Apr-04

Dear Readers, This issue of The Journal of Invasive Cardiology includes original research articles, commentaries, case reports and brief reviews, and articles from the journal special sections “Intervention in Peripheral Vascular Disease,” “Clinical Decision Making” and “Practice Management.” The first research article, Dr. Dominick Angiolillo and collaborators from the Interventional Cardiology Unit – Cardiovascular Institute at San Carlos Hospital in Madrid, Spain, describe their study to determine if the loading dose of clopidogrel should be weight-adjusted according to body mass index. Using platelet aggregation analysis, they demonstrated that overweight patients may require a higher dose to achieve therapeutic results. Drs. Manesh Patel and Eric Peterson, from the Duke Clinical Research in Durham, North Carolina, have provided a commentary that further discusses the issues surrounding weight adjustment for clopidogrel dosing. Dr. Douglas Ebersole and associates from the Watson Clinic in Lakeland, Florida, describe their experience in using excimer laser therapy to revascularize saphenous vein grafts associated with acute myocardial infarction. They found that this approach was successful in a majority of patients with a low rate of distal embolization and no-reflow, suggesting that this treatment is effective and may not require the use of distal protection devices. In the next research article, submitted by Dr. Michael Fischi and collaborators from the American Cardiovascular Research Institute in Atlanta and Duke University Medical Center in Durham, is a study to assess the impact of intra-aortic balloon counterpulsation on coronary, renal and aortic blood flow in a juvenile pigs heart failure model. Their study did not yield positive results but the authors speculated in further research. Dr. Morton Kern of the editorial board has provided a commentary on the Fischi et al. article, adding to the discussion on the limitations of the animal model and the need for further research. In the fourth original article, submitted by Dr. Nick Palmer and colleagues from the Cardiothoracic Centre in Liverpool, United Kingdom, the researchers compared complete revascularization of patients with multivessel disease versus a “culprit lesion” strategy. They found that both were effective, but complete revascularization patients had reduced residual angina, fewer re-peat PCI procedures and less need for antianginal therapies, making this the treatment of choice if complete revascularization is possible. The last original research article is also a selection in our special section “Interventions in Peripheral Vascular Disease,” edited by Dr. Frank Criado of the Division of Vascular Surgery at the Union Memorial Hospital /Medstar Health in Baltimore, Maryland. Dr. Gerald Dorros and collaborators have provided a paper showing the potential effect of embolic debris on renal function and survival after renal artery stent revascularization. Dr. Deepak Bhatt of the editorial board has written a commentary to accompany the Dorros et al article and reiterates the importance of the impact of embolization in patients with renal artery disease and the need for therapeutic intervention in these patients. In the “Clinical Decision Making” section, edited by Dr. Michael Sketch from Duke University Medical Center in Durham, North Carolina, Drs. de la Torre, Angiolillo and Antolin present a challenging case for clinical decision-making: a patient with extensive thrombus of a distal anastomosis of a saphenous vein graft. Several members of the editorial board, including Drs. David Ramsdale, John Webb and James Zidar, as well as Drs. Diaz-Sandoval and Jang from the Harvard Medical School, have made excellent comments on the management of this case and provide recommendations for alternative approaches. In the “Practice Management and Economics” section, edited by Dr. Ron Riner of the Riner Consulting Group in St. Louis, Missouri, Dr. Riner has co-authored a manuscript with Mr. Jere Palazzola and associates of the Riner Group, focused on choosing the right cardiovascular delivery model for a hospital. This comprehensive article presents numerous models with extensive analysis of the advantages and short-comings of each, and emphasizes the importance of a hospital finding the approach that best meets the needs of the hospital, its medical staff and local community. This issue of the journal includes several interesting case reports representing unusual clinical situations. Dr. Akram Abu-Ful and colleagues from the Cardiology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University in Beer-Sheva, Israel, present an unusual case involving a patient with isolated right-sided pulsus alternans that resulted from a stuck prosthetic valve. In the next case report, Dr. Sotiria Apostolopoulou and colleagues from the Department of Pediatric Cardiology at the Onassis Cardiac Surgery Center in Athens, Greece, describe their approach using transcatheter embolization of a recanalized coronary artery fistula with the Nit-Occlud device. Drs. Jim, Miu and Siu from Queen Mary Hospital in Hong Kong describe an unusual clinical presentation with PR-Segment elevation in the inferior leads, an atypical electrocardiographic sign of atrial infarction. In the last case, Drs. Venzon, Bromet, and Schaer from Rush University Medical Center in Chicago demonstrate the successful use of corticosteroids in the treatment of a patient with cholesterol crystal embolization to the distal extremity. Two of our case reports this month include brief reviews of the literature. Drs Kaneda, Nakamura, and Fitzgerald from the Stanford University Medical Center encountered a case of intractable radial artery graft spasm after stent implantation which was partially responsive to nominal nitroglycerin therapy. They review the use of IVUS to help provide important diagnostic clues in these situations. And finally, Drs. Trehan, Mukhopadhyay and Rangasetty from the Department of Cardiology, GP Pant Hospital in New Delhi describe a new technique for percutaneous transseptal myocardial ablation which can be done in place of alcohol ablation. And finally, we are pleased to provide a CME Offering this month. Dr. Jahraus and Merigooni from the University of Kentucky College of Medicine in Lexington, Kentucky. Their article provides a discussion of the use of vascular brachytherapy for renal artery in-stent restenosis. It is my hope that all of the articles in this issue of the journal provide information that is useful for cardiovascular specialists in their daily care of patients with cardiovascular disease.