Circulation. 2006;113:763
(Circulation. 2006;113:763.)
© 2006 American Heart Association, Inc.
Issue Highlights
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ARE IMPLANTABLE CARDIOVERTER DEFIBRILLATOR SHOCKS A SURROGATE FOR SUDDEN CARDIAC DEATH IN PATIENTS WITH NONISCHEMIC CARDIOMYOPATHY?, by Ellenbogen et al.
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Implantable cardioverter defibrillators (ICDs) prevent sudden
cardiac death by promptly terminating ventricular tachyarrhythmias
and providing a record of the event. Patients and physicians
commonly equate arrhythmia termination to an aborted sudden
death. Analysis of outcomes and detected arrhythmias in the
Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation
(DEFINITE) trial illustrates that this assumption overestimates
the ICD benefit. In patients with nonischemic cardiomyopathy,
the frequency of sudden death in patients randomized to no ICD
was substantially less than the number of arrhythmias detected
and automatically treated in the ICD group. These findings indicate
that with present ICD programming for prompt arrhythmia termination,
ICDs often treat arrhythmias that would not be fatal, although
some would likely produce syncope before terminating spontaneously.
The survival benefit of an ICD cannot be inferred from detected
arrhythmias, suggesting that mortality, rather than ICD therapies,
should remain the most important end point for ICD trials. See
p
776.
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ASSOCIATION OF A CONTINUOUS QUALITY IMPROVEMENT INITIATIVE WITH PRACTICE AND OUTCOME VARIATIONS OF CONTEMPORARY PERCUTANEOUS CORONARY INTERVENTIONS, by Moscucci et al.
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Increasing attention is directed toward the importance of improving
the quality of health care. A principal challenge is to develop
and evaluate interventions to improve systems of care. Investigators
in Michigan implemented a continuous quality improvement project,
which included feedback on outcomes, working group meetings,
site visits, selection of quality indicators, and the use of
bedside tools for quality improvement and risk assessment in
a consortium of 5 hospitals. They compared the experience of
the intervention group with control hospitals that did not participate.
Their outcomes were the use of preprocedural aspirin or clopidogrel,
use of glycoprotein IIb/IIIa receptor blockers, use of postprocedural
heparin, and amount of contrast media per case. They also compared
outcomes including emergency CABG, contrast nephropathy, myocardial
infarction, stroke, transfusion, and in-hospital death. See
p
814.
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CHARACTERIZATION OF ACUTE AND CHRONIC MYOCARDIAL INFARCTS BY MULTIDETECTOR COMPUTED TOMOGRAPHY: COMPARISON WITH CONTRAST-ENHANCED MAGNETIC RESONANCE, by Gerber et al.
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In recent years, there has been substantial validation regarding
the use of contrast-enhanced cardiac magnetic resonance imaging
("late hyperenhancement") for quantifying the extent of infarction/fibrosis
in ischemic heart disease and various cardiomyopathies. In this
issue of
Circulation, Gerber and colleagues demonstrate that
cardiac computed tomographic (CT) imaging is capable of providing
similar information using contrast agents suitable for CT imaging.
Validation studies are presented in a porcine model, and human
data are presented for patients with both recent and more chronic
infarction. Contrast kinetics are studied in an isolated heart
model to provide mechanistic support for the findings. These
important data open the door to extending the applicability
of cardiac CT imaging to assessment of myocardial viability.
Moreover, as the use of cardiac CT is becoming more widely accessible
for coronary imaging, these data set the stage for a comprehensive
examination of coronary anatomy and myocardial pathophysiology
in one testing session, with implications for clinical decision
making in ischemic cardiomyopathy. See p
823.
Visit http://circ.ahajournals.org:
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Clinician Update
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Inflammatory Biomarkers in Acute Coronary Syndromes: Part I:
Introduction and Cytokines. See p
e72.
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Images in Cardiovascular Medicine
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Disruption of Dystrophin in Acute Fulminant Coxsackieviral B4
Infection. See p
e76.
Assessment of Isolated Right Ventricular Myocardial Infarction by Magnetic Resonance Imaging. See p e78.
Multiple Thrombosis With Aortic Occlusion After Heparin-Induced Thrombocytopenia Demonstrated by Multislice Computed Tomography. See p e80.
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Book Review
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Angiogenesis and Direct Myocardial Revascularization. See p
e84.
Related Articles:
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Inflammatory Biomarkers in Acute Coronary Syndromes: Part I: Introduction and Cytokines
- Ehrin J. Armstrong, David A. Morrow, and Marc S. Sabatine
Circulation 2006 113: e72-e75.
[Full Text]
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Disruption of Dystrophin in Acute Fulminant Coxsackieviral B4 Infection
- Young Tak Lee, Kiick Sung, Jae-Ok Shin, and Eun-Seok Jeon
Circulation 2006 113: e76-e77.
[Full Text]
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Assessment of Isolated Right Ventricular Myocardial Infarction by Magnetic Resonance Imaging
- Tareq Ibrahim, Markus Schwaiger, and Albert Schömig
Circulation 2006 113: e78-e79.
[Full Text]
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Multiple Thrombosis With Aortic Occlusion After Heparin-Induced Thrombocytopenia Demonstrated by Multislice Computed Tomography
- Patrick A. Hein, Alexander Lembcke, and Patrik Rogalla
Circulation 2006 113: e80-e83.
[Full Text]
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Angiogenesis and Direct Myocardial Revascularization
- Sanjay Rajagopalan
Circulation 2006 113: e84.
[Full Text]
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Characterization of Acute and Chronic Myocardial Infarcts by Multidetector Computed Tomography: Comparison With Contrast-Enhanced Magnetic Resonance
- Bernhard L. Gerber, Bénédicte Belge, Gabin J. Legros, Pascal Lim, Alain Poncelet, Agnès Pasquet, Giovanna Gisellu, Emmanuel Coche, and Jean-Louis J. Vanoverschelde
Circulation 2006 113: 823-833.
[Abstract]
[Full Text]
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Association of a Continuous Quality Improvement Initiative With Practice and Outcome Variations of Contemporary Percutaneous Coronary Interventions
- Mauro Moscucci, Eva Kline Rogers, Cecelia Montoye, Dean E. Smith, David Share, Michael O’Donnell, Ann Maxwell-Eward, William L. Meengs, Anthony C. De Franco, Kirit Patel, Richard McNamara, John G. McGinnity, Sandeep M. Jani, Sanjaya Khanal, Kim A. Eagle for the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)
Circulation 2006 113: 814-822.
[Abstract]
[Full Text]
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Are Implantable Cardioverter Defibrillator Shocks a Surrogate for Sudden Cardiac Death in Patients With Nonischemic Cardiomyopathy?
- Kenneth A. Ellenbogen, Joseph H. Levine, Ronald D. Berger, James P. Daubert, Stephen L. Winters, Eugene Greenstein, Alaa Shalaby, Andi Schaechter, Haris Subacius, Alan Kadish for the Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators
Circulation 2006 113: 776-782.
[Abstract]
[Full Text]
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ARE IMPLANTABLE CARDIOVERTER...
ASSOCIATION OF A CONTINUOUS...