(Circulation. 2006;113:1.)
© 2006 American Heart Association, Inc.
Issue Highlights
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SLEEP AND EXERTIONAL PERIODIC BREATHING IN CHRONIC HEART FAILURE: PROGNOSTIC IMPORTANCE AND INTERDEPENDENCE, by Corrà et al. |
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The prediction of prognosis in patients with heart failure has important implications for therapy. Measurements of peak oxygen uptake during exercise testing provide useful information in that regard, yet such an analysis often stratifies patients into a gray zone of intermediate risk. In this issue of Circulation, Corrà et al move the field beyond peak oxygen uptake and prompt us to evaluate breathing patterns during exercise and sleep. Periodic breathing, as assessed via the apnea-hypopnea index during sleep and cyclic fluctuations in minute ventilation during exercise, was measured in 133 patients with heart failure. The authors report the incremental value of each measure when used alone or in combination in predicting adverse cardiac events. In an accompanying editorial (p 9), Ribeiro highlights the importance of these data in the context of other variables that can be obtained from gas exchange analysis in patients with heart failure. See p 44.
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INHIBITION OF HISTONE DEACETYLATION BLOCKS CARDIAC HYPERTROPHY INDUCED BY ANGIOTENSIN II INFUSION AND AORTIC BANDING, by Kee et al. |
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Class II histone deacetylases (HDACs) have been shown to antagonize a variety of pathways that lead to myocardial hypertrophy. Surprisingly, myocardial hypertrophy induced by chronic angiotensin infusion or aortic banding was inhibited by simultaneous administration of several HDAC inhibitors, including those that are nonselective with regard to class I versus class II HDACs as well as a class I–selective inhibitor. Inhibition of myocardial hypertrophy was paralleled by salutary effects on fetal gene expression and interstitial fibrosis. These observations suggest that the predominant effect of HDAC inhibition is to attenuate myocardial hypertrophy that is mediated by class I HDACs, and they offer a novel therapeutic target. See p 51.
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ELECTROCARDIOGRAPHIC STRAIN PATTERN AND PREDICTION OF NEW-ONSET CONGESTIVE HEART FAILURE IN HYPERTENSIVE PATIENTS: THE LOSARTAN INTERVENTION FOR ENDPOINT REDUCTION IN HYPERTENSION (LIFE) STUDY, by Okin et al. |
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Prior studies have reported that electrocardiographic left ventricular hypertrophy predicts increased cardiovascular morbidity and mortality. However, the prognostic significance of the ECG strain pattern per se is less certain. Investigators in the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study, a randomized study of aggressive treatment of blood pressure, examined the relation of ECG strain to incident heart failure. Of almost 9000 patients without prevalent heart failure, about 10% had ECG strain. Accounting for baseline left ventricular hypertrophy, clinical factors, and in-treatment blood pressures, ECG strain predicted an 80% increased risk of incident heart failure and an almost tripling in the risk of death from heart failure. The increased risk of heart failure occurred despite the achievement of significant blood pressure lowering (on average, about 30 mm Hg) in the trial. The study underscores the utility of the relatively inexpensive ECG for risk stratification. Whether more aggressive blood pressure lowering or different blood pressure agents could reduce the significantly increased risk of heart failure associated with ECG strain is an important area for future inquiry. See p 67.
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Clinician Update |
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TopSLEEP AND EXERTIONAL PERIODIC...INHIBITION OF HISTONE...ELECTROCARDIOGRAPHIC STRAIN...Clinician UpdateImages in Cardiovascular...Correspondence |
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Preconditioning: A New Concept About the Benefit of Exercise. See p e1.
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Images in Cardiovascular Medicine |
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TopSLEEP AND EXERTIONAL PERIODIC...INHIBITION OF HISTONE...ELECTROCARDIOGRAPHIC STRAIN...Clinician UpdateImages in Cardiovascular...Correspondence |
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Assessment of Pericardial Inflammation in a Patient With Tuberculous Effusive Constrictive Pericarditis With 18F-2-Deoxyglucose Positron Emission Tomography. See p e4.
Demonstration of Unilateral Absence of the Palmar Arch Without Collateral Circulation. See p e6.
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Percutaneous Treatment of a Large Vein Graft Aneurysm With Covered and Conventional Stents. See p e8.
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Correspondence |
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TopSLEEP AND EXERTIONAL PERIODIC...INHIBITION OF HISTONE...ELECTROCARDIOGRAPHIC STRAIN...Clinician UpdateImages in Cardiovascular...Correspondence |
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See p e10.
Related Articles:
Circulation 2006 113: e1-e3.
Circulation 2006 113: e10.
Circulation 2006 113: e4-e5.
Circulation 2006 113: e6-e7.
Circulation 2006 113: e8-e9.
Circulation 2006 113: 44-50.
Circulation 2006 113: 51-59.
Circulation 2006 113: 67-73.
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  L. S. Traywick and N. E. Schoenberg Determinants of Exercise Among Older Female Heart Attack Survivors Journal of Applied Gerontology, February 1, 2008; 27(1): 52 - 77. [Abstract] [PDF]
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