Circulation. 2005;112:2581
(Circulation. 2005;112:2581.)
© 2005 American Heart Association, Inc.
Issue Highlights
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HYBRID APPROACHES TO THORACIC AORTIC ANEURYSMS: THE ROLE OF ENDOVASCULAR ELEPHANT TRUNK COMPLETION, by Greenberg et al.
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The era of endovascular stenting of the thoracic aorta is advancing
to include novel techniques to extend the versatility of these
devices. Thoracic aortic aneurysms affecting the aortic arch
and descending thoracic aorta have required a 2-stage operative
procedure. The first stage is performed through a sternotomy
and includes replacement of the ascending aorta and aortic arch
and leaving an extension of the graft in the descending aorta
(elephant trunk). The second-stage procedure is performed via
a left thoracotomy, retrieving the elephant trunk and extending
the graft to replace the appropriate extent of the descending
aorta. In the report, "Hybrid Approaches to Thoracic Aortic
Aneurysms: The Role of Endovascular Elephant Trunk Completion,"
by Roy Greenberg, Fady Haddad, Lars Svensson, Sean O’Neill,
Daniel Clair, Sean P. Lyden, Esteban Walker, and Bruce Lytle,
the authors describe a series of patients where endovascular
grafting was employed to complete the second stage of the procedure,
ie, extending the elephant trunk. Thus, the second-stage operation
was avoided. The procedure was feasible, reducing the morbidity
and mortality associated with an open operative approach. See
p
2619.
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MORTALITY AFTER ACUTE MYOCARDIAL INFARCTION IN HOSPITALS THAT DISPROPORTIONATELY TREAT BLACK PATIENTS, by Skinner et al.
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Race-related disparities in management of cardiac disorders
have been well documented, but data on the impact of such inequalities
on health outcomes are limited. In this issue of
Circulation,
Skinner and colleagues evaluated prospective data from more
than a million fee-for-service Medicare patients treated in
4289 US hospitals between 1997 and 2001. The investigators examined
if short-term mortality after an acute myocardial infarction
(AMI) varied according to race by dividing hospitals into deciles
based on the percent of AMI patients who were black. They observed
that 90-day post-MI mortality was higher (23.7%) in hospitals
serving a larger proportion of blacks (top decile) relative
to hospitals without any black AMI patients (lowest decile;
mortality rate of 20.1%). The higher post-MI mortality in hospitals
with a greater fraction of black patients was not explained
by differences in patient characteristics (infarct severity,
comorbidity) or hospital income, ownership status, volume, region,
urban status, or surgical treatment intensity. The authors speculate
that differences in quality of care in hospitals catering to
blacks versus whites may have contributed to these disparities
in outcome. These observations raise the possibility that improving
quality of care in hospitals that disproportionately serve blacks
may help reduce the race-related gaps in outcomes of AMI patients.
See p
2634.
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SILDENAFIL INHIBITS ß-ADRENERGIC–STIMULATED CARDIAC CONTRACTILITY IN HUMANS, by Borlaug et al.
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Sildenafil and the related agents in this class of widely used
drugs inhibit the 5A isoform of phosphodiesterase, an enzyme
that degrades cGMP, resulting in increased levels of this intercellular
signaling molecule. Although it is well known that cGMP is a
potent vasodilator, the role of cGMP in regulating myocardial
function has not been as clear. This study found that a single
administration of sildenafil blunted the systolic contractile
response to ß-adrenergic receptor stimulation in patients.
These findings suggest that cGMP opposes ß-adrenergic
signaling in the human myocardium and can cause a measurable
decrement in systolic function. The clinical implications of
this finding remain to be determined. See p
2642.
Visit http://www.circ.ahajournals.org:
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Cardiology Patient Page
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Heart Attack and Stroke Prevention in Women. See p
e273.
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Images in Cardiovascular Medicine
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Carotid Plaque Reduction After Medical Treatment. See p
e276.
Renal Fibromuscular Dysplasia. See p e278.
Functional Subclavian Artery Compression Caused by Thoracic Outlet Syndrome. See p e280.
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Correspondence
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See p
e282.
Related Articles:
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Hybrid Approaches to Thoracic Aortic Aneurysms: The Role of Endovascular Elephant Trunk Completion
- Roy K. Greenberg, Fady Haddad, Lars Svensson, Sean O’Neill, Esteban Walker, Sean P. Lyden, Daniel Clair, and Bruce Lytle
Circulation 2005 112: 2619-2626.
[Abstract]
[Full Text]
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Mortality After Acute Myocardial Infarction in Hospitals That Disproportionately Treat Black Patients
- Jonathan Skinner, Amitabh Chandra, Douglas Staiger, Julie Lee, and Mark McClellan
Circulation 2005 112: 2634-2641.
[Abstract]
[Full Text]
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Sildenafil Inhibits ß-Adrenergic–Stimulated Cardiac Contractility in Humans
- Barry A. Borlaug, Vojtech Melenovsky, Tricia Marhin, Patricia Fitzgerald, and David A. Kass
Circulation 2005 112: 2642-2649.
[Abstract]
[Full Text]
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Heart Attack and Stroke Prevention in Women
- Richard C. Becker
Circulation 2005 112: e273-e275.
[Full Text]
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Carotid Plaque Reduction After Medical Treatment
- Gilda Stivali, Franca Cerroni, Palma Bianco, Pamela Fiaschetti, and Rosario Cianci
Circulation 2005 112: e276-e277.
[Full Text]
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Renal Fibromuscular Dysplasia
- D. P. McLaughlin, R. V. Kelly, R. A. Santa-Cruz, and G. A. Stouffer
Circulation 2005 112: e278-e279.
[Full Text]
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Functional Subclavian Artery Compression Caused by Thoracic Outlet Syndrome
- Gianluca Rigatelli, Massimo Rinuncini, Loris Roncon, Massimo Giordan, and Pietro Zonzin
Circulation 2005 112: e280-e281.
[Full Text]
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Letters Regarding Article by Patti et al, "Randomized Trial of High Loading Dose of Clopidogrel for Reduction of Periprocedural Myocardial Infarction in Patients Undergoing Coronary Intervention: Results From the ARMYDA-2 (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) Study" • Response
- Pierluigi Tricoci, Robert A. Harrington, Marco Valgimigli, Theresa M. Palabrica, Paul B. Burton, Giuseppe Patti, Leonardo Lassandro Pepe, Germano Di Sciascio, Giuseppe Colonna, Antonio Montinaro, and Vincenzo Pasceri
Circulation 2005 112: e282-e283.
[Full Text]
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