Issue Highlights

Abstract

HomeCirculationVol. 113, No. 11Issue Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIssue Highlights Originally published21 Mar 2006https://doi.org/10.1161/circ.113.11.1377Circulation. 2006;113:1377EPINEPHRINE 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 β-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 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.SAFETY OF CORONARY SIROLIMUS-ELUTING STENTS IN DAILY CLINICAL PRACTICE: ONE-YEAR FOLLOW-UP OF THE E-CYPHER REGISTRY, by Urban et al.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:Clinician UpdateCardiovascular Genomics. See p e450.Images in Cardiovascular MedicineA Left Atrial Appendage Thrombus Mimicking Atrial Myxoma. See p e456.Hereditary Hypertrophic Nonobstructive Cardiomyopathy Seen on Delayed Hyperenhancement Magnetic Resonance Imaging. See p e458. Download figureDownload PowerPointTime-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.CorrespondenceSee p e462. Previous Back to top Next FiguresReferencesRelatedDetails March 21, 2006Vol 113, Issue 11 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.113.11.1377 Originally publishedMarch 21, 2006 PDF download Advertisement