Circulation. 2006;114:1447
(Circulation. 2006;114:1447.)
© 2006 American Heart Association, Inc.
Issue Highlights
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RANDOMIZED TRIAL OF ATORVASTATIN FOR REDUCTION OF POSTOPERATIVE ATRIAL FIBRILLATION IN PATIENTS UNDERGOING CARDIAC SURGERY: RESULTS OF THE ARMYDA-3 (ATORVASTATIN FOR REDUCTION OF MYOCARDIAL DYSRHYTHMIA AFTER CARDIAC SURGERY) STUDY, by Patti et al.
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Atrial fibrillation after cardiac surgery is associated with
increased length of hospital stay and increased morbidity. Increasing
evidence points to a role for inflammation in the pathogenesis
of atrial fibrillation. In this issue of
Circulation, Patti
and colleagues evaluate the effect of atorvastatin on postoperative
atrial fibrillation in a randomized, placebo-controlled trial
of 200 patients undergoing cardiopulmonary bypass surgery. Atorvastatin
begun preoperatively reduced atrial fibrillation and was associated
with a small reduction in length of hospital stay. Benefit was
seen in patients taking ß-adrenergic blockers and
was not influenced by age. No benefit was demonstrated for the
small subgroup having valve surgery. The present study is unlikely
to be repeated in patients with coronary disease, as most have
an indication for therapy with a 3-hydroxy-3-methylglutaryl
coenzyme reductase inhibitor. It should, however, foster further
studies of the mechanism of benefit and should help to determine
whether patients having valve surgery alone might benefit. See
p
1455.
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RELATIONSHIP BETWEEN POSTOPERATIVE CARDIAC TROPONIN I LEVELS AND OUTCOME OF CARDIAC SURGERY, by Croal et al.
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Prior studies of the prognostic utility of cardiac troponin
levels following cardiac surgery have been relatively small
with limited duration of follow-up. Several have shown cardiac
troponins to be significant independent predictors of in-hospital
mortality and complications. The current findings by Croal et
al are comparable with prior data relating creatine kinase-MB
isoenzyme and/or troponin levels following cardiac surgery to
subsequent mortality. The present study has extended these observations
by reporting the prognostic utility of cardiac troponin I in
a large cohort with longer follow-up. In addition, the size
of the cohort allowed adjustment for potential confounding factors
inherent in this patient cohort, in particular the nature of
the surgery performed. The current data suggest that troponin
levels following cardiac surgery could be used to identify patients
who are at considerably increased risk. Cardiac troponin I levels
in the highest quartile at 24 hours were independent predictors
of short, medium, and long-term risks for adverse outcomes.
The authors concluded that routine measurement of troponin levels
after cardiac surgery may be clinically useful, and they identified
a group of patients at increased risk of death. These individuals
might benefit from more intensive investigation and treatment,
though this remains to be tested. See p
1468.
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EXERCISE AND RESPIRATORY TRAINING IMPROVE EXERCISE CAPACITY AND QUALITY OF LIFE IN PATIENTS WITH SEVERE CHRONIC PULMONARY HYPERTENSION, by Mereles et al.
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Exercise training is an effective and safe method to improve
functional capacity among patients with coronary artery disease,
heart failure, and peripheral arterial disease. Whether the
same is true in patients with pulmonary hypertension has not
been previously studied. As such, patients often have limited
exercise tolerance. In this issue of
Circulation, Mereles et
al report the results of their seminal study in which 30 patients
with pulmonary hypertension (mean pulmonary artery pressure
of 50±15 mmHg) were randomized to exercise and respiratory
training versus control. Changes in peak oxygen uptake, 6-minute
walking distance, Borg scale, WHO functional class, quality
of life, and echocardiographic parameters were assessed. The
remarkable results of this study have important implications
for the treatment of patients with pulmonary hypertension and
serve to inspire future studies in this area. These issues are
further discussed in an accompanying editorial by John Newman.
See p 1482 (editorial on p
1448).
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Sixty-Four–Multislice Computed Tomography Image of a Ruptured
Coronary Plaque. See p
e519.
Therapeutic Hypothermia–Related Torsade de Pointes. See p e521.
Rapid Resolution of Massive Lung Abscesses Complicating Tricuspid Valve Endocarditis. See p e523.
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Book Review
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Macro- and Micro Circulation in Hypertension. See p
e525.
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Correspondence
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See p
e526.
Related Articles:
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Exercise Training in Pulmonary Hypertension: Implications for the Evaluation of Drug Trials
- John H. Newman and Ivan M. Robbins
Circulation 2006 114: 1448-1449.
[Extract]
[Full Text]
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Sixty-Four–Multislice Computed Tomography Image of a Ruptured Coronary Plaque
- Nobuyoshi Tanaka, Mariko Ehara, Jean-François Surmely, Tetsuo Matsubara, Mitsuyasu Terashima, Etsuo Tsuchikane, Osamu Katoh, and Takahiko Suzuki
Circulation 2006 114: e519-e520.
[Extract]
[Full Text]
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Therapeutic Hypothermia-Related Torsade de Pointes
- Chien-Hua Huang, Min-Shan Tsai, Chiung-Yuan Hsu, and Wen-Jone Chen
Circulation 2006 114: e521-e522.
[Extract]
[Full Text]
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Rapid Resolution of Massive Lung Abscesses Complicating Tricuspid-Valve Endocarditis
- Yok-Ai Que, Olivier Muller, and Lucas Liaudet
Circulation 2006 114: e523-e524.
[Extract]
[Full Text]
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Macro- and Micro Circulation in Hypertension
- Michael O’Rourke
Circulation 2006 114: e525.
[Extract]
[Full Text]
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Letter by Schinkel et al Regarding Article, "Projected Valve Area at Normal Flow Rate Improves the Assessment of Stenosis Severity in Patients With Low-Flow, Low-Gradient Aortic Stenosis: The Multicenter TOPAS (Truly or Pseudo-Severe Aortic Stenosis) Study"
- Arend F.L. Schinkel, Manolis Bountioukos, Don Poldermans, and Jeroen J. Bax
Circulation 2006 114: e526.
[Extract]
[Full Text]
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Relationship Between Postoperative Cardiac Troponin I Levels and Outcome of Cardiac Surgery
- Bernard L. Croal, Graham S. Hillis, Patrick H. Gibson, Mohammed T. Fazal, Hussein El-Shafei, George Gibson, Robert R. Jeffrey, Keith G. Buchan, Douglas West, and Brian H. Cuthbertson
Circulation 2006 114: 1468-1475.
[Abstract]
[Full Text]
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Randomized Trial of Atorvastatin for Reduction of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: Results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) Study
- Giuseppe Patti, Massimo Chello, Dario Candura, Vincenzo Pasceri, Andrea D’Ambrosio, Elvio Covino, and Germano Di Sciascio
Circulation 2006 114: 1455-1461.
[Abstract]
[Full Text]
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