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Augoustides et al. present a risk stratification system based on ischemic pattern at presentation in patients with acute type A aortic dissection. The authors believe that, with further validation, the Penn classification system could be used to identify high-risk groups of patients for further intervention and to facilitate future trial design.
Coronary allograft vasculopathy is a severe complication of heart transplantation. In this paper, the authors used virtual histology intravascular ultrasound to characterize plaque burden and tissue composition over time in vessels of heart transplant recipients. Knowledge of the relationship between changes in plaque composition and clinical outcome might facilitate identification of high-risk patients who require more aggressive medical therapy.
Combined intracoronary and intramyocardial administration might improve outcomes for bone-marrow-derived stem cell therapy for acute myocardial infarction. In this paper patients with left ventricular ejection fraction less than 45% after acute myocardial infarction were randomly assigned stem cell delivery via intramyocardial injection and intracoronary infusion 3–6 weeks or 3–4 months after AMI. Their data shows that combined cardiac stem cell delivery induces a moderate but significant improvement in myocardial infarct size and left ventricular function.
Mitochondria of circulating white blood cells (WBC) and platelets sense oxidative stress during capillary passage and react by producing reactive oxygen species (ROS). Evidence indicates that congestive heart failure (CHF) is associated with oxidative stress; however, the role of WBC and platelets as mediators in CHF has not been investigated. In this paper the authors conducted an observational study to investigate the degree of oxidation in WBC and platelets in patients with CHF and healthy volunteers. Their data shows that in CHF, the proportion of WBC and platelets that are ROS positive is raised. The raised numbers of circulating ROS-positive WBC and platelets amplify oxidative stress in CHF.
Aortic dilatation is common among adults with bicuspid aortic valves (BAV). Predictors of risk and progression of aortic dilatation are not well described in this setting. In this retrospective analysis the authors study data on the presence of dilation in several aortic segments in 156 adult patients with BAV who had serial echocardiograms performed at least 1 year apart. Their data shows that patients with BAV and increased age, high body surface area, and moderate to severe aortic regurgitation are more likely to have a dilated aorta. Patients with right-to-left leaflet fusion are at increased risk of rapid aortic dilatation.
Because octogenarian patients have not been adequately represented in randomized trials comparing CABG and PCI, the most appropriate method of revascularization for this group of patients has not been determined. In this paper the authors performed a systematic review and a meta-analysis of 66 studies of coronary revascularization in patients aged over 80 years. Their data shows that revascularization can be performed in octogenarians with acceptable short-term and long-term outcomes. Furthermore, it is unclear whether octogenarians derive greater survival benefit from CABG or from PCI because preprocedural risk profiles differ between intervention types.
Several known candidate gene variants are useful markers for diagnosing hyperlipoproteinemia. In this paper the authors evaluate the association of two commonAPOA5 single-nucleotide polymorphisms across the range of classic hyperlipoproteinemia phenotypes. Their data shows that a high proportion of patients with four classic hyperlipoproteinemia phenotypes are carriers of either the APOA5S19W or −1131T>C variant or both. The authors conclude that these two variants are robust genetic biomarkers of a range of clinical hyperlipoproteinemia phenotypes linked by hypertriglyceridemia.
Studies of the transplantation of autologous bone marrow cells (BMCs) in patients with chronic ischemic heart disease have assessed effects on viable, peri-infarct tissue. In this paper the authors conducted a single-blinded, randomized, controlled study to investigate whether intramuscular or intracoronary administration of BMCs into nonviable scarred myocardium during CABG improves contractile function of scar segments compared with CABG alone. Their data shows that injection of autologous BMCs directly into the scar or into the artery supplying the scar is safe but does not improve contractility of nonviable scarred myocardium, reduce scar size, or improve left ventricular function more than CABG alone.