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(Circulation. 2006;113:1377.)
© 2006 American Heart Association, Inc.

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	EPINEPHRINE QT STRESS TESTING IN THE EVALUATION OF CONGENITAL LONG-QT SYNDROME: DIAGNOSTIC ACCURACY OF THE PARADOXICAL QT RESPONSE, by Vyas et al.

 
The diagnosis of congenital long-QT syndrome (LQTS) may not be entirely clear from a resting ECG. With exercise or catecholaminergic provocation, most healthy individuals have QT interval shortening, whereas patients with type 1 LQTS (LQT1; due to KCNQ1 mutations) may have QT prolongation. In this issue of Circulation, Vyas and colleagues sought to validate the diagnostic accuracy of an epinephrine infusion for paradoxical QT prolongation in LQT1 patients. They studied 125 genotyped untreated patients (40 LQT1, 30 LQT2, 11 LQT3, and 44 genotype-negative) and observed QT shortening with epinephrine provocation in most genotype-negative and LQT3 patients, but QT lengthening in 92% of LQT1 patients (compared with 18% of genotype-negative and 13% of LQT2 patients). The authors conclude that a paradoxical QT prolongation 30 ms in response to epinephrine challenge has a positive predictive value of 76% and negative predictive value of 96% for LQT1. The test characteristics were much poorer if patients were already on ß-blocker therapy. This safe, relatively simple test may be of particular value in diagnosing patients with indeterminate LQTS and may unmask "concealed LQTS." See p 1385.

	A TALE OF TWO TRIALS: A COMPARISON OF THE POST–ACUTE CORONARY SYNDROME LIPID-LOWERING TRIALS A TO Z AND PROVE IT-TIMI 22, by Wiviott et al.

 
Several trials have reported comparisons of intensive- versus moderate-dose statin therapy in patients who present with an acute coronary syndrome. Although the bulk of the evidence has fallen in favor of early intensive-dose statin therapy, the magnitude of the treatment benefit has varied from trial to trial. To help clinicians through the complex datasets of the Aggrastat to Zocor (A to Z) and Pravastatin or Atorvastatin Evaluation . . . [Full Text of this Article]