INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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Atorvastatin Reduces Microinfarction Rates After PCI: Role of Adhesion Molecules.
In the ARMYDA (Atorvastatin for Reduction of Myocardial Damage during Angioplasty) trial, 7 days of pre-treatment with atorvastatin prior to percutaneous coronary intervention (PCI) reduced the rate of peri-procedural myocardial infarction by 80%. Adhesion molecules are proteins located along the membranes of endothelial cells that facilitate adhesion and translocation of leukocytes. For this substudy, participants at one center had serial blood draws for determination of serum levels of adhesion molecules. There was no change in serum levels of these molecules with atorvastatin prior to PCI, but post-PCI increases of intercellular cell adhesion molecule-1 and E-selectin were significantly lower. This study suggests that pre-treatment with atorvastatin may reduce the inflammatory endothelial response induced by PCI and thereby lead to lower rates of peri-procedural micro infarctions. See page 1560. See figure.
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Heart Failure
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Polyunsaturated Fatty Acids Restore Baroreceptor Sensitivity in Heart Failure Patients.
Dietary supplementation with N-3 polyunsaturated fatty acids (PUFA) has been shown to reduce the risk of life-threatening arrhythmias in post-myocardial infarction (post-MI) patients. Radaelli and colleagues performed sensitive measurements of heart rate variability and arterial baroreceptor function in a small sample of post-MI patients with reduced left ventricular (LV) function who were given either 2 g of PUFA daily or placebo. Those treated with PUFA had evidence of restored baroreceptor reflexes and enhanced heart rate variability. This study shows that dietary supplementation with PUFA helps to restore normal heart rate variability in subjects with LV dysfunction. See page 1600.
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Heart Failure
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High BNP, Low GFR Predicts High Risk in Heart Failure.
The relationship between amino-terminal pro-brain natriuretic peptide (NT-proBNP), structural heart disease, and renal function remains incompletely understood. Kimmenade and colleagues studied these interactions in over 700 subjects hospitalized with heart failure and followed for 60 day mortality. The odds ratio (OR) for death with a glomerular filtration rate (GFR) below the median (<60 ml/min/1.73m2) was 2.0; the OR for an NT-proBNP concentration above the median (4,647 pg/ml) was 2.7. The OR for those with both an elevated NT-pro BNP and a reduced GFR was 3.5. The combination of serum NT-proBNP and an estimate of renal function better predicts short-term mortality for subjects with heart failure than either parameter alone. See page 1621. See figure.
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Pacing and Cardiac Function
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Optimizing Hemodynamics and Outcomes After Pacemaker Implantation.
Three articles and an editorial in this issue study the interaction between baseline clinical characteristics and outcomes after pacemaker implantation. Hayes and colleagues examined data from the DAVID trial that showed worse outcomes in patients referred for implantable cardioverter-defibrillators who were randomized to a DDDR-70 setting versus a VVI-40 mode. The increased mortality was only present in those with a baseline QRS >110 ms, suggesting that the risk of deterioration is only present in those with underlying conduction system disease. Lieberman and colleagues performed left ventricular (LV) pressure volume loop recordings on patients referred for electrophysiologic testing with variable pacing sites. Right ventricular (RV) pacing worsened LV function in patients with and without LV dysfunction, whereas LV or biventricular pacing preserved or improved LV function. In the third article, Tops and colleagues studied 55 patients who underwent atrioventricular nodal ablation and subsequent RV pacemaker implantation. One-half of patients developed evidence of LV dyssynchrony; these patients had higher New York Heart Association functional class scores and lower ejection fractions than those who did not develop dyssynchrony. An editorial by Tse and Lau summarizes the evidence and controversies regarding the selection of the optimal pacing site. See pages 1628, 1634, 1642, and 1649.
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Cardiac Imaging
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64-Slice CTA Versus Angiography Prior to Valve Surgery.
As the diagnostic accuracy of computed tomographic angiography (CTA) improves, the prospective indications are expanding. Investigators from the Thoraxcenter studied patients referred for elective valve surgery with both CTA and conventional coronary angiography (CCA). Using a 64-slice scanner, they were able to identify all patients with significant (>50%) coronary stenosis. Four patients (8%) had CTAs interpreted as showing a significant stenosis, but only luminal irregularities on CCA. If this study had been set up as a protocol with CTA as an initial screening, 69% of patients would avoid CCA, 26% would have CCA to confirm the findings from CTA, and in only 6% would an "unnecessary" CCA be performed. See page 1658.
Related Article
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Protection From Procedural Myocardial Injury by Atorvastatin Is Associated With Lower Levels of Adhesion Molecules After Percutaneous Coronary Intervention: Results From the ARMYDA-CAMs (Atorvastatin for Reduction of MYocardial Damage during Angioplasty-Cell Adhesion Molecules) Substudy
- Giuseppe Patti, Massimo Chello, Vincenzo Pasceri, Diego Colonna, Annunziata Nusca, Marco Miglionico, Andrea D’Ambrosio, Elvio Covino, and Germano Di Sciascio
J. Am. Coll. Cardiol. 2006 48: 1560-1566.
[Abstract]
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Interventional Cardiology
Heart Failure
