777 e-Letters

  • Impact of Beta-blocker on The Outcome of Takotsubo Cardiomyopathy
    Ibrahim El-Battrawy

    The article by Isogai et al. published in Heart (1) discuss the use of beta-blockers in patients diagnosed and admitted with takotsubo cardiomyopathy (TTC).

    Although no effective guidelines have been prescribed for the treatment of TTC, it is suggested that a parable could be drawn by comparing the use of beta-blocker and angiotensin-converting-enzyme inhibitors in these patients with that of control subjects a...

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  • It is important to distinguish between HFrEF and HFpEF when interpreting these data
    Colin Cunnington

    In this interesting article, Lipworth and colleagues report that beta -blockers are underused in patients with heart failure (HF) and COPD, compared to those with HF alone. However, they do not quote the proportion of "HF" patients within their dataset who had HF with reduced ejection fraction (HFrEF; left ventricular ejection fraction (LVEF) <40%) and HF with preserved ejection fraction (HFpEF; LVEF >50%). This d...

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  • Hypertrophic cardiomyopathy and the potential influence of etomidate on postoperative outcomes.
    Leigh D White

    We read with interest the paper by Dhillon and colleagues which provided a high quality propensity matched observational study of perioperative outcomes in patients with hypertrophic cardiomyopathy (HCM).1 This study showed no difference in what they defined as 'hard outcomes' such as myocardial infarction, stroke and death. They did however show an increased incidence of composite end points (10%; p= 0.03) such as post-...

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  • Does loneliness and social isolation really increase the risk of CHD and stroke? Pooled results based on quality effect model
    Chang Xu

    Dear editor,

    Loneliness and social isolation may lead to CHD and stroke? Valtorta et al. answered this question in a recent meta-analysis [1]. After pooling evidence based on 16 cohorts, they found that poor social relationships increase the risk of CHD and stroke. However, do things really like this? Maybe not. The problem is the random-effect (RE) model they used, which may lead to overconfident and biased re...

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  • Midregional pro-atrial natriuretic peptide and N-terminal pro-B natriuretic peptide for pediatric heart failure diagnosis
    zhi-de hu
    Midregional pro-atrial natriuretic peptide and N-terminal pro-B natriuretic peptide for pediatric heart failure diagnosis Running title Natriuretic peptides for pediatric HF diagnosis Guo-Ming Zhang,1 Zhi-De Hu2 1 Department of Laboratory Medicine, Shuyang People's Hospital, Shuyang, China 2 Department of Laboratory Medicine, The General Hospital, Jinan Military Command Region of PLA, Jinan, Shandong, China Correspondence to...
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  • 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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