INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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Pilot Trial of Next-Generation TAXUS Stent.
Although drug-eluting stents have dramatically reduced the rates of restenosis, some with the design of the Express stent make it somewhat difficult to deliver to complex lesions or tortuous vessels. The TAXUS ATLAS trial studied a next-generation TAXUS Liberté stent coated with the same polymer-based, paclitaxel-elution technology as the TAXUS Express. Subjects who received the new stent were matched with subjects who received the original TAXUS Express stent as part of the TAXUS IV and V trials. Procedure times were slightly shorter with the newer design, and these lesions tended to be more complex. The primary end point of 9-month target vessel revascularization was similar in the 2 groups at approximately 8%. This initial study of the TAXUS Liberté stent suggests that it may improve deliverability while retaining the benefits of reduced restenosis thanks to its paclitaxel coating. See page 1676.
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Cardiomyopathy
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More Evidence That Autoantibodies May Worsen Cardiac Function.
There is conflicting evidence regarding the significance of autoantibodies that are detectable in certain patients with dilated cardiomyopathies. Staudt and colleagues performed a series of in vitro experiments using immunoglobulins (IgGs) isolated from patients with dilated cardiomyopathy. When isolated cardiomyocytes were exposed to these IgGs, there was decreased cell shortening and decreased calcium cycling. Further experiments demonstrated that this effect was caused by the IgG binding to the antigen and also to the Fc receptors IIa, which are expressed on the surface of cardiomyocytes. This study helps us to understand the significance of these autoantibodies and suggests that they may be a potential target for therapy. See page 1684. See figure.
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Heart Failure
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Use of Rosiglitazone in Patients With CHF.
Thiazolidinediones are considered relatively contraindicated in patients with chronic heart failure (CHF) because of their known propensity for fluid retention. Dargie and colleagues performed a 1-year placebo-controlled trial on the effects of rosiglitazone (RSG) on patients with a left ventricular ejection fraction <45% and New York Heart Association functional class I to II heart failure. Over 1 year, there were no significant changes in the echocardiographic parameters studied, including measures of both systolic and diastolic function. However, approximately one-quarter of the patients randomized to RSG developed some fluid-related symptoms and almost one-third required an increase in CHF medications, both of which were higher than in those randomized to placebo. This study suggests that RSG is safe for use in diabetics with class I to II heart failure, although care must be taken to prevent adverse symptoms related to fluid retention. See page 1696. See figure.
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Cardiac Imaging
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Acute Strain Echocardiography Predicts Final Infarct Size.
Tissue Doppler-derived strain echocardiography is an emerging method for measuring ventricular function. Vartdal and colleagues calculated global strain within 2 h of emergency percutaneous coronary intervention for anterior ST-segment elevation myocardial infarction in 30 patients. All subjects were studied again 9 months later and delayed-enhancement cardiac magnetic resonance imaging was also performed. Strain in all left ventricular segments was averaged to obtain a global value, and the peak negative value was used. The correlation between final infarct size and strain was superior to the correlations for ejection fraction, creatine kinase-MB, and time to reperfusion. Segmental strain was also accurate in determining the transmural extent of infarction in each segment. Global strain may be an important clinical tool for risk stratification after myocardial infarction. See page 1715. See figure.
Related Article
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Polymer-Based, Paclitaxel-Eluting TAXUS Liberté Stent in De Novo Lesions: The Pivotal TAXUS ATLAS Trial
- Mark A. Turco, John A. Ormiston, Jeffrey J. Popma, Lazar Mandinov, Charles D. O’Shaughnessy, Tift Mann, Thomas F. McGarry, Chiung-Jen Wu, Charles Chan, Mark W.I. Webster, Jack J. Hall, Gregory J. Mishkel, Louis A. Cannon, Donald S. Baim, and Joerg Koglin
J. Am. Coll. Cardiol. 2007 49: 1676-1683.
[Abstract]
[Full Text]
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Interventional Cardiology
Cardiomyopathy
