197 e-Letters

published between 2006 and 2009

  • Coronary Physiology is not that simple
    Jos AE Spaan

    The paper of De Bruyne B, Sarma J. [1] reads very well as a tutorial on how to use FFR in a variety of clinical circumstances. However, there are several inaccurate statements in this tutorial and important aspects of coronary physiology are completely neglected. A major misconception is the underlying assumption of the tutorial as expressed by Fig. 1 [1].

    It is erroneous and misleading to regard the coronary s...

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  • What's the value of Biomarkers in NSTACS management after a PCI?
    Ameet Bakhai

    Riezebos et al. have published an elegant study trying to inform a critically important question on the optimal timing of patients admitted with a non-ST elevantion ACS suitable for revascularization. In this study which despite being multicentric had a very slow recruitment rate, the main difficulty lies in understanding the value of cardiac enzyme measurements as an outcome, given that patients were considered to have a...

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  • Cost effectiveness of transcatheter aortic valves
    Andrea Messori

    One issue that has not been discussed in the paper by Christofferson et al. [1] is the cost-effectiveness of transcatheter therapies, particularly those based on the new transcatheter aortic valves.

    Previous cost-effectiveness studies on surgical aortic valve replacement (AVR) compared AVR versus best medical therapy (or no operation) and found that AVR had an acceptable cost-effectiveness profile (cost per qua...

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  • Is there a relationship between moderate prosthesis patient mismatch and long-term
    Murat Biteker

    To the Editor: We read with great interest the article by Mascherbauer and coworkers, (1) in which they reported the short-term and long-term mortality results of moderate patient-prosthesis mismatch (PPM) after valve replacement for severe aortic stenosis. PPM, generates a great controversy with respect to its clinical relevance and in relation to its effect on survival after operation. Evidence of an association between PP...

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  • Explaining coronary heart disease trends in New Zealand
    Tom G Briffa

    As suggested in your editorial comment (1), the divergent trends in incident (falling) and recurrent (rising) myocardial infarction (MI) in New Zealand described by Chan and colleagues are puzzling.(2) We believe that this finding could well be an artifact resulting from the way in which they have defined incident MI. In their paper, incident admissions for MI are described as those having no admission for ANY form o...

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  • Scottish linked hospital and mortality data
    Adam D Redpath

    Dear Editor,

    The editorial by Avendano and Soerjomataram (Heart 2008; 94; 1524- 1525) identifies some of the key difficulties of using routine data to monitor trends in coronary heart disease (CHD) incidence, but fails to mention that researchers and statisticians have been using Scottish linked hospital discharge and deaths data for many years to produce the sort of analyses recommended. We have routinely used...

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  • Re: NICE, drug-eluting stents and the limits of trial data
    Mark de Belder

    Dear Sir

    Dr Mohindra raises interesting points.

    As regards clinical effectiveness, we must not confuse effectiveness in reducing restenosis and the need for repeat treatment (about which there is no doubt) and the potential for a reduction in later morbidity and mortality (about which there is continuing debate). The point is that we cannot exclude the latter possibility and this raises the issue of...

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  • Diabetes in Africa: the situation in the Seychelles
    Pascal Bovet

    Professor NS Levitt recently reviewed the epidemiology, management and health care challenges related to diabetes in Africa [1], however not including data from the Seychelles. We would like to add some information from the Republic of Seychelles, an island state located 1800 km east of Kenya where more than 80% of the population is of African descent.

    Based on two independent population-based surveys in 1989 an...

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  • NICE, drug-eluting stents and the limits of trial data
    Raj Mohindra

    SIR, Dr M De Belder asks the question how to determine the worth of drug-eluting stent? (1) The answer to this question does not lie in the trial data. The function of the trial data is to establish the extent of clinical-effectiveness to a given degree of certainty. In this context, whilst a trend may be hypothesis generating it does not establish clinical -effectiveness.

    There is no balance between clinical...

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  • Risk assessment in HCM
    Richard C Saumarez

    Sir, I was interested in Elliott and Spirito's lucid description of the arrhythmogenic substrate in HCM (1) in their recent review article. Although they quote no evidence for their assertions, I have advanced this hypothesis on many occasions in the last 16 years and have gathered substantial clinical evidence that is consistent with the electrophysiological effects of disarray leading to lethal arrhythmias.


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