Circulation. 2005;112:3365
(Circulation. 2005;112:3365.)
© 2005 American Heart Association, Inc.
Issue Highlights
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MORTALITY AND MORBIDITY REMAIN HIGH DESPITE CAPTOPRIL AND/OR VALSARTAN THERAPY IN ELDERLY PATIENTS WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION, HEART FAILURE, OR BOTH AFTER ACUTE MYOCARDIAL INFARCTION: RESULTS FROM THE VALSARTAN IN ACUTE MYOCARDIAL INFARCTION TRIAL (VALIANT), by White et al.
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The elderly make up an increasing proportion of patients having
an acute myocardial infarction and account for most of the morbidity
and mortality. They often are underrepresented in clinical trials.
The VALIANT trial had no age exclusions, and more than 3000
patients 75 years of age or older with heart failure and/or
a depressed ejection fraction were randomized 5 days after acute
myocardial infarction. There was no difference in outcomes among
the study treatments (captopril, valsartan, or combination).
Adverse events were more common in older patients. Each 10-year
increase in age was associated with an almost 50% increase in
mortality and a 38% increase in the likelihood of having a readmission
for heart failure. Although at higher risk, the elderly less
frequently received evidence-based therapy (aspirin, ß-blockers,
and statins). The authors recommended greater use of evidence-based
therapies and suggested that new therapies are required to improve
outcomes in this important group of patients. See p
3391.
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OUTCOMES AND ASSOCIATED RISK FACTORS FOR AORTIC VALVE REPLACEMENT IN 160 CHILDREN: A COMPETING-RISKS ANALYSIS, by Karamlou et al.
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Aortic valve replacement (AVR) in children poses unique challenges
that have hampered identification of the ideal prosthesis. Karamlou
and colleagues report a single-center experience with 160 children
undergoing AVR. Ten years after initial AVR, 19% had died without
subsequent AVR; 34% underwent a second AVR; and 47% remained
alive without replacement. Younger age, lower operative weight,
concomitant performance of aortic root replacement or reconstruction,
and use of a prosthesis type other than a pulmonary autograft
were significant predictors of death without a repeat AVR. Risk
factors for earlier repeat AVR included the use of bioprosthetic
or allograft valve type. Mortality and repeat AVR are common
after initial AVR in children, especially in younger patients
and those with bioprosthetic or homograft valves. See p
3462.
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PROTHROMBOTIC MUTATIONS, HORMONE THERAPY, AND VENOUS THROMBOEMBOLISM AMONG POSTMENOPAUSAL WOMEN: IMPACT OF THE ROUTE OF ESTROGEN ADMINISTRATION, by Straczek et al.
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Estrogen treatment and specific genetic variations have been
associated with an increased risk of venous thromboembolism.
The study by Straczek and colleagues investigates whether the
route of administration of estrogen (oral versus transdermal)
influences the risk of developing venous thromboembolism in
the setting of having a prothrombotic genetic mutation. The
authors found that subjects with either a specific prothrombin
mutation or factor V Leiden who took oral estrogen had an enhanced
venous thrombotic risk but those who had these mutations but
received transdermal estrogen had the same risk as women without
the mutations. These findings, if validated in a randomized
study, could significantly guide the use of estrogen supplementation.
See p
3495.
Visit http://www.circ.ahajournals.org:
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Cardiology Patient Page
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Atrial Flutter. See p
e334.
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Images in Cardiovascular Medicine
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Ventricular Septal Defect Complicating an Acute Myocardial Infarction.
See p
e337.
Ventricular Septal Rupture After a Nonpenetrating Chest Trauma: Findings From Real-Time Three-Dimensional Echocardiography and Cardiac Magnetic Resonance. See p e339.
Giant Blood Cyst of the Mitral Valve: Echocardiographic and Intraoperative Images. See p e341.
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Correspondence
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See p
e342.
Related Articles:
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Outcomes and Associated Risk Factors for Aortic Valve Replacement in 160 Children: A Competing-Risks Analysis
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Atrial Flutter
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Letter Regarding Article by Pellikka et al, "Severe Asymptomatic Aortic Stenosis" • Response
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Mortality and Morbidity Remain High Despite Captopril and/or Valsartan Therapy in Elderly Patients With Left Ventricular Systolic Dysfunction, Heart Failure, or Both After Acute Myocardial Infarction: Results From the Valsartan in Acute Myocardial Infarction Trial (VALIANT)
- Harvey D. White, Philip E.G. Aylward, Zhen Huang, Anthony J. Dalby, W. Douglas Weaver, Ståle Barvik, José Antonio Marin-Neto, Jan Murin, Rolf O. Nordlander, Wiek H. van Gilst, Faiez Zannad, John J.V. McMurray, Robert M. Califf, Marc A. Pfeffer for the VALIANT Investigators
Circulation 2005 112: 3391-3399.
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Prothrombotic Mutations, Hormone Therapy, and Venous Thromboembolism Among Postmenopausal Women: Impact of the Route of Estrogen Administration
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Circulation 2005 112: 3495-3500.
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