We thank Laukkanen et al. for their interest in our recent report titled "Obesity related risk of sudden cardiac death in the Atherosclerosis Risk in Communities (ARIC) study" (1). We agree that regular moderate physical activity reduces the risk of sudden cardiac death (SCD) and all-cause mortality. Physical activity, but not fitness, was captured in the ARIC study via questionnaires. However, adjustment for this variable in our...
We thank Laukkanen et al. for their interest in our recent report titled "Obesity related risk of sudden cardiac death in the Atherosclerosis Risk in Communities (ARIC) study" (1). We agree that regular moderate physical activity reduces the risk of sudden cardiac death (SCD) and all-cause mortality. Physical activity, but not fitness, was captured in the ARIC study via questionnaires. However, adjustment for this variable in our multivariable analysis did not change the results of the study. In the analysis for BMI, after adjustment for physical activity in addition to all variables in our Model 2, the HR (95% CI) for SCD were 1, 1.24 (0.75-2.04), 1.05 (0.59-1.85), and 1.42 (0.76-2.68) among non- smokers with BMI of 18.5-24.9, 25-29.9, 30-34.9 and 35+, respectively (p for trend 0.45). In the analysis for waist-hip-ratio, after additional adjustment for physical activity in our Model 2, the HR (95% CI) for SCD were 1, 0.98 (0.53-1.81), 1.45 (0.86-2.43), and 1.93 (1.13-3.30) among non -smokers with waist-hip-ratio of reference (<0.8 in women, <0.95 in men), high category 1, 2 and 3, respectively (p for trend 0.005).
REFERENCES
1. Adabag S, Huxley RR, Lopez FL, Chen LY, Sotoodehnia N, Siscovick D, Deo R, Konety S, Alonso A, Folsom AR. Obesity related risk of sudden cardiac death in the atherosclerosis risk in communities study. Heart. 2015;101:215-21
We would like to thank Dr Y-Hassan for his valuable comments [1] on
our manuscript on type 2 myocardial infarction (AMI) [2].
As pointed out in our article we share Dr Y-Hassan?s criticism against the
vague diagnostic criteria for type 2 AMI in the Universal Definition of
Myocardial Infarction [3,4] It may be difficult in many cases to
distinguish type 2 AMI from type 1 AMI and other non-ischaemic conditions
associated...
We would like to thank Dr Y-Hassan for his valuable comments [1] on
our manuscript on type 2 myocardial infarction (AMI) [2].
As pointed out in our article we share Dr Y-Hassan?s criticism against the
vague diagnostic criteria for type 2 AMI in the Universal Definition of
Myocardial Infarction [3,4] It may be difficult in many cases to
distinguish type 2 AMI from type 1 AMI and other non-ischaemic conditions
associated with myocardial damage (which includes Tako-Tsubo
cardiomyopathy (TC)). Complementary imaging studies are often necessary
for the correct classification and in our study echocardiography and
coronary angiography were performed in 73.9% and 75.1% of patients,
respectively. Nevertheless, as Dr Y-Hassan suggests, TC may have been
missed in a certain number of cases classified as myocardial infarction
and we believe, that TC, especially the apical sparing variants, probably
are more common than has been previously thought. However, the current
diagnostic criteria for TC are neither clear nor evidence based and the
real prevalence of TC mimicking AMI remains fairly unknown [5]. A
substantial proportion of type 2 AMI has minor troponin elevations and no
or only very minor visible impact on left ventricular function, which is
not compatible with a TC diagnosis. Therefore, we disagree with Dr Y-
Hassan that it is likely that most of the cases classified as type 2 AMI
would in fact be TC.
To date, the differentiation between type 2 AMI and other non-ischemic
conditions remains challenging and might be improved by more frequent use
of more advanced imaging techniques such as CMR or PET, but their
availability in real life is limited. Furthermore, it is still unclear
whether such differentiation has any therapeutic or prognostic impact or
is just more of an academic interest.
Almost all evidence on how to manage AMI are based on studies on classical
type 1 AMI. Therefore, we think that the attempt to distinguish type 1 AMI
from other forms of myocardial infarction/injury is a major step forward.
