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INSIDE THIS ISSUE OF JACC

Inside This Issue of JACC

	Myocardial Infarction

Top Myocardial Infarction Heart Failure Heart Rhythm Disorders Cardiac Imaging Valvular Heart Disease Peripheral Vascular Disease Year in Cardiology Series

	Heart Failure

Top Myocardial Infarction Heart Failure Heart Rhythm Disorders Cardiac Imaging Valvular Heart Disease Peripheral Vascular Disease Year in Cardiology Series

 
Declining Post-MI Mortality in Elderly, But Increasing CHF Diagnoses Among Survivors.  
Ezekowitz and colleagues studied a cohort of over 7,000 elderly (>65 years of age) patients who suffered a first myocardial infarction (MI) between 1994 and 2000 and had no prior history of heart failure (HF). During the index MI hospitalization, 37% of MI patients were diagnosed with new HF and 13% died. Among hospital survivors who did not have HF during their index hospitalization, 64% developed HF in the first year. The 5-year mortality rate was 39% for those with HF with their index MI compared to 27% among those without HF. Over the study period, the 5-year mortality rate after MI fell by 28%, whereas the 5-year rate of HF increased by 25%. In this large cohort of elderly patients, three-quarters of patients developed HF in the 5 years after their first MI; this proportion increased despite the fact that, or possibly because, peri-MI mortality rates declined. See pages 13 and 21. See figure.

	Heart Rhythm Disorders

Top Myocardial Infarction Heart Failure Heart Rhythm Disorders Cardiac Imaging Valvular Heart Disease Peripheral Vascular Disease Year in Cardiology Series

 
Ramipril May Prevent Recurrences of Lone AF.  
Several studies have shown that angiotensin-converting enzyme (ACE) inhibitors are effective in preventing atrial fibrillation (AF) relapses in patients with arterial hypertension or other forms of heart disease. Belluzi and colleagues performed a clinical trial to investigate whether the ACE inhibitor ramipril prevents AF relapses in patients with lone AF. Sixty-two patients with a first episode of lone AF were enrolled in the study after excluding the presence of cardiac or extracardiac conditions known to increase the risk of AF, including hypertension and echocardiographic abnormalities. After cardioversion, patients were randomized to either ramipril or placebo. After 3 years, AF relapses were observed in 3 patients treated with ramipril and in 10 patients allocated to placebo. Patients assigned to ramipril had minor decreases in left atrial size and blood pressure, while those assigned to placebo had slight increases in both. See pages 24 and 30. See figure.

	Cardiac Imaging

Top Myocardial Infarction Heart Failure Heart Rhythm Disorders Cardiac Imaging Valvular Heart Disease Peripheral Vascular Disease Year in Cardiology Series

 
Ultrasound Contrast Appears to Be Safe for Echocardiography.   Dolan and colleagues retrospectively analyzed over 40,000 patients who had recevied a UCA to determine their safety and value for patients with suboptimal images or in whom echocardiographic myocardial perfusion was assessed. No deaths or myocardial infarctions (MIs) were observed within 30 min. There were no significant differences in death rates or MIs at 1 or 30 days compared with a matched cohort who underwent echocardiography without UCA. Despite recent warnings regarding UCA, these findings indicate that it is a safe and a useful diagnostic tool. See page 32.

	Valvular Heart Disease

Top Myocardial Infarction Heart Failure Heart Rhythm Disorders Cardiac Imaging Valvular Heart Disease Peripheral Vascular Disease Year in Cardiology Series

 
Undersized AVR Increases Late Mortality.  
Mohty and colleagues have previously demonstrated that aortic valve replacement (AVR) with a low body mass indexed valve effective orifice area (EOA) increases 30-day mortality, particularly in patients with reduced left ventricular function. For this article, the outcomes of patients who survived at least 30 days were reviewed. No prosthesis-patient mismatch (PPM) was defined as those with an EOA >0.85 cm²/m², as moderate if >0.65 and 0.85 cm²/m², and severe if 0.65 cm²/m². Severe PPM was associated with increased overall mortality in patients <70 years of age and in patients with a BMI <30 kg/m², but not older or obese patients. Moderate and severe PPM were both associated with increased mortality in patients with left ventricular (LV) ejection fraction <50%. PPM is associated with increased late mortality in patients with LV dysfunction, in patients <70 years of age, and in those with a BMI <30 kg/m². See page 39. See figure.

	Peripheral Vascular Disease

Top Myocardial Infarction Heart Failure Heart Rhythm Disorders Cardiac Imaging Valvular Heart Disease Peripheral Vascular Disease Year in Cardiology Series

 
Cilostazol Improves Outcomes After Lower Extremity Angioplasty.  
Soga and colleagues performed a multicenter, randomized, open-label clinical trial of cilostazol in patients who underwent angioplasty with provisional stenting for a femoropopliteal lesion. Freedom from target vessel revascularization (TVR) and binary restenosis were both significantly lower in those randomized to cilostazol. There were no major bleeding complications. Cilostazol reduces restenosis and TVR after angioplasty for femoropopliteal disease. See page 48. See figure.

	Year in Cardiology Series

Top Myocardial Infarction Heart Failure Heart Rhythm Disorders Cardiac Imaging Valvular Heart Disease Peripheral Vascular Disease Year in Cardiology Series

 
Year in Cardiac Imaging—2008.   This review by Gibbons and colleagues covers the 15-month period from April 2007 to June 2008 highlighting what the authors feel are the most important publications related to cardiac imaging. It is organized into topical themes reflecting the growing interest in integrated multimodality imaging. A brief synopsis of key studies is provided with the goal of encouraging the reader to examine at least some of these articles in more detail. See page 54.

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