Circulation. 2007;116:231
doi: 10.1161/CIRCULATIONAHA.107.183536
(Circulation. 2007;116:231.)
© 2007 American Heart Association, Inc.
Issue Highlights
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PHOSPHODIESTERASE TYPE 5 IS HIGHLY EXPRESSED IN THE HYPERTROPHIED HUMAN RIGHT VENTRICLE, AND ACUTE INHIBITION OF PHOSPHODIESTERASE TYPE 5 IMPROVES CONTRACTILITY, by Nagendran et al.
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The beneficial effects of phosphodiesterase type 5 (PDE5) inhibitors
in patients with pulmonary hypertension have been attributed
to the inhibitors’ vasodilatory and antiproliferative
actions in the pulmonary vasculature. Nagendran et al found
that PDE5, which is not expressed in normal myocardium, is upregulated
in failing human right ventricular myocardium and also in hypertrophied
right ventricle in a rat. PDE5 inhibition with sildenafil increased
contractility in both a perfused heart preparation and in isolated
cardiac myocytes from hypertrophied, but not normal, right ventricle.
The investigators further relate this inotropic effect to cGMP-mediated
inhibition of PDE3, which in turn increases cAMP levels. These
unanticipated actions of PDE5 inhibition in the hypertrophied
right ventricle may contribute to the clinical benefits of PDE5
inhibitors. See p 238 (editorial p
233).
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MOLECULAR IMAGING OF INFLAMMATION IN ATHEROSCLEROSIS WITH TARGETED ULTRASOUND DETECTION OF VASCULAR CELL ADHESION MOLECULE-1, by Kaufmann et al.
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The inflammatory component of atherosclerosis has proven difficult
to evaluate in vivo. A noninvasive method of imaging the extent
of vascular inflammation could help to define the initiation
of atherosclerosis and potentially contribute to our understanding
of plaque vulnerability. Kaufmann and colleagues use contrast-enhanced
ultrasound to demonstrate that vascular cell adhesion molecule-1–targeted
microbubbles attach to cultured endothelial cells and then further
demonstrate attachment of these microbubbles to the aorta of
apolipoprotein-E deficient mice. They also show the contrast-enhanced
ultrasound videointensity correlates with the extent of vascular
cell adhesion molecule-1–positive plaque formation. This
provocative animal study is an exciting foray into this area
of investigation and offers the potential to diagnose and track
various stages of atherosclerosis with molecular imaging using
contrast ultrasound. See p
276.
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NITINOL STENT IMPLANTATION VERSUS PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY IN SUPERFICIAL FEMORAL ARTERY LESIONS UP TO 10 CM IN LENGTH: THE FEMORAL ARTERY STENTING TRIAL (FAST), by Krankenberg et al.
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The interventional management of intermittent claudication due
to superficial femoral artery disease remains controversial.
Although percutaneous transluminal balloon angioplasty (PTA)
is preferred by some, recent trials have suggested superior
outcomes with stenting. This multicenter randomized trial compared
the outcome of a single nitinol stent versus PTA in 244 patients
with superficial femoral artery disease and chronic limb ischemia.
Technical success was more common with stenting (95% versus
79%), resulting in a crossover rate of 11% in the PTA group.
At 1 year, the primary end point of ultrasound-determined restenosis
was not different between groups (38.6% versus 31.7%); likewise,
target vessel revascularization was also not different. The
trial did not demonstrate any differences between stent placement
and PTA, although there was a trend toward an advantage of stenting
in patients with diabetes and chronic occlusions. As the trial
was sized to determine a 20% difference, larger trials would
be needed to determine smaller differences. See p
285.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Subacute Thrombotic Occlusion and Spontaneous Recanalization
of the Right Coronary Artery After Percutaneous Coronary Intervention
for ST-Elevation Myocardial Infarction Visualized by Coronary
Angiography and Cardiac Magnetic Resonance Imaging. See p
e78.
Multiple Coronary Artery–Left Ventricular Microfistulae and Spongy Myocardium: The Eagerly Awaited Link? See p e81.
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Correspondence
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See p
e85.
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Hypertrophied Right Hearts Get Two for the Price of One: Can Inhibiting Phosphodiesterase Type 5 Also Inhibit Phosphodiesterase Type 3?
- David A. Kass
Circulation 2007 116: 233-235.
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Subacute Thrombotic Occlusion and Spontaneous Recanalization of the Right Coronary Artery After Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Visualized by Coronary Angiography and Cardiac Magnetic Resonance Imaging
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Circulation 2007 116: e78-e80.
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Circulation 2007 116: e81-e84.
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Letter by Zitterman et al Regarding Article, "Calcium/Vitamin D Supplementation and Cardiovascular Events"
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Circulation 2007 116: e85.
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Molecular Imaging of Inflammation in Atherosclerosis With Targeted Ultrasound Detection of Vascular Cell Adhesion Molecule-1
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Circulation 2007 116: 276-284.
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Nitinol Stent Implantation Versus Percutaneous Transluminal Angioplasty in Superficial Femoral Artery Lesions up to 10 cm in Length: The Femoral Artery Stenting Trial (FAST)
- Hans Krankenberg, Michael Schlüter, Hermann J. Steinkamp, Karlheinz Bürgelin, Dierk Scheinert, Karl-Ludwig Schulte, Erich Minar, Patrick Peeters, Marc Bosiers, Gunnar Tepe, Bernhard Reimers, Felix Mahler, Thilo Tübler, and Thomas Zeller
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