However, we fully agree with Dr Y-Hassan that there is an urgent need of
more stringent, evidence based, and clinically applicable diagnostic
criteria.
References:
1. Y-Hassan S. "Type 2" myocardial infarction: Evidence-based or guesswork
diagnosis. E-letter
1. Baron T, Hambraeus K, Sundstr?m J, Erlinge D, Jernberg T, Lindahl B.
Type 2 myocardial infarction in clinical practice. Heart 2015;101:101-6
3. Thygesen K, Alpert JS, White HD.; Joint ESC/ACCF/AHA/WHF Task Force for
the Redefinition of Myocardial Infarction. Universal definition of
myocardial infarction. Eur Heart J 2007;28:2525-38.
4. Thygesen K, Alpert JS, Jaffe AS, et al.; JointESC/ACCF/AHA/WHF Task
Force for Universal Definition of Myocardial Infarction. Third universal
definition of myocardial infarction. J Am Coll Cardiol 2012;60:1581-98.
5. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or
stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart
J. 2008;155:408-17.
The introduction of a Patient Safety Checklist is a welcome addition
for interventional cardiologists and is a concept practiced by surgeons in
all disciplines for a number of years since the original WHO Patient
Safety Checklist was proven to be of benefit in a global and
multidisciplinary setting (1). The European Association for Cardiothoracic
Surgery embraced this ideal in 2012 (1) with the publication of safety
check...
The introduction of a Patient Safety Checklist is a welcome addition
for interventional cardiologists and is a concept practiced by surgeons in
all disciplines for a number of years since the original WHO Patient
Safety Checklist was proven to be of benefit in a global and
multidisciplinary setting (1). The European Association for Cardiothoracic
Surgery embraced this ideal in 2012 (1) with the publication of safety
checklists which were specific to the nature of surgery undertaken,
comprehensive and failsafe.
The purpose of checklists is to ensure patient safety, confirming that the
team is prepared for the procedure ahead and that all are ready for any
eventuality.
The checklist published by Cahill et al has an obvious omission in this
regard - ensuring that those involved in the procedure are aware of the
contact details and availability of a cardiac surgeon if needed. While
less important (but sometimes needed) in coronary interventions where
surgical complications are rare, TAVI and other procedures such as pacing
lead extraction may require the attendance of the cardiac surgical team
more frequently in the event of major issues arising and preparedness is
crucial in emergency situations. The BCIS/SCTS Position Statement on TAVI
(2009) mandates the need for surgical cover on site and immediate access
to cardiopulmonary bypass. There is an opportunity in the checklist for
the cardiology team to check that they have current contact and
availability details for the cardiac surgical team so that if required
help can be summoned without delay. With more and more TAVI procedures
being performed transfemorally cardiac surgeons are not always physically
present during procedures and robust cover arrangements need to be in
place and details of cover confirmed. The checklist is the ideal
opportunity for this to be done and avoids unnecessary delays when minutes
count. The omission of a specific place on the checklist to ensure that
such details are known misses an essential step in ensuring patient
safety.
However, as is clear from the introduction of safety checklists in the
surgical arena the most significant hurdle to overcome is one of apathy
following their introduction. If this can be overcome and the motivation
of those using it maintained through strong leadership then this will
surely be an effective contribution to patient safety.
1. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger
EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K,
Reznick RK, Taylor B, Gawande AA. A surgical safety checklist to reduce
morbidity and mortality in a global population. N Engl J Med 2009;360:491-
499.
2. Clark S.C., Dunning J., Alfieri O.R., Elia S., Hamilton L.R., Kappetein
A.P., Lockowandt U., Sarris G.E., Kolh P.H.
EACTS Guidelines for the Use of Patient Safety Checklists.
European Journal of Cardiothoracic Surgery 2012; 41 (5): 993-1004
In recent article of Candilio and colleagues assessing effect of
remote ischemic preconditioning (RIPC) on postoperative outcomes in
patients undergoing cardiac surgery, they showed that RIPC reduced amount
of perioperative myocardial injury by 26% and incidence of acute kidney
injury by 48%, respectively. They should be applauded for trying to
control most of risk factors affecting postoperative myocardial and kidney
in...
