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INSIDE THIS ISSUE OF JACC

Inside This Issue of JACC

	State-of-the-Art Paper

Top State-of-the-Art Paper Antiplatelet Therapy Cardiac Resynchronization Cardiac Imaging Mini-Focus: Cell-Based Therapy Mini-Focus: Cell-Based Therapy

	Antiplatelet Therapy

Top State-of-the-Art Paper Antiplatelet Therapy Cardiac Resynchronization Cardiac Imaging Mini-Focus: Cell-Based Therapy Mini-Focus: Cell-Based Therapy

 
No Evidence of Decreased Clopidogrel Effectiveness Over 1 Year.  
Clopidogrel resistance has been described in 15% to 30% of patients with short-term therapy, but whether this changes with long-term therapy is unknown. Saw and colleagues performed a serial analyses of clopidogrel and aspirin efficacy over 12 months. There was no change in maximal platelet adenosine diphosphate-stimulated aggregation with light-transmittance aggregometry or VerifyNow clopidogrel platelet inhibition from 1 to 12 months. Similarly, there was no difference in aspirin's effects on platelet aggregation over 1 year. However, platelet expression of CD40L, CD62P, and PAC-1 did increase over time. This pilot study showed no attenuation of clopidogrel's effects with long-term administration, but the increase in platelet activation receptors merits further study. See page 1826. See figure.

	Cardiac Resynchronization

Top State-of-the-Art Paper Antiplatelet Therapy Cardiac Resynchronization Cardiac Imaging Mini-Focus: Cell-Based Therapy Mini-Focus: Cell-Based Therapy

 
CRT Reduces Risk of Hospitalization in Select NYHA Functional Class I and II Patients.  
This study evaluated the utility of cardiac resynchronization therapy (CRT) in New York Heart Association (NYHA) functional class II heart failure (HF) and NYHA functional class I with previous HF symptoms who had a QRS >120 ms and a left ventricle (LV) ejection fraction <40%. All subjects had a CRT device placed, but were randomized to the device being turned ON or OFF. There was no difference in the primary end point which included both symptoms and hospitalizations. However, those with CRT-ON showed improved LV remodeling and had delayed times to first HF hospitalization. This study shows that CRT can reduce the risk of hospitalization and improve ventricular structure and function in patients with mild or resolved HF symptoms. See pages 1834 and 1844. See figure.

	Cardiac Imaging

Top State-of-the-Art Paper Antiplatelet Therapy Cardiac Resynchronization Cardiac Imaging Mini-Focus: Cell-Based Therapy Mini-Focus: Cell-Based Therapy

 
Noninvasive Imaging of MMP Activity.  
Matrix metalloproteinase (MMP) expression and activation contributes to the degradation of fibrous caps and vulnerability to plaque rupture. Fujimoto and colleagues studied a targeting radiotracer, MPI, that incorporates technetium-99m into a compound that binds to MMP. The atherolsclerotic lesions in rabbits with experimentally induced atherosclerosis, were clearly visible with micro–single photon emission computed tomography (SPECT)/computed tomography (CT) imaging. Furthermore, MPI uptake was significantly reduced after both dietary modification and fluvastatin treatment and correlated with immunohistochemically-verified MMP-2 expression in plaques. This study demonstrates the feasibility of noninvasive imaging of MMP activity in atherosclerotic lesions. See page 1847. See figure.

	Mini-Focus: Cell-Based Therapy

Top State-of-the-Art Paper Antiplatelet Therapy Cardiac Resynchronization Cardiac Imaging Mini-Focus: Cell-Based Therapy Mini-Focus: Cell-Based Therapy

 
Combining FGF and Cardiac Stem Cells May Provide Synergistic Effect.   Both cell-based therapy and therapeutic angiogenesis have been touted as potential treatments for ischemic heart disease (IHD), but the clinical results have been disappointing. Takehara and colleagues describe a technique that embeds basic fibroblast growth factor (bFGF) into a gelatin which slowly degrades over 3 weeks and thus provides sustained local delivery of bFGF. The gelatin is attached to the epicardial surface with a polytetrafluoroethylene-reinforced pericardial sheet. This resulted in enhanced myocardial perfusion and contractile function in a porcine model of IHD. The effect of the bFGF patch on cell transplantation, was then studied and demonstrated increased donor-cell engraftment and enhanced cardiomyocyte differentiation, resulting in synergistically improved ventricular function. The sustained local release of bFGF seems to create a favorable millieu for engraftment and differentiation of cardiac stem cells as well as neoangiogenesis. See pages 1858 and 1866.

	Mini-Focus: Cell-Based Therapy

Top State-of-the-Art Paper Antiplatelet Therapy Cardiac Resynchronization Cardiac Imaging Mini-Focus: Cell-Based Therapy Mini-Focus: Cell-Based Therapy

 
Myoendothelial Progenitor Cells May Be Superior for Cardiac Cellular Transplantation.  
Okada and colleagues have recently identified a novel population of myoendothelial cells from human skeletal muscle that express both myogenic and endothelial cell characteristics. The ability of these cells to improve post-myocardial infarction cardiac function was tested in a mouse model and compared to transplantation of regular myoblasts and endothelial progenitor cells. Intramyocardial injection of myoendothelial cells produced greater improvements in left ventricular function and more robust engraftment within the infarcted myocardium compared to injection of myoblasts or endothelial cells. These findings suggest that myoendothelial cells represent a novel cell population from human skeletal muscle that may hold promise for cardiac repair. See pages 1869 and 1881. See figure.

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