INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Coronary Artery Disease
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No Benefit for ICDs if SBP >130 mm Hg.
In this retrospective review of data from the MADIT-II trial, which enrolled patients with previous myocardial infarction and ejection fraction <30%, the outcomes were analyzed according to baseline blood pressures (BPs). When implantable cardioverter-defibrillator (ICD) efficacy was analyzed according to baseline BP, no survival benefit was shown among patients with systolic blood pressure (SBP) >130 mm Hg. In subjects with with SBP  130 mm Hg, ICD implantation reduced the risk of death by 39%. This study suggests that baseline BP may be a useful risk-stratifier and questions the need for ICD implantation in those with SBP >130 mm Hg. See page 1427. See figure.
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Heart Rhythm Disorders
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Extent of Left Atrial Edema After Pulmonary Vein Isolation.
The use of radiofrequency ablation for curing paroxysmal atrial fibrillation may cause damage to the left atrium (LA). Okada and colleagues performed electron beam tomography (EBT) of the left atrium in patients undergoing either segmental ostial pulmonary vein isolation (S-PVI) or circumferential PV antrum ablation (C-PVI). The EBT assessment revealed moderate or extensive LA edema immediately after the PV ablation in 78% of S-PVI and 96% of C-PVI patients. The severity of the LA edema, number of radiofrequency applications, and amount of radiofrequency energy delivered was significantly greater for C-PVI. However, this edema resolved within 1 month of the procedure, and there was no evidence of long-term complications related to the edema. See page 1436. See figure.
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Heart Failure
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Shortened Telomeres in Patients With CHF.
Telomeres are the distal ends of chromosomes that act as caps for the chromosomes, providing protection from structural degradation. During each cell division, DNA polymerases fail to completely replicate telomeres, thereby resulting in a process of cumulative erosion. van der Harst and colleagues compared telomere length in subjects from the MERIT-HF trial with a control population. Not only were telomeres significantly shorter in those with chronic heart failure versus healthy controls, the severity of both New York Heart Association functional class and the extent of atherosclerotic disease also predicted telomere length. In this study, shortened telomeres are clearly associated with increased severity of cardiovascular disease; whether this is cause or effect remains unknown. See page 1459. See figure.
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Cardiac Surgery
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LVD No Longer a Contraindication for Surgical Repair of Aortic Regurgitation.
Patients with chronic aortic regurgitation and severe left ventricular dysfunction (LVD) (ejection fraction <30%) are considered high risk for aortic valve surgery. Bhudia and colleagues reviewed the results of surgeries performed at the Cleveland Clinic from 1975 to 1999. Hospital mortality for those with LVD fell from 50% in 1975 to 0% in 1985, and midterm survival appeared comparable to those without LVD. This study suggests that improved surgical techniques and post-surgical care have effectively mitigated the increased risk that LVD brings to surgery for chronic aortic regurgitation. See page 1465. See figure.
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Preclinical Study
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ARBs May Slow the Progression of Aortic Stenosis: Animal Model Data.
Accumulating evidence suggests that statins may slow the progression of calcific aortic stenosis; Arishiro and colleagues hypothesized that angiotensin receptor blockers (ARBs) may have a similar effect due to their antiatherosclerotic effects. Rabbits were fed a cholesterol-rich diet for 8 weeks and received either 4 weeks of olmesartan or placebo. Rabbits treated with olmesartan had decreased macrophage accumulation, decreased osteopontin expression, and improved endothelial integrity. This study suggests that ARBs may be useful in the treatment of calcific aortic stenosis by improving endothelial integrity and reducing atherosclerotic plaque on the valve. See page 1482.
Related Article
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Inverse Relationship of Blood Pressure Levels to Sudden Cardiac Mortality and Benefit of the Implantable Cardioverter-Defibrillator in Patients With Ischemic Left Ventricular Dysfunction
- Ilan Goldenberg, Arthur J. Moss, Scott McNitt, Wojciech Zareba, W. Jackson Hall, Mark L. Andrews for the MADIT-II Investigators
J. Am. Coll. Cardiol. 2007 49: 1427-1433.
[Abstract]
[Full Text]
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Coronary Artery Disease
Heart Rhythm Disorders
