INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Clinical Trial
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Hemodialysis Prevents Contrast-Induced Nephropathy.
Researchers in Taiwan performed a study to determine whether prophylactic hemodialysis after coronary angiography would prevent contrast-induced nephropathy. Eighty-two patients with chronic renal failure (creatinine >3.5 mg/dl) undergoing angiography were randomly assigned to receive either normal saline intravenously and postprocedure hemodialysis or fluid supplement only. Hemodialysis, started approximately 1 hour after angiography, reduced the need for both temporary and permanent dialysis by substantial proportions. Based on these results, prophylactic hemodialysis immediately after angiography is an effective and safe strategy to improve renal outcome in patients with advanced renal failure. See page 1015.
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Coronary Artery Disease
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ST-Segment Depression is More Sensitive Than ST-Segment Elevation for the Diagnosis of Infarction.
Martin and colleagues compared presentation electrocardiograms with cardiac biomarker levels and delayed enhancement on cardiac magnetic resonance imaging to determine the significance of ST-segment depression. Using current American College of Cardiology/European Society of Cardiology guidelines for ST-segment elevation myocardial infarction, the sensitivity was 50% and specificity 97% for acute myocardial infarction (AMI). Consideration of ST-segment depression in addition to elevation increased sensitivity for detection of AMI to 84%, with similar specificity. There were no significant differences in infarction size between patients meeting criteria for ST-segment elevation criteria and those with ST-segment depression. In patients admitted to the hospital with possible AMI, the consideration of both ST-segment elevation and depression significantly increases the sensitivity for the detection of AMI without significantly decreasing the specificity. See page 1021.
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Heart Failure
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New Biomarker for CHF Severity: GDF-15.
Growth differentiation factor (GDF)-15 is a stress-responsive member of the transforming growth factor-ß cytokine superfamily that has recently been observed to be increased in patients with chronic heart failure (CHF). Kempf and colleagues measured GDF-15 levels in 455 patients with CHF (median left ventricular ejection fraction of 32%) who were then followed for 4 years. Seventy-five percent of the patients had GDF-15 levels >1,200 ng/l, the upper limit of normal in healthy individuals. GDF-15 levels were closely related to New York Heart Association functional class, amino-terminal pro–B-type natriuretic peptide, and the risk of death. GDF-15 is a new biomarker of the risk of death in patients with CHF, providing prognostic information beyond established clinical and biochemical markers. See page 1054. See figure.
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Peripheral Arterial Disease
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Low Testosterone, High Estradiol Predict PAD in Men.
The influence of sex hormones on thrombotic and atherogenic risk remains poorly understood. The MrOS study has enrolled 3,000 Swedish men aged between 69 and 80 years. Peripheral arterial disease (PAD) was defined as an ankle-brachial index <0.90. Low serum levels of free testosterone and high levels of free estradiol were associated with increased likelihood of PAD. This study suggests that high levels of endogenous testosterone and low levels of estradiol may be protective against PAD. See page 1070. See figure.
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Cardiac Imaging
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Limited Utility of SPECT for Routine Screening in Patients With AF.
Although noninvasive stress testing is recommended by the American College of Cardiology Foundation/American Society of Nuclear Cardiology appropriateness criteria in selected asymptomatic patients with atrial fibrillation (AF), its prognostic utility has not been demonstrated. Askew and colleagues compared single-photon emission computed tomography (SPECT) study results and 5-year mortality in patients without symptoms of chest pain or dyspnea who were in AF at the time of their study with a control group in normal sinus rhythm. The mean summed stress score (SSS) and the proportion of patients with high-risk studies were similar. The SSS predicted mortality in both groups, but mortality was significantly higher in AF patients. This suggests that SPECT screening for asymptomatic patients with AF provides prognostic information, although the high rate of low-risk studies suggests that not every patient should be screened. See page 1080. See figure.
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Clinical Trial
Coronary Artery Disease
