(Circulation. 2006;114:1.)
© 2006 American Heart Association, Inc.
Issue Highlights
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CARDIOVASCULAR OUTCOMES WITH ATRIAL-BASED PACING COMPARED WITH VENTRICULAR PACING: META-ANALYSIS OF RANDOMIZED TRIALS, USING INDIVIDUAL PATIENT DATA, by Healey et al.
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Dual-chamber atrioventricular (AV) pacing has long been viewed
as more closely approximating normal physiology than single-chamber
ventricular pacing and is favored by many cardiologists. The
superiority of AV pacing has not, however, been consistently
demonstrable in randomized trials. Healey and colleagues conducted
a detailed meta-analysis comparing these 2 pacing modes in patients
with bradycardia. In over 35 000 years of patient follow-up,
AV pacing reduced atrial fibrillation. There was a favorable
trend toward reduction in stroke. The magnitude of these benefits
is not sufficient, however, to translate to a reduction in mortality.
These results should help inform decisions for selection of
chronic pacing therapy in patients with sinus rhythm and bradycardia.
See p
11.
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RENAL FUNCTION AND EFFECTIVENESS OF ANGIOTENSIN-CONVERTING ENZYME INHIBITOR THERAPY IN PATIENTS WITH CHRONIC STABLE CORONARY DISEASE IN THE PREVENTION OF EVENTS WITH ACE INHIBITION (PEACE) TRIAL, by Solomon et al.
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Angiotensin-converting enzyme (ACE) inhibitors have been shown
to reduce morbidity and mortality in patients with left ventricular
dysfunction or heart failure and after an acute myocardial infarction.
In patients at high risk for cardiovascular disease, the results
have been mixed, with positive results seen in the Heart Outcome
Prevention Evaluation (HOPE) trial and EURopean trial On reduction
of cardiac events with Perindopril in stable coronary Artery
disease (EUROPA) and negative results in the Prevention of Events
with an ACE inhibitor (PEACE) trial. In this issue of
Circulation,
the PEACE investigators evaluated the importance of renal function
on the effectiveness of the ACE inhibitor trandolapril. They
demonstrated that in patients with reduced estimated glomerular
filtration rate that trandolapril improved mortality while in
those with normal renal function, no mortality benefit was seen.
These findings have clinical importance because renal failure
may define a subset of high-risk patients who will gain cardiovascular
protection from chronic ACE inhibitor therapy. See p
26.
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CHARACTERIZATION OF THE PERI-INFARCT ZONE BY CONTRAST-ENHANCED CARDIAC MAGNETIC RESONANCE IMAGING IS A POWERFUL PREDICTOR OF POST–MYOCARDIAL INFARCTION MORTALITY, by Yan et al.
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Left ventricular function and volume are potent predictors of
outcomes following myocardial infarction (MI), but newer imaging
modalities provide the opportunity to interrogate more specific
aspects of underlying pathophysiology. Cardiac magnetic resonance
imaging can provide detailed noninvasive information on extent
and location of infarct, and recent studies have suggested the
ability to quantitatively evaluate the extent of the peri-infarct
border zone. This area, consisting of an admixture of viable
and nonviable myocardium, is likely a substrate for malignant
arrhythmias in the post-infarct setting. In this issue of
Circulation,
Yan and colleagues use distinct quantitative thresholds of gadolinium
hyperenhancement on cardiac magnetic resonance imaging in post-MI
patients to delineate the extent of both the infarct core as
well as the peri-infarct zone. Risk of death during follow-up
was higher in those with more extensive border zone, and the
extent of the peri-infarct zone was an independent predictor
of outcome, incremental to post-MI left ventricular function
and volume. These unique data set the stage for more comprehensive
anatomic assessment of the post-MI left ventricle by contemporary
noninvasive imaging, potentially leading to more precise stratification
of long-term risks. See p
32.
Visit http://circ.ahajournals.org:
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Clinician Update
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Carotid Stenting. See p
e1.
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Images in Cardiovascular Medicine
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Catheter-Based Completion of the Fontan Circuit: A Nonsurgical
Approach. See p
e5.
Acute Pneumopericardium Due to Intestino-Pericardial Fistula. See p e7.
Kimura’s Disease Presenting as Steroid-Responsive Thromboangiitis Obliterans. See p e10.
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Book Review
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Transcatheter Valve Repair. See p
e12.
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Correspondence
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See p
e13.
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Carotid Stenting
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Letter by Sanderson Regarding Article "Contractile Behavior of the Left Ventricle in Diastolic Heart Failure: With Emphasis on Regional Systolic Function"
- John E. Sanderson
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Renal Function and Effectiveness of Angiotensin-Converting Enzyme Inhibitor Therapy in Patients With Chronic Stable Coronary Disease in the Prevention of Events with ACE inhibition (PEACE) Trial
- Scott D. Solomon, Madeline M. Rice, Kathleen A. Jablonski, Powell Jose, Michael Domanski, Marc Sabatine, Bernard J. Gersh, Jean Rouleau, Marc A. Pfeffer, Eugene Braunwald for the Prevention of Events with ACE inhibition (PEACE) Investigators
Circulation 2006 114: 26-31.
[Abstract]
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Cardiovascular Outcomes With Atrial-Based Pacing Compared With Ventricular Pacing: Meta-Analysis of Randomized Trials, Using Individual Patient Data
- Jeffrey S. Healey, William D. Toff, Gervasio A. Lamas, Henning R. Andersen, Kevin E. Thorpe, Kenneth A. Ellenbogen, Kerry L. Lee, Allan M. Skene, Eleanor B. Schron, J. Douglas Skehan, Lee Goldman, Robin S. Roberts, A. John Camm, Salim Yusuf, and Stuart J. Connolly
Circulation 2006 114: 11-17.
[Abstract]
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Characterization of the Peri-Infarct Zone by Contrast-Enhanced Cardiac Magnetic Resonance Imaging Is a Powerful Predictor of Post–Myocardial Infarction Mortality
- Andrew T. Yan, Adolphe J. Shayne, Kenneth A. Brown, Sandeep N. Gupta, Carmen W. Chan, Tuan M. Luu, Marcelo F. Di Carli, H. Glenn Reynolds, William G. Stevenson, and Raymond Y. Kwong
Circulation 2006 114: 32-39.
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