INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Computed Tomography Angiography
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MSCT to Diagnose In-Stent Restenosis.
As the spatial and temporal resolutions of multislice computed tomography (MSCT) improve, it may be feasible to diagnose in-stent restenosis (ISR). Ehara and colleagues performed MSCT on 81 patients with previous stenting followed within 5 days by conventional coronary angiography. The sensitivity for detecting binary restenosis was 92%, although the positive predictive value was only 54% as the severity of 6 lesions was overestimated by MSCT. The high sensitivity of MSCT for detecting ISR suggests that it may be a useful screening test. See page 951. See figure.
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Heart Failure
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Carvedilol Reduces Stroke and MIs Compared to Metoprolol.
The COMET study randomized over 3,000 subjects with an ejection fraction <35% to either carvedilol or metoprolol tartate; carvedilol reduced the likelihood of death by 20%. In this study, Remme and colleagues further analyzed the data to determine if there were differences in the rates of stroke and myocardial infarction (MI). Carvedilol resulted in improved hazard ratios for MI (0.71), stroke (0.79), and fatal stroke or fatal MI (0.46). This study suggests that the full adrenergic blockade of carvedilol and its antioxidative effects may lead to improved vascular protection relative to beta-1 blockade alone. See page 963. See figure.
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Heart Failure
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Larger Hearts, Higher Stroke Volumes for Those With HFPEF.
The Cardiovascular Health Study has acquired echocardiograms and clinical and epidemiologic data on almost 6,000 elderly subjects. Subjects with a history of heart failure and preserved ejection fraction (HFPEF) were older, more obese, and more often African American than other subjects. The left ventricular diastolic dimension was significantly increased in HFPEF subjects (5.2 cm) compared to both those with hypertension but no heart failure (4.9) and non-hypertensive subjects (4.8). Stroke volume and cardiac output were also increased. Subjects with HFPEF had an increased prevalence of several comorbidities, including anemia, renal dysfunction, and obesity, that can cause volume overload. This study suggests that extra-cardiac factors, via volume overload, may contribute to the pathophysiology of HFPEF, rather than intrinsic properties of the ventricle such as stiffness. See page 972. See figure.
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Heart Rhythm Disorders
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No Improvement in AF Mortality Over the Last 20 Years.
Although treatment strategies for atrial fibrillation (AF) have changed over the last 20 years, there is limited data on the effect of these changes on mortality. Miyasaka and colleagues used a community-based cohort of patients with a new diagnosis of AF from 1980 to 2000. There were 2 interesting findings. The mortality from AF remains high; overall, patients with newly diagnosed AF are twice as likely to die as an age- and gender-adjusted cohort. This excess mortality is especially high in the first 4 months. The second interesting finding is that overall there has been no substantial change in life expectancy for AF over the last 20 years. This study suggests there is a need for improvement in the treatment of AF. See page 986. See figure.
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Congenital Heart Disease
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Endovascular Therapy for SVC Occlusion.
Tzifa and colleagues report on their experience treating 63 patients with obstruction of the superior vena cava (SVC). Causative factors were previous congenital cardiac surgery, extracorporeal membrane oxygenation, chronic central venous catheter, and external compression from a tumor. Adequate relief was achieved in all patients after stent implantation and in 78% with balloon dilation alone. There were no deaths associated with the procedure. Twenty percent of patients suffered a complication, but only 2 patients required emergency surgery. Patients who have undergone previous cardiac surgery are at higher risk for complications, especially tears at the SVC–right atrial junction. This report demonstrates that percutaneous treatment of SVC occlusion is possible and can substantially improve symptoms from SVC obstruction. See page 1003. See figure.
Related Article
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Diagnostic Accuracy of Coronary In-Stent Restenosis Using 64-Slice Computed Tomography: Comparison With Invasive Coronary Angiography
- Mariko Ehara, Masato Kawai, Jean-François Surmely, Tetsuo Matsubara, Mitsuyasu Terashima, Etsuo Tsuchikane, Yoshihisa Kinoshita, Tatsuya Ito, Yoshihiro Takeda, Kenya Nasu, Nobuyoshi Tanaka, Akira Murata, Hiroshi Fujita, Koyo Sato, Atsuko Kodama, Osamu Katoh, and Takahiko Suzuki
J. Am. Coll. Cardiol. 2007 49: 951-959.
[Abstract]
[Full Text]
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Computed Tomography Angiography
Heart Failure
