We read with great interest the recent article by Bhattacharyya et.
al.1 They state that a high proportion (71/250) of stress echocardiograms
(SE) were performed on low risk patients and were inappropriate,
concluding that implementation of diagnostic appropriateness criteria2
would reduce this.
Appropriateness criteria2 published in 2011 reviewed clinical
scenarios warranting SE and graded these on a scale of...
We read with great interest the recent article by Bhattacharyya et.
al.1 They state that a high proportion (71/250) of stress echocardiograms
(SE) were performed on low risk patients and were inappropriate,
concluding that implementation of diagnostic appropriateness criteria2
would reduce this.
Appropriateness criteria2 published in 2011 reviewed clinical
scenarios warranting SE and graded these on a scale of 1 to 9. Classifying
patients into 3 categories, appropriate (grade 7-9), uncertain (grade 4-6)
and inappropriate (grade 1-3). The 2013 ECS guidelines3 for investigation
of stable coronary artery disease (CAD) recommends functional testing for
patients with intermediate (15-85%) pre-test probability (PTP). However,
Bhattacharyya et. al. do not elaborate on the PTP of patients in each
classification. Thus, in accordance with new ESC guideline SE may have
been appropriate in some of the patients classified as uncertain or
inappropriate.
Furthermore, a proportion of patients classified as inappropriate
included previously revascularised patients with stable symptoms.
Cardiologists may feel obliged to perform investigations on symptomatic
previously revascularised patients, often with invasive coronary
angiography, even if they are stable with a negative SE within the
previous two years. To reduce the burden on SE, cardiac CT is a viable
alternative that demonstrates grafts and proximal stent patency.
Finally, NICE, ESC and ACC/AHA guidelines all differ in diagnostic
guidelines, enabling cardiologists to use their experience and local
expertise to select the most appropriate investigation for individual
patients.
Thank you for your correspondence with respect to our study (1). We
have read your paper (2) with interest and congratulate you on an
important paper providing further empirical evidence to support more
appropriate methods of generating body size independent cardiac indices.
We are delighted your data demonstrated the importance of fat free mass
something we and others have proposed...
Thank you for your correspondence with respect to our study (1). We
have read your paper (2) with interest and congratulate you on an
important paper providing further empirical evidence to support more
appropriate methods of generating body size independent cardiac indices.
We are delighted your data demonstrated the importance of fat free mass
something we and others have proposed empirically before and represented
in previous review articles (3, 4). Your recent study is a very insightful
contribution to this field and we hope others in the clinical field read
this work and follow suit. We feel our additional comments in the meta-
analysis support a revisionist approach to the use of cardiac indices.
We would go further though and not stop at structural data and charge
all interested groups to look at how key functional data are indexed. We
have some empirical data published in respect of longitudinal tissue
velocities (5) and we feel this work should be extended.
References
1. Utomi V, Oxborough D, Whyte GP, Somauroo J, Sharma S, Shave R, et al.
Systematic review and meta-analysis of training mode, imaging modality and
body size influences on the morphology and function of the male athlete's
heart. Heart 2013;99:1727-1733.
2. Pressler A, Haller B, Scherr J, Heitkamp D, Esefeld K, Boscheri A, et
al. Association of body composition and left ventricular dimensions in
elite athletes. European Journal of Preventive Cardiology. 2012;19(5):1194
-204.
3. Batterham A, George K, Whyte G, Sharma S, McKenna W. Scaling cardiac
structural data by body dimensions: a review of theory, practice, and
problems. Int J Sports Med. 1999;20(8):495-502.
4. Dewey F, Rosenthal D, Murphy DJ, Froelicher V, Ashley E. Does size
matter? Clinical applications of scaling cardiac size and function for
body size. Circulation. 2008;117(17):2279-87.
5. Oxborough D, Batterham AM, Shave R, Artis N, Birch KM, Whyte G, et al.
Interpretation of two-dimensional and tissue Doppler-derived strain (?)
and strain rate data: is there a need to normalize for individual
variability in left ventricular morphology? Eur J Echocardiogr.
2009;10(5):677-82.
Many thanks for your correspondence. Your recent study is a very
important contribution to this field of research.
A meta-analysis is of course dependent on the validity of the study-
level metrics that are reported by authors, and this is why we inserted
the very important point about allometric scaling in our discussion.
I have been confronted with this issue also whe...
Many thanks for your correspondence. Your recent study is a very
important contribution to this field of research.
A meta-analysis is of course dependent on the validity of the study-
level metrics that are reported by authors, and this is why we inserted
the very important point about allometric scaling in our discussion.
I have been confronted with this issue also when meta-analysing
studies on percentage flow mediated dilation, which may not be the most
precise scaling index to employ for the change in arterial diameter.
So thank you again and I personally agree with everything you say.
We read with great interest the recent article by Bhattacharyya et. al.1 They state that a high proportion (71/250) of stress echocardiograms (SE) were performed on low risk patients and were inappropriate, concluding that implementation of diagnostic appropriateness criteria2 would reduce this.
Appropriateness criteria2 published in 2011 reviewed clinical scenarios warranting SE and graded these on a scale of...
Dear Professor Pressier,
Thank you for your correspondence with respect to our study (1). We have read your paper (2) with interest and congratulate you on an important paper providing further empirical evidence to support more appropriate methods of generating body size independent cardiac indices. We are delighted your data demonstrated the importance of fat free mass something we and others have proposed...
Dear Professor Pressier,
Many thanks for your correspondence. Your recent study is a very important contribution to this field of research.
A meta-analysis is of course dependent on the validity of the study- level metrics that are reported by authors, and this is why we inserted the very important point about allometric scaling in our discussion.
I have been confronted with this issue also whe...
Pages