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INSIDE THIS ISSUE

Inside This Issue

	State-of-the-Art Paper

Top State-of-the-Art Paper Clinical Research Pre-Clinical Research

Carl J. Lavie, Richard V. Milani, Mandeep R. Mehra, Hector O. Ventura

Omega-3 polyunsaturated fatty acid (-3 PUFA) therapy appears to be beneficial for both primary and secondary prevention of cardiovascular diseases. Lavie and colleagues discuss the evidence from retrospective epidemiologic studies and from large randomized controlled trials demonstrating the benefits of -3 PUFA, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The potential mechanisms of these benefits are explored. The authors suggest that the target EPA + DHA consumption should be at least 500 mg/day for primary prevention and at least 800 mg/day for those with coronary heart disease or heart failure while further studies determine the most effective ratio of DHA to EPA.

	Clinical Research

Top State-of-the-Art Paper Clinical Research Pre-Clinical Research

 
Heart Failure.   Decreased cGMP Release May Underlie Pulmonary Hypertension in CHF Patients

595

Vojtech Melenovsky, Hikmet Al-Hiti, Ludmila Kazdova, Antonin Jabor, Petr Syrovatka, Ivan Malek, Jiri Kettner, Josef Kautzner

Melenovsky and colleagues sought to identify factors that increase pulmonary vascular resistance (PVR) in patients with congestive heart failure (CHF). CHF patients with high pulmonary vascular resistance (H-PVR) (>200 dyn·s·cm^–5) were compared with matched CHF patients with low pulmonary vascular resistance (L-PVR). H-PVR patients were then re-examined after an oral dose of sildenafil. While transpulmonary B-type natriuretic peptide uptake was similar, cyclic guanosine monophosphate (cGMP) release was diminished in H-PVR. H-PVR patients also had lower pulmonary artery compliance, systemic arterial compliance, and cardiac index. Sildenafil reduced PVR (–47%), with a significant increase in cGMP. This study provides in vivo evidence that phosphodiesterase 5A inhibition restores sensitivity of pulmonary vasculature to endogenous cGMP-dependent vasodilators.

Biomarkers.   Blood Test Appears to Identify Endothelial Dysfunction

601

Toshimitsu Nozaki, Seigo Sugiyama, Hidenobu Koga, Koichi Sugamura, Keisuke Ohba, Yasushi Matsuzawa, Hitoshi Sumida, Kunihiko Matsui, Hideaki Jinnouchi, Hisao Ogawa

Endothelium-derived microparticles (EMP) are small, membrane-shed vesicles generated from endothelial cell surfaces in response to injury/apoptosis. Nozaki and colleagues have previously reported that plasma CD144-EMP levels correlate with endothelial dysfunction in humans. In this study, the prognostic value of CD144-EMP was compared with B-type natriuretic peptide and high-sensitivity C-reactive protein for predicting future cardiovascular events. All 3 biomarkers were significant, independent predictors of future cardiovascular events. The accuracy improved when each biomarker or combinations of biomarkers were added to the Framingham risk model. CD144-EMP can improve risk stratification, presumably by more simply identifying endothelial dysfunction.

Heart Rhythm Disorders.   Questionable Efficacy of Antiarrhythmic Drugs for Arrhythmogenic Right Ventricular Cardiomyopathy
609

Gregory M. Marcus, David V. Glidden, Bronislava Polonsky, Wojciech Zareba, Lisa M. Smith, David S. Cannom, N. A. Mark Estes III, Frank Marcus, Melvin M. Scheinman, for the Multidisciplinary Study of Right Ventricular Dysplasia Investigators

Antiarrhythmic drugs are important in protecting against ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), but there is a lack of data to guide clinical decision making. Marcus and colleagues studied the use of antiarrhythmic medicines in all subjects with implantable cardioverter-defibrillators (ICDs) enrolled in the North American ARVC Registry. Sixty-one percent received beta-blockers; these medicines were not associated with an increased or decreased risk of ventricular arrhythmias. Sotalol was associated with a greater risk of ICD shock. The 10 subjects treated with amiodarone had a significantly lower risk. In ARVC subjects, neither beta-blockers nor sotalol appear to reduce the risk of ventricular arrhythmias, but amiodarone may.

