Circulation. 2005;112:2887
(Circulation. 2005;112:2887.)
© 2005 American Heart Association, Inc.
Issue Highlights
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REVERSE REMODELING OF THE LEFT CARDIAC CHAMBERS AFTER CATHETER ABLATION AFTER 1 YEAR IN A SERIES OF PATIENTS WITH ISOLATED ATRIAL FIBRILLATION, by Reant et al.
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In patients with atrial fibrillation and no specific associated
heart disease, there are identifiable abnormalities in structure
and function, including left atrial dilation and abnormalities
in diastolic ventricular function. An intriguing issue has been
whether diastolic abnormalities are cause or consequence; are
filling abnormalities related to the abnormal atrial dynamics,
or might diastolic dysfunction (and consequent left atrial dilation)
represent a driver of atrial fibrillation onset and maintenance?
In this issue of
Circulation, Reant and colleagues begin to
dissect this issue by studying patients with isolated atrial
fibrillation with echocardiography before and then 5 times during
the year after radiofrequency ablation back to sinus rhythm.
Left atrial size decreased, ventricular diastolic parameters
improved, and ejection fraction increased. These data suggest
that atrial fibrillation results in reversible structural and
functional atrial and ventricular abnormalities in the absence
of other specific pathologies. Diastolic abnormalities appear
in large part a consequence rather than a cause of atrial fibrillation.
See p
2896.
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MINERALOCORTICOID RECEPTOR ANTAGONISM AMELIORATES LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND MYOCARDIAL FIBROSIS IN MILDLY SYMPTOMATIC PATIENTS WITH IDIOPATHIC DILATED CARDIOMYOPATHY: A PILOT STUDY, by Izawa et al.
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Landmark clinical trials have previously demonstrated the benefits
of mineralocorticoid receptor antagonism in patients with symptomatic
congestive heart failure. In fact, the Randomized Aldactone
Evaluation Study (RALES) found that the addition of spironolactone
to standard therapy reduced mortality by 30% in patients with
NYHA class III or IV congestive heart failure. On the basis
of these results, mineralocorticoid receptor antagonists have
become widely accepted as part of the standard therapeutic regimen
for patients with advanced symptoms due to congestive heart
failure. It has been suggested that one mechanism by which mineralocorticoid
receptor antagonists exert their beneficial effects is by decreasing
myocardial fibrosis and, thereby, adverse ventricular remodeling;
however, this effect has not been demonstrated directly. In
this issue of
Circulation, Izawa et al evaluate the effects
of spironolactone on myocardial fibrosis regression in mildly
symptomatic patients (NYHA class I or II) with dilated cardiomyopathy
and correlate these findings with left ventricular diastolic
function. See p
2940.
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ABSORPTION, METABOLIZATION, AND ANTIPLATELET EFFECTS OF 300-, 600-, AND 900-MG LOADING DOSES OF CLOPIDOGREL: RESULTS OF THE ISAR-CHOICE (INTRACORONARY STENTING AND ANTITHROMBOTIC REGIMEN: CHOOSE BETWEEN 3 HIGH ORAL DOSES FOR IMMEDIATE CLOPIDOGREL EFFECT) TRIAL, by von Beckerath et al.
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In patients undergoing percutaneous coronary intervention, the
benefits of dual antiplatelet therapy with aspirin and clopidogrel
after stent placement are well recognized; however, because
of the variability in platelet inhibition observed among patients,
investigators have questioned the optimal loading dose of this
agent. Although the 300-mg loading dose of clopidogrel has been
considered the standard regimen, recent studies have shown that
a 600-mg loading dose provided additional, and more rapid, inhibition
of platelet aggregation. Because of the observed benefit with
an increased loading dose, investigators have now begun to study
whether platelet inhibition may be augmented further by raising
the loading dose to 900 mg. In this issue of
Circulation, von
Beckerath et al detail the results of a randomized trial of
the antiplatelet effects and pharmacokinetics of 300-, 600-,
and 900-mg loading doses of clopidogrel. See p
2946.
Visit http://www.circ.ahajournals.org:
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Clinician Update
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Homocysteine and Its Effects on In-Stent Restenosis. See p
e307.
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Images in Cardiovascular Medicine
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Medical Treatment of Varicose Veins. See p
e312.
Acute Type I Aortic Dissection With Concomitant Pulmonary Artery Dissection. See p e313.
Detection of Active Coronary Arterial Vasculitis Using Magnetic Resonance Imaging in Kawasaki Disease. See p e315.
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Correspondence
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See p
e317.
Related Articles:
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Mineralocorticoid Receptor Antagonism Ameliorates Left Ventricular Diastolic Dysfunction and Myocardial Fibrosis in Mildly Symptomatic Patients With Idiopathic Dilated Cardiomyopathy: A Pilot Study
- Hideo Izawa, Toyoaki Murohara, Kohzo Nagata, Satoshi Isobe, Hiroyuki Asano, Tetsuya Amano, Sahoko Ichihara, Tomoko Kato, Satoru Ohshima, Yosuke Murase, Shigeo Iino, Koji Obata, Akiko Noda, Kenji Okumura, and Mitsuhiro Yokota
Circulation 2005 112: 2940-2945.
[Abstract]
[Full Text]
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Homocysteine and Its Effects on In-Stent Restenosis
- Giuseppe De Luca, Harry Suryapranata, Giovanni Gregorio, Helmut Lange, and Massimo Chiariello
Circulation 2005 112: e307-e311.
[Full Text]
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Medical Treatment of Varicose Veins
- William Foster and Gerry Coghlan
Circulation 2005 112: e312.
[Full Text]
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Acute Type I Aortic Dissection With Concomitant Pulmonary Artery Dissection
- G. Khatchatourian and D. Vala
Circulation 2005 112: e313-e314.
[Full Text]
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Detection of Active Coronary Arterial Vasculitis Using Magnetic Resonance Imaging in Kawasaki Disease
- Colin J. McMahon, Jason T. Su, Michael D. Taylor, Rajesh Krishnamurthy, Raja Muthupillai, John P. Kovalchin, Taylor Chung, and G. Wesley Vick, III
Circulation 2005 112: e315-e316.
[Full Text]
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Letter Regarding Article by Diwan et al, "Doppler Estimation of Left Ventricular Filling Pressures in Patients With Mitral Valve Disease" • Response
- Jin-Oh Choi, Sang-Chol Lee, Seung Woo Park, Abhinav Diwan, Marti McCulloch, Gerald M. Lawrie, Michael J. Reardon, and Sherif F. Nagueh
Circulation 2005 112: e317.
[Full Text]
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Reverse Remodeling of the Left Cardiac Chambers After Catheter Ablation After 1 Year in a Series of Patients With Isolated Atrial Fibrillation
- Patricia Reant, Stephane Lafitte, Pierre Jaïs, Karim Serri, Rukshen Weerasooriya, Meleze Hocini, Xavier Pillois, Jacques Clementy, Michel Haïssaguerre, and Raymond Roudaut
Circulation 2005 112: 2896-2903.
[Abstract]
[Full Text]
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Absorption, Metabolization, and Antiplatelet Effects of 300-, 600-, and 900-mg Loading Doses of Clopidogrel: Results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) Trial
- Nicolas von Beckerath, Dirk Taubert, Gisela Pogatsa-Murray, Edgar Schömig, Adnan Kastrati, and Albert Schömig
Circulation 2005 112: 2946-2950.
[Abstract]
[Full Text]
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