Keeping you up to date on recent headlines in cardiovascular healthcare

Nursing researcher wins NIH grant to study detection of ischemia . . . University of Nevada, Reno Orvis School of Nursing researcher Michele Pelter has been awarded $377,000 from the National Institutes of Health to study detection of ischemia, a condition that can lead to heart attacks. Over the two-year course of the study, Pelter will work with two local cardiologists, Richard Ganchan, MD, and Anita Kedia, MD, who will serve as consultants on the study. She wants to see if different monitoring of patients experiencing symptoms of possible ischemia could lead to better care. Ischemia occurs when there is a plaque rupture, and the body responds by forming a clot in an effort to stop the bleeding. But, this causes blockage in the coronary artery, the heart starts to suffer from lack of blood flow, and if the clot doesn't dissolve itself or isn't cared for medically, it can lead to a heart attack. “The rupture creates a local injury and sets in motion a series of physiological processes,“ Pelter says. “Sometimes the clot gets washed away, but then it does it again. It can come and go.“ Because of this phenomenon of “coming and going“ and the various locations the clots can occur, Pelter wants to see if a different form of monitoring would provide more complete information on which the physicians could base their care, resulting in better care being received. An EKG is used to monitor patients experiencing chest pain or other possible related symptoms. But, an EKG can utilize varied numbers of leads or electrodes attached to the body, ranging from two to 12. Currently, the prescribed standard of care calls for two leads, or points of monitoring. “If the electrode isn't where the blockage is, it can get missed,“ Pelter said. “Sometimes a 12-lead EKG will be done once a day, or with symptoms, but since the blockages sometimes come and go, if the 12-lead monitor isn't hooked up at the right time, detection of the blockage may be missed.“ In Pelter's study, patients will be hooked to a “Holter,“ a small device that straps on to the chest, which will record results from a 12-lead EKG that will monitor the patient continuously for 48 hours. She wants to see if physicians would possibly prescribe different care if this method of monitoring were used. “Perhaps there will be ischemia detected with this form of monitoring that would have resulted in different care, such as medication being prescribed to dissolve the clots early, or possibly more invasive procedures, if needed,“ she said. Pelter says that the 12-lead constant monitoring can be cumbersome to work around when trying to care for patients, as well as expensive. But, one benefit is that it is noninvasive. If there is research indicating that this form of monitoring results in better assessment of ischemia and identifies high-risk patients who might benefit from more aggressive treatment, it could change the current standard of care.

Donated heart device saves child in Ecuador . . . Biotronik (Berlin) reported an important achievement in its partnership with Heartbeat International Foundation (Tampa, Florida): the implantation of a donated cardiac device to save the life of Yuleisy Daniela Banos Peraldo, a 7-year-old girl from Ecuador. The implantation was performed after a replacement mitral valve procedure at the children's hospital Baca Ortiz by Gerardo Davalos, MD, of Fundacion Banco de Marcapasos. “Without the cardiac device from Biotronik, sweet little Yuleisy would not have been able to live her life the way a child should, with freedom, fun, fearlessness and joy. Her condition would have continued to deteriorate significantly until her life was compromised,“ said Attilio Birga, MD, chairman of Heartbeat International Ecuador. “Thanks to the collaboration with companies like Biotronik to provide free life-saving therapies to heart patients in need, others like Yuleisy are given new hope for a healthy life and a future of possibilities.“

Loyola researcher wins $1.3M NIH grant to study cardiac protein . . . Loyola University Health System (Chicago) researcher Sakthivel Sadayappan, PhD, has been awarded a four-year, $1.3 million grant from the National Institutes of Health to study a protein that is critical for the normal functioning of the heart. The protein is called cardiac myosin binding protein-C (cMyBP-C). Sadayappan's lab has shown that during a heart attack, the protein breaks into pieces, and this fragmentation coincides with damage to the heart muscle that leads to heart failure. The grant will fund further research into what happens to cMyBP-C during a heart attack. This could lead to the development of drugs to protect cMyBP-C following a heart attack, and thereby limit damage to heart muscle, Sadayappan said. The 40th anniversary of the discovery of cMyBP-C is coming up in 2011, and scientists still have much to learn about the function of this protein in the heart. The work by Sadayappan's lab could lead to new therapies to improve muscle function in heart failure patients. “Our long-term goal is to delineate the roles of cMyBP-C protein function in the heart,“ Sadayappan said.

Family demands/worries bumps up angina risk . . . Shouldering family demands and worries seems to increase the risk of angina, the precursor to coronary artery disease, reveals research published online in the Journal of Epidemiology and Community Health. Previous research has indicated that rewarding personal relationships are a boost for heart health, so the authors wanted to know if the reverse might also be true. They tracked the heart health of more than 4,500 randomly selected men and women in their 40s and 50s for six years. None had any heart problems at the start of the study in 1999. In 2006 all participants were asked to provide information on their heart health and on the quality of their personal relationships with an intimate partner, children, other relatives, friends and neighbors. For each category of relationship, they were specifically asked what level of demand was placed on them, degree of worry they experienced, or whether they came into conflict with those individuals — and how often. Similarly, they were also asked how much support — both practical and emotional — individuals in these five categories provided them, and how often they did so. The results showed that after six years almost one in 10 of both men and women (9.5% and 9.1%, respectively) had the constrictive chest pain symptoms of angina. Unsurprisingly, those in their 50s were more likely to report angina symptoms, as were those who were less affluent and those who were depressed. But when the different categories of personal relationships were assessed, it became clear that there was evidence of a link between fraught relationships and the risk of angina across all five categories, the researchers reported. The most substantial risks were for worrisome/demanding relationships with a partner or child, where the risk of angina was more than 3.5 times and twice as likely, respectively. Excessive worries/demands from other family members were associated with an almost doubling of risk, while those from friends and neighbors posed a negligible risk. And the higher the degree of worry/demand in a relationship, the higher was the likelihood of reporting angina symptoms. While arguments with children, friends, and more distant relatives did not increase the risk of angina, frequent arguments with a partner boosted the risk by 44%, while those with a neighbor increased it by 60%. The results held true even after adjustment for other influential factors, such as smoking and lack of exercise. And they indicated that supportive relationships did not counter the negative effects on heart health of worrisome or demanding relationships.

– Compiled by Amanda Pedersen, MDD