INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
 |
Clinical Trial
|
|---|
Impact of Nesiritide on Renal Function.
Although nesiritide is approved for the treatment of acute decompensated heart failure (ADHF), retrospective analyses suggest that it may worsen renal function. Witteles and colleagues randomized 75 subjects with ADHF and calculated glomerular filtration rate between 15 and 60 ml/min to either low-dose nesiritide or placebo. There were no differences in the primary end points of a 20% rise in serum creatinine or in the mean change in serum creatinine. There were also no significant differences in the secondary end points of change in weight, net diuresis, or intravenous furosemide dosage. In this randomized, placebo-controlled clinical trial, nesiritide had no impact on renal function in patients with ADHF. See page 1835.
|
Clinical Trial
|
|---|
Clinical Efficacy of a New Platelet Inhibitor in Patients With ACS.
AZD6140 is a reversible oral P2Y12 receptor antagonist that has several theoretical advantages over clopidogrel: it does not require conversion from a pro-drug, its inhibition is reversible, and it more effectively inhibits adenosine diphosphate-induced platelet aggregation. The DISPERSE-2 trial randomized subjects to clopidogrel or AZD6140 to assess the safety, operability, and efficacy of AZD6140 in nearly 1,000 acute coronary syndrome (ACS) patients. There was no difference in the primary end point of major or minor bleeding through 4 weeks, and although not statistically significant, there were favorable trends in the rates of myocardial infarction and coronary artery bypass grafting-associated bleeding. This initial experience with AZD6140 in patients with ACS demonstrates an acceptable safety profile and encouraging results on the secondary end point of myocardial infarction; larger trials are currently being conducted with this agent. See page 1844. See figure.
|
Exercise Testing
|
|---|
Intermediate-Stage Image Acquisition Improves Accuracy of Exercise Echocardiography.
Park and colleagues hypothesized that the incorporation of intermediate stages during supine bicycle exercise echocardiography (EE) would improve the accuracy of the test. Exercise echocardiography was performed in 104 patients; the same studies were interpreted on 2 different occasions, either with or without the intermediate-stage images available. Imaging during intermediate stages significantly improved the sensitivity. A change in left ventricular end-systolic volume from intermediate stage to peak exercise of >10% predicted coronary artery disease with 94% sensitivity and 74% specificity. This study demonstrates the importance of acquiring images during intermediate stages when using EE. See page 1857. See figure.
|
Exercise Testing
|
|---|
Prognostic Validity of Age- and Gender-Adjusted Exercise Capacity Models.
Exercise capacity (EC) during treadmill testing is a robust risk stratifier, but how to adjust for age and gender is poorly understood. Kim and colleagues used 4 statistical methods to validate the prognostic value of several age- and gender-based exercise nomograms and categorical definitions of impaired EC in a cohort of over 20,000 patients. Simple cutoff values failed to fully describe EC’s strong predictive value, because EC is a weaker predictor of mortality in older subjects. This study concludes that EC provides important information regarding 5-year mortality, but models that incorporate age and gender improve diagnostic discrimination. See page 1867. See figure.
Related Articles
-
Impact of Nesiritide on Renal Function in Patients With Acute Decompensated Heart Failure and Pre-Existing Renal Dysfunction: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial
- Ronald M. Witteles, David Kao, Dianne Christopherson, Kelly Matsuda, Randall H. Vagelos, Donald Schreiber, and Michael B. Fowler
J. Am. Coll. Cardiol. 2007 50: 1835-1840.
[Abstract]
[Full Text]
[PDF]
-
Safety, Tolerability, and Initial Efficacy of AZD6140, the First Reversible Oral Adenosine Diphosphate Receptor Antagonist, Compared With Clopidogrel, in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome: Primary Results of the DISPERSE-2 Trial
- Christopher P. Cannon, Steen Husted, Robert A. Harrington, Benjamin M. Scirica, Håkan Emanuelsson, Gary Peters, Robert F. Storey for the DISPERSE-2 Investigators
J. Am. Coll. Cardiol. 2007 50: 1844-1851.
[Abstract]
[Full Text]
[PDF]
-
Supine Bicycle Echocardiography: Improved Diagnostic Accuracy and Physiologic Assessment of Coronary Artery Disease With the Incorporation of Intermediate Stages of Exercise
- Tae-Ho Park, Nawar Tayan, Kimiko Takeda, Hui-Kyung Jeon, Miguel A. Quinones, and William A. Zoghbi
J. Am. Coll. Cardiol. 2007 50: 1857-1863.
[Abstract]
[Full Text]
[PDF]
-
External Prognostic Validations and Comparisons of Age- and Gender-Adjusted Exercise Capacity Predictions
- Esther S.H. Kim, Hemant Ishwaran, Eugene Blackstone, and Michael S. Lauer
J. Am. Coll. Cardiol. 2007 50: 1867-1875.
[Abstract]
[Full Text]
[PDF]
Top
Clinical Trial
Clinical Trial
