Circulation. 2007;115:1697
doi: 10.1161/CIRCULATIONAHA.107.182498
(Circulation. 2007;115:1697.)
© 2007 American Heart Association, Inc.
Issue Highlights
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HIGH PREVALENCE OF SLEEP APNEA SYNDROME IN PATIENTS WITH LONG-TERM PACING: THE EUROPEAN MULTICENTER POLYSOMNOGRAPHIC STUDY, by Garrigue et al.
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Sleep apnea is associated with obesity, heart failure, hypertension,
and atrial fibrillation. Although cause-and-effect relationships
are still uncertain for some of these associations, treatment
may improve hypertension and heart failure in some patients.
Sleep apnea also causes transient bradyarrhythmias attributed
to increased vagal tone during apnea but has not been associated
with daytime bradyarrhythmias. Garrigue and colleagues performed
sleep studies in consecutive patients who had received a pacemaker
for bradyarrhythmias or heart failure. They found that more
than half of the population had sleep apnea, which was often
severe. The correlation with recognized clinical markers for
sleep apnea was poor, such that many would not be detected with
screening questionnaires. The findings should alert clinicians
to the high prevalence of sleep apnea in patients with bradyarrhythmias.
Further studies are needed to assess cause, effect, and the
impact of therapy. See p
1703.
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EARLY AND SUSTAINED BENEFIT ON EVENT-FREE SURVIVAL AND HEART FAILURE HOSPITALIZATION FROM FIXED-DOSE COMBINATION OF ISOSORBIDE DINITRATE/HYDRALAZINE: CONSISTENCY ACROSS SUBGROUPS IN THE AFRICAN-AMERICAN HEART FAILURE TRIAL, by Taylor et al.
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In the initial report from the African-American Heart Failure
Trial (A-HEFT), a fixed-dose combination of isosorbide dinitrate
and hydralazine significantly decreased the risk of all-cause
death and was associated with a favorable effect on a composite
score incorporating mortality as well as heart failure hospitalization
and a quality-of-life measure. In this issue of
Circulation,
the A-HEFT investigators report more extensive analysis of the
database. They find that the favorable effect of isosorbide
dinitrate and hydralazine on heart failure hospitalizations
began relatively early after randomization, in contrast to the
later-appearing effect on mortality in the initial report. They
also report that the effect on the composite endpoint score
as well as mortality or first heart failure hospitalization
was robust and remarkably consistent across a wide range of
patient subgroups. These interesting data provide additional
depth to the saga of isosorbide dinitrate and hydralazine in
the African-American heart failure population and raise interesting
questions regarding the mechanisms at play. See p
1747.
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USEFULNESS OF 64-SLICE CARDIAC COMPUTED TOMOGRAPHIC ANGIOGRAPHY FOR DIAGNOSING ACUTE CORONARY SYNDROMES AND PREDICTING CLINICAL OUTCOME IN EMERGENCY DEPARTMENT PATIENTS WITH CHEST PAIN OF UNCERTAIN ORIGIN, by Rubinshtein et al.
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Substantial data has accumulated regarding the performance of
multidetector computed tomographic coronary angiography to detect
or rule out coronary stenoses in patients referred for catheterization.
A recent study in
Circulation began to explore the use of this
modality in the population of patients reporting to Emergency
Departments with symptoms suggestive of an acute coronary syndrome.
In this issue of
Circulation, Rubinshtein and colleagues report
on the performance of computed tomographic coronary angiography
in such patients, who have no initial diagnostic ECG changes
or biomarker elevation suggestive of an acute coronary syndrome.
They report 100% sensitivity, 92% specificity, and 100% negative
predictive value for acute coronary syndrome in a modest-sized
cohort. Moreover, in novel data examining prognostic value of
the computed tomographic angiography data over approximately
15 months of follow-up, the negative predictive value for events
was 97%. These data build on the information suggesting potential
clinical utility of computed tomographic coronary angiography
in this setting and begin to establish the longer-term prognostic
value of the technique. The stage is set for randomized studies
designed to rigorously examine triage impact. See p
1762.
Visit http://circ.ahajournals.org:
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Special Report
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National Academy of Clinical Biochemistry Laboratory Medicine
Practice Guidelines for Utilization of Biochemical Markers in
Acute Coronary Syndromes and Heart Failure. See p
e350.
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Images in Cardiovascular Medicine
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A Ring in the Heart: Calcified Left Ventricular Aneurysm. See
p
e376.
Parvovirus B19–Associated Active Myocarditis With Biventricular Thrombi: Results of Endomyocardial Biopsy Investigations and Cardiac Magnetic Resonance Imaging. See p e378.
Vanishing Tumor. See p e381.
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Correspondence
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See p
e383.
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