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J Am Coll Cardiol, 2008; 51:35-36, doi:10.1016/S0735-1097(08)01372-7
© 2008 by the American College of Cardiology Foundation
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INSIDE THIS ISSUE OF JACC

Inside This Issue of JACC


   Interventional Cardiology
Top
 Interventional Cardiology
Myocardial Infarction
 Heart Failure
 Heart Failure
 Hypertension
 
DES or BMS: Effect on Quality of Life.  
Figure 1
Garg and colleagues designed a Markov model to explore the effects on quality-adjusted life expectancy of choosing drug-eluting stents (DES) versus bare-metal stents (BMS). The model attempts to answer the question: what excess risk of late stent thrombosis with DES would be an acceptable tradeoff for suppressing restenosis compared with BMS? Data regarding the relative and absolute risks of DES, BMS, and secondary procedures, and the effect of these outcomes on quality of life were compiled from a wide variety of published studies. The models indicate that if the excess risk of very late stent thrombosis is <0.14% per year over 4 years, most patients would prefer DES to BMS. This article may help physicians more effectively compare the risks and benefits of DES. See pages 1844 and 1854. See figure.


   Myocardial Infarction
Top
 Interventional Cardiology
 Myocardial Infarction
Heart Failure
 Heart Failure
 Hypertension
 
New ANP Biomarker Assay Helps Predict Acute MI Mortality.  
Figure 2
While B-type natriuretic peptide (BNP) is well validated as a post-myocardial infarction (MI) risk stratifier, the initial studies with atrial natriuretic peptide (ANP) were less compelling. Khan and colleagues noted that the ends of ANP may be degraded by proteases, and therefore developed an assay that recognizes epitopes in the mid-region of the ANP prohormone (MR-proANP), an area that is less likely to degraded. Levels of MR-proANP and N-terminal (NT)-proBNP were analyzed 3 to 5 days after the onset of chest pain in almost 1,000 persons who suffered an MI and were then followed for up to 2 years. Levels of both assays were higher in patients who died than in those who survived; the highest risk was in patients in the upper quartile for both measurements. MR-proANP is a useful risk stratifier, especially in those with an elevated NT-proBNP. See page 1857. See figure.


   Heart Failure
Top
 Interventional Cardiology
 Myocardial Infarction
 Heart Failure
Heart Failure
 Hypertension
 
Measuring BNP Precursor Peptide May Improve Diagnostic Accuracy.  
Figure 3
The initial translation and processing of the B-type natriuretic peptide (BNP) messenger ribonucleic acid results in an 108 amino acid peptide denoted as proBNP. ProBNP is then further cleaved into two fragments: BNP, a vasoactive 32 amino acid peptide, and the N-terminal peptide fragment (NT-proBNP). The currently available assays for BNP and NT-proBNP likely cross react with proBNP in the serum. This study by Waldo and colleagues used 3 different assays to measure proBNP, BNP, and NT-proBNP in patients with decompensated heart failure. The proBNP levels were not affected by body mass index (BMI), renal function, or age. All 3 peptides were significantly elevated in patients who died within 90 days. This preliminary comparison suggests that NT-proBNP has a slightly higher diagnostic yield for predicting death, but the apparent lack of interference with BMI, renal dysfunction, and age suggests that proBNP should be further studied. See page 1874. See figure.


   Heart Failure
Top
 Interventional Cardiology
 Myocardial Infarction
 Heart Failure
 Heart Failure
Hypertension
 
ET Does Not Cause Long-Term Changes in Myocardial Energy Metabolism.  
Figure 4
Reductions in phosphocreatine and adenosine triphosphate have been implicated in the altered myocardial energy metabolism that contributes to contractile dysfunction. High energy phosphate metabolism can be measured by 31P-MR spectroscopy (MRS). Beer and colleagues performed MRS on patients with non-ischemic cardiomyopathies to study the effect of an intensive exercise training (ET) program for 2 months. The ET improved peak VO 2, left ventricular (LV) end-systolic volume, and LV ejection fraction. The improvement in cardiac function was not accompanied by changes in cardiac high-energy phosphate concentrations. This study demonstrates that ET can produce substantial improvements in exertional capacity without an effect on myocardial energy metabolism; this lack of effect may be beneficial, as other modalities that stimulate the myocardium may deplete myocardial energy stores and increase mortality. See pages 1883 and 1892. See figure.


