eLetters

177 e-Letters

published between 2020 and 2023

  • Might these patients do better without inotropes?
    Richard G Fiddian-Green

    Dear Editor,

    Looking at the problem from a metabolic perspective it would seem to me that the therapeutic objective in these patients might be to achieve the highest cardiac reserve at rest by increasing the nutrient energy density per unit volume of flowing blood. This should optimise their capacity for increasing ATP resynthesis by oxidative phosphorylation in response to a sudden increase in need for energy f...

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  • Aortic changes with bicuspid aortic valve
    John P Veinot

    To the Editor;

    We read with interest the review of congenitally bicuspid aortic valve by Ward.[1] The complications of congenitally bicuspid aortic valve, including aortic stenosis, aortic regurgitation and aortic dissection, are well documented in this review.

    It is interesting to note the association of congenitally bicuspid aortic valve with aortic medial disease (cystic medial necrosis), coarct...

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  • Natural History of Bicuspid Aortic Valve without Stenosis
    Jerome Liebman

    Dear Editor:

    The excellent review by Ward on the clinical significance of the bicuspid aortic valve (Heart 2000;83:81-85) is of great interest and value. The extensive reference list as well put a good bit of the pertinent bicuspid valve literature in one place. The paper adds greatly to our knowledge.

    However, without critiquing every issue in the paper, there are two areas in particular I would...

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  • Re: Cost-effective investigation of chest pain - Authors' response
    IA Simpson

    Dear Editor,

    We thank Underwood for his kind comment about our study[1] which demonstrated an absence of gender bias in the investigation and management of patients referred to our open access chest pain clinic. We can reassure him that this study relied on routinely collected data and clinical staff were not aware that they would be under scrutiny with regard to gender bias. Also, primary physicians had guide...

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  • Cost-effective investigation of chest pain
    SR Underwood
    Dear Editor,

    Wong and colleagues very nicely demonstrate the absence of gender bias in investigation and management of 1522 patients referred by primary care physicians to an open access chest pain clinic.[1] This is very reassuring but their results raise an important issue concerning the strategies of investigation used in their clinic. To summarise their data:

    Table: Investigations in Southampton...

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  • Redefinition of myocardial infarction
    David Hildick-Smith
    Dear Editor,

    The Guideline for the management of patients with acute coronary syndromes without persistent ECG ST segment elevation[1] gives excellent and timely advice, but there is one area which continues to cause confusion, and that concerns the diagnosis of "myocardial infarction".

    The International Redefinition of Myocardial Infarction[2] states that an infarct has occurred when there has been a typical rise...

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  • Redefinition of myocardial infarction - Authors' response
    David Hackett
    Dear Editor,

    Thank you for sending us the letter from Hildick-Smith and Glennon and inviting a response. The Guideline for the management of patients with acute coronary syndromes without persistent ECG ST segment elevation (Heart 2001;85:133-142) was based on the deliberations of a working party which met in October 1999, and on a review of the literature up to December 1999. The paper referred to by Hildick-Smith a...

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  • Sensitivity of the risk assessment tool should be the most important parameter - Authors' response
    A F Jones

    Dear Editor,

    Of the paper-based coronary heart disease (CHD) risk prediction methods, the modified Sheffield tables,[1] which include the patient's HDL cholesterol, and the revised charts published by the joint British societies[2] most accurately classify subjects' risks. In our evaluation of their performance,[3] the only statistically significant difference between them was the lower specificity of the modi...

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  • The sensitivity of the risk assessment tool should be the most important parameter
    Erica J Wallis
    Dear Editor

    The comparison of the mathematical accuracy of paper-based tables or charts for estimating coronary (CHD) or cardiovascular (CVD) risk by Jones et al[1] is extremely valuable, but their conclusion that the revised Joint British Societies chart has the best combination of sensitivity and specificity is surprising. When the SMAC guidance[2] based on the original Sheffield table[3] was issued in 1997 the recom...

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  • Homocysteine and coronary heart disease
    Nicholas Wald
    Dear Editor:

    Fallon and colleagues reported no association between serum homocysteine and coronary heart disease in the Caerphilly cohort study,[1] and contrasted their result with the "positive results" shown in other studies including our own BUPA (British United Provident Association) cohort study of 21,520 men.[2] Fallon and colleagues may be incorrect in interpreting their results as negative. They express them as...

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