Circulation. 2007;116:1997
doi: 10.1161/CIRCULATIONAHA.107.187678
(Circulation. 2007;116:1997.)
© 2007 American Heart Association, Inc.
Issue Highlights
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PREDICTION OF ATRIAL FIBRILLATION VIA ATRIAL ELECTROMECHANICAL INTERVAL AFTER CORONARY ARTERY BYPASS GRAFTING, by Roshanali et al
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Atrial fibrillation (AF) is a common complication of cardiac
surgery that is associated with increased morbidity, length
of hospitalization, and costs. Yet, the risks and inconvenience
of prophylactic therapies is such that many are not routinely
used. Roshanali and coworkers prospectively evaluated the delay
between the onset of the P wave and echocardiographically detected
lateral left atrial contraction (atrial electromechanical interval),
as a predictor of AF after coronary artery bypass surgery in
365 patients with no prior history of AF. AF occurred in 19.2%
of patients and was associated with increased length of hospitalization.
A long atrial electromechanical interval was an excellent predictor
of postoperative AF. The atrial electromechanical interval is
a simple convenient marker that could potentially be used in
future studies to target strategies for preventing postoperative
AF in high-risk patients. See p
2012.
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APOLIPOPROTEIN A-II IS INVERSELY ASSOCIATED WITH RISK OF FUTURE CORONARY ARTERY DISEASE, by Birjmohun et al
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Controversy exists on whether apolipoprotein A-II (apoA-II),
the primary high-density lipoprotein–associated protein,
lowers risk, is neutral, or is proatherosclerotic. In one of
the largest studies to date, Birjmohun and colleagues conducted
a nested case control study of whether apoA-I and apoA-II predict
incident coronary artery disease in the EPIC-Norfolk (European
Prospective Investigation into Cancer and Nutrition--Norfolk)
cohort. Middle-aged to elderly men and women were matched on
age, sex, and enrollment time and followed up for an average
of 6 years. The investigators observed that apoA-II concentrations
were protective for risk of future coronary artery disease.
Individuals in the highest quartile had about half the adjusted
odds of incident coronary disease compared with those in the
lowest quartile, even after accounting for apoA-I levels. Similarly,
after adjusting for high-density lipoprotein particles and size,
apoA-II concentrations were associated with decreased risk of
coronary disease. Although apoA-II did not improve overall coronary
artery risk prediction, further research is warranted into mechanisms
underlying the protective relationship of apoA-II with incident
coronary disease. See p
2029.
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STAGED CAROTID ANGIOPLASTY AND STENTING FOLLOWED BY CARDIAC SURGERY IN PATIENTS WITH SEVERE ASYMPTOMATIC CAROTID ARTERY STENOSIS: EARLY AND LONG-TERM RESULTS, by Van der Heyden et al
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Patients with obstructive coronary artery disease often have
significant disease in other vascular territories. The best
management of patients with concomitant severe carotid and coronary
artery disease remains in dispute. In patients with asymptomatic
carotid disease, cardiac surgery is associated with a significant
incidence of perioperative stroke. Combined and staged carotid
endarterectomy has been studied in an attempt to reduce perioperative
mortality. Van der Heyden and colleagues examined the feasibility
of combined carotid angioplasty and stenting followed by cardiac
surgery in 356 consecutive patients with severe carotid disease
without neurologic symptoms. Carotid angioplasty and stenting
was highly successful (97.7%), and death and stroke rate from
carotid angioplasty and stenting to 30 days after cardiac surgery
was 4.8%. During a median follow-up of 31 months, death and
stroke occurred in 28.6%. These results suggest that combined
carotid angioplasty and stenting and cardiac surgery is feasible
and is an alternative to carotid endarterectomy and cardiac
surgery in these patients. See p 2036 (editorial p
2002).
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Clinician Update
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Cardiac Troponin Assays: A View From the Clinical Chemistry
Laboratory. See p
e501.
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Images in Cardiovascular Medicine
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Echocardiography-Guided Percutaneous Aspiration of a Large Pericardial
Cyst. See p
e505.
Inflammatory Aneurysm of the Ascending Aorta: Dissection Ante Portas? See p e508.
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Correspondence
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See p
e512.
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Prediction of Atrial Fibrillation via Atrial Electromechanical Interval After Coronary Artery Bypass Grafting
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