Volume 6 Issue 3, March 2009

Valve-sparing aortic root replacement in patients with Marfan syndrome avoids the complications of a prosthetic heart valve, particularly life-long anticoagulation therapy. Despite proven durability and excellent event-free survival, the majority of cardiac surgeons have not adopted this approach. Here, Stephen Westaby suggests that the time is right for a change in the surgical guidelines and explains that an early, elective valve-sparing operation can transform the long-term prognosis of patients with Marfan syndrome.

Renal artery stenosis (RAS) is common among patients with atherosclerosis. In this Review, Drs White and Olin outline the clinical problem of atherosclerotic RAS and its diagnosis, and critically assess treatment options and strategies to improve patient outcomes.

Understanding the mechanism by which hypertension induces vascular disease is important for the prevention of this adverse process. In this Review, Dr Rabkin examines the data on interleukin 18 involvement in the pathogenesis of hypertension-induced vascular disease.

Imaging of atheromatous plaques can provide important information about the natural history and progression of atherosclerotic disease and can help inform treatment decisions. Here, Umar Sadat and colleagues review various noninvasive imaging techniques for the clinical assessment of carotid plaques, including radionuclide imaging, CT, and MRI.

In this month's Case Study, George and colleagues present a case of antiphospholipid syndrome. The IgG anti-β₂GPI antibodies isolated from this patient enhanced experimental atherosclerosis and attenuated plaque stability in apolipoprotein-E-knockout mice.

Early detection of atherosclerosis is beneficial but the reliability of imaging techniques is unclear. This study assesses reproducibility for black-blood MRI measurement of atherosclerotic burden in the left and right carotid arteries and the thoracic descending aorta. The results suggest that measurement of some MRI parameters is reliable, and the researchers recommend further investigation of their value for predicting cardiovascular disease.

Elevated lipoprotein (a) concentrations are associated with atherothrombotic complications of coronary artery disease. In this study, combined lipid apheresis and lipid-lowering medication was efficacious in reducing extremely high levels of lipoprotein (a), and thus in preventing major adverse coronary events, in patients in whom maximally tolerated doses of medication alone had failed to control events associated with coronary artery disease.

Cardiac tissue engineering could be useful for replacement and/or repair of diseased or malformed cardiac tissue. The creation of functional, biocompatible contractile tissues, however, remains challenging. These investigators report a novel method of engineering a highly effective collagen-cell scaffold based on arginine–glycine–aspartic acid–serine peptides cross-linked to a clinically approved collagen matrix.

Apoptosis contributes notably to the pathogenesis of heart failure, but these investigators found that upregulation of endogenous antiapoptotic mechanisms counterbalance the death-receptor and mitochondrial apoptotic pathways. Concurrent activation of antiapoptotic factors can interrupt the apoptotic cascade, prevent cell loss despite the presence of multiple proapoptotic factors, and could offer an opportunity for therapeutic intervention.