Circulation. 2006;113:2565
(Circulation. 2006;113:2565.)
© 2006 American Heart Association, Inc.
Issue Highlights
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ASPIRIN USE AND OUTCOMES IN A COMMUNITY-BASED COHORT OF 7352 PATIENTS DISCHARGED AFTER FIRST HOSPITALIZATION FOR HEART FAILURE, by McAlister et al.
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Throughout the 1990s, data from large clinical trials in heart
failure and some smaller mechanistic studies suggested that
chronic treatment with aspirin may lessen the outcome benefit
of treatment with angiotensin-converting enzyme (ACE) inhibitors.
Prospective trials designed to specifically answer this clinically
relevant, though vexing, question have been either inconclusive
or challenging to conduct. In this issue of
Circulation, McAlister
and colleagues report on an analysis of a large observational
database of >7000 patients followed long-term after hospitalization
for heart failure, specifically to examine the impact of aspirin
use or non-use on outcomes with respect to the use/non-use of
ACE inhibitors and other clinical factors. They found that aspirin
use did not unfavorably affect outcomes, even in patients without
coronary disease or those with renal dysfunction, and aspirin
use did not appear to attenuate the benefits of ACE inhibitors.
In an accompanying editorial, Jhund and McMurray (see p 2566)
discuss the strength of evidence that clinicians can glean from
retrospective subgroup analysis of clinical trials, as well
as large observational databases such as those presented in
this paper, to inform clinical decisions when no prospective
trial data exist. See p
2572.
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ENDOVASCULAR STENTING OF OBSTRUCTED RIGHT VENTRICLE-TO-PULMONARY ARTERY CONDUITS: A 15-YEAR EXPERIENCE, by Peng et al.
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Postoperative right ventricular outflow tract obstruction is
a common problem in patients with various forms of congenital
heart disease. The optimal timing and type of management for
this problem is subject to debate, and practices vary considerably
among centers and individual practitioners. Peng and colleagues
describe a 15-year single-institution experience with transcatheter
placement of bare metal stents as the first-line intervention
for obstructed right ventricle-to-pulmonary artery conduits.
They demonstrate that bare stenting is a safe and effective
method of reducing conduit obstruction in most cases, with minimal
serious morbidity. Conduit lifespan was prolonged for an average
of 2.7 years overall and 3.9 years among patients over 5 years
of age. Although not the definitive answer to a pervasive and
difficult problem, bare stenting provides a safe and effective
means for reducing obstruction and prolonging lifespan of right
ventricle-to-pulmonary artery conduits in most cases. See p
2598.
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PIOGLITAZONE PREVENTS ACUTE AND CHRONIC CARDIAC ALLOGRAFT REJECTION, by Kosuge et al.
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Chronic allograft rejection with graft vasculopathy remains
a clinical problem in cardiac transplantation. Peroxisome proliferator-activated
receptors are a superfamily of ligand-dependent transcription
factors that regulate the expression of multiple components
of inflammatory pathways. Kosuge et al found that the peroxisome
proliferator-activated receptor-
activator pioglitazone caused
a marked increase in the survival from 8 to 35 days in a murine
model of cardiac transplantation and allograft rejection. This
effect was associated with suppression of neointimal hyperplasia,
and reduced expression interferon-
, interleukin-10, and monocyte
chemoattractant protein-1, as well as inhibition of the proliferation
of T-lymphocytes and smooth muscle cells in vitro. Taken together,
these findings raise the possibility that pioglitazone may be
of clinical value in the prevention of and/or therapy for cardiac
transplant rejection. See p
2613.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Two-Dimensional Strain Imaging to Assess the Origin and Extent
of Ventricular Preexcitation Associated With an Accessory Bypass.
See p
e835.
Unusual Case of Anomalous Pulmonary Venous Return With Left Atrial to Superior Vena Cava Shunt. See p e840.
Cardiac Magnetic Resonance Imaging for Myocarditis. See p e842.
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Correspondence
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See p
e844.
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