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J Am Coll Cardiol, 2007; 49:31-32, doi:10.1016/S0735-1097(07)01437-4
© 2007 by the American College of Cardiology Foundation
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INSIDE THIS ISSUE OF JACC

Inside This Issue of JACC


   Original Research Paper
Top
 Original Research Paper
Interventional Cardiology
 Metabolic Syndrome and Risk
 Preclinical Study
 
Increased Cholesterol Found on Erythrocytes After ACS.  
Figure 1
The outer membranes of erythrocytes are heavily concentrated with free cholesterol. Some studies have found erythrocyte membranes inside atherosclerotic lesions, suggesting a link with plaque cholesterol. Tziakas and colleagues studied the extent to which cholesterol on erythrocytes correlates with several factors in patients presenting for coronary angiography. Total cholesterol content in erythrocyte membranes (CEM) was higher in acute coronary syndrome (ACS) patients compared to those with stable angina. Interestingly, total plasma cholesterol concentrations did not correlate with CEM levels. As part of a focus issue on Plaque Neovascularization, Hemorrhage, and Vulnerability, this study suggests that the make-up of atherosclerotic lesions is dynamic and may lead to a better understanding of why some plaques rupture while others remain quiescent. See page 2081. See figure.


   Interventional Cardiology
Top
 Original Research Paper
 Interventional Cardiology
Metabolic Syndrome and Risk
 Preclinical Study
 
Worse Outcomes for Stenting if FFR >0.75.  
Figure 2
Percutaneous coronary intervention (PCI) of a visually significant stenosis without evidence of ischemia is often performed, but its benefit is unproven. The DEFER study randomized 325 subjects with an intermediate stenosis and a fractional flow reserve (FFR) ≥0.75 to either PCI or no PCI. After 5 years, the composite rates of cardiac death and acute myocardial infarction were more than twice as high in the PCI group, 3.3% versus 7.9%. Five-year outcomes of coronary stenoses with an FFR ≥0.75 are excellent; the risk of cardiac death or myocardial infarction related to this stenosis is <1% per year and is not decreased by stenting. See page 2105. See figure.


   Metabolic Syndrome and Risk
Top
 Original Research Paper
 Interventional Cardiology
 Metabolic Syndrome and Risk
Preclinical Study
 
Insulin Resistance May Drive Increased Risk With MetSyn.   Insulin resistance (IR) is one of the hallmarks of the metabolic syndrome (MetSyn). Jeppesen and colleagues studied nearly 2,500 Danish men and women to determine if MetSyn or IR was the primary contributor to increased cardiac risk. Prevalence of MetSyn according to International Diabetes Foundation (IDF) criteria was 21% and 16% according to NCEP criteria. The IR was defined as being in either the highest 21% or 16% in the homeostasis model assessment (HOMA). When the IDF criteria were used, HOMA-IR but not MetSyn was predictive of future events. Using National Cholesterol Education Program criteria, both HOMA-IR and MetSyn were independent predictors. While much is still unknown, this study suggests that IR leads to increased cardiac risk, independent of the other criteria of the MetSyn. See page 2112.


   Preclinical Study
Top
 Original Research Paper
 Interventional Cardiology
 Metabolic Syndrome and Risk
 Preclinical Study
 
Novel Cardiac Electrical Stimulation Method May Improve LV Remodeling.   Cardiac contractility modulation (CCM) is a novel therapy whereby the myocardium is stimulated with a pulse generator during the absolute refractory period. Dogs with microembolization-induced heart failure were randomized to 3 months of active CCM monotherapy or to a sham operation. After 3 months, the ejection fraction (EF) of dogs treated with CCM was 33%, while for control animals it was only 23%. In a second study, animals were randomized to either CCM, metoprolol succinate, or combination therapy. Dogs treated with combination therapy showed a greater increase in left ventricular (LV) EF and a greater reversal of LV global, structural, and biochemical remodeling compared with dogs treated with metoprolol alone. CCM appears to be a promising therapy for heart failure with both short- and long-term improvements in LV function. See page 2120.


Related articles in JACC:

Total Cholesterol Content of Erythrocyte Membranes Is Increased in Patients With Acute Coronary Syndrome: A New Marker of Clinical Instability?
Dimitrios N. Tziakas, Juan Carlos Kaski, Georgios K. Chalikias, Carlos Romero, Salim Fredericks, Ioannis K. Tentes, Alexandros X. Kortsaris, Dimitrios I. Hatseras, and David W. Holt
JACC 2007 49: 2081-2089. [Abstract] [Full Text]  




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