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WORKLOAD AT THE HEART RATE OF 100 BEATS/MIN AND MORTALITY IN MIDDLE-AGED MEN WITH KNOWN OR SUSPECTED CORONARY HEART DISEASE

Savonen KP, Lakka TA, Laukkanen JA, Rauramaa TH, Salonen JT, Rauramaa R

Cardiorespiratory performance as well as resting heart rate predict death and cardiac events in persons with known or suspected coronary heart disease (CHD). These findings suggest that workload at the HR of 100 beats/min (WL100), an easily and safely reachable level of exercise for CHD patients, may serve as a useful predictor of death in this patient group. In this prospective study 365 middle-aged men with known or suspected CHD at baseline were followed-up for 11.1 years and it was found that in Cox multivariable models mortality increased by 72% (95% CI 32% to 122%, p<0.001) with 1 SD (34 Watts) decrement in WL100 after adjustment for a range of standard risk factors. The risk of death was 2.4 (95% CI 1.5 to 4.0, p<0.001) times higher in 130 men with WL100 <55 W than in 235 men with WL100 ⩾55 W. WL100 predicts mortality in men with known or suspected CHD and avoids the cardiovascular risks associated with a high-intensity exertion.

For full version go to: Heart 2008;94:e14. http://heart.bmj.com/cgi/content/full/94/4/e14

LOAD-SENSITIVITY OF REGIONAL TISSUE DEFORMATION IN THE RIGHT VENTRICLE: ISOVOLUMIC VERSUS EJECTION-PHASE INDICES OF CONTRACTILITY

Missant C, Rex S, Claus P, Mertens L, Wouters PF

The assessment of right ventricular (RV) function remains difficult because of its complex geometry and load-sensitive performance. In this experimental study the value of tissue deformation (strain) measures were assessed during ejection as well as isovolumic contraction phase as measures of contractility. After inotropic modulation, different pacing rates and with control alterations of RV pre- and after-load, it was found that both maximum strain rate and isovolumic strain acceleration accurately reflected changes in RV contractility. However, the isovolumic index was less sensitive to changes in RV after-load and therefore may be a more robust index of global RV contractility.

For full version go to: Heart 2008;94:e15. http://heart.bmj.com/cgi/content/full/94/4/e15

SIGNIFICANCE OF WEDENSKY MODULATION TESTING IN THE EVALUATION OF NON-INVASIVE RISK STRATIFICATION FOR VENTRICULAR TACHYARRHYTHMIA IN PATIENTS WITH CORONARY ARTERY DISEASE AND IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR

Elgarhi N, Kreuz J, Balta O, Nickenig G, Hoium H, Lewalter T, Schwab JO

The Wedensky Modulation (WM) examination is a new non-invasive method developed to identify patients at risk of fatal ventricular tachycardia (VT). In this prospective study of 37 consecutive patients with coronary artery disease receiving an implantable cardioverter/defibrillator (ICD), a positive WM index was correlated with non-invasive Holter parameters, the occurrence of VT after an ICD implantation and inducibility of VT during electrophysiological studies. The positive predictive value of the WM index for predicting inducibility of VT during EP was 100%. A negative WM test gave a negative predictive value of 95% for the occurrence of a VT episode.

For full version go to: Heart 2008;94:e16. http://heart.bmj.com/cgi/content/full/94/4/e16

IMPLANTABLE LOOP RECORDER IN UNEXPLAINED SYNCOPE: CLASSIFICATION, MECHANISM, TRANSIENT LOSS OF CONSCIOUSNESS AND ROLE OF MAJOR DEPRESSIVE DISORDER IN PATIENTS WITH AND WITHOUT STRUCTURAL HEART DISEASE

Pezawas T, Stix G, Kastner J, Schneider B, Wolzt M, Schmidinger H

In patients with syncope and a negative standard clinical work-up it is still unclear if the presence of structural heart disease (SHD) predicts an early recurrence of syncope. In these patients, the implantable loop-recorder (ILR) is a useful diagnostic tool, although data comparing patients with and without SHD are very limited and it is reasonable to assume that apart from SHD other risk factors trigger early recurrence of syncope. In this prospective study an ILR was implanted in 70 patients in whom syncope remained unexplained after thorough testing. SHD was present in 33 patients (ischaemic cardiomyopathy = 16, dilated cardiomyopathy = 9 and hypertrophic cardiomyopathy = 8) and absent in 37 patients. A syncopal recurrence occurred during 16 (SD 8) months in 30 patients (91%) with SHD and in 30 patients (81%) without SHD. Fifteen patients (46%) with SHD versus 19 patients (51%) without SHD had an ILR-documented arrhythmia at the time of recurrence. On stepwise multivariate analysis only major depressive disorder was predictive for early recurrence during ILR follow-up (p = 0.01, HR 3.35, 95% CI). No patient with major depressive disorder had asystole compared with 33% without (p<0.0001). It is concluded that the presence of SHD has little predictive value for the occurrence or type of arrhythmia in patients with unexplained syncope. Major depressive patients are prone to early recurrence of symptoms and have no evidence of arrhythmia in most cases. Use of the ILR led to specific therapy in half of all patients.

For full version go to: Heart 2008;94:e17. http://heart.bmj.com/cgi/content/full/94/4/e17