In recent article of Candilio and colleagues assessing effect of
remote ischemic preconditioning (RIPC) on postoperative outcomes in
patients undergoing cardiac surgery, they showed that RIPC reduced amount
of perioperative myocardial injury by 26% and incidence of acute kidney
injury by 48%, respectively. They should be applauded for trying to
control most of risk factors affecting postoperative myocardial and kidney
injury. However, to differentiate the effects of one factor on study
endpoints, all of the other factors have to be standardised. In this
study, several important issues were not well addressed.
First, perioperative hemoglobin levels were not included in data analysis.
Actually, preoperative anemia is common among patients undergoing cardiac
surgery and is associated with independently increased risks of
postoperative adverse myocardial and renal events.2 Furthermore, the
lowest hemoglobin level during cardiopulmonary bypass has been associated
independently with the postoperative low-output syndrome, renal failure
and mortality.3
Additionally, their study design did not include the detail of
intraoperative complications and managements, such as hemodynamic
instability, blood loss and blood transfusion. It has been shown that
postoperative myocardial injury correlates with changes in blood pressure
and heart rate during cardiac surgery.4 Furthermore, it is well know that
perioperative blood transfusion is associated with increased troponin I
release after cardiac surgery, and increased risks of postoperative short-
and long-term mortality. Thus, we cannot exclude possibility that
existence of any imbalance in the above factors would have confounded
interpretation of their results.
Finally, the study by Candilio and colleagues was not powered to show a
difference in postoperative short-term clinical outcomes that occurred
during the follow-up period. Thus, it is unclear whether favorable effect
of RIPC on myocardial and kidney injury after cardiac surgery can be
translated to postoperative benefits on mortality and severe adverse
events. To address this issue, we agree the authors that the large-scale
clinical trials are still required. These new studies should have enough
power for postoperative mortality and severe adverse events. If further
studies show consistent beneficial effect of RIPC on postoperative
myocardial and kidney injury and mortality following cardiac surgery, the
implications for practice are immense.
REFERENCES
1 Candilio L, Malik A, Ariti C, et al. Effect of remote ischaemic
preconditioning on clinical outcomes in patients undergoing cardiac bypass
surgery: a randomised controlled clinical trial. Heart 2015; 101:185-92.
2 Kulier A, Levin J, Moser R, et al; Investigators of the Multicenter
Study of Perioperative Ischemia Research Group; Ischemia Research and
Education Foundation. Impact of preoperative anemia on outcome in patients
undergoing coronary artery bypass graft surgery. Circulation 2007; 116:471
-9
3 Loor G, Li L, Sabik JF 3rd, et al. Nadir hematocrit during
cardiopulmonary bypass: end-organ dysfunction and mortality. J Thorac
Cardiovasc Surg 2012; 144:654-62.
4 Ketenci B, Enc Y, Ozay B, et al. Myocardial injury during off-pump
surgery. The effect of intraoperative risk factors. Saudi Med J 2008;
29:203-8.
Only recently the FAME-2 trial1 showed for the first time that, in
patients with stable coronary artery disease (SCAD) and "significant"
myocardial ischemia, there is a prognostic advantage of PCI over optimal
medical therapy (OMT), and that this advantage is consistent in patients
with either single or multi-vessel coronary artery disease. The clinical
outcome of patients with coronary stenoses not associated with signi...
Only recently the FAME-2 trial1 showed for the first time that, in
patients with stable coronary artery disease (SCAD) and "significant"
myocardial ischemia, there is a prognostic advantage of PCI over optimal
medical therapy (OMT), and that this advantage is consistent in patients
with either single or multi-vessel coronary artery disease. The clinical
outcome of patients with coronary stenoses not associated with significant
ischemia is favorable with OMT alone, which is therefore a safe and
convenient therapeutic strategy.
