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HomeCirculationVol. 112, No. 14Issue Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIssue Highlights Originally published4 Oct 2005https://doi.org/10.1161/circ.112.14.2077Circulation. 2005;112:2077–2078PROGNOSTIC VALUE OF N-TERMINAL PRO–BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH CHRONIC STABLE ANGINA, by Ndrepepa et al.The heart has become an endocrine organ, and its hormones today are used for diagnostic and prognostic purposes. Brain natriuretic peptide is predictive for cardiac events and death in patients with heart failure, but its role in chronic stable angina is less clear. In their study, Gjin Ndrepepa et al report on plasma levels of NT-proBNP in more than a thousand patients with chronic stable angina with mortality as a primary end point. In their cohort, NT-proBNP levels were highly predictive for total and cardiovascular mortality. Interestingly, patients in the upper quartile of NT-proBNP had lower left ventricular ejection fraction and higher left ventricular end-diastolic pressure as well as more advanced coronary artery disease angiographically. In a multivaried analysis, NT-proBNP was the strongest of all analyzed parameters to predict mortality in these patients. Although patients with impaired left ventricular function do have higher levels of NT-proBNP, the cardiac hormone appears to provide prognostic information beyond hemodynamics. Although the mechanisms underlying this prognostic information are not yet clear, NT-proBNP has become an important prognostic marker for clinical practice, apparently in the entire spectrum of cardiovascular disease. See p 2102.POSTCONDITIONING THE HUMAN HEART, by Staat et al.The existence of serious reperfusion-induced injury, resulting in significant cell death as opposed to temporary impairment of mechanical function (stunning), has long remained controversial. And if it were to exist, what could be done to lessen this added burden? Experimentalists have established that preconditioning the heart by repetitive brief episodes of reversible ischemia before the onset of a prolonged ischemic assault lessens cardiomyocyte death at reperfusion. Thus, the ultimate infarct size is decreased. But preconditioning must be applied in advance and is relatively short lived. The group of Michel Ovize now provides a landmark human study that answers two major questions. First, how to do it—by postconditioning, a relatively simple procedure involving a few short sharp bursts of reocclusion and full reperfusion started just after angioplastic revascularization for acute myocardial infarction. Second, what is the benefit? Postconditioning reduced enzyme release by about one third, thus saving dying cells. Both the simplicity and the strength of this observation challenge current views on optimal revascularization for acute myocardial infarction. See p 2143.RANDOMIZED COMPARISON OF SIROLIMUS-ELUTING STENT VERSUS STANDARD STENT FOR PERCUTANEOUS CORONARY REVASCULARIZATION IN DIABETIC PATIENTS: THE DIABETES TRIAL, by Sabaté et al.Patients with diabetes mellitus are recognized to have an elevated risk of cardiovascular disease. This patient population presents a significant challenge with respect to percutaneous revascularization procedures owing to the presence of diffuse coronary artery disease as well as the aggressive nature of the disease process. After bare metal stent placement, diabetic patients demonstrate an increased rate of restenosis as compared with nondiabetic patients, suggesting the need for more efficacious treatment strategies. Recent studies, by subset analysis, have shown that drug-eluting stents have improved restenosis rates in diabetic patients. In this issue of Circulation, Sabaté et al present definitive findings from a multicenter, prospective, randomized study that evaluates the efficacy of sirolimus drug-eluting stents in diabetic patients. The results from this trial will help to guide interventional therapies for diabetic patients that require percutaneous coronary revascularization procedures in the future. See p 2175.Visit http://www.circ.ahajournals.org:Images in Cardiovascular MedicineCardiac Transplantation for Giant Sarcoma of the Left Ventricle. See p e247. Download figureDownload PowerPointTamponade From Acute Left Atrium Compression. See p e250.Right-Sided Heart Failure Due to Compression of the Right Atrium by Remarkable Ascending Aortic Elongation. See p e252.CorrespondenceSee p e253. Previous Back to top Next FiguresReferencesRelatedDetails October 4, 2005Vol 112, Issue 14 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.112.14.2077 Originally publishedOctober 4, 2005 PDF download Advertisement