INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Heart Failure
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Low CoQ10 Levels Associated With Worse Survival in CHF Patients.
Coenzyme Q10 (CoQ10) is an essential cofactor for myocardial adenosine triphosphate generation; low levels may impair cardiac energy reserves. Molyneux and colleagues measured CoQ10 levels in over 200 patients hospitalized with chronic heart failure (CHF) who were then followed for total mortality. There was a significant correlation between CoQ10 and total cholesterol, and an inverse correlation between CoQ10 and N-terminal peptide of B-type natriuretic peptide (NT-proBNP). CoQ10 was an independent predictor of survival with a higher strength of association than NT-proBNP. CoQ10 deficiency may be detrimental to the long-term prognosis of patients with CHF. See page 1435. See figure.
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Heart Rhythm Disorders
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CRT Responders Show a Decrease in VAs.
Cardiac resynchronization therapy (CRT) can result in significant reverse remodeling of the enlarged left ventricle. Di Biase and colleagues studied the relationship between reverse remodeling and ventricular arrhythmias (VAs) in nearly 400 patients. Spontaneous VAs detected by the device were reviewed and validated. Those patients who had a >10% reduction in left ventricular end-systolic volume, classified as responders to CRT, had significantly fewer VAs than nonresponders. In patients who respond favorably to CRT, a reduction in VAs occurs during the first few months of therapy. See page 1442. See figure.
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Cardiac Imaging
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"Step-and-Shoot" CT Angiography Significantly Reduces Radiation Exposure.
Maruyama and colleagues compared the radiation dose received and the image quality of prospectively electrocardiogram (ECG)-gated multidetector-row computed tomography coronary angiography (MDCT-CA) and retrospectively ECG-gated helical scanning with dose modulation. In this select population, >95% of the coronary segments were considered assessable for both techniques, and there was similar sensitivity and specificity for both techniques compared with findings at traditional coronary angiography. The effective radiation dose with prospective gating was 79% lower than with retrospective gating. This study shows that MDCT-CA with prospective gating can significantly reduce radiation exposure without compromising image quality. See pages 1450 and
1456. See figure.
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Biomarkers
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ST2 Correlates With HF Severity and Risk of Death in CHF Patients.
The ST2 gene is a member of the interleukin-1 receptor family whose transcription in cardiac myocytes and fibroblasts is markedly up-regulated by mechanical strain. Rehman and colleagues assayed a soluble fragment of this gene that circulates in the plasma in over 300 subjects with acute heart failure (HF). ST2 values positively correlated with markers of poor prognosis, including B-type natriuretic peptide, amino terminal B-type natriuretic peptide, New York Heart Association functional class, and 1-year mortality. ST2 appears to be a useful biomarker that may help to elucidate the relationship between HF and inflammation. See pages 1458 and
1466. See figure.
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Hypertension
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Polymorphism in CHGA Gene Associated With Hypertension.
Chromogranin A (CHGA) is a protein that is stored with catecholamines in secretory vesicles in the adrenal medulla and post-ganglionic sympathetic axons. Chen and colleagues performed a series of studies assessing the impact of polymorphisms in this gene on resting blood pressure (BP), BP response to cold pressor challenge, and circulating levels of norepinephrine. The results suggest that a common polymorphism in the 3'-untranslated region (C+87T) can significantly affect BP by modulating the release of catecholamines from these secretory vesicles, otherwise known as chromaffin granules. See page 1468. See figure.
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Hypertension
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Reduction in Heart Rate With Beta-Blockers Linked to Increased Mortality.
Previous studies in patients with acute myocardial infarction (MI), stable angina, and heart failure have shown that the reduction in heart rate by beta-blockers is closely linked to the beneficial effects. Bangalore and colleagues performed a meta-analysis to determine if the relationship holds true for patients with hypertension. In 9 trials, a lower heart rate was associated with an increased risk of all-cause mortality, cardiovascular mortality, MI, stroke, and heart failure. In patients with hypertension, a beta-blocker–induced reduction in heart rate appears to increase the risk of cardiovascular events, possibly by increasing central aortic pressure compared with other medications with similar reductions in peripheral blood pressure. See pages 1482 and
1490. See figure.
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Year in Cardiology Series
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2008 Research Highlights for Congenital Heart Disease.
