Nature Clinical Practice Cardiovascular Medicine (Nat Clin Pract Cardiovasc Med)

Publications in this journal

• Article: C-reactive protein and severity of coronary allograft vasculopathy.

  Carlos A Labarrere, John R Woods, Miguel A Ortiz, Gonzalo L Campana
  Nature Clinical Practice Cardiovascular Medicine 04/2009; 6(3):E1; discussion E2.
• Article: How important are health systems in the prevention of cardiovascular and other noncommunicable diseases?

  Sania Nishtar
  Nature Clinical Practice Cardiovascular Medicine 04/2009; 6(3):170-1.
• Article: Mild increase in coronary sinus pressure with coronary sinus reducer stent for treatment of refractory angina.

  Yoav Paz, Amihay Shinfeld
  Nature Clinical Practice Cardiovascular Medicine 04/2009; 6(3):E3.
• Article: Noninvasive imaging of atheromatous carotid plaques.

  Umar Sadat, Zhi-Yong Li, Martin J Graves, Tjun Y Tang, Jonathan H Gillard
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  ABSTRACT: Atherothrombosis is a systemic disease of the arterial wall that affects the carotid, coronary, and peripheral vascular beds, and the aorta. This condition is associated with complications such as stroke, myocardial infarction, and peripheral vascular disease, which usually result from unstable atheromatous plaques. The study of atheromatous plaques can provide useful information about the natural history and progression of the disease, and aid in the selection of appropriate treatment. Plaque imaging can be crucial in achieving this goal. In this Review, we focus on the various noninvasive imaging techniques that are being used for morphological and functional assessment of carotid atheromatous plaques in the clinical setting.
  Nature Clinical Practice Cardiovascular Medicine 04/2009; 6(3):200-9.
• Article: JUPITER strikes earth.

  Valentin Fuster, Sameer Bansilal
  Nature Clinical Practice Cardiovascular Medicine 04/2009; 6(3):159.
• Article: Use of arginine-glycine-aspartic acid adhesion peptides coupled with a new collagen scaffold to engineer a myocardium-like tissue graft.

  O Schussler, C Coirault, M Louis-Tisserand, W Al-Chare, P Oliviero, C Menard, R Michelot, P Bochet, D R Salomon, J C Chachques, A Carpentier, Y Lecarpentier
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  ABSTRACT: Cardiac tissue engineering might be useful in treatment of diseased myocardium or cardiac malformations. The creation of functional, biocompatible contractile tissues, however, remains challenging. We hypothesized that coupling of arginine-glycine-aspartic acid-serine (RGD+) adhesion peptides would improve cardiomyocyte viability and differentiation and contractile performance of collagen-cell scaffolds. Clinically approved collagen scaffolds were functionalized with RGD+ cells and seeded with cardiomyocytes. Contractile performance, cardiomyocyte viability and differentiation were analyzed at days 1 and 8 and/or after culture for 1 month. The method used for the RGD+ cell-collagen scaffold coupling enabled the following features: high coupling yields and complete washout of excess reagent and by-products with no need for chromatography; spectroscopic quantification of RGD+ coupling; a spacer arm of 36 A, a length reported as optimal for RGD+-peptide presentation and favorable for integrin-receptor clustering and subsequent activation. Isotonic and isometric mechanical parameters, either spontaneous or electrostimulated, exhibited good performance in RGD+ constructs. Cell number and viability was increased in RGD+ scaffolds, and we saw good organization of cell contractile apparatus with occurrence of cross-striation. We report a novel method of engineering a highly effective collagen-cell scaffold based on RGD+ peptides cross-linked to a clinically approved collagen matrix. The main advantages were cell contractile performance, cardiomyocyte viability and differentiation.
  Nature Clinical Practice Cardiovascular Medicine 04/2009; 6(3):240-9.
• Article: Concurrent upregulation of endogenous proapoptotic and antiapoptotic factors in failing human hearts.

