June 2006

A 77-year-old man with atrial fibrillation of more than 10 years duration was admitted to the neurology department with left-sided hemiparesis and aphasia.

We examined the association between plasma N-terminal pro-brain natriuretic peptide (Nt-pro-BNP) levels and the occurrence of cardiac events, including cardiogenic shock and mortality, among hospitalized diabetic patients with acute myocardial infarction. Nt-pro-BNP level was shown to be a reliable predictor of outcome in this group of patients.

Diabetes is a potent risk factor for adverse outcomes following acute myocardial infarction,1 but the mechanisms responsible for this association are not well understood.

In a separate analysis of patients enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, thin patients and those with moderate-to-severe obesity were at increased risk for cardiovascular events. These results indicate that patients at the low anda high ends of the body size spectrum should be treated aggressively to lower the risk of cardiovascular events.

The observed relationship linking obesity, severity of hypertension, and increase in cardiovascular risk was traditionally thought to emanate from the increase in circulatory volume, persistently increased systemic resistance from obesity, and clustering of major cardiovascular risk factors (eg, hypercholesterolemia and diabetes mellitus) among obese patients.

We evaluated how well patients taking spironolactone were monitored for hyperkalemia, as well as the association between spironolactone and hyperkalemia. Only two thirds of patients received testing for serum potassium and creatinine levels, and higher baseline serum creatinine levels predicted a high risk of hyperkalemia. These results indicate that appropriate patient selection and close monitoring are essential, especially for patients with renal impairment.

In 1999 Pitt and colleagues published the results of the RALES trial, an important study showing that the addition of a relatively small dose of the aldosterone antagonist spironolactone to a regimen that included angiotensin-converting enzyme (ACE) in­hibitors for patients with severe congestive heart failure (NYHA Class III-IV) had a striking benefit on mortality

We conducted 2 feasibility studies to assess the performance and safety of the percutaneous left atrial appendage (LAA) transcatheter occlusion system for the prevention of stroke in high-risk patients with nonrheumatic atrial fibrillation. Results showed that percutaneous LAA occlusion can be performed using the device at acceptable risk. This procedure may be particularly useful for patients at increased risk of ischemic stroke with a contraindication to anticoagulation therapy.

Atrial fibrillation commonly affects millions of patients, and often causes the disabling complication of cardioembolic stroke.