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(Circulation. 2006;114:257.)
© 2006 American Heart Association, Inc.

Issue Highlights

	SURGICAL CORRECTION OF MITRAL REGURGITATION IN THE ELDERLY: OUTCOMES AND RECENT IMPROVEMENTS, by Detaint et al.

Top SURGICAL CORRECTION OF MITRAL... CLINICAL RELEVANCE OF C-REACTIVE... GLUTARALDEHYDE-FIXED... Clinician Update Images in Cardiovascular... Correspondence

 
With an aging population and the traditionally high risks for surgical repair of mitral regurgitation, contemporary surgical results are of great importance. In this issue of Circulation, Detaint et al analyzed the results of mitral valve surgery for mitral regurgitation in elderly patients 75 years old compared to patients 65–74 and <65 years of age. They found an incremental comorbidity index in the elderly. Most important, the long-term observed and expected survival rates were similar in each group. The multivariable analysis confirmed the ability of mitral valve surgery to restore life expectancy as well in the elderly as in younger patients. Current surgical practice should be able to offer mitral valve operations to these elderly, higher-risk patients with operative mortality rates around 5%; a high reliability to repair the mitral valve for degenerative pathology causing mitral regurgitation and the restoration of the life expectancy. See p 265.

	CLINICAL RELEVANCE OF C-REACTIVE PROTEIN DURING FOLLOW-UP OF PATIENTS WITH ACUTE CORONARY SYNDROMES IN THE AGGRASTAT-TO-ZOCOR TRIAL, by Morrow et al.

Top SURGICAL CORRECTION OF MITRAL... CLINICAL RELEVANCE OF C-REACTIVE... GLUTARALDEHYDE-FIXED... Clinician Update Images in Cardiovascular... Correspondence

 
The role of measuring inflammatory markers in the setting of acute coronary syndromes is evolving. While high sensitivity C-reactive protein (hsCRP) is the most widely studied marker, it is unknown whether the associated risk of elevated levels can be modified. In this issue of Circulation, Morrow and colleagues substantially move the field forward with their analysis of 3813 patients with acute coronary syndromes in the Aggrastat-to-Zocor trial. In this prospective study, they report the association of hsCRP levels with long-term risk of death and the effect of aggressive statin therapy (simvastatin) on these levels. These important data suggest that monitoring hsCRP levels at 1 and 4 months after acute coronary syndromes can provide useful prognostic information and that associated risks can be modified by statin therapy. See p 281.

	GLUTARALDEHYDE-FIXED BIOPROSTHETIC HEART VALVE CONDUITS CALCIFY AND FAIL FROM XENOGRAFT REJECTION, by Manji et al.

Top SURGICAL CORRECTION OF MITRAL... CLINICAL RELEVANCE OF C-REACTIVE... GLUTARALDEHYDE-FIXED... Clinician Update Images in Cardiovascular... Correspondence

 
Tissue valves are the most common type of prosthesis implant. Their popularity stems from ease of implementation, excellent hemodynamics, and their favorable thrombotic profile obviating the need for chronic anticoagulation. The durability of tissue and the mechanism of failure have been a major focus for basic and clinical investigation. The relative contribution of immunological rejection, biomechanical stress, and dystrophic calcification has remained unresolved. The study by Manji et al in this issue of Circulation investigates rejection of rat aortic valves and pig aortic valves placed in the descending aorta of rats, 20 days after implantation. The xenogeneric valves compared to the syngeneric valves had more inflammation, T-cell/macrophage infiltration, and higher serum antibody levels. Future biological valve designs and surface treatments should focus on the ability to reduce and modify both cellular and humoral rejection as well as the foreign body reaction to these tissue prostheses. See p 318.

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	Clinician Update

Top SURGICAL CORRECTION OF MITRAL... CLINICAL RELEVANCE OF C-REACTIVE... GLUTARALDEHYDE-FIXED... Clinician Update Images in Cardiovascular... Correspondence

 
Intravascular Ultrasound in Cardiovascular Medicine. See p e55.

	Images in Cardiovascular Medicine

Top SURGICAL CORRECTION OF MITRAL... CLINICAL RELEVANCE OF C-REACTIVE... GLUTARALDEHYDE-FIXED... Clinician Update Images in Cardiovascular... Correspondence

 
Ventricular Tachycardia: The Spectrum Continues to Broaden: Report of Naxos Disease. See p e60.

Masking Inferior Infarction by Anterior Myocardial Injury. See p e62.

Chest Pain and Intimal Flap Detected by Chest Computed Tomography Scans. See p e64.

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	Correspondence

Top SURGICAL CORRECTION OF MITRAL... CLINICAL RELEVANCE OF C-REACTIVE... GLUTARALDEHYDE-FIXED... Clinician Update Images in Cardiovascular... Correspondence

 
See p e65.

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Intravascular Ultrasound in Cardiovascular Medicine

Stephen J. Nicholls, E. Murat Tuzcu, Ilke Sipahi, Paul Schoenhagen, and Steven E. Nissen
Circulation 2006 114: e55-e59. [Extract] [Full Text]

Ventricular Tachycardia: The Spectrum Continues to Broaden: Report of Naxos Disease

C.G. Sajeev, Johnson Francis, Vikram Sankar, Babu Vasudev, and K. Venugopal
Circulation 2006 114: e60-e61. [Extract] [Full Text]

Masking Inferior Infarction by Anterior Myocardial Injury

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Chest Pain and Intimal Flap Detected by Chest Computed Tomography Scans

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Circulation 2006 114: e64. [Extract] [Full Text]

Letter by Powers et al Regarding Article, "Riboflavin Lowers Homocysteine in Individuals Homozygous for the MTHFR 677CT Polymorphism"

Hilary J. Powers, Ian F.W. McDowell, and Stuart J. Moat
Circulation 2006 114: e65. [Extract] [Full Text]

Glutaraldehyde-Fixed Bioprosthetic Heart Valve Conduits Calcify and Fail From Xenograft Rejection

Rizwan A. Manji, Lin F. Zhu, Nimrit K. Nijjar, David C. Rayner, Greg S. Korbutt, Thomas A. Churchill, Ray V. Rajotte, Arvind Koshal, and David B. Ross
Circulation 2006 114: 318-327. [Abstract] [Full Text]

Surgical Correction of Mitral Regurgitation in the Elderly: Outcomes and Recent Improvements

Delphine Detaint, Thoralf M. Sundt, Vuyisile T. Nkomo, Christopher G. Scott, A. Jamil Tajik, Hartzell V. Schaff, and Maurice Enriquez-Sarano
Circulation 2006 114: 265-272. [Abstract] [Full Text]

Clinical Relevance of C-Reactive Protein During Follow-Up of Patients With Acute Coronary Syndromes in the Aggrastat-to-Zocor Trial

David A. Morrow, James A. de Lemos, Marc S. Sabatine, Stephen D. Wiviott, Michael A. Blazing, Amy Shui, Nader Rifai, Robert M. Califf, and Eugene Braunwald
Circulation 2006 114: 281-288. [Abstract] [Full Text]

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This Article Free upon publication Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Articles