Circulation. 2007;116:1525
doi: 10.1161/CIRCULATIONAHA.107.185633
(Circulation. 2007;116:1525.)
© 2007 American Heart Association, Inc.
Issue Highlights
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GROWTH DIFFERENTIATION FACTOR 15 FOR RISK STRATIFICATION AND SELECTION OF AN INVASIVE TREATMENT STRATEGY IN NON–ST-ELEVATION ACUTE CORONARY SYNDROME, by Wollert et al.
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A number of biomarkers have been shown to help in risk stratifying
patients with non–ST-elevation acute coronary syndrome,
but only cardiac-specific enzyme elevations have been shown
to help in identifying those who benefit from early revascularization.
Growth differentiation factor 15 is a member of the transforming
growth factor β-cytokine family that is induced in the
myocardium after ischemia and reperfusion. Prior studies have
shown it to be elevated in non–ST-elevation acute coronary
syndrome and to be independently related to mortality. This
study was undertaken to determine if an elevated level of growth
differentiation factor 15 would assist in risk stratification
and help identify those patients who would benefit most from
an early invasive strategy. On the basis of data from the Fast
Revascularization during InStability in Coronary artery disease
II (FRISC-II) trial, modest or highly elevated levels predicted
a better outcome with an invasive strategy. In patients with
normal levels of growth differentiation factor 15, an invasive
strategy was not beneficial even in the presence of ST depression
or elevated Troponin levels. This study suggests that growth
differentiation factor 15 levels may help in risk stratification
and in clinical decision making in patients with non–ST-elevation
acute coronary syndrome. See p
1540.
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PATTERNS OF WEIGHT CHANGE PRECEDING HOSPITALIZATION FOR HEART FAILURE, by Chaudhry et al.
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Among patients with chronic heart failure (HF), hospitalization
for decompensation of symptoms is a substantial morbidity burden,
as well as a major driver of the economic burden of HF. Disease
management programs are increasingly used in an attempt to homogenize
the applications of evidence-based care, as well as to respond
to short-term clinical changes in a timely fashion. A major
assumption driving these programs is that weight change represents
fluid overload and justifies diuretic changes, though little
actual data support that intuitive concept. In this issue of
Circulation, Chaudhry and colleagues present data extracted
from remote monitoring of HF patients using a case-control design
to demonstrate that weight gain can be detected beginning even
30 days before heart failure hospitalization, with more significant
divergence within a week of hospitalization. Moreover, an apparent
"dose response" existed, in that greater weight gain was associated
with greater risk of HF hospitalization. These data support
an approach to such patients with aggressive treatment for presumed
fluid overload, and they also support the hypothesis that congestion
plays the major pathophysiological role in decompensation of
HF patients. See p 1549 (editorial p
1526).
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CHANGE IN SALT INTAKE AFFECTS BLOOD PRESSURE OF CHIMPANZEES: IMPLICATIONS FOR HUMAN POPULATIONS, by Elliott et al.
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In this issue of
Circulation, Elliott and colleagues study 2
sets of chimpanzees, a cohort of 17 animals in Gabon and another
cohort of 110 in Bastrop, Tex, with varying salt intake. In
Gabon, the salt intake of the chimpanzees fluctuated annually
from 75 to 35 to 120 mmol/d over the course of 3 years. In Bastrop,
the animals were divided into 2 groups; 1 group received 250
mmol sodium/d for 2 years, while the sodium intake for the second
group was halved during year 2 of the study. In both groups
of chimpanzees, lower sodium intake was associated with lower
systolic, diastolic, and mean arterial blood pressure. Unlike
the previous human studies, these were single-variable experiments,
and lifestyle and other potential risk factors, such as change
in diet, alcohol intake, and cigarette smoking, were not present.
Even though this study was not conducted in humans, these findings
suggest that more effort is needed, by both the public and private
sectors, to achieve a decrease in salt intake in the human population.
See p 1563 (editorial p
1530).
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Images in Cardiovascular Medicine
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Pseudoaneurysm and Intracardiac Fistula Caused by an Infected
Paclitaxel-Eluting Coronary Stent. See p
e364.
Optical Coherence Tomography in the Setting of an Acute Anterior Myocardial Infarction. See p e366.
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Correspondence
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See p
e368.
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Letter by Weidemann et al Regarding Article, "Global Diastolic Strain Rate for the Assessment of Left Ventricular Relaxation and Filling Pressure"
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Growth Differentiation Factor 15 for Risk Stratification and Selection of an Invasive Treatment Strategy in Non–ST-Elevation Acute Coronary Syndrome
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GROWTH DIFFERENTIATION FACTOR 15...
PATTERNS OF WEIGHT CHANGE...