eLetters

756 e-Letters

  • Natural History of Bicuspid Aortic Valve without Stenosis
    Jerome Liebman

    Dear Editor:

    The excellent review by Ward on the clinical significance of the bicuspid aortic valve (Heart 2000;83:81-85) is of great interest and value. The extensive reference list as well put a good bit of the pertinent bicuspid valve literature in one place. The paper adds greatly to our knowledge.

    However, without critiquing every issue in the paper, there are two areas in particular I would...

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  • Homocysteine, B vitamins and risk of cardiovascular disease
    J Y Jeremy
    Sir,
    We read with interest the editorial on homocysteine, B vitamins and the risk of cardiovascular disease.(1) The editorial highlighted that the B vitamins are being used to treat homocysteine - mediated vascular disease. However, this presupposes that the absolute levels of homocysteine are the only determinants of the pathological impact of the amino acid.

    We have recently proposed an alternative mechan...

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  • Skeletal chest pain
    Richard A Best
    Sir,

    While December's editorial on non-cardiac chest pain is thoughtful and thorough,(1) there is a strange lack of emphasis on skeletal chest pain. I am not sure if this is due to selection of patients, but I wonder if it is the lack of a diagnostic test for skeletal pain. Since this may involve up to 73% of patients referred with chest pain to cardiac clinics,(2) it would seem to be of paramount importance. The author...

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  • Aortic changes with bicuspid aortic valve
    John P Veinot

    To the Editor;

    We read with interest the review of congenitally bicuspid aortic valve by Ward.[1] The complications of congenitally bicuspid aortic valve, including aortic stenosis, aortic regurgitation and aortic dissection, are well documented in this review.

    It is interesting to note the association of congenitally bicuspid aortic valve with aortic medial disease (cystic medial necrosis), coarct...

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  • Risk assessment after myocardial infarction - response from author
    Adam D Timmis

    In my review on risk stratification in acute coronary syndromes, "diagnostic value" was used conventionally to refer to the ability of predischarge tests to predict future coronary events, particularly death and myocardial infarction.

    In response to the 3 additional points:

    1. Cost-effectiveness Underwood et al are correct to caution me on statements of cost-effectiveness. My contention was (...

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  • Risk assessment after myocardial infarction
    Richard Underwood
    Adam Timmis gives an excellent overview of risk stratification in acute coronary syndromes and he outlines recommended management strategies.[1] We were confused however by his suggestion that "the diagnostic value of exertional ST segment depression and thallium perfusion defects are equivalent, making the treadmill more cost effective than the gamma camera". It is not clear whether the diagnostic value to which he refers is...
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