Circulation. 2007;116:457
doi: 10.1161/CIRCULATIONAHA.107.183538
(Circulation. 2007;116:457.)
© 2007 American Heart Association, Inc.
Issue Highlights
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IMPACT OF PREOPERATIVE ANEMIA ON OUTCOME IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT SURGERY, by Kulier et al.
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Anemia is an increasingly frequent clinical finding and is known
to be associated with increased morbidity and mortality, especially
in patients with coronary artery disease and in the perioperative
setting. The observational study by Kulier and colleagues documents
the clinical course of more than 5000 patients undergoing coronary
artery bypass surgery, describing the impact of low preoperative
hemoglobin levels on postoperative outcomes and delineating
the influence of comorbidities and other risk factors on individual
tolerance to anemia. Anemic patients with few additional risk
factors have increased postoperative renal and cerebral complications
only, whereas high-risk patients show an additional propensity
for cardiac adverse events. Although the increase in noncardiac
postoperative complications was independently associated with
low preoperative hemoglobin levels, cardiac adverse events were
caused by other factors, all of which are frequently present
in anemic patients. Thus, a patient’s perioperative risk
has to be assessed individually, considering both the hemoglobin
level and other comorbid conditions. The best therapeutic strategies
to reduce the perioperative risk of anemic patients are still
unknown and require further investigation. See p 471 (editorial
p
458).
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SOFT DRINK CONSUMPTION AND RISK OF DEVELOPING CARDIOMETABOLIC RISK FACTORS AND THE METABOLIC SYNDROME IN MIDDLE-AGED ADULTS IN THE COMMUNITY, by Dhingra et al.
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Soft drink consumption has been linked to childhood and adolescent
obesity, but it is unclear if it increases metabolic risk in
middle-aged individuals. In this issue of
Circulation, Dhingra
and colleagues use data from the community-based Framingham
Heart Study to relate soft drink consumption to the development
of metabolic syndrome and its components. The authors report
that individuals who consumed at least 1 soft drink per day
were more likely to have metabolic syndrome at the start of
the study. Further, participants who consumed
1 soft drink per
day had an approximately 40% higher risk of developing new-onset
metabolic syndrome prospectively during a follow-up of 4 years
compared with those consuming <1 soft drink per day. Daily
soft drink consumption was associated with a significant increased
risk of development of most of the components of the metabolic
syndrome, including incidence of increased waist circumference,
impaired fasting glucose, hypertriglyceridemia, and low high-density
lipoprotein cholesterol. These data suggest that daily soft
drink consumption is associated with obesity and metabolic risk
in middle-aged individuals cross-sectionally and prospectively.
See p
480.
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PREOPERATIVE THRESHOLDS FOR PULMONARY VALVE REPLACEMENT IN PATIENTS WITH CORRECTED TETRALOGY OF FALLOT USING CARDIOVASCULAR MAGNETIC RESONANCE, by Oosterhof et al.
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In patients with corrected tetralogy of Fallot and residual
long-standing pulmonary regurgitation, timing of pulmonary valve
replacement remains controversial. Oosterhof et al studied 71
patients with repaired tetralogy of Fallot before and at a median
of 9 months after pulmonary valve replacement. Pulmonary valve
replacement resulted in a significant reduction in right ventricular
volume, without a threshold, and improved New York Heart Association
class but produced no significant change in right ventricular
ejection fraction. Normalization of volumes could be achieved
when preoperative right ventricular end-diastolic volume was
<160 mL/m
2 or right ventricular end-systolic volume was <82
mL/m
2. These data add to the growing literature on optimal timing
of pulmonary valve replacement in tetralogy of Fallot. Future
studies will need to assess valve durability, objective measurement
of exercise capacity, and frequency of arrhythmia and sudden
death. See p
545.
Visit http://circ.ahajournals.org:
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Clinician Update
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Dynamic Left Ventricular Outflow Tract Obstruction in Acute
Myocardial Infarction With Shock: Cause, Effect, and Coincidence.
See p
e110.
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Images in Cardiovascular Medicine
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Caseous Calcification of the Mitral Annulus by 64-Detector-Row
Computed Tomographic Coronary Angiography: A Rare Intracardiac
Mass. See p
e114.
Diagnosis of Cleidocranial Dysplasia in Routine Chest Radiograph. See p e116.
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Correspondence
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See p
e119.
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