Expert Commentary: Frank Saltiel, M.D. 11/19/2009

Posted by Admin on November 18, 2009
The concept of gene therapy to treat heart muscle damage after a heart attack is extremely promising and exciting. These early studies hold out the hope that we can one day restore function to weakened heart tissue. The healing process after a heart attack is of course quite complicated and developing specific therapies for this will take time and careful study. In regards to the report from Sato and associates, limiting fibrous tissue will undoubtedly be helpful in better healing.

However after the heart muscle dies, some fibrous tissue is needed to prevent excessive weakening of heart wall which could lead to rupture of the heart or an out-pouching of that area (pseudo-aneurysm).  There are other investigators working on therapies to help new heart muscle grow in areas of previous damage.  Perhaps the proper therapies will be a combination of treatment to both limit fibrous tissue (scar) while simultaneously promoting new muscle growth.

On the other hand, an equally important challenge involves the prevention and early treatment of heart attacks, in this way avoiding or greatly limiting heart muscle damage and thus reducing the need for these new treatments.  With better public education, cardiovascular screening, primary and secondary prevention measures, and dedicate systems of care for the management of acute heart attacks, the number of patients left with significantly damaged heart muscle should be dramatically reduced.

Through the leadership of the American Heart Association and the Illinois chapter of the American College of Cardiology, efforts are underway to establish a state wide system of care for patients suffering from acute heart attacks.  This system will result in closer cooperation between emergency medical systems, hospitals, emergency room physicians, and cardiologists to ensure the prompt recognition of heart attacks and emergent transfer to hospitals dedicated to having physicians and staff available 24-7 to rapidly open blocked heart arteries mostly through the techniques of balloon angioplasty and intracoronary stent implantation.  Once the artery is opened, the heart attack is aborted, hence the adage “Time is muscle!!”  The consequence of these efforts will be to significantly improve the time needed to open these closed arteries and thus considerably diminish the ensuing heart muscle damage.  This will ultimately save thousands of lives each year and allow heart attack survivors to return to full and active lives.

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