Among patients with SCAD the risk of death and MI is proportional to the
extent of ischemic myocardium/number of diseased vessels. Only patients
with significant ischemia benefit from revascularization. Several studies
however, including the COURAGE and BARI-2D trials2,3, failed to
demonstrate a mortality benefit of PCI over OMT, most likely because of
the inclusion on these studies of low risk patients with only limited
ischemia or even no ischemia.
It's common practice, in most cath-labs, to stent intermediate coronary
stenoses only based on an angiographic estimation of severity. This meta-
analysis and the FAME-2 trial shows, instead, that revascularization with
PCI is safer and only confers a survival benefit when a given coronary
lesion is associated with significant myocardial ischemia, as proven by
FFR measurements. The use of FFR technique, which is simple and
relatively safe, should be therefore implemented in every day practice.
1- Fractional flow reserve-guided PCI for stable coronary artery
disease.
De Bruyne B, Fearon WF, Pijls NH, Barbato E, Tonino P, Piroth Z, Jagic N,
Mobius-Winckler S, Rioufol G, Witt N, Kala P, MacCarthy P, Engstr?m T,
Oldroyd K, Mavromatis K, Manoharan G, Verlee P, Frobert O, Curzen N,
Johnson JB, Limacher A, N?esch E, J?ni P; FAME 2 Trial Investigators. N
Engl J Med. 2014 Sep 25;371(13):1208-17.
2- Optimal medical therapy with or without PCI for stable coronary
disease.
Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson
M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz
S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman
DS, Mancini GB, Weintraub WS; COURAGE Trial Research Group.
N Engl J Med. 2007 Apr 12;356(15):1503-16.
3- A randomized trial of therapies for type 2 diabetes and coronary
artery disease.
BARI 2D Study Group, Frye RL, August P, Brooks MM, Hardison RM, Kelsey SF,
MacGregor JM, Orchard TJ, Chaitman BR, Genuth SM, Goldberg SH, Hlatky MA,
Jones TL, Molitch ME, Nesto RW, Sako EY, Sobel BE.
N Engl J Med. 2009 Jun 11;360(24):2503-15.
We have read with great interest the article written by Zhang et
al[1] and we want to congratulate the authors on his contribution in this
relevant issue. Since the first publication in 1995 by Pijls et al,
fractional flow reserve has constantly progressed with undoubted success.
After initially being validated as alternative to the non-invasive tests,
the DEFER trial showed that a strategy of PCI based in FFR achieves b...
We have read with great interest the article written by Zhang et
al[1] and we want to congratulate the authors on his contribution in this
relevant issue. Since the first publication in 1995 by Pijls et al,
fractional flow reserve has constantly progressed with undoubted success.
After initially being validated as alternative to the non-invasive tests,
the DEFER trial showed that a strategy of PCI based in FFR achieves better
outcomes than the PCI guided by angiography in stable patients with one-
vessel disease. In the following years this hypothesis was also confirmed
in multivessel disease with the FAME and FAME-2 trials and even in non-ST
elevation acute coronary syndromes with the subgroup of patients of the
FAME and the recently published FAMOUS-NSTEMI trial. Finally, in FAME the
possibility of differing between the angiographic and functional concepts
of multivessel disease was also demonstrated. The article written by Zhang
resumes perfectly the advantages of this technique. However, despite the
robust evidence supporting its value and after having received the highest
level of recommendation in the European and ACC/AHA guidelines, its
utilization is still low and in many centres even anecdotal. It has also
been recently published a disappointing median time lag of 14 years needed
between guideline recommendation to 90 % practice uptake for class I
therapies in acute coronary syndromes[2]. Although issues associated with
reimbursement have been argued, there exist additional reasons which play
an important role in the low percentage of FFR: as an example in Spain
where most of the activity is performed in public hospitals without
difficulties associated to reimbursement, in 2013 only 4.097 cases were
reported, which represented 2,9% of the coronary angiographies and 6,2% of
the PCIs[3]. We believe that fractional flow reserve has changed the
conception of the cardiac catheterization laboratory and nowadays a
complete diagnosis, risk stratification and adequate treatment in a one-
stage manner can be offer to the still high number of patients with stable
caronary disease who have not been adequately studied before the
catheterization and to most of the non-ST elevation acute coronary
syndromes, avoiding in many cases a second visit to the lab satisfying
their expectancies
and reducing unnecessary delays and costs.
