontaneous SMVT. Standard definitions of low-voltage zones and fractionated, isolated, and very late potentials were used.Results: There were no significant baseline differences between the groups in terms of LV diameter, ejection......
POSTED 07/01/2009 at 10:09 AM --
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The Effect of Age, Diagnosis, and Previous Surgery in Children and Adults Undergoing Heart Transplantation for Congenital Heart Disease
Conclusions: Patients undergoing transplantation for CHD have a good late survival if they survive the early post-operative period. Risk factors for reduced survival are older age at transplant and a previous Fontan operation. (Source: Journal of the American College of Cardiology)...
POSTED 07/01/2009 at 10:09 AM --
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Quantification of Myocardial Flow Reserve Using Positron Emission Imaging: The Journey to Clinical Use⁎
“A journey of a thousand miles begins with a single step”—Lao-tzu, The Way of Lao-tzuChinese philosopher (604 BC to 531 BC) () Of the many advantages of positron emission tomography (PET) imaging, its ability to quantify biological parameters is often identified as the most important. Yet, data linking PET-derived parameters to outcomes are often lacking. In this issue of the Journal, Herzog et al. () present one of the first studies to evaluate the prognostic value of PET-derived quantification of coronary flow reserve (CFR) using 13N-ammonia (13NH3) in patients with suspected ischemia and the first to evaluate its added prognostic value compared with relative myocardial perfusion imaging (MPI). Such evaluation is a key step on the journey to establish the clinical role of this app......
POSTED 07/01/2009 at 10:09 AM --
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Giant T–U Waves Precede Torsades de Pointes in Long QT Syndrome: A Systematic Electrocardiographic Analysis in Patients With Acquired and Congenital QT Prolongation
Conclusions: Abnormal, giant T–U waves separate TdP initiation in LQTS patients from PVCs in other heart disease and from other PVCs in LQTS patients. These ECG analyses suggest that early afterdepolarizations initiate TdP and, if present, may help to identify an imminent risk for TdP. (Source: Journal of the American College of Cardiology)...
POSTED 07/01/2009 at 10:09 AM --
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Monocyte Diversity in Myocardial Infarction⁎
A key role for monocyte-derived macrophages for the development, progression, and destabilization of atherosclerotic plaques has long been recognized. However, the scale of relatively focal macrophage activity in the plaque changes dramatically after atherothrombotic complications. While local proliferation ensures renewal and maintenance of many macrophage cardiac pools under steady-state conditions, prolonged acute ischemia and tissue injury in myocardial infarction (MI) attracts massive amounts of monocytes from circulation. The biological aim of this response is to promote healing of the damaged myocardial tissue by the removal of dead cells, replacement of necrotic areas by connective tissue, remodeling of myocardial structure and geometry to compensate cardiomyocyte loss, and ultimat......
POSTED 07/01/2009 at 10:09 AM --
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Impact of Heterogeneity of Human Peripheral Blood Monocyte Subsets on Myocardial Salvage in Patients With Primary Acute Myocardial Infarction
Conclusions: The peak levels of CD14+CD16− monocytes affect both the extent of myocardial salvage and the recovery of left ventricular function after AMI, indicating that the manipulation of monocyte heterogeneity could be a novel therapeutic target for salvaging ischemic damage. (Source: Journal of the American College of Cardiology)...
POSTED 07/01/2009 at 10:09 AM --
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The Only Better Alternative to Rescue Percutaneous Coronary Intervention Is Primary Percutaneous Coronary Intervention⁎
The superiority of primary percutaneous coronary intervention (PCI) over thrombolysis as a reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI) has been sufficiently documented (). However, thrombolysis still remains a frequently used therapeutic option for patients with STEMI, for the most part due to constraints in offering PCI in a timely manner (). Even with the use of advanced fibrin-specific thrombolytic agents, thrombolysis restores normal epicardial blood flow—Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 —in only slightly more than one-half of patients with STEMI (). The efficacy of thrombolysis is highly time-dependent, with drastic attenuation in benefit if the interval from onset of symptoms exceeds 6 h (). Available evidence ......
