Search

Background--Currently, no pharmacological treatment can modify the natural history of aortic valve stenosis (AS). This underlines the critical need to explore novel treatment strategies, which could postpone or prevent the need for aortic valve replacement in patients with asymptomatic AS. The objectives of this study were to investigate whether metoprolol reduce the hemodynamic and metabolic burden imposed by AS. Methods and Results--In a double-blinded design, 40 patients with moderate-severe asymptomatic AS (aortic valve area, 0.5±0.1 cm2/m2; peak gradient, 53±19 mm Hg) were randomized to placebo or metoprolol treatment for 22 weeks. Patients were evaluated by echocardiography, cardiovascular magnetic resonance, and 11C-acetate positron emission tomography. Compared with placebo, metoprolol (100±53 mg/d) decreased heart rate; mean difference (95% confidence interval) -8 minute-1 (-13, -3; P=0.003) and increased ejection time 26 ms (2, 50; P=0.03). Furthermore, metoprolol reduced aortic valve peak -7 mm Hg (-13, 0; P=0.05) and mean -4 mm Hg (-7, -1; P=0.03) gradients, without affecting stroke volume 3 mL/m2 (-2, 8; P=0.16). Valvuloarterial impedance (ie, global afterload) and myocardial oxygen consumption were reduced by -11% and -12% (P=0.03 and 0.01), respectively; and decreased heart rate correlated with lower valvuloarterial impedance, myocardial oxygen consumption, and improved myocardial efficiency defined as stroke work/myocardial oxygen consumption (r=0.63-0.65; all P<0.01). There were 2 adverse cardiovascular events in the metoprolol group and none in the placebo group. Conclusions--In patients with asymptomatic AS, metoprolol increases systolic ejection time and reduces aortic valve gradients, global afterload, and myocardial oxygen requirements. Thus, metoprolol displays favorable hemodynamic and metabolic effects and could improve outcome in patients with asymptomatic AS. [ABSTRACT FROM AUTHOR]

The article discusses a randomized, double-blind, placebo-controlled study which hypothesized that the effect of exenatide is more pronounced in patients with short system delay. Patients 18 years old and above and presented within 12 hours from the onset of symptoms and signs of ST-segment-elevation myocardial infarction (STEMI) were eligible. It suggests an association between exenatide treatment with a 30% decrease in final infarct size in patients with short system delay.

The article discusses the cardiovascular magnetic resonance (CMR) with a T2-weighted short-tau inversion recovery sequence (T2-STIR) as an established technique to visualize myocardial edema and measure the area-at-risk in patients with acute myocardial infarction (ACI). It cites observations that T2-STIR CMR often shows localized coronary edema in the culprit artery of patients with ACI indicating that CMR can visualize vulnerable plaques (VPs). It suggests that T2-STIR is a promising noninvasive technique to differentiate stable and high-risk plaques.