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 Paper

Top State-of-the-Art Paper Viewpoint and Commentary Clinical Research

James K. Min, Leslee J. Shaw, Daniel S. Berman

Since the introduction of 64-detector row cardiac computed tomographic angiography (CCTA), there has been considerable debate as to where CCTA fits into the algorithm for individuals with suspected coronary artery disease (CAD). Min and colleagues describe the latest available published evidence supporting the potential clinical and cost efficiency of CCTA, drawing attention to not only the significance but also the limitations of these studies. For instance, the studies showing high accuracy compared with conventional angiography are usually performed in subjects who had already been referred for conventional angiography and, therefore, have a high pre-test probability of CAD. Evaluation of acute chest pain studies have been relatively small, single-center studies. The goal of this paper is to focus discussion on what future studies are both necessary and feasible for properly determining the role of CCTA in patients with suspected CAD.

	Viewpoint and Commentary

Top State-of-the-Art Paper Viewpoint and Commentary Clinical Research

 
News From the NHLBI.   Heterogeneity in Cardiometabolic Risk in Asian Americans Provides Opportunities for Research

966

K. M. Venkat Narayan, Larissa Aviles-Santa, Reena Oza-Frank, Mona Pandey, J. David Curb, Marguerite McNeely, Maria Rosario G. Araneta, Latha Palaniappan, Swapnil Rajpathak, Elizabeth Barrett-Connor, for the Cardiovascular Disease in Asian and Pacific Islander Populations NHLBI Working Group

974

Miriam Jacob, Leslie Cho

There is considerable geographical, ethnic, cultural, and genetic diversity within the Asian and Pacific Islander population (Asian Americans) in the U.S. Limited data suggest striking differences in the risk of cardiovascular disease (CVD), obesity, type 2 diabetes, and other CVD risk factors across the Asian-American population. Varied durations of residence in the U.S. allow for studies to investigate the interplay between ethnicity and environmental exposures. These populations may offer the opportunity to further understand the link between CVD, type 2 diabetes, body size, visceral adiposity, and insulin resistance. In an accompanying commentary, Jacob and Cho provide details on how this research can best be accomplished.

	Clinical Research

Top State-of-the-Art Paper Viewpoint and Commentary Clinical Research

 
Coronary Artery Disease.   Olmesartan Reduces Progression of Coronary Atherosclerosis Independent of Blood Pressure Lowering
976

Atsushi Hirohata, Keizo Yamamoto, Toru Miyoshi, Kunihiko Hatanaka, Satoshi Hirohata, Hitoshi Yamawaki, Issei Komatsubara, Masaaki Murakami, Eiki Hirose, Shinji Sato, Keisuke Ohkawa, Makoto Ishizawa, Hirosuke Yamaji, Hiroshi Kawamura, Shozo Kusachi, Takashi Murakami, Kazuyoshi Hina, Tohru Ohe

This study used intravascular ultrasound (IVUS) to determine if the angiotensin-II receptor-blocking agent olmesartan slows coronary atheroma progression. Almost 250 subjects undergoing percutaneous coronary intervention had IVUS performed on a nonculprit lesion and were then randomized to olmesartan or to other blood pressure–lowering medications, with repeat IVUS 14 months later. Patient characteristics and blood pressure control were identical between the 2 groups. However, follow-up IVUS showed significantly decreased total atheroma volume (TAV) and percent change in percent atheroma volume (PCPAV) in the olmesartan group (5.4% vs. 0.6% for TAV and 3.1% vs. –0.7% for PCPAV). These results suggest that olmesartan slows coronary atheroma progression independent of its effect on blood pressure.

Editorial Comment Steven P. Marso, p. 983

Diseases of the Aorta.   Meta-Analysis of Endovascular Versus Open Surgical Repair for Descending Thoracic Aortic Disease
986

Davy Cheng, Janet Martin, Hani Shennib, Joel Dunning, Claudio Muneretto, Stephan Schueler, Ludwig Von Segesser, Paul Sergeant, Marko Turina

The efficacy of thoracic endovascular aortic repair (TEVAR) compared with open surgery for descending thoracic aortic disease remains unclear. Cheng and colleagues combined data from comparative studies of TEVAR versus open repair through meta-analysis and meta-regression. Forty-two nonrandomized studies involving almost 6,000 subjects were included. Registry data suggested overall perioperative complications were reduced with TEVAR. In comparative studies, all-cause mortality at 30 days (odds ratio [OR]: 0.44) and paraplegia (OR: 0.42) were reduced with TEVAR. There was no significant difference in stroke, myocardial infarction, aortic reintervention, and mortality beyond 1 year. The data from nonrandomized studies suggest that TEVAR may reduce early death, paraplegia, and several other complications compared with open surgery, although long-term data is sparse.

