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 Google Scholar Google Scholar Search for Related Content Related Collections Related Articles

INSIDE THIS ISSUE

Inside This Issue

	State-of-the-Art Papers

Top State-of-the-Art Papers Clinical Research Year in Cardiology Series

Han W. Kim, Afshin Farzaneh-Far, Raymond J. Kim

In patients with known or suspected myocardial infarction, cardiovascular magnetic resonance (CMR) provides a comprehensive, multifaceted view of the heart. Kim and colleagues review the data, which indicate that delayed enhancement (DE)-CMR is a well-validated, robust technique. Because DE-CMR can differentiate between ischemic and various nonischemic forms of myocardial injury, it is especially useful when there is diagnostic uncertainty. Furthermore, CMR provides clinically relevant information, such as residual viability, microvascular damage, stunning, and right ventricular infarction. Because quantification of infarct size by DE-CMR is highly reproducible, it may provide a useful surrogate end point for clinical trials.

State-of-the-Art Paper.   A Critical Review of Clinical Arteriogenesis Research

17

Niels van Royen, Jan J. Piek, Wolfgang Schaper, William F. Fulton

van Royen and colleagues discuss the potential to exploit the body's natural processes to stimulate arteriogenesis. This review occurs 50 years after it was conclusively shown that all healthy hearts contain an extensive collateral network. Further experimental studies showed that the increase in diameter of collateral vessels is not passive dilation; rather, it requires active proliferation of endothelial and smooth muscle cells, suggesting that pharmacological modulation could stimulate collateral development. To date, clinical trials of arteriogenesis stimulation have had, at best, limited success. The use of intracoronary-derived collateral flow index may increase the sensitivity to detect the effects of pharmacological compounds on arteriogenesis.

	Clinical Research

Top State-of-the-Art Papers Clinical Research Year in Cardiology Series

 
Interventional Cardiology.   Optical Coherence Tomography Imaging 5 Years After BMS Implantation

26

Masamichi Takano, Masanori Yamamoto, Shigenobu Inami, Daisuke Murakami, Takayoshi Ohba, Yoshihiko Seino, Kyoichi Mizuno

Takano and colleagues performed optical coherence tomography (OCT) imaging on selected patients who had a bare-metal stent (BMS) implanted at least 5 years earlier and compared those to images taken <6 months after BMS implantation. For stent segments imaged within 6 months, normal neointima proliferated homogeneously and lipid-laden intima was not detected. In contrast, after 5 years, lipid-laden intima, intimal disruption, and thrombus were frequently found. There was also evidence of intra-intima neovascularization in the late but not the early images. This OCT study suggests that neointima within the BMS often transforms into lipid-laden tissue during extended follow-up.

Editorial Comment: Brigitta C. Brott, p. 33

Lipids and Coronary Disease.   Quantifying Cholesterol-Related Cardiac Risk

35

Benoit J. Arsenault, Jamal S. Rana, Erik S. G. Stroes, Jean-Pierre Després, Prediman K. Shah, John J. P. Kastelein, Nicholas J. Wareham, S. Matthijs Boekholdt, Kay-Tee Khaw

Arsenault and colleagues tested the hypothesis that at any low-density lipoprotein cholesterol (LDL-C) level, other lipid parameters such as non–high-density lipoprotein cholesterol (HDL-C), triglycerides (TGs), and the total cholesterol (TC)/HDL-C ratio predict the risk for coronary heart disease (CHD). In the EPIC (European Prospective Investigation Into Cancer and Nutrition)-Norfolk prospective population study, over 20,000 participants without diabetes or CHD ages 45 to 79 years were followed for 11 years. Among individuals with LDL-C levels <100 mg/dl, those with non–HDL-C >130 mg/dl had a hazard ratio for future CHD of 1.84 compared to those with non–HDL-C levels <130 mg/dl. Elevated risk was also found in those with TG levels >150 mg/dl and those with a TC/HDL-C ratio >5. In this prospective study, subjects with high non–HDL-C levels, high TG levels, or with an elevated TC/HDL-C ratio were at increased CHD risk, even if their LDL-C level was under 100 mg/dl.

Editorial Comment: Jennifer G. Robinson, p. 42

Heart Failure.   High Rate of Adverse Events During Pregnancy for Women With Dilated Cardiomyopathy

45

Jasmine Grewal, Samuel C. Siu, Heather J. Ross, Jennifer Mason, Olga H. Balint, Mathew Sermer, Jack M. Colman, Candice K. Silversides

This study sought to determine the rate of adverse events for the fetus and the mother in women with a history of a dilated cardiomyopathy (DCM) who become pregnant. A total of 36 pregnancies in 32 women with DCM were included. Thirty-nine percent of the pregnancies were complicated by at least 1 maternal cardiac event, most often the development of pulmonary edema in the third trimester or post-partum. Adverse obstetric outcomes occurred in 14%, composed of pre-eclampsia and post-partum hemorrhage. Adverse fetal outcomes occurred in 20%, mostly composed of pre-term delivery (<37 weeks) and low birth weight (<2,500 g). In pregnant women with DCM, the risk of adverse cardiac events is considerable, but pre-pregnancy characteristics can identify women at the highest risk.

Heart Failure.   Mixed Results for NT-proBNP–Guided Treatment for CHF
53

John G. Lainchbury, Richard W. Troughton, Kim M. Strangman, Christopher M. Frampton, Anna Pilbrow, Timothy G. Yandle, Amjad K. Hamid, M. Gary Nicholls, A. Mark Richards

The concept that periodically measuring N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels and titrating medications appropriately can improve outcomes for patients with chronic heart failure (CHF) is intellectually appealing, but there is limited clinical evidence to support this. Lainchbury and colleagues conducted a long-term study comparing the effects of NT-proBNP–guided therapy with intensive clinical management or usual care after a hospitalization for CHF, which followed patients for 3 years. One-year mortality was approximately 50% lower in both the hormone-guided and intensively-followed groups compared with usual care. Three-year mortality was lower in patients age <75 years receiving hormone-guided treatment. Intensive management of CHF improves 1-year mortality and hormone-guided treatment may improve long-term mortality in younger patients.

Editorial Comment: Alan Maisel, p. 61

	Year in Cardiology Series

Top State-of-the-Art Papers Clinical Research Year in Cardiology Series

 
Year in Cardiology Series.   The Year in Hypertension
65

Bryan Williams

Williams reviews the literature for clinically-relevant studies regarding the treatment of hypertension over the last year. Among the recent results that are reviewed include data from the ONTARGET (Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial) program regarding the efficacy of an angiotensin receptor blocker (ARB) to reduce cardiac events, either alone or in combination with an angiotensin-converting enzyme (ACE) inhibitor. The utility of combination therapy with an ACE inhibitor plus either an ARB or a direct renin inhibitor for preventing the progression of renal dysfunction is also reviewed. Data from ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) showing the efficacy of diuretic-based therapy is also summarized, as is data on the use of and rationale for single-pill combination therapy.

Related Articles

Cardiovascular Magnetic Resonance in Patients With Myocardial Infarction: Current and Emerging Applications

Han W. Kim, Afshin Farzaneh-Far, and Raymond J. Kim
J. Am. Coll. Cardiol. 2010 55: 1-16. [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 Google Scholar Google Scholar Search for Related Content Related Collections Related Articles