Editorial Comment: L. Brent Mitchell, p. 616

Cardiac Imaging.   Echocardiographic Strain Superior to Ejection Fraction for Predicting Outcomes

618

Goo-Yeong Cho, Thomas H. Marwick, Hyun-Sook Kim, Min-Kyu Kim, Kyung-Soon Hong, Dong-Jin Oh

Left ventricular (LV) systolic function is a complex, coordinated action involving longitudinal contraction, circumferential shortening, and radial thickening. Contraction of muscle fibers in the mid-wall, which is measured as circumferential strain, may better reflect intrinsic contractility than endocardial contraction. Cho and colleagues measured global longitudinal strain (GLS) and global circumferential strain (GCS) using 2-dimensional speckle tracking in over 200 patients with congestive heart failure. During follow-up, both GLS and GCS were predictive of subsequent cardiac admissions or death. By the Cox proportional-hazards model, GCS was a powerful predictor of cardiac events that was more useful than ejection fraction.

Editorial Comment: Stephane Lafitte, p. 625

Cardiac Imaging.   Determinants of Functional Capacity in Peripheral Arterial Disease
628

Justin D. Anderson, Frederick H. Epstein, Craig H. Meyer, Klaus D. Hagspiel, Hongkun Wang, Stuart S. Berr, Nancy L. Harthun, Arthur Weltman, Joseph M. DiMaria, Amy M. West, Christopher M. Kramer

Anderson and colleagues examined the pathophysiology of peripheral arterial disease (PAD) by determining the relationship between large vessel obstruction, atherosclerotic plaque burden, tissue perfusion, cellular metabolism, and functional capacity using magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) Eighty-five patients with mild-to-moderate PAD (mean ankle brachial index 0.69) were studied with MRI/MRS both at rest and after exercise. The phosphocreatine recovery time constant (PCr) at peak exercise was the predictor of treadmill exercise time, whereas calf muscle perfusion seemed to determine 6-min walk distance. However, there was no correlation between PCr and tissue perfusion. These results suggest that functional limitations in PAD are multifactorial and are caused by both hemodynamic factors, such as atherosclerotic plaque burden, and factors that alter cellular metabolism.

Editorial Comment: Marc Dewey, p. 636

	Pre-Clinical Research

Top State-of-the-Art Paper Clinical Research Pre-Clinical Research

 
Pre-Clinical Research.   Mitral Cerclage Annuloplasty: Initial Results in Swine

638

June-Hong Kim, Ozgur Kocaturk, Cengizhan Ozturk, Anthony Z. Faranesh, Merdim Sonmez, Smita Sampath, Christina E. Saikus, Ann H. Kim, Venkatesh K. Raman, J. Andrew Derbyshire, William H. Schenke, Victor J. Wright, Colin Berry, Elliot R. McVeigh, Robert J. Lederman

Inspired by epicardial purse-string annuloplasty before the cardiopulmonary bypass era, Kim and colleagues developed a novel catheter-based technique to reduce mitral annular circumference using a "cerclage" suture. The procedure, "cerclage annuloplasty," is guided by magnetic resonance imaging roadmaps fused with live X-ray. A coronary sinus guidewire traverses a short segment of basal septal myocardium to re-enter the right heart, where it is exchanged for a suture. Tension is applied until the regurgitation decreases and the degree of tension is secured with a locking device. The technique was tested in a swine model of ischemic cardiomyopathy with good efficacy.

Pre-Clinical Research.   Liposomes Can Be Filled With NO for Local Delivery to Vascular Tissues

652

Shao-Ling Huang, Patrick H. Kee, Hyunggun Kim, Melanie R. Moody, Stephen M. Chrzanowski, Robert C. MacDonald, David D. McPherson

While nitric oxide (NO) delivery to the arterial wall has a number of potential benefits, successful NO delivery is challenging. Huang and colleagues describe their experience using echogenic liposomes (ELIP) as the gas carrier. NO-ELIP results are fairly rapid, but the additional of argon (AR) gas provides a more stable, sustained release. NO/AR-ELIP enhanced the viability of cultured vascular smooth muscle cells and attenuated the development of intimal hyperplasia in a rabbit vascular injury model. Liposomes may be an effective vehicle for delivering NO to vascular tissues.

Related Articles

Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Diseases

Carl J. Lavie, Richard V. Milani, Mandeep R. Mehra, and Hector O. Ventura
J. Am. Coll. Cardiol. 2009 54: 585-594. [Abstract] [Full Text] [PDF]

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