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(Circulation. 2006;114:529.)
© 2006 American Heart Association, Inc.

Issue Highlights

	PERFORMANCE OF TOP-RANKED HEART CARE HOSPITALS ON EVIDENCE-BASED PROCESS MEASURES, by Williams et al.

Top PERFORMANCE OF TOP-RANKED HEART... INHIBITION OF UROKINASE-TYPE... TRANSAPICAL TRANSCATHETER AORTIC... Images in Cardiovascular... Correspondence

 
The US News & World Report annual publication of "America’s Best Hospitals" attracts considerable attention each year, but the validity of the ranking is not known. Investigators from the Joint Commission on Accreditation of Healthcare Organizations sought to determine how ranked and unranked hospitals compared on the publicly reported quality-of-care measures for patients admitted with acute myocardial infarction and heart failure. Williams and colleagues compare 41 ranked hospitals and 733 unranked hospitals with respect to their performance on 6 acute myocardial infarction and 4 heart failure process measures. The study determined if the ranked hospitals, in aggregate, performed better and then investigated how well the ranking discriminated between hospitals by their performance. The results provide important information about the value of this popular system. See p 558.

	INHIBITION OF UROKINASE-TYPE PLASMINOGEN ACTIVATOR OR MATRIX METALLOPROTEINASES PREVENTS CARDIAC INJURY AND DYSFUNCTION DURING VIRAL MYOCARDITIS, by Heymans et al.

Top PERFORMANCE OF TOP-RANKED HEART... INHIBITION OF UROKINASE-TYPE... TRANSAPICAL TRANSCATHETER AORTIC... Images in Cardiovascular... Correspondence

 
The mechanisms by which viral myocarditis leads to cardiac injury and failure are not fully understood. In this issue of Circulation, Heymans et al examined the role of the proteinases urokinase-type plasminogen activator (uPA) and matrix metalloproteinases (MMPs) in mediating cardiac inflammation, injury, and subsequent failure during coxsackievirus-B3 induced myocarditis. The expression and activity of uPA and MMP-9 was increased in mice 7 days after infection with coxsackievirus-B3. In mice with deletion of uPA or inhibition of MMPs by adenoviral gene overexpression of tissue inhibitor of metalloproteinases-1, there was decreased cardiac inflammation and reduced myocardial necrosis, decreased cardiac fibrosis at 35 days, and prevention of cardiac dilatation and dysfunction. These data implicate these proteinases in the pathogenesis of viral myocarditis and thereby raise the possibility of new therapeutic interventions. See p 565.

	TRANSAPICAL TRANSCATHETER AORTIC VALVE IMPLANTATION IN HUMANS: INITIAL CLINICAL EXPERIENCE, by Lichtenstein et al.

Top PERFORMANCE OF TOP-RANKED HEART... INHIBITION OF UROKINASE-TYPE... TRANSAPICAL TRANSCATHETER AORTIC... Images in Cardiovascular... Correspondence

 
Surgical aortic valve replacement has been the standard of care for symptomatic patients with severe aortic stenosis. Recently, percutaneous transfemoral aortic valve replacement has been proposed. In this study by Lichtenstein et al, a new technique is reported, in which surgical exposure of the left ventricular apex allows aortic valve replacement of a pericardial valve prosthesis via a direct left ventricular apical puncture. The initial experience in 7 patients is described. All patients were considered too high risk for conventional surgery. The procedure was successful in all with an increase in aortic valve area from 0.7±0.1 cm² to 1.8±0.8 cm². At an average of 87 days follow-up, all patients were alive and doing well. This initial experience suggests that aortic valve replacement via direct left ventricular access without cardiopulmonary bypass is feasible. See p 591.

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	Images in Cardiovascular Medicine

Top PERFORMANCE OF TOP-RANKED HEART... INHIBITION OF UROKINASE-TYPE... TRANSAPICAL TRANSCATHETER AORTIC... Images in Cardiovascular... Correspondence

 
Percutaneous Transluminal Angioplasty for Treatment of Critical Hand Ischemia. See p e232.

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Gastroesophageal Reflux Facilitates Esophageal Imaging During Pulmonary Vein Ablation. See p e235.

Hybrid Cardiac Single Photon Emission Computed Tomography/Computed Tomography Imaging With Myocardial Perfusion Single Photon Emission Computed Tomography and Multidetector Computed Tomography Coronary Angiography for the Assessment of Unstable Angina Pectoris After Coronary Artery Bypass Grafting. See p e237.

	Correspondence

Top PERFORMANCE OF TOP-RANKED HEART... INHIBITION OF UROKINASE-TYPE... TRANSAPICAL TRANSCATHETER AORTIC... Images in Cardiovascular... Correspondence

 
See p e240.

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Percutaneous Transluminal Angioplasty for Treatment of Critical Hand Ischemia

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Circulation 2006 114: e232-e234. [Extract] [Full Text]

Gastroesophageal Reflux Facilitates Esophageal Imaging During Pulmonary Vein Ablation

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Letter Regarding Article by Newby et al, "Long-Term Adherence to Evidence-Based Secondary Prevention Therapies in Coronary Artery Disease"

Matthew R. Jezior and Lance E. Sullenberger
Circulation 2006 114: e240. [Extract] [Full Text]

Inhibition of Urokinase-Type Plasminogen Activator or Matrix Metalloproteinases Prevents Cardiac Injury and Dysfunction During Viral Myocarditis

Stephane Heymans, Matthias Pauschinger, Armando De Palma, Angela Kallwellis-Opara, Susanne Rutschow, Melissa Swinnen, Davy Vanhoutte, Fangye Gao, Raimund Torpai, Andrew H. Baker, Elisabeth Padalko, Johan Neyts, Heinz-Peter Schultheiss, Frans Van de Werf, Peter Carmeliet, and Yigal M. Pinto
Circulation 2006 114: 565-573. [Abstract] [Full Text]

Performance of Top-Ranked Heart Care Hospitals on Evidence-Based Process Measures

Scott C. Williams, Richard G. Koss, David J. Morton, and Jerod M. Loeb
Circulation 2006 114: 558-564. [Abstract] [Full Text]

Transapical Transcatheter Aortic Valve Implantation in Humans: Initial Clinical Experience

Samuel V. Lichtenstein, Anson Cheung, Jian Ye, Christopher R. Thompson, Ronald G. Carere, Sanjeevan Pasupati, and John G. Webb
Circulation 2006 114: 591-596. [Abstract] [Full Text]

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