  Nezam Haider, Eloisa Arbustini, Sudhir Gupta, Han Liu, Navneet Narula, Roger Hajjar, Narain Moorjani, Stephen Westaby, Marc J Semigran, G William Dec, Y Chandrashekhar, Jagat Narula
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  ABSTRACT: Despite widespread activation of proapoptotic stimuli and mediators, the degree of apoptosis in failing hearts is not very high. Endogenous antiapoptotic mechanisms are thought to be triggered by the heart-failure process. We investigated whether activation of endogenous apoptosis inhibitors plays a part when death receptor and mitochondrial apoptotic pathways have been triggered. We evaluated various proapoptotic and antiapoptotic factors in myocardial tissue specimens obtained from normal and explanted end-stage ischemic and dilated cardiomyopathic hearts. Caspases (CASPs) 3, 8 and 9, total and activated Bcl-2 homology domain 3-interacting domain death agonist, the X-linked inhibitor of apoptosis (XIAP), and DNA fragmentation factor (DFF) proteins were analyzed by western blotting. Expression of messenger RNA was measured by reverse-transcription polymerase chain reaction for the XIAP, DIABLO, CFLAR and DFF genes. We also assessed CASP3, CASP8 and CASP9 and DFF activity. Cytochrome c1 localization in myocytes was analyzed by immunohistochemistry and immunoelectron microscopy. We collected myocardial tissue from eight cardiomyopathic hearts and five normal hearts. Cytochrome c1 was released from mitochondria into the cytosol in the cardiomyopathic hearts but CASP9 was not activated. CASP8 activity was increased compared with that in normal myocardium. Although CASP3 was cleaved, activity was not greatly increased because of an increase in XIAP and decrease in DIABLO expression. DFF proteins were conspicuously absent. Concurrent upregulation of endogenous antiapoptotic mechanisms can interrupt the apoptotic cascade and prevents cell loss despite the presence of multiple proapoptotic factors. This period might offer a therapeutic window for restoration of myocardial function in heart failure.
  Nature Clinical Practice Cardiovascular Medicine 04/2009; 6(3):250-61.
• Article: Longitudinal cohort study on the effectiveness of lipid apheresis treatment to reduce high lipoprotein(a) levels and prevent major adverse coronary events.

  Beate R Jaeger, Yvonne Richter, Dorothea Nagel, Franz Heigl, Anja Vogt, Eberhard Roeseler, Klaus Parhofer, Wolfgang Ramlow, Michael Koch, Gerd Utermann, Carlos A Labarrere, Dietrich Seidel
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  ABSTRACT: We investigated in a longitudinal, multicenter, cohort study whether combined lipid apheresis and lipid-lowering medication can reduce extremely high levels of lipoprotein(a) (Lp[a]) and thus prevent major adverse coronary events (MACE) more efficaciously than lipid-lowering medication alone. Eligible patients had coronary artery disease and Lp(a) levels > or =2.14 micromol/l (95th percentile). All patients received lipid-lowering medications alone until maximally tolerated doses were no longer effective, followed by combined lipid apheresis and lipid-lowering medication. The rates of the primary outcome, MACE, were recorded for both periods. A total of 120 patients were included. The mean duration of lipid-lowering therapy alone was 5.6+/-5.8 years, and that of apheresis was 5.0+/-3.6 years. Median Lp(a) concentration was reduced from 4.00 micromol/l to 1.07 micromol/l with apheresis treatment (P<0.0001); the corresponding mean annual MACE rate per patient was 1.056 versus 0.144 (P<0.0001). Lowering of Lp(a) levels by apheresis was efficacious and safe, and we recommend this therapy for patients in whom maximally tolerated doses of medication alone have failed to control coronary artery disease-associated events.
  Nature Clinical Practice Cardiovascular Medicine 04/2009; 6(3):229-39.
• Article: The role of interleukin 18 in the pathogenesis of hypertension-induced vascular disease.

  Simon W Rabkin
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  ABSTRACT: Understanding the mechanism by which chronic high blood pressure induces vascular disease is of fundamental importance for prevention of the adverse consequences of hypertension. Clinical and population studies have consistently found increased circulating levels of interleukin 18 (IL-18) in patients with hypertension. Although obesity, and possibly age, is a determinant of plasma IL-18 levels, the relationship of IL-18 to hypertension seems to be independent of these factors. Experimental evidence indicates that the expression of IL-18 and/or its receptor can be induced by catecholamines or angiotensin, two factors that are involved in the pathophysiology of hypertension. Elevated circulating IL-18 levels are associated with vascular changes in the carotid artery, including increased carotid intima-media thickness, which, in turn, is a predictor of cardiovascular events in patients with established coronary disease. IL-18, either directly or through oxidative stress pathways and matrix metalloproteins, can alter endothelial function or induce vascular smooth muscle cell migration and/or proliferation to produce the vascular changes that occur with hypertension. This Review examines the data on IL-18 and hypertensive vascular disease, and explores the potential cellular and molecular mechanisms that might connect hypertension to vascular disease.
  Nature Clinical Practice Cardiovascular Medicine 04/2009; 6(3):192-9.
• Article: Coronary venous pressure elevation 'risks and benefit'.

