HomeCirculationVol. 112, No. 19Issue Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIssue Highlights Originally published8 Nov 2005https://doi.org/10.1161/circ.112.19.2887Circulation. 2005;112:2887REVERSE REMODELING OF THE LEFT CARDIAC CHAMBERS AFTER CATHETER ABLATION AFTER 1 YEAR IN A SERIES OF PATIENTS WITH ISOLATED ATRIAL FIBRILLATION, by Reant et al.In patients with atrial fibrillation and no specific associated heart disease, there are identifiable abnormalities in structure and function, including left atrial dilation and abnormalities in diastolic ventricular function. An intriguing issue has been whether diastolic abnormalities are cause or consequence; are filling abnormalities related to the abnormal atrial dynamics, or might diastolic dysfunction (and consequent left atrial dilation) represent a driver of atrial fibrillation onset and maintenance? In this issue of Circulation, Reant and colleagues begin to dissect this issue by studying patients with isolated atrial fibrillation with echocardiography before and then 5 times during the year after radiofrequency ablation back to sinus rhythm. Left atrial size decreased, ventricular diastolic parameters improved, and ejection fraction increased. These data suggest that atrial fibrillation results in reversible structural and functional atrial and ventricular abnormalities in the absence of other specific pathologies. Diastolic abnormalities appear in large part a consequence rather than a cause of atrial fibrillation. See p 2896.MINERALOCORTICOID RECEPTOR ANTAGONISM AMELIORATES LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND MYOCARDIAL FIBROSIS IN MILDLY SYMPTOMATIC PATIENTS WITH IDIOPATHIC DILATED CARDIOMYOPATHY: A PILOT STUDY, by Izawa et al.Landmark clinical trials have previously demonstrated the benefits of mineralocorticoid receptor antagonism in patients with symptomatic congestive heart failure. In fact, the Randomized Aldactone Evaluation Study (RALES) found that the addition of spironolactone to standard therapy reduced mortality by 30% in patients with NYHA class III or IV congestive heart failure. On the basis of these results, mineralocorticoid receptor antagonists have become widely accepted as part of the standard therapeutic regimen for patients with advanced symptoms due to congestive heart failure. It has been suggested that one mechanism by which mineralocorticoid receptor antagonists exert their beneficial effects is by decreasing myocardial fibrosis and, thereby, adverse ventricular remodeling; however, this effect has not been demonstrated directly. In this issue of Circulation, Izawa et al evaluate the effects of spironolactone on myocardial fibrosis regression in mildly symptomatic patients (NYHA class I or II) with dilated cardiomyopathy and correlate these findings with left ventricular diastolic function. See p 2940.ABSORPTION, METABOLIZATION, AND ANTIPLATELET EFFECTS OF 300-, 600-, AND 900-MG LOADING DOSES OF CLOPIDOGREL: RESULTS OF THE ISAR-CHOICE (INTRACORONARY STENTING AND ANTITHROMBOTIC REGIMEN: CHOOSE BETWEEN 3 HIGH ORAL DOSES FOR IMMEDIATE CLOPIDOGREL EFFECT) TRIAL, by von Beckerath et al.In patients undergoing percutaneous coronary intervention, the benefits of dual antiplatelet therapy with aspirin and clopidogrel after stent placement are well recognized; however, because of the variability in platelet inhibition observed among patients, investigators have questioned the optimal loading dose of this agent. Although the 300-mg loading dose of clopidogrel has been considered the standard regimen, recent studies have shown that a 600-mg loading dose provided additional, and more rapid, inhibition of platelet aggregation. Because of the observed benefit with an increased loading dose, investigators have now begun to study whether platelet inhibition may be augmented further by raising the loading dose to 900 mg. In this issue of Circulation, von Beckerath et al detail the results of a randomized trial of the antiplatelet effects and pharmacokinetics of 300-, 600-, and 900-mg loading doses of clopidogrel. See p 2946.Visit http://www.circ.ahajournals.org:Clinician UpdateHomocysteine and Its Effects on In-Stent Restenosis. See p e307.Images in Cardiovascular MedicineMedical Treatment of Varicose Veins. See p e312.Acute Type I Aortic Dissection With Concomitant Pulmonary Artery Dissection. See p e313.Detection of Active Coronary Arterial Vasculitis Using Magnetic Resonance Imaging in Kawasaki Disease. See p e315. Download figureDownload PowerPointCorrespondenceSee p e317. Previous Back to top Next FiguresReferencesRelatedDetails November 8, 2005Vol 112, Issue 19 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.112.19.2887 Originally publishedNovember 8, 2005 PDF download Advertisement