INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Coronary Artery Disease
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Intravenous Iron Improves Exercise Tolerance.
Patients with chronic heart failure (CHF) have impaired skeletal muscle oxidative capacity which causes an early shift to anerobic metabolism and early fatigue. Iron is critical for oxidative metabolism. The FERRIC-HF (Ferric Iron Sucrose in Heart Failure) trial randomized 35 patients with CHF and low ferritin levels, and/or low transferrin saturations, to intravenous iron sucrose or no treatment. Iron therapy delayed the onset of anaerobic metabolism. Benefits were more marked in patients who were also anemic, but were present in those without anemia. This study suggests that normalizing iron stores may improve exercise capacity by increasing the threshold for skeletal muscle anerobic metabolism in patients with CHF. See page 103.
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Infarction and Psychosocial Factors
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Anxiety Associated With Increased Risk of Myocardial Infarction.
Several psychosocial factors have been associated with increased cardiovascular risk, but anxiety has not been examined extensively. Shen and colleagues followed over 700 patients enrolled in the Normative Aging Study who were assessed with the Minnesota Multiphasic Personality Inventory. Over the next 12 years, those with anxiety characteristics were more likely to suffer a myocardial infarction, even after controlling for traditional risk factors and other psychological variables. Subjects in the highest quartile of anxiety were at almost 3 times higher risk. This study suggests that patients with anxiety-prone dispositions are at significantly increased risk for future cardiovascular events. See page 113. See figure.
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Heart Failure and Resynchronization
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Response to Cardiac Resynchronization Therapy Associated With Improvements in Myocardial Gene Expression.
Cardiomyocytes from failing ventricles often revert to the "fetal" gene program, with alterations in genes that regulate contractile function and pathologic hypertrophy. Vanderheyden and colleagues hypothesized that patients who respond to cardiac resynchronization therapy (CRT), may normalize their gene expression profiles. Left ventricular endomyocardial biopsies were obtained pre- and post-CRT implantation. Responders to CRT showed an increase in messenger ribonucleic acid levels of  -mysoin heavy chain, sarcoplasmic reticulum calcium ATPase 2 (SERCA), and an increase in the ratio of SERCA/phospholamban. No changes were observed in nonresponders. Functional improvement related to CRT is associated with favorable changes in established molecular markers of heart failure. See page 129.
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Cardiac Imaging
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Myocardial Fatty Acid Imaging Predicts Cardiac Risk in Dialysis Patients.
Over 70% of the energy expended by the normal myocardium under aerobic conditions is derived from free fatty acid metabolism, but during ischemia, myocytes shift to glucose as an energy source. Single-photon emission computed tomography (SPECT) using 123iodine–β-methyl iodophenyl-pentadecanoic acid (BMIPP) as a tracer allows the quantification of cardiac fatty acid metabolism. Nishimura and colleagues performed SPECT imaging with BMIPP in dialysis patients. The cardiac death-free survival rates at 3 years were 61% and 98% in patients with BMIPP summed scores of >12 and <12. This study demonstrates that BMIPP SPECT imaging can identify patients at high risk for cardiac death, probably by identifying areas of chronic myocardial ischemia. See page 139. See figure.
Related Articles
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Effect of Intravenous Iron Sucrose on Exercise Tolerance in Anemic and Nonanemic Patients With Symptomatic Chronic Heart Failure and Iron Deficiency: FERRIC-HF: A Randomized, Controlled, Observer-Blinded Trial
- Darlington O. Okonko, Agnieszka Grzeslo, Tomasz Witkowski, Amit K.J. Mandal, Robert M. Slater, Michael Roughton, Gabor Foldes, Thomas Thum, Jacek Majda, Waldemar Banasiak, Constantinos G. Missouris, Philip A. Poole-Wilson, Stefan D. Anker, and Piotr Ponikowski
J. Am. Coll. Cardiol. 2008 51: 103-112.
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Anxiety Characteristics Independently and Prospectively Predict Myocardial Infarction in Men: The Unique Contribution of Anxiety Among Psychologic Factors
- Biing-Jiun Shen, Yael E. Avivi, John F. Todaro, Avron Spiro, III, Jean-Philippe Laurenceau, Kenneth D. Ward, and Raymond Niaura
J. Am. Coll. Cardiol. 2008 51: 113-119.
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Myocardial Gene Expression in Heart Failure Patients Treated With Cardiac Resynchronization Therapy: Responders Versus Nonresponders
- Marc Vanderheyden, Wilfried Mullens, Leen Delrue, Marc Goethals, Bernard de Bruyne, William Wijns, Peter Geelen, Sofie Verstreken, Francis Wellens, and Jozef Bartunek
J. Am. Coll. Cardiol. 2008 51: 129-136.
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Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging
- Masato Nishimura, Kazumasa Tsukamoto, Naoyuki Hasebe, Nagara Tamaki, Kenjiro Kikuchi, and Toshihiko Ono
J. Am. Coll. Cardiol. 2008 51: 139-145.
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Coronary Artery Disease
Infarction and Psychosocial...
