eLetters

218 e-Letters

published between 2003 and 2006

  • Author's reply
    Stefan Illien

    Dear Editor

    We wish to thank Claudia Stöllberger and Josef Finsterer very much for their comments on our paper.

    The primary aim of our study was to correlate clinical risk factors for thromboembolism with transoesephageal markers of a thrombogenic milieu. Actually, we could demonstrate that those parameters were related closely. 58.8% of patients with clinical risk factors had a thrombogenic milieu. An incre...

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  • Drug-eluting stents: maximising benefit and minimising cost
    Julian Gunn

    Dear Editor

    We are grateful to Dr Francis for his response to our analysis [1] of the real implications, both clinical and financial, of implementing a policy of implanting drug-eluting stents. He has stated the case rather more starkly than we did, but we would agree that the main problem is pricing. If these new stents were only slightly more expensive than the current (rather satisfactory) generation of con...

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  • Pathology neglected
    Mary N Sheppard

    Dear Editor

    I have read the fifth report on services for patients with coronary heart disease and while primary care, district, tertiary services, cardiac nursing etc. all duely given emphasis, nowwhere is there a mention of cardiac pathology services. Under the chapter on audit, clinical governence and CPD, I eagerly expected some token reference especially under Bristol enquiry where autopsy reports formed part...

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  • The relevance of spontaneous echo contrast and reduced left atrial appendage flow velocities as inde
    Claudia Stöllberger

    Dear Editor

    In their interesting study, Illien et al.[1] recently reported that among 302 consecutive patients with nonrheumatic atrial fibrillation(AF), 8 were detected who had no clinical risk factors for stroke/embolism (age>65, previous stroke/embolism, arterial hypertension, diabetes mellitus, heart failure) but a transesophageal echocardiographic(TEE) finding of a “thrombogenic milieu”, either sponta...

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  • Brutal analysis suggests that current drug-elution costs are never financially justifiable
    Darrel P Francis

    Dear Editor

    The authors superbly and convincingly demonstrate the difference between clear advantage for the patient (reduced risk of restenosis) and unclear benefit to the healthcare system (increased cost per lesion managed, or reduced number of patients manageable per year). Ultimately, mathematical analysis is likely to reveal that the breakeven point is when the scale factor of the price of the drug eluting stent e...

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  • Where do we start to tackle unexpected sudden cardiac death?
    Robert J MacFadyen

    Dear Editor

    Herlitz and colleagues [1] paint a rather gloomy picture of the impact of 20 years of effort in managing out of hospital cardiac arrest. Their large population observations are very valuable and will have a familiar feel to many practising cardiologists. The study showing survival rates over the last 20 years have not improved is comparable to previous studies.[2,3] If survival rates for victims of out-...

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  • Re. Why do UK cardiac surgeons not perform their first choice operation
    Hratch L Karamanoukian

    Dear Editor

    We read with extreme interest the timely scientific letter which addresses "why …UK surgeons not perform their first choice operation [all arterial revascularization] for coronary artery bypass graft(ing)".[1]

    The results are intriguing and confirm a related study recently published by our group following a survey of US surgeons called "Is hybrid coronary revascularization favored by cardiologists...

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  • Re: Seasonality of coronary deaths
    Robert West

    Dear Editor

    Dr Weerasinghe and colleagues have reported on seasonal variation in deaths from coronary artery disease, as have many authors previously. They report a kind of proportional mortality taking as denominator monthly all cause deaths,[1,2] although numerator (ischaemic heart disease ICD 410-414 deaths) and denominator (all cause deaths) were drawn from different data sources: hospital statistics and national s...

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