Graham reviews and summarizes several articles published in 2008 with a focus on patients with congenital heart disease. This paper includes summaries of several articles that range from the morbidity of surgery in infants to long-term follow-up of post-Fontan patients to the efficacy of clopidogrel in children. See page 1492.
Related Articles
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Coenzyme Q10: An Independent Predictor of Mortality in Chronic Heart Failure
- Sarah L. Molyneux, Christopher M. Florkowski, Peter M. George, Anna P. Pilbrow, Christopher M. Frampton, Michael Lever, and A. Mark Richards
J. Am. Coll. Cardiol. 2008 52: 1435-1441.
[Abstract]
[Full Text]
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Antiarrhythmic Effect of Reverse Ventricular Remodeling Induced by Cardiac Resynchronization Therapy: The InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry
- Luigi Di Biase, Maurizio Gasparini, Maurizio Lunati, Massimo Santini, Maurizio Landolina, Giuseppe Boriani, Antonio Curnis, Mario Bocchiardo, Antonio Vincenti, Alessandra Denaro, Sergio Valsecchi, Andrea Natale, Luigi Padeletti on behalf of the InSync/InSync ICD Italian Registry Investigators
J. Am. Coll. Cardiol. 2008 52: 1442-1449.
[Abstract]
[Full Text]
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Radiation Dose Reduction and Coronary Assessability of Prospective Electrocardiogram-Gated Computed Tomography Coronary Angiography: Comparison With Retrospective Electrocardiogram-Gated Helical Scan
- Takao Maruyama, Masanori Takada, Toshiaki Hasuike, Atsushi Yoshikawa, Eiji Namimatsu, and Tohru Yoshizumi
J. Am. Coll. Cardiol. 2008 52: 1450-1455.
[Abstract]
[Full Text]
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Low-Dose Computed Tomography Coronary Angiography With Prospective Triggering: A Promise for the Future
- Philipp A. Kaufmann
J. Am. Coll. Cardiol. 2008 52: 1456-1457.
[Full Text]
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Characteristics of the Novel Interleukin Family Biomarker ST2 in Patients With Acute Heart Failure
- Shafiq U. Rehman, Thomas Mueller, and James L. Januzzi, Jr
J. Am. Coll. Cardiol. 2008 52: 1458-1465.
[Abstract]
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Serum Soluble ST2 as a Biochemical Marker of Acute Heart Failure: Future Areas of Research
- Javier Díez
J. Am. Coll. Cardiol. 2008 52: 1466-1467.
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Naturally Occurring Human Genetic Variation in the 3'-Untranslated Region of the Secretory Protein Chromogranin A Is Associated With Autonomic Blood Pressure Regulation and Hypertension in a Sex-Dependent Fashion
- Yuqing Chen, Fangwen Rao, Juan L. Rodriguez-Flores, Manjula Mahata, Maple M. Fung, Mats Stridsberg, Sucheta M. Vaingankar, Gen Wen, Rany M. Salem, Madhusudan Das, Myles G. Cockburn, Nicholas J. Schork, Michael G. Ziegler, Bruce A. Hamilton, Sushil K. Mahata, Laurent Taupenot, and Daniel T. O'Connor
J. Am. Coll. Cardiol. 2008 52: 1468-1481.
[Abstract]
[Full Text]
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Relation of Beta-Blocker–Induced Heart Rate Lowering and Cardioprotection in Hypertension
- Sripal Bangalore, Sabrina Sawhney, and Franz H. Messerli
J. Am. Coll. Cardiol. 2008 52: 1482-1489.
[Abstract]
[Full Text]
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Beta-Blockers in Hypertension: Adding Insult to Injury
- Norman M. Kaplan
J. Am. Coll. Cardiol. 2008 52: 1490-1491.
[Full Text]
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The Year in Congenital Heart Disease
- Thomas P. Graham, Jr
J. Am. Coll. Cardiol. 2008 52: 1492-1499.
[Full Text]
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Heart Failure
Heart Rhythm Disorders
