HomeCirculationVol. 113, No. 10Issue Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIssue Highlights Originally published14 Mar 2006https://doi.org/10.1161/circ.113.10.1271Circulation. 2006;113:1271HEMODYNAMIC EFFECTS OF LONG-TERM CARDIAC RESYNCHRONIZATION THERAPY: ANALYSIS BY PRESSURE-VOLUME LOOPS, by Steendijk et al.Although it has been shown that chronic resynchronization therapy for heart failure exerts beneficial effects on clinical outcomes and cardiac remodeling, little is known about the long-term effects on myocardial function. Pressure-volume loop analyses were performed before and after 6 months of biventricular pacing in 22 patients with NYHA class III–IV heart failure. At 6 months there were improvements in left ventricular ejection fraction, dP/dtmax, and stroke work at both resting and increased heart rates. Of note, there were improvements in ventricular-arterial coupling and mechanical efficiency, as well. These data indicate that the initial improvements in myocardial function with resynchronization therapy are sustained during chronic therapy. See p 1295.IMPROVEMENT IN STROKE MORTALITY IN CANADA AND THE UNITED STATES, 1990 TO 2002, by Yang et al.The US Public Health Service recommended in September 1992 that all women of childbearing age consume 400 micrograms (μg) of folic acid daily to reduce their risk of having a pregnancy affected with spina bifida or other neural tube defects. Owing to the relationship between folic acid fortification and blood homocysteine levels, some experts have speculated that fortification may also have a favorable effect on cardiovascular health and stroke. The United States and Canada implemented policies of mandatory fortification in the late 1990s, and the populations of both countries experienced a reduction in blood homocysteine levels, a factor that appears to be related to the risk of stroke. Investigators from both countries collaborated to compare trends in stroke mortality in the United States and Canada, where these policies were mandatory, with England and Wales, where the policies were not. See p 1335.ADVANCED GLYCATION END PRODUCTS ACTIVATE A CHYMASE-DEPENDENT ANGIOTENSIN II–GENERATING PATHWAY IN DIABETIC COMPLICATIONS, by Koka et al.Angiotensin II is intimately involved in the development of cardiovascular complications of diabetes. Indeed, angiotensin-converting enzyme (ACE) inhibitors reduce, but do not prevent, the occurrence of clinical events in these patients. Interestingly, there are alternative pathways such as the enzyme chymase expressed in vascular tissue that are able to generate angiotensin II even in the presence of ACE inhibitors. In this study, Koka et al report that chymase is upregulated in the vasculature of diabetic patients. The upregulation of this alternative pathway is associated with tissue disposition of advanced glycation end products (AGEs), another consequence of hyperglycemia. AGEs induce chymase expression via the receptor for AGEs (RAGE)–Erk1/2 MAP kinase pathway. Under these conditions, chymase appears to account for the majority of angiotensin II produced in the vasculature, and this can be prevented by RAGE antibodies or inhibitions of Erk1/2 MAP kinase. This study therefore provides new insights into the cellular mechanisms of angiotensin II–induced vascular complications in diabetes and also a novel therapeutic target for the treatment of these high-risk patients. See p 1353.Visit http://circ.ahajournals.org:Clinician UpdateA Clinician’s Guide to Tissue Doppler Imaging. See p e396.Images in Cardiovascular MedicineOvarian Malignancy Presenting as Multiple Intracardiac Masses. See p e399.Bubble in the Heart: A Rare Cause of Mitral Regurgitation. See p e401. Download figureDownload PowerPointSpontaneous Coronary Dissection: Computed Tomography Appearance and Insights From Intravascular Ultrasound Examination. See p e403.CorrespondenceSee p e406. Previous Back to top Next FiguresReferencesRelatedDetails March 14, 2006Vol 113, Issue 10 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.113.10.1271 Originally publishedMarch 14, 2006 PDF download Advertisement