JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
QUICK SEARCH:   [advanced]


     

J Am Coll Cardiol, 2008; 51:35-36, doi:10.1016/S0735-1097(08)00374-4
© 2008 by the American College of Cardiology Foundation
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in JACC
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager

INSIDE THIS ISSUE OF JACC

Inside This Issue of JACC


   Interventional Cardiology
Top
 Interventional Cardiology
Interventional Cardiology
 Lipids and CAD
 Heart Rhythm Disorders
 Pulmonary Hypertension
 
Periprocedural Bleeding Is a Robust Risk Marker for Post-PCI Mortality.  
Figure 1
Traditionally, the composite triple end point used to assess PCI procedures is the combined incidence of death, myocardial infarction (MI), and urgent revascularization (UR) at 30 days. Recently, some studies have used a quadruple end point that includes periprocedural bleeding complications. Ndrepepa and colleagues combined data from the 4 ISAR trials to investigate the relationship between bleeding and 1-year mortality. The hazard ratio for 1-year mortality was 3.0 for bleeding, 2.3 for MI, and 2.5 for UR; all 3 outcomes had similar discriminatory power. This study demonstrates a strong relationship between periprocedural bleeding and 1-year mortality and supports the inclusion of periprocedural bleeding in a 30-day quadruple end point. See pages 690 and 698. See figure.


   Interventional Cardiology
Top
 Interventional Cardiology
 Interventional Cardiology
Lipids and CAD
 Heart Rhythm Disorders
 Pulmonary Hypertension
 
The Problem With Composite End Points.  
Figure 2
The term MACE (major adverse cardiac events) is a commonly used end point for cardiovascular research; however, there is no standard definition for MACE. Kip and colleagues conducted a 2-phase literature review on the use of MACE as a composite end point, and then simulated different definitions of MACE in a large percutaneous coronary intervention registry. The review identified substantial heterogeneity in the outcomes used to define MACE; these different definitions of MACE significantly altered the apparent efficacy of various interventions. The authors conclude that the term MACE should not be used unless a standard definition can be agreed upon. See page 701. See figure.


   Lipids and CAD
Top
 Interventional Cardiology
 Interventional Cardiology
 Lipids and CAD
Heart Rhythm Disorders
 Pulmonary Hypertension
 
Lower TGs Improve Outcomes in Post-ACS Patients.  
Figure 3
The risk associated with elevated triglycerides (TGs) in patients achieving optimal low-density lipoprotein (LDL) reduction is unclear. Miller and colleagues studied the effect of TG levels on outcomes in patients enrolled in the PROVE IT-TIMI 22 trial, which randomized post–acute coronary syndrome (ACS) patients to either atorvastatin 80 mg/day or pravastatin 40 mg/day. Subjects with TG <150 mg/dl were at reduced risk for future events, independent of the LDL level. Those with LDL <70 mg/dl and TG <150 mg/dl were at the lowest risk. These data suggest that both LDL cholesterol and TG levels are important therapeutic parameters in patients following ACS. See page 724. See figure.


   Heart Rhythm Disorders
Top
 Interventional Cardiology
 Interventional Cardiology
 Lipids and CAD
 Heart Rhythm Disorders
Pulmonary Hypertension
 
EVM Can Distinguish ARVD From RVOT.  
Figure 4
It can be difficult to distinguish the fairly benign right ventricular outflow tract (RVOT) tachycardia from the more dangerous arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). Corrado and colleagues performed right ventricular electroanatomic voltage mapping (EVM), using a CARTO system, in 27 patients with RVOT tachycardia and morphologically normal right ventricles. In 26% of patients, they identified areas of low signal amplitude; these patients were more likely to have fibrofatty replacement of the myocardium on biopsy. Forty three percent of these patients went on to require an implantable cardioverter-defibrillator, versus none of the patients with normal EVMs. Electroanatomic voltage mapping may be a valid method for distinguishing early or minor ARVC/D from idiopathic RVOT tachycardia. See pages 731 and 740. See figure.