  Werner Mohl, Dejan Milasinovic, Günter Steurer
  Nature Clinical Practice Cardiovascular Medicine 04/2009; 6(3):E4.
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  Article: Diagnosis and management of atherosclerotic renal artery stenosis: improving patient selection and outcomes.

  Christopher J White, Jeffrey W Olin
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  ABSTRACT: Renal artery stenosis (RAS) is common among patients with atherosclerosis, and is found in 20-30% of individuals who undergo diagnostic cardiac catheterization. Renal artery duplex ultrasonography is the diagnostic procedure of choice for screening outpatients for RAS. Percutaneous renal artery stent placement is the preferred method of revascularization for hemodynamically significant RAS, and is favored over balloon angioplasty alone. Stent placement carries a class I recommendation for atherosclerotic RAS according to ACC and AHA guidelines. Discordance exists between the very high (>95%) procedural success rate and the moderate (60-70%) clinical response rate after renal stent placement, which is likely to be a result of poor selection of patients, inadequate angiographic assessment of lesion severity, and the presence of renal parencyhmal disease. Physiologic lesion assessment using translesional pressure gradients, and measurements of biomarkers (e.g. brain natriuretic peptide), or both, could enhance the selection of patients and improve clinical response rates. Long-term patency rates for renal stenting are excellent, with 5-year secondary patency rates greater than 90%. This Review will outline the clinical problem of atherosclerotic RAS and its diagnosis, and will critically assess treatment options and strategies to improve patients' outcomes.
  Nature Clinical Practice Cardiovascular Medicine 04/2009; 6(3):176-90.
• Article: Prospective, observational study of antiplatelet and coagulation biomarkers as predictors of thromboembolic events after implantation of ventricular assist devices.

  Farhan Majeed, Willem J Kop, Robert S Poston, Seeta Kallam, Mandeep R Mehra
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  ABSTRACT: Long-term success in ventricular assist device (VAD) recipients is limited by thromboembolic events, the prediction of which remains elusive. We evaluated the predictive value of aspirin hyporesponsiveness and markers of coagulation and fibrinolysis. We prospectively enrolled patients scheduled to undergo VAD implantation between June 2004 and March 2006. Once before surgery, daily during hospitalization, and weekly after discharge we assessed platelet function, measured prothrombin activation fragment 1.2 (F1.2) and plasminogen activator inhibitor-1 (PAI-1) concentrations, and evaluated aspirin hyporesponsiveness by whole-blood aggregometry and thromboelastography. All patients received 325 mg oral aspirin daily from at least 7 days before VAD implantation. Follow-up continued until heart transplantation, death or closure of the database. We included 26 patients (median follow-up 315 days, range 9-833 days). In eight (31%) patients, 14 thromboembolic events occurred at a median of 42 (interquartile range 26-131) days. Only six (43%) events based on whole-blood aggregometry and one (7%) based on thromboelastography coincided with aspirin hyporesponsiveness. Within-patient variability was high for both tests (59% and 567%, respectively). Compared with levels before surgery, PAI-1 concentrations were raised for up to 45 days (P <0.0001) and those of F1.2 for up to 3 days (P = 0.0001) after VAD implantation. PAI-1 and F1.2 levels did not rise significantly further before thromboembolic events. Aspirin hyporesponsiveness was not associated with raised risk of future clinical thromboembolic events after VAD implantation. Impaired fibrinolysis, demonstrated by raised PAI-1 concentrations, might, however, indicate a predisposition to such events early after surgery.
  Nature Clinical Practice Cardiovascular Medicine 03/2009; 6(2):147-57.
• Article: Emergency surgical treatment of advanced endomyocardial fibrosis in Mozambique.

