Circulation. 2007;116:125
doi: 10.1161/CIRCULATIONAHA.107.183535
(Circulation. 2007;116:125.)
© 2007 American Heart Association, Inc.
Issue Highlights
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PREVALENCE AND PROGNOSTIC SIGNIFICANCE OF WALL-MOTION ABNORMALITIES IN ADULTS WITHOUT CLINICALLY RECOGNIZED CARDIOVASCULAR DISEASE: THE STRONG HEART STUDY, by Cicala et al.
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Although it has been established that asymptomatic left ventricular
systolic dysfunction predicts worse prognosis, the prognosis
of regional-wall motion abnormalities in individuals without
known cardiovascular disease has been uncertain. Cicala and
colleagues examined the Strong Heart Study, an American Indian
population--based cohort, to address the outcome of echocardiographic
wall-motion abnormalities in previously undiagnosed cardiovascular
disease. They observed that 5% of individuals had segmental
and 1.5% had global wall-motion abnormalities by echocardiography.
Not surprisingly, participants with segmental wall-motion abnormalities
had a higher prevalence of cardiovascular disease risk factors,
including diabetes and higher blood pressure, C-reactive protein,
creatinine, and albuminuria. In 8 years of follow-up, those
with either regional or global wall-motion abnormalities had
an adjusted 2- to 3-fold increased risk of cardiovascular events
and death. The present study is consistent with many previous
studies suggesting that indicators of subclinical disease are
associated with worse prognosis. The optimal management of indicators
of silent ischemia is controversial and is not addressed by
the present study. However, in the absence of data specifically
addressing clinically unrecognized cardiovascular disease, strict
adherence to guideline-based preventive therapy is indicated
with evidence of subclinical disease. See p 143 (editorial p
126).
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FAVORABLE LONG-TERM OUTCOME AFTER DRUG-ELUTING STENT IMPLANTATION IN NONBIFURCATION LESIONS THAT INVOLVE UNPROTECTED LEFT MAIN CORONARY ARTERY: A MULTICENTER REGISTRY, by Chieffo et al.
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Surgery is the treatment of choice for unprotected left main
coronary artery disease, but percutaneous intervention using
drug-eluting stents is increasingly being used. Stenting of
the ostium or body of the left main coronary artery is technically
easier and usually only requires 1 stent; however, the short-
and long-term outcome of these patients is not known. The study
by Chieffo and colleagues evaluated 147 consecutive patients
from 5 centers with stenosis in the ostium and/or the body of
the left main coronary artery not involving the bifurcation.
Technical success occurred in 99% of the patients, and there
was only 1 death in the first 30 days. At long-term clinical
follow-up (886±308 days), 5 patients died and 7 required
target vessel revascularization. The present study demonstrates
that drug-eluting stent implantation in patients with unprotected
nonbifurcation left main coronary artery disease is safe and
has a favorable long-term outcome. The study supports the need
for a randomized clinical trial in order to compare outcomes
of coronary intervention with drug-eluting stents versus coronary
artery bypass surgery. See p
158.
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OXIDANT STRESS IMPAIRS IN VIVO REENDOTHELIALIZATION CAPACITY OF ENDOTHELIAL PROGENITOR CELLS FROM PATIENTS WITH TYPE 2 DIABETES MELLITUS: RESTORATION BY THE PEROXISOME PROLIFERATOR-ACTIVATED RECEPTOR- AGONIST ROSIGLITAZONE, by Sorrentino et al.
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Diabetes mellitus is often complicated by peripheral arterial
disease, resulting in significant morbidity because of an increased
need for revascularization procedures or limb amputation. In
diabetes, advanced peripheral arterial disease results from
accelerated atherosclerosis as well as impaired vascular repair
processes. Endothelial progenitor cells (EPCs), resident in
the bone marrow and released in response to vascular injury
or tissue ischemia, have been shown to effect vascular repair.
Although insufficient numbers of circulating EPCs have been
associated with vascular dysfunction and adverse clinical outcomes,
EPC function has also been shown to play a significant role
in vascular repair. In diabetes mellitus, EPCs are dysfunctional
and exhibit aberrant migration and tube formation capacity;
however, the mechanism underlying this dysfunctional state remains
largely unknown. In this issue of
Circulation, Sorrentino et
al examine EPC function in cells isolated from patients randomized
to rosiglitazone or placebo and provide mechanistic insight
into EPC dysfunction associated with diabetes mellitus. See
p
163.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Percutaneous Coronary Intervention of Chronic Total Occlusion
With Retrograde Approach: Follow-Up by Cardiovascular Magnetic
Resonance Imaging. See p
e22.
Mitochondrial Cardiomyopathy Evaluated With Cardiac Magnetic Resonance. See p e25.
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Correspondence
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See p
e27.
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