INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Clinical Trials
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BNP Predicts Risk of Death or CHF, But Not Benefit From ACE-I.
Baseline plasma B-type natriuretic peptide (BNP) and (N-terminal) NT-proBNP concentrations were measured in 3,761 patients with stable coronary artery disease and preserved left ventricular function participating in the PEACE trial, a long-term, placebo-controlled trial of trandolapril. Both BNP and NT-proBNP levels were strongly related to the risk of cardiovascular mortality, heart failure, and stroke, but not myocardial infarction; both added additional prognostic information to traditional risk factors. There was no benefit to trandolapril in the overall trial; there was no difference in patients with high or low baseline BNP levels. This suggests that BNPs add prognostic value in low-risk patients with stable coronary artery disease. See page 205
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Coronary Risk Stratification
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Predicting Cardiac Risk in Patients With Kidney Disease.
Patients with chronic kidney disease (CKD) are known to have higher rates of incident coronary disease, but whether this represents a confluence of multiple cardiac risk factors or is independent remains controversial. Weiner and colleagues used the Framingham equations to calculate future cardiac risk in patients with glomerular filtration rate 15 to 60 ml/min/1.73 m2 (mean creatinine 1.5 mg/dl). The 5- and 10-year risk of cardiac events was nearly twice as high as predicted by the Framingham model and the discriminating ability was substantially reduced. Further analyses showed that if the risk factors used in the model were "re-weighted," the accuracy of the model improved suggesting that traditional risk factors are still important, but the magnitude of importance is altered by the presence of CKD. See page 217
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Heart Rhythm Disorders
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Heart Rate Dependence of QT Length Predicts Arrhythmic Risk.
Iacoviello and colleagues hypothesized that the QT interval should provide valuable information regarding the subsequent risk of arrhythmia in patients with idiopathic dilated cardiomyopathy (DCM). Subjects underwent standard electrocardiogram evaluation and 24- h Holter recordings. The dependence of the QT interval on heart rate was calculated by measuring both the QT and RR intervals every 30 s for 24 h and then plotting a regression line for each subject. Those with the steepest lines had the most variability in the length of the QT interval. This regression line calculation proved nearly as robust at stratifying the arrhythmic risk as the ejection fraction. This novel calculation, which they term QT dynamicity, may improve the accuracy of risk stratification in patients with DCM. See page 225
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Cardiac Resynchronization Therapy
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Measuring Dyssynchrony With CMR Provides Powerful Risk Stratification.
Chalil and colleagues developed and tested a novel method for measuring intraventricular dyssnchrony which they term cardiovascular magnetic resonance tissue synchronization imaging (CMR-TSI). This technique slices the left ventricle into 8 short-axis layers and then measures radial motion along 100 cords; the time of peak radial motion can then be assessed for each cord. Over 2 years of follow-up, patients with a CMR-TSI 
110 ms were nearly 4 times more likely to suffer a cardiovascular death than those with a CMR-TSI <110 ms, despite both groups undergoing cardiac resynchronization therapy (CRT). The novel measure of myocardial dyssynchrony appears to be a powerful independent predictor of mortality and morbidity following CRT. See page 243
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Prognostic Value of B-Type Natriuretic Peptides in Patients With Stable Coronary Artery Disease: The PEACE Trial
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Clinical Trials
Coronary Risk Stratification
