Circulation. 2006;113:2473
(Circulation. 2006;113:2473.)
© 2006 American Heart Association, Inc.
Issue Highlights
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IMPACT OF TRANSFORMING GROWTH FACTOR-ß1 ON ATRIOVENTRICULAR NODE CONDUCTION MODIFICATION BY INJECTED AUTOLOGOUS FIBROBLASTS IN THE CANINE HEART, by Bunch et al.
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Pharmacological treatment of atrial fibrillation using antiarrhythmic
agents or ventricular rate control is challenging because of
variable success and medication side effects. Catheter ablation
also is not 100% successful and carries the risk of procedural
complications. In this issue of
Circulation, Bunch and colleagues
describe a technique of percutaneously injecting cultured fibroblasts
from skin biopsies to modulate atrioventricular (AV) nodal conduction
and rate control in a canine model. Using electroanatomic mapping
and intracardiac echocardiography to guide delivery, they injected
fibroblasts (with or without transforming growth factor-ß1)
through a NOGA catheter at several AV nodal input regions. Regulation
of AV nodal conduction and ventricular rate reduction during
induced atrial fibrillation was observed and was more pronounced
in dogs receiving transforming growth factor-ß1–treated
fibroblast injections. There were no major complications or
long-term high-grade AV block. Local cell delivery may eventually
be a potential therapeutic option, perhaps combined with medication
and/or device therapy to modulate ventricular rate control during
atrial arrhythmias. See p 2485 (and editorial on p
2474).
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ENHANCED VENTRICULAR UNTWISTING DURING EXERCISE: A MECHANISTIC MANIFESTATION OF ELASTIC RECOIL DESCRIBED BY DOPPLER TISSUE IMAGING, by Notomi et al.
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Classical concepts of myocardial function learned by all cardiologists
center around pressure-volume relationships in the right and
left ventricles. It is important to realize, however, that the
sequence and pattern of contraction of the 2 ventricles is different:
The right ventricle contracts more like a bellows, but the left
ventricle undergoes a complex cycle of twisting and untwisting
in systole and diastole. Notomi et al provide a detailed analysis
of left ventricular (LV) untwisting both at rest and during
exercise using Doppler tissue imaging. Although healthy volunteers
enhance the rate of untwisting during exercise, thus increasing
the diastolic intraventricular pressure gradient (facilitating
LV "suction"), patients with hypertrophic cardiomyopathy have
a blunted untwisting response to exercise. The new insights
into the dynamic relationship between LV systolic and diastolic
function described in this paper offer new tools for evaluating
diastolic LV function in a variety of cardiovascular disease
states and potentially monitoring the response to therapy. See
p
2524.
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PERCUTANEOUS TREATMENT WITH DRUG-ELUTING STENT IMPLANTATION VERSUS BYPASS SURGERY FOR UNPROTECTED LEFT MAIN STENOSIS: A SINGLE-CENTER EXPERIENCE, by Chieffo et al.
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Coronary artery bypass grafting (CABG) is the preferred revascularization
strategy for left main coronary artery (LMCA) disease. Improvements
in results with percutaneous coronary intervention (PCI) with
drug-eluting stents (DES) have led interventional cardiologists
to perform unprotected LMCA procedures. Clinical trial evidence
supporting such an approach is lacking, however. In this issue
of
Circulation, Chieffo et al report the single-center retrospective
experience in patients with LMCA stenosis treated with PCI and
DES (n=107) or CABG (n=142). At 1 year, there was no difference
in the degree of protection against death, stroke, myocardial
infarction, and revascularization between PCI with DES and CABG
for LMCA disease. These results support the need for randomized
trials with longer clinical follow-up to define optimal revascularization
strategies for LMCA disease. See p
2542.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Untreated 37-Year-Old Homozygous Familial Hypercholesterolemic
Smoker. See p
e777.
Near Sudden Death From Cardiac Lipoma in an Adolescent. See p e778.
Left Ventricular Pseudoaneurysm: A Late Complication of Low-Energy DC Ablation. See p e780.
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Correspondence
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See p
e782.
Related Articles:
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Cell Therapy for Rate Control in Atrial Fibrillation: A New Approach to an Old Problem
- Kevin F. Kwaku
Circulation 2006 113: 2474-2476.
[Extract]
[Full Text]
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Untreated 37-Year-Old Homozygous Familial Hypercholesterolemic Smoker
- Stephen L. Archer, Ian Paterson, and Gordon A. Francis
Circulation 2006 113: e777.
[Extract]
[Full Text]
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Near Sudden Death From Cardiac Lipoma in an Adolescent
- Mark K. Friedberg, Irene L. Chang, Norman H. Silverman, Chandra Ramamoorthy, and Frandics P. Chan
Circulation 2006 113: e778-e779.
[Extract]
[Full Text]
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Left Ventricular Pseudoaneurysm: A Late Complication of Low-Energy DC Ablation
- Fadi Mansour, Arsène J. Basmadjian, Denis Bouchard, Reda Ibrahim, Peter G. Guerra, and Paul Khairy
Circulation 2006 113: e780-e781.
[Extract]
[Full Text]
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Letter by Williams and Tabas Regarding Article "Atherosclerosis 2005: Recent Discoveries and Novel Hypotheses"
- Kevin Jon Williams and Ira Tabas
Circulation 2006 113: e782.
[Extract]
[Full Text]
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Percutaneous Treatment With Drug-Eluting Stent Implantation Versus Bypass Surgery for Unprotected Left Main Stenosis: A Single-Center Experience
- Alaide Chieffo, Nuccia Morici, Francesco Maisano, Erminio Bonizzoni, John Cosgrave, Matteo Montorfano, Flavio Airoldi, Mauro Carlino, Iassen Michev, Gloria Melzi, Giuseppe Sangiorgi, Ottavio Alfieri, and Antonio Colombo
Circulation 2006 113: 2542-2547.
[Abstract]
[Full Text]
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Enhanced Ventricular Untwisting During Exercise: A Mechanistic Manifestation of Elastic Recoil Described by Doppler Tissue Imaging
- Yuichi Notomi, Maureen G. Martin-Miklovic, Stephanie J. Oryszak, Takahiro Shiota, Dimitri Deserranno, Zoran B. Popovic, Mario J. Garcia, Neil L. Greenberg, and James D. Thomas
Circulation 2006 113: 2524-2533.
[Abstract]
[Full Text]
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IMPACT OF TRANSFORMING GROWTH...
ENHANCED VENTRICULAR UNTWISTING...