INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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New Stent Design Does Not Inhibit Local Coronary Vasodilation.
The Nobori (Teroumo Corp., Tokyo, Japan) coronary stent system employs a bioresorbable polymer from which biolimus A9 is eluted. Biolimus A9 is a sirolimus derivative that is more lipophillic, which should promote increased uptake in local endothelium. Hamilos and colleagues measured endothelium-dependent and -independent coronary vasomotion proximally and distally to the stent 9 months after randomization to either a biolumus-eluting stent (BES) or sirolimus-eluting stent (SES). Those with a biolumis stent were more likely to vasodilate during rapid pacing than those with a sirolimus stent, particulary in the segment distal to the stent, while endothelium-independent vasomotion was not different. These results suggest that the Nobori stent does not inhibit endothelium-dependent vasomotion to the extent that sirolimus-eluting stents do. See page 2123. See figure.
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Vascular Function
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Flavanols Improve Endothelial Function.
Epidemiological data has shown that diets rich in flavanols are associated with reduced cardiovascular risk. Balzer and colleagues studied the effects of flavanols on endothelial function using a placebo-controlled study with flow-mediated dilation (FMD) of the brachial artery. After a preliminary exploratory study, subjects were randomized to drink a cocoa-based mix containing flavanols or placebo for 30 days; FMD improved by 30% in those assigned to flavanols. Treatment was well-tolerated and there were no changes in the response to nitroglycerin, blood pressure, heart rate, or glycemic control. These findings suggest that a diet rich in flavanols, or supplemented with flavanols, can improve endothelial function in diabetics. See page 2141. See figure.
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Heart Rhythm Disorders
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AF Begets AF.
Patients with a history of atrial fibrillation (AF) have shorter effective refractory periods (ERPs) and more pronounced decremental conduction properties in their pulmonary veins (PVs). However, it is not known if these differences identify patients at risk for AF or are caused by previous episodes of AF. Rostock and colleagues studied patients with no history of AF. The ERPs and conduction times were determined, both before and after a 15-min episode of intentionally induced AF. At baseline, the PVs displayed significantly longer ERPs than the atria. After a short episode of AF, the ERP of the PVs was markedly reduced and their conduction velocity was slowed, which was associated with an increased susceptibility to induction of AF. These findings suggest that AF does beget AF, by altering the conduction properties of the PVs. See page 2153. See figure.
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Heart Failure
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New Alogrithm Predicts the Risk of RV Failure After LVAD Implantation.
Right ventricular (RV) failure following left ventricular assist device (LVAD) surgery is associated with increased mortality, but identifying LVAD candidates at risk for RV failure remains difficult. Matthews and colleagues retrospectively reviewed a database of nearly 200 LVAD implants for pre-operative predictors of RV failure. An RV failure risk score (RVFRS) was then developed which included 4 components: vasopressor requirement, aspartate aminotransferase >80 IU/l, bilirubin >2.0 mg/dl, and creatinine >2.3 mg/dl. The odds of RV failure for patients with an RVFRS >5.5 were 15-fold greater than those with an RVFRS  3.0, and these scores also predicted 6-month mortality. The RVFRS stratifies the risk of RV failure and death following LVAD implantation. See page 2163. See figure.
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Biomarkers
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SCUBE1 May Be A Serum Biomarker for Platelet Activation.
After stimulation by thrombin, SCUBE1 (signal peptide-CUB-EGF domain containing protein 1) is released from platelets as smaller soluble fragments which are then incorporated into thrombus. Dai and colleagues measured plasma concentrations of SCUBE1 from 40 subjects with acute coronary syndrome (ACS) and 40 with acute ischemic stroke (AIS) and compared these levels to those of healthy controls or patients with stable coronary artery disease (CAD). Plasma SCUBE1 concentration was virtually undetectable in healthy controls and CAD patients, but was significantly higher in ACS and AIS patients. The increase in plasma SCUBE1 concentration was an independent predictor of stroke severity. Plasma SCUBE1 concentration may serve as useful biomarker of platelet activation in acute thrombotic events. See page 2173.
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Differential Effects of Drug-Eluting Stents on Local Endothelium-Dependent Coronary Vasomotion
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Plasma Concentration of SCUBE1, a Novel Platelet Protein, Is Elevated in Patients With Acute Coronary Syndrome and Ischemic Stroke
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Interventional Cardiology
Vascular Function
