Circulation. 2006;113:2783
(Circulation. 2006;113:2783.)
© 2006 American Heart Association, Inc.
Issue Highlights
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COGNITIVE OUTCOMES IN ELDERLY HIGH-RISK PATIENTS AFTER OFF-PUMP VERSUS CONVENTIONAL CORONARY ARTERY BYPASS GRAFTING: A RANDOMIZED TRIAL, by Jensen et al.
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Understanding neurocognitive outcomes after coronary bypass
surgery has been the focus of many recent investigations, few
of which were randomized studies. The incidence of stroke is
a perioperative event, but postoperative cognitive dysfunction
is a condition characterized by impairment of memory or concentration.
The article "Cognitive Outcomes in Elderly High-Risk Patients
After Off-Pump Versus Conventional Coronary Artery Bypass Grafting:
A Randomized Trial," by Jensen et al, addresses these issues
in a substudy of the randomized Best Bypass Surgery (BBS) Trial
that compared off-pump coronary artery bypass grafting to conventional
coronary artery bypass grafting treatment, with respect to preoperative
and postoperative morbidity in patients with a moderate to high
predicted preoperative risk. The outcome was cognitive function
in 120 elderly patients (mean age 76 years) who underwent psychometric
testing before surgery and at a mean of 103 (standard deviation,
15) days postoperatively, using a neuropsychological test battery
with 7 parameters from 4 tests. Cognitive dysfunction was defined
as the occurrence of at least 2 deficits out of a possible 7.
The authors found no difference in the incidence of cognitive
dysfunction between the groups regardless of the definition
applied. The search for techniques and strategies to enhance
the safety of coronary surgery will continue. See p
2790.
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CAUSES AND CONSEQUENCES OF HEART FAILURE AFTER PROPHYLACTIC IMPLANTATION OF A DEFIBRILLATOR IN THE MULTICENTER AUTOMATIC DEFIBRILLATOR IMPLANTATION TRIAL II, by Goldenberg et al.
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Depressed left ventricular function is a marker for both arrhythmias
and heart failure. Implantable cardioverter defibrillators (ICDs)
reduce sudden arrhythmic death and prolong survival in selected
patient populations. Goldenberg and colleagues examined the
relationship between ICD therapy, survival and heart failure
hospitalizations in the Multicenter Automatic Defibrillator
Implantation Trial II population of patients with coronary artery
disease and left ventricular ejection fraction <0.30. ICDs
reduced mortality, but heart failure hospitalizations were increased
by almost 40%. Heart failure was associated with a 4-fold increase
in mortality. Spontaneous ventricular arrhythmias predicted
increased heart failure even though the arrhythmias were effectively
terminated by the ICD. These findings support the concept that
ICDs change the mode of death, but progressive pump failure
limits the extension of survival in some patients. Arrhythmias
indicate increased risk for progressive heart failure. Emphasis
on therapies to preserve ventricular function and prevent progression
of heart failure is appropriate in patients who receive ICDs.
See p
2810.
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DETERMINANTS OF ARTERIAL WALL REMODELING DURING LIPID LOWERING THERAPY: SERIAL INTRAVASCULAR ULTRASOUND OBSERVATIONS FROM THE REVERSAL OF ATHEROSCLEROSIS WITH AGGRESSIVE LIPID LOWERING THERAPY (REVERSAL) TRIAL, by Schoenhagen et al.
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Statins have been shown to stabilize coronary artery atherothrombotic
plaques and thereby decrease adverse cardiovascular events.
It has been suggested that the low-density lipoprotein cholesterol--lowering
and antiinflammatory properties of these agents limit plaque
progression and may, in fact, promote regression. Previous intravascular
studies have shown that, at sites of unstable coronary plaques,
there is, in addition, positive remodeling and outward expansion
of the vessel wall. This observation suggests that therapies,
such as statins, that promote plaque stabilization could initiate
negative vascular remodeling. In this issue of
Circulation,
Schoenhagen et al present data from a prospectively designed
substudy of the Reversal of Atherosclerosis With Aggressive
Lipid Lowering Therapy (REVERSAL) trial. In this investigation,
the investigators use serial intravascular ultrasound studies
to evaluate changes in coronary artery architecture over time
in response to statin therapy and obtain evidence that negative
remodeling may occur in humans. See p
2826.
Visit http://circ.ahajournals.org:
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Clinician Update
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Contemporary Approach to Hypertrophic Cardiomyopathy. See p
e858.
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Images in Cardiovascular Medicine
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Interrupted Aortic Arch With Bilateral Ductus Arteriosi and
Bilateral Aberrant Subclavian Arteries. See p
e863.
Echocardiographic Demonstration of Electrical Alternans. See p e866.
Hydatid Cyst of the Interventricular Septum. See p e869.
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Correspondence
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See p
e871.
Related Articles:
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A Contemporary Approach to Hypertrophic Cardiomyopathy
- Carolyn Y. Ho and Christine E. Seidman
Circulation 2006 113: e858-e862.
[Full Text]
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Interrupted Aortic Arch With Bilateral Ductus Arteriosi and Bilateral Aberrant Subclavian Arteries
- Jeremy D. Asnes, Jacobo Kirsch, Richard D. White, and Brian Duncan
Circulation 2006 113: e863-e865.
[Full Text]
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Echocardiographic Demonstration of Electrical Alternans
- Sreedhar Billakanty and Riyaz Bashir
Circulation 2006 113: e866-e868.
[Full Text]
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Hydatid Cyst of the Interventricular Septum
- Murat Ugurlucan, Omer Ali Sayin, Benguhan Surmen, Tarhan Cinar, Ensar Yekeler, Memduh Dursun, Emin Tireli, and Enver Dayioglu
Circulation 2006 113: e869-e870.
[Full Text]
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Letter by Brook et al Regarding Article "Diesel Exhaust Inhalation Causes Vascular Dysfunction and Impaired Endogenous Fibrinolysis"
- Robert D. Brook, Marie S. O’Neill, and Sanjay Rajagopalan
Circulation 2006 113: e871.
[Full Text]
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Causes and Consequences of Heart Failure After Prophylactic Implantation of a Defibrillator in the Multicenter Automatic Defibrillator Implantation Trial II
- Ilan Goldenberg, Arthur J. Moss, W. Jackson Hall, Scott McNitt, Wojciech Zareba, Mark L. Andrews, David S. Cannom for the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II Investigators
Circulation 2006 113: 2810-2817.
[Abstract]
[Full Text]
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Determinants of Arterial Wall Remodeling During Lipid-Lowering Therapy: Serial Intravascular Ultrasound Observations From the Reversal of Atherosclerosis With Aggressive Lipid Lowering Therapy (REVERSAL) Trial
- Paul Schoenhagen, E. Murat Tuzcu, Carolyn Apperson-Hansen, Chaohui Wang, Kathy Wolski, Songhua Lin, Ilke Sipahi, Stephen J. Nicholls, William A. Magyar, Aaron Loyd, Tammy Churchill, Tim Crowe, and Steven E. Nissen
Circulation 2006 113: 2826-2834.
[Abstract]
[Full Text]
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Cognitive Outcomes in Elderly High-Risk Patients After Off-Pump Versus Conventional Coronary Artery Bypass Grafting: A Randomized Trial
- Birte Ostergaard Jensen, Pia Hughes, Lars S. Rasmussen, Preben U. Pedersen, and Daniel A. Steinbrüchel
Circulation 2006 113: 2790-2795.
[Abstract]
[Full Text]
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