INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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Higher Risk of Stent Thrombosis in Poor Responders to Clopidogrel.
Buonamici and colleagues measured platelet reactivity after clopidogrel loading in over 800 patients undergoing percutaneous coronary intervention with a drug-eluting stent (DES) and then followed them for evidence of stent thrombosis over the next 6 months. Overall, 3.1% of patients experienced late stent thrombosis and 13% of patients were considered nonresponders to clopidogrel. The incidence of stent thrombosis was 8.6% in nonresponders versus 2.3% in responders. In a multivariable analysis, the hazard ratio for nonresponders was 3.1. Reduced responsiveness to clopidogrel appears to be an important risk factor for late stent thrombosis with DES. See pages 2312
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2318
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Heart Failure
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Aerobic Exercise Improves LV Remodeling.
Exercise training is now recommended by a number of international scientific organizations for patients with mild to moderate heart failure (HF) symptoms, but whether it can improve left ventricular (LV) function remains controversial. Haykowsky and colleagues performed a meta-analysis of studies in which patients with HF and systolic dysfunction were randomized to exercise training or standard therapy and echocardiographic parameters were reported pre- and post. Fourteen trials reported ejection fraction (EF) data (812 patients). Aerobic training significantly improved EF by 2.6%. End-diastolic and -systolic volume also improved with aerobic training. No benefits were seen with either combined aerobic and strength training or strength training alone. This study confirms that aerobic exercise can modestly improve LV remodeling. See pages 2329
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2337
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Heart Failure
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Decreased Efficacy of Bone Marrow Cells from Patients With Ischemic Cardiomyopathy.
Kissel and colleagues compared the total number of endothelial progenitors cells (EPCs), their migration to vascular endothelial growth factor, and their colony-forming capacity in normal controls and patients with ischemic or idiopathic chronic congestive heart failure (CHF). The number of EPCs was reduced in CHF, regardless of its etiology. In contrast, the migratory capacity and colony forming ability were impaired only in subjects with ischemic cardiomyopathy. Ischemic cardiomyopathy is associated with a selective impairment of progenitor cell function in the bone marrow and in the peripheral blood, which may contribute to an unfavorable left ventricular remodeling process. See page 2341
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Heart Rhythm Disorders
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Amiodarone-Induced Thyrotoxicosis.
Amiodarone-induced thyrotoxicosis (AIT) is a poorly understood complication of amiodarone therapy. Conen and colleagues performed a retrospective review of 84 patients with AIT. Fifty-six percent of patients subsequently died or were hospitalized for a cardiac-related diagnosis, either related to the underlying cardiac problem or as a direct result of the AIT. Twenty-seven patients received prednisone; there was no difference in time to normalization of free T4 between patients receiving and those not receiving prednisone, although patients who received prednisone were more likely to be subsequently hospitalized. Patients with AIT are likely to be hospitalized for cardiac reasons; prednisone appears to be ineffective and may worsen long-term outcomes, though a randomized trial is needed in order to determine optimal strategies. See page 2350
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Biomarkers
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MPO May Help Clarify Risk in Patients With Chronic HF.
Myeloperoxidase (MPO) is released during inflammation; its measurement can be used as a marker of leukocyte activation and oxidant stress and has been shown to help stratify risk in subjects presenting with chest pain. Tang and colleagues measured MPO levels in 140 subjects with stable systolic dysfunction who also underwent echocardiography and measurement of B-type natriuretic peptide (BNP) levels. Elevated plasma MPO levels were associated with increased likelihood of restrictive diastolic filling and were predictive of long-term clinical outcomes. MPO levels remained predictive after adjustment for age, left ventricular ejection fraction, plasma BNP, creatinine clearance, or diastolic stage. Measuring MPO appears to provide additional prognostic information in patients with systolic heart failure (HF). See page 2364
. See figure.
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Interventional Cardiology
Heart Failure
