Circulation. 2006;113:1271
(Circulation. 2006;113:1271.)
© 2006 American Heart Association, Inc.
Issue Highlights
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HEMODYNAMIC EFFECTS OF LONG-TERM CARDIAC RESYNCHRONIZATION THERAPY: ANALYSIS BY PRESSURE-VOLUME LOOPS, by Steendijk et al.
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Although it has been shown that chronic resynchronization therapy
for heart failure exerts beneficial effects on clinical outcomes
and cardiac remodeling, little is known about the long-term
effects on myocardial function. Pressure-volume loop analyses
were performed before and after 6 months of biventricular pacing
in 22 patients with NYHA class III–IV heart failure. At
6 months there were improvements in left ventricular ejection
fraction, dP/dt
max, and stroke work at both resting and increased
heart rates. Of note, there were improvements in ventricular-arterial
coupling and mechanical efficiency, as well. These data indicate
that the initial improvements in myocardial function with resynchronization
therapy are sustained during chronic therapy. See p
1295.
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IMPROVEMENT IN STROKE MORTALITY IN CANADA AND THE UNITED STATES, 1990 TO 2002, by Yang et al.
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The US Public Health Service recommended in September 1992 that
all women of childbearing age consume 400 micrograms (µg)
of folic acid daily to reduce their risk of having a pregnancy
affected with spina bifida or other neural tube defects. Owing
to the relationship between folic acid fortification and blood
homocysteine levels, some experts have speculated that fortification
may also have a favorable effect on cardiovascular health and
stroke. The United States and Canada implemented policies of
mandatory fortification in the late 1990s, and the populations
of both countries experienced a reduction in blood homocysteine
levels, a factor that appears to be related to the risk of stroke.
Investigators from both countries collaborated to compare trends
in stroke mortality in the United States and Canada, where these
policies were mandatory, with England and Wales, where the policies
were not. See p
1335.
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ADVANCED GLYCATION END PRODUCTS ACTIVATE A CHYMASE-DEPENDENT ANGIOTENSIN II–GENERATING PATHWAY IN DIABETIC COMPLICATIONS, by Koka et al.
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Angiotensin II is intimately involved in the development of
cardiovascular complications of diabetes. Indeed, angiotensin-converting
enzyme (ACE) inhibitors reduce, but do not prevent, the occurrence
of clinical events in these patients. Interestingly, there are
alternative pathways such as the enzyme chymase expressed in
vascular tissue that are able to generate angiotensin II even
in the presence of ACE inhibitors. In this study, Koka et al
report that chymase is upregulated in the vasculature of diabetic
patients. The upregulation of this alternative pathway is associated
with tissue disposition of advanced glycation end products (AGEs),
another consequence of hyperglycemia. AGEs induce chymase expression
via the receptor for AGEs (RAGE)–Erk1/2 MAP kinase pathway.
Under these conditions, chymase appears to account for the majority
of angiotensin II produced in the vasculature, and this can
be prevented by RAGE antibodies or inhibitions of Erk1/2 MAP
kinase. This study therefore provides new insights into the
cellular mechanisms of angiotensin II–induced vascular
complications in diabetes and also a novel therapeutic target
for the treatment of these high-risk patients. See p
1353.
Visit http://circ.ahajournals.org:
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Clinician Update
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A Clinician’s Guide to Tissue Doppler Imaging. See p
e396.
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Images in Cardiovascular Medicine
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Ovarian Malignancy Presenting as Multiple Intracardiac Masses.
See p
e399.
Bubble in the Heart: A Rare Cause of Mitral Regurgitation. See p e401.
Spontaneous Coronary Dissection: Computed Tomography Appearance and Insights From Intravascular Ultrasound Examination. See p e403.
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Correspondence
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See p
e406.
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