   Hypertension
Top
 Interventional Cardiology
 Myocardial Infarction
 Heart Failure
 Heart Failure
 Hypertension
 
Evidence that Cardiac Autonomic Dysfunction Precedes Hypertension.  
Figure 5
This study by Wu and colleagues examined the hypothesis that cardiac autonomic function (CAF) is altered in pre-hypertensive subjects and those with a family history of hypertension (FHH). Nearly 1,500 subjects were classified as having normotension (<120/80 mm Hg), pre-hypertension (120 to 139/80 to 89 mm Hg), or hypertension (≥140/90 mm Hg). Cardiac autonomic function was determined by multiple methods, including standard deviation of RR interval, the heart rate variability with standing, and respiratory variation in the heart rate. There was a significant, graded difference in all CAF indexes along the spectrum of hypertension. This study provides evidence that CAF plays a role in pre-hypertension and that altered autonomic function is already present in subjects with FHH. See pages 1896 and 1902. See figure.


Related articles in JACC:

Balancing the Risks of Restenosis and Stent Thrombosis in Bare-Metal Versus Drug-Eluting Stents: Results of a Decision Analytic Model
Pallav Garg, David J. Cohen, Thomas Gaziano, and Laura Mauri
JACC 2008 51: 1844-1853. [Abstract] [Full Text]  

Interpreting the Music of Drug-Eluting Stents: Halcyon Song or Albatross Dirge?
Daniel B. Mark
JACC 2008 51: 1854-1856. [Full Text]  

Plasma N-Terminal B-Type Natriuretic Peptide as an Indicator of Long-Term Survival After Acute Myocardial Infarction: Comparison With Plasma Midregional Pro-Atrial Natriuretic Peptide: The LAMP (Leicester Acute Myocardial Infarction Peptide) Study
Sohail Q. Khan, Onkar Dhillon, Dominic Kelly, Iain B. Squire, Joachim Struck, Paulene Quinn, Nils G. Morgenthaler, Andreas Bergmann, Joan E. Davies, and Leong L. Ng
JACC 2008 51: 1857-1864. [Abstract] [Full Text]  

Pro-B-Type Natriuretic Peptide Levels in Acute Decompensated Heart Failure
Stephen W. Waldo, Jennifer Beede, Susan Isakson, Sylvie Villard-Saussine, Jeannette Fareh, Paul Clopton, Robert L. Fitzgerald, and Alan S. Maisel
JACC 2008 51: 1874-1882. [Abstract] [Full Text]  

Effects of Exercise Training on Myocardial Energy Metabolism and Ventricular Function Assessed by Quantitative Phosphorus-31 Magnetic Resonance Spectroscopy and Magnetic Resonance Imaging in Dilated Cardiomyopathy
Meinrad Beer, Doris Wagner, Jonathan Myers, Jörn Sandstede, Herbert Köstler, Dietbert Hahn, Stefan Neubauer, and Paul Dubach
JACC 2008 51: 1883-1891. [Abstract] [Full Text]  

Exercise Training and Myocardial Energetics in Patients With Heart Failure: When More Is Less
Howard J. Eisen
JACC 2008 51: 1892-1895. [Full Text]  

Epidemiological Study on the Effect of Pre-Hypertension and Family History of Hypertension on Cardiac Autonomic Function
Jin-Shang Wu, Feng-Hwa Lu, Yi-Ching Yang, Thy-Sheng Lin, Jia-Jin Chen, Chih-Hsing Wu, Ying-Hsiang Huang, and Chih-Jen Chang
JACC 2008 51: 1896-1901. [Abstract] [Full Text]  

Cardiac Autonomic Imbalance in Pre-Hypertension and in a Family History of Hypertension
Daniel A. Duprez
JACC 2008 51: 1902-1903. [Full Text]  




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