INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Coronary Artery Disease
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Evidence for Prolonged Neutrophil Activation in Patients With Unstable Angina.
Telomeres are the protective caps on the ends of chromosomes; cells with shortened telomeres are more likely to undergo apoptosis. Telomerase is the enzyme that lengthens telomeres. Narducci and colleagues hypothesized that polymorphonuclear neutrophils (PMN) from patients with unstable angina (UA) would have increased telomerase activity. This increased activity during UA implies that these PMN are resistant to apoptosis and thus may be secreting superoxide and other reactive oxygen species for longer periods of time, which may ultimately lead to plaque rupture. Polymorphonuclear neutrophils were isolated from both venous blood and coronary atherosclerotic plaque and then assayed for telomerase activity. As hypothesized, telomerase activity was higher in coronary plaque PMN of patients with UA and higher in PMN from coronary plaque than in peripheral blood. See page 2369.
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Heart Failure
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Implantable Device Accurately Measures Pulmonary Artery Pressure.
The CardioMEMS heart failure sensor (HFS) is a percutaneously implanted device for ambulatory pulmonary artery pressure (PAP) monitoring. The device was implanted in the pulmonary artery of 12 patients with congestive heart failure who then underwent serial echocardiographic assessments and traditional Swan-Ganz catheterization on 2 occasions. There was excellent correlation between all 3 measurements of PAP and no serious adverse reactions. This study confirms that the HFS provides accurate measurements of PAP; larger trials are planned to confirm its safety and clinical utility. See page 2375. See figure.
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Cardiac Imaging
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DSCT Accurate for Heart Rates >65 beats/min.
Dual-source computed tomography (DSCT) provides higher temporal resolution than previous CT angiography technology, which should reduce the image degradation found in patients with fast heart rates. Ropers and colleagues evaluated the influence of heart rate on image quality in 100 patients undergoing DSCT who were not pre-treated with beta-blockers. Per-segment evaluability was 92% for heart rates >65 beats/min versus 100% for heart rates <65 beats/min, although no differences were found in the accuracy of stenosis detection. This study suggests that the higher temporal resolution of DSCT obviates the need for heart rates <65 beats/min during CT angiography. See page 2393.
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Cardiomyopathy
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Testing for Fabry Disease in Patients With Hypertrophic Cardiomyopathy.
Fabry disease (FD) is caused by decreased activity of lysosomal  -galactosidase A (-gal), an enzyme that catalyzes the breakdown of globotriaosylceramides (GL-3). In patients with FD, GL-3 accumulates in lysosomes and may lead to ventricular hypertrophy. Monserrat and colleagues studied the prevalence of FD in over 500 patients with hypertrophic cardiomyopathy (HCM) using an initial test of serum activity of -gal and then sequencing the gene in those with low serum activity. Three percent of these HCM patients had low serum activity, and 1% were confirmed to have FD. Studies of these patients’ families allowed the diagnosis of 14 carriers, including 5 patients with cardiac disease. An accompanying editorial by Ackerman and Landstrom cautions that screening all patients with HCM has low yield and would not be cost-effective, but that targeted screening of patients with a suspicious family history may be viable. See pages 2399 and 2404.
Related Articles
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High Telomerase Activity in Neutrophils From Unstable Coronary Plaques
- Maria Lucia Narducci, Annalisa Grasselli, Luigi Marzio Biasucci, Antonella Farsetti, Antonino Mulè, Giovanna Liuzzo, Giuseppe La Torre, Giampaolo Niccoli, Rocco Mongiardo, Alfredo Pontecorvi, and Filippo Crea
J. Am. Coll. Cardiol. 2007 50: 2369-2374.
[Abstract]
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Comparison of a Radiofrequency-Based Wireless Pressure Sensor to Swan-Ganz Catheter and Echocardiography for Ambulatory Assessment of Pulmonary Artery Pressure in Heart Failure
- Hugo E. Verdejo, Pablo F. Castro, Roberto Concepción, Marcela A. Ferrada, Mario A. Alfaro, Milton E. Alcaíno, Carlos C. Deck, and Robert C. Bourge
J. Am. Coll. Cardiol. 2007 50: 2375-2382.
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Influence of Heart Rate on the Diagnostic Accuracy of Dual-Source Computed Tomography Coronary Angiography
- Ulrike Ropers, Dieter Ropers, Tobias Pflederer, Katharina Anders, Axel Kuettner, Nikolaos I. Stilianakis, Sei Komatsu, Willi Kalender, Werner Bautz, Werner G. Daniel, and Stephan Achenbach
J. Am. Coll. Cardiol. 2007 50: 2393-2398.
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Prevalence of Fabry Disease in a Cohort of 508 Unrelated Patients With Hypertrophic Cardiomyopathy
- Lorenzo Monserrat, Juan Ramón Gimeno-Blanes, Francisco Marín, Manuel Hermida-Prieto, Antonio García-Honrubia, Inmaculada Pérez, Xusto Fernández, Rosario de Nicolas, Gonzalo de la Morena, Eduardo Payá, Jordi Yagüe, and Jesús Egido
J. Am. Coll. Cardiol. 2007 50: 2399-2403.
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Detection of Subclinical Fabry Disease in Patients Presenting With Hypertrophic Cardiomyopathy
- Michael J. Ackerman and Andrew P. Landstrom
J. Am. Coll. Cardiol. 2007 50: 2404-2405.
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Coronary Artery Disease
Heart Failure