INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Coronary Artery Disease
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High Platelet Reactivity Increases Risk of MACE for Diabetics on Clopidogrel.
Diabetics are more likely to exhibit high platelet reactivity. Angiolillo and colleagues assessed platelet reactivity in nearly 200 diabetics with known coronary artery disease after they had been taking clopidogrel and aspirin for at least 6 months. Over the next 2 years, the quartile of subjects with the highest platelet reactivity, in other words those with the weakest response to clopidogrel, were 3 times more likely to suffer a major adverse cardiac event (MACE) than the other quartiles. This study confirms the importance of platelet reactivity as a risk factor for poor outcomes. See page 1541. See figure.
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Heart Failure
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Adenosine Antagonist Safely Improves Diuresis.
Plasma adenosine levels are elevated in patients with heart failure, and adenosine A1 receptors in the kidney mediate vasoconstriction of afferent arterioles and reabsorption of sodium and water in proximal tubules. Givertz and colleagues performed 2 related proof-of-concept trials using KW-3902, an adenosine A1-receptor antagonist, in subjects with volume overload and either impaired renal function (creatinine clearance 20 to 80 ml/min) or those deemed refractory to loop diuretics. KW-3902 increased urine output, reduced the need for intravenous furosemide administration, and improved renal function. Thus, adenosine A1-receptor blockade with KW-3902 promotes diuresis and may have a renal protective effect in patients with volume overload. See page 1551. See figure.
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Cardiac Imaging
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Renal Artery Calcium Is Independently Associated With Hypertension.
Allison and colleagues hypothesized that the presence and extent of calcified atherosclerosis in the renal arteries would be a surrogate marker for hypertension. Almost 1,500 subjects underwent electron beam computed tomography of the renal arteries. The overall prevalence of calcium in either renal artery was 17%, with men having a significantly higher prevalence. After adjustment for age, gender, body mass index, percent body fat, diabetes, smoking, dyslipidemia, and the extent of calcified atherosclerosis in the nonrenal vasculature, those with any renal artery calcium (RAC) were 1.5 times more likely to have hypertension than those with no RAC. This study suggests that RAC is associated with hypertension independent of CVD risk factors. See page 1578.
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Congenital Heart Disease
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Heritability of Hypoplastic Left Heart Syndrome.
Hinton and colleagues were interested in the risk factors for hypoplastic left heart syndrome (HLHS) and, therefore, performed echocardiograms on family members’ 38 probands with HLHS. The frequency of first-degree relatives with HLHS was 3.5% and it was 8% for siblings versus a <1% incidence in the general population. Twenty-two percent of siblings had a cardiovascular malformation (most often bicuspid aortic valve), as did 18% of first-degree relatives. The frequent occurrence of left- and right-sided valve dysplasia in HLHS probands and the increased prevalence of valvular abnormalities in family members suggest that HLHS is a severe, heritable disorder of valve malformation. See page 1590. See figure.
Related Articles
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Impact of Platelet Reactivity on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease
- Dominick J. Angiolillo, Esther Bernardo, Manel Sabaté, Pilar Jimenez-Quevedo, Marco A. Costa, Jorge Palazuelos, Rosana Hernández-Antolin, Raul Moreno, Javier Escaned, Fernando Alfonso, Camino Bañuelos, Luis A. Guzman, Theodore A. Bass, Carlos Macaya, and Antonio Fernandez-Ortiz
J. Am. Coll. Cardiol. 2007 50: 1541-1547.
[Abstract]
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The Effects of KW-3902, an Adenosine A1-Receptor Antagonist,on Diuresis and Renal Function in Patients With Acute Decompensated Heart Failure and Renal Impairment or Diuretic Resistance
- Michael M. Givertz, Barry M. Massie, Tara K. Fields, Leeanne L. Pearson, Howard C. Dittrich on behalf of the CKI-201 and CKI-202 Investigators
J. Am. Coll. Cardiol. 2007 50: 1551-1560.
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Renal Artery Calcium Is Independently Associated With Hypertension
- Matthew A. Allison, Elizabeth O. Lillie, Dominic DiTomasso, C. Michael Wright, and Michael H. Criqui
J. Am. Coll. Cardiol. 2007 50: 1578-1583.
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Hypoplastic Left Heart Syndrome Is Heritable
- Robert B. Hinton, Jr, Lisa J. Martin, Meredith E. Tabangin, Mjaye L. Mazwi, Linda H. Cripe, and D. Woodrow Benson
J. Am. Coll. Cardiol. 2007 50: 1590-1595.
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Coronary Artery Disease
Heart Failure
