eLetters

218 e-Letters

published between 2003 and 2006

  • Caution in Heart Failure Stage Differentiation
    Christopher S Lee, RN, MSN, CCRN

    Dear Editor,

    I commend Azevedo and colleagues(1) for testing the ACC/AHA stages of heart failure.(2) Although these stages are theoretically appealing, they are challenging to use in practice. I am, however, concerned about the criteria used to differentiate asymptomatic and symptomatic structural abnormalities. The authors use a narrow definition of heart failure symptoms: shortness of breath and edema. Many heart...

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  • TIMI scoring fails to predict MACE rates in conventional high risk cases with low front door scores
    Stephen H Dorman

    Dear Editor,

    We read with interest the article by Conway Morris et al.(1) on the utility of the ‘front door’ TIMI risk score. The authors suggest that the TIMI score may be used to risk stratify patients with undifferentiated chest pain presenting to the emergency department and further state that patients with low scores (0 or 1) are at low risk of further cardiac events. Whilst the TACTICS-TIMI 18 investigators sugg...

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  • Valvar myxoid tissue is not a predisposition for rheumatic heart disease
    Pradeep Vaideeswar

    Dear Editor,

    We read with great interest the article by Nayar et al (1) on the concept of increased myxomatous tissue of the mitral valve serving as nidus for development of rheumatic heart disease. In developing countries, the morbidity and mortality related to rheumatic heart disease continues unabated. At our institution, we perform a large number of autopsies and many have rheumatic heart disease.(2)...

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  • Inter-atrial shunts in endurance-trained athletes: potential mechanism for EIAH during exercise.
    Darren E R Warburton

    Dear Editor,

    We were pleased to read the innovative and compelling work by Dr. Agnoletti and colleagues [1]. The authors have eloquently (via surgical procedures) revealed the importance of right-to-left shunting (through an inter-atrial communication) on arterial oxyhemoglobin saturation during resting and exercise conditions. They have also provided convincing evidence of the detrimental effects of an inter-atrial s...

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  • Therapeutic benefit might be attributable to effect on diastolic function
    Oscar M Jolobe

    Dear Editor,

    Given the fact that patients with subnormal left ventricular ejection fractions frequently have co-existing diastolic dysfunction(1)the therapeutic benefits resulting from blockade of the renin-angiotensin-aldosterone system(RAAS)in studies enrolling heart failure(HF) patients with subnormal left ventricular ejection fraction(LVEF)(2)(3)might, arguably, be attributable, at least in part, to amelioration of...

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  • What is 'high risk' PCI?
    Fraser N Witherow

    Dear Editor,

    In the April edition of Heart, the North West Quality Improvement Programme (NWQIP) produced a multivariate prediction model to assess the risk of major adverse cardiac events (MACE) in patients undergoing percutaneous coronary revascularisation.(1) The risk score was based on the outcomes of 9914 patients undergoing PCI in the four PCI centres in the northwest of England. From the data, a formula was pro...

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  • Pharmacokinetics invalidate study
    Steve Hickey

    Dear Editor,

    The conclusions of the paper by Tousoulis et al, which compares the effects on inflammatory processes of atorvastatin with those of 2g doses of vitamin C, are invalid. In concluding that atorvastatin (but not vitamin C) improved endothelial function, the authors state that,

    “All studies were conducted between 08:00-10:00 AM after a 12 hours fasting period, and the last medication was administered th...

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  • THE CHALLENGE OF PATIENTS ON ORAL COAGULATION NEEDING CARE FOR ISCHEMIC HEART DISEASE
    Andrea Rubboli

    Dear Editor,

    The paper by Oudot et al. (1) should be acknowledged of great importance, since it is one of the very few reports on the prevalence of patients on chronic oral anticoagulation (OAC) needing care for ischemic heart disease. The management of this patient subset is challenging, both in the setting of acute coronary syndromes and stable coronary artery disease, because of the increased hemorrhagic risk asso...

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  • Authors' response
    Wiley V. Chan

    Dear Editor,

    Our sincere apologies. We realized that we mistakenly stated that the Wilson version of the Framingham risk predictor has a variable for antihypertensive treatment. In fact, this variable does not appear in the Wilson version, but it does in appear in subsequent Framingham risk predictors. Please accept this corrected letter.

  • Re: Accuracy and impact of risk assessment in primary prevention of cardiovascular disease
    Wiley V. Chan

    Dear Editor,

    We applaud the systematic review by Brindle, et al (1), which explores a common use of the Framingham risk predictors. Kaiser Permanente, a large US Health Maintenance Organization, is among the organizations that use a modified Framingham risk predictor to help guide clinicians and patients in cardiovascular risk reduction interventions. The letters by Lenz and Eichler point out several issues wit...

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