Circulation. 2007;115:1969
doi: 10.1161/CIRCULATIONAHA.107.182500
(Circulation. 2007;115:1969.)
© 2007 American Heart Association, Inc.
Issue Highlights
 |
OPTIMAL TREATMENT OF OBESITY-RELATED HYPERTENSION: THE HYPERTENSION-OBESITY-SIBUTRAMINE (HOS) STUDY, by Scholze et al.
|
|---|
This article by Scholze and colleagues provides much-needed
guidance on how to deal with the obese patient with mild hypertension
(147/93 mm Hg on randomization). The entry point is the use
of the weight-reducing drug sibutramine, which achieved weight
loss at the cost of a small increase in 24-hour diastolic blood
pressure. To control the blood pressure and to annul this increase,
3 combination antihypertensive therapies were used, 2 of them
a calcium channel blocker and an angiotensin-converting enzyme
inhibitor, and the third a ß-blocker plus diuretic
combination. Sibutramine led to weight loss and improved glucose
tolerance. These benefits were abrogated in the cohort treated
by the ß-blocker-diuretic, as compared with both calcium
channel blocker–angiotensin-converting enzyme inhibitor
regimes. Triglyceride levels were reduced with sibutramine but
not with placebo. Thus, when treating overweight hypertensive
patients by sibutramine, blood pressure reduction by a calcium
channel blocker–angiotensin-converting enzyme inhibitor
regimen is preferred to a ß-blocker-diuretic regimen.
See p
1991.
|
INFARCT TISSUE HETEROGENEITY BY MAGNETIC RESONANCE IMAGING IDENTIFIES ENHANCED CARDIAC ARRHYTHMIA SUSCEPTIBILITY IN PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION, by Schmidt et al.
|
|---|
In recent years, the ability to define carefully the presence,
extent, and transmurality of infarct has been strongly validated
using noninvasive cardiac magnetic resonance (CMR) imaging.
More recently in
Circulation, investigators began to explore
the ability of CMR to define a border zone surrounding an infarct,
likely representing an admixture of viable and infarcted tissue,
showing that the presence of such a border zone was associated
with an adverse prognosis. Those data suggested the possibility
that the border zone represents a milieu for arrhythmia generation.
In this issue of
Circulation, Schmidt et al report on a group
of patients undergoing implantation of implantable cardioverter
defibrillators for primary prevention who had CMR before the
implantation. They find that quantification of tissue heterogeneity
at the infarct periphery (the border zone) by CMR was strongly
associated with inducibility for monomorphic ventricular tachycardia.
These provocative data provide a mechanistic rationale for further
study on whether CMR parameters such as infarct border zone
quantification may allow for more precise prediction of patients
at risk for fatal arrhythmias. See p
2006.
|
CLINICAL ASPECTS AND PROGNOSIS OF BRUGADA SYNDROME IN CHILDREN, by Probst et al.
|
|---|
Brugada syndrome is an inherited arrhythmia disorder that is
most commonly identified in young adults and carries a risk
of sudden cardiac death. In this issue of
Circulation, Probst
and colleagues report their multicenter findings in 30 children
under the age of 16 years with Brugada syndrome, describing
their clinical aspects and genetic testing results. Many of
these children were identified during family screening after
an adult index case. Unlike adult Brugada syndrome clinical
series, there was not a male predominance seen. Interestingly,
the authors found that fever often preceded arrhythmic events
and syncope. Symptomatic children and those with an abnormal
Brugada ECG pattern without sodium channel blocker provocation
were more likely to have an arrhythmic event. See p
2042.
Visit http://circ.ahajournals.org:
|
Images in Cardiovascular Medicine
|
|---|
Neonatal Tuberous Sclerosis and Multiple Cardiac Arrhythmias.
See p
e395.
Definitive Diagnosis of Pulmonary Artery Sling in a Critically Ill Infant With High-Resolution Computed Tomography. See p e398.
Percutaneous Closure of a False Aneurysm of the Right Ventricle in a Congenital Heart Disease Patient. See p e400.
|
Correspondence
|
|---|
See p
e403.
Top
OPTIMAL TREATMENT OF OBESITY...
INFARCT TISSUE HETEROGENEITY BY...