INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
 |
Clinical Trials
|
|---|
Improved Survival With LVAD as Destination Therapy.
The INTrEPID trial assessed the effectiveness of the Novacor (WorldHeart, Oakland, California) left ventricular assist device (LVAD) for long-term circulatory support in patients who were inotrope-dependent but ineligible for transplantation. The relative risk of mortality was reduced by >50% at both 6 and 12 months in those who received LVADs; however, mortality was high in both arms. An accompanying editorial notes that a relative risk reduction of 50% is statistically significant, but the absolute mortality of 75% at 1 year is not an acceptable outcome for a device proposed for long-term use. See pages 741 and
748. See figure.
|
Atherosclerosis
|
|---|
WHR Is the Best Indicator of Atherosclerotic Burden in Obesity.
Whether obesity alone, or its associated comorbidities such as hypertension and insulin resistance, leads to atherosclerosis is poorly understood. See and colleagues studied the associations between differing measures of obesity, coronary artery calcium (CAC), and abdominal aortic plaque detectable by magnetic resonance imaging in almost 3,000 individuals in the Dallas Heart Study. The measures of obesity used were: body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). Of the 3 measures, WHR alone was independently associated with CAC and aortic plaque. A high WHR seems to be the strongest link between obesity and atherosclerosis. See page 752. See figure.
|
Heart Failure
|
|---|
Post-Discharge Mortality Similar for Preserved and Reduced EF.
This analysis of the OPTIMIZE-HF registry compared 20,118 patients with left ventricular systolic dysfunction (LVSD) (ejection fraction [EF] <40%) and 21,149 patients with preserved systolic function (PSF) (EF 
40%). The risk of in-hospital mortality was lower in patients with PSF (3% vs. 4%). During short-term post-discharge follow-up, both groups had similar mortality risk (
10%) and rehospitalization rates (30%). This study confirms the high mortality risk of congestive heart failure with PSF, but unfortunately offers no insight into which medications may improve outcomes. See page 768. See figure.
|
Cardiac Imaging
|
|---|
DSCT Improves Accuracy of Computed Tomography Angiography.
Dual-source computed tomography (DSCT) allows for more images per gantry rotation, which improves the temporal resolution. Weustink and colleagues performed DSCT on patients referred for conventional angiography. Including all segments, not just those with adequate images, sensitivity, specificity, and the negative predictive value of DSCT were all >95%. Positive predictive value was lower, at 75%, due to overgrading of segments with calcified plaque. Noninvasive DSCT coronary angiography is highly sensitive to detect and to reliably rule out the presence of a significant coronary stenosis. See page 786. See figure.
|
Cardiomyopathy
|
|---|
Surgical Myectomy Improves Symptoms After Failed Alcohol Ablation.
Nagueh and colleagues examined records from 20 patients that underwent a surgical myectomy for refractory symptoms after an unsuccessful alcohol ablation. Myectomy was performed, on average, 1.5 years after the initial procedure. There was no operative mortality, and all patients improved to New York Heart Association functional class I. Two patients required permanent pacing after the surgery. The authors conclude that myectomy can be successfully performed after failed alcohol ablation, but with a higher incidence of heart block. See page 795.
Related Articles
-
Chronic Mechanical Circulatory Support for Inotrope-Dependent Heart Failure Patients Who Are Not Transplant Candidates: Results of the INTrEPID Trial
- Joseph G. Rogers, Javed Butler, Steven L. Lansman, Alan Gass, Peer M. Portner, Michael K. Pasque, Richard N. Pierson, III for the INTrEPID Investigators
J. Am. Coll. Cardiol. 2007 50: 741-747.
[Abstract]
[Full Text]
[PDF]
-
On the Fledgling Field of Mechanical Circulatory Support
- Lynne Warner Stevenson and Gregory Couper
J. Am. Coll. Cardiol. 2007 50: 748-751.
[Full Text]
[PDF]
-
The Association of Differing Measures of Overweight and Obesity With Prevalent Atherosclerosis: The Dallas Heart Study
- Raphael See, Shuaib M. Abdullah, Darren K. McGuire, Amit Khera, Mahesh J. Patel, Jason B. Lindsey, Scott M. Grundy, and James A. de Lemos
J. Am. Coll. Cardiol. 2007 50: 752-759.
[Abstract]
[Full Text]
[PDF]
-
Characteristics, Treatments, and Outcomes of Patients With Preserved Systolic Function Hospitalized for Heart Failure: A Report From the OPTIMIZE-HF Registry
- Gregg C. Fonarow, Wendy Gattis Stough, William T. Abraham, Nancy M. Albert, Mihai Gheorghiade, Barry H. Greenberg, Christopher M. O’Connor, Jie Lena Sun, Clyde W. Yancy, James B. Young for the OPTIMIZE-HF Investigators and Hospitals
J. Am. Coll. Cardiol. 2007 50: 768-777.
[Abstract]
[Full Text]
[PDF]
-
Reliable High-Speed Coronary Computed Tomography in Symptomatic Patients
- Annick C. Weustink, Willem B. Meijboom, Nico R. Mollet, Masato Otsuka, Fransesca Pugliese, Carlos van Mieghem, Roberto Malago, Niels van Pelt, Marcel L. Dijkshoorn, Filippo Cademartiri, Gabriel P. Krestin, and Pim J. de Feyter
J. Am. Coll. Cardiol. 2007 50: 786-794.
[Abstract]
[Full Text]
[PDF]
-
Outcome of Surgical Myectomy After Unsuccessful Alcohol Septal Ablation for the Treatment of Patients With Hypertrophic Obstructive Cardiomyopathy
- Sherif F. Nagueh, John M. Buergler, Miguel A. Quinones, William H. Spencer, III, and Gerald M. Lawrie
J. Am. Coll. Cardiol. 2007 50: 795-798.
[Abstract]
[Full Text]
[PDF]
Top
Clinical Trials
Atherosclerosis
