INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
 |
Clinical Trials
|
|---|
Darbepoetin May Improve Exercise Tolerance in CHF.
Anemia often co-exists with congestive heart failure; reversing anemia may improve exercise tolerance. Ponikowski and colleagues randomized 41 patients to either darbepoetin (with a targeted hemoglobin between 12 and 15 g/dl) or placebo. There were mild, nonstatistically significant improvements in peak VO
2 and exercise duration. There was a significant improvement in the self-reported patient global assessment, but no significant differences in heart failure–specific questionnaires. This small study suggests that increasing hemoglobin levels with darbepoetin may mildly improve exercise duration and patient well-being for subjects with congestive heart failure and reduced systolic function. See page 753. See figure.
|
Interventional Cardiology
|
|---|
Successful Stenting of Carotid Total Occlusions.
Previous studies have shown that surgical bypass of chronic carotid artery occlusions does not improve outcomes. Kao and colleagues report on their experience in opening these arteries with percutaneous techniques in patients with symptomatic carotid occlusions. The procedure was attempted in 30 patients, and the lesion was successfully crossed and dilated in 73%. There was one fatal periprocedural cerebrovascular accident, which was felt to be unrelated to the procedure, but no other complications. There was evidence of hemodynamic improvement with reversal of flow in the opthalmic artery in 80% of patients who were successfully opened. Although technically challenging, this study suggests that chronic carotid occlusions can be percutaneously treated. See page 765. See figure.
|
Heart Failure
|
|---|
Beta-Blockers May Improve Ventricular Dyssynchrony.
Beta-blockers confer substantial improvements in cardiac function and symptoms of heart failure, but little is known about their effect on ventricular dyssynchrony. Takemoto and colleagues studied patients with idiopathic dilated cardiomyopathies and normal QRS using both tissue Doppler and strain echocardiography. Initial studies confirmed that there is a substantial dyssynchrony between peak movements of the walls of the ventricle, even when the QRS is <120 ms. After 6 months of carvedilol therapy, there were significant improvements in ejection fraction, ventricular size, and measurements of dyssynchrony. These improvements in global and regional mechanical function may underlie the beneficial effects of carvedilol therapy and obviate the need for electrical resynchronization in certain heart failure patients. See page 778.
|
Heart Failure
|
|---|
Small Wireless Transmitter Accurately Measures PA Pressures.
Rozenman and colleagues describe a novel, implantable pressure transducer that can be permanently implanted in the pulmonary artery. The device is delivered percutaneously and anchored to the wall of the pulmonary artery via a self-expanding nitinol platform. The implanted unit is small, and it sends a recording to an external device using acoustic waves, rather than electromagnetic waves, thereby reducing interference, attenuation, and energy requirements. There was good correlation with standard Milar catheters and no evidence of rejection on histologic examination in animal models. This device may prove useful for quickly, accurately, and serially measuring pulmonary artery pressures, and it may prove useful for both in- and outpatient management. See page 784. See figure.
|
Patent Foramen and Stroke
|
|---|
PFO May Not Increase Stroke Risk.
Several lines of evidence suggest that patent foramen ovales (PFOs) may increase the risk of ischemic stroke, but the magnitude of the increased risk is not known. Di Tullio and colleagues studied over 1,000 subjects with no previous stroke and performed transthoracic echocardiograms with contrast injection. The prevalence of PFO was 15% in this community-based cohort, and over the next 8 years, 6% of subjects had a stroke. The relative risk of stroke for those with a PFO was 1.6, which was not statistically significant. This study suggests that the overall risk of stroke associated with a PFO is low; more studies may be needed to identify those patients with a PFO at increased risk. See page 797.
Related Article
-
Effect of Darbepoetin Alfa on Exercise Tolerance in Anemic Patients With Symptomatic Chronic Heart Failure: A Randomized, Double-Blind, Placebo-Controlled Trial
- Piotr Ponikowski, Stefan D. Anker, Joanna Szachniewicz, Darlington Okonko, Mark Ledwidge, Robert Zymlinski, Enda Ryan, Scott M. Wasserman, Nigel Baker, Dylan Rosser, Stuart D. Rosen, Philip A. Poole-Wilson, Waldemar Banasiak, Andrew J.S. Coats, and Ken McDonald
J. Am. Coll. Cardiol. 2007 49: 753-762.
[Abstract]
[Full Text]
[PDF]
|
Top
Clinical Trials
Interventional Cardiology
