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A roundtable discussion was convened in December 2005 to discuss current and future applications of blood B-type natriuretic peptide testing in the diagnosis and treatment of cardiovascular disease. Dr. Peter McCullough, consulting cardiologist and Chief of the Division of Preventive Medicine at William Beaumont Hospital in Royal Oak, MI, chaired the discussion. Dr. Christian Mueller, consultant cardiologist and active researcher in the area of cardiac natriuretic peptides at the Department of Internal Medicine, University Hospital, Basel, Switzerland; and Dr. Clyde Yancy, Associate Dean for Medical Affairs at the University of Texas Southwestern Medical Center, Dallas, TX, participated in the discussion. [ABSTRACT FROM AUTHOR]

Continuous measurement of spontaneous heart rate variability is now possible from permanently implanted devices and may contain information useful in the chronic management of patients with congestive heart failure. Since heart rate variability semi-quantifies autonomic control of the heart, changes noted from continuous measurement provide insight into cardiac control system status, which may reflect clinical status of the patient. This review outlines clinical evidence supporting the use of heart rate variability derived from implanted electronic devices and suggests a practical application in an every day clinical setting for its use. Changes in continuously measured heart rate variability coupled with the absolute value of the standard deviation of the atrial-to-atrial activation period predict subsequent risk for decompensation and hospitalization. Prospective clinical trials will evaluate this approach and the use of such markers on health care utilization in populations of patients with long-term chronic heart failure. [ABSTRACT FROM AUTHOR]

Objectives: The goal of this study was to determine the influence of gender on baseline characteristics, response to treatment, and prognosis in patients with heart failure (HF) and impaired left ventricular ejection fraction (LVEF).Background: Under-representation of women in HF clinical trials has limited our understanding of gender-related differences in patients with HF.Methods: The impact of gender was assessed in the Beta-Blocker Evaluation of Survival Trial (BEST) which randomized 2,708 patients with New York Heart Association class III/IV and LVEF ≤0.35 to bucindolol versus placebo. Women (n = 593) were compared with men (n = 2,115). Mean follow-up period was two years.Results: Significant differences in baseline clinical and laboratory characteristics were found. Women were younger, more likely to be black, had a higher prevalence of nonischemic etiology, higher right and left ventricular ejection fraction, higher heart rate, greater cardiothoracic ratio, higher prevalence of left bundle branch block, lower prevalence of atrial fibrillation, and lower plasma norepinephrine level. Ischemic etiology and measures of severity of HF were found to be predictors of prognosis in women and men. However, differences in the predictive values of various variables were noted; most notably, coronary artery disease and LVEF appear to be stronger predictors of prognosis in women. In the nonischemic patients, women had a significantly better survival rate compared with men.Conclusions: In HF patients with impaired LVEF, significant gender differences are present, and the prognostic predictive values of some variables vary in magnitude between women and men. The survival advantage of women is confined to patients with nonischemic etiology. [Copyright &y& Elsevier]

Hyperlipidemia occurs frequently after heart transplantation, and accelerated coronary artery disease remains the major cause of morbidity and mortality in patients who survive more than 1 year after heart transplantation. However, the risks and benefits of lipid-lowering therapy after heart transplantation remain poorly defined, and national guidelines for lipid-lowering drug therapy do not specifically address treatment of dyslipidemia in transplant recipients. Since the initial reports in the 1980s of rhabdomyolysis in heart transplant patients receiving high-dosage lovastatin, results of 11 post-transplantation series that used lovastatin, simvastatin, or pravastatin at lower dosages as drug monotherapy have been published. These studies have shown an overall 1% incidence of rhabdomyolysis, defined as creatine kinase > 10 times the upper limit of normal plus muscle symptoms. One randomized, controlled prospective trial has investigated the effects of lipid-lowering pharmacotherapy on patient outcome in cardiac transplant recipients. At 1-year follow-up in this nonblinded, single-center trial, patients treated with pravastatin (20 or 40 mg/day) initiated within 2 weeks of transplantation had a significant reduction in mortality rate and a significantly lower incidence of transplant arteriopathy. A number of important issues remain unanswered regarding treatment guidelines in patients with hyperlipidemia after heart transplantation. In January 1995 we began the Heart Transplant Lipid Registry, with 12 participant centers, to gather data prospectively on the efficacy and safety of lipid-lowering drugs in the treatment of dyslipidemia after heart transplantation. [ABSTRACT FROM AUTHOR]