INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Coronary Artery Disease
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Knowledge of Elevated Calcium Score Encourages Use of Statins.
Taylor and colleagues hypothesized that patients found to have high coronary artery calcium (CAC) scores would be more likely to be prescribed aspirin and a statin, and more likely to continue therapy once prescribed. Subjects enrolled in the PACC (Prospective Army Coronary Calcium) Project underwent electron beam computed tomography; the CAC score was shared with the participants and available to their physicians. Those with a CAC > 0 were 3 times more likely to be taking a statin or acetylsalicylic acid, even after adjusting for other National Cholesterol Education Program risk factors. This study suggests that if patients and physicians know that a patient's CAC score is elevated, they are more likely to be treating their cardiac risk factors. See page 1337. See figure.
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Obesity and Cardiac Function
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LVH Reverses in Obese Adolescents After Gastric Bypass Surgery.
Left ventricular hypertrophy (LVH), diabetes, and hypertension are associated with morbid obesity, even in adolescents. Ippisch and colleagues compared pre- and post-bariatric surgery echocardiograms from 38 subjects age 13 to 19 years. Weight and body mass index decreased substantially. These changes correlated closely with changes in left ventricular mass index. There were also significant improvements in left ventricular geometry, diastolic function, and the rate–pressure product. These results indicate that substantial weight loss likely improves future cardiovascular morbidity in morbidly obese adolescents. See page 1342. See figure.
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Heart Failure
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Endothelial Dysfunction in Patients With Chronic Heart Failure Linked to NADPH Oxidase.
Endothelial dysfunction in patients with heart failure contributes to increased vascular tone, and dysregulation of vascular volume. Dworakowski and colleagues hypothesized that reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidases may increase oxidative stress and contribute to this endothelial dysfunction. Saphenous vein segments were harvested from patients undergoing coronary artery bypass graft who had a history of heart failure (mean ejection fraction 37%) versus a control group with normal left ventricular function. Heart failure patients had significantly worse endothelial relaxation and over 2-fold higher NADPH-dependent superoxide generation. This study confirms that patients with reduced left ventricular function have endothelial dysfunction, and suggests that up-regulation of NADPH oxidase is the cause. See page 1349. See figure.
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Heart Rhythm Disorders
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Frequency of Inappropriate ICD Shocks.
Inappropriate shocks can result in impaired quality of life and psychiatric disturbances for patients with implantable cardioverter-defibrillators (ICD). Daubert and colleagues analyzed ICD electrograms from the MADIT (Multicenter Automatic Defibrillator Implantation Trial) II to classify ICD shocks as appropriate or inappropriate, and to sub-classify inappropriate shocks as triggered by either atrial fibrillation, sinus or supraventricular tachycardia, or sensing abnormality/lead malfunction. One or more inappropriate shocks occurred in 11% of the patients, and accounted for 31% of total shock episodes. Inappropriate ICD shocks occurred commonly in MADIT II. See page 1357.
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Hypertrophic Cardiomyopathy
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Myocardial Fibrosis Linked to Arrhythmic Risk in HCM Patients.
While myocardial fibrosis is identified frequently in autopsy specimens from patients with hypertrophic cardiomyopathies (HCM), the link between fibrosis and arrhythmias is not clear. Adabag and colleagues examined cardiac magnetic resonance imaging for areas of delayed enhancement (DE), and compared these to the findings on 24-h ambulatory Holter electrocardiogram. Those with DE were twice as likely to have ventricular couplets and more than 7 times more likely to have nonsustained ventricular tachycardia. Nonsustained ventricular tachycardia has been linked to the arrhythmic risk in patients with HCM, suggesting a link between DE and increased risk for ventricular arrhythmias. See page 1369. See figure.
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Community-Based Provision of Statin and Aspirin After the Detection of Coronary Artery Calcium Within a Community-Based Screening Cohort
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Reversibility of Cardiac Abnormalities in Morbidly Obese Adolescents
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Reduced Nicotinamide Adenine Dinucleotide Phosphate Oxidase-Derived Superoxide and Vascular Endothelial Dysfunction in Human Heart Failure
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Inappropriate Implantable Cardioverter-Defibrillator Shocks in MADIT II: Frequency, Mechanisms, Predictors, and Survival Impact
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Occurrence and Frequency of Arrhythmias in Hypertrophic Cardiomyopathy in Relation to Delayed Enhancement on Cardiovascular Magnetic Resonance
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Coronary Artery Disease
Obesity and Cardiac Function
