Circulation. 2007;115:2591
doi: 10.1161/CIRCULATIONAHA.107.183528
(Circulation. 2007;115:2591.)
© 2007 American Heart Association, Inc.
Issue Highlights
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RISK OF THROMBOEMBOLISM IN HEART FAILURE: AN ANALYSIS FROM THE SUDDEN CARDIAC DEATH IN HEART FAILURE TRIAL (SCD-HeFT), by Freudenberger et al.
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In the current issue of
Circulation, Freudenberger and colleagues
evaluated the incidence of thromboembolism in patients with
heart failure who did not have atrial fibrillation or a prosthetic
heart valve. An analysis of 2144 patients who participated in
the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) demonstrated
that the risk of thromboembolism, including stroke, pulmonary
embolization, or peripheral embolization, was approximately
1.7% per year, without antiarrhythmic therapy. In this cohort
of patients with moderately stable symptomatic heart failure
and an ejection fraction <0.35%, the incidence of clinical
thromboembolism events was low and dependent on the level of
left ventricular dysfunction at baseline. In addition, rates
of thromboembolism were lower in patients randomized to amiodarone
or implantable cardioverter-defibrillator devices compared to
those randomized to placebo. Taken together, these data suggest
that strategies for the prevention of thromboembolism in patients
with heart failure may be possible. See p
2637.
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CASE VOLUME AND MORTALITY IN PEDIATRIC CARDIAC SURGERY PATIENTS IN CALIFORNIA, 1998–2003, by Bazzani and Marcin
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Annual surgical case volume for congenital heart surgery has
been reported to be inversely related to in-hospital mortality.
Recent studies have suggested that the magnitude of association
between mortality and case volume may be decreasing with time.
Bazzani and Marcin reassess the hospital case volume–outcome
relationship in California among pediatric cardiac surgery patients,
using a more contemporary data set than previous investigations.
Older models no longer predicted a consistent case volume–mortality
relationship. Using a new model, increasing hospital volume
was associated significantly with lower mortality, but this
relationship was highly dependent upon the single institution
in California performing >400 surgical cases per year over
the time period being studied. These data suggest that the current
California Children’s Services minimum pediatric cardiac
surgery volume recommendation of 75 cases per year should be
reexamined. See p 2652 (editorial p
2599).
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ACCURACY OF SERIAL NATIONAL INSTITUTES OF HEALTH STROKE SCALE SCORES TO IDENTIFY ARTERY STATUS IN ACUTE ISCHEMIC STROKE, by Mikulik et al.
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Recovery after stroke is crucially dependent on the reestablishment
of cerebrovascular blood flow in the affected territory. Intravenous
thrombolysis provides recanalization and clinical improvement
in a substantial number of patients. Although angiography and
continuous transcranial Doppler are reliable imaging tools to
determine arterial patency status, they are not commonly used
or widely available. Therefore, clinical assessment is of importance.
Mikulik et al analyzed the accuracy of serial National Institutes
of Health Stroke Scale scores to identify artery status in 220
patients with acute ischemic stroke. Compared with transcranial
Doppler, a
40% reduction of the National Institutes of Health
Stroke Scale score offered the best rate of sensitivity and
specificity positive and negative predictive value both at 60
minutes and 120 minutes. Thus, relative changes in serial National
Institutes of Health Stroke Scale scores provide a simple clinical
tool to determine arterial status after intravenous thrombolysis
in acute ischemic stroke. This may be useful for risk assessment
and patient management. See p 2660 (editorial p
2602).
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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A Magic Bullet Through the Heart. See p
e467.
Wolff-Parkinson-White Syndrome and Atrial Fibrillation in a Patient With a Coronary Sinus Diverticulum. See p e469.
Duration of Discharge of Neuromuscular Incapacitating Device and Inappropriate Implantable Cardioverter-Defibrillator Detections. See p e472.
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Correspondence
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See p
e475.
Related Articles:
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Reevaluation of the Volume-Outcome Relationship for Pediatric Cardiac Surgery
- Kimberlee Gauvreau
Circulation 2007 115: 2599-2601.
[Extract]
[Full Text]
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Recanalization and Stroke Outcome
- Gregory J. del Zoppo and James A. Koziol
Circulation 2007 115: 2602-2605.
[Extract]
[Full Text]
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A Magic Bullet Through the Heart
- Numan Ali Aydemir, Ihsan Bakir, Firat Altin, Sinan Sahin, and Mehmet Salih Bilal
Circulation 2007 115: e467-e468.
[Extract]
[Full Text]
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Wolff-Parkinson-White Syndrome and Atrial Fibrillation in a Patient With a Coronary Sinus Diverticulum
- Robert Blank, Thomas Dieterle, Stefan Osswald, and Christian Sticherling
Circulation 2007 115: e469-e471.
[Extract]
[Full Text]
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Duration of Discharge of Neuromuscular Incapacitating Device and Inappropriate Implantable Cardioverter-Defibrillator Detections
- Rajneesh Calton, Douglas Cameron, Stephane Masse, and Kumaraswamy Nanthakumar
Circulation 2007 115: e472-e474.
[Extract]
[Full Text]
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Letter by Ridker and Everett Regarding Article, "The Inflammatory Hypothesis: Any Progress in Risk Stratification and Therapeutic Targets?"
- Paul M Ridker and Brendan M. Everett
Circulation 2007 115: e475.
[Extract]
[Full Text]
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Risk of Thromboembolism in Heart Failure: An Analysis From the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)
- Ronald S. Freudenberger, Anne S. Hellkamp, Jonathan L. Halperin, Jeanne Poole, Jill Anderson, George Johnson, Daniel B. Mark, Kerry L. Lee, Gust H. Bardy for the SCD-HeFT Investigators
Circulation 2007 115: 2637-2641.
[Abstract]
[Full Text]
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