INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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Rescue Angioplasty Superior to Repeat Fibrinolysis.
The majority of patients with ST-segment elevation myocardial infarctions are treated with fibrinolytics, but nearly one-half do not successfully reperfuse. The optimal therapy for failed fibrinolysis is controversial. Wijeysundera and colleagues performed a meta-analysis of 8 trials to determine if either rescue percutaneous coronary intervention (PCI) or repeat fibrinolysis was superior to no further intervention. Rescue PCI resulted in a substantial reduction in a composite end point of all-cause mortality, reinfarction, and heart failure, with a relative risk reduction of 28%. Repeat fibrinolysis was not superior to conservative therapy. From this data, rescue PCI appears superior to repeat fibrinolytic therapy for failed fibrinolysis. See page 422.
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Coronary Artery Disease
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CXCL16 is a Marker of Inflammation and Atherosclerosis.
CXCL16 is a protein expressed predominantly on macrophages which recognizes oxidized low-density lipoprotein, among other stimuli, and stimulates other inflammatory pathways. Lehrke and colleagues performed a series of studies to address its role in the initiation and progression of atherosclerosis. Highlights from their findings include the result that soluble levels of CXCL16 are higher in patients with acute coronary syndromes and that expression of CXCL16 can be reduced by aspirin and peroxisome proliferator-activated receptor-gamma agonists, such as pioglitazone. Overall, these findings suggest that CXCL16 may play a pro-inflammatory role in atherosclerosis, particularly during acute coronary syndromes. See page 442.
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Heart Failure
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Beneficial Effects of CPAP for Patients With OSA and CHF.
The repeated apnea-arousal cycles that characterize obstructive sleep apnea (OSA) lead to altered cardiac loading conditions, hypoxia, and sympathetic nervous system activation, conditions that are probably detrimental in patients with congestive heart failure (CHF). Yoshinaga and colleagues studied the effects of both short and long-term continuous positive airway pressure (CPAP) therapy in 7 patients with CHF and OSA. Initially, CPAP reduced stroke volume and cardiac oxidative metabolism; longer-term CPAP improved left ventricular ejection fraction and reduced oxidative metabolism. These effects are similar to the effects seen with beta-blocker therapy for CHF, suggesting a potential role for CPAP in patients with CHF and OSA. See pages 450 and 459. See figure.
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Cardiovascular Pharmacology
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Urocortin 2 Infusion Increases Cardiac Output, Decreases Systemic Vascular Resistance.
Urocortin 2 is one of the corticotrophin-releasing-factor peptides; recent research suggests that it may have beneficial effects for treating heart failure. Davis and colleagues describe the first experience of infusing this peptide into healthy volunteers in a dose titration study. The higher dose was found to nearly double cardiac output with a fall in systemic vascular resistance of almost 50%; the side-effects were minor. Urocortin 2 appears to merit further study as a potential way to temporarily increase cardiac output. See page 461. See figure.
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Diastolic Dysfunction
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Diastolic Dysfunction Predicts Poor Outcomes in Sickle Cell Disease.
Pulmonary hypertension is a known risk factor for death in patients with sickle cell disease (SCD), but whether this reflects increased resistance in the lung parenchyma or is related to left ventricular failure is unknown. Sachdev and colleagues performed echocardiograms on over 200 patients with SCD. Evidence of diastolic dysfunction was present in 18% of patients. Diastolic dysfunction was associated with a relative risk of death of 3.5; the presence of both diastolic dysfunction and pulmonary hypertension conferred a risk ratio of 12.0. In this study, diastolic dysfunction and pulmonary hypertension independently and synergistically predicted increased mortality in patients with SCD. See page 472. See figure.
Related Article
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Rescue Angioplasty or Repeat Fibrinolysis After Failed Fibrinolytic Therapy for ST-Segment Myocardial Infarction: A Meta-Analysis of Randomized Trials
- Harindra C. Wijeysundera, Ram Vijayaraghavan, Brahmajee K. Nallamothu, JoAnne M. Foody, Harlan M. Krumholz, Christopher O. Phillips, Amir Kashani, John J. You, Jack V. Tu, and Dennis T. Ko
J. Am. Coll. Cardiol. 2007 49: 422-430.
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Interventional Cardiology
Coronary Artery Disease
