INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Alcohol Septal Ablation Versus Myectomy.
There is an ongoing debate as to the preferred treatment modality for patients with medically refractory, symptomatic, obstructive hypertrophic cardiomyopathy (HCM). Whereas both alcohol septal ablation (ASA) and surgical myectomy offer high initial success rates, there is less long-term outcome data for alcohol ablation. This suggests the need for a randomized trial. Olivotto and colleagues argue that the logistics of such a trial may be insurmountable; given the rarity of the disease and the high rates of procedural success with both techniques, more than 34,000 cases would need to be screened to have adequate power for the trial. See page 831. See figure.
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Metabolic Syndrome
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Cholesterol Lowering Improves Inflammatory Markers in Patients With RA.
Some studies have suggested that statins can improve markers of inflammation in patients with rheumatoid arthritis (RA), but whether this reflects cholesterol lowering or statin pleiotropism is unknown. Mäki-Petäjä and colleagues compared the effects of 20 mg of simvastatin with 10 mg of ezetimibe. Both drugs significantly reduced C-reactive protein, disease activity score, and aortic pulse wave velocity (PWV) and improved endothelial flow-mediated dilation to similar degrees. This study demonstrates that both ezetimibe and simvastatin reduce disease activity and inflammatory markers in patients with RA, suggesting that cholesterol lowering, regardless of the method, has anti-inflammatory effects. See page 852. See figure.
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Heart Failure
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Torasemide Reduces Cardiac Fibrosis More Than Furosemide.
López and colleagues have previously reported that torasemide reduces myocardial fibrosis. This study sought to understand the mechanisms for this effect and to determine if it was a class effect. Patients were randomized to either torasemide or furosemide and underwent serial endomyocardial biopsies. In torasemide-treated patients, both the collagen volume fraction and the activity of procollagen were reduced. There were no changes in furosemide-treated patients. These findings suggest that the ability of torasemide to reduce myocardial fibrosis is mediated through decreased procollagen activation and is not a class effect of loop diuretics. See page 859.
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Heart Rhythm Disorders
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Remote Magnetic Navigation for Pulmonary Vein Isolation.
Recently, a novel magnetic navigation (MN) system has been developed that allows the use of a soft ablation catheter that is positioned by directional magnetic fields. Di Biase and colleagues report their experience in using this system for pulmonary vein isolation procedures. Although there was good utility in navigating the catheter to the desired position, the ability to acheive electrical isolation was very low. These results indicate that remote MN in the left atrium is feasible, but suggest that the 4-mm tip catheter used for the current study is too small to achieve adequately sized lesions for atrial fibrillation ablations. See page 868. See figure.
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Cardiac Imaging
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Quantifying Atherosclerotic Inflammation With FDG-PET.
Several recent studies have suggested that 18fluorodeoxyglucose positron emission tomography (FDG-PET) imaging can be used to measure inflammation in atherosclerotic plaques. Rudd and colleagues performed serial FDG-PET studies over 2 weeks to determine the variability and reproducibility of this technique, specifically assessing inter- and intraobserver agreement and interscan variability. All measurements appear to be highly reproducible. The authors conclude that FDG-PET meets 2 important criteria for serial imaging: spontaneous changes in plaque FDG uptake are low and interobserver agreement is high. See page 892. See figure.
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Surgical Myectomy Versus Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy: Will There Ever Be a Randomized Trial?
- Iacopo Olivotto, Steve R. Ommen, Martin S. Maron, Franco Cecchi, and Barry J. Maron
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Ezetimibe and Simvastatin Reduce Inflammation, Disease Activity, and Aortic Stiffness and Improve Endothelial Function in Rheumatoid Arthritis
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Identification of a Potential Cardiac Antifibrotic Mechanism of Torasemide in Patients With Chronic Heart Failure
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Remote Magnetic Navigation: Human Experience in Pulmonary Vein Ablation
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18Fluorodeoxyglucose Positron Emission Tomography Imaging of Atherosclerotic Plaque Inflammation Is Highly Reproducible: Implications for Atherosclerosis Therapy Trials
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