   Pulmonary Hypertension
Top
 Interventional Cardiology
 Interventional Cardiology
 Lipids and CAD
 Heart Rhythm Disorders
 Pulmonary Hypertension
 
Prolonged RV Contraction Causes Septal Bowing in PAH Patients.  
Figure 5
In pulmonary arterial hypertension (PAH), leftward ventricular septal bowing (LVSB) is most prominent in early diastole and seems to be caused by a relative delay in maximal right ventricle (RV) pressure. However, it is not clear if this delay is caused by delayed onset of RV contraction or prolonged RV contraction. Marcus and colleagues studied patients with PAH using cine magnetic resonance imaging. There was no delay in the onset of contraction in the RV; however, peak RV free wall strain occurred 120 ms after the peak strain in the septum and 59 ms after closure of the pulmonic valve. In PAH, LVSB is caused by lengthening of the duration of RV contraction, which results in decreased left ventricle filling and, therefore, decreased stroke volume. See pages 750 and 758. See figure.


Related articles in JACC:

Periprocedural Bleeding and 1-Year Outcome After Percutaneous Coronary Interventions: Appropriateness of Including Bleeding as a Component of a Quadruple End Point
Gjin Ndrepepa, Peter B. Berger, Julinda Mehilli, Melchior Seyfarth, Franz-Josef Neumann, Albert Schömig, and Adnan Kastrati
JACC 2008 51: 690-697. [Abstract] [Full Text]  

Percutaneous Coronary Intervention Pharmacology: From a Triangle to a Square
Harold L. Dauerman
JACC 2008 51: 698-700. [Full Text]  

The Problem With Composite End Points in Cardiovascular Studies: The Story of Major Adverse Cardiac Events and Percutaneous Coronary Intervention
Kevin E. Kip, Kim Hollabaugh, Oscar C. Marroquin, and David O. Williams
JACC 2008 51: 701-707. [Abstract] [Full Text]  

Impact of Triglyceride Levels Beyond Low-Density Lipoprotein Cholesterol After Acute Coronary Syndrome in the PROVE IT-TIMI 22 Trial
Michael Miller, Christopher P. Cannon, Sabina A. Murphy, Jie Qin, Kausik K. Ray, Eugene Braunwald, and for the PROVE IT-TIMI 22 Investigators
JACC 2008 51: 724-730. [Abstract] [Full Text]  

Three-Dimensional Electroanatomical Voltage Mapping and Histologic Evaluation of Myocardial Substrate in Right Ventricular Outflow Tract Tachycardia
Domenico Corrado, Cristina Basso, Loira Leoni, Barbara Tokajuk, Pietro Turrini, Barbara Bauce, Federico Migliore, Andrea Pavei, Giuseppe Tarantini, Massimo Napodano, Angelo Ramondo, Gianfranco Buja, Sabino Iliceto, and Gaetano Thiene
JACC 2008 51: 731-739. [Abstract] [Full Text]  

Diagnosing Subtle Forms of Potentially Life-Threatening Diseases
David J. Callans
JACC 2008 51: 740-741. [Full Text]  

Interventricular Mechanical Asynchrony in Pulmonary Arterial Hypertension: Left-to-Right Delay in Peak Shortening Is Related to Right Ventricular Overload and Left Ventricular Underfilling
J. Tim Marcus, C. Tji-Joong Gan, Jaco J.M. Zwanenburg, Anco Boonstra, Cor P. Allaart, Marco J.W. Götte, and Anton Vonk-Noordegraaf
JACC 2008 51: 750-757. [Abstract] [Full Text]  

Heart Inefficiency in Pulmonary Hypertension: A Double Jeopardy
Rafael Beyar
JACC 2008 51: 758-759. [Full Text]  




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in JACC
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager

HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK