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INSIDE THIS ISSUE

Inside This Issue

	State-of-the-Art Paper

Top State-of-the-Art Paper Clinical Research From Around the World

Francisco Marín, Rocío González-Conejero, Piera Capranzano, Theodore A. Bass, Vanessa Roldán, Dominick J. Angiolillo

Polymorphisms affecting disposition, metabolism, transporters, or targets of a drug can all modify an individual's drug response and, therefore, the drug's safety and efficacy. This paper by Marín and colleagues reviews each of the major classes of antithrombotic medications and the various genetic variations that may modify the clinical benefit. Some examples include the reduced conversion of clopidogrel to its active metabolite seen in patients with CYP2C19 (681G>A) and the increased risk of bleeding and need for lower dosing in patients with CYP2C9 treated with warfarin.

	Clinical Research

Top State-of-the-Art Paper Clinical Research From Around the World

 
Clinical Trial.   Atrial Natriuretic Peptide Infusion Prevents Renal Deterioration After Bypass Surgery

1058

Akira Sezai, Mitsumasa Hata, Tetsuya Niino, Isamu Yoshitake, Satoshi Unosawa, Shinji Wakui, Shunji Osaka, Tadateru Takayama, Yuji Kasamaki, Atsushi Hirayama, Kazutomo Minami

Sezai and colleagues previously reported that continuous infusion of low-dose human atrial natriuretic peptide (hANP) during cardiopulmonary bypass (CPB) suppressed renin-angiotensin-aldosterone system activity and had a potent diuretic effect. For this study, 500 subjects undergoing CPB were randomized to continuous infusions of hANP or placebo. Post-operatively, the maximum post-operative creatinine level, the percent increase in creatinine, and the need for hemodialysis were less frequent in the hANP group. Continuous infusion of low-dose hANP from the start of CPB prevents post-operative acute renal failure.

Interventional Cardiology.   Intracoronary Streptokinase Improves Results of Primary PCI
1065

Murat Sezer, Arif Çimen, Emre Aslanger, Ali Elitok, Berrin Umman, Zehra Bura, Ebru Yormaz, Cüneyt Türkmen, Ik Adalet, Yilmaz Nianci, Sabahattin Umman

Sezer and colleagues hypothesized that intracoronary streptokinase (ICSK) given immediately after primary percutaneous coronary intervention (PCI) would break down microvascular obstruction and improve tissue perfusion and thus left ventricular recovery. A total of 95 patients undergoing primary PCI were randomized to ICSK or no additional therapy, in addition to standard PCI medications including aspirin, clopidogrel, heparin, and tirofiban. At 2 days, the fractional flow reserve and other indexes of microvascular function were significantly better in the ICSK group. At 6 months, infarct size, left ventricular end-systolic volume, and ejection fraction were all significantly better in the ICSK group. These results suggest that ICSK improves tissue perfusion and limits infarct damage when given immediately after primary PCI.

Cardiac Imaging.   Adenosine-Induced Stress MPI Using CT

1072

Ron Blankstein, Leon D. Shturman, Ian S. Rogers, Jose A. Rocha-Filho, David R. Okada, Ammar Sarwar, Anand V. Soni, Hiram Bezerra, Brian B. Ghoshhajra, Milena Petranovic, Ricardo Loureiro, Gudrun Feuchtner, Henry Gewirtz, Udo Hoffmann, Wilfred S. Mamuya, Thomas J. Brady, Ricardo C. Cury

Blankstein and colleagues developed and tested a protocol to assess myocardial perfusion during adenosine infusion using dual-source computed tomography (CT). Subjects who had already undergone single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) underwent a CT protocol during which they received adenosine while the contrast was administered and the CT was performed. The results of the CT perfusion study were then compared to the MPI images, to CT angiography data, and to invasive coronary angiography. Almost all SPECT MPI perfusion abnormalities with a >50% corresponding stenosis were detected by CT perfusion. CT angiography further improved the accuracy. Adenosine stress CT has diagnostic accuracy comparable to SPECT, with a similar radiation dose and with the advantage of visualizing coronary anatomy.

