In the Literature

CLINICAL SHORTS

Methadone and Levomethadyl Cause Prolonged QTc Compared with Bupernorphine

A randomized double-blind trial of 165 opioid-addicted participants demonstrates that buprenorphine is associated with significantly less QTc prolongation (0%) compared with treatment with methadone (23%) or levomethadyl (28%).

Citation: Wedam EF, Bigelow GE, Johnson RE, Nuzzo PA, Haigney MC. QT-interval effects of methadone, levomethadyl and buprenorphine in a randomized trail. Arch Intern Med. 2007;167:2469-2475..

Elevated BMI in Childhood Increases Risk of Coronary Heart Disease in Adulthood

A cohort study of 276,835 children with 5,063,622 person-years of follow-up showed a linear increase in risk of coronary heart disease as body-mass index increased in boys and girls ages 7 to 13.

Citation: Baker JL, Olsen LW, Sorensen TIA. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007;357:2329-2337.

Pre-emptive Ablation Reduces Incidence of ICD Firing

A randomized control trial of patients with myocardial infarction (MI) within one month and spontaneous ventricular tachycardia/fibrillation to either ablation and defibrillator placement or defibrillator alone. Ablation provided no mortality benefit but reduced ICD firing/pacing (37% vs. 12%).

Citation: Reddy VY, Reynolds MR, Neuzil P, et. al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med. 2007;357:2567-2565.

Dexmedetomidine Causes Fewer Side Effects than Lorazepam in Ventilated Patients

Double-blind, randomized controlled trial demonstrated that dexmedetomidine (an alpha 2 agonist) sedated, mechanically ventilated intensive-care unit patients had more days without delirium or coma than patients treated with lorazepam.

Citation: Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs. lorazepam on acute brain dysfunction in mechanically ventilated patients. JAMA 2007;298(22):2644-2653

Rosiglitazone Increases Risk of CONGESTIVE HEART FAILURE, MI, Mortality

Population-based case-control cohort study of elderly patients (65 or older) with type 2 diabetes found that rosiglitazone was associated with an increased risk of congestive heart failure (RR, 1.60), MI (RR, 1.40) and all-cause mortality (RR, 1.29) compared with other oral diabetic agents. Pioglitazone was not associated with adverse outcomes, potentially because of the relatively small number of patients receiving it.

Citation: Lipscombe LL, Gomes T, Levesque LE, Hux JE, Juurlink DN, Alter DA. Thiazolidinediones and cardiovascular outcomes in older patients with diabetes. JAMA. 2007;298:2634-2643.

CRT Not Beneficial in Heart Failure Patients with Narrow QRS

Randomized trial of cardiac resynchronization therapy (CRT) of heart failure patients with dyssynchrony showed no benefit with QRS less than 120 milliseconds, but did improve six-minute walk and New York Heart Association classification if QRS was more than 120 and less than 130 milliseconds. Patients with QRS more than 130 milliseconds were not studied.

Citation: Beshai JF, Grimm RA, Nagueh SF, et al. Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med. 2007;357:2461-2471.

Early Nephrology Referral Reduces Mortality in Patients with Chronic Kidney Disease

Meta-analysis of more than 12,000 patients with chronic kidney disease showed that early referral to nephrologists shortened hospital stay by 12 days from the initiation of dialysis (CI 8.0-16.1, p=0.0007) and decreased mortality (RR 1.99, CI 1.66-2.39).

Citation: Chan MR, Dall AT, Fletcher KE, Lu N, Trivedi H. Outcomes in patients with chronic kidney disease referred late to nephrologists: a meta-analysis. Am J Med. 2007; 120:1063-1070.