Circulation. 2006;113:1377
(Circulation. 2006;113:1377.)
© 2006 American Heart Association, Inc.
Issue Highlights
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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.
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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.
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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.
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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 and Infection Therapy (PROVE IT) trials, Wiviott
et al analyze the demographics, end point definitions, impact
on low-density lipoprotein (LDL), and impact of C-reactive protein
(CRP) in those two studies. Potential implications from their
analysis include the benefit of early intensive therapy when
combined with revascularization. The relationship of reductions
in CRP to early benefit provides further support for the antiinflammatory
events of statins. This type of synthesis across trials is a
welcome addition to the cardiovascular literature and helps
focus therapeutic decision making for clinicians. See p
1406.
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SAFETY OF CORONARY SIROLIMUS-ELUTING STENTS IN DAILY CLINICAL PRACTICE: ONE-YEAR FOLLOW-UP OF THE E-CYPHER REGISTRY, by Urban et al.
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Over the past several years, drug-eluting stents have become
widely utilized in coronary interventional procedures as the
revascularization modality of choice. Increased use of these
stents, in turn, has markedly reduced restenosis rates as compared
to rates seen with bare metal stents, resulting in a decrease
in target vessel revascularization rates. A number of randomized
clinical trials now have clinical and angiographic follow-up
demonstrating the long-term durability of these stents. Interestingly,
although these landmark trials studied only highly select patient
populations with prespecified lesion characteristics, it remained
unknown if these findings would extend to a heterogeneous patient
population with higher-risk coronary artery lesions. In this
issue of
Circulation, Urban et al present data from the e-Cypher
registry that examine the safety and efficacy of sirolimus-eluting
stents in daily practice. See p
1434.
Visit http://circ.ahajournals.org:
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Clinician Update
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Cardiovascular Genomics. See p
e450.
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Images in Cardiovascular Medicine
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A Left Atrial Appendage Thrombus Mimicking Atrial Myxoma. See
p
e456.
Hereditary Hypertrophic Nonobstructive Cardiomyopathy Seen on Delayed Hyperenhancement Magnetic Resonance Imaging. See p e458.
Time-Resolved 3-Dimensional Magnetic Resonance Velocity Mapping at 3 T Reveals Drastic Changes in Flow Patterns in a Partially Thrombosed Aortic Arch. See p e460.
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Correspondence
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See p
e462.
Related Articles:
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Cardiovascular Genomics
- Marc S. Sabatine, Jonathan G. Seidman, and Christine E. Seidman
Circulation 2006 113: e450-e455.
[Extract]
[Full Text]
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A Left Atrial Appendage Thrombus Mimicking Atrial Myxoma
- Barbara Hesse, Ross T. Murphy, Jonathan Myles, Julie Huang, and Ellen Mayer Sabik
Circulation 2006 113: e456-e457.
[Extract]
[Full Text]
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Hereditary Hypertrophic Nonobstructive Cardiomyopathy Seen on Delayed Hyperenhancement Magnetic Resonance Imaging
- Henning Steen, Philipp Ehlermann, Constanze Merten, Philipp Schnabel, Matthias Lutz, Evangelos Giannitsis, and Hugo A. Katus
Circulation 2006 113: e458-e459.
[Extract]
[Full Text]
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Time-Resolved 3-Dimensional Magnetic Resonance Velocity Mapping at 3 T Reveals Drastic Changes in Flow Patterns in a Partially Thrombosed Aortic Arch
- Alex Frydrychowicz, Ernst Weigang, Andreas Harloff, Friedhelm Beyersdorf, Jürgen Hennig, Mathias Langer, and Michael Markl
Circulation 2006 113: e460-e461.
[Extract]
[Full Text]
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Letter Regarding Article by Koller et al, "Altered Dynamics of Action Potential Restitution and Alternans in Humans With Structural Heart Disease"
- Arthur M. Yue, Marcus L. Koller, Sebastian K.G. Maier, Wolfgang R. Bauer, M. Meesmann, Anna R. Gelzer, and Robert F. Gilmour, Jr
Circulation 2006 113: e462.
[Extract]
[Full Text]
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Safety of Coronary Sirolimus-Eluting Stents in Daily Clinical Practice: One-Year Follow-Up of the e-Cypher Registry
- Philip Urban, Anthony H. Gershlick, Giulio Guagliumi, Philippe Guyon, Chaim Lotan, Joachim Schofer, Ashok Seth, J. Eduardo Sousa, William Wijns, Claude Berge, Monika Deme, Hans-Peter Stoll on behalf of the e-Cypher Investigators
Circulation 2006 113: 1434-1441.
[Abstract]
[Full Text]
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A Tale of Two Trials: A Comparison of the Post–Acute Coronary Syndrome Lipid-Lowering Trials A to Z and PROVE IT–TIMI 22
- Stephen D. Wiviott, James A. de Lemos, Christopher P. Cannon, Michael Blazing, Sabina A. Murphy, Carolyn H. McCabe, Robert Califf, and Eugene Braunwald
Circulation 2006 113: 1406-1414.
[Abstract]
[Full Text]
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Epinephrine QT Stress Testing in the Evaluation of Congenital Long-QT Syndrome: Diagnostic Accuracy of the Paradoxical QT Response
- Himeshkumar Vyas, Joseph Hejlik, and Michael J. Ackerman
Circulation 2006 113: 1385-1392.
[Abstract]
[Full Text]
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EPINEPHRINE QT STRESS TESTING...
A TALE OF TWO...