Reference List
(1) Zhang D, Lv S, Song X, Yuan F, Xu F, Zhang M, Yan S, Cao X.
Fractional flow reserve versus angiography for guiding percutaneous
coronary intervention: a meta-analysis. Heart 2015.
(2) Putera M, Roark R, Lopes RD, Udayakumar K, Peterson ED, Califf
RM, Shah BR. Translation of acute coronary syndrome therapies: From
evidence to routine clinical practice. Am Heart J 2015; 169(2):266-273.
(3) Garcia dB, Hernandez HF, Rumoroso C, Jr., Trillo NR. Spanish
Cardiac Catheterization and Coronary Intervention Registry. 23rd official
report of the Spanish Society of Cardiology Working Group on Cardiac
Catheterization and Interventional Cardiology (1990-2013). Rev Esp Cardiol
(Engl Ed) 2014; 67(12):1013-1023.
Since the study shows a lower heart rate in paroxysmal or persistent
AF is associated with lesser chance of progression to permanent AF, would
rigorous treatment of heart rate with beta blockers in paroxysmal or
persistent AF reduce the chance of their progression to permanent AF ?
I read a paper by Xie et al. with interest (1). There is also a
review article in the same issue by Chin on the mechanism on the
relationship between air pollution and cardiovascular events (2), and
expert position paper was also published (3). Xie et al. handled large
samples in Beijing and conducted their survey with special emphasis on
fine particulate matter (PM2.5) concentration and ischaemic heart disease
(IHD) mo...
I read a paper by Xie et al. with interest (1). There is also a
review article in the same issue by Chin on the mechanism on the
relationship between air pollution and cardiovascular events (2), and
expert position paper was also published (3). Xie et al. handled large
samples in Beijing and conducted their survey with special emphasis on
fine particulate matter (PM2.5) concentration and ischaemic heart disease
(IHD) morbidity and mortality. The authors clarified that a 10
microgram/cubic meter increase in PM2.5 was associated with a 0.27%
increase in IHD morbidity and a 0.25% increase in mortality on the same
day. In addition, they estimated that 7703 cases and 1475 deaths were
observed during the 3 years by exceeding environmental criteria by WHO on
M2.5. I have some comments on this relationship.
Beelen et al. (4) reported a meta-analysis for the effect of long-
term exposure to air pollution on cardiovascular mortality (overall and
cause-specific), and concluded that there was no significant association.
Yamamoto et al. (5) reported a systematic review on the association
between air pollution and cardiovascular disease in South Asia, and they
could not elucidate air pollution as a significant risk factor for
cardiovascular disease (CVD). Heinrich et al. (6) mentioned that each
study of meta-analysis showed different number of samples and sex
distribution, which was related to the study outcomes. In addition to
difference of follow-up period and ethnicity, indicators of air pollution
are speculated to become a key factor on the relationship.
CVD is composed of specific causes such as cerebrovascular disease,
IHD and myocardial infarction, and sub-analysis with enough number of
samples are needed to confirm the causality of the association. Namely, a
systematic review should be conducted by specifying the types of air
pollution and classification of CVD.
References
1. Xie W, Li G, Zhao D, et al. Relationship between fine particulate
air pollution and ischaemic heart disease morbidity and mortality. Heart
2015;101:257-63.
2. Chin MT. Basic mechanisms for adverse cardiovascular events
associated with air pollution. Heart 2015;101:253-6.
3. Newby DE, Mannucci PM, Tell GS, et al. Expert position paper on
air pollution and cardiovascular disease. Eur Heart J 2015;36:83-93.
4. Beelen R, Stafoggia M, Raaschou-Nielsen O, et al. Long-term
exposure to air pollution and cardiovascular mortality: an analysis of 22
European cohorts. Epidemiology 2014;25:368-78.
5. Yamamoto SS, Phalkey R, Malik AA. A systematic review of air
pollution as a risk factor for cardiovascular disease in South Asia:
limited evidence from India and Pakistan. Int J Hyg Environ Health
2014;217:133-44.
