Circulation. 2006;113:1633
(Circulation. 2006;113:1633.)
© 2006 American Heart Association, Inc.
Issue Highlights
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CLINICAL FEATURES OF ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA/CARDIOMYOPATHY ASSOCIATED WITH MUTATIONS IN PLAKOPHILIN-2, by Dalal et al.
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and
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PLAKOPHILIN-2 MUTATIONS ARE THE MAJOR DETERMINANT OF FAMILIAL ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA/CARDIOMYOPATHY, by van Tintelen et al.
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Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C)
may be challenging to diagnose because of variable expressivity
and penetrance. There are multiple gene mutations responsible
for the disease, with overlapping clinical phenotypes, analogous
to other inherited cardiac diseases with arrhythmia vulnerability.
Most of the genes associated with ARVD/C encode for desmosomal
proteins involved in cell-to-cell adhesion. In this issue of
Circulation, 2 reports by Dalal et al and van Tintelen et al
sought to determine the prevalence and clinical expression of
mutations in the plakophilin-2 gene (
PKP2) in ARVD/C patients.
Both groups found a high frequency of
PKP2 mutations in patients
with familial ARVD/C. Dalal and colleagues found that patients
with
PKP2 mutations presented earlier in life. However, neither
study could identify distinguishing clinical features associated
with PKP2 mutations compared with other (non-
PKP2) patients
with ARVD/C. They conclude that molecular genetic testing for
PKP2 mutations may allow presymptomatic identification of ARVD/C
and may refine treatment strategies. See pp 1641 and 1650 (and
editorial on p
1634).
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EFFECT OF CLOPIDOGREL PREMEDICATION IN OFF-PUMP CARDIAC SURGERY: ARE WE FORFEITING THE BENEFITS OF REDUCED HEMORRHAGIC SEQUELAE? by Kapetanakis et al.
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Dual antiplatelet therapy with aspirin and clopidogrel reduces
major adverse cardiovascular events after unstable angina, enhances
infarct-related artery patency after thrombolytic therapy in
ST-elevation myocardial infarction, and decreases post--percutaneous
coronary intervention thrombotic complications after both elective
and urgent stenting procedures. However, the enhanced efficacy
of dual antiplatelet therapy is associated with an increased
risk of bleeding that is particularly troublesome for patients
requiring surgical revascularization because of the irreversible
nature of clopidogrel action. In this issue of
Circulation,
Kapetanakis and colleagues report on their retrospective study
of 1572 patients undergoing isolated off-pump coronary artery
bypass surgery (OPCAB) to evaluate the effect of preoperative
clopidogrel administration on bleeding. Risk-adjusted logistic
regression and matched pair propensity score analyses demonstrated
that clopidogrel preadministration increased the risk for hemostatic
reoperation and blood transfusion requirements during and after
OPCAB surgery. The findings of this nonrandomized, nonblinded
retrospective analysis add to the controversy surrounding the
optimal timing of clopidogrel administration given the nonsignificant
trends for only modest increases in bleeding observed in patients
who continued clopidogrel within 5 days before surgery in prospective,
double-blind, randomized trials (Clopidogrel in Unstable Angina
to Prevent Recurrent Events [CURE] and Clopidogrel as Adjunctive
Reperfusion Therapy [CLARITY]-Thrombolysis in Myocardial Infarction
[TIMI] 28). See p
1667.
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MAGNESIUM INTAKE AND INCIDENCE OF METABOLIC SYNDROME AMONG YOUNG ADULTS, by He et al.
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The metabolic syndrome is defined as a constellation of risk
factors that appear to directly promote the development of atherosclerotic
cardiovascular disease. Owing to its potential to adversely
affect cardiovascular health, much attention is now focused
on strategies that may prevent and treat this condition. Prior
studies suggest that increased magnesium intake is associated
with a more favorable lipid profile and a lower risk of hypertension
and diabetes. Accordingly, these data prompt the question of
whether there is a relationship between dietary magnesium and
the development of metabolic syndrome. In this issue, He and
colleagues report the results of their carefully conducted observational
study to assess the association of dietary magnesium and the
incidence of metabolic syndrome among 4637 young adults, who
were followed up for 15 years. Their provocative results suggest
a promising role for dietary magnesium intake that can only
be verified by the future performance of randomized controlled
trials. Whether taking magnesium supplements can provide similar
benefits requires further study as well. See p
1675.
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Cardiology Patient Page
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Catheter Ablation of Atrial Fibrillation. See p
e666.
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Images in Cardiovascular Medicine
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Acute Myocardial Infarction Caused by Extension of a Proximal
Aortic Dissection Flap Into the Right Coronary Artery: An Intracoronary
Ultrasound Image. See p
e669.
"Shock Advised": Inappropriate Public Access Defibrillation. See p e672.
Magnetic Resonance Imaging and Computed Tomography Findings in Arrhythmogenic Right Ventricular Cardiomyopathy. See p e673.
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Correspondence
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See p
e676.
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