INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Cardiometabolic Risk
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HRT Blunts Risk Associated With High Lp(a).
While previous studies have shown that hormone replacement therapy (HRT) decreases plasma levels of lipoprotein(a) [Lp(a)], few studies have been adequately powered to assess the effect on cardiovascular outcomes. Danik and colleagues measured Lp(a) levels in over 27,000 subjects enrolled in the Women's Health Study, approximately one-half of whom were taking HRT. The Lp(a) values were lower among women taking HRT. In women not taking HRT, the hazard ratio for cardiac events for the highest Lp(a) quintile compared with the lowest was 1.8. There was no excess risk associated with Lp(a) in those taking HRT. This study suggests that HRT lowers Lp(a) and attenuates the risk associated with elevated Lp(a) levels. See pages 124 and
132. See figure.
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Heart Failure
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Spironolactone May Protect Against Fractures.
Because animal models suggest that spironolactone can improve skeletal strength, Carbone and colleagues hypothesized that the incidence of new fractures would be less in patients with congestive heart failure (CHF) who were taking spironolactone compared with those who were not. The records of all male patients seen at a Veterans Affairs hospital with a diagnosis of CHF were abstracted for incident fractures. Those taking spironolactone were 40% less likely to suffer a fracture. These results suggest that spironolactone may help to prevent, or possibly reverse, osteoporosis in male with CHF. See page 135.
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Heart Rhythm Disorders
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VAs May Originate From the Aortic Root.
Yamada and colleagues performed a systematic review of 265 ventricular arrhythmias (VAs) with an inferior QRS axis that were referred for ablation. In 17% of cases, the successful ablation site was within or below the aortic cusps. Most of the origination sites were on the left coronary cusp; only 2% were from the noncoronary cusp. Several electrocardiographic signs were useful for discriminating VAs from the left versus the right coronary cusps. This study confirms that some VAs originate from the aortic root and provides certain algorithms and techniques to identify these origin sites. See page 139. See figure.
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Cardiac Imaging
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CMR for the Detection of LV Thrombus.
Weinsaft and colleagues reviewed cardiovascular magnetic resonance (CMR) studies from almost 800 patients with systolic dysfunction to identify the prevalence of, risk factors for, and best CMR techniques to identify left ventricular (LV) thrombus. Delayed-enhancement (DE)-CMR detected thrombus in 7% compared with 5% for cine-CMR. Pathologic follow-up showed that cine-CMR was unreliable for detecting mural thrombi and small thrombi. DE-CMR appears to be a useful technique for identifying LV thrombus because the thrombus appears prominently as an area of avascular tissue. See page 148. See figure.
Related Articles
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Lipoprotein(a), Hormone Replacement Therapy, and Risk of Future Cardiovascular Events
- Jacqueline Suk Danik, Nader Rifai, Julie E. Buring, and Paul M. Ridker
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Role of Lipoprotein(a) in Cardiovascular Disease: Current and Future Perspectives
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Fracture Risk in Men With Congestive Heart Failure: Risk Reduction With Spironolactone
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Idiopathic Ventricular Arrhythmias Originating From the Aortic Root: Prevalence, Electrocardiographic and Electrophysiologic Characteristics, and Results of Radiofrequency Catheter Ablation
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J. Am. Coll. Cardiol. 2008 52: 139-147.
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Detection of Left Ventricular Thrombus by Delayed-Enhancement Cardiovascular Magnetic Resonance: Prevalence and Markers in Patients With Systolic Dysfunction
- Jonathan W. Weinsaft, Han W. Kim, Dipan J. Shah, Igor Klem, Anna Lisa Crowley, Rhoda Brosnan, Olga G. James, Manesh R. Patel, John Heitner, Michele Parker, Eric J. Velazquez, Charles Steenbergen, Robert M. Judd, and Raymond J. Kim
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Cardiometabolic Risk
Heart Failure
