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Patient-prosthesis mismatch (PPM) is common after aortic valve replacement and has been shown to be associated with poor hemodynamic and symptomatic status, a high rate of cardiac events, and increased mortality. In this article, Philippe Pibarot and Jean G. Dumesnil highlight the importance of defining and recognizing PPM and its clinical impact. They also assert that, because PPM is a predictable and modifiable risk factor, it is vital to identify susceptible patients and to apply preventive strategies to avoid PPM or reduce its severity.
Aspirin can effectively prevent arterial thrombosis; however, its efficacy is limited as it inhibits the synthesis of only one platelet agonist (thromboxane A2). Here Raju and colleagues review agents that target ADP-mediated platelet activation. They examine controversies and unresolved issues associated with clopidogrel—the optimum loading dose, duration of treatment and incomplete platelet inhibition—and the new ADP-receptor antagonists prasugrel, AZD6140 and cangrelor, and explore their potential relative to each other and to clopidogrel.
Atrial fibrillation is characterized by structural remodeling of the atrial myocardium—a slow process that comprises morphological changes that affect atrial myocardial architecture and atrial ultrastructure. Here Corradi et al. examine the morphological changes that characterize the fibrillating atrial myocardium at histological and ultrastructural levels, and explore how the pathogenetic mechanisms involved in AF could lead to new treatments.
Vascular complications following cancer treatment are relatively common, particularly in patients with advanced stages of cancer. In this Review, Dr Daher and Dr Yeh describe the vascular complications of treatment with 5-fluorouracil, bevacizumab, and several new tyrosine kinase inhibitors, with special emphasis on thrombotic complications and hypertension.
Ramcharitar and colleagues present an interesting case of a patient with drug-refractory hypertrophic obstructive cardiomyopathy and NYHA class II–III heart failure who was treated with septal coil embolization. This article demonstrates, for the first time, the acute changes in hemodynamics that occur following septal coil embolization, and shows that this treatment is a viable alternative to percutaneous coronary intervention.
Mitochondria of circulating white blood cells (WBC) and platelets sense oxidative stress during capillary passage and react by producing reactive oxygen species (ROS). Evidence indicates that congestive heart failure (CHF) is associated with oxidative stress; however, the role of WBC and platelets as mediators in CHF has not been investigated. In this paper the authors conducted an observational study to investigate the degree of oxidation in WBC and platelets in patients with CHF and healthy volunteers. Their data shows that in CHF, the proportion of WBC and platelets that are ROS positive is raised. The raised numbers of circulating ROS-positive WBC and platelets amplify oxidative stress in CHF.
Aortic dilatation is common among adults with bicuspid aortic valves (BAV). Predictors of risk and progression of aortic dilatation are not well described in this setting. In this retrospective analysis the authors study data on the presence of dilation in several aortic segments in 156 adult patients with BAV who had serial echocardiograms performed at least 1 year apart. Their data shows that patients with BAV and increased age, high body surface area, and moderate to severe aortic regurgitation are more likely to have a dilated aorta. Patients with right-to-left leaflet fusion are at increased risk of rapid aortic dilatation.
