772 e-Letters

  • Fontan conversion is a dated approach to the Failing Fontan
    Louise Coats

    We read with great interest the report by van Melle et al. who conducted a retrospective multi-centre European study to assess surgical options for the failing Fontan [1]. Firstly, we would like to acknowledge the effort made to bring together the results of these infrequently performed, difficult interventions. However, we would also like to highlight concerns with the conclusions reached from this historical mixed regi...

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  • Loneliness and social isolation and increased risk of of coronary heart disease and stroke: clinical implications
    Redford B. Williams

    The recent meta-analysis published in Heart by Valtorta et al. (1) showed that loneliness and social isolation are associated with increased coronary heart disease and stroke incidence in 16 large longitudinal studies conducted in high income countries. This finding is not surprising given the extensive literature documenting such harmful consequences of social isolation, including a study my research group published i...

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  • Response: A novel troponin I rule-out value below the upper reference limit for acute myocardial infarction
    Andrew R. Chapman

    To the Editor,

    Goorden et al aim to establish the optimal threshold to rule out myocardial infarction using a high-sensitivity cardiac troponin I assay. They report that a cardiac troponin I concentration <10 ng/L or a change of <20 ng/L on serial testing had a negative predictive value for the diagnosis of myocardial infarction of 99.8% and 98.7% respectively [1]. Whilst we agree there are better appro...

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  • Regarding sex differences in cardiovascular ageing: let's not forget iron
    Mark R. Goldstein

    The interesting paper of Merz and Cheng did not mention iron as a plausible non-hormonal factor, which might in part explain the sex differences in cardiovascular aging [1].

    Mounting evidence suggests that the metabolic derangements and detrimental cardiovascular effects usually attributed to menopause represent only a mere consequence of the older age of menopausal women, rather than related to the loss of ov...

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  • Author Reply: Sex Differences in Cardiovascular Ageing
    Susan Cheng

    We thank Dr. Goldstein for bringing to our attention the iron hypothesis as a potential non-hormonal factor contributing to sex differences in cardiovascular aging. We also find intriguing the possibility that iron depletion in menstruating women may be cardio- protective. We had previously been aware of the potential role of iron as a byproduct of heme-oxygenase activity in mediating cardiometabolic risk,[1] with a numb...

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    Testing article responses 2

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    Testing article responses

  • The enigma of high adiponectin levels and adverse outcomes in older people: a consequence of proinflammatory state and autoimmune activation?
    Altan Onat

    The excellently analyzed paper from the Cardiovascular Health Study on higher circulating adiponectin being associated with elevated risk of atrial fibrillation (AF) in the elderly [1), calls for focusing attention on this and analogous paradoxical manifestations accumulating in the medical literature. The investigation by Macheret and associates involved 886 incident AF events in a cohort of older -predominantly female-...

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  • Carotid Artery Stenting Outcomes in Dataset Registries: A Cause of Concern or an Opportunity for Improvement?
    A. Ross Naylor

    Roffi et al.1 report that contemporary outcomes following carotid stenting (CAS) in large-scale registries were comparable to carotid endarterectomy (CEA). They also concluded that, over time, complication rates following CAS had decreased.1

    We recently reviewed outcomes after >1,500,000 procedures in 21 administrative dataset registries where procedural death/stroke rates were reported for both CEA and CAS....

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  • Complete multivessel revascularization in STEMI. Reply to the letter by Shah et al.
    Eliano Navarese

    To the Editor:

    We read with interest the letter by dr Shah [1] regarding our recent meta-analysis: "Complete revascularisation in ST-elevation myocardial infarction and multivessel disease: meta-analysis of randomised controlled trials" [2]. The meta-analysis was designed to compare complete multivessel PCI (MV-PCI) with non-complete MV-PCI in ST-elvation myocardial infarction (STEMI) and MV disease. Complete MV...

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