Editorial Comment

Stephan Achenbach, p. 1085

Heart Rhythm Disorders.   Comparative Efficacy of Dronedarone and Amiodarone
1089

Jonathan P. Piccini, Vic Hasselblad, Eric D. Peterson, Jeffrey B. Washam, Robert M. Califf, David F. Kong

Dronedarone is a noniodinated amiodarone congener developed to have similar electrophysiologic properties with less toxicity than amiodarone. Piccini and colleagues conducted a systematic overview of all randomized, controlled trials evaluating dronedarone or amiodarone for the prevention of atrial fibrillation (AF) to determine relative efficacy and safety profiles, as there are limited direct comparison trials. A model incorporating all trial evidence found amiodarone to be superior to dronedarone (odds ratio [OR]: 0.49) for the prevention of recurrent AF; however, there was a trend toward higher all-cause mortality (OR: 1.61) and higher overall adverse events requiring drug discontinuation with amiodarone (OR: 1.81). For every 1,000 patients treated with dronedarone instead of amiodarone, the authors estimate 228 more recurrences of AF in exchange for 9.6 fewer deaths and 62 fewer adverse events requiring discontinuation of the drug.

Editorial Comment

Paul S. Chan, Brahmajee K. Nallamothu, Hakan Oral, p. 1096

Valvular Heart Disease.   BNP Useful for Predicting Outcomes in Patients With Severe MR
1099

Rodolfo Pizarro, Oscar O. Bazzino, Pablo F. Oberti, Mariano Falconi, Federico Achilli, Anibal Arias, Juan G. Krauss, Arturo M. Cagide

The purpose of this investigation by Pizarro and colleagues was to determine the prognostic value of brain natriuretic peptide (BNP) measurements in asymptomatic patients with severe organic mitral regurgitation (MR) and normal left ventricular (LV) function. BNP was measured at baseline, and subjects were then followed for the development of LV dysfunction, congestive heart failure, or death. Event-free survival was >93% for those with BNP <105 pg/ml and only 29% in those with higher BNP levels. Among patients with severe, asymptomatic, organic MR, BNP 105 pg/ml identifies a subgroup of patients at higher risk.

Editorial Comment

Peter A. McCullough, George S. Hanzel, p. 1107

	From Around the World

Top State-of-the-Art Paper Clinical Research From Around the World

 
Focus on China.   Regional Differences in the Incidence of SCD in China

1110

Wei Hua, Lin-Feng Zhang, Yang-Feng Wu, Xiao-Qing Liu, Dong-Shuang Guo, Hong-Ling Zhou, Zhi-Ping Gou, Lian-Cheng Zhao, Hong-Xia Niu, Ke-Ping Chen, Jin-Zhuang Mai, Li-Nan Chu, Shu Zhang

This study by Hua and colleagues explored the epidemiologic features of sudden cardiac death (SCD) in various regions of China by conducting a population-based surveillance study in 4 socioeconomically diverse regions. Almost 700,000 residents were monitored and there were 2,983 all-cause deaths, including 284 SCDs. The overall incidence of SCD was 41.8 per 100,000 population per year (44.6 for men and 39.0 for women). The age-standardized incidence of SCD was highest in Yuxian, an undeveloped inland rural area with little access to medical care. Further results suggest that targeting common cardiac conditions such as hypertension and angina in Yuxian could reduce the incidence of SCD in this province.

Related Articles

Pharmacogenetics in Cardiovascular Antithrombotic Therapy

Francisco Marín, Rocío González-Conejero, Piera Capranzano, Theodore A. Bass, Vanessa Roldán, and Dominick J. Angiolillo
J. Am. Coll. Cardiol. 2009 54: 1041-1057. [Abstract] [Full Text] [PDF]

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