November 2007

A 76-year-old woman with palpitations and fatigue of several months' duration presented to the outpatient department.

A 72-year-old man presented with angina, dynamic ST-segment depression, and increased troponin and creatine kinase-myocardial band (CK-MB) levels above the institutional upper limits of normal (ULN).

A 76-year-old man sought follow-up care after his primary care provider retired.

We evaluated the prognostic value of cardiac magnetic resonance (CMR) stress testing with direct comparison of adenosine stress first-pass perfusion and dobutamine stress wall motion imaging among 513 subjects with known or suspected coronary heart disease over a median follow-up period of 2.3 years. Positive results on CMR stress testing identified subjects at high risk for subsequent cardiac events (nonfatal myocardial infarction or cardiac death), whereas normal CMR stress test results were associated with a very low annual cardiac event rate.

In Jahnke et al's study, the authors showed the prognostic value of yet another imaging modality—perfusion magnetic resonance (MR) imaging and dobutamine stress MR.

We conducted a substudy of the Rate Control Versus Electrical Cardioversion (RACE) study to evaluate cardiovascular morbidity, mortality, and the outcome of rate and rhythm control treatment in subjects with and without hypertension with persistent atrial fibrillation.

This review summarizes an important substudy of the Rate Control Versus Electrical Cardioversion (RACE) trial, which randomized 522 patients with atrial fibrillation (AF) to rate versus rhythm control treatment strategies and followed them for up to 2.3 years with a primary composite endpoint that included cardiovascular mortality, heart failure, thromboembolic complications, bleeding, severe adverse effects of anti-arrhythmic agents, and pacemaker implantation.

The use of anticoagulation therapy for atrial fibrillation has slowly increased in the last decade, yet many patients at relatively high risk for thromboembolic events are still not receiving anticoagulants. Patients receiving therapy that is intended to maintain sinus rhythm may be at higher risk for underuse of anticoagulation therapy than those receiving rate control therapies. In addition, the increase in the use of anticoagulation therapy appears to have been particularly notable among patients for whom it may not be indicated and in whom safer, less expensive antithrombotic therapies would suffice.

Atrial fibrillation (AF) is the most common clinical arrhythmia and is of enormous importance for public health in view of its significant mortality and morbidity.

We evaluated more than 26 000 subjects from 4 large trials that included subjects with non–ST-segment elevation acute coronary syndromes to determine the prognostic importance of creatine kinase-myocardial band (CK-MB) elevation after coronary artery bypass graft (CABG) surgery during the index hospitalization. Results showed that mortality at 6 months increased with increasing peak CK-MB ratios (CK-MB value post-CABG/CK-MB upper limit of normal), and peak CK-MB ratio was an independent predictor of 6-month outcome.

In their study consisting of coronary artery bypass graft (CABG) patients recruited from 4 major trials, Mahaffey found that creatine kinase-myocardial band (CK-MB) elevations following CABG surgery are independently associated with an increased risk of mortality in patients with non–ST-segment elevation acute coronary syndromes, especially if the peak CK-MB level is > 5 x the upper limit of normal (ULN).