Echo Predicts Mortality in Aortic Stenosis

from AMERICAN SOCIETY OF ECHOCARDIOGRAPHY - 22ND ANNUAL SCIENTIFIC MEETING

Population: Elderly patients with normal LV function & did not undergo Aortic Valve Replacement

Poor survival with

Greater LV concentric remodeling

Lower stroke volume

Elevated LV filling pressures

Elevated PA pressure

Gastric Bypass Does More Than Just Reduce Weight

April 29, 2011 (New York, NY) -- Gastric-bypass surgery may provide benefits to patients with type 2 diabetes beyond the benefits that can be directly attributed to weight loss, a new study finds [1].

According to Dr Blandine Laferrère (St Luke's Roosevelt Hospital, New York, NY) and colleagues, recent studies that show a strong correlation between the concentrations of plasma branched-chain amino acids (BCAAs) and related metabolites with insulin resistance and loss of insulin sensitivity raise the possibility that the rapid remission of diabetes seen in many diabetic patients after gastric-bypass surgery may be related to the pronounced changes in BCAAs or other metabolites and not the weight loss alone.

In a study published in the April 27, 2011 issue of Science Translational Medicine, Laferrère et al found the total amino acids and BCAAs decreased in the gastric bypass surgery group but not in a similar group of patients who lost the same amount of weight (10 kg) with diet alone. Also, the metabolites derived from BCAA oxidation decreased only in the surgery group. Levels of acylcarnitines and BCAAs and their metabolites were inversely correlated with proinsulin concentrations, C-peptide response to oral glucose, and the insulin-sensitivity index after weight loss, whereas the BCAAs and their metabolites were uniquely correlated with levels of insulin resistance.

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Now you see me, now you don't: The bioabsorbable stent in clinical practice

Washington, DC - Predicting the future is a fool's game, and predicting successful drug and device therapy in cardiovascular medicine is just as tricky.

When bioabsorbable stents emerged on the radar of interventionalists this past decade, some dared to dream that they might one day have a stent that would do its job, then disappear, eliminating the long-term use of dual antiplatelet therapy, without a subsequent risk of stent thrombosis. In addition, bioabsorbable stents wouldn't interfere with diagnostic evaluations using noninvasive imaging, such as MRI and computed tomography (CT). Equally important, the technology offered the promise of doing away with vessels loaded up with multiple stents, the so-called full metal jacket, which has the potential to interfere with future coronary surgery.

After a number of years, one stent, a fully bioabsorbable everolimus-eluting stent (BVS, Abbott Vascular) shows promise and is furthest along in clinical development, but not everybody is sure of the role the vanishing scaffolds will play in everyday practice. Some experts see a more expansive role for the devices, even implanting the stents into vulnerable arteries that are not yet significantly closed, with the intention of making an unhealthy vessel healthy again. Others, however, see interventionalists implanting the stents only in a minority of patients.

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New CT method gets calcium score and coronary anatomy in a single scan

Dr James Otton (St Vincent's Hospital, Sydney, Australia) and colleagues presented results from theirProspective Evaluation of an Algorithm for Coronary Calcium Estimation, a study of their algorithm for quantifying extraluminal coronary calcium in the major epicardial vessels from a contrast-enhanced CT scan.

Measuring calcium score from a single contrast CT has been tried before, but it has usually been impossible to accurately measure calcium across the whole range of Agatston scores, Otton told heartwire. "The key to [our] success was realizing, first, that it is not possible to adequately separate contrast from arterial-wall calcium using solely the traditional axial measurement approach, and second, that traditional calcium-score thresholds don't apply to high-resolution contrast-enhanced coronary CT."

Instead, Otton et al tested coaxial analysis—looking at the coronary artery in short axis—which allows for precise separation of the contrast-filled lumen and the vessel wall and can be mostly automated with standard software tools, he explained. The researchers also found that a lot of noncalcified material appears in the Hounsfield range of 130 to 200 Hounsfield units (HU) on high-resolution coronary CT scans, while the true calcium generally greatly exceeds 200 HU. This finding is supported by previous intravascular ultrasound (IVUS) studies.

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