Statins and Endothelial Dysfunction.   Rosuvastatin Limits Negative Effects of Ischemia Reperfusion on Endothelial Function

1002

Andrew Liuni, Mary Clare Luca, Tommaso Gori, John D. Parker

Liuni and colleagues sought to determine if single-dose rosuvastatin would abrogate ischemia and reperfusion (IR)-induced endothelial dysfunction in humans and whether this effect is cyclooxygenase-2 (COX-2)-dependent. Volunteers were randomized to a single dose of oral rosuvastatin (40 mg) or placebo. The next day, endothelium-dependent flow-mediated dilation (FMD) was measured before and after IR (15 min of upper arm ischemia followed by 15 min of reperfusion). IR significantly blunted FMD in the placebo group, but rosuvastatin prevented this impairment. Pre-treatment with celecoxib completely abolished rosuvastatin's protective effect. These findings help to understand the clinical benefits of statins and the potential cardiac risk of COX-2 inhibition.

Heart Rhythm Disorders.   RA Ablation May Be Necessary When AF CL Does Not Change During Ablation
1007

Mélèze Hocini, Isabelle Nault, Matthew Wright, George Veenhuyzen, Sanjiv M. Narayan, Pierre Jaïs, Kang-Teng Lim, Sébastien Knecht, Seiichiro Matsuo, Andrei Forclaz, Shinsuke Miyazaki, Amir Jadidi, Mark D. O'Neill, Frédéric Sacher, Jacques Clémenty, Michel Haïssaguerre

Hocini and colleagues investigated if additional ablation in the right atrium (RA) would improve the success of atrial fibrillation (AF) ablation procedures, and what factors would predict who was likely to require RA ablation. AF cycle length (CL) was monitored in both atria during stepwise ablation with a procedural end point of AF termination. Two distinct patterns of AF CL change were found in left atrial (LA) ablation. In 70% of patients, there was a parallel increase of AF CL in LA and RA culminating in AF termination. In 19% of patients, RA AF CL did not prolong; these patients had a longer AF history and larger RA diameter. For the patients in whom RA ablation terminated AF, clinical success was good, but further studies are needed to elucidate the complex interplay between LA and RA sources for AF.

Cardiac Imaging.   CTA Independently Predicts Long-Term Mortality
1017

Benjamin J. W. Chow, George A. Wells, Li Chen, Yeung Yam, Paul Galiwango, Arun Abraham, Tej Sheth, Carole Dennie, Rob S. Beanlands, Terrence D. Ruddy

Chow and colleagues sought to determine the prognostic value of coronary artery disease (CAD) severity and location measured with coronary computed tomographic angiography (CTA). Over 2,000 patients who had not been previously revascularized underwent clinically-driven CTA and were followed for a mean of 16 months. Multivariate analysis showed that CAD severity (hazard ratio [HR]: 3.02) was a predictor of major adverse cardiovascular events, and that left ventricular ejection fraction (LVEF) (HR: 1.47) had incremental value over CAD severity. Using CTA, CAD severity, LVEF, and total plaque score appear to have prognostic and incremental value over routine clinical predictors. CTA appears to be a promising noninvasive modality with prognostic value.

Editorial Comment Daniel B. Mark, David F. Kong, p. 1029

Vascular Disease.   Ratio of Carotid to Brachial PP Strongly Predicts CV and All-Cause Mortality
1032

Athanase Benetos, Frédérique Thomas, Laure Joly, Jacques Blacher, Bruno Pannier, Carlos Labat, Paolo Salvi, Harold Smulyan, Michel E. Safar

Brachial and carotid pulse pressure (PP) are independent predictors of cardiovascular (CV) risk, but measuring carotid PP is complicated. PP amplification, calculated by the carotid/brachial (C/B) ratio, may be a better marker of CV risk. Benetos and colleagues used a cohort of 834 subjects who had brachial and carotid PP measured with pulse wave analysis to create a nomogram to calculate carotid PP in a larger cohort of over 120,000 subjects. In the large cohort, both brachial and carotid PP were associated with both CV and all-cause mortality. The C/B ratio was slightly better, especially for CV mortality. While brachial PP, calculated carotid PP, and C/B PP amplification all predict CV mortality, the C/B ratio is less dependent on blood pressure calibration and thus may be more useful in large population studies.

Editorial Comment Theodore G. Papaioannou, Athanase D. Protogerou, Christodoulos Stefanadis, p. 1038

Intervention in Congenital Heart Disease.   Long-Term Risk of PR Following Balloon Valvuloplasty for Pulmonary Stenosis
1041

David M. Harrild, Andrew J. Powell, Trang X. Trang, Tal Geva, James E. Lock, Jonathan Rhodes, Doff B. McElhinney

In this study, Harrild and colleagues evaluated patients previously treated for uncomplicated valvar pulmonary stenosis with percutaneous balloon dilation (BD). Forty-one patients underwent cardiac magnetic resonance (CMR) imaging and treadmill testing a median 13 years after BD. A larger balloon to annulus ratio and younger age at intervention were associated with a higher pulmonary regurgitation (PR) fraction. Patients with PR fraction >15% had significantly lower peak oxygen consumption. These results help to understand the optimal balloon sizing for, and long-term outcomes from, pulmonic balloon valvuloplasty.

Editorial Comment Larry A. Latson, p. 1048

Related Articles

Rosuvastatin Prevents Conduit Artery Endothelial Dysfunction Induced by Ischemia and Reperfusion by a Cyclooxygenase-2–Dependent Mechanism

Andrew Liuni, Mary Clare Luca, Tommaso Gori, and John D. Parker
J. Am. Coll. Cardiol. 2010 55: 1002-1006. [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