This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Articles

INSIDE THIS ISSUE

Inside This Issue

	State-of-the-Art Paper

Top State-of-the-Art Paper Clinical Research Year in Cardiology Series

Thomas Münzel, Tommaso Gori

Although it has been in clinical use in Europe for almost ten years, nebivolol has only recently been introduced in the U.S. market. Like carvedilol, nebivolol belongs to a third-generation of β-blockers, which possess direct vasodilator properties in addition to their adrenergic blocking characteristics. Nebivolol improves endothelial function by stimulating endothelial nitric oxide synthase and via antioxidative properties. Nebivolol has proven antihypertensive and anti-ischemic effects as well as beneficial effects on hemodynamics and prognosis in patients with congestive heart failure. Further studies are warranted to compare nebivolol with other β-blockers, and to determine whether the novel properties of nebivolol make it a viable first-line agent for hypertension.

	Clinical Research

Top State-of-the-Art Paper Clinical Research Year in Cardiology Series

 
Interventional Cardiology.   Long-Term Results of Unprotected Left Main Stenting

1500

Pawel E. Buszman, Piotr P. Buszman, R. Stefan Kiesz, Andrzej Bochenek, Blazej Trela, Magda Konkolewska, David Wallace-Bradley, Mirosaw Wilczyski, Iwona Banasiewicz-Szkróbka, Ewa Peszek-Przybyla, Marek Krol, Marek Kondys, Krzysztof Milewski, Szymon Wiernek, Marcin Dbiski, Aleksander urakowski, Jack L. Martin, Micha Tendera

This study by Buszman and colleagues evaluated early and late outcomes in 252 patients after percutaneous coronary intevention in unprotected left main coronary arteries (ULMCA) with either bare-metal stent (BMS) or drug-eluting stent (DES) use. Major adverse cardiovascular and cerebral events (MACCE) occurred in 4.8% of patients during the first 30 days and included death in 1.5%. After 12 months, angiographically confirmed restenosis occurred in 12%. The 5- and 10-year survival rates were 78% and 69%, respectively. Despite differences in demographical and clinical data in favor of BMS patients, there was a significantly lower MACCE rate in DES patients (26% vs. 15%). Stenting of ULMCA is feasible and offers good long-term outcome, particularly in patients who receive DES.

Editorial Comment: Jeffrey W. Moses, Martin B. Leon, Gregg W. Stone, p. 1512

Heart Failure.   Mathematical Model May Improve the Diagnosis of AHF
1515

Brian Steinhart, Kevin E. Thorpe, Ahmed M. Bayoumi Gordon Moe, James L. Januzzi, Jr, C. David Mazer

Steinhart and colleagues hypothesized that using N-terminal pro–B-type natruiretic peptide (NT-proBNP) levels as a continuous variable rather than a single cut-point would improve the accuracy of diagnosis of acute heart failure (AHF). Subjects who presented to an emergency department (ED) with shortness of breath were divided based on the ED clinician's assessment of the probability of AHF: low (20%), high (80%), and intermediate. The etiology of the shortness of breath was determined by chart review but was blinded to the B-type natriuretic peptide level. Variables used in the model to predict AHF were age, pre-test probability and log NT-proBNP. The model appropriately reclassified 44% of patients with intermediate clinical probability to either low or high probability with negligible (<3%) inappropriate redirection. This diagnostic prediction model for AHF that utilized both clinical assessment and NT-proBNP has excellent diagnostic accuracy and can help reduce the incidence of intermediate probability.

Editorial Comment: Kenneth Dickstein, p. 1522

Diabetic Cardiomyopathy.   Decreased Myocardial Glucose Uptake and Diastolic Dysfunction in Diabetics
1524

Luuk J. Rijzewijk, Rutger W. van der Meer, Hildo J. Lamb, Hugo W. A. M. de Jong, Mark Lubberink, Johannes A. Romijn, Jeroen J. Bax, Albert de Roos, Jos W. Twisk, Robert J. Heine, Adriaan A. Lammertsma, Johannes W. A. Smit, Michaela Diamant

Rijzewijk and colleagues investigated how myocardial substrate and high-energy phosphate metabolism affected myocardial function in patients with well-controlled, uncomplicated type 2 diabetes (T2DM). Subjects with T2DM and healthy controls with no evidence of ischemia on stress echocardiograms underwent cardiac magnetic resonance imaging to evaluate left ventricular (LV) morphology and function and positron emission tomography imaging to measure myocardial perfusion and substrate metabolism. In T2DM subjects, LV diastolic function and myocardial glucose uptake were decreased, whereas myocardial nonesterified fatty acid uptake and oxidation were increased. There were no differences in myocardial high energy phosphate metabolism or perfusion. Patients with uncomplicated T2DM have impaired LV diastolic function in the setting of myocardial insulin resistance leading to altered myocardial substrate metabolism.

Cardiac Imaging.   Measuring the Costs and Implications of Incidental Findings on Cardiac CT
1533

Jimmy MacHaalany, Yeung Yam, Terrence D. Ruddy, Arun Abraham, Li Chen, Rob S. Beanlands, Benjamin J. W. Chow

MacHaalany and colleagues sought to determine the incidence, clinical significance, and potential financial impact of noncardiac incidental findings (IF) identified with cardiac computed tomography (CT). In nearly 1,000 consecutive patients undergoing cardiac CT, the noncardiac structures were evaluated after full field of view (32 to 50 cm) reconstruction. IF were categorized as: clinically significant (CS) (a new or unsuspected diagnosis such as pulmonary embolism), indeterminate (such as nodules requiring serial evaluation), or clinically insignificant. Forty-one percent of patients had noncardiac IF, including CS findings in 1.2% and indeterminate findings in 7%. After a median 1.5 years of follow-up, none of the indeterminate findings became CS. One patient suffered a major complication related to the investigation of an IF. The total direct cost associated with investigating IF was $57,596. Although noncardiac IF are common, they are rarely clinically significant. Investigating IF is associated with increased cost and patient risk.

Editorial Comment: Mark A. Hlatky, Carlos Iribarren, p. 1542

	Year in Cardiology Series

Top State-of-the-Art Paper Clinical Research Year in Cardiology Series

 
Year in Cardiology Series.   The Year in Non–ST-Segment Elevation Acute Coronary Syndrome
1544

Robert P. Giugliano, Eugene Braunwald

Guigliano and Braunwald review the literature for pertinent articles related to the treatment and prognosis in patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS). This review ranges from imaging techniques to identify vulnerable plaque, to treatment options, to measures of compliance with recommended therapies. Well over 100 articles are referenced, almost all of which were published in the last year, providing a succinct, practical reference resource for clinicians regarding the contemporary management of NSTE-ACS patients.

Related Articles

Nebivolol: The Somewhat-Different β-Adrenergic Receptor Blocker

Thomas Münzel and Tommaso Gori
J. Am. Coll. Cardiol. 2009 54: 1491-1499. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Articles