INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Invasive Cardiology
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No Benefit to Bicarbonate Hydration Prior to Angiography.
Some studies suggest that hydration with sodium bicarbonate can reduce the incidence of contrast-induced nephropathy (CIN). Maoli and colleagues randomized 500 patients with baseline creatinine clearance <60 ml/min to pre-hydration with either saline or sodium bicarbonate. All patients received N-acetylcysteine (NAC). There was no difference in the primary end point of CIN, defined as a rise >0.5 mg/dl in creatinine. Hydration with sodium bicarbonate plus NAC before contrast exposure is not more effective than hydration with isotonic saline plus NAC at preventing CIN. See page 599.
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Obesity and Heart Disease
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Waist-to-Height Ratio Is Slightly Better Than BMI for CV Risk.
Using body mass index (BMI) to define overweight and obesity may miss identifying persons at "normal" BMI levels with increased cardiovascular (CV) risk related to central fat distribution. Using data from 2 large prospective cohorts (Physicians' Health Study and Women's Health Study), Gelber and colleagues examined the predictive risk of several anthropometric indexes (BMI, waist circumference, waist-to-hip ratio, and waist-to-height ratio [WHtR]). While WHtR was statistically the best, the differences were small and not clinically significant. These findings emphasize that higher levels of adiposity, however measured, confer increased risk of CV death and that BMI can be used to measure this risk. See pages 605 and
616. See figure.
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Lipid Reduction Therapy
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Statin Therapy Alters the Relationship Between ApoB and LDL and HDL Cholesterol.
Apolipoprotein B (apoB) levels may better predict cardiovascular risk than low-density lipoprotein cholesterol (LDL-C). However, the relationship between apoB and LDL-C may be altered by the concentration of small, dense low-density lipoprotein particles or treatment with statins. Ballantyne and colleagues examined the relationship between apoB and LDL-C before and after statin therapy. In untreated patients, an apoB level <90 mg/dl was equivalent to an LDL-C level <100 mg/dl. However, during statin therapy, it was necessary to reduce LDL-C to <70 mg/dl (in high-triglyceride patients) or <80 mg/dl (in lower-triglyceride patients). These data suggest that in patients treated with statins, it is necessary to reduce LDL-C to <70 mg/dl to achieve apoB levels <90 mg/dl. See pages 626 and
633.
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Cardiac Imaging
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CTCA Has Poor Specificity for Functional Stenosis Severity.
Meijboom and colleagues reviewed studies from patients who had undergone both computed tomography coronary angiography (CTCA) and traditional coronary angiography (CA) with fractional flow reserve (FFR). Correlations between quantitative computed tomography and quantitative CA with FFR measurement were weak. The diagnostic accuracy of qualitative CTCA to detect a lesion with an FFR <0.75 was only 49%. CTCA can be used to exclude significant stenoses, but decisions regarding the need for revascularization should include other modalities to determine functional significance. See page 636. See figure.
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Heart Failure
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No Association Between Adrenergic Receptor Polymorphisms and Survival in HF Patients.
There have been discordant findings regarding the significance of genetic variations in adrenergic receptors and outcomes in patients with systolic dysfunction. Sehnert and colleagues genotyped over 600 patients with heart failure (HF) who were treated with beta-blockers (metoprolol succinate or carvedilol). There were no significant associations between genotypes or haplotypes in ADRB1, ADRB2, and ADRA2C and survival. These results do not support the clinical use of adrenergic receptor genotypes to stratify outcomes or to individualize therapy. See pages 644 and
652.
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Sodium Bicarbonate Versus Saline for the Prevention of Contrast-Induced Nephropathy in Patients With Renal Dysfunction Undergoing Coronary Angiography or Intervention
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Re-Evaluating Therapeutic Target Goals for Statin-Treated Patients: Time for Revolutionary Changes?
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Comprehensive Assessment of Coronary Artery Stenoses: Computed Tomography Coronary Angiography Versus Conventional Coronary Angiography and Correlation With Fractional Flow Reserve in Patients With Stable Angina
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Lack of Association Between Adrenergic Receptor Genotypes and Survival in Heart Failure Patients Treated With Carvedilol or Metoprolol
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Pharmacogenomics and the Failing Heart: Are We Waiting for Godot?
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