INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
 |
Viewpoint
|
|---|
A Call for More Studies of Coronary Perfusion in Patients With Heart Failure.
Beohar and colleagues note that the vasoactive medications used to treat acute heart failure may increase mortality, particularly in patients with coronary artery disease. Different techniques for assessing both epicardial stenoses and myocardial perfusion are reviewed. The conclusion is that the relationship between vasoactive medications, coronary perfusion, and myocardial injury merits further investigation with imaging techniques that can reliably quantify myocardial perfusion. See page 13.
|
Coronary Artery Disease
|
|---|
CAC Scoring Predicts Mortality in Elderly Subjects.
It is unclear if coronary artery calcium scoring (CAC) adds prognostic information for elderly subjects. Raggi and colleagues reviewed CAC scores and subsequent mortality from more than 35,000 patients who underwent CAC testing, 10% of whom were >70 years of age. Higher CAC scores were associated with higher mortality across all age deciles. Several elderly patients were moderate or high risk based on Framingham risk scores, but had low CACs and low mortality, suggesting that they could be reclassified based on their low CAC. CAC appears to provide prognostic information in elderly patients. See page 17. See figure.
|
Vascular Medicine
|
|---|
Smoking Inhibits Fibrinolytic Pathways.
Distinct from its role in the coagulation cascade, thrombin can stimulate protease activated receptor type 1 (PAR-1). PAR-1 activation causes arterial vasodilatation and the release of fibrinolytic factors. Lang and colleagues compared forearm blood flow during infusions of a PAR-1–activating-peptide in smokers and nonsmokers. Smokers had impaired vasodilatation and less release of tissue-type plasminogen activator compared to nonsmokers. Cigarette smoking seems to impair PAR-1–mediated functions, and may thereby increase cardiac risk. See page 33. See figure.
|
Cardiac Surgery
|
|---|
A Systematic Approach for Repairing Bicuspid Aortic Valves.
Pettersson and colleagues report on their results at attempted valve repair, rather than replacement, in 63 patients with bicuspid aortic valves. Valves were characterized using a descriptive system that included cusp pathology, commissure variations, and aortic root morphology. Two-thirds of the valves were repaired with good results. Using this systematic analysis may help to facilitate aortic valve repair by defining key abnormalities and standardizing the language to describe them. See page 40.
Related Articles
-
Acute Heart Failure Syndromes and Coronary Perfusion
- Nirat Beohar, Ata K. Erdogan, Daniel C. Lee, Hani N. Sabbah, Morton J. Kern, John Teerlink, Robert O. Bonow, and Mihai Gheorghiade
J. Am. Coll. Cardiol. 2008 52: 13-16.
[Abstract]
[Full Text]
[PDF]
-
Coronary Artery Calcium to Predict All-Cause Mortality in Elderly Men and Women
- Paolo Raggi, Maria C. Gongora, Ambarish Gopal, Tracy Q. Callister, Matthew Budoff, and Leslee J. Shaw
J. Am. Coll. Cardiol. 2008 52: 17-23.
[Abstract]
[Full Text]
[PDF]
-
Marked Impairment of Protease-Activated Receptor Type 1-Mediated Vasodilation and Fibrinolysis in Cigarette Smokers: Smoking, Thrombin, and Vascular Responses In Vivo
- Ninian N. Lang, Ingibjörg J. Guðmundsdóttir, Nicholas A. Boon, Christopher A. Ludlam, Keith A. Fox, and David E. Newby
J. Am. Coll. Cardiol. 2008 52: 33-39.
[Abstract]
[Full Text]
[PDF]
-
Toward Predictable Repair of Regurgitant Aortic Valves: A Systematic Morphology-Directed Approach to Bicommissural Repair
- Gösta B. Pettersson, Adrian C. Crucean, Robert Savage, Carmel M. Halley, Richard A. Grimm, Lars G. Svensson, Sepehre Naficy, A. Marc Gillinov, Jingyuan Feng, and Eugene H. Blackstone
J. Am. Coll. Cardiol. 2008 52: 40-49.
[Abstract]
[Full Text]
[PDF]
|
Top
Viewpoint
Coronary Artery Disease