  Ana Olga Mocumbi, Carla Carrilho, Margaret M Burke, Gavin Wright, Magdi H Yacoub
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  ABSTRACT: An 11-year-old girl presented to a specialist cardiac facility in Mozambique. She had severe heart failure and massive cardiac enlargement, herniation of the heart into the epigastrium, atrial fibrillation, signs of severe pulmonary hypertension and a low cardiac output. Chest radiography, echocardiography, 24 h Holter monitoring, and cardiac catheterization. Left and right endomyocardial fibrosis in conjunction with an aneurysmal left atrium, severe heart failure, and atrial fibrillation. Left ventricular endocardiectomy with mobilization of the chordae tendineae, mitral valve repair, tricuspid annuloplasty, and left atrial resection.
  Nature Clinical Practice Cardiovascular Medicine 03/2009; 6(3):210-4.
• Article: Prime time for a polypill after myocardial infarction?

  Valentin Fuster
  Nature Clinical Practice Cardiovascular Medicine 03/2009; 6(2):83.
• Article: Is intravenous recombinant plasminogen activator effective up to 4.5 h after onset of ischemic stroke?

  Peter M Rothwell
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  ABSTRACT: Randomized, controlled trials and subsequent observational studies in routine clinical practice have shown that intravenous recombinant tissue plasminogen activator is safe and effective when used in selected patients within 3h of the onset of acute ischemic stroke. Results of the ECASS III (European Cooperative Acute Stroke Study III) trial have now confirmed the finding of a previous meta-analysis of data from individual patients from smaller trials, which showed that the time-window for benefit actually extends to 4.5h. However, the absolute benefit of treatment falls substantially with time after the onset of ischemic stroke and clinicians should, therefore, still aim to treat patients with intravenous recombinant tissue plasminogen activator within 90 min of stroke onset, if at all possible. Ongoing trials aim to determine whether eligibility for thrombolysis can be extended in other ways, such as to patients aged over 80 years, patients with severe stroke, or patients with lacunar stroke.
  Nature Clinical Practice Cardiovascular Medicine 02/2009; 6(3):164-5.
• Article: The emerging role of cardiovascular magnetic resonance in refining the diagnosis of hypertrophic cardiomyopathy.

  James C Moon, William J McKenna
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  ABSTRACT: Hypertrophic cardiomyopathy (HCM) is a genetically and phenotypically diverse disease with some patients at risk of sudden death or heart failure. Maron et al. used cardiovascular magnetic resonance, in a specialist clinic setting, to identify a cohort of HCM patients with left ventricular apical aneurysms that were not detected by conventional echocardiography. Apical aneurysms were variable in morphology and associated with scarring, thrombus, and the occurrence of monomorphic ventricular tachycardia. Preliminary follow-up data indicate that they could be associated with poor medium-term outcome. The paper by Maron et al. continues the gradual evolution of our understanding of HCM, highlighting an important clinical subset of patients and a phenotypic feature of HCM. The study also identifies cardiovascular magnetic resonance as an important technique for phenotyping cardiac diseases, identifying prognostically important features, and highlighting pathophysiological mechanisms.
  Nature Clinical Practice Cardiovascular Medicine 02/2009; 6(3):166-7.
• Article: A case of coronary artery fistula visualized by 64-slice multidetector CT.

  Francesco Versaci, Costantino Del Giudice, Massimiliano Sperandio, Giovanni Simonetti, Luigi Chiariello
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  ABSTRACT: A 27-year-old woman was admitted to hospital with a 1-year history of mild dyspnea. Physical examination, chest radiography, electrocardiography, transthoracic echocardiography, 64-slice multidetector CT and coronary angiography. Fistula originating from the left anterior coronary artery and draining into the right ventricle, in conjunction with an aneurysm of the left anterior descending artery. Surgical closure of the fistula using normothermic cardiopulmonary bypass.
  Nature Clinical Practice Cardiovascular Medicine 02/2009; 6(1):57-60.
• Article: Diabetes and aspirin: beware of underpowered negative trials.

  Michael E Farkouh, Valentin Fuster
  Nature Clinical Practice Cardiovascular Medicine 02/2009; 6(1):1.
• Article: The Marfan aortic root: time to refine surgical guidelines.

  Stephen Westaby
  Nature Clinical Practice Cardiovascular Medicine 02/2009; 6(3):172-5.