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(Circulation. 2005;112:449.)
© 2005 American Heart Association, Inc.

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	PERCUTANEOUS VERSUS SURGICAL TREATMENT FOR PATIENTS WITH HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY AND ENLARGED ANTERIOR MITRAL VALVE LEAFLETS, by van der Lee et al.

 
Surgical myectomy is an accepted therapy for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM). When this condition is accompanied by enlargement of the anterior mitral valve leaflet, combining myectomy with mitral leaflet extension reduces the postoperative aortic outflow gradient and mitral regurgitation. Percutaneous transluminal septal myocardial ablation by alcohol injection into the septal coronary arteries is emerging as an alternative treatment for HOCM. In this issue of Circulation, van der Lee and colleagues compared outcome after percutaneous ablation in 43 patients with HOCM and enlargement of the anterior mitral valve leaflet to the outcomes of 29 historical control patients who were treated surgically. The authors report that percutaneous treatment is associated with more periprocedural complications and greater need for a second intervention, providing evidence that the surgical approach might be preferred in such patients. See p 482.

	ELEVATED HIGH-DENSITY LIPOPROTEIN CHOLESTEROL LEVELS ARE PROTECTIVE AGAINST PLAQUE PROGRESSION: A FOLLOW-UP STUDY OF 1952 PERSONS WITH CAROTID ATHEROSCLEROSIS: THE TROMSØ STUDY, by Johnson et al.

 
Carotid intimal medial thickness and carotid plaques are important markers of subclinical atherosclerosis. Whereas studies have evaluated cross-sectional relations of carotid plaques, data on correlates of plaque progression/growth are lacking. In this issue of Circulation, Johnsen and colleagues performed serial carotid ultrasonography on participants in the community-based Tromso Study. The investigators evaluated determinants of change in the size (area) and echogenicity of carotid plaques prospectively. Higher age, systolic blood pressure, and smoking and lower high-density lipoprotein (HDL) cholesterol were key correlates of plaque growth. Additionally, greater plaque echogenicity at baseline was associated with less growth over time. Thus, the study demonstrates the feasibility of assessing carotid plaque growth and changes . . . [Full Text of this Article]