182 e-Letters

published between 2008 and 2011

  • MHRA, NICE, MTAC, MTEC - whatever next?
    David E Ward

    Mr first thought on seeing this article was "how does this (MTAC) fit in with the MHRA?" I did a search of the .pdf and to my surprise there was not a single mention of the MHRA. Why do we need yet another pseudo- committee (quango)? Will new "devices" need to be "evaluated" by both bodies? Will they speak to each other? Is MHRA giving up some of its powers? Has MTAC even heard of MHRA and vice versa? What a mess. Why is t...

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  • Mistaken conclusions
    Tom Marshall

    To whom it may concern,

    The meta-analysis reported by Lasserson et al provides evidence that half of the effect of antihypertensive treatment on blood pressure takes place within the first week of treatment. [1] There is no reason to doubt these findings. However the analysis does not support the conclusion that "estimation of maximal effect could be made between 1 and 2 weeks after initiation of antihypertensi...

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  • Systemic inflammation sometimes displays paradoxical outcomes
    Carr J Smith

    To the editor: The very interesting study by Logue et al. (2011) on a group of middle- aged, hypercholesterolic men with no prior history of diabetes or CVD, recently reported that obesity is associated with fatal coronary heart disease (CHD), but not non -fatal CHD independently of traditional CVD risk factors. The authors hypothesize that since excessive adipose tissue is known to secrete inflammatory mediators, that in...

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  • MIBG and Risk Stratification
    A Salih

    I would like to mention the place of MIBG as other modality of Cardiac Imaging for risk stratification of patients with heart failure in need for ICD; see Bax et al, Cardiac Sympathetic Denervation Assessed With 123-Iodine Metaiodobenzylguanidine Imaging Predicts Ventricular Arrhythmias in Implantable Cardioverter-Defibrillator Patients

    J Am Coll Cardiol, 2010; 55:2769-2777, doi:10.1016/j.jacc.2009.12.066...

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  • Improving echocardiographic estimation of pulmonary vascular resistance
    Corrado Magnino

    We appreciated the paper by Dahiya et al. attempting to improve non- invasive estimation of pulmonary vascular resistance (PVR)(1). However, some points deserve few comments. 1. The new formula (PVRc) compared to the previous one by Abbas et al.(2) (PVRe) includes E/e' ratio, in order to take into account pulmonary capillary wedge pressure (PCWP) and better estimate transpulmonary gradient. E/e' is a ratio, but needs to...

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  • Heart-type fatty acid-binding protein in the early diagnosis of acute myocardial infarction: a systematic review and meta-analysis
    James A. Shand

    To the Editor

    We read with interest the systematic review and metanalysis by Bruins Slot et al concerning early diagnosis of myocardial infarction using heart type fatty acid binding protein (HFABP) (1). We agree with their summary that used in isolation, HFABP may not offer a diagnostic advantage over the current troponin standard. However it should be noted that in 5 of the included studies, constituting 1573 pa...

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  • Family history of premature coronary heart disease and risk prediction
    M. Adnan Nadir

    We read the article by Sivapalaratnam and colleagues with great interest. Although, self-reported family history of coronary heart disease (CHD) was an independent risk factor for future CHD events in this study, the addition of family history of CHD to Framingham Risk Score (FRS) failed to improve the overall risk prediction of future CHD events. Since age is a heavily weighted risk factor incorporated in the contempora...

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  • GRACE risk recommendations in NICE GC94 are not appropriate
    Elved B Roberts

    To the Editor,

    The article by Gray et al is a succinct and useful summary of NICE clinical guidance 94 on the management of unstable angina and non ST elevation myocardial infarction (1). The NICE document is itself a major piece of work which synthesises vast bodies of evidence (2). The majority of the document and the resulting summary to which we respond are to be applauded. However, we believe the risk stra...

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  • A Single Level of Plasma Troponin-I Predict Left Ventricular Remodeling after Primary Angioplasty
    Gen-Min Lin

    To the Editor: We appreciate the work by Hall?n et al. which reported a single-point measurement of cardiac troponin-I (cTnI) 24- or 48-hours after primary angioplasty for those with ST-segment elevation myocardial infarction (STEMI) provides substantial prognostic information on the evolution of left ventricular (LV) function and the risk of LV expansion.(1) Actually, a single level of cTnI after primary angioplasty is...

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  • QRISK2 (2010) - the key issue is ethnicity and extent of reallocation
    Julia Hippisley-Cox

    In their recent paper[1], the authors describe the performance of ASSIGN and Framingham algorithms in comparison to the original QRISK equations.

    Readers may be interested that the QRISK2 algorithm was published in February 2009[2] and made available as free open source software in April 20103. This can be found at http://svn.clinrisk.co.uk/opensource/qrisk2/. The open source is intended to further increase the...

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