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(Circulation. 2004;110:1513.)
© 2004 American Heart Association, Inc.

Issue Highlights

An extract of the first 250 words of the full text is provided, because this article has no abstract.

TRANSPLACENTAL FETAL TREATMENT IMPROVES THE OUTCOME OF PRENATALLY DIAGNOSED COMPLETE ATRIOVENTRICULAR BLOCK WITHOUT STRUCTURAL HEART DISEASE, by Jaeggi et al.

Morbidity and mortality are high in fetuses with isolated complete atrioventricular block (CAVB), often caused by maternal anti-Ro and anti-La autoantibodies that enter the fetal circulation and trigger immune-mediated inflammation of the atrioventricular nodal and myocardial tissues. Fetal CAVB was treated with maternal dexamethasone at CAVB diagnosis and ß-stimulation for fetal heart rates <55 bpm. Cases treated with this protocol, compared with those who did not receive such treatment, had a lower rate of immune-mediated conditions (myocarditis, hepatitis, cardiomyopathy) resulting in postnatal death or heart transplantation. These data suggest that a standardized treatment approach including transplacental fetal administration of dexamethasone and ß-stimulation at heart rates <55 bpm may reduce the morbidity and improve the outcome of isolated fetal CAVB. The safety and efficacy of this approach should be further tested in a prospective, randomized trial. See p 1542.

EFFECT OF PRAVASTATIN ON CARDIOVASCULAR EVENTS IN PEOPLE WITH CHRONIC KIDNEY DISEASE, by Tonelli et al.

Cardiovascular events occur more frequently in patients with kidney disease, even in those with mild renal insufficiency. Pravastatin has been shown to reduce risk in mild renal failure and myocardial infarction, but little is known about the use of statins in moderate renal failure. In the Pravastatin Pooling Project, approximately 4500 patients had moderate renal failure. In these patients, the risk of cardiovascular events was 26% higher, and pravastatin reduced coronary deaths, myocardial infarction, and the need for revascularization by 23% and total mortality by 14%. Although the relative risk reduction was similar to the overall trial results, because of the higher absolute risk in patients with kidney disease, the absolute . . . [Full Text of this Article]

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