Volume 5 Issue 10, October 2008

Patients with asymptomatic, severe aortic stenosis are at risk of cardiac death. In this Viewpoint, Pellikka and Sundt assert that aortic valve replacement should be considered in these patients, if surgery is likely to prolong life expectancy. Risk stratification of the asymptomatic aortic stenosis patient remains inadequate, however, and the decision to operate must be individualized, particularly in the elderly. The authors call for a randomized trial to help optimize the selection of patients for surgery.

Results of the STRADIVARIUS and ADAGIO-Lipids trials have fuelled debate about the use of the controversial CB1 receptor antagonist rimonabant. Here, Vincenzo Di Marzo discusses the key findings from these studies and their potential clinical sequelae, and identifies a subgroup of patients who might derive the most benefit from this drug.

How should trial-derived evidence be interpreted so that findings can be applied directly in patient care? By understanding study design and statistical methodology, the results of observational studies, prospective randomized trials, and registry studies can be reconciled. Here Brown and coworkers examine different study designs and their impact on the interpretation of data.

Despite the wealth of research into C-reactive protein (CRP), it remains unclear which patient populations would benefit from and should be targeted for high-sensitivity assay CRP testing. In this important Review, Musunuru et al. address the relevance of CRP in a variety of scenarios encountered in clinical practice—from primary prevention of cardiovascular disease, stroke and diabetes mellitus, to secondary prevention of cardiovascular disease.

Tohru Minamino and Issei Komuro examine the research on age-associated vascular pathophysiology at the cellular level, specifically telomere shortening, DNA damage and the replicative ability of cardiovascular cells, particularly stem cells or progenitor cells. They explore vascular senescence in the context of human progeroid syndromes and what the future holds for the treatment of age-associated vascular disease.

Device infection is devastating in individuals with permanent pacemakers or implantable cardioverter-defibrillators. In this month's Case Study, Simon and colleagues present a patient who had a duel pacemaker lead infection and tricuspid valve endocarditis. They examine the best course of action for this serious complication.

Cardiac rehabilitation, in most developed countries, is a proven means of reducing mortality but it is grossly underutilized owing to factors involving both the health system and patients. These issues have not been investigated concurrently. In this paper the authors describe a prospective study with a multilevel design to show that the most relevant physician perceptions of such programs are program quality and perceived benefit. For patients, they are barriers to cardiac rehabilitation, which might be conveyed during pre-referral discussions. Work to improve physicians' perceptions and patients' understanding of rehabilitation services might improve use.

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.