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(Circulation. 2004;110:2551.)
© 2004 American Heart Association, Inc.
Issue Highlights |
DIAGNOSIS OF SLEEP-RELATED BREATHING DISORDERS BY VISUAL ANALYSIS OF TRANSTHORACIC IMPEDANCE SIGNALS IN PACEMAKERS, by Scharf et al.
Sleep apnea is common and aggravates arrhythmias, hypertension, and congestive heart failure. Pacemakers that sense respiratory rate for rate-responsive pacing rate can potentially detect apneic episodes. In a series of patients, thoracic impedance measured between the pacing electrode and pacemaker case, used for sensing respiration, was recorded continuously by telemetry. The number of apnea/hypopnea episodes detected was in good agreement with the results of polysomnography. Incorporation of this analysis into pacemakers and defibrillators could assist in diagnosis and assessment of therapy for this common but often overlooked condition. See p 2562.
CLINICAL INHIBITION OF THE SEVEN-TRANSMEMBRANE THROMBIN RECEPTOR (PAR1) BY INTRAVENOUS APROTININ DURING CARDIOTHORACIC SURGERY, by Day et al.
PAR1 (protease-activated receptor) is the principle thrombin receptor in humans, expressed on platelets and vascular cells mediating platelet aggregation induced by thrombin and other events (ie, inflammatory responses). The potential to therapeutically antagonize PAR1 was the goal in this article by Day et al. This in vivo, randomized, placebo-controlled trial studied elective CABG patients treated with either an intraoperative saline infusion or aprotinin (a serine protease inhibitor) during cardiopulmonary bypass. Platelet dysfunction after cardiopulmonary bypass is thought to be due to selective activation of PAR1. Aprotinin in vitro selectively inhibits PAR1-dependent platelet activation. This clinical study demonstrated that aprotinin inhibited platelet PAR1 activation by thrombin. The clinical potential to inhibit PAR1 has interesting possibilities for cardiovascular therapeutics. See p 2597.
PREDICTIVE VALUE OF 16-SLICE MULTIDETECTOR SPIRAL COMPUTED TOMOGRAPHY TO DETECT SIGNIFICANT OBSTRUCTIVE CORONARY ARTERY DISEASE IN PATIENTS AT HIGH RISK FOR CORONARY ARTERY DISEASE: PATIENT- VERSUS SEGMENT-BASED ANALYSIS, by Hoffmann et al.
There is great interest in newer noninvasive coronary imaging techniques to more directly assess the presence and location of coronary stenoses. In this issue of Circulation, Hoffman and colleagues continue investigation into 16-slice multidetector spiral computed tomography imaging of the coronary tree. In a group of patients with high likelihood for coronary artery disease referred for angiography, the authors explore the differences between patient-based and segment-based analysis. They find only moderate diagnostic accuracy for specific segmental stenoses, despite fewer unevaluable segments with higher-resolution scanners compared with previous technology, and examine the factors that limit diagnostic accuracy. This study emphasizes the importance of critical assessment of new technology before widespread dissemination and lays the groundwork for further enhancements of this technology. See p 2638.
Visit www.circ.ahajournals.org:
Images in Cardiovascular Medicine
Right Atrial Primary Cardiac Lymphoma Presenting With Stroke. See p e451.
Book Review
Cardiac Electrophysiology: From Cell to Bedside, 4th ed. See p e453.
Related Articles:
Circulation 2004 110: 2597-2600.
Circulation 2004 110: 2562-2567.
Circulation 2004 110: 2638-2643.
Circulation 2004 110: e451-e452.
Circulation 2004 110: e453.
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