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(Circulation. 2004;110:1513.)
© 2004 American Heart Association, Inc.
Issue Highlights |
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 risk reduction with pravastatin was much greater than in patients without kidney disease. On the basis of these data, patients with moderate renal failure and coronary disease should be considered aggressively for statin therapy. See p 1557.
UPPER-EXTREMITY DEEP VEIN THROMBOSIS: A PROSPECTIVE REGISTRY OF 592 PATIENTS, by Joffe et al.
Deep vein thrombosis primarily occurs in the lower extremity but can occur in the upper extremity. Much less is known about this potentially devastating complication of catheters or systemic illness. Joffe and colleagues studied close to 600 patients with upper-extremity deep vein thrombosis and compared them to more than 4700 patients with lower-extremity deep vein thrombosis using a multicenter registry. They found that the strongest predictor of upper-extremity deep vein thrombosis was the presence of an indwelling central venous catheter. In subjects who did not have a central venous catheter, leaner body mass index and age less than 67 years were predictors of upper-extremity thrombosis. These findings highlight the distinct differences in risk factors between upper- and lower-extremity deep vein thrombosis and suggest further research is needed to both understand this disease and better define its treatment. See p 1605.
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Images in Cardiovascular Medicine
Intramural Hematoma With Complex Atherosclerosis of the Descending Aorta. See p e310.
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Ruptured Plaque Visualization by Noninvasive Coronary Computed Tomography Angiography. See p e311.
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Book Review
Heart Physiology From Cell to Circulation, 4th ed. See p e313.
Correspondence
See p e314.
Related Articles:
Circulation 2004 110: 1542-1548.
Circulation 2004 110: 1605-1611.
Circulation 2004 110: 1557-1563.
Circulation 2004 110: e310.
Circulation 2004 110: e311-e312.
Circulation 2004 110: e313.
Circulation 2004 110: e314.
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