Circulation. 2005;111:2151
(Circulation. 2005;111:2151.)
© 2005 American Heart Association, Inc.
Issue Highlights
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PERCUTANEOUS MITRAL VALVE REPAIR FOR CHRONIC ISCHEMIC MITRAL REGURGITATION: A REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHIC STUDY IN AN OVINE MODEL, by Daimon et al.
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Ischemic mitral regurgitation is associated with adverse prognosis
in patients with chronic heart failure as well as after myocardial
infarction and coronary revascularization. There is great interest
in surgical remodeling procedures and mitral valve reconstruction
to correct the mitral regurgitation and potentially improve
prognosis. One of the limitations to this approach has been
the relatively high operative morbidity and even mortality associated
with such surgical procedures. In this issue of Circulation,
Daimon et al demonstrate the utility of percutaneous placement
of an annuloplasty device in a sheep model of chronic ischemic
mitral regurgitation. They demonstrate the benefit of this approach
in reducing mitral regurgitation as well as beneficially improving
mitral annular dimension and functional closure of the valve.
This study supports the clinical potential of percutaneous nonsurgical
approaches to treating patients with ischemic mitral regurgitation.
See p
2183.
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INFLAMMATION AND CAROTID ARTERY—RISK FOR ATHEROSCLEROSIS STUDY (ICARAS), by Schillinger et al.
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Prior studies have demonstrated that inflammatory markers such
as C-reactive protein (CRP) are related to prevalent and incident
cardiovascular events. However, the temporality of the relations
between inflammation and atherosclerosis has been less clear.
Inflammation may predispose to atherosclerosis, but it is equally
plausible that atherosclerosis predisposes to inflammation.
In a prospective study of almost 1300 patients, Schillinger
and colleagues examined the relation between CRP and serum amyloid
A and ultrasound progression of carotid atherosclerosis. In
adjusted analyses compared with the bottom quartile, individuals
in the top quartiles of CRP and serum amyloid A, respectively,
were about 4 and 2 times more likely to develop progression
of carotid atherosclerosis. This study documents that inflammatory
markers predict atherosclerosis progression. Although the authors
cannot prove a causal relation, their study is consistent with
the hypothesis that inflammation may contribute to atherosclerosis
progression. See p
2203.
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DUAL ANTIPLATELET THERAPY WITH CLOPIDOGREL AND ASPIRIN IN SYMPTOMATIC CAROTID STENOSIS EVALUATED USING DOPPLER EMBOLIC SIGNAL DETECTION: THE CLOPIDOGREL AND ASPIRIN FOR REDUCTION OF EMBOLI IN SYMPTOMATIC CAROTID STENOSIS (CARESS) TRIAL, by Markus et al.
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Patients with symptomatic carotid stenosis are at high risk
for stroke. Unlike coronary occlusion, cerebrovascular ischemia
in such patients is rarely caused by carotid occlusion at the
plaque but rather is due to platelet emboli arising from its
ruptured surface. Indeed, asymptomatic microembolic signals
can be detected by transcranial Doppler ultrasound in up to
half of patients with symptomatic carotid stenosis. The role
of platelets was for the first time convincingly clarified in
the CARESS study, which randomized such patients to aspirin
or aspirin and clopidogrel. Not only were microemboli more frequent
in patients with events than in those without, dual platelet
inhibition also was more effective in inhibiting platelet activity
ex vivo and in reducing microemboli as detected by transcranial
Doppler ultrasound. Thus, CARESS adds to the plausibility of
dual antiplatelet therapy to prevent embolic stroke. See p
2233.
Visit http://www.circ.ahajournals.org:
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Clinician Update
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Controversies in Antiplatelet Therapy for Patients With Cardiovascular
Disease. See p
e267.
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Images in Cardiovascular Medicine
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Traumatic Coronary Artery Fistula in a Child. See p
e272.
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Correspondence
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Letter Regarding Article by Rosenhek et al, "Statins but Not
Angiotensin-Converting Enzyme Inhibitors Delay Progression of
Aortic Stenosis." See p
e274.
