INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Invasive Cardiology
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Thrombolysis May Improve Outcomes for Post-Catheterization Cerebrovascular Accidents.
Ischemic strokes occur after approximately 1% of cardiac catheterizations, yet there is little known about the best treatment algorithms. Khatri and colleagues compared the clinical outcomes of 66 cases treated either with or without thrombolysis. Twelve (18%) were treated with thrombolysis, either intravenous or intra-arterial, using recombinant tissue plasminogen activator. Improvement in stroke symptoms, as measured by the change in National Institutes of Health stroke scale score from baseline to 24 h, was greater in treated versus nontreated cases. There were no significant differences in bleeding events. This retrospective study suggests that thrombolysis may improve outcomes for post-catheterization strokes. Thrombolysis should be considered in those with significant symptoms, even those who are already anticoagulated. See pages 906 and
912.
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Coronary Heart Disease
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Lp-PLA2 Levels Improve Cardiac Risk Prediction in Older Adults.
Lipoprotein-associated phospholipase A2 (Lp-PLA2) hydrolyzes oxidized phospholipids, yielding proinflammatory and proatherogenic products. Some, but not all, studies have found levels of Lp-PLA2 to be an independent predictor of cardiac risk. Daniels and colleagues analyzed serum samples collected nearly 20 years ago from participants in the Rancho Bernardo Study, which enrolled over 1,000 men and women with a median age of 72 years and no known coronary heart disease (CHD). After a mean follow-up of 16 years, 228 participants had incident CHD events. Lp-PLA2 levels in the second, third, and fourth quartiles predicted an increased risk of CHD compared with the lowest quartile (hazard ratios 1.66, 1.80, and 1.89, respectively). This association persisted after adjusting for C-reactive protein and other CHD risk factors. These results show that Lp-PLA2 levels predict CHD events in older adults independently of other known CHD risk factors. See page 913. See figure.
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Heart Rhythm Disorders
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Heart Rate Variability is an Important Risk Modifier in LQTS.
Some long QT syndrome (LQTS) patients experience life-threatening cardiac arrhythmias, whereas others remain asymptomatic. Those with LQT1 mutations typically experience arrythmias during stressful situations. Shwartz and colleagues studied markers of sympathetic activation and cardiac responsiveness in patients with LQT1 mutations who had or had not experienced a significant arrythmia. The mean heart rate was lower among asymptomatic patients; baroreflex sensitivity (BRS) was also lower among asymptomatic than symptomatic mutation carriers. Lower resting heart rate and "relatively low" BRS appear to be protective factors in certain LQT1 carriers; this may occur because a blunted autonomic response prevents rapid changes in heart rate, which may be arrhythmogenic when delayed rectifier current (slow) is reduced. See pages 920 and
930.
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Preclinical Research
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Pre-Treating Stem Cells with GFs Improves Cardiac Differentiation and Integration.
The goal of this study was to investigate several putative growth factors (GFs) for their effect on mesenchymal stem cells (MSCs). Mesenchymal stem cells obtained from the bone marrow of rats were pre-treated with fibroblast GF-2, insulin-like GF-1, and bone morphogenetic protein 2. The priming of MSCs with this combination enhanced the commitment of MSCs to cardiomyocyte (CMC) lineage when cocultured with CMCs. Pre-treated cells also formed more gap junctions with neighboring CMCs, which helped to prevent apoptosis under hypoxic conditions and seemed to reduce the tendency towards lethal arrythmias. Treatment of MSCs with a combination of GFs may increase the therapeutic efficacy of MSC transplantation to infarcted myocardium. See page 933. See figure.
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The Safety and Efficacy of Thrombolysis for Strokes After Cardiac Catheterization
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Lipoprotein-Associated Phospholipase A2 Is an Independent Predictor of Incident Coronary Heart Disease in an Apparently Healthy Older Population: The Rancho Bernardo Study
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Neural Control of Heart Rate Is an Arrhythmia Risk Modifier in Long QT Syndrome
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The Congenital Long QT Syndrome: A Mask for Many Faces
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Pre-Treatment of Mesenchymal Stem Cells With a Combination of Growth Factors Enhances Gap Junction Formation, Cytoprotective Effect on Cardiomyocytes, and Therapeutic Efficacy for Myocardial Infarction
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Invasive Cardiology
Coronary Heart Disease
