INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Myocardial Infarction
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CMR to Detect Post-MI Microvascular Obstruction.
Nijveldt and colleagues used cardiovascular magnetic resonance (CMR) imaging to assess for persistent microvascular obstruction (MVO) after acute myocardial infarction (AMI). CMR with gadolinium-enhancement was performed with both first-pass perfusion imaging (early MVO) and late enhancement. Late MVO was defined as an area of hypoenhancement within the hyperenhanced area diagnostic of infarction. Early and late MVO were both related to incomplete ST-segment resolution, but late MVO was a better predictor of changes in ejection fraction at follow-up. Late MVO on CMR can identify areas of infarction that will not functionally recover. See page 181. See figure.
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Heart Failure
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Stopping Beta-Blockers During Hospitalization May Increase Mortality.
While beta-blockers (BB) improve mortality in patients with reduced left ventricular (LV) function, there is controversy as to whether they should be continued or withdrawn in patients with decompensated heart failure (HF). Fonarrow and colleagues studied outcomes in over 2,000 patients who were hospitalized and had no contraindication to BB. Continuation of BB therapy was associated with a lower risk of death/rehospitalization compared with no BB therapy; withdrawal of BB was associated with higher mortality. The continuation of BB therapy in patients hospitalized with decompensated HF is associated with improved outcomes. See page 190. See figure.
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Heart Rhythm Disorders
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Serum Markers of Collagen Turnover Elevated in Patients With AF.
Previous studies have shown that atrial fibrosis can lead to the development or persistence of atrial fibrillation (AF). Kallergis and colleagues compared the serum levels of several markers of collagen turnover in patients with structurally normal hearts with either persistent AF, permanent AF, or controls. Serum C-terminal propeptide of collagen type-I (CICP) showed a step-wise increase from control, to paroxysmal, to persistent AF. Measuring collagen turnover with these markers may help to define the pathophysiology of AF. See page 211. See figure.
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Cardiac Imaging
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Contrast Ultrasound Can Identify Neovascularization in Carotid Lesions.
Coli and colleagues hypothesized that ultrasound contrast could identify areas of neovascularization in carotid atherosclerotic lesions. They studied 32 patients with standard and contrast ultrasound, one-half of whom subsequently underwent endarterectomy. The surgical specimen was examined histologically for microvessel density. A correlation was observed between higher contrast enhancement and greater neovascularization, but not with the severity of stenosis. This study suggests that it may be possible to assess carotid neovascularization noninvasively. See page 223. See figure.
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Myocardial Infarction
Heart Failure