6. Heinrich J, Thiering E, Rzehak P,et al. Long-term exposure to NO2
and PM10 and all-cause and cause-specific mortality in a prospective
cohort of women. Occup Environ Med 2013;70:179-86.
We thank Buteau and colleague (Buteau et al. 2014) for their
interest in our meta-analysis on Heart Rate Variability (HRV) and air
pollution (Pieters et al. 2012). Their concern about combining studies
from different types of regression models ignores the strength of our meta
-analysis to combine all the available evidence on HRV and air pollution
published before February 2012. Combining the available evidence is
criti...
We thank Buteau and colleague (Buteau et al. 2014) for their
interest in our meta-analysis on Heart Rate Variability (HRV) and air
pollution (Pieters et al. 2012). Their concern about combining studies
from different types of regression models ignores the strength of our meta
-analysis to combine all the available evidence on HRV and air pollution
published before February 2012. Combining the available evidence is
critically important for the goal of computing a summary effect.
Nevertheless, Buteau is right that the percentage change calculated from
linear and logarithmic models are not exactly the same. However, we
disagree that the use of linear models impacted the overall estimates of
our meta-analysis based on both logarithmic and linear models. We re-ran
our analysis with exclusion of the linear studies (n=6). In this
sensitivity analysis, using only studies with logarithmic models (n=23),
the combined estimate for an increase of 10 ?g/m? in PM2.5 was associated
with significant reduction in the frequency domain parameters including
low frequency (-1.77%, 95% CI: -2.82 to -0.72%), high frequency (-2.46%,
95% CI: -3.79 to -1.12%) and time domain parameters SDNN (-0.98%, 95% CI:
-1.44 to -0.52%) and RMSSD (-2.62%, 95% CI: -3.65 to -1.61%). These
overall estimates did not differ meaningfully from the originally reported
estimates combining both linear and logarithmic estimates.
We agree that meta-analysis should be interpreted in the context of
their limitations. Meta-analysis which are based on the information given
in the publication, cannot provide the same detail as combining the
original data of all studies. Being too stringent to leave out studies
based on the models used may also introduce a potential bias towards the
overall evidence. However, sensitivity of the findings as presented now,
is indeed useful.
References:
Stephane Buteau, Mark S. Goldberg Comment on: An epidemiological appraisal
of the association between heart rate variability and particulate air
pollution: a meta-analysis Heart published online December 29, 2014
Pieters N, Plusquin M, Cox B, Kicinski M, Vangronsveld J, Nawrot TS.
An epidemiological appraisal of the association between heart rate
variability and particulate air pollution: a meta-analysis.
Heart. 2012;98:1127-35.
Choi and colleagues describe an association between moderate coffee
consumption and lower prevalence of subclinical coronary atherosclerosis
[1]. This is consistent with a growing body of evidence that supports this
finding. A similar large prospective study of over 400 000 participants,
demonstrated that coffee consumption was inversley associated with both
total and cause-specific mortality, specifically heart disease [...
Choi and colleagues describe an association between moderate coffee
consumption and lower prevalence of subclinical coronary atherosclerosis
[1]. This is consistent with a growing body of evidence that supports this
finding. A similar large prospective study of over 400 000 participants,
demonstrated that coffee consumption was inversley associated with both
total and cause-specific mortality, specifically heart disease [2]. These
findings were independent of the caffeine content of the coffee,
suggesting that other compounds might be important. Coffee contains many
other compounds that might be responsible for the observations of these
studies, including antioxidants, but the naturally occurring diterpenes,
cafestol and kahweol, are of significant interest. Both are found in
Arabica beans and released during the brewing process of regular and
decaffeinated coffee. The amount in coffee preparations varies enormously
depending on the brewing method used. Instant and drip-filtered coffee
contains insignificant quantities of diterpenes, which are removed by
industrial processing and the lipid binding properties of filter paper
respectively. In contrast, high concentrations occur in French press,
Scandinavian boiled and Turkish-style coffees [3]. Diterpenes have
pleiotropic effects including elevating serum lipids, anti-oxidant, anti-
inflammatory, pro-apoptotic, and anti-angiogenic properties [2-4]. Whilst
this work contributes to the evidence that coffee may confer health
benefits, future studies need to account for coffee brewing technique as a
significant confounding variable.
