November 2001 Letter to Readers

Dear Readers, This issue of the Journal of Invasive Cardiology includes original research articles, commentaries, a special teaching collection on innovative treatments for valvular heart disease, and articles from the special sections “Clinical Decision Making” and “The Electrophysiology Corner “. The research articles in this issue cover a broad range of topics that touch on important aspects of patient care. The first research article, submitted by Dr. Eric Grassman and collaborators from Loyola University Medical Center (Maywood), Hines Veterans Administration Center (Hines) and Midwest Heart Institute (Downers Grove) in Illinois, presents their randomized trial of a low molecular weight (certoparin) to prevent restenosis following coronary angioplasty. Their study showed that although safe, the drug was not effective in reducing the rate of restenosis compared with the control group. Drs. George Dangas and Ioannis Iakovou from the Lenox Hill Heart and Vascular Institute and Cardiovascular Research Foundation in New York have provided a commentary on the Grassman et al. article. They review previous work in this area and conclude that it is established that low molecular weight heparins are not effective in preventing restenosis and other avenues need to be explored. In the second original research article, Dr. Debabrata Mukherjee and colleagues from the Department of Cardiology at the University of Michigan Health System in Ann Arbor and the Cleveland Clinic Foundation in Cleveland present their study comparing a Nitinol versus a stainless-steel self-expanding stent in carotid intervention. Their study showed that there was no difference in neurological outcomes between the two stents 6 months after hospital discharge. In a commentary on this article, Dr. Antonio Colombo of the Centro Cuore Columbus in Milan, Italy provides a further discussion of the features of self-expanding stents and their utility in treating cerebrovascular disease. In the third original research article, Dr. Nicolas Shammas and associates from the Genesis Heart Institute and the Cardiovascular Medicine Group in Davenport, Iowa present their study examining the effect of aminophylline in protecting against radiocontrast nephropathy in patients undergoing percutaneous angiographic procedures. In their matched control study, patients taking aminophylline did not have significantly lower creatinine changes following angiography compared to the control group. Drs. Krishna Ramanathan and John Webb from the Cardiac Catheterization and Interventional Cardiology Program at St. Paul’s Hospital in Vancouver, British Columbia have provided a commentary on the Shammas et al. article. They review several classes of agents that may be useful in ameliorating contrast-induced nephropathy and reiterate the fact that more large-scale studies need to be conducted in this area. The last original research article, submitted by Dr. Timur Timurkaynak and colleagues from the Department of Cardiology at the Gazi University Medical School in Ankara, Turkey evaluates the use of direct stenting in lesions where angiographically documented thrombus is present. They demonstrate a high rate of success and conclude that this strategy is especially effective in avoiding the no re-flow phenomenon. This issue of the Journal includes a special teaching collection of reports on the treatment of valvular heart disease. In the first report, Drs. Jiri Endrys, Atef Habashy and Nasser Hayat from the Department of Cardiology at the Chest Hospital in Kuwait describe their successful use of balloon mitral valvuloplasty in treating a patient with cardiogenic shock after cardiac arrest. This approach resulted in an excellent outcome for this patient and demonstrates the value of this technique in this extreme clinical situation. In the second report of this teaching collection, Dr. S. Ramamurthy and colleagues from the Cardiothoracic Sciences Center at the All India Institute of Medical Sciences in New Delhi, India describe their adaptation of the Inoue balloon catheter to overcome septal balloon entrapment and difficulty crossing the mitral valve during a balloon mitral valve intervention for severe mitral stenosis. This issue also has articles from two of our special sections. In the Clinical Decision Making section, edited by Dr. Michael Sketch from Duke University Medical Center in Durham, North Carolina, several perspectives are provided for deciding on treatment for a complicated case of a 50-year-old man presenting with angina and, along with other significant coronary disease, has a critical narrowing of the ostium of the second diagonal branch. The perspectives offered demonstrate how these kinds of difficult cases can challenge the decision-making process of clinicians with extensive skill and experience. This issue of the Journal also includes articles from one of our other special sections, the Electrophysiology Corner, edited by Dr. Todd Cohen of the Department of Cardiology at Winthrop-University Hospital in Mineola, New York. Dr. Cohen has invited Dr. Mohammad Saeed and colleagues from the Division of Cardiology at the New England Medical Center in Boston, Massachusetts to discuss the role of invasive electrophysiology testing to provide risk stratification for predicting sudden cardiac death in patients who may be at risk for ventricular tachycardia. Dr. Cohen has also provided an editorial note pointing out the fact that electrophysiology procedures are still evolving and are a moving target, which may influence the role that EP plays in the risk stratification of these patients. This issue is completed with a commentary and brief review submitted by Drs. Yasuhiro Honda and Peter Fitzgerald from the Center for Research in Cardiovascular Intervention at Stanford University. Drs. Honda and Fitzgerald recount the different eras in the development of directional atherectomy and show how there may be current applications of the technique, especially in the situation of debulking prior to stent delivery. It is my hope that all of the articles in this issue of the Journal provide information that is timely and useful for all professionals involved in the delivery of health care to cardiac patients.