Circulation. 2006;114:2089
(Circulation. 2006;114:2089.)
© 2006 American Heart Association, Inc.
Issue Highlights
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GENOTYPE-SPECIFIC ONSET OF ARRHYTHMIAS IN CONGENITAL LONG-QT SYNDROME: POSSIBLE THERAPY IMPLICATIONS, by Tan et al.
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Mutations in a variety of different proteins cause the long-QT
syndrome (LQTS), which may result in syncope or sudden death
because of the polymorphic ventricular tachycardia, torsade
de pointes. It has long been recognized that a pause that further
lengthens the QT interval initiates some but not all episodes
of torsade de pointes. In this issue of
Circulation, Tan and
colleagues analyzed spontaneous initiation of torsade de pointes
in genotyped LQTS subjects. Interestingly, in the 2 most common
forms of LQTS, a pause-dependent onset was characteristic of
LQT2 but was often absent for LQT1. The abnormal current (
IKr)
in LQT2 is also the most common target of drug-induced torsade
de pointes, which is typically pause dependent. This heterogeneity
suggests different arrhythmia mechanisms in the 2 most common
forms of congenital LQTS and has potential implications for
clinical recognition of the genotype and for therapy, such as
pacing, to prevent torsade de pointes. See p
2096.
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CONTEMPORARY IMPACT OF STATE CERTIFICATE-OF-NEED REGULATIONS FOR CARDIAC SURGERY: AN ANALYSIS USING THE SOCIETY OF THORACIC SURGEONS’ NATIONAL CARDIAC SURGERY DATABASE, by DiSesa et al.
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Certificate-of-need regulation is an approach employed by some
states to control the utilization of high-cost procedures. Investigators
DiSesa et al have made use of the Society for Thoracic Surgeons’
National Cardiac Surgery Database to determine whether certificate-of-need
regulations influence coronary bypass surgery volumes and risk-adjusted
mortality rates. The investigators compared 26 states and the
District of Columbia, which had certificate-of-need regulations
during 2000–2003, with the other nonregulated states.
The authors report that certificate-of-need regulation was associated
with a higher operation volume per hospital, but was not associated
with a reduction in mortality. These findings suggest that certificate-of-need
regulation may not have the expected effect on quality of care.
See p
2122.
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IMPAIRED CHRONOTROPIC AND VASODILATOR RESERVES LIMIT EXERCISE CAPACITY IN PATIENTS WITH HEART FAILURE AND A PRESERVED EJECTION FRACTION, by Borlaug et al.
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Clinicians and investigators in the field of heart failure recognize
that approximately half of all heart failure patients have preserved
ejection fraction (EF). Symptoms in those patients are most
commonly ascribed to underlying abnormalities in diastolic function.
In this issue of
Circulation, Borlaug and colleagues challenge
that conventional wisdom with unique findings. In a comprehensive
study of patients with heart failure and preserved EF and a
group of very well-matched referent controls, all studied at
rest and during graded exercise, the investigators found that
the limited exercise tolerance and blunted stress cardiac output
in the patients with heart failure and preserved EF wass associated
with blunted chronotropic reserve as well as abnormalities in
peripheral systemic vasodilatation during stress. These novel
data add complexity to the underlying pathophysiology of heart
failure in the setting of preserved EF, and perhaps most important,
suggest potential new avenues for treatment of this syndrome,
for which little evidence-based therapy exists. See p
2138.
Visit http://circ.ahajournals.org:
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Cardiology Patient Page
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Modern Treatment for Heart Attacks: Opening Blocked Arteries
Quickly. See p
e578.
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Images in Cardiovascular Medicine
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Percutaneous Implantation of a Systemic-to-Pulmonary Shunt.
See p
e581.
Successful Percutaneous Renal Intervention in a Patient With Acute Traumatic Renal Artery Thrombosis. See p e583.
Damage to Polymer of Sirolimus-Eluting Stent. See p e586.
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Correspondence
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See p
e588.
Related Articles:
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Modern Treatment for Heart Attacks: Opening Blocked Arteries Quickly
- Amy F. Marple, Elliott M. Antman, and Mary M. Hand
Circulation 2006 114: e578-e580.
[Full Text]
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Percutaneous Implantation of a Systemic-to-Pulmonary Shunt
- Gianfranco Butera, Luciane Piazza, Giuseppe Pomè, Massimo Chessa, and Mario Carminati
Circulation 2006 114: e581-e582.
[Full Text]
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Successful Percutaneous Renal Intervention in a Patient With Acute Traumatic Renal Artery Thrombosis
- Seung-Woon Rha, Sunil P. Wani, Soon Yong Suh, Eung Ju Kim, Jin Won Kim, Chang Gyu Park, Hong Seog Seo, and Dong Joo Oh
Circulation 2006 114: e583-e585.
[Full Text]
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Damage to Polymer of a Sirolimus-Eluting Stent
- Nehiro Kuriyama, Yoshio Kobayashi, Takashi Nakayama, Nakabumi Kuroda, and Issei Komuro
Circulation 2006 114: e586-e587.
[Full Text]
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Letter by van der Linden et al Regarding Article, "Effect of Clopidogrel Premedication in Off-Pump Cardiac Surgery: Are We Forfeiting the Benefits of Reduced Hemorrhagic Sequelae?"
- Jan van der Linden, Gabriella Lindvall, and Ulrik Sartipy
Circulation 2006 114: e588.
[Full Text]
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Contemporary Impact of State Certificate-of-Need Regulations for Cardiac Surgery: An Analysis Using the Society of Thoracic Surgeons’ National Cardiac Surgery Database
- Verdi J. DiSesa, Sean M. O’Brien, Karl F. Welke, Sarah M. Beland, Constance K. Haan, Mary S. Vaughan-Sarrazin, and Eric D. Peterson
Circulation 2006 114: 2122-2129.
[Abstract]
[Full Text]
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Impaired Chronotropic and Vasodilator Reserves Limit Exercise Capacity in Patients With Heart Failure and a Preserved Ejection Fraction
- Barry A. Borlaug, Vojtech Melenovsky, Stuart D. Russell, Kristy Kessler, Karel Pacak, Lewis C. Becker, and David A. Kass
Circulation 2006 114: 2138-2147.
[Abstract]
[Full Text]
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Genotype-Specific Onset of Arrhythmias in Congenital Long-QT Syndrome: Possible Therapy Implications
- Hanno L. Tan, Abdennasser Bardai, Wataru Shimizu, Arthur J. Moss, Eric Schulze-Bahr, Takashi Noda, and Arthur A. M. Wilde
Circulation 2006 114: 2096-2103.
[Abstract]
[Full Text]
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