INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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Bedside Test Can Identify Clopidogrel Nonresponders at Increased Risk for Periprocedural Myocardial Infarction.
Wide interindividual variability is reported for the efficacy of clopidogrel. Patti and colleagues prospectively correlated a point-of-care measurement of residual platelet reactivity with clinical outcome in 160 patients receiving clopidogrel before percutaneous coronary intervention. All patients received a 600-mg loading dose 6 h prior to the procedure or were chronically using 75 mg per day. The quartile of patients with the least inhibition of platelet reactivity was at a 6-fold increased risk of 30-day major adverse cardiac events. This rapid point-of-care assay of clopidogrel efficacy may identify patients in whom more aggressive antithrombotic strategies are needed during coronary intervention. See page 1128.
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Lipid Reduction Therapy
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No Evidence That Statins Cause Cancer.
Epidemiologic studies have shown higher rates of cancer in patients with low cholesterol, prompting a concern that statins may increase the risk of cancer. Alsheikh-Ali and colleagues pooled data from 15 trials with over 400,000 patient-years of follow-up. There was a correlation between lower low-density lipoprotein cholesterol (LDL-C) and incident cancer in both statin- and placebo-treated subjects. The slopes of the regression lines for both groups were similar, meaning that statin-treated patients had lower levels of LDL-C at similar levels of cancer risk. These findings do not support a link between cancer and statin therapy, despite the LDL-C lowering. See page 1141. See figure.
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Heart Failure
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Subclinical Thyroid Dysfunction May Increase Risk of HF.
Subclinical thyroid dysfunction has been associated with cardiac dysfunction, but the risk of incident heart failure (HF) has not been established. Rodondi and colleagues reviewed data from adults age >65 years who had baseline thyroid function measured and were then followed for up to 12 years. Subclinical thyroid dysfunction was defined as an elevated thyroid-stimulating hormone (TSH), but a normal free thyroxine level. Participants with TSH  10.0 mU/l were almost twice as likely to be diagnosed with HF. These findings confirm that subclinical hypothyroidism predisposes to HF. See page 1152.
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Cardiac Imaging
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MRI May Be Useful for Assessing Transplant CAD.
Transplant coronary artery disease (TCAD) is a pan-arterial disease with diffuse, concentric intimal hyperplasia. The severity of TCAD may be underestimated by traditional coronary angiography, which is more geared for the evaluation of focal stenoses. Steen and colleagues compared contrast-enhanced magnetic resonance imaging (CE-MRI) with coronary angiography in 53 post-transplant patients. CE-MRI enhancement patterns typical for infarction were seen in patients with TCAD, and the likelihood of such findings increased as the severity of TCAD increased. There was no association between TCAD and enhancement patterns that were atypical for infarctions. Because nontransmural myocardial infarctions and diffuse coronary stenoses may be missed using conventional coronary angiography, CE-MRI may be able to establish an earlier diagnosis of TCAD. See page 1160.
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Aortic Diseases
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CT Predicts Outcomes in Patients With Type B Dissections.
The early mortality rate for type B aortic dissection ranges from 10% to 12%; the preferred treatment for patients without complications is medical therapy, but the potential complications may result in rapid death. Chang and colleagues reviewed the computed tomography (CT) scans of 55 patients who were found to have acute type B aortic dissections and were followed for in-hospital complications. The mean maximal false lumen area (MFLA) and the number of branch vessels involved (BVI) were found to be significant predictors of in-hospital complications. Patients with initial MFLA >922 mm2 or BVI number >1 have a higher incidence of in-hospital complications and may need earlier evaluation for surgical intervention. See page 1170. See figure.
Related Articles
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Point-of-Care Measurement of Clopidogrel Responsiveness Predicts Clinical Outcome in Patients Undergoing Percutaneous Coronary Intervention: Results of the ARMYDA-PRO (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Platelet Reactivity Predicts Outcome) Study
- Giuseppe Patti, Annunziata Nusca, Fabio Mangiacapra, Laura Gatto, Andrea D'Ambrosio, and Germano Di Sciascio
J. Am. Coll. Cardiol. 2008 52: 1128-1133.
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Subclinical Thyroid Dysfunction, Cardiac Function, and the Risk of Heart Failure: The Cardiovascular Health Study
- Nicolas Rodondi, Douglas C. Bauer, Anne R. Cappola, Jacques Cornuz, John Robbins, Linda P. Fried, Paul W. Ladenson, Eric Vittinghoff, John S. Gottdiener, and Anne B. Newman
J. Am. Coll. Cardiol. 2008 52: 1152-1159.
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Prevalence of Different Gadolinium Enhancement Patterns in Patients After Heart Transplantation
- Henning Steen, Constanze Merten, Sonja Refle, Roland Klingenberg, Thomas Dengler, Evangelos Giannitsis, and Hugo A. Katus
J. Am. Coll. Cardiol. 2008 52: 1160-1167.
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The Role of False Lumen Size in Prediction of In-Hospital Complications After Acute Type B Aortic Dissection
- Chih-Ping Chang, Juhn-Cherng Liu, Ying-Ming Liou, Shih-Sheng Chang, and Jan-Yow Chen
J. Am. Coll. Cardiol. 2008 52: 1170-1176.
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Statins, Low-Density Lipoprotein Cholesterol, and Risk of Cancer
- Alawi A. Alsheikh-Ali, Thomas A. Trikalinos, David M. Kent, and Richard H. Karas
J. Am. Coll. Cardiol. 2008 52: 1141-1147.
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Interventional Cardiology
Lipid Reduction Therapy
