This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Articles

INSIDE THIS ISSUE OF JACC

Inside This Issue of JACC

	State-of-the-Art Paper

Top State-of-the-Art Paper Interventional Cardiology Coronary Disease Heart Failure Heart Failure Heart Rhythm Disorders Cardiac Imaging

	Interventional Cardiology

Top State-of-the-Art Paper Interventional Cardiology Coronary Disease Heart Failure Heart Failure Heart Rhythm Disorders Cardiac Imaging

 
Clinical Experience With a Combined CABG/PCI Suite.  
Routine angiography immediately after coronary artery bypass grafting (CABG), prior to chest closure, may help to identify graft anomalies that will increase the risk of failure and allow surgical revision or percutaneous revascularization. Zhao and colleagues describe their experiences with routine completion angiography in almost 400 patients who underwent CABG, some of whom had simultaneous ("1-stop") percutaneous coronary intervention (PCI) in a hybrid catheterization laboratory/operating room. Nearly one-third had a combined procedure; 60% of these were planned and 40% were ad hoc based on intraoperative findings. Twelve percent of grafts were found to have angiographic defects that were repaired with a minor adjustment of the graft, intraoperative open-chest PCI, or traditional surgical revision. Hybrid patients had clinical outcomes similar to standard CABG patients. Routine completion angiography may help to identify grafts with suboptimal results and allow appropriate corrections prior to CABG completion. See pages 232 and 242. See figure.

	Coronary Disease

Top State-of-the-Art Paper Interventional Cardiology Coronary Disease Heart Failure Heart Failure Heart Rhythm Disorders Cardiac Imaging

 
Lipid Profiles of Asians With First MI.  
Most of the information regarding the contributions of various lipid fractions to cardiovascular disease risk is derived from studies in white Caucasians, but might vary between ethnic groups due to either genetic or environmental factors such as high carbohydrate diets, reduced physical activity, smoking rates, and so on. The INTERHEART study is an international study of subjects with a first acute myocardial infarction (AMI) compared with control patients, with 65 centers in Asia and almost 6,000 Asian patients with AMI. Among both cases and control subjects, mean low-density lipoprotein cholesterol (LDL-C) levels were about 10 mg/dl lower in Asians compared with non-Asians. Asian cases and control subjects were more likely to have LDL-C 100 mg/dl. Despite these differences in absolute levels, the risk of AMI associated with increases in LDL-C and decreases in high-density lipoprotein cholesterol was similar for Asians and non-Asians. Because Asians are at risk for AMI despite lower LDL-C levels, the treatment threshold and targets may need to be reassessed in this population. See page 244. See figure.

	Heart Failure

Top State-of-the-Art Paper Interventional Cardiology Coronary Disease Heart Failure Heart Failure Heart Rhythm Disorders Cardiac Imaging

 
A Call to Assess All AHFS Patients for CAD.  
Patients with acute heart failure syndromes (AHFS) are heterogeneous in terms of their clinical presentation, pathophysiology, prognosis, and therapeutic options. The majority of patients presenting with AHFS have coronary artery disease (CAD), which can be either stable or unstable, but the role of CAD in AHFS has not been well-studied in clinical trials. This paper represents a consensus summary of discussions that occurred during the Fourth International Acute Heart Failure Syndromes Working Group meeting. Currently, there are no consensus statements or practice guidelines on the most appropriate timing and methods to detect or reassess CAD in patients with AHFS, but several lines of evidence suggest that CAD can significantly affect outcomes for AHFS patients, but it is most likely underdiagnosed during the index hospitalization. See page 254. See figure.

	Heart Failure

Top State-of-the-Art Paper Interventional Cardiology Coronary Disease Heart Failure Heart Failure Heart Rhythm Disorders Cardiac Imaging

 
VADs May Increase Post-Transplant Mortality.   Ventricular assist devices (VADs) have been shown to improve end organ perfusion and are increasingly being used to bridge patients to heart transplantation, but the effect of these devices on post-transplant mortality is unclear. Patlolla and colleagues reviewed data from the United Network for Organ Sharing (UNOS) Thoracic Registry for over 10,000 patients who underwent a single-organ heart transplantation. One thousand four hundred thirty-three patients were bridged with intracorporeal VADs and 448 patients with extracorporeal VADs. Intracorporeal VADs were associated with a hazard ratio (HR) of 1.2 for 6-month post-transplant mortality and an HR of 2.0 beyond 5 years. The HRs for extracorporeal VADs were 1.9 and 2.9, respectively. These data suggest that VADs increase both short- and long-term mortality and argue against using these devices as bridges in stable UNOS status I patients awaiting heart transplantation. See pages 264 and 272.

	Heart Rhythm Disorders

Top State-of-the-Art Paper Interventional Cardiology Coronary Disease Heart Failure Heart Failure Heart Rhythm Disorders Cardiac Imaging

 
Predictors of Arrhythmias in Asymptomatic Children With Pre-Excitation.  
Patients with ventricular pre-excitation (Wolff-Parkinson-White [WPW] syndrome) on the electrocardiogram (ECG) are at a small but real risk of sudden death, but the predictors of which patients are at highest risk are poorly understood. Santinelli and colleagues performed electrophysiologic testing and prospectively followed more than 200 children (ages 5 to 18 years) who were found to have WPW syndrome on a screening ECG and were asymptomatic. More than 70% of the children had no arrhythmic events over a median follow-up of almost 5 years. Thirty percent did develop a first arrhythmic event, which was potentially life-threatening in approximately 10% of all children screened, or >40% of children with arrhythmias. Tachyarrhythmia inducibility, short anterograde refractory period of accessory pathways (APs), and presence of multiple pathways were predictors of potentially life-threatening arrhythmias. These findings will help to identify high-risk asymptomatic children with ventricular pre-excitation who may be candidates for AP ablation. See pages 275 and 281. See figure.

	Cardiac Imaging

Top State-of-the-Art Paper Interventional Cardiology Coronary Disease Heart Failure Heart Failure Heart Rhythm Disorders Cardiac Imaging

 
Cardiac Fibrosis Common in Patients With LVH.  
The relationship between left ventricular hypertrophy (LVH) and myocardial fibrosis as defined by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is not well understood. Rudolph and colleagues evaluated the incidence and patterns of LGE in different forms of LVH. Over 400 patients with aortic stenosis, arterial hypertension, or hypertrophic cardiomyopathy with echocardiographic criteria of LVH underwent CMR. LGE was present in all forms of LVH and correlated with LV mass index. There were no significant differences in the frequency of LGE. Fibrosis as detected by CMR is a frequent feature of LVH regardless of its cause and depends on the severity of the increase in the LV mass index. See pages 284 and 292. See figure.

Related Articles

Contraceptive Hormone Use and Cardiovascular Disease

Chrisandra L. Shufelt and C. Noel Bairey Merz
J. Am. Coll. Cardiol. 2009 53: 221-231. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				H. G. Bezerra, M. A. Costa, G. Guagliumi, A. M. Rollins, and D. I. Simon Intracoronary Optical Coherence Tomography: A Comprehensive Review: Clinical and Research Applications J. Am. Coll. Cardiol. Intv., November 1, 2009; 2(11): 1035 - 1046. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Articles