803 e-Letters

  • Expediating the pathway to SVT ablation
    Claire E.P. Brough

    Honarbakhsh et al should be congratulated upon their innovative research in improving the care for patients with arrhythmias. Their paper not only demonstrates an effective community treatment strategy but importantly is cost effective during the current austerity. Potential further cost savings and enhanced patient experiences could be anticipated by encouraging General Practitioners to subsequently refer patients wishi...

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  • Multilevel analysis of variance and hospital performance in heart failure management
    Nermin M. Ghith

    Dear Editor,

    We have read with interest the article written by Emdin et al (1) using multilevel regression analysis of variance to investigate hospital performance for heart failure management. We were pleased to note that the authors apply and refer to our previous methodological work concerning the use of the Intraclass Correlation (ICC) and Median Odds Ratio (MOR).(2) However, the authors did not consider a re...

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  • T1 Mapping with CMR: an emerging clinical biomarker.
    David P. Ripley

    Dear Editor,

    We read the educational review on distinguishing ventricular septal bulge (VSB) versus hypertrophic cardiomyopathy (HCM) by Canepa et al[1] with great interest. The authors recognise the increasingly established role of cardiovascular magnetic resonance (CMR) in the assessment of this difficult diagnostic dilemma. They describe the gold standard role of CMR in the quantification of myocardial mass,...

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  • Microcirculation impairment in acute coronary syndrome: It is not always the same story
    Matteo Tebaldi

    We read with great interest the elegant work of Kasula et al. recently published on Heart [1]. The Authors showed that fractional flow reserve (FFR) may be an effective tool to discriminate the long-term functional outcome after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) [1]. This retrospective study included exclusively ACS patients for whom FFR evaluation resulted "flow lim...

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  • Re Larsson et al, Chocolate consumption adn risk fo myocardial infarction: a propspective stusy and meta-analysis
    Barbara J Boucher

    Comment to the Heart Journal website

    re Larsson et al, Chocolate consumption and risk of myocardial infarction: a prospective study and meta-analysis. The findings of Larsson et al are fascinating and in line with earlier reports of cardio-protective effects of chocolate consumption, especially of dark chocolate. Having noticed this in the literature, a colleague and I were inspired to measure the vitamin D con...

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  • Re:It is important to distinguish between HFrEF and HFpEF when interpreting these data
    Brian J Lipworth

    We would like to thank Dr Cunnington for his interest in our study and raising some potentially interesting points . We do not have a breakdown of patients with heart failure ( HF) who had either preserved (HFpEF) or reduced ejection fraction (HFrEF) . Since beta-blockers only have a licensed indication for HFrEF on the basis of an echocardiogram , we do not believe that this is likely to be a relevant factor withi...

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  • Impact of Beta-blocker on The Outcome of Takotsubo Cardiomyopathy
    Ibrahim El-Battrawy

    The article by Isogai et al. published in Heart (1) discuss the use of beta-blockers in patients diagnosed and admitted with takotsubo cardiomyopathy (TTC).

    Although no effective guidelines have been prescribed for the treatment of TTC, it is suggested that a parable could be drawn by comparing the use of beta-blocker and angiotensin-converting-enzyme inhibitors in these patients with that of control subjects a...

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  • It is important to distinguish between HFrEF and HFpEF when interpreting these data
    Colin Cunnington

    In this interesting article, Lipworth and colleagues report that beta -blockers are underused in patients with heart failure (HF) and COPD, compared to those with HF alone. However, they do not quote the proportion of "HF" patients within their dataset who had HF with reduced ejection fraction (HFrEF; left ventricular ejection fraction (LVEF) <40%) and HF with preserved ejection fraction (HFpEF; LVEF >50%). This d...

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  • Hypertrophic cardiomyopathy and the potential influence of etomidate on postoperative outcomes.
    Leigh D White

    We read with interest the paper by Dhillon and colleagues which provided a high quality propensity matched observational study of perioperative outcomes in patients with hypertrophic cardiomyopathy (HCM).1 This study showed no difference in what they defined as 'hard outcomes' such as myocardial infarction, stroke and death. They did however show an increased incidence of composite end points (10%; p= 0.03) such as post-...

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  • Does loneliness and social isolation really increase the risk of CHD and stroke? Pooled results based on quality effect model
    Chang Xu

    Dear editor,

    Loneliness and social isolation may lead to CHD and stroke? Valtorta et al. answered this question in a recent meta-analysis [1]. After pooling evidence based on 16 cohorts, they found that poor social relationships increase the risk of CHD and stroke. However, do things really like this? Maybe not. The problem is the random-effect (RE) model they used, which may lead to overconfident and biased re...

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