POSTED 07/01/2009 at 10:09 AM --
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Serial Intravascular Ultrasound Analysis of the Main and Side Branches in Bifurcation Lesions Treated With the T-Stenting Technique
This study sought to investigate the mechanism of restenosis and the predictive value of post-procedural minimum stent area (MSA) in the side branch (SB) after coronary bifurcation stenting.Background: The mechanism of restenosis, especially at the SB ostium, has not been fully elucidated.Methods: This study examined 73 bifurcation lesions with post-procedural and 9-month follow-up intravascular ultrasound images for both main vessel (MV) and SB. All lesions were treated with drug-eluting stents using the T-stenting technique. Analysis included 5 distinct locations: MV proximal stent, MV middle area, MV distal stent, SB ostium ( (Source: Journal of the American College of Cardiology)...
POSTED 07/01/2009 at 10:09 AM --
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Combining Antiplatelet and Anticoagulant Therapies
Antiplatelet therapy is the cornerstone for both primary and secondary prevention therapies for ischemic events resulting from coronary atherosclerotic disease. Dual antiplatelet therapy (aspirin plus a thienopyridine, usually clopidogrel) has assumed a central role in the treatment of acute coronary syndromes and after coronary stent deployment. In addition to antiplatelet therapy, anticoagulant therapy might be indicated for stroke prevention in a variety of conditions that include atrial fibrillation, profound left ventricular dysfunction, and after mechanical prosthetic heart valve replacement. For this reason, the use of triple antithrombotic therapy (a dual antiplatelet regimen plus warfarin) is expected to become more prominent, given an aging patient population. But although triple......
POSTED 07/01/2009 at 10:09 AM --
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Myocardial hemorrhage common after successful MI reperfusion with PCI
Myocardial hemorrhage may occur in as many as a quarter of patients after successful mechanical reperfusion for acute myocardial infarction, a study indicates. (Source: MedWire News - Cardiology)...
POSTED 07/01/2009 at 10:07 AM --
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Barriers to optimal termination of resuscitation in out-of-hospital cardiac arrest identified
Insurance-reimbursement rules, state laws, and the public's false perceptions of survival after cardiac arrest may impede emergency medical workers from using best resuscitation attempts, a study finds. (Source: theHeart.org)...
POSTED 07/01/2009 at 09:30 AM --
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Journal Scan: Diet and Incident Venous Thromboembolism: The Iowa Women's Health Study (Am Heart J 2009;157:1081-1087.)
The authors reported data from the Iowa Women's Health Study (IWHS), a cohort study of 41,836 women ages 55-69 who responded to a questionnaire sent to randomly sampled residents of the state of Iowa. Participants responded to a 127-item food frequency questionnaire. Data were linked to U.S. Center. . . (Source: Cardiosource)...
POSTED 07/01/2009 at 06:04 AM --
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Clinical Trial Summary: Safety and Efficacy of Recombinant Activated Factor VII (Safety and Efficacy of Recombinant Activated Factor VII)
The goal of this trial was to evaluate treatment with recombinant activated factor VII (rFVIIa) compared with placebo among bleeding patients after cardiac surgery. (Source: Cardiosource)...
POSTED 06/30/2009 at 07:00 PM --
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New meta-analysis: Statins of benefit in primary prevention
A new meta-analysis including some of the more contemporary statin trials has found that the agents significantly improve survival and reduce coronary and cardiovascular end points in primary-prevention populations, a benefit that extends to all subgroups. But the exact cost/benefit equation for each group remains to be determined. (Source: theHeart.org)...
POSTED 06/30/2009 at 06:01 PM --
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Peak oxygen uptake and exercise capacity: a reliable predictor of quality of life?: reply
(Source: European Heart Journal)...
POSTED 06/30/2009 at 06:00 PM --
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