Circulation. 2006;113:1155
(Circulation. 2006;113:1155.)
© 2006 American Heart Association, Inc.
Issue Highlights
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PREVENTION OF SYNCOPE TRIAL (POST): A RANDOMIZED, PLACEBO-CONTROLLED STUDY OF METOPROLOL IN THE PREVENTION OF VASOVAGAL SYNCOPE, Sheldon et al.
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Stimulation of cardiac mechanoreceptors by vigorous cardiac
contraction has been implicated in eliciting the reflex sympathetic
withdrawal and parasympathetic activation that causes neurocardiogenic
(vasovagal syncope). ß-Adrenergic blockers are commonly
prescribed, and failure to consistently confirm benefit in controlled
trials has been attributed to inclusion of patients with uncharacterized
causes of syncope and a spectrum of ages. Sheldon and coworkers
conducted a randomized controlled trial of metoprolol in patients
with recurrent vasovagal syncope that could be confirmed on
tilt table testing. Metoprolol failed to provide benefit. Additional
analysis of age and the requirement for isoproterenol infusion
to provoke a positive tilt table test are presented. The failure
of ß-blocker therapy raises further questions as to
the mechanisms eliciting vasovagal syncope and has important
implications for treatment. See p
1164.
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DRIVING TIMES AND DISTANCES TO HOSPITALS WITH PERCUTANEOUS CORONARY INTERVENTION IN THE UNITED STATES: IMPLICATIONS FOR PREHOSPITAL TRIAGE OF PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION, Nallamothu et al.
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There is growing interest in regionalization of care for patients
with ST-elevation myocardial infarction (STEMI) and the prehospital
ambulance triage of these patients to PCI hospitals. However,
delays that are incurred from directly transporting patients
to a PCI hospital may eliminate the advantage of primary PCI
or even place the patient at a disadvantage if a closer, non-PCI
hospital is available but bypassed. The success of prehospital
triage protocols depend in large part on how patients are geographically
distributed around hospitals with and without percutaneous coronary
intervention and other advanced technologies. To address this
issue, investigators from the University of Michigan and Yale
University estimated driving times and distances to the nearest
PCI hospital for the adult population in the United States.
Furthermore, they estimated the additional driving time and
distance required to reach the nearest PCI hospital when a closer
non-PCI hospital was available. These latter findings, in particular,
have important implications for the design of prehospital triage
protocols across the United States. See p
1189.
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FACTOR XIII DEFICIENCY CAUSES CARDIAC RUPTURE, IMPAIRS WOUND HEALING, AND AGGRAVATES CARDIAC REMODELING IN MICE WITH MYOCARDIAL INFARCTION, Nahrendorf et al.
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Factor XIII (FXIII) is a circulating clotting factor that has
also been shown to play a role in wound healing. In this study,
Nahrendorf and colleagues examined mice deficient in FXIII to
determine if this clotting factor also contributes to left ventricular
remodeling and healing after myocardial infarction. Mice deficient
in FXIII died from cardiac rupture but morbidity was prevented
by intravenous FXIII supplementation. The conclusion of the
study is that FXIII is important for remodeling of the myocardium
after infarction. Although preliminary, these studies suggest
a potential target to facilitate myocardial healing after ischemia
and injury. See p
1196.
Visit http://circ.ahajournals.org:
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Clinician Update
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Inflammatory Biomarkers in Acute Coronary Syndromes: Part IV:
Matrix Metalloproteinases and Biomarkers of Platelet Activation.
See p
e382.
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Images in Cardiovascular Medicine
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Diagnosis of a "Single" Coronary Artery and Determination of
Functional Significance of Concomitant Coronary Artery Disease.
See p
e386.
Left Ventricle Apical Conduit to Bilateral Subclavian Artery in a Patient With Porcelain Aorta and Aortic Stenosis. See p e388.
Myocardial Bridging. See p e390. 
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Book Review
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Pulmonary Circulation: Diseases and Their Treatment. See p
e392.
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Correspondence.
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See p
e393.
Related Articles:
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Driving Times and Distances to Hospitals With Percutaneous Coronary Intervention in the United States: Implications for Prehospital Triage of Patients With ST-Elevation Myocardial Infarction
- Brahmajee K. Nallamothu, Eric R. Bates, Yongfei Wang, Elizabeth H. Bradley, and Harlan M. Krumholz
Circulation 2006 113: 1189-1195.
[Abstract]
[Full Text]
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Inflammatory Biomarkers in Acute Coronary Syndromes: Part IV: Matrix Metalloproteinases and Biomarkers of Platelet Activation
- Ehrin J. Armstrong, David A. Morrow, and Marc S. Sabatine
Circulation 2006 113: e382-e385.
[Extract]
[Full Text]
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Diagnosis of a "Single" Coronary Artery and Determination of Functional Significance of Concomitant Coronary Artery Disease
- C. Jahnke, E. Nagel, P.C. Ostendorf, T. Tangcharoen, E. Fleck, and I. Paetsch
Circulation 2006 113: e386-e387.
[Extract]
[Full Text]
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Left Ventricle Apical Conduit to Bilateral Subclavian Artery in a Patient With Porcelain Aorta and Aortic Stenosis
- Kuan-Ming Chiu, Tzu-Yu Lin, Jer-Shen Chen, Shao-Jung Li, Chih-Yang Chan, and Shu-Hsun Chu
Circulation 2006 113: e388-e389.
[Extract]
[Full Text]
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Myocardial Bridging
- Sebastiaan C.A.M. Bekkers and Tim Leiner
Circulation 2006 113: e390-e391.
[Extract]
[Full Text]
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Pulmonary Circulation: Diseases and Their Treatment
- Harrison W. Farber
Circulation 2006 113: e392.
[Extract]
[Full Text]
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Letter Regarding Article by Weitzman et al, "Tobacco Smoke Exposure Is Associated With the Metabolic Syndrome in Adolescents"
- Celia M. Ross, Michael Weitzman, Stephen Cook, Peggy Auinger, Todd Florin, Stephen Daniels, Michael Nguyen, and Jonathan Winickoff
Circulation 2006 113: e393.
[Extract]
[Full Text]
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Prevention of Syncope Trial (POST): A Randomized, Placebo-Controlled Study of Metoprolol in the Prevention of Vasovagal Syncope
- Robert Sheldon, Stuart Connolly, Sarah Rose, Thomas Klingenheben, Andrew Krahn, Carlos Morillo, Mario Talajic, Teresa Ku, Fetnat Fouad-Tarazi, Debbie Ritchie, Mary-Lou Koshman for the POST Investigators
Circulation 2006 113: 1164-1170.
[Abstract]
[Full Text]
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Factor XIII Deficiency Causes Cardiac Rupture, Impairs Wound Healing, and Aggravates Cardiac Remodeling in Mice With Myocardial Infarction
- Matthias Nahrendorf, Kai Hu, Stefan Frantz, Farouc A. Jaffer, Ching-Hsuan Tung, Karl-Heinz Hiller, Sabine Voll, Peter Nordbeck, David Sosnovik, Stefan Gattenlöhner, Mikhail Novikov, Gerhard Dickneite, Guy L. Reed, Peter Jakob, Anthony Rosenzweig, Wolfgang R. Bauer, Ralph Weissleder, and Georg Ertl
Circulation 2006 113: 1196-1202.
[Abstract]
[Full Text]
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