1 Choi Y, Chang Y, Ryu S, et al. Heart Published Online First: 2
March 2015 doi:10.1136/heartjnl-2014- 306663.
2 Freedman ND, Park Y, Abnet CC, et al. Association of coffee
drinking with total and cause-specific mortality. N Engl J Med
2012;366:1891-904.
3 Urgert R, van der Weg G, Kosmeijer-Schuil TG, et al. Levels of the
cholesterol-elevating diterpenes cafestol and kahweol in various coffee
brews. J Agric Food Chem 1995;43:2167-2172.
4 C?rdenas C, Quesada AR, Medina MA. Anti-angiogenic and anti-
inflammatory properties of kahweol, a coffee diterpene. PLoS One.
2011;6(8):e23407.
We would like to thank Dr Y-Hassan for his valuable comments [1] on our manuscript on type 2 myocardial infarction (AMI) [2]. As pointed out in our article we share Dr Y-Hassan?s criticism against the vague diagnostic criteria for type 2 AMI in the Universal Definition of Myocardial Infarction [3,4] It may be difficult in many cases to distinguish type 2 AMI from type 1 AMI and other non-ischaemic conditions associated...
The introduction of a Patient Safety Checklist is a welcome addition for interventional cardiologists and is a concept practiced by surgeons in all disciplines for a number of years since the original WHO Patient Safety Checklist was proven to be of benefit in a global and multidisciplinary setting (1). The European Association for Cardiothoracic Surgery embraced this ideal in 2012 (1) with the publication of safety check...
In recent article of Candilio and colleagues assessing effect of remote ischemic preconditioning (RIPC) on postoperative outcomes in patients undergoing cardiac surgery, they showed that RIPC reduced amount of perioperative myocardial injury by 26% and incidence of acute kidney injury by 48%, respectively. They should be applauded for trying to control most of risk factors affecting postoperative myocardial and kidney in...
Only recently the FAME-2 trial1 showed for the first time that, in patients with stable coronary artery disease (SCAD) and "significant" myocardial ischemia, there is a prognostic advantage of PCI over optimal medical therapy (OMT), and that this advantage is consistent in patients with either single or multi-vessel coronary artery disease. The clinical outcome of patients with coronary stenoses not associated with signi...
We have read with great interest the article written by Zhang et al[1] and we want to congratulate the authors on his contribution in this relevant issue. Since the first publication in 1995 by Pijls et al, fractional flow reserve has constantly progressed with undoubted success. After initially being validated as alternative to the non-invasive tests, the DEFER trial showed that a strategy of PCI based in FFR achieves b...
Since the study shows a lower heart rate in paroxysmal or persistent AF is associated with lesser chance of progression to permanent AF, would rigorous treatment of heart rate with beta blockers in paroxysmal or persistent AF reduce the chance of their progression to permanent AF ?
Conflict of Interest:
None declared
I read a paper by Xie et al. with interest (1). There is also a review article in the same issue by Chin on the mechanism on the relationship between air pollution and cardiovascular events (2), and expert position paper was also published (3). Xie et al. handled large samples in Beijing and conducted their survey with special emphasis on fine particulate matter (PM2.5) concentration and ischaemic heart disease (IHD) mo...
We thank Buteau and colleague (Buteau et al. 2014) for their interest in our meta-analysis on Heart Rate Variability (HRV) and air pollution (Pieters et al. 2012). Their concern about combining studies from different types of regression models ignores the strength of our meta -analysis to combine all the available evidence on HRV and air pollution published before February 2012. Combining the available evidence is criti...
Choi and colleagues describe an association between moderate coffee consumption and lower prevalence of subclinical coronary atherosclerosis [1]. This is consistent with a growing body of evidence that supports this finding. A similar large prospective study of over 400 000 participants, demonstrated that coffee consumption was inversley associated with both total and cause-specific mortality, specifically heart disease [...
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