Circulation. 2005;112:2077-2078
(Circulation. 2005;112:2077-2078.)
© 2005 American Heart Association, Inc.
Issue Highlights
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PROGNOSTIC VALUE OF N-TERMINAL PRO–BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH CHRONIC STABLE ANGINA, by Ndrepepa et al.
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The heart has become an endocrine organ, and its hormones today
are used for diagnostic and prognostic purposes. Brain natriuretic
peptide is predictive for cardiac events and death in patients
with heart failure, but its role in chronic stable angina is
less clear. In their study, Gjin Ndrepepa et al report on plasma
levels of NT-proBNP in more than a thousand patients with chronic
stable angina with mortality as a primary end point. In their
cohort, NT-proBNP levels were highly predictive for total and
cardiovascular mortality. Interestingly, patients in the upper
quartile of NT-proBNP had lower left ventricular ejection fraction
and higher left ventricular end-diastolic pressure as well as
more advanced coronary artery disease angiographically. In a
multivaried analysis, NT-proBNP was the strongest of all analyzed
parameters to predict mortality in these patients. Although
patients with impaired left ventricular function do have higher
levels of NT-proBNP, the cardiac hormone appears to provide
prognostic information beyond hemodynamics. Although the mechanisms
underlying this prognostic information are not yet clear, NT-proBNP
has become an important prognostic marker for clinical practice,
apparently in the entire spectrum of cardiovascular disease.
See p
2102.
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POSTCONDITIONING THE HUMAN HEART, by Staat et al.
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The existence of serious reperfusion-induced injury, resulting
in significant cell death as opposed to temporary impairment
of mechanical function (stunning), has long remained controversial.
And if it were to exist, what could be done to lessen this added
burden? Experimentalists have established that preconditioning
the heart by repetitive brief episodes of reversible ischemia
before the onset of a prolonged ischemic assault lessens cardiomyocyte
death at reperfusion. Thus, the ultimate infarct size is decreased.
But preconditioning must be applied in advance and is relatively
short lived. The group of Michel Ovize now provides a landmark
human study that answers two major questions. First, how to
do it—by postconditioning, a relatively simple procedure
involving a few short sharp bursts of reocclusion and full reperfusion
started just after angioplastic revascularization for acute
myocardial infarction. Second, what is the benefit? Postconditioning
reduced enzyme release by about one third, thus saving dying
cells. Both the simplicity and the strength of this observation
challenge current views on optimal revascularization for acute
myocardial infarction. See p
2143.
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RANDOMIZED COMPARISON OF SIROLIMUS-ELUTING STENT VERSUS STANDARD STENT FOR PERCUTANEOUS CORONARY REVASCULARIZATION IN DIABETIC PATIENTS: THE DIABETES TRIAL, by Sabaté et al.
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Patients with diabetes mellitus are recognized to have an elevated
risk of cardiovascular disease. This patient population presents
a significant challenge with respect to percutaneous revascularization
procedures owing to the presence of diffuse coronary artery
disease as well as the aggressive nature of the disease process.
After bare metal stent placement, diabetic patients demonstrate
an increased rate of restenosis as compared with nondiabetic
patients, suggesting the need for more efficacious treatment
strategies. Recent studies, by subset analysis, have shown that
drug-eluting stents have improved restenosis rates in diabetic
patients. In this issue of
Circulation, Sabaté et al
present definitive findings from a multicenter, prospective,
randomized study that evaluates the efficacy of sirolimus drug-eluting
stents in diabetic patients. The results from this trial will
help to guide interventional therapies for diabetic patients
that require percutaneous coronary revascularization procedures
in the future. See p
2175.
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Images in Cardiovascular Medicine
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Cardiac Transplantation for Giant Sarcoma of the Left Ventricle.
See p
e247.
Tamponade From Acute Left Atrium Compression. See p e250.
Right-Sided Heart Failure Due to Compression of the Right Atrium by Remarkable Ascending Aortic Elongation. See p e252.
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Correspondence
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See p
e253.
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PROGNOSTIC VALUE OF N-TERMINAL...
POSTCONDITIONING THE HUMAN...