197 e-Letters

published between 2006 and 2009

  • Mechanisms of angina
    MJ Quinn

    Angina is traditionally thought to be “ischaemic” in origin with increasing demands for blood in the myocardium giving rise to visceral pain. Prolonged ischaemia leads to myocardial infarction. The prognosis for each condition may depend on their varying aetiologies (1). Recent studies demonstrate aberrant myocardial reinnervation in ventricular arrhythmias, cardiomyopathies and following myocardial infarction; in some...

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  • More questions about the Coronary Heart Disease Epidemics
    Paulo Lotufo
    We have some questionings about the paper from Mirzaei and colleagues. The authors pointed out correctly that differences among countries may be due to variation in classification of the cause of death certification and coding practices. To avoid the influence of ascertainment bias regarding to death certification, we are proposing a parallel analysis of a broader category as “non-rheumatic heart disease and hypertension” to...
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  • Normalization of Predictive Values in Medical Imaging
    Thomas F Heston

    In the study looking at cardiac CT angiography (CTA) using perfusion scintigraphy as the reference standard (1), cardiac CTA had a sensitivity of 75%, specificity of 98%, positive predictive value of 68%, and negative predictive value of 99%. The authors concluded that cardiac CTA had a moderate sensitivity, a moderate positive predictive value, high specificity and a high negative predictive value.

    What is wrong with thi...

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  • Radiation and Risk
    John B Partridge
    Einstein's editorial(1)on radiation risk from coronary artery imaging (December 2008) rightly emphasises that the effective radiation dose from a radiographic examination is intended to be applied to a population rather than to the individual. This is not an easy concept, and makes it difficult to relate the dose to the risk/benefit decision that it required of the IRMER practitioner. It is easy enough to avoid radiation of a no...
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  • What Constitutes a Simple and Useful Risk Score?
    Andrew T Yan

    What Constitutes a Simple and Useful Risk Score?

    We read with interest the study by Dr. Gale and colleagues.[1] We fully agree with the authors that age, heart rate, and systolic blood pressure are among the most powerful prognosticators in acute coronary syndromes (ACS).[2,3] However, we believe that several key issues deserve clarification.

    First, by dichotomizing continuous variables such as creatin...

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  • The influence of a stiff aorta on the coronary supply-demand balance to the heart
    Tomoaki MURAKAMI

    Dear Editor, The recent article by Davies and colleagues (1) discussed the role of aorta in directing coronary circulation. They mainly treated the subject from the viewpoint of blood pressure, however, there remains a further point which needs to be clarified: namely, the coronary blood flow. The aorta serves predominantly as a cushioning reservoir of blood during systole, and thereafter expelling it to the peripheral c...

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  • BP changes and survival in chronic heart failure
    Colin J Petrie

    I read with great interest the paper by Raphael et al. in Heart regarding the seemingly paradoxical effect of high blood pressure (BP) and improved survival in chronic heart failure (1). Shortly after this was accepted/available on online and typically characteristic of the tempo of research, was the publication by Grigorian-Shamagian L et al. who followed up 1062 patients with chronic heart failure (CHF) for a mean of 1.9 ye...

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  • Value-based versus real prices of four innovative devices for interventional cardiology
    Andrea Messori

    The guidance on drug-eluting stents by Richarson et al. (1) is a typical application of the value-based approach that NICE systematically uses to examine costs and benefits of innovative treatments.


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  • Statin therapy in the elderly: the controversy persists.
    Mark R Goldstein, MD, FACP

    In their review on statin use in controversial subgroups, Drs. Jukema and Bergheanu [1] comment on the protective role of statin therapy in the elderly at risk for cardiovascular events. We do not share that same optimism, since statin therapy in this group has increased cancer at the expense of decreasing cardiovascular disease. Moreover, recent investigations offer insight why this might occur.

    Importantly, th...

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  • NICE, drug-eluting stents and the role of the clinician
    R Mohindra

    I am grateful to Dr De Belder for his thoughtful response to my original comments. Ordinarily I would leave the author the last say however Dr De Belder has raised fresh issues that merit a response. I will address those issues.

    The possibility of clinical benefit in the form of mortality and morbidity reducti...

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