208 e-Letters

published between 2005 and 2008

  • Impaired left ventricular energy metabolism in Hypertrophic Cardiomyopathy is not due to fibrosis
    Steffen E. Petersen

    Esposito et al address an important pathophysiological question, i.e., whether altered cardiac energy metabolism in hypertrophic cardiomyopathy (HCM) is primary or secondary, due to fibrosis (1). The authors conclude that “the inverse relation observed between LE extension (LE = late enhancement a measure of fibrosis) and the alteration of PCr/ATP-ratio (PCr = phosphocreatine; ATP = adenosinetriphosphate) suggests that...

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  • 3 D echocardiography
    Rahul mehrotra

    We in cardiac imaging have long been grappling with reconstructed two dimensional imaging of the heart for decision making which not only is inaccurate,frought with danger but has a long learning curve.3D Echocardiography has truly come of age and is fast emerging as a "Real imaging" modality.3D echo has the potential of redifining and simplifying cardiac imaging as it adds a new much needed dimension to this otherwise...

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  • Physiological fetal to neonatal transition is safer.
    David J R Hutchon
    Re: Fetal to neonatal cardiac transition is affected by cord clamping and interruption of the placental transfusion.

    In her paper, Gardiner (1) describes “the most dramatic changes in loading occur at birth when there is a sudden increase in distal impedance associated with removal of the placental circulation, a six fold increase in pulmonary blood flow leading to a rise in left at...

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  • Thiazolidinediones and cardiovascular disease
    Peter J Grant

    It is very disappointing to read a largely uncritical regurgitation of opinion on the clinical use of thiazolidinediones in type 2 diabetes. Far too often, cardiology based opinions are being published without proper reference to the importance of glycaemic control in the prevention of microvascular complications and the conclusion that thiazolidinediones should be taken off the market or not prescribed pays no heed to t...

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  • Acute discrete dissection of the ascending aorta
    Fabio Chirillo

    We thank Dr Breithardt 1 for his interest in our paper reporting a case of discrete dissection of the ascending aorta 2. In the transoesophageal echocardiographic image published Dr Breithardt has interpreted the presence of a hazy horizontal line located approximately in the middle of the aortic lumen as an intimal flap dividing the aorta into an anterior false lumen and a posterior false lumen suggesting the presence...

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  • Multislice CT is not essential before atrial ablation
    Neil Maredia

    To the Editor:

    We read with interest Drs. Tops and Schalij’s editorial regarding the use of multislice computed tomography (MSCT) to delineate left atrial and pulmonary vein anatomy prior to catheter ablation [1]. Although we agree with the value of combining three-dimensional (3D) imaging with electro- anatomical mapping techniques to guide catheter ablation, we would suggest that for the majority of patients,...

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  • Anticoagulation in Libman-Sacks Endocarditis?
    Jeffrey J Silbiger

    To the Editor,

    In the April 2008 issue of the Journal, Aldous (1) reported the striking case of a young male with Libman-Sacks endocarditis due to primary antiphospholipid syndrome (PAS) A transesophageal echocardiogram performed on the patient revealed a 1.5 X 1.5cm aortic valve vegetation which had apparently embolized to his left lower extremity. A trial of anticoagulation failed to result regression of the...

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  • Discrete dissection or overt intimal flap?
    Ole A. Breithardt

    Dear Editor,

    I am puzzled by the image published by Chirillo et al.(1) which supposedly shows a "discrete aortic dissection", but - according to the authors - no intimal flap.

    My interpretation of the provided image would be that the hazy horizontal line which runs through the middle of the aorta most likely represents a typical intimal flap separating a true lumen (lower part) from the false lumen (w...

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  • Moderate patient-prosthesis mismatch can impact on mortality after aortic valve replacement
    Jean G. Dumesnil

    Dear Editor,

    We have read with interest the article of Mascherbauer et al.[1] recently published in Heart and we congratulate our colleagues for an honest effort on shedding some light on an important issue which is still generating some controversy. Nonetheless, based on the title and the conclusions of both the abstract and the paper, we are concerned that the paper may unfortunately convey the wrong message i....

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  • Author's response
    John E Sanderson

    Dear Editor,

    We appreciate the interest of Rosa et al in our study.[1] They raise 3 points with respect to our results.[2] The first queries whether we had left out the subjects dropped out during the course of the study, which might have overestimated the clinical effectiveness of the treatment arms. The second deals with the additional beneficial effects of irbesartan and ramipril beyond their blood pressure c...

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