Letter Regarding Article by Masoudi et al, "National Patterns of Use and Effectiveness of Angiotensin-Converting Enzyme Inhibitors in Older Patients With Heart Failure and Left Ventricular Systolic Dysfunction." See p e276.
Letter Regarding Article by Kaufmann et al, "Systemic Inhibition of Nitric Oxide Synthase Unmasks Neural Constraint of Maximal Myocardial Blood Flow in Humans." See p e278.
Related Articles:
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Percutaneous Mitral Valve Repair for Chronic Ischemic Mitral Regurgitation: A Real-Time Three-Dimensional Echocardiographic Study in an Ovine Model
- Masao Daimon, Takahiro Shiota, A. Marc Gillinov, Motoya Hayase, Marc Ruel, William E. Cohn, Steven J. Blacker, and John R. Liddicoat
Circulation 2005 111: 2183-2189.
[Abstract]
[Full Text]
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Dual Antiplatelet Therapy With Clopidogrel and Aspirin in Symptomatic Carotid Stenosis Evaluated Using Doppler Embolic Signal Detection: The Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) Trial
- Hugh S. Markus, Dirk W. Droste, Manfred Kaps, Vincent Larrue, Kennedy R. Lees, Mario Siebler, and E. Bernd Ringelstein
Circulation 2005 111: 2233-2240.
[Abstract]
[Full Text]
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Inflammation and Carotid Artery—Risk for Atherosclerosis Study (ICARAS)
- Martin Schillinger, Markus Exner, Wolfgang Mlekusch, Schila Sabeti, Jasmin Amighi, Robert Nikowitsch, Ewald Timmel, Bernhard Kickinger, Christoph Minar, Matthias Pones, Wolfgang Lalouschek, Helmut Rumpold, Gerald Maurer, Oswald Wagner, and Erich Minar
Circulation 2005 111: 2203-2209.
[Abstract]
[Full Text]
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Controversies in Antiplatelet Therapy for Patients With Cardiovascular Disease
- Eric R. Bates and Wei C. Lau
Circulation 2005 111: e267-e271.
[Extract]
[Full Text]
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Traumatic Coronary Artery Fistula in a Child
- Brian E. Grace, James F. Cnota, Michael H. Hines, R. Mark Payne, and Douglas G. Ririe
Circulation 2005 111: e272-e273.
[Extract]
[Full Text]
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Letter Regarding Article by Rosenhek et al, "Statins but Not Angiotensin-Converting Enzyme Inhibitors Delay Progression of Aortic Stenosis" • Response
- Helen C. Routledge, Jonathan N. Townend, Raphael Rosenhek, Florian Rader, Nicole Loho, Harald Gabriel, Maria Heger, Ursula Klaar, Thomas Binder, Gerald Maurer, Helmut Baumgartner, and Michael Schemper
Circulation 2005 111: e274-e275.
[Extract]
[Full Text]
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Letter Regarding Article by Masoudi et al, "National Patterns of Use and Effectiveness of Angiotensin-Converting Enzyme Inhibitors in Older Patients With Heart Failure and Left Ventricular Systolic Dysfunction" • Response
- Tony Sabatini, Renzo Rozzini, Marco Trabucchi, Frederick A. Masoudi, Edward P. Havranek, Saif S. Rathore, Yongfei Wang, Jeptha P. Curtis, JoAnne Micale Foody, and Harlan M. Krumholz
Circulation 2005 111: e276-e277.
[Extract]
[Full Text]
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Letter Regarding Article by Kaufmann et al, "Systemic Inhibition of Nitric Oxide Synthase Unmasks Neural Constraint of Maximal Myocardial Blood Flow in Humans" • Response
- Henry Gewirtz, Ornella Rimoldi, Tomaso Gnecchi-Ruscone, Paolo G. Camici, Robert S. Bonser, Philipp A. Kaufmann, and Thomas F. Lüscher
Circulation 2005 111: e278-e279.
[Extract]
[Full Text]
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